The handwriting brain in middle childhood.

While the brain network supporting handwriting has previously been defined in adults, its organization in children has never been investigated. We compared the handwriting network of 23 adults and 42 children (8- to 11-year-old). Participants were instructed to write the alphabet, the days of the week, and to draw loops while being scanned. The handwriting network previously described in adults (five key regions: left dorsal premotor cortex, superior parietal lobule (SPL), fusiform and inferior frontal gyri, and right cerebellum) was also strongly activated in children. The right precentral gyrus and the right anterior cerebellum were more strongly activated in adults than in children, while the left fusiform gyrus (FuG) was more strongly activated in children than in adults. Finally, we found that, contrary to adults, children recruited prefrontal regions to complete the writing task. This constitutes the first comparative investigation of the neural correlates of writing in children and adults. Our results suggest that the network supporting handwriting is already established in middle childhood. They also highlight the major role of prefrontal regions in learning this complex skill and the importance of right precentral regions and cerebellum in the performance of automated handwriting.

Motor control of handwriting in the developing brain: A review.

This review focuses on the acquisition of writing motor aspects in adults, and in 5-to 12-year-old children without learning disabilities. We first describe the behavioural aspects of adult writing and dominant models based on the notion of motor programs. We show that handwriting acquisition is characterized by the transition from reactive movements programmed stroke-by-stroke in younger children, to an automatic control of the whole trajectory when the motor programs are memorized at about 10 years old. Then, we describe the neural correlates of adult writing, and the changes that could occur with learning during childhood. The acquisition of a new skill is characterized by the involvement of a network more restricted in space and where neural specificity is increased in key regions. The cerebellum and the left dorsal premotor cortex are of fundamental importance in motor learning, and could be at the core of the acquisition of handwriting.

Brain correlates of phonological recoding of visual symbols.

Learning to read involves setting up associations between meaningless visual inputs (V) and their phonological representations (P). Here, we recorded the brain signals (ERPs and fMRI) associated with phonological recoding (i.e., V-P conversion processes) in an artificial learning situation in which participants had to learn the associations between 24 unknown visual symbols (Japanese Katakana characters) and 24 arbitrary monosyllabic names. During the learning phase on Day 1, the strength of V-P associations was manipulated by varying the proportion of correct and erroneous associations displayed during a two-alternative forced choice task. Recording event related potentials (ERPs) during the learning phase allowed us to track changes in the processing of these visual symbols as a function of the strength of V-P associations. We found that, at the end of the learning phase, ERPs were linearly affected by the strength of V-P associations in a time-window starting around 200ms post-stimulus onset on right occipital sites and ending around 345ms on left occipital sites. On Day 2, participants had to perform a matching task during an fMRI session and the strength of these V-P associations was again used as a probe for identifying brain regions related to phonological recoding. Crucially, we found that the left fusiform gyrus was gradually affected by the strength of V-P associations suggesting that this region is involved in the brain network supporting phonological recoding processes.

Twelve months of active musical training in 8- to 10-year-old children enhances the preattentive processing of syllabic duration and voice onset time.

Musical training has been shown to positively influence linguistic abilities. To follow the developmental dynamics of this transfer effect at the preattentive level, we conducted a longitudinal study over 2 school years with nonmusician children randomly assigned to music or to painting training. We recorded the mismatch negativity (MMN), a cortical correlate of preattentive mismatch detection, to syllables that differed in vowel frequency, vowel duration, and voice onset time (VOT), using a test-training-retest procedure and 3 times of testing: before training, after 6 months and after 12 months of training. While no between-group differences were found before training, enhanced preattentive processing of syllabic duration and VOT, as reflected by greater MMN amplitude, but not of frequency, was found after 12 months of training in the music group only. These results demonstrate neuroplasticity in the child brain and suggest that active musical training rather than innate predispositions for music yielded the improvements in musically trained children. These results also highlight the influence of musical training for duration perception in speech and for the development of phonological representations in normally developing children. They support the importance of music-based training programs for children's education and open new remediation strategies for children with language-based learning impairments.

Functional specificity in the motor system: Evidence from coupled fMRI and kinematic recordings during letter and digit writing.

