Before most of us learned to read, our parents read aloud to us from colorful children’s books, pointing at the words as they said them. They read us our favorite books so many times that they really didn’t even need the text anymore. This same idea of reading a story over and over again can help adults who have lost their ability to read fluently.
The Problem: Alexia
Problems with reading that are acquired after a person has already learned to read are called alexia or acquired dyslexia. Alexia typically happens after damage to the language center of the brain from a stroke or brain injury, and it is a common part of aphasia. There are different types of alexia:
- Surface alexia: regularly-spelled words (e.g. “mint”) are easier to read than irregular ones (e.g. “pint”)
- Phonological alexia: familiar words are easier to read than unfamiliar ones, such as newly-coined words (e.g. “bling”) or non-words/pseduowords (e.g. “gillering”).
- Deep alexia: in addition to many of the symptoms of phonological alexia, words may be misread as semantically-related words (e.g. “boat” for “ship”) as the meaning is recognized, but the sounds are not; grammatical function words (e.g. “for” or “the”) are particularly difficult as they have little meaning
- Pure alexia: also known as pure word blindness, people with this type of alexia often have no problems in other areas of language except reading (alexia without agraphia). They must read letter-by-letter (LBL), which doesn’t always work, as words like “phone” are not pronounced as they are spelled. Reading is extremely slow and effortful.
Watch this incredible video of The Writer Who Couldn’t Read to see what it would be like to have alexia.
The Treatment: Multiple Oral Re-Reading (MOR)
Developed as a treatment for pure alexia, multiple oral re-reading (MOR) has shown promising results for many people with varying types of alexia. The goal of treatment is to improve the rate and accuracy at which people with alexia can read new text-level material, so it is perfect for those who complain of slow, effortful reading. The idea is that by reading a passage over and over, the meaning and grammar of the passage help to facilitate recognizing whole words, in a top-down learning approach. The focus is on the fluency of oral reading, rather than on reading comprehension.
This treatment requires lots of repetition, so motivation to improve and determination to practice are essential. While time-intensive, this practice can largely be done at home with simple tools or apps.
How To Do Multiple Oral Re-Reading
- Step 1: Select a Passage
The fun part about this treatment is that you can use almost anything as a passage to read. And it’s best if you pick something the person with alexia likes, because they’re going to be reading it a lot! Ideal passages are between 100 and 500 words in length, and they can be anywhere from Grade 1-12 reading level (but Grade 2-6 may be best to start). Since the research suggests that the words and phrases in the practiced text tend to generalize best, try to pick something with fairly common vocabulary. Magazine articles, news items, or pieces of fiction all make good choices, based on what the person is interested in.
Did You Know? You can check the grade level of any passage using Microsoft Word. Simply paste in the text, run the Spelling and Grammar Check, and you’ll see a Readability Statistics pop-up window. Look for the Flesch-Kincaid Grade Level to know where your text falls. If you don’t see this window, here’s how to ensure it pops up.
- Step 2: Collect a Baseline
The person with alexia needs to read the passage aloud for the first time while the clinician times them. If it’s a longer passage, it’s okay to just read the first 100 words. Calculate the reading rate in words per minute (wpm) and the error rate (number of errors/number of total words).
Fun Fact: The average adult oral reading rate ranges from 150-200 words per minute.
- Step 3: Begin Treatment
Now the repetition begins. The person with alexia reads the passage aloud again. And again. And again. If they are struggling, they can start by reading in unison with the clinician. If they need help for certain words, or make mistakes, the clinician provides them with the correct word or draws attention to missed words. They read the passage several times in the session to establish familiarity with the text and improve accuracy.
But Wait! Isn’t the person just memorizing the text? No, aphasia makes it very hard to memorize verbal material word-for-word in this way. They are increasing their familiarity with it, but it’s still reading, not memorizing.
- Step 4: Home Practice
The power of this treatment approach is repetition – daily repetition. The person with alexia must commit to reading the passage at home. Depending on the length of the passage and rate, they must agree to read it aloud at least 3-5 times a day or for 30 minutes once or twice a day. If the person needs the audio model, the clinician can send a recording of the passage home with the client. The person with alexia keeps a log of how often they practiced.
Tip: Save the trip to the clinic by recording yourself reading aloud at home. Emailing the digital recording can allow the therapist to monitor your progress and make recommendations for continuing the same passage or knowing when you’ve hit your target rate and are ready to switch things up.
