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JMIR Serious Games Oct 2020Difficulties in handwriting, such as dysgraphia, impact several aspects of a child's everyday life. Current methodologies for the detection of such difficulties in...
BACKGROUND
Difficulties in handwriting, such as dysgraphia, impact several aspects of a child's everyday life. Current methodologies for the detection of such difficulties in children have the following three main weaknesses: (1) they are prone to subjective evaluation; (2) they can be administered only when handwriting is mastered, thus delaying the diagnosis and the possible adoption of countermeasures; and (3) they are not always easily accessible to the entire community.
OBJECTIVE
This work aims at developing a solution able to: (1) quantitatively measure handwriting features whose alteration is typically seen in children with dysgraphia; (2) enable their study in a preliteracy population; and (3) leverage a standard consumer technology to increase the accessibility of both early screening and longitudinal monitoring of handwriting difficulties.
METHODS
We designed and developed a novel tablet-based app Play Draw Write to assess potential markers of dysgraphia through the quantification of the following three key handwriting laws: isochrony, homothety, and speed-accuracy tradeoff. To extend such an approach to a preliteracy age, the app includes the study of the laws in terms of both word writing and symbol drawing. The app was tested among healthy children with mastered handwriting (third graders) and those at a preliterate age (kindergartners).
RESULTS
App testing in 15 primary school children confirmed that the three laws hold on the tablet surface when both writing words and drawing symbols. We found significant speed modulation according to size (P<.001), no relevant changes to fraction time for 67 out of 70 comparisons, and significant regression between movement time and index of difficulty for 44 out of 45 comparisons (P<.05, R>0.28, 12 degrees of freedom). Importantly, the three laws were verified on symbols among 19 kindergartners. Results from the speed-accuracy exercise showed a significant evolution with age of the global movement time (circle: P=.003, square: P<.001, word: P=.001), the goodness of fit of the regression between movement time and accuracy constraints (square: P<.001, circle: P=.02), and the index of performance (square: P<.001). Our findings show that homothety, isochrony, and speed-accuracy tradeoff principles are present in children even before handwriting acquisition; however, some handwriting-related skills are partially refined with age.
CONCLUSIONS
The designed app represents a promising solution for the screening of handwriting difficulties, since it allows (1) anticipation of the detection of alteration of handwriting principles at a preliteracy age and (2) provision of broader access to the monitoring of handwriting principles. Such a solution potentially enables the selective strengthening of lacking abilities before they exacerbate and affect the child's whole life.
PubMed: 33090110
DOI: 10.2196/20126 -
Neurological Sciences : Official... Dec 2020COVID-19 following infection by SARS-CoV-2 can affect the brain causing confusion, depression, and dementia-like signs. Nonetheless, the presence of more specific...
COVID-19 following infection by SARS-CoV-2 can affect the brain causing confusion, depression, and dementia-like signs. Nonetheless, the presence of more specific neuropsychological signs because of COVID-19 remains unexplored. We report on LA, a patient who was affected by a left-hemisphere ischemic stroke, probably because of SARS-CoV-2. The patient showed a highly specific neuropsychological profile characterized by severe agraphia and some signs of conduction aphasia. All other cognitive and sensorimotor functions remained intact. We sustain that specific neuropsychological signs can be observed in patients with COVID-19. Therefore, in-depth and comprehensive neuropsychological assessment should be included to better explore and qualify the neuropsychological consequences of COVID-19. This is a new challenge for diagnosis and rehabilitation, with important consequences for the involved neuropsychological services.
Topics: Agraphia; Aphasia, Conduction; Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Male; Middle Aged; Pandemics; Pneumonia, Viral; SARS-CoV-2; Stroke
PubMed: 32989587
DOI: 10.1007/s10072-020-04768-w -
PloS One 2020Handwriting is a complex skill to acquire and it requires years of training to be mastered. Children presenting dysgraphia exhibit difficulties automatizing their...
Handwriting is a complex skill to acquire and it requires years of training to be mastered. Children presenting dysgraphia exhibit difficulties automatizing their handwriting. This can bring anxiety and can negatively impact education. 280 children were recruited in schools and specialized clinics to perform the Concise Evaluation Scale for Children's Handwriting (BHK) on digital tablets. Within this dataset, we identified children with dysgraphia. Twelve digital features describing handwriting through different aspects (static, kinematic, pressure and tilt) were extracted and used to create linear models to investigate handwriting acquisition throughout education. K-means clustering was performed to define a new classification of dysgraphia. Linear models show that three features only (two kinematic and one static) showed a significant association to predict change of handwriting quality in control children. Most kinematic and statics features interacted with age. Results suggest that children with dysgraphia do not simply differ from ones without dysgraphia by quantitative differences on the BHK scale but present a different development in terms of static, kinematic, pressure and tilt features. The K-means clustering yielded 3 clusters (Ci). Children in C1 presented mild dysgraphia usually not detected in schools whereas children in C2 and C3 exhibited severe dysgraphia. Notably, C2 contained individuals displaying abnormalities in term of kinematics and pressure whilst C3 regrouped children showing mainly tilt problems. The current results open new opportunities for automatic detection of children with dysgraphia in classroom. We also believe that the training of pressure and tilt may open new therapeutic opportunities through serious games.
