A treatment sequence for phonological alexia/agraphia

Abstract

Purpose: Damage to left perisylvian cortex often results in impaired phonological processing abilities with written language profiles consistent with phonological alexia and phonological agraphia. The purpose of this article was to examine a behavioral treatment sequence for such individuals intended to strengthen phonological processing and links between phonology and orthography, as well as train a means to maximize use of residual orthographic and phonological knowledge for spelling.

Method: Two women with persistent impairments of written language and phonological processing following damage to left perisylvian cortical regions participated in this study. Both exhibited characteristic features of phonological alexia and agraphia in that reading and spelling performance for real words was better preserved than nonwords (lexicality effect). A 2-stage treatment protocol was administered to strengthen sublexical skills (phonological treatment) and to train interactive use of lexical and sublexical information to maximize spelling performance (interactive treatment).

Results: Both participants improved phonological processing abilities and reading/spelling via the sublexical route. They also improved spelling of real words and were able to detect and correct most residual errors using an electronic spelling aid.

Conclusions: Behavioral treatment served to strengthen phonological skills supporting reading and spelling, and provided a functional compensatory strategy to overcome residual weaknesses.

Figures

Figure 1

Surface rendering of participants’ left-hemisphere lesion and depiction of the lesion on standard axial slices.

Figure 2

Pretreatment oral reading and spelling (writing to dictation) of words versus nonwords by Participants 1 and 2 and the average performance of 12 healthy control participants. Error bars indicate standard error of the mean for the control group.

Figure 3

Participant 1’s performance on sound–letter and letter–sound correspondences for consonants (3A) and vowels (3B) and her nonword spelling performance in response to phonological treatment directed toward sublexical spelling (3C). The ordinate depicts the number of items correct; the abscissa indicates treatment sessions.

Figure 4

Participant 2’s performance on sound–letter and letter–sound correspondences for vowels (A) and her nonword spelling performance in response to phonological treatment directed toward sublexical spelling (B). The ordinate depicts the number of items correct; the abscissa indicates treatment sessions.

Figure 5

Reading and spelling performance for words and nonwords before (PreTx) and after treatment (PostTx). Spelling accuracy when using the electronic speller is also indicated for real words. *denotes significant improvement from pretreatment (p < .05).