- Step 5: Return to the Clinic
When the person with alexia comes back for treatment, the clinician has them read the passage again, calculating rate and accuracy to compare to the baseline or previous session. They review the homework logs. Once the target rate (e.g. 100 wpm) is achieved with reasonable accuracy (this may take several sessions), a new passage is selected and the process begins again. The length and complexity of the text can be stepped up or down.
MOR Using the Advanced Reading Therapy App
As with all of our How-To guides for evidence-based speech therapy, we’re going to tell you how you can simplify the process using a Tactus Therapy app. The go-to app for multiple oral re-reading is Advanced Reading Therapy.
- Step 1 – Select a Passage: Advanced Reading Therapy is filled with over 200 passages that are already divided by grade level and word count. Choose any Level 2 or Level 3 passage for MOR. Level 2 passages are 50-150 words and are written at a Grade 2-3 reading level. Level 3 passages are 150-600 words at a Grade 3-6 reading level. Choose from 15 different categories of passages to find something that fits with the interests of each client. Jokes, fiction, science, news, health, letters – plenty to choose from!
- Step 2 – Collect a Baseline: Use the built-in recording function on the top of the screen to record the first reading. This will give you something to compare to later to really hear the improvement. Use a stopwatch or the Clock app’s Timer to get the reading time. Email the results and recording when you’re done. (Use a Calculator app to work out those rate and accuracy counts too!)
- Step 3 – Begin Treatment: Encourage self-sufficiency by using the built-in Play button to read in unison with the app. Go sentence-by-sentence to allow for listening before reading. Touch any word to hear it – perfect for when the person with alexia gets stuck. Adjust the speech rate at any time using the on-screen adjustments.
- Step 4 – Home Practice: Having the app at home means the audio supports are always there, and the homework log is easily sent to the clinician by pressing Email Results (and Recordings) every time the passage is practiced. All Tactus Therapy apps let you input a default email address for the results, so the clinician can set up the app in the clinic with his/her email address in the Settings.
Bonus features of using the Advanced Reading Therapy app:
- Comprehension questions: Each passage has 4-5 questions following the text to test reading comprehension. If sticking strictly to the MOR protocol, these can be skipped, but they’re always there if you want them.
- Print out the text: Go into the Settings of the app and turn the Touch to Hear Words setting to Regular Selection. Now when you go back to the passage you’ve selected, you can highlight the text. Copy it, then paste it into an email or note. Send it to a computer with word-processing ability or straight to a printer.
- Adjust text size: Touch the Adjust button in the lower left corner to change the font size and line spacing for the most comfortable visual experience.
- Try it for free: Download the Advanced Reading Therapy Lite app to get 5 full passages in each level. That’s 10 Level 2 and 3 passages to get you started with MOR right away!
Resources for Multiple Oral Re-Reading
First described in the literature by Moyer in 1979, multiple oral re-reading has been studied in numerous case studies and small clinical trials over the past 40 years. There’s a detailed overview of MOR treatment and the evidence for this approach on the Communication Therapies for Adults blog. This PDF handout from a 2008 ASHA presentation describes MOR clearly with references. The chapter entitled “Comprehension and Production of Written Words” by Beeson and Hillis in the Chapey textbook provides a nice overview as well.
Selected research articles on MOR:
- Starrfelt, R., Ólafsdóttir, R. R., & Arendt, I-M. (2013). Rehabilitation of pure alexia: A review. Neuropsychological Rehabilitation, 23(5), 755-779.
- Kim, M., & Russo, S. (2010). Multiple Oral Reading (MOR) treatment: Who is it for? Contemporary Issues in Communication Science and Disorders, 37, 58-68.
- Lacey, E. H., Lott, S. N., Snider, S. F., et al (2010). Multiple Oral Re-reading treatment for alexia: The parts may be greater than the whole. Neuropsychological Rehabilitation, 20(4), 601-623.
- Beeson, P. M., Magloire, J. G., & Robey, R. R. (2005). Letter-By-Letter Reading: Natural Recovery and Response to Treatment. Behavioural Neurology, 16(4), 191–202.
- Beeson, P. M., & Insalaco, D. (1998). Acquired alexia: Lessons from successful treatment. Journal of the International Neuropsychological Society, 4, 621–635.
- Tuomainen, J., & Laine, M. (1991). Multiple oral re-reading technique in rehabilitation of pure alexia. Aphasiology, 5, 401–409.
- Moody, S. (1988). The Moyer reading technique re-evaluated. Cortex, 24, 473–476.
- Moyer, S. B. (1979). Rehabilitation of alexia: a case study. Cortex, 15, 139–144.
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