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Overview
Deficits in receptive language are a common effect experienced by 68% of adults with aphasia (Thumbeck et al., 2021). In particular, difficulties with reading comprehension may be present, even when literacy skills remain in tact. Because reading skills are such an integral part of daily life for many adults, this can be an excellent area to target during therapy sessions. Reading comprehension therapy has shown to be highly effective for helping persons with aphasia increase their receptive language skills (Cherney, 2010; Purdy et al., 2019). Oral Reading for Language in Aphasia (ORLA) therapy is an evidence-based practice that has been shown to help adults with mild to moderate chronic fluent and non-fluent aphasia who have intact literacy skills to increase receptive language (Cherney, 1987; Cherney, 2010; Lingraphica, 2020). While ORLA was originally created to target reading comprehension skills, it is also beneficial for increasing auditory comprehension, prosody, memory, and other aspects of speech and language (Purdy et al., 2018; Lingraphica, 2020).
What is ORLA?
Oral Reading for Langauge in Aphasia is a is a reading comprehension treatment that targets reading at the sentence level (Lingraphica, 2020). The difficulty of reading material provided can be adapted depending on the severity level of aphasia and will increase in complexity from simple sentences up to the paragraph and passage level as the client progresses.
How to Utilize ORLA During Treatment
The clinician should sit opposite to the client so that the client is able to view the clinician's mouth and facial expressions as they speak and use these visual cues to increase comprehension.
The clinician will first model the sentence or passage by reading it aloud to the client and moving their finger along each word as they read.
Next, the clinician and client will read the sentence or passage aloud together while both moving their fingers along each word as they read.
The clinician will chose a word from the sentence or passage and ask the client to identify that word on the page. The client will then read the word aloud.
The client will independently read the sentence or passage aloud.
As the client progress over time, the clinican may conclude the activity by asking the client questions about the sentence or passage that they have read. The clinician may ask questions about the content of the reading material or they may ask the client to summarize the material.
(Cherney, 1987; Cherney, 2010; Therapy Insights, 2022)
(Therapy Insights, 2022)
Materials
There are no specific reading materials required for ORLA therapy (Cherney, 1987). Any reading materials can be used during therapy, allowing individualization of the therapy plan. The reading materials can be based on functionality or the client's interests. The clinician may choose reading material from a news article, a book, a website, or any other source (Lingraphica, 2020).
Example Goal
In three months, Client will be able to accurately summarize the content of a three sentence paragraph with a verbal prompt in 4/5 trials across three consecutive sessions as measured by clinician data.
Copy of Data Collection Sheet with Cues.docxPrompting and Data Collection
Visual, gestural, and verbal prompts and cuing may be used throughout the implementation of ORLA and are built into the procedural steps. Initially, clients may require maximal verbal and visual cueing. As the client progresses and becomes more independent, the clincian may choose to reduce verbal modeling or reduce the number of visual/gestural cues given. During sessions, the clinician should keep data by tracking the number of times the client correctly identifies a written word when asked by the clinician and the number of times the client correctly answers questions regarding the content or concepts in the reading material. Data tracked should be reflective of the client's goal. A data sheet such as the example to the left will allow a clinician to track the targeted goal, number of successful attempts, and the prompting provided by the clinician.
References
Cherney, Leora R., Merbitz, Charles T., & Grip, Jeffrey C. (1987). Efficacy of Oral Reading in Aphasia Treatment Outcome. Rehabilitation Literature.
Cherney, Leora. (2010) Oral Reading for Language in Aphasia (ORLA): Evaluating the Efficacy of Computer-Delivered Therapy in Chronic Nonfluent Aphasia. Topics in Stroke Rehabilitation. doi: 10.1310/tsr1706-423.
Lingraphica. (2020). Oral Reading for Language in Aphasia (ORLA). Lingraphica.
Purdy, Mary, Coppens, Patrick, Madden, Elizabeth B., Mozeiko, Jennifer, Patterson, Janet, Wallace, Sarah E., & Freed, Donald (2019) Reading comprehension treatment in aphasia: a systematic review. Aphasiology, 33:6, 629-651, DOI: 10.1080/02687038.2018.1482405
Therapy Insights. (2022). Oral Reading for Language in Aphasia (ORLA) – Printable Handouts for Speech, Occupational, and Physical Therapists. Therapy Insights.
Thumbeck S., Schmid P., & Chesneau S. (2021). Efficacy of a strategy-based intervention on text-level reading comprehension in persons with aphasia: a study protocol for a repeated measures study. BMJ Open. doi: 10.1136/bmjopen-2020-048126.
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