Untrained Words Research Articles

Increasing Word-Reading Speed in Poor Readers: No Additional Benefits of Explicit Letter-Cluster Training

The present study examined whether explicit training of letter-clusters leads to more gains in word-reading speed than training of the separate letters of the same clusters. Ninety-nine poor reading second-grade children were randomly assigned to a cluster-training, a parallel letter-training, or a no-training condition. The cluster-training condition showed superior short-term and long-term improvement on rapid naming of trained and untrained letter clusters, whereas the letter-training condition showed superior short-term improvement on rapid naming of trained letters. In addition, compared with the no-training condition, the cluster and letter training showed the same superior short-term and long-term improvement on trained words and pseudowords. However, both training conditions showed only marginally more short-term improvement for untrained pseudowords and only marginally more long-term improvement on a word reading-fluency task. Apparently, improvement of rapid naming of letter clusters does not, or barely, result in improvement of untrained words and pseudowords.

A Comparison of Intention and Pantomime Gesture Treatment for Noun Retrieval in People With Aphasia

The effects of intention gesture treatment (IGT) and pantomime gesture treatment (PGT) on word retrieval were compared in people with aphasia. Four individuals with aphasia and word retrieval impairments subsequent to left-hemisphere stroke participated in a single-participant crossover treatment design. Each participant viewed target nouns on a computer screen in 2 counterbalanced training phases. Training included paired verbal + gesture treatment strategies to elicit verbal and/or gestural productions of target nouns. Treatment effects were measured using daily picture-naming probes for verbal naming and gesture productions for trained and untrained words as well as pre-/posttreatment standardized aphasia tests. Outcomes and Results IGT resulted in immediate effects on the verbal productions of 2 participants but lacked carryover to untrained words. PGT resulted in improved verbal production for 2 participants and immediate effects on the gesture productions of 3 participants, with carryover of gesture production to untrained words in 1 participant. Improvements on standardized aphasia tests were evident in 2 participants. IGT and PGT had positive treatment effects, but for contrasting communication modalities. Two individuals with mild-moderate aphasia improved verbal production with both IGT and PGT, and 2 individuals with severe aphasia improved gesture use with PGT.

Multimodal alexia: Neuropsychological mechanisms and implications for treatment

Letter-by-letter (LBL) reading is the phenomenon whereby individuals with acquired alexia decode words by sequential identification of component letters. In cases where letter recognition or letter naming is impaired, however, a LBL reading approach is obviated, resulting in a nearly complete inability to read, or global alexia. In some such cases, a treatment strategy wherein letter tracing is used to provide tactile and/or kinesthetic input has resulted in improved letter identification. In this study, a kinesthetic treatment approach was implemented with an individual who presented with severe alexia in the context of relatively preserved recognition of orally spelled words, and mildly impaired oral/written spelling. Eight weeks of kinesthetic treatment resulted in improved letter identification accuracy and oral reading of trained words; however, the participant remained unable to successfully decode untrained words. Further testing revealed that, in addition to the visual-verbal disconnection that resulted in impaired word reading and letter naming, her limited ability to derive benefit from the kinesthetic strategy was attributable to a disconnection that prevented access to letter names from kinesthetic input. We propose that this kinesthetic-verbal disconnection resulted from damage to the left parietal lobe and underlying white matter, a neuroanatomical feature that is not typically observed in patients with global alexia or classic LBL reading. This unfortunate combination of visual-verbal and kinesthetic-verbal disconnections demonstrated in this individual resulted in a persistent multimodal alexia syndrome that was resistant to behavioral treatment. To our knowledge, this is the first case in which the nature of this form of multimodal alexia has been fully characterized, and our findings provide guidance regarding the requisite cognitive skills and lesion profiles that are likely to be associated with a positive response to tactile/kinesthetic treatment.

