Multi-Step Treatment for Acquired Alexia and Agraphia: Treatment Effects, Generalization, and Response to Individual Therapy Tasks
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1
Boston University, Speech, Language, and Hearing Sciences, United States
There is considerable evidence supporting the efficacy of treatments for acquired alexia and agraphia (e.g., Beeson, 2004; Brown, Hux, & Fairbanks, 2016; Moss, Rothi, & Fennell, 1991; Cherney, 2004; Thiel, Sage, & Conroy, 2016). However, the extent and nature of treatment effects and generalization are variable. In this study, we tested the efficacy of a comprehensive treatment with steps targeting core processes involved in reading or writing (i.e., lexical and semantic access, sublexical conversion, and phonological or graphemic buffering). We hypothesized that treatment would improve reading and writing of trained words and untrained but related words, and that a subset of key treatment steps would emerge.
Methods
Eight adults with alexia and agraphia received treatment for reading (n=2) or writing (n=6) twice per week for eight weeks. Participants were assigned four sets of stimuli: 16 trained words; 16 orthographic neighbors (ONs) of trained words; 16 semantic associates (SAs) of trained words; and 10 irregularly spelled words to control for repeated probing. Treatment modality and stimuli were assigned based on three baseline reading and writing assessments. Reading and writing of all sets were probed weekly during treatment and three times after treatment. Treatment involved 13 steps, including spoken/written lexical decision and word-picture matching tasks, grapheme-to-phoneme/phoneme-to-grapheme conversion, semantic feature analysis, and multiple attempts at reading or writing. Accuracy on each step was measured at every session.
Treatment effects and generalization were analyzed via linear mixed-effects models in which the dependent variable was accuracy in the trained or untrained modality; time, item set, and their interaction were fixed effects and participants were a random effect. Treatment steps were analyzed via mixed models predicting accuracy over time with participants as a random effect. A complimentary error analysis of participant responses is described in Ross et al. (submitted).
Results
Figure 1 depicts average probe accuracy. The model for the trained modality revealed significant slopes for the trained, ON, and SA sets (βs = .031, .020, and .011, respectively, all p < .001), indicating improvement at rates of 3.1%, 2% and 1.1% per week, respectively. Post-hoc comparisons indicated that trained items improved more rapidly than all other sets, while ONs improved faster than the control set (all p < .05). In the untrained modality, slopes for all four sets were significant (βs range from .010 to .015, all p < .001), with no significant differences between sets. Treatment-step analysis revealed significant improvement on seven steps (βs range from .010 to .020, all p < .05), which increased by an average of 1.5% per session.
Discussion
Irrespective of whether reading or writing was trained, participants showed a clear effect of treatment and generalization within and across modalities. Thus, engaging multiple processes in a single protocol is an efficient way to achieve widespread treatment benefits. Notably, not all treatment steps were equally effective. The seven most beneficial steps targeted lexical access, sublexical conversion, and buffering, three distinct processes whose remediation coincided with overall improvement in reading/writing accuracy, further reiterating the value of a comprehensive treatment approach.
Acknowledgements
This project was completed with the generous support of the Dudley Allen Sargent Research Fund, Sargent College of Health and Rehabilitation Sciences, Boston University.
References
Beeson, P. M. (2004). Remediation of Written Language. Topics in Stroke Rehabilitation, 11(1), 37–48. http://doi.org/10.1310/D4AM-XY9Y-QDFT-YUR0
Brown, J., Hux, K., & Fairbanks, S. (2016). Reading recovery: a case study using a multicomponent treatment for acquired alexia. Aphasiology, 30(1), 23–44. http://doi.org/10.1080/02687038.2015.1052728
Moss, S. E., Rothi, L. J. G., & Fennell, E. B. (1991). Treating a case of surface dyslexia after closed head injury. Archives of Clinical Neuropsychology, 6(1–2), 35–47. http://doi.org/10.1093/arclin/6.1-2.35
Cherney, L. (2004). Aphasia, Alexia, and Oral Reading. Topics in Stroke Rehabilitation, 11(1), 22–36. http://doi.org/10.1310/VUPX-WDX7-J1EU-00TB
Ross, K., Johnson, J.P., Ramesh, S., Zedan, M., & Kiran, S. Multi-step treatment for acquired alexia and agraphia: Two-dimensional analysis of reading and writing errrors. Poster submitted to the 2016 Annual Meeting of the Academy of Aphasia, Llandudno, Wales, UK. [submitted]
Thiel, L., Sage, K., & Conroy, P. (2016). Comparing uni-modal and multi-modal therapies for improving writing in acquired dysgraphia after stroke. Neuropsychological Rehabilitation, 26(3), 345–373. http://doi.org/10.1080/09602011.2015.1026357
Keywords:
alexia and agraphia,
reading,
Writing,
Treatment,
generalization,
Aphasia
Conference:
54th Annual Academy of Aphasia Meeting, Llandudno, United Kingdom, 16 Oct - 18 Oct, 2016.
Presentation Type:
Poster Sessions
Topic:
Student Submissions
Citation:
Johnson
JP,
Ross
K and
Kiran
S
(2016). Multi-Step Treatment for Acquired Alexia and Agraphia: Treatment Effects, Generalization, and Response to Individual Therapy Tasks.
Front. Psychol.
Conference Abstract:
54th Annual Academy of Aphasia Meeting.
doi: 10.3389/conf.fpsyg.2016.68.00081
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Received:
29 Apr 2016;
Published Online:
15 Aug 2016.
*
Correspondence:
Mr. Jeffrey P Johnson, Boston University, Speech, Language, and Hearing Sciences, Boston, Massachusetts, 02215, United States, johnsojp@bu.edu