Human Movement Science 65 (2019) 51–59

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Human Movement Science

journal homepage: www.elsevier.com/locate/humov

Full Length Article

Quantitative assessment of drawing tests in children with dyslexia

and dysgraphia
⁎
Manuela Gallia, , Veronica Cimolina, Giacomo Stellab, Maria Francesca De Pandisc,
Andrea Ancillaod,1, Claudia Condolucie
a
Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
b
Department of Education and Human Sciences University of Modena and Reggio Emilia, Italy
c
“San Raffaele Cassino”, San Raffaele SPA, Cassino, Italy
d
Dept. of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, Italy
e
IRCCS “San Raffaele Pisana”, Tosinvest Sanità, Roma, Italy

A R T IC LE I N F O ABS TRA CT

Keywords: Drawing tests in children diagnosed with dyslexia and dysgraphia were quantitatively compared.
Dysgraphia Fourteen children with dysgraphia, 19 with dyslexia and 13 normally developing were asked to
Dyslexia copy 3 figures: a circle, a square and a cross. An optoelectronic system allowed the acquisition of
Drawing test the drawing track in three-dimensions. The participants’ head position and upper limb move-
Learning disabilities
ments were measured as well. A set of parameters including movement duration, velocity, length
Motor control
of the trace, Range of Motion of the upper limb, was computed and compared among the 3
Movement analysis
groups. Children with dyslexia traced the circle faster than the other groups. In the cross test,
dyslexic participants showed a reduced execution time and increased velocity while drawing the
horizontal line. Children with dyslexia were also faster in drawing certain sides of square with
respect to the other groups.

1. Introduction

“Learning Disabilities” is an “umbrella” term describing a number of other, more specific learning disabilities, such as dyslexia
and dysgraphia. Dysgraphia is a learning disability that affects handwriting abilities and fine motor skills. Major issues observed are
illegible handwriting, inconsistent spacing, poor spatial planning on paper, poor spelling, and difficulty composing writing as well as
thinking and writing at the same time. Although dyslexia is often defined as a language-based impairment, the behavioral mani-
festations of dyslexia are not restricted to the realm of language (Eden, Wood, & Stein, 2003). The prevalence of developmental
writing disorders is in between 7 and 15% among school-aged children, and, as a trend, males are more often affected than females
(Hawke, Olson, Willcut, Wadsworth, & DeFries, 2009; Katusic, Colligan, Weaver, & Barbaresi, 2009). This percentage is similar to the
incidence of developmental dyslexia, which is about 17% (Shaywitz & Shaywitz, 2005).
As several children with dyslexia and dysgraphia have specific drawing and writing difficulties due to a variety of perceptual-
motor and learning problems (Mati-Zissi, Zafiropoulou, & Bonoti, 1998; Rosenblum, Dvorkin, & Weiss, 2006), graphic tests are
fundamental for the clinical assessment of these subjects. The main difficulties in writing production were observed in comprehension
of differences, coordination of parts in an organized whole, spatial movement, size scaling and classification or distinction of figures

⁎
Corresponding author at: Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, p.za Leonardo da Vinci 32, 20133 Milano, Italy.
E-mail address: [email protected] (M. Galli).
1
Andrea Ancillao was at Dept. of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, Italy when the study was conducted. He is now with
“Tyndall National Institute”, University College Cork, Ireland.

https://doi.org/10.1016/j.humov.2018.05.001
Received 8 January 2018; Received in revised form 3 March 2018; Accepted 1 May 2018
Available online 08 May 2018
0167-9457/ © 2018 Elsevier B.V. All rights reserved.
M. Galli et al. Human Movement Science 65 (2019) 51–59

(Mati-Zissi et al., 1998; Rosenblum et al., 2006).

