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RESUMO Apresentamos o relato de caso de um participante do sexo masculino, 61 anos, com afasia de condução crônica e agrafia profunda após acidente vascular cerebral isquêmico que recebeu treinamento de escrita sob ditado associado à estimulação transcraniana por corrente contínua. O tratamento consistiu em cinco sessões de 50 minutos de escrita sob ditado com aplicação de 2 mA de estimulação transcraniana por corrente contínua anódica durante 20 minutos sobre o córtex occipitotemporal esquerdo. O participante apresentou melhora na produção escrita de pseudopalavras e de palavras regulares de baixa frequência, via rota fonológica, além de uma pequena melhora na produção de palavras irregulares, via rota lexical. Após o treinamento, houve também pequena melhora da escrita de estímulos não treinados, sugerindo generalização. Na avaliação realizada 5 meses após o término do tratamento, o benefício foi mantido para estímulos processados via rota fonológica. Os resultados são promissores dada a gravidade e cronicidade do caso e sugerem que a estimulação transcraniana por corrente contínua associada à terapia de escrita representa possível alternativa clínica para pacientes com agrafia profunda.
ABSTRACT We present the case report of a 61-year-old male participant with chronic conduction aphasia and deep agraphia after ischemic stroke who received training on writing under dictation associated with transcranial direct current stimulation. The treatment consisted of five 50-minute dictation sessions with the application of 2 mA of anodal transcranial direct current stimulation for 20 minutes over the left occipitotemporal cortex. The participant improved his written production of pseudowords and regular low-frequency words, via the phonological route, in addition to a small improvement in the production of irregular words, via the lexical route. After training, there was also a small improvement in writing for untrained stimuli, suggesting generalization. In the assessment carried out 5 months after the end of the treatment, the benefit was maintained for stimuli processed via the phonological route. The results are promising given the severity and chronicity of the case and suggest that transcranial direct current stimulation associated with writing therapy represents a possible clinical alternative for patients with deep agraphia.
ABSTRACT
BACKGROUND AND PURPOSE: Korean-speaking patients with a brain injury may show agraphia that differs from that of English-speaking patients due to the unique features of Hangul syllabic writing. Each grapheme in Hangul must be arranged from left to right and/or top to bottom within a square space to form a syllable, which requires greater visuospatial abilities than when writing the letters constituting an alphabetic writing system. Among the Hangul grapheme positions within a syllable, the position of a vowel is important because it determines the writing direction and the whole configuration in Korean syllabic writing. Due to the visuospatial characteristics of the Hangul vowel, individuals with early-onset Alzheimer's disease (EOAD) may experiences differences between the difficulties of writing Hangul vowels and consonants due to prominent visuospatial dysfunctions caused by parietal lesions. METHODS: Eighteen patients with EOAD and 18 age-and-education-matched healthy adults participated in this study. The participants were requested to listen to and write 30 monosyllabic characters that consisted of an initial consonant, medial vowel, and final consonant with a one-to-one phoneme-to-grapheme correspondence. We measured the writing time for each grapheme, the pause time between writing the initial consonant and the medial vowel (P1), and the pause time between writing the medial vowel and the final consonant (P2). RESULTS: All grapheme writing and pause times were significantly longer in the EOAD group than in the controls. P1 was also significantly longer than P2 in the EOAD group. CONCLUSIONS: Patients with EOAD might require a higher judgment ability and longer processing time for determining the visuospatial grapheme position before writing medial vowels. This finding suggests that a longer pause time before writing medial vowels is an early marker of visuospatial dysfunction in patients with EOAD.
