Reading Comprehension: Targeting Both Cognitive and Language Skills

These text-level reading exercises help more than just reading goals. Learn about these tasks and how they target areas like attention, memory, and inferencing.

How many words did you read this week?  Chances are, that number is in the thousands.  Reading is a fundamental part of our lives, and it’s easy to take for granted how many activities require it. Thinking about your own week, it’s likely that you’ve read many of these materials without much of an afterthought:

• Traffic signs
• Hallway and building signs
• Menu at a restaurant
• Text messages or emails
• Newspaper or online news articles
• Books
• Work-related content (articles, projections, reports, etc.)

Because of its prevalence in almost everything that we do, when this skill is affected, it can significantly and negatively impact one’s daily life.

Reading comprehension difficulties can affect people of all ages.  Children can struggle with acquiring this skill, and many who had reading problems in school continue to have trouble with reading in adulthood. Additionally, acquired injuries such as stroke, aphasia, or other types of brain injury can impact reading comprehension for adults and school-aged children.

Reading is Not Just a Language Skill

Language impairments are not the only root cause of reading problems. There are many cognitive processes that are at work when reading.  For example, attention and working memory are significantly involved in reading comprehension. In fact, research found that in people with traumatic brain injury, discourse comprehension was highly predicted by working memory capacity (Meteyard et al., 2014).  Another cognitive process that is essential for reading comprehension is inferencing. To draw an inference, individuals must use prior knowledge to connect gaps in the text. Problems with inferencing can significantly impact comprehension and memory of the text.

How to improve reading comprehension? In speech-language therapy, there are many evidence-based reading comprehension strategies such as SQ3R, ARCS, PICS, and ORLA that have been shown to help address reading comprehension impairments at the paragraph and multi-paragraph level.

Using Constant Therapy to Target Reading in the Clinic

One challenge when incorporating these strategies into therapy is finding materials that are at the appropriate reading level, topic, and length.  Particularly for adult and older school-aged clients, there are limited reading comprehension worksheets available for clinicians to use, and they quickly become outdated.  Often the burden falls on the clinician to find appropriate reading comprehension passages to use with a client.

We interviewed one clinician who reported that it takes her about a half hour to find an appropriate article for a client, read it, and create comprehension questions.  Because this is a time-consuming task, it is challenging for her to find a large number of passages. As a result, the client’s homework is often limited to one or two passages per week.  

When in search for speech therapy materials, Constant Therapy is a huge time saver for clinicians. At your fingertips are hundreds of passages.  They are organized by length and difficulty level, and there are already comprehension questions created.  

Instead of recreating the wheel, use the passages in your therapy sessions to train comprehension strategies with your client.

Using Constant Therapy to Target Reading Goals At Home

Chapey (2008) talks about the advantages of using technology at home to address reading comprehension. Because reading is generally a solitary task, using a device to carryover reading goals outside of SLP sessions can be quite functional.  One study that looked at using technology for a home reading program is Katz & Wertz (1997). They found that this digital reading treatment is efficacious and can be administered with minimal assistance from a clinician.

Using technology like Constant Therapy to help supplement your therapy can be an incredibly powerful tool for you and your patients. Additionally, your clients can use the program for however long they want, so they can do as many reading comprehension exercises as they wish, and it takes the burden off of the clinician from having to locate or create the content. It’s all right there on the Constant Therapy app!

Paragraph and Multi-Paragraph Reading Passages for You and Your Patients

Let’s take a look at 3 Constant Therapy tasks that are available to you and your patients: Read a paragraph, Read multiple paragraphs, and Infer from multiple paragraphs.

Featured Task: Read a paragraph

What is Read a paragraph?

This task contains single paragraph (~4 sentence length) passages.  You will answer a series of questions based on the information read.  The text is available to refer to while answering the questions.

The questions ask about information explicitly stated in the passage. The questions are multiple choice with 2 distractors.

Need to enlarge the text? No problem! You can either increase the font size or enlarge the text to a full screen.

How is “Read a paragraph” leveled?

This task is leveled based on the difficulty of the reading passage. Lexile scores, which measure semantic and syntactic complexity, are utilized to divide the reading passages into three different levels. They are:

• Level 1: Lexile Level <1100
• Level 2: Lexile Level 1100-1299
• Level 3: Lexile Level >1300

How is “Read a paragraph” scored?

Scoring is binary (response is either correct or incorrect). The client has the opportunity to review response before moving on to the next item. Overall score is based on the % correct items given.

Featured Task: Read multiple paragraphs

What is Read multiple paragraphs?

This task contains multi-paragraph passages.  You will answer a series of questions based on the information read.  The text is available to refer to while answering the questions.

The questions ask about information explicitly stated in the passage. The questions are multiple choice with 2 distractors.

If you need the text to be enlarged, you can either increase the font size or enlarge the text to a full screen.