The Importance of Production Frequency in Therapy for Childhood Apraxia of Speech

This study explores the importance of production frequency during speech therapy to determine whether more practice of speech targets leads to increased performance within a treatment session, as well as to motor learning, in the form of generalization to untrained words. Two children with childhood apraxia of speech were treated with an alternating treatment AB design, with production frequency differing in the 2 treatments. The higher production frequency treatment required 100+ productions in 15 min, while the moderate-frequency treatment required 30-40 productions in the same time period. One child was treated 3 times weekly for 11 weeks; the other child was treated twice weekly for 5 weeks. At the conclusion of each treatment phase, 5 min of probes were administered to determine whether generalization had occurred. Maintenance data to measure performance and learning were collected after a break from treatment. Both children showed improvement on all targets; however, the targets with the higher production frequency treatment were acquired faster, evidenced by better in-session performance and greater generalization to untrained probes. Both treatment designs were effective, though frequent and intense practice of speech resulted in more rapid response to treatment in 2 children whose primary communication difficulty was childhood apraxia of speech.

Skill generalisation in teaching spelling to children with learning difficulties

A central focus in remedial teaching is the generalisation of responses to contexts in which a student has never been explicitly instructed. Remarkably little is known about how and when generalisation occurs. In this article we examine generalisation effects in the context of spelling. Three areas are discussed: generalisation between spelling and reading, generalisation to untrained sound-letter-correspondences and generalisation to untrained unpredictable words. The research presented indicates both that reading training often leads to spelling improvements and that spelling training leads to reading improvements. There is a tendency for spelling training to be more likely to induce changes in reading than vice versa. In addition, for unpredictable words, generalisation is more likely to occur for words of high frequency and words that are orthographically similar to many other words. We conclude that a better understanding of how generalisation occurs will enable us to improve the efficiency and effectiveness of remedial spelling programmes.

Serial and Free Recall in Children Can Be Improved by Training

Children were assigned to three groups given training on unfamiliar words—phoneme-awareness training, rhyme training, and vocabulary training—and an untrained control group. Before and after training, we assessed the children’s performance on serial- and free-recall tasks with these words, as well as their ability to define the words, manipulate phonemes in them, and generate rhymes for them. We found that phoneme-awareness training improved serial recall substantially and improved free recall to a lesser extent. In contrast, vocabulary training produced a substantial increase in free recall and a lesser increase in serial recall. These effects on recall were specific and did not generalize to untrained words. Rhyme training produced increases in rhyming skills but no increase in either serial or free recall. We argue that serial and free recall depend on common memory mechanisms, but serial recall relies more on phonological codes and free recall relies more on semantic codes.

Overt use of a tactile/kinaesthetic strategy shifts to covert processing in rehabilitation of letter-by-letter reading

Background: Letter-by-letter readers identify each letter of the word they are reading serially in left to right order before recognising the word. When their letter naming is also impaired, letter-by-letter reading is inaccurate and can render even single word reading very poor. Tactile and/or kinaesthetic strategies have been reported to improve reading in these patients, but only under certain conditions or for a limited set of stimuli. Aims: The primary aim of the current study was to determine whether a tactile/kinaesthetic treatment could significantly improve reading specifically under normal reading conditions, i.e., reading untrained words presented in free vision and read without overt use of the strategy. Methods & Procedures: Three chronic letter-by-letter readers participated in a tactile/kinaesthetic treatment aimed at first improving letter-naming accuracy (phase 1) and then letter-by-letter reading speed (phase 2). In a multiple case series design, accuracy and speed of reading untrained words without overt use of the trained tactile/kinaesthetic strategy was assessed before phase 1, after phase 1, and again after phase 2. Outcomes & Results: All three patients significantly improved both their speed and accuracy in reading untrained words without overt use of the trained tactile/kinaesthetic strategy. All three patients required the additional practice in phase 2 to achieve significant improvement. Treatment did not target sentence-level reading, yet two of the three patients became so adept that they could read entire sentences. Conclusions: This study replicates previous findings on the efficacy of tactile/kinaesthetic treatment for letter-by-letter readers with poor letter naming. It further demonstrates that this treatment can alter cognitive processing such that words never specifically trained can be read in free vision without overtly using the trained strategy. The data suggest that an important element in achieving this level of generalisation is continuing training beyond the point of initial mastery (i.e., accurate letter naming).

