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Jolly C, Jover M, Danna J. Dysgraphia Differs Between Children With Developmental Coordination Disorder and/or Reading Disorder. J Learn Disabil 2024:222194231223528. [PMID: 38284390 DOI: 10.1177/00222194231223528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Handwriting deficits, or dysgraphia, are present in several neurodevelopmental disorders. To investigate whether dysgraphia differs according to the associated disorder, we performed a detailed analysis of handwriting in children with developmental coordination disorders (DCD), reading disorder (RD), or comorbid RD and DCD. Handwriting deficits were investigated at the product (quality of the trace) and the process (movement that generates the trace) levels. Nineteen children with singular RD (among which eight with dysgraphia), 13 children with singular DCD (among which seven with dysgraphia), 16 children with comorbid RD+DCD (among which 11 with dysgraphia), and 20 typically developing children, age 7 to 12, performed the BHK (Brave Handwriting Kinder) test, a standardized assessment of handwriting, on a graphic tablet. Developmental coordination disorders primarily affected handwriting quality, while RD affected slowness and, to a lesser extent, quality. Children with RD, solely or comorbid with DCD, wasted time by lifting and stopping the pen when writing. The comorbidity added to but did not worsen, handwriting difficulties. These results reflect distinct motor impairments and/or strategies in children with DCD or RD. We identified subtypes of dysgraphia and advocated for a fine-grained analysis of the writing process and the assessment of motor and reading skills when studying dysgraphia.
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Affiliation(s)
- Caroline Jolly
- Université Grenoble Alpes, Université Savoie Mont-Blanc, CNRS, LPNC, France
| | - Marianne Jover
- Aix Marseille Université, PSYCLE, Aix-en-Provence, France
| | - Jérémy Danna
- Aix Marseille Université, CNRS, LNC, Marseille, France
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Puyjarinet F, Chaix Y, Biotteau M. Is There a Deficit in Product and Process of Handwriting in Children with Attention Deficit Hyperactivity Disorder? A Systematic Review and Recommendations for Future Research. Children (Basel) 2023; 11:31. [PMID: 38255345 PMCID: PMC10813961 DOI: 10.3390/children11010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024]
Abstract
Handwriting abnormalities in children with attention deficit hyperactivity disorder (ADHD) have sometimes been reported both (i) at the product level (i.e., quality/legibility of the written trace and speed of writing) and (ii) at the process level (i.e., dynamic and kinematic features, such as on-paper and in-air durations, pen pressure and velocity peaks, etc.). Conversely, other works have failed to reveal any differences between ADHD and typically developing children. The question of the presence and nature of handwriting deficits in ADHD remains open and merits an in-depth examination. The aim of this systematic review was, therefore, to identify studies that have investigated the product and/or process of handwriting in children with ADHD compared to typically developing individuals. This review was conducted and reported in accordance with the PRISMA statement. A literature search was carried out using three electronic databases. The methodological quality of the studies was systematically assessed using the Critical Appraisal Skills Program (CASP) criteria. Twenty-one articles were identified. Of these, 17 described handwriting quality/legibility, 12 focused on speed and 14 analyzed the handwriting process. All the studies (100%) with satisfactory methodology procedures reported an impaired product and process in children with ADHD, while 25% evidenced a difference in the speed of production. Most importantly, the studies differed widely in their methodological approaches. Substantial gaps remain, particularly with regard to ascertaining comorbidities, ADHD subtypes and the medical status of the included children. The lack of overall homogeneity in the samples calls for higher quality studies. We conclude with recommendations for further studies.
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Affiliation(s)
- Frédéric Puyjarinet
- Montpellier Psychomotor Training Institute, UFR de Medicine Montpellier-Nîmes, University of Montpellier, 34090 Montpellier, France
| | - Yves Chaix
- Pediatric Neurology Unit, Children’s Hospital, Toulouse University Hospital Center, 31059 Toulouse, France;
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse, INSERM, 31024 Toulouse, France
| | - Maëlle Biotteau
- Pediatric Neurology Unit, Children’s Hospital, Toulouse University Hospital Center, 31059 Toulouse, France;
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse, INSERM, 31024 Toulouse, France
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Alabbad M, Khan MA, Siddique N, Hassan JA, Bashir S, Abualait T. Early predictors in language-based learning disabilities: a bibliometric analysis. Front Psychiatry 2023; 14:1229580. [PMID: 38111620 PMCID: PMC10725967 DOI: 10.3389/fpsyt.2023.1229580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction Language-based learning disabilities (LBLD) refers to a spectrum of neurodevelopmental-associated disorders that are characterized by cognitive and behavioral differences in comprehending, processing and utilizing spoken and/or written language. The focus of this work was on identifying early predictors of three main specific LBLD including dyslexia, dyscalculia, and dysgraphia. Methods The Web of Science (WoS) was searched for literature related to (neurocognitive, neurophysiological, and neuroimaging) measurements used to identify early predictors of LBLD from 1991 to 25 October 2021. A retrospective bibliometric analysis was performed to analyze collaboration among countries, institutions, authors, publishing journals, reference co-citation patterns, keyword co-occurrence, keyword clustering, and burst keywords using Biblioanalytics software. Results In total, 921 publications related to the identification of LBLD using (neurocognitive, neurophysiological, and neuroimaging) modalities were included. The data analysis shows a slow growth in research on the topic in the 90s and early 2000 and growing trend in recent years. The most prolific and cited journal is Neuroimage, followed by Neuropsychologia. The United States and Finland's Universities Jyvaskyla and Helsinki are the leading country and institution in this field, respectively. "Neuroimaging," "brain," "fMRI," "cognitive predictor," "comorbidity," "cortical thickness" were identified as hotspots and trends of (neurocognitive, neurophysiological, and neuroimaging) modalities in the identification of LBLD. Discussion Early predictors of LBLDs would be useful as targets for specific prevention and intervention programs to be implemented at very young ages, which could have a significant clinical impact. A novel finding of neuroimaging predictors combined with neurocognitive and neuropsychological batteries may have implications for future research.
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Affiliation(s)
- Maryam Alabbad
- Department of Medical Rehabilitation and Long-Term Care, Al-Ahsa Health Cluster, Al-Ahsa, Saudi Arabia
- College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhammad Ajmal Khan
- Deanship of Library Affairs, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nadeem Siddique
- Library Department, Lahore University of Management Sciences, Lahore, Pakistan
| | - Jaber Abou Hassan
- Department of Medical Rehabilitation and Long-Term Care, Al-Ahsa Health Cluster, Al-Ahsa, Saudi Arabia
| | - Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Turki Abualait
- College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Chung WK, Herrera FF. Health supervision for children and adolescents with 16p11.2 deletion syndrome. Cold Spring Harb Mol Case Stud 2023; 9:a006316. [PMID: 38050025 PMCID: PMC10815286 DOI: 10.1101/mcs.a006316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023] Open
Abstract
Rare genetic conditions are challenging for the primary care provider to manage without proper guidelines. This clinical review is designed to assist the pediatrician, family physician, or internist in the primary care setting to manage the complexities of 16p11.2 deletion syndrome. A multidisciplinary medical home with the primary care provider leading the care and armed with up-to-date guidelines will prove most helpful to the rare genetic patient population. A special focus on technology to fill gaps in deficits, review of case studies on novel medical treatments, and involvement with the educational system for advocacy with an emphasis on celebrating diversity will serve the rare genetic syndrome population well.
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Affiliation(s)
- Wendy K Chung
- Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts 02115, USA
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Puyjarinet F, Madramany P, Autexier A, Madieu E, Nesensohn J, Biotteau M. Psychomotor intervention to improve handwriting skills in children with ADHD: A single-case experimental design with direct inter-subject and systematic replications. Neuropsychol Rehabil 2023; 33:1537-1563. [PMID: 36007100 DOI: 10.1080/09602011.2022.2114503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/15/2022] [Indexed: 02/04/2023]
Abstract
Dysgraphia is highly prevalent in children with attention deficit hyperactivity disorder (ADHD) and adversely affects academic and developmental trajectories. To date, no study has rigorously examined the effects of a training program on handwriting quality in this specific population. Our objective was thus to develop an innovative program - we entitled PRO-PEN - and to evaluate its effects. We planned a multiple-baseline design across participants from grade 3-5, with direct inter-subject and systematic replications. Children of Group 1 (n = 4) were diagnosed with ADHD. Systematic replication was conducted in a second group of participants (Group 2, n = 4) with a diagnosis of developmental coordination disorder in addition to ADHD. The primary assessment focused on quality of handwriting. Generalization measures evaluated diverse neuropsychological and behavioural domains. In Group 1, effect sizes regarding handwriting quality were large (Taus > .60). Improvement was also observed for children of Group 2 (Taus > .50). Importantly, the positive effects persisted three months after the end of the training. Generalization effects extended beyond handwriting sphere. Therefore, PRO-PEN can be considered a promising training program for improving handwriting quality in ADHD, with a possible impact on wide cerebral regulation loops underpinning both handwriting and other neuropsychological and behavioural domains.
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Affiliation(s)
- Frédéric Puyjarinet
- University of Montpellier, UFR Médecine Montpellier-Nîmes, Institut de Formation en Psychomotricité de Montpellier, Montpellier, France
| | | | - Anne Autexier
- Academy of Montpellier, French National Education Institute, France
| | | | - Jessica Nesensohn
- University of Montpellier, UFR Médecine Montpellier-Nîmes, Institut de Formation en Psychomotricité de Montpellier, Montpellier, France
- CHRU of Montpellier, Montpellier, France
| | - Maëlle Biotteau
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
- Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
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Lopez C, Vaivre-Douret L. Exploratory Investigation of Handwriting Disorders in School-Aged Children from First to Fifth Grade. Children (Basel) 2023; 10:1512. [PMID: 37761473 PMCID: PMC10528446 DOI: 10.3390/children10091512] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
Handwriting disorders (HDs) are prevalent in school-aged children, with significant interference with academic performances. The current study offers a transdisciplinary approach with the use of normed and standardized clinical assessments of neuropsychomotor, neuropsychological and oculomotor functions. The aim is to provide objective data for a better understanding of the nature and the etiology of HDs. Data from these clinical assessments were analyzed for 27 school-aged children with HD (first to fifth grade). The results underline a high heterogeneity of the children presenting HDs, with many co-occurrences often unknown. However, it was possible to highlight three levels of HDs based on BHK scores: mild HD not detected by the BHK test (26% of children), moderate HD (33%) and dysgraphia (41% of children). The mild nature of the HDs not detected by the BHK test appears to occur at a relatively low frequency of the associated disorders identified during clinical evaluations. On the contrary, dysgraphia appears to be associated with a high frequency of co-occurring disorders identified in the clinical assessment, with a predominance of oculomotor disorders (55% of children), leading to visual-perceptual difficulties and a high level of handwriting deterioration. Finally, children with moderate HD have fewer co-occurrences than children with dysgraphia, but have more difficulties than children with mild HD. This highlights the importance of differentiating between different degrees of HDs that do not respond to the same semiologies. Our findings support the interest in performing a transdisciplinary and standardized clinical examination with developmental standards (neuropsychomotor, neuropsychological and oculomotor) in children with HD. Indeed, HDs can therefore be associated with a multitude of disorders of different natures ranging from poor coordination of the graphomotor gesture to a more general and more complex impairment affecting perceptual-motor, cognitive and/or psycho-affective functions.
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Affiliation(s)
- Clémence Lopez
- Unit 1018-CESP, PsyDev/NDTA Team, National Institute of Health and Medical Research (INSERM), Faculty of Medicine, University of Paris-Saclay, UVSQ, 91190 Villejuif, France;
| | - Laurence Vaivre-Douret
- Unit 1018-CESP, PsyDev/NDTA Team, National Institute of Health and Medical Research (INSERM), Faculty of Medicine, University of Paris-Saclay, UVSQ, 91190 Villejuif, France;
- Department of Medicine Paris Descartes, Faculty of Health, Université Paris Cité, 75006 Paris, France
- Clinical Neurodevelopmental Phenotyping, University Institute of France (Institut Universitaire de France, IUF), 75005 Paris, France
- Department of Child Psychiatry, AP-HP Centre, Necker-Enfants Malades University Hospital, 75015 Paris, France
- Department of Endocrinology, IMAGINE Institute, Necker-Enfants Malades University Hospital, 75015 Paris, France
- Necker-Enfants Malades University Hospital, “Neuro-Développement et Troubles des Apprentissages (NDTA)”, INSERM UMR 1018-CESP, Carré Necker Porte N4, 149, Rue de Sèvres, 75015 Paris, France
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Jebakumar D, Marconi S, Kattula D, Priscilla RA. Knowledge of schoolteachers on learning disabilities in urban Vellore - A cross-sectional study. J Family Med Prim Care 2023; 12:1582-1587. [PMID: 37767410 PMCID: PMC10521813 DOI: 10.4103/jfmpc.jfmpc_2018_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 09/29/2023] Open
Abstract
Background Specific learning disability (SLD) is a cognitive neurobiological disorder caused by atypical brain functioning. SLD is recognized when the individual's achievement in school is below that expected for age, schooling, and level of intelligence. Screening millions of students with SLD by health personnel is a logistical impossibility. Awareness and knowledge about learning disorders among schoolteachers may play a major role in the early identification and management of children with these disorders. Therefore, the assessment of teachers' knowledge and perceptions about learning disabilities (LDs) is relevant. Method A school-based cross-sectional study was conducted among teachers in government/government-aided and private schools in Vellore, India. The participants were selected by a simple random sampling method. There was a total of 80 teachers included in the study. Data capture was done using a questionnaire. A Chi-square test was done to test the association and the odds ratio test helped determine the strength of the association. A P-value of <0.05 was considered to be statistically significant. Results The majority of the teachers (70%) had adequate general knowledge regarding LDs. When analyzed separately, 82.5% of government/aided teachers and only 57.5% of teachers were having adequate general knowledge regarding LDs. There was a significant association between the type of school and general knowledge regarding LDs. Government/aided teachers had better general knowledge regarding LDs and dyslexia than private teachers. Conclusions Among 80 teachers, 70% (56) of them had adequate general knowledge regarding LDs. When analyzed separately, 82.5% (33) of government/aided teachers and only 57.5% (23) teachers were having adequate general knowledge regarding LDs. The government/aided schoolteachers had significantly higher levels of knowledge in most domains of the general knowledge section as compared to private schoolteachers. If teachers are having adequate knowledge regarding LDs, it will significantly increase the chances of children with LDs getting detected early and undergoing the treatment they require. Teacher education programs and workshops are needed to be conducted at regular intervals to improve the knowledge regarding SLDs among teachers.
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Affiliation(s)
- Daniel Jebakumar
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sam Marconi
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dheeraj Kattula
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ruby A. Priscilla
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
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Hurschler Lichtsteiner S, Nideröst M, Di Brina C, Marquardt C, Wyss S, Buholzer A, Wicki W. Effectiveness of Psychomotor Therapy among Children with Graphomotor Impairment with and without DCD-Diagnosis. Children (Basel) 2023; 10:964. [PMID: 37371196 DOI: 10.3390/children10060964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
In Switzerland, psychomotor therapy (PMT) is a standard treatment for children with graphomotor impairments, but scientific evidence of its effectiveness is rare. To investigate the effectiveness of PMT, we conducted a randomised field trial (RFT). The sample consisted of 121 first and second graders with graphomotor impairments, some of whom met the criteria of developmental coordination disorder, while the remaining suffered from developmental dysgraphia. The treatments lasted over 5 months. Handwriting fluency and consistency were measured five times on a digitising tablet. All participating children completed a self-concept interview, and a standardised fine motor performance test twice. Psychomotor therapy significantly improved the fine motor skills of the therapy group compared to those of the waiting group. However, there was no evidence that the treated children improved more than the waiting children in terms of their graphomotor skills such as frequency, automaticity, and consistency of forming letters. Finally, the children of the therapy group showed partial improvements in their handwriting self-concept, while those of the waiting group children remained stable. This short-term RFT demonstrated the effectiveness of PMT in terms of fine motor skills and some aspects of the handwriting self-concept but showed no effects on handwriting fluency and consistency.
