Rehabilitation of pure alexia: A review

Figures & data

TABLE 1
All included studies

Author(s)	Patient	Sex	Age	Aetiology^a	Time since lesion^b	Lesion localisation (imaging type)	Diagnosis in article^c	Alexia severity	Reading deficits^d	Agraphia	Aphasia	Anomia	Visual field defect^e	Additional impairments
Tuomainen & Laine (1991)	HT*	M	56	NR	16 m	No new lesion; old right cerebellum (CT, MRI)	PA/AWA	Moderate	Slow Read	–	–	–	Remitted	Mild visuo-spatial Mild amnesia
Tuomainen & Laine (1991)	TT	M	42	Stroke	22 m	Left parieto-occipital (CT)	PA	Moderate	Slow Read	Mild	Mild	Mild	URQ	Mild visuo-spatial
Tuomainen & Laine (1991)	PA	M	65	Stroke	19 m	Left occipital, cortical + central atrophy (CT)	PA	Severe	Slow Read	–	–	–	RH	Severe visuo-spatial apraxia Neglect Severe amnesia
Daniel et al. (1992)	KV	M	43	Stroke (h) surgery	2 m	Left temporoparietal-occipital (CT)	AWA	Moderate	LBL-reading	Mild	–	Mild	URQ, partial Lo RQ	Memory deficit; tactile, verbal, visual.
Rothi & Moss (1992)	XX*	M	59	Stroke	5 y	Left occipital + posterior left internal capsule (CT)	AWA	Moderate	Slow Read	–	–	–	LoRQ	–
Arguin & Bub (1994)	DM*	NR	24	Stroke (h)	2 y	Left PCA, no callosal damage (CT, surgical report)	PA	Severe	Let Name Let Rec WLE	–	–	–	RH	Amnesia
Lott et al. (1994)	TL	M	67	Stroke (h)	>1 y	Left post. temporal and lateral occipital (CT, 3 months), left parietal atrophy (MRI, 8 months)	PA/some agraphia	Severe	Let Name WLE	Mild	Fluent	Moderate	LRQ	Mild auditory
Behrmann & McLeod (1995)	SI	F	46	Stroke	11 m	Left parietal, occipital, temporal, incl. hippocampus, fusiform and lingual gyri (SPECT, MRI)	PA, surface dysgraphia	Severe	Let Name in word endings WLE	Severe	–	Mild	RQ	Mild amnesia
Beeson (1998)	HL	M	53	Stroke (h)	10 w	Left posterior occipito-temporal, subjacent white matter (CT)	PA	Moderate	Slow Read Let Name in words	Premorbid spelling problems	–	Mild	Remitted	–
Maher et al. (1998)	VT*	F	43	Stroke	2 ½ y	Left occipital; Brodman's 28, 31, 18, lingual and fusiform gyri, cuneus, retrosplenial area (MRI)	AWA	Severe	Let Rec WLE	–	–	–	RH	–
Rothi et al. (1998)	MC	M	72	Stroke	13 m	Left occipital / occipito-parietal junction (CT)	AWA	Severe	WLE Slow Read	–	–	Moderate	URQ, partial LoRQ	Memory problems Topographic amnesia
Lott & Friedman (1999)	DL	M	67	Stroke	10 m	Left posterior temporal-occipital + old inf. right frontal parietal lobe, lacune in right basal ganglia (CT)	PA	Severe	Let Name Let Rec WLE Slow Read	Mild	–	Moderate	NR	Mild auditory
Friedman & Lott (2000)	RS	M	46	Hemangio- pericytoma. Two surgeries	4 m	Left occipital (surgery)	PA	Mild^1	WLE Slow Read	Spelling deficit	Mild	–	RH	–
Beeson et al. (2005)	RB	M	59	Stroke (h)	22 w	Left inferior temporal, occipital (MRI)	LBL	Moderate	WLE Slow Read	Moderate	–	Mild	URQ	–
Sage et al. (2005)	FD	M	73	Stroke (h)	NR	Left parietal, temporal, occipital, right parietal, occipital (CT)	LBL	Severe	Let Name WLE	Moderate	Mild	Moderate	RH	Moderate visual
Ablinger & Domahs (2009)	KA	M	64	Stroke	13½ m	Left post. Hippocampus, medial lingual and fusiform gyri (CT)	PA	Severe	Let Name Let Rec WLE	. -	Fluent	Moderate	RH	Mild visual Moderate amnesia
Lacey et al. (2010)	PA1*^2	NR	53	Stroke (h)	2 y	Left occipital/ medial temporal (description only)	PA	Mild	Errors on word-endings in text reading	–	–	–	URQ blurred	–
Lacey et al. (2010)	PA2*^2	NR	62	TBI	2 y	Right frontal, left temporo-occipital (description only)	PA	Mild	WLE Errors on word-endings in text reading	–	–	–	URQ	–
Lott et al. (2010)	LDR	M	61	Stroke	2 y	Left hemisphere (no scans)	PA	Severe	Let Name WLE	–	Fluent	Mild	NR	–
Lott et al. (2010)	DBR	F	84	Stroke (h)	>2 y	Left lateral occipital and post. temporal (CT)	PA	Severe	Let Name Let Rec WLE	Mild	Fluent	Severe	NR	Mild auditory impairments
Lott et al. (2010)	IND	M	68	Stroke	>1 y	Left occipital + BA 19/7 and inferior calcarine fissure (CT)	Surface alexia with agraphia / LBL-reading	Moderate	Let Name WLE	Mild	Fluent	Severe	NR	–
Patients, background variables, diagnoses provided, as well as information about the severity of the reading deficit and other cognitive or perceptual deficits given in the original publications. Studies are listed chronologically, and patients conforming to our definition of pure alexia are marked with an *.
NR = not reported; m = month; w = week; y = year.
^a Aetiology: Stroke = infarction; Stroke (h) = haemorrhagic stroke; TBI = traumatic brain injury.
^b Time since lesion: Number of weeks (w); months (m), or years (y) since injury.
^cDiagnosis in article: Lists the label provided for the patients reading deficit in the original publications: AWA = alexia without agraphia; PA = pure alexia; LBL = letter-by-letter.
^d Reading deficits: Lists the main characteristics of the patients reading performance, as provided in the original publications: LetName = deficit in letter naming; LetRec = deficit in letter recognition; SlowRead: elevated response times in word or text reading; WLE = word length effect.
^e Visual field defect: L = left, R = right, U = Upper, Lo = Lower, H = hemianopia, Q = quadrantanopia.
^1 This patient is reported to have mild pure alexia, but is reported to have single word reaction times of up to 35 seconds.
^2 See main text for our concerns regarding the diagnosis of these patients.

