The Modularity of Dysgraphia

Research regarding dysgraphia, an impairment in writing, is attaining more attention in recent times. The existing studies on dysgraphia draw insights from cognitive, behavioural, neurological, and genetic fields of knowledge. However, these multiple studies on dysgraphia fail to illustrate how these cognitive, behavioural, neurological, and genetic systems interact and intersect in dysgraphia. Therefore, the studies could not offer a comprehensive understanding of dysgraphia. In order to fill this gap, the review attempts to study dysgraphia using the notion of modularity by accommodating insights from cognitive, behavioural, neurological, and genetic aspects of dysgraphia. Such a profound understanding could facilitate an early diagnosis and holistic intervention towards dysgraphia.

Early diagnosis of the learning disabilities in kids using a computer game-based solution

PURPOSE

Learning disabilities or learning disorders are umbrella terms used for wide variety of learning problems like Dyslexia, Dyscalculia, Dysgraphia, and Dyspraxia. These disabilities are due to the neurological disorders which affects brain functions. Early diagnosis of these disabilities in kids from age 3 to 6 will help to start early medical treatments and get them back to the normal condition.

MATERIAL AND METHOD

we developed a software-based Learning Disability Evaluation Kit called YALU with computer Game Modules for kids targeting their learning disabilities. These Computer game-based modules of the YALU consist of different tasks for the different age levels to identify the symptoms of the disabilities mentioned above. The children's interaction results to each task of the game modules with the answers of the questioner about the children given by the parents will be evaluated with the threshold values given by a panel of consultant psychologist and paediatrician of the normal kids to identify the learning disabilities in kids aged 3-6 years. The result will be given to the respective parties and uploaded to the Website under the child's name.

RESULT

YALU has been tested using 50 students in age 3-5 in three preschools. The teachers have identified Fourteen students with some learning disability symptoms. Using YALU, twelve out of fourteen students had been clearly identified. Hence, the YALU Evaluation Kit to have an accuracy 85% in diagnosing the right disability. However, the accuracy could be increased with the accurate assessments of the parents about their kids.IMPLICATIONS FOR REHABILITATIONLearning disabilities are neurological disorders that affect the brain's ability to receive, process, store, respond to and communicate information; and there are four types (Dyslexia, Dyspraxia, Dysgraphia and Dyscalculia)In this paper, we present the extracted computational techniques targeting the Dyslexia, Dyspraxia, Dysgraphia and Dyscalculia and developed a software application (YALU Learning Disability Evaluation Kit) which consists of computer game modules for the kids for evaluation their learning disabilities.The developed game modules can screen the learning disabilities and these gamification modules (YALU) consists of tasks which are based on symptoms of the said disabilities. The outcomes of each module is evaluated these learning disabilities in kids age from 3 years to 6 years by analysing children's interactions to the each tasks, the child condition and then compare the result with the threshold values of the normal kids given by consultant psychologist and paediatrician.

Dysgraphia disorder forecasting and classification technique using intelligent deep learning approaches

Writing abilities are impacted by dysgraphia, a condition of learning disability. It might be challenging to diagnose dysgraphia at an initial point of a child's upbringing. Problematic abilities linked to Dysgraphia difficulties that is utilized in detecting the learning disorder. The features used in this research to identify dysgraphia include handwriting and geometric features that is reclaimed using kekre-discrete cosine mathematical model. The feature learning step of deep transfer learning makes good use of the obtained features to identify dysgraphia. The results of the data collection indicate that this study can use handwritten images to detect children who have dysgraphia. Compared to past investigations, this experiment has shown a significant improvement in the capacity to identify dysgraphia using handwritten drawings. The proposed approach is compared with the machine learning and deep learning approaches where the Kekre-Discrete Cosine Transform with Deep Transfer Learning (K-DCT-DTL) outperforms the existing approaches. The proposed K-DCT-DTL approach attains 99.75% of highest accuracy that exhibits the efficiency of the proposed method.

Novel insights into the effects of levodopa on the up- and downstrokes of writing sequences

Motor control of automatized and overlearned sequences, such as writing, is affected in Parkinson's disease (PD), impacting patients' daily life. Medication effects on motor performance are not only task-specific, but also variable within tasks. The nature of this variance is still unclear. This study aimed to investigate whether medication affects writing sequences differently when producing up- or downstrokes. Writing was assessed in healthy controls (HC) (N = 31) and PD (N = 32), when ON and OFF medication in a randomized order (interspersed by two months). Subjects wrote a sequential pattern with an increasing size on a digital tablet. Writing outcomes were movement vigor (amplitude and velocity), error and end-point variability, and sequence continuation, calculated separately for up- and downstrokes. Results showed that PD patients OFF-medication reduced movement vigor (amplitude) for up- and downstrokes compared to HC. Clear deficits were found for up- but not for downstroke error in PD patients in OFF, suggesting a directional bias. Dopaminergic medication improved motor vigor by increasing writing amplitude and upstroke continuation, but this occurred at the cost of the downstroke trajectory. Other writing outcomes did not improve with medication intake. In conclusion, we interpret these findings as that the impact of dopamine is complex, highly task-specific, supporting the most highly energy demanding components of a writing sequence. As medication did not regulate downstroke writing, we recommend supplementary training to address task demands that were less modulated by dopamine (registration: https://osf.io/gk5q8/ , 17 July 2018).

