The inability to write after a stroke is called agraphia. It’s primarily caused by impaired motor control in the hand (peripheral agraphia) or disrupted language processing skills (central agraphia).
Writing exercises for stroke patients can help improve agraphia by retraining fine motor skills and cognitive functioning.
This article includes the most effective writing exercises for stroke patients with peripheral or central agraphia.
Writing Exercises for Stroke Patients with Peripheral Agraphia (Hand Weakness)
First, we’ll cover writing exercises for stroke patients with peripheral agraphia.
Patients with peripheral agraphia know what they want to write, but they don’t have the fine motor control to manage writing skills due to strength, grip, or tremor.
To treat this condition, writing exercises should focus on improving hand function and handwriting.
Here are some writing exercises for stroke patients that improve strength and dexterity in the hand:
1. Practicing Grasp and Release Exercises
Regaining the ability to grasp and hold a pencil is the foundation to writing again after a stroke. By practicing grasp and release activities, you can improve your ability to hold a pencil.
The key is to practice a high number of repetitions of each exercise to help rewire the brain. Especially after a stroke, high repetition is key to regaining mobility.
But you also have to be aware of muscle fatigue. The smaller the muscle, the quicker the fatigue. The further away from the body, the slower the recovery. For example, this is why hand function often takes longer to improve than arm function.
Therefore, take frequent, short breaks during writing exercises to prevent frustration or negatively activating bigger muscles to complete the movement.
2. Using a Universal Cuff
If you’re experiencing difficulties holding a pen or pencil after stroke, using a universal cuff may assist with maintaining a functional grip on the pen.
By sliding your writing utensil inside the slits of the universal cuff, you create a handle that helps ensure your writing utensil will not drop, even if you lose your grip on it.
There are additional adaptive devices that can assist with writing. An occupational therapist can help you decide which item is best suited for successful writing skills.
3. Pressing Piano Keys
Pressing on piano keys is a great way to develop finger strength, dexterity, and hand-eye coordination. When you perform an activity that is familiar, the brain may activate the muscle movement easier and quicker.
These fine motor skills are essential for improving handwriting after stroke. Playing the piano is a fun and engaging activity that makes it easy to perform the repetitions necessary to promote neuroplasticity.
Have someone write a few words on a piece of paper so that you can use it as a reference to trace over.
Ask them to write large and use a thick marker so that the words will be easier to trace.
You can also type the words on your computer, adjust the font size and thickness, and print it to create your own reference sheet.
Having a reference sheet will encourage you to compare and fix your mistakes for more accurate handwriting.
5. Using Grasp and Release Rehab Technology
There’s a rehab tool that focuses specifically on grasp and release activities called MusicGlove from Flint Rehab.
By following the keys on the screen and pinching your fingertips together, you practice curling your fingers in the same way you would grip a pen.
6. Connect the Dots
Have someone write letters in dots, or find a worksheet like this one online and print it. Visualize the letters and connect the dots.
This activity will guide your writing and familiarize your brain with the appropriate movements.
7. Finger Resistance Training
Place your fingers inside a rubber band and separate your fingers. The resistance of the rubber band will help strengthen your finger muscles. To increase resistance, add more rubber bands.
Writing Exercises for Stroke Patients with Central Agraphia (Language Processing Difficulties)
Next, we’ll cover writing exercises that help improve central agraphia.
With central agraphia, the cognition is affected. Even though you may be physically able to write, you may experience difficulties remembering how to spell or write down the correct letters.
Central agraphia is generally treated by working with a speech-language pathologist. These therapists are highly trained in helping stroke patients relearn how to write words after stroke.
Try these writing exercises if you have central agraphia:
8. Copy and Recall Treatment (CART)
Copy and recall treatment involves repeatedly copying and re-writing to ensure that the individual can spell the targeted words. The more the patient writes the word, the more successfully its spelling is retained.
In therapy, a speech-language pathologist will write the word down and say it aloud. Then, the patient will be asked to copy the word down multiple times.
Next, the speech-language pathologist will take away or cover all examples of the written word and ask the patient to write it down from memory multiple times.
The set of words will be continuously practiced until spelling is mastered.
9. Anagram and Copy Treatment (ACT)
Anagram and copy treatment involves training the patient to recognize the letters that make up a word and arranging them in the proper order.
A speech-language pathologist will display the letters that make up a word in scrambled order and then ask the patient to spell the target word using the letters available.
If correct, the patient will be asked to write it down multiple times.
If incorrect, the speech-language pathologist will write it down for the patient, and then have the patient write it down multiple times. The letters will be re-scrambled until the patient can independently write the word correctly.
Lastly, the speech-language pathologist will take away or cover all written forms of the word and ask the patient to write the word multiple times.
Getting Back to Writing After Stroke
If you struggle with agraphia after stroke, make sure you get an accurate diagnosis from your Speech-Language Pathologist. A correct diagnosis will help you practice the most relevant exercises to improve writing after stroke.
It’s important to promote neuroplasticity by performing high repetition of each exercise. More repetition means more stimulation for the brain, which helps the brain rewire itself and regain control of the hand.
We hope these exercises help you get back to writing after stroke!