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Dysgraphia

Editor: Orlando De Jesus Updated: 9/30/2022 4:09:13 PM

Definition/Introduction

Dysgraphia is defined as a difficulty or inability to communicate clearly and correctly through written language. This evaluation requires adjustment to the patient's age and education. Syntax errors, ineligible handwriting, odd spelling, and inaccurate word production are common. Writing is a complex task that requires exquisite coordination of higher levels of complex cognitive domains, including expressive language and fine motor skills.

Issues of Concern

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Issues of Concern

Anatomy

Dysgraphia is usually associated with multiple cortical and subcortical damage in the functional language regions. Multiple bi-hemispheric cortical networks produce written language, including the anterior cingulate, supramarginal, and frontal gyrus. The functional areas include the left supero-frontal sulcus/middle frontal gyrus, the left supero-parietal lobule, the left inferior parietal lobule, the angular gyrus, the primary motor cortex, and the somatosensory cortex. Other associated areas include the right anterior and posterior cerebellum, the left posterior nucleus of the thalamus, the left inferior frontal gyrus, the right superior frontal cortex, the right inferior parietal lobule, the left fusiform gyrus, and the left putamen. Agraphia is a complete impairment when it comes to writing correctly. Different types of agraphia can result from brain damage in multiple cortical and subcortical regions of the central nervous system.[1][2][3][4][5]

Types of Agraphia

  • Deep agraphia affects orthographic memory and phonology production, leading to semantic errors. It is associated with left parietal lobe damage.[6][7]
  • Peripheral agraphia is the inability to connect letters to form words and full sentences; visual misperception is another manifestation. It can be associated with temporal atrophy and temporal lobe neurodegeneration.[8][9][10]
  • Lexical agraphia- inability to spell irregular words.[11][12][13]
  • Alexia, with agraphia, cannot read and write, and the patient cannot retrieve orthographic memory. It is attributable to frontal lobe and thalamic damage.[14][15][16][17]
  • Phonological agraphia- inability to sound out a word, difficulties with writing abstract thoughts more than concrete thoughts. It appears to be caused by left-hemispheric damage.[18][19][20][21]
  • Reiterative or repetitive agraphia-affected individuals tend to repeat letters or words as they write.[18]
  • Apraxic or pure agraphia-inability produces written language with preserved reading and speaking. Associated with frontoparietal, frontotemporal, and thalamic structure damage.[22][23][24][25]
  • Visuospatial agraphia-inability to organize the letters of a word in a sentence correctly (spacial semantic errors), sometimes can lead to vertical writing or writing that focuses on 1 area of a page. Related to the damage to the right hemisphere (middle cerebral artery territory).[26][27]
  • Dysexecutive agraphia- inability to organize planned thoughts in written language. Associated with neurodegenerative disorders (frontotemporal dementia, Parkinson disease) usually involving the frontal lobes.[27][28]
  • Musical agraphia- inability to write musical language (disrupting creativity) because of traumatic brain injury.[29][30]
  • Other manifestations include Gerstmann syndrome-finger agnosia (inability to recognize fingers), right-left confusion, agraphia, and acalculia (inability to perform simple math operations). It is related to the damage to the dominant left angular gyrus.[31][32][33]

Causes of Agraphia

Prognosis

Prognosis is mainly dependent on etiology. Dysgraphia may improve with lifelong therapy, but many patients do not regain the ability to write at their original baseline writing ability. When caused by neurodegenerative disorders, it is expected to worsen progressively.

Treatment

  • Speech/language therapy and occupational therapy are mandatory
  • Treat motor disorders to control writing movements[9][62][63][64]
  • Cognitive rehabilitation[65] 
    • Training exercises involved pattern association of ocular visual recognition of serial and synchronous movements of hands and fingers in producing written language
    • Conscious effort to correct deficiencies
  • Behavioral change
    • Spend more time writing with pen and pencil as opposed to computer writing (journal diary)[66]
    • Concentrate on the activity
  • Deep brain stimulation
    • Parkinson disease with tremors and micrographia

Clinical Significance

Agraphia or dysgraphia, in the context of other neurological symptoms, can be cognitive, motor, or visuospatial. It can be a useful anatomical diagnostic clue to a myriad of neurological disorders. Therefore, it is crucial to understand the definition, types, and potential causes of agraphia. Dysgraphia frequently presents together with other neurological communicative and learning disorders.

