Writing is a fine motor skill that quickly becomes difficult when muscle atrophy caused by ALS is observed in the hands.
There are approximately 20 muscles found within the hand, and an additional 14 found in the forearm that are directly responsible for movement of parts of the hand. Any amount of atrophy experienced in any of these muscles may have an effect on the ability to write clearly.
Adaptive equipment to maintain the ability to write well is limited. Pens or pencils with a large grip diameter may be easier to hold, at least for a period when atrophy is minimal. Rubber or foam sleeves may be used over top of conventional pens or pencils to improve grip.
Electronic devices can be used in place of hand writing when the ability to do the latter has been lost. Typing on a conventional keyboard requires less fine motor skill than gripping a pen or a pencil. Voice dictation can be used to enter large amounts of text into a computer or smart phone.
Losing the ability to write brings with it the loss of the ability to sign documents.
Creating an e-signature on a computer or smart phone is useful as many documents can be filled out electronically. An e-signature should be made as early as possible when the ability to use a mouse or swipe a phone screen is preserved.
Stamps can be made by office supply stores that offer such services; these can be used in place of a signature for documents that must be signed in ink.
As part of memory preservation, one may choose to write notes or letters to create keepsakes for loved ones, and to demonstrate their writing.