Retraining writing for functional purposes: a review of the writing therapy literature

Background: Acquired dysgraphia (impaired writing/spelling skills) can significantly restrict people from participating in social, professional, and educational life. Using writing in order to access the Internet via computers, tablets, and mobile phones has become an important part of everyday life for people of all ages. Improving writing in people with acquired dysgraphia could facilitate communication, reduce isolation, and increase access to information. Aims: This review evaluates the writing therapy literature in terms of its usefulness in guiding clinicians in training writing in adults with acquired dysgraphia generally, with specific reference to functional writing activities. The databases Web of Knowledge and Psychinfo were searched for studies evaluating writing therapies for participants with acquired dysgraphia following brain injury. Studies were categorised according to type of treatment (e.g., impairment-based or assistive technology training) and outcome measures (e.g., single words or sentences). Main Contribution: Sixty-two studies were found. Of these, 54 described impairment-based writing therapies targeting single words or sentences using either lexical or phonological therapies. A small body of 14 studies evaluated the use of assistive writing technologies either alone or in conjunction with an impairment-based therapy. Although all studies reported positive effects of some kind, only 28 measured the effects of therapy on functional or spontaneous writing and only 21 explicitly encouraged the transfer of writing skills to functional tasks. Conclusions: The writing therapy literature has a dominant tradition of using theoretically motivated treatments to improve single-word writing. It provides limited guidance to clinicians treating functional writing, especially in natural contexts. There may be a specific therapeutic role for assistive technologies which have been as yet largely unexplored in the literature. Furthermore, the cognitive requirements of effective use of assistive technology for dysgraphia warrant research in order to understand which people with dysgraphia may benefit from their use. Keywords : brain injury, therapy, stroke, spelling, writing, technology