ABSTRACT

Although rehabilitation of acquired dysgraphia can be quite effective, identifying predictors of responsiveness to treatment is useful for prognosis and individualization of treatment protocols. This study examined whether various features of treatment response were predicted by the integrity of one or more of the central cognitive components of spelling: orthographic long-term memory, orthographic working memory, and phoneme-grapheme conversion. Twenty dysgraphic individuals received 12 weeks of bi-weekly, individualized, lexically-based spelling rehabilitation using a spell-study-spell paradigm. Linear multiple regression modelling examined whether the type and severity of the dysgraphic deficit, assessed before rehabilitation, predicted the magnitude and rate of improvement, generalization to untrained items and maintenance of treatment gains. The results revealed that pseudoword spelling accuracy – indexing the integrity of the phoneme-grapheme conversion system – was the only factor examined that significantly predicted the rate of accuracy gains for trained words as well as the extent of generalization to untrained words. Pre-treatment pseudoword spelling accuracy also predicted retention of gains for trained and untrained words at 3-month follow-up. These findings reveal that the integrity of the phoneme-grapheme conversion system prior to dysgraphia rehabilitation may play a key role in rehabilitation-driven recovery, even when the treatment approach targets lexical rather than pseudoword spelling processes.

摘要

尽管获得性书写障碍的康复可能非常有效，但确定对治疗反应的预测因子对于预后和治疗方案的个体化很有用。这项研究检查了治疗反应的各种特征是否可以通过一个或多个拼写的核心认知成分的完整性来预测：正字法长期记忆、正字法工作记忆和音素-字素转换。20 名拼写障碍个体接受了为期 12 周的双周、个性化、基于词汇的拼写康复，使用拼写-学习-拼写范式。线性多元回归模型检查了在康复前评估的视力障碍的类型和严重程度是否可以预测改善的幅度和速度、推广到未经训练的项目和维持治疗收益。结果表明，伪词拼写准确度——索引音素-字素转换系统的完整性——是唯一能显着预测训练词的准确率提高率以及对未训练词的泛化程度的检查因素。治疗前的伪词拼写准确度还预测训练和未训练单词在 3 个月随访时的收益保留。这些发现表明，在书写障碍康复之前，音素-字素转换系统的完整性可能在康复驱动的康复中发挥关键作用，即使治疗方法针对的是词汇而不是假词拼写过程。