Improved single-letter identification after whole-word training in pure alexia

Pure alexia is characterised by a very time-consuming letter-by-letter reading strategy due to an impaired identification or integration of single letters. So far, therapy interventions have addressed impaired letter identification using specific single-letter training approaches. In the present study, we report patient KA with pure alexia and letter-by-letter reading. Contrary to common approaches, we investigated whether a whole-word reading approach can be successful despite severe impairments at the level of single-letter identification. As a first step, auditory-visual verification tasks were used to familiarise the patient with the training items, which in a second step were read with limited exposure duration. After a four week intervention, KA's word reading performance improved significantly for trained and control items in terms of speed and accuracy. Although not specifically addressed during our training programme, even single-letter identification and text reading performance increased significantly. However, the patient's reading was still based on a letter-by-letter strategy.