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Article

Handwriting Analysis in Children and Adolescents with Hemophilia: A Pilot Study

by
Gianluigi Pasta
1,
Maria Elisa Mancuso
2,
Filomena De Felice
2,
Alexander Seuser
3,
Salvatore Annunziata
1,*,
Flora Peyvandi
2,
Elena Santagostino
2,
Mario Mosconi
1 and
Axel Seuser
4
1
Operative Unit of Orthopedics and Traumatology, Department of Clinical-Surgical Sciences, Diagnostics and Pediatrics, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
2
Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy
3
Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätklinikum, 53127 Bonn, Germany
4
Praxis für Prävention, Rehabilitation und Orthopädie, 53225 Bonn, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(11), 3663; https://doi.org/10.3390/jcm9113663
Submission received: 23 October 2020 / Revised: 6 November 2020 / Accepted: 12 November 2020 / Published: 14 November 2020
(This article belongs to the Special Issue Diagnosis and Treatment of Hemophilia)
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Abstract

Background: Handwriting is a complex task that requires the integrity of different sensorimotor components to be performed successfully. Patients with hemophilia suffer from recurrent joint bleeds that may occur in the elbow, causing elbow dysfunction with handwriting performance impairment. In our study, we described instrumental dysgraphia that is related to functional disturbances. This pilot study aims to evaluate the handwriting performance in a group of patients with hemophilia. Methods: The study was performed at the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center in Milan. Boys with severe and moderate hemophilia A and B regularly followed-up at that Center, with age between 6–19 years, were eligible. Patients were invited to the Center for one multidisciplinary evaluation of the upper limbs that included: Clinical examination, surface electromyography, and handwriting assessment. Results: All patients, but one, completed handwriting assessment. Overall, 14/19 (74%) had abnormal handwriting, which was overt instrumental dysgraphia in six (32%). There was no difference in Hemophilia Joint Health Score (HJHS) between dysgraphic and non-dysgraphic boys, while surface electromyography (sEMG) revealed a prevalence of flexor muscles of the upper limb in dysgraphic as compared with non-dysgraphic boys. Conclusions: The rather high prevalence of instrumental dysgraphia found in this pilot study deserves a further development of this preliminary experience by increasing the number of examined patients and comparing them with a control group, including quality of life and psychological assessment.
Keywords: hemophilia; handwriting; upper limb; sEMG; HJHS hemophilia; handwriting; upper limb; sEMG; HJHS

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MDPI and ACS Style

Pasta, G.; Mancuso, M.E.; De Felice, F.; Seuser, A.; Annunziata, S.; Peyvandi, F.; Santagostino, E.; Mosconi, M.; Seuser, A. Handwriting Analysis in Children and Adolescents with Hemophilia: A Pilot Study. J. Clin. Med. 2020, 9, 3663. https://doi.org/10.3390/jcm9113663

AMA Style

Pasta G, Mancuso ME, De Felice F, Seuser A, Annunziata S, Peyvandi F, Santagostino E, Mosconi M, Seuser A. Handwriting Analysis in Children and Adolescents with Hemophilia: A Pilot Study. Journal of Clinical Medicine. 2020; 9(11):3663. https://doi.org/10.3390/jcm9113663

Chicago/Turabian Style

Pasta, Gianluigi, Maria Elisa Mancuso, Filomena De Felice, Alexander Seuser, Salvatore Annunziata, Flora Peyvandi, Elena Santagostino, Mario Mosconi, and Axel Seuser. 2020. "Handwriting Analysis in Children and Adolescents with Hemophilia: A Pilot Study" Journal of Clinical Medicine 9, no. 11: 3663. https://doi.org/10.3390/jcm9113663

APA Style

Pasta, G., Mancuso, M. E., De Felice, F., Seuser, A., Annunziata, S., Peyvandi, F., Santagostino, E., Mosconi, M., & Seuser, A. (2020). Handwriting Analysis in Children and Adolescents with Hemophilia: A Pilot Study. Journal of Clinical Medicine, 9(11), 3663. https://doi.org/10.3390/jcm9113663

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