Pure alexia: attempted rehabilitation and its implications for interpretation of the deficit

On the basis of data indicating the failure to encode letters as abstract orthographic identities in a pure alexic patient (D.M.) coupled with hypotheses about the effect of such a failure on word reading, an attempt at changing the nature of letter processing in D.M. was conducted. The training procedures failed to produce any fundamental change in the operations used by D.M. to encode isolated letters or words. However, rapid and massive benefits occurred in the overall speed of reading as a result of the training program. These appear to result from an increased rate of letter identification and the faster integration of individual letters into letter combinations. The observations gathered throughout this rehabilitation attempt provided evidence which constrains the range of possible explanations for the characteristic features of pure alexia. It is proposed that the letter-by-letter reading procedure which is the hallmark of the disorder may follow from an incapacity to directly encode visual letters as abstract orthographic types.