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PubMed2006

Mirror writing: neurological reflections on an unusual phenomenon.

Mirror writing is an unusual script, in which the writing runs in the opposite direction to normal, with individual letters reversed, so that it is most easily read using a mirror. This writing is seen in healthy individuals; it is also associated with various focal lesions that most commonly involve the left hemisphere, as well as with certain diffuse cerebral disorders. Mirror writing is nearly always undertaken with the left hand, and left-handers, and those whose languages are written leftwards, have an unusual facility for this writing. Concerning possible underlying processes, the implications of using the left hand when writing are considered first. Motor pathways that may be important, the surrogate model of bimanual mirror movements and the contribution of the corpus callosum are then discussed. The reasons why left-handed writing is mirrored, and the factors that tend to inhibit mirroring, are outlined. After commenting on mirrored motor and visual engrams, the possibility that the right hemisphere may play an important part is entertained, and Leonardo da Vinci's unique, habitual mirror writing proves to be of unexpected relevance. Further investigations, ranging from epidemiological to functional imaging studies, may provide valuable insights into mirror writing.

Adult↗

PubMed1998

Repeated writing facilitates children's memory for pseudocharacters and foreign letters.

In a logographic language culture, repeated (hand) writing is a common memory strategy for learning letters and Chinese characters. The purpose of this paper is to determine whether this strategy facilitates children's memory for pseudologographic characters and foreign letters. It also explores which aspect of writing, the use of stroke orders or the writing action itself, is responsible for the effect. First, third, and fifth grade Japanese children participated in the study. Results showed that, for all the subjects, characters and letters were better recalled when learned by writing rather than by looking only (Experiments 1 and 4). The advantage of writing was decreased, however, when the proper writing action prevented (i.e., when subjects were instructed to trace or write without feedback; Experiments 3 and 4) but not when the proper stroke orders were prevented (i.e., when subjects were instructed to write in reverse or random orders; Experiment 2). The results indicate that the writing action, rather than the use of stroke orders, is responsible for the effect.

Child↗

PubMed1992

Mirror writing of Chinese characters in children and neurologic patients.

Mirror writing was done in 72 preschool children, 40 school children, 60 mentally retarded school children, 40 normal adults, 37 patients suffering from cerebrovascular diseases with or without aphasia and 13 patients with Parkinson's disease. The results showed that total mirror writing was demonstrated in only 2 cases and partial mirror writing with the left hand in 72 cases and with the right hand in 16 cases. The incidence of mirror writing in writing with left hand was higher (45.8%) in preschool children. It gradually decreased to 43.3% in mentally retarded school children, 24.3% in cerebrovascular disease (CVD) patients, 10.0% in school children, 7.7% in Parkinson's disease (PD) patients and 2.5% in normal adults. The relationships between mirror writing and left/right disorientation, between mirror writing and development of Chinese writing language and between mirror writing and higher cerebral function were observed.

Adult↗

PubMed1995

[A case of pure alexia whose writing ability with eyes closed was superior to that with eyes open].

We compared the writing ability between eyes open (looking at one's writing) and eyes closed (without looking) in a case of pure alexia. The patient is a 84-year-old right handed man who developed pure alexia following an infarction in the distribution of the left posterior cerebral artery. He showed right homonymous hemianopsia, slight memory disorder and slight anomia. He could not read any kinds of letters and words at all though he could categorize letters: Kana (phonograms), Kanji (morphograms) and Arabic numbers, and he could distinguish the real letters from false ones. He could achieve almost 60-70% of Kana and Kanji dictation, though it was not perfect. He was often confused and could not continue writing correct letters once interrupted. He wrote poorly when looking at what he was writing. So we compared the ability of dictation with his eyes closed, and that with his eyes open. We found the former way never caused confusion and got better results, which was statistically significant (Fisher's exact test (p < 0.05)). It seemed that his visual feedback of his own writing rather caused trouble in his writing. Thus we concluded that input (reading) process and output (writing) process work simultaneously and bi-directionally. Slight impairment of writing in pure alexia patients might be caused by the effect of impairment of input (reading) process, which is simultaneously connected with the output (writing) process.

