Musicians and dyslexia. Or not being ‘dysdansic’
There is debate about the roles of and relationships between
visual processing and phonological processing in dyslexia.
This is a short review and a relevant case.
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The case study outlined below reinforces the idea that we should look at two specific subtypes .
1. Where the phonological output is limited by Auditory/phonological processing.
2. Where the phonological processing and hence the phonological output is being limited by visual processing.
The point is that the latter limitation, can be much more easily dealt with than the audiological processing .
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At the Oxford-Kobe symposium, last week, the relationship between these two distinct processing
problems has been dissected.
The case study outlined below reinforces the idea that we should look at two specific subtypes.
1. Where the phonological output is limited by Auditory/phonological processing.
2. Where the phonological processing and hence the phonological output is being limited by visual processing.
The point is that the latter limitation, can be much more easily dealt with than the audiological processing .
Interventions which concentrated on Visual processing,
such as the Action Video Games research from Andrea Facoetti et al in Italy and the Auditory processing interventions of Nina
Kraus et al, including the use of assistive devices in this modality, http://tinyurl.com/cdb8myc both appear to
have measurable beneficial outcomes in terms of the reading process.
If we look at dyslexic people with a phonological
awareness /processing deficit, their appears to be specific deficits.
1. A delay in rhythm perception in the neuro studies… This
group appears less able to ‘match’ a rhythm which they ‘receive’.
a. So
for example to be able to tap you fingers in time with a drum beat.
b. Or finding it hard to match body movement., such
as in dancing, to the beat of the music. ( sounds like me! I feel Dysdansic.
c. This
would make it almost impossible to participate a ‘Jam session’ if you were
wanting to be a Jazz musician.
2. A
difficulty in identifying changes in
tone.
a. Very
robust research shows that the auditory processing system has a deficit in
identifying subtle changes in tone.
b. Again
this would restrict the ability of a musician to ‘play from ear’ but is not
quite the same as the rhythm deficit above.
Another relevant issue raised/ reported in the Symposium
was that of the origin of the functions of the ‘neural nodes’ in terms of
evolution and their relationships in terms of which communicates with which and
in which direction.
How does the original function of a node make it suitable
for a new role in the ‘reading process’. Looking at the plasticity of the
neurobiology. This aspect it is essential
to understand before any assumptions about data from fMRI or MEG studies are
used to ascribe ‘causality’ or ‘deficit role.
A particularly good example of this a part of the brain
cortex, used when we read, which in preliterate people was used for facial
recognition purposes. ( Data from Brazil and Portugal)
Without the preliterate studies the information would
have been misinterpreted or rather the significance not understood.
So can I add to this debate about the issue of the role
of Auditory processing?
The work By Nina Kraus et al tells us that it is
possible, at least in children to intervene effectively in reducing this capability
as an intervention and that the outcome is reduced ‘dyslexia’… By this I mean an increasing in the quality
/quantitative, phonological output when reading.
I have worked with several dyslexic adults, who were very
accomplished musicians, who had experienced and participated in all the auditory
processing therapies unknowingly.
The common experience of all of them was that they could
not read music!
I include in today’s blog a detailed case history of one
of them.
This guy is a skilled craftsman, a joiner, a keen successful
sportsman, an accomplished musician who was able to hear and then play music at
a high level. We have to assume than
that he would not show up in testing as having an auditory processing problem.
What he DID HAVE is a phonological output/processing problem. He could not read
effectively aloud, there was no effective prosody, it was tiring. His good
friend is the optician I am working with.
( As an aside Ken Pugh, at the Symposium assures me that
it is getting very close now to the effective ability to measure Prosody. As far I and many others are
concerned this is what really matters. When we use reading speed or oral
reading fluency measures what we are really trying to influence is prosody. The
quality of the phonological output…. More later on this topic.)
Following a comprehensive removal of limitations to his visual processing skills. Ian now reads music! And reads text fluently and easily with a great deal of pleasure.
The introduction refers to two case studies. Detail from
the other study will be provided in another blog.
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1.1.
