Computer-assisted assessment and intervention www.speechpathologyaustralia.org.au JCPSLP Volume 15, Number 1 2013 13 Toni Seiler (top), Suze Leitão (centre) and Mara Blosfelds THIS ARTICLE HAS BEEN PEER- REVIEWED KEYWORDS COMPUTER- SUPPORTED INTERVENTION ORTHOGRAPHIC PROCESSING PHONOLOGICAL RECODING READING DIFFICULTIES TREATMENT EFFECTIVENESS difficulty with the skills involved in the nonlexical route, that is, phonological recoding, the act of sounding out and blending to read the word or nonword (Herrmann, Matyas, & Pratt, 2006). There is strong evidence that phonological recoding plays a key role in the development of MORs (Cunningham, 2006; Cunningham, Perry, Stanovich, & Share, 2002; Share, 1999). Moreover, when phonological recoding is compromised, MOR development is also reduced (Kyte & Johnson, 2006), suggesting that the establishment of orthographic representations of written words is dependent on the degree and accuracy of phonological recoding. Other factors that influence MOR development include the provision of repetition (Nation, Angell, & Castles, 2007) and presentation of words of similar types (Goswami, Ziegler, Dalton, & Schneider, 2003). However, presentation of words in context has not been found to influence MOR development (Cunningham, 2006). Recent research has shown that orthographic processing, the ability to acquire, store, and use MORs and orthographic pattern knowledge (Apel, 2011), also makes a unique and significant contribution to the development of word identification (Cunningham, Perry, & Stanovich, 2001) and predicts later word reading and comprehension skills (Badian, 2001). However, the relationship between orthographic processing skills and reading is a complex one. Apel (2009) found that preschool children without phonological recoding skills still developed MORs and were sensitive to the orthotactic probability of words (frequency with which a word’s graphemes and bigraphs appear in English), thus supporting the independent contribution of orthographic processing skills. More recently, Deacon, Benere and Castles (2012) evaluated the direction of the relationship between orthographic processing and reading in a longitudinal study of children from grade 1 to 3. While their results indicated that reading skills predicted orthographic processing skills and supported the role played by phonological recoding, they concluded that the reverse could also be true: that orthographic processing plays a role in determining reading success. Intervention for word identification disorders Over the past 20 years, the focus of many reading intervention studies has been phonemic awareness because these skills have been identified as predictors of reading development (Bishop & Snowling, 2004), having significant positive effects on word identification skills (Torgerson, Brooks, & Hall, 2006). However, there is This study investigated the effectiveness of a computer-supported intervention targeting orthographic processing and phonological recoding for word identification skills. Participants were three children (aged 7–8 years) with persistent word identification impairment. A single subject design with three phases was used, comprising a total of 31 sessions (8 baseline, 15 intervention, and a further 8 baseline) over 10 weeks. Results indicated a significant treatment effect based on measures of rate and accuracy of nonword reading measured at the start of every session. In addition, all participants made clinically significant gains in accuracy of nonword reading from pre- to post- intervention, and demonstrated mixed results with word and nonword reading efficiency. A bout 8% of Australian children in year 2 do not meet the minimum National Benchmarks for Reading (Rowe, 2005). Given that this stage at school represents the beginning of the transition from learning to read to reading to learn, and that most children with early reading problems continue to have reading delays at the secondary school level (Kamhi, 2009), the development of effective interventions in the early years is a priority. Reading is a complex activity that involves a range of language skills (Bishop & Snowling, 2004). Coltheart (2006) suggests that in order to understand the reading process, the skills that underlie reading need to be understood first. Accurate word reading is considered to be a key skill in learning to read. Furthermore, poor performance on word identification has been found to predict later reading difficulties (Botting, Simkin, & Conti-Ramsden, 2006). Theories underlying reading and word identification The dual route model (Coltheart, 2006) proposes that there are two processes or routes involved in skilled reading aloud. The lexical route accesses a store of previously identified written words, referred to as mental orthographic representations (MORs), while the nonlexical route uses letter–sound relationships to decode unfamiliar words. Most children with significant reading problems demonstrate The effectiveness of a computer- supported intervention targeting orthographic processing and phonological recoding for children with impaired word identification A preliminary study Toni Seiler, Suze Leitão and Mara Blosfelds
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1919NCB Proximal Humerus Plating System Surgical Technique
2. Temporary Plate FixationThe plate can be temporary fixed to thebone with ∅ 1.6mm K-wire through the proximal cannulated fixation screwof the targeting device (Fig. 37).
3. Insert Tocar SleevesInsert the NCB tissue protection sleeve assembly ∅ 1.6 to 10mm through a skin incision (Fig. 38).
4. Insert ∅ 1.6mm Guide WireL =190mmInsert ∅ 1.6mm guide wire with a lengthof 190mm and confirm the correct positionwith an image intensifier (Fig. 39).
Note: The distal center can be foundwith ∅ 1.6mm K-wire by finding theanterior and posterior bone cortex andputting the K-wire in the middle of thesetwo reference points (Fig. 40).
Fig. 39 Insert ∅ 1.6mm guide wire
Fig. 40 Find the distal center
Threaded partto connect to the NCB Plate
Fig. 37
Fig. 38
20 NCB Proximal Humerus Plating System Surgical Technique
Fig. 43 Insert the CannulatedSelf-Drilling Screw
5. Drilling and Measuring theScrew LengthDetermine the screw length from the measurement with the NCB depth gauge along the ∅ 1.6mm guide wire (L = 190mm only) (Fig. 41).
