Writing and drawing tilts after right hemisphere stroke are signs of a wrong verticality representation
Résumé
BACKGROUND
Many signs of spatial dysgraphia and drawing errors after right hemispheric stroke (RHS) have been attributed to spatial neglect or impaired sensory feedback. Counterclockwise (contralesional) tilts of graphomotor productions remained to be explained.
OBJECTIVE
To test whether graphomotor tilts stem from a tilted representation of verticality transposed to the top/bottom axis of the sheet of paper, from data of the DOBRAS cohort.
METHODS
Handwriting and drawing orientations were measured from the writing of three lines and the drawing of the Gainotti Figure (house roof lines). Verticality perception was measured with the visual (VV) and postural (PV) verticals. Severity of extra-body (EBN) and body (BN) neglect were each quantified with composite scores (battery of 8 tests).
RESULTS
We analyzed data of 133 individuals: 64 healthy individuals (median age 63 years) and 69 with a subacute RHS (median age 68 years). With respect to normal cut-offs (writing -5.4°; drawing - 8.1°), 26/69 (38%) individuals with RHS showed at least one graphomotor tilt (median[IQR] of writing tilt: -6.8°[-9.7;-1.7]; drawing tilt: -10.9°[-17.6;-6.4]). Compared to individuals without graphomotor tilts, those having both writing and drawing tilts showed greater contralesional tilts in verticality perception (VV: -1.4°[-4;0.6] vs -7.9°[-11.5;-7.5]; PV: -1°[-2.4;0.2] vs -8°[-9;-5.4], Ps ≤.001) and more severe spatial neglect (EBN: 4.2[1.8;9.3] vs 16.6[10.2;20.4]; BN: 22.7[17;28.2] vs 37.8[35.9;39.7], Ps ≤.01). Composite graphomotor z-scores on writing and drawing correlated both with verticality estimates (VV+PV, rs=.46, p <10-4 23 ) and spatial neglect scores (EBN+BN, rs=-.36, p <.01).
CONCLUSION
Contralesional tilts of writing and drawing after RHS are primary related to a tilted representation of verticality, and secondary related to spatial neglect. They are easy to detect and could be considered as a first step to perform early, before conventional tests of verticality perception.
Mots clés
Right hemisphere stroke graphomotor tilts spatial dysgraphia verticality representation spatial 30 neglect 31 BN: body neglect 34 CBS: Catherine Bergego Scale 35 DOBRAS: Determinants of Balance Recovery After Stroke 36 SCP: Scale for Contraversive Pushing 39 VP: postural vertical 40 VV: visual vertical 41
Right hemisphere stroke
graphomotor tilts
spatial dysgraphia
verticality representation
spatial 30 neglect 31 BN: body neglect 34 CBS: Catherine Bergego Scale 35 DOBRAS: Determinants of Balance Recovery After Stroke 36 SCP: Scale for Contraversive Pushing 39 VP: postural vertical 40 VV: visual vertical 41
Domaines
Sciences cognitivesOrigine | Fichiers produits par l'(les) auteur(s) |
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