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Beeson & Rising ASHA 2011

Pélagie M. Beeson, Ph.D., CCC-SLP

Kindle Rising, M.S., CCC-SLP

Department of Speech, Language,

& Hearing Sciences Written language is better-

preserved than spoken

language

Broca’s Aphasia with severe

apraxia of speech

Bobo … one … Bobo

one … bye… bye

Broca’s Aphasia evolved to Anomic

Aphasia

Tell me what’s going on in the picture.

A Picnic at My Parents.

Biff and Heidi are having a picnic.

And Max is flying a kite. And

Devon is playing in the sand. And,

no... Poppi’s fishing… It’s a lovely

day.

Spoken language is better-

preserved than written

Heidi and Robert are way a

picnic. Max is fling a kite.

Devon is make is a sand

castle. Ed and Chris are

sailing a boat. Shech is

fishing. It is ____ day.

No aphasia but

persistent

spelling and

reading

difficulties.

First, let’s consider how spoken and written language skills develop

Concepts

Audition Vision

We derive meaning

from what we hear

and see.


Acoustic

Representations

Visual

Representations

We derive meaning

from what we hear

and see.

Concepts

Auditory

Representations

Visual

Representations

Phonology

(spoken words) “dog”

“mommy” “car”

“house” “flower”

“hammer” “Jake”

Concepts

(word meanings)

Knowledge of lexical

representations

develops

… for spoken words

Auditory

Representations Vision

Orthography

(written words)

Phonology

(spoken words) “dog”

“car”

“house” “flower”

“hammer”

dog

car

house flower

hammer

mommy Jake

“mommy” “Jake”

Concepts

(word meanings)


representations

develops

… for written words … for spoken words

Auditory


Orthography

(written words)

Phonology

(spoken words)

“dog”

“car”

“mommy”

“hammer”

dog

car

mommy

hammer

“Jake” Jake

Concepts

(word meanings)


representations

develops

… for spoken words … for written words

Auditory


Orthography

(graphemes)

Phonology

(phonemes)

/d/

/k/

/m/

/h/

d

c, k

m

h

/dj/ j

Concepts

(word meanings)

… and sublexial

knowledge as well

… for spoken words … for written words


representations

develops

“apple”

“apple”

Phonological

Lexicon

Orthographic

Lexicon

apple

apple

Phonemes Graphemes

Semantics

words

sounds

words

letters

lexical

sublexical

Viewed as a

cognitive model


Semantics

Ortho

g

Phonology

Semantics

Phonology

Left perisylvian damage impairs

phonological processing

• Resulting in Broca’s, Wernicke’s,

Conduction, and Global Aphasia

• Mostly due to left middle cerebral artery

stroke

0

20

40

60

80

100

Perc

ent

Corr

ect

Regular

Irregular

Nonwords• Marked impairment of spelling

knowledge for words (< 30% correct)

• Marked impairment of phonology

(unable to spell nonwords)

“apple”

Phonologic

Lexicon

Orthographic

Lexicon

apple

Phonemes Graphemes

Semantics

Lexical

Sub-lexical

Lexical

Sub-lexical

sopt

Global Agraphia

Global Alexia ?

stop

pillow

doubt

castle

type

flig

hoach

snite

glope

boak

Real Words Nonwords

Large MCA

stroke

“apple”

“apple”

Phonologic

Lexicon

Orthographic

Lexicon

apple

apple

Phonemes Graphemes

Semantics

Lexical

Sublexical

Lexical

Sublexical

orange Deep Agraphia

Deep Alexia

“orange”

with semantic errors


talk

grab

bride

outside

shove

develop

hard

shrug

summer

debt

enough

bake

worm

Writing to Dictation (semantic errors)

single letter error single letter error

semantic error multiple errors multiple errors

◦ Arizona Battery for Reading and Spelling* ◦ 40 regular, 40 irregular words

balanced for length, frequency, imageability

◦ 20 pronounceable nonwords

broom

mile

spring

branch

hunch

fact

slate

Regular Words

yacht

circuit

doubt

choir

sword

island

debt

Irregular Words

flig

hoach

snite

glope

boak

cheed

merber

Nonwords

*http://web.me.com/pelagie1/Aphasia_Research

_Project/Welcome.html

“apple”

“apple”

Phonologic

Lexicon

Orthographic

Lexicon

apple

apple

Phonemes Graphemes

Semantics

sound-letter

letter-sound

retrain spellings for specific words


Purpose ◦ Strengthen lexical-semantic and orthographic representations for

specific words

Goal ◦ To retrain single-word written vocabulary for use in communicative

interactions ◦ To establish written “key words” for use in later stages of treatment

Approach ◦ Train 24 written words using Copy and Recall Treatment approach

(CART)

Trained as 4 groups of 6 words

leaf chin net cake

Copy and Recall Treatment (CART)

“Book.”