The assessment of these tests in clinical routine remains nowadays mostly qualitative and based on the visual evaluation made by
the operator. The drawings are administered using the ‘‘pen and sheet method’’ and are given a score with respect to the presence or
absence of some features (for instance number of particulars in the ‘‘Draw-a-Man’’ test (Abell, von Briesen, & Watz, 1996)) or to the
‘‘correctness’’ of the drawing in the Denver Developmental Screening Test (for instance if the child draws a closed-figure circle
(Frankenburg, Dodds, Archer, Shapiro, & Bresnick, 1992)). This method of evaluation has some important limitations due to the
qualitative (instead of quantitative) evaluation of the drawings and lack of information about the kinematics aspects of movement
(velocity, start and end point, pen lifts, angles amplitudes, side lengths, etc.) (Ancillao, Galli, Vimercati, & Albertini, 2013).
Previous researches (Rosenblum et al., 2006; Longstaff & Heath, 2006; Stanley & Hagenah, 2010; Tam, Churchill, Strother, &
Graham, 2011; Pagliarini et al., 2015; Pagliarini et al., 2017) enforced the importance of analyzing handwriting and drawing in a
quantitative way. The computerized tablets methods introduced some important advantages in the evaluation of the graphic gesture
as they allow a quantitative evaluation administrable in ambulatory settings. On the other side, the technological interface of the
tablet and its constrained position (it is not possible to rotate it as it would with a paper sheet) do not ensure completely natural
conditions of movement. Besides this, if the digitalized tables are suitable to provide the 2D representation of the pen trace on the
sheet during time, giving the possibility to analyze trace kinematics in terms of starting and ending point, velocity and smoothness of
the movement, they fall when the evaluation of posture and related upper limb movement are required.
To overcome this limit, some attempts were performed in order to quantify the graphic gesture by using an optoelectronic system.
Recently, Ancillao and colleagues (Ancillao et al., 2013) developed an experimental set-up to quantify the graphic gesture by using a
motion capture system. It was well tolerated by the subjects, as they were able to draw with a common pen on a sheet of paper and
were allowed to rotate the sheet. Such a protocol was proved suitable for recording the drawing of complex figures the acquisition of
handwriting.
To the author’s best knowledge, a few works about handwriting analysis were conducted on subjects with pathology. Some
examples are: Parkinson’s disease (Galli et al., 2014; De Pandis, Galli, Vimercati, & Albertini, 2009; De Pandis et al., 2010), Down
Syndrome (Vimercati et al., 2015; Rigoldi et al., 2015) and learning disabilities (Galli et al., 2011). There are other quantitative
studies on healthy subjects on the upper limb during specific tasks, such as in a violin player (Ancillao, Savastano, Galli, & Albertini,
2017).
Having some quantitative data to support clinical observation may allow to precisely define the causes of such motor control
issues, which is fundamental from a clinical point of view. Two studies (Galli et al., 2011; Vimercati et al., 2015) were conducted on
the handwriting in children with learning and intellectual disabilities by using the optoelectronic system, but no quantitative analyses
of drawing tests were applied to specific forms of learning disabilities, such as dyslexia and dysgraphia. Thus, the drawing analysis in
children with dyslexia and dysgraphia remains nowadays mostly based on subjective or at least semi-quantitative evaluations.
The aim of the present study was to record drawing tests, performed by children with dyslexia and dysgraphia, by using a
quantitative protocol based on an optoelectronic system. The hypothesis of this study is that both dysgraphia and dyslexia are
characterized by drawing abnormalities detectable by this method.

2. Materials and methods

2.1. Participants

Three groups of Italian monolingual children aged 7–10 were tested: 14 children with pure dysgraphia (Dysgraphic Group; males:
7; females: 7), 19 children with pure dyslexia (Dyslexic Group; males: 10; females: 9) and 13 normally developing children (Control
Group: CG; males: 7; females: 6). The three groups were matched by age and school grade. The children were all born in Italy and
used Italian as their first oral and written language. They were recruited in the Movement Analysis Laboratory of IRCSS San Raffaele
Pisana, Roma, IT. A qualified team of psychologists and speech therapists diagnosed pure form of dyslexia and dysgraphia in ac-
cordance with the National Guidelines (PARCC DSA., 2011) and the recommendations of the Congresso Nazionale AIRIPA (2010).
The diagnosis was made by means of standardized tests and, to complete the diagnosis of dysgraphia, the writing production of
children at school was examined. The same team determined that the children of both the Dysgraphic Group and the Dyslexic Group
had no psychological, neurological or auditory problems, nor did they have Developmental Coordination Disorders. All participants
had no physical or psychological dysfunction and a regular school education.
All procedures performed in the study were in accordance with the ethical standards of the institutional and national research
committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All participants were
volunteers and their parents gave informed consent to participation in the study.