Aged↗

PubMed1993

Prescription-writing errors and markers: the value of knowing the diagnosis.

BACKGROUND AND OBJECTIVES: Duplicate prescription pads are used in many family practice residency programs to monitor prescribing patterns and detect errors in the actual prescription-writing process. This study looked at whether the review of duplicate prescriptions could be enhanced by adding the patient's diagnosis to the prescription. METHODS: The prescription-writing errors of Shaughnessy and Nickel were revised to include prescription-writing markers. These markers were defined as either an indication of use or a duration of therapy that differed from current medical literature or manufacturers' recommendations. Duplicate prescriptions of first-year family practice residents were reviewed for prescription-writing errors and markers before and after an in-service training regarding prescription writing. RESULTS: Following the in-service training, the number of prescriptions containing the patient's diagnosis increased significantly (20% to 61%). Nineteen percent of all prescriptions contained prescription-writing errors. Eight percent of the prescriptions with the patient's diagnosis contained prescription-writing markers. CONCLUSIONS: The addition of the patient's diagnosis to the prescription enhanced the review of duplicate prescriptions. It permitted the evaluation of not only the prescription-writing process but also the decision-making process that led to writing the prescription. It also permitted a more thorough evaluation of appropriate drug use.

Diagnosis↗

PubMed2007

Comparison of the neural basis for imagined writing and drawing.

Drawing and writing are complex processes that require the synchronization of cognition, language, and perceptual-motor skills. Drawing and writing have both been utilized in the treatment of aphasia to improve communication. Recent research suggests that the act of drawing an object facilitated naming, whereas writing the word diminished accurate naming in individuals with aphasia. However, the relationship between object drawing and subsequent phonological output is unclear. Although the right hemisphere is characteristically mute, there is evidence from split-brain research that the right hemisphere can integrate pictures and words, likely via a semantic network. We hypothesized that drawing activates right hemispheric and left perilesional regions that are spared in aphasic individuals and may contribute to semantic activation that supports naming. Eleven right-handed subjects participated in a functional MRI (fMRI) experiment involving imagined drawing and writing and 6 of the 11 subjects participated in a second fMRI experiment involving actual writing and drawing. Drawing and writing produced very similar group activation maps including activation bilaterally in the premotor, inferior frontal, posterior inferior temporal, and parietal areas. The comparison of drawing vs. writing revealed significant differences between the conditions in areas of the brain known for language processing. The direct comparison between drawing and writing revealed greater right hemisphere activation for drawing in language areas such as Brodmann area (BA) 46 and BA 37.

Adult↗

PubMed1996

Individual differences in children's working memory and writing skill.

The purpose of this research is to address (a) whether individual differences in working memory (WM) and writing are related to a general or process-specific system, (b) whether WM tasks operate independently of phonological short-term memory (STM) on measures of writing and reading, and (c) whether working memory predicts variance in writing beyond that predicted by reading alone. The present study correlated several WM and phonological STM measures with writing and reading measures. The study showed among the memory measures that a four-factor model reflecting phonological STM, verbal WM span, executive processing, and visual-spatial WM span best fit the multivariate data set. Working memory was correlated significantly with a number of writing measures, particularly those related to text generation. WM measures contributed unique variance to writing that was independent of reading skill, and STM measures best predicted transcription processes and reading recognition, whereas WM measures best predicted text generation and reading comprehension. Both verbal and visual-spatial working memory measures predicted reading comprehension, whereas only WM measures that reflect executive processing significantly predicted writing. In general, the results suggest that individual differences in children's writing reflect a specific capacity system, whereas reading comprehension draws upon a multiple capacity system.

Attention↗

PubMed2006

An event-related fMRI study of self-paced alphabetically ordered writing of single letters.

