Exploration of Neuroprotective Therapy

Table 2. Main characteristics of the included studies.

FA	YoP	SD	PT	NIP	Intervention	Comparator/Control	Outcome measures	Main findings	O-RoB
Moss [13]	2024	non-RCT	Aphasia with dysgraphia	10	Writing intervention using mainstream assistive technology	None	Writing accuracy, reading comprehension, functional communication	Improved writing and reading comprehension; benefits in functional communication	SR²
Pisano [48]	2021	RCT	Chronic stroke	14	Dual-tDCS over the temporo-parietal cortex + writing tasks	Sham stimulation	Writing accuracy and speed	Active dual-tDCS enhanced writing performance; improvements stable post-treatment	SC¹
Marshall [49]	2019	RCT	Stroke with aphasia	21	Technology-enhanced writing therapy using assistive software	Usual care/waitlist	Functional writing, communication measures	Technology-based therapy improved functional writing performance	HR¹
Thiel [50]	2016	non-RCT	Stroke with writing impairment	8	Uni-modal vs multi-modal writing therapy	Between-condition comparison	Writing accuracy (trained/untrained), follow-up	Both therapies improved writing; no clear advantage of multi-modal; some gains not maintained at 6 weeks	SR²
Johnson [51]	2019	non-RCT	Stroke with alexia and agraphia	8	Multi-step lexical + sublexical treatment	None	Reading and writing of trained/untrained words	Significant gains on trained items; generalization to related untrained items across modalities	SR²
Thiel [52]	2016	non-RCT	Stroke with writing impairment	45	Learning-based writing therapy	None	Functional writing tasks	Improved functional writing; practice and error correction contributed to gains	SR²
Mousavi [53]	2025	non-RCT	Stroke with chronic non-fluent aphasia	6	Persian writing treatment protocol	None	Writing accuracy for trained/untrained functional words	Significant improvement for trained words; stable results; no generalization to untrained words	SR²
Simpson [54]	2016	non-RCT	Stroke with writing impairment	7	Home-based handwriting program	None	Handwriting legibility and speed	Feasible home-based program with preliminary handwriting improvements	CR²
Thiel [55]	2014	non-RCT	Stroke with dysgraphia	4	Errorless vs errorful writing therapy	Errorless vs errorful comparison	Writing accuracy; follow-up	Both therapies effective; errorless slightly superior in one patient; gains maintained at 5 weeks	SR²
Johansson-Malmeling [56]	2022	non-RCT	Stroke with spelling deficits	6	Digital spelling aid (tablet-based)	None	Spelling accuracy, generalisation tasks, usability	Significant improvements in spelling; some generalization; high usability and acceptance	SR²
Curtis [57]	2009	non-RCT	Stroke with writing impairment	5	Interactive game-based handwriting rehab	None	Handwriting kinematics and legibility	Feasible and engaging; preliminary improvements in handwriting performance	CR²
Raymer [58]	2010	non-RCT	Post-stroke acquired dysgraphia	4	Errorless spelling treatment	Errorful spelling treatment	Spelling accuracy (trained/untrained words)	Errorless training produced greater gains on trained words; some generalization across tasks	SR²

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FA: first author; YoP: year of publication; SD: study design; PT: population type; NIP: number of included patients; O-RoB: overall Risk of Bias; tDCS: transcranial direct current stimulation; RCT: randomized clinical trial; SC: some concerns; HR: high risk of bias; SR: serious risk of bias; CR: critical risk of bias; ¹: evaluated through the Risk of Bias 2 tool (RoB 2); ²: evaluated through the Risk Of Bias In Non-randomized Studies—of Interventions tool (ROBINS-I).

Supplementary materials

The supplementary tables for this article are available at: https://www.explorationpub.com/uploads/Article/file/1004145_sup_1.pdf.

Declarations

Acknowledgements

During the preparation of this work, the authors used ChatGPT (OpenAI, 2023; https://chatgpt.com/) to generate the brain icon in Figure 1. After utilizing the tool, the authors reviewed and edited the content as necessary and take full responsibility for the final content of the publication.

Author contributions

FL: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. ET: Data curation, Investigation, Formal analysis. GV: Validation, Supervision, Methodology, Visualization, Writing—review & editing, Project administration. All authors read and approved the submitted version.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

The datasets that support the findings of this study are available from the corresponding author upon reasonable request.

Funding

Not applicable.

Copyright

Publisher’s note

Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

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