Improving spelling and everyday writing after a CVA: A single‐case therapy study

Abstract

Background: Recent years have seen a growing number of dysgraphia therapy studies informed by models of the normal writing mechanism (see Beeson & Rapcsak, 2002, for review). Although outcomes from these studies have been encouraging, measures are often confined to clinical tests, leaving it unclear whether everyday writing activities have benefited. This study similarly applied a processing model but was driven from the outset by the everyday writing goal of the aphasic participant. Aims: The study aimed to explore whether therapy could improve the note‐taking abilities of an aphasic individual. Evaluations aimed to determine whether gains reflected improvements to the writing mechanism and/or the application of writing strategies. Methods & Procedures: This is a single‐case therapy study of “Ray”, an individual with chronic aphasia and dysgraphia. Ray's priority for therapy was writing, with the goal of improving his note‐taking abilities for work. Ray's dysgraphia seemed due to a buffer‐level impairment, with length effects and errors of letter deletion, addition, transposition, and substitution. Therapy involved spelling practice and work on writing strategies. The outcome measures showed improvements both in note taking and in writing to dictation. Conclusions: The results suggested that therapy reduced the effects of Ray's buffer impairment and improved his use of writing strategies. The study demonstrates how model‐based thinking can be integrated with a functional approach in intervention.