Treating acquired writing impairment: strengthening graphemic representations

A writing treatment protocol was designed for a 75 year-old man with severe Wernicke's aphasia. Four treatment phases were implemented: (1) a multiple baseline design that documented improvement in single-word writing for targeted words; (2) a clinician-directed home program that increased the corpus of correctly-spelled single words; (3) another multiple baseline series that documented acquisition of additional written words, as well as pragmatic training in the use of single-word writing to support conversational communication; and (4) a self-directed home treatment to further expand written vocabulary. The patient's acquisition of targeted words suggested an item-specific treatment effect that strengthened weakened graphemic representations. The patient's continued acquisition of correctly spelled words during the self-directed home treatment supported the use of this approach to supplement more traditional clinician-directed treatment.