Progressive macrographia for block letter writing: A case study

"Macrographia", a relatively rare symptom generally following cerebellar diseases, consists of an abnormally large handwriting. The case reported in the present investigation shows several outstanding features. First, it is of the progressive variety, letters increase in size as one goes through the word towards the lower-right portion of space. Moreover, it is limited to one allographic variety, that is, block letters. This phenomenon is previously unreported, all allographic varieties being usually equally affected. Finally, no prominent cerebellar or basal ganglia abnormality could be demonstrated with structural MRI or PET. From a cognitive point of view, a peculiar combination of spatial attention, executive function and working memory deficits is proposed to account for the progressive misalignment and elongation of individual letters when specifically writing in block prints. From an anatomical perspective, the pattern of multifocal lesions, encompassing multiple cortical areas in both hemispheres and the corpus callosum, may support this multi-componential interpretation of the reported phenomenon.

Test Review of the Feifer Assessment of Writing (FAW)

The Feifer Assessment of Writing (FAW) is a comprehensive test of writing that was designed to measure three subtypes of written language disorders. Academic achievement tests endeavor to evaluate core neuropsychological and theoretical perspectives that identify students at risk. Written assessments have historically focused more on the ability to write, putting ideas together in a sentence, and being able to do so efficiently. Missing from these evaluations is the impact of working memory and other executive functioning abilities, such as the ability to strategically develop a plan, evaluate, monitor, draft, and revisit the text. This review explores the FAW, and its contribution to the neuropsychological evaluation of writing.

Dysgraphia and dysprosody in a patient with arteriovenous malformation: a case report

Arteriovenous malformation (AVM) results from development of abnormal connections between veins and arteries. This study reported anAVM case suffering from dysgraphia and dysprosody. According to the results after the trauma, the patient's handwriting was identified as macrographic and illegible, and written letters and verbs were neglected in free writing or dictation. Moreover, prosody of the patient's utterances was changed. Finally, an intervention was conducted to improve the writing impairments whereby they eventually enhanced. AVM can adversely affect communication opportunities and working life due to these impairments. Thus referring the patient to speech and language pathologists seems sensible and necessary.

Some evidence on Gerstmann's syndrome: A case study on a variant of the clinical disorder

We describe the case of a bilingual patient with persistent symptoms largely, although not fully, consistent with those that are usually reported in Gerstmann's syndrome. Twenty months after a spontaneous primary intracranial hemorrhage, the patient was evaluated with a series of neuropsychological tasks and underwent an MRI investigation based on Diffusion Tensor Imaging probabilistic tractography. The patient suffered from dysgraphia (difficulty in the access to the graphemic representation of letter forms), autotopoagnosia (difficulties in locating body parts on verbal command), right-left confusion (difficulties in localizing right and left side of symmetrical body parts), and number processing/calculation impairments (predominant difficulties on transcoding tasks). Probabilistic tractography revealed a relatively spared superior longitudinal fasciculus and severe damage to the subcortical white matter connecting the angular gyrus with other parietal regions, such as the intraparietal sulcus and the supramarginal gyrus. Within the framework of the contemporary cognitive accounts of Gerstmann's syndrome, the case supports the assumption of an anatomical intraparietal disconnection more than a functional Grundstörung (core impairment).

An epidemiological study of prevalence and comorbidity of non-clinical Dyslexia, Dysgraphia and Dyscalculia symptoms in Public and Private Schools of Pakistan

OBJECTIVE

Dealing with Dyslexia, Dysgraphia and Dyscalculia symptoms is a major challenge for teachers and school psychologists while addressing students' issues. The present study was designed to examine the prevalence and comorbidity of specific learning disabilities (SLD) symptoms such as dyslexia, dysgraphia and dyscalculia in public and private schools of Lahore, Pakistan.

METHODS

This cross-sectional study was conducted in four schools of Lahore from June, 2019 to December 2019. We examined 666 participants (boys= 384, girls= 282) from two public (n=409) and two private (n=257) schools of Lahore with a mean age of 13 years (SD±1.44). Participants were assessed on Learning Disabilities Checklist (LDC) along with a demographic sheet. The data were analyzed by using descriptive statistics (frequencies and percentages) and inferential analyses of Chi Square test of association and Cohen's Kappa by using SPSS version 24.