Treating apraxia of speech (AOS) with EMA-supplied visual augmented feedback

Background: Previous studies have suggested that visual augmented feedback provided by electromagnetic articulography (EMA) helps persons with apraxia of speech (AOS) recover speech motor control following stroke (e.g., Katz et al., 2007). However, the data are few, both in terms of the variety of participants and the speech motor targets investigated. Aims: This study was designed to determine whether EMA supplied feedback improves articulatory accuracy in an adult with acquired AOS. We also examined whether reduced feedback frequency results in (1) decreased performance during acquisition and (2) enhanced maintenance and generalisation of the targeted behaviours. Methods & Procedures: A multiple-baseline across-behaviours design was used to assess the efficacy of this treatment for an individual with AOS. Over a 27-week period, the participant received visual feedback provided by an EMA system for treatment of three groups of speech motor targets (SMTs): /j/, /θ/, and /t∫ / with various following VCs. The consonant clusters /br/ and /sw/ served as untreated controls. Frequency of feedback scheduling was 100% for /j/ and /t∫ /, and 50% for /θ/. Outcomes & Results: For the first group of SMTs treated, /j/, there was acquisition for 4/5 trained words. These were maintained post-treatment and at the long-term probe. Improved performance and maintenance were also noted for 5/8 untreated stimuli, with maintenance shown for most of these words by 1 month post-treatment. The next treated SMT, /θ/, showed acquisition for all five treated items. Two of these five targets were maintained one month post-treatment. All three untreated /θ/ probes showed generalisation, with two of these showing maintenance post-treatment. The third treated group of SMTs, /t∫/, showed improved performance for all of the five treated words. However, these gains could only be attributed to /t∫/ treatment for three of the five words. Two treated items appeared well maintained at 1 month post-treatment. Generalisation and maintenance were also noted for all six untreated /t∫ / words. However, generalisation from previously treated /j/ and /t∫/ targets was involved in their improved performance. The untrained (control) word data suggested that the gains noted for treated items did not result from across-the-board improvement or unassisted recovery. There were no consistent differences corresponding with low- versus high-frequency feedback conditions. Conclusions: Augmented kinematic feedback provided by an EMA system improved production for some, but not all, treated targets. Generalisation to untreated probes was also evident. Predictions concerning the effects of feedback frequency on the acquisition, maintenance, and transfer of trained behaviours were not supported.

Errorless versus errorful training of spelling in individuals with acquired dysgraphia

We examined effects of error production in training of spelling in four individuals with stroke-induced dysgraphia. In a single participant crossover design, we provided errorless and errorful spelling training in counterbalanced phases. Improvements in spelling to dictation (large effect sizes) were evident for trained words in all participants following both errorful and errorless training phases, with some advantage of errorful over errorless for three of four participants. Little generalisation was noted for untrained control words. Post-treatment improvements were also noted in a standardised writing test in three of four participants. At one month after training completion, gains were largely maintained for trained words, again with larger effect sizes for errorful than errorless words in three of four participants. However, despite benefits for errorful training, participants stated a preference for the less frustrating errorless training protocol.

