Differences in Treatment Outcomes for Persons With Acquired Alexia

Differences in Treatment Outcomes for Persons with Acquired Alexia Sue Ann Eidson, MS ; Janet D. Whiteside, PhD; Debbie Harrison, MA Department of Communication Sciences and Disorders; University of Central Florida; Orlando, FL. BACKGROUND •Acquired alexia is a frequent symptom of persons with aphasia. Acquired reading disorders have been defined as central alexias (surface, phonological, and deep alexia) and peripheral alexias (attention, neglect and pure alexia). •There are differing models regarding single word and contextual reading. The Dual Route Cascaded model (DRC) (Ellis and Young, 1988) purports that the word is recognized via either a lexical or nonlexical route. In contrast, the Parallel Distributed Processing model (PDP) (Plaut et al.; 1996) or connectionist model proposes that a connected network relates orthographic, phonological, and semantic information in word reading and other lexical tasks. •The purpose of this study was to investigate the effectiveness of a multisensory approach for the treatment of clients diagnosed with acquired alexia and to relate the findings to the above mentioned models. RESULTS/DISCUSSION Performance on Pre- and Post-Test Measurements Table 2 The Effects of Treatment as Monitored by Periodic Probing of Untrained Pseudoword Combinations Participant 1 Participant 2 Tracking Spring/Summer 100 80 Percent Correct 60 V/C C/V Participant #1 Western Aphasia Battery (AQ) Comprehensive Test of Phonological Processes * Elision * Blending Words * Non-Word Repetition * Blending Non-Words * Segmenting Words * Segmenting Non-Words Lindamood Auditory Conceptualization Test Gray Oral Reading Test Pre-Test 1/05 77.5 Post Test 4/05 15 weeks 76.2 Post Test 5/05 19 weeks 76.1 Post Test 7/05 30 weeks 72 40 VC/CV CVC 20 0 1/20/05 (baseline) 2/01/05 1/27/05 (baseline) 2/15/05 3/01/05 3/29/05 4/11/05 5/31/05 6/14/05 6/28/05 7/12/05 6 7 4 1 8 6 56 6 7 4 7 10 9 57 7 4 4 1 9 6 55 7 4 4 5 9 100 Date Participant 2 Participant 1 Tracking Spring/Summer RESEARCH QUESTIONS #1:Will persons with acquired alexia improve in the area of decoding as an effect of a multisensory rehabilitation treatment program (LiPS)? #2: Will the effectiveness of the LiPS program be greater with persons with acquired surface alexia than those with acquired deep alexia? #3:Will LiPS instruction have a positive effect on cognitive/communicative abilities other than reading among persons with acquired alexia? 8 66 52 60 Percent Correct V/C C/V 40 VC/CV CVC 20 80 Table 3 0 1/20/05 (baseline) 2/01/05 1/27/05 (baseline) 2/15/05 3/01/05 3/29/05 Date 4/11/05 5/31/05 6/14/05 6/28/05 7/12/05 Participant #2 Pre-Test 1/05 49.1 2 4 4 3 7 1 METHODS •After University IRB approval, three participants were selected. Participant #1 met criteria for surface dyslexia with Participant #2 being classified as a deep dyslexic and Participant #3 as a phonological dyslexia. (See demographic Table 1 information) •The treatment approach used in this study was The Lindamood Phoneme Sequencing Program (LiPS)(Lindamood & Lindamood; 1998) which is a multisensory approach designed to stimulate sensory-cognitive function and changes the manner in which information is processed while reading print. •During the initial 3 months of the study, the participants were introduced to the LiPS program which included learning to identify consonants and vowels. •Pre- and post- test measurements were conducted at the beginning and end of the Spring and Summer semesters. Test instruments included: The Western Aphasia Battery (WAB) (Aphasia Quotient only), The Clinical Test of Phonological Processing (CTOPP), The Lindamood Auditory Conceptualization Test-3(LAC3), and the Gray Oral Reading Test-4 (GORT4). •Each participant attended biweekly sessions over the duration of the study, one