Small Handwriting in Parkinson’s: Understanding the Early Symptom and Strategies for Management



Parkinson’s disease is a condition which affects the brain and make it harder to control your body. While most people are familiar with the characteristics of tremors and muscle stiffness associate with Parkinson’s there are other lesser-known symptoms such as small handwriting, also known as micrographia, that also manifest.

Micrographia may cause many people to stop writing and depend on others to write for them. Things like writing a check or a birthday card can become more difficult due to the impact symptoms that come with Parkinson’s disease. Reduced fine motor control and an increase in rigidity can make writing seem impossible to accomplish.

Detecting Small Handwriting Early:

Symptoms of Parkinson’s disease such as bradykinesia (slow movements) can impact the repetitive movement involved in writing which makes the act of writing slower and smaller over time. However, it is important to note that not everyone with small handwriting will develop Parkinson’s. If you notice that your handwriting has become progressively smaller over time, especially if it is accompanied by other symptoms like tremors or stiffness, it is advisable to consult a healthcare professional for proper evaluation.

Strategies to Manage Small Handwriting:

While there is no cure for Parkinson’s disease, there are several strategies that can help manage small handwriting and improve writing legibility:

      1. Hand and finger exercises: engage in hand and finger exercises to improve dexterity, strength and fine motor control. This can include using a stress ball, therapy putty and/or our hand exercise video which you can find on our website.
      2. Practice: Regularly practice writing to maintain and improve your skills. Set aside time each day for writing exercises, such as copying short passages or practicing specific letter formations. Consistent practice can help train your muscles and reinforce muscle memory.
      3. Write During your “ON” Times: Write when your medication is working best. This will allow you to perform handwriting tasks when your symptoms are controlled, helping you to concentrate better and have better quality pencil control.
      4. Slowing Down and Taking Breaks: Allow yourself ample time for writing tasks. Slowing down the writing pace and taking frequent breaks can help manage muscle fatigue and improve the quality of your handwriting.
      5. Larger Writing Tools: Consider using larger pens or pencils with thicker or shaped grips. Try grips with a bumpy surface to provide a more comfortable grip and increase sensory input to the brain.
      6. Ink Types: Choose a good flowing pen! Gel pens can be easier to use than ball points. Find one that is right for you and your style of handwriting.
      7. Think BIG: Writing “think BIG” at the top of your page can prompt you to write bigger. Focus on the size and shape of each letter or word and increase the spacing between letters, words and lines to make your writing more legible. 
      8. You can use our practice sheets to help with visual cues to guide your handwriting. Using templates or lined paper with larger spaces can help you maintain a consistent size and shape for your letters.

    The Role of NeuYou Rehab:

    NeuYou Rehab is a leading provider of specialised rehabilitation services for individuals with neurological conditions like Parkinson’s disease. Our occupational therapists work closely with patients to develop personalised treatment plans aimed at improving functioning abilities, including handwriting. Through targeted exercises, adaptive techniques and assistive technologies, NeuYou Rehab aims to enhance the quality of life for individuals living with Parkinson’s.

    Bringing It All Together:

    Small handwriting, or micrographia, is a common symptom experienced by individuals with Parkinson’s disease. Recognising this early sign can help facilitate timely intervention and management strategies. While small handwriting cannot be completely reversed, occupational therapy, adaptive tools, medication and think BIG strategies, and the expertise of organisations like NeuYou Rehab can significantly improve writing legibility and enhance overall daily functioning. If you or a loved one are facing challenges with small handwriting due to Parkinson’s disease, it is advisable to seek professional help and explore the available resources for support and assistance.


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