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Affiliation(s)
| | - Melanie Nideröst
- Institute for Educational Support for Behaviour, Social-Emotional, and Psychomotor Development, University of Teacher Education in Special Needs Zurich, CH-8050 Zurich, Switzerland
| | - Carlo Di Brina
- Department of Human Neuroscience, Sapienza University of Rome, I-00185 Rome, Italy
| | | | - Stefanie Wyss
- Languages Research Group, University of Teacher Education Lucerne, CH-6003 Lucerne, Switzerland
| | - Alois Buholzer
- Institute for Diversity in Education, University of Teacher Education Lucerne, CH-6003 Lucerne, Switzerland
| | - Werner Wicki
- Languages Research Group, University of Teacher Education Lucerne, CH-6003 Lucerne, Switzerland
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Ganguly J, Choudhury S, Kumar H. Pattern Specific Dysgraphia-Beyond Letter Specificity. Mov Disord Clin Pract 2023; 10:856-857. [PMID: 37205257 PMCID: PMC10187001 DOI: 10.1002/mdc3.13721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 03/14/2023] Open
Affiliation(s)
- Jacky Ganguly
- Movement Disorder Centre Institute of Neurosciences Kolkata Kolkata India
| | - Supriyo Choudhury
- Movement Disorder Centre Institute of Neurosciences Kolkata Kolkata India
| | - Hrishikesh Kumar
- Movement Disorder Centre Institute of Neurosciences Kolkata Kolkata India
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Mayes SD, Bangert L, Kallus R, Fosco W, Calhoun SL, Waschbusch DA. Sluggish cognitive tempo: Association with neuropsychological test scores, motor incoordination, and dysgraphia in elementary school children. Clin Child Psychol Psychiatry 2023; 28:610-622. [PMID: 35751158 DOI: 10.1177/13591045221110730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research on the relationship between sluggish cognitive tempo (SCT) and scores on neuropsychological tests (such as those measuring processing speed and reaction time) is inconclusive, and the association between SCT and motor incoordination and dysgraphia has not been objectively investigated. Mothers of 413 elementary school children (6-12 years of age) rated their children on the Pediatric Behavior Scale (PBS), which yields psychological problem scores, including SCT. Children were administered an extensive battery of neuropsychological tests assessing processing and performance speed, working memory, immediate and delayed recall, sustained attention, response inhibition, cognitive flexibility, fine motor manipulative skill, verbal fluency and retrieval, set shifting, and interference control, as well as intelligence and reading and math achievement. Only three of the 19 correlations between SCT and neuropsychological scores were significant, and all involved graphomotor tests (two timed and one untimed). In regression analysis, the strongest independent predictor of SCT was the maternal PBS incoordination factor score, followed by ratings of autism, inattention, and depression. Neuropsychological test scores did not contribute significantly more to predicting SCT. Among the incoordination PBS factor items, clumsy and draws or writes poorly were significant SCT predictors. Our novel and unexpected findings showed that motor incoordination was a stronger correlate of SCT than other variables assessed in our study, including those previously linked with SCT. Future SCT research needs to include measures of incoordination and dysgraphia in order to replicate and expand upon the current findings. Our results suggest that SCT traits are not reliably measured by currently available neuropsychological tests.
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Affiliation(s)
- Susan D Mayes
- Department of Psychiatry and Behavioral Health, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Lauren Bangert
- Department of Psychiatry and Behavioral Health, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Rachel Kallus
- Department of Psychiatry and Behavioral Health, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Whitney Fosco
- Department of Psychiatry and Behavioral Health, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Susan L Calhoun
- Department of Psychiatry and Behavioral Health, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Daniel A Waschbusch
- Department of Psychiatry and Behavioral Health, 12310Penn State College of Medicine, Hershey, PA, USA
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Piazzalunga C, Dui LG, Termine C, Bortolozzo M, Matteucci M, Ferrante S. Investigating Visual Perception Impairments through Serious Games and Eye Tracking to Anticipate Handwriting Difficulties. Sensors (Basel) 2023; 23:1765. [PMID: 36850364 PMCID: PMC9958538 DOI: 10.3390/s23041765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Dysgraphia is a learning disability that causes handwritten production below expectations. Its diagnosis is delayed until the completion of handwriting development. To allow a preventive training program, abilities not directly related to handwriting should be evaluated, and one of them is visual perception. To investigate the role of visual perception in handwriting skills, we gamified standard clinical visual perception tests to be played while wearing an eye tracker at three difficulty levels. Then, we identified children at risk of dysgraphia through the means of a handwriting speed test. Five machine learning models were constructed to predict if the child was at risk, using the CatBoost algorithm with Nested Cross-Validation, with combinations of game performance, eye-tracking, and drawing data as predictors. A total of 53 children participated in the study. The machine learning models obtained good results, particularly with game performances as predictors (F1 score: 0.77 train, 0.71 test). SHAP explainer was used to identify the most impactful features. The game reached an excellent usability score (89.4 ± 9.6). These results are promising to suggest a new tool for dysgraphia early screening based on visual perception skills.
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Affiliation(s)
- Chiara Piazzalunga
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Linda Greta Dui
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Cristiano Termine
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Marisa Bortolozzo
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Matteo Matteucci
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Simona Ferrante
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
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Thiel L, Conroy P. 'I think writing is everything': An exploration of the writing experiences of people with aphasia. Int J Lang Commun Disord 2022; 57:1381-1398. [PMID: 35929726 PMCID: PMC9805004 DOI: 10.1111/1460-6984.12762] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Written communication has become an increasingly important part of everyday life in social, educational and professional spheres. The substantial increase in writing via the internet and mobile technologies provides both an opportunity for social engagement and distinct challenges for people with aphasia. Within the current literature there has been limited research into the lived experiences of people with aphasia of their writing difficulties and how these affect their ability to communicate. AIMS This qualitative study aimed to explore the experiences of people with aphasia of living with language-related writing difficulties and the impact of these on their lives. METHODS & PROCEDURES Eight people with post-stroke aphasia and writing difficulties took part in semi-structured interviews. The interviews were analysed using inductive reflexive thematic analysis. OUTCOMES & RESULTS Two themes were found in the data. The first theme was a gradual and effortful improvement to writing: Participants described how writing had improved since their stroke due to strategies and support, but they still found writing to be difficult and frustrating and described many barriers to writing. The second theme was the importance of writing for fulfilling adult social roles: Participants found writing to be important for communicating with family, friends and organizations, but their participation in society and self-esteem and confidence were impacted by writing difficulties; reduced social roles meant reduced need for writing, but participants were still motivated to work towards writing goals. CONCLUSIONS & IMPLICATIONS The findings demonstrate the emerging importance of writing skills for people with aphasia with respect to communication, well-being, participation and inclusion in society, and carrying out social roles. They provide an insight into the process of improvement, including the difficulties, facilitators and barriers. Implications for speech and language therapy assessment and management are discussed. WHAT THIS PAPER ADDS What is already known on the subject People with aphasia have difficulties with writing that can affect their ability to communicate. A small body of qualitative research has provided insights into individuals' experiences of literacy difficulties. More research is needed to understand the writing experiences of people with aphasia to help design appropriate assessments and interventions. What this paper adds to existing knowledge Participants experienced gradual and effortful improvement since their stroke. They felt negative about aspects of their writing, including speed, accuracy and range of vocabulary. Writing was facilitated through assistive technologies, spelling practice and support from others; barriers included technology, lack of time, stroke-related symptoms and others' lack of awareness about aphasia. Participants considered writing skills to be important, particularly for communication, carrying out adult social roles and participating in society, and were therefore still working towards goals related to everyday writing activities. What are the potential or actual clinical implications of this work? This study suggests that speech and language therapy assessment should include interviewing participants about their activities, strengths, difficulties, facilitators and barriers in writing, and informal assessment of a range of functional writing tasks. Intervention should be tailored to the individual's needs. This should include meaningful activities that relate to functional everyday writing and, where appropriate, self-management, compensatory technologies and group approaches, while making use of existing strategies identified by the individual.
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Affiliation(s)
- Lindsey Thiel
- Leeds School of Social SciencesLeeds Beckett UniversityLeedsUK
| | - Paul Conroy
- Division of Human Communication Development and Hearing, School of Health SciencesUniversity of ManchesterManchesterUK
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Hen-Herbst L, Rosenblum S. Handwriting and Motor-Related Daily Performance among Adolescents with Dysgraphia and Their Impact on Physical Health-Related Quality of Life. Children (Basel) 2022; 9:1437. [PMID: 36291371 PMCID: PMC9600430 DOI: 10.3390/children9101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Knowledge is limited about dysgraphia in adolescence and its association with daily motor-related daily performance and health-related quality of life (HRQOL). This study aimed to (1) compare and (2) examine correlations between handwriting measures, motor-related daily performance, and HRQOL of adolescents with and without dysgraphia and (3) examine the contribution of motor-related daily performance and handwriting measures to predict their physical HRQOL. There were eighty adolescents (13-18 yr): half with dysgraphia and half matched controls without dysgraphia per the Handwriting Proficiency Screening Questionnaire and Handwriting Legibility Scale participated. They copied a paragraph script onto a paper attached to the Computerized Penmanship Evaluation Tool digitizer and completed the World Health Organization Quality of Life Questionnaire-brief version and the Adult Developmental Coordination Disorder Checklist (ADC). We found significant between-group differences in motor-related daily performance, handwriting measures, and HRQOL and significant correlations between HRQOL and handwriting process measures and motor-coordination ability. Handwriting measures predicted 25%, and the ADC A and C subscales 45.6%, of the research group's physical QOL domain score variability. Notably, the control group's current perceptions of their motor-coordination performance (ADC-C) predicted 36.5% of the variance in physical QOL. Dysgraphia's negative effects during childhood and adolescence may reduce adolescents' HRQOL now and into adulthood.
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Affiliation(s)
- Liat Hen-Herbst
- Department of Occupational Therapy, School of Health Sciences, University of Ariel, Ariel 4077625, Israel
| | - Sara Rosenblum
- Department of Occupational Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel
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Jazdarehee A, Huget-Penner S, Pawlowska M. Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report. Endocrinol Diabetes Metab Case Rep 2022; 2022:21-0100. [PMID: 35212265 PMCID: PMC8897593 DOI: 10.1530/edm-21-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/02/2022] [Indexed: 11/11/2022] Open
Abstract
SUMMARY Obstructive sleep apnea (OSA) is a condition of intermittent nocturnal upper airway obstruction. OSA increases sympathetic drive which may result in clinical and biochemical features suggestive of pheochromocytoma. We present the case of a 65-year-old male with a 2.9-cm left adrenal incidentaloma on CT, hypertension, symptoms of headache, anxiety and diaphoresis, and persistently elevated 24-h urine norepinephrine (initially 818 nmol/day (89-470)) and normetanephrine (initially 11.2 µmol/day (0.6-2.7)). He was started on prazosin and underwent left adrenalectomy. Pathology revealed an adrenal corticoadenoma with no evidence of pheochromocytoma. Over the next 2 years, urine norepinephrine and normetanephrine remained significantly elevated with no MIBG avid disease. Years later, he was diagnosed with severe OSA and treated with continuous positive airway pressure. Urine testing done once OSA was well controlled revealed complete normalization of urine norepinephrine and normetanephrine with substantial symptom improvement. It was concluded that the patient never had a pheochromocytoma but rather an adrenal adenoma with biochemistry and symptoms suggestive of pheochromocytoma due to untreated severe OSA. Pseudo-pheochromocytoma is a rare presentation of OSA and should be considered on the differential of elevated urine catecholamines and metanephrines in the right clinical setting. LEARNING POINTS Obstructive sleep apnea (OSA) is a common condition among adults. OSA may rarely present as pseudo-pheochromocytoma with symptoms of pallor, palpitations, perspiration, headache, or anxiety. OSA should be considered on the differential of elevated urine catecholamines and metanephrines, especially in patients with negative metaiodobenzylguanidine (MIBG) scan results.
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Key Words
- adolescent/young adult
- adult
- geriatric
- neonatal
- paediatric
- pregnant adult
- female
- male
- american indian or alaska native
- asian - bangladeshi
- asian - chinese
- asian - filipino
- asian - indian
- asian - japanese
- asian - korean
- asian - pakistani
- asian - vietnamese
- asian - other
- black - african
- black - caribbean
- black - other
- hispanic or latino - central american or south american
- hispanic or latino - cuban
- hispanic or latino - dominican
- hispanic or latino - mexican, mexican american, chicano
- hispanic or latino - puerto rican
- hispanic or latino - other
- native hawaiian/other pacific islander
- white
- other
- afghanistan
- aland islands
- albania
- algeria
- american samoa
- andorra
- angola
- anguilla
- antarctica
- antigua and barbuda
- argentina
- armenia
- aruba
- australia
- austria
- azerbaijan
- bahamas
- bahrain
- bangladesh
- barbados
- belarus
- belgium
- belize
- benin
- bermuda
- bhutan
- bolivia
- bosnia and herzegovina
- botswana
- bouvet island
- brazil
- british indian ocean territory
- brunei darussalam
- bulgaria
- burkina faso
- burundi
- cambodia
- cameroon
- canada
- cape verde
- cayman islands
- central african republic
- chad
- chile
- china
- christmas island
- cocos (keeling) islands
- colombia
- comoros
- congo
- congo, the democratic republic of the
- cook islands
- costa rica
- côte d'ivoire
- croatia
- cuba
- cyprus
- czech republic
- denmark
- djibouti
- dominica
- dominican republic
- ecuador
- egypt
- el salvador
- equatorial guinea
- eritrea
- estonia
- ethiopia
- falkland islands (malvinas)
- faroe islands
- fiji
- finland
- france
- french guiana
- french polynesia
- french southern territories
- gabon
- gambia
- georgia
- germany
- ghana
- gibraltar
- greece
- greenland
- grenada
- guadeloupe
- guam
- guatemala
- guernsey
- guinea
- guinea-bissau
- guyana
- haiti
- heard island and mcdonald islands
- holy see (vatican city state)
- honduras
- hong kong
- hungary
- iceland
- india
- indonesia
- iran, islamic republic of
- iraq
- ireland
- isle of man
- israel
- italy
- jamaica
- japan
- jersey
- jordan
- kazakhstan
- kenya
- kiribati
- korea, democratic people's republic of
- korea, republic of
- kuwait
- kyrgyzstan
- lao people's democratic republic
- latvia
- lebanon
- lesotho
- liberia
- libyan arab jamahiriya
- liechtenstein
- lithuania
- luxembourg
- macao
- macedonia, the former yugoslav republic of
- madagascar
- malawi
- malaysia
- maldives
- mali
- malta
- marshall islands
- martinique
- mauritania
- mauritius
- mayotte
- mexico
- micronesia, federated states of
- moldova, republic of
- monaco
- mongolia
- montenegro
- montserrat
- morocco
- mozambique
- myanmar
- namibia
- nauru
- nepal
- netherlands
- netherlands antilles
- new caledonia
- new zealand
- nicaragua
- niger
- nigeria
- niue
- norfolk island
- northern mariana islands
- norway
- oman
- pakistan
- palau
- palestinian territory, occupied
- panama
- papua new guinea
- paraguay
- peru
- philippines
- pitcairn
- poland
- portugal
- puerto rico
- qatar
- réunion
- romania
- russian federation
- rwanda
- saint barthélemy
- saint helena
- saint kitts and nevis
- saint lucia
- saint martin
- saint pierre and miquelon
- saint vincent and the grenadines
- samoa
- san marino
- sao tome and principe
- saudi arabia
- senegal
- serbia
- seychelles
- sierra leone
- singapore
- slovakia
- slovenia
- solomon islands
- somalia
- south africa
- south georgia and the south sandwich islands
- spain
- sri lanka
- sudan
- suriname
- svalbard and jan mayen
- swaziland
- sweden
- switzerland
- syrian arab republic
- taiwan, province of china
- tajikistan
- tanzania, united republic of
- thailand
- timor-leste
- togo
- tokelau
- tonga
- trinidad and tobago
- tunisia
- turkey
- turkmenistan
- turks and caicos islands
- tuvalu
- uganda
- ukraine
- united arab emirates
- united kingdom
- united states
- united states minor outlying islands
- uruguay
- uzbekistan
- vanuatu
- vatican city state
- venezuela
- viet nam
- virgin islands, british
- virgin islands, u.s.