Function
of this study
It is recognised that the reading ability of a nation
controls the academic performance and ultimately the economic might of a country.
Despite the best efforts of educationalists with young
people and adults there is little evidence of any actual change in the reading
performance of the population over the last few decades.
This study is associated with the development of a
programme which seeks to remove, where possible, any limitations by visual
components to the reading performance of an adult population.
It is hoped this study will contribute to the debate on
the interventions available and the role of visually enabling individuals.
The interventions studied here are intended to
complement, not to replace, other supportive technology and strategies
developed in the teaching/support of adults with restricted reading, visual
stress or dyslexia.
The development of the computer screen over the last 30
years has, for the first time in the history of literacy, made it possible to
‘fit’ the reading material to the eyes of the reader. It is now simple to move
away from the default font sizes and prescribed background settings to use the
large 16.5 million colour palette and the extensive array of font sizes
available within standard computers to offer people specific solutions to
maximise their performance.
The computer screen parameters which can and will be
objectively optimised for each individual in this analysis are,
·
Font size
·
Screen Brightness
·
Background red/green pixel brightness ratio.
·
Blue pixel brightness.
1.2.
Background
to the study
It is accepted that the quality of a person’s reading
performance is often the limiting factor in their academic and life chances.
The main approach with dyslexic adults is to provide
technologies and strategies enabling the individuals to participate fully and
successfully despite difficulties in reading performance and other attributes.
If the adult is not diagnosed/labelled as dyslexic then
protracted efforts are made to improve their level of ‘literacy’ or reading
performance.
These case studies seek to evaluate the effect of
available visual interventions on the enhancement of the reading performance of
two particular adults. This is not to teach them how
to read better, but to enable them to read at a higher level of performance,
more effectively and hopefully enable them to participate more fully in
learning.
The discussion tries to place the implications of these
outcomes into the debate on raising literacy standards. This is not primarily concerned with
teaching; it is more aligned to the analogy of providing well fitting shoes so
a person can walk more comfortably, for longer and
with more pleasure/less stress.
It is hoped this will add to and inform the debate on
maximising reading performance for individuals.
OmniRead
is involved in collaborative work at colleges in Yorkshire where a programme of
maximal support is being developed to enable the students’ literacy levels/reading
performance to be maximised to empower them to make best use of the courses on
offer. This work is in conjunction with
a team from a large university department of optometry.
1.3.
Structure
of the case studies
The data collected will attempt to disentangle how the
components of the interventions contribute to the improvements in reading
performance experienced.
The reading performance was measured in terms of
·
Eye movement data showing the way the eyes
saccade and fixate on the text during reading
·
Rapid automated naming
·
Oral reading fluency
·
Silent reading performance of
complex/meaningful text
The eye movement data was recorded using the ASL X-300
binocular eye tracking system allowing free head and body movement during the
read. This device identifies and measures, in a relative way, how both the left
and right eyes saccade and fixate on the text during reading.
This eye tracker further offers
·
A comparison of the strategies employed by
people who experience reading problems with those used by fluent readers.
·
A ‘subliminal’ solution, whereby the reader
has no control over the process which is consequential of the visual strategies
adopted by the person’s brain to maximise the reading performance within the
limitations of focussing, extra-ocular muscle (orthoptic issues) management and prior total reading
experience. This can all be considered
further within the context of such models as the “E–Z Reader: A cognitive-control,
serial-attention model of eye-movement behaviour during reading”
The use of a binocular eye tracker with a typical fluent
reader gives rise to graphs similar to those shown below in graph 1. In this
case the person had not had, to our knowledge, a full optometric and orthoptic
correction.
Each saccade and fixation is clear and the two eyes are
fully coordinated except for the fixation disparity (the difference between the
two eyes and denoted by the bottom green line) which appears to be increasing
as they read.
The neat step-like pattern is typical of a fluent
reader. If the fixation disparity was
constant, then the person is likely to have an even higher level of reading
performance. The increasing fixation disparity feature suggests the individual
may be prone to being easily distracted during reading /writing
fluent
If at least one eye appears to be undertaking these clear
steps, the person is likely to read quite fluently although not necessarily
with a great deal of stamina.
