Treatment for Reading and Writing Deficits Following Acquired Brain Injury

Study Overview
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Brief Summary
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Many people with acquired brain injuries have deficits in reading decoding, reading comprehension, and written expression. Alexia is a phenomenon in which a person who previously could read has trouble doing so after having sustained a brain injury; likewise, agraphia is an acquired writing problem affecting one or more aspects of written communication. Alexia and agraphia sometimes co-occur with one another and/or with other language challenges, but they can also occur as isolated phenomena. Methods to treat alexia and agraphia often focus on single intervention techniques that address aspects of reading or writing in isolation-such as matching written and spoken letters or letter sounds, performing choral reading, tracing letters, etc. Existing research suggests that the effectiveness of these techniques is limited. However, when used in combination, such techniques may promote improved reading and written communication skills. As such, the purpose of this research is to determine the extent to which a multicomponent intervention program improves the reading and writing capabilities of people with acquired alexia and/or agraphia.

Official Title
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Treatment for Reading and Writing Deficits Following Acquired Brain Injury

Conditions
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Acquired Brain Injury, Alexia, Agraphia

Intervention / Treatment
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* Behavioral: Multicomponent reading and writing treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Survivor of acquired brain injury Exhibits alexia and/or agraphia Past or current client of Quality Living, Inc., Omaha, Nebraska Fluent speaker of English Exclusion Criteria: Vision impairment prohibiting reading of 24-point text Auditory comprehension problems precluding understanding of consent/assent information

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Acquired brain injury participants<br>People with acquired alexia and/or agraphia secondary to brain injury who participate in the reading/writing intervention. | Behavioral: Multicomponent reading and writing treatment<br>* Intervention procedures incorporated into the program include drilling on sight words to improve immediate recognition of common words; engaging in Multiple Oral Reading procedures to increase reading fluency; practicing oral spelling of sight words to improve spelling accuracy; generating written sentences to improve accurate spelling and use of written conventions (e.g., punctuation, capitalization); and summarizing and subsequently writing sentences about read material to establish strategies to enhance reading comprehension and promote written expression.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in score on Word Attack subtest of the Woodcock-Johnson III Test of Achievement. | Subtest raw sores range from 0 to 32,with higher scores indicating better performance. | Change from baseline at 8 weeks | 
| Change in score on Passage Comprehension subtest of the Woodcock-Johnson III Test of Achievement. | Subtest raw scores range from 0 to 47, with higher scores indicating better performance. | Change from baseline at 8 weeks | 
| Change in score on Word Reading subtest of the Wide Range Achievement Test 4. | Subtest raw scores range from 0 to 70, with higher scores indicating better performance. | Change from baseline at 8 weeks | 
| Change in score on Spelling subtest of the Wide Range Achievement Test 4. | Subtest raw scores range from 0 to 57, with higher scores indicating better performance. | Change from baseline at 8 weeks | 
| Change in score on Test of Silent Reading Speed and Efficiency. | Raw scores range from 0 to 70, with higher scores indicating better performance. | Change from baseline at 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sight word decoding accuracy | Percent of correct decoding on 315 words included in Dolch pre-primer, primer, kindergarten, first grade, second grade, third grade, and nouns lists. Each word is scored as correct or incorrect, and a percent correct score is computed based on this scoring. | One time per week for 8 weeks | 
| Oral reading rate of passages | Words per minute (wpm) during independent oral reading of passages. The criteria for progression to subsequent passages is a reading rate of 80wpm or better. | As the first of five tasks of each session for 8 weeks (each session is 1 hour). | 
| Decoding errors during oral reading of passages | Percent of uncorrected word decoding errors in a specified passage. The criterion for progression to subsequent passages is fewer than 5% uncorrected words production errors. | As the first of five tasks of each session for 8 weeks (each session is 1 hour). | 
| Oral spelling of words | Number of words spelled correctly on lists containing 15 words each. Introduction of a new word list will occur only after a participant correctly spells all words on the current list. | As the second of five tasks of each session for 8 weeks (each session is 1 hour). |