“Write ‘book’?”

• Correct: present next word

book

book

book

• Incorrect: proceed Beeson, 1999, Aphasiology

Beeson, Rewega, Hirsch, 2002, Aphasiology

Beeson, Rising, & Volk, 2003, JSLHR

“talking” photo album Listen, repeat word, copy word.

Homework for Copy and Recall Treatment

Video

Daily homework pages for repeated copy practice

Review each session for accountability

Homework is fun!

0123456

1 2 3 4 5 6 7 8 9 10 11 12 13

Set 1

0123456

1 2 3 4 5 6 7 8 9 10 11 12 13

Set 2

0123456

1 2 3 4 5 6 7 8 9 10 11 12 13

Set 3

0123456

1 2 3 4 5 6 7 8 9 10 11 12 13

Set 4

4 sets/6 words trained to >80% accuracy. Treatment duration ~ 6-8 weeks 4 sets/6 words trained to >80% accuracy. Treatment duration ~ 6-8 weeks

4 sets/6 words trained to >80% accuracy. Treatment duration ~ 6-8 weeks


G1 G2 G3 G4 G5 G6 G7

Aphasia Wernicke Broca* Broca* Broca* Wernicke Broca* Wernicke

Aph Q 61.8 45.2 22.1 27.6 35.2 51.7 51.8

Read 2.5 0 0 0 0 10 60

Spell 0 0 0 0 2.5 0 6.25

G8 G9 G10 G11 G12 G13 G14

Aphasia Wernicke Broca Broca* Cond Cond Cond Broca/A

Aph Q 58.7 36.6 41.0 53.9 49.5 74.3 79.1

Read 5 11.25 7.5 16.25 0 93.75 61.67

Spell 0 0 2.5 30 11.25 5 6.7

* with apraxia of speech

Global

Agraphia

All but 1 of 14 participants met criterion for spellings of targeted words. Spoken naming also improved.

Group Performance on Trained Items Pre-Post Treatment (14 participants; 24 spellings each)

0

10

20

30

40

50

60

70

80

90

100

Spelling Naming

Perc

ent

Corr

ect

Gain

Pre

Lesion overlay

Personally relevant words ◦ Work with patient and

family to select words

◦ Select words that are not easily communicated by pointing or gesture

◦ Include important people, places, and things (including proper names)

T-CART (texting)

◦ Cell phone with a slide-out QWERTY keyboard

Individual with severe Broca’s aphasia

and apraxia of speech

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Baseline Maintenance

Treatment Follow-

up Baseline

Treatment

Maintenance Follow-

up

CART (written) T-CART (typed)

Set 1

Set 3

Set 5

Criterion: 4+ words spelled correctly in 2 probes

Set 2

Set 4

Set 6

d=4.50 d=3.81 d=6.12 d=4.25

0

1

2

3

4

5

CARTspelled

CARTspoken

T-CARTspelled

T-CARTspoken

Ave

rage

# o

f It

ems

Co

rrec

t

Spelling and Spoken Naming Accuracy

Pre-tx

Maintenance

Follow Up

Better long-term

retention for CART

vs T-CART


0

20

40

60

80

100

Perc

ent

Corr

ect

Regular

Irregular

NonwordsRelatively preserved lexical

knowledge with marked impairment

of phonological skills (e.g., nonword

spelling)

“dust?”

“dusp”

Phonologic

Lexicon

Orthographic

Lexicon

druffs

dusp

Phonemes Graphemes

Semantics

Phonological Agraphia

Phonological Alexia

difficulty with nonwords

lexical

sublexical

words

sounds

words

letters

Difficulty with nonwords compared to regular & irregular words

Irregular Words

walk +

blood + castle +

Regular Words

bake +

count +

platform +

Nonwords

flig -

glope -

merber -

*Stimuli available at

http://web.me.com/pelagie1/Aphasia_Research

_Project/Welcome.html

drive

spring

grave

circuit

yacht

choir flig

wape

snite

Writing to dictation

Functional implications of

phonological impairment (10

years post stroke)

Also associated with poor

written performance at the

sentence level.

Difficulty with functors & verb

inflections.