Subject(s)
Adult , Humans , Agraphia , Alzheimer Disease , Brain Injuries , Judgment , Rabeprazole , WritingABSTRACT
El síndrome de Gerstmann es una rara enfermedad neurológica de causa vascular que afecta al lóbulo parietal. Se reporta el caso de un paciente masculino de 63 años con antecedentes patológicos personales de miocardiopatía dilatada. El 24 de enero de 2016 en horas de la mañana presentó de forma súbita pérdida de la conciencia con caída al suelo. Después de recuperarse tuvo estado confusional, desorientación topográfica de breve duración y dificultad para la expresión del lenguaje y la nominación de los objetos, por esta causa se decide su ingreso, durante el cual se realiza resonancia magnética simple de cráneo donde se observó imagen hipointensa en FLAIR en región parietal izquierda compatible con lesión isquémica. Se efectuó evaluación neuropsicológica encontrándose: agnosia digital, agrafia, acalculia y confusión derecha-izquierda. Se diagnostica un síndrome de Gerstmann completo(AU)
Gerstmann syndrome is a rare neurological disease of vascular cause that affects the parietal lobe. The case is reported of a 63-year-old male patient with a personal pathological history of dilated cardiomyopathy. In the morning of January 24, 2016, the patient presented sudden loss of consciousness with a fall to the ground. After recovering, he experienced a confusion state, short-lived topographical disorientation, and difficulty in expressing language and the naming of objects, a reason why his admittance was decided. During the admittance, simple magnetic resonance imaging to the skull was performed, which permitted to observe a hypo-intense image in FLAIR in the left parietal region and that was compatible with an ischemic lesion. A neuropsychological evaluation was performed: digital agnosia, agraphia, acalculia and confusion regarding right or left. A whole Gerstmann syndrome was diagnosed.(AU)
Subject(s)
Humans , Male , Aged , Gerstmann Syndrome/history , Gerstmann Syndrome/epidemiology , Case ReportsABSTRACT
Fundamento: la dislexia, la disgrafia y la discalculia son trastornos psíquicos que presentan una situación desfavorable en el sistema educativo ecuatoriano, repercuten en la desmotivación, la baja autoestima y la deserción escolar. El profesorado no tiene conocimientos para diagnosticar los mismos en sus alumnos. Objetivo: ofrecer algunas consideraciones teóricas acerca de estos trastornos del aprendizaje que afectan el desarrollo escolar. Métodos: se realizó una búsqueda bibliográfica acerca del tema en las bases de datos Latindex, Scielo, Redalycs, Hinari, se encontraron 32 documentos de ellos se utilizaron 13 que trataron en, específico, el tema de la investigación. Se utilizaron los Descriptores en Ciencias de la Salud: dislexia, disgrafia y discalculia. Resultados: se pudo determinar que los alumnos que presentan estos trastornos psíquicos que afectan el aprendizaje son tratados como incapaces, ineptos y malcriados, se culpa a los padres de los resultados insuficientes de sus hijos. Conclusiones: la desmotivación por el estudio, la baja autoestima y la deserción escolar en este tipo de alumno es una de las consecuencias más notables en todos los niveles de enseñanza, por lo que merece una intervención científica inmediata.
Background: dyslexia, dysgraphia and dyscalculia are mental disorders that present an unfavorable situation in the Ecuadorian educational system, which influence the motivation, low self-esteem and school dropout and teachers have no knowledge to diagnose them in their students. Objective: To provide some theoretical considerations about these learning disorders affecting school development. Methods: dyslexia, dysgraphia, dyscalculia and teaching attitude: a search was conducted in PubMed, Scielo, Redalycs data descriptors were used. Results: it was determined that students who have these mental disorders that affect learning are treated as incapable, inept and ill-bred, blaming parents of their children insufficient results.
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The purpose of the present study was to investigate the relationship between Korean language-specific dysgraphia and unilateral spatial neglect in 31 right brain stroke patients. All patients were tested for writing errors in spontaneous writing, dictation, and copying tests. The dysgraphia was classified into visuospatial omission, visuospatial destruction, syllabic tilting, stroke omission, stroke addition, and stroke tilting. Twenty-three (77.4%) of the 31 patients made dysgraphia and 18 (58.1%) demonstrated unilateral spatial neglect. The visuospatial omission was the most common dysgraphia followed by stroke addition and omission errors. The highest number of errors was made in the copying and the least was in the spontaneous writing test. Patients with unilateral spatial neglect made a significantly higher number of dysgraphia in the copying test than those without. We identified specific dysgraphia features such as a right side space omission and a vertical stroke addition in Korean right brain stroke patients. In conclusion, unilateral spatial neglect influences copy writing system of Korean language in patients with right brain stroke.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Agraphia/pathology , Brain/pathology , Brain Injuries/pathology , Language , Neuropsychological Tests , Perceptual Disorders/pathology , Republic of Korea , Spatial Processing/physiology , Stroke/pathology , WritingABSTRACT
