“Neural plasticity is believed to be the basis for both learning in the intact brain and relearning in the damaged brain that occurs through physical rehabilitation. Neuroscience research has made significant advances in understanding experience-dependent neural plasticity, and these findings are beginning to be integrated with research on the degenerative and regenerative effects of brain damage. The qualities and constraints of experience-dependent neural plasticity are likely to be of major relevance on rehabilitation efforts in humans with brain damage”
(Kleim & Jones, 2008:S225).
Neuroscientists are conducting numerous experiments, investigating neurocognitive behaviour and development. Comprehending the impact of the learning process on cerebral functioning is a complex requirement. However, the data presented in this work, strongly support the existence of a relationship between brain anatomy, function, dyslexia and reading disabilities, in different cerebral levels. It seems that reading or problematic reading is related to many cerebral areas in the human brain.
Berninger and Richards said that cerebral differences between the dyslexic and the normal group refer to auditory language and not to non-linguistic auditory function. They also discovered that chemical differences in the brain function of dyslexics and control do exist. They suggest further research and investigation on the molecular and neural mechanisms underlying dyslexia (Berninger & Richards, 1999).
Simos and colleagues revealed that reading difficulties in developmental dyslexia may very possibly be related to an unusual pattern of functional connectivity between cerebral areas (the ventral visual association cortex and temporoparietal areas in the left hemisphere) normally involved in the reading process (Simos et al.,2000).
Brown and colleagues discovered reduced gray matter in the dyslexic brains in the following cerebral areas: left temporal lobe, temporoparietooccipital juncture bilaterally, frontal lobe, caudate, thalamus, cerebellum (Brown et al.,2001).
Von Plessen and colleagues have shown that the corpus callosum experiences a massive myelination in normal readers during the reading acquisition period. The shape analysis used in their study, showed that the corpus callosum of dyslexic individuals does not experience such a procedure, therefore is shorter than the corpus callosum of the control group (Von Plessen et al.,2002).
Vlachos and colleagues suggested that the act of learning to read may depend on implicit learning processes (responsible for executing new motor, perceptual and cognitive skills) regulating the automatization of reading mechanisms (phonological processing, automatization of basic articulatory and auditory skills) may be partially settled by the cerebellum (Vlachos et al.,2007).
It is obvious that research has covered most of the areas of the human brain. Neuroscientists investigating the functioning of the brain are trying to locate or understand the mechanism of reading. Neuroscience is evolving but it is still a relatively new field, therefore every new research study raises questions that scientists may have never considered when designing their research plans. All researchers dealing with the complex-miraculous organ called brain encourage further research. Paraphrasing Eckert, the complexity of the process of reading so far has made identification of an anatomical marker, differentiating dyslexics from control an elusive target (Eckert et al.,2003).
In addition to the structural-functional relation of the human brain with the complex act of reading, this thesis also analysed reading as “the process of understanding speech written down. The goal is to gain access to meaning. To acquire reading, children must learn the code used by their culture for representing speech as series of visual symbols. Learning to read is thus fundamentally a process of matching distinctive visual symbols to units of sound (phonology)” (Ziegler & Goswami, 2005:3). Children who fail to establish these processes experience a deficit in reading. To help them overcome their reading disorder, remedial reading training should be followed.
Reading scientists agree that the most beneficial way for treating dyslexia is by early reading intervention via phonemic awareness training. “It makes sense that early intervention, before the child becomes too anxious about reading or develops an aversion to it is helpful” (Blakemore & Frith, 2005:88). In the case of adult dyslexics, researchers are also positive. Studies conducted on dyslexic adults and their reading skills, have shown significant improvement in reading after specialised training. It has been revealed that a dyslexic trained group, started using the right parietal lobe (area that integrates sights and sounds), in order to compensate for the limited performance of the left parietal lobe (Eden et al.,1996). “These results emphasize the fact that the adult brain is capable of change and it is worth trying to train people with dyslexia even as adults” (Blakemore &Frith, 2005:93).