Topics: Agraphia; Biomechanical Phenomena; Child; Female; Handwriting; Humans; Male; Motor Skills
PubMed: 32915793
DOI: 10.1371/journal.pone.0237575 -
Internal Medicine (Tokyo, Japan) Dec 2020A 70-year-old dextral woman was admitted to a hospital with agraphia for kanji (Japanese morphograms). She had a history of severe constipation, nightmares, and visual...
A 70-year-old dextral woman was admitted to a hospital with agraphia for kanji (Japanese morphograms). She had a history of severe constipation, nightmares, and visual hallucinations. Neurological examinations revealed no obvious Parkinson's disease symptoms. She showed poor skills in writing the kanji for looking at picture objects, [e.g., writing the Japanese word "inu" (which means dog) when she saw a drawing of a dog] or dictated words. A reduced striatal uptake of [I]-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (FP-CIT) on single-photon-emission computed tomography and reduced meta-iodobenzylguanidine (MIBG) cardiac uptake on myocardial scintigraphy were detected. The accumulation of amyloid beta in the bilateral cerebral cortices was observed on amyloid-positron emission tomography. We herein report a case of Lewy body dementia with pure agraphia for kanji with underlying Alzheimer's disease pathology.
Topics: Agraphia; Amyloid beta-Peptides; Animals; Dogs; Female; Humans; Japan; Lewy Body Disease; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed
PubMed: 32788534
DOI: 10.2169/internalmedicine.4777-20 -
Cortex; a Journal Devoted To the Study... Oct 2020This study, through a series of univariate and multivariate (classification) analyses, investigated fMRI task-based functional connectivity (FC) at pre- and...
This study, through a series of univariate and multivariate (classification) analyses, investigated fMRI task-based functional connectivity (FC) at pre- and post-treatment time-points in 18 individuals with chronic post-stroke dysgraphia. The investigation examined the effects of lesion and treatment-based recovery on functional organization, focusing on both inter-hemispheric (homotopic) and intra-hemispheric connectivity. The work confirmed, in the chronic stage, the "network phenotype of stroke injury" proposed by Siegel et al. (2016) consisting of abnormally low inter-hemispheric connectivity as well as abnormally high intra-hemispheric (ipsilesional) connectivity. In terms of recovery-based changes in FC, this study found overall hyper-normalization of these abnormal inter and intra-hemispheric connectivity patterns, suggestive of over-correction. Specifically, treatment-related homotopic FC increases were observed between left and right dorsal frontal-parietal regions. With regard to intra-hemispheric connections, recovery was dominated by increased ipsilateral connectivity between frontal and parietal regions along with decreased connectivity between the frontal regions and posterior parietal-occipital-temporal areas. Both inter and intra-hemispheric changes were associated with treatment-driven improvements in spelling performance. We suggest an interpretation according to which, with treatment, as posterior orthographic processing areas become more effective, executive control from frontal-parietal networks becomes less necessary.
Topics: Brain; Brain Mapping; Humans; Magnetic Resonance Imaging; Phenotype; Stroke
PubMed: 32781259
DOI: 10.1016/j.cortex.2020.06.011 -
Behavioral Sciences (Basel, Switzerland) Jul 2020Disruption 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...
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.
PubMed: 32635620
DOI: 10.3390/bs10070109 -
Translational Pediatrics Feb 2020Writing 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... (Review)
Review
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.
PubMed: 32206583
DOI: 10.21037/tp.2019.11.01 -
Scientific Reports Feb 2020This paper proposes new ways to assess handwriting, a critical skill in any child's school journey. Traditionally, a pen and paper test called the BHK test (Concise...
This paper proposes new ways to assess handwriting, a critical skill in any child's school journey. Traditionally, a pen and paper test called the BHK test (Concise Evaluation Scale for Children's Handwriting) is used to assess children's handwriting in French-speaking countries. Any child with a BHK score above a certain threshold is diagnosed as 'dysgraphic', meaning that they are then eligible for financial coverage for therapeutic support. We previously developed a version of the BHK for tablet computers which provides rich data on the dynamics of writing (acceleration, pressure, and so forth). The underlying model was trained on dysgraphic and non-dysgraphic children. In this contribution, we deviate from the original BHK for three reasons. First, in this instance, we are interested not in a binary output but rather a scale of handwriting difficulties, from the lightest cases to the most severe. Therefore, we wish to compute how far a child's score is from the average score of children of the same age and gender. Second, our model analyses dynamic features that are not accessible on paper; hence, the BHK is useful in this instance. Using the PCA (Principal Component Analysis) reduced the set of 53 handwriting features to three dimensions that are independent of the BHK. Nonetheless, we double-checked that, when clustering our data set along any of these three axes, we accurately detected dysgraphic children. Third, dysgraphia is an umbrella concept that embraces a broad variety of handwriting difficulties. Two children with the same global score can have totally different types of handwriting difficulties. For instance, one child could apply uneven pen pressure while another one could have trouble controlling their writing speed. Our new test not only provides a global score, but it also includes four specific score for kinematics, pressure, pen tilt and static features (letter shape). Replacing a global score with a more detailed profile enables the selection of remediation games that are very specific to each profile.
