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Reading ability and central visual field after photodynamic therapy.

PURPOSE: We examined whether photodynamic therapy (PDT) can prevent severe loss of reading acuity and further depression of the visual field in cases of predominantly classic subfoveal neovascularization due to age-related macular degeneration. PATIENTS AND METHODS: Sixty eyes of 52 patients underwent biomicroscopy, assessment of reading and distance acuity, 10 degrees static threshold perimetry, distance acuity, and fluorescein angiography at baseline, after 6 weeks, 3 months and then every 3 months after therapy. RESULTS: After 18 months only 16.7% had lost more than 3 levels of reading acuity, 23.3% had lost less than 3 levels, 6.7% had remained unchanged and 53.3% had gained reading acuity, 18.7% of these more than 3 levels. 81.7% of the eyes lost less than 3 lines of distance acuity. 78.3% did not show any increase of the mean defect in the central visual field. CONCLUSION: PDT can prevent severe loss of distance and reading acuity and further deterioration of the central visual field in about 80% of the eyes. The baseline reading acuity was poor and the patients should be aware of the fact that loss of reading acuity cannot be regained even after successful PDT.

Aged↗

From orthography to phonetics: ERP measures of grapheme-to-phoneme conversion mechanisms in reading.

Neuroimaging has provided evidence that the first stages of visual word recognition activate a visual word-form center localized in the left extrastriate cortex (fusiform gyrus). Accordingly, neurological cases of patients suffering from pure alexia reported the left posterior occipital lobe as the possible locus of orthographic analysis. There is less agreement in the literature about which brain structures are involved in the subsequent stages of word processing and, in particular, their time course of activation. Functional magnetic resonance imaging and magnetic source imaging studies recently reported data that could indicate a dual route model of reading. These findings are particularly relevant to studies on the functional deficits associated with phonological and surface dyslexia. There is evidence for the existence of two different brain mechanisms supporting phonological processing in visual word recognition: one mechanism subserving "assembled phonology" for reading letter strings and another one subserving "addressed phonology" for reading meaningful words. However, available knowledge on the time course and neural locus of grapheme-to-phoneme conversion mechanisms in reading is still inadequate. In this study, we compared processing of meaningful and meaningless Italian words in a task requiring a phonemic/phonetic decision task. Stimuli were 1152 different orthographic stimuli presented in the central visual field. Half the stimuli were Italian words (with a high or low frequency of occurrence), the other half were meaningless strings of letters (legal pseudowords and letter strings). Event-related potentials were recorded from 28 scalp sites in 10 Italian university students. The task consisted of deciding about the presence/absence of a given "phone" in the hypothetical enunciation of word read: for example, "Is there a /k/ in cheese?". Results showed that lexical frequency and orthographical regularity affected linguistic processing within 150 msec poststimulus. Indeed, the amplitude of a centroparietal P150 varied as a function of stimulus type, being larger in response to high-frequency words than to low-frequency ones and to words and pseudowords than to letter strings. This component might index visual categorization processes and recognition of familiar objects, being highly sensitive to orthographic regularity and "ill-formedness" of words. The amplitude of the P150 was the same in response to well-formed meaningless and to meaningful words, when these latter had a low lexical frequency. This might indicate that highly familiar words are recognized as meaningful unitary visual objects at very early stages of processing, through a visual route to an orthographic input lexicon. Moreover, the amplitude of the negativity recorded between 250 and 350 msec showed an anteroposterior topographic dissociation for access to the phonemic representation of well- or ill-formed strings of characters. Brain responses were larger over the left occipito-temporal regions during reading of words and pseudowords and over the left frontal regions during reading of letter strings.

Adult↗

Two visual motion processing deficits in developmental dyslexia associated with different reading skills deficits.

