A Treatment Sequence for “Phonological Aphasias”: Strengthening the Core Deficit

Phonological impairment is a common core deficit in individuals with left perisylvian damage resulting in the classic aphasia syndromes (Broca’s, Wernicke’s, and Conduction aphasia). The impairment is particularly evident on written language tasks that require transcoding of sound-letter correspondences, such as nonwords, but many individuals with these chronic “phonological aphasias” have limited residual ability to write real words as well. We report here on a treatment sequence intended to strengthen phonological skills in individuals with aphasia and global agraphia. Treatment outcomes from a case series of 16 participants demonstrated the value of this approach for written and spoken language

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

A Framework to Guide Treatment Planning in Aphasia

Approximately 700 empirical research studies have been conducted that examine treatment outcomes in adults with acquired language impairment. This rich body of literature provides guidance regarding the therapeutic value of interventions that target skills across communication modalities. What appears to be lacking, however, is a comprehensive, integrated framework for treatment planning that might serve as a guide for clinical decision-making. Such a heuristic framework is proposed here for consideration. The schema is not intended to be prescriptive in a rigid sense, but rather should help to guide clinical practice and to invite further refinement and evaluation

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

A Framework to Guide Treatment Planning in Aphasia

Approximately 700 empirical research studies have been conducted that examine treatment outcomes in adults with acquired language impairment. This rich body of literature provides guidance regarding the therapeutic value of interventions that target skills across communication modalities. What appears to be lacking, however, is a comprehensive, integrated framework for treatment planning that might serve as a guide for clinical decision-making. Such a heuristic framework is proposed here for consideration. The schema is not intended to be prescriptive in a rigid sense, but rather should help to guide clinical practice and to invite further refinement and evaluation

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

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

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