## 4 Discussion
Stroke survivors often experience a significant loss of fine motor control due to damage to the brain regions responsible for precise motor coordination. This impairment hampers the ability to perform controlled and accurate movements, which are essential for tasks like writing. Writing requires precise control of upper extremity muscles, and without regular activation, stroke patients may compensate by using larger, less coordinated muscles [31]. Since the JTHFT does not fully assess writing ability, this study compared writing speed, letter size, and muscle activity with two different writing aids to gain a more comprehensive understanding of stroke patients' writing capabilities. The slower writing speed on the PS compared to the NPS is consistent with the known motor deficits experienced by stroke patients, including impaired fine motor control and reduced coordination in the paretic limb. These deficits are exacerbated by the complexity of consonant writing, which requires multiple precise strokes and changes in direction, as opposed to the simpler, fluid movements involved in writing vowels [32]. The observed improvement in writing speed using SW compared to AG may be attributed to its wider triangular base, which enhances stability and reduces the effort needed for controlled movements. This study investigated writing speed and letter size on the horizontal and vertical axes when stroke patients wrote Korean consonants and vowels with the PS and NPS using two writing aids. The significant increase in horizontal letter size on the PS was likely due to motor control limitations form hemiparesis and spatial neglect, common post-stroke conditions. Hemiparesis impairs fine motor control, leading to exaggerated horizontal movements [33], while spatial neglect, often associated with right hemisphere damage, may worsen horizontal exaggerations [34]. These findings support previous studies showing compensatory strategies in handwriting that favor broader horizontal strokes. In contrast, the absence of significant differences in vertical size may be due to the simpler nature of vertical movements, which require less spatial coordination [35]. Regarding the writing aids, AG's design, which stabilizes the thumb and limits wrist movement, may cause broader, less controlled horizontal strokes, increasing horizontal letter size on the PS. In contrast, SW's triangular base provides better stability and spatial control, reducing compensatory movements and preventing excessive increases in letter size [36; 37]. The observed increase in horizontal letter size on the PS highlights the importance of addressing motor coordination and visuospatial challenges in stroke rehabilitation. Interventions combining writing aids like SW with targeted exercise to improve spatial control and fine motor precision may help optimize handwriting outcomes. Furthermore, the differential effects of AG and SW suggest that selecting writing aids based on the specific needs of patients, such as improving speed or reducing compensatory movements, could enhance the efficacy of rehabilitation strategies. The design of SW, with its wide triangular base and 55-degree angle, likely encourages greater activation of wrist flexor muscles, such as the FCR, by requiring more active wrist control. This enhances dynamic and controlled movements, particularly on the PS, contributing to rehabilitation by increasing muscle activation and improving the functional use of the affected limb [38]. In contrast, AG stabilizes the thumb and redistributes force, reducing wrist involvement and resulting in lower muscle activity compared to SW. The similar muscle activity between AG and SW for the ECRL suggests that both aids similarly support wrist movement without engaging wrist extensors significantly, as writing primarily involve flexors [39]. Despite using these aids, the reduced ECRL engagement on the PS indicates that full restoration of symmetrical muscle function may not occur.