Pure alexia is characterised by a very time-consuming letter-by-letter reading strategy due to an impaired identification or integration of single letters. So far, therapy interventions have addressed impaired letter identification using specific single-letter training approaches. In the present study, we report patient KA with pure alexia and letter-by-letter reading. Contrary to common approaches, we investigated whether a whole-word reading approach can be successful despite severe impairments at the level of single-letter identification. As a first step, auditory-visual verification tasks were used to familiarise the patient with the training items, which in a second step were read with limited exposure duration. After a four week intervention, KA's word reading performance improved significantly for trained and control items in terms of speed and accuracy. Although not specifically addressed during our training programme, even single-letter identification and text reading performance increased significantly. However, the patient's reading was still based on a letter-by-letter strategy.
Due to their brain damage, aphasic patients with acquired dyslexia often rely to a greater extent on lexical or segmental reading procedures. Thus, therapy intervention is mostly targeted on the more impaired reading strategy. In the present work we introduce a novel therapy approach based on real-time measurement of patients' eye movements as they attempt to read words. More specifically, an eye movement contingent technique of stepwise letter de-masking was used to support sequential reading, whereas fixation-dependent initial masking of non-central letters stimulated a lexical (parallel) reading strategy. Four lexical and four segmental readers with acquired central dyslexia received our intensive reading intervention. All participants showed remarkable improvements as evident in reduced total reading time, a reduced number of fixations per word and improved reading accuracy. Both types of intervention led to item-specific training effects in all subjects. A generalisation to untrained items was only found in segmental readers after the lexical training. Eye movement analyses were also used to compare word processing before and after therapy, indicating that all patients, with one exclusion, maintained their preferred reading strategy. However, in several cases the balance between sequential and lexical processing became less extreme, indicating a more effective individual interplay of both word processing routes.
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