2.2. Methods

The drawing gesture was acquired by an optoelectronic system with six cameras (SMART-D BTS; Italy), at a frequency of 200 Hz,
and with an integrated video system (Vixta, BTS, Italy) for video recording. The cameras were positioned in front and laterally to a
table, facing the volume where the motion had to be acquired, in order to allow every marker to be seen by at least two cameras. The
optoelectronic system measured the 3D coordinates (X, Y, and Z) of reflective markers placed on the subject and on the pen according
to the directions given in (Ancillao et al., 2013) (Fig. 1).
Before every data acquisition, a calibration was performed to define a global reference system frame for all the cameras and

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Fig. 1. Marker placement (for the static acquisition).

compute the extrinsic and intrinsic parameters for each camera. The calibrated volume (around 0.6 m × 0.4 m × 0.6 m) was defined
considering that the volume had to include the whole motion and it had to be as small as possible, in order to obtain a high accuracy.
At the end of the process, calibration was considered acceptable if the mean error on the computation of the difference between the
measure and actual distance of two markers fixed on the extremities of a rigid bar at the distance of 150 mm was within 0.20 mm
(standard deviation: 0.20 mm).
The markers were fixed on the pen-cap, in order to allow a free and natural grasp of the pen. To reconstruct the pen tip co-
ordinates, two trials were needed: a static trial and a drawing trial. In both acquisitions, three markers (named P1–P3) were fixed to a
regular pen cap using three wooden sticks about 50 mm long. A fourth marker (P4) was added in the middle of one stick to distinguish
the branch from the other two. The fourth marker allowed the user to easily understand the position of the pen and correctly label the
other three markers during the tracking procedure. At this point, the pen cap could be easily fixed on a regular pen. For the static
acquisition, the markerized pen was placed over a desk in the calibrated volume and an additional marker (labelled “Pen tip”) was
placed on the pen tip, which allowed acquiring the position of the tip in the space. In addition, four hemispherical markers were
placed at the corners of a sheet (named F1–F4 in clockwise order, beginning from top left corner). These markers allowed the
computation of sheet dimensions and the identification of the plane of the sheet. A data acquisition of about 5 s was performed and
the acquired positions of markers were averaged over all the acquired frames. After the static acquisition, a drawing acquisition was
performed. The marker on the pen tip was removed, also the two lower markers on the sheet were removed while the upper corners
(F1 and F2) were maintained to continue tracking the sheet position (Ancillao et al., 2013).
The children seated comfortably on an adjustable chair, in front of a desk. Their height respect to the desk was regulated to allow
easy and comfortable drawing. They were given a paper sheet with a printed figure (a circle, an equilateral cross and a square) and
were asked to ‘copy the illustrated figure’ with their dominant hand. The name of the figure was not mentioned, as specified in the
DDST (Frankenburg et al., 1992). The figures were presented one per time. After drawing the first figure, the child was presented with
the second and then with the third. The figures had fixed dimension and each figure was requested to be copied on different sheets.
Three acquisitions (one for each drawing) were recorded and analyzed for each child (Vimercati et al., 2015).

2.3. Data analysis

Data reconstruction was carried out using the software Smart Tracking (BTS Bioengineering, Italy), which computes the tracking
phase (Fig. 2).
After the tracking, the acquisitions were computed using Smart Analyzer software (BTS Bioengineering, Italy). In particular,
starting from the co-ordinates of the markers on the pen tip, a system of reference was defined on the pen. During the dynamic
acquisition, the pen tip co-ordinates were reconstructed (Ancillao et al., 2013) and it was possible to obtain the digitalized drawing
trace (i.e. the drawn figure) and the trace of the pen lifts. Another system of reference was defined starting from the markers on the
sheet and from the laboratory reference system. In this way, the participants could rotate the sheet during the drawing without
interfering with the measurements, allowing free and natural movements of the participants. Markers were also put on the body of
the participant. Landmarks on the body were chosen in order to minimize the effect of the skin artefacts. In particular, markers were
put on the head (on the central point of forehead), shoulders (on the acromion bilaterally), trunk (seven cervical vertebra), elbows
(lateral epicondyle of homerus bilaterally), wrists (between the styloid processes of ulna and of radius) and hands on the side of the
dominant hand (Vimercati et al., 2015).
After reconstructing the 3D coordinates of the markers, the following parameters were computed. To characterize the position of
the participant’s head during the drawing, the maximum and minimum projections of the marker on forehead on the table were
computed and the difference between these two values was named head-table distance (head-table_dist) (m). To characterize the

