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Original Article
PAKISTAN BIOMEDICAL JOURNAL
Handwriting is a well-designed activity that requires the
synchronization of a number of person's skills. On the other
hand, it is a complex skill. Handwriting depends on the
development and integration of Visual Perceptual,
cognitive and ne motor system ability. Smooth writing is
created by combined and synchronized movements of
in dividual for s ensory mo tor feedback a nd visual
monitoring simultaneously [1]. In everyone's daily life, ADLs
upper limbs play an important role to perform task
effectively. There are some important sensory motor
DOI: https://doi.org/10.54393/pbmj.v5i8.718
Butt K et al.,
Effect of Hand Grip Strength and Endurance on Writing Speed Among Students
of DPT in AMNC
1 2* 1 1 1 1 3
Khushbakhat Butt , Sania Maqbool , Urooj Fatima, Madiha Arif , Ammara Arooj, Laiba Amir ,Falak Noor and
4
Bayyaniha Zaheer
¹Rehab Care School for Special Children, Lahore, Pakistan
²Department of Physical Medicine & Rehabilitation School of Health Sciences, University of Management & Technology, Lahore,
Pakistan
³Ability Plus, Lahore, Pakistan
⁴King Edward Medical University, Lahore, Pakistan
parameters that include grip strength and endurance
which are essential for their satisfactory actions. In clinical
practice practitioner assume the strength of grip as a sign
of many diseases which can lead patient toward disability
[2]. The wrist is a sophisticated biological structure with 27
bones, 15 joints, and around 30° of freedom in rotation and
translation. It is used to grasp and exert force on objects of
all sizes and shapes as well as to carry out a variety of
complicated, highly coordinated actions [3]. Grip strength
is being used worldwide due to portability and practicality
Hand Grip Strength on Writing Speed Among Students
VOL. 05, ISSUE. 07
JULY 2022
https://www.pakistanbmj.com/journal/index.php/pbmj/index
Volume 5, Issue 8 (August 2022)
PBMJ VOL. 5, Issue. 8 August 2022
Copyright (c) 2022. PBMJ, Published by Crosslinks International Publishers
I N T R O D U C T I O N
Hand grip strength is a measure and indicator of general strength of upper limb as well as
general body strength. The grip strength varies in different populations and regions due to
difference in genetic makeup, nutritional habits, body type and level of activity. ADLs of upper
limb depend on strength and endurance of hand as greater the strength and endurance greater
the performance. Objectives: To nd the effect of handgrip strength and endurance on
handwriting speed. Methods: Associational study included 113 healthy young adult students.
Convenience sampling technique was used. Dynamometer was used to measure the hand grip
strength and endurance in a standardized manner. Letters per Minute test was used to assess
the handwriting speed. Dynamometer is an instrument with excellent validity, consistency and
reliability. Results: The hand grip strength and writing speed was moderately correlated as (r
0.559) and the hand endurance and writing speed was moderately correlated as (r 0.57).
Conclusions: We concluded that hand grip strength and hand endurance have positive
moderate effect on writing speed. Exercises that increase hand strength and endurance can
increase the writing speed and ultimately academic performance of students.
A R T I C L E I N F O A B S T R A C T
How to Cite:
Butt , K. ., Maqbool , S. ., Fatima, U. ., Arif , M. ., Arooj, A.
., Amir, L. ., Noor , F. ., & Zaheer , B. . (2022). Effect Of
Hand Grip Strength and Endurance on Writing Speed
¬¬Am ong Stu dents of DPT In AM NC: Hand Grip
Stre ngth on Writing Speed ¬¬Amon g Stude nts.