Furthermore, a large literature based on fMRI studies indicates significant brain changes in dyslexic children after remedial training programmes. Temple and colleagues demonstrated that reading and cerebral dysfunction in left temporo-parietal cortex in dyslexic children can improve after remedial programmes. In addition, they found a strong relationship between the improvement of linguistic skills and the extent of activity increase in left temporo-parietal areas, after therapy (Temple et al.,2003).
Meyler and colleagues investigated how a remedial reading training programme based on reading sentences for comprehension, can affect brain activation in poor readers. They demonstrated that, immediately after remedial intervention, impaired readers improved significantly their reading skills and also increased brain activation in the left angular gyrus and left superior parietal lobule (Meyler et al.,2008).
In 2009, scientists Timothy Keller and Marcel Just, conducted a study that revealed for the first time, that after a 100 hour intensive remedial reading training programme, the brain can actually rewire itself by improving the quality of cerebral white matter. Moreover, dyslexic student improve reading skills as the quality of white matter increases and attends normal levels (Keller & Just, 2009).
Based on the enormous, yet to be charted potential of the human brain, it can be inferred that in the future, our knowledge on the functioning of the dyslexic brain during reading will advance further, enabling reading researchers to devise a perfect phonemic awareness brain-based specialised training that will allow dyslexics to acquire effortless reading and reading speed.
The mutually–enabling processes of neuroplasticity and remedial reading training programmes in phonological awareness for overcoming the symptoms of dyslexia have been devised and are being implemented. One of these is the Remedial Reading Training Programme with the additional use of a metronome (RRTP-MT) or XEK method designed in the 1990s by Greek neuropsycholinguist Ch. Karpathiou. A characteristic feature of this method is that it employs a reoccurring metronome (MT) beat to facilitate concentration and assimilation. The author of this thesis has adopted the above method and has been applying it since 1996, in addition she has contributed to translating it and adapting it for use in English and French. This thesis describes this RRTP-MT and lists the evidence obtained so far of its successful application on eight French speaking subjects who have participated in this research study.
The RRTP-MT is designed to prevent or treat dyslexia, establish proper reading techniques, a convenient reading rhythm and reading comprehension. It relies heavily on the acquisition of phonics instruction with the additional use of a metronome.The RRTP-MT aims at establishing solid grapheme-phoneme relationship (known also as: graphophonemic relationship, letter-sound associations, letter-sound correspondences, sound-symbol correspondences or sound-spellings) by giving a systematic reading training, in a clearly defined sequence during forty sessions. The participants are trained systematicallyto specific reading skills, such as phonics, decoding, fluency, vocabulary, comprehension and spelling. Its final goal is to meet the five objectives for successful reading as presented by Ramirez: “Understand how phonemes are connected to print. Decode unfamiliar words. Read fluently. Develop sufficient vocabulary to foster reading comprehension. Motivation to read.” (Ramirez, 1999:3).
The RRTP-MT used as a therapeutic tool for treating reading deficiency of the eight dyslexic students participated in this research revealed significant reading improvement over the eleven month period demonstrating that it is appropriate method for treating dyslexia. Reading skill was the only component measured in this study. The measurement was made using the benchmark Alouette reading test. Nevertheless, the participants also showed remarkable improvement in writing skills and concentration. Conclusive, solid visualised evidence on brain changes after the application of the RRTP-MT can only be provided through fMRI. This research cannot provide this data and it is left for future studies to do so.
The RRTP-MT is a complete and well structured systematic intervention programme that improves linguistic and cognitive functions in a very precise way. The dyslexic child follows a specific reading procedure that develops fine reading and concentration skills as he pays attention to auditory (beat of the metronome) and visual (syllables or words) stimuli, suspected to cause long-term plastic change on dyslexic students brains. To our knowledge, the RRTP-MT is the only programme that besides phonological, syntactic, semantic and linguistic tasks is also using a metronome (rhythm) for the treatment of dyslexia.
