+

Acquired Reading DisordersEvaluation and treatment

+Objectives

Describe a model of normal reading

Briefly describe neurological involvement in reading

Generally classify types of acquired reading disorders

Discuss evaluation and treatment strategies for reading

Discuss compensatory strategies for reading

+Age of Literacy

Imagine that your ability to read was suddenly taken away.

What daily activities would you no longer be able to do?

+Alexia Simulation

Last weekend, I went to Orlando, Florida with my

family. We toured the two theme parks, Sea world and

Universal Studios. Both parks have many

entertainment shows and adventure rides. At Sea

World park, ‘Shamu’ show was the most attractive one.

+Alexia Simulation

iksp pjfenaz, j psed qj ucxajfk, gehcuwa myfr ho

gawxhy. Bc khmnfd qwe tyuio asdf, dfg hjklz xcv

cvbnmqw ertyui. Yuio ghjkl zxcv vbnm ertyuioasdfg

fghj mnb vcxzlkjhg gfds. Oi oiu uytre rewq, ‘gfdsa’ jhgf

nbv vcx uytr oiiuytr ewq.

+Beeson & Hills (2001) model

Written Stimulus

EVA

LR

GIL

SR

POL

PB

Oral Response

GPC

Lexical-Semantic Route for familiar words VS

Sublexical-Phonological Route for unfamiliar words

+Beeson & Hills Model parts

EVA : Early Visual Analysis (see a word)

LR : Letter Representation (see letters)

GIL : Graphemic Input Lexicon (ltter patterns)

SR: Semantic Representations (meaning)

POL: Phonological Output Lexicon (sound-symbol)

PB: Phonological Buffer (working memory)

GPC: Grapheme-Phoneme Conversion (sound-symbol)

+2 Types of Processing

Automatic Processing Learned association in LT memory After consistent training Not much attention required

Controlled Processing novel words comprehension of difficult text more attention & active cognitive engagement

+Automatic vs Controlled Processing with Brain Injury

No Brain In-jury

Brain Injury0123456789

10

AC

Most reading tasks (for non brain-injured) use automatic processing

+Which areas of the brain are involved in reading???

+RESEARCH says….

Regions typically associated with language – L hemisphere

All 4 lobes of the cortex

Some R hemisphere participation

Some subcortical structures

Indirect associative pathways

What does this mean for us as SLP????

+Overview of Acquired Dyslexias

2 traditional Classifications:

1. Alexia without agraphia “ Pure alexia”

2. Alexia with agraphiaa. Aphasic alexia (Wernicke’s/Broca’s)b. Agraphic alexia

+1st Steps in Evaluation

Print size Print size Print size Print size Print size Visual field

No distractions

Oral vs silent reading

Present knowledge base & cognition

Skills mastered pre-morbidly

Motivation / interest level

Level of attention

+THE QUESTION

Where does comprehension breakdown occur and what factors contribute to the breakdown?

Comprehension and preservation of meaning is the key!

+Assessment Design

Gradual & Systematic

Vocabulary & context

length & complexity

Many passages; different grade-levels

Each passage ~ 100-500 words in length

Material pt can understand & relate to, yet novel to reader

Can use adult literacy materials (e.g., Laubach)

+Single Words in List

Vary features of …

Frequency

Concreteness

Spelling Regularity

Word Length

Real/ Non-words

+Sentence Reading

Present sentences with…

Key vocabulary

Homophones

Varied syntax

Varied parts of speech

Have pt point to the picture that best corresponds to the sentence

+Longer Texts

Assess comprehension using…

Multiple choice Q’s

Cloze procedures

Story retell

Following written directions

Audio recordings of readings

+Higher-Order Skills

Hypothesizing

Cause/Effect

Relating to Self/Personal Experience

Inference/Prediction

+Assessing Sub-Lexical Route

Letter Naming

Sound-Symbol Correspondence

Phonological Awareness Skills

+Common Types of Errors

Visual confusions (e.g., bear/bean)

Semantic confusions (e.g., plane/jet)

Derived errors (e.g., wonder/wonderful)

Regularization errors (e.g., played/plaid)

Phonological rule errors (e.g., pet/pete)

+1st Steps in Treatment

Print size Print size Print size Print size Print size

Visual field

No distractions

OT co-tx as option

Pt/ caregiver input

Strength of other modalities

Relevance

+Decoding Treatment

Basic letter-to-sound conversion (may use associations to familiar names/pictures)

Brief exposure to whole words to build pattern recognition

Multiple oral reading of target words

+Fluency Treatment

Guided Reading Strategies

1. I read. You follow along.

2. We read together.

3. We take turns reading

4. You read. I follow along

Reading along to audio recordings. Library, bookstores, homemade

+Basic Phonics Rules

1. ‘c’ rule (before ‘a, o, u’ = /k/; otherwise, /s/)

2. ‘g’ rule (before ‘a,o,u’ or end of the word = /g/; otherwise, /dz)

3. VC pattern (short, closed)

4. VV pattern (first vowel long, second silent)

5. VCE pattern (first vowel long, ‘e’ silent)

6. CV pattern (long, open)

7. ‘r’- controlled vowels

+Comprehension Treatment

Severely – Impaired

Basic goal is survival reading

Use functional vocabulary lists

Target in real-life experiences to 90% acc.

Consider: word length, frequency, familiarity, part of speech, concreteness, pt/caregiver input

+Comprehension Treatment

Moderately – Impaired

Can read at sentence level

Material should be in context

Determine instructional level (comprehension 45-55% accurate without cues)

Have pt identify semantic/syntactic errors in sentences provided

+Comprehension Treatment

Moderately – Impaired

Move to paragraph level (200+ words) ASAP

Have pt always read both silently & orally

Increase difficulty in 2 ways1. Increase length

2. Increase complexity (vocab & syntax)

+Comprehension Treatment

Moderately – Impaired

Teach readers to use context to predict / guess

Teach readers to ask themselves, “Does it make sense?”

Ask comprehension questions beyond the basics (ask about associations, deductive reasoning, sequencing, analysis)

Make functional outcomes the primary objective (e.g., recipes, assembly manuals, etc.)

+Comprehension Treatment

Mildly – Impaired

Accuracy WNL; Fluency Impaired

Higher-order cognitive-linguistic impairment

Help pt relearn study skills & how to interact with the text

+Comprehension Treatment

Mildly – Impaired

Emphasize on main idea, skim unimportant details, take in a lot of info in one viewing

Use flash cards, scanning telephone books, scanning passages for particular facts, scrolling texts at a given rate to increase speed

+Compensatory Strategies

• Books on Tape for reading pleasure

• Portable Speaking Language Master – pt can type word to get pronunciation & definition

• Start by reading to kids… involves family & community services… builds accuracy & fluency

• Use wordless picture books or magazines with illustrations.