The term agrafie (also agraphy ) denotes the inability to write words and texts , although the necessary mobility of the hand ( motor skills ) and the intellect are still available. The Dysgraphie ( Dysgrafie ) is a write disturbance in the sense of a slight Agraphie. It is divided into developmental dysgraphy, in which there are difficulties in learning to spell, and acquired dysgraphy. This is a disorder of writing after having completed language acquisition.
The disorder can be found in the International Classification of Disablities (ICD-10). It is identified with the code R48.8 (other and unspecified tool disorders including agrafia and acalculia)
The term Agraphia was coined in 1869 by John William Ogle (1824-1905).
Agrafia are the result of brain damage and often occur together with aphasia .
The most common cause of aphasia and therefore also of agrafia are traumatic brain injuries (80%). Furthermore, can the stroke , brain or meningitis , hypoxia , brain tumors , Angioma and epilepsy cause of this writing disorder.
Agrafie may result from solitary confinement to be. Many patients have a stroke difficulties with writing because they under a hemiplegia ( hemiparesis suffer), as in many other neurological disorders, such as the Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). If the side of the writing hand is affected, writing is often difficult or impossible due to this paralysis, so that one has to write with the other hand. Often this is also not possible because paralysis of the writing hand is often associated with aphasia and this is responsible for the agrafie.
Agrafy can, however, also occur in isolation in connection with a spatial-constructive impairment.
There are different forms of agrafy that can lead to a complete inability to write:
- Lexical agraphy: words that are difficult to distinguish cannot be pronounced, visual word images arise more from visual and less from phonological engrams ; Lesion in the left angular gyrus (area 39 according to Brodmann).
- Phonological agraphy: With this form, those affected can write real words in writing. However, it is not possible for them to write neologisms (word creations). Grammatical morphemes are more difficult to retrieve than lexical morphemes. If the phonological agraphy is pronounced, the phoneme-grapheme conversion is severely disturbed.
- Semantic agraphy: meaningful material cannot be spoken or written; Disturbances in the pathways from the semantic region to the Wernicke area and angular gyrus or subcortical lesion.
- Global agraphy: In this form of agraphy, writing is completely disturbed. Errors can occur with all words, regardless of whether they are long, short, high or low frequency. Likewise, the meaning of the words does not affect whether mistakes are made or not. The attempts to write either consist of a pointless stringing together of graphemes or are canceled after just one or two letters. Another form of error are perseverations , in which graphemes or syllables are repeated several times.
- Apractical agraphia: This form, a disorder of the fine motor skills , is usually coupled with aphasia . Left parietal regions are disturbed in right-handed people .
- Pure agraphy: This form is a peripheral writing disorder and often occurs with spatial-constructive disorders. This sometimes leads to incorrect graphic design of letters, especially with rarely occurring letters such as x, y, q. It often takes several tries to produce the correct letter. The disturbance can occur both when converting sounds to letters and when copying given words. When changing from print to cursive letters or case in lowercase difficulties are also noticeable. The disorder also affects non-linguistic issues, which means that drawing or copying figures is difficult.
- Neglect dysgraphy: In this disorder, the left side of the word is left out or the left side of the sheet is not used due to the neglect .
- Alexia with agrafie: Here the patients can neither read nor write. However, the disorder is not based on an aphasic disorder.
Furthermore, it is necessary to differentiate between agriculture and illiteracy .
In the area of acquired dysgraphy, further forms can be distinguished:
- Surface dysgraphy: the person affected shows deficits in holistic writing, whereby the writing of pseudo-words and regular words largely works. In view of the logogen model -Sprachverarbeitungsmodell, the phoneme grapheme correspondence (sublexical route) is used. This means that difficulties arise especially with words that are written differently from the way they are spoken (e.g. ax is written as "Akst"). This means that there are hardly any errors in rule-based words.
- Depth dysgraphy: Characteristics of depth dysgraphy are semantic errors in which target words are replaced, for example “dog” instead of “cat”. However, most of the written words are spelling correct. High-frequency and concrete lexical morphemes can be realized better than low-frequency and abstract ones.
Course and prognosis
No studies are available on the spontaneous course or the prognosis of the individual dysgraphy syndromes. Due to the localization (left hemisphere) of the damage in most forms, one suspects similar courses as in aphasia.
- Training of graphomotor patterns
- The linework of individual letters and syllables is practiced at high frequency, based on the standard spelling. If the patient is unable to use his former dominant side for writing due to paresis, or if original patterns cannot be reactivated, the standard spelling can be neglected.
- Reactivation of the phoneme-grapheme conversion
- Association therapy: This form of therapy makes use of most of the German graphemes. This often takes place within about 20 therapy sessions. A fluent spelling is usually not achieved, but association therapy can be used as a compensation strategy. The therapy takes place in three building stages.
- Dyslexia , dyslexia , dyscalculia , agnosia , dyspraxia - other similar disorders
- secondary illiteracy , illetrism (functional illiteracy) - writing weakness with non-medical causes
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