Int. J.

Devl Neuroscience 26 (2008) 655663

Contents lists available at ScienceDirect

International Journal of Developmental Neuroscience

journal homepage: www.elsevier.com/locate/ijdevneu

Inuence of age and movement complexity on kinematic hand movement

parameters in childhood and adolescence
Stefan Mark Rueckriegel a,1, Friederike Blankenburg a, Roland Burghardt b, Stefan Ehrlich b,
Gunter Henze a, Roland Mergl c, Pablo Hernaiz Driever a,*
a
b
c

Pediatric Neurooncology Program, Department of Pediatric Oncology and Hematology, Charite-Universitatsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Department of Child and Adolescent Psychiatry, Charite-Universitatsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
Department of Psychiatry, University of Leipzig, Germany

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 15 May 2008
Received in revised form 30 July 2008
Accepted 30 July 2008

Development of ne motor functions, especially drawing and handwriting, are crucial for performance in
school, autonomy in everyday life and the general human development. A variety of neurological and
psychiatric conditions in childhood and adolescence stunt the normal development of ne motor skills.
We sought to dene the normal development of the kinematic parameters of ne motor movement and
determine the inuence of gender, laterality of handedness and extracurricular training on ne motor
skills.
One hundred and eighty-seven children and adolescents (mean age: 11.6 years (S.D.: 3.58), range: 6
18 years) were included in the study. Participants performed drawing and handwriting tasks on a digitizing
graphic tablet. Movement and pressure data were transferred to a computer using a sensor-equipped pen and
post-processed using CSWIN. Movements were segmented into strokes and several kinematic parameters
were calculated. The kinematic parameters that were analyzed represented speed (frequency and stroke peak
velocity), automation (number of direction changes of velocity per stroke), variability (variation coefcient of
stroke peak velocity) and pressure.
Progression of kinematic parameters for each movement domain of the handwriting and circle
drawing tasks correlated signicantly with age (Pearsons correlation, p < 0.003). Speed, automation and
pressure increased with age, whereas variability decreased. Nonlinear regressions revealed maturation of
hand movements at a certain age. Age of completed maturation depended on the task complexity
(drawing circles vs. handwriting) and kinematic parameters. In the speed and automation domains,
handwriting movements nish maturing later than circle drawing. Male subjects drew circles at
signicantly higher speeds than female subjects. Fine motor practice and laterality of handedness did not
inuence kinematic parameters. A repeated measure ANOVA conrmed the signicant interdependency
between age and complexity level for speed and automation (p < 0.001).
The digitizing graphic tablet is an extremely valuable tool in determining the normal development of
hand movement skills of children and adolescents by measuring relevant daily tasks like handwriting and
drawing. In our study, we showed that future analyses of impaired movement in children and adolescents
need to take age and gender into consideration. Furthermore, differences were observed in the
maturation of different task complexities, the complex ne motor function reaching maturity later than
basic and repetitive movement patterns.
2008 ISDN. Published by Elsevier Ltd. All rights reserved.

Keywords:
Hand writing development
Digitizing tablet
Kinematic analysis
Maturation
Children and adolescents

* Corresponding author. Tel.: +49 30 450666173; fax: +49 30 450566906.

E-mail address: pablo.hernaiz@charite.de (P. Hernaiz Driever).
1
S.M. Rueckriegel was supported by a fellowship of Kind-Philipp-Stiftung.
Abbreviations: F, frequency; SPV, stroke peak velocity; NCV, number of direction
changes of velocity; VARPV, variation coefcient of stroke peak velocity; VARD,
variation coefcient of stroke duration; P, pressure; VI, verbal intelligence.
0736-5748/$34.00 2008 ISDN. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijdevneu.2008.07.015

Handwriting is a fundamental skill that impacts various elds of

ones everyday-life and professional performance. Despite of the
widespread use of keyboards, handwriting is still an important
means of communicating through space and time (Friedland,
1990). Especially in childhood and adolescence, it plays a crucial
role due to its implications in motor and cognitive development.
Childrens performance in school as well as their self-esteem
depends on their handwriting (Sassoon, 1990). Pupils spend 30

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S.M. Rueckriegel et al. / Int. J. Devl Neuroscience 26 (2008) 655663

60% of their time in school on handwriting and ne motor tasks

(Mchale and Cermak, 1992). Among low-achieving children,
impaired functions commonly include ne motor abilities and
nger agnosia (Levine et al., 1981). Impairment of ne motor
abilities can be modulated by a variety of performance components.
Visual-motor integration, bilateral motor integration, motor planning, proprioception, visual perception and sustained attention are
important components that contribute to complex ne motor skills
like handwriting and drawing (Feder and Majnemer, 2007).
2D-visual communication begins both phylogenetically and
ontogenetically by conveying information through drawings (Friedland, 1990). Infants start learning to draw basic geometric shapes,
like vertical strokes, at an age of 2 years. Preschoolers learn to copy
circles at 3 years and squares at 5 years (Beery Ke, 1989; Feder and
Majnemer, 2007). The development of handwriting, as regards its
resulting two-dimensional appearance and simple writing speed, is
well documented (Smits-Engelsman and Van Galen, 1997; Feder and
Majnemer, 2007). Writing speed, the number of letters written in a
given time period (Childrens Handwriting Evaluation Scale), was
strongly correlated with age (Hamstra-Bletz and Blote, 1990). Model
letter forms develop into personal letter forms during adolescence
(Hamstra-Bletz and Blote, 1993).
Strokes and loops are the basic components of graphics and
handwriting. Sequences of simple, prestructured motor programs
are commonly regarded to control motor behavior, i.e. a sequence
of abstract spatiotemporal goal trajectories in handwriting (Van
Galen and Weber, 1998). Stroke generation emerges through
different subsystems of neuromuscular networks that control
exion and extension.
Analyses of static stroke and loop sequences on a 2D ink-trace
image are limited to investigations of accuracy and/or legibility.
Since the addition of digitizing graphic tablets to the tools of
graphonomic research, kinematic parameters of hand movements
can be analyzed more precisely (Marquardt and Mai, 1994; Van
Galen and Stelmach, 1993). Position and pressure of a specialized
pen are determined on the digitizer with a high spatial and
temporal resolution. These data are then saved on a PC and postprocessed using computational algorithms to determine a broad
variety of kinematic parameters that reect different aspects of
movement. A reduced number of variables is necessary for the
practical analysis of movement data. We suggest the categorization of the kinematic parameters into four subgroups that we
termed movement domains: automation of stroke generation,
speed, variability and axial pen pressure (i.e. average pressure
measured over time of writing movement exerted by the tip of the
pen). We conrmed an acceptable independence of the movement
domains and chose representative kinematic parameters using a
factor analysis.
The digitizing tablets ability to describe hand movements and
group them into specic movement domains is just one advantage
that it has over classical methods of evaluating drawing and
handwriting. Other important advantages are the highly objective
test procedure and analysis. The movement tasks given to the
participant are standardized and easily understandable, in order to
avoid confusion. Movement analysis is completely independent of
the examiner. Therefore, the digitizing graphic tablet has already
been used commonly in the psychology of writing (Van Galen and
Stelmach, 1993). It provided sensitive information for the detection
and quantication of neurological movement disorders (Erasmus
et al., 2001; Elble et al., 1996) and was implemented to test for
neurological soft signs in psychiatric diseases like schizophrenia and
depression (Tigges et al., 2000; Mergl et al., 2004a). Furthermore, it
was used to detect drug remediation effects on ne motor
movements (Mergl et al., 2004b; Tucha and Lange, 2001; Tucha
et al., 2006). One of the authors showed that in healthy adults,

