Disclaimer: this resource is intended for speech and language therapists and students of this profession. If you require therapy for aphasia please contact a speech and language therapist.
Oral Reading for Language in Aphasia (ORLA)
Summary: Oral Reading for Language in Aphasia (ORLA), developed by Cherney (1995), is a treatment that primarily targets written comprehension and involves a range of reading tasks, e.g. spoken word to written word matching, reading single words aloud, and reading sentences in unison/independently (Cherney, 2010a). Drawing on neuropsychological models of reading, this approach seeks to stimulate both the lexical and nonlexical reading routes. Variants of ORLA are available: while ORLA+Writing adapts the approach to also target writing ability, ORLA-VT is delivered on a computer by a virtual therapist.
Example: ORLA is arranged into four levels of increasing sentence length and reading level:
Having selected the appropriate level to begin treatment, the therapist presents the client with written sentences and works through the five stages below. Support in locating and reading targets aloud is provided as necessary.
(From Cherney, 2010a)
- Level 1: 3-5 word sentences, 1st grade reading level
- Level 2: 8-12 words (1-2 sentences), 3rd grade reading level
- Level 3: 15-30 words (2-3 sentences), 6th grade reading level
- Level 4: 50-100 word paragraph, 6th grade reading level
Having selected the appropriate level to begin treatment, the therapist presents the client with written sentences and works through the five stages below. Support in locating and reading targets aloud is provided as necessary.
- The therapist reads the sentence aloud, pointing to each word as they do so. The client observes.
- The therapist and client read the sentence aloud in unison, pointing to each word as they do so. This step can be repeated, varying the rate and volume of delivery.
- The therapist says one of the words in the sentence or line and the client locates and points to this target.
- The therapist points to a word in a sentence or line and the client reads this word aloud.
- The client reads the sentence aloud independently.
(From Cherney, 2010a)
Evidence Base: An early study by Cherney (1995) delivered ORLA to two participants with chronic Broca's aphasia over 30 sessions. Improvements in ability to read target sentences was noted for both participants and this was maintained post-treatment. One of the participants also demonstrated generalisation to non-targeted sentences and wider language tasks.
Cherney (2010a) delivered ORLA to 25 participants with chronic nonfluent aphasia of varying severity. 24 sessions were delivered (from 1-3 sessions per week). A small, significant improvement was noted in mean change on the Western Aphasia Battery Aphasia Quotient (WAB-AQ) following treatment. When results were analysed by severity type medium effect sizes were noted in some subtests - i.e. a medium effect size was noted for those with severe aphasia on the reading subtest, for those with moderate aphasia on the discourse subtest, and for mild to moderate aphasia on the discourse and writing subtests.
Cherney (2010b) also carried out a study comparing the efficacy of ORLA-VT (i.e. delivered via software) with ORLA delivered by a speech and language pathologist. 25 participants with chronic nonfluent aphasia were randomly assigned to these treatment conditions and underwent 24 sessions of ORLA (from 1-3 sessions per week). Positive effect sizes (medium or large) were observed when WAB-AQ and measures of discourse for the pre-treatment phase were compared with scores achieved following treatment. No significant difference was noted between scores for those in the computer-delivered ORLA condition and those in the therapist-delivered ORLA condition.
Cherney (2010a) delivered ORLA to 25 participants with chronic nonfluent aphasia of varying severity. 24 sessions were delivered (from 1-3 sessions per week). A small, significant improvement was noted in mean change on the Western Aphasia Battery Aphasia Quotient (WAB-AQ) following treatment. When results were analysed by severity type medium effect sizes were noted in some subtests - i.e. a medium effect size was noted for those with severe aphasia on the reading subtest, for those with moderate aphasia on the discourse subtest, and for mild to moderate aphasia on the discourse and writing subtests.
Cherney (2010b) also carried out a study comparing the efficacy of ORLA-VT (i.e. delivered via software) with ORLA delivered by a speech and language pathologist. 25 participants with chronic nonfluent aphasia were randomly assigned to these treatment conditions and underwent 24 sessions of ORLA (from 1-3 sessions per week). Positive effect sizes (medium or large) were observed when WAB-AQ and measures of discourse for the pre-treatment phase were compared with scores achieved following treatment. No significant difference was noted between scores for those in the computer-delivered ORLA condition and those in the therapist-delivered ORLA condition.
References
Cherney, L.R., 1995. Efficacy of oral reading in the treatment of two patients with chronic Broca's aphasia. Topics in Stroke Rehabilitation, 2(1), 57-67
Cherney, L.R., 2010a. Oral Reading for Language in Aphasia: Impact of aphasia severity on cross-modal outcomes in chronic nonfluent aphasia. Seminars in Speech and Language, 31(1), 42-51
Cherney, L.R., 2010b. Oral Reading for Language in Aphasia: Evaluating the efficacy of computer-delivered therapy in chronic nonfluent aphasia. Topics in Stroke Rehabilitation, 17(6), 423-431
Cherney, L.R., 1995. Efficacy of oral reading in the treatment of two patients with chronic Broca's aphasia. Topics in Stroke Rehabilitation, 2(1), 57-67
Cherney, L.R., 2010a. Oral Reading for Language in Aphasia: Impact of aphasia severity on cross-modal outcomes in chronic nonfluent aphasia. Seminars in Speech and Language, 31(1), 42-51
Cherney, L.R., 2010b. Oral Reading for Language in Aphasia: Evaluating the efficacy of computer-delivered therapy in chronic nonfluent aphasia. Topics in Stroke Rehabilitation, 17(6), 423-431
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