- wallis and futuna
- western sahara
- yemen
- zambia
- zimbabwe
- maylaysia
- adipose tissue
- adrenal
- bone
- duodenum
- heart
- hypothalamus
- kidney
- liver
- ovaries
- pancreas
- parathyroid
- pineal
- pituitary
- placenta
- skin
- stomach
- testes
- thymus
- thyroid
- andrology
- autoimmunity
- cardiovascular endocrinology
- developmental endocrinology
- diabetes
- emergency
- endocrine disruptors
- endocrine-related cancer
- epigenetics
- genetics and mutation
- growth factors
- gynaecological endocrinology
- immunology
- infectious diseases
- late effects of cancer therapy
- mineral
- neuroendocrinology
- obesity
- ophthalmology
- paediatric endocrinology
- puberty
- tumours and neoplasia
- vitamin d
- 17ohp
- acth
- adiponectin
- adrenaline
- aldosterone
- amh
- androgens
- androstenedione
- androsterone
- angiotensin
- antidiuretic hormone
- atrial natriuretic hormone
- avp
- beta-endorphin
- big igf2
- brain natriuretic peptide
- calcitonin
- calcitriol
- cck
- corticosterone
- corticotrophin
- cortisol
- cortisone
- crh
- dehydroepiandrostenedione
- deoxycorticosterone
- deoxycortisol
- dhea
- dihydrotestosterone
- dopamine
- endothelin
- enkephalin
- epitestosterone
- epo
- fgf23
- fsh
- gastrin
- gh
- ghrelin
- ghrh
- gip
- glp1
- glp2
- glucagon
- glucocorticoids
- gnrh
- gonadotropins
- hcg
- hepcidin
- histamine
- human placental lactogen
- hydroxypregnenolone
- igf1
- igf2
- inhibin
- insulin
- kisspeptin
- leptin
- lh
- melanocyte-stimulating hormone
- melatonin
- metanephrines
- mineralocorticoids
- motilin
- nandrolone
- neuropeptide y
- noradrenaline
- normetanephrine
- oestetrol (e4)
- oestradiol (e2)
- oestriol (e3)
- oestrogens
- oestrone (e1)
- osteocalcin
- oxyntomodulin
- oxytocin
- pancreatic polypeptide
- peptide yy
- pregnenolone
- procalcitonin
- progesterone
- prolactin
- prostaglandins
- pth
- relaxin
- renin
- resistin
- secretin
- somatostatin
- testosterone
- thpo
- thymosin
- thymulin
- thyroxine (t4)
- trh
- triiodothyronine (t3)
- tsh
- vip
- 17-alpha hydroxylase/17,20 lyase deficiency
- 17-beta-hydroxysteroid dehydrogenase type 3 deficiency
- 3-m syndrome
- 22q11 deletion syndrome
- 49xxxxy syndrome
- abscess
- acanthosis nigricans
- acromegaly
- acute adrenocortical insufficiency
- addisonian crisis
- addison's disease
- adenocarcinoma
- aip gene mutation
- adrenal insufficiency
- adrenal salt-wasting crisis
- adrenarche
- adrenocortical adenoma
- adrenocortical carcinoma
- adrenoleukodystrophy
- aip gene variant
- amenorrhoea (primary)
- amenorrhoea (secondary)
- amyloid goitre
- amyloidosis
- anaplastic thyroid cancer
- anaemia
- aneuploidy
- androgen insensitivity syndrome
- anti-phospholipid antibody syndrome
- asthma
- autoimmune disorders
- autoimmune polyendocrine syndrome 1
- autoimmune polyendocrine syndrome 2
- autoimmune polyglandular syndrome
- autoimmune hypophysitis
- autosomal dominant hypophosphataemic rickets
- autosomal dominant osteopetrosis
- bardet-biedl syndrome
- bartter syndrome
- bilateral adrenal hyperplasia
- biliary calculi
- breast cancer
- brenner tumour
- brown tumour
- burkitt's lymphoma
- casr gene mutation
- catecholamine secreting carotid body paraganglionoma
- cancer-prone syndrome
- carcinoid syndrome
- carcinoid tumour
- carney complex
- carotid body paraganglioma
- c-cell hyperplasia
- cerebrospinal fluid leakage
- chronic fatigue syndrome
- circadian rhythm sleep disorders
- congenital adrenal hyperplasia
- congenital hypothyroidism
- congenital hyperinsulinism
- conn's syndrome
- corticotrophic adenoma
- craniopharyngioma
- cretinism
- crohn's disease
- cryptorchidism
- cushing's disease
- cushing's syndrome
- cystolithiasis
- de quervain's thyroiditis
- denys-drash syndrome
- desynchronosis
- developmental abnormalities
- diabetes - lipoatrophic
- diabetes - mitochondrial
- diabetes - steroid-induced
- diabetes insipidus - dipsogenic
- diabetes insipidus - gestational
- diabetes insipidus - nephrogenic
- diabetes insipidus - neurogenic/central
- diabetes mellitus type 1
- diabetes mellitus type 2
- diabetic foot syndrome
- diabetic hypoglycaemia
- diabetic ketoacidosis
- diabetic muscle infarction
- diabetic nephropathy
- diverticular disease
- donohue syndrome
- down syndrome
- eating disorders
- ectopic acth syndrome
- ectopic cushing's syndrome
- ectopic parathyroid adenoma
- empty sella syndrome
- endometrial cancer
- endometriosis
- eosinophilic myositis
- euthyroid sick syndrome
- familial hypocalciuric hypercalcaemia
- familial dysalbuminaemic hyperthyroxinaemia
- familial euthyroid hyperthyroxinaemia
- fat necrosis
- female athlete triad syndrome
- fetal demise
- fetal macrosomia
- follicular thyroid cancer
- fractures
- frasier syndrome
- friedreich's ataxia
- functional parathyroid cyst
- galactorrhoea
- gastrinoma
- gastritis
- gastrointestinal perforation
- gastrointestinal stromal tumour
- gck mutation
- gender identity disorder
- gestational diabetes mellitus
- giant ovarian cysts
- gigantism
- gitelman syndrome
- glucagonoma
- glucocorticoid remediable aldosteronism
- glycogen storage disease
- goitre
- goitre (multinodular)
- gonadal dysgenesis
- gonadoblastoma
- gonadotrophic adenoma
- gorham's disease
- granuloma
- granulosa cell tumour
- graves' disease
- graves' ophthalmopathy
- growth hormone deficiency (adult)
- growth hormone deficiency (childhood onset)
- gynaecomastia
- hamman's syndrome
- haemorrhage
- hajdu-cheney syndrome
- hashimoto's disease
- hemihypertrophy
- hepatitis c
- hereditary multiple osteochondroma
- hirsutism
- histiocytosis
- huntington's disease
- hürthle cell adenoma
- hyperaldosteronism
- hyperandrogenism
- hypercalcaemia
- hypercalcaemic crisis
- hyperglucogonaemia
- hyperglycaemia
- hypergonadotropic hypogonadism
- hypergonadotropism
- hyperinsulinaemia
- hyperinsulinaemic hypoglycaemia
- hyperkalaemia
- hyperlipidaemia
- hypernatraemia
- hyperosmolar hyperglycaemic state
- hyperparathyroidism (primary)
- hyperparathyroidism (secondary)
- hyperparathyroidism (tertiary)
- hyperpituitarism
- hyperprolactinaemia
- hypersexuality
- hypertension
- hyperthyroidism
- hypoaldosteronism
- hypocalcaemia
- hypoestrogenism
- hypoglycaemia
- hypoglycaemic coma
- hypogonadism
- hypogonadotrophic hypogonadism
- hypoinsulinaemia
- hypokalaemia
- hyponatraemia
- hypoparathyroidism
- hypophosphataemia
- hypophosphatasia
- hypophysitis
- hypopituitarism
- hypothyroidism
- iatrogenic disorder
- idiopathic bilateral adrenal hyperplasia
- idiopathic pituitary hyperplasia
- igg4-related systemic disease
- inappropriate tsh secretion
- incidentaloma
- infertility
- insulin autoimmune syndrome
- insulin resistance
- insulinoma
- intracranial vasospasm
- intrauterine growth retardation
- iodine allergy
- ischaemic heart disease
- kallmann syndrome
- ketoacidosis
- klinefelter syndrome
- kwashiorkor
- kwashiorkor (marasmic)
- leg ulcer
- laron syndrome
- latent autoimmune diabetes of adults (lada)
- laurence-moon syndrome
- left ventricular hypertrophy
- leukocytoclastic vasculitis
- leydig cell tumour
- lipodystrophy
- lipomatosis
- liver failure
- lung metastases
- luteoma
- lymphadenopathy
- macronodular adrenal hyperplasia
- macronodular hyperplasia
- macroprolactinoma
- marasmus
- maturity onset diabetes of young (mody)
- mccune-albright syndrome
- mckittrick-wheelock syndrome
- medullary thyroid cancer
- meigs syndrome
- membranous nephropathy
- men1
- men2a
- men2b
- men4
- menarche
- meningitis
- menopause
- metabolic acidosis
- metabolic syndrome
- metastatic carcinoma
- metastatic chromaffin cell tumour
- metastatic gastrinoma
- metastatic melanoma
- metastatic tumour
- microadenoma
- microprolactinoma
- motor neurone disease
- myasthenia gravis
- myelolipoma
- myocardial infarction
- myositis
- myotonic dystrophy type 1
- myotonic dystrophy type 2
- myxoedema
- myxoedema coma
- nelson's syndrome
- neonatal diabetes
- nephrolithiasis
- neuroblastoma
- neuroendocrine tumour
- neurofibromatosis
- nodular hyperplasia
- non-functioning pituitary adenoma
- non-hodgkin lymphoma
- non-islet-cell tumour hypoglycaemia
- noonan syndrome
- oculocerebrorenal syndrome
- osteogenesis imperfecta
- osteomalacia
- osteomyelitis
- osteoporosis
- osteoporosis (pregnancy/lactation-associated)
- osteosclerosis
- ovarian cancer
- ovarian dysgenesis
- ovarian hyperstimulation syndrome
- ovarian tumour
- paget's disease
- paget's disease (juvenille)
- pancreatic neuroendocrine tumour
- pancreatitis
- panhypopituitarism
- papillary thyroid cancer
- paraganglioma
- paranasal sinus lesion
- paraneoplastic syndromes
- parasitic thyroid nodules
- parathyroid adenoma
- parathyroid adenoma (ectopic)
- parathyroid carcinoma
- parathyroid cyst
- parathroid hyperplasia
- pcos
- periodontal disease
- phaeochromocytoma
- phaeochromocytoma crisis
- pickardt syndrome
- pituitary abscess
- pituitary adenoma
- pituitary apoplexy
- pituitary carcinoma
- pituitary cyst
- pituitary haemorrhage
- pituitary hyperplasia
- pituitary hypoplasia
- pituitary tumour (malignant)
- plurihormonal pituitary adenoma
- poems syndrome
- polycythaemia
- porphyria
- pneumonia
- posterior reversible encephalopathy syndrome
- post-prandial hypoglycaemia
- prader-willi syndrome
- prediabetes
- pre-eclampsia
- pregnancy
- premature ovarian failure
- premenstrual dysphoric disorder
- premenstrual syndrome
- primary hypertrophic osteoarthropathy
- prolactinoma
- prostate cancer
- pseudohypoaldosteronism type 1
- pseudohypoaldosteronism type 2
- pseudohypoparathyroidism
- psychosocial short stature
- puberty (delayed or absent)
- puberty (precocious)
- pulmonary oedema
- quadrantanopia
- rabson-mendenhall syndrome
- rhabdomyolysis
- rheumatoid arthritis
- rickets
- schwannoma
- sellar reossification
- sertoli cell tumour
- sertoli-leydig cell tumour
- sexual development disorders
- sheehan's syndrome
- short stature
- siadh
- small-cell carcinoma
- small intestine neuroendocrine tumour
- solitary fibrous tumour
- solitary sellar plasmacytoma
- somatostatinoma
- somatotrophic adenoma
- squamous cell thyroid carcinoma
- stiff person syndrome
- struma ovarii
- subcutaneous insulin resistance
- systemic lupus erythematosus
- takotsubo cardiomyopathy
- tarts
- testicular cancer
- thecoma
- thyroid adenoma
- thyroid carcinoma
- thyroid cyst
- thyroid dysgenesis
- thyroid fibromatosis
- thyroid hormone resistance syndrome
- thyroid lymphoma
- thyroid nodule
- thyroid storm
- thyroiditis
- thyrotoxicosis
- thyrotrophic adenoma
- traumatic brain injury
- tuberculosis
- tuberous sclerosis complex
- tumour-induced osteomalacia
- turner syndrome
- unilateral adrenal hyperplasia
- ureterolithiasis
- urolithiasis
- von hippel-lindau disease
- wagr syndrome
- waterhouse-friderichsen syndrome
- williams syndrome
- wolcott-rallison syndrome
- wolfram syndrome
- xanthogranulomatous hypophysitis
- xlaad/ipex
- zollinger-ellison syndrome
- abdominal adiposity
- abdominal distension
- abdominal cramp
- abdominal discomfort
- abdominal guarding
- abdominal lump
- abdominal pain
- abdominal tenderness
- abnormal posture
- abdominal wall defects
- abrasion
- acalculia
- accelerated growth
- acne
- acrochorda
- acroosteolysis
- acute stress reaction
- adverse breast development
- aggression
- agitation
- agnosia
- akathisia
- akinesia
- albuminuria
- alcohol intolerance
- alexia
- alopecia
- altered level of consciousness
- amaurosis
- amaurosis fugax
- ambiguous genitalia
- amblyopia
- amenorrhoea
- ameurosis
- amnesia
- amusia
- anasarca
- angiomyxoma
- anhedonia
- anisocoria
- ankle swelling
- anorchia
- anorectal malformations
- anorexia
- anosmia
- anosognosia
- anovulation
- antepartum haemorrhage
- anuria
- anxiety
- apathy
- aphasia
- aphonia
- apnoea
- appendicitis
- appetite increase
- appetite reduction/loss
- apraxia
- aqueductal stenosis
- arteriosclerosis
- arthralgia
- articulation impairment
- ascites
- asperger syndrome
- asphyxia
- asthenia
- astigmatism
- asymptomatic
- ataxia
- atrial fibrillation
- atrial myxoma
- atrophy
- adhd
- autism
- autonomic neuropathy
- avulsion
- babinski's sign
- back pain
- bacteraemia
- behavioural problems
- belching
- bifid scrotum
- biliary colic
- bitemporal hemianopsia
- blindness
- blistering
- bloating
- bloody show
- boil(s)
- bone cyst
- bone fracture(s)
- bone lesions
- bone pain
- bony metastases
- borborygmus
- bowel movements - bleeding
- bowel movements - increased frequency
- bowel movements - pain
- bowel obstruction
- bowel perforation
- brachycephaly
- brachydactyly
- bradycardia
- bradykinesia
- bradyphrenia
- bradypnea
- breast contour change
- breast enlargement
- breast lump
- breast reduction
- breast tenderness
- breastfeeding difficulties
- breathing difficulties
- bronchospasms
- brushfield spots
- bruxism
- buffalo hump
- cachexia
- calcification
- cardiac fibrosis
- cardiac malformations
- cardiac tamponade
- cardiogenic shock
- cardiomegaly
- cardiomyopathy
- cardiopulmonary arrest
- carpal tunnel syndrome
- caruncle - inflammation
- cataplexy
- cataract(s)
- catathrenia
- central obesity
- cerebrospinal fluid rhinorrhoea
- cervical pain
- cheeks - full
- cheiloschisis
- chemosis
- chest pain
- chest pain (pleuritic)
- chest pain (precordial)
- cheyne-stokes respiration
- chills
- cholecystitis
- cholestasis
- chondrocalcinosis
- chordee
- chorea
- choroidal atrophy
- chronic pain
- circulatory collapse
- cirrhosis
- citraturia
- claudication
- clitoromegaly
- cloacal exstrophy
- clonus
- club foot
- clumsiness
- coagulopathy
- coarctation
- coeliac disease
- cognitive problems
- cold intolerance
- collapse
- colour blindness
- coma
- concentration difficulties
- confusion
- congenital heart defect
- conjunctivitis
- constipation
- convulsions
- coordination difficulties
- coughing
- crackles
- cramps
- craniofacial abnormalities
- craniotabes
- cutaneous ischaemia
- cutaneous myxoma
- cutaneous pigmentation
- cyanosis
- dalrymple's sign
- deafness
- deep vein thrombosis
- dehydration
- delayed puberty
- delirium
- dementia
- dental abscess(es)
- dental problems
- depression
- diabetes insipidus
- diabetic neuropathy
- diabetic foot infection
- diabetic foot neuropathy
- diabetic foot ulceration
- diarrhoea
- diplopia
- dizziness
- duodenal atresia
- duplex kidney(s)
- dysarthria
- dysdiadochokinesia
- dysgraphia
- dyslexia
- dyslipidaemia
- dysmenorrhoea
- dyspareunia
- dyspepsia
- dysphagia
- dysphonia
- dysphoria
- dyspnoea
- dystonia
- dysuria
- ear, nose and/or throat infection
- early menarche
- ears - low set
- ears - pinna abnormalities
- ears - small
- ecchymoses
- ectopic ureter
- emotional immaturity
- encopresis
- endometrial hyperplasia
- enlarged bladder
- enlarged prostate
- eosinophilia
- epicanthic fold
- epilepsy
- epistaxis
- erectile dysfunction
- erythema
- euphoria
- eyebrows - bushy
- eyelid retraction
- eyelid swelling
- eyelids - redness
- eyes - almond-shaped
- eyes - dry
- eyes - feeling of grittiness
- eyes - inflammation
- eyes - irritation
- eyes - itching
- eyes - pain (gazing down)
- eyes - pain (gazing up)
- eyes - redness
- eyes - watering
- face - change in appearance
- face - coarse features
- face - numbness
- facial fullness
- facial palsy
- facial plethora
- facial weakness
- facies - abnormal
- facies - hippocratic
- facies - moon
- faecal incontinence
- failure to thrive
- fallopian tube hyperplasia
- fasciculation
- fatigue
- fatigue (post-exertional)
- feet - cold
- feet - increased size
- feet - large
- feet - pain
- feet - small
- fingers - thick
- flaccid paralysis
- flatulence
- flushing
- fontanelles - enlarged
- frontal bossing
- fungating lesion
- fungating mass
- funny turns
- gait abnormality
- gait unsteadiness
- gallbladder calculi
- gallstones
- gangrene
- gastro-oesophageal reflux
- genital oedema
- genu valgum
- genu varum
- gestational diabetes
- glaucoma
- glucose intolerance
- glucosuria
- growth hormone deficiency
- growth retardation
- haematemesis
- haematochezia
- haematoma
- haematuria
- haemoglobinuria
- haemoptysis
- hair - coarse
- hair - dry
- hair - temporal balding
- hairline - low
- hallucination
- hands - enlargement
- hands - large
- hands - single palmar crease