Nursing, Allied Health, and Interprofessional Team Interventions

An interprofessional team with an integrated approach to dysgraphia can help achieve the best possible outcomes. A neurologist, neuropsychologist, cognitive neurologist, psychiatrist, psychologist, social worker, occupational therapist, and speech therapist should be consulted to provide the best care and quality of life for a patient with dysgraphia or agraphia and its accompanying neurological symptoms. Collaboration, shared decision-making, and communication are key elements for a good outcome. The interprofessional care provided to the patient must use an integrated care pathway combined with an evidence-based approach to planning and evaluating all joint activities.

References


[1]

Planton S, Jucla M, Roux FE, Démonet JF. The "handwriting brain": a meta-analysis of neuroimaging studies of motor versus orthographic processes. Cortex; a journal devoted to the study of the nervous system and behavior. 2013 Nov-Dec:49(10):2772-87. doi: 10.1016/j.cortex.2013.05.011. Epub 2013 Jun 12     [PubMed PMID: 23831432]

Level 1 (high-level) evidence

[2]

Magrassi L, Bongetta D, Bianchini S, Berardesca M, Arienta C. Central and peripheral components of writing critically depend on a defined area of the dominant superior parietal gyrus. Brain research. 2010 Jul 30:1346():145-54. doi: 10.1016/j.brainres.2010.05.046. Epub 2010 May 24     [PubMed PMID: 20580692]

Level 3 (low-level) evidence

[3]

Roux FE, Durand JB, Réhault E, Planton S, Draper L, Démonet JF. The neural basis for writing from dictation in the temporoparietal cortex. Cortex; a journal devoted to the study of the nervous system and behavior. 2014 Jan:50():64-75. doi: 10.1016/j.cortex.2013.09.012. Epub 2013 Oct 19     [PubMed PMID: 24239010]


[4]

Ptak R, The frontoparietal attention network of the human brain: action, saliency, and a priority map of the environment. The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry. 2012 Oct     [PubMed PMID: 21636849]

Level 3 (low-level) evidence

[5]

Roux FE, Dufor O, Giussani C, Wamain Y, Draper L, Longcamp M, Démonet JF. The graphemic/motor frontal area Exner's area revisited. Annals of neurology. 2009 Oct:66(4):537-45. doi: 10.1002/ana.21804. Epub     [PubMed PMID: 19847902]


[6]

Bub D, Kertesz A. Deep agraphia. Brain and language. 1982 Sep:17(1):146-65     [PubMed PMID: 7139266]

Level 3 (low-level) evidence

[7]

Snowden JS, Kindell J, Thompson JC, Richardson AM, Neary D. Progressive aphasia presenting with deep dyslexia and dysgraphia. Cortex; a journal devoted to the study of the nervous system and behavior. 2012 Oct:48(9):1234-9. doi: 10.1016/j.cortex.2012.02.010. Epub 2012 Mar 7     [PubMed PMID: 22465163]

Level 3 (low-level) evidence

[8]

Grossman M,Libon DJ,Ding XS,Cloud B,Jaggi J,Morrison D,Greenberg J,Alavi A,Reivich M, Progressive peripheral agraphia. Neurocase. 2001     [PubMed PMID: 11557829]

Level 3 (low-level) evidence

[9]

Beeson PM, Bayley C, Shultz C, Rising K. Maximising recovery from aphasia with central and peripheral agraphia: The benefit of sequential treatments. Neuropsychological rehabilitation. 2019 Oct:29(9):1399-1425. doi: 10.1080/09602011.2017.1417873. Epub 2018 Jan 3     [PubMed PMID: 29298550]


[10]

Lambert J, Giffard B, Nore F, de la Sayette V, Pasquier F, Eustache F. Central and peripheral agraphia in Alzheimer's disease: from the case of Auguste D. to a cognitive neuropsychology approach. Cortex; a journal devoted to the study of the nervous system and behavior. 2007 Oct:43(7):935-51     [PubMed PMID: 17941351]

Level 2 (mid-level) evidence

[11]

Rapcsak SZ, Arthur SA, Bliklen DA, Rubens AB. Lexical agraphia in Alzheimer's disease. Archives of neurology. 1989 Jan:46(1):65-8     [PubMed PMID: 2910263]


[12]

Beauvois MF,Dérouesné J, Lexical or orthographic agraphia. Brain : a journal of neurology. 1981 Mar     [PubMed PMID: 7470843]

Level 3 (low-level) evidence

[13]

