Computerized assessment of handwriting in de novo Parkinson's disease: A kinematic study.

INTRODUCTION: Dysgraphia, a recognized PD motor symptom, lacks effective clinical assessment. Current evaluation relies on motor assessment scales. Computational methods introduced over the past decade offer an objective dysgraphia assessment, considering size, duration, speed, and handwriting fluency. Objective evaluation of dysgraphia may be of help for early diagnosis of PD. OBJECTIVE: Computerized assessment of dysgraphia in de novo PD patients and its correlation with clinical scales. METHODS: We evaluated 38 recently diagnosed, premedication PD patients and age-matched controls without neurological disorders. Participants wrote "La casa de Pamplona es bonita" three times on paper and once on a Wacom tablet under the paper, totaling four phrases. Writing segments of 5-10 s were analyzed. The Wacom tablet captured kinematic data, including mean velocity, mean acceleration, and pen pressure. Data were saved in.svc format and analyzed using specialized software developed by Tecnocampus Mataró. Standard clinical practice data, Hoehn & Yahr staging, and UPDRS scales were used for evaluation. RESULTS: Significant kinematic differences existed; patients had lower mean speed (27 ± 12 vs. 48 ± 18, p < 0.0001) and mean acceleration (7.2 ± 3.9 vs. 15.01 ± 7, p < 0.0001) than controls. Mean speed and mean acceleration correlated significantly with UPDRS III scores (speed: r = -0.52, p < 0.0007; acceleration: r = 0.60, p < 0.0001), indicating kinematic parameters' potential in PD evaluation. CONCLUSIONS: Dysgraphia is identifiable in PD patients, even de novo, indicating an early symptom and correlates with clinical scales, offering potential for objective PD patient evaluation.

AI-Enhanced Dyscalculia Screening: A Survey of Methods and Applications for Children.

New forms of interaction made possible by developments in special educational technologies can now help students with dyscalculia. Artificial intelligence (AI) has emerged as a promising tool in recent decades, particularly between 2001 and 2010, offering avenues to enhance the quality of education for individuals with dyscalculia. Therefore, the implementation of AI becomes crucial in addressing the needs of students with dyscalculia. Content analysis techniques were used to examine the literature covering the influence of AI on dyscalculia and its potential to assist instructors in promoting education for individuals with dyscalculia. The study sought to create a foundation for a more inclusive dyscalculia education in the future through in-depth studies. AI integration has had a big impact on educational institutions as well as people who struggle with dyscalculia. This paper highlights the importance of AI in improving the educational outcomes of students affected by dyscalculia.

Development of potential dysgraphia handwriting dataset.

This report presents a dataset of offline handwriting samples among Malaysian schoolchildren with potential dysgraphia. The images contained Malay sentences written by primary school students and children under intervention by the Malaysia Dyslexia Association (PDM). Students were expected to copy and write the sentences provided on the paper form that was used to gather data. Students were required to write three sets of sentences. The paper was digitalized by scanning it and converting it into digital form. Furthermore, the images were pre-processed using image processing techniques by converting the images into binary format and interchanging the foreground and background colors. The images were then classified into two categories, namely potential dysgraphia and low potential dysgraphia. The dataset comprised a total of 249 handwriting images, obtained from a sample of 83 participants who were selected in the data collection process, with 114 for potential dysgraphia and 135 for low potential dysgraphia. Both categories of handwriting images were prepared in black and white images.

Dysgraphia Differs Between Children With Developmental Coordination Disorder and/or Reading Disorder.

Handwriting deficits, or dysgraphia, are present in several neurodevelopmental disorders. To investigate whether dysgraphia differs according to the associated disorder, we performed a detailed analysis of handwriting in children with developmental coordination disorders (DCD), reading disorder (RD), or comorbid RD and DCD. Handwriting deficits were investigated at the product (quality of the trace) and the process (movement that generates the trace) levels. Nineteen children with singular RD (among which eight with dysgraphia), 13 children with singular DCD (among which seven with dysgraphia), 16 children with comorbid RD+DCD (among which 11 with dysgraphia), and 20 typically developing children, age 7 to 12, performed the BHK (Brave Handwriting Kinder) test, a standardized assessment of handwriting, on a graphic tablet. Developmental coordination disorders primarily affected handwriting quality, while RD affected slowness and, to a lesser extent, quality. Children with RD, solely or comorbid with DCD, wasted time by lifting and stopping the pen when writing. The comorbidity added to but did not worsen, handwriting difficulties. These results reflect distinct motor impairments and/or strategies in children with DCD or RD. We identified subtypes of dysgraphia and advocated for a fine-grained analysis of the writing process and the assessment of motor and reading skills when studying dysgraphia.

