Handwriting on a tablet screen: Role of visual and proprioceptive feedback in the control of movement by children and adults

Tablets are increasingly being used in schools for a variety of handwriting tasks. Given that the control of handwriting relies on both visual and proprioceptive feedback, especially in younger writers, this raises the question of whether the texture of the tablet surface affects graphomotor execution. A series of recent studies found that when the smoothness of a tablet screen modifies proprioceptive feedback, the impact on graphomotor execution varies according to the level of the writer’s handwriting skills. However, as the writing on the screen remained visible in these studies, participants may have compensated for the decrease in proprioceptive feedback by relying more heavily on visual information. The aim of the present study was therefore to unravel the respective contributions of different types of sensory feedback during handwriting development and, consequently, the compensatory role of visual information when children and adults have to write on a tablet. To this end, we asked second and fifth graders and adult participants to write letters and pseudowords on a plastic board placed on top of a tablet screen. Participants wrote on either the smooth or the granular side of the plastic board (manipulation of surface friction), and with normal vision or behind a shield that hid the hand and handwriting from direct view (manipulation of vision). Kinematic parameters and legibility were recorded to assess handwriting performances. Results revealed a significant interaction between proprioceptive and visual feedback on letter size, pen speed and legibility, regardless of participants’ age. Furthermore, reducing the visual and proprioceptive feedback had a greater effect on the children’s handwriting performances than on those of adults. Overall, the present study provides new insight into the contribution of the different types of sensory feedback and their interaction with handwriting development. In addition, our results on the impact of tablet surface on graphomotor execution will serve as useful pointers for improving the design of this tool for children, such as increasing the degree of friction of the screen surface.     

The impact of graphomotor demands on letter-like shapes recognition: A comparison between hampered and normal handwriting

Recent research suggests that graphic motor programs acquired through writing are part of letter representations and contribute to their recognition. Indeed, learning new letter-like shapes through handwriting gave rise to better recognition than learning through methods suppressing the graphomotor activity (e.g., typing or viewing). The present study aimed at further assessing the role of the graphic motor programs in letter-like shape recognition by disturbing the graphomotor activity during learning. We compared recognition performance following normal handwriting to recognition performance following hampered handwriting. Adult participants learned sets of symbols by copying them either with a standard pen or with a hampering writing tool. Recognition tests were administered immediately after the learning phase and again one week later. The results revealed lower recognition accuracy following hampered handwriting than following normal handwriting suggesting a contribution of graphomotor skills in the construction of letter representation.     

Lifts and stops in proficient and dysgraphic handwriting

In this study, the handwriting performances of dysgraphic children were compared to those of proficient children and adults. The task consisted in writing a single word at normal and fast speeds. A distinction was made between two kinds of pauses, which are often confounded: pen lifts, when the pen is above the paper, and pen stops, when it is immobile on the paper. The number and duration of lifts and stops were analyzed, together with the mean velocity. No difference in the number of lifts was observed between the three groups of writers, but the lift durations were shorter for adults. While dysgraphic children were able to write as fast as proficient children, their stops were more numerous and longer than those of proficient children who, themselves, made more stops than adults. A distinction was made between short, normal, and long, abnormal, stops. The results of this study suggest that pen stops are more appropriate than pen lifts in differentiating the handwriting fluency of dysgraphic and proficient children.     

Brain dopamine and kinematics of graphomotor functions

Three experiments were performed in an attempt to achieve a better understanding of the effect of dopamine on handwriting. In the first experiment, kinematic aspects of handwriting movements were compared between healthy participants and patients with Parkinson's disease (PD) on their usual dopaminergic treatment and following withdrawal of dopaminergic medication. In the second experiment, the writing performance of healthy participants with a hyperechogenicity of the substantia nigra as detected by transcranial sonography (TCS) was compared with the performance of healthy participants with low echogenicity of the substantia nigra. The third experiment examined the effect of central dopamine reduction on kinematic aspects of handwriting movements in healthy adults using acute phenylalanine and tyrosine depletion (APTD). A digitising tablet was used for the assessment of handwriting movements. Participants were asked to perform a simple writing task. Movement time, distance, velocity, acceleration and measures of fluency of handwriting movements were measured. The kinematic analysis of handwriting movements revealed that alterations of central dopaminergic neurotransmission adversely affect movement execution during handwriting. In comparison to the automatic processing of handwriting movements displayed by control participants, participants with an altered dopaminergic neurotransmission shifted from an automatic to a controlled processing of movement execution. Central dopamine appears to be of particular importance with regard to the automatic execution of well-learned movements.     

