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Βελτίωση θεραπεία της ικανότητας της ανάγνωσης σε ασθενείς με αγγειακό εγκεφαλικό επεισόδιο (Master thesis)

Νταλταγιάννης, Γεώργιος

Acquired alexia or dyslexia in individuals with aphasia may vary depending on lesion location (i.e., left perisylvian ROI) and/or difficulty with phonological encoding and selecting and organizing either through the non-lexical or lexical routes but also differ with “design features” of text. This study examines the rehabilitation for reading aloud as it relates to letter case. Our hypothesis is that individuals with aphasia will be more accurate word readers when the first letter is uppercase rather than letters are all small print. Unlike word reading, non-word reading is phototactically regular and may look like targets in that paraphasic errors or neologisms may be present when reading errors occur. Target items included reading real words and pseudo- words (2,3,4 words stimuli). 2 female and 7male individuals with a medical diagnosis of ischemic left hemisphere stroke and presented with a clinical diagnosis of aphasia of different classifications (2 expressive, 3 mixed type, 2 anomic, 1 global). Eight participants presented with alexia and one with alexia without agraphia and were between the ages of 46 and 80 (Mean=66.2). For the experimental training portion participants trained daily and met with the experimenter 2x a week for a supervised 45-minute clinical session. The other homework sessions mirrored these and the experimenter monitored participants progress weekly. A multiple baseline design of 2,3,4 syllable word lists respectively. Pseudo-word reading therapy tasks was also used to prevent carryover effects at the end of each training session daily. The standardized version of the Boston Diagnostic Aphasia Test in Greek was used as a multiple baseline measure. Four to nine-month training program included randomly presented auditory and visual feedback exercises, read out-loud, Multiple Oral re-Read (MOR) and shared reading (ORLA) strategies. Reading accuracy in tasks was assessed as well as carry over to other reading materials. 6 of the total nine individuals with reading difficulties were used because reading difficulty were targeted at the word level not sentence level so that upper case letters could be targeted. Two were excluded due to difficulty at sentence/paragraph reading not word level.Results of a t-test repeated sample showed reading performance were found to be significantly improved in real word reading vs non-word reading with first letter as uppercase across 2,3,4 syllable words (p=0.044, <.05) as compared to all lower-case letters but not for pseudo word reading (p=.062 >.05), respectively. Qualitative errors are presented for all participants and linguistic properties as well as particular characteristics of the Greek language are discussed as limitations as well as new therapy approach aimed at improving reading accuracy using first uppercase letter word. Three of the nine subjects returned to normal levels of reading. Discussion also describes differences between non- word reading and word reading. A note on one subject with alexia without agraphia who improved significantly but used a self-developed reading aid by kinesthetic mediation (finger guided) to profit from motor-tactile information about the form of single letters.