A few intriguing neuropsychologial studies report dissociations where agraphic patients are severely impaired for writing letters whereas they write digits nearly normally. Here, using functional magnetic resonance imaging (fMRI) together with graphic tablet recordings, we tested the hypothesis that the motor patterns for writing letters are coded in specific regions of the cortex. We found a set of three regions that were more strongly activated when participants wrote letters than when they wrote digits and whose response was not explained by low-level kinematic features of the graphic movements. Two of these regions (left dorsal premotor cortex and supplementary motor complex) are part of a motor control network. The left premotor activation belongs to what is considered in the literature a key area for handwriting. Another significant activation, likely related to phoneme-to-grapheme conversion, was found in the right anterior insula. This constitutes the first neuroimaging evidence of functional specificity derived from experience in the cortical motor system.

From micrographia to Parkinson's disease dysgraphia.

Micrographia, an abnormal reduction in writing size, is a specific behavioral deficit associated with Parkinson's disease (PD). In recent years, the availability of graphic tablets has made it possible to study micrographia in unprecedented detail. Consequently, a growing number of studies show that PD patients also exhibit impaired handwriting kinematics. Is micrographia still the most characteristic feature of PD-related handwriting deficits? To answer this question, we identified studies that investigated handwriting in PD, either with conventional pencil-and-paper measures or with graphic tablets, and we reported their findings on key spatiotemporal and kinematic variables. We found that kinematic variables (velocity, fluency) differentiate better between control participants and PD patients, and between off- and on-treatment PD patients, than the traditional measure of static writing size. Although reduced writing size is an important feature of PD handwriting, the deficit is not restricted to micrographia stricto sensu. Therefore, we propose the term PD dysgraphia, which encompasses all deficits characteristic of Parkinsonian handwriting. We conclude that the computerized analysis of handwriting movements is a simple and useful tool that can contribute to both diagnosis and follow-up of PD.

Effects of biscriptuality on graphomotor coordination dynamics.

Biscriptuality is the ability to write in two different writing systems. The aim of this study was to examine the effects of biscriptuality on graphomotor coordination dynamics in right-handed adults. Thirty-four French monoscriptuals and 34 French-Arabic biscriptual participants traced series of loops in two writing directions and in two directions of rotation. We found that biscriptuals displayed a general advantage over monoscriptuals in terms of tracing frequency, while both groups displayed a preference for the left-to-right direction. These results provide novel evidence on the effects of writing direction and type of expertise on graphomotor performance by showing that biscriptuality could be an asset. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Writing letters in two graphic systems: Behavioral and neural correlates in Latin-Arabic biscripters.

Biscriptuality is the ability to read and write using two scripts. Despite the increasing number of biscripters, this phenomenon remains poorly understood. Here, we focused on investigating graphomotor processing in French-Arabic biscripters. We chose the French and Arabic alphabets because they have comparable visuospatial complexity and linguistic features, but differ dramatically in their graphomotor characteristics. In a first experiment we describe the graphomotor features of the two alphabets and showed that while Arabic and Latin letters are produced with the same velocity and fluency, Arabic letters require more pen lifts, contain more right-to-left strokes and clockwise curves, and take longer to write than Latin letters. These results suggest that Arabic and Latin letters are produced via different motor patterns. In a second experiment we used functional magnetic resonance imaging to ask whether writing the two scripts relies upon partially distinct or fully overlapping neural networks, and whether the elements of the previously described handwriting network are recruited to the same extent by the two scripts. We found that both scripts engaged the so-called "writing network", but that within the network, Arabic letters recruited the left superior parietal lobule (SPL) and the left primary motor cortex (M1) more strongly than Latin letters. Both regions have previously been identified as holding scale-invariant representations of letter trajectories. Arabic and Latin letters also activated distinct regions that do not belong to the writing network. Complementary analyses indicate that the differences observed between scripts at the neural level could be driven by the specific graphomotor features of each script. Overall, our results indicate that particular features of the practiced scripts can lead to different motor organization at both the behavioral and brain levels in biscripters.

Altered Inhibitory Mechanisms in Parkinson's Disease: Evidence From Lexical Decision and Simple Reaction Time Tasks.