P1 P2 P3 P4 P5

Aphasia Conduction Broca/A Anomic Conduction/A

Anomic*

Aphasia Q 66.7 82.2 73.6 76 83.5

Read Words 27.5 97.17 80.0 83.33 93.75

Spell Words 27.5 36.66 50.0 60.0 60.0

* with apraxia of speech

P6 P7 P8 P9 P10

Aphasia Broca/A Anomic Anomic Anomic Anomic

Aphasia Q 93.8 96.4 83 93.5 88.4

Read Words 97.5 96.6 96.25 97.5 92.5

Spell Words 68.75 78.33 85 92.5 96.25

Phonological

Agraphia


“apple”

“apple”

Phonologic

Lexicon

Orthographic

Lexicon

apple

apple

Phonemes Graphemes

Semantics

sound-letter

letter-sound

retrain sound-letter correspondences

Purpose ◦ To strengthen sound-letter correspondences

◦ Improve phonological manipulation abilities.

Goal ◦ To use phonological information to assist in reading and spelling.

Approach ◦ Establish “Key Words” to assist in relearning sound-letter and letter-

sound correspondences (20 consonants, 12 vowels)

◦ Re-train sound-letter correspondences for each targeted phoneme

fire --- /f/ --- f

Prerequisite skills ◦ Able to read, write, and name 24 key words

high frequency, concrete, regularly spelled nouns

used to retrain sound-letter (and letter-sound) correspondences

◦ Train with lexical approach if necessary

Key words-Consonants Set 1 rug, top, leaf, safe, net Set 2 cake, fire, moon, pie, dog Set 3 book, goat, zoo, ship, van Set 4 hat, web, chin, judge, three Key words-Vowels Set 1 hat/van, cake/safe, ship/chin fire/pie, net/web, leaf/three Set 2 top/dog, bone/goat, rug/judge moon/zoo, cow/mouth, foot/book

Clinician Patient

Say /p/ /p/

What is your key word for /p/? (Show picture if necessary).

“pie”

Write your key word for /p/ pie

Underline /p/ in your word pie

Now say the sound /p/

Clinician Patient

• Show the letter “s”

“safe”

s

• What is your key word for this ?

• Show the picture if necessary

• Your key word is “safe”, write “safe” safe

• Show the letter “s”

•What is this sound?

s

“ssss”

•What’s the 1st sound? “ssss”


Daily homework

Videotaped (DVD) stimuli


20 Consonants Trained in 4 sets of 5. Sound Letter Letter Sound

Trained to >80% accuracy. Treatment duration ~ 6-8 weeks

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14

20 Nonwords ◦ 4 sets of 5

e.g. mog, noash, glipe, zook, peth

Probes: written spelling to dictation ◦ Therapy tasks

Focus on “sound it out strategy” using nonwords Practice complex phonological manipulation tasks

e.g. phoneme replacement with nonwords

◦ Criteria to master a set of 5 80% accuracy across 2 consecutive sessions

Homework: Videotape or DVD for stimuli

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13


Nonword Spelling 4 Sets of 5 Nonwords Trained to >80% accuracy. Treatment duration ~ 6-8 weeks

n = 10

Reading Spelling

0

10

20

30

40

50

60

70

80

90

100

Letter-Sound Read Word Read Nonword Sound-Letter Spell Word Spell Nonword

Per

cen

t C

orr

ect

w/ Speller

TxGain

PreTx

10

Improved Sound-Letter Correspondence

Improved reading/spelling of real and nonwords


Before Tx

After Tx

Heidi and Robert are way a

picnic. Max is fling a kite.

Devon is make is a sand

castle. Ed and Chris are

sailing a boat. Shech is

fishing. It is ____ day.

Biff and I were out here have

having a picnic. Max was flying

a kite and Lucy was standing

near him. Devon and Andrew

were sailing along. Grandma

and Poppy were fixing dinner.

This was a wonderful day.

Semantics

Orthog

Phonology

Semantics

Phonology

Left perisylvian damage impairs

phonological processing

Phonological

agraphia (n = 10)

Global agraphia

(n = 14)

anterior cerebral artery

middle cerebral artery

posterior cerebral artery

A reminder regarding

blood supply to the brain

Semantics

Orthog

Phonology

Semantics

Phonology

Left inferior temporo-occipital

region is critical for reading and

spelling

Such damage spares the left

perisylvian region, thus preserving

phonological skills

“chore?”

