Direct attention training as a treatment for reading impairment in mild aphasia

Background: Although a variety of interventions for acquired reading disorders have been described in the aphasia literature, most have been designed for severe impairments. Individuals with mildly impaired reading characterised by inconsistent comprehension problems and/or by slower and variable reading rates, do not seem to benefit as much from these treatment approaches. These difficulties suggest relatively intact constituent reading processes that may be functioning inefficiently. Attentional deficits have been described in individuals with a variety of reading disabilities including acquired dyslexia. Although the treatment of nonlinguistic cognitive abilities such as attention has been suggested as an approach to improving language function in aphasia, little evidence exists documenting the treatment effectiveness of such interventions for aphasia in general, or reading in particular. Aims: The present study is a case report of an individual with mild aphasia whose primary complaint was reading difficulty. A treatment approach directed towards improving various aspects of attention was implemented. Aspects of reading were monitored as outcome measures. It was hypothesised that treatment based on attention training would facilitate improvements in this individual's reading. Methods & Procedures: The treatment programme was based on Attention Process Training-II (APT-II) (Sohlberg, Johnson, Paule, Raskin, & Mateer, 2001). The eight-week programme began with activities/tasks addressing sustained attention, and progressed through alternating, selective, and divided attention. Baseline and treatment probes consisted of the individual reading magazine articles and answering comprehension questions. Reading rate was also monitored. Outcomes & Results: The individual treated in this study progressed steadily through the APT-II programme. Treatment effects for improved reading comprehension and decreased reading rate were noted. In addition, changes in pre- and post-treatment test scores, reported reading effort, and reading enjoyment were also documented. Conclusions: The observed reading improvements were not felt to be the result of linguistic recovery. As this individual's proficiency to sustain attention, cope with distractions, and concentrate increased, her ability to read longer, more complex materials also improved. These results are consistent with previous studies that have noted improvements in nonlinguistic cognitive abilities of individuals with aphasia following direct intervention.