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Abstract

When a patient presents with tremor, it can be useful to perform a few simple pen and paper tests. In this article, we explain how to maximise the value of handwriting and of drawing Archimedes spirals and straight lines as clinical assessments. These tasks take a matter of seconds to complete but provide a wealth of information that supplements the standard physical examination. They aid the diagnosis of a tremor disorder and can contribute to its longitudinal monitoring. Watching the patient’s upper limb while they write and draw may reveal abnormalities such as bradykinesia, dystonic posturing and distractibility. The finished script and drawings can then be evaluated for frequency, amplitude, direction and symmetry of oscillatory pen movements and for overall scale of penmanship. Essential, dystonic, functional and parkinsonian tremor each has a characteristic pattern of abnormality on these pen and paper tests.

Item Type:	Article
Authors/Creators:	Alty, J and Cosgrove, J and Thorpe, D and Kempster, P
Keywords:	Archimedes spiral, dystonia, handwriting, Parkinson's disease, tremor
Journal or Publication Title:	Practical Neurology
Publisher:	BMJ Group
ISSN:	1474-7758
DOI / ID Number:	https://doi.org/10.1136/practneurol-2017-001719
Copyright Information:	© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) http://creativecommons.org/licenses/by/4.0/
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