RESULTS

Findings indicated that 39% participants showed SLD symptoms, 33% dyslexia, 48% dysgraphia and 45% dyscalculia symptoms. Significant co-morbidities were seen, such as 30% for dyslexia and dysgraphia symptoms, dyslexia and dyscalculia 26% and dysgraphia and dyscalculia as 36%. Variations in SLD, dyslexia, dysgraphia and dyscalculia symptoms were also seen across gender and schools with significant higher prevalence in public schools.

CONCLUSION

High prevalence of SLD symptoms and comorbidity in students was found which is alarming, particularly in public sector schools in Pakistan. SLD and dyslexia were higher for boys, whereas girls scored high on dysgraphia and dyscalculia. Therefore, there is great need of introducing screening measure of assessment of SLD and management strategies to deal with these issues.

Pseudoword spelling ability predicts response to word spelling treatment in acquired dysgraphia

Although rehabilitation of acquired dysgraphia can be quite effective, identifying predictors of responsiveness to treatment is useful for prognosis and individualization of treatment protocols. This study examined whether various features of treatment response were predicted by the integrity of one or more of the central cognitive components of spelling: orthographic long-term memory, orthographic working memory, and phoneme-grapheme conversion. Twenty dysgraphic individuals received 12 weeks of bi-weekly, individualized, lexically-based spelling rehabilitation using a spell-study-spell paradigm. Linear multiple regression modelling examined whether the type and severity of the dysgraphic deficit, assessed before rehabilitation, predicted the magnitude and rate of improvement, generalization to untrained items and maintenance of treatment gains. The results revealed that pseudoword spelling accuracy - indexing the integrity of the phoneme-grapheme conversion system - was the only factor examined that significantly predicted the rate of accuracy gains for trained words as well as the extent of generalization to untrained words. Pre-treatment pseudoword spelling accuracy also predicted retention of gains for trained and untrained words at 3-month follow-up. These findings reveal that the integrity of the phoneme-grapheme conversion system prior to dysgraphia rehabilitation may play a key role in rehabilitation-driven recovery, even when the treatment approach targets lexical rather than pseudoword spelling processes.

Disorder of written expression and dysgraphia: definition, diagnosis, and management

Writing is a complex task that is vital to learning and is usually acquired in the early years of life. 'Dysgraphia' and 'specific learning disorder in written expression' are terms used to describe those individuals who, despite exposure to adequate instruction, demonstrate writing ability discordant with their cognitive level and age. Dysgraphia can present with different symptoms at different ages. Different theories have been proposed regarding the mechanisms of dysgraphia. Dysgraphia is poorly understood and is often undiagnosed. It has a high rate of co-morbidity with other learning and psychiatric disorders. The diagnosis and treatment of dysgraphia and specific learning disorders typically centers around the educational system; however, the pediatrician can play an important role in surveillance and evaluation of co-morbidity as well as provision of guidance and support.

Re-learning to be different: Increased neural differentiation supports post-stroke language recovery

Identifying the neural changes that support recovery of cognitive functions after a brain lesion is important to advance our understanding of human neuroplasticity, which, in turn, forms the basis for the development of effective treatments. To date, the preponderance of neuroimaging studies has focused on localizing changes in average brain activity associated with functional recovery. Here, we took a novel approach by evaluating whether cognitive recovery in chronic stroke is related to increases in the differentiation of local neural response patterns. This approach is supported by research indicating that, in the intact brain, local neural representations become more differentiated (dissimilar) with learning (Glezer et al., 2015). We acquired fMRI data before and after 21 individuals received approximately 12 weeks of behavioral treatment for written language impairment due to a left-hemisphere stroke. We used Local-Heterogeneity Regression Analysis (Purcell and Rapp, 2018) to measure local neural response differentiation associated with written language processing, assuming that greater heterogeneity in the pattern of activity across adjacent neural areas indicates more well-differentiated neural representations. First, we observed pre to post-treatment increases in local neural differentiation (Local-Hreg) in the ventral occipital-temporal cortex of the left hemisphere. Second, we found that, in this region, higher local neural response differentiation prior to treatment was associated with less severe written language impairment, and that it also predicted greater future responsiveness to treatment. Third, we observed that changes in neural differentiation were systematically related to performance changes for trained and untrained items. Fourth, we did not observe these brain-behavior relationships for mean BOLD responses, only for Local-Hreg. Thus, this is the first investigation to quantify changes in local neural differentiation in the recovery of a cognitive function and the first to demonstrate the clear behavioral relevance of these changes. We conclude that the findings provide strong support for the novel hypothesis that the local re-differentiation of neural representations can play a significant role in functional recovery after brain lesion.

