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

Abstract

Background: Writing is a human communication tool. No disability behavioral assessment of dysgraphia due to stroke-induced neglect has been conducted in Iran. Objectives: We investigated rehabilitation of dysgraphia in patients with stroke-related neglect in Persian language- specific constructive errors of writing. Methods: All patients were suffering from stroke-induced visual neglect. Five patients were evaluated for dysgraphia in a spontaneous writing task before and after rehabilitation without writing practice for 10 sessions with prism adaption (PA). Dysgraphia was classified into visuospatial omission error, visuospatial destruction error, visuospatial size error, visuospatial tilting error, poor handwriting style, visuospatial distance error, and visuospatial perseveration (addition) error. Neglect was evaluated using the star cancellation test (SCT), and line bisection test (LBT) and activities of daily living (ADL) was assessed by the Barthel index (BI) and the Catherine Bergego scale (CBS). Results: All patients showed significant improvement in dysgraphia (measured using spontaneous writing test), ADL (measured using CBS and BI), and neglect (measured using LBT and SCT) (P < 0.05). Visuospatial ‎destruction errors were the most frequent and visuospatial‎ omission errors were the least frequent errors. Conclusions: PA is a potential effective strategy in stroke rehabilitation of dysgraphia, visuospatial neglect and ADL. Unilateral spatial neglect and rehabilitation improves dysgraphia in Persian language speaking patients with right brain stroke.