TABLE 2
Tactile-kinesthetic treatment studies

Category	Paper	Patient	Method	Treatment schedule^a	Home Practice^b	Improved Accuracy^c	Improved Speed^d	Test material familiar/unfamiliar^e	Statistical comparison^f
Pure alexia	Maher et al. (1998) Task 2	VT	Kinesthetic	1 hr 4x /week 4½ weeks	No	NR	Sentence Read	Test items – repeatedly	No
Alexia	Lott et al. (1994)	TL	Tactile- kinesthetic	1 hr 3x/week 5 months	Min. 3x/day	Let Name Word Read Pseudo-word Read	Not tested	Pre-test – post-test Test items – repeatedly	No
	Lott & Friedman (1999)	DL	Tactile- kinesthetic	1 hr 3x/week 11 months	Yes	Let Name Let String Name Word Read	Let String Name Word Read	Pre-test – post-test	No
	Sage et al. (2005) Task 2	FD	Tactile, errorless	7 weeks	Treated at home	Word Read	Word read	Test items – repeatedly	Yes (sign)
	Lott et al. (2010)	LDR	Tactile- kinesthetic	1 hr 3x/week	Min. 3x/day; phase 1	Let Name Word Read Sentence Read	Let Name Word Read	Pre-test – post-test Test items – repeatedly	Yes (sign)
	Lott et al. (2010)	DBR	Tactile- kinesthetic	1 hr 3x/week	Min. 3x/day; phase 1	Let Name Word Read	Let Name Word Read	Pre-test – post-test Test items – repeatedly	Yes (sign)
	Lott et al. (2010)	IND	Tactile- kinesthetic	1 hr 3x/week	Min. 3x/day; phase 1	Let Name Word Read Sentence Read	Let Name	Pre-test – post-test Test items – repeatedly	Yes (sign)
Main details of the treatment provided and the results reported in the original publications. Pure alexic patients (according to the definition provided in the introduction) are listed first, then patients with alexia and associated deficits in chronological order.
^a Treatment schedule: The duration of training (number of times per week, number of weeks) as given in the original publications.
^b Home practice: The ”homework” the patient was to do during the training phase.
^c Improved accuracy: The improvement in accuracy reported in the original publication (regardless of statistical support). Abbreviations: NR = not reported; LetName = single letter naming; Let String Name = letter string naming; Pseudoword Read = pseudoword reading, Sentence Read = sentence reading; Word Read = word reading.
^d Improved speed: Improvement in reading speed or reaction times as reported in the original publications. Abbreviations as in previous column.
^e Test-material familiar/unfamiliar: List whether the reported improvement was shown on material new or familiar to the patient. Pre-test – post-test: Outcome was measured by using the same test material before and after treatment. Test-items – repeatedly = progress was measured by testing the patient on the same material several times over the course of traning.
^f Statistical comparison: List whether the reported improvement in speed or accuracy was tested statistically (and whether this was found significant).

