![]() ![]() (A) A cognitive model of written language processing depicting disruption of visual input to the orthographic lexicon (hash marks), an alternate letter-by-letter reading route (dashed lines), and graying of the orthographic lexicon to indicate damage. Degraded orthographic representations also affect spelling, so that phonologically plausible errors are common for irregularly spelled words, as in spelling blood as blud. This sublexical reading approach is prone to error for irregularly spelled words, such as blood, which may ultimately be pronounced to rhyme with rude (see Figure 1a). For reading, the identification of the graphemic sequence comprising a word does not necessarily lead to accurate word recognition, and further decoding is achieved by letter-to-sound conversion. In other words, LBL reading may co-occur with surface alexia and surface agraphia as depicted in Figure 1a. In some cases, however, the serial LBL reading profile is accompanied by an impairment of orthographic knowledge, so that reading and spelling are accomplished with overreliance on grapheme–phoneme and phoneme–grapheme conversion, respectively ( Bowers, Arguin, & Bub, 1996 Friedman & Hadley, 1992 Patterson & Kay, 1982). LBL reading is often characterized as pure alexia, or alexia without agraphia, when spelling knowledge is preserved. ![]() LBL reading is the typical compensatory strategy observed when there is disconnection or disruption of visual input to critical regions for orthographic processing ( Binder & Mohr, 1992 Damasio & Damasio, 1983). The associated syndromes include letter-by-letter (LBL) reading, surface alexia, and surface agraphia ( Déjerine, 1892 Epelbaum et al., 2008 Rapcsak & Beeson, 2004 Sebastian et al., 2014). Acquired impairments of written language processing are relatively common after damage to left ventral occipito-temporal (lvOT) cortex and underlying white matter.
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