Format distortion and word reading: The role of multiletter units

A single case study is presented of an unusual and previously unreported language impairment in a 48-year-old right-handed man (YD). Following a right hemisphere cerebrovascular accident, the patient became markedly impaired at reading single words and non-words mutilated with a + symbol (e.g. c + h + u + r + c + h). The effects of this distortion were significantly worse than either increasing the spacing between letters of a word (e.g. c h u r c h) or mixing upper and lower case letters (e.g. CHuRcH). YD was able to retrieve orthographic and phonological information about single letters but not conjoin this information into a spoken word. A significant improvement in reading mutilated words occurred when the + symbol was positioned between functional spelling units (phonemes). This pattern of results suggests that single letter identification is not always sufficient for lexical access and implicates the use of multiletter units in visual word identification.