Recovery in a letter-by-letter reader: more efficiency at the expense of normal reading strategy

Abstract

Although changes in reading performance of recovering letter-by-letter readers have been described in some detail, no prior research has provided an in-depth analysis of the underlying adaptive word processing strategies. Our work examined the reading performance of a letter-by-letter reader, FH, over a period of 15 months, using eye movement methodology to delineate the recovery process at two different time points (T1, T2). A central question is whether recovery is characterized either by moving back towards normal word processing or by refinement and possibly automatization of an existing pathological strategy that was developed in response to the impairment. More specifically, we hypothesized that letter-by-letter reading may be executed with at least four different strategies and our work sought to distinguish between these alternatives. During recovery significant improvements in reading performance were achieved. A shift of fixation positions from the far left to the extreme right of target words was combined with many small and very few longer regressive saccades. Apparently, ‘letter-by-letter reading’ took the form of local clustering, most likely corresponding to the formation of sublexical units of analysis. This pattern was more pronounced at T2, suggesting that improvements in reading efficiency may come at the expense of making it harder to eventually return to normal reading.

Keywords:

• Letter-by-letter
• Pure alexia
• Recovery process
• Eye movements
• Reading strategy

Acknowledgments

The present investigation was supported by the German Science Foundation, DFG (project HU 292/9-2). We would like to thank patient FH for participating in our study. We are grateful to Prof. Klaus Willmes for his advice during data analysis, Dr. Michael Mull for providing his expertise in the interpretation of the radiological images and two anonymous reviewers who made extremely helpful suggestions on a previous version of this manuscript.