Aphasia rehabilitation can target reading

5.12 Aphasia rehabilitation can target reading at the:
     • word level
     • sentence level
     • above-sentence level.

References:  Brady et al., 2016: Cochrane review; Cherney, 2004: Narrative review; Cistola et al., 2021: Systematic review of 13 studies (7 quantitative and 6 qualitative); Purdy et al., 2019: Systematic review of 15 studies (10 single-case studies and 5 RCTs or group studies); Watter et al., 2017: Systematic review of 23 studies (3 RCTs, 8 cohort studies, and 12 case studies); Woodhead et al., 2018: RCT

NHMRC Levels of Evidence: I

Rationale: Speech and language therapy has been found to lead to positive reading comprehension outcomes compared to no therapy (Brady et al., 2016). An RCT found similarly positive effects of treatment on reading aloud at the word level, both in terms of accuracy and reading speed (e.g., Woodhead et al., 2018). Reading treatment may focus on reading aloud and/or reading comprehension at the word level (which may have a lexical or sublexical focus depending on the nature of the impairment; see Cherney, 2004), sentence level, and above-sentence level (e.g., discourse level text comprehension). Reading is a complex process that involves visual, perceptual, cognitive, and linguistic skills. Speech pathologists may therefore want to consider assessment of both cognitive and linguistic features of reading in order to select appropriate treatment (Watter et al., 2017). Because of this complexity, there is no one treatment that is considered the “gold standard” (Watter et al., 2017). Individual client characteristics (e.g., impairment, reading habits, availability of carer support) can be considered when deciding on a treatment plan (Purdy et al., 2019).

Treatment at each of the aforementioned levels may include a combination of the below treatments:
● Hierarchical reading treatment containing reading tasks of increasing difficulty (e.g., starting with matching tasks and gradually moving on to more complex tasks, such as text comprehension),
● Oral reading treatments (e.g., Oral Reading for Language in Aphasia (ORLA) – Cherney, 2004; Multiple Oral Rereading (MOR) – Beeson, 1998; and Modified Multiple Oral Rereading (MMOR) – e.g., Kim & Russo, 2010), 
● Strategy-based interventions for reading comprehension (e.g., visual, content-based, metacognitive strategies), and ● Cognitive treatments with a reading focus (e.g., visual perception, scanning, attention, memory)

Efficacy of these treatments has been shown to varying degrees, mostly through single case studies (see Purdy et al., 2019; Watter et al., 2017)

Compensatory/facilitative interventions may involve reading aids (including technology designed for other target populations such as e.g., developmental dyslexia) or technologies embedded in mainstream devices (e.g., screen readers; Cistola et al., 2021).

References:

1. Brady, M.C., Kelly, H., Godwin, J., Enderby, P., & Campbell, P. (2016). Speech and language therapy for aphasia following stroke. The Cochrane Database of Systematic Reviews, 6(6). DOI: 10.1002/14651858.cd000425.pub4
2.  Cochrane review; Cherney, 2004: Narrative review 
3. Cistola, G., Farrús, M., & Van der Meulen, I. (2021). Aphasia and acquired reading impairments: What are the high-tech alternatives to compensate for reading deficits? International Journal of Language and Communication Disorders, 56(1), 161-173. DOI: 10.1111/1460-6984.12569
4. Purdy, M., Coppens, P., Brookshire Madden, E., Mozeiko, J., Patterson, J., Wallace, S.E., & Freed, D. (2019). Reading comprehension treatment in aphasia: A systematic review. Aphasiology, 33(6), 629-651. DOI: 10.1080/02687038.2018.1482405
5.  Watter, K., Copley, A., & Finch, E., (2017). Discourse level reading comprehension interventions following acquired brain injury: A systematic review. Disability and Rehabilitation, 39(4), 315-337. DOI: 10.3109/09638288.2016.1141241
6. Woodhead, Z.V.J., Kerry, S.K., Aguilar, O.M., Ong, Y, Hogan, J.S., Pappa, K., Leff, A.P., Crinion, J.T. (2018). Randomized trial of iReadMore word reading training and brain stimulation in central alexia. Brain, 141. 2127-2124. DOI: 10.1093/brain/awy138