Biomechanical analyses of prolonged handwriting in subjects with and without perceived discomfort

Since wrist-joint position affects finger muscle length and grip strength, we studied its biomechanical relevance in prolonged handwriting. We recruited participants from young adults, aged 18–24, and separated them into control (n = 22) and in-pain (n = 18) groups, based whether or not they experience pain while handwriting. The participants then performed a writing task for 30 min on a computerized system which measured their wrist-joint angle and documented their handwriting kinematics. The in-pain group perceived more soreness and had a less-extended wrist joint, longer on-paper time, and slower stroke velocity compared to control group. There was no significant difference in handwriting speed and quality between the two groups. The wrist extension angle significantly correlated with perceived soreness. Ergonomic and biomechanical analyses provide important information about the handwriting process. Knowledge of pen tip movement kinematics and wrist-joint position can help occupational therapists plan treatment for individuals with handwriting induced pain.     

Do motor ability and handwriting kinematic measures predict organizational ability among children with Developmental Coordination Disorders?

Background and aimChildren with Developmental Coordination Disorders (DCD) exhibit deficient daily performance concealed in their perception–action mechanism. The aim of this study was to analyze behavior organization of children with DCD, in varied tasks that require generating and monitoring mental representations related to space and time inputs/requirements, for achieving better insight about their perception–action mechanism.MethodParticipants included 42 children aged 7–10, half of whom were defined with DCD and half were typically developing (TD). The children were matched for age, gender and school. They were evaluated using the Movement–ABC and performed three handwriting tasks on an electronic tablet that is part of a computerized system (ComPET – Computerized Penmanship Evaluation Tool). In addition, their teachers completed the Questionnaire for Assessing Students’ Organizational Abilities-Teachers (QASOA-T) to assess the children’s daily organizational ability.ResultsSignificant group differences (DCD versus controls) were found for all handwriting kinematic measures across the three handwriting tasks and for the children’s organizational abilities. Motor ability predicted a considerable percentage of the variance of the kinematic handwriting measures (30–37%), as well as a high percentage of the variance of their organizational abilities (67%). The coefficient of variance of the pen tilt added an additional 3% to the prediction of their organizational abilities.ConclusionsThe results of this study exhibited deficient ability among children with DCD in organizing their behavior in varied real-world tasks requiring generation and monitoring representation related to space and time. The significance of the results to understanding the performance mechanism and implication to the clinical field are discussed.     

Attention and movement execution during handwriting

Two studies were performed in order to test the hypothesis that movement execution during handwriting in skilled writers is independent of attention. Study I examined the relationship between attentional functioning and kinematic aspects of handwriting movements in 24 adult participants. A digitizing tablet was used for the assessment of handwriting movements. Participants were asked to perform a simple writing task and various components of their attention were assessed. Correlation analysis indicated no significant relationship between attention functions and both kinematic aspects of handwriting movements and quality of handwriting. In Study II, 20 participants underwent total sleep deprivation (TSD) for 24h. While attention, as assessed with alertness and vigilance tasks, deteriorated during TSD, the execution of handwriting movements, as assessed with a digitizing tablet, improved markedly. The quality of handwriting was not affected by TSD. These findings may suggest an independence between attention and movement generation during handwriting.     

Eye movements during the handwriting of words: Individually and within sentences

Handwriting, a complex motor process involves the coordination of both the upper limb and visual system. The gaze behavior that occurs during the handwriting process is an area that has been little studied. This study investigated the eye-movements of adults during writing and reading tasks. Eye and handwriting movements were recorded for six different words over three different tasks. The results compared reading and handwriting the same words, a between condition comparison and a comparison between the two handwriting tasks. Compared to reading, participants produced more fixations during handwriting tasks and the average fixation durations were longer. When reading fixations were found to be mostly around the center of word, whereas fixations when writing appear to be made for each letter in a written word and were located around the base of letters and flowed in a left to right direction. Between the two writing tasks more fixations were made when words were written individually compared to within sentences, yet fixation durations were no different. Correlation of the number of fixations made to kinematic variables revealed that horizontal size and road length held a strong correlation with the number of fixations made by participants.     

