MOR evidence for the therapeutic value of multiple oral re-reading

Multiple oral re-reading (MOR) is a text-based intervention that has been used to improve reading rate and accuracy in individuals with acquired alexia. In the present study, six individuals with word-length effects for single-word reading speed were treated with MOR. Although they ranged in alexia severity, all six individuals benefitted from MOR treatment, demonstrating significantly improved single-word reading reaction times. Four of the six significantly improved text reading rates, and the remaining two (who were the mildest in severity) improved text reading accuracy following treatment. The results support the therapeutic value of MOR across a range of alexia severity

A Novel Means to Examine Response to Spelling Treatment

According to a dual-route model of written language processing, spelling of irregular words provides an index of the status of lexical spelling procedures, whereas nonword spelling provides information about non-lexical processing that relies on phoneme-grapheme conversion. Because regular words can be spelled using either route, accuracy for such words may reflect the combined function of the two routes, and may be mathematically predicted on the basis of spelling accuracy for irregular words and nonwords. Pre- and post-treatment spelling performance of a group of eight individuals with acquired spelling impairment demonstrated the utility of comparing such predictions with actual performance

Examining a Treatment Continuum for Acquired Impairments of Reading and Spelling

Damage to left hemisphere cortical regions can variously disrupt lexical-semantic and sublexical procedures for reading and spelling. Ideally, treatment for these impairments should be well-suited to the specific deficit(s) and support a progression toward maximal recovery. In this study, we implemented a diagnostic and treatment algorithm to address written language impairments in a heterogeneous group of individuals with acquired alexia and agraphia. Following syndrome classification, participants were entered into the appropriate stage of a treatment continuum that included lexical, phonological, and interactive approaches. Outcomes from 20 individuals characterize the therapeutic effects of each treatment relative to specific alexia/agraphia profiles

Progressive Aphasia: Patterns of Language Behavior and Regional Cortical Atrophy

Individuals with progressive aphasia may demonstrate impairments of syntax, semantics, phonology, and orthography, and can provide important insight into the role of specific cortical regions in these language processing domains. In this study, eleven individuals with progressive aphasia underwent comprehensive language testing and structural MRI scanning. Voxel-based morphometry was used to examine the relation between cortical atrophy and behavioral measures. Results confirm the critical role of left perisylvian cortex for phonological processes involved in spoken and written communication and also for syntactic processing, whereas left temporal regions are critically involved in semantic processing common to spoken and written language

Implications of treatment failure for interpreting the cognitive mechanisms underlying acquired alexia

We present a case of alexia with agraphia following damage to left temporo-parieto-occipital cortex. Single-word reading was severely limited and spoken letter naming was also notably impaired. Treatment was implemented using a motor/kinesthetic strategy to improve letter recognition and naming in the context of single-word reading and writing. Although single letter naming improved following treatment, the participant remained unable to successfully decode words using a letter-by-letter strategy. Her limited response to treatment stands in contrast to the few other reported treatment studies employing a motor/kinesthetic approach for severe alexia, and warranted consideration of cognitive and neuroanatomical prognostic factors

Do reading and spelling share the same orthographic lexicon?

We conducted a feasibility study to determine whether an fMRI paradigm could be used to address the controversy about whether reading and spelling rely on the same orthographic lexical representations. Specifically, we explored whether reading and spelling tasks produced overlapping patterns of neural activation in a within-subjects experimental design. Results showed that a cortical region corresponding to the “visual word form area” is involved not only in orthographic processing in reading but also in retrieval of orthographic information for spelling. These findings demonstrate the utility of this technique and suggest that a single orthographic lexicon mediates both reading and spelling

