M4, T3, remediation of dyslexia and treatment case study of deep dyslexia Flashcards

1
Q

Remediation/rehabilitation of patients with dyslexia

A

Goal and success of remediation or rehabilitation depends the individual patient profile of intact and impaired reading processes

Individual patient cases requires detailed assessment of reading, writing, spelling, spoken language, short-term memory and motivation

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2
Q

Remediation/rehab of patients with pure alexia

A
  • Intervention studies have focused on improving the letter-by-letter reading strategy used by pure alexics and found improved reading accuracy and rate for reading of words and individual letters (e.g., Friedman & Lott, 2000)
  • Use implicit tasks to increase access of whole words in the orthographic input lexicon (Nickels, Tripolone, & Kohnen, 2010) e.g., repeated visual lexical decision task training
    -> Resulted in significant improvements for trained and untrained words
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3
Q

Rem/rehab for patients with pure alexia, Moyer (1979) and Moody (1988)

A

Moyer (1979) and Moody (1988) used multiple oral reading to remediate pure alexia.
-> Multiple oral reading - repeated reading aloud of texts leads to improvements in accuracy and reading rate for trained and untrained texts
-> Possibly by improving access to the word representations in the orthographic input lexicon or by increasing top-down support

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4
Q

Rem/rehab for patients with attentional dyslexia

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Friedmann, Kerbel, and Shvimer (2010) – patient severe developmental difficulties in reading texts and word pairs, could read nearly perfectly when using a word-size window cardboard cutout

Shvimer, Kerbel, and Friedmann (2009) trialed six different strategies to read one word at a time
- Reading with cardboard word–size window cutout led to reduction in reading errors for most of the subjects, followed by finger-tracking underneath the word
-> Not all subjects responded to all strategies in the same way, need to trial different strategies

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5
Q

Rem/rehab for patients with letter-position dyslexia

A

Study with six different strategies were trialed for 10 Hebrew - speaking developmental letter - position dyslexics (Friedmann & Rahamim,2014)

Strategy successful for most participants was finger-word tracking

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6
Q

Rem/rehab for patients with neglect dyslexia

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Techniques rely on shifting attention to the left side using task instruction and also visual cues, unclear if they improve actual processing capacity
- Finger tracking underneath the word
- Colour-coding of the left-most letter
- Flashing LED lights at the left side of a word
- Tapping to the left of words
- Placing a hash sign next to the left-most letter of a word
- Vertical presentation of words can improve performance, but this is not the case for all neglect dyslexics

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7
Q

Rem/rehab for patients with surface dyslexia

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Interventions usually focus on reading of irregular words (e.g., sword, friend) and homophones (e.g., caught /court)

Different training types depending on problem with irregular–word reading

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8
Q

Rem/rehab for patients with surface dyslexia, damage at orthographic input lexicon

A
  • Goal to improve the quality of or access to lexical orthographic representations
  • Successful intervention presented written irregular words on flashcard along with a mnemonic aid (e.g., picture that matches to word or something that remind of word)
  • Ellis et al. (2000) improved patient’s reading through reading a list of words and then listening to recording of correct pronunciation. For incorrect responses needed to repeat the correct word several times and think word meaning
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9
Q

Rem/rehab for patients with surface dyslexia, difficulties with accessing pronunciations for written words

A
  • Goal to improve connection between orthographic lexicon input lexicon and the phonological output lexicon
  • Train connections between written words and their pronunciations
  • Requires repeated exposure to written word and it’s pronunciation
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10
Q

Rem/rehab for patients with surface dyslexia, difficulty with comprehension of written words

A
  • Goal to improve the connection between the orthographic input lexicon and the word meaning (semantics)
  • Sentence Completion Task – select the correct word to complete the sentence
    The ladies served cream ____ ( teas [target], tease [homophone foil], teeze [homophonic nonword foil], tens, team, tense [orthographically similar foils]).
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11
Q