kinematic parameters were dependent on age, verbal intelligence

(VI) and ne motor practice. Testretest reliability was determined
by one of the authors in a previous study for mean of stroke peak
velocity (SPV), number of direction changes of velocity per stroke
(NCV) and pressure by repeating the measurements in the same
subjects after one week. Testretest reliability depended on the task
and parameter (r ranged from r = 0.59 in handwriting SPV to r > 0.88
in handwriting NCV) (Mergl et al., 1999).
The digitizing tablet is a valuable tool not only in the
assessment of ne motor function in adults but also in children.
So far, only the development of the 2D product of handwriting in
children and adolescents has been investigated while the
development of kinematic parameters remains unclear. Few
kinematic handwriting analyses of children have been mentioned
in the literature. They addressed either age-homogeneous
populations or comparisons of patients with controls (Tucha
and Lange, 2001; Smits-Engelsman and Van Galen, 1997;
Rosenblum et al., 2006b; Rosenblum et al., 2006a). First steps
toward understanding the development of hand movement were
taken by Blank et al., who investigated frequency of simple
repetitive hand movements in 7- to 15-year-old children using a
digitizing graphic tablet (Blank et al., 1999). Lange-Kuttner also
addressed developmental aspects by comparing several kinematic
parameters in 4- and 6-year-old children (Lange-Kuttner, 1998).
Van Mier addressed the development of laterality in hand
movement and bimanual interference (Van Mier, 2006; Otte and
Van Mier, 2006). Nevertheless, the age of completed maturation for
ne motor skills of different complexity levels is unknown.
In this study, we investigated the inuence of age, gender,
laterality of handedness and ne motor practice on drawing and
handwriting. We hypothesized that these covariates inuence
kinematic parameters and would therefore have to be considered
critical for the interpretation of the results when assessing pediatric
and adolescent patients. This would allow us a robust transfer of
experimental methods to clinical applications of the digitizing tablet
in pediatrics. We used a paradigm that included different complexity
levels of drawing and handwriting movements. We thereby
investigated the difference in maturation for different levels of
movement complexity. Laterality was determined using the
Edinburgh handedness inventory (Oldeld, 1971). A standardized
interview provided information on habitual ne and gross motor
activities like drawing, playing a music instrument and athletics.
Thus, the objective of our study was to describe the maturation in
drawing and handwriting of participants, ranging from the 1st grade
to adulthood, using kinematic parameters.
1. Experimental procedures
1.1. Study population
Handwriting movements were assessed from 191 healthy children and
adolescents between the ages of 618 years. Age and gender distribution of the
participants is shown in Fig. 1. Four participants, who met the exclusion criteria,
were excluded due to neurological diseases, neurological or psychiatric medication
and/or a declared consumption of alcohol and illegal drugs in the last 24 h. Data for
disease exclusion criteria were collected in all subjects and for exclusion due to
consumption of alcohol and illegal drugs in subjects older than 11 years. The
movement performance and standardized interviews of remaining 187 children
and adolescents were then analyzed and evaluated.
Assessments took place in three different schools. Children at an age of 612
years were assessed in a primary school, which included bilingual classes (German
Spanish). Adolescents at an age of 1319 years were recruited from a Gymnasium
(secondary school offering higher level education in Germany) and a
Gesamtschule (secondary school offering standard level education). In Germany,
pupils are sent to different school types after primary school depending on their
academic performance. We chose different high school types to make sure that the
group composition reects a cross-section of different educational levels.
The Institutional Review Board approved this study and all subjects (and, if
underage, their guardians) provided written informed consent.

