The nature and treatment of phonological text agraphia.

Only four participants were studied, so the results are a case series rather than evidence of an average effect. The authors say the pattern emerged post hoc and they did not predict that phonological treatment would improve written sentence grammar. The treatment package included phonological treatment, interactive spelling treatment, homework, an electronic spell-checker, and, for one participant, oral reading treatment, so the contribution of any single component cannot be separated. Written narratives were self-generated and collected on different days, so direct word-by-word or sentence-by-sentence comparisons were not possible. Two participants were only 4 months post-stroke, and the authors cannot entirely rule out natural recovery. Participants had average or better pre-stroke language, normal hearing, and preserved nonverbal problem solving, so it may not apply to people with more severe or broader impairments.

Do not conclude that phonological treatment alone caused the grammar gains, because all participants also received interactive spelling treatment, homework, an electronic spell-checker, and one also received oral reading treatment. The authors say the components cannot be teased apart, and this was a four-person case series.