Croisile B, Trillet M, Laurent B, Latombe D, Schott B. [Lexical agraphia caused by left temporoparietal hematoma]. Revue neurologique. 1989:145(4):287-92     [PubMed PMID: 2660220]

Level 3 (low-level) evidence

[14]

Henderson VW. Alexia and Agraphia from 1861 to 1965. Frontiers of neurology and neuroscience. 2019:44():39-52. doi: 10.1159/000494951. Epub 2019 Apr 30     [PubMed PMID: 31220840]


[15]

de Gobbi Porto FH, d'Ávila Freitas MI, de Oliveira MO, Lucato LT, Orsini M, de Menezes SL, Magaldi RM, Porto CS, Dozzi Brucki SM, Nitrini R. Thalamic alexia with agraphia. Neurology international. 2012 Jan 9:4(1):e4. doi: 10.4081/ni.2012.e4. Epub 2012 Feb 9     [PubMed PMID: 22593808]

Level 3 (low-level) evidence

[16]

Henderson VW, Alexia and agraphia: contrasting perspectives of J.-M. Charcot and J. Hughlings Jackson. Neurology. 2008 Jan 29     [PubMed PMID: 18227421]

Level 3 (low-level) evidence

[17]

Sheldon CA, Malcolm GL, Barton JJ. Alexia with and without agraphia: an assessment of two classical syndromes. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques. 2008 Nov:35(5):616-24     [PubMed PMID: 19235446]

Level 3 (low-level) evidence

[18]

Nardone R, De Blasi P, Zuccoli G, Tezzon F, Golaszewski S, Trinka E. Transient beneficial effects of excitatory theta burst stimulation in a patient with phonological agraphia after left supramarginal gyrus infarction. Brain and language. 2012 Mar:120(3):422-6. doi: 10.1016/j.bandl.2012.01.001. Epub 2012 Jan 31     [PubMed PMID: 22296779]

Level 3 (low-level) evidence

[19]

Beeson PM, Rising K, DeMarco AT, Foley TH, Rapcsak SZ. The nature and treatment of phonological text agraphia. Neuropsychological rehabilitation. 2018 Jun:28(4):568-588. doi: 10.1080/09602011.2016.1199387. Epub 2016 Jul 8     [PubMed PMID: 27392251]


[20]

DeMarco AT,Wilson SM,Rising K,Rapcsak SZ,Beeson PM, The neural substrates of improved phonological processing following successful treatment in a case of phonological alexia and agraphia. Neurocase. 2018 Feb     [PubMed PMID: 29350575]

Level 3 (low-level) evidence

[21]

Sakurai Y, Furukawa E, Kurihara M, Sugimoto I. Frontal Phonological Agraphia and Acalculia with Impaired Verbal Short-Term Memory due to Left Inferior Precentral Gyrus Lesion. Case reports in neurology. 2018 Jan-Apr:10(1):72-82. doi: 10.1159/000487849. Epub 2018 Mar 14     [PubMed PMID: 29681826]

Level 3 (low-level) evidence

[22]

Trojano L, Chiacchio L. Pure dysgraphia with relative sparing of lower-case writing. Cortex; a journal devoted to the study of the nervous system and behavior. 1994 Sep:30(3):499-501     [PubMed PMID: 7805390]

Level 3 (low-level) evidence

[23]

Vandenborre D, van Dun K, Mariën P. Apraxic agraphia following bithalamic damage. Brain and cognition. 2015 Apr:95():35-43. doi: 10.1016/j.bandc.2015.01.012. Epub 2015 Feb 14     [PubMed PMID: 25682350]

Level 3 (low-level) evidence

[24]

Vandenborre D,van Dun K,Engelborghs S,Mariën P, Apraxic agraphia following thalamic damage: Three new cases. Brain and language. 2015 Nov;     [PubMed PMID: 26460984]

Level 3 (low-level) evidence

[25]

Sakurai Y, Ishii K, Sonoo M, Saito Y, Murayama S, Iwata A, Hamada K, Sugimoto I, Tsuji S, Mannen T. Progressive apraxic agraphia with micrographia presenting as corticobasal syndrome showing extensive Pittsburgh compound B uptake. Journal of neurology. 2013 Aug:260(8):1982-91. doi: 10.1007/s00415-013-6908-0. Epub 2013 Apr 16     [PubMed PMID: 23589191]


[26]