“choir”

Phonologic

Lexicon

Orthographic

Lexicon

kwire

choir

Phonemes Graphemes

Semantics

Surface Agraphia

Surface Alexia

Lexical Lexical

Sub-lexical Sub-lexical sound-letter

letter-sound

difficulty with irregular words

Difficulty with irregularly spelled words compared to regular words & nonwords

Irregular Words

choir –

blood – castle –

Regular Words

bake +

count +

platform +

Nonwords

flig +

glope +

merber +


trade doubt

pine castle

ground type

0

20

40

60

80

100

Perc

en

t co

rrect

Spelling

Regular

Irregular

Nonwords

L L

Regularity Effect:

regular > irregular

regular irregular

S1 S2 S3 S4 S5

Aphasia Anomic Anomic Anomic Anomic MinAph

Aphasia Q 95 89.4 90.4 91.4 98.8

Read Words 96.25 86.25 95 91.25 95

Spell Words 68.75 61.25 87.5 73.75 77.5

Surface

Agraphia

Overlap of 5 pt.

0

20

40

60

80

100

Perc

ent

Corr

ect

Regular

Irregular

Nonwords

“choir”

Phonologic

Lexicon

Orthographic

Lexicon

choir

Phonemes Graphemes

Semantics

sound-letter

letter-sound

Facilitate interactive use of residual orthography, phonology & semantics problem-

solving approach “chore choir” kwire choir

Purpose ◦ Strengthen the interactive use of orthography and phonology

Goal ◦ To improve spelling accuracy by increasing self-

detection and correction of errors

Approach ◦ Use residual or re-trained phonology to sound-out

plausible spellings ◦ Identify and correct errors ◦ Use of electronic spell-checker to aid in error

correction

Serkit Circuit

Target Phonologically Plausible

Misspelling

Franklin Speller Microsoft Word

Spell Check

circuit serkit circuit serif, sprit, straight,

sari, merit

subtle suttle subtle settle, scuttle,

shuttle, subtle

pursuit persoot pursuit per soot, person

presort, persist

Instructions 1. Listen to the word. 2. Repeat it. 3. Try to spell it. 4. Look at it carefully. Is it as close as you can get?

If not, try again.

5. When you get as close as you can, enter it into the spell checker.

6. Look through the list and choose the correct

spelling. 7. Remember to press “say” to double check! 8. Copy the correct spelling. 9. Circle the words that you get by using the spell

checker.


Phonologically plausible attempts

Best guess entered into spell checker

n = 5

Reading and Spelling of Untrained Words & Nonwords

Reading Spelling

-10

0

10

20

30

40

50

60

70

80

90

100

Read Word Read Nonword Spell Word Spell Nonword

Per

cen

t C

orr

ect

w/ Speller

TxGain

PreTx

Spelling Accuracy

real words

< 30% correct >30% <90% correct

Lexical-Semantic & Phonological Impairment

Global or Deep

Agraphia

+ lexicality effect + regularity effect

Predominantly Phonological Impairment

Phonological

Agraphia

Predominantly Lexical-Semantic Impairment

Surface

Agraphia

Lexical Spelling Tx

Phonological Tx

Interactive Tx

Letter-by-Letter Reading

Alexia without

Agraphia

spelling preserved

retrain spelling for

specific words

retrain sound-letter

& letter-sound

correspondences

train problem-solving

strategies to maximize

performance

Spelling Accuracy

real words



Global or Deep

Agraphia



Phonological

Agraphia


Surface

Agraphia

Lexical Spelling Tx

Phonological Tx

Interactive Tx

Text Reading Tx


Alexia without

Agraphia

spelling preserved

A Treatment Sequence for Written Language Impairment (Beeson, Rising, Kim, Andersen, & Rapcsak, JSLHR, 2010)

14 Participants (12 male; 2 female)

mean range Age 56.1 yrs. (29-77) Education 14.9 yrs. (10-20) Time Post Onset 4.1 yrs. (.33–12) Aphasia Quotient 52.4 (22.1-79.1) Perisylvian Aphasia Types

◦ 7 Broca’s Aphasia ◦ 3 Conduction Aphasia ◦ 4 Wernicke’s Aphasia

Severe impairment of single-word spelling

L 0

20

40

60

80

100

Perc

ent

Corr

ect

Regular

Irregular

Nonwords(Beeson, Rising, Kim, Andersen, &

Rapcsak, in prep)