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657

with the commercially available program CSWIN 1.2 (Marquardt and Mai, 1994)
and analyzed with SPSS 15.0. Non-parametric kernel estimation was used for the
calculation and smoothing of movement derivatives like velocity and acceleration
(Marquardt and Mai, 1994). Writing and drawing movements were segmented into
vertical strokes, i.e. up and downward movements. A stroke segment ended when
the velocity projection on the y-axis passed through zero. Although all strokes of the
writing tasks were included in analysis, only the rst 99 strokes of the 30 s circle
drawing task were analyzed.
Several kinematic parameters were determined for each of the tasks. We
categorized them into four movement domains of handwriting. Speed, the most
commonly described feature of hand movement in the literature, constitutes the
rst movement domain (Blank et al., 1999; Lange-Kuttner, 1998; Hamstra-Bletz
and Blote, 1993; Tucha and Lange, 2001; Schoemaker et al., 2005; Van Mier, 2006;
Mergl et al., 1999). Another important characteristic of hand movement is its degree
of automation. When movements are highly automated and smooth, they are
conducted without hesitation and display a low number of direction changes of
velocity and acceleration within a single stroke (Schoemaker et al., 2005; Mergl
et al., 1999; Tigges et al., 2000; Eichhorn et al., 1996). The next important feature of
hand movement is the variability of stroke peak velocity and stroke duration
(Phillips et al., 1999; Mergl et al., 2004a). Low variability is important for an efcient
and rhythmic pattern of movement. The fourth parameter assessed mean writing
and drawing pressure, which reects the underlying tension of the movement
(Lange-Kuttner, 1998).

Fig. 1. Distribution of age and gender. Each age group included a minimum of 30
subjects. f: female; m: male.

1.2. Assessment
Trained test supervisors interviewed all children and adolescents. We used a
questionnaire that included the Edinburgh Handedness Inventory and several
questions about gross and ne motor practice. We assessed hours of extracurricular
ne motor activity per week (e.g.: crafting, playing music, tinkering), of
extracurricular muscular energy consuming activity (e.g.: bodybuilding, gardening,
rowing), and of playing computer games. Furthermore, we assessed whether
subjects performed activities that required parallel hand movements (e.g.: playing
piano or violin, ten nger writing on a keyboard). All data on gross and ne motor
practice are based on the subjects self-assessment. Reliability and validity of our
questionnaire was not tested. Edinburgh Handedness Inventory determines a
laterality score between 100, i.e. maximal lateralized left-hander and +100, i.e.
maximal lateralized right-hander. Assessments and interviews were carried out in
quiet classrooms and lasted approximately 30 minutes. Participants were seated
comfortably in their usual school chairs with a back. Size of chairs and tables were
adjusted to the height of the subjects. The pupils were assigned several writing and
drawing tasks. The task composition was analogue to those in prior studies of adults
(Mergl et al., 1999, 2004a; Tigges et al., 2000).
Participants used a specialized pen equipped with a sensor that did not produce
an ink trace, in order to prevent visual control of the trace. The tip of the pen
consisted of a simple plastic imitation of a pencil lead without a ball. Tasks of
different demands were performed on white paper sheets that were labeled with
task graphics. A header containing brief instructions was written on the sheets.
Tasks were explained verbally, suitable to age and comprehension of the
participant. An overview of the tasks used in this study is listed in Table 1. Circle
drawing was to be carried out at maximum velocity because previous studies
showed the most reliable effects of age under this condition (Blank et al., 1999;
Carlier et al., 1993). First grade pupils (11 boys and 15 girls) did not perform the
writing task (task 2).
Task sheets were xed under the transparent overlay of a digitizing graphic
tablet (WACOM IV), which imitated the papers surface. Friction of that foil was
comparable to the friction of normal paper (WACOM Translucent Overlay).
Performance was visualized on the screen in order to administer the tasks and to
verify that they were carried out correctly. Participants were not able to see the
screen and thus had no visual feedback. Position and pressure of the pen were
detected with a sampling rate of 200 Hz and a spatial resolution of 0.05 mm.
Measurements began automatically when the participant rst touched the pen to
the digitizing tablet. All kinematic data were transferred to a PC, post-processed

(a) Speed: Frequency (F) of strokes and arithmetic mean of stroke peak velocity
(SPV).
(b) Automation: Number of changes of y-axis velocity (NCV) from acceleration to
deceleration and vice versa, i.e. number of y-axis velocity maxima and minima,
per stroke.
(c) Variability: Variation coefcient of stroke peak velocity (VARPV) and stroke
duration (VARD).
(d) Writing and drawing pressure (P).

2. Statistical analysis
2.1. Selection of kinematic parameters
CSWin provides more than 50 different variables for analyzing
various kinematic parameters. We considered a reduction of
variables for practical reasons. Therefore, the variables were fed
into a factor analysis of main components (eigenvalue > 1) that
extracted four independent components for the analysis in task 1
and ve components in tasks 2 and 3. These components
corresponded with the movement domains mentioned previously.
One representative kinematic parameter was chosen for each
component. The factor analysis indicated that NCV (automation),
SPV (speed), VARPV (variability) and P (pressure) were representative for the respective components. Frequency of strokes (F) was
used in all analyses because it was a major factor in earlier studies
and allows comparability with similar investigations. Furthermore, VARD was added in tasks 2 and 3 as the additional
component extracted for these tasks in the factor analysis.
2.2. Analysis of kinematic parameters considering different variables
2.2.1. Age
Each of the relevant kinematic parameters for a simple (circles)
and a complex (sentence) task of the dominant hand was
correlated to age (Pearsons correlation). If correlation was
signicant, regression analysis of linear, logarithmic, square and

Table 1
Overview of tasks

Task 1
Task 2
Task 3

Task

Description

Circles
Sentence
Letters a, lower case

Smooth and quick drawing of circles between two lines (16 mm apart) with the dominant hand for 30 s
Smooth cursive writing of the German sentence Der Ball rollt ins Tor. Speed is not critical (1st grade pupils were excluded)
Fluent cursive writing of letters a between two lines 10 cm long and 1.8 cm apart (ca. eight letters)

All tasks were conducted with the pupils dominant hand.

