An efficacy study of the treatment of a severe writing disorder in a dysphasic individual based on computer‐assisted therapy

  This efficacy study, based on the treatment of a writing deficit in an individual with dysphasia, MF, was conducted to investigate the following: (1) Is it possible to improve a severe writing deficit in a dysphasic individual in which no spontaneous recovery had taken place during the first year post‐onset? (2) Is it possible for improvement to lead to functional gains in order that the intervention made a difference to MF in his everyday life, and not just an increased score in the assessments administered in clinic? (3) Can a computer be used in the home on a ‘self‐help’ basis, in order to provide (a) more intensive therapy and (b) give the client independence and control over therapy? MF is a 67‐year‐old gentleman who suffered a cerebrovascular accident (CVA) one year prior to this study. His verbal expression at the time of referral was mainly affected by dysarthria. He showed some high‐level word‐finding difficulties, and high‐level planning problems when formulating sentences. His reading was good, being able to read the newspaper, but he found reading novels difficult. MF's writing was severely affected; because his reading was good he was aware of his spelling errors. MF's writing was assessed pre‐therapy. He was then offered a period of computer‐assisted therapy in six‐week blocks over an 18‐month period. He had access to a computer to provide intensive practice to supplement the therapy give by the speech therapist. Assessment (AAT, Palpa) showed that MF had a very severe writing disorder: (1) He had no functional spelling ability (being unable to spell his name or even three‐letter words); (2) He showed a residual spelling ability of being able to spell out aloud a word, letter by letter. He was, however, then unable to write the word down. The therapy was based on developing a strategy which utilised MF's residual spelling ability which could then be applied to writing generally and not just to items targeted in therapy. The therapy was based on the following hierarchy: (1) Improve accuracy of writing a letter from dictation; (2) Improve awareness of residual skill of being able to spell a word out loud; (3) Practise using the strategy in three‐, four‐ and five‐letter words; (4) Use of a dictionary to look up and spell words; (5) Using the strategy to write sentences; (6) Using a word processor. Each stage needed to be completed before the next one could be introduced. MF responded very well to the therapy. He was able to use the computer independently and for an average of 45 minutes a day. His writing improved significantly on the assessments and showed functional benefits as he is now able to use a word processor and to write letters to family and friends. This therapy shows that a severe writing deficit can improve with targeted intensive strategy‐based therapy even beyond the period of spontaneous recovery. The improvement also led to functional benefits. There is no doubt that the computer played an important role in this successful outcome. Computers are becoming much more common in the clinical and home setting, and a wide range of tasks can now be administered via the computer, potentially making this a very useful ‘tool’ for the clinician as a supplement to conventional therapy.