Cognitive Processes Underlying Reading Improvement during a Rhythm-Based Intervention. A Small-Scale Investigation of Italian Children with Dyslexia

Music-Based and Auditory-Based Interventions for Reading Difficulties: A Literature Review

Remediation of reading difficulties through music and auditory-based interventions in children with impairments in reading (such as developmental dyslexia) has been suggested in light of the putative neural and cognitive overlaps between the music and language domains. Several studies had explored the effect of music training on reading development, showing mixed results. However, to date, the meta-analyses on this topic did not differentiate the studies on typical children from those on children with reading difficulties. To draw a clear picture of the remedial effects of music-based and auditory-based interventions, the present review of the literature included studies on struggling readers only. Eighteen studies have been categorized according to the type of the main training activity – either specific auditory training or more broad music training – and the combination with reading exercises. The reviewed studies showed that musical and auditory interventions yielded a positive, but not consistent, effect on reading. Nevertheless, significantly larger improvements of phonological abilities, relative to the control conditions, were overall reported. These findings support the hypothesis of a transfer effect of musical and auditory training on phonological and literacy skills in children with reading difficulties.

The Role of Auditory and Visual Components in Reading Training: No Additional Effect of Synchronized Visual Cue in a Rhythm-Based Intervention for Dyslexia

Based on the transfer effects of music training on the phonological and reading abilities of children with dyslexia, a computerized rhythmic intervention—the Rhythmic Reading Training (RRT)—was developed, in which reading exercises are combined with a rhythmic synchronization task. This rehabilitation program was previously tested in multiple controlled clinical trials, which confirmed its effectiveness in improving the reading skills of children and adolescents with dyslexia. In order to assess the specific contribution of the visual component of the training, namely, the presence of a visual cue supporting rhythmic synchronization, a controlled experimental study was conducted. Fifty-eight students with dyslexia aged 8 to 13 years were assigned to three conditions: (a) RRT auditory and visual condition, in which a visual cue was synchronized with the rhythmic stimulation; (b) RRT auditory-only condition, in which the visual cue was excluded; (c) no intervention. Comparisons of the participants’ performance before, after, and 3 months after the end of the intervention period revealed the significant immediate and long-term effect of both RRT conditions on reading, rapid naming, phonological, rhythmic, and attentional abilities. No significant differences were found between visual and auditory conditions, therefore showing no additional contribution of the visual component to the improvements induced by the RRT. Clinical Trial ID: NCT04995991.

Dyslexia Telerehabilitation during the COVID-19 Pandemic: Results of a Rhythm-Based Intervention for Reading

The COVID-19 outbreak necessitated a reorganization of the rehabilitation practices for Learning Disorders (LDs). During the lockdown phase, telerehabilitation offered the possibility to continue training interventions while enabling social distancing. Given such an advantage of telerehabilitation methods for LDs, clinical research is still needed to test the effectiveness of diverse teletraining approaches by comparing their outcomes with those of face-to-face interventions. To compare the effectiveness of telerehabilitation vs. in-presence rehabilitation of dyslexia, a rhythm-based intervention for reading, called Rhythmic Reading Training (RRT), was tested in a small-scale clinical trial during the lockdown phase of the COVID-19 pandemic. Thirty children aged 8-13 with a diagnosis of developmental dyslexia were assigned to either a telerehabilitation or an in-presence rehabilitation setting and received RRT for 10 biweekly sessions of 45 min, supervised by a trained practitioner. The results showed that both telerehabilitation and in-presence rehabilitation were effective in improving reading and rapid automatized naming in children with dyslexia and that the effects were comparable between settings. Therefore, RRT was found to be effective in spite of the administration method (remote or in-presence). These results confirm the potential of telemedicine for the rehabilitation of LDs. Clinical Trial ID: NCT04995471.

The Neurological Basis of Developmental Dyslexia and Related Disorders: A Reappraisal of the Temporal Hypothesis, Twenty Years on

In a now-classic article published a couple of decades ago (Brain, 2000; 123: 2373-2399), I proposed an "extended temporal processing deficit hypothesis of dyslexia", suggesting that a deficit in temporal processing could explain not only language-related peculiarities usually noticed in dyslexic children, but also a wider range of symptoms related to impaired processing of time in general. In the present review paper, I will revisit this "historical" hypothesis both in the light of a new clinical perspective, including the central yet poorly explained notion of comorbidity, and also taking a new look at the most recent experimental work, mainly focusing on brain imaging data. First, consistent with daily clinical practice, I propose to distinguish three groups of children who fail to learn to read, of fairly equal occurrence, who share the same initial presentation (difficulty in mastering the rules of grapheme-phoneme correspondence) but with differing associated signs and/or comorbid conditions (language disorders in the first group, attentional deficits in the second one, and motor coordination problems in the last one), thus suggesting, at least in part, potentially different triggering mechanisms. It is then suggested, in the light of brain imaging information available to date, that the three main clinical presentations/associations of cognitive impairments that compromise reading skills acquisition correspond to three distinct patterns of miswiring or "disconnectivity" in specific brain networks which have in common their involvement in the process of learning and their heavy reliance on temporal features of information processing. With reference to the classic temporal processing deficit of dyslexia and to recent evidence of an inability of the dyslexic brain to achieve adequate coupling of oscillatory brain activity to the temporal features of external events, a general model is proposed according to which a common mechanism of temporal uncoupling between various disconnected-and/or mis-wired-processors may account for distinct forms of specific learning disorders, with reading impairment being a more or less constant feature. Finally, the potential therapeutic implications of such a view are considered, with special emphasis on methods seeking to enhance cross-modal connectivity between separate brain systems, including those using rhythmic and musical training in dyslexic patients.