TABLE 3
Other letter-based treatments – methods and results

Category	Paper	Patient	Method	Treatment schedule^a	Home Practice^b	Improved Accuracy^c	Improved Speed^d	Test material familiar/unfamiliar^e	Statistical comparison^f
Pure alexia	Arguin & Bub (1994)	DM	Recognition of orthographic representations	2 weeks	Yes	Let String Name	Let Match Let String Name Word Read	Test items – repeatedly	Yes (sign)
Alexia	Daniel et al. (1992)	KV	LBL-reading	15 min 3x/day, 3 weeks	Treated at home	Sentence Read	Not tested	Test items – repeatedly	No
	Behrmann & McLeod (1995)	SI	Ends-in	90 min 2x/week, 9 weeks	NR	Letter report	Word Read	Pretest – posttest	Yes (sign)
Main details of the treatment provided and the results reported in the original publications. Pure alexic patients (according to the definition provided in the introduction) are listed first, then patients with alexia and associated deficits in chronological order.
^a Treatment schedule: The duration of training (number of times per week, number of weeks) as given in the original publications.
^v Home practice: The ”homework” the patient was to do during the training phase. NR = not reported.
^c Improved accuracy: The improvement in accuracy reported in the original publication (regardless of statistical support). Abbreviations: LetMatch = letter matching; Letter report = report of letters in given positions in a string; Let String Name = letter string naming; Sentence Read = sentence reading; Word Read = word reading.
^d Improved speed: Improvement in reading speed or reaction times as reported in the original publications. Abbreviations as in previous column.
^e Test-material familiar/unfamiliar: List whether the reported improvement was shown on material new or familiar to the patient Pre-test – post-test: Outcome was measured by using the same test material before and after treatment. Test-items – repeatedly = progress was measured by testing the patient on the same material several times over the course of traning.
^f Statistical comparison: List whether the reported improvement in speed or accuracy was tested statistically (and whether this was found significant).