Two types of developmental surface dysgraphia: to bee but not to bea.

We report on two types of developmental surface dysgraphia. One type, exhibited by 8 participants, is orthographic lexicon surface dysgraphia, which involves an impairment in the orthographic output lexicon, leading to nonword phonologically-plausible misspellings. The other type, shown by 3 participants, is disconnection surface dysgraphia. In this type, the orthographic output lexicon is disconnected from the semantic system and from the phonological input lexicon, but still contributes to spelling via support to the orthographic output buffer, resulting in mainly lexical phonologically-plausible misspellings (writing be as "bee" but not "bea").The specific localization of the impairment in spelling, in the lexicon or in its connections, allowed us to examine the question of one or two orthographic lexicons; four participants who had a deficit in the orthographic output lexicon itself in writing had intact orthographic-input-lexicon in reading. They made surface errors in writing but not in reading the same words, supporting separate input and output orthographic lexicons.

Health supervision for children and adolescents with 16p11.2 deletion syndrome.

Rare genetic conditions are challenging for the primary care provider to manage without proper guidelines. This clinical review is designed to assist the pediatrician, family physician, or internist in the primary care setting to manage the complexities of 16p11.2 deletion syndrome. A multidisciplinary medical home with the primary care provider leading the care and armed with up-to-date guidelines will prove most helpful to the rare genetic patient population. A special focus on technology to fill gaps in deficits, review of case studies on novel medical treatments, and involvement with the educational system for advocacy with an emphasis on celebrating diversity will serve the rare genetic syndrome population well.

Early predictors in language-based learning disabilities: a bibliometric analysis.

Introduction: Language-based learning disabilities (LBLD) refers to a spectrum of neurodevelopmental-associated disorders that are characterized by cognitive and behavioral differences in comprehending, processing and utilizing spoken and/or written language. The focus of this work was on identifying early predictors of three main specific LBLD including dyslexia, dyscalculia, and dysgraphia. Methods: The Web of Science (WoS) was searched for literature related to (neurocognitive, neurophysiological, and neuroimaging) measurements used to identify early predictors of LBLD from 1991 to 25 October 2021. A retrospective bibliometric analysis was performed to analyze collaboration among countries, institutions, authors, publishing journals, reference co-citation patterns, keyword co-occurrence, keyword clustering, and burst keywords using Biblioanalytics software. Results: In total, 921 publications related to the identification of LBLD using (neurocognitive, neurophysiological, and neuroimaging) modalities were included. The data analysis shows a slow growth in research on the topic in the 90s and early 2000 and growing trend in recent years. The most prolific and cited journal is Neuroimage, followed by Neuropsychologia. The United States and Finland's Universities Jyvaskyla and Helsinki are the leading country and institution in this field, respectively. "Neuroimaging," "brain," "fMRI," "cognitive predictor," "comorbidity," "cortical thickness" were identified as hotspots and trends of (neurocognitive, neurophysiological, and neuroimaging) modalities in the identification of LBLD. Discussion: Early predictors of LBLDs would be useful as targets for specific prevention and intervention programs to be implemented at very young ages, which could have a significant clinical impact. A novel finding of neuroimaging predictors combined with neurocognitive and neuropsychological batteries may have implications for future research.

Tools and Methods for Diagnosing Developmental Dysgraphia in the Digital Age: A State of the Art.