The spatial location of activation for writing individual letters and for writing simple dots was studied using event-related functional MRI. Ten healthy right-handed subjects were scanned while performing two different protocols with self-paced repetitive movement. In the first protocol with self-paced dot writing, we observed significant activation in regions known to participate in motor control: contralateral to the movement in the primary sensorimotor and supramarginal cortices, the supplementary motor area (SMA) with the underlying cingulate, in the thalamus and, to a lesser extent, in the ipsilateral inferior parietal and occipital cortices. In the second protocol, we investigated an elemental writing feature--writing single letters. We observed statistically significant changes in the premotor, sensorimotor and supramarginal cortices, the SMA and the thalamus with left predominance, and in the bilateral premotor and inferior/superior parietal cortices. The parietal region that was active during the writing of single letters spanned the border between the parietal superior and inferior lobuli Brodmann area (BA 2, 40), deep in the intraparietal sulcus, with a surprising right-sided dominance. The direct comparison of the results of the two protocols was not significant with a confidence level of P<0.05 corrected for whole brain volume. Thus, the ROI approach was used, and we tried to find significant differences within the two predefined regions of interest (ROI) (BA 7, BA 37). The differences were found with a confidence level of P<0.05 corrected for the volume of these predicted areas. The ROI were located in the posterior parts of hemispheres, in the ventral and in the dorsal visual pathway. The right-sided posterior cortices may play a role in the elemental mechanisms of writing. It is possible that activation of this region is linked with the spatial dimension of the writing.

Adult↗

PubMed2006

The frequency of item writing flaws in multiple-choice questions used in high stakes nursing assessments.

Multiple-choice questions are a common assessment method in nursing examinations. Few nurse educators, however, have formal preparation in constructing multiple-choice questions. Consequently, questions used in baccalaureate nursing assessments often contain item-writing flaws, or violations to accepted item-writing guidelines. In one nursing department, 2770 MCQs were collected from tests and examinations administered over a five-year period from 2001 to 2005. Questions were evaluated for 19 frequently occurring item-writing flaws, for cognitive level, for question source, and for the distribution of correct answers. Results show that almost half (46.2%) of the questions contained violations of item-writing guidelines and over 90% were written at low cognitive levels. Only a small proportion of questions were teacher generated (14.1%), while 36.2% were taken from testbanks and almost half (49.4%) had no source identified. MCQs written at a lower cognitive level were significantly more likely to contain item-writing flaws. While there was no relationship between the source of the question and item-writing flaws, teacher-generated questions were more likely to be written at higher cognitive levels (p<0.001). Correct answers were evenly distributed across all four options and no bias was noted in the placement of correct options. Further training in item-writing is recommended for all faculty members who are responsible for developing tests. Pre-test review and quality assessment is also recommended to reduce the occurrence of item-writing flaws and to improve the quality of test questions.

Bias↗

PubMed1995

Essay writing in nursing: alerting students and teachers to the educational benefits.

Essay writing has recently emerged as an important tool in the appraisal of nursing students at pre- and post-registration level. However, despite its popularity, this activity seems to be somewhat taken for granted. Undoubtedly some nursing students find the transition to essay writing in Higher Education difficult. They seem unaware of assessment procedures, the importance of feedback and more importantly the individual sub-processes which go to make up the process of writing itself. Consequently, the essay is seen as a task and not as an opportunity for learning. This paper is aimed at pre- and post-registration nursing students and their teachers. The paper seeks to reveal some of the research evidence around essay writing. Under the heading of research, four areas are explored. These include the context of essay writing; writing itself; essay planning and finally perspectives on essay writing. The implications of this research are then examined under the separate headings of assessment procedures and the nature of teachers' feedback comments. ... The Essay then, is not a routine exercise, a chore for the student to write, a chore for the professor to read. It is, if properly approached by both parties, education in the truest sense. (Harris & McDougall 1958, p viii)

Education, Nursing, Baccalaureate↗

PubMed2002

Predictive validity of the Medical College Admissions Test Writing Sample for the United States medical licensing examination steps 1 and 2.