- hands - small
- head - large
- headache
- hearing loss
- heart failure
- heart murmur
- heat intolerance
- height loss
- hemiballismus
- hemianopia
- hemiparesis
- hemispatial neglect
- hepatic cysts
- hepatic metastases
- hepatomegaly
- hidradenitis suppurativa
- high-arched palate
- hip dislocation
- hippocampal dysgenesis
- hirschsprung's disease
- hot flushes
- hydronephrosis
- hypolipidaemia
- hyperactivity
- hyperacusis
- hyperandrogenaemia
- hypercalciuria
- hypercapnea
- hypercholesterolaemia
- hypercortisolaemia
- hyperflexibility
- hyperglucagonaemia
- hyperhidrosis
- hyperhomocysteinaemia
- hypernasal speech
- hyperopia
- hyperoxaluria
- hyperpigmentation
- hyperplasia
- hyperpnoea
- hypersalivation
- hyperseborrhea
- hypersomnia
- hyperthermia
- hypertrichosis
- hypertrophy
- hyperuricaemia
- hyperventilation
- hypoadrenalism
- hypoalbuminaemia
- hypocalciuria
- hypocitraturia
- hypomagnesaemia
- hypopigmentation
- hypoplastic scrotum
- hypopotassaemia
- hypoprolactinaemia
- hyporeflexia
- hyposmia
- hypospadias
- hypotension
- hypothermia
- hypotonia
- hypoventilation
- hypovitaminosis d
- hypovolaemia
- hypovolaemic shock
- hypoxia
- immunodeficiency
- impulsivity
- inattention
- infections
- inflexibility
- insomnia
- instability
- intussusception
- irritability
- ischaemia
- ischuria
- itching
- jaundice
- keratoconus
- ketonuria
- ketotic odour
- kidney dysplasia
- kidney stones
- kyphoscoliosis
- kyphosis
- labioscrotal fold abnormalities
- laceration
- late dentition
- learning difficulties
- leg pain
- legs - increased length
- leukaemia
- leukocytosis
- libido increase
- libido reduction/loss
- lichen sclerosus
- lips - dry
- lips - thin
- little finger - in-curved
- little finger - short
- liver masses
- lordosis
- lordosis (loss of)
- lymphadenectomy
- lymphadenitis
- lymphocytosis
- lymphoedema
- macroglossia
- malaise
- malaise (post-exertional)
- malodorous perspiration
- mania
- marcus gunn pupil
- mastalgia
- meckel's diverticulum
- melena
- menorrhagia
- menstrual disorder
- mesenteric ischaemia
- metabolic alkalosis
- microalbuminuria
- microcephaly
- micrognathia
- micropenis
- milk-alkali syndrome
- miscarriage
- mood changes/swings
- mouth - down-turned
- mouth - small
- movement - limited range of
- mucosal pigmentation
- muscle atrophy
- muscle freezing
- muscle hypertrophy
- muscle rigidity
- myalgia
- myasthaenia
- mydriasis
- myelodysplasia
- myeloma
- myoclonus
- myodesopsia
- myokymia
- myopathy
- myopia
- myosis
- nail clubbing
- nail dystrophy
- nasal obstruction
- nausea
- neck - loose skin (nape)
- neck - short
- neck mass
- neck pain/discomfort
- necrolytic migratory erythema
- necrosis
- nephrocalcinosis
- nephropathy
- neurofibromas
- night terrors
- nipple change
- nipple discharge
- nipple inversion
- nipple retraction
- nipples widely spaced
- nocturia
- normochromic normocytic anaemia
- nose - depressed bridge
- nose - flat bridge
- nose - thickening
- nystagmus
- obsessive-compulsive disorder
- obstetrical haemorrhage
- obstructive sleep apnoea
- odynophagia
- oedema
- oesophageal atresia
- oesophagitis
- oligomenorrhoea
- oliguria
- onychauxis
- oophoritis
- ophthalmoplegia
- optic atrophy
- orbital fat prolapse
- orbital hypertelorism
- orthostatic hypotension
- osteoarthritis
- osteopenia
- otitis media
- ovarian cysts
- ovarian hyperplasia
- palatoschisis
- pallor
- palmar erythema
- palpebral fissure (downslanted)
- palpebral fissure (extended)
- palpebral fissure (reduced)
- palpebral fissure (upslanted)
- palpitations
- pancreatic fibrosis
- pancytopaenia
- panic attacks
- papilloedema
- paraesthesia
- paralysis
- paranoia
- patellar dislocation
- patellar subluxation
- pedal ulceration
- pellagra
- pelvic mass
- pelvic pain
- penile agenesis
- peptic ulcer
- pericardial effusion
- periodontitis
- periosteal bone reactions
- peripheral oedema
- personality change
- pes cavus
- petechiae
- peyronie's disease
- pharyngitis
- philtrum - long
- philtrum - short
- phosphaturia
- photophobia
- photosensitivity
- pleurisy
- poikiloderma
- polydactyly
- polydipsia
- polyphagia
- polyuria
- poor wound healing
- postmenopausal bleeding
- post-nasal drip
- postprandial fullness
- postural instability
- prehypertension
- premature birth
- premature labour
- prenatal growth retardation
- presbyopia
- pretibial myxoedema
- proctalgia fugax
- prognathism
- proptosis
- prosopagnosia
- proteinuria
- pruritus
- pruritus scroti
- pruritus vulvae
- pseudarthrosis
- psoriatic arthritis
- psychiatric problems
- psychomotor retardation
- psychosis
- pterygium colli
- ptosis
- puberty (delayed/absent)
- puberty (early/precocious)
- puffiness
- pulmonary embolism
- purpura
- pyelonephritis
- pyloric stenosis
- pyrexia
- pyrosis
- pyuria
- rash
- rectal pain
- rectorrhagia
- refractory anemia
- reluctance to weight-bear
- renal agenesis
- renal clubbing
- renal colic
- renal cyst
- renal failure
- renal insufficiency
- renal phosphate wasting (isolated)
- renal tubular acidosis
- respiratory failure
- reticulocytosis
- retinitis pigmentosa
- retinopathy
- retrobulbar pain
- retrograde ejaculation
- retroperitoneal fibrosis
- salivary gland swelling
- salpingitis
- salt craving
- salt wasting
- sarcoidosis
- schizophrenia
- scoliosis
- scotoma
- seborrhoeic dermatitis
- seizures
- sensory loss
- sepsis
- septic arthritis
- septic shock
- shivering
- singultus
- sinusitis
- sixth nerve palsy
- skeletal deformity
- skeletal dysplasia
- skin - texture change
- skin infections
- skin necrosis
- skin pigmentation - spotty
- skin thickening
- skin thinning
- sleep apnoea
- sleep difficulties
- sleep disturbance
- sleep hyperhidrosis
- slow growth
- slurred speech
- social difficulties
- soft tissue swelling
- somnambulism
- somniloquy
- somnolence
- sore throat
- spasms
- spastic paraplegia
- spasticity
- speech delay
- spider naevi
- splenomegaly
- sputum production
- steatorrhoea
- stomatitis
- strabismus
- strangury
- striae
- stridor
- stroke
- subfertility
- suicidal ideation
- supraclavicular fat pads
- supranuclear gaze palsy
- sweating
- syncope
- syndactyly
- tachycardia
- tachypnoea
- teeth gapping
- telangiectasias
- telecanthus
- tetraparesis
- t-reflex (absent)
- t-reflex (depressed)
- tetany
- thermodysregulation
- thrombocytopenia
- thrombocytosis
- thrombophilia
- thrush
- tics
- tinnitus
- toe clubbing
- toe deformities
- toes - thick
- toes - widely spaced
- tongue - protruding
- tracheo-oesophageal compression
- tracheo-oesophageal fistula
- tremulousness
- tricuspid insufficiency
- umbilical hernia
- uraemia
- ureter duplex
- uricaemia
- urinary frequency
- urinary incontinence
- urogenital sinus
- urticaria
- uterine hyperplasia
- uterus duplex
- vagina duplex
- vaginal bleeding
- vaginal discharge
- vaginal dryness
- vaginal pain/tenderness
- vaginism
- ventricular fibrillation
- ventricular hypertrophy
- vertigo
- viraemia
- virilisation (abnormal)
- vision - acuity reduction
- vision - blurred
- visual disturbance
- visual field defect
- visual impairment
- visual loss
- vitiligo
- vocal cord paresis
- vomiting
- von graefe's sign
- weight gain
- weight loss
- wheezing
- widened joint space(s)
- xeroderma
- xerostomia
- 3-methoxy 4-hydroxy mandelic acid
- 17-hydroxypregnenolone (urine)
- 17-ketosteroids
- 25-hydroxyvitamin-d3
- 5hiaa
- aberrant adrenal receptors
- acid-base balance
- acth stimulation
- activated partial thromboplastin time
- acyl-ghrelin
- adrenal antibodies
- adrenal function
- adrenal scintigraphy
- adrenal venous sampling
- afp tumour marker
- alanine aminotransferase
- albumin
- albumin to creatinine ratio
- aldosterone (24-hour urine)
- aldosterone (blood)
- aldosterone (plasma)
- aldosterone (serum)
- aldosterone to renin ratio
- alkaline phosphatase
- alkaline phosphatase (bone-specific)
- alpha-fetoprotein
- ammonia
- amniocentesis
- amylase
- angiography
- anion gap
- anti-acetylcholine antibodies
- anticardiolipin antibody
- anti-insulin antibodies
- anti-islet cell antibody
- anti-gh antibodies
- antinuclear antibody
- anti-tyrosine phosphatase antibodies
- asvs
- barium studies
- basal insulin
- base excess
- apolipoprotein h
- beta-hydroxybutyrate
- bicarbonate
- bilirubin
- biopsy
- blood film
- blood pressure
- bmi
- body fat mass
- bone age
- bone biopsy
- bone mineral content
- bone mineral density
- bone mineral density test
- bone scintigraphy
- bone sialoprotein
- bound insulin
- brca1/brca2
- c1np
- c3 complement
- c4 complement
- ca125
- calcifediol
- calcium (serum)
- calcium (urine)
- calcium to creatinine clearance ratio
- carcinoembryonic antigen
- cardiac index
- catecholamines (24-hour urine)
- catecholamines (plasma)
- cd-56
- chemokines
- chest auscultation
- chloride
- chorionic villus sampling
- chromatography
- chromogranin a
- chromosomal analysis
- clomid challenge
- clonidine suppression
- collagen
- colonoscopy
- colposcopy
- continuous glucose monitoring
- core needle biopsy
- corticotropin-releasing hormone stimulation test
- cortisol (9am)
- cortisol (plasma)
- cortisol (midnight)
- cortisol (salivary)
- cortisol (serum)
- cortisol day curve
- cortisol, free (24-hour urine)
- c-peptide (24-hour urine)
- c-peptide (blood)
- c-reactive protein
- creatinine
- creatine kinase
- creatinine (24-hour urine)
- creatinine (serum)
- creatinine clearance
- crh stimulation
- ctpa scan
- ct scan
- c-telopeptide
- cytokines
- deoxypyridinoline
- dexa scan
- dexamethasone suppression
- dexamethasone suppression (high dose)
- dexamethasone suppression (low dose)
- dhea sulphate
- discectomy
- dldl cholesterol
- dmsa scan
- dna sequencing
- domperidone
- down syndrome screening
- ductal lavage
- echocardiogram
- eeg
- electrocardiogram
- electrolytes
- electromyography
- endoscopic ultrasound
- endoscopy
- endosonography
- enzyme immunoassay
- epinephrine (plasma)
- epinephrine (urine)
- erythrocyte sedimentation rate
- estimated glomerular filtration rate
- ethanol ablation
- ewing and clarke autonomic function
- exercise tolerance
- fbc
- ferritin
- fine needle aspiration biopsy
- flow cytometry
- fludrocortisone suppression
- fluticasone-propionate-17-beta carboxylic acid
- fmri
- folate
- ft3
- ft4
- gada
- gallium nitrate
- gallium scan
- gastric biopsy
- genetic analysis
- genitography
- gh day curve
- gh stimulation
- gh suppression
- glp-1
- glp-2
- glucose suppression test
- glucose (blood)
- glucose (blood, fasting)
- glucose (blood, postprandial)
- glucose (urine)
- glucose tolerance
- glucose tolerance (intravenous)
- glucose tolerance (oral)
- glucose tolerance (prolonged)
- gluten sensitivity
- gnrh stimulation
- gonadotrophins
- growth hormone-releasing peptide-2 test
- gut hormones (fasting)
- haematoxylin and eosin staining
- haemoglobin
- haemoglobin a1c
- hcg (serum)
- hcg (urine)
- hcg stimulation
- hdl cholesterol
- hearing test
- heart rate
- hepatic venous sampling with arterial stimulation
- high-sensitivity c-reactive protein
- histopathology
- hla genotyping
- holter monitoring
- homa
- homocysteine
- hyaluronic acid
- hydrocortisone day curve
- hydroxyproline
- hydroxyprogesterone
- hysteroscopy
- igfbp2
- igfbp3
- igg4/igg ratio
- immunocytochemistry
- immunohistochemistry
- immunoglobulins
- immunoglobulin g2
- immunoglobulin g4
- immunoglobulin a
- immunoglobulin m
- immunostaining
- inferior petrosal sinus sampling
- inhibin b
- insulin (fasting)
- insulin suppression
- insulin tissue resistance tests
- insulin tolerance
- intracranial pressure
- irm imaging
- ketones (plasma)
- ketones (urine)
- kidney function
- lactate
- lactate dehydrogenase
- laparoscopy
- laparoscopy and dye
- laparotomy
- ldl cholesterol
- leuprolide acetate stimulation
- leukocyte esterase (urine)
- levothyroxine absorption
- lipase (serum)
- lipid profile
- liquid-based cytology
- liquid chromatography-mass spectrometry
- liver biopsy
- liver function
- lumbar puncture
- lung function testing
- luteinising hormone releasing hormone test
- macroprolactin
- magnesium
- mag3 scan
- mammogram
- mantoux test
- metanephrines (plasma)
- metanephrines (urinary)
- methoxytyramine
- metoclopramide
- metyrapone cortisol day curve
- metyrapone suppression
- metyrapone test dose
- mibg scan
- microarray analysis
- molecular genetic analysis
- mri
- myocardial biopsy
- nerve conduction study
- neuroendocrine markers
- neuron-specific enolase
- norepinephrine
- ntx
- oct
- octreotide scan
- octreotide suppression test
- osmolality
- ovarian venous sampling
- p1np
- palpation
- pap test
- parathyroid scintigraphy
- pentagastrin
- perchlorate discharge
- percutaneous umbilical blood sampling
- peripheral blood film
- pet scan
- ph (blood)
- phosphate (serum)
- phosphate (urine)
- pituitary function
- plasma osmolality
- plasma viscosity
- platelet count
- pneumococcal antigen
- pneumococcal pcr
- polymerase chain reaction
- polysomnography
- porter-silber chromogens
- potassium
- pregnancy test
- proinsulin
- prostate-specific antigen
- protein electrophoresis
- protein fingerprinting
- protein folding analysis
- psychiatric assessment
- psychometric assessment
- pulse oximetry
- pyelography
- pyridinium crosslinks
- quicki
- plasma renin activity
- radioimmunoassay
- radionuclide imaging
- raiu test
- red blood cell count
- renal biopsy
- renin (24-hour urine)
- respiratory status
- renin (blood)
- renin plasma activity
- rheumatoid factor
- salt loading
- sdldl cholesterol
- secretin stimulation
- selective parathyroid venous sampling
- selective transhepatic portal venous sampling
- semen analysis
- serotonin
- serum osmolality
- serum free insulin
- sestamibi scan
- sex hormone binding globulin
- shbg
- skeletal muscle mass
- skin biopsy
- sleep diary
- sodium
- spect scan
- supervised 72-hour fast
- surgical biopsy
- sweat test
- synaptophysin
- systemic vascular resistance index
- tanner scale
- thoracocentesis
- thyroid transcription factor-1
- thyroglobulin
- thyroid antibodies
- thyroid function
- thyroid scintigraphy
- thyroid ultrasonography
- total cholesterol
- total ghrelin
- total t3
- total t4
- trabecular thickness
- transaminase
- transvaginal ultrasound
- trap 5b
- trh stimulation
- triglycerides
- triiodothyronine (t3) suppression
- troponin
- tsh receptor antibodies
- type 3 precollagen
- type 4 collagen
- ultrasound-guided biopsy
- ultrasound scan
- urea and electrolytes
- uric acid (blood)
- uric acid (urine)
- urinalysis
- urinary free cortisol
- urine 24-hour volume
- urine osmolality
- vaginal examination
- vanillylmandelic acid (24-hour urine)
- visual field assessment
- vitamin b12
- vitamin e
- waist circumference
- water deprivation
- water load
- weight
- western blotting
- white blood cell count
- white blood cell differential count
- x-ray
- zinc
- abscess drainage
- acetic acid injection
- adhesiolysis
- adrenalectomy
- amputation
- analgesics
- angioplasty
- arthrodesis
- assisted reproduction techniques
- bariatric surgery
- bilateral salpingo-oophorectomy
- blood transfusion
- bone grafting
- caesarean section
- cardiac transplantation
- cardiac pacemaker
- cataract extraction
- chemoembolisation
- chemotherapy
- chemoradiotherapy
- clitoroplasty
- continuous renal replacement therapy
- contraception
- cordotomy
- counselling
- craniotomy
- cryopreservation
- cryosurgical ablation
- debridement
- dialysis
- diazoxide
- diet
- duodenotomy
- endonasal endoscopic surgery
- exercise
- external fixation
- extracorporeal shock wave lithotripsy
- extraocular muscle surgery
- eye surgery
- eyelid surgery
- fasciotomy
- fluid repletion
- fluid restriction
- gamma knife radiosurgery
- gastrectomy
- gastrostomy
- gender reassignment surgery
- gonadectomy
- heart transplantation
- hormone replacement
- hormone suppression
- hypophysectomy
- hysterectomy
- inguinal orchiectomy
- internal fixation
- intra-cardiac defibrillator
- islet transplantation
- ivf
- kidney transplantation
- laparoscopic adrenalectomy
- laryngoplasty
- laryngoscopy
- laser lithotripsy
- light treatment
- liver transplantation
- lumpectomy
- lymph node dissection
- mastectomy
- molecularly targeted therapy
- neuroendoscopic surgery
- oophorectomy
- orbital decompression
