Speech and Language Therapy for Acquired Central Dysgraphia in Neurological Patients: A Systematic Review to Describe and Identify Trainings for Clinical Practice.

PURPOSE: Acquired central dysgraphia is a heterogeneous neurological disorder that usually co-occurs with other language disorders. Written language training is relevant to improve everyday skills and as a compensatory strategy to support limited oral communication. A systematic evaluation of existing writing treatments is thus needed. METHOD: We performed a systematic review of speech and language therapies for acquired dysgraphia in studies of neurological diseases (PROSPERO: CRD42018084221), following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist with a search on several databases for articles written in English and published until August 31, 2021. Only methodological well-designed studies were included. Further assessment of methodological quality was conducted by means of a modified version of the Downs and Black checklist. RESULTS: Eleven studies of 43 patients in total were included. For each study, we collected data on type of population, type of impairment, experimental design, type of treatment, and measured outcomes. The studies had a medium level of assessed methodological quality. An informative description of treatments and linkages to deficits is reported. CONCLUSIONS: Although there is a need for further experimental evidence, most treatments showed good applicability and improvement of written skills in patients with dysgraphia. Lexical treatments appear to be more frequently adopted and more flexible in improving dysgraphia and communication, especially when a multimodal approach is used. Finally, the reported description of treatment modalities for dysgraphia in relation to patients' deficits may be important for providing tailored therapies in clinical management.

Efficacy of botulinum toxin type-A and swallowing treatment for oropharyngeal dysphagia recovery in a patient with lateral medullary syndrome.

BACKGROUND: Wallenberg's syndrome (WS) is known as posterior inferior cerebellar artery syndrome. Dysphagia has been reported from 51% to 94% of the patients, ranging from mild to severe. CASE REPORT: We reported a case of a patient (male; 52 years) with WS. MRI showed an intense hypodense area in the dorsolateral part of the ponto-medullary junction. The clinical signs were severe dysphagia, fed by PEG (FOIS 1; PAS 7), sialorrhea, trismus and ataxia. CLINICAL REHABILITATION IMPACT: Dysphagia was treated by botulinum toxin type-A (BoNT-A), which was injected into the parotid and submandibular salivary glands, temporalis and masseter muscles, cricopharyngeal muscle associated with specific swallowing exercise and food trails. The 3-months follow-up showed significant saliva reduction and improvement of swallowing to from PEG feeding to consistent oral intake of food (FOIS 3, PAS 5). The treatment with BoNT-A combined with swallowing rehabilitation was fundamental in order to restore the swallowing functions.