Speech therapy and hyperbaric oxygen for aphasia after carbon monoxide intoxication.

Acute carbon monoxide (CO) intoxication may result in delayed neurological sequelae, which can include amnesia, ataxia, aphasia, emotional lability, disorientation, dysphagia, and other manifestations. A 27-year-old man reported symptoms of aphasia with agraphia and alexia in a review after CO intoxication. The patient received outpatient speech therapy, as well as repeated sessions of hyperbaric oxygen for 15 days, interspersing speech therapy with hyperbaric oxygen therapy for two months. After this period of combined treatment the aphasic symptomatology remitted, and oral and written language was normal. The complete disappearance of aphasia with agraphia and alexia confirms the efficacy of the combined intervention. More data from large clinical studies are needed to assess the outcomes of hyperbaric oxygen treatment in patients with delayed neurological sequelae after CO intoxication, but this case suggests it may be a good therapeutic option in combination with specific speech therapy.

Sluggish cognitive tempo: Association with neuropsychological test scores, motor incoordination, and dysgraphia in elementary school children.

Research on the relationship between sluggish cognitive tempo (SCT) and scores on neuropsychological tests (such as those measuring processing speed and reaction time) is inconclusive, and the association between SCT and motor incoordination and dysgraphia has not been objectively investigated. Mothers of 413 elementary school children (6-12 years of age) rated their children on the Pediatric Behavior Scale (PBS), which yields psychological problem scores, including SCT. Children were administered an extensive battery of neuropsychological tests assessing processing and performance speed, working memory, immediate and delayed recall, sustained attention, response inhibition, cognitive flexibility, fine motor manipulative skill, verbal fluency and retrieval, set shifting, and interference control, as well as intelligence and reading and math achievement. Only three of the 19 correlations between SCT and neuropsychological scores were significant, and all involved graphomotor tests (two timed and one untimed). In regression analysis, the strongest independent predictor of SCT was the maternal PBS incoordination factor score, followed by ratings of autism, inattention, and depression. Neuropsychological test scores did not contribute significantly more to predicting SCT. Among the incoordination PBS factor items, clumsy and draws or writes poorly were significant SCT predictors. Our novel and unexpected findings showed that motor incoordination was a stronger correlate of SCT than other variables assessed in our study, including those previously linked with SCT. Future SCT research needs to include measures of incoordination and dysgraphia in order to replicate and expand upon the current findings. Our results suggest that SCT traits are not reliably measured by currently available neuropsychological tests.

Does surface dyslexia/dysgraphia relate to semantic deficits in the semantic variant of primary progressive aphasia?

The semantic variant of primary progressive aphasia (sv-PPA) is a degenerative condition which causes surface dyslexia/dysgraphia, resulting in reading/writing errors of irregular words with non-transparent grapheme-to-phoneme correspondences (e.g., 'plaid') as opposed to regular words (e.g., 'cat'). According to connectionist models, most authors have attributed this deficit to semantic impairments, but this assumption is at odds with symbolic models, such as the DRC account, stating that the reading/writing of irregulars relies on the mental lexicon. Our study investigated whether sv-PPA affects the lexicon in addition to the semantic system, and whether semantic or lexical deficits cause surface dyslexia/dysgraphia, while challenging the two major models of written language. We explored a cohort of 12 sv-PPA patients and 25 matched healthy controls using a reading and writing task, a semantic task (category decision: living vs. non-living), and a lexical task (lexical decision: word vs. no-neighbor non-word). Correlation analyses were conducted to assess the relationship between reading/writing scores of irregulars and semantic vs. lexical performance. Furthermore, item-by-item analyses explored the consistency of reading/writing errors with item-specific semantic and lexical errors. Results showed that sv-PPA patients are impaired at reading and writing irregular words, and that they have impaired performance in both the semantic and the lexical task. Reading/writing scores with irregulars correlated significantly with performance in the lexical but not the semantic task. Item-by-item analyses revealed that failure in the lexical task on a given irregular word is a good predictor of reading/writing errors with that item (positive predictive value: 77.5%), which was not the case for the semantic task (positive predictive value: 42.5%). Our findings show that sv-PPA is not restricted to semantic damage but that it also comprises damage to the mental lexicon, which appears to be the major factor for surface dyslexia/dysgraphia. Our data support symbolic models whereas they challenge connectionist accounts.

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.

Molecular neuroimaging in primary progressive aphasia with predominant agraphia.