Note: With this procedure the distancefrom the plate to the tip of the K-wire ismeasured.
For hard cortical bone it is possible to use the ∅ 3.3mm cannulated drill bit (only for the lateral cortex, tomake sure that the K-wire does not fallout). If the drill bit is used without a K-wire, the screw length can be determined from the calibration on thedrill bit shaft (Fig. 42).
6. Distal Cannulated ScrewInsertionUse the 3.5mm cannulated hexagonalscrew driver to insert the cannulatedself-drilling screw over the 1.6mm guidewire (Fig. 43).
The NCB screws should be tightened moderately to the bone.
Note: For adequate stable fixation, bi cortical screw insertion isrecommended.
Note: Care should be taken to avoid the branch of the axillary nerve in thediaphyseal area of the plate.
Fig. 42 Determine the screw lengthwith the scaling on the drill bit shaft
Fig. 41 Determine the screw lengthwith the Depth Gauge
2121NCB Proximal Humerus Plating System Surgical Technique
7. Add Locking ScrewInsert the Locking Screw Caps with the 3.5mm cannulated Hexagonal ScrewDriver over the ∅ 1.6mm guide wire(Fig. 44).
Tighten the locking screw moderately.
Note: Make sure there is no blood in thescrewdriver cannulation since this maypush the K-wire forward.
8. Achieve Final Angular StabilityTo achieve the final angular stabilityremove the guide wire and tighten theLocking Screw Caps with the TorqueScrewdriver until the wrench declutches(clicking sound) (Fig. 45).
Note: The guide wire must be removedas the Torque-Limiting Screwdriver isnot cannulated.
Fig. 44 Insert the Locking Screws
Fig. 45 Tighten the Locking Screwswith the Torque-Limiting Wrench
22 NCB Proximal Humerus Plating System Surgical Technique
9. Proximal Screw InsertionInsert ∅ 1.6mm guide wire with a lengthof 190mm close to the subchondralbone and confirm the correct positionunder image intensification (Fig. 46).
10. Drilling and Measuring theScrew LengthMeasure the length with the NCB DepthGauge along the ∅ 1.6mm guide wire (L = 190mm only) (Fig. 47).
Note: With this procedure the distancefrom the plate to the tip of the K-wire ismeasured. Determine the screw lengthby subtracting a sufficient distance to make sure that the screw is in an adequate distance from the joint.
Fig. 46 Insert the guide wire
Fig. 47
2323NCB Proximal Humerus Plating System Surgical Technique
11. Cannulated Screw InsertionUse the 3.5mm Cannulated HexagonalScrew Driver to insert the CannulatedSelf-Drilling Cancellous Screw over the1.6mm guide wire (Fig. 48).
Apply compression for reduction of thefracture. The NCB Screws should only betightened moderately to the bone.
12. Add Locking ScrewInsert the Locking Screw Caps with theCannulated Hexagonal Screwdriver hex3.5mm over the ∅ 1.6mm guide wire.
Tighten the Locking Screw moderately.
13. Achieve Final AngularStabilityTo achieve the final angular stabilityremove the guide wire and tighten theLocking Screw Caps with the Torque-Limiting Screwdriver until the wrenchdeclutches (clicking sound) (Fig. 49).
Fig. 49 Tighten the Locking Screwswith the Torque Screwdriver
Fig. 48 Insert the Cannulated Self-Drilling Cancellous Screw
24 NCB Proximal Humerus Plating System Surgical Technique
14. Last Proximal Screw Setting(No. 3)To insert the last proximal screw turn the targeting module and use the hole numbering 3 and the yellow frame on top. Fit the two yellow arrowheadmarkings (Fig. 50). Then follow thesame screw-setting procedure asdescribed in step 9-13 (Fig. 51).
Fig. 50 Turn the Targeting Module and usethe yellow top marking with hole no. 3
Fig. 51 Position of the TargetingModule to place screw no. 3
Implant RemovalTo remove the NCB-PH Humerus Plate,remove all ∅ 8mm Locking Screw Capsfrom the plate first, then loosen all bonescrews. This prevents simultaneousrotation of the plate when removing thelast bone screw. Remove all bonescrews completely from the bone.
No. 3
2525NCB Proximal Humerus Plating System Surgical Technique
NCB-PH PlateProtasul®-64 Metal AlloyHoles Quantity* Length REF
4 2 79.5mm 02.03262.0045 2 93mm 02.03262.005
NCB Cerclage Wire for T. minus plateStainless Steel-316LL mm ∅ mm Quantity* REF
115 0.8 2 02.01362.108
NCB-PH – Implants
24.4
12
79.5
4.5
14
11.5
115∅ 0.8
NCB T. minus plate, 7 holesProtasul-Ti Metal AlloyHoles Quantity* Length REF
7 2 52mm 02.03262.101
24.4
1214
93
4.5
17.2
1.2
52
NCB Locking Screw CapProtasul-64 Metal Alloy
∅ mm mm Quantity* REF
8 3.5 20 02.03150.300
NCB Blind screw insertProtasul-64 Metal Alloy
Quantity* REF
2 02.03150.310
NCB Spacer(red, green, blue)Protasul-64 Metal Alloy