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Fig. 2. Model used for tracking data coming from static trial.

movement of the upper limb, the shoulder angle was defined as the acute angle between the markers positioned on the right and left
acromion and the elbow; the elbow angle was defined as the acute angle between the markers positioned on the acromion, elbow and
wrist. The wrist angle was defined as the acute angle between the markers positioned on the elbow, wrist and hand. The ranges of
motion (ROMs) of these two angles (elbow ROM and wrist ROM parameters) were computed from the co-ordinates of the external
markers.
To characterize the drawing traces of the different figures, some parameters were computed from the acquired drawing trace,
starting from the coordinates of the reconstructed position of the pen tip on the horizontal plane, i.e. the sheet plane. The analyzed
parameters were chosen in order to assess quantitatively the correctness of the drawing and the presence or absence of features that
characterize the different geometrical figures. The parameters were chosen with respect to the features that are visually evaluated in
the DDST (Frankenburg et al., 1992) and among those parameters that could characterize the figure’s geometrical features (Galli
et al., 2011):
Circle test (Fig. 3(a))

- Trace length (L): the length of the trace drawn by the participants (m);
- Time (T): the duration of the movement execution (s);
- Velocity (V): mean velocity of the movement execution (m/s);
- Circle error: it is computed according to the following formula [Eq. (1)]
Circle error = |1−D1/D2| (1)
where D1 is the vertical diameter and D2 is the horizontal diameter; the closer the value is to 0, the closer the circle is to an ideal
circle. This parameter was chosen to assess the presence of an ellipsoidal rather than circular tendency.
Cross test (Fig. 3(b))

• Trace length: the length of the vertical (L1) and horizontal (L2) side of the cross (m);
• Time: the duration of drawing the vertical (T1) and of the horizontal (T2) side of the cross (s);
• Velocity: mean velocity of drawing the vertical (V1) and the horizontal (V2) side of the cross (m/s);
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Fig. 3. (a) Circle test and the vertical (D1) and horizontal (D2) diameter of the circle. (b) Cross test and the vertical (L1) and horizontal (L2) side of
the cross. (c) Square test and the upper (L1), lower (L2), left (L3) and right (L4) sides of the square.

• Cross side error: computed according the following formula [Eq. (2)]
Cross side error = |1−L2/L1| (2)

The closer the value is to 0, the more precise is the drawing, i.e. the sides have more similar lengths.
Square test (Fig. 3 (c))

• Trace length: the length of upper (L1), lower (L2), left (L3) and right (L4) sides of the square (m);
• Time: the duration of drawing the upper (T1), lower (T2), left (T3) and right (T4) sides of the square (s);
• Velocity: mean velocity of drawing the upper (V1), lower (V2), left (V3) and right (V4) sides of the square (m/s);
• Square side error (m): computed according the following formula [Eq. (3)]
Square side error = |L1−L2| + |L3−L4| (3)

The closer the value is to 0, the more precise is the drawing, i.e. the sides have more similar lengths.

• Index of Curvature (IC): it is computed for each side according to the following formula [Eq. (4)]
IC = |1−plot/distance| (4)

where plot is the real length of each drawn side and distance is the linear distance between the start and the end of the drawn side; the
closer the value is to 0, the more linear is the drawing of the side.

2.4. Statistical analysis

All the previously defined parameters were computed for each participant and then the median and interquartile range values of
all indexes were calculated for each group. Kolmogorov–Smirnov tests were used to verify if the parameters were normally dis-
tributed; the parameters were not normally distributed, so we used the Kruskal-Wallis tests followed the post hoc analysis for
comparing data among Dysgraphic Group, the Dyslexic Group and Control Group. Level of significance was set at p < 0.05.

3. Results

All the children were able to complete the evaluation. The results of the drawing tests are reported in the following.