INTRODUCTION: Although the motor signs of Parkinson's disease (PD) are well defined, nonmotor symptoms, including higher-level language deficits, have also been shown to be frequent in patients with PD. In the present study, we used a lexical decision task (LDT) to find out whether access to the mental lexicon is impaired in patients with PD, and whether task performance is affected by bradykinesia. MATERIALS AND METHODS: Participants were 34 nondemented patients with PD, either without (off) medication (n = 16) or under optimum (on) medication (n = 18). A total of 19 age-matched control volunteers were also recruited. We recorded reaction times (RTs) to the LDT and a simple RT (control) task. In each task, stimuli were either visual or auditory. Statistical analyses consisted of repeated-measures analyses of variance and Tukey's HSD post hoc tests. RESULTS: In the LDT, participants with PD both off and on medication exhibited intact access to the mental lexicon in both modalities. In the visual modality, patients off medication were just as fast as controls when identifying real words, but slower when identifying pseudowords. In the visual modality of the control task, RTs for pseudowords were significantly longer for PD patients off medication than for controls, revealing an unexpected but significant lexicality effect in patients that was not observed in the auditory modality. Performances of patients on medication did not differ from those of age-matched controls. DISCUSSION: Motor execution was not slowed in patients with PD either off or on medication, in comparison with controls. Regarding lexical access, patients off medication seemed to (1) have difficulty inhibiting a cognitive-linguistic process (i.e., reading) when it was not required (simple reaction time task), and (2) exhibit a specific pseudoword processing deficit in the LDT, which may have been related to impaired lateral word inhibition within the mental lexicon. These deficits seemed to be compensated by medication.

Musical sonification improves motor control in Parkinson's disease: a proof of concept with handwriting.

A growing number of studies postulate the use of music to improve motor control in patients with Parkinson's disease (PD). The effects of music are greatly variable from one individual to the other and do not always reach the expected benefits. This study aimed to optimize the use of music in the management of movement disorders inherent to PD in a handwriting task. We developed and tested musical sonification (MS), a method that transforms in real-time kinematic variables into music. Twelve patients with PD, on medication, and 12 healthy controls were recruited in a pretest/training/posttest design experiment. Three training sessions were compared, for which participants were asked to produce graphomotor exercises: one session with music (unrelated to handwriting), one with MS (controlled by handwriting), and one in silence. Results showed that the performance in training was better under MS than under silence or background music, for both groups. After training, the benefits of MS were still present for both groups, with a higher effect for PD patients than for control group. Our results provide a proof of concept to consider MS as a relevant auditory guidance strategy for movement rehabilitation in patients with PD.

Comparing Comprehension of a Long Text Read in Print Book and on Kindle: Where in the Text and When in the Story?

Digital reading devices such as Kindle differ from paper books with respect to the kinesthetic and tactile feedback provided to the reader, but the role of these features in reading is rarely studied empirically. This experiment compares reading of a long text on Kindle DX and in print. Fifty participants (24 years old) read a 28 page (∼1 h reading time) long mystery story on Kindle or in a print pocket book and completed several tests measuring various levels of reading comprehension: engagement, recall, capacities to locate events in the text and reconstructing the plot of the story. Results showed that on most tests subjects performed identically whatever the reading medium. However, on measures related to chronology and temporality, those who had read in the print pocket book, performed better than those who had read on a Kindle. It is concluded that, basically comprehension was similar with both media, but, because kinesthetic feedback is less informative with a Kindle, readers were not as efficient to locate events in the space of the text and hence in the temporality of the story. We suggest that, to get a correct spatial representation of the text and consequently a coherent temporal organization of the story, readers would be reliant on the sensorimotor cues which are afforded by the manipulation of the book.

E-book reading hinders aspects of long-text comprehension for adults with dyslexia.

Developmental dyslexia is a long-lasting reading deficit that persists into adulthood. In spite of many difficulties, some adults with dyslexia reach levels of reading comprehension similar to those of unimpaired readers and successfully study at university. While digital technologies offer many potential tools to facilitate reading, there are differences between printed books and e-books, particularly regarding the interaction between the reader and the text (paratextual cues). This study used long-text reading to investigate (1) different aspects of reading comprehension skills (literal and inferential processes, location of events within a story, and reconstruction of the plot) among university students with dyslexia and (2) the impact of e-book reading on reading comprehension in this population. Thirty adults with dyslexia and 30 matched skilled readers read the same text presented from a printed book and an e-book (Amazon Kindle). Questions were open-ended and both questions and answers used oral format. Results showed that with the printed book, dyslexic adults performed similarly to skilled readers in both literal and inferential reading comprehension tasks. Moreover, they performed at the same level or higher than skilled readers in tasks assessing spatiotemporal aspects of reading (localization of events and plot reconstruction). Conversely, with the e-book reader, the dyslexic adults were outperformed by skilled readers both in literal and spatiotemporal comprehension tasks. These results suggest that reading from an e-book hinders some aspects of reading comprehension for adults with dyslexia. However, when reading a printed book without time pressure, university students with dyslexia performed as well as, or better than, non-impaired readers on some measures of reading comprehension. Therefore, digital reading devices might not always be advantageous to them.