Variability of kinematic graphomotor fluency in adults with ADHD

Although graphomotor differences and variability of performance have been observed in children with attention deficit hyperactivity disorder (ADHD), no study has investigated whether this variability manifests in the kinematic graphomotor domain in adults with ADHD. Fourteen ADHD and 20 control participants wrote a novel grapheme and common word on a digitizing tablet 30 times each, with ADHD participants counterbalanced on and off stimulant medication. Variability of graphomotor fluency was significantly greater in ADHD versus control participants only in the novel writing task, both on, F(1, 31) = 5.988, p = .020, and off stimulant medication, F(1, 32) = 8.789, p = .006. Results suggest that motor control differences in ADHD are not limited to childhood and extend into adulthood. Given sufficient additional research, variability of kinematic graphomotor fluency may increase the sensitivity/specificity of differential diagnoses and/or represent a biomarker for ADHD.     

Reduced graphomotor procedural learning in children and adolescents with ADHD

Purpose: The present study sought to determine if children and adolescents with ADHD demonstrate reduced procedural learning of a graphomotor program. Method: Thirty-two children and adolescents between age 9 and 15 with (n = 16) and without ADHD (n = 16) participated in the study. Each group of participants practiced a novel grapheme on a digitizing tablet 30 times. Participants with ADHD were off stimulant medication or were medication naïve. Results: Control participants demonstrated significant improvement in graphomotor fluency from the beginning to the end of practice, T = 2, z = −2.534, p = .009, whereas participants with ADHD did not, T = 4, z = −1.810, p = .074. Conclusions: Consistent with findings in adults with ADHD, results indicate that graphomotor procedural learning in children and adolescents with ADHD is attenuated. Findings have implications for future research that may inform remediation of handwriting difficulties, academic accommodations, and using digitizing technology for neuropsychological assessment.     

Handwriting or Typewriting? The Influence of Pen- or Keyboard-Based Writing Training on Reading and Writing Performance in Preschool Children

Digital writing devices associated with the use of computers, tablet PCs, or mobile phones are increasingly replacing writing by hand. It is, however, controversially discussed how writing modes influence reading and writing performance in children at the start of literacy. On the one hand, the easiness of typing on digital devices may accelerate reading and writing in young children, who have less developed sensory-motor skills. On the other hand, the meaningful coupling between action and perception during handwriting, which establishes sensory-motor memory traces, could facilitate written language acquisition. In order to decide between these theoretical alternatives, for the present study, we developed an intense training program for preschool children attending the German kindergarten with 16 training sessions. Using closely matched letter learning games, eight letters of the German alphabet were trained either by handwriting with a pen on a sheet of paper or by typing on a computer keyboard. Letter recognition, naming, and writing performance as well as word reading and writing performance were assessed. Results did not indicate a superiority of typing training over handwriting training in any of these tasks. In contrast, handwriting training was superior to typing training in word writing, and, as a tendency, in word reading. The results of our study, therefore, support theories of action-perception coupling assuming a facilitatory influence of sensory-motor representations established during handwriting on reading and writing.     

Dyslexic children fail to comply with the rhythmic constraints of handwriting

In this study, we sought to demonstrate that deficits in a specific motor activity, handwriting, are associated to Developmental Dyslexia. The linguistic and writing performance of children with Developmental Dyslexia, with and without handwriting problems (dysgraphia), were compared to that of children with Typical Development. The quantitative kinematic variables of handwriting were collected by means of a digitizing tablet. The results showed that all children with Developmental Dyslexia wrote more slowly than those with Typical Development. Contrary to typically developing children, they also varied more in the time taken to write the individual letters of a word and failed to comply with the principles of isochrony and homothety. Moreover, a series of correlations was found among reading, language measures and writing measures suggesting that the two abilities may be linked. We propose that the link between handwriting and reading/language deficits is mediated by rhythm, as both reading (which is grounded on language) and handwriting are ruled by principles of rhythmic organization.     

The effect of real-time auditory feedback on learning new characters

The present study investigated the effect of handwriting sonification on graphomotor learning. Thirty-two adults, distributed in two groups, learned four new characters with their non-dominant hand. The experimental design included a pre-test, a training session, and two post-tests, one just after the training sessions and another 24 h later. Two characters were learned with and two without real-time auditory feedback (FB). The first group first learned the two non-sonified characters and then the two sonified characters whereas the reverse order was adopted for the second group. Results revealed that auditory FB improved the speed and fluency of handwriting movements but reduced, in the short-term only, the spatial accuracy of the trace. Transforming kinematic variables into sounds allows the writer to perceive his/her movement in addition to the written trace and this might facilitate handwriting learning. However, there were no differential effects of auditory FB, neither long-term nor short-term for the subjects who first learned the characters with auditory FB. We hypothesize that the positive effect on the handwriting kinematics was transferred to characters learned without FB. This transfer effect of the auditory FB is discussed in light of the Theory of Event Coding.     