Motor functions of higher education students with dysgraphia

This study examines the motor skills and motor-related daily functions of higher education students with and without dysgraphia, and their contribution in predicting handwriting performance. The sample included 82 higher education students aged 20-35 years old. Thirty-four were students without any known developmental disorder (NDD) and 48 students had dysgraphia. We individually administered a test battery evaluating handwriting performance, fine-motor skills, and visual-motor spatial-organization skills. Students also filled out a questionnaire relating to their fine- and gross-motor-related daily functions. Overall, the NDD students had significantly better motor skills and motor-related daily functions. Additionally, the motor skills and daily functions explained 62.9% of the variance in handwriting performance, and they correctly classified 90% of the students into the handwriting performance groups. Yet only visual-motor spatial organization and fine-motor-related daily functions significantly contributed to the fit of the model. These findings suggest that students with dysgraphia continue to encounter handwriting difficulties in higher education. These difficulties are linked to poor motor skills and motor-related daily functions. Therefore, higher education students with dysgraphia may require assistance and accommodations throughout their studies, not only with regard to their academic performance, but also in their motor-related daily functions.

Academic accommodation strategies for pharmacy students with learning disabilities: What else can be done?

INTRODUCTION

Colleges and schools of pharmacy in the US are faced with the challenge of providing appropriate academic accommodations for students with learning disabilities (SLD) including those with dyslexia, dyscalculia, or dysgraphia. Although there are no population statistics about SLD in pharmacy schools, current data show that their number at higher education institutions across the US has increased. This commentary discusses how the rigorous pharmacy school curriculum affects SLD and proposes creative and innovative measures to overcome these obstacles.

PERSPECTIVE

The shift in the public perception about SLD from a state of stigma to a manageable condition in recent years has greatly contributed to increase the number of SLD enrolled in higher education institutions. Although most colleges and universities can now offer some type of academic accommodation to SLD compared to few years ago, other academic accommodation recommendations to SLD remain challenging to implement, especially for SLD enrolled in pharmacy programs.

IMPLICATIONS

SLD enrolled in pharmacy programs could benefit from a multifaceted approach involving the school's office of disability services, medical practitioners, behavioral and language specialists, as well as some sort of curricular changes in order to be academically successful and become practice ready upon graduation.

Too harts, won sole: Using dysgraphia treatment to address homophone representation

Previous spoken homophone treatment in aphasia found generalization to untreated homophones and interpreted this as evidence for shared phonological word form representations. Previous written treatment of non-homophones has attributed generalization to orthographic neighbours of treated items to feedback from graphemes to similarly spelled orthographic word forms. This feedback mechanism offers an alternative explanation for generalization found in treatment of spoken homophones. The aim of this study was to investigate the mechanism underpinning generalization (if any) from treatment of written homophones. To investigate this question a participant with acquired dysgraphia and impaired access to orthographic output representations undertook written spelling treatment. Generalization to untreated items with varying degrees of orthographic overlap was investigated. Three experimental sets included homographs (e.g., bank-bank), heterographs (e.g., sail-sale), and direct orthographic neighbours (e.g., bath-path). Treatment improved written picture naming of treated items. Generalization was limited to direct neighbours. Further investigation of generalization found that items with a greater number of close neighbours in the treated set showed greater generalization. This suggests that feedback from graphemes to orthographic word forms is the driving force of generalization. The lack of homograph generalization suggests homographs do not share a representation in the orthographic lexicon.

The effects of lesion and treatment-related recovery on functional network modularity in post-stroke dysgraphia

A better understanding of the neural network properties that support cognitive recovery after a brain lesion is important for our understanding of human neuroplasticity and may have valuable clinical implications. In fifteen individuals with chronic, acquired written language deficits subsequent to left-hemisphere stroke, we used task-based functional connectivity to evaluate the relationship between the graph-theoretic measures (modularity, participation coefficient and within-module degree z-score) and written language production accuracy before and after behavioral treatment. A reference modular structure and local and global hubs identified from healthy controls formed the basis of the analyses. Overall, the investigation revealed that less modular networks with greater global and lower local integration were associated with greater deficit severity and lower response to treatment. Furthermore, we found treatment-induced increases in modularity and local integration measures. In particular, local integration within intact ventral occipital-temporal regions of the spelling network showed the greatest increase in local integration following treatment. This investigation significantly extends previous research by using task-based (rather than resting-state) functional connectivity to examine a larger set of network characteristics in the evaluation of treatment-induced recovery and by including comparisons with control participants. The findings demonstrate the relevance of network modularity for understanding the neuroplasticity supporting functional neural reorganization.

