A case of pure alexia and how it can inform our approach to therapy

What do we know about therapy techniques for pure alexia? The short answer is…not much. Why? Because pure alexia is a rare disorder that occurs in a heterogeneous population. As a result, research efforts are often limited to case reports and single-subject designs. What we do know is that clinicians often take one of two approaches: either “bottom-up” (i.e., letter-based treatment) or “top-down” (i.e., phrase or word-based treatment). If you’re stuck trying to decide which approach to take with your patient, then consider this: Ramsberger et al. found that both bottom-up and top-down approaches resulted in large treatment effects for trained and untrained stimuli for their participant. This adds to a previous case by Sage et al. with similar findings. So, the good news is that both approaches may be effective for your patient…now you don’t have to lose sleep over whether or not you selected the right one! Phew. But if you’re still not sure…the authors suggest conducting your own single-participant study. And it’s not as cumbersome as you might think!

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Ramsberger et al. suggest that conducting your own single-participant design is feasible and can help to inform the long-term treatment of individuals with pure alexia. As informed SLPs, this is definitely worth a shot!


Ramsberger, G., Messamer, P., Robinaugh, G., Ervin, M., Knauss Spees, H., Tran, NV. (2019). Top-down and Bottom-up Treatment Approaches Compared in a Single Case of Pure Alexia. Aphasiology. doi:10.1080/02687038.2019.1637813