• S Broeder, E Nackaerts, A Nieuwboer, B C M Smits-Engelsman, S P Swinnen, and E Heremans.
• Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, bus 1501, B-3001 Heverlee, Belgium. Electronic address: sanne.broeder@faber.kuleuven.be.
• Neuroscience. 2014 Mar 28;263:193-202.

AbstractPrevious studies have shown that patients with Parkinson's disease (PD) experience extensive problems during dual tasking. Up to now, dual-task interference in PD has mainly been investigated in the context of gait research. However, the simultaneous performance of two different tasks is also a prerequisite to efficiently perform many other tasks in daily life, including upper limb tasks. To address this issue, this study investigated the effect of a secondary cognitive task on the performance of handwriting in patients with PD. Eighteen PD patients and 11 age-matched controls performed a writing task involving the production of repetitive loops under single- and dual-task conditions. The secondary task consisted of counting high and low tones during writing. The writing tests were performed with two amplitudes (0.6 and 1.0cm) using a writing tablet. Results showed that dual-task performance was affected in PD patients versus controls. Dual tasking reduced writing amplitude in PD patients, but not in healthy controls (p=0.046). Patients' writing size was mainly reduced during the small-amplitude condition (small amplitude p=0.017; large amplitude p=0.310). This suggests that the control of writing at small amplitudes requires more compensational brain-processing recourses in PD and is as such less automatic than writing at large amplitudes. In addition, there was a larger dual-task effect on the secondary task in PD patients than controls (p=0.025). The writing tests on the writing tablet proved highly correlated to daily life writing as measured by the 'Systematic Screening of Handwriting Difficulties' test (SOS-test) and other manual dexterity tasks, particularly during dual-task conditions. Taken together, these results provide additional insights into the motor control of handwriting and the effects of dual tasking during upper limb movements in patients with PD.Copyright © 2014 IBRO. Published by Elsevier Ltd. All rights reserved.

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