Overt use of a tactile/kinaesthetic strategy shifts to covert processing in rehabilitation of letter-by-letter reading

Abstract

Background Letter-by-letter readers identify each letter of the word they are reading serially in left to right order before recognizing the word. When their letter naming is also impaired, letter-by-letter reading is inaccurate and can render even single word reading very poor. Tactile and/or kinesthetic strategies have been reported to improve reading in these patients, but only under certain conditions or for a limited set of stimuli. Aims The primary aim of the current study was to determine whether a tactile/kinesthetic treatment could significantly improve reading specifically under normal reading conditions, i.e. reading untrained words presented in free vision and read without overt use of the strategy. Methods & Procedures Three chronic letter-by-letter readers participated in a tactile/kinesthetic treatment aimed at first improving letter naming accuracy (phase 1) and then letter-by-letter reading speed (phase 2). In a multiple case series design, accuracy and speed of reading untrained words without overt use of the trained tactile/kinesthetic strategy was assessed before phase 1, after phase 1 and again after phase 2. Outcomes & Results All three patients significantly improved both their speed and accuracy reading untrained words without overt use of the trained tactile/kinesthetic strategy. All three patients required the additional practice in phase 2 to achieve significant improvement. Treatment did not target sentence level reading, yet two of the three patients became so adept that they could read entire sentences. Conclusions This study replicates previous findings on the efficacy of tactile/kinesthetic treatment for letter-by-letter readers with poor letter naming. It further demonstrates that this treatment can alter cognitive processing such that words never specifically trained can be read in free vision without overtly using the trained strategy. The data suggest that an important element in achieving this level of generalization is continuing training beyond the point of initial mastery (i.e. accurate letter naming).

The neural substrates of improved phonological processing following successful treatment in a case of phonological alexia and agraphia

“…Our proposed interpretation that JW was performing the reading tasks with less effort were consistent with the subjective view of JW’s performance at the end of treatment. From a therapeutic standpoint, these findings are consistent with the rationale of training beyond initial mastery of skills in order to increase automaticity and/or generalization (see, for example, Lott, Carney, Glezer, & Friedman, 2010; Lott & Friedman, 1999). In that vein, the first phase of treatment served to re-establish letter-to-sound and sound-to-letter relations and the application to regularly spelled words and pseudoword spelling.…”

Rehabilitation of pure alexia: A review

“…Six patients (HT, Tuomainen & Laine, 1991; XX (no initials given), Rothi & Moss, 1992; DM, Arguin & Bub, 1994; VT, Maher, Clayton, Barrett, Schober Peterson, & Rothi, 1998; PA1 and PA2, Lacey, Lott, Snider, Sperling, & Friedman, 2010) are considered pure alexics according to this definition, as they have alexia with no (reported) agraphia or aphasia. Of the remaining patients, one has moderate anomia (Rothi, Greenwald, Maher, & Ochipa, 1998), and another seven are reported to have aphasia (TT, Tuomainen & Laine, 1991; TL, Lott, Friedman, & Linebaugh, 1994; FD, Sage, Hesketh, & Lambon Ralph, 2005; KA, Ablinger & Domahs, 2009; LDR, DBR, IND, Lott, Carney, Glezer, & Friedman, 2010). Eleven patients are reported to have writing deficits consistent with agraphia (TT, Tuomainen & Laine, 1991; KV, Daniel, Bolter, & Long, 1992; TL, Lott et al, 1994; SI, Behrmann & McLeod, 1995; DL, Lott & Friedman, 1999; RS, Friedmann & Lott, 2000; FD, Sage et al, 2005; RB, Beeson, Magloire, & Robey, 2005; LDR, DBR, IND, Lott et al, 2010), while one had quite severe spelling difficulties premorbidly (HL, Beeson, 1998).…”

Reading therapy strengthens top–down connectivity in patients with pure alexia

“…There have been many case studies of rehabilitation in pure alexia (Moyer, 1979; Tuomainen and Laine, 1991; Daniel et al , 1992; Arguin and Bub, 1994; Lott et al , 1994, 2010; Behrmann and McLeod, 1995; Seki et al , 1995; Beeson, 1998; Maher et al , 1998; Rothi et al , 1998; Friedman and Lott, 2000; Sage et al , 2005; Ablinger and Domahs, 2009; Lacey et al , 2010); but to date, no group-level studies have been published and there is no generally accepted rehabilitation approach in current clinical use. Attempts to train compensatory reading strategies, such as kinaesthetic reading (tracing the letters to use the intact writing ability to facilitate word recognition), have had positive effects (Lott et al , 1994, 2010; Seki et al , 1995; Maher et al , 1998; Sage et al , 2005).…”

“…Attempts to train compensatory reading strategies, such as kinaesthetic reading (tracing the letters to use the intact writing ability to facilitate word recognition), have had positive effects (Lott et al , 1994, 2010; Seki et al , 1995; Maher et al , 1998; Sage et al , 2005). However, the maximum reading speeds achievable using this technique are likely to be limited by the patient’s writing speed, and may actively prevent the recovery of the whole-word recognition strategy that affords rapid and efficient reading in skilled readers (Coslett et al , 1993).…”