being an individual two hour session and the other was a one hour individual session followed by a one hour group session. Data collection spanned over the Spring and Summer semesters of 2005. •Participants were trained to track syllables, words, and pseudowords during individual sessions. During group sessions, tracking was reinforced and contextual reading exercises were introduced. Post Test 4/05 15 weeks 86 7 5 4 1 9 7 55 Post Test 5/05 19 weeks 84 7 6 6 4 10 6 55 Post Test 7/05 30 weeks 93.6 7 6 3 10 6 57 58 0 1/20/05 (baseline) Western Aphasia Battery (AQ) Comprehensive Test of Phonological Processes * Elision * Blending Words * Non-Word Repetition * Blending Non-Words * Segmenting Words * Segmenting Non-Words Lindamood Auditory Conceptualization Test Gray Oral Reading Test Participant 3 Participant 3 Tracking Spring/Summer 100 80 Percent Correct 1 60 V/C C/V 40 VC/CV CVC 20 2/01/05 1/27/05 (baseline) 2/15/05 3/01/05 3/29/05 4/11/05 5/31/05 6/14/05 6/28/05 7/12/05 Date Table 4 Answers to Research Questions Participant #3 Western Aphasia Battery (AQ) Comprehensive Test of Phonological Processes * Elision * Blending Words * Non-Word Repetition * Blending Non-Words * Segmenting Words * Segmenting Non-Words Lindamood Auditory Conceptualization Test Gray Oral Reading Test 2 2 4 4 6 5 55 3 2 5 4 7 6 55 3 4 4 2 6 3 55 4 7 9 10 7 8 76 61 Pre-Test 1/05 84.8 Post Test 4/05 15 weeks 91 Post Test 5/05 19 weeks 90.1 Post Test 7/05 30 weeks 91 # 1 Participant 1, the surface dyslexic, exhibited the strongest phonemic awareness abilities at the onset. She was able to achieve perfect scores on the decoding activities. Secondly, she consistently utilized this approach when decoding novel pseudowords and words. Participant 2, the deep alexic, exhibited poor phonological awareness as evidenced in his baseline measures. His ability to make fine discriminations between vowels which were adjacent to one another on the vowel quadrilateral was compromised. His ability to decode vowels remains a weakness for him. Participant 3, the phonological dyslexic, exhibited difficultly throughout the study with tracking secondary to his aided sensorineural hearing loss. His best scores were in the tracking of CVC words because of their resemblance to real words. He also performed the best on contextual reading exercises. # 2 Participant 2 achieved the highest level in the tracking probes. All three exhibited greater ease in decoding of words in contrast to pseudowords. The deep dyslexic did better with words rather than pseudowords. # 3 Participant 2 exhibited the largest gains in overall communicative functioning on the WAB. Our data suggests reading disorders seen in our participants reflected multiple levels of impairment. Although the DRC model was beneficial in isolating selective reading impairments, we feel our data may better be explained by a connectionist network theory that postulates reading as an interconnective input/output process. Improvement in decoding of both trained and untrained words may be explained by strengthened interconnections between semantic, orthographic and phonological systems. Demographic Information for Subjects Table 1 Participant 1 Age Site of Lesion 49 Bilateral cerebral hemorrhages 5 yrs. 16 Participant 2 44 L parietal occipital infarct w/ L internal capsule 4 yrs.; 2 mos. 16 Participant 3 63 L parietal infarct; hematoma 3 yrs.; 4 mos. 20+ References 1) Ellis, A. W. & Young, A. W.(1988). Human cognitive neuropsychology. Hove, U.K.: Lawrence Erlbaum. 2) Lindamood, P. & Lindamood, P.; (1988). The Lindamood Phoneme Sequencing Program for Reading, Spelling, and Speech; Pro Ed, Inc. 3) Plaut, David C.; (1999). A Connectionist Approach to Word Reading and Acquired Dyslexia: Extension to Sequential Processing;; Cognitive Science; Volume 23; (4); pp. 543-568. Post onset Years of Education