Rehabilitation can be Aided by Insights on how a Stroke Affects Reading

Life after a stroke can be difficult. Many patients wonder if they will ever fully recover their muscle coordination, as well as how long and difficult the recovery process will be. Fortunately, the field of occupational and physical therapy has come a long way in developing approaches that assist patients in regaining control of their muscle movements following a stroke. Rehabilitation enables you to recover as quickly as possible and re-learn skills for everyday life. Therapists conduct assessments and collaborate with you to establish goals for your rehabilitation.

When Georgetown University researchers studied people’s ability to sound out words after a stroke, they discovered that knowing which region of the brain was affected by the stroke could have significant implications for helping to target rehabilitation efforts. The discovery was published in the journal Brain Communications.

“In the United States, one in every five stroke survivors has persistent language impairment. The majority of these people also have difficulty reading “J. Vivian Dickens, Ph.D., a Georgetown University MD/Ph.D. student conducting research in the university’s Cognitive Recovery Lab and Center for Aphasia Research and Rehabilitation at Georgetown’s Medical Center is the study’s first author. “Our findings shed light on the neuroanatomical and cognitive bases of post-stroke reading and language deficits, which may aid in the prediction of deficits in stroke survivors and the development of targeted treatments.”

Researchers, looking at the ability of people to sound out words after a stroke, found that knowing which region of the brain was impacted by the stroke could have important implications for helping target rehabilitation efforts.

Reading difficulties are common after a stroke. This “acquired dyslexia” or “alexia” can occur with or without other language difficulties, and it can occur even when writing ability is intact. For many survivors, the inability to read interferes with work and recreation, making it difficult to follow written instructions, pay bills, or use the computer. Reading’s ease and pleasure are frequently replaced by effort and frustration. Many people, however, improve their reading skills through spontaneous recovery, direct practice, or compensatory strategies.

The study focused on phonological processing, which is the understanding and use of the sounds that comprise language. This processing has three major components: auditory, or the ability to recognize the sounds of words, such as determining whether words rhyme; motor, or the ability to produce accurate and clear speech; and auditory-motor translation, or the translation of sounds heard into speech.

Insights into how a stroke affects reading could help with rehabilitation

“The goal of this study was to understand how post-stroke difficulties with three different aspects of phonology relate to reading difficulties,” Dickens explains. “People read words in two ways: one involves sounding out words, which is especially important when learning new words, and the other involves whole-word recognition. People with post-stroke language impairment frequently struggle to sound out words.”

The researchers assessed 67 people’s reading and phonological abilities, 30 of whom had had a stroke and 37 who had not. The researchers were able to trace out white matter connections, which are similar to wiring diagrams for the brain, as well as map out stroke locations in the brains of affected study participants using advanced MRI techniques.

“We discovered two distinct patterns of reading difficulties. Strokes to the left frontal lobe disrupted motor phonology and one of the two reading methods, specifically sounding out words. Strokes to the left temporal and parietal lobes, on the other hand, caused problems with auditory-motor translation and both ways of reading “Dickens says “These findings may aid clinicians in developing therapies aimed at specific reading problems that individual stroke survivors frequently face.”

“This study focused on reading single words aloud, a classic measure of reading ability,” says Peter E. Turkeltaub, MD, Ph.D., director of the Cognitive Recovery Lab in the Center for Brain Plasticity and Recovery, medical director in the Center for Aphasia Research and Rehabilitation, and senior author of the study. “Our findings represent an important step forward in elucidating the mechanisms of translating print to sound, which is critical for developing rehabilitative therapies for stroke patients.”

The researchers are planning studies to help confirm how far these findings can be generalized to silent reading, which relies on the same core psychological processes as oral reading and is more important for everyday reading. The researchers also hope to translate their findings into clinical tests for phonological processing.