Handwriting is a complex perceptual motor task that requires years of training and practice before complete mastery. Its acquisition is crucial, since handwriting is the basis, together with reading, of the acquisition of higher-level skills such as spelling, grammar, syntax, and text composition. Despite the correct learning and practice of handwriting, some children never master this skill to a sufficient level. These handwriting deficits, referred to as developmental dysgraphia, can seriously impact the acquisition of other skills and thus the academic success of the child if they are not diagnosed and handled early. In this review, we present a non-exhaustive listing of the tools that are the most reported in the literature for the analysis of handwriting and the diagnosis of dysgraphia. A variety of tools focusing on either the final handwriting product or the handwriting process are described here. On one hand, paper-and-pen tools are widely used throughout the world to assess handwriting quality and/or speed, but no universal gold-standard diagnostic test exists. On the other hand, several very promising computerized tools for the diagnosis of dysgraphia have been developed in the last decade, but some improvements are required before they can be available to clinicians. Based on these observations, we will discuss the pros and cons of the existing tools and the perspectives related to the development of a universal, standardized test of dysgraphia combining both paper-and-pen and computerized approaches and including different graphomotor and writing tasks.

Hemispheric Dominance and Neurodevelopmental Disorders: Global Effects for Intensive Motor Training on White Matter Plasticity.

Cerebral maturation is characterized by different age-dependent molecular and cellular processes and follows a different course for grey matter (GM) and white matter (WM). During brain development, a crucial point seems to be represented by the establishment of a hemispheric specialization with the left hemisphere dominant for language and motor control and the right hemisphere dominant for visuospatial processing and attention. Therefore, motor and cognitive development are strongly connected. Atypical motor development and lateralization can be associated with neurodevelopmental disorders, such as Language Disorder, Learning Disorders (Dysgraphia and Dyslexia), Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder. The aim of our research was to investigate the possible effects of intensive motor training on WM plasticity and writing skills in children with Developmental Dysgraphia through a tractography study of the main WM tracts. Considering the effect of training for the Mean Diffusivity (MD) over 18 WM tracts, in 6 collaborating dysgraphic patient MD decrease (-4.3%) and in 3 not. Intensive motor training affects both stimulated and not stimulated WM tracts and showed a double not-specificity: for not stimulated hemilate and for not directly stimulated WM tracts. Intensive motor training improves both some lateralized brain functions and intra- and inter-hemispheric connectivity in our patients with good compliance with motor treatment. Moreover, our findings have shown that WM plasticity improvement concerned cortical areas responsible for both motor and cognitive functions.

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.

Exploratory Investigation of Handwriting Disorders in School-Aged Children from First to Fifth Grade.

Handwriting disorders (HDs) are prevalent in school-aged children, with significant interference with academic performances. The current study offers a transdisciplinary approach with the use of normed and standardized clinical assessments of neuropsychomotor, neuropsychological and oculomotor functions. The aim is to provide objective data for a better understanding of the nature and the etiology of HDs. Data from these clinical assessments were analyzed for 27 school-aged children with HD (first to fifth grade). The results underline a high heterogeneity of the children presenting HDs, with many co-occurrences often unknown. However, it was possible to highlight three levels of HDs based on BHK scores: mild HD not detected by the BHK test (26% of children), moderate HD (33%) and dysgraphia (41% of children). The mild nature of the HDs not detected by the BHK test appears to occur at a relatively low frequency of the associated disorders identified during clinical evaluations. On the contrary, dysgraphia appears to be associated with a high frequency of co-occurring disorders identified in the clinical assessment, with a predominance of oculomotor disorders (55% of children), leading to visual-perceptual difficulties and a high level of handwriting deterioration. Finally, children with moderate HD have fewer co-occurrences than children with dysgraphia, but have more difficulties than children with mild HD. This highlights the importance of differentiating between different degrees of HDs that do not respond to the same semiologies. Our findings support the interest in performing a transdisciplinary and standardized clinical examination with developmental standards (neuropsychomotor, neuropsychological and oculomotor) in children with HD. Indeed, HDs can therefore be associated with a multitude of disorders of different natures ranging from poor coordination of the graphomotor gesture to a more general and more complex impairment affecting perceptual-motor, cognitive and/or psycho-affective functions.

Knowledge of schoolteachers on learning disabilities in urban Vellore - A cross-sectional study.