- orbital radiation
- orchidectomy
- orthopaedic surgery
- osteotomy
- ovarian cystectomy
- ovarian diathermy
- oxygen therapy
- pancreas transplantation
- pancreatectomy
- pancreaticoduodenectomy
- parathyroidectomy
- percutaneous adrenal ablation
- percutaneous nephrolithotomy
- pericardiocentesis
- pericardiotomy
- physiotherapy
- pituitary adenomectomy
- plasma exchange
- plasmapheresis
- psychotherapy
- radiofrequency ablation
- radionuclide therapy
- radiotherapy
- reconstruction of genitalia
- resection of tumour
- right-sided hemicolectomy
- salpingo-oophorectomy
- small bowel resection
- speech and language therapy
- spinal surgery
- splenectomy
- stereotactic radiosurgery
- termination of pregnancy
- thymic transplantation
- thyroidectomy
- tracheostomy
- transcranial surgery
- transsphenoidal surgery
- transtentorial surgery
- vaginoplasty
- vagotomy
- 5-alpha-reductase inhibitors
- 17?-estradiol
- abiraterone
- acarbose
- acetazolamide
- acetohexamide
- adalimumab
- albiglutide
- alendronate
- alogliptin
- alpha-blockers
- alphacalcidol
- alpha-glucosidase inhibitors
- amiloride
- amlodipine
- amoxicillin
- anastrozole
- angiotensin-converting enzyme inhibitors
- angiotensin receptor antagonists
- anthracyclines
- antiandrogens
- antibiotics
- antiemetics
- antiepileptics
- antipsychotics
- antithyroid drugs
- antiseptic
- antivirals
- aripiprazole
- aromatase inhibitors
- aspirin
- astragalus membranaceus
- ativan
- atenolol
- atorvastatin
- avp receptor antagonists
- axitinib
- azathioprine
- bendroflumethiazide
- benzodiazepines
- beta-blockers
- betamethasone
- bexlosteride
- bicalutamide
- bisphosphonates
- bleomycin
- botulinum toxin
- bromocriptine
- cabergoline
- cabozantinib
- calcimimetics
- calcitonin (salmon)
- calcium
- calcium carbonate
- calcium chloride
- calcium dobesilate
- calcium edta
- calcium gluconate
- calcium-l-aspartate
- calcium polystyrene sulphonate
- canagliflozin
- capecitabine
- captopril
- carbimazole
- carboplatin
- carbutamide
- carvedilol
- ceftriaxone
- chlorothiazide
- chlorpropamide
- cholecalciferol
- cholinesterase inhibitors
- ciclosporin
- cinacalcet
- cisplatin
- clodronate
- clomifene
- clomiphene citrate
- clopidogrel
- co-cyprindiol
- codeine
- colonic polyps
- combined oral contraceptive pill
- conivaptan
- cortisone acetate
- continuous subcutaneous hydrocortisone infusion
- continuous subcutaneous insulin infusion
- coumadin
- corticosteroids
- cortisol
- cyproterone acetate
- dacarbazine
- danazol
- dapagliflozin
- daunorubicin
- deferiprone
- demeclocycline
- denosumab
- desmopressin
- dexamethasone
- diazepam
- diethylstilbestrol
- digoxin
- diltiazem
- diphenhydramine
- diuretics
- docetaxel
- dopamine agonists
- dopamine antagonists
- dopamine receptor agonists
- doxazosin
- doxepin
- doxorubicin
- dpp4 inhibitors
- dutasteride
- dutogliptin
- eflornithine
- enoxaparin
- empagliflozin
- epinephrine
- epirubicin
- eplerenone
- epristeride
- equilenin
- equilin
- erlotinib
- ethinylestradiol
- etidronate
- etomidate
- etoposide
- everolimus
- exenatide
- fenofibrate
- finasteride
- fluconazole
- fluticasone
- fludrocortisone
- fluorouracil
- fluoxetine
- flutamide
- furosemide
- gaba receptor antagonists
- gefitinib
- gemcitabine
- gemigliptin
- ginkgo biloba
- glibenclamide
- glibornuride
- gliclazide
- glimepiride
- glipizide
- gliquidone
- glisoxepide
- glp1 agonists
- glucose
- glyclopyramide
- gnrh analogue
- gnrh antagonists
- heparin
- hrt (menopause)
- hydrochlorothiazide
- hydrocortisone
- ibandronate
- ibuprofen
- idarubicin
- idebenone
- imatinib
- immunoglobulin therapy
- implanon
- indapamide
- infliximab
- iron supplements
- isoniazid
- insulin aspart
- insulin glargine
- insulin glulisine
- insulin lispro
- interferon
- intrauterine system
- iopanoic acid
- ipilimumab
- ipragliflozin
- irbesartan
- izonsteride
- ketoconazole
- labetalol
- lactulose
- lanreotide
- leuprolide acetate
- levatinib
- levodopa
- levonorgestrel
- levothyroxine
- linagliptin
- liothyronine
- liraglutide
- lithium
- lisinopril
- lixivaptan
- loperamide
- loprazolam
- lormetazepam
- losartan
- low calcium formula
- magnesium glycerophosphate
- magnesium sulphate
- mecasermin
- medronate
- medroxyprogesterone acetate
- meglitinides
- menotropin
- metformin
- methadone
- methimazole
- methylprednisolone
- metoprolol
- metyrapone
- miglitol
- mitotane
- mitoxantrone
- mozavaptan
- mtor inhibitors
- multivitamins
- naproxen
- natalizumab
- nateglinide
- nelivaptan
- neridronate
- nifedipine
- nilutamide
- nitrazepam
- nivolumab
- nsaid
- octreotide
- oestradiol valerate
- olanzapine
- olpadronate
- omeprazole
- opioids
- oral contraceptives
- orlistat
- ornipressin
- otelixizumab
- oxandrolone
- oxidronate
- oxybutynin
- paclitaxel
- pamidronate
- pancreatic enzymes
- pantoprazole
- paracetamol
- paroxetine
- pasireotide
- pegvisomant
- perindopril
- phenobarbital
- phenoxybenzamine
- phosphate binders
- phosphate supplements
- phytohaemagglutinin induced interferon gamma
- pioglitazone
- plicamycin
- potassium chloride
- potassium iodide
- pramlintide
- prazosin
- prednisolone
- prednisone
- premarin
- promethazine
- propranolol
- propylthiouracil
- protease inhibitors
- proton pump inhibitors
- pyridostigmine
- quetiapine
- quinagolide
- quinestrol
- radioactive mibg
- radioactive octreotide
- radioiodine
- raloxifene
- ramipril
- relcovaptan
- remogliflozin etabonate
- repaglinide
- risperidone
- risedronate
- rituximab
- romidepsin
- rosiglitazone
- salbutamol
- saline
- salmeterol
- salt supplements
- satavaptan
- saxagliptin
- selective progesterone receptor modulators
- selenium
- sglt2 inhibitors
- sildenafil
- simvastatin
- sirolimus
- sitagliptin
- sodium bicarbonate
- sodium chloride
- sodium polystyrene sulfonate (kayexalate)
- somatostatin analogues
- sorafenib
- spironolactone
- ssris
- statins
- streptozotocin
- steroids
- strontium ranelate
- sucralfate
- sulphonylureas
- sunitinib
- tamoxifen
- taspoglutide
- temazepam
- temozolomide
- teplizumab
- terazosin
- teriparatide
- testolactone
- testosterone enanthate esters
- tetrabenazine
- thalidomide
- thiazolidinediones
- thyrotropin alpha
- tibolone
- tiludronate
- tiratricol (triac)
- tofogliflozin
- tolazamide
- tolbutamide
- tolvaptan
- tramadol
- trastuzumab
- trazodone
- triamcinolone
- triamterene
- trimipramine
- troglitazone
- tryptophan
- turosteride
- tyrosine-kinase inhibitors
- valproic acid
- valrubicin
- vandetanib
- vaptans
- vildagliptin
- vinorelbine
- voglibose
- vorinostat
- warfarin
- zaleplon
- z-drugs
- zoledronic acid
- zolpidem
- zopiclone
- cardiology
- dermatology
- gastroenterology
- general practice
- genetics
- geriatrics
- gynaecology
- nephrology
- neurology
- nursing
- obstetrics
- oncology
- otolaryngology
- paediatrics
- pathology
- podiatry
- psychology/psychiatry
- radiology/rheumatology
- rehabilitation
- surgery
- urology
- insight into disease pathogenesis or mechanism of therapy
- novel diagnostic procedure
- novel treatment
- unique/unexpected symptoms or presentations of a disease
- new disease or syndrome: presentations/diagnosis/management
- unusual effects of medical treatment
- error in diagnosis/pitfalls and caveats
- february
- 2022
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Affiliation(s)
- Aria Jazdarehee
- Department of Medicine and Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Sawyer Huget-Penner
- Division of Endocrinology and Metabolism, Fraser Health Authority, British Columbia, Canada
| | - Monika Pawlowska
- Division of Endocrinology and Metabolism, University of British Columbia, British Columbia, Canada
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15
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Devillaine L, Lambert R, Boutet J, Aloui S, Brault V, Jolly C, Labyt E. Analysis of Graphomotor Tests with Machine Learning Algorithms for an Early and Universal Pre-Diagnosis of Dysgraphia. Sensors (Basel) 2021; 21:s21217026. [PMID: 34770333 PMCID: PMC8588387 DOI: 10.3390/s21217026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
Five to ten percent of school-aged children display dysgraphia, a neuro-motor disorder that causes difficulties in handwriting, which becomes a handicap in the daily life of these children. Yet, the diagnosis of dysgraphia remains tedious, subjective and dependent to the language besides stepping in late in the schooling. We propose a pre-diagnosis tool for dysgraphia using drawings called graphomotor tests. These tests are recorded using graphical tablets. We evaluate several machine-learning models and compare them to build this tool. A database comprising 305 children from the region of Grenoble, including 43 children with dysgraphia, has been established and diagnosed by specialists using the BHK test, which is the gold standard for the diagnosis of dysgraphia in France. We performed tests of classification by extracting, correcting and selecting features from the raw data collected with the tablets and achieved a maximum accuracy of 73% with cross-validation for three models. These promising results highlight the relevance of graphomotor tests to diagnose dysgraphia earlier and more broadly.
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Affiliation(s)
- Louis Devillaine
- CEA, University Grenoble Alpes, Leti, 38000 Grenoble, France; (L.D.); (R.L.); (J.B.); (S.A.)
| | - Raphaël Lambert
- CEA, University Grenoble Alpes, Leti, 38000 Grenoble, France; (L.D.); (R.L.); (J.B.); (S.A.)
- CNRS, University Grenoble Alpes, University Savoie Mont Blanc, LPNC, 38000 Grenoble, France;
| | - Jérôme Boutet
- CEA, University Grenoble Alpes, Leti, 38000 Grenoble, France; (L.D.); (R.L.); (J.B.); (S.A.)
| | - Saifeddine Aloui
- CEA, University Grenoble Alpes, Leti, 38000 Grenoble, France; (L.D.); (R.L.); (J.B.); (S.A.)
| | - Vincent Brault
- CNRS, University Grenoble Alpes, Grenoble INP, LJK, 38000 Grenoble, France;
| | - Caroline Jolly
- CNRS, University Grenoble Alpes, University Savoie Mont Blanc, LPNC, 38000 Grenoble, France;
| | - Etienne Labyt
- CEA, University Grenoble Alpes, Leti, 38000 Grenoble, France; (L.D.); (R.L.); (J.B.); (S.A.)
- Correspondence: ; Tel.: +33-(0)4-38-78-06-87
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16
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Yuen C, Rezania K, Kelly T, Bishop MR. Clinical predictors of chimeric antigen receptor T-cell therapy neurotoxicity: a single-center study. Immunotherapy 2021; 13:1261-1269. [PMID: 34558978 DOI: 10.2217/imt-2021-0084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aims: Neurotoxicity (NT) is a common complication of chimeric antigen receptor (CAR) T-cell therapy. Data on early clinical identifiers for impending severe NT are lacking. Methods: The authors performed a retrospective study on 26 adult relapsed/refractory diffuse large B cell lymphoma patients treated with commercial CAR T-cell therapy (December 2017 - September 2018). Results: NT of any grade and severe NT occurred in 88 and 31% of patients, respectively. Dysgraphia (p < 0.01), disorientation (p = 0.01) and inattention (p = 0.018) were associated with severe NT, with positive predictive values of 100, 87.5 and 87.5%, respectively. Dysnomia was not associated with severe NT. Conclusion: In the authors' limited cohort, the dysgraphia, disorientation and inattention components of the CAR T-cell therapy-associated toxicity 10 scoring system were significantly associated with and predictive of impending severe NT.
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Affiliation(s)
- Carlen Yuen
- Department of Neuro-Oncology, Columbia University, New York, NY 10033 USA.,Department of Neurology, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Kourosh Rezania
- Department of Neurology, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Thomas Kelly
- Department of Neurology, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Michael R Bishop
- Department of Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
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17
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Fornazzari L, Tan YB, Haladyn J, Bharatha A, Barfett J, Wilson-Sanchez M, Afroz N, Fischer CE. The painter who changed her brain at the flick of a switch. Neurocase 2021; 27:333-337. [PMID: 34436984 DOI: 10.1080/13554794.2021.1954198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The study of artists with acquired brain damage is an empirical way to investigate the multiplicity of cerebral changes that occur with artistic training. We describe a talented painter with a left progressive cerebral lesion. In spite of losing function of her right hand, she regained dexterity of the left one in ten days for painting and drawing but not for writing. We discuss two potential explanations for her rapid recovery: (a) her extensive artistic training and/or (b) the slow-growing nature of her cerebral lesion.
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Affiliation(s)
- Luis Fornazzari
- Keenan Research Centre for Biomedical Research, St Michael's Hospital, London, UK.,, University of Toronto, Toronto, Canada.,Faculty of Music, University of Toronto, Toronto, Canada
| | - Yu Bin Tan
- Keenan Research Centre for Biomedical Research, St Michael's Hospital, London, UK.,Department of Psychology, University of Toronto Scarborough, Scarborough, Canada
| | | | - Aditya Bharatha
- Neuro Radiology Department, St Michael's Hospital, London, UK
| | - Joseph Barfett
- Neuro Radiology Department, St Michael's Hospital, London, UK.,Nuclear Medicine Department, St Michael's Hospital, Toronto, Canada
| | - Maya Wilson-Sanchez
- OCAD University, Toronto, Canada.,Art History, University of Toronto, Toronto, Canada
| | - Nausheen Afroz
- Keenan Research Centre for Biomedical Research, St Michael's Hospital, London, UK
| | - Corinne E Fischer
- Keenan Research Centre for Biomedical Research, St Michael's Hospital, London, UK.,Department of Psychiatry, Division of Geriatric Psychiatry, University of Toronto, Toronto, Canada
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18
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Zham P, Poosapadi SA, Kempster P, Raghav S, Nagao KJ, Wong K, Kumar D. Differences in Levodopa Response for Progressive and Non-Progressive Micrographia in Parkinson's Disease. Front Neurol 2021; 12:665112. [PMID: 34046005 PMCID: PMC8147867 DOI: 10.3389/fneur.2021.665112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Micrographia, one element of the dysgraphia of Parkinson's disease (PD), may be classified according to the presence or absence of a decremental pattern. The decremental form, progressive micrographia, is an expression of the sequence effect seen generally in bradykinesia. Its responsiveness to levodopa has not been evaluated kinematically. Objectives: Aim of this study is to investigate the difference in levodopa response for progressive and non-progressive micrographia. Methods: Twenty-four PD patients and 24 age-matched repeatedly wrote the letter e on a computerized digital tablet. PD patients performed the task two times, in a defined off state and again after levodopa. Scripts were classified as progressive micrographia (PDPM) or non-progressive micrographia (PDNPM) depending on whether a 10% decrement was seen between the first and final characters of a line of lettering. Results: While levodopa produced a similar response on the MDS-UPDRS motor scale for the two groups, the effect on the two types of micrographia was different. While writing speed improved significantly in both groups after levodopa, the responses were over twofold greater for PDNPM. Moreover, the decremental features of PDPM-in size, speed, and pen-pressure-were largely unaltered by a levodopa dose. Conclusions: Progressive micrographia is less responsive to levodopa. Our findings agree with research showing that the sequence effect of bradykinesia is relatively resistant to medication. Yet we did not find a weaker overall levodopa motor benefit. Caution is needed in the interpretation of such micrographia measurements for estimating drug responses.