TABLE 4
Word level treatment methods and results

Category	Paper	Patient	Method	Treatment schedule^a	Home Practice^b	Improved Accuracy^c	Improved Speed^d	Test material familiar/unfamiliar^e	Statistical comparison^f
Pure alexia	Rothi & Moss (1992) Task 1–3	XX	Reading of words (task 1), semantic categorisation (2) and lexical decision(3), limited exposure durations	1 h 2x/day, 2 weeks	No	Word Read (trained only)	Word Read	Pre-test – post-test	No
	Maher et al. (1998) Task 1	VT	Semantic categorisation, limited exposure durations	6 hr/total	No	No	No	Test items – repeatedly Training items(text)	No
Alexia	Rothi et al. (1998)	MC	Semantic categorisation, limited exposure durations	30 min 5x/day, 2 weeks	No	No	No	Pre-test – post-test	No
	Friedman & Lott (2000)	RS	Semantic categorisation + reading of words, limited exposure durations	2 h 2x/day, 40 weeks	Yes	Word Read	Word Read	Pre-test – post-test Test items – repeatedly	No
	Sage et al. (2005) Task 1	FD	Word recognition (errorless learning)	7 weeks	Treated at home	Word Read, (trained only)	Word Read	Test items – repeatedly	Yes (sign)
	Ablinger & Domahs (2009)	KA	Reading of words, limited exposure durations	2x/day, 4 weeks	No	Word Read Text Read	Let Name Word Read Text Read	Test items – repeatedly Training items (text)	Yes (sign)
Main details of the treatment provided and the results reported in the original publications. Pure alexic patients (according to the definition provided in the introduction) are listed first, then patients with alexia and associated deficits in chronological order.
^a Treatment schedule: The duration of training (number of times per week, number of weeks) as given in the original publications.
^v Home practice: The ”homework” the patient was to do during the training phase. NR = not reported.
^c Improved accuracy: The improvement in accuracy reported in the original publication (regardless of statistical support). Abbreviations: LetName = letter naming; Text Read = text reading; Word Read = word reading.
^d Improved speed: Improvement in reading speed or reaction times as reported in the original publications. Abbreviations as in previous column.
^e Test-material familiar/unfamiliar: List whether the reported improvement was shown on material new or familiar to the patient. Pre-test – post-test: Outcome was measured by using the same test material before and after treatment. Test-items – repeatedly = Progress was measured by testing the patient on the same material several times over the course of traning. Training items = Outcome measured on the same material as used during training.
^f Statistical comparison: List whether the reported improvement in speed or accuracy was tested statistically (and whether this was found significant).

TABLE 5
Multiple oral re-reading: Methods and results

Category	Paper	Patient	Method	Treatment schedule^a	Home practice^b	Improved accuracy^c	Improved speed^d	Test material familiar/unfamiliar	Statistical comparison
Pure alexia	Tuomainen & Laine (1991)	HT	MOR	1x/week, 2x3 months	Min. 2x/day	NR	Word Read Text Read Non-words	Test items – repeatedly	Yes (words, sign)
	Lacey et al. (2010)	PA1	MOR	2 hrs, 1x/week 8 weeks	Read text 5x/day	Remained high	Text Read (trained texts + texts with trained words)	Training items	Yes (sign)
	Lacey et al. (2010)	PA2	MOR	2 hrs 1x/week 8 weeks	Read text 5x/day	Remained high	Text Read (trained texts + texts with trained words)	Training items	Yes (sign)
Alexia	Tuomainen & Laine (1991)	TT	MOR	1x/week 2x3 months	Min. 2x/day	NR	Text Read	Test items – repeatedly	Yes (words, nonsign)
	Tuomainen & Laine (1991)	PA	MOR	1x/week 3 months	Min. 2x/day	NR	No	Test items – repeatedly	Yes (words, nonsign)
	Beeson (1998)	HL	MOR	1 hr 2x/week 5 months then: 1x/week, 1 month	Min. 3x/day	NR	Text Read	Unfamiliar	Yes (words, nonsign) No (text reading)
	Beeson et al. (2005)	RB	MOR	1x/week 32 weeks	Min. 30 min/day	Word Read	Text Read Word Read (slightly)	Unfamiliar	Yes (text, sign) No (words)
Lists the main details of the treatment provided and the results reported in the original publications. Pure alexic patients (according to the definition provided in the introduction) are listed first, then patients with alexia and associated deficits in chronological order.
^a Treatment schedule: The duration of training (number of times per week, number of weeks) as given in the original publications.
^b Home practice: The ”homework” the patient was to do during the training phase. NR = not reported.
^c Improved accuracy: The improvement in accuracy reported in the original publication (regardless of statistical support). Abbreviations: NR = not reported; Text Read = text reading; Word Read = word reading.
^d Improved speed: Improvement in reading speed or reaction times as reported in the original publications. Abbreviations as in previous column.
^e Test-material familiar/unfamiliar: List whether the reported improvement was shown on material new or familiar to the patient. Pre-test – post-test: Outcome was measured by using the same test material before and after treatment. Test-items – repeatedly = Progress was measured by testing the patient on the same material several times over the course of traning. Training items = Outcome measured on the same material as used during training.
^f Statistical comparison: List whether the reported improvement in speed or accuracy was tested statistically (and whether this was found significant).

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