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Multi-Step Treatment for Acquired Alexia and Agraphia: Two-Dimensional Analysis of Reading and Writing Errors

Katrina Ross1*, Jeffrey P. Johnson1, Shreya Ramesh1, Marcos A. Zedan1 and Swathi Kiran1
  • 1 Boston University, United States

Background Within a dual-route neuropsychological model (e.g. Ellis & Young, 1988), lexical (i.e. whole-word) and sublexical (i.e. letter-level) routes are distinct but interrelated in reading and writing tasks (Folk & Jones, 2010; Folk & Rapp, 2004; Folk, Rapp, & Goldrick, 2002; Hillis, Rapp, & Caramazza, 1999; Rapp, Epstein, Tainturier, 2002; Zorzi, Houghton, & Butterworth, 1998). When examining the nature of errors in acquired reading and writing disorders, a single error reflects varying degrees of lexical and sublexical accuracy; however, current systems typically assign binary (i.e. correct/incorrect) scores with commentary about error types only as supplemental information. No evaluation system exists that assigns value to errors in both routes and modalities based on relative accuracy to a target. In this project, a two-dimensional scoring system was developed to assess sublexical and lexical accuracy in single-word reading and writing. It was hypothesized that this novel two-dimensional system would capture the nature of errors and treatment-induced progress, and that it would elucidate individual error profiles as well as group error patterns. Methods To develop these scoring hierarchies, data were drawn from a novel treatment study involving eight PWA who received reading or writing treatment for eight weeks (Johnson, Ross, & Kiran, submitted). Responses were evaluated from pre-treatment (x3), post-treatment (x3), and follow-up (x1) probes. The sublexical and lexical scoring hierarchies each range from 0 (no response) to 9 (target), based on relative proximity to the target. Sublexical scores are distinguished by percent-overlap with the target (> or ≤ 50%), response length (in graphemes/phonemes), and specific error type (e.g., addition, substitution). Lexical scores are distinguished by nature of the response (e.g., real word, multi-word, gesture) and semantic accuracy. Results Quantitative analysis of overall performance showed significant transitions in error scores as a function of treatment and generalization. Repeated-measures multivariate analyses of variance on averaged scores revealed significant treatment effects in the trained and untrained modalities (F(2, 375) = 139.97, p < .001, Wilks’ λ = 0.57; F(2, 375) = 59.23, p <0.001, Wilks’ λ = 0.76, respectively), as well as significant interactions of time and patient (F(14, 750) = 9.80, p < .001, Wilks’ λ = 0.72; F(14, 750) = 76.74, p <0.001, Wilks’ λ = 0.17). Qualitative analyses of individual patient scores revealed distinct error profiles as well as group trends in error evolution, none of which can be captured in binary scoring. The four patterns of progression were 1) from non-responses to novel attempts; 2) increased production of nonwords with ≤50% sublexical overlap with the target; 3) from nonwords with ≤50% sublexical overlap with the target toward improved response accuracy; and 4) increased frequency of real word responses. Conclusions The results demonstrate that these scoring systems capture error profiles and treatment-induced progress in reading and writing. This information can be used to inform clinicians and researchers about patient responsiveness to treatment and change over time. Overall, the results of this study indicate that error evolution toward increased accuracy and communicative value can be comprehensively represented by this novel scoring system.

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Acknowledgements

Dudley Allen Sargent Research Fund

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Keywords: error analysis, lexical, sublexical, alexia, Agraphia, dual-route model

Conference: 54th Annual Academy of Aphasia Meeting, Llandudno, United Kingdom, 16 Oct - 18 Oct, 2016.

Presentation Type: Poster Sessions

Topic: Student Submissions

Citation: Ross K, Johnson JP, Ramesh S, Zedan MA and Kiran S (2016). Multi-Step Treatment for Acquired Alexia and Agraphia: Two-Dimensional Analysis of Reading and Writing Errors. Front. Psychol. Conference Abstract: 54th Annual Academy of Aphasia Meeting. doi: 10.3389/conf.fpsyg.2016.68.00099

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Received: 30 Apr 2016; Published Online: 15 Aug 2016.

* Correspondence: Ms. Katrina Ross, Boston University, Boston, MA, United States, kjross@bu.edu