Purpose: Improving writing in people with aphasia could improve ability to communicate, reduce isolation and increase access to information. One area that has not been sufficiently explored is the effect of impairment based spelling therapies on functional writing. A multiple case study was conducted with eight participants with aphasia subsequent to stroke. This aimed to measure the effects of spelling therapy on functional writing and perception of disability.Method: Participants engaged in ten sessions of copy and recall spelling therapy.Outcome measures included spelling to dictation of trained and untrained words, written picture description, spelling accuracy within emails, a disability questionnaire and a writing frequency diary.Results: All participants made significant gains on treated words and six demonstrated improvements to untreated words. Group analyses showed significant improvements to written picture description, but not email writing, writing frequency or perceptions of disability.Conclusions: These results show that small doses of writing therapy can lead to large gains in specific types of writing. These gains did not extend to improvements in frequency of writing in daily living, nor ecological measures of email writing. There is a need to develop bridging interventions between experimental tasks towards more multi-faceted and ecological everyday writing tasks.
IntroductionIn recent years, written communication via the internet and mobile phones has become an increasingly important part of everyday life in social, educational and professional spheres [1,2]. Among the multiple disabilities that can result from brain injury, one that could significantly impede access to the internet is dysgraphia, an acquired disorder of writing [3]. Dysgraphia frequently occurs as one symptom of aphasia [4], an acquired multi-modal language disorder caused by traumatic brain injury, brain tumour, surgery, infection, or most commonly, stroke [5]. A recent survey study conducted by Menger, Morris & Salis [6] found that people with aphasia use the internet less than people with stroke and no aphasia. Moreover, people with aphasia reported that their aphasia was the main barrier to using the internet.The writing rehabilitation literature is dominated by single case studies evaluating model-driven impairment-based therapies, such as copy and recall therapy [7] and strategies such as visual-imagery [8] or phoneme to grapheme conversion (i.e., sounds to letters) [9]. The aim of many of these therapies has been to improve single word writing, and the effects on functional, everyday writing activities (e.g. letters,emails, text messages, shopping lists) have not usually been measured. However, there have been some exceptions. Several studies have encouraged participants to generalise gains of impairment-based spelling therapies to more natural writing contexts such as letters, emails and essays [8,10,11,12,13]. For example, Mortley, Enderby and Petheram [13] conducted a single case study with a participant wi...