Pakistan BioMedical Journal, 5(8).
https://doi.org/10.54393/pbmj.v5i8.718
Key Words:
Grip s tren gth, Endu ranc e, Handw riting s peed ,
Healthy young adults, Gender
*Corresponding Author:
Sania Maqbool
Department of Physical Medicine & Rehabilitation
S ch oo l of H ea lt h Sc ie n ce s, U ni ve r si ty o f
Management & Technology, Lahore, Pakistan
saniamaqbool28@gmail.com
rd
Received Date: 3 August, 2022
th
Acceptance Date: 13 August, 2022
st
Published Date: 31 August, 2022
22
Butt K et al.,
compare to the normal weight group in males, but not in
females [14]. The values of handgrip strength in subjects of
normal healthy adult using a hand Dynamometer. They nd
that the normal suggested values of strength handgrip
should be recognized and graded according to gender or
age. Variation in height does not require changes to be
made in order to get and illustrate the average scores for
han dwri ting speed in heal thy p erso ns [15 ]. The y
recommended that norms of the handwriting speed should
be reorganized regularly. The obtained ndings will update
the therapists about the cause that affect the adult's
handwriting speed [16]. Dynamometers to conclude their
co-existing reliability and validity for assessing the
strength of hand grip in clinical settings. They discovered
that there is no major difference between dynamometers'
validity and reliability [17]. Because no studies have been
conducted to determine the impact of hand grip strength
and endurance on handwriting speed, this study is
distinctive in that regard. This study will raise students'
understanding of how improving hand grip strength and
endurance can increase handwriting speed, enabling them
to effectively manage their time and writing speed
throughout tests.
Hand Grip Strength on Writing Speed Among Students
PBMJ VOL. 5, Issue. 8 August 2022
Copyright (c) 2022. PBMJ, Published by Crosslinks International Publishers
M E T H O D S
of the dynamometer [4]. Grip strength is evaluated as a
module of hand function (American Society of Hand
Therapists), hand grip strength just not only used to
demonstrate the importance of the hand but also to signify
as entire upper extremity strength. ASHT has suggested
the grip strength to be measured by using the Jamar
dynamometer [5]. Since handwriting speed and the
capacity to communicate knowledge are closely related,
both have a signicant impact in academic performance
[6]. Grip strength of hand shows overall muscle strength
that is measured by using a hand dynamometer. To
measure the grip strength and endurance, dynamometer is
declared as a gold standard test. Both strength and
endurance of the hand was checked in students by using
the hand dynamometer and writing speed assessment.
Grip strength basically tests the isometric contraction of
the hand. Additionally, it was discovered that there are
variances based on gender, with males having stronger
dominant hand grips [7]. Writing speed is calculated by
using the number of letters written with in one minute [8].
Letters per minute test (LPM) is being used instead of
words per minute test (WPM) bec ause of the high
unpredictability of words. For the training purpose of
working adults and amputees this test is very useful for the
vocational evaluators and as well as hand therapists. It is
also very useful for assessing a patient's ability to return to
s pe ci c wo rk s itua ti o ns t ha t r equi re w ri t te n
communication [9]. Many professional and job related
responsibilities requires handling of tools, equipment and
ne movements of hands. Avery simple instance is the
inability of older persons to open food jars due to diminish
strength of grip. The overall performance of upper
extremity functions and ability to perform specic tasks is
due to weak grip strength [10]. The Jamar is very reliable
and also valid for measuring hand grip strength. Its
reliability is (ICC [3, 1] = 0.98) and its validity is (ICC (2, K) =
0.99) [11]. The writing speed is evaluated through letters
per minute test. According to Dave Bledsoe. for an adult
population (age ranges 18-64) the average speed of copying
letters is 68 in a minute, with range from a minimum letters
of 26 to maximum letters of 113 in a minute [12]. Another
study recommend the task based training procedure that
can advance the performance and reduce handwriting
diculties in children. The results of this research show
that the comprehensive and competence of motor skill
improve handwriting in children [13]. The study considered
inspecting the handgrip endurance and strength which is
considered a signicant tool for the measurement the
status of nutrition and as an indicator of the muscle quality
in underweight individuals with overweight individuals.
They discover that the overweight and under weight
subjects had a lower grip endurance and strengths
The study type is associational study and the study data
collection center was Azra Naheed Medical College (ANMC)
Lahore. This research was completed in three months and
convenience sampling technique was used. A Sample of 113
Students of DPT was taken from total population of 600
DPT students in ANMC. Inclusion criteria: Students of DPT
in ANMC who were willing to participate in this study, both
male and female students were included. Exclusion
criteria: Students with fracture or any deformity of upper
extremity, any skin lesion or pathology in dominant hand.
