ACQ Vol 12 no 1 2010

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ACQ Volume 12, Number 1 2010 39
his self-report on the post therapy feedback questionnaire,
wherein he reported positive outcomes.
PW showed gains across all measures. Her reading
accuracy increased, her rate was largely stable, and she
comprehended more of the text in each extract. Association
naming and sentence construction (MWHLLT) also improved.
Her reading confidence increased and negative emotions
decreased, and she increased her community participation
by visiting the library.
TU’s most observable gain from therapy was a substantial
increase in reading accuracy which was evident in the pre
and post extracts and in weekly baselines. His awareness
of reading errors increased, and he often self-corrected.
Reading rate remained stable, and some improvement in
comprehension was noted. TU also improved on passage
recall and association naming (MWHLLT). His reading
confidence increased, although emotions related to reading
did not change.
KJ’s reading accuracy improved as a result of improved
grapheme to phoneme conversion abilities, which had
a positive impact upon his comprehension of the texts.
Reading errors decreased also across the weekly baseline.
He displayed similar visual errors post therapy, but made
very few phonological or morphological errors. His rate was
generally stable or even slowed over the project, as KJ took
more time to read carefully. His confidence and emotions (on
7 of the 19 questionnaire items) showed positive change. He
reported that he found himself reading more on a day-to-
day basis. KJ also reported he felt his speech had become
“more fluent” when reading as he was able to break words
down and sound them out. The student clinician also
observed KJ’s improved confidence and felt that he was now
more “open to learn” new things.
Discussion
This study investigated the effectiveness of a functional
reading program for four people with acquired reading
difficulties. All participants were at least four years post brain
damage, with two participants who had acquired their brain
damage 18 years previously. All four participants improved in
reading accuracy, reading comprehension, and reading
workers, and in the final session, provided information and
further activities and materials for the participant.
Therapy: approaches, goals and
personal relevance
For all participants, therapy involved learning functional strategies
to aid reading, with an emphasis on independent use. Strategies
such as highlighting keywords to understand the gist of the
text and using prompt sheets to help recall were used. However,
all therapy was tailored to the individual participant and modified
according to individual strengths, areas of need, preferences
and interests. For example, one participant needed several
sessions in order to identify keywords independently in the text,
whereas another participant learned this quickly and moved
on to therapy that targeted phoneme to grapheme conversion.
All participants had materials modified visually, often by
modifying font or increasing font size, and by using colour
contrasts. Therapy-related information is detailed in table 2.
Outcome measures
Weekly baselines were completed throughout therapy to
monitor progress, in addition to comparisons made with
pre- and post therapy assessments. These collected
information on reading accuracy (reading aloud),
comprehension, ability to summarise, and use of strategies.
Materials used for the weekly baselines were chosen to
reflect the participant’s interests (see table 2). Each
investigator analysed the baseline texts chosen for each
individual to ensure that they were similar in complexity to
each other, using either SMOG 3 values (McLaughlin 1969) or
Flesch-Kincaid measures4 (Flesch, 1948).
Results
Results for four individuals are reported in tables 3 and 4.
Feedback questionnaires with participants and key-workers
revealed positive changes for the individuals involved.
MM’s reading rate on assessment extracts and weekly
baselines remained largely stable across the project;
however, his reading accuracy improved as reading errors
decreased. MM’s reading confidence decreased and
negative emotions increased post therapy. This contradicted
Table 2. Therapy related information for each participant
Participant Reading prior to therapy Goals for therapy Materials and approaches
MM Newspapers, letters and bills To remember what he had Mock and real bills and letters, horoscopes, newspaper
Able to read short pieces of text, read, without needing to articles, and R&B music reviews
but struggled to glean and recall re-read the text several times Identifying and highlighting keywords, then re-reading these
the salient information to aid memory. Prompt cards to aid independence, and as
reminders to remain calm and positive about abilities
PW Novels To use compensatory A novel that she had read previously but was unable to recall.
Slow reading rate, errors when strategies at a functional Summarising, writing down key points in a note book,
reading aloud, particularly level to enable her to blocking out the line of text below the line being read, using
substituting one word for another, complete a novel, and to her finger or a ruler to facilitate her reading. Using a dictionary
difficulty reading numbers, recalling retain and recall the to research unfamiliar words. Prompt card to remind her to
chunks of text read and drawing information read over time use strategies
appropriate inferences from text
TU Newspapers, letters, bills To be able to remember what BBC Wildlife magazine
Errors when reading aloud, slow he had read, and to discuss Identifying keywords (nouns and verbs), starting with short
reading rate, and difficulties with this with others, especially sentences and building up to short articles, aided with prompt
comprehension and recall his wife. To improve his cards to support independent use
confidence
KJ Newspapers To improve reading Geography text, the National Geographic Magazine, and a
Difficulty remembering what comprehension and read history novel about the Battle of Britain.
he had read and difficulty more fluently out loud Strategic approaches such as summarising text, and more
drawing inferences from text targeted phoneme to grapheme conversion therapy, prompt
cards to encourage independence