Does letter-by-letter reading involve the spelling system?

Warrington and Shallice (Brain 103, 99-112, 1980) proposed that letter-by-letter readers can no longer access the visual word-form system, and read by using the spelling system 'in reverse'. Contrary to their suggestion, this paper presents the case of a letter-by-letter reader who appears to use quite different strategies in word reading and spelling. Reading and spelling are both impaired, but they appear to be impaired in different ways. Most strikingly, the patient's spelling errors consist largely of phonological regularizations--indeed there is little evidence that he has any lexical spelling knowledge available--whereas there are virtually no regularizations amongst his reading errors. These are largely visual paralexias and letter misidentifications. It is suggested that this pattern is more easily explained in terms of compensatory mechanisms that access the reading lexicon than by use of the spelling system 'in reverse'.