Diagnosis and rehabilitation attempt of a patient with acquired dyslexia

Carthery-Goulart, Maria Teresa; Senaha, Mirna Lie Hosogi

doi:10.1590/S1980-57642008DN10100014

Abstract

Although dyslexia is a common consequence of brain damage there are few studies about the rehabilitation of this disorder. Cognitive Neuropsychology models of reading have been used to describe several syndromes of acquired dyslexia. Phonological dyslexia is a reading disorder characterized by a dysfunctional grapheme-to-phoneme conversion procedure, which affects the ability to read low frequency words and nonwords. Lexical reading is preserved and patients can read frequent words (regular and irregular).

Objective:

Verify the application of the cognitive model in the characterization of the reading disorder of a patient with acquired dyslexia and in the devising and implementation of a rehabilitation plan.

Methods:

This study presents OCS, a 57-year-old patient who suffered from acquired phonological dyslexia after a left temporo-parietooccipital ischemic stroke. A rehabilitation program based on the principles of Cognitive Neuropsychology was devised non-words and low frequency words with controlled lengths were used and the patient was stimulated to read them aloud in a 22-session treatment.

Results:

The post-test evaluation showed quantitative and qualitative improvements Significant improvements were verified in the total number of correct responses including self-correction attempts (p<0.01) and in the reading of trisyllabic and polysyllabic non-words of simple syllabic structure (p=0.0007 and p=0.02 respectively).

Conclusions:

The use of the cognitive model to devise a rehabilitation program was successful and we observed significant improvement of reading skills in a short period of treatment. The achievements over this period provided the patient with functional reading performance.

Key words:
acquired dyslexia; diagnosis; language and speech disorder rehabilitation; aphasia.

Resumo

Embora a dislexia seja uma seqüela comum após lesões cerebrais há poucos estudos sobre a reabilitação deste distúrbio. Modelos de leitura da Neuropsicologia Cognitiva têm sido utilizados para descrever diversas síndromes de dislexia adquirida. A dislexia fonológica é um distúrbio de leitura caracterizado por disfunção do procedimento de conversão grafema-fonema que afeta a capacidade de leitura de palavras de baixa freqüência e de não-palavras. A leitura lexical está preservada e os pacientes podem ler palavras freqüentes (regulares e irregulares).

Objetivo:

Verificar a aplicação do modelo cognitivo na caracterização do distúrbio de leitura de uma paciente com dislexia adquirida e na elaboração e implementação de um programa de reabilitação.

Métodos:

Este estudo apresenta OCS, uma paciente de 57 anos, com dislexia do tipo fonológica adquirida após acidente vascular cerebral isquêmico temporo-parieto-occipital à esquerda. Um programa de reabilitação baseado nos princípios da Neuropsicologia Cognitiva foi elaborado. Não-palavras e palavras de baixa freqüência com tamanhos controlados foram usadas e a paciente era estimulada a ler os estímulos em voz alta em um tratamento realizado em 22 sessões.

Resultados:

A avaliação pós-teste mostrou melhoras quantitativas e qualitativas. Melhoras significativas foram verificadas no total de respostas corretas, incluindo autocorreções (p<0.01) e na leitura de palavras trissílabas e polissílabas de estrutura silábica simples (p=00007 e p=002 respectivamente).

Conclusões:

O uso do modelo cognitivo para propor um programa de reabilitação foi bem sucedido e pudemos observar melhora significativa das habilidades de leitura em um período curto de tratamento. As melhoras atingidas nesse período resultaram em desempenho funcional de leitura.

Palavras-chave:
dislexia adquirida; diagnóstico; reabilitação dos transtornos da fala e da linguagem; afasia.