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Affiliation(s)
- Poonam Zham
- School of Engineering, RMIT University, Melbourne, VIC, Australia.,IBM Research Australia, Southbank, VIC, Australia
| | - Sridhar A Poosapadi
- School of Engineering, RMIT University, Melbourne, VIC, Australia.,Center for Human Movement Research and Analysis, Department of Electronics and Instrumentation, SRM Institute of Science and Technology, Chennai, India
| | - Peter Kempster
- Department of Medicine, Monash University, Clayton, VIC, Australia.,Neurosciences Department, Monash Medical Centre, Melbourne, VIC, Australia
| | - Sanjay Raghav
- School of Engineering, RMIT University, Melbourne, VIC, Australia.,Neurosciences Department, Monash Medical Centre, Melbourne, VIC, Australia
| | - Kanae J Nagao
- Neurosciences Department, Monash Medical Centre, Melbourne, VIC, Australia
| | - Kitty Wong
- Neurosciences Department, Monash Medical Centre, Melbourne, VIC, Australia
| | - Dinesh Kumar
- School of Engineering, RMIT University, Melbourne, VIC, Australia
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19
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Krajenbrink T, Nickels L, Kohnen S. Serial position effects in graphemic buffer impairment: An insight into components of orthographic working memory. Cogn Neuropsychol 2021; 38:153-177. [PMID: 33886410 DOI: 10.1080/02643294.2021.1914015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study investigated the nature of graphemic buffer functioning and impairment, through analysis of the spelling impairment shown by GEC, a man with acquired dysgraphia and clear characteristics of graphemic buffer impairment. We discuss GEC's error patterns in relation to different processes of orthographic working memory. This is the first study to show the contribution of these processes in one individual through performance on different spelling tasks. GEC's spelling errors in writing to dictation showed a linear serial position effect, including deletions of final letters. These "fragment errors" can be explained as the result of information rapidly decaying from the buffer (reduced temporal stability). However, in tasks that reduced working memory demands, GEC showed a different error distribution that may indicate impairment to a different buffer process (reduced representational distinctiveness). We argue that different error patterns can be a reflection of subcomponents of orthographic working memory that can be impaired separately.
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Affiliation(s)
- Trudy Krajenbrink
- Department of Cognitive Science, Macquarie University, Sydney, Australia.,International Doctorate for Experimental Approaches to Language and Brain (IDEALAB), Macquarie University, Universities of Newcastle, Groningen, Potsdam, Trento
| | - Lyndsey Nickels
- Department of Cognitive Science, Macquarie University, Sydney, Australia
| | - Saskia Kohnen
- Department of Cognitive Science, Macquarie University, Sydney, Australia
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20
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Thapliyal M, Ahuja NJ. Underpinning implications of instructional strategies on assistive technology for learning disability: a meta-synthesis review. Disabil Rehabil Assist Technol 2021; 18:423-431. [PMID: 33449814 DOI: 10.1080/17483107.2020.1864669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This article reviews the instructional strategies used by assistive technologies and maps their problem manifestation and effectiveness for children with learning disabilities. The objective of this article is to investigate the most common types of assistive tools used in learning to study their attributes, limited to the needs of learners with the condition of dyslexia, dysgraphia and dyscalculia. REVIEW METHODS It studies currently available low, mid and high-level assistive learning technologies available to deal with problems faced by these learners. Assistive tools studied in this article range from simple hardware tools to multi-sensory software. A simple analytical framework by interlinking, Problem Manifestation, Underpinned Implication, Instructional Strategy and Cognitive Strength Developed (PISC) is formulated to examine the tools. RESULTS Five assistive tools types (non-electronic products, low-tech products, mid-tech products, high-tech products apps and learning software) for each learning disability are identified, analysed and associated learning implication is studied under PISC framework. This helps to map the problems and learning style of learning disabled and analyses the underpinned implication along with the corresponding development of skills (cognitive, affective or psychomotor) by these assistive technologies. CONCLUSION Performance of identified assistive tool types using PISC framework is analysed. Findings are reported and discussed.Implications for RehabilitationAvailable assistive tools are not learning disability specific. So, in order to differentiate the learning path of a Learning Disabled learner from that of a Non-Learning Disabled learner, study is conducted under four attributes of PISC framework: Problem Manifestation, Underpinned Implication, Instructional Strategy and Cognitive Strength.Available assistive tools in the field of remedial education are found to be problem centric and only able in dealing with single academic learning need of a learner with specific learning difficulty.The mapping of the available assistive technologies under PISC framework provides a detailed structure for the selection of most suited assistive tool as per learning requirement of a learner with learning disability.This study also conclude the non- availability of the High-tech assistive tools and Educational Software specifically designed for learners with learning disability.
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Affiliation(s)
- Monika Thapliyal
- School of Computer Science, University of Petroleum and Energy Studies, Dehradun, India
| | - Neelu Jyothi Ahuja
- School of Computer Science, University of Petroleum and Energy Studies, Dehradun, India
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21
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Gargot T, Asselborn T, Zammouri I, Brunelle J, Johal W, Dillenbourg P, Archambault D, Chetouani M, Cohen D, Anzalone SM. "It Is Not the Robot Who Learns, It Is Me." Treating Severe Dysgraphia Using Child-Robot Interaction. Front Psychiatry 2021; 12:596055. [PMID: 33716812 PMCID: PMC7950539 DOI: 10.3389/fpsyt.2021.596055] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/04/2021] [Indexed: 12/15/2022] Open
Abstract
Writing disorders are frequent and impairing. However, social robots may help to improve children's motivation and to propose enjoyable and tailored activities. Here, we have used the Co-writer scenario in which a child is asked to teach a robot how to write via demonstration on a tablet, combined with a series of games we developed to train specifically pressure, tilt, speed, and letter liaison controls. This setup was proposed to a 10-year-old boy with a complex neurodevelopmental disorder combining phonological disorder, attention deficit/hyperactivity disorder, dyslexia, and developmental coordination disorder with severe dysgraphia. Writing impairments were severe and limited his participation in classroom activities despite 2 years of specific support in school and professional speech and motor remediation. We implemented the setup during his occupational therapy for 20 consecutive weekly sessions. We found that his motivation was restored; avoidance behaviors disappeared both during sessions and at school; handwriting quality and posture improved dramatically. In conclusion, treating dysgraphia using child-robot interaction is feasible and improves writing. Larger clinical studies are required to confirm that children with dysgraphia could benefit from this setup.
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Affiliation(s)
- Thomas Gargot
- Department of Child and Adolescent Psychiatry, APHP, Sorbonne Université, Hôpital de la Pitié-Salpêtrière-Charles Foix, Assistance Publique Hôpitaux de Paris, Paris, France.,CHART EA 4004, THIM, Paris 8 University, Saint Denis, France.,ISIR, Sorbonne Université, CNRS UMR 7222, Paris, France
| | - Thibault Asselborn
- Computer Human Interaction in Learning and Instruction Lab, Ecole Polytechnique Fédérale de Lausanne, Route Cantonale, Lausanne, Switzerland
| | - Ingrid Zammouri
- Department of Child and Adolescent Psychiatry, APHP, Sorbonne Université, Hôpital de la Pitié-Salpêtrière-Charles Foix, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Julie Brunelle
- Department of Child and Adolescent Psychiatry, APHP, Sorbonne Université, Hôpital de la Pitié-Salpêtrière-Charles Foix, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Wafa Johal
- Department of computer Science and Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Pierre Dillenbourg
- Computer Human Interaction in Learning and Instruction Lab, Ecole Polytechnique Fédérale de Lausanne, Route Cantonale, Lausanne, Switzerland
| | | | | | - David Cohen
- Department of Child and Adolescent Psychiatry, APHP, Sorbonne Université, Hôpital de la Pitié-Salpêtrière-Charles Foix, Assistance Publique Hôpitaux de Paris, Paris, France.,ISIR, Sorbonne Université, CNRS UMR 7222, Paris, France
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22
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Aziz MAA, Razak RA, Garraffa M. Targeting Complex Orthography in the Treatment of a Bilingual Aphasia with Acquired Dysgraphia: The Case of a Malay/English Speaker with Conduction Aphasia. Behav Sci (Basel) 2020; 10:E109. [PMID: 32635620 DOI: 10.3390/bs10070109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Disruption of spoken language in people with aphasia tends to interfere with the ability to write, which is referred to as dysgraphia. This study examined the effectiveness of the anagram and copy treatment (ACT), administered in English on a bilingual Malay/English patient with conduction aphasia (GM). ACT is the arrangement of component letters presented in scrambled order (i.e., an anagram) so that the patient could use the letters to form target words, followed by repeated copying of the word. Methods: A single-subject multiple-baseline design was used with sets of English words (both nouns and verbs) sequentially targeted for treatment. Prior to the treatment, a series of single word writing and reading baselines were conducted in two languages: English and Malay. The ACT treatment was done in English, the language reported as more dominant for reading by the patient. Probes assessing generalizations to untrained pictures were presented at 8th, 13th, and 18th sessions. Results: GM showed steady and incremental improvement in the writing of trained nouns and verbs, with generalizations to untrained English nouns and verbs. Conclusions: Single word writing treatment in a non-transparent language may improve dysgraphia among adults with bilingual aphasia through the administration of a structured and systematic treatment.
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Abstract
This study employed a multi-dimensional (i.e., orthographic, phonological, and semantic) and bi-level (i.e., character and radical) approach to analyze the character writing of 120 Hong Kong Chinese children with developmental dyslexia in Grades 2-5 and 120 typically developing age-matched controls. Relative to their typically developing peers, children with dyslexia were less sensitive to the positional and functional consistencies of sublexical radicals and exhibited prolonged use of phonology at the character level as grade-level advanced. Furthermore, the children with dyslexia relatively relied more on phonology at the radical level than younger, reading level-matched children. These results indicate the effects of implicit statistical learning on the development of Chinese character writing skills and suggest that the prolonged use and overreliance on phonology in character writing by Chinese children with dyslexia may reflect their difficulties in implicit statistical learning.
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Affiliation(s)
- Stephen Man Kit Lee
- Human Communication, Development, and Information Sciences, Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong
| | - Xiuli Tong
- Human Communication, Development, and Information Sciences, Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong
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24
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Dunn M, Zajic MC, Berninger V. The Self in Self-Regulated Writing of Fourth to Ninth Graders with Dysgraphia. Int J Sch Educ Psychol 2020; 9:S34-S46. [PMID: 34925970 PMCID: PMC8673780 DOI: 10.1080/21683603.2020.1721384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Dysgraphia, a specific learning disability, impairs legible and automatic letter production by hand, which can interfere with written composing. The goal of the current study was not to investigate effective methods for teaching self-regulated writing to students with dysgraphia, but rather to investigate their self that is involved in their self-regulated writing. Students with dysgraphia in grades 4 to 9 (17 males; 3 females, M=139.44 months, SD=12.15) composed six personal narratives about themselves and their relationships to others. Five indicators of self/self-others, informed by Theory of Mind (Frith & Frith, 2010), were coded in the six personal narratives. They also completed normed measures of self-regulation of attention and of written composing. Correlations identified which coded indicators of self/self-others and which measures of attention regulation were significantly related to the same written composing measure to be used as predictors in multiple regressions. Results showed that coded quality of Text Organization (Self Schema in Personal Story) for "My Life Before the School Years" as first predictor AND either Focused or Switching Attention as second predictor jointly accounted for significant variance and each predictor explained unique variance in writing fluency (timed composing). Implications of findings for educational practice and future research are discussed.
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Affiliation(s)
- Michael Dunn
- Washington State University Vancouver, Vancouver, WA
| | - Matthew C Zajic
- Curry School of Education and Human Development, University of Virginia, Charlottesville
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25
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Abstract
OBJECTIVE Prevalence of dysgraphia by age across all grade levels was determined in students with ADHD or autism. METHOD Referred children with normal intelligence and ADHD-Combined, ADHD-Inattentive, or autism ( N = 1,034) were administered the Developmental Test of Visual-Motor Integration (VMI) and Wechsler Intelligence Scale for Children (WISC). RESULTS VMI and WISC Coding scores were significantly lower than IQ and the normal mean of 100 for all diagnoses. More than half (59%) had dysgraphia, and 92% had a weakness in graphomotor ability relative to other abilities. Dysgraphia prevalence did not differ between diagnostic or age groups (6-7 years, 56%; 8-10 years, 60%; and 11-16 years, 61%). CONCLUSION Dysgraphia is common at all ages in children and adolescents with ADHD and autism. Accommodations and strategies for addressing this problem are discussed.
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Affiliation(s)
| | | | | | - Sara S Frye
- 1 Penn State College of Medicine, Hershey, USA
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Lau DKY, Yuen CT. Representations of grapho-motor patterns unique to Chinese character writing: evidence from a patient with mirror writing. Clin Linguist Phon 2019; 33:1031-1049. [PMID: 31035802 DOI: 10.1080/02699206.2019.1602788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/27/2019] [Accepted: 03/30/2019] [Indexed: 06/09/2023]
Abstract
This study investigated the grapho-motor patterns used in writing Chinese characters. A Chinese patient, CSC, who demonstrated post-brain-injury mirror writing, was recruited. In Experiment 1, non-mirrored writing responses were obtained when CSC was instructed to copy asymmetrical non-verbal symbols and pictures. Resembling the patterns observed in a patient's writing reported in a previous study, it was hypothesized that CSC's mirror writing was a result of untransformed preserved grapho-motor patterns. In Experiments 2 and 3, CSC was further instructed to copy real Chinese characters, pseudo-characters with authentic radicals and logographemes (i.e., stroke clusters that frequently occur in radicals), and Hangul characters with stroke clusters resembling the shapes of authentic logographemes. The results showed that CSC demonstrated mirror writing only when authentic Chinese orthographic units were involved. Non-mirrored writing responses were obtained from stimuli without authentic Chinese orthographic units. In sum, CSC's performance supported the existence of grapho-motor patterns of Chinese orthographic units represented in the brain. Theoretical implications were discussed.
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Affiliation(s)
- Dustin Kai-Yan Lau
- Department of Chinese and Bilingual Studies, Hong Kong Polytechnic University , Hong Kong SAR
| | - Carol Ting Yuen
- Hong Kong Society for the Aged , Hong Kong SAR
- Hospital Authority , Hong Kong SAR
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27
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Abstract
BACKGROUND Advances in statistical methods and computing power have led to a renewed interest in addressing the statistical analysis challenges posed by Small-N Designs (SND). Linear mixed-effects modeling (LMEM) is a multiple regression technique that is flexible and suitable for SND and can provide standardized effect sizes and measures of statistical significance. AIMS Our primary goals are to: 1) explain LMEM at the conceptual level, situating it in the context of treatment studies, and 2) provide practical guidance for implementing LMEM in repeated measures SND. METHODS & PROCEDURES We illustrate an LMEM analysis, presenting data from a longitudinal training study of five individuals with acquired dysgraphia, analyzing both binomial (accuracy) and continuous (reaction time) repeated measurements. OUTCOMES & RESULTS The LMEM analysis reveals that both spelling accuracy and reaction time improved and, for accuracy, improved significantly more quickly under a training schedule with distributed, compared to clustered, practice. We present guidance on obtaining and interpreting various effect sizes and measures of statistical significance from LMEM, and include a simulation study comparing two p-value methods for generalized LMEM. CONCLUSION We provide a strong case for the application of LMEM to the analysis of training studies as a preferable alternative to visual analysis or other statistical techniques. When applied to a treatment dataset, the evidence supports that the approach holds up under the extreme conditions of small numbers of individuals, with repeated measures training data for both continuous (reaction time) and binomially distributed (accuracy) dependent measures. The approach provides standardized measures of effect sizes that are obtained through readily available and well-supported statistical packages, and provides statistically rigorous estimates of the expected average effect size of training effects, taking into account variability across both items and individuals.
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Affiliation(s)
- Robert W Wiley
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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Lau DKY, Ma KHW. A phonetic radical account of the phonology-to-Orthography consistency effect on writing Chinese characters: Evidence from a Chinese Dysgraphic patient. Cogn Neuropsychol 2018; 35:403-414. [PMID: 30145937 DOI: 10.1080/02643294.2018.1510387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study investigated the sublexical route in writing Chinese characters. Using a writing-to-dictation task, we compared neurotypical participants' performance on writing a set of 40 characters with homophones sharing different phonetic radicals and another set of 40 characters with homophones sharing the same phonetic radicals. The first set of stimuli was regarded as both syllable-to-character and syllable-to-radical inconsistent, while the second set of stimuli was considered syllable-to-radical consistent but syllable-to-character inconsistent. The results of the error analysis showed that the control participants demonstrated a greater tendency to make errors with preserved phonetic radicals in the second set of stimuli. Furthermore, we conducted the same task with a Chinese brain-injured patient, WCY, who had mild dyslexia and severe dysgraphia associated with mild impairment to the lexical semantic route as shown by the patient's character writing. The results showed that WCY demonstrated similar error patterns as those of the control participants and a shorter writing time in the second set of stimuli. Altogether, the observations were taken as evidence that supported our claim that a syllable-to-phonetic radical route governs the sublexical route in Chinese character writing.