3.1. Circle test

In Table 1, the results for the circle test are displayed. The Dyslexic Group was found statistically different from Dysgraphic Group
and Control Group in terms of duration (T index) and velocity (V index). The Dyslexic Group performed faster the circle drawing and
with shorter duration respect to the other two groups; no other differences were identified. On the contrary, the Dysgraphic Group
was similar to the Control Group. In addition, it is important to underline that, even if the circle error parameter is not statistical
different between the two groups, the analysis revealed that in Dysgraphic Group 100% of participants showed the ratio between D1
and D2 higher than 1, representative of the vertical diameter longer than the horizontal one; in the Dyslexic Group this percentage is
36.7%.

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Table 1
Median (interquartile range) of the parameters related to the circle test for the three analyzed groups. * = p < 0.05, Dysgraphic Group vs.
Dyslexic Group; + = p < 0.05, Dysgraphic Group and/or Dyslexic Group vs. Control Group.
Circle test

Dysgraphic Group Dyslexic Group Control Group

L (m) 0.17 (0.04) 0.16 (0.03) 0.17 (0.04)

T (s) 6.35 (3.18) 4.54 (1.81)*+ 6.09 (1.65)
V (m/s) 0.03 (0.01) 0.05 (0.02)*+ 0.03 (0.01)
D1 (m) 0.05 (0.02) 0.05 (0.01) 0.05 (0.01)
D2 (m) 0.04 (0.01) 0.05 (0.02) 0.05 (0.01)
Circle error 0.23 (0.32) 0.19 (0.18) 0.09 (0.07)
ROM shoulder (°) 4.17 (1.69) 6.05 (5.24) 3.38 (1.78)
ROM elbow (°) 6.16 (3.13) 6.46 (3.48) 6.70 (3.05)
ROM wrist (°) 8.74 (4.44) 9.39 (4.04) 9.95 (5.42)
Head-table_dist (m) 0.05 (0.01) 0.07 (0.04) 0.05 (0.04)

3.2. Cross test

In Table 2, the results for the cross test are displayed. The Dyslexic Group was found statistically different from Dysgraphic Group
and Control Group in terms of duration (T2 index) and velocity (V2 index) to draw the horizontal side. The cross drawing, in
particular of the horizontal side, was performed by the Dyslexic Group faster and with shorter duration respect to the other two
groups; no other differences were displayed. On the contrary, the Dysgraphic Group was similar to the Control Group.

3.3. Square test

In Table 3, the results for the cross test are displayed. The Dyslexic Group was found statistically different from Dysgraphic Group
and Control Group in terms of some duration parameters (T2 and T4 indices), the length of the upper side (L1 index) and Index of
Curvature (IC2, IC3 and IC4 indices). The square drawing, in particular of the lower (T2 index) and the right (T4 index) sides, was
performed by the Dyslexic Group with reduced duration while the upper side is shorter respect to the other two groups; on the other
side, the Dysgraphic Group are characterized by higher IC in most sides (lower, right and left sides) than Dyslexic and Control Group.
The kinematic parameters of upper limb motion (ROM of shoulder, elbow and wrist) and head position did not reveal any
statistically significant difference among groups in the three tests.

4. Discussion

Since learning disabilities, including dysgraphia and dyslexia, are frequently characterized by writing and drawing problems, the
assessment of children’s ability using graphic tests is important from a clinical point of view. In this study, a quantitative and
comparative assessment of drawing test was conducted in dyslexic and dysgraphic children. The participants were asked to copy
some figures (a circle, a square and a cross) commonly used in clinical evaluation using the traditional pen and sheet method
(Frankenburg et al., 1992).
Our results showed that the children with dyslexia traced the circle faster with respect to the dysgraphic children and the Control
Group (T and V indices); on the other side, all the circles drawn by the dysgraphic participants displayed the vertical diameter (D1

Table 2
Median (interquartile range) of the parameters related to the cross test for the three analyzed groups. * = p < 0.05, Dysgraphic Group vs.
Dyslexic Group; + = p < 0.05, Dysgraphic Group and/or Dyslexic Group vs. Control Group.
Cross test

Dysgraphic Group Dyslexic Group Control Group

L1 (m) 0.05 (0.01) 0.05 (0.02) 0.05 (0.01)