Spelling Accuracy

real words



Global or Deep

Agraphia



Phonological

Agraphia


Surface

Agraphia

Lexical Spelling Tx

Phonological Tx

Interactive Tx

Text Reading Tx


Alexia without

Agraphia

spelling preserved

Global Agraphia

14

Spelling Accuracy

real words



Global or Deep

Agraphia



Phonological

Agraphia


Surface

Agraphia

Lexical Spelling Tx

Phonological Tx

Interactive Tx

Text Reading Tx


Alexia without

Agraphia

spelling preserved

Global

Agraphia

14 13

7

LexicalPhonological Tx

6

-10

0

10

20

30

40

50

60

70

80

90

100

Letter-Sound Read Word Read

Nonword

Sound-Letter Spell Word Spell Nonword

Per

cen

t C

orr

ect

TxGain

PreTx

Reading Spelling

Global Agraphia response to

Lexical Phonological Treatment

n = 7

Phonological tx prompted additional

improvement of sublexical skills

A lot

worse

A lot

better

Worse Somewhat

worse

Somewhat

better

Unchanged Better

Overall Communication Ability?

Average Self Ratings Post Treatment

LexicalPhonological Group

Since treatment, how would you rate your:

Overall Spelling Ability?

A lot

worse

A lot

better

Worse Somewhat

worse

Somewhat

better

Unchanged Better

χ χ

χ χ

Patients Spouses

Spelling Accuracy

real words



Global or Deep

Agraphia



Phonological

Agraphia


Surface

Agraphia

Lexical Spelling Tx

Phonological Tx

Interactive Tx

Text Reading Tx


Alexia without

Agraphia

spelling preserved

Global

Agraphia

14 13

6 7

LexicalPhonologicalInteractive Tx

Degraded orthographic knowledge

Some reliance on re-trained phonology

Use of spell checker


Reading Spelling

Global Agraphia: Response to

Lexical Phonological InteractiveTx

n = 6

0

10

20

30

40

50

60

70

80

90

100


Per

cen

t C

orr

ect

w/ Speller

TxGain

PreTx

Improvement of sublexical,

lexical, and problem-solving skills

A lot

worse

A lot

better

Worse Somewhat

worse

Somewhat

better

Unchanged Better



LexicalPhonologicalInteractive Group



A lot

worse

A lot

better

Worse Somewhat

worse

Somewhat

better

Unchanged Better

χ χ

χ χ

Patients Spouses

Spelling Accuracy

real words



Global or Deep

Agraphia



Phonological

Agraphia


Surface

Agraphia

Lexical Spelling Tx

Phonological Tx

Interactive Tx

Text Reading Tx


Alexia without

Agraphia

spelling preserved

Phonological

Agraphia

10 8

0

20

40

60

80

100Perc

ent

Corr

ect

Regular

Irregular

Nonwords

Phonological Alexia/Agraphia

10 Participants (4 male; 6 female)

mean range • Age 62.9 yrs. (37-79) • Education 15.3 yrs. (12-20) • Time Post Onset 4.5 yrs. (.33–9.5) • Aphasia Quotient 83.7 (66.7-96.4) • Aphasia Types

– 3 Conduction Aphasia – 4 Anomic (evolved from Broca’s) – 1 Anomic (evolved from Conduction) – 2 Very mild anomic

Lesion Overlap

L n = 10

n = 10

Reading Spelling

0

10

20

30

40

50

60

70

80

90

100


Per

cen

t C

orr

ect

w/ Speller

TxGain

PreTx

10

Improvement of sublexical,

lexical, and problem-solving skills


A lot

worse

A lot

better

Worse Somewhat

worse

Somewhat

better

Unchanged Better



PhonologicalInteractive Group



A lot

worse

A lot

better

Worse Somewhat

worse

Somewhat

better

Unchanged Better

χ χ

χ χ

Patients Spouses

Spelling Accuracy

real words



Global or Deep

Agraphia



Phonological

Agraphia


Surface

Agraphia

Lexical Spelling Tx

Phonological Tx

Interactive Tx


Alexia without

Agraphia

spelling preserved


specific words


& letter-sound

correspondences



performance

Text Reading Tx

Spelling Accuracy

real words



Global or Deep

Agraphia



Phonological

Agraphia


Surface

Agraphia

Lexical Spelling Tx

Phonological Tx

Interactive Tx

Text Reading Tx


Alexia without

Agraphia

spelling preserved

Surface

Agraphia

5

HARD

MILE

GRUMBLE

CIRCUIT

LEARN

ROUTINE

FACT

CHANT

BOWL

CHARGE

VAGUE

DEBT

GROSS bump debt pint

Video

Reading Reaction Time

0

1000

2000

3000

4000

5000

6000

RRT

Reacti

on

Tim

e (

msec)

four

five

six

seven

HARD

MILE

GRUMBLE

CIRCUIT

LEARN

ROUTINE

FACT

CHANT

BOWL

CHARGE

VAGUE

DEBT

GROSS

Word length effect for reading reaction time

• Often accompanied by right visual field cut

Posterior cerebral artery stroke: Left inferior temporo-occipital lesion

L

right upper quadrantanopia

• Spoken language may be unimpaired

• or anomia


“apple”