With permission of HOD and Supervisor researcher gave
consent form to students and conducted data. After
teaching the whole procedure the researcher rst task was
to measure maximal grip strength in three trails. The
subject was asked to squeeze the dynamometer and the
readings of three maximal contractions were noted down in
three trials e.g. T1, T2, and T3 with a rest period of 5 seconds
between each trial to prevent muscle fatigue. For each
subject the dynamometer was reset to zero before the
reading of next grip strength. The second task was of
muscle endurance (sustained grip strength). This task
consisted of a sustained maximal isometric contraction
over a period of 10 seconds. After every 10th second the
reading for endurance in kilograms was noted down. Using
the stop watch, the task was initiated on a start signal and
end on a stop signal given by the researcher. For writing
speed measurement, Letters per Minute Test (LPM) was
used. A paper with a paragraph of 57 words printed on it was
23
DOI: https://doi.org/10.54393/pbmj.v5i8.718
Butt K et al.,
The relation of hand grip strength and endurance on
handwriting speed was evaluated in this study. To
det ermin e t he relati on b etwe en 3 param eters a
standardized tool, Dy namometer was used for the
meas urement of strength a nd e nduranc e. Fo r th e
assessment of hand writing speed, Letters per minute Test
was used. The report of this study showed the high
correlation of strength and endurance (r 0.95), and
moderate positive correlation of handwriting speed and
strength (r 0.559) and moderate positive correlation of
handwriting and endurance (r 0.570). Forceful contraction
of muscles required for picking and pulling of object but
sustain isometric contraction required for holding any
object as in writing both strength and endurance required
for movement of pen and holding pen vertically so both
characteristics of muscle of hand strength and endurance
required for better ecacy and speed of handwriting. As
shown in result that strength and endurance are highly
correlated so weakness in one of these characteristic will
affect the performance of second. A study conducted in
2011 by Bledsoe et al., on hand writing speed in an adult
population included 300 individuals. Letters per minute
test was selected to assess the handwriting speed. He
concluded that the Letters per minute test was very useful
for the hand therapists to establish the handwriting speed
among young adults by improving their hand grip strength.
In the present study, the maximal strength and endurance
of the right hand showed a positive relation on handwriting
speed which is similar to above mentioned study [12].
According to Massy-Westroop et al., hand grip strength can
be calculated by measuring the amount of static force that
the hand can squeeze around a dynamometer. Hand grip
strength is a reliable measurement when standardized
methods and adjusted equipment are used, even when
there are different assessors or different brands of
dynamometers. The Published normative data for hand
Hand Grip Strength on Writing Speed Among Students
PBMJ VOL. 5, Issue. 8 August 2022
Copyright (c) 2022. PBMJ, Published by Crosslinks International Publishers
R E S U L T S
Table 1 shows the descriptive characteristics n=113 of the
study participants. The gender distribution was out of 113
students, 59 were male while 54 were females. The mean
values for the age was 26 ± 21.70. All 113 study participants
were right hand dominant.
provided to each subject. The subjects were verbally
instructed to write down their names on the paper and go
thr ough the sho rt par agrap h. Af ter the subje cts
understood the procedure and were ready for the test they
were asked to copy the paragraph of 57 words in 1 minute.
After one minute, the papers were collected and the
number of letters written in one minute by each subject
were counted and noted down. The writing speed was
calculated as the number of letter. Dynamometer was used
for assessment of both Strength and Endurance of hand [5,
7]. Letter per minute test was used to assess the writing
speed [8]. Study conducted after an informed consent was
signed. The subject was fully informed about the research
and the reason for conducting it. The condentiality of the
subject was ensured and not shared with any outside
source for public display. Subject was free to withdraw at
any stage. Collected data were entered in SPSS version 16.0
and analyzed through correlation test. Result revealed that
the hand strength and writing speed was moderately
correlated as (r 0.559). The hand endurance and wiring
speed was moderately correlated as (r 0.57). Statically
results approved the alternative hypothesis.