Music Training Positively Influences the Preattentive Perception of Voice Onset Time in Children with Dyslexia: A Longitudinal Study.

Previous results showed a positive influence of music training on linguistic abilities at both attentive and preattentive levels. Here, we investigate whether six months of active music training is more efficient than painting training to improve the preattentive processing of phonological parameters based on durations that are often impaired in children with developmental dyslexia (DD). Results were also compared to a control group of Typically Developing (TD) children matched on reading age. We used a Test-Training-Retest procedure and analysed the Mismatch Negativity (MMN) and the N1 and N250 components of the Event-Related Potentials to syllables that differed in Voice Onset Time (VOT), vowel duration, and vowel frequency. Results were clear-cut in showing a normalization of the preattentive processing of VOT in children with DD after music training but not after painting training. They also revealed increased N250 amplitude to duration deviant stimuli in children with DD after music but not painting training, and no training effect on the preattentive processing of frequency. These findings are discussed in view of recent theories of dyslexia pointing to deficits in processing the temporal structure of speech. They clearly encourage the use of active music training for the rehabilitation of children with language impairments.

Developmental coordination disorder and dysgraphia: signs and symptoms, diagnosis, and rehabilitation.

Developmental coordination disorder (DCD) is a common and well-recognized neurodevelopmental disorder affecting approximately 5 in every 100 individuals worldwide. It has long been included in standard national and international classifications of disorders (especially the Diagnostic and Statistical Manual of Mental Disorders). Children and adults with DCD may come to medical or paramedical attention because of poor motor skills, poor motor coordination, and/or impaired procedural learning affecting activities of daily living. Studies show DCD persistence of 30-70% in adulthood for individuals who were diagnosed with DCD as children, with direct consequences in the academic realm and even beyond. In particular, individuals with DCD are at increased risk of impaired handwriting skills. Medium-term and long-term prognosis depends on the timing of the diagnosis, (possible) comorbid disorders (and their diagnosis), the variability of signs and symptoms (number and intensity), and the nature and frequency of the interventions individuals receive. We therefore chose to investigate the signs and symptoms, diagnosis, and rehabilitation of both DCD and developmental dysgraphia, which continues to receive far too little attention in its own right from researchers and clinicians.

The impact of spelling regularity on handwriting production: A coupled fMRI and kinematics study.

Current models of writing assume that the orthographic processes involved in spelling retrieval and the motor processes involved in the control of the hand are independent. This view has been challenged by behavioral studies, which showed that the linguistic features of words impact motor execution during handwriting. We designed an experiment coupling functional magnetic resonance imaging and kinematic recordings during a writing to dictation task. Participants wrote orthographically regular and irregular words. The presence of an irregularity impacts both the initiation of the movement and its fine motor execution. At the brain level, the left inferior frontal and fusiform gyri, two regions belonging to the core of the written language system, were found to be sensitive to the presence of an irregularity and to its position in the word during writing execution. Moreover, the left superior parietal lobule, the left superior frontal gyrus and the right cerebellum, three motor-related regions, displayed a stronger response to irregular than regular words. These results constitute direct evidence that orthographic and motor processes occur in a continuous and interactive fashion during writing.

Digitalized spiral drawing in Parkinson's disease: A tool for evaluating beyond the written trace.

One of the current scientific challenges is to propose novel tools and tasks designed to identify new motor biomarkers in Parkinson's disease (PD). Among these, a focus has placed on drawing tasks. Independently from clinical ratings, this study aimed to evaluate the pen movement and holding in digitalized spiral drawing in individuals with PD without and with medical treatment and in healthy controls. A three-step data-driven analysis was conducted. First, the effects of spatial and temporal constraints on several variables were determined. Second, the relationship between handedness and dominance of PD symptoms was investigated for the most relevant variables. Finally, a third analysis was conducted to assess the occurrence of changes associated with PD. The first analysis revealed that the number of velocity peaks and pen altitude variations were the most relevant variables in spiral drawing for evaluating the effect of the disease and medication. The second analysis revealed that the effect of medication was present for the movement fluency only, when spirals with spatial constraints were produced at a spontaneous speed by the hand on the side of dominant PD signs. Finally, the third analysis showed that the effect of medication was greater at the beginning of drawing than at the end. Digitalized spiral drawing makes it possible to observe precisely when the kinematic changes related to the disease occur during the task. Such a simple and quick task might be of great relevance to contribute to the diagnosis and follow-up of PD.

Proactive inhibitory control of movement assessed by event-related fMRI.