The purpose of the present study was to investigate the relationship between Korean language-specific dysgraphia and unilateral spatial neglect in 31 right brain stroke patients. All patients were tested for writing errors in spontaneous writing, dictation, and copying tests. The dysgraphia was classified into visuospatial omission, visuospatial destruction, syllabic tilting, stroke omission, stroke addition, and stroke tilting. Twenty-three (77.4%) of the 31 patients made dysgraphia and 18 (58.1%) demonstrated unilateral spatial neglect. The visuospatial omission was the most common dysgraphia followed by stroke addition and omission errors. The highest number of errors was made in the copying and the least was in the spontaneous writing test. Patients with unilateral spatial neglect made a significantly higher number of dysgraphia in the copying test than those without. We identified specific dysgraphia features such as a right side space omission and a vertical stroke addition in Korean right brain stroke patients. In conclusion, unilateral spatial neglect influences copy writing system of Korean language in patients with right brain stroke.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Agraphia/pathology , Brain/pathology , Brain Injuries/pathology , Language , Neuropsychological Tests , Perceptual Disorders/pathology , Republic of Korea , Spatial Processing/physiology , Stroke/pathology , WritingABSTRACT
Objective: This study aimed to assess the strengths and difficulties in word and pseudoword writing in adults with left- and right-hemisphere strokes, and discuss the profiles of acquired dysgraphia in these individuals. Methods: The profiles of six adults with acquired dysgraphia in left- or right-hemisphere strokes were investigated by comparing their performance on word and pseudoword writing tasks against that of neurologically healthy adults. A case series analysis was performed on the patients whose impairments on the task were indicative of acquired dysgraphia. Results: Two patients were diagnosed with lexical dysgraphia (one with left hemisphere damage, and the other with right hemisphere damage), one with phonological dysgraphia, another patient with peripheral dysgraphia, one patient with mixed dysgraphia and the last with dysgraphia due to damage to the graphemic buffer. The latter patients all had left-hemisphere damage (LHD). The patterns of impairment observed in each patient were discussed based on the dual-route model of writing. Conclusion: The fact that most patients had LHD rather than right-hemisphere damage (RHD) highlights the importance of the former structure for word processing. However, the fact that lexical dysgraphia was also diagnosed in a patient with RHD suggests that these individuals may develop writing impairments due to damage to the lexical route, leading to heavier reliance on phonological processing. Our results are of significant importance to the planning of writing interventions in neuropsychology.
Objetivo: Investigar aspectos preservados e dificuldades na escrita de palavras e pseudopalavras em adultos que sofreram acidente vascular cerebral (AVC) à esquerda e à direita e discutir os perfis de disgrafia adquirida nesses indivíduos. Métodos: Investigaram-se perfis de disgrafia adquirida a partir da avaliação das habilidades e dificuldades na escrita de palavras e pseudopalavras de seis adultos que sofreram AVC no hemisfério direito (LHD) e no hemisfério esquerdo (LHE), comparados a adultos neurologicamente saudáveis. Realizou-se análise de séries de casos com os pacientes que apresentaram desempenho deficitário na escrita de palavras, que indicavam a presença de uma disgrafia adquirida. Resultados: Foram identificados dois casos com disgrafia lexical (sendo um com LHE e outro com LHD), um caso com disgrafia fonológica, um com disgrafia periférica, um com disgrafia mista e um com disgrafia por déficit no buffer grafêmico, todos estes com LHE. Destacou-se nesse estudo a heterogeneidade das habilidades linguísticas dos casos clínicos, discutidas de acordo com o modelo cognitivo de dupla-rota de escrita. Conclusão: O maior prejuízo encontrado nos pacientes com LHE ressalta a importância desse hemisfério cerebral para o processamento da escrita de palavras. A presença de um caso com LHD com perfil de disgrafia lexical destaca a necessidade de melhor estudar o papel do hemisfério direito no processamento de palavras. Espera-se que esse estudo contribua para o planejamento de estratégias de intervenção neuropsicológica direcionadas à escrita de palavras.
Subject(s)
Humans , Agraphia , Dominance, Cerebral , NeuropsychologyABSTRACT
@#Objective To study the writing characteristics and related focuses in brain in patients with Uighur and Chinese agraphia.Methods Aphasia Battery of Chinese (ABC) and Uighur ABC were used to examine the characteristics of speaking and writing. The focues were observed with CT and MRI. Results 67 patients were with agraphia, in which 37 were Uigur and 30 were ethnic Han. Both groups mostly showed aphasic agraphia, the focuses were found in various areas in the brain, and mostly located on the left frontal, parietal, temporal lobes and basal ganglion. Conclusion The characteristics of writing were various with the types of agraphia, but similar between Uighur and Chinese cases with same writing characteristics.Writing behavior relies on the cooperation of the whole neuromechanism.
