title: What letters can "learn" from Arabic digits--fMRI-controlled single case therapy study of peripheral agraphia.
abstract: Research on (hand-)writing has revealed that Exner's area subserves transferring linguistic impulses into writing programmes. We report on a patient with a lesion affecting Broca's and Exner's area suffering from severe peripheral agraphia for letters but not for Arabic digits. Analogous to semantic (magnitude) information in numbers, we developed a specifically tailored writing training: additional mental imagery based semantic information was attached to letters. The training resulted in significant improvements. Imaging data revealed stronger fronto-parietal network activity including perilesional activation around Exner's area and precuneus for writing letters to dictation than for writing letters corresponding to their mental image expressions. Follow-up testing showed not only stable training effects but also an activation shift into the left angular gyrus. Results document neuronal correlates of a successful intervention by attaching additional meanings to letters in order to retrieve their grapho-motor patterns. These findings contribute to understanding the impact of Exner's area.
authors.affiliation: Leibniz-Institut für Wissensmedien, Tuebingen, Germany; Department of Psychology, Eberhard Karls University, Tuebingen, Germany. Electronic address: s.jung@iwm-tuebingen.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Neurology, University Hospital RWTH Aachen University, Aachen, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Halm
authors.affiliation: Department of Neurology, University Hospital RWTH Aachen University, Aachen, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Huber
authors.affiliation: Section Neuropsychology, Department of Neurology, University Hospital RWTH Aachen University, Aachen, Germany; Interdisciplinary Centre for Clinical Research, University Hospital RWTH Aachen University, Aachen, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Willmes
authors.affiliation: Leibniz-Institut für Wissensmedien, Tuebingen, Germany; Section Neuropsychology, Department of Neurology, University Hospital RWTH Aachen University, Aachen, Germany; Interdisciplinary Centre for Clinical Research, University Hospital RWTH Aachen University, Aachen, Germany.
authors.forename: Elise
authors.initials: E
authors.lastname: Klein
mesh_terms: D000381:Agraphia / Q000473:pathology / Q000503:physiopathology*; D001931:Brain Mapping; D065711:Broca Area / Q000473:pathology / Q000503:physiopathology; D005625:Frontal Lobe / Q000473:pathology / Q000503:physiopathology*; D006236:Handwriting; D006801:Humans; D019018:Imagery, Psychotherapy; D007858:Learning; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010296:Parietal Lobe / Q000473:pathology / Q000503:physiopathology; D012660:Semantics
keywords: Peripheral agraphia; Stroke; Therapy; fMRI