Effect of levodopa on handwriting tasks of different complexity in Parkinson's disease: a kinematic study

Levodopa treatment does improve Parkinson's disease (PD) dysgraphia, but previous research is not in agreement about which aspects are most responsive. This study investigated the effect of levodopa on the kinematics of writing. Twenty-four patients with PD of less than 10 years duration and 25 age-matched controls were recruited. A practically defined off state method was used to assess the levodopa motor response, measured on the Unified Parkinson's Disease Rating Scale Part III. The kinematic features for six handwriting tasks involving different levels of complexity were recorded from PD patients in off and on states and from the control group. Levodopa is effective for simple writing activities involving repetition of letters, denoting improved fine motor control. But the same benefit was not seen for copying a sentence and a written category fluency test, tasks that carry memory and cognitive loads. We also found significant differences in kinematic features between control participants and PD patients, for all tasks and in both on and off states. Serial testing of handwriting in patients known to be at risk for developing PD might prove to be an effective biomarker for cell loss in the substantia nigra and the associated dopamine deficiency. We recommend using a panel of writing tasks including sentence copying and memory dependence. Dual-task effects may make these activities more sensitive to early motor deficits, while their weaker levodopa responsiveness would cause them to be more stable indicators of motor progression once symptomatic treatment has been commenced.

Intervention for a lexical reading and spelling difficulty in two Greek-speaking primary age children

An intervention study was carried out with two nine-year-old Greek-speaking dyslexic children. Both children were slow in reading single words and text and had difficulty in spelling irregularly spelled words. One child was also poor in non-word reading. Intervention focused on spelling in a whole-word training using a flashcard technique that had previously been found to be effective with English-speaking children. Post-intervention assessments conducted immediately at the end of the intervention, one month later and then five months later showed a significant improvement in spelling of treated words that was sustained over time. In addition, both children showed generalisation of improvement to untrained words and an increase in scores in a standardised spelling assessment. The findings support the effectiveness of theoretically based targeted intervention for literacy difficulties.

Quantitative assessment of drawing tests in children with dyslexia and dysgraphia

Drawing tests in children diagnosed with dyslexia and dysgraphia were quantitatively compared. Fourteen children with dysgraphia, 19 with dyslexia and 13 normally developing were asked to copy 3 figures: a circle, a square and a cross. An optoelectronic system allowed the acquisition of the drawing track in three-dimensions. The participants' head position and upper limb movements were measured as well. A set of parameters including movement duration, velocity, length of the trace, Range of Motion of the upper limb, was computed and compared among the 3 groups. Children with dyslexia traced the circle faster than the other groups. In the cross test, dyslexic participants showed a reduced execution time and increased velocity while drawing the horizontal line. Children with dyslexia were also faster in drawing certain sides of square with respect to the other groups.

Relationships between Translation and Transcription Processes during fMRI Connectivity Scanning and Coded Translation and Transcription in Writing Products after Scanning in Children with and without Transcription Disabilities

Students with transcription disabilities (dysgraphia/impaired handwriting, n = 13 or dyslexia/impaired word spelling, n = 16) or without transcription disabilities (controls) completed transcription and translation (idea generating, planning, and creating) writing tasks during fMRI connectivity scanning and compositions after scanning, which were coded for transcription and translation variables. Compositions in both groups showed diversity in genre beyond usual narrative-expository distinction; groups differed in coded transcription but not translation variables. For the control group specific transcription or translation tasks during scanning correlated with corresponding coded transcription or translation skills in composition, but connectivity during scanning was not correlated with coded handwriting during composing in dysgraphia group and connectivity during translating was not correlated with any coded variable during composing in dyslexia group. Results are discussed in reference to the trend in neuroscience to use connectivity from relevant seed points while performing tasks and trends in education to recognize the generativity (creativity) of composing at both the genre and syntax levels.

Developmental dysgraphia is often associated with minor neurological dysfunction in children with developmental coordination disorder (DCD)

OBJECTIVES

Children with developmental coordination disorder (DCD) are particularly affected by handwriting disorders, which remain poorly understood and are not clearly defined. The aim of our study is to provide a better understanding of handwriting disorders, and specifically of dysgraphia in children with DCD.

METHODS

Sixty-five children with DCD (5-15 years), enrolled according to DSM-5, were assessed with handwriting testing and standardized assessments of neuropsychological, neurovisual, MRI and neuropsychomotor functions, with special attention paid to muscular tone examination.

RESULTS

While handwriting disorders were strongly represented in our sample of children with DCD (89%), dysgraphia appeared uncommon (17%) and was closely related to several specific dysfunctions of laterality establishment; mild pyramidal tract dysfunction with distal phasic stretch reflex (PSR) in lower limbs; digital praxis slowness (both P<0.05).

DISCUSSION

In our sample, dysgraphia was closely related to minor neurological dysfunction (MND) suggesting a disturbance of motor control at the level of the corticospinal motor pathway. This highlights the uncommon character of dysgraphia in children with DCD for which diagnosis should be made through a particular attention to evaluation of MND with muscular tone examination. This consideration, both in the research setting and in clinical practice, appears necessary to avoid inaccurate clinical diagnosis and to optimize appropriate therapeutic management.