Background: Specific learning disability (SLD) is a cognitive neurobiological disorder caused by atypical brain functioning. SLD is recognized when the individual's achievement in school is below that expected for age, schooling, and level of intelligence. Screening millions of students with SLD by health personnel is a logistical impossibility. Awareness and knowledge about learning disorders among schoolteachers may play a major role in the early identification and management of children with these disorders. Therefore, the assessment of teachers' knowledge and perceptions about learning disabilities (LDs) is relevant. Method: A school-based cross-sectional study was conducted among teachers in government/government-aided and private schools in Vellore, India. The participants were selected by a simple random sampling method. There was a total of 80 teachers included in the study. Data capture was done using a questionnaire. A Chi-square test was done to test the association and the odds ratio test helped determine the strength of the association. A P-value of <0.05 was considered to be statistically significant. Results: The majority of the teachers (70%) had adequate general knowledge regarding LDs. When analyzed separately, 82.5% of government/aided teachers and only 57.5% of teachers were having adequate general knowledge regarding LDs. There was a significant association between the type of school and general knowledge regarding LDs. Government/aided teachers had better general knowledge regarding LDs and dyslexia than private teachers. Conclusions: Among 80 teachers, 70% (56) of them had adequate general knowledge regarding LDs. When analyzed separately, 82.5% (33) of government/aided teachers and only 57.5% (23) teachers were having adequate general knowledge regarding LDs. The government/aided schoolteachers had significantly higher levels of knowledge in most domains of the general knowledge section as compared to private schoolteachers. If teachers are having adequate knowledge regarding LDs, it will significantly increase the chances of children with LDs getting detected early and undergoing the treatment they require. Teacher education programs and workshops are needed to be conducted at regular intervals to improve the knowledge regarding SLDs among teachers.

Clinimetric properties of relevant criteria for assessing writing and drawing orientation after right hemisphere stroke.

BACKGROUND: Writing and drawing orientation is rarely assessed in clinical routine, although it might have a potential value in detecting impaired verticality perception after right hemispheric stroke (RHS). Assessment tools and criteria must be conceived and validated. We therefore explored the clinimetric properties of a set of quantitative writing and drawing orientation criteria, their ranges of normality, and their tilt prevalence in RHS individuals. NEW METHODS: We asked 69 individuals with subacute RHS and 64 matched healthy controls to write three lines and to copy the Gainotti Figure (house and trees). We determined six criteria referring to the orientation of writing and drawing main axes: for writing, the line and margin orientations, and for drawing, the tree, groundline, wall, and roofline orientations. Orientations were measured by using an electronic protractor from specific landmarks positioned by independent evaluators. RESULTS: The set of criteria fulfilling all clinimetric properties (feasibility, measurability, reliability) comprised the line orientation of the writing and the wall and roofline orientations of the drawing. Writing and drawing tilts were frequent after RHS (about 30% by criterion). COMPARISON WITH EXISTING METHODS: So far, graphomotor orientation was mostly tested qualitatively and could not be objectively appreciated in absence of validated tools and criteria, and without ranges of normality. Writing and drawing tilts may now be assessed both in routine clinical practice and research. CONCLUSIONS: Our study paves the way for investigating the clinical determinants of graphomotor tilts, including impaired verticality perception, to better understand their underlying mechanisms.

Effectiveness of Psychomotor Therapy among Children with Graphomotor Impairment with and without DCD-Diagnosis.

In Switzerland, psychomotor therapy (PMT) is a standard treatment for children with graphomotor impairments, but scientific evidence of its effectiveness is rare. To investigate the effectiveness of PMT, we conducted a randomised field trial (RFT). The sample consisted of 121 first and second graders with graphomotor impairments, some of whom met the criteria of developmental coordination disorder, while the remaining suffered from developmental dysgraphia. The treatments lasted over 5 months. Handwriting fluency and consistency were measured five times on a digitising tablet. All participating children completed a self-concept interview, and a standardised fine motor performance test twice. Psychomotor therapy significantly improved the fine motor skills of the therapy group compared to those of the waiting group. However, there was no evidence that the treated children improved more than the waiting children in terms of their graphomotor skills such as frequency, automaticity, and consistency of forming letters. Finally, the children of the therapy group showed partial improvements in their handwriting self-concept, while those of the waiting group children remained stable. This short-term RFT demonstrated the effectiveness of PMT in terms of fine motor skills and some aspects of the handwriting self-concept but showed no effects on handwriting fluency and consistency.

Relationship between Product and Process Characteristics of Handwriting Skills of Children in the Second Grade of Elementary School.

