Treatment of reading impairment after stroke

Reading impairments after left or right hemisphere stroke are common yet receive little attention from clinicians and therapists. In this review, we focus on the classification of acquired alexia and the current theory and practice underlying the rehabilitation of this diverse set of disorders.

The underlying behavioural impairments that dictate reading ability in the acquired alexias are becoming better understood; this, in turn, has led to targeted therapies being undertaken, mainly on a single subject basis. In hemianopic alexia, the most 'peripheral' of the acquired alexias, where text reading speed is determined largely by damage to the visual field, therapies have been directed at improving reading eye movements. In 'pure' alexia, techniques are usually aimed at improving whole-word recognition. In central alexic syndromes, where other language functions are also involved, the emphasis has been on strengthening connections between lexical and semantic representations, strengthening phonological representations, or both, and their association with lexical/semantic knowledge.

Despite targeted approaches to the rehabilitation of patients with alexia caused by stroke, there is still a preponderance of largely descriptive, single-case studies in the literature. In some syndromes, small trials have been attempted and the hope is that, in the future, more systematic investigations will be carried out so rehabilitation efforts can be built on a strong theoretical and empirical foundation. Well designed, single-case studies continue to play an important role in informing therapy, as these disorders are, by nature, heterogeneous.