Developmental dyslexia is associated with deficits in the processing of visual motion stimuli, and some evidence suggests that these motion processing deficits are related to various reading subskills deficits. However, little is known about the mechanisms underlying such associations. This study lays a richer groundwork for exploration of such mechanisms by more comprehensively and rigorously characterizing the relationship between motion processing deficits and reading subskills deficits. Thirty-six adult participants, 19 of whom had a history of developmental dyslexia, completed a battery of visual, cognitive, and reading tests. This battery combined motion processing and reading subskills measures used across previous studies and added carefully matched visual processing control tasks. Results suggest that there are in fact two distinct motion processing deficits in developmental dyslexia, rather than one as assumed by previous research, and that each of these deficits is associated with a different type of reading subskills deficit. A deficit in detecting coherent motion is selectively associated with low accuracy on reading subskills tests, and a deficit in discriminating velocities is selectively associated with slow performance on these same tests. In addition, evidence from visual processing control tasks as well as self-reports of ADHD symptoms suggests that these motion processing deficits are specific to the domain of visual motion, and result neither from a broader visual deficit, nor from the sort of generalized attention deficit commonly comorbid with developmental dyslexia. Finally, dissociation between these two motion processing deficits suggests that they may have distinct neural and functional underpinnings. The two distinct patterns of motion processing and reading deficits demonstrated by this study may reflect separable underlying neurocognitive mechanisms of developmental dyslexia.

Adult↗

Dynamic interactions of eye and head movements when reading with single-vision and progressive lenses in a simulated computer-based environment.

PURPOSE: To assess dynamic interactions of eye and head movements during return-sweep saccades (RSS) when reading with single-vision (SVL) versus progressive-addition (PAL) lenses in a simulated computer-based business environment. METHODS: Horizontal eye and head movements were recorded objectively and simultaneously at a rate of 60 Hz during reading of single-page (SP; 14 degrees horizontal [H]) and double-page (DP; 37 degrees H) formats at 60 cm with binocular viewing. Subjects included 11 individuals with normal presbyopic vision aged 45 to 71 years selected by convenience sampling from a clinic population. Reading was performed with three types of spectacle lenses with a different clear near field of view (FOV): a SVL (60 degrees H clear FOV), a PAL-I with a relatively wide intermediate zone (7.85 mm; 18 degrees H clear FOV), and a PAL-II with a relatively narrow intermediate zone (5.60 mm; 13 degrees H clear FOV). RESULTS: Eye movements were initiated before head movements in the SP condition, and the reverse was found in the DP condition, with all three lens types. Duration of eye movements increased as the zone of clear vision decreased in the SP condition, and they were longer with the PALs than with the SVL in the DP condition. Gaze stabilization occurred later with the PALs than with the SVL in both the SP and DP conditions. The duration of head movements was longer with the PAL-II than with the SVL in both the SP and DP conditions. Eye movement peak velocity was greater with the SVL than the PALs in the DP condition. CONCLUSIONS: Eye movement and head movement strategies and timing were contingent on viewing conditions. The longer eye movement duration and gaze-stabilization times suggested that additional eye movements were needed to locate the clear-vision zone and commence reading after the RSS. Head movements with PALs for the SP condition were similarly optically induced. These eye movement and head movement results may contribute to the reduced reading rate and related symptoms reported by some PAL wearers. The dynamic interactions of eye movements and head movements during reading with the PALs appear to be a sensitive indicator of the effect of lens optical design parameters on overall reading performance, because the movements can discriminate between SVL and PAL designs and at times even between PALs.

Aged↗

Paragraph text reading using a pixelized prosthetic vision simulator: parameter dependence and task learning in free-viewing conditions.

PURPOSE: To investigate the feasibility of adequate reading by recipients of future prosthetic visual implants through simulation in sighted observers. METHODS: Four normally sighted subjects used a video headset to view short-story segments at a sixth grade reading level, presented in 6- to 11-word paragraphs through a pixelizing grid defined by five parameters (dot size, grid size, dot spacing, random dropout percentage, and gray-scale resolution). Grid parameters were varied individually, and four character sizes and two contrast levels were used. RESULTS: Reading speeds of 30 to 60 words per minute without errors were recorded for some parameter combinations. In general, reading accuracy and speed were influenced by all parameters. Reading accuracy exceeded 90% if the following conditions were met: At least 3 dots/charwidth were presented, and dropout did not exceed 50%. Reading speed deteriorated below 20 words per minute if accuracy fell below 90% and at low contrast if the grid spanned less than two characters. CONCLUSIONS: It is uncertain whether and to what extent retinal reorganization may limit the perception of multiple phosphenes by blind prosthesis recipients. If distinct phosphenes can be perceived, these results suggest that a 3 x 3-mm2 prosthesis with 16 x 16 electrodes should allow paragraph reading. The effects of stabilizing the dot grid on the retina must be investigated further.