Topics: Agraphia; Algorithms; Biomechanical Phenomena; Child; Child, Preschool; Cluster Analysis; Female; Handwriting; Humans; Machine Learning; Male; Motor Skills; Pattern Recognition, Automated; Principal Component Analysis; Psychomotor Performance
PubMed: 32081940
DOI: 10.1038/s41598-020-60011-8 -
Frontiers in Psychology 2019Dysgraphia (D) is a complex specific learning disorder with a prevalence of up to 30%, which is linked with handwriting issues. The factors recognized for assessing...
Dysgraphia (D) is a complex specific learning disorder with a prevalence of up to 30%, which is linked with handwriting issues. The factors recognized for assessing these issues are legibility and performance time. Two questionnaires, the Handwriting Proficiency Screening Questionnaire (HPSQ) for teachers and its modification for children (HPSQ-C), were established as quick and valid screening tools along with a third factor - emotional and physical well-being. Until now, in the Czechia, there has been no validated screening tool for D diagnosis. A study was conducted on a set of 294 children from 3rd and 4th year of primary school (132 girls/162 boys; 8.96 ± 0.73) and 21 teachers who spent most of their time with them. Confirmatory factor analysis based on the theoretical background showed poor fit for HPSQ [χ(32) = 115.07, < 0.001; comparative fit index (CFI) = 0.95; Tucker-Lewis index (TLI) = 0.93; root mean square error of approximation (RMSEA) = 0.09; standard root mean square residual (SRMR) = 0.05] and excellent fit for HPSQ-C [χ(32) = 31.12, = 0.51; CFI = 1.0; TLI = 1.0; RMSEA = 0.0; SRMR = 0.04]. For the HPSQ-C models, there were no differences between boys and girls [Δχ(7) = 12.55, = 0.08]. Values of McDonalds's ω indicate excellent (HPSQ, ω = 0.9) and acceptable (HPSQ-C, ω = 0.7) reliability. Boys were assessed as worse writers than girls based on the results of both questionnaires. The grades positively correlate with the total scores of both HPSQ ( = 0.54, < 0.01) and HPSQ-C ( = 0.28, < 0.01). Based on the results, for the assessment of handwriting difficulties experienced by Czech children, we recommend using the HPSQ-C questionnaire for research purposes.
PubMed: 32038361
DOI: 10.3389/fpsyg.2019.02937 -
Neurologia I Neurochirurgia Polska 2020This paper describes six cases of patients with myoclonus-dystonia syndrome who are members of a family in which an SGCE gene mutation has been confirmed.
AIM OF THE STUDY
This paper describes six cases of patients with myoclonus-dystonia syndrome who are members of a family in which an SGCE gene mutation has been confirmed.
CLINICAL RATIONALE FOR THE STUDY
Myoclonus-dystonia syndrome is a very rare disease, with an incidence in Europe of about 2 in every million. Due to the fact that only a few case reports of this illness are accessible in the literature, the material we collected seems to be valuable for clinical practice.
MATERIALS AND METHODS
A history was taken, and physical and genetic examinations of the patients were performed. Furthermore, the clinical examination of three patients was video-recorded.
RESULTS
The clinical picture of the disease varied significantly between the described individuals, from a healthy carrier of the SGCE mutation to patients presenting mild to moderate symptoms. The differences concerned the age at onset of the disease, the initial symptoms, the intensity of involuntary movements, and the predominant symptoms. In addition to the typical movement disorders which are myoclonus and dystonia, in the described family there was also the coexistence of epilepsy, obsessive-compulsive behaviour, dyslexia, dysgraphia, non-harmonious development of cognitive processes, as well as mild phenotypic features of muscular dystrophy. The mutation (NM_001099401.2:c.806-809delACTG) found in the presented family has not been described elsewhere.
CONCLUSIONS AND CLINICAL IMPLICATIONS
Our description of six cases of patients demonstrates the heterogeneity of the natural course of the disease, even in patients with the same mutation. It seems reasonable to regularly examine relatives of patients with myoclonus-dystonia syndrome, who should be observed for involuntary movements as well as non-motor symptoms.
Topics: Dystonic Disorders; Humans; Mutation; Myoclonus; Phenotype; Sarcoglycans
PubMed: 31956970
DOI: 10.5603/PJNNS.a2020.0005