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PubMed1991

Left alien hand sign and mirror writing after left anterior cerebral artery infarction.

A 43-year-old, right-handed man was admitted complaining of peculiar movements of his left hand. Computed tomography scan and magnetic resonance imaging showed an infarct area in the territory of the left anterior cerebral artery. The abnormal movements of the left hand were diagnosed as so-called alien hand sign. This patient also exhibited mirror writing with his left hand. The clinical manifestations and neuroradiological findings of this case are described in detail, and the possible mechanisms of these extremely rare combinations of alien hand sign and mirror writing are discussed.

Adult↗

PubMed1983

An analysis of writing in a case of deep dyslexia.

In tests of her ability to produce written and spoken language, this deep dyslexic patient produced semantic, visual, and derivational errors, including functor substitutions, and exhibited part-of-speech and abstractness effects in oral reading, oral and written naming, and writing to dictation, but not in repetition of single words and copying from memory. This patient therefore provides confirmation of the hypothesis presented in Nolan and Caramazza (1982) that the defining symptoms of deep dyslexia will be observed in responses to any task which requires lexical mediation. The patient's written responses in all tasks but direct copying were characterized by spelling errors which included transpositions, omissions, substitutions, and additions of letters. A model of writing is proposed which explains these errors in terms of a disruption of a phoneme-grapheme conversion process which normally functions to prevent decay of information from a Graphemic Buffer.

Agraphia↗

PubMed1983

Mirror writing in right-handers and in left-handers.

To determine whether normal left-handers were more adept than were normal right-handers at mirror writing, we tested right-handers and left-handers for their ability to mirror write. Independent of hand used, left-handers wrote mirror words (but not normal words) faster than did right-handers, which suggest that left-handers may be better able to reverse directions (left leads to right to right leads to left). Although when using their preferred hand, left-handers made fewer errors than did right-handers (using their preferred hand), the left hand both in right- and in left-handers was superior to the right hand. That the left hand was superior to the right is compatible with the hypothesis either that the right hemisphere contains mirror engrams or that movements away from the body are more accurate than movements toward the body or both.

Adolescent↗

PubMed1983

Hemiplegic writing in severe aphasia.

Three patients with severe aphasia and right hemiplegia are described who could write to dictation with the right arm using a limb prosthesis though agraphic with the "intact" left hand. The phenomenon of "hemiplegic writing" is explained as an access to submerged or preprocessing levels in language and action structure, through the use of older proximal motor systems. This interpretation has implications for our understanding of language and brain function, as well as for approaches to the treatment of patients with severe language disorders.

Adult↗

PubMed1983

Ideogram writing in a disconnection syndrome.

A case of disconnection-type agraphia coupled with alexia was reported. The patient showed several asymmetrical manual capacities between the two hands, i.e., dissociated difficulty of Kanji (ideogram) writing between the two hands, left unilateral difficulty of Kana (phonogram) writing, right unilateral dyscopia of letters as well as geometrical figures, and right unilateral difficulty in drawing without a model. Anatomically, lesions involved most of the corpus callosum in its posterior portion including the splenium and the left medial occipital lobe. From these data, a possible linguistic capacity of the right hemisphere was suggested.

Adolescent↗

PubMed1986

Dissociations of writing and praxis: two cases in point.

For normal writing it is essential that both motoric and linguistic competence be present; disruption of one or the other of these faculties may result in qualitatively different types of agraphia. Two right-handed patients became agraphic after left hemisphere lesions; pure apraxic agraphia in the absence of limb apraxia developed in one patient and pure linguistic agraphia in association with severe ideomotor limb apraxia in the other. The performance of these patients not only serves to illustrate the dissociation between the motoric and linguistic faculties that underlie writing but also confirms that ideomotor limb apraxia and apraxic agraphia are distinct and dissociable entities.

Aged↗

PubMed1995

EORTC guidelines for writing protocols for clinical trials of radiotherapy.

The concept of a Master Protocol for phase III studies was raised at the Steering Committee of the EORTC Radiotherapy Group, in order to make the work of the study coordinators easier, when writing protocols and to give them more homogeneity. The Master Protocol defines and clarifies in a logical order the different steps which must be taken when designing a randomized trial--from the rationale to the references. It pays particular attention to eligibility criteria, volumes of interest defined in agreement with ICRU Report 50 (gross tumor volume, clinical target volume, planning target volume and organs at risk), simulation procedure, treatment technique, normal tissue sparing, dose computation, equipment, dose specification (also in agreement with ICRU Report 50). Last but not least, the different procedures of quality assurance for protocols and patients are also defined (site visits, dummy run procedure, in vivo dosimetry, individual case review) to allow working plans to be made in advance. We are aware that this work is not exhaustive, but hope that the contents will be of help to those who are writing a protocol.

Clinical Trials as Topic↗

PubMed1984

Writing hand posture and four indexes of lateral preference.