A 62-year-old male presented with progressive isolated writing and spelling difficulties. Neurological, neuropsychological, speech, and language evaluations identified only minimal additional abnormalities. The presenting characteristics did not meet criteria for any particular variant of primary progressive aphasia; his clinical presentation is best described as primary progressive aphasia, with a predominant, almost pure agraphia. Brain MRI showed asymmetric, bilateral parenchymal volume loss, with left hippocampal atrophy. Fluorodeoxyglucose-F18 positron emission tomography showed hypometabolism in the lateral left frontal lobe, including Exner's area. Beta-amyloid and tau-positron emission tomography scans were negative, indicating the etiology was not Alzheimer's disease. The underlying neurodegenerative process is most likely related to TDP-43, although a 4-repeat tauopathy cannot be excluded. Following his clinical evolution, and ultimately identifying the underlying pathology from autopsy, will elucidate the etiology of this interesting clinical presentation.

The nature and treatment of phonological text agraphia.

Phonological alexia and agraphia are written language disorders characterised by disproportionate difficulty reading and spelling nonwords in comparison to real words. In phonological alexia, it has been shown that, despite relatively accurate reading of words in isolation, text-level reading deficits are often marked and persistent. Specifically, some individuals demonstrate difficulty reading functors and affixes in sentences, a profile referred to as phonological text alexia. In this paper, we demonstrate an analogous manifestation of the phonological impairment on text-level writing and suggest the term "phonological text agraphia". We examined four individuals with phonological alexia/agraphia who also showed disproportionate difficulty writing well-formed sentences in comparison to their grammatical competence in spoken utterances. Implementation of a phonological treatment protocol resulted in significantly improved sublexical phonology skills as well as improvements in grammatical accuracy of written narratives. These findings support the notion of a common phonological impairment underlying nonword reading/spelling deficits and sentence-level difficulties.

Lexical processing and distributional knowledge in sound-spelling mapping in a consistent orthography: A longitudinal study of reading and spelling in dyslexic and typically developing children.

This study examined the ability to master lexical processing and use knowledge of the relative frequency of sound-spelling mappings in both reading and spelling. Twenty-four dyslexic and dysgraphic children and 86 typically developing readers were followed longitudinally in 3rd and 5th grades. Effects of word regularity, word frequency, and probability of sound-spelling mappings were examined in two experimental tasks: (a) spelling to dictation; and (b) orthographic judgment. Dyslexic children showed larger regularity and frequency effects than controls in both tasks. Sensitivity to distributional information of sound-spelling mappings was already detected by third grade, indicating early acquisition even in children with dyslexia. Although with notable differences, knowledge of the relative frequencies of sound-spelling mapping influenced both reading and spelling. Results are discussed in terms of their theoretical and empirical implications.

Lexical decision performance in developmental surface dysgraphia: Evidence for a unitary orthographic system that is used in both reading and spelling.

The relationship between spelling, written word recognition, and picture naming is investigated in a study of seven bilingual adults who have developmental surface dysgraphia in both Greek (their first language) and English (their second language). Four of the cases also performed poorly at orthographic lexical decision in both languages. This finding is consistent with similar results in Italian that have been taken as evidence of a developmental impairment to a single orthographic system that is used for both reading and spelling. The remaining three participants performed well at orthographic lexical decision. At first sight, preserved lexical decision in surface dysgraphia is less easy to explain in terms of a shared orthographic system. However, the results of subsequent experiments showed clear parallels between the nature of the reading and spelling difficulties that these three individuals experienced, consistent with the existence of a single orthographic system. The different patterns that were observed were consistent with the claims of Friedmann and Lukov (2008. Developmental surface dyslexias. Cortex, 44, 1146-1160) that several distinct sub-types of developmental surface dyslexia exist. We show that individual differences in spelling in surface dysgraphia are also consistent with these sub-types; there are different developmental deficits that can give rise, in an individual, to a combination of surface dyslexia and dysgraphia. Finally, we compare the theoretical framework used by Friedmann and her colleagues that is based upon the architecture of the DRC model with an account that relies instead upon the Triangle model of reading].

The Ege Agraphia Test Battery for Identifying the Writing Disorders in Cases with Mild Cognitive Impairment and Alzheimer's Disease. / Ege Agrafi Test Bataryasi'nin Hafif Bilissel Bozukluk ve Alzheimer Hastaligi Olgularindaki Yazma Bozukluklarini Belirlemedeki Yeri.

