ACQ Vol 12 no 1 2010

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ACQ Volume 12, Number 1 2010 37
Literacy
Naomi Cocks
(top) and
Madeline Cruice
This article
has been
peer-
reviewed
Keywords
ACQUIRED
DYSLEXIA
APHASIA
FUNCTIONAL
THERAPY
HEAD INJURY
READING
THERAPY
for identity, meaningfulness, responsibility, and the role of
an individual in family and society. Assessment and therapy
approaches that address the barriers to everyday reading are
therefore essential for individuals with brain injury.
There are surprisingly few assessments available that
assess everyday reading difficulties commonly found in
individuals who have sustained brain damage. While a
number of widely used assessments for people with aphasia
assess aspects of reading ability, such as the Mount Wilga
High Level Language Test (MWHLLT) (Christie, Clark, &
Mortensen, 1986), or the Western Aphasia Battery (Kertesz,
1982) such assessments are often based on standardised
and artificial reading stimuli and often do not measure the
functional impact that the difficulties have on an individual
performing an everyday task (Wallace, Evans, Arnold, & Hux
2007; Worrall & Fratalli, 2000).
Similarly, there is limited published research that has explored
the effectiveness of functional reading therapy programs.
This is despite the fact that reading plays a part in a variety
of everyday activities (Parr, 1995), ranging from reading
instructions, utility bills, emails, magazines, newspapers, and
books. The aim of the functional approach is text-level
reading, for example reading a whole article or whole page of
a book, rather than single-word or sentence-level reading. In
addition, it allows for planning of activities that are relevant to
the client (e.g., a personally chosen novel), and it combines
both linguistic variables and functional elements (e.g., using
summarising and recall strategies).
Despite Parr’s (1995) research on the significant changes
to functional reading practices as a result of aphasia, much
research on reading difficulties following brain damage
has continued to concentrate on single-word reading
(e.g., Peach, 2002) at the expense of functional reading
and reading for pleasure. As a consequence, very little
literature has been published which addresses more mild
reading difficulties, such as problems with attention and
concentration, which might be seen in traumatic brain
injury or in high functioning stroke patients (Coelho, 2005).
Fawcus, Kerr, Whitehead, and Williams (1991) published a
reading therapy manual that included a range of strategies
recommended for individuals with acquired reading
difficulties, including summarising, scanning and covering
parts of the text or underlining salient words. However
the effectiveness of these strategies in therapy has not
been systematically tested, and the effectiveness of some
functional reading therapy is only incidentally reported. For
example, Worrall and Fratalli (2000) described a client who
pre-morbidly had enjoyed reading restaurant reviews. As a
result of his aphasia, he did not feel confident in his ability to
Functional reading therapy targets everyday
reading such as books or magazines. There is
limited research investigating the effectiveness
of functional reading therapy for acquired
reading difficulties. The aim of this preliminary
research, involving a series of four case studies,
was to evaluate the effectiveness of functional
reading therapy for individuals with acquired
reading difficulties. All participants had different
levels of reading impairment and were at least
four years post-brain damage. Following
individually tailored therapy, all participants
demonstrated a reduction in reading errors,
showed increased comprehension, and
reported increased confidence with reading.
Other improvements relating to rate of reading
and language, such as association naming,
were found in some but not all participants.
Some participants also reported further
psychosocial benefits, such as increased
participation in reading activities. The results
from this study are promising and suggest that
functional reading therapy can be effective
even for participants up to 18 years post-brain
damage.
Reading difficulties are a common consequence of
brain damage (Richardson, 2000), and can restrict
individuals’ access to everyday written materials
within their natural environment. Social isolation, depression
and, low self confidence following brain damage are
recognised as negative long term outcomes, resulting from
the inability of an individual to participate in meaningful
activities, including reading (e.g., Hoofien, Gilboa, Vakil, &,
Donovick, 2001). Two-thirds of the traumatic brain injury
population are under the age of 30 and most are of working
age (Ponsford, Sloan, & Snow, 1995), where basic literacy
is important for performance in the workplace, and literacy
difficulties may impact upon the individual’s confidence and
motivation (Department for Education and Skills, 2007).
Improvement in literacy could help encourage the individual
to access learning, to read for pleasure, and to increase their
confidence in returning to the workplace. The latter may
have significant importance as it could have implications
Functional reading therapy
for individuals with acquired
reading difficulties
A preliminary investigation exploring its effectiveness
Naomi Cocks, Niina Matthews, Lisa Barnett, Emma Phillips, Ruth Middleton, Joan Gregoire-Clarke, and
Madeline Cruice