{"title":"书写和绘画在右半球笔划后倾斜是错误的垂直表示的标志。","authors":"Rémi Lafitte, Flora Diaine, Shenhao Dai, Olivier Carré, Eve Dupierrix, Caroline Jolly, Céline Piscicelli, Dominic Pérennou","doi":"10.1016/j.rehab.2024.101923","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>To test whether graphomotor tilts stem from a tilted representation of verticality transposed to the top/bottom axis of the sheet of paper, using data from the DOBRAS cohort.</p><p><strong>Methods: </strong>Handwriting and drawing orientations were measured from the writing of 3 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).</p><p><strong>Results: </strong>We analyzed data from 133 individuals: 64 healthy individuals (median [Q1; Q3] age 63 [59; 71] years) and 69 in the subacute phase after RHS (median age 68 [62; 73] 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] writing tilt:6.8° [-9.7; -1.7]; drawing tilt:10.9° [-17.6; -6.4]). Compared to individuals without graphomotor tilts, those with 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], P-values ≤0.001) 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], P-values ≤0.001). Composite graphomotor z-scores for writing and drawing correlated with verticality estimates (VV+PV, r<sub>s</sub> =0.46, P < 10<sup>-4</sup>) and spatial neglect scores (EBN+BN, r<sub>s</sub> = -0.36, P < 0.01).</p><p><strong>Conclusion: </strong>Contralesional tilts of writing and drawing after RHS are primarily related to a tilted representation of verticality and secondarily to spatial neglect. They are easy to detect and could be considered a first step to perform early, before conventional tests of verticality perception.</p><p><strong>Registration: </strong>ClinicalTrials.gov: NCT03203109.</p>","PeriodicalId":56030,"journal":{"name":"Annals of Physical and Rehabilitation Medicine","volume":"68 4","pages":"101923"},"PeriodicalIF":3.9000,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Writing and drawing tilts after right hemisphere stroke are signs of a wrong verticality representation.\",\"authors\":\"Rémi Lafitte, Flora Diaine, Shenhao Dai, Olivier Carré, Eve Dupierrix, Caroline Jolly, Céline Piscicelli, Dominic Pérennou\",\"doi\":\"10.1016/j.rehab.2024.101923\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>To test whether graphomotor tilts stem from a tilted representation of verticality transposed to the top/bottom axis of the sheet of paper, using data from the DOBRAS cohort.</p><p><strong>Methods: </strong>Handwriting and drawing orientations were measured from the writing of 3 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).</p><p><strong>Results: </strong>We analyzed data from 133 individuals: 64 healthy individuals (median [Q1; Q3] age 63 [59; 71] years) and 69 in the subacute phase after RHS (median age 68 [62; 73] 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] writing tilt:6.8° [-9.7; -1.7]; drawing tilt:10.9° [-17.6; -6.4]). Compared to individuals without graphomotor tilts, those with 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], P-values ≤0.001) 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], P-values ≤0.001). Composite graphomotor z-scores for writing and drawing correlated with verticality estimates (VV+PV, r<sub>s</sub> =0.46, P < 10<sup>-4</sup>) and spatial neglect scores (EBN+BN, r<sub>s</sub> = -0.36, P < 0.01).</p><p><strong>Conclusion: </strong>Contralesional tilts of writing and drawing after RHS are primarily related to a tilted representation of verticality and secondarily to spatial neglect. 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引用次数: 0
摘要
背景：右半脑卒中（RHS）后的许多空间书写困难和绘画错误的迹象都归因于空间忽视或感觉反馈受损。逆时针（对视）倾斜的运动产物仍有待解释。目的：使用来自DOBRAS队列的数据，测试笔迹运动倾斜是否源于垂直性的倾斜表示转置到纸张的上下轴。方法：通过3条线的书写和盖诺蒂图（屋顶线）的绘制来测量笔迹和绘画方向。垂直度知觉通过视觉垂直（VV）和姿势垂直（PV）测量。体外（EBN）和体外（BN）忽视的严重程度分别用综合评分（8组测试）进行量化。结果：我们分析了133例个体的数据：64例健康个体(中位数[Q1；Q3] 63岁[59岁；71])， RHS后亚急性期69岁(中位年龄68岁[62；73年)。相对于正常截止(写-5.4°；绘画-8.1°),26/69 (38%)RHS患者表现出至少一次书写运动倾斜(中位数[IQR]:6.8°[-9.7；-1.7);拉伸倾角：10.9°[-17.6；-6.4])。与没有书写运动倾斜度的个体相比，具有书写和绘画倾斜度的个体在垂直感知上表现出更大的对立倾斜度(VV:1.4°[-4]；0.6°vs -7.9°[-11.5；- 7.5);PV: 1°[-2.4;0.2°vs -8°[-9；-5.4]， p值≤0.001)和更严重的空间忽视(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]， p值≤0.001)。写作和绘画的复合书写运动z分数与垂直度估计（VV+PV, rs =0.46, P < 10-4）和空间忽视得分（EBN+BN, rs = -0.36, P < 0.01）相关。结论：RHS后书写和绘画的对立性倾斜主要与垂直的倾斜表现有关，其次与空间忽视有关。它们很容易被发现，可以被认为是在传统的垂直感知测试之前尽早进行的第一步。注册：ClinicalTrials.gov: NCT03203109。
Writing and drawing tilts after right hemisphere stroke are signs of a wrong verticality representation.
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, using data from the DOBRAS cohort.
Methods: Handwriting and drawing orientations were measured from the writing of 3 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 from 133 individuals: 64 healthy individuals (median [Q1; Q3] age 63 [59; 71] years) and 69 in the subacute phase after RHS (median age 68 [62; 73] 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] writing tilt:6.8° [-9.7; -1.7]; drawing tilt:10.9° [-17.6; -6.4]). Compared to individuals without graphomotor tilts, those with 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], P-values ≤0.001) 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], P-values ≤0.001). Composite graphomotor z-scores for writing and drawing correlated with verticality estimates (VV+PV, rs =0.46, P < 10-4) and spatial neglect scores (EBN+BN, rs = -0.36, P < 0.01).
Conclusion: Contralesional tilts of writing and drawing after RHS are primarily related to a tilted representation of verticality and secondarily to spatial neglect. They are easy to detect and could be considered a first step to perform early, before conventional tests of verticality perception.
期刊介绍：
Annals of Physical and Rehabilitation Medicine covers all areas of Rehabilitation and Physical Medicine; such as: methods of evaluation of motor, sensory, cognitive and visceral impairments; acute and chronic musculoskeletal disorders and pain; disabilities in adult and children ; processes of rehabilitation in orthopaedic, rhumatological, neurological, cardiovascular, pulmonary and urological diseases.
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