Adult↗

Predicting delay in reading achievement in a highly transparent language.

A random sample of 91 preschool children was assessed prior to receiving formal reading instruction. Verbal and nonverbal measures were used as predictors for the time of instruction required to accurately decode pseudowords in the highly orthographically regular Finnish language. After 2 years, participants were divided into four groups depending on the duration of instruction they had required to reach 90 % accuracy in their reading of pseudowords. Participants were classified as precocious decoders (PD), who could read at school entry; early decoders (ED), who learned to read within the first 4 months of Grade 1; ordinary decoders (OD), who learned to read within 9 months; and late decoders (LD), who failed to reach the criterion after 18 months of reading instruction at Grade 2. Phonological awareness played a significant role only in differentiating PD from ED and OD. However, phonological awareness failed to predict the delayed learning process of LD. LD differed from all other groups in visual analogical reasoning in an analysis not containing phonological awareness measures. Letter knowledge and visual analogical reasoning explained above 90% of the PD-LD difference. Preschool composite (objects, colors, and digits) naming speed measures best predicted reading fluency at the end of Grade 2. The supportive role of orthographic knowledge in phonological awareness, the role of visual analogical reasoning, and the inability of phonological measures to discriminate late decoders are discussed.

Child↗

Understanding the relations between RAN letter subtest components and word reading in first-grade students.

First-grade students (N = 221) were individually tested on a battery of cognitive and achievement measures of verbal fluency, visual attention, phonological awareness, orthographic recognition, rapid automatized naming (RAN) of letters and objects, and reading. All tests were subjected to postacquisition scoring, and all RAN measures were segregated into measures of articulation time, pause time, and consistency of the pause time. Structural equation modeling demonstrated that word reading was directly and significantly predicted by RAN letter naming and general RAN cognitive processing time of objects. Moreover, RAN letter reading constructs were significantly and directly predicted by the latent variables of phonological awareness, orthographic recognition, and general RAN object articulation and cognitive processing times. RAN letter naming constructs were also significantly and indirectly predicted by visual attention. The reading model was found to be consistent with a total mediation of the relation of phonological awareness and reading through RAN letter naming and supported the validity of the RAN letter naming subtest as a basic letter reading test. These findings supported the double-deficit hypothesis for letter reading. We suggest that phonological memory is a basic factor underlying general RAN cognitive processing time of objects and domain-specific information associated with phonemes and their graphic representations.

Attention↗

Effectiveness of Spanish intervention for first-grade English language learners at risk for reading difficulties.

The effectiveness of an explicit, systematic reading intervention for first-grade students whose home language was Spanish and who were at risk for reading difficulties was examined. Participants were 69 students in 20 classrooms in 7 schools from 3 districts who initially did not pass the screening in Spanish and were randomly assigned within schools to a treatment or comparison group; after 7 months, 64 students remained in the study. The intervention matched the language of instruction of their core reading program (Spanish). Treatment groups of 3 to 5 students met daily for 50 min and were provided systematic and explicit instruction in oral language and reading by trained bilingual intervention teachers. Comparison students received the school's standard intervention for struggling readers. Observations during core reading instruction provided information about the reading instruction and language use of the teachers. There were no differences between the treatment and comparison groups in either Spanish or English on any measures at pretest, but there were significant posttest differences in favor of the treatment group for the following outcomes in Spanish: Letter-Sound Identification (d = 0.72), Phonological Awareness composite (d = 0.73), Woodcock Language Proficiency Battery-Revised Oral Language composite (d = 0.35), Word Attack (d = 0.85), Passage Comprehension (d = 0.55), and two measures of reading fluency (d = 0.58-0.75).