L2 (m) 0.05 (0.01) 0.05 (0.02) 0.05 (0.01)
T1 (s) 3.13 (2.13) 2.00 (1.27) 2.72 (0.89)
T2 (s) 2.69 (1.79) 1.38 (0.80)*+ 2.41 (0.90)
V1 (m/s) 0.02 (0.05) 0.04 (0.02) 0.03 (0.02)
V2 (m/s) 0.03 (0.53) 0.05 (0.09)*+ 0.03 (0.02)
Cross side error 0.12 (0.09) 0.16 (0.17) 0.16 (0.12)
ROM1 elbow (°) 4.93 (4.08) 4.36 (3.06) 6.41 (5.43)
ROM2 elbow (°) 4.23 (2.42) 3.59 (2.51) 3.13 (1.97)
ROM1 wrist (°) 4.87 (2.69) 5.62 (3.69) 3.74 (1.55)
ROM2 wrist (°) 7.32 (2.16) 6.91 (4.84) 6.08 (3.48)
Head-table_dist (m) 0.07 (0.04) 0.04 (0.03) 0.07 (0.07)

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Table 3
Median (interquartile range) of the parameters related to the square test for the three analyzed groups. * = p < 0.05, Dysgraphic Group vs.
Dyslexic Group; + = p < 0.05, Dysgraphic Group and/or Dyslexic Group vs. Control Group.
Square test

Dysgraphic Group Dyslexic Group Control Group

L1 (m) 0.05 (0.01) 0.04 (0.02)*+ 0.05 (0.01)

L2 (m) 0.04 (0.02) 0.04 (0.03) 0.05 (0.01)
L3 (m) 0.05 (0.04) 0.04 (0.01) 0.04 (0.01)
L4 (m) 0.04 (0.02) 0.04 (0.01) 0.05 (0.01)
T1 (s) 1.94 (1.22) 1.71 (1.21) 2.04 81.72)
T2 (s) 2.99 (1.49) 1.67 (0.87)*+ 2.28 (1.34)
T3 (s) 2.14 (1.65) 1.91 (1.55) 1.76 (1.44)
T4 (s) 2.13 (1.08) 1.30 (0.53)* 1.45 (1.37)
V1 (m/s) 0.03 (0.02) 0.02 (0.01) 0.03 (0.02)
V2 (m/s) 0.03 (0.04) 0.04 (0.05) 0.03 (0.02)
V3 (m/s) 0.02 (0.02) 0.03 (0.06) 0.02 (0.01)
V4 (m/s) 0.03 (0.01) 0.03 (0.01) 0.03 (0.02)
IC1 0.09 (0.11) 0.07 (0.19) 0.065 (0.05)
IC2 0.12 (0.27)+ 0.01 (0.02)* 0.01 (0.03)
IC3 0.17 (0.26)+ 0.06 (0.13)* 0.08 (0.05)
IC4 0.15 (0.12)+ 0.09 (0.17)* 0.04 (0.03)
Square side error 0.02 (0.02) 0.03 (0.02) 0.01 (0.01)
ROM shoulder (°) 10.29 (7.16) 8.59 (5.33) 7.39 (3.21)
ROM elbow (°) 10.74 (4.01) 9.59 (3.55) 10.28 (2.36)
ROM wrist (°) 11.93 (5.76) 11.27 (6.31) 8.32 (4.49)
Head-table_dist (m) 0.06 (0.04) 0.05 (0.05) 0.05 (0.03)

