Crossed Dysgraphia: A case Report

Introduction Considering the prevailing view of right hemisphere’s limited capacity for lexical-semantics and its lack of phonological capacity (Coslet & Saffran, 1998), it is quite predictable that writing difficulties in right hemisphere damaged (RHD) is mainly attributed to impairment in peripheral mechanism involved in visual and/or kinesthetic information processing. This type of peripheral agraphia has been termed as ‘‘spatial agraphia’’ or ‘‘afferent dysgraphia’’. (Ardila, & Rosselli, 1993; Croisile, & Hibert, 1998; Cubelli, Guiducci, & Consolmagno, 2000; Margolin & Binder, 1984; Seki et al., 1998). However, under unusual circumstances such as damage to the left hemisphere, the RH may develop some capacity to write and spell (Weekes, 1995). A subgroup of RHD patients with symptoms of crossed aphasia (CA) may also display deficits in written language (Basso et. al, 1985). However, cognitive model-based description of crossed dysgraphia (CD) is seldom seen in the literature, with one single exception (Gonzales-Rothi, Roeltgen, & Kooistra, 1987). Currently, it is difficult to predict to what extent RHD in general, and CA in particular, will result in impairments of the central components of writing/spelling. The hypothesis of limited lexical-semantic and phonological capacity of the right hemisphere, as mentioned earlier, will predict that the RHD patients will not experience significant problems in the central linguistic components of writing/spelling. The current study reports on a case of CD in a RHD elderly adult who has evidenced symptoms of impairments of central components of writing/spelling. Method Subject. SE, a 69-year-old right-handed female had a sudden onset of speechlessness and left-sided hemiplegia. A repeat CT scan revealed lesions in the head of caudate and putamen of the right hemisphere. The left hemisphere was spared. In the acute stage, SE’s communication status was characterized by global aphasia. In the sub-acute stage, global aphasia began to resolve. At one month post-onset, SE’s language impairment resembled the profile of Broca’s aphasia. In addition, SE’s speech was characterized by moderate to severe apraxia of speech. Experimental tasks. SE was tested on several subtests of reading and writing part of the Psycholinguistic Assessment of Language Processing (PALPA) in Aphasia. (Kay, Lesser, & Coltheart, 1992). These sub-tests have examined the effects of several independent variables including letter length, imageability and frequency, grammatical class, lexical morphology, regularity, non-words, and homophones. Results and discussion. The results of SE’s performance on these tests are summarized in Table 1. SE’s performance on the PALPA tests revealed the profile of phonological dysgraphia: Variable effect of letter lengths, better performance on high imagery/high frequency words than the low imagery/low frequency ones, responses were much better on nouns and verbs than on adjectives and functors, better performance on regularly spelled words when compared to irregular words, profoundly impaired performance on words and homophones. These results clearly establish the impairments of the central/linguistic components of writing/spelling in SE. It is hoped that the discovery of a variety of CD patterns will reinforce the view of individual differences in structural and functional brain organization in relation to language.