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Affiliation(s)
- Dustin Kai-Yan Lau
- a Department of Chinese and Bilingual Studies , Hong Kong Polytechnic University , Hong Kong , Hong Kong
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Shuster VP, Miozzo M. The processing of inflected and derived words in writing. Cogn Neuropsychol 2018; 35:385-401. [PMID: 30071771 DOI: 10.1080/02643294.2018.1496904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We report on an English-speaking, aphasic individual (RB) with a spelling deficit more severely affecting orthographically irregular words for which phonologically plausible errors (PPEs) were produced. PPEs were observed for all word forms, with the exception of inflectional suffixes, despite the irregular sound-print mappings of many inflectional suffixes (e.g., walked → /wɔkt/). RB's pattern replicates that reported in Badecker, Rapp, and Caramazza (Badecker, W., Rapp, B., & Caramazza, A. (1996). Lexical Morphology and the Two Orthographic Routes. Cognitive Neuropsychology, 13, 161-176). We extended their investigation by examining RB's spelling of derived words and found a selective deficit for derived words compared to inflected words in writing. This selective deficit did not appear to reflect differences in morphological transparency or suffix frequencies that exist between inflection and derivation. This is the first evidence that distinct neural mechanisms support inflection and derivation in spelling.
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Affiliation(s)
| | - Michele Miozzo
- a Department of Psychology , The New School , New York , NY , USA
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Farghaly WM, Ahmed MA, El-Tallawy HN, Elmestikawy TA, Badry R, Farghaly MS, Omar MS, Hussein ASR, Salamah M, Mohammed AT. Construction of an Arabic computerized battery for cognitive rehabilitation of children with specific learning disabilities. Neuropsychiatr Dis Treat 2018; 14:2123-2131. [PMID: 30174425 PMCID: PMC6110296 DOI: 10.2147/ndt.s155987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to design an Arabic computerized battery of cognitive skills for training children with specific learning disabilities (SLD). SUBJECTS AND METHODS Nineteen students from fourth grade primary schools in Assiut, Egypt, who were previously diagnosed with SLD, agreed to participate in the rehabilitation program. The study passed through four stages: first stage, detailed analysis of the cognitive profile of students with SLD (n=19), using a previously constructed diagnostic cognitive skill battery, to identify deficits in their cognitive skills; second stage, construction of an Arabic computerized battery for cognitive training of students with SLD; third stage, implementation of the constructed training program for the students, each tailored according to his/her previously diagnosed cognitive skill deficit/deficits; and fourth stage, post-training re-evaluation of academic achievement and cognitive skills' performance. RESULTS Students with SLD have a wide range of cognitive skill deficits, which are more frequent in auditory cognitive skills (68.4%) than in visual cognitive skills (64.1%), particularly in phonological awareness and auditory sequential memory (78.9%). Following implementation of the training program, there was a statistically significant increase (P<0.001) in the mean scores of total auditory and visual cognitive skills, as well as in academic achievement (P<0.001) of the study group. CONCLUSION Remediation-oriented diagnosis of cognitive skills, when tailored according to previously diagnosed cognitive deficits, leads to the improvement in learning abilities and academic achievement of students with SLD.
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Affiliation(s)
- Wafaa Ma Farghaly
- Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed A Ahmed
- Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hamdy N El-Tallawy
- Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Reda Badry
- Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammed Sh Farghaly
- Department of Educational Psychology, Faculty of Education, Assiut University, Assiut, Egypt
| | - Montaser S Omar
- Department of Educational Psychology, Faculty of Education, Assiut University, Assiut, Egypt
| | - Amr Sayed Ramadan Hussein
- Department of Hearing Disability, Faculty of Sciences of Special Needs, Beni-Suef University, Beni-Suef, Egypt,
| | - Mohammed Salamah
- Department of Phoniatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Adel T Mohammed
- Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt
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31
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Sanders EA, Berninger VW, Abbott RD. Sequential Prediction of Literacy Achievement for Specific Learning Disabilities Contrasting in Impaired Levels of Language in Grades 4 to 9. J Learn Disabil 2018; 51:137-157. [PMID: 28199175 PMCID: PMC5538955 DOI: 10.1177/0022219417691048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Sequential regression was used to evaluate whether language-related working memory components uniquely predict reading and writing achievement beyond cognitive-linguistic translation for students in Grades 4 through 9 ( N = 103) with specific learning disabilities (SLDs) in subword handwriting (dysgraphia, n = 25), word reading and spelling (dyslexia, n = 60), or oral and written language (oral and written language learning disabilities, n = 18). That is, SLDs are defined on the basis of cascading level of language impairment (subword, word, and syntax/text). A five-block regression model sequentially predicted literacy achievement from cognitive-linguistic translation (Block 1); working memory components for word-form coding (Block 2), phonological and orthographic loops (Block 3), and supervisory focused or switching attention (Block 4); and SLD groups (Block 5). Results showed that cognitive-linguistic translation explained an average of 27% and 15% of the variance in reading and writing achievement, respectively, but working memory components explained an additional 39% and 27% of variance. Orthographic word-form coding uniquely predicted nearly every measure, whereas attention switching uniquely predicted only reading. Finally, differences in reading and writing persisted between dyslexia and dysgraphia, with dysgraphia higher, even after controlling for Block 1 to 4 predictors. Differences in literacy achievement between students with dyslexia and oral and written language learning disabilities were largely explained by the Block 1 predictors. Applications to identifying and teaching students with these SLDs are discussed.
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Abbott RD, Raskind WH, Matsushita M, Price ND, Richards T, Berninger VW. Patterns of biomarkers for three phenotype profiles of persisting specific learning disabilities during middle childhood and early adolescence: A preliminary study. Biomark Genes 2017; 1:103. [PMID: 30854516 PMCID: PMC6407889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Students without specific learning disabilities [SLDs] [n=18] and with one of three persisting SLDs in written language despite early and current specialized instruction-Dysgraphia [n=21], Dyslexia [n=40], or oral and written language learning disability OWL LD [n=14]- in grades 4 to 9 [N=56 boys, 38 girls] completed behavioral phenotyping assessment and gave a small blood or saliva sample. Molecular analyses informed by current cross-site research on gene candidates for learning disabilities identified associations between molecular genetic markers and the two defining behavioral phenotypes for each SLDs-WL; dysgraphia [impaired writing alphabet from memory for rs3743204 and sentence copying in best handwriting for rs79382 both in DYX1C1], dyslexia [impaired silent word reading/decoding rate for rs4535189 in DCDC2 and impaired spelling/encoding for rs374205 in DYX1C1], and OWL LD [impaired aural syntax comprehension for rs807701 and oral syntax construction for rs807701 both in DYX1C1]. Implications of these identified associations between molecular markers for alleles for different sites within two gene candidates [and mostly one] and hallmark phenotypes are discussed for translation science [application to practice] and neuroimaging that has identified contrasting brain bases for each of the three SLDs.
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Affiliation(s)
- Robert D. Abbott
- University of Washington, Quantitative Studies and Measurement, USA
| | - Wendy H. Raskind
- University of Washington, Medicine, USA,University of Washington, Psychiatry and Behavioral Sciences, USA
| | | | - Nathan D. Price
- Institute for Systems Biology, USA,University of Washington, Bioengineering, Computer Science & Engineering, Molecular & Cellular Biology, USA
| | - Todd Richards
- University of Washington, Integrated Brain Imaging Center and Radiology, USA
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Thomas M, Lenka A, Kumar Pal P. Handwriting Analysis in Parkinson's Disease: Current Status and Future Directions. Mov Disord Clin Pract 2017; 4:806-818. [PMID: 30363367 PMCID: PMC6174397 DOI: 10.1002/mdc3.12552] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The majority of patients with Parkinson's disease (PD) have handwriting abnormalities. Micrographia (abnormally small letter size) is the most commonly reported and easily detectable handwriting abnormality in patients with PD. However, micrographia is perhaps the tip of the iceberg representing the handwriting abnormalities in PD. Digitizing tablet technology, which has evolved over the last 2 decades, has made it possible to study the pressure and kinematic features of handwriting. This has resulted in a surge of studies investigating graphomotor impairment in patients with PD. METHODS The objectives of this study were to review the evolution of the kinematic analysis of handwriting in PD and to provide an overview of handwriting abnormalities observed in PD along with future directions for research in this field. Articles for review were searched from the PubMed and SCOPUS databases. RESULTS Digitizing tablet technologies have resulted in a shift of focus from the analysis of only letter size to the analysis of several kinematic features of handwriting. Studies based on the kinematic analysis of handwriting have revealed that patients with PD may have abnormalities in velocity, fluency, and acceleration in addition to micrographia. The recognition of abnormalities in several kinematic parameters of handwriting has given rise to the term PD dysgraphia. In addition, certain kinematic properties potentially may be helpful in distinguishing PD from other parkinsonian disorders. CONCLUSION The journey from micrographia to PD dysgraphia is indeed a paradigm shift. Further research is warranted to gain better insight into the graphomotor impairments in PD and their clinical implications.
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Affiliation(s)
- Mathew Thomas
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
| | - Abhishek Lenka
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
- Department of Clinical NeurosciencesNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
| | - Pramod Kumar Pal
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
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Abstract
The nature of handwriting difficulties have been explored in children with specific developmental disorders. The aim of this study was to investigate the nature of handwriting difficulties in children with dysgraphia, a less studied group who have significant handwriting difficulties in the absence of motor control or cognitive difficulties. The performance of a dysgraphia group aged 8-14 years was compared to a group with Developmental Coordination Disorder and to typically developing (TD) controls. Participants completed two handwriting tasks on a digitizing writing tablet. The amount and accuracy of the handwriting product was measured, plus various temporal and spatial features of the writing process. There were no significant differences in performance between the two groups with handwriting difficulties but both performed more poorly than the TD group. Individual differences in the type and severity of handwriting impairments suggest the need for a range of classroom assessments to tailor intervention appropriately.
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Affiliation(s)
- Mellissa Prunty
- a Department of Clinical Sciences , Brunel University London , Uxbridge , UK
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35
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Abstract
A single case study is reported of a 10-year-old, English-speaking boy, L.S., who presented with spelling errors similar to those described in acquired graphemic buffer dysgraphia (GBD). We used this case to evaluate the appropriateness of applying adult cognitive models to the investigation of developmental cognitive disorders. The dual-route model of spelling guided this investigation. L.S. primarily made "letter errors" (deletions, additions, substitutions, transpositions, or a combination of these errors) on words and nonwords and in all input (aural and visual) and output modalities (writing, typing, oral spelling); there was also some evidence of a length effect and U-shaped serial position curve. An effect of lexical variables on spelling performance was also found. We conclude that the most parsimonious account is an impairment at the level of the graphemic buffer and without systematic cognitive neuropsychological investigation, the nature of L.S.'s spelling difficulty would likely have been missed.
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Affiliation(s)
- Kristina Barisic
- a ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science , Macquarie University , Sydney , NSW , Australia
| | - Saskia Kohnen
- a ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science , Macquarie University , Sydney , NSW , Australia
| | - Lyndsey Nickels
- a ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science , Macquarie University , Sydney , NSW , Australia
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36
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Beers SF, Mickail T, Abbott R, Berninger V. Effects of transcription ability and transcription mode on translation:: Evidence from written compositions, language bursts and pauses when students in grades 4 to 9, with and without persisting dyslexia or dysgraphia, compose by pen or by keyboard. J Writ Res 2017; 9:1-25. [PMID: 30761210 PMCID: PMC6369520 DOI: 10.17239/jowr-2017.09.01.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study explored the effects of transcription on translation products and processes of adolescent students in grades 4 to 9 with and without persisting specific language disabilities in written language (SLDs-WL). To operationalize transcription ability (handwriting and spelling) and transcription mode (by pen on digital tablet or by standard US keyboard), diagnostic groups contrasting in patterns of transcription ability were compared while composing autobiographical (personal) narratives by handwriting or by keyboarding: Typically developing students (n=15), students with dyslexia (impaired word reading and spelling, n=20), and students with dysgraphia (impaired handwriting, n=19). They were compared on seven outcomes: total words composed, total composing time, words per minute, percent of spelling errors, average length of pauses, average number of pauses per minute, and average length of language bursts. They were also compared on automaticity of transcription modes-writing the alphabet from memory by handwriting or keyboarding (they could look at keys). Mixed ANOVAs yielded main effects for diagnostic group on percent of spelling errors,, words per minute, and length of language burst. Main effects for transcription modes were found for automaticity of writing modes, total words composed, words per minute, and length of language bursts; there were no significant interactions. Regardless of mode, the dyslexia group had more spelling errors, showed a slower rate of composing, and produced shorter language bursts than the typical group. The total number of words, total time composing, words composed per minute, and pauses per minute were greater for keyboarding than handwriting, but length of language bursts was greater for handwriting. Implications of these results for conceptual models of composing and educational assessment practices are discussed.
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Affiliation(s)
- Scott F Beers
- Seattle Pacific University, School of Education | USA
| | - Terry Mickail
- University of Washington, Measurement and Statistics | USA
| | - Robert Abbott
- University of Washington, Measurement and Statistics | USA
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Yagle K, Richards T, Askren K, Mestre Z, Beers S, Abbott R, Nagy W, Boord P, Berninger V. Relationships between Eye Movements during Sentence Reading Comprehension, Word Spelling and Reading, and DTI and fmri Connectivity In Students with and without Dysgraphia or Dyslexia. ACTA ACUST UNITED AC 2017; 3. [PMID: 28936361 PMCID: PMC5604484 DOI: 10.15761/jsin.1000150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While eye movements were recorded and brains scanned, 29 children with and without specific learning disabilities (SLDs) decided if sentences they read (half with only correctly spelled words and half with homonym foils) were meaningful. Significant main effects were found for diagnostic groups (non-SLD control, dysgraphia control, and dyslexia) in total fixation (dwell) time, total number of fixations, and total regressions in during saccades; the dyslexia group had longer and more fixations and made more regressions in during saccades than either control group. The dyslexia group also differed from both control groups in (a) fractional anisotropy in left optic radiation and (b) silent word reading fluency on a task in which surrounding letters can be distracting, consistent with Rayner's selective attention dyslexia model. Different profiles for non-SLD control, dysgraphia, and dyslexia groups were identified in correlations between total fixation time, total number of fixations, regressions in during saccades, magnitude of gray matter connectivity during the fMRI sentence reading comprehension from left occipital temporal cortex seed with right BA44 and from left inferior frontal gyrus with right inferior frontoccipital fasciculus, and normed word-specific spelling and silent word reading fluency measures. The dysgraphia group was more likely than the non-SLD control or dyslexia groups to show negative correlations between eye movement outcomes and sentences containing incorrect homonym foils. Findings are discussed in reference to a systems approach in future sentence reading comprehension research that integrates eye movement, brain, and literacy measures.
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Affiliation(s)
- Kevin Yagle
- Integrated Brain Imaging Center, Department of Radiology, University of Washington, Seattle, USA
| | - Todd Richards
- Integrated Brain Imaging Center, Department of Radiology, University of Washington, Seattle, USA
| | - Katie Askren
- Integrated Brain Imaging Center, Department of Radiology, University of Washington, Seattle, USA
| | - Zoe Mestre
- Integrated Brain Imaging Center, Department of Radiology, University of Washington, Seattle, USA
| | - Scott Beers
- School of Education, Seattle Pacific University, Seattle, USA
| | - Robert Abbott
- Department of Educational Psychology, University of Washington, Seattle, USA
| | - William Nagy
- School of Education, Seattle Pacific University, Seattle, USA
| | - Peter Boord
- Integrated Brain Imaging Center, Department of Radiology, University of Washington, Seattle, USA
| | - Virginia Berninger
- Department of Educational Psychology, University of Washington, Seattle, USA
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38
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Iwabuchi M, Hirabayashi R, Nakamura K, Dim NK. Machine Learning Based Evaluation of Reading and Writing Difficulties. Stud Health Technol Inform 2017; 242:1001-1004. [PMID: 28873918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The possibility of auto evaluation of reading and writing difficulties was investigated using non-parametric machine learning (ML) regression technique for URAWSS (Understanding Reading and Writing Skills of Schoolchildren) [1] test data of 168 children of grade 1 - 9. The result showed that the ML had better prediction than the ordinary rule-based decision.
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Havaei N, Rezaei M, Rostami HR. Dexterity and two-point discrimination of the hand in school-aged children with dysgraphia. Med J Islam Repub Iran 2016; 30:434. [PMID: 28210599 PMCID: PMC5307631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background: Dysgraphia as a problem with handwriting, affects student's performance in school activities and participation. The purpose of the study was to compare dexterity and two-point discrimination of the hand between learning disabled students with dysgraphia and healthy students. Methods: Forty-three students with developmental dysgraphia and 55 normal students in grade two to four from special and regular schools participated in this study. Hand dexterity and static/dynamic discriminative touch were assessed via Purdue Pegboard and Two-Point Discriminator respectively. Results: Significant differences were found in Purdue Pegboard scores between two groups except in doing the test with the left hand (p<0.05). Purdue Pegboard scores were significantly lower in left-handed children with dysgraphia compared to healthy children (p<0.05). There was no significant difference in dynamic two point discrimination between two groups of children (p>0.05). Static two-point discrimination of the thumb finger was significantly higher in children with dysgraphia (p<0.05). Conclusion: Hand dexterity affects handwriting performance in children with dysgraphia. There were no correlations between two-point discrimination and Purdue Pegboard scores of children with dysgraphia. Intervention should focus on other aspects of dexterity rather than sensory components. Hand dominancy also may be a factor influencing hand performance in dysgraphia.