Many neuronal processes play a role in the overall performance of inhibition tasks, often making it difficult to associate particular behavioral results to specific processes and structures. Indeed, in classical Go/NoGo, Stop or subliminal masked-prime tasks, inhibition is usually triggered at the same time as the sensorimotor processes involved in movement selection and conflict monitoring. To account for motor inhibition, many conflicting candidate structures, which depend on specific task requirements, have been proposed. In the present paper, first we used a simple reaction (RT) time task and, second, we took advantage of the fact that volitional inhibition is usually implemented before any stimulus occurs when subjects are aware that a warning signal will be presented before a target. This proactive inhibition would be intended to prevent anticipated responses and would be lifted as soon as the warning signal has been identified. In other words, we postulate that the same event does not trigger both inhibition and target processing, and that, indeed, these mechanisms can be separated in time. Event-related fMRI revealed that the medial prefrontal cortex and the inferior parietal cortex may be responsible for proactive inhibition, and that the primary motor cortex, the supplementary motor cortex and the putamen are the likely targeted sites of this inhibition. We conclude that executive control in these tasks may consist of switching from controlled inhibition (suppression of the neuronal processes underlying movement initiation) to automatic sensorimotor processing. The possible contribution of the medial prefrontal cortex to the tonic inhibition state adds new perspectives to possible meanings of a "default mode of brain function".

Cueing method biases in visual detection studies.

Questions about attention are usually addressed by cueing tasks assessing whether knowledge of stimulus-related information provided in advance will improve target processing. Here, we test the reliability of this classical paradigm by means of using neutral cues in a simple visual detection task. We compared "mixed-block" (cued/no-cued trials are intermixed in the same block of trials) to "pure-block" (cued/no-cued trials are presented separately) protocols. We report converging evidence with behavioral and fMRI experiments that cueing methods entail competing processes of automatic motor activation (triggered by the cue) and proactive response inhibition (intended to counteract automatic responses to the cue). This competition strongly affects the reaction time baseline necessary to measure the "cueing" effect in a mixed-block design. Indeed, in such a protocol, proactive inhibition cannot be released before target presentation. Accordingly, we suggest that this design inevitably leads to biases in interpreting cueing data, and that the effects classically observed with mixed-block protocols are likely to be artifacts that are not attentional in origin. We conclude that the identification of this methodological issue now calls for a reassessment of the theoretical framework used to interpret some cueing effects with respect to their control baseline.

On the Auditory-Proprioception Substitution Hypothesis: Movement Sonification in Two Deafferented Subjects Learning to Write New Characters.

The aim of this study was to evaluate the compensatory effects of real-time auditory feedback on two proprioceptively deafferented subjects. The real-time auditory feedback was based on a movement sonification approach, consisting of translating some movement variables into synthetic sounds to make them audible. The two deafferented subjects and 16 age-matched control participants were asked to learn four new characters. The characters were learned under two different conditions, one without sonification and one with sonification, respecting a within-subject protocol. The results revealed that characters learned with sonification were reproduced more quickly and more fluently than characters learned without and that the effects of sonification were larger in deafferented than in control subjects. Secondly, whereas control subjects were able to learn the characters without sounds the deafferented subjects were able to learn them only when they were trained with sonification. Thirdly, although the improvement was still present in controls, the performance of deafferented subjects came back to the pre-test level 2 h after the training with sounds. Finally, the two deafferented subjects performed differently from each other, highlighting the importance of studying at least two subjects to better understand the loss of proprioception and its impact on motor control and learning. To conclude, movement sonification may compensate for a lack of proprioception, supporting the auditory-proprioception substitution hypothesis. However, sonification would act as a "sensory prosthesis" helping deafferented subjects to better feel their movements, without permanently modifying their motor performance once the prosthesis is removed. Potential clinical applications for motor rehabilitation are numerous: people with a limb prosthesis, with a stroke, or with some peripheral nerve injury may potentially be interested.

Handwriting in Children and Adults With Down Syndrome: Developmental Delay or Specific Features?

While there is a long history and tradition of behavioral research on basic motor skills in Down syndrome (DS), there has been only limited research on handwriting ability. We analyzed the spatiotemporal features of handwriting produced by children and adults with DS (n = 24), and compared their productions with those of comparison groups matched for developmental (n = 24) or chronological (n = 24) age. Results indicated that the participants with DS performed an alphabet letter-writing task just as efficiently as the children of the same developmental age, in terms of the length, duration and speed of their handwriting, and the number and duration of their pauses. Our study highlights a substantial delay in the stages of writing acquisition.