This article describes a unique multisensory approach to dyslexic remediation, suitable for children beyond the age of 7 years, that involves the use of both hands; the left for learning the spatial order and the right for learning the sequential order of letters in syllables.

• Dyslexia; Remediation; Learning; Syllables

Mather DS. Remediating Developmental Dyslexia: Two Hands Are Better Than One. Ann Pediatr Child Health 2022; 10(5): 1282.

Over 90 years ago, in an analysis of the lateral dominance of approximately 100 cases of extreme difficulty in learning to read, Walter Dearborn [1], found a “preponderance in the clinical cases of (1) left-eyedness, of (2) the lack of ocular and manual dominance, and (3) of mixed conditions of ocular and manual dominance, e.g., left-eyedness associated with right handedness or ambidexterity”. He noted that “The dextral sequence of eye movements is kinesthetically the essence of reading” and that “Left-eyed children may tend to move in the opposite direction, to begin at the wrong end of words or even to perceive letters in the wrong way as in seeing b as d, or boy as dog” (p. 704). In accord, a recent review concluded that dyslexia develops in left eye-right brain dominant children when compensating for eye tracking that is reversed to the left-to-right order of letters in words [2]. Consequently, “the fundamental deficit in developmental dyslexia may be one in the spatiotemporal attentional sampling of the visual input which can lead not only to poor reading ability but potentially also to poorer phonological skills” [3].

A procedure which appears to address this spatiotemporal attentional sampling deficit was developed by a Junior High School remedial teacher [4]: Zorotovich wrote words with syllable breaks in large cursive script on slips of paper. Students were then taught to first pronounce the syllables while tracing them with the non-writing forefinger and immediately following to simultaneously ‘pound’ and name their letter sequence with the writing hand forefinger (both actions countering any hand/ eye tendency to move in a right-to-left direction). She claimed that this method developed sight word and phonological coding in reading-disabled students in a remarkably short time. Her claim is bolstered by evidence of non-preferred hand superiority in tactile-kinesthetic word-learning [5]. As well, rightward letter-name ‘pounding’ may rectify the dissociation between procedural learning of letter names and hand-motor sequencing found in university and college dyslexic readers by Gabay, Schiff & Vakil [6]. Zorotovich’s method is also congruent with remedial success achieved by multisensory teaching (Johnston, 2019) and by ameliorating global-local [7], and ground-figure [8], precedence deficits in dyslexia. These results argue against the assumption that reading deficiencies in dyslexia are caused by phonological or language deficits and thus require a paradigm shift from a phonologically-based treatment to a visually-based treatment of dyslexia. More generally it resonates with a “framecontent” (global-local/ground-figure) view of language evolution [9], and therefore may be universally applicable to the teaching of reading.

Guiard [9], in the context of explaining bimanual action, argued that there is “a general hierarchy principle according to which human action, whether perceptual, intellectual, or motor, preferentially proceeds from the macro- to the micro-metric, that is, outlines global traits before delineating more detailed aspects” (p. 502) and that “[t]o use the terms of MacNeilage, Studdert-Kennedy and Lindblom [10], we may say that the left hand delineates ‘frames’ into which the activity of the right hand inserts ‘contents’” (p. 494). MacNeilage et al. [10], compared the activity of the left and right hands to that of two contiguous motors in a kinematic chain, noting that with a single motor “one must be either farsighted or near-sighted in action” (p. 513).

Using Zorotovich’s procedure, I found that ten 1/2 hour sessions with two Junior High School 12-year-old reading disabled boys produced twice the improvement in reading rate and accuracy compared to that obtained by Shaywitz, B., Shaywitz, S., Blachman, B. et al. [11], with a 105 hours per child, one-on-one phonics intervention with reading disabled children aged 6.1 to 9.4 years. With the two Junior High School 12-year-old boys, I found that any reasonable word-syllable pronunciation subdivision was acceptable as long as each syllable contained a vowel. For example: trans port a tion, tran spor ta tion, or tran spor ta tion. Counter-intuitively, practice with multi-syllable words leads to more word pattern (orthographic) learning than single syllable words: It also speeds syllable boundary sensitivity because more frequent letter patterns occur within rather than across syllable boundaries. Moreover, multi-syllable words have been found to motivate intermediate grade learners because they felt they were no longer dealing with ‘baby’ words [12]. A syllable-based learning strategy for the mastery of middle school science vocabulary is available [13], as well as a frequency list of the most commonly occurring multisyllabic science words in texts encountered by adolescents [14]. The following task may be used to assess the effects of this intervention:

Students place animal tokens on a horizontal series of empty circles, ordered so that their favorites are first in the line to get fed. The instructions leave out whether the head of the line begins on the left or the right side. A University of British Columbia study administered this task to 547 to public school children in grades K,1,2,4 and 6 [15]. It found a high percentage of right-to left organizers [K(35), 1(37), 2(29), 4(17), 6(16)], indicating that it may be sensitive to the left-to-right directional problem common to both reading and spelling/handwriting difficulties.

The specifics of the technique are as follows:

1. Aided by the instructor, the student claps and pronounces the syllable chunks of a selected word.

2. The instructor then writes the whole word in large cursive script, underlining the syllables (Zorotovich used 2 inch by15 inch word slips).

