A thesis submitted in partial fulfilment of - Queen Margaret University

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weekly speech and language therapy. P3 lived with his wife and was fully mobile with no residual paresis but had post-stroke epilepsy which was managed by medication. He was a retired pharmacist who had completed 20 years in education (encompassing two undergraduate degrees and a post-graduate degree). P3 described his language difficulties as frustrating, as some days his speech was fluent and on others he was unable to speak intelligibly. He stated that he knew the words he wanted to say, but found great difficulty pronouncing them. He reported that he did not experience any memory processing difficulties and his reading and writing skills, while impaired, were gradually improving. 4.6.2 Training and assessment sessions P3 was eager to succeed and showed consistent attention to all procedures. He followed all instructions easily and completed all tasks with no apparent difficulties. P3 participated in the pre-training screening assessments, training and immediate recall of all four sessions, and also delayed recall tasks. He reported these procedures to be straightforward and had no difficulties with the instructions or tasks. Task Pre-training baseline assessments Training session one Training session two Training session three Training session four Delayed assessments Table 4.10 Pilot Study Three Timing of all sessions for P3 Total time 60 minutes 60 minutes 60 minutes 50 minutes 65 minutes 50 minutes P3 utilised the full 30 minutes allotted for independent learning for each session and the length of time required for all training and assessments is presented by session in Table 4.10. A number of methodological issues arose following the training and assessment sessions and are now discussed. 127
4.6.3 Methodological issues A number of methodological issues emerged following the immediate recall assessment of pilot study three. Firstly, it was apparent that P3 knew some of the creature names but was unable to pronounce them accurately. While he often (eventually) managed to speak the words, albeit with phonological errors, other participants with aphasia may not be able to do so, because of severe spoken and/or written difficulties. A task was devised for the main investigation that would tap into the phonological knowledge of the word forms of the new vocabulary. The task chosen was a picture-syllable matching task, where a picture of an object (in this case a picture of a creature) would be shown to the participant and they would indicate how many syllables the creature’s name contained by pointing to the number one, two or three (tapping into the phonological output lexicon). This information would be taught to participants during the training sessions. To practise this task some pictures of familiar items would be shown to participants (for example, apple, banana, tomato etc.) to ensure that any task difficulty artefact was eliminated. At this stage it was also considered that it would be advantageous to observe if participants could read aloud the new words that they had learned. Following the errorless learning approach this would only be appropriate after training, otherwise, it could give rise to ‘errorful’ memory traces being established if done as a baseline measure. The words could then be compared to the participant’s ability to read words and non-words which were gathered during the pre-training screening assessments. These additional tasks were piloted on P3 during the delayed recall assessment and found to be useful assessment tools for the main investigation. 4.6.4 Summary of pilot study three The amended methodology from pilot study one was evaluated to ascertain its suitability for participants with post-stroke aphasia. The outcome confirmed the 128
Page 1 and 2:
An Investigation into the Ability o
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Abstract Recent studies have establ
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Christine Malcolm (Chief Speech and
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2.6.2.1 Lesion size and site 37 2.6
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3.6.1.2 Number and type of items to
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4.8 Chapter summary 132 Chapter 5 T
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5.9.1.1 Personal attributes 176 5.9
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5.15.1.1 Personal attributes 208 5.
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6.3.3.5 The impact of clock drawing
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Appendices 2.1 Main representative
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5.2 Raw and percentage scores for n
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Figures 2i Cognitive neuropsycholog
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Younger people who are having and s
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Chapter 2 Review of the literature
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sentences. As aphasia also affects
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continue to experience significant
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noted that there were three areas t
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natural reaction to the loss of abi
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2.3.3 Impact of aphasia on the fami
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facets of a person’s life as well
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with the literature regarding the l
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Rehabilitation is not thought to al
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everything that we learn and experi
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eorganisation in hemiplegic stroke
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(Kasten and Sabel, 1995) and replic
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1998), tingling, itching or painful
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Emission Tomography (PET) scans ana
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ehabilitation, function can be limi
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Studies have not always found age t
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larger intracranial capacity could
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permanent loss of particular skills
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depression in people with severe ap
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maintenance of permanent records of
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intensity aphasia rehabilitation wa
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2.7 CURRENT THEORETICAL ACCOUNTS OF
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people with apparently similar char
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Additionally, harmful or redundant
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information about a word (Harley, 2
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(as in semantic dementia) as well a
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esearchers (Breedin et al., 1998; W
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As many adults have acquired a wide
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healthy individuals as mentioned ab
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et al. (2001) evaluated the ability
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of new vocabulary where both the wo
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syllables in each word, therefore t
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vocabulary; facilitate the demonstr
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methodology developed and used in t
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Chapter 3 Preliminary Studies 3.1 I
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for the main investigation by the n
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Page 109 and 110: Graph 3.2 Comparison of number of i
Page 111 and 112: As with preliminary study one, part
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Page 115 and 116: 3.5 PRELIMINARY STUDY FOUR This stu
Page 117 and 118: Fifty four percent of participants
Page 119 and 120: preliminary studies the British Nat