The relationship between writing hand posture and lateral preference for hand, foot, eye, and ear was examined in a sample of 3709 college undergraduates. A markedly different pattern of lateral preferences was observed in left-handed males and females as a function of hand posture. Left-handed male inverters displayed a tendency toward more leftward lateral preferences in all four indexes; while it was found that hand inversion during writing in left-handed females reflected, if anything, a tendency toward more rightward lateral preferences.

Ear↗

PubMed2006

Remembering the orientation of newly learned characters depends on the associated writing knowledge: a comparison between handwriting and typing.

Recent data support the idea that movements play a crucial role in letter representation and suggest that handwriting knowledge contributes to visual recognition of letters. If so, using different motor activities while subjects are learning to write should affect their subsequent recognition performances. In order to test this hypothesis, we trained adult participants to write new characters either by copying them or by typing them on a keyboard. After three weeks of training we ran a series of tests requiring visual processing of the characters' orientation. Tests were ran immediately, one week after, and three weeks after the end of the training period. Results showed that when the characters had been learned by typing, they were more frequently confused with their mirror images than when they had been written by hand. This handwriting advantage did not appear immediately, but mostly three weeks after the end of the training. Our results therefore suggest that the stability of the characters' representation in memory depends on the nature of the motor activity produced during learning.

Adult↗

PubMed2006

The Trial Protocol Tool: The PRACTIHC software tool that supported the writing of protocols for pragmatic randomized controlled trials.

OBJECTIVE: To develop a tool that would make it easier for researchers, especially those in low- and middle-income countries, to write research protocols for pragmatic randomized controlled trials. STUDY DESIGN AND SETTING: A series of focus groups was held at the inaugural meeting of the Pragmatic RAndomized Controlled Trials in Health Care (PRACTIHC) project in 2001 to develop a desired specification for the Trial Protocol Tool. A working group of five individuals from the PRACTIHC group was formed to develop content for the tool. RESULTS: The Trial Protocol Tool was developed in English and Spanish as a Microsoft Windows HTML help system. A Web-based version is also available. This main body of the tool provides information, advice, and resources about the major headings that should be part of every research protocol. Illustrative examples are used throughout and are taken directly from the tool's protocol library. Additional resources include checklists, programs (e.g., a sample size calculator), and example documents (e.g., patient information leaflets). CONCLUSION: The Trial Protocol Tool packages all the key requirements for the development of a research protocol into one resource. We believe that the use of the tool will help researchers to design effective trials and to write high-quality protocols.

Clinical Protocols↗

PubMed2005

Primary writing tremor: motor cortex reorganisation and disinhibition.

BACKGROUND: Primary writing tremor (PWT) is a task-specific tremor of uncertain origin. There has been debate as to whether PWT represents a variant of essential tremor or a tremulous form of focal dystonia related to writer's cramp. In writer's cramp there is evidence of changes in intracortical inhibition (ICI), as well as cortical motor reorganisation. OBJECTIVE: To study corticomotor organisation and short-latency ICI in a patient with typical task-specific PWT. METHODS: Transcranial magnetic stimulation mapping of the corticomotor representation of the hand and studies of ICI using paired-pulse stimulation were performed in a 47-year-old right-handed woman with a pure task-specific writing tremor. RESULTS: The motor maps for the hand were displaced posteriorly on both sides and reverted to a normal position after treatment with botulinum toxin. Short-latency ICI was reduced for the dominant hand. CONCLUSION: The findings indicate reorganisation and disinhibition of the corticomotor projection to the hand and point to the participation of cortical centres in the origin of PWT.

Botulinum Toxins, Type A↗

PubMed2005

Premotor activations in response to visually presented single letters depend on the hand used to write: a study on left-handers.

In a previous fMRI study on right-handers (Rhrs), we reported that part of the left ventral premotor cortex (BA6) was activated when alphabetical characters were passively observed and that the same region was also involved in handwriting [Longcamp, M., Anton, J. L., Roth, M., & Velay, J. L. (2003). Visual presentation of single letters activates a premotor area involved in writing. NeuroImage, 19, 1492-1500]. We therefore suggested that letter-viewing may induce automatic involvement of handwriting movements. In the present study, in order to confirm this hypothesis, we carried out a similar fMRI experiment on a group of left-handed subjects (Lhrs). We reasoned that if the above assumption was correct, visual perception of letters by Lhrs might automatically activate cortical motor areas coding for left-handed writing movements, i.e., areas located in the right hemisphere. The visual stimuli used here were either single letters, single pseudoletters, or a control stimulus. The subjects were asked to watch these stimuli attentively, and no response was required. The results showed that a ventral premotor cortical area (BA6) in the right hemisphere was specifically activated when Lhrs looked at letters and not at pseudoletters. This right area was symmetrically located with respect to the left one activated under the same circumstances in Rhrs. This finding supports the hypothesis that visual perception of written language evokes covert motor processes. In addition, a bilateral area, also located in the premotor cortex (BA6), but more ventrally and medially, was found to be activated in response to both letters and pseudoletters. This premotor region, which was not activated correspondingly in Rhrs, might be involved in the processing of graphic stimuli, whatever their degree of familiarity.