1.4.
Rapid
automated naming (RAN)
The use of RAN data in the study of reading performance
has a long history. Such data being the bedrock of the work by Arnold Wilkins et
al in the work on the benefits of the use of coloured acetates and coloured
glasses in reading. In his original work on the Irlen process and in his work
on developing the intuitive overlay system for identifying who might benefit
from the prolonged use of acetates or glasses while reading, the published
research demonstrates that the gains in reading performance associated with
‘intuitive colour preference’ were not placebo effects.
RAN performance was also important in the development of
the Phonological Deficit model and the Double Deficit Model.
1.5.
Oral
reading fluency (ORF)
This is a measure of the speed of a person reading real
text aloud in meaningful sentences and measured in words per minute.
In this study both subjects read all of the words in the
test. What varied, in addition to the speed, was the disjointedness and prosody
of the reading – fluency. These latter two points can be heard and contribute
to the speed but were not measured, but the changes in fluency were noted on a
qualitative basis.
The ORF is considered to be a good indicator of potential
academic performance. In our work with adults at University, using the same
text material, the mean ORF for dyslexic undergraduates is 138 words per minute
whereas for the non dyslexic university population it appears to be around 184
words per minute. These figures vary
depending on the institutions and appear (from our data) to be related to the
average A level grades needed to gain entrance to the institutions. Curiously,
at university level the mean figures for RAN and ORF appear to be very similar,
however those with ‘reading difficulties’ tend to have higher RAN values than
ORF. The rest of the population appear to have ORF values higher than RAN.
1.6.
Expectations
before the consultations
Because of the backgrounds of the two subjects it was
expected that both RAN and ORF values would be below 138 words per minute. Both
subjects had had optometric intervention over a period of time. As a part of
this study Chris Coakley undertook optometric consultations looking for any
optometric or orthoptic intervention which might assist them. Their original
prescriptions and their adjusted prescriptions are detailed below. Both subjects underwent a colour preference
assessment with Intuitive overlays. This procedure was in accordance with the
protocols as in Appendix A at the end of this report.
2. Case study 1 - Ian
Ian is a cabinet maker by trade. He is from a generation
where dyslexia was not recognised. He is a long standing client of Coakley
Associates of Wisbech.
2.1.
Ophthalmic
Intervention
Recently Chris Coakley decided together with Ian that
they should apply everything available in optometry to finding out if Ian’s
reading problems over the years could be associated with visual issues.
Chris Coakley undertook an extensive study of Ian to identify and
quantify any optometric and orthoptic parameters which may have contributed to
his poor reading performance.
Before any intervention Ian’s reading performance was recorded
using the Wilkins rate of reading test in his present spectacles; the rate
was determined to be 67 w.p.m.
The following tests were also performed.
·
A full refraction examination,
·
accurate determination of ADD(The difference
between the distance and near prescription ) using dynamic retinoscopy,
binocular duo-chrome and amplitude of accommodation tests,
·
eye and hand dominance testing,
·
motility and dynamic fixation analysis,
·
near point of convergence with a ‘RAF rule
·
near phoria with Maddox wing,
·
fixation disparity at near with ADD in place.
The tests resulted in the following optometric/orthoptic outcomes
and deficits were identified and a corrective prescription was produced
which replaced his original prescription which were
Varifocals R….+0.75/
-0.5 X90 L
+0.75/-0.25X90 Add +1.75
·
Low level hypermetropia and astigmatism attaining 6/5 R&L,
with expected ADD for age found,
·
Good near-point of convergence (6cm) but 8 exophoria requiring 2
base in for R.E. according to Mallett which was given, although he is right
handed and showed a dominant RE on classic dominancy testing
·
He showed good smooth eye movements on motility testing and had a
reasonable score on dynamic fixation analysis (22 sec)
·
Prescription given for reading in single vision form
Right:
+2.75/-0.50x85 2B.in Left:
+2.75/-0.25x90
It is expected that correction of these deficits are likely
to give rise to improved reading performance because he is now balanced
binocularly for both refractivity and orthoptics.
