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Therapy Helps Victims of Alexia
by Lauran Neergaard, Associated Press, July 5, 2004
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An experimental
therapy is helping people with a bewildering condition called
alexia, which can leave its victims speaking normally and able
to spell words aloud but unable to read.
A stroke left Bill seeing written letters that looked like
gibberish - devastating to an educated 62-year-old left
terrified of getting lost amid street signs he couldn't
decipher.
The condition occurs when damage from a stroke or other head
injury severs a crucial connection in the complex brain system
required for reading.
"We're getting information about the shape of the letter into
the part of the brain that knows that shape," but in a different
way, explains Georgetown University neurology professor Rhonda
Friedman, who is leading the experiment funded by the National
Institutes of Health.
It's too early to know how well the technique works, although
Friedman and co-researcher Susan Lott report that a handful of
patients so far, some who hadn't recognized letters in years,
have mastered menus, signs and other everyday reading tasks.
"What good is a person who can't read one letter?" says Bill,
who asked that his last name not be used as he described more
than a year of frustration and embarrassment coping with alexia.
It was more difficult, he says, than relearning to walk. Doctors
had few suggestions; $160-an-hour speech-pathology sessions
failed.
Most bizarre, Bill could write meaningful sentences, but he
couldn't read what he'd written down. The bridge linking his
vision to the brain region that stored memories of those letters
was gone.
Then his doctor heard about Friedman's experiment, a
simple-sounding strategy despite the name "tactile-kinesthetic
reading": First, patients are taught the correct way to write
letters. Then, using a capped pen in one hand, they trace
letters one at a time onto the palm of the other hand until they
can read a word letter-by-letter.
The theory holds that the technique trains brain cells to
retrieve letter memories via another sense than vision, similar
to how children sometimes are taught by tracing letters in sand.
After about six months of therapy, Bill can read some words and
phrases, more and more with practice.
"I couldn't tell an A from an O, and now I can read, now I can
do things on my own," he says with a grin.
It is unknown how often alexia, sometimes called "acquired
dyslexia," occurs. One major study suggests that 19 percent of
elderly stroke survivors suffer some type of language difficulty
involving either verbal or written communication, or both, six
months after the brain attack.
"Disorders of reading are very common following stroke," says
Louis Quatrano of the NIH's National Center for Medical
Rehabilitation Research. Because stroke survivors often have so
many other, more visible disabilities, however, "It is probably
an overlooked or underserved group," Quatrano said.
"A lot of these patients get lost," agrees Georgetown's
Friedman. "The doctors say, `Oh, they can't read; that's not so
bad.'"
Complicating matters, alexia comes in bafflingly different
forms. Unlike Bill's pure alexia, people with so-called partial
alexias recognize letters but can read only certain types of
words. They may read concrete nouns such as "inn," as in hotel,
but cannot decipher more abstract words such as the preposition
"in." Or they may interpret only words spelled like they sound,
understanding "winter" but not "thought."
It depends on exactly where the brain was injured. And
understanding the conditions may provide a better window into
how the brain processes language and learns to read in the first
place, Quatrano says.
Scientists have tried different approaches for each alexia type.
For example, some teach patients automatically to match a vague
word with a concrete one, to trigger recognition.
But there's little data on how well the approaches work.
Friedman's NIH-funded experiment aims to change that, matching
different therapies to different alexias, along with some MRI
scans to see if patients' brain connections really change.
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