Oral Reading for Language in Aphasia: Impact of Aphasia Severity on Cross-Modal Outcomes in Chronic Nonfluent Aphasia

ABSTRACT

This study examined the efficacy of a treatment, Oral Reading for Language in Aphasia (ORLA), for individuals with chronic nonfluent aphasia of varying severity levels. With ORLA, the person with aphasia systematically and repeatedly reads sentences aloud, first in unison with the clinician and then independently. Following a period of no treatment, 25 individuals with chronic nonfluent aphasia received 24 sessions of ORLA, 1 to 3 times per week. A small, but significant mean change in the Western Aphasia Battery (WAB) Aphasia Quotient (AQ) was obtained from pre- to post-treatment. When subjects were divided by severity, medium effect sizes were obtained for all severity levels from pre- to post-treatment for the WAB AQ. Medium effect sizes were obtained for the severe aphasia group on the WAB reading subtests only, for the moderate aphasia group on the discourse measures only, and for the mild to moderate aphasia group on both the discourse and WAB writing subtests. Although more intensive therapy is preferred, individuals with chronic nonfluent aphasia may improve their language skills with low-intensity ORLA treatment, and differences in modality-specific outcomes may be anticipated based on the severity of the aphasia.

KEYWORDS

Aphasia - rehabilitation - language therapy - reading

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Appendix: Oral Reading for Language in Aphasia (ORLA)

1. The speech-language pathologist reads aloud to the patient, pointing to each word as he or she reads along. The length of the material may vary from 3 to 100 words, depending on the auditory comprehension skills of the patient.

2. The speech-language pathologist reads aloud to the patient again, pointing to each word as he or she reads along and encouraging the patient to also point to each word.

3. The speech-language pathologist reads the paragraph aloud together with the patient, while continuing to point to each word as he or she reads along. The patient also points to each word. The clinician adjusts the rate and volume of the oral reading according to the specific patient (e.g., reading a little ahead of the patient so he or she is able to hear the initial phonemes of the words; decreasing volume as the patient requires fewer cues).

4. For each line or sentence of the paragraph, the speech-language pathologist states a word that the patient must then identify. Words may be content words (e.g., nouns, verbs) or function words (e.g., pronouns, prepositions, conjunctions).

5. For each line or sentence of the paragraph, the speech-language pathologist points to a word for the patient to read aloud. Both content and function words are selected.

6. The patient reads the whole sentence aloud again in unison with the speech-language pathologist.