Ian now attained 85 w.p.m. on Wilkins speed of reading test – a
27% improvement.
A pair of prescription glasses was produced using all
optometric and orthoptic data.
These
glasses were used during the computer screen optimisation consultation with
OmniRead.
Using
the old glasses and blue/aqua overlay
RAN= 114
Using
new glasses and blue/aqua overlay
RAN= 160
2.2.
OmniRead
computer setting intervention
This
consultation involved the use of a binocular eye-tracker to monitor eye
movement during reading using the optometric correction.
OmniRead then objectively calculated the optimal parameter
settings for Ian to use on a computer screen, to maximise his reading
performance.
Before commencing the optimisation, Ian’s reading
performance, using his new glasses, was measured in terms of
1. RAN
(rapid automatic naming) using an equivalent of the Wilkins rate of reading
test of an array of simple words in a randomised sequence.
2. ORF
(oral reading fluency) a short piece of text used already with thousands of
dyslexic undergraduates and non-dyslexic adults.
3. Eye
movement patterns whilst reading a short piece of meaningful text off a
Microsoft Windows based laptop computer.
The default background settings used, namely
and all text was presented at font 12 and in a standard
Ariel font style as requested by Ian.
The eye tracker was used to record Ian’s eye movements
whilst reading a piece of normal text.
The text used was as follows and presented across the
screen in 3 lines.
Text 1
A
catering worker is needed for the Maid’s Head Hotel near Filey. You will be
working at a modern well-equipped hotel. Experience is preferred but is not
essential. You must be willing to train for the food hygiene certificate. The wage is £5.30 per hour for a six-day
week, 8 hours per day. Duties will include food preparation, washing up and
keeping the food preparation area clean. This position is available immediately
and will last until the end of the summer season, mid-September.
The silent reading results were:
90 words in 29 seconds, or
182 words per minute.
The OmniRead protocols identified the computer screen
settings as noted below for his optimal performance parameters and the
following eye traces.
Graph 5: Ian reading using his optimal
computer settings. Note the greater step-like performance.
The right eye (blue line) appears not to be closely
teamed with his left eye under these reading conditions.
What is interesting is that the fixation disparity
appears to increase to the
same ‘value’
(around 250 units) but on the optimal background this seems to have been
reached in about half the time that it did on default. There
does however appear to be a discrepancy between the eye movements of his left
and right eye; the right moves more (the vertical range) compared to the
tighter, more confined, left eye.
To avoid any learning effects, a similar piece of normal
text was used to identify Ian’s reading speed using his new optimal conditions
as noted above.
Text 2
A
special police team begins a different beat today, swapping their
cars
for a boat. Three officers will spend the summer protecting
holidaymakers
along the 200 kilometres of rivers and lakes which
make
up the Norfolk Broads.
The
team’s main role is to advise holidaymakers on safety on the
water
and to protect their boats from thieves.
The
scheme has been made possible because of the generous funding
by
local businesses. They have raised the thousands of pounds
needed
to purchase and run the boat for the police.
The data obtained was as follows,
88 words read in 18.7 seconds or 282 words per minute.
During the measurement process, data for the oral reading
fluency (ORF) was taken using text as used daily with undergraduates. In
addition timing data was also recorded for Ian to silently read the text.
The next graph shows the effect of using his optimal
glasses reading complex text initially on a white background with default font
size compared with reading equivalent text with optimised background and font
size
Using everything we could give him his reading
performance was better than the average non dyslexic undergraduate which is 184
words per minute.
At 195 words per minute, it is likely that his reading
performance was being limited by the bio
mechanics of the act of reading aloud. A second measure was taken that of the
silent reading of complex text. At this speed the fluency/ intonation was at a
very high level. Unlike the more stocatal style on the white background.
Finally a reading performance value was obtained under
the more normal style of silent reading.
Using everything with complex text Ian showed a massive
87% improvement in reading performance. From the additional use of optimal font
size and colour background. This was benefit not derived from ophthalmic and orthoptic
optimisation.