OBJECTIVE: The purpose of this study is to create an agraphia test battery specific to Turkish language, to obtain normative data for the performance and error types of this test and to demonstrate its success in detecting cognitive disorders in mild cognitive impairment (MCI) cases that can't be diagnosed by formal neuropsychological tests due to the fact that writing is a complex function. METHOD: For this purpose, 20 healthy control (HC) subjects, 20 MCI cases and 20 Alzheimer's disease (AD) patients with Clinical Dementia Rating (CDR) of 1 were evaluated with Ege Agraphia Test Battery. RESULTS: Significant differences between the performance points and the error types of HC subjects, MCI cases and AD patients were obtained. As the cognitive impairment of the subjects in the study got worse, the writing skills also became worse revealing lower test points. Besides, some statistically significant differences between the error types of MCI cases and AD patients were found. CONCLUSION: Ege Agraphia Test Battery is not only a practical test, but also is the first defined agraphia test specific for Turkish language. Writing disorders in cases with MCI support the view that MCI is a transition period for AD. Further studies are required to increase the test data and proper rearrangements of the test battery.

Dysfluent Handwriting in Schizophrenic Outpatients.

Taking into account findings in the literature, the author aimed to test whether specific graphical characteristics of handwriting can distinguish patients diagnosed with schizophrenic disorders from healthy controls. Handwriting samples (one sample from each person) from 60 outpatients (29 women, 31 men; age M = 28.5, SD = 5.4) with paranoid schizophrenia were analyzed by three documents examiners and were compared to samples from 60 controls (30 men, 30 women, age M = 28.0, SD = 3.0) without psychiatric disorders. Document examiners assessed 32 graphical features potentially related to schizophrenia. The comparisons between groups revealed that only 7 out of 32 handwriting properties were significantly different in the handwriting of schizophrenic outpatients from controls: the calligraphic forms of letters, loops in ovals, lacking of dots, tremor, sinusoidal baseline, and irregularities size of lower zone. These findings are discussed in terms of motor disturbances in schizophrenia and in relation to the previous research on handwriting of other mental disorders. Similarities between the graphical patterns of handwriting of schizophrenic patients and those of other mental disorders and/or other mental states have been demonstrated.

Amplitude Manipulation Evokes Upper Limb Freezing during Handwriting in Patients with Parkinson's Disease with Freezing of Gait.

BACKGROUND: Recent studies show that besides freezing of gait (FOG), many people with Parkinson's disease (PD) also suffer from freezing in the upper limbs (FOUL). Up to now, it is unclear which task constraints provoke and explain upper limb freezing. OBJECTIVE: To investigate whether upper limb freezing and other kinematic abnormalities during writing are provoked by (i) gradual changes in amplitude or by (ii) sustained amplitude generation in patients with and without freezing of gait. METHODS: Thirty-four patients with PD, including 17 with and 17 without FOG, performed a writing task on a touch-sensitive writing tablet requiring writing at constant small and large size as well as writing at gradually increasing and decreasing size. Patients of both groups were matched for disease severity, tested while 'on' medication and compared to healthy age-matched controls. RESULTS: Fifty upper limb freezing episodes were detected in 10 patients, including 8 with and 2 without FOG. The majority of the episodes occurred when participants had to write at small or gradually decreasing size. The occurrence of FOUL and the number of FOUL episodes per patient significantly correlated with the occurrence and severity of FOG. Patients with FOUL also showed a significantly smaller amplitude in the writing parts outside the freezing episodes. CONCLUSIONS: Corroborating findings of gait research, the current study supports a core problem in amplitude control underlying FOUL, both in maintaining as well as in flexibly adapting the cycle size.

Recognition of oral spelling is diagnostic of the central reading processes.

The task of recognition of oral spelling (stimulus: "C-A-T", response: "cat") is often administered to individuals with acquired written language disorders, yet there is no consensus about the underlying cognitive processes. We adjudicate between two existing hypotheses: Recognition of oral spelling uses central reading processes, or recognition of oral spelling uses central spelling processes in reverse. We tested the recognition of oral spelling and spelling to dictation abilities of a single individual with acquired dyslexia and dysgraphia. She was impaired relative to matched controls in spelling to dictation but unimpaired in recognition of oral spelling. Recognition of oral spelling for exception words (e.g., colonel) and pronounceable nonwords (e.g., larth) was intact. Our results were predicted by the hypothesis that recognition of oral spelling involves the central reading processes. We conclude that recognition of oral spelling is a useful tool for probing the integrity of the central reading processes.

Intermittent alien hand syndrome and callosal apraxia in multiple sclerosis: implications for interhemispheric communication.