A meta-analysis of word-finding treatments for aphasia

Background: The research literature on treatment methods for word-finding deficits in aphasia is extensive. A meta-analysis of studies for word-finding therapy was conducted in order to objectively synthesise this information to answer large-scale questions of treatment efficacy. Aims: The purpose of this study was to examine the efficacy of various treatment approaches for word-finding deficits for individuals with aphasia. This analysis also examined gains made to trained and untrained words, the level of maintenance after therapy, and the effect of the time post-onset of aphasia on the recovery of language function. Methods & Procedures: Various search methods were used to gather anomia treatment studies for this analysis. From 44 studies, 107 effect sizes were calculated for the final analysis. These data were sorted according to the following moderator variables: treatment category (semantic, phonological, or mixed), word set (trained, exposed-related, exposed-unrelated, unexposed-unrelated, and unexposed-related), follow-up measures, and median number of months post-onset. Outcomes & Results: All therapy approaches showed evidence of efficacy, although the variance between studies was large. Strong gains were seen for trained and exposed words, but only minor gains for unexposed words. Large effects were seen for up to 2 months post-therapy, with lingering effects at 3 months post-therapy. Treatment appeared efficacious even for individuals that were years post-onset. Conclusions: An objective synthesis of the literature shows that intervention for word-finding deficits is efficacious. However, the level of gains varied widely across studies and therapy approaches. As expected, little generalisation was found for untrained-unexposed words.

Bimodal audio–visual training enhances auditory adaptation process

Effects of auditory training with bimodal audio-visual stimuli on monomodal aural speech intelligibility were examined in individuals with normal hearing using highly degraded noise-vocoded speech sound. Visual cue simultaneously presented with auditory stimuli during the training session significantly improved auditory speech intelligibility not only for words used in the training session, but also untrained words, when compared with the auditory training using only auditory stimuli. Visual information is generally considered to complement insufficient speech information conveyed by the auditory system during audio-visual speech perception. However, the present results showed another beneficial effect of audio-visual training that the visual cue enhances the auditory adaptation process to the degraded new speech sound, which is different from those given during bimodal training.

Therapy for naming deficits in two variants of primary progressive aphasia

Background: Primary progressive aphasia (PPA) refers to a progressive and selective decline in language due to neurodegenerative disease. There are three variants of PPA, progressive nonfluent aphasia (PNFA), semantic dementia (SD), and logopaenic progressive aphasia (LPA). All variants include impaired object naming, but distinct underlying deficits might interfere with naming. Therefore, individuals with different types of PPA may respond differently to naming therapy. Aims: To identify differences in patterns of success and generalisation in response to the same treatment in patient with LPA and a patient with SD. Furthermore, we wished to identify whether the treatment effect was item specific (trained words) or generalised to untrained words in trained or untrained categories. Methods & Procedures: Participants included an individual with LPA and one with SD. An assessment of lexical processing was administered before and after a naming treatment to assess underlying deficits and generalisation effects. Therapy consisted of a cueing hierarchy treatment. Treatment items consisted of pictured objects in the categories of fruits/vegetables and clothing. Outcomes & Results: Two different patterns of performance were observed. The LPA participant improved in naming of treated items and untreated items in both treated and untreated categories. The participant with SD improved in naming treated items only, but showed less deterioration in untreated items in treated than untreated categories. Conclusions: Individuals with PPA can show improved naming (at least temporarily) with therapy, but generalisation to untrained items may depend on the underlying cause of the naming deficit, which may differ across subtypes.

Treatment for lexical retrieval using abstract and concrete words in persons with aphasia: Effect of complexity