The purpose of this study was to analyze the relationship between the quality and speed of handwriting and the process characteristics of the handwriting of children in the second grade of elementary school considered as a function of age and gender. A sample of 57 children (mean age 7.25 years, SD 0.43) participated in the study. The Concise Assessment Method for Children's Handwriting (BHK) was used to assess the quality and speed of handwriting. The characteristics of the process of handwriting were assessed using MovAlyzeR® software. The handwriting of boys showed a significantly greater number of strokes and slanted more to the right than the handwriting of girls. Handwriting quality and speed significantly correlated with several process characteristics: the number of strokes, reaction time, duration, relative pen-down duration, average pen pressure, vertical size, horizontal size, road length, and average absolute velocity. This research contributes to the construction of normative values in the process characteristics of the handwriting of elementary school children and provides a promising step towards the early identification of difficulties that can lead to dysgraphia, thus preventing later difficulties in handwriting.

Deep Learning and Procrustes Analysis for Early Dysgraphia Risk Detection with a Tablet Application.

Dysgraphia is a neurodevelopmental disorder specific to handwriting. Classical diagnosis is based on the evaluation of speed and quality of the final handwritten text: it is therefore delayed as it is conducted only when handwriting is mastered, in addition to being highly language-dependent and not always easily accessible. This work presents a solution able to anticipate dysgraphia screening when handwriting has not been learned yet, in order to prevent negative consequences on the individuals' academic and daily life. To quantitatively measure handwriting-related characteristics and monitor their evolution over time, we leveraged the Play-Draw-Write iPad application to collect data produced by children from the last year of kindergarten through the second year of elementary school. We developed a meta-model based on deep learning techniques (ensemble techniques and Quasi-SVM) which receives as input raw signals collected after a processing phase based on dimensionality reduction techniques (autoencoder and Time2Vec) and mathematical tools for high-level feature extraction (Procrustes Analysis). The final dysgraphia classifier can identify "at-risk" children with 84.62% Accuracy and 100% Precision more than two years earlier than current diagnostic techniques.

Investigating Visual Perception Impairments through Serious Games and Eye Tracking to Anticipate Handwriting Difficulties.

Dysgraphia is a learning disability that causes handwritten production below expectations. Its diagnosis is delayed until the completion of handwriting development. To allow a preventive training program, abilities not directly related to handwriting should be evaluated, and one of them is visual perception. To investigate the role of visual perception in handwriting skills, we gamified standard clinical visual perception tests to be played while wearing an eye tracker at three difficulty levels. Then, we identified children at risk of dysgraphia through the means of a handwriting speed test. Five machine learning models were constructed to predict if the child was at risk, using the CatBoost algorithm with Nested Cross-Validation, with combinations of game performance, eye-tracking, and drawing data as predictors. A total of 53 children participated in the study. The machine learning models obtained good results, particularly with game performances as predictors (F1 score: 0.77 train, 0.71 test). SHAP explainer was used to identify the most impactful features. The game reached an excellent usability score (89.4 ± 9.6). These results are promising to suggest a new tool for dysgraphia early screening based on visual perception skills.

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.

Psychomotor intervention to improve handwriting skills in children with ADHD: A single-case experimental design with direct inter-subject and systematic replications.

Dysgraphia is highly prevalent in children with attention deficit hyperactivity disorder (ADHD) and adversely affects academic and developmental trajectories. To date, no study has rigorously examined the effects of a training program on handwriting quality in this specific population. Our objective was thus to develop an innovative program - we entitled PRO-PEN - and to evaluate its effects. We planned a multiple-baseline design across participants from grade 3-5, with direct inter-subject and systematic replications. Children of Group 1 (n = 4) were diagnosed with ADHD. Systematic replication was conducted in a second group of participants (Group 2, n = 4) with a diagnosis of developmental coordination disorder in addition to ADHD. The primary assessment focused on quality of handwriting. Generalization measures evaluated diverse neuropsychological and behavioural domains. In Group 1, effect sizes regarding handwriting quality were large (Taus > .60). Improvement was also observed for children of Group 2 (Taus > .50). Importantly, the positive effects persisted three months after the end of the training. Generalization effects extended beyond handwriting sphere. Therefore, PRO-PEN can be considered a promising training program for improving handwriting quality in ADHD, with a possible impact on wide cerebral regulation loops underpinning both handwriting and other neuropsychological and behavioural domains.