Changes in Pen Pressure, Letter Size, and Writing Speed According to Visual Cues in Patients with Parkinson’s Disease

Purpose: Writing performance can be improved in patients with Parkinson’s disease (PD) by providing the visual cues. This study aimed to investigate the changes in pen pressure, letter size, and writing speed as per levels of visual cues. Methods: Sixty-three participants (38 PD patients and 25 normal adults) performed tasks, including sentence writing along visual cue levels using a tablet personal computer, digital pen, and software that could measure the pen pressure, stroke length, and duration. Results: First, the PD group’s pen pressure and letter size were improved when the visual cue was provided. Second, the effect of visual cues was shown more in the performance of ‘writing within square blanks’ than in the performance of ‘copying’ and ‘writing between parallel lines’. Especially, there were no significant differences between the groups in terms of the letter size in ‘writing within square blanks’. Conclusion: Despite movement disorders in PD patients, our findings suggest that pen pressure and letter size can be improved when the patients are provided visual cues. Our results indicate that providing visual cues hierarchically and objectively confirms changes in writing performance.