Background: The significance of imageability and concreteness as factors for lexical tasks in aphasic individuals is under debate. No previous treatment studies have looked specifically at training abstract words compared to concrete for improved lexical retrieval in patients with chronic aphasia. Aims: The goal of the present study was to determine the efficacy of a treatment for lexical retrieval that is based on models of lexical processing by utilising abstractness as a mode of complexity. It was hypothesised that training abstract words in a category will result in improvement of those words and generalisation to untrained target concrete words in the same category. However, training concrete words in a category will result in the retrieval of trained concrete words, but not generalisation to target abstract words. Methods & Procedures: A single‐participant experimental design across participants and behaviours was used to examine treatment and generalisation. Generative naming for three categories (church, hospital, courthouse) was tested during baseline and treatment. Each treatment session was carried out in five steps: (1) category sorting, (2) feature selection, (3) yes/no feature questions, (4) word recall, and (5) free generative naming. Outcomes & Results: Although participant 1 demonstrated neither significant learning nor generalisation during abstract or concrete word training, participants 2, 3, and 4 showed significant learning during abstract word training and generalisation to untrained concrete words. Participants 3 and 4 were also trained on concrete words, on which they improved, but did not show generalisation to untrained abstract words. Conclusions: The results of the present experiment support our hypothesis that training abstract words would result in greater learning and generalisation to untrained concrete words. They also tentatively support the idea that generalisation is facilitated by treatment focusing on more complex constructions (Kiran & Thompson, 2003; Thompson, Shapiro, Kiran, & Sobecks, 2003).

What Is the Evidence for Use Dependent Learning After Stroke?

Our laboratory has been interested in the patterns of synaptic plasticity after cortical stroke in animal models.1 These protein expression studies suggest that regions both ipsilateral and contralateral to the stroke are involved during the recovery period. An emerging issue of interest is whether the recovered function is indeed normal or reflects some compensatory function.2 One approach to resolving these questions is to assess different patterns of functional recovery in patients who do and do not recover function with and without therapy and compare them to normal patterns. Investigation of the molecular mechanisms of brain plasticity after injury suggests that functional activity stimulates this recovery and guides the development of functional pathways.3,4 Several investigators postulate that recovery from stroke resembles “use-dependent” learning.5 For this report, we review pertinent literature related to this phenomenon, assess how recovery of language resembles normal language function, and provide examples from our own research on functional imaging that assess patterns of activation related to recovery. The primary treatment modality that we review is constraint-induced language therapy (CILT), in which stroke patients are restricted to using verbal communication.6 CILT is based on principles of constraint-induced therapy for other conditions.6 CILT is performed in chronic stroke …

Neural Mechanisms Underlying Learning Following Semantic Mediation Treatment in a Case of Phonologic Alexia

Patients with phonologic alexia can be trained to read semantically impoverished words (e.g., functors) by pairing them with phonologically-related semantically rich words (e.g, nouns). What mechanisms underlie success in this cognitive re-training approach? Does the mechanism change if the skill is "overlearned", i.e., practiced beyond criterion? We utilized fMRI pre- and post-treatment, and after overlearning, to assess treatment-related functional reorganization in a patient with phonologic alexia, two years post left temporoparietal stroke. Pre-treatment, there were no statistically significant differences in activation profiles across the sets of words. Post-treatment, accuracy on the two trained sets improved. Compared with untrained words, reading trained words recruited larger and more significant clusters of activation in the right hemisphere, including right inferior frontal and inferior parietal cortex. Post-overlearning, with near normal performance on overlearned words, predominant activation shifted to left hemisphere regions, including perilesional activation in superior parietal lobe, when reading overlearned vs. untrained words.

A novel method for examining response to spelling treatment

Background: According to a dual-route model of written language processing, spelling of irregular words provides an index of the status of lexical spelling procedures, whereas nonword spelling provides information about non-lexical processing that relies on phoneme-grapheme conversion. Because regular words can be spelled using either route, accuracy for such words may reflect the combined function of the two routes, and may be mathematically predicted on the basis of spelling accuracy for irregular words and nonwords. Aims: The purpose of the present study was to examine the application of a dual-route prediction equation, and a related multiple regression model, to evaluate pre-post treatment spelling performance of individuals with acquired alexia/agraphia. Methods & Procedures: Eight individuals with language impairment due to left hemisphere damage received behavioral treatment to improve their written spelling. Their spelling performance was examined before and after treatment on untrained word lists with regular and irregular spellings, and pronounceable nonwords, and concurrence between predicted and observed spelling of regular words was evaluated. Outcomes & Results: The group demonstrated significantly improved spelling performance after treatment, and the prediction equation and multiple regression model both accurately predicted regular word performance on the basis of irregular word and nonword scores. In addition, the multiple regression model provided potentially useful information about the relative contribution of the lexical and non-lexical routes to spelling performace. Conclusions: The prediction equation and related multiple regression model used in this study can offer novel insight into the cognitive processes available to individuals with agraphia as well as provide a quantitative means to characterize response to treatment.