Morishima R, Bandoh M, Sunami Y, Isozaki E. [Progressive supranuclear palsy-Richardson syndrome with visual attention disturbance (Holmes and Horrax) and ataxie optique (Garcin): a case report]. Rinsho shinkeigaku = Clinical neurology. 2019 Nov 8:59(11):730-735. doi: 10.5692/clinicalneurol.cn-001273. Epub 2019 Oct 26     [PubMed PMID: 31656263]

Level 3 (low-level) evidence

[27]

Sitek EJ, Narozanska E, Barczak A, Jasinska-Myga B, Harciarek M, Chodakowska-Zebrowska M, Kubiak M, Wieczorek D, Konieczna S, Rademakers R, Baker M, Berdynski M, Brockhuis B, Barcikowska M, Zekanowski C, Heilman KM, Wszolek ZK, Slawek J. Agraphia in patients with frontotemporal dementia and parkinsonism linked to chromosome 17 with P301L MAPT mutation: dysexecutive, aphasic, apraxic or spatial phenomenon? Neurocase. 2014:20(1):69-86. doi: 10.1080/13554794.2012.732087. Epub 2012 Nov 5     [PubMed PMID: 23121543]

Level 3 (low-level) evidence

[28]

Ardila A,Surloff C, Dysexecutive agraphia: a major executive dysfunction sign. The International journal of neuroscience. 2006 May;     [PubMed PMID: 16644524]

Level 3 (low-level) evidence

[29]

Vitturi BK, Sanvito WL. Maurice Ravel's dementia: the silence of a genius. Arquivos de neuro-psiquiatria. 2019 Feb:77(2):136-138. doi: 10.1590/0004-282X20180134. Epub     [PubMed PMID: 30810599]


[30]

Baeck E. Was Maurice Ravel's illness a corticobasal degeneration? Clinical neurology and neurosurgery. 1996 Feb:98(1):57-61     [PubMed PMID: 8681483]


[31]

Rusconi E. Gerstmann syndrome: historic and current perspectives. Handbook of clinical neurology. 2018:151():395-411. doi: 10.1016/B978-0-444-63622-5.00020-6. Epub     [PubMed PMID: 29519471]

Level 3 (low-level) evidence

[32]

Altabakhi IW,Liang JW, Gerstmann Syndrome StatPearls. 2021 Jan     [PubMed PMID: 30137813]


[33]

Roux FE, Boetto S, Sacko O, Chollet F, Trémoulet M. Writing, calculating, and finger recognition in the region of the angular gyrus: a cortical stimulation study of Gerstmann syndrome. Journal of neurosurgery. 2003 Oct:99(4):716-27     [PubMed PMID: 14567608]

Level 3 (low-level) evidence

[34]

Hux K, Mahrt T. Alexia and Agraphia Intervention Following Traumatic Brain Injury: A Single Case Study. American journal of speech-language pathology. 2019 Aug 9:28(3):1152-1166. doi: 10.1044/2019_AJSLP-18-0245. Epub 2019 Jun 13     [PubMed PMID: 31194917]

Level 3 (low-level) evidence

[35]

Nolan KA, Volpe BT, Burton LA. The continuum of deep/surface dyslexia. Journal of psycholinguistic research. 1997 Jul:26(4):413-24     [PubMed PMID: 9232009]

Level 3 (low-level) evidence

[36]

Weinschenk C. [The difference in writing disorders in primary agraphia and congenital dyslexia and their clinical relevance]. Fortschritte der Neurologie-Psychiatrie. 1988 Aug:56(8):259-64     [PubMed PMID: 3169676]

Level 3 (low-level) evidence

[37]

Miyakawa Y, Fuchigami T, Aoki M, Mine Y, Suzuki J, Urakami T, Takahashi S. Agraphia with reversible splenial corpus callosum lesion caused by hypoglycemia. Brain & development. 2018 Aug:40(7):592-595. doi: 10.1016/j.braindev.2018.03.003. Epub 2018 Mar 30     [PubMed PMID: 29606344]


[38]

Tao Y, Rapp B. The effects of lesion and treatment-related recovery on functional network modularity in post-stroke dysgraphia. NeuroImage. Clinical. 2019:23():101865. doi: 10.1016/j.nicl.2019.101865. Epub 2019 May 22     [PubMed PMID: 31146116]


[39]

Zukic S, Mrkonjic Z, Sinanovic O, Vidovic M, Kojic B. Gerstmann'S syndrome in acute stroke patients. Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH. 2012 Dec:20(4):242-3. doi: 10.5455/aim.2012.20.242-243. Epub     [PubMed PMID: 23378691]


[40]

Sinanović O, Mrkonjić Z, Zukić S, Vidović M, Imamović K. Post-stroke language disorders. Acta clinica Croatica. 2011 Mar:50(1):79-94     [PubMed PMID: 22034787]


[41]

Ogura K, Fujii T, Suzuki K, Mori E. Pure agraphia in Romaji after left inferior frontal gyrus infarction: A case of selective deficit in syllable-to-grapheme conversion in Japanese. Brain and language. 2013 Oct:127(1):1-5. doi: 10.1016/j.bandl.2013.06.004. Epub 2013 Aug 15     [PubMed PMID: 23954318]

Level 3 (low-level) evidence

[42]

Shinoura N, Onodera T, Kurokawa K, Tsukada M, Yamada R, Tabei Y, Koizumi T, Yagi K. Damage to the upper portion of area 19 and the deep white matter in the left inferior parietal lobe, including the superior longitudinal fasciculus, results in alexia with agraphia. European neurology. 2010:64(4):224-9. doi: 10.1159/000318175. Epub 2010 Aug 26     [PubMed PMID: 20798545]

Level 2 (mid-level) evidence

[43]

Moreno-Flagge N, [Language disorders. Diagnosis and treatment]. Revista de neurologia. 2013 Sep 6     [PubMed PMID: 23897160]


[44]

Hanley JR, Sotiropoulos A. Developmental surface dysgraphia without surface dyslexia. Cognitive neuropsychology. 2018 Jul-Sep:35(5-6):333-341. doi: 10.1080/02643294.2018.1468317. Epub 2018 Jun 25     [PubMed PMID: 29940788]


[45]

Van Hoorn JF, Maathuis CG, Hadders-Algra M. Neural correlates of paediatric dysgraphia. Developmental medicine and child neurology. 2013 Nov:55 Suppl 4():65-8. doi: 10.1111/dmcn.12310. Epub     [PubMed PMID: 24237283]


[46]

Schomer DL, Pegna A, Matton B, Seeck M, Bidaut L, Slossman D, Roth S, Landis T. Ictal agraphia: a patient study. Neurology. 1998 Feb:50(2):542-5     [PubMed PMID: 9484395]

Level 3 (low-level) evidence

[47]

Kudo T,Yagi K, Chronological progression of a language deficit appearing to be postictally reversible in a patient with symptomatic localization-related epilepsy. Psychiatry and clinical neurosciences. 2000 Apr     [PubMed PMID: 10803805]

Level 3 (low-level) evidence

[48]

Shimotake A, Fujita Y, Ikeda A, Tomimoto H, Takahashi J, Takahashi R. [Ictal Gerstmann's syndrome in a patient with symptomatic parietal lobe epilepsy]. Rinsho shinkeigaku = Clinical neurology. 2008 Mar:48(3):208-10     [PubMed PMID: 18409543]

Level 3 (low-level) evidence

[49]

Cirelli A, Ciardi M, Salotti A, Rossi F. An unusual neurological feature of HIV-1 encephalopathy: Gerstmann's syndrome. Acta neurologica. 1994 Jun:16(3):110-3     [PubMed PMID: 7992659]

Level 3 (low-level) evidence

[50]

Takase K, Ohyagi Y, Furuya H, Nagashima K, Taniwaki T, Kira J. [A case of progressive multifocal leukoencephalopathy presenting white matter MRI lesions extending over the cerebral cortex and a marked decrease in cerebral blood flow on SPECT, and associated with HTLV-I infection]. Rinsho shinkeigaku = Clinical neurology. 2005 Jun:45(6):426-30     [PubMed PMID: 16022467]

Level 3 (low-level) evidence

[51]

Erdem S,Kansu T, Alexia without either agraphia or hemianopia in temporal lobe lesion due to herpes simplex encephalitis. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society. 1995 Jun     [PubMed PMID: 7550926]

Level 3 (low-level) evidence

[52]

PELLNITZ D. [Motor aphasia and agraphia in rhinogenous cerebral abscess]. Zeitschrift fur Laryngologie, Rhinologie, Otologie und ihre Grenzgebiete. 1950 May:29(5):214-24     [PubMed PMID: 15431863]


[53]