Adult↗

PubMed1998

The stability of pen-joint and interjoint coordination in loop writing.

This study is concerned with pen-joint and interjoint coordination in handwriting. In particular, it focuses on the stability of coordination as a means to find the locus of coordination control in the arm-pen effector system. Twelve subjects generated loop sequences of varying length at various positions on the baseline of writing. Joint excursions and pen-tip displacements were recorded by means of a 3D-motion tracking system. The coordination stability of 15 pairs of 6 mechanical degrees of freedom (d.f.s) of the arm-pen effector system was investigated by means of relative phase analyses. Pen-joint coordination between horizontal pen-tip displacements and wrist excursions was found to be most stable; that between vertical pen-tip displacements and finger excursions was considerably less stable. Interjoint coordination was generally less stable than pen-joint coordination, and most stable between the wrist and the elbow. Sequence length and its position on the line differentially affected the coordination stability of the d.f. combinations. The results are discussed in relation to assumptions about joint coordination in writing as expressed by computational handwriting models.

Adult↗

PubMed2002

Development and implementation of the Clinical Privileges for Dietitian Nutrition Order Writing program at a long-term acute-care hospital.

A patient nutrition care plan is of little value unless it is quickly and efficiently implemented. Recognition of the value of appropriate and timely medical nutrition intervention in improving patients' nutritional status led to the development of the Clinical Privileges for Dietitian Nutrition Order Writing (CPD NOW) program at a long-term, acute-care hospital. CPD NOW is a formalized approach specifying the types of nutrition care orders that may be written by a registered dietitian (RD), allowing nutrition recommendations to be implemented immediately. More than 95% of the facility's primary attending physicians participate in this optional program. Development included an initial evaluation of physician use of RD recommendations, identification of problems in implementing these recommendations, formulation of an efficient nutrition order writing system, and adoption of this system by the medical staff. In the first 5 years of implementation, the benefits achieved by this program were: expedited order implementation, improved patient nutritional response, and increased RD responsibility. A survey demonstrated physician support of this new RD role. CPD NOW may be applicable as a model to develop similar systems in other hospitals.

Critical Care↗

PubMed2006

When Ciarli Ciaplin drives a Pejio' in Itali: writing loan words in a shallow language.

With increasing frequency the lexicon of every language incorporates words taken from other languages (loan words) that become of common use, but whose orthography does not necessarily conform to the rules of the native language. This is particularly true for languages like Italian, where most words can be correctly written by the application of a sublexical phonology-to-orthography conversion procedure. Here we report the case of a neurologically unimpaired, highly educated Italian person, with a specific deficit in writing loan words. The aim of the study is to clarify the nature of her dysgraphic impairment, if linked to a semantic deficit, or alternatively reflecting an acquisition deficit, present both in the phonological and orthographic output lexicons, or specific only for the orthographic lexicon. A qualitative analysis of her errors and a comparison with the performance of a group of age and education matched subjects showed that her error pattern was not an amplification of the task difficulty effect observed in the control subjects, but rather an expression of an impairment in acquiring specific writing procedures.

Adult↗

PubMed1994

Pure dysgraphia with relative sparing of lower-case writing.

We describe the cognitive analysis of a patient with acquired pure dysgraphia. She presented a peculiar dissociation between lower- and upper-case handwriting: lower-case writing was relatively spared and showed a significant superiority of words versus nonwords. Upper-case writing and oral spelling did not show lexical effects, but were affected by item length. In all modalities errors consisted mainly of single graphemic substitutions, deletions, insertions and transpositions, resulting in legal or illegal nonwords, and showed a similar distribution across letter positions. These findings were suggestive of an impairment of the graphemic output buffer, which however revealed itself to different degrees in the two handwriting styles.

Aged↗

PubMed1978

Inverted writing in right- and left-handers in relation to lateralization of face recognition.

In a study with 157 right-handed and 69 left-handed college students, Gilbert's two-face choice task, which was used as an indicator of cerebral lateralization for face recognition, distinguished left-handers from right-handers. Right-handers primarily attended to the right side of the face (left visual field), while the group of left-handers had no visual field preference. Levy's hypothesis that inverted-writing left-handers are cortically lateralized like right-handers, and that inverted-writing right-handers are lateralized like left-handers found some support among the males. However, the females in both handedness groups performed in an opposite manner to that predicted by Levy's hypothesis.

Dominance, Cerebral↗

PubMed1989

When a patient can write but not copy: report of a single case.

A dissociation between spared spontaneous and impaired writing on copy is described in a patient with severe limb and constructional apraxia. Visual-perceptual abilities were normal as well as oral language and reading. The findings are discussed in the light of an information processing model of writing.

Aged↗