The element of rhythm used in the RRTP-MT raises various thoughts and questions for further investigation and research. Research conducted to prove the beneficial effects the IM has on children with various disorders have showed that “Awareness of beats may influence the way young children assimilate speech patterns and affect their ability to break down the sounds of words” (Swarbrick & Marshall, 2004:114). It is also argued that “by learning to keep the beat, children become better able to sustain focus, disregard distractions and stay on task for longer periods of time” (Swarbrick & Marshall, 2004:114) Based on the research they conducted where they taught monkeys new skills, Jenkins and Merzenich concluded that individual neurons became more selective with training; they also showed that as neurons are trained they become more efficient and process faster, thus leading to faster thought, a crucial component for intelligence (Doidge, 2008). These findings give strong evidence that systematic training optimizes functional outcome.
The reading remedial intervention material used in the majority of the studies focuses mostly on phonological reading to improve word-level decoding skills (Karpathiou et al., 1999; Meyller et al.,2008; Keller & Just, 2009). Moreover, the implementation of rhythm as a therapeutic tool for the treatment of dyslexia forces the dyslexic person to pay close attention to the reading material he is given by the instructors. The element of rhythm provides a maximum level of concentration to the student and also reorganizes and treats the reading rhythm of the dyslexic person, enabling him/her to achieve a very good level of reading comprehension. Merzenich’s findings indicate that paying close attention is essential to long term plastic changes in the brain. In the experiments he conducted with monkeys, he found out that lasting changes occurred only in the cases where monkeys paid close attention to the task they were asked to perform (Doidge, 2008). In the case of dyslexic children, during a remedial intervention programme it is difficult to measure attention and concentration. However, the RRTP-MT is most probably the only reading programme that can ensure attention, since the students are asked to pay sharp attention to the beat of the metronome and read syllables or words after the beat.
It is assumed that rhythm helps the brain to reorganize and restructure itself by acquiring and processing new data in an effortless more successful way. A future study, that will exhibit evidence of the major importance of rhythm as an additional tool for treating reading disorders with the use of modern neuroimaging techniques may possibly lead to breakthroughs in the treatment of dyslexia.
Results from numerous studies conducted by neuroscientists from all over the world demonstrate clearly that neuroplasticity and the process of learning are closely related. To our knowledge, the RRTP-MT is still the only reading intervention programme that uses a metronome for treating dyslexia in the field of logopedics and improves cognitive functions in general. During the past 15 years, over 300 dyslexic children of all ages followed the RRTP-MT at the Athens Neurolinguistics Center and improved significantly in reading, writing and oral speech. Dyslexic students who have followed the RRTP-MT are encouraged to return for an additional evaluation on reading and learning skills, a year after the completion of the remedial intervention. Retests showed that results are permanent. These findings lead to the assumption that the specific remedial intervention is possibly also interfering in cerebral changes at various levels in cortical areas also responsible for cognitive processes other than reading. These empirical findings increase our understanding of neuroplasticity and inspire the creation of more effective treatments for brain disorders.
All research findings presented in this thesis strongly encourage neuroscientists and reading experts to continue research towards the same direction. The creation and perfection of a standardized RRTP-MT recognized by the majority of neuroscientists is still at process. However, this thesis gives strong evidence of the importance of rhythm as a therapeutic element for treating dyslexia. Therefore, future studies that will investigate how rhythm affects the cerebral function of the Dyslexic Brain, with the use of modern brain imaging techniques, will provide scientists with solid knowledge in this virgin area of research and definitely contribute to the creation of new and more efficient remedial reading programmes for the treatment of dyslexia.
We feel fortunate to be witnessing all the scientific evidence of neuroplasticity which enables scientists to understand the function and ‘behaviour’ of the human brain and therefore create therapeutic tools for treating cognitive dysfunctions in a physical way.