[When shape-invariant recognition ('A' = 'a') fails. A case study of pure alexia and kinesthetic facilitation].

A right-handed patient, aged 72, manifested alexia without agraphia, a right homonymous hemianopia and an impaired ability to identify visually presented objects. He was completely unable to read words aloud and severely deficient in naming visually presented letters. He responded to orthographic familiarity in the lexical decision tasks of the Psycholinguistic Assessments of Language Processing in Aphasia (PALPA) rather than to the lexicality of the letter strings. He was impaired at deciding whether two letters of different case (e.g., A, a) are the same, though he could detect real letters from made-up ones or from their mirror image. Consequently, his core deficit in reading was posited at the level of the abstract letter identifiers. When asked to trace a letter with his right index finger, kinesthetic facilitation enabled him to read letters and words aloud. Though he could use intact motor representations of letters in order to facilitate recognition and reading, the slow, sequential and error-prone process of reading letter by letter made him abandon further training.