Effects of Long-Term Training on Aided Speech-Recognition Performance in Noise in Older Adults

This study examined how repeated presentations of words in noise affected understanding of both trained and untrained words in noise (in isolation and in sentences). Eight older listeners with hearing impairment completed a word-based auditory training protocol lasting approximately 12 weeks. Training materials were presented in a closed-set condition with both orthographic and auditory feedback on a trial-to-trial basis. Performance on both trained and untrained lexically easy and hard words, as well as generalization to sentences, was measured. Listeners then returned for an additional 14 weeks to monitor retention of the trained materials. Training listeners on 1 set of words improved both their open- and closed-set recognition of the trained materials but did not improve performance on another set of untrained words. When training switched to the other set, performance for the new set of words improved significantly, whereas significant improvements on the previously trained words were maintained. Training generalized to unfamiliar talkers but did not generalize to untrained words or untrained keywords within running speech. Listeners were able to maintain improved performance over an extended period. Older listeners were able to improve their word-recognition performance in noise on a set of 150 words with training.

Predicting generalization in the training of irregular-word spelling: Treating lexical spelling deficits in a child

This paper presents a single case study investigating the mechanisms underlying generalization of treatment benefits to untrained words in spelling. Brunsdon, Coltheart, and Nickels (2005) observed that untreated words that improved tended to be those whose errors were closest to being correct prior to treatment. These words also tended to be high in written frequency. The present study employed the same treatment techniques as those used by Brunsdon et al. with K.M., a developmental surface dysgraphic. During a first treatment the characteristics of words whose spelling improved without specific training were identified. These characteristics were then used in a second treatment to test whether it was possible to predict generalization. The results showed that treatment generalization to untreated irregular words was best predicted by neighbourhood size and frequency. We suggest that the processes underlying treatment generalization are based on the interaction between the orthographic lexicon and the graphemic buffer. Clinical implications are discussed.

Patterns of generalisation after treating sub‐lexical spelling deficits in a child with mixed dysgraphia

This paper presents a treatment study with a developmental dysgraphic girl, KM, and addresses the mechanisms by which orthographic learning of spelling rules might occur. Before treatment, KM's spelling of words and nonwords was impaired. Analyses of spelling errors indicated poor knowledge of sound‐to‐letter correspondences. Treatment focused on two spelling rules and was successful: spelling improved for both regular words and nonwords. Untrained words that included the training rules also improved, but later than nonwords and trained words. This delayed generalisation was explained through feedback mechanisms between orthographic lexicon and graphemic buffer.

Perceptual learning of noise vocoded words: Effects of feedback and lexicality.

Speech comprehension is resistant to acoustic distortion in the input, reflecting listeners' ability to adjust perceptual processes to match the speech input. This adjustment is reflected in improved comprehension of distorted speech with experience. For noise vocoding, a manipulation that removes spectral detail from speech, listeners' word report showed a significantly greater improvement over trials for listeners that heard clear speech presentations before rather than after hearing distorted speech (clear-then-distorted compared with distorted-then-clear feedback, in Experiment 1). This perceptual learning generalized to untrained words suggesting a sublexical locus for learning and was equivalent for word and nonword training stimuli (Experiment 2). These findings point to the crucial involvement of phonological short-term memory and top-down processes in the perceptual learning of noise-vocoded speech. Similar processes may facilitate comprehension of speech in an unfamiliar accent or following cochlear implantation.