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References

¹
Ellis AW, Young AW. Human cognitive neuropsychology. Londres: Lawrence Erlbaum; 1988:191-238.
²
Lecours AR, Delgado AP, Pimenta MAM. Distúrbios adquiridos da leitura e da escrita. In: LL Mansur, Rodrigues N, editors. Temas em neurolinguística. São Paulo: Tec Art; 1993:45-62.
³
Lecours AR, Parente MAMP. Dislexias na escrita do Português. Porto Alegre: Artes Médicas; 1997.
⁴
Seron X, Deloche G. Cognitive approaches in neuropsychological rehabilitation London: Lawrence Erlbaum Associates; 1989.
⁵
Riddoch MJ, Humphreys GW. Cognitive neuropsychologyand cognitive rehabilitation. Hillsdale, NJ: Lawrence Erlbaum Associates; 1994.
⁶
Bachy-Langedock N, De Partz MP. Coordination of tworeorganization therapies in a deep dyslexic patient with oral naming disorder In: Seron X, Deloche G, editors. Cognitive approaches in neuropsychological rehabilitation London: Lawrence Erlbaum Associates; 1989.
⁷
Mitchum CC, Berndt RS. Diagnosis and treatment of thenon-lexical route in acquired dyslexia: an illustration of the cognitive neuropsychological approach. J Neurolinguistics 1991;6:103-137.
⁸
De Partz MP, Seron X,Van Der Linden M. Re-education of asurface dysgraphia with a visual imagery strategy. Cog Neuropsychol 1992;50:369-401.
⁹
Friedman RB. Recovery from deep alexia to phonologicalalexia: points on a continuum, Brain Lang 1996;52:114-128.
¹⁰
Luiz MOR, Senaha MLH. Cognitive approach efficacy in therehabilitation of a deep dyslexic patient (Abstr). Arq Neuropsiquiatr 1998;56(suppl 1):335.
¹¹
Goodglass H, Kaplan E, The assessment of aphasia andrelated disorders. Philadelphia Lea: Febiger; 1972.
¹²
Parente MAMP, Hosogi MLS, Delgado AP, Lecours AR, Protocolo de leitura para o projeto Human Frontier Science Project, São Paulo; 1992.
¹³
Parente MAMP, Senaha MLH, Carthery MT. A abordagemda neuropsicologia cognitiva nos distúrbios adquiridos de leitura e escrita. In: Macedo EC, Gonçalves MJ, Capovilla FC, Sennyey AL, editors. Tecnologia em (Re)habilitação cognitiva, um novo olhar para avaliação e intervenção São Paulo: Centro universitário São Camilo e Sociedade Brasileira de Neuropsicologia; 2002:92-102.
¹⁴
Coltheart M, Byng S. A treatment for surface dyslexia In: Seron X, Deloche G, editors., Cognitive approaches in neuropsychological rehabilitation London: Lawrence Erlbaum Associates; 1989.
¹⁵
Weekes B, Coltheart M. Surface dyslexia and surface dysgraphia: treatment studies and their theoretical implication. Cog Neuropsychol 1996;13:277-315.

Publication Dates

Publication in this collection
Jan-Mar 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Ellis AW, Young AW. Human cognitive neuropsychology. Londres: Lawrence Erlbaum; 1988:191-238.

[2] ²
Lecours AR, Delgado AP, Pimenta MAM. Distúrbios adquiridos da leitura e da escrita. In: LL Mansur, Rodrigues N, editors. Temas em neurolinguística. São Paulo: Tec Art; 1993:45-62.

[3] ³
Lecours AR, Parente MAMP. Dislexias na escrita do Português. Porto Alegre: Artes Médicas; 1997.

[4] ⁴
Seron X, Deloche G. Cognitive approaches in neuropsychological rehabilitation London: Lawrence Erlbaum Associates; 1989.

[5] ⁵
Riddoch MJ, Humphreys GW. Cognitive neuropsychologyand cognitive rehabilitation. Hillsdale, NJ: Lawrence Erlbaum Associates; 1994.

[6] ⁶
Bachy-Langedock N, De Partz MP. Coordination of tworeorganization therapies in a deep dyslexic patient with oral naming disorder In: Seron X, Deloche G, editors. Cognitive approaches in neuropsychological rehabilitation London: Lawrence Erlbaum Associates; 1989.

[7] ⁷
Mitchum CC, Berndt RS. Diagnosis and treatment of thenon-lexical route in acquired dyslexia: an illustration of the cognitive neuropsychological approach. J Neurolinguistics 1991;6:103-137.

[8] ⁸
De Partz MP, Seron X,Van Der Linden M. Re-education of asurface dysgraphia with a visual imagery strategy. Cog Neuropsychol 1992;50:369-401.

[9] ⁹
Friedman RB. Recovery from deep alexia to phonologicalalexia: points on a continuum, Brain Lang 1996;52:114-128.

[10] ¹⁰
Luiz MOR, Senaha MLH. Cognitive approach efficacy in therehabilitation of a deep dyslexic patient (Abstr). Arq Neuropsiquiatr 1998;56(suppl 1):335.

[11] ¹¹
Goodglass H, Kaplan E, The assessment of aphasia andrelated disorders. Philadelphia Lea: Febiger; 1972.

[12] ¹²
Parente MAMP, Hosogi MLS, Delgado AP, Lecours AR, Protocolo de leitura para o projeto Human Frontier Science Project, São Paulo; 1992.

[13] ¹³
Parente MAMP, Senaha MLH, Carthery MT. A abordagemda neuropsicologia cognitiva nos distúrbios adquiridos de leitura e escrita. In: Macedo EC, Gonçalves MJ, Capovilla FC, Sennyey AL, editors. Tecnologia em (Re)habilitação cognitiva, um novo olhar para avaliação e intervenção São Paulo: Centro universitário São Camilo e Sociedade Brasileira de Neuropsicologia; 2002:92-102.

[14] ¹⁴
Coltheart M, Byng S. A treatment for surface dyslexia In: Seron X, Deloche G, editors., Cognitive approaches in neuropsychological rehabilitation London: Lawrence Erlbaum Associates; 1989.

[15] ¹⁵
Weekes B, Coltheart M. Surface dyslexia and surface dysgraphia: treatment studies and their theoretical implication. Cog Neuropsychol 1996;13:277-315.

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