Child↗

Language abilities and progress in a direct instruction reading program for students with learning disabilities.

Direct instruction reading programs have been found to be a successful way to teach reading to many, but not all, students with learning disabilities. This study investigated whether reading improvement for students with learning disabilities receiving reading instruction through a direct instruction reading program might be related to their language abilities. The reading progress of 26 students (19 male, 7 female), 7 to 10 years old, was measured over 2 years. In addition, phonological and syntactic abilities were assessed. The results indicated that phonological ability was related to progress in word attack skills and that syntactic ability was related to improvement in comprehension skills. These results have implications for the reading instruction of students with learning disabilities.

Achievement↗

Early reading performance: a comparison of teacher-based and test-based assessments.

An unresolved question in early screening is whether test-based or teacher-based assessments should form the basis of the classification of children at risk of educational failure. Available structured teacher rating scales are lacking in predictive validity, and teacher predictions of students likely to experience reading difficulties have yielded disappointing true positive rates, with teachers failing to identify the majority of severely disabled readers. For this study, three educational screening instruments were developed: (a) a single teacher rating, categorizing children into three levels of reading ability (advanced, average, poor); (b) a 15-item teacher questionnaire designed to measure students' cognitive and language ability, attentional and behavioral characteristics, and academic performance; and (c) a battery of language and reading tests that are predictive of, or correlate with, reading failure. The concurrent validity of each instrument was assessed in a sample of 312 Australian schoolchildren from kindergarten, Year 1, and Year 2. Students were assessed at the end of the 1989 school year after having completed 1, 2, or 3 years of schooling. The results suggest that the nature of the skills required for success in reading changes in the first 3 years of schooling. Both teachers and tests concur more closely as children progress through the elementary years and as the risk behavior (reading) becomes more accessible to direct measurement. Carefully focused teacher rating scales may be a cost-effective means of identifying children at risk of reading failure. Improved teacher rating scales should be developed and used to assist in the early screening process.

Child↗

Preference for visual scanning strategies versus phonological rehearsal in university students with reading disabilities.

This study investigated strategic preferences for visual scanning versus phonological rehearsal for recognizing words, pronounceable letter strings, and symbol strings by university students with reading disabilities (RD). Forty-seven subjects participated in this study: 20 students with reading disabilities who reported current difficulties in reading, as well as problems in learning to read at an early age; 15 students with learning disabilities (LD) who reported current difficulties in learning in areas other than reading but did not recall difficulties in learning to read; and 12 nondisabled readers (NR). The main dependent measures were response latency on a matching task for words, nonwords, and symbol strings, and posttest verbal reports of strategies used. Results showed that (a) most subjects in the NR group consistently used a strategy of phonological rehearsal for both words and nonwords, whereas most subjects with RD consistently used a strategy of visual scanning for these tasks, and (b) the NR group responded significantly faster than did the RD and LD groups to all three types of stimuli. The results indicate differences between university students who have a reading disability and nondisabled readers in strategic preferences for processing phonological information, with a clear preference by the former for using visual scanning rather than phonological rehearsal in matching tasks of words and nonwords.

Adult↗

Detection of target phonemes in spontaneous and read speech.

Although spontaneous speech occurs more frequently in most listeners' experience than read speech, laboratory studies of human speech recognition typically use carefully controlled materials read from a script. The phonological and prosodic characteristics of spontaneous and read speech differ considerably, however, which suggests that laboratory results may not generalise to the recognition of spontaneous speech. In the present study listeners were presented with both spontaneous and read speech materials, and their response time to detect word-initial target phonemes was measured. Responses were, overall, equally fast in each speech mode. However, analysis of effects previously reported in phoneme detection studies revealed significant differences between speech modes. In read speech but not in spontaneous speech, later targets were detected more rapidly than targets preceded by short words. In contrast, in spontaneous speech but not in read speech, targets were detected more rapidly in accented than in unaccented words and in strong than in weak syllables. An explanation for this pattern is offered in terms of characteristic prosodic differences between spontaneous and read speech. The results support claims from previous work that listeners pay great attention to prosodic information in the process of recognising speech.