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O objetivo deste estudo foi avaliar o impacto de uma intervenção terapêutica individualizada, com enfoque nas habilidades motoras fundamentais, no desempenho motor grosso, na motricidade fina e no autoconceito de uma menina de sete anos, portadora de sequelas de epilepsia rolândica, com atraso no desenvolvimento motor global. Durante a intervenção de três meses, foram praticadas oito habilidades motoras de locomoção e quatro manipulativas. A escrita foi avaliada em características referentes à disgrafia. Para avaliação da motricidade foram utilizados padrões de movimento, e para a do autoconceito foi utilizada a Pictorial Scale of Perceived Competence and Acceptance for Young Children. Os resultados foram positivos e significativos em relação às habilidades motoras fundamentais, à escrita e à percepção de competência.
The purpose of this study was to evaluate the impact of an individualized therapeutic intervention focusing on fundamental motor skills, performance of gross motor skills, fine motor skills and on the self-concept of a 7 year old girl with rolandic epilepsy sequels, showing global motor development delays. During the intervention along three months, eight motor skills of locomotion and four manipulative skills were practiced. Written skills were evaluated considering characteristics related to dysgraphia. Motor patterns were used to assess motor development and the Pictorial Scale of Perceived Competence and Acceptance for Young Children was apllied for assessing self-concept. The results were positive showing significant changes in relation to fundamental motor skills, writing and self-concept.
Subject(s)
Humans , Female , Child , Agraphia , Developmental Disabilities , Locomotion , MovementABSTRACT
This study verifies the environmental effects on agraphia in mild cognitive impairment and dementia. We compared elderly Japanese subjects living in Japan and Brazil. Methods: We retrospectively analyzed the database of the Prevalence Study 1998 in Tajiri (n=497, Miyagi, Japan) and the Prevalence Study 1997 of elderly Japanese immigrants living in Brazil (n=166, migrated from Japan and living in the São Paulo Metropolitan Area). In three Clinical Dementia Rating (CDR) groups, i.e., CDR 0 (healthy), CDR 0.5 (questionable dementia), and CDR 1+ (dementia) , the Mini-Mental State Examination (MMSE) item of spontaneous writing and the Cognitive Abilities Screening Instrument (CASI) domain of dictation were analyzed with regard to the number of Kanji and Kana characters. Formal errors in characters and pragmatic errors were also analyzed. Results: The immigrants in Brazil wrote similar numbers of Kanji or Kana characters compared to the residents of Japan. In spontaneous writing, the formal Kanji errors were greater in the CDR 1+ group of immigrants. In writing from dictation, all the immigrant CDR groups made more formal errors in Kana than the Japan residents. No significant differences in pragmatic errors were detected between the two groups. Conclusions: Subjects living in Japan use Kanji frequently, and thus the form of written characters was simplified, which might be assessed as mild formal errors. In immigrants, the deterioration in Kanji and Kana writing was partly due to decreased daily usage of the characters. Lower levels of education of immigrants might also be related to the number of Kanji errors.
Este estudo verifica os efeitos do meio ambiente sobre a agrafia em comprometimento cognitivo leve e demência. Nós comparamos indivíduos idosos vivendo no Japão e Brasil. Métodos: Nós, retrospectivamente, analisamos a base de dados do Estudo de Prevalência 1998 em Tajiri (n=497, Miyagi, Japão) e do Estudo de Prevalência 1997 de imigrantes idosos japoneses vivendo no Brasil (n=166, imigrados do Japão e residindo na área metropolitana da cidade de São Paulo). Em três grupos de CDR (Clinical Dementia Rating), isto é, CDR 0 (saudáveis), CDR 0.5 (demência questionável) e CDR1+ (demência), o item de escrita espontânea do Mini-Exame do Estado Mental (MEEM) e o domínio de ditado do Cognitive Abilities Screening Instrument (CASI) foram analisados em relação ao número de caracteres em Kanji e Kana. Erros formais nos caracteres e erros pragmáticos foram também analisados. Resultados: Os imigrantes no Brasil escreveram número similar de caracteres de Kanji e Kana comparados aos residentes no Japão. Na escrita espontânea, os erros formais de Kanji foram maiores no grupo de CDR1+ em imigrantes. Na escrita sob ditado, todos os grupos de CDR de imigrantes fizeram mais erros formais em Kana do que os residentes no Japão. Nenhuma diferença foi encontrada em erros pragmáticos entre os grupos. Conclusões: Sujeitos vivendo no Japão usam Kanji freqüentemente, e então, a forma de caracteres escritos foi simplificada, o que pode ser avaliado como discretos erros formais. Em imigrantes, a deterioração na escrita em Kanji e Kana foi parcialmente devida ao uso diário restrito dos caracteres. Baixos níveis educacionais dos imigrantes podem estar relacionados ao número de erros em Kanji.