Improvement in children's fine motor skills following a computerized typing intervention

Children spend a large proportion of their school day engaged in tasks that require manual dexterity. If children experience difficulties with their manual dexterity skills it can have a consequential effect on their academic achievement. The first aim of this paper was to explore whether an online interactive typing intervention could improve children’s scores on a standardised measure of manual dexterity. The second aim was to implement a serial reaction time tapping task as an index of children's finger movement learning, and to see whether performance on this task would improve after the intervention. Seventy-eight typically developing children aged between 8 and 10 were tested at their school on the pre-intervention Movement Assessment Battery for Children (2nd edition; MABC-2) and tapping tasks. Twenty-eight of these children volunteered to be randomly allocated to the intervention or control group. Children in the intervention group had a choice of two online games to play at home over a period of four weeks, while the children in the control group were not given these games to play. The intervention and control groups were then re-tested on the MABC-2 manual dexterity and the tapping task. Children in the intervention group significantly improved their manual dexterity scores in the MABC-2 compared to the control group. On average, all children learnt the tapping sequence, however, there were no group differences and no effect of the intervention on the tapping task. These results have important implications for implementing a freely available, easy to administer, fun and interactive intervention to help children improve their manual dexterity skills.

Does neuromuscular taping influence hand kinesiology? A pilot study on Down's Syndrome

PURPOSE

This paper is a first attempt analysis of hand and upper limb proprioception coordination induced by NeuroMuscular Taping (NMT): application in a group of 5 participants with Down syndrome.

MATERIALS AND METHODS

The participants underwent a drawing test with motion capture system acquisition before and after NMT application. Specific and descriptive parameters were computed and analysed in order to quantify the differences.

RESULTS

Results showed statistical differences between pre and post treatment sessions: the 5 participants with Down syndrome evidenced more reliance on proprioceptive signals in the post treatment session during the execution of the specific writing tasks.

CONCLUSIONS

Based on the hypothesis that modifications in proprioception should alter motor pathway mapping of the motor cortex, Neuromuscular taping may play a role in the treatment of dysgraphia and improving hand coordination following CNS impairment, even though a small treatment group was chosen for this pilot study the results lead to further discussions concerning the role of different afferent signals in a pathological context.

A novel approach for monitoring writing interferences during navigated transcranial magnetic stimulation mappings of writing related cortical areas

BACKGROUND

It has recently been shown that navigated repetitive transcranial magnetic stimulation (nTMS) is useful in preoperative neurosurgical mapping of motor and language brain areas. In TMS mapping of motor cortices the evoked responses can be quantitatively monitored by electromyographic (EMG) recordings. No such setup exists for monitoring of writing during nTMS mappings of writing related cortical areas.

NEW METHOD

We present a novel approach for monitoring writing during nTMS mappings of motor writing related cortical areas.

COMPARISON WITH EXISTING METHOD(S)

To our best knowledge, this is the first demonstration of quantitative monitoring of motor evoked responses from hand by EMG, and of pen related activity during writing with our custom made pen, together with the application of chronometric TMS design and patterned protocol of rTMS.

RESULTS

The method was applied in four healthy subjects participating in writing during nTMS mapping of the premotor cortical area corresponding to BA 6 and close to the superior frontal sulcus. The results showed that stimulation impaired writing in all subjects. The corresponding spectra of measured signal related to writing movements was observed in the frequency band 0-20 Hz. Magnetic stimulation affected writing by suppressing normal writing frequency band.

CONCLUSION

The proposed setup for monitoring of writing provides additional quantitative data for monitoring and the analysis of rTMS induced writing response modifications. The setup can be useful for investigation of neurophysiologic mechanisms of writing, for therapeutic effects of nTMS, and in preoperative mapping of language cortical areas in patients undergoing brain surgery.

Contrasting brain patterns of writing-related DTI parameters, fMRI connectivity, and DTI-fMRI connectivity correlations in children with and without dysgraphia or dyslexia