The effect of caffeine on handwriting movements in skilled writers

In laboratory tasks, caffeine has been shown to improve psychomotor performance. The aim of the present experiment was to assess the effects of caffeine on a skilled everyday life task in habitual caffeine consumers. The assessment of handwriting movements of 20 adults was performed following the administration of 0mg/kg (placebo), 1.5mg/kg, 3.0mg/kg or 4.5mg/kg of caffeine. A digitising tablet was used for the assessment of fine motor movements. Participants were asked to perform a simple writing task. Kinematic analysis of handwriting movements showed that, in comparison to placebo administration, high doses of caffeine (i.e., 4.5mg/kg) can produce improvements in handwriting as indicated by more fluent handwriting movements as well as an increase in maximum velocity and maximum positive and negative accelerations. The results suggest that higher doses of caffeine can enhance psychomotor performance.     

Cognitive processes in writing during pause and execution periods

The present study investigated how writing processes are activated during pause and execution periods. In two experiments, handwriting demands were manipulated by asking participants to compose with their familiar handwriting or with a high-demanding cursive uppercase calligraphy. Experiment 1 investigated narrative writing, a task with low planning demands. Experiment 2 addressed essay writing, a task with stronger planning demands. Occurrences of processes and their cognitive effort were analysed by asking participants to respond to random auditory probes and then to report their ongoing mental activity according to learned categories referring to the planning, translating, and revising writing processes. All together, the findings indicate that demands on planning did not affect how writing processes were activated during pauses and execution periods but automaticity of handwriting did. When handwriting was effortless, translating was mostly activated in parallel with motor execution, whereas revising and planning were mainly activated during pauses. However, none of the writing processes could be characterised as being typical of pauses, since translating was activated to a similar extent as the other two processes. By contrast, when handwriting was effortful, participants shifted to a more sequential functioning and activated translating mainly during pauses.     

Processing of syllables during handwriting: Effects of graphomotor constraints

The processing of syllables during the writing of isolated words has been shown to occur either before or during the writing of the word containing them. To demonstrate that this difference is related to graphomotor constraints, participants copied bi- and trisyllabic words three times, in four conditions where graphomotor constraints were gradually increased. As expected, latencies were only affected by syllable number in the low-constraint condition. In all four conditions, interletter intervals at syllable boundaries were longer than intrasyllabic interletter intervals. The difference between inter- and intrasyllabic intervals increased with the level of graphomotor constraint. Taken together, these findings indicate that under low graphomotor-constraint conditions, all the syllable processing takes place prior to the writing of a word, whereas under higher graphomotor-constraint conditions, syllable processing is more sequential, each syllable being processed just before it is written.     

Graphomotor skills in children with developmental coordination disorder (DCD): Handwriting and learning a new letter

The aim of the present study was to analyze handwriting difficulties in children with developmental coordination disorder (DCD) and investigate the hypothesis that a deficit in procedural learning could help to explain them. The experimental set-up was designed to compare the performances of children with DCD with those of a non-DCD group on tasks that rely on motor learning in different ways, namely handwriting and learning a new letter. Ten children with DCD and 10 non-DCD children, aged 8–10 years, were asked to perform handwriting tasks (letter/word/sentence; normal/fast), and a learning task (new letter) on a graphic tablet. The BHK concise assessment scale for children’s handwriting was used to evaluate their handwriting quality. Results showed that both the handwriting and learning tasks differentiated between the groups. Furthermore, when speed or length constraints were added, handwriting was more impaired in children with DCD than in non-DCD children. Greater intra-individual variability was observed in the group of children with DCD, arguing in favor of a deficit in motor pattern stabilization. The results of this study could support both the hypothesis of a deficit in procedural learning and the hypothesis of neuromotor noise in DCD.     

VIDANN: A video annotation system

VIDANN is a computer program that allows participants to watch a video on a standard TV and to write their annotations (thought/feeling entries) on paper attached to a writing tablet. The system is designed as a Microsoft ActiveXmodule. It can be further adapted by the individual researcherthrough the use of a VBScript. All data, including the participant’s handwriting, are stored in an XML database. An accompanying Wizard has been designed that enables researchers to generate VBScripts for standard configurations.