A combined lexical and segmental therapy approach in a participant with pure alexia

ABSTRACT

Background: Pure alexia is characterized by effortful left-to-right word processing, leading to a pathological length effect during reading aloud. Results of previous therapy outcome research suggest that patients with pure alexia tend to develop and maintain an adaptive sequential reading strategy in an effort to cope with their severe deficit and at least master a slow and laborious reading mode.

Aim: We applied a theory-based, strategy-driven and eye-movement-supported therapy approach on HC, a participant with pure alexia. Our intention was to help optimizing his very persistent sequential reading strategy, while concurrently facilitating fast parallel word processing.

Methods & Procedures: Therapy included a systematic combination of segmental and holistic reading as well as text reading components. Exposure duration and font size were gradually reduced. Following a single case experimental reading design with follow-up testing, we assessed reading performance at four testing points focusing on analyses of linguistic errors and word viewing patterns.

Outcomes & Results: With respect to reading accuracy and oculomotor measures, the combined therapy approach resulted in sustained training effects evident in significant improvements for trained and untrained word materials. Text reading intervention only led to therapy specific improvements. Spatio-temporal analyses of eye fixation positions revealed a more and more efficient adaptive strategy to compensate for reading difficulties. However, spatial changes in fixation position were less pronounced at T4, suggesting some diminishing of success at follow-up.

Conclusions: Our results underscore the need for a continuous systematic training of underlying reading strategies in pure alexia to develop and sustain more economic reading procedures.

KEYWORDS:

• Pure alexia
• letter-by-letter reading
• therapy
• eye movements
• reading strategy

Acknowledgments

We thank patient HC for participating in our study, Laura Schliebs for assisting with speech therapy and we are grateful to two anonymous reviewers for their helpful feedback.

Disclosure statement

No potential conflict of interest was reported by the authors.