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Saturday, November 14, 2009

Conquering Alexia

Practice + tools = aphasia and alexia overcome

Time. Success in aphasia rehabilitation is about therapeutic time on task. This newsletter is the second in a series about the critical value of lots of patient practice both outside the clinic and more importantly when formal treatment is finished. The best evidence for how important independent or coached practice is to success in aphasia rehabilitation is a true story of one individual persevering and overcoming the effects of stroke on his/her communication abilities. This is one such story.

Dr. Roy Ivy of El Paso, TX faced a dilemma. He fervently wanted to engage in his passion- practicing medicine and helping his patients, but, he could not. A stroke left him unable to read (acquired alexia) accurately and quickly enough to see patients. Months of speech/language therapy and personal effort had failed to help him accomplish his goal. He was informed that as more time elapsed his recovery would slow and that he would reach an untreatable plateau. True to his persistent nature, Dr. Ivy and his wife Charlotte, who likewise was unwavering in her determination to see Roy maximize his recovery, searched for an answer. They knew intuitively that with the right tools and guidance, Roy could read again. The search was on.

On February 6th, 2009 they found www.aphasiatoolbox.com and the Aphasia Sight Reader Program. After an online consultation, the Ivy's and I created a plan, incorporating our Pure Alexia Treatment Protocol, AphasiaPhonics Program and extensive use of the Aphasia Sight Reader practice software. Charlotte trained to become Roy's practice coach. Taking advantage of neuroplasticity and a reconnectionist rehabilitation approach, we made the program highly individualized and multifaceted. See (http://convention.asha.org/2006/handouts/855_1436Small_Steven_091028_111206014434.pdf ; http://www9.georgetown.edu/faculty/friedmar/pdfs/Lott_et_al_2008_much_from_mud_pies.pdf ) . Together, we consistently nurtured and grew the plan. Dr. Ivy spent 2-3 hours each day with therapeutic time on task, practicing, growing, and reconnecting neural pathways. We utilized the flexibility of the Aphasia Sight Reader program to make continual adjustments such as: reducing time the stimulus was exposed; using words that began, ended, or had in the middle the same letter; words of a similar category; manipulation of key word sentence placement and semantic content complexity; gradual expansion of number of words flashed; focus on cognitive skills of verbal working memory and attention training and learning from reading errors instead of experiencing frustration. See http://www.speechpathology.com/askexpert/display_question.asp?question_id=243 .

From the beginning, Dr. Ivy had acquired some bad habits and strategies that were inadvertently counterproductive. For example, following some ill-advised advice, he moved his entire head to read a short sentence. We switched Roy to a more normal brief scan of his eyes to sight read the sentence quickly. Dr. Ivy had assumed, given information provided to him, that he had right visual field loss. With lots of smart practice, however, his brain and eyes made adjustments and eventually he missed very few words at the end of a sentence. See http://speech-language-pathology-audiology.advanceweb.com/Editorial/Content/Editorial.aspx?CC=206475 . Finally, instead of continuing to utilize a letter-by-letter approach, he began to use more normal word attack and whole word/phrase sight-reading skills. See http://content.karger.com/ProdukteDB/produkte.asp?Doi=52668 ; http://journals.cambridge.org/action/displayAbstract;jsessionid=5B39D82D1DB9E6A33ED5834A034355E2.tomcat1?fromPage=online&aid=49433.

Using the Aphasia Sight Reader's data collection capabilities, we found that at the onset of his program, he required 45 minutes to read a short paragraph [ 5 sentences; 68 words ] with 15 % comprehension and 10 % retention at 10 minutes; he read 3-word canonical sentences [ containing a Subject-Verb-Object ] at a rate of .3 words per second [ 18 words per minute ] with 45% comprehension.

After 3 months of independent, self-help practice, Dr. Ivy required 3 minutes to read a short paragraph [ 6 sentences; 70 words ] with 95 % comprehension and 75 % retention at 10 minutes; he read 3-word canonical sentences [ containing a Subject-Verb-Object ] at a rate of 1.5 words per second [ 72 words per minute ] with 90% comprehension. He began to read again - newspapers, novels and professional journals. Eventually, his reading and comprehension progress allowed him to return to seeing patients. He is able to read patient charts and other medical information.

A 75% decrease in time required to read a paragraph and an increase in words read per minute of 54 in just 3 months - these statistics reflect a remarkable accomplishment. I am so very proud of what this determined, yet humble man achieved. Dr. Ivy's story is just one of the many fantastic success stories that our clients and subscribers want to share with you. We know now that time since stroke and a person's age are irrelevant to a person's potential for improvement in speaking and reading skills. Our programs, materials and software tools are totally unique and available only to our subscribers at www.aphasiatoolbox.com . For a personal demonstration of the power, versatility and effectiveness of the Aphasia Sight Reader, please contact me at 724.494.2534 or bill@aphasiatoolbox.com . We use www.skype.com and www.oovoo.com for our online consultations and treatment.

Bill Connors

References:

Beeson, P., & Insalaco, D. (1998). Acquired alexia: Lessons from successful treatment. Journal of the International Neuropsychological Society, 4, 621-635.

Francis, D. R., Clark, N., & Humphreys, G. W. (2003). The treatment of an auditory working memory deficit and the implications for sentence comprehension abilities in mild receptive aphasia. Aphasiology, 17, 723-750.

Mayer, J. F., & Murray, L. L. (2002). Approaches to the treatment of alexia in chronic aphasia. Aphasiology, 16, 727-744.

Orjada, S. & Beeson, P.M. (2005). Concurrent treatment for reading and spelling in aphasia . Aphasiology, 19. 341-351

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