Page 121 and 122: where main investigation participan
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Page 129 and 130: 4.3 TRAINING SESSION PROCEDURE Each
Page 131 and 132: 4.3.2.1 Training of stimuli: phonol
Page 133 and 134: assessments was administered both i
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Page 137 and 138: 4.4.3 Results of P1’s post-traini
Page 139 and 140: Table 4.4 Pilot Study One Total raw
Page 141 and 142: session. This reflected the general
Page 143 and 144: 4.4.5 Summary of pilot study one Pi
Page 145 and 146: 4.5.2 Results of P2’s performance
Page 147 and 148: P2 recalled 14 (70%) of the new wor
Page 149: demonstrate this learning during im
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Page 155 and 156: 4.8 CHAPTER SUMMARY The three pilot
Page 157 and 158: Chapter 5 Main Investigation 5.1 IN
Page 159 and 160: - The medical stability of particip
Page 161 and 162: The methodology for the training an
Page 163 and 164: (i.e. C1, P3 and C2) remained the t
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Page 167 and 168: Table 5.5 Characteristics of error
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Page 173 and 174: 5.4.2.3 Severity of aphasia While t
Page 175 and 176: 5.5 PARTICIPANT C1 Participant C1
Page 177 and 178: SPOKEN WORD PICTURE WRITTEN WORD Au
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Page 185 and 186: emembering 49% of information origi
Page 187 and 188: 5.7.1.1 Personal attributes C2 was
Page 189 and 190: GOB pathways). C2’s speech was ch
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Page 195 and 196: C3’s narration of the Cinderella
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5.9.1.4 Rehearsal and consolidation
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achieved 100% recognition on the li
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5.10.1.1 Personal attributes C5 was
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any other fictional stories so he w
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the reading task. C5 matched eight
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some word-finding difficulties with
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5.12 PARTICIPANT C7 Participant C7
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pathways), spell words and non-word
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(reading) words she made 15 false p
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and PLC pathways). C8’s speech wa
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C9’s data (see Table 5.26 and Fig
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assessments indicated that she had
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5.15.1.1 Personal attributes C10 wa
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naming. C10 had some difficulties c
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SPOKEN WORD PICTURE WRITTEN WORD Au
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Table 5.31 C11’s detailed perform
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influencing factors (for example, a
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each participant’s relevant data,
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Table 5.32 Hierarchical cluster ana
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for months post-stroke, severity of
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Table 5.33 Correlation co-efficient
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ecency and primacy effect, however,
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drawing skills and the ability to l
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with the creation of new neuronal c
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5.8.2.1). Secondly, the participant
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6.3.1.1 The impact of age on the le
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education that an individual experi
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unethical, even perhaps illegal, to
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assessment and treatment of emotion
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theories on the negative effects of
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(CLQT) was developed as a screening
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6.3.3.2 The impact of memory on the
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(executive scores of moderate, mild
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320). Additionally, the CLQT indica
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6.3.4.1 Pre-training language scree
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abilities of each participant and a
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person with aphasia only ever produ
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6.4.2 Methodology As previous resea
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assessing the learning of new vocab
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provided flexibility not only for s
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presentation. It was proposed that
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participants also lexicalised the n
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module and how it communicates with
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theory of rehabilitation and in rel
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experience in different ways and ch
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upon language rehabilitation, for e
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the investigation of people with po
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Further statistical analyses with a
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extend the examination of the abili
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task), severity of aphasia and amou
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References Alexander, M. P. (1994)
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Candia, V., Schafer, Th., Taub, E.,
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Fillingham, J. K., Sage, K. and Lam
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Howard and Hatfield (1987) Aphasia
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Linebaugh, C. W. (1999) Merging the
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Nation, I. S. P. (1983) Teaching an
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Scheibel, A., Conrad, T., Perdue, S
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Warrington, E. K. and McCarthy (198
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Appendix 3.1 Preliminary study one:
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Appendix 3.2 (continued) Preliminar
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Appendix 3.4a Preliminary study two
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Appendix 3.6 Stimuli used for the m
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Appendix 3.6 (continued) Stimuli us
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Appendix 4.1 Methods of learning ne
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Appendix 4.2 Hospital Anxiety and D
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Appendix 4.2 (Continued) Hospital A
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Appendix 4.4 Non-linguistic learnin
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Appendix 4.5 Language screening ass
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Appendix 4.6 Familiar, trained and
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Appendix 4.8 Examples of written an
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APPENDIX 5.2 Participant consent fo
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Appendix 5.3 (Continued) Narrations
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Appendix 5.3 (Continued) Narrations
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Appendix 5.4 (continued) Hierarchic
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Appendix 5.5 (continued) Group corr
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Appendix 5.5 (continued) Group corr
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Appendix 5.7 Total recall of tasks
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