Despite the amount of published research on the predictive validity of the Medical College Admissions Test (MCAT) taken as a whole, few published reports separate the individual predictive validity of the Writing Sample. The purpose of this study is to provide data on the predictive validity of the Writing Sample for the national licensing exam used in the United States. Subjects consisted of 1992-1995 matriculants from a publicly owned medical school in the Southeastern United States. Independent variables were undergraduate grade point average, and four section scores on a required admissions test (Biological Sciences, Physical Sciences, Verbal Reasoning, and Writing Sample). The dependent variables were Steps 1 and 2 on the three step licensing examination. Steps 1 and 2 of the examination are taken during medical school. Multiple regression models calculated additional variance accounted for by the addition of the Writing Sample to a model containing grade point average and the other admissions test section scores. In multivariate analyses, when grade point average and all admissions test scores were considered as predictors of licensing exam scores, the Writing Sample variable did not add to the ability to predicting the Step 1 or Step 2 scores. The results of this study suggest that the Writing Sample has limited predictive validity for assessing success on a national licensing exam. However, as others suggest, the value of the Writing Sample and other surrogates of communication probably lie in predicting performance in the clinical years of medical school and beyond. Additional work should include evaluating the predictive validity of the Writing Sample and other pre-medical school measures of communication with widely acceptable measures of performance in clinical settings, including physician-patient communication.

Adult↗

PubMed2006

Contributions of mother-child storybook telling and joint writing to literacy development in kindergartners with hearing loss.

PURPOSE: This study investigated mother-child storybook telling and joint writing as predictors of early literacy among kindergartners with hearing loss. METHOD: Participants were 30 Israeli kindergartners with hearing loss and their mothers. Early literacy assessments tapped children's alphabetic skills (e.g., word writing, word recognition, and letter knowledge) and linguistic skills (e.g., phonological awareness, general knowledge, and receptive vocabulary). Each mother told her child the story of a wordless book and helped her child write words. Both interactions were videotaped and analyzed. RESULTS: Our major findings showed that maternal storybook telling correlated with linguistic skills, and maternal writing mediation correlated with basic alphabetic skills. A series of 3-step hierarchical regression analyses revealed that beyond children's age, children's degree of hearing loss, and joint writing, storybook telling predicted children's phonological awareness (22%), general knowledge (28%), and receptive vocabulary (18%). Beyond children's age, children's degree of hearing loss, and storybook telling, joint writing predicted word writing (15%), word recognition (31%), and letter knowledge (36%). IMPLICATIONS: Recommendations focused on encouraging parent and teacher awareness about the differential contributions of storybook telling and writing mediation to early literacy. We also advocated enhancing parents' skills for promoting children's literacy.

Case-Control Studies↗

PubMed2006

Point-of-view writing: A method for increasing medical students' empathy, identification and expression of emotion, and insight.

CONTEXT: Although interest exists among medical educators in using writing that reflects on clinical experience to enhance medical students' communication skills, empathy, and overall professionalism, little empirical research documents the value of this approach. This study explored whether students trained in one type of writing would first demonstrate increased awareness of emotional aspects of a clinical encounter in their writing; and second, be evaluated more positively in an OSCE situation by standardized patients. METHOD: Ninety-two students were assigned to either a point-of-view writing or a clinical reasoning condition as part of a second year doctoring course. At the end of the year, students were evaluated in an OSCE format on 3 cases, and completed a writing assignment about an ER death from cardiac arrest. Student essays were scored according to presence or absence of various themes. A linguistic analysis of the essays was also performed. Point-of-view and clinical reasoning group scores were compared on both measures, as well as on the standardized patient OSCE ratings. RESULTS: Students trained in point-of-view writing demonstrated significantly more awareness of emotional and spiritual aspects of a paper case in a writing assignment than did students trained in clinical reasoning. By contrast, students in the clinical reasoning group were more likely to distance from the scenario. The two groups did not differ on SP OSCE ratings. CONCLUSION: Training in point-of-view writing can improve medical students' written skills on certain affective dimensions. It is not clear that these skills can translate into clinical behavior.

Adult↗

PubMed1982

Clinical reading and writing skills of junior medical students.

A three-year study was designed to assess general reading and writing skills of 231 entering medical students and to compare these scores with those of clinically oriented reading and writing skills in the same cohort of students three years later. Standardized reading and writing tests were administered to all entering freshmen in the class of 1982. Clinical reading and writing examinations were developed by the authors and members of the faculty. The reading test consisted of 16 multiple-choice questions in response to three short discussions in medical journals. Clinical writing was assessed through scoring each student's latter of referral to another physician after he read a "mock" chart of a patient's hospital care. The results showed that entry-level reading comprehension and clinical reading had a significant association as did entry-level English composition and clinical writing. Regression analysis showed that the entry-level reading and writing scores were better predictors of clinical reading and writing skills than any other prematriculation variables. The implications of these findings for medical education are discussed.