Subject(s)
Humans , Agraphia , Cognition , Dementia , Education , Health of the ElderlyABSTRACT
We report a man who exhibited pure agraphia after suffering a left subcortical infarction involving part of the thalamus and the basal ganglia. His writing difficulty was characterized by stopping, letter omission, and substitution in spontaneous writing and writing to dictation, but he was able to copy normally. Decreased perfusion in the left frontal lobe and temporal cortex was noted on brain single-photon-emission computed tomography . This patient's agraphia persisted at follow-up 52 days later. We suggest that the subcortical lesion in this patient caused pure agraphia secondary to diaschisis of the interconnected cortical area.
Subject(s)
Humans , Agraphia , Basal Ganglia , Brain , Cerebral Infarction , Coat Protein Complex I , Follow-Up Studies , Frontal Lobe , Infarction , Perfusion , Stress, Psychological , Thalamus , WritingABSTRACT
Objective:To investigate the neuropsychological characteristics of Chinese agraphia caused by basal ganglia(BG)infarction.Methods:The writing abilities of 40 patients with BG infarction were detected by Chinese agraphia battery(CAB),and all the writing scores and agraphia quotient were calculated.The head CT/MRI images in agraphia and non-agraphia groups were standardized,the infarction were revealed and the superposition of two-dimensional arrays were performed,so that the central tendency of infarction was visually displayed.Results: Among the 40 patients,21 had left BG infraction,and 17 had agraphia;19 had right BG infraction,and 4 had agraphia.The two-dimensional superimposing neuroimages showed that BG infarctions caused agraphia was mostly in the left BG,including the left putamen,the head and body of the caudate nucleus,but there were fewer infarctions in the right putamen and the body of the candate nucleus.BG infarction caused agraphia was mostly aphasic agraphia,which was characterized by the orthographic disorders,paragraphia,and grammar mistakes.Conclusions: BG infarction may result in aphasic agraphia,which suggested that BG is involed in writing and processing,and it is the subcortical center of this advanced neurofunction in writing.
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Korean written language is composed of ideogram (Hanja) and phonogram (Hangul), as Japanese consists of Kanji (ideogram) and Kana (phonogram). Dissociation between ideogram and phonogram impairment after brain injury has been reported in Japanese, but few in Korean. We report a 64-yr-old right-handed man who showed alexia with agraphia in Hanja but preserved Hangul reading and writing after a left posterior inferior temporal lobe infarction. Interestingly, the patient was an expert in Hanja; he had been a Hanja calligrapher over 40 yr. However, when presented with 65 basic Chinese letters that are taught in elementary school, his responses were slow both in reading (6.3 sec/letter) and writing (8.8 sec/letter). The rate of correct response was 81.5% (53 out of 65 letters) both in reading and writing. The patient's performances were beyond mean-2SD of those of six age-, sex-, and education-matched controls who correctly read 64.7 out of 65 and wrote 62.5 out of 65 letters with a much shorter reaction time (1.3 sec/letter for reading and 4.0 sec/letter for writing). These findings support the notion that ideogram and phonogram can be mediated in different brain regions and Hanja alexia with agraphia in Korean patients can be associated with a left posterior inferior temporal lesion.
Subject(s)
Humans , Male , Middle Aged , Cerebral Infarction/complications , Dyslexia/etiology , Magnetic Resonance Imaging , Task Performance and Analysis , Temporal Lobe/injuries , WritingABSTRACT
This article reported cerebral vascular disease who the behaviour obstruction of word writting as clinical feature and CT scanning showed an infarction in the left putamen. Neurolinquistic examination showed a barrier of high level coding link of the visual language. Record of simultaneous (EEG) examination showed some alterations on the picture of cerebral electrical wave, and the degree of the alteration of EEG record was at the same level of the barrier as showing on the recordes neurolihquistic tests. The cerebral cortex of the contra-side was also in a state of electrical activity. This article not only provided the neuromechanism of the behaviour obstruction of word writting but also supplies the theorical basis for treatment.