Macrography (megalography) is a handwriting characterized by the writing of excessively large graphic elements. With macrography, letters and numbers are over 1 cm in size, which is why no more than 10-20 words fit on the page. It occurs in the structure of neurological syndromes (cerebellar ataxia, cerebral gliomatosis), visual and mental disorders (micropsia), writing disorders (optical dysgraphia). A patient with macrography is shown a psychoneurological, ophthalmological, speech therapy examination. When choosing treatment tactics, the leading syndrome is taken into account, drug treatment, psychotherapy, speech therapy classes are carried out.
At the initial stage of learning to write, all children write in excessively large letters, do not respect the line and margins on the page. The elements are disproportionate to each other, differ in different heights and lengths, have different inclinations. Sometimes there is too much pressure, hand tremor. These features of writing in older preschoolers are explained by insufficient formation of visual-motor coordination, strong functional stress and rapid fatigue when writing.
However, large letters in the initial period of learning to write are not a pathological sign. As the hand is trained, the handwriting becomes more even and confident, the student learns to correlate the size of the letters with the boundaries of the line. If the tendency to write large graphic elements persists and takes on a persistent character, it is necessary to search for the root cause of macrography.
The writing of excessively tall and wide letters is typical for children with high-functioning autism. Studies show that the letters written by children with ASD are, on average, 1 cm taller and 4 cm wider than those of normal children. The size and slope of the letters in the process of writing in children with autism is constantly changing. Macrography in autistic disorders is explained by difficulties with fine and gross motor skills, optic-spatial and hand-eye coordination.
A change in handwriting by the type of micrography or macrography occurs in children suffering from optical dysgraphia. The leading mechanism is the difficulty in mastering graphic symbols due to reduced, mismatched control of the visual and motor implementation of the act of writing. Along with the substitutions and mixing of similar letters, underwriting or writing superfluous elements, the originality of the handwriting is noted: uneven, angular, “trembling” letters of different sizes and inclinations. Characterized by a slow pace of writing, great muscle tension during movements of the hand, fatigue of the hand.
Macrography
A disorder of motor functions, in particular, voluntary movements of the hands necessary for the implementation of writing, occurs with damage to the cerebellum of various etiologies. Cerebellar ataxia can occur with the following nosologies:
In the speech status, a specific cerebellar dysarthria is revealed, which, first of all, is characterized by a disorder of oral utterance. Speech becomes intermittent ("chopped"), disprosodic, sometimes the patient shouts out individual sounds. Macrography phenomena are noted on the letter: uncertain sweeping handwriting, enlargement of letters, difficulties in smooth connection of elements.
Megalographic writing may indicate the presence of hypermetropia. With farsightedness, near reading improves as the font size increases. A similar situation is noted in writing: the handwriting becomes stretched, with large distances between words, the letters acquire a rounded shape and a large size. In older people with presbyopia, handwriting becomes larger, i.e., age-related macrography develops.
This disorder can be caused by both visual pathologies (accommodation paralysis, damage to the macula of the retina) and psychosensory disorders (Alice in Wonderland syndrome). With micropsia, visible objects appear small, reduced in size, which is not true. Macrography may be observed on the letter. The real perception of the size of the letters is disturbed, which is why the patient depicts them as excessively large.
The manic stage of the disease is characterized by excitement, a leap of ideas, which is reflected in writing. Patients write a lot and enthusiastically, but they express their thoughts incoherently and inconsistently. The letters become large (sometimes gigantic) in size, which is why only a few lines or words fit on one page. At one time, the patient can write a whole notebook. Most often, the pronouns “I”, “You” are written in unreasonably large letters. The letter as a whole is careless, illegible, sometimes new words are written according to the already written text. In the phase of depression, macrography is replaced by micrography.
With micropsia, it is necessary to carry out a complex of diagnostic measures aimed at identifying the central mechanism of handwriting changes. The patient needs to be examined by a neurologist, an ophthalmologist. If necessary, a psychological and pedagogical examination is carried out (consultation of a neuropsychologist, speech therapist). Main diagnostic steps:
Handwriting correction
Macrography is a consequence of the main neurological, ophthalmological, neuropsychological syndrome, so its correction is not an end in itself and is not carried out in isolation. Moreover, the elimination of megalography is not always possible. So, with progressive diseases of the brain in advanced stages, a complete disintegration of written speech is noted.
The main emphasis during treatment is aimed at eliminating the causes of the underlying disease, which led to a change in handwriting in the form of macrography. Sometimes, as the somatic status improves, the handwriting takes on its former form.
In diseases accompanied by cerebellar ataxia, the basis of treatment is pharmacotherapy (nootropics, vitamins, metabolic drugs, anticoagulants, etc.). To strengthen the muscles and normalize the coordination of motor skills, motor rehabilitation is of paramount importance: physiotherapy exercises, mechanotherapy, ergotherapy.
In the treatment of macular degeneration, an integrated approach is used, including drug therapy (vitamins, antioxidants, peptide bioregulators), intravitreal injections of angiogenesis inhibitors, laser coagulation of the retina, removal of epiretinal membranes. In the case of macrography caused by refractive errors, spectacle correction is selected or refractive surgery is performed using the LASIK method.
Patients with autism are recommended cognitive behavioral therapy, training in self-care skills and social interaction. Psychotherapeutic treatment is also indicated for persons with derealization syndrome. Effective methods of psychoanalysis, gestalt therapy, behavioral therapy.
Speech therapy classes are necessary for children with optical dysgraphia, ASD, patients after a stroke, who have macrography in writing. A child or an adult is taught to hold a line, write alphabetic characters of the same size, about 5 mm high. Key areas of work include development or restoration of: