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1.  Overt use of a tactile-kinesthetic strategy shifts to covert processing in rehabilitation of letter-by-letter reading 
Aphasiology  2010;24(11):1424-1442.
Letter-by-letter readers identify each letter of the word they are reading serially in left to right order before recognizing the word. When their letter naming is also impaired, letter-by-letter reading is inaccurate and can render even single word reading very poor. Tactile and/or kinesthetic strategies have been reported to improve reading in these patients, but only under certain conditions or for a limited set of stimuli.
The primary aim of the current study was to determine whether a tactile/kinesthetic treatment could significantly improve reading specifically under normal reading conditions, i.e. reading untrained words presented in free vision and read without overt use of the strategy.
Methods & Procedures
Three chronic letter-by-letter readers participated in a tactile/kinesthetic treatment aimed at first improving letter naming accuracy (phase 1) and then letter-by-letter reading speed (phase 2). In a multiple case series design, accuracy and speed of reading untrained words without overt use of the trained tactile/kinesthetic strategy was assessed before phase 1, after phase 1 and again after phase 2.
Outcomes & Results
All three patients significantly improved both their speed and accuracy reading untrained words without overt use of the trained tactile/kinesthetic strategy. All three patients required the additional practice in phase 2 to achieve significant improvement. Treatment did not target sentence level reading, yet two of the three patients became so adept that they could read entire sentences.
This study replicates previous findings on the efficacy of tactile/kinesthetic treatment for letter-by-letter readers with poor letter naming. It further demonstrates that this treatment can alter cognitive processing such that words never specifically trained can be read in free vision without overtly using the trained strategy. The data suggest that an important element in achieving this level of generalization is continuing training beyond the point of initial mastery (i.e. accurate letter naming).
PMCID: PMC3002229  PMID: 21170161
aphasia; cognitive rehabilitation; Speech-Language Pathology; pure alexia; letter-by-letter reading; generalization
2.  Design of short Italian sentences to assess near vision performance 
Journal of Optometry  2014;7(4):203-209.
To develop and validate 28 short Italian sentences for the construction of the Italian version of the Radner Reading Chart to simultaneously measure near visual acuity and reading speed.
41 sentences were constructed in Italian language, following the procedure defined by Radner, to obtain “sentence optotypes” with comparable structure and with the same lexical and grammatical difficulty. Sentences were statistically selected and used in 211 normal, non-presbyopic, native Italian-speaking persons. The most equally matched sentences in terms of reading speed and number of reading errors were selected. To assess the validity of the reading speed results obtained with the 28 selected short sentences, we compared the reading speed and reading errors with the average obtained by reading two long 4th-grade paragraphs (97 and 90 words) under the same conditions.
The overall mean reading speed of the tested persons was 189 ± 26 wpm. The 28 sentences more similar in terms of reading times were selected, achieving a coefficient of variation (the relative SD) of 2.2%. The reliability analyses yielded an overall Cronbach's alpha coefficient of 0.98. The correlation between the short sentences and the long paragraph was high (r = 0.85, P < 0.0001).
The 28 short single Italian sentences optotypes were highly comparable in syntactical structure, number, position, and length of words, lexical difficulty, and reading length. The resulting Italian Radner Reading Chart is precise (high consistency) and practical (short sentences) and therefore useful for research and clinical practice to simultaneously measure near reading acuity and reading speed.
PMCID: PMC4213852  PMID: 25323641
Near vision; Reading acuity; Reading speed; Visual acuity; Visión cercana; Agudeza lectora; Velocidad lectora; Agudeza visual
3.  Brain Bases of Reading Fluency in Typical Reading and Impaired Fluency in Dyslexia 
PLoS ONE  2014;9(7):e100552.
Although the neural systems supporting single word reading are well studied, there are limited direct comparisons between typical and dyslexic readers of the neural correlates of reading fluency. Reading fluency deficits are a persistent behavioral marker of dyslexia into adulthood. The current study identified the neural correlates of fluent reading in typical and dyslexic adult readers, using sentences presented in a word-by-word format in which single words were presented sequentially at fixed rates. Sentences were presented at slow, medium, and fast rates, and participants were asked to decide whether each sentence did or did not make sense semantically. As presentation rates increased, participants became less accurate and slower at making judgments, with comprehension accuracy decreasing disproportionately for dyslexic readers. In-scanner performance on the sentence task correlated significantly with standardized clinical measures of both reading fluency and phonological awareness. Both typical readers and readers with dyslexia exhibited widespread, bilateral increases in activation that corresponded to increases in presentation rate. Typical readers exhibited significantly larger gains in activation as a function of faster presentation rates than readers with dyslexia in several areas, including left prefrontal and left superior temporal regions associated with semantic retrieval and semantic and phonological representations. Group differences were more extensive when behavioral differences between conditions were equated across groups. These findings suggest a brain basis for impaired reading fluency in dyslexia, specifically a failure of brain regions involved in semantic retrieval and semantic and phonological representations to become fully engaged for comprehension at rapid reading rates.
PMCID: PMC4109933  PMID: 25058010
4.  Word-Initial Letters Influence Fixation Durations during Fluent Reading 
The present study examined how word-initial letters influence lexical access during reading. Eye movements were monitored as participants read sentences containing target words. Three factors were independently manipulated. First, target words had either high or low constraining word-initial letter sequences (e.g., dwarf or clown, respectively). Second, targets were either high or low in frequency of occurrence (e.g., train or stain, respectively). Third, targets were embedded in either biasing or neutral contexts (i.e., targets were high or low in their predictability). This 2 (constraint) × 2 (frequency) × 2 (context) design allowed us to examine the conditions under which a word’s initial letter sequence could facilitate processing. Analyses of fixation duration data revealed significant main effects of constraint, frequency, and context. Moreover, in measures taken to reflect “early” lexical processing (i.e., first and single fixation duration), there was a significant interaction between constraint and context. The overall pattern of findings suggests lexical access is facilitated by highly constraining word-initial letters. Results are discussed in comparison to recent studies of lexical features involved in word recognition during reading.
PMCID: PMC3317262  PMID: 22485100
reading; eye movements; word-initial letter constraint; word frequency; contextual predictability
5.  Repetition priming in oral text reading: a therapeutic strategy for phonologic text alexia 
Aphasiology  2009;23(6):659-675.
Phonologic text alexia (PhTA) is a reading disorder in which reading of pseudowords is impaired, but reading of real words is impaired only when reading text. Oral reading accuracy remains well preserved when words are presented individually, but when presented in text the part-of-speech effect that is often seen in phonologic alexia (PhA) emerges.
To determine whether repetition priming could strengthen and/or maintain the activation of words during text reading.
Methods & Procedures
We trained NYR, a patient with PhTA, to use a strategy, Sentence Building, designed to improve accuracy of reading words in text. The strategy required NYR to first read the initial word, and then build up the sentence by adding on sequential words, in a step-wise manner, utilizing the benefits of repetition priming to enhance accuracy.
Outcomes & Results
When using the strategy, NYR displayed improved accuracy not only for sentences she practiced using the strategy, but unpracticed sentences as well. Additionally, NYR performed better on a test of comprehension when using the strategy, as compared to without the strategy.
In light of research linking repetition priming to increased neural processing efficiency, our results suggest that use of this compensatory strategy improves reading accuracy and comprehension by temporarily boosting phonologic activation levels.
PMCID: PMC2906786  PMID: 20664804
phonologic text alexia; repetition priming; aphasia; alexia; rehabilitation
6.  The Effect of Letter-stroke Boldness on Reading Speed in Central and Peripheral Vision 
Vision research  2013;84:33-42.
People with central vision loss often prefer boldface print over normal print for reading. However, little is known about how reading speed is influenced by the letter-stroke boldness of font. In this study, we examined the reliance of reading speed on stroke boldness, and determined whether this reliance differs between the normal central and peripheral vision. Reading speed was measured using the rapid serial visual presentation paradigm, where observers with normal vision read aloud short single sentences presented on a computer monitor, one word at a time. Text was rendered in Courier at six levels of boldness, defined as the stroke-width normalized to that of the standard Courier font: 0.27, 0.72, 1, 1.48, 1.89 and 3.04× the standard. Testings were conducted at the fovea and 10° in the inferior visual field. Print sizes used were 0.8× and 1.4× the critical print size (smallest print size that can be read at the maximum reading speed). At the fovea, reading speed was invariant for the middle four levels of boldness, but dropped by 23.3% for the least and the most bold text. At 10° eccentricity, reading speed was virtually the same for all boldness <1, but showed a poorer tolerance to bolder text, dropping by 21.5% for 1.89x boldness and 51% for the most bold (3.04x) text. These results could not be accounted for by the changes in print size or the RMS contrast of text associated with changes in stroke boldness. Our results suggest that contrary to the popular belief, reading speed does not benefit from bold text in the normal fovea and periphery. Excessive increase in stroke boldness may even impair reading speed, especially in the periphery.
PMCID: PMC3642228  PMID: 23523572
Reading; stroke boldness; peripheral vision
7.  Dependence of Reading Speed on Letter Spacing in Central Vision Loss 
Crowding, the difficulty in recognizing a letter in close proximity with other letters, has been suggested as an explanation for slow reading in people with central vision loss. The goals of this study were (1) to examine whether increased letter spacing in words, which presumably reduces crowding among letters, would benefit reading for people with central vision loss; and (2) to relate our finding to the current account of faulty feature integration of crowding.
Fourteen observers with central vision loss read aloud single sentences, one word at a time, using rapid serial visual presentation (RSVP). Reading speeds were calculated based on the RSVP exposure durations yielding 80% accuracy. Letters were rendered in Courier, a fixed-width font. Observers were tested at 1.4× the critical print size (CPS), three were also tested at 0.8× CPS. Reading speed was measured for five center-to-center letter spacings (range: 0.5–2× the standard spacing). The preferred retinal locus (PRL) for fixation was determined for nine of the observers, from which we calculated the horizontal dimension of the integration field for crowding.
All observers showed increased reading speed with letter spacing for small spacings, until an optimal spacing, beyond which reading speed either showed a plateau, or dropped as letter spacing further increased. The optimal spacing averaged 0.95±0.06× [±95%CI] the standard spacing for 1.4× CPS (similar for 0.8× CPS), which was not different from the standard. When converted to angular size, the measured values of the optimal letter spacing for reading show a good relationship with the calculated horizontal dimension of the integration field.
Increased letter spacing beyond the standard size, which presumably reduces crowding among letters in text, does not improve reading speed for people with central vision loss. The optimal letter spacing for reading can be predicted based on the PRL.
PMCID: PMC3429790  PMID: 22842309
reading; crowding; central vision loss; low vision; age-related macular degeneration
8.  Effects of Word Frequency and Modality on Sentence Comprehension Impairments in People with Aphasia 
It is well known that people with aphasia have sentence comprehension impairments. The present study investigated whether lexical factors contribute to sentence comprehension impairments in both the auditory and written modalities using on-line measures of sentence processing.
People with aphasia and non-brain-damaged controls participated in the experiment (n=8 per group). Twenty-one sentence pairs containing high and low frequency words were presented in self-paced listening and reading tasks. The sentences were syntactically simple and differed only in the critical words. The dependent variables were response times for critical segments of the sentence and accuracy on the comprehension questions.
The results showed that word frequency influences performance on measures of sentence comprehension in people with aphasia. The accuracy data on the comprehension questions suggested that people with aphasia have more difficulty understanding sentences containing low frequency words in the written compared to auditory modality. Both group and single case analyses of the response time data also pointed to more difficulty with reading than listening.
The results show that sentence comprehension in people with aphasia is influenced by word frequency and presentation modality.
PMCID: PMC3934565  PMID: 22294411
9.  Difficulty with Out-Loud and Silent Reading in Glaucoma 
We evaluated the impact of glaucoma on out-loud and silent reading.
Glaucoma patients with bilateral visual field (VF) loss and normally-sighted controls had the following parameters measured: speed reading an International Reading Speed Text (IReST) passage out loud, maximum out-loud MNRead chart reading speed, sustained (30 minutes) silent reading speed, and change in reading speed during sustained silent reading.
Glaucoma subjects read slower than controls on the IReST (147 vs. 163 words per minute [wpm], P < 0.001), MNRead (172 vs. 186 wpm, P < 0.001), and sustained silent (179 vs. 218 wpm, P < 0.001) tests. In multivariable analyses adjusting for age, race, sex, education, employment, and cognition, IReST and MNRead reading speeds were 12 wpm (6%–7%) slower among glaucoma subjects compared to controls (P < 0.01 for both), while sustained silent reading speed was 16% slower (95% confidence interval [CI] = −24 to −6%, P = 0.002). Each 5 decibel (dB) decrement in better-eye VF mean deviation was associated with 6 wpm slower IReST reading (95% CI = −9 to −3%, P < 0.001), 5 wpm slower MNRead reading (95% CI = −7 to −2%, P < 0.001), and 9% slower sustained silent reading (95% CI = −13 to −6%, P < 0.001). A reading speed decline of 0.5 wpm/min or more over the sustained silent reading period was more common among glaucoma subjects than controls (odds ratio [OR] = 2.2, 95% CI = 1.0–4.9, P < 0.05).
Reading speed is slower among glaucoma patients with bilateral VF loss, with the greatest impact present during sustained silent reading. Persons with glaucoma fatigue during silent reading, resulting in slower reading over time.
Bilateral visual field loss from glaucoma is associated with slower reading speed and decline of reading speed during prolonged silent reading. Silent reading speed over prolonged durations is more affected by glaucomatous visual field loss than reading out loud for short durations.
PMCID: PMC3559070  PMID: 23074207
10.  Visual word learning in adults with dyslexia 
We investigated word learning in university and college students with a diagnosis of dyslexia and in typically-reading controls. Participants read aloud short (4-letter) and longer (7-letter) nonwords as quickly as possible. The nonwords were repeated across 10 blocks, using a different random order in each block. Participants returned 7 days later and repeated the experiment. Accuracy was high in both groups. The dyslexics were substantially slower than the controls at reading the nonwords throughout the experiment. They also showed a larger length effect, indicating less effective decoding skills. Learning was demonstrated by faster reading of the nonwords across repeated presentations and by a reduction in the difference in reading speeds between shorter and longer nonwords. The dyslexics required more presentations of the nonwords before the length effect became non-significant, only showing convergence in reaction times between shorter and longer items in the second testing session where controls achieved convergence part-way through the first session. Participants also completed a psychological test battery assessing reading and spelling, vocabulary, phonological awareness, working memory, nonverbal ability and motor speed. The dyslexics performed at a similar level to the controls on nonverbal ability but significantly less well on all the other measures. Regression analyses found that decoding ability, measured as the speed of reading aloud nonwords when they were presented for the first time, was predicted by a composite of word reading and spelling scores (“literacy”). Word learning was assessed in terms of the improvement in naming speeds over 10 blocks of training. Learning was predicted by vocabulary and working memory scores, but not by literacy, phonological awareness, nonverbal ability or motor speed. The results show that young dyslexic adults have problems both in pronouncing novel words and in learning new written words.
PMCID: PMC4018562  PMID: 24834044
word learning; reading; dyslexia; word length; repetition; working memory; phonological awareness
11.  Word learning and the cerebral hemispheres: from serial to parallel processing of written words 
Reading familiar words differs from reading unfamiliar non-words in two ways. First, word reading is faster and more accurate than reading of unfamiliar non-words. Second, effects of letter length are reduced for words, particularly when they are presented in the right visual field in familiar formats. Two experiments are reported in which right-handed participants read aloud non-words presented briefly in their left and right visual fields before and after training on those items. The non-words were interleaved with familiar words in the naming tests. Before training, naming was slow and error prone, with marked effects of length in both visual fields. After training, fewer errors were made, naming was faster, and the effect of length was much reduced in the right visual field compared with the left. We propose that word learning creates orthographic word forms in the mid-fusiform gyrus of the left cerebral hemisphere. Those word forms allow words to access their phonological and semantic representations on a lexical basis. But orthographic word forms also interact with more posterior letter recognition systems in the middle/inferior occipital gyri, inducing more parallel processing of right visual field words than is possible for any left visual field stimulus, or for unfamiliar non-words presented in the right visual field.
PMCID: PMC2846318  PMID: 19933140
word learning; reading; hemispheres; visual fields; word length; case alternation
12.  The locus of impairment in English developmental letter position dyslexia 
Many children with reading difficulties display phonological deficits and struggle to acquire non-lexical reading skills. However, not all children with reading difficulties have these problems, such as children with selective letter position dyslexia (LPD), who make excessive migration errors (such as reading slime as “smile”). Previous research has explored three possible loci for the deficit – the phonological output buffer, the orthographic input lexicon, and the orthographic-visual analysis stage of reading. While there is compelling evidence against a phonological output buffer and orthographic input lexicon deficit account of English LPD, the evidence in support of an orthographic-visual analysis deficit is currently limited. In this multiple single-case study with three English-speaking children with developmental LPD, we aimed to both replicate and extend previous findings regarding the locus of impairment in English LPD. First, we ruled out a phonological output buffer and an orthographic input lexicon deficit by administering tasks that directly assess phonological processing and lexical guessing. We then went on to directly assess whether or not children with LPD have an orthographic-visual analysis deficit by modifying two tasks that have previously been used to localize processing at this level: a same-different decision task and a non-word reading task. The results from these tasks indicate that LPD is most likely caused by a deficit specific to the coding of letter positions at the orthographic-visual analysis stage of reading. These findings provide further evidence for the heterogeneity of dyslexia and its underlying causes.
PMCID: PMC4042363  PMID: 24917802
phonological output deficit; orthographic input lexicon deficit; orthographic-visual analysis deficit; migration errors; substitution errors; developmental dyslexia
13.  Assessing multimodal spoken word-in-sentence recognition in children with normal hearing and children with cochlear implants 
To examine multimodal spoken word-in-sentence recognition in children.
Two experiments were undertaken. In Experiment I, the youngest age with which the multimodal sentence recognition materials could be used was evaluated. In Experiment II, lexical difficulty and presentation modality effects were examined, along with test-retest reliability and validity in normal-hearing children and those with cochlear implants.
Normal-hearing children as young as 3.25 years and those with cochlear implants just under 4 years who have used their device for at least 1 year were able to complete the multimodal sentence testing. Both groups identified lexically easy words in sentences more accurately than lexically hard words across modalities, although the largest effects occurred in the auditory-only modality. Both groups displayed audiovisual integration with the highest scores achieved in the audiovisual modality, followed sequentially by auditory-only and visual-only modalities. Recognition of words in sentences was correlated with recognition of words in isolation. Preliminary results suggest fair to good test-retest reliability.
The results suggest that children’s audiovisual word-in-sentence recognition can be assessed using the materials developed for this investigation. With further development, the materials hold promise for becoming a test of multimodal sentence recognition for children with hearing loss.
PMCID: PMC3056932  PMID: 20689028
14.  An electrophysiological analysis of contextual and temporal constraints on parafoveal word processing 
Psychophysiology  2012;50(1):48-59.
During natural reading, parafoveal information is processed to some degree. Although isolated words can be fully processed in the parafovea, not all sentence reading experiments have found evidence of semantic processing in the parafovea. We suggest a possible reconciliation for these mixed results via two ERP studies in which volunteers read sentences presented word by word at fixation, flanked bilaterally by the next word to its right and the previous word to its left. Half the words in the right parafovea of critical triads and in the fovea for the subsequent triad were semantically incongruent. The conditions under which parafoveal words elicit canonical visual N400 congruity effects suggest that they are processed in parallel with foveal words, but that the extraction of semantic information parafoveally is a function of contextual constraint and presentation rate, most likely under high contextual constraint and at slower rates.
PMCID: PMC4096715  PMID: 23153323
Reading; parafovea; parafoveal-on-foveal effect; preview benefit; ERPs; N400
15.  Description and Validation of a Test to Evaluate Sustained Silent Reading 
To construct and validate a test of sustained silent reading.
Standardized 7300 and 7600 word passages were written to evaluate sustained silent reading. Two hundred forty subjects validated whether comprehension questions could discriminate subjects who did and did not read the passage. To evaluate test–retest properties, 49 subjects silently read the standardized passages on separate days. Sixty glaucoma suspect controls and 64 glaucoma subjects had their out loud reading evaluated with the MNRead card and an International Reading Speed Texts (IReST) passage, and their silent reading measured using the 7300 word passage. Sustained silent reading parameters included reading speed and reading speed slope over time.
Comprehension questions distinguished individuals who had and had not read passage materials. Bland-Altman analyses of intersession sustained reading speed and reading speed slope demonstrated 95% coefficients of repeatability of 57 words per minute (wpm) and 2.76 wpm/minute. Sustained silent reading speed was less correlated with MNRead (r = 0.59) or IReST passage (r = 0.68) reading speeds than the correlation of these two measures of out loud reading speed with each other (r = 0.72). Sustained silent reading speed was more likely to differ from IReST reading speed by more than 50% in rapid silent readers (odds ratio [OR] = 29, 95% confidence interval [CI] = 10–87), and comparisons of sustained and out loud reading speeds demonstrated proportional error in Bland-Altman analyses.
Tests of out loud reading do not accurately reflect silent reading speed in individuals with normal vision or glaucoma. The described test offers a standardized way to evaluate the impact of eye disease and/or visual rehabilitation on sustained silent reading.
Sustained silent reading is not captured well by traditional tests of out loud reading, suggesting fundamental differences between these types of reading. A test to evaluate sustained silent reading is described here, and may be useful in assessing the relationship between reading and vision.
PMCID: PMC3559071  PMID: 23258146
16.  Reading with a Simulated 60-Channel Implant 
First generation retinal prostheses containing 50–60 electrodes are currently in clinical trials. The purpose of this study was to evaluate the theoretical upper limit (best possible) reading performance attainable with a state-of-the-art 60-channel retinal implant and to find the optimum viewing conditions for the task. Four normal volunteers performed full-page text reading tasks with a low-resolution, 60-pixel viewing window that was stabilized in the central visual field. Two parameters were systematically varied: (1) spatial resolution (image magnification) and (2) the orientation of the rectangular viewing window. Performance was measured in terms of reading accuracy (% of correctly read words) and reading rates (words/min). Maximum reading performances were reached at spatial resolutions between 3.6 and 6 pixels/char. Performance declined outside this range for all subjects. In optimum viewing conditions (4.5 pixels/char), subjects achieved almost perfect reading accuracy and mean reading rates of 26 words/min for the vertical viewing window and of 34 words/min for the horizontal viewing window. These results suggest that, theoretically, some reading abilities can be restored with actual state-of-the-art retinal implant prototypes if “image magnification” is within an “optimum range.” Future retinal implants providing higher pixel resolutions, thus allowing for a wider visual span might allow faster reading rates.
PMCID: PMC3089939  PMID: 21625622
retinal prostheses; reading; neuroscience; spatial vision; psychophysics; resolution; field of view; simulation of artificial vision
17.  Does pronounceability modulate the letter string deficit of children with dyslexia? A study with the rate and amount model 
Frontiers in Psychology  2014;5:1353.
The locus of the deficit of children with dyslexia in dealing with strings of letters may be a deficit at a pre-lexical graphemic level or an inability to bind orthographic and phonological information. We evaluate these alternative hypotheses in two experiments by examining the role of stimulus pronounceability in a lexical decision task (LDT) and in a forced-choice letter discrimination task (Reicher–Wheeler paradigm). Seventeen fourth grade children with dyslexia and 24 peer control readers participated to two experiments. In the LDT children were presented with high-, low-frequency words, pronounceable pseudowords (such as DASU) and unpronounceable non-words (such as RNGM) of 4-, 5-, or 6- letters. No sign of group by pronounceability interaction was found when over-additivity was taken into account. Children with dyslexia were impaired when they had to process strings, not only of pronounceable stimuli but also of unpronounceable stimuli, a deficit well accounted for by a single global factor. Complementary results were obtained with the Reicher–Wheeler paradigm: both groups of children gained in accuracy in letter discrimination in the context of pronounceable primes (words and pseudowords) compared to unpronounceable primes (non-words). No global factor was detected in this task which requires the discrimination between a target letter and a competitor but does not involve simultaneous letter string processing. Overall, children with dyslexia show a selective difficulty in simultaneously processing a letter string as a whole, independent of its pronounceability; however, when the task involves isolated letter processing, also these children can make use of the ortho-phono-tactic information derived from a previously seen letter string. This pattern of findings is in keeping with the idea that an impairment in pre-lexical graphemic analysis may be a core deficit in developmental dyslexia.
PMCID: PMC4251298  PMID: 25520680
developmental dyslexia; lexical decision; Reicher–Wheeler paradigm; pronounceability; global factor; letter string
18.  Effect of Orthographic Processes on Letter Identity and Letter-Position Encoding in Dyslexic Children 
The ability to identify letters and encode their position is a crucial step of the word recognition process. However and despite their word identification problem, the ability of dyslexic children to encode letter identity and letter-position within strings was not systematically investigated. This study aimed at filling this gap and further explored how letter identity and letter-position encoding is modulated by letter context in developmental dyslexia. For this purpose, a letter-string comparison task was administered to French dyslexic children and two chronological age (CA) and reading age (RA)-matched control groups. Children had to judge whether two successively and briefly presented four-letter strings were identical or different. Letter-position and letter identity were manipulated through the transposition (e.g., RTGM vs. RMGT) or substitution of two letters (e.g., TSHF vs. TGHD). Non-words, pseudo-words, and words were used as stimuli to investigate sub-lexical and lexical effects on letter encoding. Dyslexic children showed both substitution and transposition detection problems relative to CA-controls. A substitution advantage over transpositions was only found for words in dyslexic children whereas it extended to pseudo-words in RA-controls and to all type of items in CA-controls. Letters were better identified in the dyslexic group when belonging to orthographically familiar strings. Letter-position encoding was very impaired in dyslexic children who did not show any word context effect in contrast to CA-controls. Overall, the current findings point to a strong letter identity and letter-position encoding disorder in developmental dyslexia.
PMCID: PMC3356879  PMID: 22661961
letter-string processing; letter-position encoding; letter-identity encoding; letter transposition; letter substitution; reading acquisition; dyslexic children
19.  Training understanding of reversible sentences: a study comparing language-impaired children with age-matched and grammar-matched controls 
PeerJ  2014;2:e656.
Introduction. Many children with specific language impairment (SLI) have problems with language comprehension, and little is known about how to remediate these. We focused here on errors in interpreting sentences such as “the ball is above the cup”, where the spatial configuration depends on word order. We asked whether comprehension of such short reversible sentences could be improved by computerized training, and whether learning by children with SLI resembled that of younger, typically-developing children.
Methods. We trained 28 children with SLI aged 6–11 years, 28 typically-developing children aged from 4 to 7 years who were matched to the SLI group for raw scores on a test of receptive grammar, and 20 typically-developing children who were matched to the SLI group on chronological age. A further 20 children with SLI were given pre- and post-test assessments, but did not undergo training. Those in the trained groups were given training on four days using a computer game adopting an errorless learning procedure, during which they had to select pictures to correspond to spoken sentences such as “the cup is above the drum” or “the bird is below the hat”. Half the trained children heard sentences using above/below and the other half heard sentences using before/after (with a spatial interpretation). A total of 96 sentences was presented over four sessions. Half the sentences were unique, whereas the remainder consisted of 12 repetitions of each of four sentences that became increasingly familiar as training proceeded.
Results. Age-matched control children performed near ceiling (≥ 90% correct) in the first session and were excluded from the analysis. Around half the trained SLI children also performed this well. Training effects were examined in 15 SLI and 16 grammar-matched children who scored less than 90% correct on the initial training session. Overall, children’s scores improved with training. Memory span was a significant predictor of improvement, even after taking into account performance on training session 1. Unlike the grammar-matched controls, children with SLI showed greater accuracy with repeated sentences compared with unique sentences. Training did not improve children’s performance on a standardized test of receptive grammar.
Discussion. Overall, these results indicate that a subset of children with SLI perform well below ceiling on reversible sentences with three key words and simple syntactic structure. For these children, weak verbal short-term memory appears to impair comprehension of spoken sentences. In contrast to the general finding that rule-learning benefits from variable input, these children seem to do best if given repeated exposure to the same nouns used with a given sentence frame. Generalisation to other sentences using the same syntactic frame may be more effective if preceded by such item-specific learning.
PMCID: PMC4226637  PMID: 25392757
Specific language impairment; Child; Language; Intervention; Grammar; Receptive language; Comprehension; Verbal memory; Procedural learning; Speech and language therapy
20.  Modelling normal and impaired letter recognition: Implications for understanding pure alexic reading 
Neuropsychologia  2012;50(12):2773-2788.
Letter recognition is the foundation of the human reading system. Despite this, it tends to receive little attention in computational modelling of single word reading. Here we present a model that can be trained to recognise letters in various spatial transformations. When presented with degraded stimuli the model makes letter confusion errors that correlate with human confusability data. Analyses of the internal representations of the model suggest that a small set of learned visual feature detectors support the recognition of both upper case and lower case letters in various fonts and transformations. We postulated that a damaged version of the model might be expected to act in a similar manner to patients suffering from pure alexia. Summed error score generated from the model was found to be a very good predictor of the reading times of pure alexic patients, outperforming simple word length, and accounting for 47% of the variance. These findings are consistent with a hypothesis suggesting that impaired visual processing is a key to understanding the strong word-length effects found in pure alexic patients.
► We develop a connectionist letter recognition model which provides the link between visual input and letter recognition. ► The model can deal with the invariance problem and generalise to previously unseen letters. ► The model can extract key features for letter recognition. ► We demonstrate the model can simulate confusability effects in normal readers and predict PA patients' RTs. ► Impaired visual processing is a key to understanding the strong word-length effects found in PA patients.
PMCID: PMC3657697  PMID: 22841988
Letter recognition; Letter confusability; Pure alexia; Computational modelling
21.  Eye Movements Reveal Effects of Visual Content on Eye Guidance and Lexical Access during Reading 
PLoS ONE  2012;7(8):e41766.
Normal reading requires eye guidance and activation of lexical representations so that words in text can be identified accurately. However, little is known about how the visual content of text supports eye guidance and lexical activation, and thereby enables normal reading to take place.
Methods and Findings
To investigate this issue, we investigated eye movement performance when reading sentences displayed as normal and when the spatial frequency content of text was filtered to contain just one of 5 types of visual content: very coarse, coarse, medium, fine, and very fine. The effect of each type of visual content specifically on lexical activation was assessed using a target word of either high or low lexical frequency embedded in each sentence
No type of visual content produced normal eye movement performance but eye movement performance was closest to normal for medium and fine visual content. However, effects of lexical frequency emerged early in the eye movement record for coarse, medium, fine, and very fine visual content, and were observed in total reading times for target words for all types of visual content.
These findings suggest that while the orchestration of multiple scales of visual content is required for normal eye-guidance during reading, a broad range of visual content can activate processes of word identification independently. Implications for understanding the role of visual content in reading are discussed.
PMCID: PMC3414467  PMID: 22905106
22.  Predicting Robust Vocabulary Growth from Measures of Incremental Learning 
We report a study of incremental learning of new word meanings over multiple episodes. A new method called MESA (Markov Estimation of Semantic Association) tracked this learning through the automated assessment of learner-generated definitions. The multiple word learning episodes varied in the strength of contextual constraint provided by sentences, in the consistency of this constraint, and in the spacing of sentences provided for each trained word. Effects of reading skill were also examined. Results showed that MESA scores increased with each word learning encounter. MESA growth curves were affected by context constraint, spacing of practice, and reading skill. Most important, the accuracy of participant responses (MESA scores) during learning predicted which words would be retained over a 1-week period. These results support the idea that word learning is incremental and that partial gains in knowledge depend on properties of both the context and the learner. The introduction of MESA presents new opportunities to test word-learning theories and the complex factors that affect growth of word knowledge over time and in different contexts.
PMCID: PMC3064477  PMID: 21442050
23.  What’s the Story? The Tale of Reading Fluency Told at Speed 
Human brain mapping  2011;33(11):2572-2585.
Fluent readers process written text rapidly and accurately, and comprehend what they read. Historically, reading fluency has been modeled as the product of discrete skills such as single word decoding. More recent conceptualizations emphasize that fluent reading is the product of competency in, and the coordination of, multiple cognitive sub-skills (a multi-componential view). In this study, we examined how the pattern of activation in core reading regions changes as the ability to read fluently is manipulated through reading speed. We evaluated 13 right-handed adults with a novel fMRI task assessing fluent sentence reading and lower-order letter reading at each participant’s normal fluent reading speed, as well as constrained (slowed) and accelerated reading speeds. Comparing fluent reading conditions with rest revealed regions including bilateral occipito-fusiform, left middle temporal, and inferior frontal gyral clusters across reading speeds. The selectivity of these regions’ responses to fluent sentence reading was shown by comparison with the letter reading task. Region of interest analyses showed that at constrained and accelerated speeds these regions responded significantly more to fluent sentence reading. Critically, as reading speed increased, activation increased in a single reading-related region: occipital/fusiform cortex (left > right). These results demonstrate that while brain regions engaged in reading respond selectively during fluent reading, these regions respond differently as the ability to read fluently is manipulated. Implications for our understanding of reading fluency, reading development, and reading disorders are discussed.
PMCID: PMC3499039  PMID: 21954000
reading; language; fluency; fluent; fMRI; event-related
24.  Pseudo-Synesthesia through Reading Books with Colored Letters 
PLoS ONE  2012;7(6):e39799.
Synesthesia is a phenomenon where a stimulus produces consistent extraordinary subjective experiences. A relatively common type of synesthesia involves perception of color when viewing letters (e.g. the letter ‘a’ always appears as light blue). In this study, we examine whether traits typically regarded as markers of synesthesia can be acquired by simply reading in color.
Methodology/Principal Findings
Non-synesthetes were given specially prepared colored books to read. A modified Stroop task was administered before and after reading. A perceptual crowding task was administered after reading. Reading one book (>49,000 words) was sufficient to induce effects regarded as behavioral markers for synesthesia. The results of the Stroop tasks indicate that it is possible to learn letter-color associations through reading in color (F(1, 14) = 5.85, p = .030). Furthermore, Stroop effects correlated with subjective reports about experiencing letters in color (r(13) = 0.51, p = .05). The frequency of viewing letters is related to the level of association as seen by the difference in the Stroop effect size between upper- and lower-case letters (t(14) = 2.79, p = .014) and in a subgroup of participants whose Stroop effects increased as they continued to read in color. Readers did not show significant performance advantages on the crowding task compared to controls. Acknowledging the many differences between trainees and synesthetes, results suggest that it may be possible to acquire a subset of synesthetic behavioral traits in adulthood through training.
To our knowledge, this is the first evidence of acquiring letter-color associations through reading in color. Reading in color appears to be a promising avenue in which we may explore the differences and similarities between synesthetes and non-synesthetes. Additionally, reading in color is a plausible method for a long-term ‘synesthetic’ training program.
PMCID: PMC3384588  PMID: 22761905
25.  A dual-route perspective on eye movements of dyslexic readers 
Cognition  2010;115(3):367-379.
This study assessed eye movement abnormalities of adolescent dyslexic readers and interpreted the findings by linking the dual-route model of single word reading with the E-Z Reader model of eye movement control during silent sentence reading. A dysfunction of the lexical route was assumed to account for a reduced number of words which received only a single fixation or which were skipped and for the increased number of words with multiple fixations and a marked effect of word length on gaze duration. This pattern was interpreted as a frequent failure of orthographic whole-word recognition (based on orthographic lexicon entries) and on reliance on serial sublexical processing instead. Inefficiency of the lexical route was inferred from prolonged gaze durations for singly fixated words. These findings were related to the E-Z Reader model of eye movement control. Slow activation of word phonology accounted for the low skipping rate of dyslexic readers. Frequent reliance on sublexical decoding was inferred from a tendency to fixate word beginnings and from short forward saccades. Overall, the linkage of the dual-route model of single word reading and a model of eye movement control led to a useful framework for understanding eye movement abnormalities of dyslexic readers.
PMCID: PMC2976468  PMID: 20227686
Developmental dyslexia; Dual-route model of reading; Eye movement control; E-Z Reader; Lexical route; Sublexical route

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