Adult↗

A technique to train new oculomotor behavior in patients with central macular scotomas during reading related tasks using scanning laser ophthalmoscopy: immediate functional benefits and gains retention.

BACKGROUND: Reading with a central scotoma involves the use of preferred retinal loci (PRLs) that enable both letter resolution and global viewing of word. Spontaneously developed PRLs however often privilege spatial resolution and, as a result, visual span is commonly limited by the position of the scotoma. In this study we designed and performed the pilot trial of a training procedure aimed at modifying oculomotor behavior in subjects with central field loss. We use an additional fixation point which, when combined with the initial PRL, allows the fulfillment of both letter resolution and global viewing of words. METHODS: The training procedure comprises ten training sessions conducted with the scanning laser ophthalmoscope (SLO). Subjects have to read single letters and isolated words varying in length, by combining the use of their initial PRL with the one of an examiner's selected trained retinal locus (TRL). We enrolled five subjects to test for the feasibility of the training technique. They showed stable maculopathy and persisting major reading difficulties despite previous orthoptic rehabilitation. We evaluated ETDRS visual acuity, threshold character size for single letters and isolated words, accuracy for paragraphed text reading and reading strategies before, immediately after SLO training, and three months later. RESULTS: Training the use of multiple PRLs in patients with central field loss is feasible and contributes to adapt oculomotor strategies during reading related tasks. Immediately after SLO training subjects used in combination with their initial PRL the examiner's selected TRL and other newly self-selected PRLs. Training gains were also reflected in ETDRS acuity, threshold character size for words of different lengths and in paragraphed text reading. Interestingly, subjects benefited variously from the training procedure and gains were retained differently as a function of word length. CONCLUSION: We designed a new procedure for training patients with central field loss using scanning laser ophthalmoscopy. Our initial results on the acquisition of newly self-selected PRLs and the development of new oculomotor behaviors suggest that the procedure aiming primarily at developing an examiner's selected TRL might have initiated a more global functional adaptation process.

Aged↗

The information sources and journals consulted or read by UK paediatricians to inform their clinical practice and those which they consider important: a questionnaire survey.

BACKGROUND: Implementation of health research findings is important for medicine to be evidence-based. Previous studies have found variation in the information sources thought to be of greatest importance to clinicians but publication in peer-reviewed journals is the traditional route for dissemination of research findings. There is debate about whether the impact made on clinicians should be considered as part of the evaluation of research outputs. We aimed to determine first which information sources are generally most consulted by paediatricians to inform their clinical practice, and which sources they considered most important, and second, how many and which peer-reviewed journals they read. METHODS: We inquired, by questionnaire survey, about the information sources and academic journals that UK medical paediatric specialists generally consulted, attended or read and considered important to their clinical practice. RESULTS: The same three information sources--professional meetings & conferences, peer-reviewed journals and medical colleagues--were, overall, the most consulted or attended and ranked the most important. No one information source was found to be of greatest importance to all groups of paediatricians. Journals were widely read by all groups, but the proportion ranking them first in importance as an information source ranged from 10% to 46%. The number of journals read varied between the groups, but Archives of Disease in Childhood and BMJ were the most read journals in all groups. Six out of the seven journals previously identified as containing best paediatric evidence are the most widely read overall by UK paediatricians, however, only the two most prominent are widely read by those based in the community. CONCLUSION: No one information source is dominant, therefore a variety of approaches to Continuing Professional Development and the dissemination of research findings to paediatricians should be used. Journals are an important information source. A small number of key ones can be identified and such analysis could provide valuable additional input into the evaluation of clinical research outputs.

Adult↗

Reading: selective sparing of closed-class words in Wernicke's aphasia.

One aspect of Broca's aphasia, induced by anterior perisylvian lesions, is an inability to read closed-class words (eg, articles, prepositions) with a preserved ability to read open-class words (eg, nouns, verbs). We examined a man with profound Wernicke's aphasia induced by an infarct of the posterior portion of the superior temporal gyrus (Wernicke's area). He could not read substantive words or pronounceable nonwords but could read closed-class words. These observations suggest that the reading of closed- and open-class words is mediated by separable systems. Whereas the anterior perisylvian region appears to be important in reading functional words, the posterior perisylvian region is important in reading substantive words.

