What are specific areas to target for writing treatment at the sentence-level? ๐คท๐ผโโ๏ธ๐โโฃ
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When treating agaraphia at the sentence-level, syntax and morphology are areas that may be contributing to writing difficulties โ๐ผ โฃ
Agraphia Assessment: Sentence-Level Assessment
Have you ever had a client who writes single words successfully, but struggles when trying to string those words together into sentences? โ๐ผโ๐ซโฃ
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Agraphia assessment at the sentence-level examines the language skills outside of spelling, such as ๐ด๐บ๐ฏ๐ต๐ข๐น and ๐ฎ๐ฐ๐ณ๐ฑ๐ฉ๐ฐ๐ญ๐ฐ๐จ๐บ ๐โฃ
The Neuroscience of Writing
What areas of the brain have been associated with agraphia when lesioned? ๐ง ๐ฅ โฃ
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Writing is a complex process, with ๐ ๐๐ก๐ฌ areas of the brain playing a role. This results in large neural networks responsible for the writing process โ๐ผ โฃ
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That being said, the traditional agraphia classifications do have lesion sites that are associated with them.
Assistive Technology: Speech-to-Text Software
What kinds of technology supports are available to people with agraphia? โ๐ผ ๐ป โฃ
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๐ฆ๐ฝ๐ฒ๐ฒ๐ฐ๐ต-๐๐ผ-๐ง๐ฒ๐
๐ ๐๐ผ๐ณ๐๐๐ฎ๐ฟ๐ฒ allows spoken material captured by a microphone/headset to be transcribed into text for computer programs. ๐ โฃ
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Though many softwares exist, here are some popular options that you may consider looking into for your clients.
Combined Lexical and Sublexical Treatment
In order to correctly write a word, there are a LOT of steps involved ๐งฉ โฃ
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Therefore, for many people with agraphia there is no one single cause for their writing problems. Rather, there are a variety of language processing components that are compromised and result in difficulty writing single words. โ๐ผ โฃ
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๐๐ผ๐บ๐ฏ๐ถ๐ป๐ฒ๐ฑ ๐๐ฒ๐
๐ถ๐ฐ๐ฎ๐น ๐ฎ๐ป๐ฑ ๐ฆ๐๐ฏ๐น๐ฒ๐
๐ถ๐ฐ๐ฎ๐น ๐ง๐ฟ๐ฒ๐ฎ๐๐บ๐ฒ๐ป๐ (Johnson, Ross & Kiran, 2017) is designed to target ALL aspects of written word processing. ๐๐ผโฃ
Agraphia Treatment: Single Word-Level Treatments
What are your go-to treatment approaches for writing at the single word-level? ๐โฃ
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Though the specific treatment technique used will depend on your clientโs individual needs, itโs helpful to be familiar with a variety of approaches so that youโll always be ready to go at a momentโs notice! ๐๐ผ๐๐ผโฃ
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Here are 3 different approaches that youโll want to have in your clinical toolbox:โฃ
Agraphia Classifications
Agraphia Assessment: Single-Word Assessment
When assessing for agraphia at the single word-level, what are you looking for? ๐ต๏ธโโ๏ธ โฃ
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Written language is complicated, and there are lots of factors that go into understanding the difference between why a client may write COW for โhorseโ or spell SIGHKIK for โpsychicโ ๐ ๐ฎ โฃ
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Here are some linguistic variables youโll want to pay close attention to when assessing agraphia at the single word-level:โฃ
What Books Do Your Clients Want to Read?