Based on comprehensive testing and educational history, children in grades 4-9 (on average 12 years) were diagnosed with dysgraphia (persisting handwriting impairment) or dyslexia (persisting word spelling/reading impairment) or as typical writers and readers (controls). The dysgraphia group (n = 14) and dyslexia group (n = 17) were each compared to the control group (n = 9) and to each other in separate analyses. Four brain region seed points (left occipital temporal gyrus, supramarginal gyrus, precuneus, and inferior frontal gyrus) were used in these analyses which were shown in a metaanalysis to be related to written word production on four indicators of white matter integrity and fMRI functional connectivity for four tasks (self-guided mind wandering during resting state, writing letter that follows a visually displayed letter in alphabet, writing missing letter to create a correctly spelled real word, and planning for composing after scanning on topic specified by researcher). For those DTI indicators on which the dysgraphic group or dyslexic group differed from the control group (fractional anisotropy, relative anisotropy, axial diffusivity but not radial diffusivity), correlations were computed between the DTI parameter and fMRI functional connectivity for the two writing tasks (alphabet and spelling) by seed points. Analyses, controlled for multiple comparisons, showed that (a) the control group exhibited more white matter integrity than either the dysgraphic or dyslexic group; (b) the dysgraphic and dyslexic groups showed more functional connectivity than the control group but differed in patterns of functional connectivity for task and seed point; and (c) the dysgraphic and dyslexic groups showed different patterns of significant DTI-fMRI connectivity correlations for specific seed points and written language tasks. Thus, dysgraphia and dyslexia differ in white matter integrity, fMRI functional connectivity, and white matter-gray matter correlations. Of clinical relevance, brain differences were observed in dysgraphia and dyslexia on written language tasks yoked to their defining behavioral impairments in handwriting and/or in word spelling and on the cognitive mind wandering rest condition and composition planning.

Contrasting brain patterns of writing-related DTI parameters, fMRI connectivity, and DTI-fMRI connectivity correlations in children with and without dysgraphia or dyslexia

Based on comprehensive testing and educational history, children in grades 4-9 (on average 12 years) were diagnosed with dysgraphia (persisting handwriting impairment) or dyslexia (persisting word spelling/reading impairment) or as typical writers and readers (controls). The dysgraphia group (n = 14) and dyslexia group (n = 17) were each compared to the control group (n = 9) and to each other in separate analyses. Four brain region seed points (left occipital temporal gyrus, supramarginal gyrus, precuneus, and inferior frontal gyrus) were used in these analyses which were shown in a metaanalysis to be related to written word production on four indicators of white matter integrity and fMRI functional connectivity for four tasks (self-guided mind wandering during resting state, writing letter that follows a visually displayed letter in alphabet, writing missing letter to create a correctly spelled real word, and planning for composing after scanning on topic specified by researcher). For those DTI indicators on which the dysgraphic group or dyslexic group differed from the control group (fractional anisotropy, relative anisotropy, axial diffusivity but not radial diffusivity), correlations were computed between the DTI parameter and fMRI functional connectivity for the two writing tasks (alphabet and spelling) by seed points. Analyses, controlled for multiple comparisons, showed that (a) the control group exhibited more white matter integrity than either the dysgraphic or dyslexic group; (b) the dysgraphic and dyslexic groups showed more functional connectivity than the control group but differed in patterns of functional connectivity for task and seed point; and (c) the dysgraphic and dyslexic groups showed different patterns of significant DTI-fMRI connectivity correlations for specific seed points and written language tasks. Thus, dysgraphia and dyslexia differ in white matter integrity, fMRI functional connectivity, and white matter-gray matter correlations. Of clinical relevance, brain differences were observed in dysgraphia and dyslexia on written language tasks yoked to their defining behavioral impairments in handwriting and/or in word spelling and on the cognitive mind wandering rest condition and composition planning.

Neural correlates of spelling difficulties in Alzheimer's disease

Alzheimer's disease (AD) is associated with a general cognitive decline that affects the memory and language domains. Thus, an oral production deficit with a lexical-semantic origin has been widely observed in these patients. Their written production capacities, however, have been much less studied. We assessed the spelling abilities of 22 AD patients and a group of matched healthy controls with a test battery including written picture naming and word and pseudoword dictation tests, as well as text dictation and spontaneous writing tasks. The results of the AD patients in the discriminative tasks were then entered into voxel-based morphometry analyses along with their grey matter volumes. The patient group presented a selective impairment for word dictation, which contrasted with a spared capacity to spell pseudowords, and showed more difficulties for words with arbitrary and rule-based orthography. Moreover, they also produced less complete syntactic units in the spontaneous writing task. These results point out the lexical-semantic, as opposed to sublexical, nature of the spelling deficit associated to AD. In addition, we recognized a mainly left-lateralized cortical network, including areas in the posterior inferior temporal lobe and the superior region of the parietal cortex, which might be responsible for this impairment. Other regions, such as the putamen, were also associated to the deficit. The results of this study, hence, improve our understanding of the neuropsychological and neuroanatomical mechanisms that underlie the cognitive symptoms associated to AD.

