Top-down and bottom-up treatment approaches compared in a single case of pure alexia

ABSTRACT

Background

The purpose of this study was to determine which of two evidence-based treatment options (top-down or bottom-up) held the greatest promise as a long-term rehabilitation strategy for a patient with severe pure alexia.

Aims

A single-subject, alternate treatment, multiple baselines across behaviors design was applied to a patient with pure alexia in 22 sessions over a six-week period. Five different behaviors were measured three times prior to the beginning and at the end of treatment. The same baselines measures were used as probes after each treatment session. Each of the two treatments (top down and bottom up) was administered in a block of 8, 1-h sessions delivered over 2-week periods.

Main Contribution

Both bottom-up and top-down treatments resulted in large effects for trained stimuli. There also was a generalization of treatment effects following the combined delivery of the two treatments.

Conclusions

This is only the second report comparing the relative effectiveness of bottom-up and top-down treatment approaches for pure alexia. Results indicated that both treatment approaches were similarly beneficial for this patient who presented with a severe form of this disorder.

KEYWORDS:

• Pure alexia
• acquired reading impairment
• rehabilitation
• treatment
• therapy

Acknowledgments

Portions of the literature review are based on the master’s degree thesis of the third author. This investigation would not have been possible were it not for the willingness of EF to participate in, and the support of his wife to assure that he could attend, the 22 required sessions.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. A subsequent literature search for publications from 2012 to 2019 carried out by the authors of this paper found only one new paper related to rehabilitation of pure alexia. This paper by Lacey et al. (2015) describes transcranial direct current stimulation for pure alexia.