Cumulative reading training: a systematic study into a new, cost effective way to improve reading skills in middle aged and older adults with visual impairments of central and peripheral origin

Research of one of the applicants indicated that approximately 15% of, primarily older, adults that visit an insitute for visual impairment such as Sensis have brain damage (Verstraten, 2005). Reading problems plague the acquired brain-injured population (Kapoor & Ciuffreda, 2002). The majority of these patients manifest oculomotor abnormalities, such as saccadic intrusions, jerk nystagmus, and saccadic dysmetria. As reading is one of the most important activities of daily living (Ciuffreda, 1994), it is not surprising that a great interest exists for the systematic development of training methods that facilitate reading. Despite its obvious eminent theoretical, clinical, and societal importance there have only been very limited systematic and formal investigations in the area. Existing methods are primarily aimed at improving eye-control (saccade, scanning, and tracking control), but the results are equivocal with respect to success (Zihl, 1995; Ciuffreda et al., 2006; Bouwmeester et al., 2007). In a recent pilot study, Vandermeulen et al. (2008) had six clients (aged 48-67) with left hemipshere damage involved in a cumulative training method, which can be characterised as an intensive set of reading experiences with texts which are attuned to the motivation and the reading level of each client. The results showed a very strong effect of training on reading speed, as evidenced by a gain of approximately 15%. The robustness of these promising findings have yet to be proven. This is the topic of the present project. Our first aim is to test the cumulative reading method in a larger and more diverse group of participants (including four groups clients of middle age and older [48 year and older, in line with the original pilot study], -1- clients with visual impairments from a peripheral origin, central origin [including clients with -2- left and -3- right acquired hemisphere brain damage], and -4- clients without neurological or perception disorders). Our second aim is to systemtaically scrutinise crucial neuropsychological factors that may affect reading improvement, and that are often compromised following brain damage. Following inclusion of eligible participants, pre-testing is performed. Neuropsychological testing is perofmred to assess visual memory, sustained and selective attention, visual search and attention, and visual spatial working memory. Their contribution to reading improvement will be analysed. In addition, an important aspect of vision rehabilitation is its effect on quality of life. This will be assessed in all participants by means of two questionnaires developed by Langelaan (2007). Finally, participants are tested on a motor planning task with a double-task setting in order to find out if anticipatory gaze control is improved after reading training and also translates to other tasks of daily life. With the double-task setting, the extent to which anticipatory gaze is under working memory control can also be assessed. Following pre-testing, participants are involved in a cumulative reading program of 4 weeks in which they have to read texts at home, similar to the procedure in the pilot study of Vandermeulen et al. (2008). Post-testing and retention testing are subsequently done in week 6 and week 10. This study will fill the void in studies on reading training in individuals with a visual impairment as a consequence of acquired brain damage. In particular, it extends previous studies that have predominantly focused on oculomotor training, by placing emphasis on crucial neuropsychological, cognitive, factors that may contribute to reading and that are known to be compromised following acquired brain damage. If the results of this study confirm the positive findings of the pilot study in the larger group, this cost effective training method may in future be used in rehabilitation practice. In addition, as the contribution of a multitude of neuropsychological processes are systematically analysed more precise inclusion criteria can be determined for future use of this method. Finally, theoretically, the project will provide valuable information for our understanding of the triad eye-brain-behaviour.