Cascading activation from lexical processing to letter-level processing in written word production

Descriptions of language production have identified processes involved in producing language and the presence and type of interaction among those processes. In the case of spoken language production, consensus has emerged that there is interaction among lexical selection processes and phoneme-level processing. This issue has received less attention in written language production. In this paper, we present a novel analysis of the writing-to-dictation performance of an individual with acquired dysgraphia revealing cascading activation from lexical processing to letter-level processing. The individual produced frequent lexical-semantic errors (e.g., chipmunk → SQUIRREL) as well as letter errors (e.g., inhibit → INBHITI) and had a profile consistent with impairment affecting both lexical processing and letter-level processing. The presence of cascading activation is suggested by lower letter accuracy on words that are more weakly activated during lexical selection than on those that are more strongly activated. We operationalize weakly activated lexemes as those lexemes that are produced as lexical-semantic errors (e.g., lethal in deadly → LETAHL) compared to strongly activated lexemes where the intended target word (e.g., lethal) is the lexeme selected for production.

The effect of computer-assisted therapeutic practice for children with handwriting deficit: a comparison with the effect of the traditional sensorimotor approach

The objective of this study was to compare the effect of computer-assisted practice with the sensorimotor approach on the remediation of handwriting problems in children with dysgraphia. In a randomized controlled trial, experiments were conducted to verify the intervention effect. Forty two children with handwriting deficit were assigned to computer-assisted instruction, sensorimotor training, or a control group. Handwriting performance was measured using the elementary reading/writing test and computerized handwriting evaluation before and after 6 weeks of intervention. Repeated-measures ANOVA of changed scores were conducted to show whether statistically significant differences across the three groups were present. Significant differences in the elementary reading/writing test were found among the three groups. The computer group showed more significant improvements than the other two groups did. In the kinematic and kinetic analyses, the computer group showed promising results in the remediation of handwriting speed and fluency. This study provided clinical evidence for applying a computer-assisted handwriting program for children with dysgraphia. Clinicians and school teachers are provided with a systematic intervention for the improvement of handwriting difficulties.

Measuring dysgraphia: a graded-difficulty spelling test

In this paper we describe the construction of a graded-difficulty spelling test for adults consisting of two alternative forms each containing 30 words (GDST, Forms A and B). The spelling test, together with background tests of verbal and non-verbal skills, was administered to 100 control patients with orthopaedic injuries. The two forms of the spelling test were highly correlated (0.92). Spelling was highly correlated with reading (0.75, 0.77) and moderately correlated with vocabulary (0.57) and naming (0.39, 0.40). There was no correlation between spelling skills and non-verbal reasoning. The test was validated in a group of 26 patients with left hemisphere and 20 patients with right hemisphere lesions. Spelling was shown to be lateralized to the left hemisphere and there appeared to be a shift in scores of the left hemisphere group towards the lower quartile, with 65% of the left hemisphere group falling within this band. The most severe spelling impairments were invariably associated with other language disorders but a number of dissociations were documented at spelling levels falling between the 5th and 25th percentile band. Two patients with left hemisphere lesions (8%) were identified as having selective dysgraphias. The lack of overlap between the anatomical sites of the two patients with specific lexical dysgraphia argues against a single site for this type of dysgraphia and argues for further refinement of this classification of spelling disorder.

Signal-to-noise velocity peaks difference: a new method for evaluating the handwriting movement fluency in children with dysgraphia

This study evaluated handwriting movement dysfluency related to dysgraphia. A new variable, the Signal-to-Noise velocity peaks difference (SNvpd), was proposed to describe abnormal velocity fluctuations in cursive handwriting. This variable was compared to two variables most frequently used variables for assessing handwriting fluency. This comparison was carried out for three different groups, children with dysgraphia, proficient children, and adults, all of whom wrote the same single word. The adults were taken as the reference. Results revealed that, of the three variables studied, the SNvpd proved most efficient in discriminating children with dysgraphia, and that furthermore, it had the significant advantage of facilitating the localization of dysfluency peaks within a word. Our results also showed that the movement dysfluency of children with dysgraphia was specific to certain letters. In light of these results, we discuss the methodological and theoretical relevance of this new variable to the analysis of handwriting movement with the aim of characterizing dysgraphia.

Handwriting movement analyses comparing first and second graders with normal or dysgraphic characteristics

Dysgraphia of sufficient severity to interfere with the school work has been recognized as representing a distinct deficit; characterization of its movement problem is a necessary step toward offering improved intervention. From among children aged 6-8, 69 children with dysgraphic characteristics (study group) and 69 matched proficient hand-writers (control group) were recruited into this study. Four copying tests of differing complexity levels were administered using a digital tablet. The acquired data included direct measure (axial pen tip force) and derived parameters (stroke velocity, pause time, number of velocity peaks and ratio of In Air to On Paper measures). The major finding is that children with dysgraphic characteristics had increased pause time per stroke and an increased number of directional changes in velocity. Significant differences were also found between students in two different grades, especially in the control group. The parameters extracted and observed in this study can further differentiate and characterize the handwriting problems originating from fine motor deficits.