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658

cubic curve tting was applied. Maxima or minima of the best

tting curve (highest r2) corresponded to the age of maturation.
2.2.2. Gender, extracurricular ne motor practice and laterality level
In a second step, univariate general linear models were applied
to four kinematic parameters (NCV, F, VARPV and P) to test for the
inuence of gender, ne motor practice and laterality level with
age as a covariate for both complexity levels. Because four
kinematic parameters were tested, the probability level was
corrected (Bonferroni) from p < 0.05 to 0.0125.
2.2.3. Interdependency of age and complexity of ne motor tasks
In a third step, we added the task writing of repeated letters to
test whether the maturation course is different for differing levels
of task complexity. Therefore, we used a repeated measures
ANOVA (intra-subject variable: task complexity with three levels:
circles, sentence, letters; between-subject factors: six age groups).
General linear modeling and Pearsons correlation assume a
Gaussian distribution of the variables. Nevertheless, these analyses
are robust against non-violated deviation of Gaussian distribution.
A ShapiroWilks test conrmed a Gaussian distribution in some of
the variables (F, VAPRV and P). Visual inspection of the distribution
permitted the acceptance of all parameters for use in parametric
tests. NCV distribution was left-skewed. Therefore, NCV data were
used in logarithmic form to approximate the Gaussian distribution.
3. Results
3.1. Incidence of covariates
The Edinburgh Laterality Handedness Inventory was used to
group subjects into right and left-handers. All tasks were
performed with the dominant hand. The sample contained eight
subjects with a negative laterality score (left-handers) accounting
for 4.2% of the sample. A median score was determined because the
distribution was skewed. The median laterality score in righthanders was 87.5 (interquartile range: 30) and 58.8 (interquartile
range: 42) in left-handers. Right-handers showed stronger

lateralization. When analyzing the handedness of both groups

together, the overall median laterality score remained 87.5
(interquartile range: 30.2). One hundred and twenty-one subjects
acknowledged to practicing ne motor skills beyond the required
amount at school. Median duration of ne motor practice was 1 h
per week (interquartile range: 3.5). 72 subjects (i.e. 37.9% of the
whole sample) played a musical instrument at the time of
assessment.
Mean values of kinematic parameters when drawing circles,
writing a sentence and writing letters are displayed in Table 2.
3.1.1. Inuence of age on kinematic parameters
Correlation parameters were calculated for each of the
kinematic parameters of two tasks with different complexity
levels (task 1: drawing circles and task 2: writing a sentence).
Curve ttings of different models (linear, square, logarithmic and
cubic) in regression analysis showed that cubic models provided
the highest r2 for every parameter and task.
3.1.1.1. Speed. F correlated signicantly with age (Pearsons
correlation: p < 0.001) in both tasks (correlation coefcients:
0.28 in task 1; 0.64 in task 2). Regression analysis for F produced a
curve that stabilized at an age of 11 years in task 1 (r2 = 0.11, Fig. 2)
and at 17 years in task 2 (r2 = 0.43, Fig. 2). SPV did not correlate
signicantly with age in either task 1 or in task 2.
3.1.1.2. Automation. NCV correlated signicantly with age (Pearsons correlation: p < 0.001) at both complexity levels (tasks 1 and
2). Correlation coefcients of NCV were 0.32 in task 1 and 0.59
in task 2. Regression analysis for NCV generated a curve that
plateaued at an age of 13 years in task 1 (r2 = 0.13, Fig. 2) and at 16
years in task 2 (r2 = 0.4, Fig. 2).
3.1.1.3. Variability. Correlation of VARPV with age was signicant
in tasks 1 and 2 (Pearsons correlation in tasks 1 and 2: p < 0.001,
correlation coefcients of VARPV: 0.58 in task 1, 0.46 in task 2).
Regression analysis for VARPV provided a curve that did not
plateau until 18 years of age in task 1 (r2 = 0.37, Fig. 2), but at 16

Table 2
Kinematic parameters of speed, automation, variability and pressure in different handwriting and drawing tasks
Age groups

Circles
F
SPV
NCV
VARPV
P
Sentence
F
SPV
NCV
VARPV
VARD
P
Letters
F
SPV
NCV
VARPV
VARD
P

67 years

89 years

1011 years

1213 years

1415 years

1618 years

2.62 (0.73)
108 (30.6)
0.19 (0.14)
23.0 (6,0)
1.86 (0.91)

2.8 (0.89)
111 (36.6)
0.18 (0.16)
19.1 (4.2)
1.92 (0.78)

3.61 (0.77)
148 (55.5)
0.05 (0.06)
17.2 (3.6)
1.96 (0.76)

3.42 (0.73)
127 (52.3)
0.08 (0.12)
16.2 (5.0)
2.59 (0.85)

3.34 (0.95)
104 (51.4)
0.07 (0.12)
13.9 (4.0)
2.81 (0.69)

3.4 (0.92)
114 (56.9)
0.06 (0.09)
13.5 (2.9)
2.68 (0.76)

1.69 (0.36)
43.4 (9.6)
0.40 (0.14)
50.2 (7.6)
53.7 (9.8)
2.06 (0.73)

2.03 (0.51)
49.7 (15.9)
0.30 (0.13)
47.0 (8.3)
52.4 (12.6)
1.87 (0.83)

2.82 (0.68)
52.6 (14.6)
0.16 (0.11)
43.3 (9.0)
45.3 (15.5)
2.31 (0.78)

2.79 (0.71)
46.0 (17.8)
0.18 (0.13)
37.9 (7.7)
43.1 (13.8)
2.49 (0.64)

3.06 (0.73)
48.2 (15.3)
0.14 (0.16)
40.5 (7.2)
40.1 (14.0)
2.43 (0.75)

1.53 (0.42)
30.8 (6.8)
0.55 (0.19)
36.3 (10.0)
39.7 (10.3)
2.30 (0.86)

1.71 (0.42)
34.2 (9.1)
0.46 (0.16)
32.9 (8.6)
41.6 (11.4)
2.18 (0.87)

1.91 (0.41)
30.4 (6.7)
0.38 (0.16)
30.5 (9.5)
37.7 (16.5)
2.75 (0.86)

1.93 (0.67)
29.5 (11.5)
0.40 (0.20)
25.6 (9.7)
33.3 (12.3)
2.8 (0.79)

2.02 (0.46)
30.2 (10.7)
0.35 (0.19)
28.5 (10.3)
34.6 (13.3)
2.76 (0.83)

1.05 (0.52)
25.4 (8.6)
0.80 (0.26)
39.5 (12.0)
48.2 (11.4)
2.13 (0.72)

Values represent the means of each age group. Values in parenthesis indicate S.D. values. F: frequency of strokes (Hz); SPV: arithmetic mean of stroke peak velocity (m/s);
NCV: number of direction changes of velocity per stroke (common logarithm); VARPV: variation coefcient of stroke peak velocity (%); VARD: variation coefcient of stroke
duration (%); P: pressure (N).

