reading and writing

dual route model

neural pathway of reading

1. sensor (converts image to be relayed for visual processing)

2. visual processing

3. letter analysis, orthographic input lexicon

4. orthography → phonology, integration of semantic, orthography, and phonology

5. phonological encoding

6. meaning

7. attention

neural structure of sensor (converts image to be relayed for visual processing)

retina

neural structure of visual processing (visual feature analysis)

primary then secondary visual cortices

neural structure of letter analysis, orthographic input lexicon

left fusiform gyrus: visual word form are (VWFA) in L occipito-temporal region

neural structure of orthography → phonology, integration of semantic, orthography, and phonology

left angular and supramarginal gyri

neural structure of phonological encoding

LIFG, insula, SMA

neural structure of meaning

left temporal gyrus (optional)

neural structure of attention

right superior parietal lobe

for the reading network, consider damage to …

white matter network structures

• Posterior corpus callosum

• Arcuate fasciculus

• Inferior longitudinal fasciculus

neural pathway of reading: peripheral processes

• retina

  • sensor needed to relay image

• primary then secondary visual cortices

  • visual feature analysis

• left fusiform gyrus

  • letter analysis

  • orthographic input lexicon

• right superior or left parietal lobe

  • attention

acquired peripheral alexias

Impairments up to the level of visual word form processing

• pure alexia

• visual alexia

Impairments to right (or sometimes left) superior parietal lobe

• neglect/hemionopic alexia

• attentional neglect alexia

Impairments up to the level of visual word form processing are which types of alexia?

• pure alexia

• visual alexia

Impairments to right (or sometimes left) superior parietal lobe

• neglect/hemionopic alexia

• attentional neglect alexia

have to do letter-by-letter reading → A-P-P-L-E, oh apple!

pure alexia

Serial processing due to impairments occurring between visual feature analysis and letter analysis

pure alexia

which alexia has impaired letter analysis or orthographic input lexicon?

visual alexia

better → butter, prince → price (note: errors are orthographically related)

visual alexia

Left versus Right neglect

neglect/hemionopic alexia

clock → block; clock → clot

neglect/hemionopic alexia

Impaired attention causing difficulties like migration errors

attentional neglect alexia

WIN FED → FIN FED

attentional neglect alexia

neural pathway of reading: central processes

Left angular and supramarginal gyri

• Orthography to phonology conversion

• Integration of semantics, orthography and phonology

Left IFG, insula, SMA

• Phonological encoding (reading aloud)

Left middle and inferior temporal gyrus

• Meaning

patients with ________ generally also have aphasia

central alexias

NOT peripheral alexias

acquired central alexias

• surface alexia

• phonological alexia

• deep alexia

• semantic alexia

Damage: Typically left temporal and temporoparietal lesions (impaired ____ pathway) which alexia?

surface alexia; what

Damage: Left perisylvian or superior temporal lesions (impaired ____ pathway) which alexia?

phonological alexia; where

which alexia has impaired orthographic input lexicon. Impaired recognition of site words

surface alexia

which alexia has reliance on grapheme-phoneme conversion (sounding out)

surface alexia

which alexia has impaired grapheme-phoneme conversion?

phonological alexia

which alexia has reliance on lexical-semantic route (site words)?

phonological alexia

which alexia is better with regular and non-words > irregular (yacht, pint) substitutions with visually- and semantically- related words (car for cab)

surface alexia

which alexia is better with real words > non-words (pseudowords are read as real words)

phonological alexia

which alexia is absent of semantic paralexias?

phonological alexia

which alexia has extensive left hemisphere lesions?

deep alexia

which alexia has impaired lexical and sublexical routes?

deep alexia

which alexia surface + phonological alexia?

deep alexia

which alexia has semantic paralexias (cat → dog)?

deep alexia

which alexia has severe pseudo-word reading impairment (inability to sound out words)?

deep alexia

which alexia has morphological errors, visual errors, imageability effects, content > function words

deep alexia

which alexia has impaired comprehension of texts, overall meaning?

semantic alexia

which alexia has temporal and frontal lobe lesions?

