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Problems with handwriting can arise for a variety of reasons, such as limitations in dexterity, coordination or strength. Also, the loss of function in one or both upper extremities can affect not only the ability to write but also the ability to hold and stabilize the paper.

Pen Basics

Ballpoint Pens

  • The flow of ink will increase if greater pressure is applied to the pen.
  • Ink flow works best if the pen is held perpendicular to the paper.
  • The width of the line gradually decreases as the angle of pen to paper is increased.
  • At some point the angle is too great and the ink stops flowing.
  • Gravity plays a factor. Ink will quickly stop flowing if the pen is held upside down.
  • Ballpoint pens use oil-based ink.
  • Ballpoint pens have a ball on the tip. The size of the ball dictates the amount of ink that flows when writing. While most ballpoint pens have a thin or medium ball, broad line tips are available. These pens will allow for more ink to flow with a resulting thicker line.

Ballpoint Pen TipBallpoint Pen Tip

Ballpoint PenBallpoint Pen

Rollerball Pens

  • Rollerball pens utilize water-based liquid or gel ink. This type of ink provides greater saturation of the paper.
  • Rollerball pens require less pressure than ballpoints. Consequently, there is less hand fatigue when writing with a rollerball pen.
  • Because rollerball inks dry slower than ballpoint pen ink there is a greater chance of smudging.


  • Oil-based Ink
    • Ballpoint pens use oil-based ink.
  • Water-based liquid ink
    • Often soaks (bleeds) through the paper on to the reverse side.
    • When writing with water-based liquid ink, you usually cannot write on both sides of the paper.
  • Gel-ink
    • Gel ink sets quickly and does not soak through the paper as much as liquid ink.
    • Can write on both sides of the paper.
    • Gel inks have a greater chance of “skipping” (ink flow stops) because they do not flow as readily as liquid inks.
    • Gel ink pens run out of ink faster than other inks as the gel ink flows at a faster rate

Rollerball Gel-filled Pen Tips:

Gel Pen Tip

Gel Pen Tip

Gel Based RollerballGel Based Rollerball

Stabilizing Paper

Stabilizing paper can be a big problem for someone who has limited functional ability in one of their upper extremities. A simple low-tech solution is to use a clipboard placed on a piece of non-slip material (such as Dycem). Other solutions include clamping the paper, using alligator clamps, to the writing surface.

Unable to Apply Adequate Pressure

Standard ballpoint pens require pressure to be applied to the pen. To accommodate this problem consider using a gel ink pen (see Pen Basics). Other devices, such as the Writing Bird (see Difficulty Holding a Pen), may assist.