Deficits in musical rhythm perception in children with specific learning disabilities

BACKGROUND

A specific learning disability comes with a cluster of deficits in the neurocognitive domain. Phonological processing deficits have been the core of different types of specific learning disabilities. In addition to difficulties in phonological processing and cognitive deficits, children with specific learning disability (SLD) are known to have deficits in more innate non-language-based skills like musical rhythm processing.

OBJECTIVES

This paper reviews studies in the area of musical rhythm perception in children with SLD. An attempt was made to throw light on beneficial effects of music and rhythm-based intervention and their underlying mechanism.

METHODS

A hypothesis-driven review of research in the domain of rhythm deficits and rhythm-based intervention in children with SLD was carried out.

RESULTS

A summary of the reviewed literature highlights that music and language processing have shared neural underpinnings. Children with SLD in addition to difficulties in language processing and other neurocognitive deficits are known to have deficits in music and rhythm perception. This is explained in the background of deficits in auditory skills, perceptuo-motor skills and timing skills. Attempt has been made in the field to understand the effect of music training on the children's auditory processing and language development. Music and rhythm-based intervention emerges as a powerful intervention method to target language processing and other neurocognitive functions. Future studies in this direction are highly underscored.

CONCLUSIONS

Suggestions for future research on music-based interventions have been discussed.

Neural Responses to Musical Rhythm in Chinese Children With Reading Difficulties

The perception of the musical rhythm has been suggested as one of the predicting factors for reading abilities. Several studies have demonstrated that children with reading difficulties (RD) show reduced neural sensitivity in musical rhythm perception. Despite this prior evidence, the association between music and reading in Chinese is still controversial. In the present study, we sought to answer the question of whether the musical rhythm perception of Chinese children with RD is intact or not, providing further clues on how reading and music might be interlinked across languages. Oddball paradigm was adapted for testing the difference of musical rhythm perception, including predictable and unpredictable omission, in elementary school children with RD and typically developing age-controlled children with magnetoencephalography (MEG). We used the cluster-based permutation tests to examine the statistical difference in neural responses. The event-related field (ERF) components, mismatch negativity (MMNm) and P3a(m), were elicited by the rhythmical patterns with omitted strong beats. Specifically, differential P3a(m) components were found smaller in children with RD when comparing the rhythmical patterns between predictable and unpredicted omission patterns. The results showed that brain responses to the omission in the strong beat of an unpredicted rhythmic pattern were significantly smaller in Chinese children with RD. This indicated that children with RD may be impaired in the auditory sensitivity of rhythmic beats. This also suggests that children with reading difficulties may have atypical neural representations of rhythm that could be one of the underlying factors in dysfluent reading development.

The Effectiveness of Interventions for Developmental Dyslexia: Rhythmic Reading Training Compared With Hemisphere-Specific Stimulation and Action Video Games

Developmental dyslexia is a very common learning disorder causing an impairment in reading ability. Although the core deficit underlying dyslexia is still under debate, significant agreement is reached in the literature that dyslexia is related to a specific deficit in the phonological representation of speech sounds. Many studies also reported an association between reading skills and music. These findings suggest that interventions aimed at enhancing basic auditory skills of children with DD may impact reading abilities. However, music education alone failed to produce improvements in reading skills comparable to those resulting from traditional intervention methods for DD. Therefore, a computer-assisted intervention method, called Rhythmic Reading Training (RRT), which combines sublexical reading exercises with rhythm processing, was implemented. The purpose of the present study was to compare the effectiveness of RRT and that of an intervention resulting from the combination of two yet validated treatments for dyslexia, namely, Bakker’s Visual Hemisphere-Specific Stimulation (VHSS) and the Action Video Game Training (AVG). Both interventions, administered for 13 h over 9 days, significantly improved reading speed and accuracy of a group of Italian students with dyslexia aged 8–14. However, each intervention program produced improvements that were more evident in specific reading parameters: RRT was more effective for improvement of pseudoword reading speed, whereas VHSS + AVG was more effective in increasing general reading accuracy. Such different effects were found to be associated with different cognitive mechanisms, namely, phonological awareness for RRT and rapid automatized naming for VHSS + AVG, thus explaining the specific contribution of each training approach. Clinical Trial registration: ClinicalTrials.gov NCT02791841.

Gamification as a Supportive Tool for School Children with Dyslexia

Gamification, in its nature, combines not only games but also the whole psychological environment. Thanks to this, a properly prepared implementation of gameplaying can encourage people to compete with others and achieve the set tasks and goals. A person feels fulfilled that through his actions has performed a mission or reached a new level. It stimulates them to continue their activity and self-improvement to be better and beat their records. Its advantage is also that it does not have to be limited to one technology or method—it can be realized both through a simple scenario and a corkboard with results, it can also be embedded, e.g., in a virtual or augmented reality. This article focuses on the gamification of dyslexia, a common disorder of developmental disorders among pupils. It affects about 10%–15% of school-age children. The research narrowed the field of the study to one of the aspects of developmental dyslexia—dysorthography and making spelling mistakes by people affected by this disorder. This work aims to present an original application which is using gamification as a supportive tool for the learning of school children with diagnosed dyslexia. The conducted study was based on the implementation of original algorithms and scenarios of gamification on mobile devices, especially smartphones. School children are following a gamification approach for a specified period. As a conclusion, it can be stated that the proposed framework and gamification can help in the learning of people with dyslexia.