Aged↗

Spike-triggered fMRI in reading epilepsy: involvement of left frontal cortex working memory area.

OBJECTIVE: To determine the origin of epileptiform activity in reading epilepsy (RE) and the association between these regions and regions activated by reading, and to assess brain morphometry in these areas. METHODS: In two subjects with RE, EEG was recorded inside the three tesla MRI while subjects read silently. Spike-triggered fMRI images were compared to baseline. In a second fMRI study, 30 seconds of silent reading was compared to visual fixation. Morphometry of these areas was assessed using curvilinear surface reconstruction. Left central sulcal patterns in three subjects with RE were compared to three subjects with idiopathic generalized epilepsy (IGE) and 12 normal controls. RESULTS: One subject with RE showed spike-related activity (17 spikes) in the left precentral gyrus, and bilaterally in the central sulcus and globus pallidus. The other showed no definite activation owing to low spike numbers (4 spikes). In both subjects, the block reading task recruited normal visual and language areas including the left posterior middle frontal gyrus. Two subjects with RE showed an unusual gyrus branching anteriorly off the left central sulcus. A similar sulcal pattern was seen in none of the subjects with IGE and only 1 of 12 controls. CONCLUSION: Spike activity overlapped with reading activity in the left middle frontal gyrus, a structure recruited during working memory cognitive tasks. The authors postulate that, because of a local structural anomaly, the spikes of reading epilepsy spread from working memory areas into adjacent motor cortex, activating a cortical subcortical circuit.

Action Potentials↗

Reading skills of otolaryngology outpatients: implications for information provision.

The aim of this prospective observational study was to estimate the proportion of otolaryngology patients with poor reading skills, as a guide to information provision. The subjects were a consecutive series of 50 adult outpatients attending a general otolaryngology clinic at the Victoria Infirmary, Glasgow, and whose first language was English. Reading skills were estimated using the Rapid Estimate of Adult Literacy in Medicine. For comparison, the SMOG readability formula was used to estimate the reading skills required to understand the Department's 35 information leaflets, the standard elective admission notification letter and the surgical consent form. Fourteen (28 per cent) patients were found to have poor reading skills (8th grade or less). The surgical consent from required 11th grade reading ability, as did the standard admission letter, and the leaflets required 9th to 15th grade (graduate) reading ability (median 11th grade). Many patients could be expected to have difficulty understanding these written materials. Information must be written in plain English to be suitable for a wide range of patients, including those with poor reading skills.

Adolescent↗

Reading errors in first- and second-grade readers of a shallow orthography: evidence from Spanish.

BACKGROUND: Studies focusing on reading errors can help to understand how children learn to read and to structure key components of reading instruction. However, no prior studies have examined which letters might be a greater source of difficulty for beginning readers in Spanish. AIMS: First, to examine the pattern of reading errors in beginning readers in a shallow orthography like Spanish with a particular focus on both the context-dependant (c, g, r) and the visual similar (b, d, g, p, q) consonants. (The dual-route cascade model is used as a theoretical framework for predictions.) Second, to examine the effect of visual similarity on orientation reversals, using upper and lower case letters. SAMPLE: Ninety Spanish-speaking children (45 in Grade 1 and 45 in Grade 2) participated in the study. METHOD: Children were required to read aloud both words and non-words. Seven categories of errors were examined. To clarify the influence of visual similarity of easily confused consonants (b, d), upper and lower case letters were used. RESULTS: We found that most reading errors (as a function of opportunity) were due to context-dependant consonants (c, g, r), and a small proportion were due to the remaining consonants, or even the visually-similar consonants. Further, visual similarity of reversible letters had a significant effect on orientation reversals. Finally, there was a significant influence of factors such as syllable frequency on the number of word errors. CONCLUSIONS: The implications of these findings for early reading instruction and future research are discussed.

Child↗