Gender
Age
Hand Dominance
113 (59 M/54 F)
26 ±21.70
113 (RHD)
M= Male, F= Female, R=Right Hand Dominant
Table 1: Descriptive statistical analysis (N=113)
Table 2 represents the relationship between hand strength
and endurance. The mean score of hand strength was
score as 34.16 ± 26.24 and mean score of hand endurance
was 34.74 ± 24.48. The (r) of 0.95 is showing strong positive
correlation between hand power and hand endurance.
Hand Strength (Dynamometer)
Hand Endurance (Dynamometer)
34.16 ± 26.244
34.74 ± 24.486 0.95
Variables Mean ± SD Pearson correlation
coecient®
Table 2: Relationship b/w Hand strength & Endurance
Table 3 depicts the effect of hand strength on writing
speed. The mean value of hand strength score was 34.16 ±
26.244 and mean score of wiring speed was 100.12 ± 28.589.
The (r) of 0.559 is showing effective relationship between
hand power and writing speed.
Hand Strength (Dynamometer)
Writing Speed (Letters per minute)
34.16 ± 26.244
100.12 ± 28.589 0.559
Variables Mean ± SD Pearson correlation
coecient®
Table 3: Effect of hand grip strength on writing speed
Table 4 shows the effect of hand endurance on writing
speed. The mean score of hand endurance was 34.74 ±
24.48 and mean score of wiring speed was 100.12 ± 28.589.
The (r) of 0.57 is showing moderate positive correlation
between hand power and writing speed.
Hand Endurance (Dynamometer)
Writing Speed (Letters per minute)
34.74 ± 24.486
100.12 ± 28.589 0.570
Variables Mean ± SD Pearson correlation
coecient®
Table 4: Effect of hand endurance on writing speed
D I S C U S S I O N
24
DOI: https://doi.org/10.54393/pbmj.v5i8.718
Butt K et al., Hand Grip Strength on Writing Speed Among Students
PBMJ VOL. 5, Issue. 8 August 2022
Copyright (c) 2022. PBMJ, Published by Crosslinks International Publishers
grip strength are available from many countries, and in
most cases, data are divid ed into age and gender
subgroups. Analysis of grip strength by gender shows
higher grip by males and lower grip by females at all ages.
This trend is always present even though some studies
divide participants by age, gender, and then by right and left
hand, while a small number of studies divide participants by
age gender and then dominant and non-dominant hand.
These trends can be seen in the current study also. Thus
going through all the literatures that showed a positive
relation between strength, endurance and writing speed
students can improve their academic performance
through exercises that increase hand strength and
en duranc e can increa se th eir writ ing spee d [18].
Padmavathi et al., reported a study based on gender
difference in muscle strength and endurance on young
adults and shows positive relation between strength and
endurance. The results of the study showed that males had
close to twice the hand grip strength of females in absolute
terms (P < 0.01). In contrast, the rate of decline of muscle
strength during sustained isometric contraction was lower
in females as compared to males (P < 0.05), suggestive of
greater muscle endurance in females. Our study shows
similar results as above mention study that there is a
positive relation between these two variables (hand
strength and endurance) but the only difference is our
study is not based on gender difference [19]. In the medical
context, handgrip strength (HGS) is frequently employed as
a bedside test of muscular function. The purpose of this
study was to determine the relationship between HGS,
endurance, and work (force during endurance 3 times), as
determined by mobility and physical activity (PA), and
physical function in young, healthy volunteers. Additionally,
the connections between HGS, mobility, PA, and patient
quality of life (QoL) were looked at. A total of 45 patients (56
percent men, mean age 55 y) and 92 healthy volunteers (45
percent men, mean age 30 y) had their mobility (timed up-
and-go test) and PA examined (Baecke questionnaire or
Bouchard activity diary) [20].
This study concludes that hand grip strength and hand
endurance had positive moderate effect on writing speed.
It was found that majority of the students were unaware
about the fact that if they had a better hand grip strength
and endurance, their writing speed can be greatly
inuenced. Exercises that increases hand strength and
endurance can increase the writing speed and ultimately
academic performance of students.
C O N C L U S I O N S
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