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Affiliation(s)
- Naser Havaei
- 1 PhD in Occupational Therapy, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Mandana Rezaei
- 2 PhD in Physiotherapy, Assistant Professor, Department of Physiotherapy, School of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran. ,(Corresponding author) PhD in Physiotherapy, Assistant Professor, Department of Physiotherapy, School of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Hamid Reza Rostami
- 3 PhD in Occupational Therapy, Assistant Professor, Department of Occupational Therapy, School of Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran.
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40
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Abstract
Up to 17% of German school children suffer from reading and writing disabilities. Unlike developmental dyslexia, only few studies have addressed dysgraphia. Presenting a comprehensive overview of the current state of the art in developmental dyslexia and dysgraphia, this paper aims to determine how far existing knowledge about the causes of developmental dyslexia also apply to developmental dysgraphia. To promote understanding of developmental dysgraphia, the paper discusses relevant aspects such as predictors, causes and comorbidities, models of acquisition as well as existing deficit models. A comparison of definitions in the DSM-V and ICD-10 complemented by an overview of the most recent German guideline ought to give the reader deeper insight into this topic. The current issue of growing up bilingually and the connection between reading and writing deficits are also discussed. In conclusion, this paper presents a critical survey of theoretical and practical implications for the diagnostics and treatment of developmental dysgraphia.
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Affiliation(s)
- Diana Döhla
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen Aachen, Germany
| | - Stefan Heim
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH AachenAachen, Germany; Institute of Neuroscience and Medicine, Research Centre Jülich Jülich, Germany
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41
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Gentili M, Marinaccio PM, Galimberti C, Carnovale C, Antoniazzi S, Pozzi M, Clementi E, Viganò C, Radice S. A case of dysgraphia induced by sertraline and a review of official spontaneous adverse reaction databases. J Clin Pharm Ther 2016; 41:106-7. [PMID: 26792111 DOI: 10.1111/jcpt.12356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES The occurrence of dysgraphia after sertraline intake has never been reported. The objective was to describe a case of this adverse drug reaction and present a review of similar cases held in international databases with a discussion of the possible pharmacological mechanisms. CASE SUMMARY We observed a 60-year-old man who experienced resting tremors, dyskinesia and dysgraphia 2 months after a stepwise increase in sertraline dosing from 50 to 200 mg/day. WHAT IS NEW AND CONCLUSION Dysgraphia is a possible adverse drug reaction to sertraline, and we suggest that inhibition of extrapyramidal dopaminergic activity might be the pharmacological mechanism.
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Affiliation(s)
- M Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - P M Marinaccio
- Psychiatry Unit, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - C Galimberti
- Psychiatry Unit, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - C Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - S Antoniazzi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy.,Scientific Direction, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Pozzi
- Scientific Institute, IRCCS E. Medea, Lecco, Italy
| | - E Clementi
- Scientific Institute, IRCCS E. Medea, Lecco, Italy.,Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University Hospital 'Luigi Sacco', Università di Milano, Milan, Italy
| | - C Viganò
- Psychiatry Unit, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - S Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
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42
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Rapp B, Purcell J, Hillis AE, Capasso R, Miceli G. Neural bases of orthographic long-term memory and working memory in dysgraphia. Brain 2015; 139:588-604. [PMID: 26685156 DOI: 10.1093/brain/awv348] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/12/2015] [Indexed: 11/14/2022] Open
Abstract
Spelling a word involves the retrieval of information about the word's letters and their order from long-term memory as well as the maintenance and processing of this information by working memory in preparation for serial production by the motor system. While it is known that brain lesions may selectively affect orthographic long-term memory and working memory processes, relatively little is known about the neurotopographic distribution of the substrates that support these cognitive processes, or the lesions that give rise to the distinct forms of dysgraphia that affect these cognitive processes. To examine these issues, this study uses a voxel-based mapping approach to analyse the lesion distribution of 27 individuals with dysgraphia subsequent to stroke, who were identified on the basis of their behavioural profiles alone, as suffering from deficits only affecting either orthographic long-term or working memory, as well as six other individuals with deficits affecting both sets of processes. The findings provide, for the first time, clear evidence of substrates that selectively support orthographic long-term and working memory processes, with orthographic long-term memory deficits centred in either the left posterior inferior frontal region or left ventral temporal cortex, and orthographic working memory deficits primarily arising from lesions of the left parietal cortex centred on the intraparietal sulcus. These findings also contribute to our understanding of the relationship between the neural instantiation of written language processes and spoken language, working memory and other cognitive skills.
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Affiliation(s)
- Brenda Rapp
- 1 Department of Cognitive Science, Johns Hopkins University, Baltimore, USA 2 Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, USA 3 Department of Neuroscience, Johns Hopkins University, Baltimore, USA
| | - Jeremy Purcell
- 1 Department of Cognitive Science, Johns Hopkins University, Baltimore, USA
| | - Argye E Hillis
- 1 Department of Cognitive Science, Johns Hopkins University, Baltimore, USA 4 Department of Neurology, Johns Hopkins University, Baltimore, USA 5 Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, USA
| | | | - Gabriele Miceli
- 7 Center for Mind/Brain Sciences, University of Trento, Trento, Italy
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Tanimoto S, Thompson R, Berninger VW, Nagy W, Abbott RD. Computerized Writing and Reading Instruction for Students in Grades 4 to 9 With Specific Learning Disabilities Affecting Written Language. J Comput Assist Learn 2015; 31:671-689. [PMID: 26858470 PMCID: PMC4743045 DOI: 10.1111/jcal.12110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Computer scientists and educational researchers evaluated effectiveness of computerized instruction tailored to evidence-based impairments in specific learning disabilities (SLDs) in students in grades 4 to 9 with persisting SLDs despite prior extra help. Following comprehensive, evidence-based differential diagnosis for dysgraphia (impaired handwriting), dyslexia (impaired word reading and spelling), and oral and written language learning disability (OWL LD), students completed 18 sessions of computerized instruction over about 3 months. The 11 students taught letter formation with sequential, numbered, colored arrow cues with full contours who wrote letters on lines added to iPAD screen showed more and stronger treatment effects than the 21 students taught using only visual motion cues for letter formation who wrote on an unlined computer monitor. Teaching to all levels of language in multiple functional language systems (by ear, eye, mouth, and hand) close in time resulted in significant gains in reading and writing skills for the group and in diagnosed SLD hallmark impairments for individuals; also, performance on computerized learning activities correlated with treatment gains. Results are discussed in reference to need for both accommodations and explicit instruction for persisting SLDs and the potential for computers to teach handwriting, morphophonemic orthographies, comprehension, and composition.
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Affiliation(s)
- Steven Tanimoto
- Department of Computer Science and Engineering, University of Washington
| | - Rob Thompson
- Department of Computer Science and Engineering, University of Washington
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Abstract
We describe a 44-year-old Chinese-speaking patient with semantic dementia (SD), who demonstrates dyslexia and dysgraphia. The man was administered a series of neuropsychological inspections, including general language tests and reading and writing examinations. The patient demonstrated surface dyslexia when reading single Chinese characters aloud. While most writing errors demonstrated by the patient were orthographically similar errors and noncharacter responses, such as pictograph, logographeme, and stroke errors, rather than phonologically plausible errors that were homophonous or different only in tone from the targets. We suggest that the type of acquired dysgraphia demonstrated by Chinese-speaking SD patients is determined by the unique features of the Chinese writing system.
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Affiliation(s)
- Xiao-qin Wu
- a Department of Neurology , Southern Medical University of Nanfang Hospital , Guangzhou , PR China
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45
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Khandaker GM, Stochl J, Zammit S, Lewis G, Jones PB. A population-based longitudinal study of childhood neurodevelopmental disorders, IQ and subsequent risk of psychotic experiences in adolescence. Psychol Med 2014; 44:3229-3238. [PMID: 25066026 PMCID: PMC4180723 DOI: 10.1017/s0033291714000750] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Schizophrenia has a neurodevelopmental component to its origin, and may share overlapping pathogenic mechanisms with childhood neurodevelopmental disorders (NDs). Nevertheless, longitudinal studies of psychotic outcomes among individuals with NDs are limited. We report a population-based prospective study of six common childhood NDs, subsequent neurocognitive performance and the risk of psychotic experiences (PEs) in early adolescence. METHOD PEs were assessed by semi-structured interviews at age 13 years. IQ and working memory were measured between ages 9 and 11 years. The presence of six NDs (autism spectrum, dyslexia, dyspraxia, dysgraphia, dysorthographia, dyscalculia) was determined from parent-completed questionnaires at age 9 years. Linear regression calculated the mean difference in cognitive scores between children with and without NDs. Associations between NDs and PEs were expressed as odds ratios (ORs) with 95% confidence intervals (CIs); effects of cognitive deficits were examined. Potential confounders included age, gender, father's social class, ethnicity and maternal education. RESULTS Out of 8220 children, 487 (5.9%) were reported to have NDs at age 9 years. Children with, compared with those without, NDs performed worse on all cognitive measures; the adjusted mean difference in total IQ was 6.84 (95% CI 5.00-8.69). The association between total IQ and NDs was linear (p < 0.0001). The risk of PEs was higher in those with, compared with those without, NDs; the adjusted OR for definite PEs was 1.76 (95% CI 1.11-2.79). IQ (but not working memory) deficit partly explained this association. CONCLUSIONS Higher risk of PEs in early adolescence among individuals with childhood ND is consistent with the neurodevelopmental hypothesis of schizophrenia.
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Affiliation(s)
- Golam M. Khandaker
- Department of Psychiatry, University of Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Stanley Zammit
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Glyn Lewis
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK
- Mental Health Sciences Unit, University College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Letanneux A, Danna J, Velay JL, Viallet F, Pinto S. From micrographia to Parkinson's disease dysgraphia. Mov Disord 2014; 29:1467-75. [PMID: 25156696 DOI: 10.1002/mds.25990] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 07/03/2014] [Accepted: 07/14/2014] [Indexed: 11/10/2022] Open
Abstract
Micrographia, an abnormal reduction in writing size, is a specific behavioral deficit associated with Parkinson's disease (PD). In recent years, the availability of graphic tablets has made it possible to study micrographia in unprecedented detail. Consequently, a growing number of studies show that PD patients also exhibit impaired handwriting kinematics. Is micrographia still the most characteristic feature of PD-related handwriting deficits? To answer this question, we identified studies that investigated handwriting in PD, either with conventional pencil-and-paper measures or with graphic tablets, and we reported their findings on key spatiotemporal and kinematic variables. We found that kinematic variables (velocity, fluency) differentiate better between control participants and PD patients, and between off- and on-treatment PD patients, than the traditional measure of static writing size. Although reduced writing size is an important feature of PD handwriting, the deficit is not restricted to micrographia stricto sensu. Therefore, we propose the term PD dysgraphia, which encompasses all deficits characteristic of Parkinsonian handwriting. We conclude that the computerized analysis of handwriting movements is a simple and useful tool that can contribute to both diagnosis and follow-up of PD.
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Affiliation(s)
- Alban Letanneux
- Aix-Marseille Université, CNRS, Laboratoire Parole et Langage, UMR 7309, Aix-en-Provence, France
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Purcell JJ, Rapp B. Identifying functional reorganization of spelling networks: an individual peak probability comparison approach. Front Psychol 2013; 4:964. [PMID: 24399981 PMCID: PMC3872307 DOI: 10.3389/fpsyg.2013.00964] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 12/06/2013] [Indexed: 11/13/2022] Open
Abstract
Previous research has shown that damage to the neural substrates of orthographic processing can lead to functional reorganization during reading (Tsapkini et al., 2011); in this research we ask if the same is true for spelling. To examine the functional reorganization of spelling networks we present a novel three-stage Individual Peak Probability Comparison (IPPC) analysis approach for comparing the activation patterns obtained during fMRI of spelling in a single brain-damaged individual with dysgraphia to those obtained in a set of non-impaired control participants. The first analysis stage characterizes the convergence in activations across non-impaired control participants by applying a technique typically used for characterizing activations across studies: Activation Likelihood Estimate (ALE) (Turkeltaub et al., 2002). This method was used to identify locations that have a high likelihood of yielding activation peaks in the non-impaired participants. The second stage provides a characterization of the degree to which the brain-damaged individual's activations correspond to the group pattern identified in Stage 1. This involves performing a Mahalanobis distance statistics analysis (Tsapkini et al., 2011) that compares each of a control group's peak activation locations to the nearest peak generated by the brain-damaged individual. The third stage evaluates the extent to which the brain-damaged individual's peaks are atypical relative to the range of individual variation among the control participants. This IPPC analysis allows for a quantifiable, statistically sound method for comparing an individual's activation pattern to the patterns observed in a control group and, thus, provides a valuable tool for identifying functional reorganization in a brain-damaged individual with impaired spelling. Furthermore, this approach can be applied more generally to compare any individual's activation pattern with that of a set of other individuals.
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Affiliation(s)
- Jeremy J Purcell
- Department of Cognitive Science, Johns Hopkins University Baltimore, MD, USA
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University Baltimore, MD, USA
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Abstract
PURPOSE Treatment studies have documented the therapeutic and functional value of lexical writing treatment for individuals with severe aphasia. The purpose of this study was to determine whether such retraining could be accomplished using the typing feature of a cellular telephone, with the ultimate goal of using text messaging for communication. METHOD A 31-year-old man with persistent Broca's aphasia, severe apraxia of speech, global dysgraphia, and right hemiparesis participated in this study. Using a multiple baseline design, relearning and maintenance of single-word spellings (and oral naming) of targeted items were examined in response to traditional Copy and Recall Treatment (CART) for handwriting and a new paradigm using 1-handed typing on a cell phone keyboard (i.e., a texting version of CART referred to as T-CART). RESULTS Marked improvements were documented in spelling and spoken naming trained in either modality, with stronger maintenance for handwriting than cell phone typing. Training resulted in functional use of texting that continued for 2 years after treatment. CONCLUSIONS These results suggest that orthographic retraining using a cell phone keyboard has the potential to improve spelling knowledge and provide a means to improve functional communication skills. Combined training with both handwriting and cell phone typing should be considered in order to maximize the durability of treatment effects.
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Abstract
Perseverations, the inappropriate intrusion of elements from a previous response into a current response, are commonly observed in individuals with acquired deficits. This study specifically investigates the contribution of failure-to activate and failure-to-inhibit deficit(s) in the generation of letter perseveration errors in acquired dysgraphia. We provide evidence from the performance 12 dysgraphic individuals indicating that a failure to activate graphemes for a target word gives rise to letter perseveration errors. In addition, we also provide evidence that, in some individuals, a failure-to-inhibit deficit may also contribute to the production of perseveration errors.
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Affiliation(s)
- Simon Fischer-Baum
- Beckman Institute, University of Illinois, Urbana-Champaign, Urbana, IL 61801, United States.
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50
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Kozintseva E, Skvortsov A, Ulicheva A, Vlasova (Zaykova) A. Cognitive structure of writing disorders in Russian: what would Luria say? Behav Neurol 2012; 25:223-32. [PMID: 22713406 PMCID: PMC5294242 DOI: 10.3233/ben-2012-119010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Acquired disorders of writing in the Russian language have been reported for more than a century. The study of these disorders reflects the history of Russian neuropsychology and is dominated by the syndrome approach most notably by the writings of Luria. Indeed, our understanding of acquired dysgraphia in Russian speakers is conceptualized according to the classical approach in Modern Russia. In this review, we describe the classical approach and compare it to the cognitive neuropsychological models of writing disorders that are developed to explain dysgraphia in English and in other Western European languages. We argue that the basic theoretical assumptions of the two approaches - cognitive and classical or syndrome approach - share similarities. It is therefore proposed that identification of acquired cases of dysgraphia in Russian could potentially benefit from taking the cognitive neuropsychological perspective. We also conclude that adopting elements of the syndrome approach would substantially enrich the understanding of acquired dysgraphia since these offer an insight into processes not described in the cognitive neuropsychological approach.
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Affiliation(s)
- Elena Kozintseva
- The National Research University Higher School of EconomicsMoscowRussia,The Centre of Speech Pathology and NeurorehabilitationMoscowRussia
| | - Anatoly Skvortsov
- The National Research University Higher School of EconomicsMoscowRussia,The Centre of Speech Pathology and NeurorehabilitationMoscowRussia,The Russian National Research Medical UniversityMoscowRussia,Moscow Research Institute of PsychiatryMoscowRussia,*Anatoly Skvortsov:
| | | | - Anna Vlasova (Zaykova)
- The National Research University Higher School of EconomicsMoscowRussia,The Centre of Speech Pathology and NeurorehabilitationMoscowRussia,The Russian National Research Medical UniversityMoscowRussia
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