Rem/rehab for patients with direct dyslexia

A
  • Does not appear to be any studies/treatment for direct dyslexia
  • Due to progressive nature of disorder
  • Treatment could focus on the orthographic and semantic link
  • Treatment could focus on oral language if comprehension difficulty is not restricted to written words
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12
Q

Rem/rehab for patients with phonological dyslexia or deep dyslexia, grapheme-phoneme conversion pathway

A
  • Training Phonological Dyslexic focus on the nonlexical route to reading aloud (grapheme-phoneme conversion)
  • Interventions for Deep Dyslexics may also focus on the nonlexical route because an improved grapheme-phoneme conversion pathway can increase correct word selection and decrease semantic errors
  • Focusing on an improved grapheme-phoneme conversion pathway has potential to transfer to untrained words more as it can be used to process words that have a regular pronunciation
  • Does not appear to be any studies/treatment using the right hemisphere approach to remediate deep dyslexia
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13
Q

Rem/rehab for patients with phonological or deep dyslexia, letter-sound correspondence

A
  • Improving reading via the nonlexical route, need to train letter–sound correspondences
  • DePartz (1986) trained letter–sound correspondences with a deep dyslexic patient
    1. Patient learned to associate letters with a word (e.g., m with maman)
    2. Patient learned to sound out single letters
    3. Non-word reading asking the patient to sound out each letter of a nonword and then blend these sounds together
    -> Single letters were taught before multiple-letter graphemes
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14
Q

Rem/rehab of patients with phonological or deep dyslexia, improve oral blending accuracy

A
  • Improving reading via the nonlexical route, and goal is to improve oral blending accuracy
  • Deep Dyslexic patient had to sound out each letter, tap the sound when doing so and then drag her finger underneath the letter cards when blending the sounds together to form a word (Yampolsky & Waters, 2002)
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15
Q

Rem/rehab for patients with phonological or deep dyslexia, improve parsing accuracy

A
  • Improving reading via the nonlexical route, and goal is to improve parsing accuracy
  • Brunsdon et al. (2002) taught grapheme parsing by presenting two or three grapheme nonwords (e.g., pow , dru ). Patient had to circle the constituent graphemes of the nonwords.
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16
Q

Ska, Garneau-Beaumont, Chesneau & Damien (2003)

A
  • Assessed reading of DD patient according to a cognitive model of reading
  • Assessed a priming paradigm rehabilitation program focus on the lexical route to reading aloud
  • Patient JH 56 yrs old in 1997
    -> Suffered a left ischemic cerebral vascular Sylvain stroke following a triple aorta-coronary by-pass operation
    -> Right hemianopsia, right brachio-facial hemiparesis and receptive and expressive aphasia symptoms
17
Q

Ska, Garneau-Beaumont, Chesneau & Damien (2003), patient JH rehab program

A
  • Appeared to have Deep Dyslexia
  • JH right-handed physician, multi-lingual
  • One year JH individually followed by speech therapist 4 x week
  • Two years in a rehabilitation program
    -> 3 individual therapies a week
    -> exercises to be done at home and
    -> a weekly group therapy session
  • Dec 2000 JH began rehabilitation for his reading problems
18
Q

Assessment of JH’s deep dyslexia - peripheral processes

A
  • pass Matching identical words – sill (bill, pill, till, sill)
  • pass Letter identification among visually similar letters (c, d, o, p)
  • pass Letter identification among auditorily similar letters (b, c, d, e)
  • pass Letter denomination – A, d, E, s
  • pass Word and nonword repetition (talk, wux)
  • pass Unexpected delay repetition of words
19
Q

Assessment of JH’s deep dyslexia - phonological route (grapheme-phoneme conversion)

A

pass Letter reading – a, q d, z

fail Phoneme reading – ph, ch,

fail Phoneme identification – ph, ch, sh

20
Q

Assessment of JH’s deep dyslexia - lexical route

A

fail Reading words aloud – doll, even, one

fail Reading non-words – wux, lept, phocks

21
Q

Assessment of JH’s deep dyslexia - assessing linguistic variables and error analysis