Phonological Lexicon

apple

Phonemes Graphemes

Semantics

lexical

sublexical

“apple”

Acoustic Analysis

Visual Analysis

apple

Letter naming a-p-p-l-e

Impaired access to orthography

Orthographic Lexicon

Pure Alexia:


“apple”

Phonological Lexicon

Orthographic Lexicon

apple

Phonemes Graphemes

Semantics

lexical

sublexical

“apple”

Acoustic Analysis

Visual Analysis

apple

Letter naming a-p-p-l-e

Impaired access to orthography

Letter-by-Letter Reading with degraded orthographic knowledge

Goal ◦ Increase reading rate and accuracy for novel text

Approach ◦ Repeated oral reading of the same text

◦ Daily homework

Candidacy ◦ Word length effect for single words

◦ Slow reading rate for text

◦ Relatively preserved visual perception of orthography

letter identification and single word reading relatively accurate

0

10

20

30

40

50

60

70

80

9 10 11 12 13 14 15 16 17 18 19 20 22 23 24 25 26 28 29 30 31 32 33 37 38 39 40 46 47 48 49 47 52 54

Weeks Post Onset

Wo

rds p

er

Min

ute

0%

1%

2%

3%

4%

5%

6%

7%

err

ors

pe

r 1

00

wo

rds

rate

errors

No Tx MOR Tx

Reading rate: d = 2.69 pre-tx; 9.21 treated

Error rate: d = 0.82 pre-tx; 2.18 treated

rate

errors

Beeson, Magloire, & Robey (2005). Behavioural Neurology.


Practiced Text

0

10

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Re

ad

ing

Ra

te:

WP

M

Session

Practice Text

0

500

1000

1500

2000

2500

3000

3500

Ctrl P3 pre P3 post

RT

(m

se

c)

LBL Pre-Post Word Length List RT

4 letters

5 letters

6 letters

7 letters

LBL Pre-Post Improved Reading Reaction Time

Pre-tx

Post-tx

0

20

40

60

80

100

Locks and Keys Petra

Word

s p

er

Min

ute

(w

pm

)

PreTx

PostTx

50 90 wpm

Video

Video

0

500

1000

1500

2000

2500

3000

3500

Ctrl Pre Post Pre Post Pre Post Pre Post

P1 P4 P2 P3

Reacti

on t

ime (m

sec)

4 letters

5 letters

6 letters

7 letters

A lot

worse

A lot

better

Worse Somewhat

worse

Somewhat

better

Unchanged Better

Overall Reading Ability?

Average Self Ratings Post Treatment Interactive + MOR Tx



A lot

worse

A lot

better

Worse Somewhat

worse

Somewhat

better

Unchanged Better

χ

χ

Participants

A lot

worse

A lot

better

Worse Somewhat

worse

Somewhat

better

Unchanged Better


χ

Spelling Accuracy

real words



Global or Deep

Agraphia



Phonological

Agraphia


Surface

Agraphia

Lexical Spelling Tx

Phonological Tx

Interactive Tx


Alexia without

Agraphia

spelling preserved


specific words


& letter-sound

correspondences



performance

Text Reading Tx

We provided the rationale and support for these treatment approaches ◦ Lexical Treatment for Global/Deep Agraphia

◦ Phonological Treatment for Phonological Agraphia

◦ Interactive Treatment for Surface Agraphia

◦ Multiple Oral Re-reading Treatment for Letter-by-Letter Reading

We advocate for the implementation of a treatment sequence to maximize recovery ◦ Current research extends the sequence discussed

with additional focus on spoken language


Aphasia Research Project

This research is supported by RO1 DC007646 and RO1 357030 from the National Institute on Deafness and other Communication Disorders

Esther Kim

Maya Henry

Erin O’Bryan

Christine Shipman

Kristina Higgenson

Steve Rapcsak

Sarah Andersen

Dianne Patterson

Andrew DeMarco

aphasia.arizona.eduaphasia.arizona.edu/aphasia_research_project/for_professionals... · beeson...

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