๐ What books do your clients want to read? ๐ โฃ
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Iโve been working with a client who belongs to an online book club, and the most recent discussion focused on passages from Kate Andersen Browerโs โ๐๐ถ๐ฟ๐๐ ๐ช๐ผ๐บ๐ฒ๐ป: ๐ง๐ต๐ฒ ๐๐ฟ๐ฎ๐ฐ๐ฒ ๐ฎ๐ป๐ฑ ๐ฃ๐ผ๐๐ฒ๐ฟ ๐ผ๐ณ ๐๐บ๐ฒ๐ฟ๐ถ๐ฐ๐ฎโ๐ ๐๐ถ๐ฟ๐๐ ๐๐ฎ๐ฑ๐ถ๐ฒ๐โ ๐บ๐ธโฃ
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Weโve been using ๐๐๐๐ฒ๐ป๐๐ถ๐๐ฒ ๐ฅ๐ฒ๐ฎ๐ฑ๐ถ๐ป๐ด ๐ฎ๐ป๐ฑ ๐๐ผ๐ป๐๐๐ฟ๐ฎ๐ถ๐ป๐ฒ๐ฑ ๐ฆ๐๐บ๐บ๐ฎ๐ฟ๐ถ๐๐ฎ๐๐ถ๐ผ๐ป (๐๐ฅ๐๐ฆ) and the ๐ฃ๐ค๐ฅ๐ฆ๐ง ๐บ๐ฒ๐๐ต๐ผ๐ฑ to dive into the passages for the book club, allowing my client to better understand what she is reading and come up with discussion points for the group ๐ฃโฃ
What is Agraphia?
โ๐ผ A writing problem following neurological damage is known as ๐ฎ๐ด๐ฟ๐ฎ๐ฝ๐ต๐ถ๐ฎ โ๐ผโฃ
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Agraphia can have both a ๐ฎ๐ฐ๐ต๐ฐ๐ณ component and a ๐ญ๐ข๐ฏ๐จ๐ถ๐ข๐จ๐ฆ component. The motor component involves difficulties with formation of letter shapes, while the language component involves difficulties with spelling ๐โฃ
Alexia and Aphasia Textbooks
๐ Textbook Time! ๐ โฃ
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A good textbook is invaluable when trying to dive into the specifics of a certain disorder or condition. When I find a text that is well-written and full of resources, I find that I come back to it time and time again.โฃ
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For alexia, here are the texts that I have found to be helpful as clinical resources:โฃ
Alexia Treatment: Life Participation Approach
In order for therapy to make the biggest impact, therapy tasks need to be centered around meaningful activities ๐ฃโฃ
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The ๐๐ถ๐ณ๐ฒ ๐ฃ๐ฎ๐ฟ๐๐ถ๐ฐ๐ถ๐ฝ๐ฎ๐๐ถ๐ผ๐ป ๐๐ฝ๐ฝ๐ฟ๐ผ๐ฎ๐ฐ๐ต ๐๐ผ ๐๐ฝ๐ต๐ฎ๐๐ถ๐ฎ utilizes a model known as the ๐-๐๐ฅ๐ข๐ (Living with Aphasia: Framework for Outcome Measurement). The A-FROM has 4 distinct domains that all contribute to living with aphasia.
Alexia Classifications
When diagnosing an alexia, there are 2 major types of classifications: ๐ฃ๐ฒ๐ฟ๐ถ๐ฝ๐ต๐ฒ๐ฟ๐ฎ๐น ๐๐น๐ฒ๐
๐ถ๐ฎ๐ and ๐๐ฒ๐ป๐๐ฟ๐ฎ๐น ๐๐น๐ฒ๐
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๐๐ฆ๐ณ๐ช๐ฑ๐ฉ๐ฆ๐ณ๐ข๐ญ ๐๐ญ๐ฆ๐น๐ช๐ข๐ด affect the early stages of the reading process and involve difficulty perceiving the written word. In a Peripheral Alexia, individual letters may be misidentified and lead to errors such as reading โbookโ for BOOT.โฃ
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๐๐ฆ๐ฏ๐ต๐ณ๐ข๐ญ ๐๐ญ๐ฆ๐น๐ช๐ข๐ด affect the later stages of the reading process and involve impairments of lexical processing and sublexical processing. In a Central Alexia, the semantic system may be impaired which results in the word COW being misread as โhorseโ (thereby making a semantic substitution).โฃ
Assistive Technology: Text-to-Speech Software
Text-to-Speech is a type of assistive technology that reads digital text aloud. While there are quite a few Text-to-Speech (TTS) softwares and apps to choose from, several popular ones include the following:โฃ ๐ก๐ฎ๐๐๐ฟ๐ฎ๐น ๐ฅ๐ฒ๐ฎ๐ฑ๐ฒ๐ฟ, ๐ง๐ง๐ฆ๐ฅ๐ฒ๐ฎ๐ฑ๐ฒ๐ฟ, ๐ง๐ฎ๐น๐ธ ๐๐๐๐๐ผ๐ป, and ๐๐ฟ๐ผ๐๐๐ฒ๐ฎ๐น๐ผ๐๐ฑ.
