A thesis submitted in partial fulfilment of - Queen Margaret University

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suitability of the training and assessment procedures. P3 understood all instructions and completed all of the required tasks. Comparing the time used by P1 (see Table 4.5) and P3 (see Table 4.10), the pre-training screening assessment took the same amount of time (1 hour). P1’s four training sessions lasted 45 minutes each whereas P3’s varied between 1 hour for sessions one, two and four and 50 minutes for session three. The delayed assessment took 50 minutes whereas P1’s only took 20 minutes. However, two additional tasks were inserted into P3’s assessment (picture-syllable matching and reading creature names aloud). P3 used more independent learning time to learn the creatures than P1, which was also reflected in the longer time required for each session. On the whole, the time required by P3 fell within the time originally allotted for the sessions. The process of this study confirmed that the methodology employed was appropriate for an adult with aphasia. As discussed, two additional assessment tasks were inserted into the delayed assessment procedure for P3 (see section 4.6.3). The picture-syllable matching task facilitated the demonstration of word form knowledge without the requirement for speech, thus facilitating the demonstration of learning at the phonological output level. The final methodology for the main investigation included this task during the immediate as well as the delayed recall. Participants also read the creature names aloud during both the immediate and delayed assessments. As this study incorporated an errorless learning approach it was essential to ensure that any errors made during the training phase were noted and corrected. It was noted that P3 sometimes found it difficult to repeat a new word without first making errors. On most occasions he was able to correct his pronunciation. However, not all participants with aphasia would be able to correct their speech regardless of the number of attempts. Therefore, if a participant repeated a word incorrectly they would be corrected immediately and asked to repeat it again following the modelling of the target word. If following two attempts participant were still unable to correctly repeat the word, they 129
would be asked not to repeat the word again, but to listen to the researcher saying the word twice. The level of frustration experienced by P3 when he was not succeeding, particularly during the delayed recall session, along with the percentage of items being forgotten at this stage (see section 5.6) led to the decision not to proceed with a one-month post-training assessment for participants in the main investigation. The final methodology that was employed in the main investigation is presented below. It is discussed in relation to the single word processing model that was chosen to support the methodology for facilitation of learning the new vocabulary (see section 2.9.3). 4.7 THE METHODOLOGY FOR THE MAIN INVESTIGATION The outcome of the pilot studies in this chapter culminated in the completion of the final methodology. This would be employed to facilitate the learning of new vocabulary and enable the demonstration of this new learning by main investigation participants. The various tasks involved in the pre-training screening assessments, the procedure followed during the four training sessions and the immediate and delayed recall assessment of this new learning are summarised in Chapter 5 (see Figure 5.1, section 5.5.2). As discussed in Chapter 2, the cognitive neuropsychology approach was chosen to support the learning and assessment methodology for the main investigation (see section 2.9.3). The importance of the assessment procedure enabling participants with all levels of severity of aphasia to demonstrate any learning has been discussed throughout the development of the methodology. The cognitive neuropsychology model was considered an appropriate model to this facilitate the various levels of the training and assessment procedure. 130
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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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3.2.1.4 Delayed recall Approximatel
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Page 103 and 104: indicates a large reduction of item
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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
Page 113 and 114: during the training session, some p
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 125 and 126: preliminary studies as described in
Page 127 and 128: emember the route taking them from
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
Page 135 and 136: to match the name and skill present
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 and 150: demonstrate this learning during im
Page 151: 4.6.3 Methodological issues A numbe
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
Page 165 and 166: the immediate recall was not the sa
Page 167 and 168: Table 5.5 Characteristics of error
Page 169 and 170: scores (Zigmond and Snaith, 1983) a
Page 171 and 172: expected that younger participants
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
Page 179 and 180: written form again without the aid
Page 181 and 182: vocabulary than younger participant
Page 183 and 184: was non-fluent with many repetition
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
Page 191 and 192: assessment tasks (see Table 5.2), w
Page 195 and 196: C3’s narration of the Cinderella
Page 197 and 198: errors with six out of the 20 new w
Page 201 and 202: 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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