How Does iReadMore Therapy Change the Reading Network of Patients with Central Alexia?

Abstract

Central alexia (CA) is an acquired reading disorder co-occurring with a generalized language deficit (aphasia). The roles of perilesional and ipsilesional tissue in recovery from poststroke aphasia are unclear. We investigated the impact of reading training (using iReadMore, a therapy app)ontheconnectionswithinandbetweentherightandlefthemisphereofthereadingnetworkofpatientswithCA.Inpatientswithpurealexia, iReadMore increased feedback from left inferior frontal gyrus (IFG) region to the left occipital (OCC) region. We aimed to identify whether iReadMore therapy was effective through a similar mechanism in patients with CA. Participants with chronic poststroke CA (n ϭ 23) completed 35 h of iReadMore training over 4 weeks. Reading accuracy for trained and untrained words was assessed before and after therapy. The neural response to reading trained and untrained words in the left and right OCC, ventral occipitotemporal, and IFG regions was examined using event-related magnetoencephalography. The training-related modulation in effective connectivity between regions was modeled at the group level with dynamic causal modeling. iReadMore training improved participants' reading accuracy by an average of 8.4% (range, Ϫ2.77 to 31.66) while accuracy for untrained words was stable. Training increased regional sensitivity in bilateral frontal and occipital regions, and strengthened feedforward connections within the left hemisphere. Our data suggest that iReadMore training in these patients modulates lower-order visual representations, as opposed to higher-order, more abstract representations, to improve word-reading accuracy.

The contribution of phonological information to visual word recognition: Evidence from Chinese phonetic radicals

“…After all, this is an area in the visual cortex, which is more responsible for visual feature extraction of visual word recognition (Lerma-Usabiaga et al, 2018) but not typically associated with phonological processing (remember that the lateralization was stronger for PhoW stimuli than for SemW stimuli). However, this finding is in line with Price and Devlin's (2011) model of visual word recognition, which assumes highly interactive processes between the anterior language areas in the frontal cortex and the posterior language areas in the occipitotemporal cortex (for empirical evidence related to the model, see Barca et al, 2011;Chu & Meltzer, 2019;Kerry et al, 2019;Pammer et al, 2004;Selpien et al, 2015;Stevens et al, 2017;Strother et al, 2016Strother et al, , 2017Woodhead et al, 2013Woodhead et al, , 2014. Woodhead et al 2014 On the basis of Woodhead et al (2014), we had hoped to find lateralization in VWFA and IFG for PhoW stimuli.…”

“…Stevens et al (2017) presented evidence that the occipital word form area may already have functional connectivity with the other language areas shown in Fig 1. Also in patients with pure alexia, there is evidence that the connections between the left occipital cortex and left vOT and IFG can be strengthened by reading training (Woodhead et al, 2013;Kerry et al, 2019).…”

Effect of mobile application types on stroke rehabilitation: a systematic review

“…The characteristics for all 18 quasi-experimental studies are presented in Table 2 . Thirteen quasi-experimental studies used a pre-test post-test design [ 32 – 34 , 36 , 37 , 40 – 43 , 45 – 49 ], 3 were a nonrandomized clinical trial [ 35 , 38 , 39 , 45 ], and 1 was a crossover design study [ 43 ].…”

“…Six quasi-experimental studies (Table 2 ) used therapy apps to study aphasia, and each showed improvement in aphasia recovery. The mobile app designs focused on expressive and receptive communication by creating visual associations with pictures [ 40 , 45 , 46 ] or using voice recognition software to guide tasks [ 34 , 36 , 44 ]. One study also used a spatial awareness game, Bejeweled, to target chronic (> 1 year) expressive aphasia but it had no impact on recovery [ 44 ].…”

“…In a 2020 systematic review and meta-analysis, there was evidence supporting the use of face-to-face constraint-induced aphasia therapy which focuses on forcing patients to use verbal language with massed practice [ 62 ]. In this review, 6 quasi-experimental studies [ 34 , 36 , 40 , 44 – 46 ] explored the impact on aphasia using mobile apps built on similar principles to constraint-induced aphasia. In all the studies, aphasia scores were found to improve after each study period.…”