3. With the non-writing forefinger, each syllable is then simultaneously traced and pronounced by the student, followed by “air-writing” with the writing hand before pounding. This provides an arm-to-finger (whole-to-part) progression that is consistent with handwriting learning instruction and may eliminate repeated pounding in order to recall spelling sequences. Immediately following, each syllable letter sequence is simultaneously pounded and named with the forefinger of the writing hand. This cycle is repeated until the word can be cursively written correctly from memory. Importantly, the student pronounces each syllable either to himself or aloud as he traces it and as he writes it. Pronunciation is “stretched” so as to end with the last letter traced. Cursive writing by the student is essential for complete success with this intervention as it has been found to be an advantage for children with dyslexia and handwriting difficulties compared to those without these difficulties [16]. In teaching cursive writing it is essential that the teaching process emphasize the orderly and rhythmical flow of those movements which cursive writing naturally encourages. If the teacher does not exploit this built-in aspect of cursive writing, then cursive writing alone probably will not help. It is most important that in early cursive writing the student uses large letters, six to eight inches high. As the child gains competence with large letters, the size can be reduced progressively. The child first learning to control fairly gross movements of his arm in writing and progressively bringing the fine movements of his hand and fingers into play. This gross-to-fine sequence is developmentally sound in view of the proximo-distal developmental sequence.

“Too often, children are required to use fine movements before gross movements are efficient” [17]. As well, using a white board and a dry/erase marker may facilitate handwriting rhythm.

This procedure may only be successful with dyslexic children beyond 7 years-of-age. The age of 8 years is a developmental milestone for the integration of vision with proprioception [a term interchangeable with kinesthesia [18]. For example, eight-yearold but not six-year-old children are able to map proprioceptive space onto visual space in a line-drawing visuomotor adaptation task [19]. And in a mirror-drawing task in which 5-to-6 year old and 7-to-8 year old children practiced tracing a square while looking at the reflection of their hand in a mirror, only the older group was able to re-calibrate their perceptual and sensorimotor systems to learn the required visual-proprioceptive mapping [20]. This proprioceptive/kinesthetic developmental faculty may be essential for recalling the spatial order of letters in syllables while tracing with the non-writing forefinger and the sequential order of letters while pounding with the right forefinger. Congruently, several studies have found that the development of bimanual coordination is not attained until 8 years-of-age [21- 26]. Thus, de Boer et al. [21], found that in-phase (mirror) and anti-phase (non mirror) coordination developed in parallel from age 7 with no evidence of enhanced inhibition of mirror activity. In turn, Fagard & Pezé [23], concluded that the disappearance of mirror and parallel performance differences between the two hands at 8 years-of-age implied “[a] relationship between lateralized control of the two hands as a coordinative structure and the maturation of interhemispheric communication . . .” (p. 82). Correspondingly, at 8 years-of-age bimanual temporal sequencing develops in the dominant hand leading condition [25], and the non-dominant hand achieves a similar level of performance as the leading dominant hand [26], consistent with RH proprioceptive movement dominance for both arms [27,28]. Denckla [22], speculated that the motor-skill developmental pattern of right-sided function before a rapid increase in leftsided function at 8 years-of-age could be due to the maturation of interhemisphere connections. In line with this speculation, the preferred and non-preferred arms respectively rely on LH visual guidance and RH proprioceptive feedback [27], faculties that do not integrate before 8 years-of-age. Furthermore, between the ages of 5 and 8 there is dramatically improved proprioceptive utilization with only minor improvement during adolescence and adulthood [29-31]. In sum, it appears that by the time children reach their eighth birthday “from the cooperative action of two arms there emerges, so to speak, a superordinate arm” (Guiard, 1987, p. 512) capable of interhemispheric coordination of left hand mirror and right hand non mirror movements.

Mesker (a child neurologist) had a different stance [32]. From extensive experience with Dutch children affected by learning disorders, he found that many were slow to achieve lateralization of hand dominance, remaining in a bilateral proximal stage of development until 8 years-of-age. He claimed that writing before this age could result in manual-motor and ocular-motor habits detrimental to the development of reading and spelling proficiency. Congruently, there is evidence in dyslexia of impaired bimanual [34], and binocular coordination [34-36]. Regrettably, Mesker’s clinical results lacked empirical validation and have received attention only in Holland [37].

The present article describes a unique multisensory approach for remediating children with dyslexia who are above the age of 7 years-of-age It involves the use of both hands, the left hand in learning the global order and the right hand learning the sequential order of letters in syllables. The method is consistent with a global-to-local/ground-figure view of language evolution and therefore may be universally applicable to the teaching of reading. It may remediate both major subtypes of dyslexia: the one in which poor phonological decoding is associated with good reading comprehension and the other in which good decoding proficiency is associated with poor reading comprehension [38]. In the latter, poor reading comprehension is manifested by difficulty in globally decoding words that are typically read with semantic support [39,40]. Conversely, good comprehension dyslexia relies heavily on semantic support in reading [39]. This multisensory bimanual procedure, discovered by Zorotovich [4], argues against the assumption that reading deficiencies in dyslexia are caused by phonological or language deficits and thus requires a paradigm shift from phonologically-based treatments to visually-based treatments of dyslexia [41].

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