Neuroanatomy of Handwriting and Related Reading and Writing Skills in Adults and Children with and without Learning Disabilities: French-American Connections

Visual Function and Neuropsychological Profiling of Idiopathic Infantile Nystagmus

Though considered a benign condition, idiopathic infantile nystagmus (IIN) may be associated with decreased visual acuity and oculo-motor abnormalities, resulting in developmental delays and poor academic performance. Nevertheless, the specific visual function profile of IIN and its possible impact on neuropsychological development have been poorly investigated. To fill this gap, we retrospectively collected the clinical data of 60 children presenting with IIN over a 10-year period (43 male; mean age of 7 years, range of 2 months-17 years, 9 months). The majority of the subjects in our cohort presented with reduced visual acuity for far distances and normal visual acuity for near distances, associated with oculo-motor abnormalities. The overall scores of cognitive and visual-cognitive tests were in the normal range, but revealed peculiar cognitive and visual-cognitive profiles, defined by specific frailties in processing speed and visual-motor integration. The same neuropsychological profiles characterize many neurodevelopmental disorders and may express a transnosographic vulnerability of the dorsal stream. As the first study to explore the neuropsychologic competencies in children with IIN, our study unveils the presence of subclinical frailties that need to be addressed to sustain academic and social inclusion.

In a split second: Handwriting pauses in typical and struggling writers

Introduction

A two-second threshold has been typically used when analyzing the writing processes. However, there is only a weak empirical basis to claim that specific average numbers and durations of pauses may be associated with specific writing processes. We focused on handwriting execution pauses, because immature writers are known to struggle with transcription skills. We aimed to provide an evidence-based account of the average number and duration of handwriting pauses in the mid-Primary grades and to identify process-level markers of writing difficulties.

Methods

Eighty 3rd and 5th graders, with and without writing difficulties, participated in the study. We examined pauses in a handwriting-only task, to be able to isolate those which could only be attributed to handwriting processes. Letter features were considered, as well as children's handwriting fluency level.

Results

The average duration of handwriting pauses was around 400ms, in line with assumptions that transcription pauses would fall under the 2,000ms threshold. We found that 3rd graders made more and longer pauses than 5th graders. Struggling writers made a similar number of pauses across grades than typically-developing children, although they were significantly longer, even after controlling for the effect of handwriting fluency.

Discussion

Our findings provide an evidence-based account of the duration of handwriting pauses. They also suggest that children need fewer and shorter handwriting pauses as they progress in automatizing transcription. However, some young writers struggle with letter formation even after 3 to 5 years of instruction.

Letter-Like Shape Recognition in Preschool Children: Does Graphomotor Knowledge Contribute?

Based on evidence that learning new characters through handwriting leads to better recognition than learning through typing, some authors proposed that the graphic motor plans acquired through handwriting contribute to recognition. More recently two alternative explanations have been put forward. First, the advantage of handwriting could be due to the perceptual variability that it provides during learning. Second, a recent study suggests that detailed visual analysis might be the source of the advantage of handwriting over typing. Indeed, in that study, handwriting and composition –a method requiring a detailed visual analysis but no specific graphomotor activity– led to equivalent recognition accuracy, both higher than typing. The aim of the present study was to assess whether the contribution of detailed visual analysis is observed in preschool children and to test the variability hypothesis. To that purpose, three groups of preschool children learned new symbols either by handwriting, typing, or composition. After learning, children performed first a four-alternative recognition task and then a categorization task. The same pattern of results as the one observed in adults emerged in the four-alternative recognition task, confirming the importance of the detailed visual analysis in letter-like shape learning. In addition, results failed to reveal any difference across learning methods in the categorization task. The latter results provide no evidence for the variability hypothesis which would predict better categorization after handwriting than after typing or composition.

Influence of visual control on the quality of graphic gesture in children with handwriting disorders

Handwriting disorders (HD) are considered one of the major public health problems among school-aged children worldwide with significant interference on academic performances. The current study hypothesized that HD could be partly explained by a deficit in sensory feedback processing during handwriting. To explore this hypothesis, we have analyzed the effect of vision suppression on postural-gestural and on spatial/temporal/kinematic organization of drawing during an early pre-scriptural loop task with a digital pen, under two conditions: eyes open and eyes closed. Data collected from 35 children with HD were compared to data collected from typical children (typical group) from primary schools. The HD group showed significantly poorer postural control and an improvement on the spatial/temporal/kinematic organization of drawings when they closed their eyes compared to eyes opened. While in the typical group, postural-gestural organization became significantly more mature but there was no significant influence found on spatial/temporal/kinematic parameters of the loops. Thus, handwriting disorders could be explained by both proprioceptive/kinesthetic feedback disabilities and a disruptive effect of the visual control on the quality of the pre-scriptural drawings among these children who have kinesthetic memory and visuospatial disabilities. The ability of directing the strokes would remain dependent on sensory feedbacks, themselves insufficiently efficient, which would lead to difficulties in reaching a proactive control of handwriting. This current research is a liable contribution to enhance clinical practice, useful in clinical decision-making processes for handwriting disorders remediation.

From Hand to Eye With the Devil In-Between: Which Cognitive Mechanisms Underpin the Benefit From Handwriting Training When Learning Visual Graphs?

Cognitive science has recently shown a renewed interest on the benefit from training in handwriting (HW) when learning visual graphs, given that this learning experience improves more subsequent visual graph recognition than other forms of training. However, the underlying cognitive mechanism of this HW benefit has been elusive. Building on the 50 years of research on this topic, the present work outlines a theoretical approach to study this mechanism, specifying testable hypotheses that will allow distinguishing between confronting perspectives, i.e., symbolic accounts that hold that perceptual learning and visual analysis underpin the benefit from HW training vs. embodied sensorimotor accounts that argue for motoric representations as inner part of orthographic representations acquired via HW training. From the evidence critically revisited, we concluded that symbolic accounts are parsimonious and could better explain the benefit from HW training when learning visual graphs. The future challenge will be to put at test the detailed predictions presented here, so that the devil has no longer room in this equation.

