The role of learning in improving functional writing in stroke aphasia

Abstract

Purpose: Improving writing in people with aphasia could improve ability to communicate, reduce isolation and increase access to information. One area that has not been sufficiently explored is the effect of impairment based spelling therapies on functional writing. A multiple case study was conducted with eight participants with aphasia subsequent to stroke. This aimed to measure the effects of spelling therapy on functional writing and perception of disability.Method: Participants engaged in ten sessions of copy and recall spelling therapy.Outcome measures included spelling to dictation of trained and untrained words, written picture description, spelling accuracy within emails, a disability questionnaire and a writing frequency diary.Results: All participants made significant gains on treated words and six demonstrated improvements to untreated words. Group analyses showed significant improvements to written picture description, but not email writing, writing frequency or perceptions of disability.Conclusions: These results show that small doses of writing therapy can lead to large gains in specific types of writing. These gains did not extend to improvements in frequency of writing in daily living, nor ecological measures of email writing. There is a need to develop bridging interventions between experimental tasks towards more multi-faceted and ecological everyday writing tasks. IntroductionIn recent years, written communication via the internet and mobile phones has become an increasingly important part of everyday life in social, educational and professional spheres [1,2]. Among the multiple disabilities that can result from brain injury, one that could significantly impede access to the internet is dysgraphia, an acquired disorder of writing [3]. Dysgraphia frequently occurs as one symptom of aphasia [4], an acquired multi-modal language disorder caused by traumatic brain injury, brain tumour, surgery, infection, or most commonly, stroke [5]. A recent survey study conducted by Menger, Morris & Salis [6] found that people with aphasia use the internet less than people with stroke and no aphasia. Moreover, people with aphasia reported that their aphasia was the main barrier to using the internet.The writing rehabilitation literature is dominated by single case studies evaluating model-driven impairment-based therapies, such as copy and recall therapy [7] and strategies such as visual-imagery [8] or phoneme to grapheme conversion (i.e., sounds to letters) [9]. The aim of many of these therapies has been to improve single word writing, and the effects on functional, everyday writing activities (e.g. letters,emails, text messages, shopping lists) have not usually been measured. However, there have been some exceptions. Several studies have encouraged participants to generalise gains of impairment-based spelling therapies to more natural writing contexts such as letters, emails and essays [8,10,11,12,13]. For example, Mortley, Enderby and Petheram [13] conducted a single case study with a participant wi...

Language-Specific Dysgraphia in Persian Patients with Right Brain Stroke: Influence of Visuospatial Neglect and Rehabilitation

“…In contrast, our present study of without practice in writing of recovery, previous studies on the dysgraphia therapy methods are based on writing, copying, spelling, and learning of practices in writing (12,15). Inhibition of 4…”

“…Non-pharmacological approaches have been shown to aid rehabilitation in dysgraphia. Non-pharmacological treatments used include spelling therapy, PA, RTMS, relearning in based spelling therapies on functional writing with unity-modal and multi-modal therapies, technology-enhanced writing therapy using assistive writing software to improve email writing, and rereading treatment with slow reading coupled interactive spelling treatment with errorful spelling (8,12,13,15,(24)(25)(26)(27). The novelty of the present study was without writing practice, a new suggestion was provided for dysgraphia pattern and rehabilitation of dysgraphia, neglect and disability function.…”

“…However, these language-specific dysgraphia or constructive errors of writing are not quite understood. The errors may be affected by visuospatial processing, have a convened array of letters of the alphabet, and require a particular rehabilitation strategy of their letters of the alphabet graphemic systems (3,9,10,(12)(13)(14)(15). Stroke-induced neglect is an important factor to influence dysgraphia and is usually a comorbid sign.…”

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

“…As in previous studies of technology‐enhanced writing treatments (Thiel et al . , Caute and Woolf ) this points to a compensatory outcome. Participants learnt to use the technology to improve the quality of their writing.…”

“…A recent addition to the therapy literature explored writing treatment outcomes with a small group of participants (N = 8) and examined gains beyond single word spelling tests (Thiel et al 2016). Each participant worked on the spelling of 80 words, using tasks that required them to copy and recall the words and select the words from given written options.…”