We report a case of a 47-year-old woman with 35-year history of multiple sclerosis, who showed alien hand signs, a rare behavioural disorder that involves unilateral goal-directed movements that are contrary to the individual's intention. Alien hand syndrome has been described in multiple sclerosis (MS) only occasionally and is generally suggestive of callosal disconnection. The patient presented also with bilateral limb apraxia and left hand agraphia, raising the possibility of cortical dysfunction or disconnection, in addition to corpus callosum and white matter involvement. Her specific pattern of symptoms supports the role of the corpus callosum in interhemispheric communication for complex as well as fine motor activities and may indicate that it can serve as both an inhibitory and excitatory function depending on task demands.

Beyond the visual word form area: the orthography-semantics interface in spelling and reading.

Lexical orthographic information provides the basis for recovering the meanings of words in reading and for generating correct word spellings in writing. Research has provided evidence that an area of the left ventral temporal cortex, a subregion of what is often referred to as the visual word form area (VWFA), plays a significant role specifically in lexical orthographic processing. The current investigation goes beyond this previous work by examining the neurotopography of the interface of lexical orthography with semantics. We apply a novel lesion mapping approach with three individuals with acquired dysgraphia and dyslexia who suffered lesions to left ventral temporal cortex. To map cognitive processes to their neural substrates, this lesion mapping approach applies similar logical constraints to those used in cognitive neuropsychological research. Using this approach, this investigation: (a) identifies a region anterior to the VWFA that is important in the interface of orthographic information with semantics for reading and spelling; (b) determines that, within this orthography-semantics interface region (OSIR), access to orthography from semantics (spelling) is topographically distinct from access to semantics from orthography (reading); (c) provides evidence that, within this region, there is modality-specific access to and from lexical semantics for both spoken and written modalities, in both word production and comprehension. Overall, this study contributes to our understanding of the neural architecture at the lexical orthography-semantic-phonological interface within left ventral temporal cortex.

Written language production disorders: historical and recent perspectives.

Written language production is often the least examined neuropsychological function, yet it provides a sensitive and subtle sign to a variety of different behavioral disorders. The dissociation between written and spoken language and reading and writing first came to clinical prominence in the nineteenth century, with respect to ideas about localization of function. Twentieth century aphasiology research focused primarily on patients with unifocal lesions from cerebrovascular accidents, which have provided insight into the various levels of processing involved in the cognitively complex task of producing written language. Recent investigations have provided a broader perspective on writing impairments in a variety of disorders, including progressive and diffuse brain disorders, and functional brain imaging techniques have been used to study the underlying processes in healthy individuals.

Patterns of dysgraphia in primary progressive aphasia compared to post-stroke aphasia.

We report patterns of dysgraphia in participants with primary progressive aphasia that can be explained by assuming disruption of one or more cognitive processes or representations in the complex process of spelling. These patterns are compared to those described in participants with focal lesions (stroke). Using structural imaging techniques, we found that damage to the left extrasylvian regions, including the uncinate, inferior fronto-occipital fasciculus, and sagittal stratum (including geniculostriate pathway and inferior longitudinal fasciculus), as well as other deep white and grey matter structures, was significantly associated with impairments in access to orthographic word forms and semantics (with reliance on phonology-to-orthography to produce a plausible spelling in the spelling to dictation task). These results contribute not only to our understanding of the patterns of dysgraphia following acquired brain damage but also the neural substrates underlying spelling.

Dysgraphia in Korean patients with Alzheimer's disease as a manifestation of bilateral hemispheric dysfunction.

BACKGROUND: In writing, linguistic (i.e., spelling) and nonlinguistic (i.e., arranging strokes or letters) functions are processed by the left and right hemispheres, respectively. The configuration of Korean alphabet, 'Hangul' invokes nonlinguistic, visuospatial functions that other writing systems use less extensively. Patients with Alzheimer's disease (AD) have bilateral involvement of temporoparietal-frontal areas that are responsible for processing language and visuospatial functions. OBJECTIVES: The aim of this study was to examine the nature of Hangul writing dysfunction, which may be associated with bilateral hemispheric impairments in AD. METHODS: A sample of 75 patients with AD and 20 healthy controls (HC) performed a Hangul writing task. Neuroimaging positron emission tomography (PET) data of 22 patients were utilized to measure the regional brain glucose metabolism associated with Hangul writing. RESULTS: The writing performance of the AD group was significantly reduced and different types of errors were observed as the disease got worse. Glucose hypometabolism correlated with Hangul writing impairment was located in the right occipitotemporal lobe and left temporoparietal lobe. CONCLUSIONS: The PET findings demonstrate that impairment in Hangul writing performance in Korean AD patients is closely related to a functional decline in both the right and left hemispheres. The study provides a unique contribution to the knowledge of dysgraphia in a non-alphabetical writing system as well as the underlying neuropathology of dysgraphic features in such languages.