Physical Activity With Eduball Stimulates Graphomotor Skills in Primary School Students

Despite the general agreement that the interdisciplinary model of physical education (PE), based on the incorporation of core academic subjects into the PE curriculum, stimulates the holistic development of students, there is still a lack of methods for its implementation. Therefore, Eduball was created, i.e., a method that uses educational balls with printed letters, numbers, and other signs. Numerous studies have shown that children participating in activities with Eduballs can develop their physical fitness while simultaneously improving their academic performance, particularly in math and language, including some writing skills. However, little is known about the effects of Eduball on children's graphomotor skills, which are key for the academic performance of students throughout the entire schooling process. Here, we investigate whether 6-month participation in PE with Eduball stimulates graphomotor skills in primary school students, such as drawing prehandwriting letter patterns on unlined or lined paper and rewriting text on unlined or lined paper. Our results show that the Eduball class (N = 28) significantly improved these skills compared to the control class (N = 26) participating in traditional PE. For example, students from the experimental group wrote with a lower pen pressure and better stability of the line, in contrast to those from the control group. Therefore, this study demonstrates that the Eduball method successfully supports teachers in developing graphomotor skills in children. More broadly, our findings make clear once again that there is the need to integrate physical and cognitive development in education, which can be achieved by using an interdisciplinary model of PE.

Lasting Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation in Writer's Cramp: A Case Report

The treatment of writer’s cramp (W’sC) is essentially based on the use of botulinum toxin. However, additional treatments are sometime required to prolong the effects of the toxin, compensate for its progressive loss of efficacy in some subjects, and re-educate handwriting (e.g., rehabilitation strategies). Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been employed to improve W’sC, but with short-lasting and controversial outcomes. We report on the effects of a long-lasting low-frequency rTMS paradigm on W’sC symptoms. A 25-year-old male with a diagnosis of simple W’sC was enrolled in the study. He underwent an objective assessment using the Writer’s Cramp Rating Scale (WCRS) and the 1-min writing test. Further, we recorded muscle activation of the upper limb during handwriting using an EMG wireless system. The patient was provided with 1,200 biphasic magnetic pulses delivered at 1 Hz over the left premotor cortex (PMC), 15 times scheduled every 2 days, thus covering a period of 5 weeks, followed by 10 days of rest. This block of stimulations was practiced other four times, for a period of 6 months. The patient showed a gradual clinical improvement with the progression of the treatments. W’sC symptoms totally disappeared and all the clinical scores showed a significant improvement after rTMS completion. Such improvement lasted up to 1 year after the end of the treatment. Moreover, we detected a long-lasting improvement in sensorimotor plasticity as measured by a paired associative stimulation protocol. Our case suggests that the long-lasting application of 1 Hz rTMS to PMC is a safe and potentially valuable tool to improve W’sC symptoms enduringly, probably by reverting maladaptive plasticity mechanisms within the sensory-motor areas of the hemisphere contralateral to the dystonic hand.

Relationships between Translation and Transcription Processes during fMRI Connectivity Scanning and Coded Translation and Transcription in Writing Products after Scanning in Children with and without Transcription Disabilities

Students with transcription disabilities (dysgraphia/impaired handwriting, n = 13 or dyslexia/impaired word spelling, n = 16) or without transcription disabilities (controls) completed transcription and translation (idea generating, planning, and creating) writing tasks during fMRI connectivity scanning and compositions after scanning, which were coded for transcription and translation variables. Compositions in both groups showed diversity in genre beyond usual narrative-expository distinction; groups differed in coded transcription but not translation variables. For the control group specific transcription or translation tasks during scanning correlated with corresponding coded transcription or translation skills in composition, but connectivity during scanning was not correlated with coded handwriting during composing in dysgraphia group and connectivity during translating was not correlated with any coded variable during composing in dyslexia group. Results are discussed in reference to the trend in neuroscience to use connectivity from relevant seed points while performing tasks and trends in education to recognize the generativity (creativity) of composing at both the genre and syntax levels.

Relationships between Eye Movements during Sentence Reading Comprehension, Word Spelling and Reading, and DTI and fmri Connectivity In Students with and without Dysgraphia or Dyslexia

While eye movements were recorded and brains scanned, 29 children with and without specific learning disabilities (SLDs) decided if sentences they read (half with only correctly spelled words and half with homonym foils) were meaningful. Significant main effects were found for diagnostic groups (non-SLD control, dysgraphia control, and dyslexia) in total fixation (dwell) time, total number of fixations, and total regressions in during saccades; the dyslexia group had longer and more fixations and made more regressions in during saccades than either control group. The dyslexia group also differed from both control groups in (a) fractional anisotropy in left optic radiation and (b) silent word reading fluency on a task in which surrounding letters can be distracting, consistent with Rayner's selective attention dyslexia model. Different profiles for non-SLD control, dysgraphia, and dyslexia groups were identified in correlations between total fixation time, total number of fixations, regressions in during saccades, magnitude of gray matter connectivity during the fMRI sentence reading comprehension from left occipital temporal cortex seed with right BA44 and from left inferior frontal gyrus with right inferior frontoccipital fasciculus, and normed word-specific spelling and silent word reading fluency measures. The dysgraphia group was more likely than the non-SLD control or dyslexia groups to show negative correlations between eye movement outcomes and sentences containing incorrect homonym foils. Findings are discussed in reference to a systems approach in future sentence reading comprehension research that integrates eye movement, brain, and literacy measures.