Overt use of a tactile-kinesthetic strategy shifts to covert processing in rehabilitation of letter-by-letter reading

Abstract

BACKGROUND: Letter-by-letter readers identify each letter of the word they are reading serially in left to right order before recognizing the word. When their letter naming is also impaired, letter-by-letter reading is inaccurate and can render even single word reading very poor. Tactile and/or kinesthetic strategies have been reported to improve reading in these patients, but only under certain conditions or for a limited set of stimuli. AIMS: The primary aim of the current study was to determine whether a tactile/kinesthetic treatment could significantly improve reading specifically under normal reading conditions, i.e. reading untrained words presented in free vision and read without overt use of the strategy. METHODS #ENTITYSTARTX00026; PROCEDURES: Three chronic letter-by-letter readers participated in a tactile/kinesthetic treatment aimed at first improving letter naming accuracy (phase 1) and then letter-by-letter reading speed (phase 2). In a multiple case series design, accuracy and speed of reading untrained words without overt use of the trained tactile/kinesthetic strategy was assessed before phase 1, after phase 1 and again after phase 2. OUTCOMES #ENTITYSTARTX00026; RESULTS: All three patients significantly improved both their speed and accuracy reading untrained words without overt use of the trained tactile/kinesthetic strategy. All three patients required the additional practice in phase 2 to achieve significant improvement. Treatment did not target sentence level reading, yet two of the three patients became so adept that they could read entire sentences. CONCLUSIONS: This study replicates previous findings on the efficacy of tactile/kinesthetic treatment for letter-by-letter readers with poor letter naming. It further demonstrates that this treatment can alter cognitive processing such that words never specifically trained can be read in free vision without overtly using the trained strategy. The data suggest that an important element in achieving this level of generalization is continuing training beyond the point of initial mastery (i.e. accurate letter naming).

Figures

Figure 1

Word reading length effects of the three patients. Patients DBR and LDR demonstrated length effects in their reading accuracy. Patient IND did not demonstrate a typical length effect as measured by his reading accuracy, but did as measured by reading response time (dashed line). Note that IND’s data for 7-letter words show a speed-accuracy trade off.

Figure 2

Mean response times for naming letters (line graph) and reading words (bar graph) throughout Phase 2 treatment. Changes in response times for word reading were significant for each time interval, with the exception of IND's change from After Phase 2a to After Phase 2b.

Figure 3

Accuracy and speed reading untrained words without overt use of the strategy throughout the treatment phases. Data were collected at baseline (B), following Phase 1 (1), following Phase 2a (2a) and following Phase 2b (2b). No patient significantly improved following Phase 1. All patients significantly improved both accuracy and speed following Phase 2b. Only patients DBR and IND were tested following Phase 2a; both patients had already achieved significant gains in accuracy and speed by this point in treatment.