What we do not know from this data is what contribution
the latter made to the benefit that can be gained from the screen optimisation
We suspect that it is synergistic.
Graph 6: the step activity illustrating
the improved quality of the fixations and saccades.
2.3.
Fixation
disparity comparison.
To try and understand how fixation
disparity may contribute to visual stress or visual data processing
difficulties. A study was undertaken which looked at the total change in
fixation disparity occurring in 0.5 second intervals during the reading period.
This looks more closely at binocular
instability during fixations. This gave rise to the graph below.
A
comparison of the Fixation Disparity index of the default conditions and the optimal
settings generated the following graph
Graph 7: comparison of
fixation disparity data.
The
data from the optimal conditions suggests that the binocular stability during
fixations is much more stable and consistent than with the default conditions..
Under default conditions the amount of instability increases throughout the
reading period implying increase ‘stress’ in the binocular management process
and hence in visual data processing.
2.4.
Comments
on Ian’s data
Ian, a mature craftsman, has always found reading hard
work.
The combined use of optometric/orthoptic and image
optimisation appears to have brought about a notable improvement in reading
performance.
The initial very low RAN was improved by 27% by
optometric /orthoptic ( optimal glasses with prism) intervention but this level of RAN is still indicative of
person with severe unresolved problems. From our data, dyslexic adults who
enter higher education have a mean RAN of approx. 138 wpm.
The reading fluency performance with his new glasses with
a default screen setting and font size nearly matches that of the average
performance dyslexic adults in higher education - the same level of text
difficulty was used with Ian as with undergraduates.
Using the simpler text designed for Further Education,
NEET students, his silent reading speed was 182 wpm. Using default settings.
This is a strong indication that Ian needed to sub-vocalise which would limit his performance, enjoyment
and comprehension. When using his optimised conditions with this simpler level
of text there was a substantial improvement in silent reading taking him into a
non sub-vocalising strategy.
With the more complex text - longer words more complex
phrasing - used for the ORF index, the change was even more dramatic. Initially
just using his new glasses the change in reading index with computer screen
optimisation took him well above that for non-dyslexic undergraduates (184 wpm)
and with such fluency and prosody that is was a clear quantum leap in reading
performance with no hesitancy at all. The change in silent read performance
with this complex text produced a comparable outcome.
It could be argued that there was an overall performance
improvement from the combined intervention of between 100% and 200%.
Whether the benefits from screen optimisation would be as
obvious without the optometric/orthoptic intervention is not evidenced from
this study… discuss.
Certainly undergraduates who have had unresolved
optometric difficulties do not appear to gain as much from screen optimisation.
We do not know yet what will happen after using the
combined interventions for an extended period. The issue of whether the
magnocellular component of the reading process might be plastic and maintain
its responsiveness to the intervention is unknown. Further consultations may give us some
insight into this issue.
2.5.
Follow-up
On re-testing the eye tracking data the next day
following its use, the eye turn information was noted.
When using the orthoptic correction (prism) there appears
to be no eye-turn taking place as Ian reads, independent of the background
settings and font size.
However when using his glasses with no prism component
the eye turn appears to be less when using the optimal font size and
background.
It is plausible that the eye-turns are to some extent in
response to some processing difficulties as opposed to a muscle weakness. This data supports the notion that in this case the eye
turn is correctable by orthoptic/optometric intervention but also implies that
the background colour setting is a component factor in this ‘strategic eye
turn’. This perspective is supported by research by Sue Fowler of the Dyslexia
Research Trust shows improved convergence and accommodation when using the
Yellow or blue glasses developed by the DRT.
One of the issues that seems to vary with reading
performance is the average time duration of the fixations as a person becomes
more fluent. If this is reflective of
the speed with which the eye captures enough data to decode the text, then we
might expect the fixation time to reduce as the data capture process becomes
more efficient. In the case of Ian this
appears to be the situation.
Ian’s mean fixation duration times were
This data supports the notion that the number
of milliseconds need for processing or
edge detecting the image/grapheme, is significantly reduced when the background
setting is optimised and further reduced if the font size is optimised.