The executive control of face memory

Abstract. Patients with frontal lobe damage and cognitively normal elderly individuals demonstrate increased susceptibility to false facial recognition. In this paper we review neuropsychological evidence consistent with the notion that the common functional impairment underlying face memory distortions in both subject populations is a context recollection/source monitoring deficit, coupled with excessive reliance on relatively preserved facial familiarity signals in recognition decisions. In particular, we suggest that due to the breakdown of strategic memory retrieval, monitoring, and decision operations, individuals with frontal lobe impairment caused by focal damage or age-related functional decline do not have a reliable mechanism for attributing the experience of familiarity to the correct context or source. Memory illusions are mostly apparent under conditions of uncertainty when the face cue does not directly elicit relevant identity-specific contextual information, leaving the source of familiarity unspecified or ambiguous. Based on these findings, we propose that remembering faces is a constructive process that requires dynamic interactions between temporal lobe memory systems that operate in an automatic or bottom-up fashion and frontal executive systems that provide strategic top-down control of recollection. Executive memory control functions implemented by prefrontal cortex play a critical role in suppressing false facial recognition and related source memory misattributions

Lexical Retrieval Treatment for Primary Progressive Aphasia

Similar to aphasia due to stroke, lexical retrieval difficulties are pervasive in primary progressive aphasia (PPA).  In fact, increasing word retrieval difficulties typically herald the onset of PPA, regardless of the underlying etiology or PPA subtype.  For that reason, behavioral interventions to improve or sustain word retrieval abilities have considerable potential to enhance language performance in PPA.  We report here on positive responses to lexical retrieval treatment in two individuals with fluent progressive aphasia profiles.  The treatment approach extends work accomplished in stroke-related aphasia that promotes strategic engagement of residual language abilities to promote self-cueing to resolve lexical retrieval difficulties

Phonological processing in primary progressive aphasia

Primary progressive aphasia (PPA) is a debilitating condition wherein speech and language deteriorate as a result of neurodegenerative disease. Three variants of PPA are now recognized, each of which shows a unique constellation of speech-language deficits and pattern of underlying atrophy in the brain (Gorno-Tempini et al., 2011). The variants include a nonfluent/agrammatic type (nfvPPA), characterized by syntactic and motor speech deficits and fronto-insular atrophy in the left hemisphere. The semantic variant (svPPA) shows degradation of semantic knowledge in the context of anterior and inferior temporal lobe atrophy (left hemisphere greater than right). Finally, the more recently characterized logopenic variant (lvPPA) shows impairments in naming and repetition that are thought to be phonological in nature. This variant, associated with atrophy of temporoparietal regions in the left hemisphere, has also been referred to as the “phonological” variant of PPA due to observed deficits on tasks that require phonological storage (i.e., the “phonological loop”) and to the presence of phonological paraphasias in connected speech (Gorno-Tempini et al., 2008). Impaired phonological processing has been considered a unique feature of the logopenic variant of PPA, however, phonological skills have not been thoroughly characterized across the three variants. Recent models of the functional neuroanatomy of language propose two pathways by which speech is processed in the brain (Hickok & Poeppel, 2007). A dorsal pathway involving temporoparietal and posterior frontal structures is thought to be involved in mapping phonological representations onto articulatory representations. A ventral pathway located in the middle and inferior temporal lobes is considered crucial for mapping phonological representations onto lexical-semantic representations. Both the dorsal and ventral streams emanate from a common cortical region in posterior, superior temporal cortex/sulcus that appears critical to the mental representation of phonology. We investigated phonological processing in PPA, with the goal of identifying whether patterns of performance in the different variants support this functional-anatomical framework. Based on our knowledge of the locus of anatomical damage in the subtypes of PPA, we hypothesized that patients with damage to dorsal route structures (nonfluent and logopenic variants) would show greater impairment on phonological processing tasks, whereas patients with damage to ventral route structures (semantic variant) would show relative preservation of phonological abilities

A Treatment Sequence for Phonological Alexia/Agraphia

We present two individuals with persistent impairment of phonological processing following damage to left perisylvian cortex. A two-stage treatment protocol was administered that strengthened sound-letter correspondences (phonological treatment), and trained interactive use of lexical and sublexical information to maximize spelling performance (interactive treatment). Both participants improved phonological processing abilities and reading/spelling via the sublexical route. They also improved spelling of real words, and were able to detect and correct most residual errors using an electronic spelling aid. In sum, treatment strengthened cognitive processes supporting reading and spelling, and provided a functional compensatory strategy to overcome residual weaknesses