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659

Fig. 2. Non-linear regression analysis of age for tasks 1 and 2. Non-linear regression curves show maturation of kinematic parameters. Age of completed maturation
corresponds to the curves plateaux. F: frequency of strokes; NCV: number of direction changes of velocity per stroke (common logarithm); VARPV: variation coefcient of
stroke peak velocity.

years of age in task 2 (r2 = 0.23, Fig. 2). VARD also correlated highly
signicantly with age (Pearsons correlation: p < 0.001) in both
tasks (correlation coefcients of VARD: 0.28 in task 1 and 0.38
in task 2). The regression analysis curve reached a plateau at an age
of 15 years in task 1 (r2 = 0.1, Fig. 2) yet not until 18 years in task 2
(r2 = 1.5, Fig. 2).
3.1.1.4. Pressure. Pressure correlated signicantly with age (Pearsons correlation: p < 0.003) in both tasks (correlation coefcients
of P: 0.4 in task 1, 0.23 in task 2). Regression analysis for P produced
a curve that plateaued at an age of 15 years in both tasks 1 and 2
(r2 = 0.19 and 0.08, respectively, Fig. 2).
3.1.2. Inuence of gender, ne motor practice and laterality level
We modeled the gender differences in the kinematic parameters using univariate general linear modeling with age as a
covariate because it strongly inuences kinematics of drawing

and handwriting as shown in the previous section. Age distribution of male and female subjects was not identical. Hence, a
corrected comparison of both gender groups may eliminate the
confounding effect of age. Four kinematic parameters were tested
(NCV, F, VARPV and P). Speed (F) in drawing circles was the only
parameter that showed a signicant gender difference (p = 0.009)
when analyzed for gender after the Bonferroni correction of the
probability level (p < 0.0125). The estimated mean was 3.39 Hz
(95% condence interval: 3.21; 3.57) in the male group and
3.06 Hz (95% CI: 2.89; 3.23) in the female group. There was a
statistical trend for females showing lower NCV values in writing a
sentence (p = 0.053). For this kinematic parameter, the estimated
mean for the male group was 0.27 (95% CI: 0.24; 0.3) and 0.23 (95%
CI: 0.2; 0.26) for the female group. VARPV in drawing circles
showed a tendency towards lower values in females (p = 0.04), but
failed to reach signicance upon correction. The modeled mean
was 17.77% (95% CI: 16.84; 18.7) in the male group and 16.47%

660

S.M. Rueckriegel et al. / Int. J. Devl Neuroscience 26 (2008) 655663

Fig. 3. Prole plots of repeated measures ANOVA. The continuous line represents task 1 (drawing circles), dotted line task 2 (writing a sentence), and dashed line task 3
(writing letters). Maturation of these tasks was signicantly different for speed and automation (signicant within subject effect of task-complexity on age). F: frequency of
strokes; NCV: number of direction changes of velocity per stroke (common logarithm).

(95% CI: 15.61; 17.33) in the female group. A gender difference

was not found for P.
Fine motor practice did not show any signicant effect or
statistical trend on the tested kinematic parameters.
Laterality level also did not inuence the tested kinematic
parameters in the age-corrected model. However, age correlated
signicantly with the level of laterality (Pearsons correlation:
r = 0.28, p < 0.001). Older subjects showed stronger lateralization.
3.1.3. Interdependency of age and complexity of ne motor tasks
The tasks drawing a circle, writing a sentence and writing
a line of the same letter a differ in the complexity of their
movements and in the participants familiarity with the procedure. A repeated measure ANOVA was performed to test whether
maturation of hand movements varies with the level of complexity. Again four variables (NCV, F, VARPV and P) that represent the
four movement domains of handwriting were tested. We found
the interdependency between the complexity level and age group
to be signicant for speed (F, p < 0.001, Fig. 3) and automation
(NCV, p = 0.001, Fig. 4), but not for variability (VARPV) and
pressure.***
4. Discussion
4.1. Maturation of drawing and handwriting
Analysis of kinematic data obtained by a digitizing tablet
proved to be sensitive to age-related variations. The highly
signicant correlation between kinematic parameters and age
reects the inuence that motor maturation has on the kinematic
parameters. Each of the four movement domains (automation,
speed, variability and pressure) was found to be an important
substrate of motor development.
As expected, speed increased with age, resulting in an
augmentation of stroke frequency (F). This nding concurs with
the results of previous studies that examined the effects of age on
simple repetitive graphic tasks in children, in which a positive
correlation between age and velocity also emerged (Blank et al.,
1999; Van Mier, 2006). Mergl et al. found a decrease of hand
movement velocity for specic tasks conducted by adults older
than 55 years when compared with younger adults (Mergl et al.,
1999). This shows that velocity of hand movement is an indicator
of physiological CNS maturation as well as degeneration. In
contrast to the increase of F, mean peak velocity did not increase in
either drawing circles or handwriting. This discrepancy may be