Curriculum↗

PubMed2004

Facilitating scholarly writing in academic medicine.

Scholarly writing is a critical skill for faculty in academic medicine; however, few faculty receive instruction in the process. We describe the experience of 18 assistant professors who participated in a writing and faculty development program which consisted of 7 monthly 75-minute sessions embedded in a Collaborative Mentoring Program (CMP). Participants identified barriers to writing, developed personal writing strategies, had time to write, and completed monthly writing contracts. Participants provided written responses to open-ended questions about the learning experience, and at the end of the program, participants identified manuscripts submitted for publication, and completed an audiotaped interview. Analysis of qualitative data using data reduction, data display, and conclusion drawing/verification showed that this writing program facilitated the knowledge, skills, and support needed to foster writing productivity. All participants completed at least 1 scholarly manuscript by the end of the CMP. The impact on participants' future academic productivity requires long-term follow-up.

Attitude of Health Personnel↗

PubMed2006

The craft of writing: a physician-writer's workshop for resident physicians.

INTRODUCTION: How can residency programs help trainees address conflicting emotions about their professional roles and cultivate a curiosity about their patients' lives beyond their diseases? We drew on the medical humanities to address these challenges by creating an intensive writing workshop for internal medicine residents. AIM: To help participants become better physicians by reflecting on their experiences and on what gives meaning to work and life. This paper describes the workshop and how residents were affected by the focus on the craft of writing. SETTING: A group of 15 residents from 3 training programs affiliated with 1 institution. PROGRAM DESCRIPTION: We engaged the expertise of physician-writer Abraham Verghese in planning and facilitating the 2 and one-half day workshop. Residents' submissions were discussed with a focus on the effectiveness of the writing. We also conducted a focus group with participants to evaluate the workshop. PROGRAM EVALUATION: Themes in the writing included dysphoria, impotence of the physician, and the healing power of compassion. Our focus group data suggested that this workshop served as a creative outlet from the rigors of medicine, created a sense of community among participants, enhanced both self-awareness and awareness of their patients' lives, and increased intra-institutional and extra-institutional interest in writing and the residency program. DISCUSSION: Teaching creative writing to residents in an intensive workshop may deepen interactions with peers and patients, improve writing skills, and increase interest in writing and the residency program.

Education↗

PubMedDate not supplied

Shared understandings: structuring the writing experience through dialogue.

When teachers view writing as a social process in which authors write for real audiences and authentic purposes, they change their instruction accordingly to meet the needs of writers with learning disabilities. As more experienced members of a larger community of writers, teachers play a primary role in apprenticing students into the inherently social functions of writing. Through teacher-student dialogues about the complexities of the writing process, students gradually develop and control their own writing "voice" as they use and transform the shared understandings of the group process. Text structure, writing strategies, and metacognitive knowledge of the writing process provide opportunities for teachers and students with learning disabilities to interact and create shared understandings about the composition process. This article reviews some recent attempts to use text structures and the writing process as frameworks to guide the composition dialogue.

Child↗

PubMed2006

Alphabetic skills in preschool: a preliminary study of letter naming and letter writing.

Development of letter naming and writing (skills in writing first name, dictated and copied letters, and dictated and copied numbers) was examined in 79 preschool children (M age = 56 months). Skills were assessed in the fall to determine the status of these procedural skills that are components of alphabetic knowledge at the start of the school year. Children with high letter-naming scores also had high scores on letter writing, including dictated or copied letters and writing some or all of the letters of their names. Letter-naming skills were related to number-writing skills whether the numbers were dictated or copied. The highest writing scores were found for first name writing compared to writing or copying letters and numbers. A focus on the development of procedural knowledge in the preschool period may yield the hopep for impacts on later reading skills that has not been found in curricula emphasizing conceptual knowledge (e.g., knowledge of print concepts, book conventions).

Child↗