Chinese calligraphy handwriting (CCH): a case of rehabilitative awakening of a coma patient after stroke

Neuropsychiatric Disease and Treatment Dovepress open access to scientific and medical research C a s e r e p o rt Neuropsychiatric Disease and Treatment downloaded from https://www.dovepress.com/ by 37.59.46.207 on 12-Jul-2018 For personal use only. Open Access Full Text Article Chinese calligraphy handwriting (CCH): a case of rehabilitative awakening of a coma patient after stroke This article was published in the following Dove Press journal: Neuropsychiatric Disease and Treatment Henry SR Kao 1 Stewart PW Lam 2 Tin Tin Kao 3,4 Calligraphy Therapy Laboratory, Shenzhen Institute of Neuroscience, Shenzhen, China; 2Research and Development Division, Calli-Health Society, 3Department of Geography, 4 Department of Psychology, University of Hong Kong, Hong Kong 1 Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: http://youtu.be/vpQJNiHCMcI Correspondence: Henry SR Kao Shenzhen Institute of Neuroscience, A407 Shenzhen Virtual University Park, No 6 Yuexing 2nd Road, Nanshan District, Shenzhen, 518057, China Tel +86 755 8695 6837 Email Plain language summary Calligraphy therapy involves handwriting of Chinese characters with a brush, which entails the marking of visual-spatial properties of the characters. This writing process activates and facilitates positive changes in the practitioner’s physiological, cognitive, and emotional wellbeing with proven therapeutic and rehabilitative success. The effective improvements include behavioral, neuro-cognitive, and somatic disorders or diseases such as posttraumatic stress disorder, autism, attention deficit hyperactivity disorder, Alzheimer’s disease, depression, and strokes. In this study, we employed Chinese calligraphy handwriting training to a stroke patient in a severe state of coma for 2 years. After 9 months of such calligraphy handwriting, the patient woke up from his coma state and showed behavior changes in the predicted direction. 407 submit your manuscript | www.dovepress.com Neuropsychiatric Disease and Treatment 2018:14 407–417 Dovepress © 2018 Kao et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/NDT.S147753 Powered by TCPDF (www.tcpdf.org) Introduction: This study investigated the efficacy of Chinese calligraphy handwriting (CCH) for the awakening of patients under a vegetative state after stroke. The theories, the instrument, and the treatment protocols were reported. A single case of a severe stroke patient who was in a coma state for 2 years is presented in this study. The objectives were to apply finger writing as a new method to awaken a stroke patient in a coma state and to test the effect of this method in improving the patient’s vegetative states over time. Case presentation: A 55-year-old man suffered a severe stroke in 2004 which left him in a coma for 2 years without any systematic rehabilitation. A culture-based finger-writing method of visual-spatial intervention was then applied to improve his condition. The writing tasks involved aided viewing and finger tracing of sets of innovative characters with enriched visual-spatial and movement characteristics. Following regular treatment protocols involving diverse movement and sensory feedback, the patient was awakened after 12 months. As a consequence, the patient showed significant behavioral changes favoring enhanced focusing, alertness, visual scan, visual span, and quickened visual and motor responses. The treatment continued for another 12 months. As the treatment progressed, we gradually observed improvements in his attention span and mental concentration. His eye ball movements – the left eye in particular – were quickened and showed wider visual angularity in his focal vision. Currently, the patient can now watch television, engage in improved visual sighting, and focus on visual-spatial and cognitive-linguistic materials. Conclusion: This CCH method of training by finger tracking has shown its effectiveness in awakening the patient from his coma state and in producing long-term, clinical outcomes that were similar from those that took place 10 years ago. This finding supports the efficacy of the system for clinical improvement of the patient’s conditions. Keywords: calligraphy therapy, coma, vegetative state, awakening, functional plasticity, finger writing Dovepress Kao et al Neuropsychiatric Disease and Treatment downloaded from https://www.dovepress.com/ by 37.59.46.207 on 12-Jul-2018 For personal use only. His conditions have remained stable in the past 10 years. The areas of improvement have included visual attention, mental concentration, quickened reactions, and wider visual span. A unique approach of finger writing was adopted in the effective treatment of this patient’s vegetative states. Introduction In our everyday speech, the word “coma” is often used in a general way to cover a wide range of conditions in which individuals have suffered brain injury, leaving them with no consciousness at all or with very limited consciousness. We read or hear about celebrities, sports stars who are said to be in a “coma” for months or years, but they may probably be in a vegetative or minimally conscious state. It is very unusual for a coma to last more than a few weeks at most. People in a coma are completely unresponsive. They do not move, do not react to light or sound, and cannot feel pain. Their eyes are closed. The brain responds to extreme trauma by effectively “shutting down.” After a few days or weeks in a coma, they may “wake up” to full consciousness with relatively little damage. If they have very severe brain injuries, they may move from coma into a vegetative or minimally conscious state. In a vegetative state, they are still unconscious. They have no awareness of themselves or their environment. Patients in the “vegetative state” may have their eyes open and have involuntary movements of parts of their body or make reflex responses to loud noises or even occasional words. After 4 weeks, they are said to be in a “prolonged” vegetative state. If they remain in a vegetative state for several months after brain damage for 1 year after a traumatic brain injury, the chances of recovering consciousness are very low, and they are said to be in a “permanent” vegetative state. In the areas of treatment and rehabilitation for coma recovery, brain stim (...truncated)