due to an increase in baseline movement speed rather than to a

faster execution of short movement phases. Underlying reasons
could be an increase in speed for a greater part of the stroke time
axis and a more efcient prestructured combination of strokes.
These steps are processed early in motor organization (i.e. motor
planning).
The kinematic parameters of automation (NCV) and variability
(VARPV, VARD) decreased as expected in both tasks. Hence, hand
movement became more automated (NCV is reciprocal to degree of
automation) and more stable.
In both tasks, pressure increased unexpectedly and signicantly
with age. Based on the assumption that writing tension and friction
diminishes in older subjects, we had hypothesized that writing
pressure would decrease during the course of maturation. To date,
the current literature concerning writing pressure is contradictory.
One prior study by Blank et al. did not reveal any age-related effect
on drawing pressure in children and adults (Blank et al., 1999).
However, in another study, which corroborates ours, LangeKuttner noted the phenomenon of increasing drawing pressure
when comparing children at an age of 4 and 6 years (LangeKuttner, 1998). She explained the increase of pressure with a
generally higher tension present in 6-year-old children while
drawing. This explanation may be applicable to the older subjects
in our study. The mandatory use of fountain pens in lower grades,
which trains pupils to write with low pressure, could further
explain the observed age-related increase in pressure. Pupils
generally change their writing device to other types of pens in
higher grades, which may promote the higher writing pressure
detected in older subjects.
4.2. Differences between tasks 1 and 2
The task drawing circles is an extraction and repetition of the
basic handwriting component of closed loops. In contrast to
handwriting, this task does not require complex sequences of prestructured motor programs. In drawing circles we observed an
association of speed (F) and automation (NCV) with age. However,
this association was not as strong when compared to writing a
sentence. This means that the increase of speed and automation
was greater in writing a sentence than in drawing circles. A
repeated measure ANOVA tested the interaction of age group and
complexity level (drawing circles, writing letters and writing a sentence). This analysis conrmed that age as a covariate
had a distinct inuence on the diverse complexity levels of
movement when tested for automation and speed. Interestingly,

S.M. Rueckriegel et al. / Int. J. Devl Neuroscience 26 (2008) 655663

Blank et al. compared simple repetitive movements of proximal

(shoulder and wrist) and distal (nger) muscle groups in children
and adults (Blank et al., 1999). They only found a higher degree of
maturation in the nger muscle groups as compared with those
of the wrist and shoulder, but they did not reveal differentiated
age-related effects on task complexity. Our data support this
nding by showing a differentiated maturation effect when
examining simple and complex movements both within the
nger/wrist muscle groups. The Muller group showed an
association between the speed of simple repetitive movements
(tapping, pointing and pegboard transport movements) and the
conductance velocity of cortico-motoneural efferents as measured by transcranial magnetoelectrical stimulation (Muller and
Homberg, 1992). A training effect of these repetitive movements
was not found by repeated measurements. Hence, they conclude
that the development of central conduction times, which is
dependent on myelinization, determines the speed of repetitive
movements. Because drawing circles is a similarly simple
movement, this may be true in this task of our study, too. Also
comparable to our nding for drawing speed maturation (11
years), the conductance velocity reached the same values as in
adults at an age of 810 years (Muller et al., 1991).
We assumed that the amount of necessary motor planning, a
component of motor organization, is greater in the complex task
of writing a sentence than in drawing circles. On the other
hand, in the simple and repetitive task of drawing circles, the
role of its execution in the resulting movement becomes more
important in comparison to the role of motor planning. Bearing
these assumptions in mind, our ndings indicate that maturation of ne motor skills occurs both in the execution of simple
repetitive motor programs (maturation in drawing circles) and
in the planning phase of different goal trajectories (additional
age-related effects in handwriting, as shown by different
maturation courses across all complexity levels). Brain imaging
studies have shown that complex nger movements led to an
increase in blood ow to the medial premotor area, including
the supplementary and pre-supplementary motor area, while
simple nger exion is represented in M1 only (Roland et al.,
1980). Thus, we speculate that the maturation of the execution
of the simple task corresponds to the myelinization of
corticospinal tracts, whereas the maturation of the more
complex task may predominantly depend on the maturation
of neuronal networks.
4.3. Age of completed maturation
This study is the rst to investigate the completion of hand
movement maturation in writing and drawing. Therefore, curve
ttings were used in regression analyses of each kinematic
parameter. Commonly, only the rst phase of the cubic function
was within the measured eld (Fig. 2). This rapid slope phase,
which plateaues, can be plausibly interpreted as a demonstration of the course of hand movement maturation. We assumed
that the point of the plateau corresponded to the age of
completed maturation. Ages of completed maturation differed
between tasks (circles and sentence) and kinematic parameters
(Table 3). Development of variability (VARPV) in drawing circles
was not yet completed in the oldest subjects of 18 years. Speed
was the rst movement domain that showed completed
maturation for drawing circles (at an age of 11 years), while
it matured later for writing a sentence (at an age of 17 years).
Thus, an increase in handwriting speed after an age of 11 years
seems to be predominantly due to the improved motor planning
of complex stroke and loop sequences, which is faster and more
efciently processed simultaneously to execution (Roland et al.,

661

Table 3
Age of completed maturation of a simple and a complex task

Speed (F)
Automation (NCV)
Variability (VARPV)
Pressure (P)

Circles (y)

Sentence (y)

11
13

15

17
16
16
15

Slopes of non-linear regressions approximating zero indicate completed maturation. Age, at this point, is displayed for each of the four movement domains and two
tasks. Slope of VARPV in Circles did not approximate zero in the measured eld. F:
frequency of strokes; NCV: number of direction changes of velocity per stroke;
VARPV: variation coefcient of stroke peak velocity; y: years.

1980; Hoshi and Tanji, 2007). The isolated execution seen in

drawing circles seems to already be mature at an age of 11
years. This contrasts with the ndings of Blank et al., who
evidenced an increase in frequency until adulthood by analyzing
distal and proximal drawing movements. The disparity of age
distribution between this study and ours makes a direct
comparison inadequate; the oldest participants in the pediatric
age group were 14 years old and the youngest adult studied was
27 years of age (Blank et al., 1999). Another study investigating
the developmental differences in drawing performance of
children aged 412 years also documented a continuous
development of drawing movements throughout the age range
of the sample (Van Mier, 2006).
These developmental processes are similar to the development
of grasping movements in children as measured by optoelectronic
analysis, which was shown to last until the end of the rst decade
of life (Kuhtz-Buschbeck et al., 1998). The coordination between
hand transport and grip formation especially improved in those up
to 12 years of age, the oldest subjects of the sample. The Forssberg
group found that the temporal and force parameters of precision
grip movements continued to develop in children, adolescents and
adults (Forssberg et al., 1991). Despite the ongoing development,
beyond the age of 8 years differences compared with adults were
not signicant.
4.3.1. Gender and ne motor practice
An evident effect of gender was seen only in the speed (F) of
drawing circles. This result contrasts to a certain extent with the
ndings of Blank et al., who did not nd any gender differences in
simple drawing tasks (Blank et al., 1999). Furthermore, we noticed
a trend of higher automation and lower variability in females.
These ndings underscore the results of a prior study of adults that
showed faster, but less accurate, ne motor movements in males
than in females (Mergl et al., 1999). Our data illustrate that gender
differences regarding hand movement development are already
apparent in childhood.
We did not observe any inuence of ne motor practice or
laterality level on writing and drawing performance. This may be
due to a continuous amount of training of drawing and writing
skills in school, which is similar for all pupils. Information on
extracurricular activities, which was collected in the questionnaire, revealed that these were not important for the development
of ne motor function as tested in our study.
Although Mergl et al. observed an inuence of verbal
intelligence (VI) in adults in a prior study, we did not investigate
VI. We assumed that the inuence of VI on kinematic parameters is
low in children because VI is strongly associated with the practice
of writing in adults. Interpersonal variations in writing practice are
high in adults but low in children due to the similarly distributed
demands on pupils writing skills and ne motor functions in
school (Mergl et al., 1999).

662

S.M. Rueckriegel et al. / Int. J. Devl Neuroscience 26 (2008) 655663

4.4. Limitations
This study concentrated on the investigation of simple drawing
and writing performance. It did not collect data about general
school performance or academic achievements. Hence, the
predictive value of the kinematic analysis for general intellectual
abilities was not determined.
In the short interview before the test, we only asked for history
of neurological diseases and medication. No specic neurological
and neuropsychological assessments were conducted. The absence
of neurological anomalies and the normal distribution of
neuropsychological features can only be assumed but was not
veried.
Only the movement output of central nervous motor network
processes was investigated. Conclusions about underlying central
nervous mechanisms can only be reached indirectly. Studies using
functional MRI or MR Diffusion Tensor Imaging are required in
order to gain direct information about the development of cortical
areas and myelination of cortical and corticospinal tracts involved
in handwriting.
The sample size of 187 participants was sufcient to detect
crucial developmental features of hand movements. Nevertheless,
the number of 15 boys and 15 girls in two years interval is still too
small to establish robust percentile curves.
5. Conclusion
This study provides normative data about important movement
properties of handwriting and drawing movements in children and
adolescents. Knowledge of the distribution of kinematic parameters in healthy subjects is crucial for the understanding and
evaluation of peers, who suffer from motor impairment. Our
ndings may optimize and objectify the diagnostic methods,
enabling better assessment of deciencies in motor function of
pediatric patient groups.
Movement parameters of handwriting and drawing strongly
correlate with age in children and mature towards adolescence,
remaining rather constant throughout adulthood (Mergl et al.,
1999). Therefore, the examination of these movements in children
and adolescents must be age-specic. The maturation of such
movements also depends on the complexity of the task. Development of a simple movement, like drawing a circle, concludes
earlier than the development of the special skill handwriting. The
motor learning process of handwriting maturation seems to be not
yet completed in primary school. Movement properties are
inuenced by age and gender, whereas an inuence of extracurricular ne motor practice and extent of laterality was not
found.
We conclude that the analysis of data provided by a digitizing
graphic tablet is a valuable approach to detecting deviations of
normal hand movement skills at the level of a handicap, such as
handwriting impairment, which is relevant to everyday life.
Further studies that examine the impact of impaired kinematic
parameters of ne motor functions on academic achievement are
warranted. This next step would be to demonstrate the digitizing
graphic tablets capability to identify those pupils who need special
training in ne motor movements.
Acknowledgements
We acknowledge the support of Kind-Philipp-Stiftung by
providing a doctoral thesis scholarship to S.M. Rueckriegel. We are
highly indebted to the principals Mr. Schuknecht, Mr. Panteleit and
Mr. Balan and their students for their support of the study. We
gratefully acknowledge the help of the senate of Berlin. We are

