Empowering Everyday Living: OT Tips for Handwriting

For people with Parkinson’s disease (PD), writing can be a challenge because of micrographia and tremor.

Micrographia — small handwriting and handwriting that becomes progressively more cramped and smaller — is a common and early sign of PD.

Tremor — a common motor symptom of PD — may start in the hand and arm on one side of the body and eventually affect the other side. Tremor can obviously have a big impact on handwriting legibility.

Occupations — the meaningful and purposeful everyday activities that you need and want to do — may be impacted by these handwriting challenges. Occupational therapists often work with people with PD to improve handwriting for everyday activities.

For example, think about how handwriting is needed for:

• taking care of yourself (self care or activities of daily living “ADLs”) - signing a check, taking down a phone number

• work or productive activities - filling out a form, taking notes at a meeting or class

• leisure and recreation (including social interaction) - writing cards or keeping a journal

Here are helpful OT tips to make writing easier and more legible:

Prep for Success — plan to do your writing during medication ”on” times

Lay the Groundwork - sit in a chair that supports good posture (and feet on the floor!), use a table with height that provides full elbow and arm support, make sure you have adequate task lighting

Get in the Zone — write in quiet place free of distractions; try motor imagery to mentally practice writing before starting your work

Get a Grip — use pens with an ergonomic design or built up grip; try a weighted pen if you experience tremor in your writing hand; use an erasable ink pen to make corrections

Let it Flow — experiment with gel ink pens, which write more smoothly with less pressure needed than ball point pens (note: lefties should watch out for smudging since gel ink takes slightly longer to dry)

Be on Cue — use lined paper instead of plain paper — visual cues (like lines) are a big help in reducing micrographia and increasing legibility; wider spacing between lines will cue you to write larger. Don’t have lined paper? Click here for a website to print your own.

Warm Up — practice flicks to get your fingers moving

GO BIG — Try BIG AIR WRITING. Hold a pen and write in the air. Make the writing as BIG as possible, then try to make it even BIGGER. You can sign your name, write numbers or draw a picture. Just make it BIG. Use a window or mirror frame cue you to help keep the letters BIG! Do this for 2-3 minutes before writing and as needed while you work.

Be a Copy Cat — Use this website to make handwriting practice sheets for practice; trace and copy words you need to write often — practice makes progress!

Take breaks — Focus on writing one word at a time — not the whole name or sentence. Take breaks between words to “reset” (try finger flicks or motor imagery) if writing starts to become smaller or more cramped.

Stay Straight — use a straight edge or ruler and a pencil to draw guide lines for your letters; erase them after you are done; use block letters instead of cursive because straight lines are easier to write out

Loop the loops — for a more legible signature or cursive handwriting, warm up by practicing letters that loop and curve such as a, c, u, l and f

Focus on the Big Picture — handwriting is necessary for all kinds of everyday activities (signing a form, writing a grocery list, keeping a daily journal, sending a birthday card) — your handwriting needs only to be legible NOT perfect!