index) longer than the horizontal (D2 index) one, if compared to the dyslexic children. As concerns the cross test, the Dyslexic Group
showed a reduced time (T2 index) and increased velocity (V2 index) during drawing of the horizontal side. In terms of square test,
children with dyslexia are faster in drawing some sides of the square respect to the other two groups; in addition, the upper side (L1
index) is shorter. The dysgraphic participants displayed some IC parameters greater than Dyslexic and Control Group. These results
showed that, when drawing the square, the children with dysgraphia traced the side not perpendicularly but with a sort of in-
clination, while the dyslexic participants draw the opposite sides more perpendicularly but with different length.
From our results, we observed that the dyslexic children seem to be characterized by lower motor control during drawing, due to a
faster trace and to a reduction in the movement planning, respect to the dysgraphic children; they could be more interested in the
trace completion rather than in the precision and accuracy. It is particularly evident in the cross test, where the horizontal side,
generally the last traced, is faster than the vertical one. It is possible to make to hypothesis that the results in this group may be
connected to an attentional deficit.
From literature on dyslexia, dyslexic children often suffer from fine and gross motor difficulties, like motor coordination, poor
balance and clumsiness (Capellini, Coppede, & Valle, 2010; Nicolson, & Fawcett, 1990), in association with developmental co-
ordination disorders (Ramus, Pidgeon, & Frith, 2003; Rochelle, Witton, & Talcott, 2009).
In addition, there are reports of a high correlation between word reading and writing performance. The two skills have much in
common: acquisition is similar with respect to the developmental phases. While knowledge about the alphabetic system plays an
important role, the connection between the uses of the semantic system does too. These facts lead to the conclusion that the un-
derlying abilities necessary for reading and writing are likely similar, if not the same. However, looking more closely, writing seems
to be more demanding than reading (Döhla and Heim, 2015).
Interestingly, the dysgraphic children evidenced a trace more similar to Control Group than to dyslexic participants, even if some
abnormalities were displayed especially in the square test. They seem to be characterized by higher control when copying the figures
respect to the dyslexic children; however, when copying more complex figure, such as the square, their control is reduced, as
evidenced by IC parameter values. Probably, for the fine movements, the disturbances are mainly related to cognitive and attentional
aspects rather than to motor alterations. Unlike dyslexia, only few studies have addressed dysgraphia and they are focused mainly on
handwriting, with controversial results. Rosemblum et colleagues (Rosenblum, Parush, & Weiss, 2003) for example found dysgraphic
writing slower than controls; Hamstra-Bletz & Blöte, on the contrary, displayed than not only do children with dysgraphia show the
same writing speed as controls (Hamstra-Bletz & Blöte, 1993), but also controls write at a slower rate compared to dysgraphic
children. These inconsistent results could be connected to different experimental set-up and tools (Pagliarini et al., 2015).
This study has some limitations. The small number of participants resulted in limited strength of the statistical findings. The
inclusion of a larger sample and the assessment not only of graphic but also of writing tests could provide the opportunity to make a
deeper investigation of the differences between dyslexic and dysgraphic children.
Besides this further studies might be dedicated to the analysis of trace done during drawing it could be of interest to evaluate
possible differences at start - end of the movement. This analysis might provide data to show if there is the difference uniformly
distributed along the circle and other symbols. It is important to underline that this study was based on a copy task. Future devel-
opments might include tests asking to the subjects to dray symbols upon experimenter input. This test will evaluate better the

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drawing behavior of the considered population.

Further studies could assess also the muscle activation (using electromyography) and/or cerebral activity (using electro-
encephalography) during the gesture execution, could give additional information useful from a clinical point of view to deeply
investigate these learning disabilities. In addition, it could be interesting to make a similar evaluation but during a dual task, so to
assess the presence of drawing alterations when the attention is moved away, especially in children with dysgraphia.
Besides this, it is important to underline that this study shows that quantitative motion analysis, which is typically focused on gait
analysis for the characterization of the gait alterations in specific pathologies (Rigoldi et al., 2012; Piccinini et al. 2011; Ancillao,
2018) and /or in treatment outcomes quantifications (Galli et al. 2001), can be extended to fine-motor skills by developing some ad-
hoc protocols for the characterization of specific motor features.

Competing interest

All authors declare no conflicts of interest and any financial interest. All authors attest and affirm that the material within has not
been and will not be submitted for publication elsewhere.

Compliance with ethical standards

All authors declare that they have no conflicts of interest and any financial interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institu-
tional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical
standards.
Informed consent was obtained from all the parents of the participants included in the study.
All authors attest and affirm that the material within has not been and will not be submitted for publication elsewhere.

Acknowledgments

The authors would like to commemorate and to give a special thanks to Prof. Giorgio Albertini as the incipit of this paper started
from him as well as many other papers.
The authors would like to acknowledge Eng. Barbara Giuppani for her contribution in data elaboration.

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