A

Assessing linguistic variables
- Word length effect – work, elephant
- Word frequency – the, aisle read equally
- Orthographic complexity – better irregular than regular words (pint, mint)
- Concrete vs. abstract words (cup, wish)

Error analysis
- semantic, phonological, visual, morphological

22
Q

Assessing JH’s deep dyslexia, phonological and orthographic input tasks

A

Phonological input lexicon
pass, Auditory lexical decision task

Orthographic input lexicon
fail, Visual lexical decision (wux, fox)
pass, Irregular words letter switch task (yacth, pnit)

23
Q

Assessment of JH’s deep dyslexia, semantic system (using pictures)

A

Semantic system (using pictures)

pass Odd item (choose the image that doesn’t fit)
pass Odd item with subtle relations
pass Written word-picture matching
pass Semantic relation between picture and written word
pass Picture-written word matching (choose the word that matches the pic)

24
Q

Assessing JH’s deep dyslexia, semantic system (words)

A

Semantic system (written words)

fail Odd item (written) – fly, frog, spider, tree
fail Odd item with visually similar words (school, schoolgirl, schoolboy, ecology)
fail Semantic matching (carrot, potato, lettuce, pastry)

25
Q

Assessing JH’s deep dyslexia, phonological output lexicon

A

pass Picture naming task
pass Semantic association task
fail Homophones - hear (here, hair, hail)
fail Word designation (cook, book, look, sook)

26
Q

JH deep dyslexia summary

A
  • Impaired phonological route to reading aloud
  • Orthographic route to reading aloud impaired even though he can read irregular words aloud
  • Errors – semantic, morphological, phonological for reading real words
  • JH has deep dyslexia
27
Q

Rehab for JH’s deep dyslexia

A
  • Aim to use matching pictures to their written labels to build a new lexicon
    Pre-test
    -> 140 concrete written words (76 low frequency and 64 high frequency)
    -> At pre-test 34 (24%) words read correctly
    -> No frequency effect
    -> 50 words that were badly read or not read were selected for use in the training program
    -> Other 56 words not used in training

Post-test
-> 140 words presented for reading aloud
-> Post-test run 1 week after completion program and an 8-month follow-up

28
Q

Tests involved in JH’s rehab program

A

Tests as control measures to assess the effect of the training program
- Token Test (aphasia test)
- Semantic Fluency task (animal names)
- Phonological Fluency task (P, T, L)

29
Q

JH’s training program for rehab of deep dyslexia

A
  • Weekly session with speech therapist
  • Words to be read aloud presented in blocks
  • Each block practised once during a training session
  • Word written on one side of a card, picture and word written on other side of card
  • JH tried to read word alone, then look at picture to identify word
  • Word read by speech therapist
  • JH invited to construct a mental association between picture and written word
30
Q

JH’s training program continued

A
  • During the week JH read words twice a day
  • Next session studied words assessed without picture support and a new block of words presented
  • Final session words presented that were read incorrectly at the weekly meetings
  • Total of five sessions
  • Post-test and follow-up JH required to read all 140 words
31
Q

JH rehab program - post-test results

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Post-test 84/140 (60%) word read correctly
- Trained words 90% correct
- Non-trained words 18% correct
- Original (control) words correctly read 85% correct
-> post-test performance on control tasks comparable to pre-test

32
Q

JH rehab program - 8 month follow-up

A

8-month follow-up JH read 260 words (140 old words)
- 55% correct original 140 words
- 84% correct on trained words
- 25% correct non-trained words
- 62% original (control) words correctly read

33
Q

Rehabilitation implications from JH’s program

A
  • After 5 sessions there was a specific training effect
  • No progress on control tasks
  • Use of picture and auditory input assisted JH
  • JH retained high score on trained words at 8-months despite no written contact with these words during that time
  • Training via the lexical route does not allow the effects to generalise to learning new words beyond those trained
    -> Does not train generalised reading strategy
  • Training did increase JH’s motivation to continue with reading
  • Future training of phonological reading pathway