Progressive aphasia presenting with deep dyslexia and dysgraphia.

Primary progressive aphasia is clinically heterogeneous. We report a patient, alias Don, with a novel form of progressive aphasia, characterised by deep dyslexia and dysgraphia and dissociated access to phonological and orthographic word forms. The hallmarks of deep dyslexia and dysgraphia were present early in the course and persisted over time. Writing was initially poorer than reading, but this reversed over time. There was a lack of concordance between reading and writing errors. Don benefited from a semantic mediation strategy to learn letter sounds, involving associating letters with a country name (e.g., A=Afghanistan). Remarkably, he continued to be able to generate those phonologically complex country names when no longer able to name or sound letters. Don's performance is compatible with a traditional dual-route account of deep dyslexia and dysgraphia. The findings have potential practical implications for speech and language therapy in progressive aphasia. Moreover, they illustrate both the remarkable specificity yet clinical diversity in presentation of progressive aphasia.

Inflectional spelling deficits in developmental dyslexia.

The goal of this study was to examine past-tense spelling deficits in developmental dyslexia and their relationship to phonological abilities, spoken morphological awareness and word specific orthographic memory. Three groups of children (28 9-year-old dyslexic, 28 chronological age-matched and 28 reading/spelling age-matched children) completed a battery of tests including spelling regularly inflected words (e.g., kissed) and matched one-morpheme words (e.g., wrist). They were also assessed on a range of tests of reading and spelling abilities and associated linguistic measures. Dyslexic children were impaired in relation to chronological age-matched controls on all measures. Furthermore, they were significantly poorer than younger reading and spelling age-matched controls at spelling inflected verbs, supporting the existence of a specific deficit in past-tense spelling in dyslexia. In addition to under-using the -ed spelling on inflected verbs, the dyslexic children were less likely to erroneously apply this spelling to one-morpheme words than younger controls. Dyslexics were also poorer than younger controls at using a consistent spelling for stems presented in isolation versus as part of an inflected word, indicating that they make less use of the morphological relations between words to support their spelling. In line with this interpretation, regression analyses revealed another qualitative difference between the spelling and reading age-matched group and the dyslexic group: while both spoken morphological awareness and orthographic word specific memory were significant predictors of the accuracy of past-tense spelling in the former group, only orthographic memory (irregular word reading and spelling) was a significant factor in the dyslexic group. Finally, we identified a subgroup of seven dyslexic children who were severely deficient in past-tense spelling. This subgroup was also significantly worse than other dyslexics and than younger controls on scores of orthographic memory. The implications of our findings for teaching and remediation strategies are discussed.

A visual processing but no phonological disorder in a child with mixed dyslexia.

The case study of Martial, a French 9-year-old boy, who exhibits severe mixed dyslexia and surface dysgraphia is reported. Despite very poor pseudo-word reading, Martial has preserved phonological processing skills as his good oral language, good phoneme awareness and good verbal short-term memory show. He exhibited a strong length effect when reading briefly presented words but no sign of mini-neglect. His letter-string processing abilities were assessed through tasks of whole and partial report. In whole report, Martial could only name a few letters from briefly displayed 5-consonant strings. He showed an initial-position advantage and a sharper than expected left-to-right gradient of performance. He performed better when asked to report a single cued letter within the string but then showed an atypical right-side advantage. The same rightward attentional bias was observed in whole report when top-down control was prevented. Otherwise, Martial showed preserved single letter identification skills and good processing of 5-letter strings when letters were sequentially displayed one at a time. His poor letter-string processing thus reflects a parallel visual processing disorder that is compatible with either a visual attention (VA) span or a visual short-term memory disorder. Martial was further engaged in a complex reaching movement task involving VA and simultaneous processing. He performed motor sequences not as a whole but as a succession of independent motor units, suggesting that his attention was not allocated in parallel to the two to-be-reached targets prior to movement execution. Against a more basic motor disorder however, he showed good performance in a task of cyclical pointing movements. The overall findings suggest that Martial suffers from a visual simultaneous processing disorder that disturbs letter identification in strings. Instead of being restricted to letter-string processing, this VA disorder might extend to non-verbal task.