How is “Read multiple paragraphs” leveled?

This task is also leveled based on the difficulty of the reading passage. There are 3 levels based on Lexile scores, which again measure semantic and syntactic complexity. They are as follows:

• Level 1: Lexile Level <1100
• Level 2: Lexile Level 1100-1199
• Level 3: Lexile Level >1200

How is “Read multiple paragraphs” scored?

Scoring is binary (response is either correct or incorrect). The client has the opportunity to review response before moving on to the next item. Overall score is based on the % correct items given.

Featured Task: Infer from multiple paragraphs

What is Infer from multiple paragraphs?

Looking for an advanced reading therapy app? This task contains multi-paragraph passages, and you will answer a series of more challenging, inference-based questions based on the information read.  The text is available to refer to while answering the questions.

To answer these questions accurately, you must “read between the lines” and draw conclusions based on what is read.

The questions ask about information that is not explicitly stated in the passage. You must use inferencing skills to select the correct answer. The questions are multiple choice with 2 distractors.

If you need to view larger sized text, you can either increase the font size or enlarge the passage to a full screen.

How is “Infer from multiple paragraphs” leveled?

There are 3 levels based on Lexile scores that reflect the difficulty of the reading passage. They are:

• Level 1: Lexile Level <1100
• Level 2: Lexile Level 1100-1199
• Level 3: Lexile Level >1200

How is “Infer from multiple paragraphs” scored?

Scoring is binary (response is either correct or incorrect). The client has the opportunity to review response before moving on to the next item. Overall score is based on the % correct items given.

Applying Reading Tasks to Therapy Goals

How can Read a paragraph, Read multiple paragraphs, and Infer from multiple paragraphs be used in therapy?

These tasks do not only target reading comprehension skills.  Here’s some examples on how to use these tasks to target other cognitive and language domains:

• Verbal Expression: Generate a verbal summary to demonstrate understanding or even take a stance with supporting arguments based on the content
• Written Expression: Take written notes while reading, write a summary or persuasive essay based on the content to demonstrate comprehension
• Attention: Reading the passage requires the client to hold attention for a period of time (sustained attention).  You can increase the demands on attention by creating background noise (selective attention), interrupting the client in the middle of the reading task (alternating attention), or presenting another activity simultaneously (divided attention)  
• Memory: Both reading and drawing inferences absolutely exercise working memory skills. You can also target retrieval of new information by prompting the patient to answer comprehension questions without referencing the text.  
• Problem Solving: Your search for inference-based therapy tasks is over! With Infer from multiple paragraphs, you can target inferencing skills with these multiple-choice questions.  
• Processing Speed: Constant Therapy automatically tracks latency times, so you and your client can monitor reading fluency and processing speed.
• Unilateral Left Neglect or Left Inattention: The client must use scanning and left anchor strategies to read the entire text.

Looking for More Tasks to Help with Reading Comprehension?

The research indicates that cognitive processes such as attention, memory, and reasoning skills contribute to discourse comprehension.  Looking for more speech therapy exercises to target these cognitive skills? Visit our Tasks webpage to learn about cognitive tasks like Repeat a pattern, Infer from voicemail, Remember pictures in order (N-back), Find alternating words, and more!

For more information about the tasks in this blog or to watch our tutorial videos, please visit our Read a paragraph, Read multiple paragraphs, or Infer from multiple paragraphs pages.

References:

1. Baretta, L., Tomitch, L., MacNair, N., Lim, V., & Waldie, K. (2009). Inference making while reading narrative and expository texts: An ERP study. Psychology & Neuroscience, 137-45.
2. Chapey, R. (2008). Language intervention strategies in aphasia and related neurogenic disorders. Brooklyn: Wolters Kluwer.
3. Elbro, C., & Buch-Iverson, I. (2013). Activation of background knowledge for inference making: Effects on reading comprehension. Scientific Studies of Reading, 435-52.
4. Katz, R., & Wertz, R. (1997). The efficacy of computer-provided reading treatment for chronic aphasic adults. Journal of Speech, Language, and Hearing Research, 493-507.
5. Kiran, S., Sandberg, C., & Abbott, K. (2009). Treatment for lexical retrieval using abstract and concrete words in persons with aphasia: Effect of complexity. Aphasiology, 23(7), 835-53.
6. Meteyard, L., Bruce, C., Edmundson, A., & Oakhill, J. (2014). Profiling text comprehension impairments in aphasia. Aphasiology, 1-28.
7. Sandberg, C. and S. Kiran, How justice can affect jury: Training abstract words promotes generalisation to concrete words in patients with aphasia. Neuropsychological Rehabilitation, 2014: p. 1-32.
8. Webster, J., Morris, J., Connor, C., Horner, R., McCormac, C., & Potts, A. (2013). Text level reading comprehension in aphasia: What do we know about therapy and what do we need to know? Aphasiology, 1362-80.