+ Acquired Reading Disorders Evaluation and treatment
Jan 02, 2016
+
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.