semantic alexia

what is a graphemic buffer?

buffer- im going to hold it in my head

short-term memory of holding letter sequence in head

which dysgraphia has damage: parietal lobe (where graphic motor plans are stored) or premotorarea

acquired dysgraphias: peripheral

acquired dysgraphias: peripheral have problems with…

• Problems with visual shapes, case, or size

• Problems with copying

• Graphemic buffer problems: substitutions, additions

acquired dysgraphias: central

• surface dysgraphia

• phonological dysgraphia

• deep dysgraphia

which dysgraphia has damage to inferior parietal lobe?

surface dysgraphia

which dysgraphia has impaired orthographic output lexicon (site words); reliance on sublexical route?

surface dysgraphia

which dysgraphia can spell regularly spelled words > Irregular (oshen for ocean) or unfamiliar words

surface dysgraphia

which dysgraphia has left perisylvian lesions?

phonological dysgraphia

which dysgraphia has damage to sound-grapheme conversion route; reliance on lexical route?

phonological dysgraphia

which dysgraphia has known words > unfamiliar words or nonwords

phonological dysgraphia

which dysgraphia is Phonological + surface dysgraphia (all routes are impaired)?

deep dysgraphia

assessments

• WAB-R part 2 and BDAE subtests

• Reading Comprehension Battery for Aphasia (RCBA)

• PPT for semantic knowledge for single words, orthographic stimuli

“Unstandardized assessments” per LPAA

What types of reading activities do you want to engage in?

• books, text messages, email (reading or writing), letter writing, menus and shopping lists, signs, labels, instructions, newspapers (articles or just headlines)

How do you think or feel about reading?

• enjoyable, easy, confident, happy to try/work on it, motivated, importance, speed, frequency

reading treatments for peripheral alexias

Neglect treatments; OT referral

reading treatments for pure alexia

Multiple Oral Rereading (MOR)

reading treatments for surface alexia

Multiple Oral Rereading (MOR)

reading treatments for phonological alexia

Grapheme-phoneme conversion

reading treatments for deep alexia

Oral Reading for Language in aphasia (ORLA)

reading treatments for semantic alexia

Attentive Reading and Constrained Summarization discourse treatment (ARCS)

writing treatments for peripheral dysgraphia

Train font, strategies for STM, OT referral

writing treatments for surface dysgraphia

ACT and CART

writing treatments for phonological dysgraphia

ACT and CART

writing treatments for deep dysgraphia

ACT and CART

writing treatment follow what principle?

Specificity principle: specific targets and tasks

specificity principle for confrontation naming and dictation

• confrontation naming = target what the pt wants to write

• dictation = train writing phone messages

reading direct approaches

• Multiple Oral Re-Reading (MOR)

• Oral Reading for Language in Aphasia (ORLA)

• Phoneme-Grapheme conversion tasks

reading indirect approaches

• slow down

• reduce distraction

• use support from family

writing interventions

Anagram Copy Treatment (ACT) and Copy and Recall Treatment (CART)

Usually these patients are "word blind" and start off with inaccurate letter naming. To treat this we developed a tactile-kinesthetic approach in which we trained the patients to trace single letters first on a card with arrows, then on a card without arrows, then on their palm with a pencil. Once their accuracy in naming the letters as they traced on their palm improved we moved on to training letter naming for speed, then letter strings, whole words, etc.

pure alexia or mild surface

Grapheme-Phoneme conversion purpose

To directly target the underlying reading impairment

grapheme-phoneme conversion training:

Grapheme-phoneme correspondence at the sound level: _______

Blending of bigraphs: ______ combinations

Word-level with ___________

• letter sounds

• consonant-vowel combinations

• targeted graphemes

what should you consider in grapheme-phoneme conversion training?

Consider developmental v. CATE progression

Consider linguistic variables (frequency, imageability, etc.)

grapheme-phoneme conversion stimuli

• Train ___ not ___(5-10 items)

• _____ or ____ may be equally effective

• Do not use ________

• Train deep not broad (5-10 items)

• Nonwords or real words may be equally effective

• Do not use pediatric materials