Alexia Treatment: Discourse/Paragraph-Level Treatments
Treatment for alexia at the paragraph/discourse-level tends to emphasize metacognitive strategy use and environmental supports. โฃ Approaches you may consider using include:โฃ ๐๐๐๐ฒ๐ป๐๐ถ๐๐ฒ ๐ฅ๐ฒ๐ฎ๐ฑ๐ถ๐ป๐ด ๐ฎ๐ป๐ฑ ๐๐ผ๐ป๐๐๐ฟ๐ฎ๐ถ๐ป๐ฒ๐ฑ ๐ฆ๐๐บ๐บ๐ฎ๐ฟ๐ถ๐๐ฎ๐๐ถ๐ผ๐ป (๐๐๐ฅ๐ฆ), PQRST, and Supported Reading Comprehension Strategies.
The Neuroscience of Reading
Reading is not something that we are inherently hard-wired to do, like talking or listening. Instead, we need to be taught this skill through direct instruction. โฃ
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In order to accomplish this, we rely on the brainโs ability to change itself (also called ๐ป๐ฒ๐๐ฟ๐ผ๐ฝ๐น๐ฎ๐๐๐ถ๐ฐ๐ถ๐๐). Through neuroplasticity, neurological pathways are developed throughout the brain that allow for the skill of reading to develop and solidify.โฃ
Alexia Assessment: Paragraph/Discourse-Level Assessments
When assessing reading skills at the paragraph/discourse-level, emphasis is typically placed on comprehension of stated and implied main ideas โฃ
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By utilizing a paragraph/discourse-level assessment, youโll get better insight into your clientโs inferencing skills, the effect of text length on comprehension, and better insight into how reading difficulties may impact functional reading tasks in everyday life (such as reading a menu or reading an online news article) โฃ
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Oral Reading for Language in Aphasia
Looking for a general sentence/discourse-level treatment for alexia? Consider checking out ๐ข๐ฟ๐ฎ๐น ๐ฅ๐ฒ๐ฎ๐ฑ๐ถ๐ป๐ด ๐ณ๐ผ๐ฟ ๐๐ฎ๐ป๐ด๐๐ฎ๐ด๐ฒ ๐ถ๐ป ๐๐ฝ๐ต๐ฎ๐๐ถ๐ฎ (ORLA)!โฃ
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ORLA is based on a stimulation approach, where repetitive practice through multiple modalities leads to over-learning of skills (and therefore better maintenance of therapy gains)โฃ
Assistive Technology: iPhone Speak Screen
Many people are familiar with text-to-speech apps that are downloaded onto a computer or phone, but did you know that many smartphones have their own built-in text-to-speech programs? ๐ฑ โฃ
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๐ถ๐ฃ๐ต๐ผ๐ป๐ฒ ๐ฆ๐ฝ๐ฒ๐ฎ๐ธ ๐ฆ๐ฐ๐ฟ๐ฒ๐ฒ๐ป is an accessibility option that will enable the iPhone to read aloud all the text on the phone screen. Whether you are browsing through the IG app, checking the weather on your phone, or reading online news articles on Safari, iPhone Speak Screen can read aloud almost any text displayed! ๐ โฃ
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