GRAPHESTESIA: ORIGIN, CONCEPT, RELATED DISORDERS - ANATOMY AND PHYSIOLOGY - 2025

The graphesthesia is a term that refers to the sensory property possessed by humans to perceive and recognize writings, signs or figures drawn on a portion of the skin, the individual having eyes closed.

In other words, the figure is made by simply rubbing the skin with an object, the individual being able to identify which figure or symbol it is. This exercise is done without using the sense of sight, but only touch.

Execution of the assessment of graphesia. Source: Image taken from: Daza J. (2007). Clinical functional evaluation of human body movement. Editorial Médica Panamericana. Bogota Colombia. Edited image.

Graphesia can be assessed through simple sensitive exercises. This practice is part of a series of tests used in the medical field for neurological examination. Among the analyzes that examine the sensory property of the patient we can mention: the tests that measure the superficial, deep and discriminative sensory capacity.

Superficial sensitivity includes touch, pain and temperature, deep sensory capacity, or also called proprioceptive, involves arthrokinetic, positional and vibratory sensitivity and the discriminative or cortical sensitivity called mixed, assesses stereoognosia and graphestesia.

Specifically, graphestesia explores somatic sensitivity, while other tests evaluate the density of innervation, graphestesia assesses the functional state of tactile gnosis.

For this reason, it can be said that graphesia serves to evaluate the central nervous system, helping to diagnose neurological diseases.

As can be seen, graphesia is only a small part of what can be evaluated from the point of view of motor sensory perception.

Origin and concept

The term grapheesthesia is a word composed of three roots of Greek origin.

The first is (graphein) which means to record or write, from there other words also come from such as spelling, calligraphy, etc. The second word is (aisthesis) which means sensation, and the third is (ia) whose meaning is quality.

If we unite the meaning of the 3 terms, it can be deduced that it is the quality of feeling the writing. It is clear that feeling refers to the sense of touch.

Graphesia assessment test

It should be noted that this test can be very useful, as long as it is done properly. It requires a good preparation and expertise of the specialist and collaboration and willingness of the patient. If any of these conditions fail, the exam loses its validity and reliability.

General conditions

The first step in performing the exam is for the patient to be relaxed, both physically and mentally. The environment should be calm and quiet so that both the specialist and the patient are focused on the test.

The specialist must give the patient the instructions for the test clearly so that he understands the importance of the study and what is being sought with it.

The specialist must explain the correct way to issue their answers at the time indicated. Avoid suggesting the answers to the patient.

Process

The patient is seated on a gurney, his eyes are covered, and the place where the test will be performed is chosen. It is usually done at the level of the palm of the hands, feet, or back.

Suppose the palm of the hand is chosen. You are asked to stretch your hand palm up. With a blunt pointed object or simply with the finger, a symbol known to the patient is imagined.

It can start with a number. To do this, the palm of the hand is gently brushed making the chosen number. The patient is asked if she recognizes what is written. The patient must give a clear and concise answer. The result is noted.

If the patient is a child, the figure can be drawn twice and a demonstration of the exercise with the eyes open can even be done before starting the test, in order to familiarize the child with the test and how to do it. answer.

The exercise is repeated again, now using a letter and also asked to mention that it was drawn and the result is noted.

Finally, the procedure is repeated but now a geometric figure is drawn. The result is noted.

The entire procedure can be repeated on the other hand. This allows you to compare the result between one hand and another. This practice is especially useful when looking for the nervous origin of a dysfunction in one of the hands.

Results

Depending on the results, the doctor will issue a verdict on the exam. If the patient is correct, it will be concluded that the patient has intact graphesia.

When graphesia is assessed in a person and he or she fails to recognize the symbols or signs traced on a specific place on their skin, it is said that there is a disorder or injury at the level of the central nervous system. The inability to recognize the traced figures is called "agrafesthesia" or "graphanesthesia"

If there are some successes and many mistakes, it is said that the patient presents a hypografesthesia, or what is the same, a diminished grapheesthesia.

Related disorders

Focal dysphonias of the hand

It is a motor disorder related to some work occupation. It is characterized by a lack of motor control in the hand that includes involuntary movements, incoordination, pain, spasms and hypertrophy at the muscular level, increase or decrease in strength and mobility.

Furthermore, these patients may present alterations in cortical sensory sensitivity, that is, graphestesia is altered and at the same time there is loss of spatial and temporal discrimination.

Alzheimer's

It is a disease that occurs with various disorders, among them are psychomotor, neurological, behavioral, cognitive or sensitive, among others. Sensory disorders may include aphaesthesia.

Parkinson Plus syndromes or atypical parkinsonisms

They are a group of diseases of unknown origin, characterized by being neurodegenerative disorders.

One of the best known is the ganglionic corticobasal degeneration syndrome. In general, this clinical entity begins with the loss of abilities in one limb (mainly the upper one), generated by ideomotor apraxia (incoordination of movements).

Later, signs of asymmetric parkinsonism appear, such as: loss of muscle tone and focal reflex myoclonus.

Finally, there is a cortical sensory deficit, characterized by agrafesthesia, this manifestation appears early and helps the diagnosis.

Other alterations are also observed along with the astereognosia (loss of recognition of objects with touch), alien hand (inability to recognize his hand as his own, when it is placed on top of the other with the eyes closed).

Verger-Dejerine syndrome

In this syndrome, the ability to perceive basic or superficial sensations (touch, pain and temperature) are almost normal or intact, however, the graphesia is altered and also presents astereognosia, that is, there is difficulty in discriminating sensation.

References

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