Retraining writing for functional purposes: a review of the writing therapy literature

Abstract

Background: Acquired dysgraphia (impaired writing/spelling skills) can significantly restrict people from participating in social, professional, and educational life. Using writing in order to access the Internet via computers, tablets, and mobile phones has become an important part of everyday life for people of all ages. Improving writing in people with acquired dysgraphia could facilitate communication, reduce isolation, and increase access to information. Aims: This review evaluates the writing therapy literature in terms of its usefulness in guiding clinicians in training writing in adults with acquired dysgraphia generally, with specific reference to functional writing activities. The databases Web of Knowledge and Psychinfo were searched for studies evaluating writing therapies for participants with acquired dysgraphia following brain injury. Studies were categorised according to type of treatment (e.g., impairment-based or assistive technology training) and outcome measures (e.g., single words or sentences). Main Contribution: Sixty-two studies were found. Of these, 54 described impairmentbased writing therapies targeting single words or sentences using either lexical or phonological therapies. A small body of 14 studies evaluated the use of assistive writing technologies either alone or in conjunction with an impairment-based therapy. Although all studies reported positive effects of some kind, only 28 measured the effects of therapy on functional or spontaneous writing and only 21 explicitly encouraged the transfer of writing skills to functional tasks. Conclusions: The writing therapy literature has a dominant tradition of using theoretically motivated treatments to improve single-word writing. It provides limited guidance to clinicians treating functional writing, especially in natural contexts. There may be a specific therapeutic role for assistive technologies which have been as yet largely unexplored in the literature. Furthermore, the cognitive requirements of effective use of assistive technology for dysgraphia warrant research in order to understand which people with dysgraphia may benefit from their use.

Technology‐enhanced writing therapy for people with aphasia: results of a quasi‐randomized waitlist controlled study

“…Unlike many previous therapy investigations (see Thiel et al . for review) the improvement was not confined to tests of written naming, but was evident on a functional task involving e‐mail composition. Many participants also generated personally meaningful outputs during their therapy, such as autobiographical texts, which provided them with a satisfying legacy of the treatment.…”

“…Treatment aimed to improve functional writing skills, which have proved difficult to remediate in previous treatment studies (Thiel et al . ). Accordingly, the primary outcome measure reflected an authentic writing task, that of e‐mail composition.…”

“…This study evaluated outcomes from technologyenhanced writing therapy delivered to 21 people with aphasia and dysgraphia. Treatment aimed to improve functional writing skills, which have proved difficult to remediate in previous treatment studies (Thiel et al 2015). Accordingly, the primary outcome measure reflected an authentic writing task, that of e-mail composition.…”

“…In part, this reflected a problem of measurement. Thiel and colleagues () make the point that there is no standard assessment of functional writing skills in aphasia. As a result, previous studies have employed informal tasks such as writing essays (Beeson et al .…”

“…A systematic review of the writing therapy literature identified several weaknesses in the evidence base (Thiel et al 2015). Most of the reviewed studies used single-case or case-series designs, with very few group studies and no randomized controlled trials.…”