Shimizu H, Yamada M, Matsubara N, Takano H, Umeda Y, Kawase Y, Kitamoto T, Nishizawa M, Takahashi H. Creutzfeldt-Jakob disease with an M232R substitution: report of a patient showing slowly progressive disease with abundant plaque-like PrP deposits in the cerebellum. Neuropathology : official journal of the Japanese Society of Neuropathology. 2009 Dec:29(6):735-43. doi: 10.1111/j.1440-1789.2009.01019.x. Epub 2009 Apr 21     [PubMed PMID: 19422537]

Level 3 (low-level) evidence

[54]

Pachalska M, Kurzbauer H, MacQueen BD, Formińska-Kapuścik M, Herman-Sucharska I. Neuropsychological features of rapidly progressive dementia in a patient with an atypical presentation of Creutzfeldt-Jakob Disease. Medical science monitor : international medical journal of experimental and clinical research. 2001 Nov-Dec:7(6):1307-15     [PubMed PMID: 11687748]

Level 3 (low-level) evidence

[55]

Himeno E,Tanaka M,Araki T, [Kanji-predominant alexia with agraphia in opticospinal multiple sclerosis]. No to shinkei = Brain and nerve. 2006 Apr     [PubMed PMID: 16681264]

Level 3 (low-level) evidence

[56]

Varley R, Cowell PE, Gibson A, Romanowski CA. Disconnection agraphia in a case of multiple sclerosis: the isolation of letter movement plans from language. Neuropsychologia. 2005:43(10):1503-13     [PubMed PMID: 15989940]

Level 3 (low-level) evidence

[57]

Wellingham-Jones P. Characteristics of handwriting of subjects with multiple sclerosis. Perceptual and motor skills. 1991 Dec:73(3 Pt 1):867-79     [PubMed PMID: 1792135]


[58]

Evyapan Akkuş D, Güler A. The Ege Agraphia Test Battery for Identifying the Writing Disorders in Cases with Mild Cognitive Impairment and Alzheimer's Disease. Turk psikiyatri dergisi = Turkish journal of psychiatry. 2016 Fall:27(3):185-194     [PubMed PMID: 27711939]

Level 3 (low-level) evidence

[59]

Cui B,Cui LY,Gao J,Liu CY,Liu Q,Liu MS,Shen DC,Liu F, Agraphia in Amyotrophic Lateral Sclerosis with Frontotemporal Lobe Degeneration. Chinese medical journal. 2016 Mar 5     [PubMed PMID: 26905000]


[60]

Maeda K, Shiraishi T, Idehara R. Agraphia in Mobile Text Messages in a Case of Amyotrophic Lateral Sclerosis with Frontotemporal Dementia. Internal medicine (Tokyo, Japan). 2015:54(23):3065-8. doi: 10.2169/internalmedicine.54.4982. Epub 2015 Dec 1     [PubMed PMID: 26631894]

Level 3 (low-level) evidence

[61]

Ichikawa H, Kawamura M. [Language impairment in amyotrophic lateral sclerosis]. Brain and nerve = Shinkei kenkyu no shinpo. 2010 Apr:62(4):435-40     [PubMed PMID: 20420185]


[62]

Beeson PM, Higginson K, Rising K. Writing treatment for aphasia: a texting approach. Journal of speech, language, and hearing research : JSLHR. 2013 Jun:56(3):945-55. doi: 10.1044/1092-4388(2012/11-0360). Epub     [PubMed PMID: 23811474]

Level 3 (low-level) evidence

[63]

Chiappedi M,DE Bernardi E,Togni R,Baschenis IM,Nonini L,Balottin U,Bejor M, Developmental writing disorders: assess to rehabilitate. Minerva pediatrica. 2018 Apr     [PubMed PMID: 26899671]


[64]

Papathanasiou I, Filipović SR, Whurr R, Jahanshahi M. Plasticity of motor cortex excitability induced by rehabilitation therapy for writing. Neurology. 2003 Oct 14:61(7):977-80     [PubMed PMID: 14557572]


[65]

Ardila A, Rosselli M. Cognitive Rehabilitation of Acquired Calculation Disturbances. Behavioural neurology. 2019:2019():3151092. doi: 10.1155/2019/3151092. Epub 2019 Apr 4     [PubMed PMID: 31093301]


[66]

Beeson PM. Remediation of written language. Topics in stroke rehabilitation. 2004 Winter:11(1):37-48     [PubMed PMID: 14872398]