Functional Brain Imaging: Sensory Integration, Reading and Reading

InterventionMultisensory integration in the brainPaul J. Laurienti, M.D., Ph.D.Wake Forest University School of Medicine The neural substrate of the development of auditory and visual word representationsJames R. Booth, Ph.D.Northwestern University

Intervention studies in children using a MSL approach Guinevere Eden, D.Phil.Georgetown University Medical Center

19981998 20002000

Component skills that are Component skills that are essential for growth of readingessential for growth of reading

Phonemic AwarenessPhonemic Awareness

PhonicsPhonics

FluencyFluency

VocabularyVocabulary

Comprehension strategiesComprehension strategies

Identifying words Identifying words accurately and accurately and fluentlyfluently

Constructing Constructing meaning meaning once words once words are identifiedare identified

Remediation Approaches • Phonology and other language structures are explicitly and systematically taught

• Large amount of practice given

• Mode of delivery: small group or one-one

• Use of enhancing techniques (multi-sensory techniques linking listening, speaking, reading, and writing)

MSL Remediation Approaches • Systematic, cumulative, explicit, and sequential approaches that allow professionals to teach language structure at many levels

• Emphasize the importance of multi-sensory engagement of the learner using motor, visual, auditory, and kinesthetic feedback combined with extensive, controlled practice in word recognition.

Multisensory Structured Language (MSL) Programs

• Long history of use in the classroom and clinics – successful in teaching students to read, write and use language.

• Programs vary in the extent to which they have been investigated using scientifically valid research studies.

Further Information about MSL approaches

• IDA Matrix of Multisensory Structured Language Programs

• Birsh J. (2005) Multisensory Teaching of Basic Language Skills. Baltimore: Paul Brookes

• Florida Center for Reading Research (www.fcrr.org)

• Eden G. and Moats L. (2002) Nature Neuroscience Reviews

Institute of Educational SciencesUS Department of Education

“There are a vast array of educational interventions that claim to improve educational outcomes and to be supported by evidence…

...introduced with great fanfare as being able to produce dramatic gains…

…yielding little in the way of positive and long lasting changes”

The What Works Clearinghouse: http://www.w-w-c.org

Randomized Controlled TrialsGroups

• Intervention (under study)

• Other intervention program

•Active control (Placebo control

or “sugar pill” )

•No intervention (passive control)

Randomized Controlled TrialsDesign

• Randomized assignment of dyslexic individuals into different groups

• Compare the groups after intervention

• Groups are equal in reading measures prior to the intervention

• Cross over design

Clinical Trial: Study Design 1• Randomized assignment of individuals into two groups receiving different interventions

• Groups are equal in reading measures prior to the intervention

• Compare the two groups after intervention

Group1 Group 2

Pre intervention

Program A Program B

Post intervention

Clinical Trial: Study Design 2

Randomized assignment into two groups receiving different interventions, followed by cross over

Group1 Group 2

Pre intervention

Program A Program B

Post intervention 1

Program B Program A

Post intervention 2

Institute of Educational SciencesUS Department of Education

Guidelines on how to evaluate whether an educational intervention is supported by rigorous evidence

Randomized controlled trials

+

Effective in two or more settings

= Strong Evidence

Pre-post studies do not comprise “strong” or even “possible evidence” - often produce erroneous results

CSL – Jemicy School Study

• Treatment Group: Reading Intervention (“Seeing Stars”)

• Active Control Group: Math Intervention (“On Cloud Nine”)

• Developmental Control: No Intervention

Interventions administered in the same five-on-one fashion.

Study Design

Reading

Math

Reading Break

Reading

Math

Assessm

ent &

Imaging

Assessm

ent & Im

aging

Assessm

ent & Im

aging

1

2

3

Reading Intervention: Lindamood-Bell Seeing Stars ®: Symbol Imagery for Phonemic Awareness, Sight Words and Spelling Program.Math Intervention: Lindamood-Bell On Cloud Nine ®:

Seeing Stars: Symbol Imagery for Phonemic Awareness, Sight

Words, and SpellingGoal: Develop symbol imagery (i.e. the ability to create

mental representations for sounds and letters within words).

● refining the speed and accuracy of PA and PP● establishing a visual memory base for sight words● increasing fluency and rate in contextual reading● improving phonetic and orthographic spelling.

Program progresses from visualization for single sounds and letters through to multisyllable reading and spelling, with application to contextual reading and spelling.

Results: still being analyzed

John AgnewKate CappellEmily CurranEmma ColeNicole DietzIain DeWittErin EinbinderLynn GareauKaren JonesJessica KoehlerJoe MaisogMartha MirandaAlison MerikangasCorinna MooreEileen NapolielloJenni RosenbergPeter TurkeltaubRobert TwomeyJohn VanMeterThomas Zeffiro

Wake Forest UniversityLynn FlowersFrank WoodDebi Hill

Gallaudet UniversityCarol LaSassoKelly Crain

Supported by NICHD, NIDCD, NIMH

Special Thanks to

Jemicy School

and

Lindamood-Bell Learning Processes