highly indebted to Lindy Musial-Bright for critical reading of the

manuscript.
References
Beery Ke, B.N., 1989. Developmental Test of Visual-motor Integration-revised.
Follett Publishing Company, Chicago.
Blank, R., Miller, V., Von Voss, H., Von Kries, R., 1999. Effects of age on distally and
proximally generated drawing movements: a kinematic analysis of school
children and adults. Dev. Med. Child Neurol. 41, 592596.
Carlier, M., Dumont, A.M., Beau, J., Michel, F., 1993. Hand performance of French
children on a nger-tapping test in relation to handedness, sex, and age.
Percept. Mot. Skills 76, 931940.
Eichhorn, T.E., Gasser, T., Mai, N., Marquardt, C., Arnold, G., Schwarz, J., Oertel, W.H.,
1996. Computational analysis of open loop handwriting movements in Parkinsons disease: a rapid method to detect dopamimetic effects. Mov. Disord. 11,
289297.
Elble, R.J., Brilliant, M., Lefer, K., Higgins, C., 1996. Quantication of essential
tremor in writing and drawing. Mov. Disord. 11, 7078.
Erasmus, L.P., Sarno, S., Albrecht, H., Schwecht, M., Pollmann, W., Konig, N., 2001.
Measurement of ataxic symptoms with a graphic tablet: standard values in
controls and validity in Multiple Sclerosis patients. J. Neurosci. Methods 108,
2537.
Feder, K.P., Majnemer, A., 2007. Handwriting development, competency, and intervention. Dev. Med. Child Neurol. 49, 312317.
Forssberg, H., Eliasson, A.C., Kinoshita, H., Johansson, R.S., Westling, G., 1991.
Development of human precision grip. I. Basic coordination of force. Exp. Brain
Res. 85, 451457.
Friedland, J., 1990. Development and breakdown of written language. J. Commun.
Disord. 23, 171186.
Hamstra-Bletz, L., Blote, A.W., 1990. Development of handwriting in primary
school: a longitudinal study. Percept. Mot. Skills 70, 759770.
Hamstra-Bletz, L., Blote, A.W., 1993. A longitudinal study on dysgraphic handwriting in primary school. J. Learn. Disabil. 26, 689699.
Hoshi, E., Tanji, J., 2007. Distinctions between dorsal and ventral premotor areas:
anatomical connectivity and functional properties. Curr. Opin. Neurobiol. 17,
234242.
Kuhtz-Buschbeck, J.P., Stolze, H., Johnk, K., Boczek-Funcke, A., Illert, M., 1998.
Development of prehension movements in children: a kinematic study. Exp.
Brain Res. 122, 424432.
Lange-Kuttner, C., 1998. Pressure, velocity, and time in speeded drawing of basic
graphic patterns by young children. Percept. Mot. Skills 86, 12991310.
Levine, M.D., Oberklaid, F., Meltzer, L., 1981. Developmental output failure: a study
of low productivity in school-aged children. Pediatrics 67, 1825.
Marquardt, C., Mai, N., 1994. A computational procedure for movement analysis in
handwriting. J. Neurosci. Methods 52, 3945.
Mchale, K., Cermak, S.A., 1992. Fine motor activities in elementary school: preliminary ndings and provisional implications for children with ne motor
problems. Am. J. Occup. Ther. 46, 898903.
Mergl, R., Juckel, G., Rihl, J., Henkel, V., Karner, M., Tigges, P., Schroter, A., Hegerl, U.,
2004a. Kinematical analysis of handwriting movements in depressed patients.
Acta Psychiatr. Scand. 109, 383391.
Mergl, R., Mavrogiorgou, P., Juckel, G., Zaudig, M., Hegerl, U., 2004b. Effects of
sertraline on kinematic aspects of hand movements in patients with obsessivecompulsive disorder. Psychopharmacology (Berlin) 171, 179185.
Mergl, R., Tigges, P., Schroter, A., Moller, H.J., Hegerl, U., 1999. Digitized analysis of
handwriting and drawing movements in healthy subjects: methods, results and
perspectives. J. Neurosci. Methods 90, 157169.
Muller, K., Homberg, V., 1992. Development of speed of repetitive movements in
children is determined by structural changes in corticospinal efferents. Neurosci. Lett. 144, 5760.
Muller, K., Homberg, V., Lenard, H.G., 1991. Magnetic stimulation of motor cortex
and nerve roots in children. Maturation of cortico-motoneuronal projections.
Electroencephalogr. Clin. Neurophysiol. 81, 6370.
Oldeld, R.C., 1971. The assessment and analysis of handedness: the Edinburgh
inventory. Neuropsychologia 9, 97113.
Otte, E., Van Mier, H.I., 2006. Bimanual interference in children performing a dual
motor task. Hum. Mov. Sci. 25, 678693.
Phillips, J.G., Gallucci, R.M., Bradshaw, J.L., 1999. Functional asymmetries in the
quality of handwriting movements: a kinematic analysis. Neuropsychology 13,
291297.
Roland, P.E., Larsen, B., Lassen, N.A., Skinhoj, E., 1980. Supplementary motor area
and other cortical areas in organization of voluntary movements in man. J.
Neurophysiol. 43, 118136.
Rosenblum, S., Chevion, D., Weiss, P.L., 2006a. Using data visualization and signal
processing to characterize the handwriting process. Pediatr. Rehabil. 9, 404
417.
Rosenblum, S., Goldstand, S., Parush, S., 2006b. Relationships among biomechanical
ergonomic factors, handwriting product quality, handwriting efciency, and
computerized handwriting process measures in children with and without
handwriting difculties. Am. J. Occup. Ther. 60, 2839.
Sassoon, 1990. Handwriting: A New Perspective. Stanley Thornes, Celtenham, UK.
Schoemaker, M.M., Ketelaars, C.E., Van Zonneveld, M., Minderaa, R.B., Mulder, T.,
2005. Decits in motor control processes involved in production of graphic

S.M. Rueckriegel et al. / Int. J. Devl Neuroscience 26 (2008) 655663

movements of children with attention-decit-hyperactivity disorder. Dev. Med.
Child Neurol. 47, 390395.
Smits-Engelsman, B.C., Van Galen, G.P., 1997. Dysgraphia in children: lasting
psychomotor deciency or transient developmental delay? J. Exp. Child Psychol. 67, 164184.
Tigges, P., Mergl, R., Frodl, T., Meisenzahl, E.M., Gallinat, J., Schroter, A., Riedel, M.,
Muller, N., Moller, H.J., Hegerl, U., 2000. Digitized analysis of abnormal
hand-motor performance in schizophrenic patients. Schizophr. Res. 45,
133143.
Tucha, O., Lange, K.W., 2001. Effects of methylphenidate on kinematic aspects of
handwriting in hyperactive boys. J. Abnorm. Child Psychol. 29, 351356.

663

Tucha, O., Walitza, S., Mecklinger, L., Stasik, D., Sontag, T.A., Lange, K.W., 2006. The
effect of caffeine on handwriting movements in skilled writers. Hum. Mov. Sci.
25, 523535.
Van Galen, G.P., Stelmach, G.E., 1993. Handwritingissues of psychomotor control
and cognitive models. Acta Psychol. (Amst.) 82.
Van Galen, G.P., Weber, J.F., 1998. On-line size control in handwriting demonstrates
the continuous nature of motor programmes. Acta Psychol. (Amst.) 100, 195
216.
Van Mier, H., 2006. Developmental differences in drawing performance of the
dominant and non-dominant hand in right-handed boys and girls. Hum.
Mov. Sci. 25, 657677.