ACQ Vol 12 no 1 2010

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 measures 4 (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

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

Materials and approaches

MM

Newspapers, letters and bills Able to read short pieces of text, but struggled to glean and recall

To remember what he had read, without needing to

Mock and real bills and letters, horoscopes, newspaper

articles, and R&B music reviews

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 A novel that she had read previously but was unable to recall. Summarising, writing down key points in a note book, blocking out the line of text below the line being read, using her finger or a ruler to facilitate her reading. Using a dictionary to research unfamiliar words. Prompt card to remind her to

PW

Novels

To use compensatory strategies at a functional level to enable her to complete a novel, and to

Slow reading rate, errors when reading aloud, particularly substituting one word for another,

difficulty reading numbers, recalling retain and recall the

chunks of text read and drawing appropriate inferences from text

information read over time

use strategies

TU

Newspapers, letters, bills

To be able to remember what BBC Wildlife magazine

Errors when reading aloud, slow reading rate, and difficulties with

he had read, and to discuss Identifying keywords (nouns and verbs), starting with short

this with others, especially his wife. To improve his

sentences and building up to short articles, aided with prompt

comprehension and recall

cards to support independent use

confidence

KJ

Newspapers

To improve reading

Geography text, the National Geographic Magazine , and a

Difficulty remembering what he had read and difficulty drawing inferences from text

comprehension and read more fluently out loud

history novel about the Battle of Britain.

Strategic approaches such as summarising text, and more targeted phoneme to grapheme conversion therapy, prompt cards to encourage independence

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ACQ Volume 12, Number 1 2010

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