ACQ Vol 12 no 1 2010

Literacy

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

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. R eading 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

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

Keywords ACQUIRED DYSLEXIA APHASIA FUNCTIONAL THERAPY HEAD INJURY

READING THERAPY

This article has been peer- reviewed

Naomi Cocks (top) and Madeline Cruice

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ACQ Volume 12, Number 1 2010

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