A thesis submitted in partial fulfilment of - Queen Margaret University

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5.7 PARTICIPANT C2 Participant C2’s profile is displayed in Table 5.12. He lived with his wife and, despite severe hemiparesis on his right dominant side (upper limb), was fully mobile and independent. C2 was actively involved in a charity for post-stroke people and had an active social life. C2 was receiving weekly individual and group speech and language therapy at the time of the investigation. Table 5.12 C2’s personal, medical, language and cognitive data Personal details Language screening Word N-word scores Gender M Listening lexical decision 8 6 Age 33;11 Repetition 7 3 Education (yrs) 17 Reading lexical decision 8 6 Pre-morbid employment - Engineer Read aloud 2 0 Months post-stroke 39 Spelling 6 2 Stroke details – Categorisation 15 15 15 Left middle cerebral infarct HADs anxiety 4 Naming 6.5 HADs depression 4 CLQT language 17.5 Severe Independent learning 120mins Aphasia score 99.5 74.8% Cognitive sub-test scores on CLQT Stepping-stone Route Attention Memory Executive function Visuospatial skills Clock drawing Non-linguistic learning 197 129 30 103 13 18 WNL Moderate WNL WNL WNL 100% 5.7.1 Predictive factors for learning new vocabulary The various factors for determining predictors of new learning are discussed in section 5.4.2 and are evaluated below for C2 with reference to the data in Table 5.12. 163
5.7.1.1 Personal attributes C2 was aged 33.11 at the time of the investigation and was the youngest participant. It would therefore be predicted that C2 would learn more vocabulary than older participants. C2 had experienced 17 years in education and would be expected to have developed learning skills. He was employed in a highly specialised job, which required the development of analytical skills and the ability to critically evaluate complex problems and solutions as well as excellent communication skills (www.learndirect-advice.co.uk - profile 357). C2’s selfrating for anxiety and depression was considered to be within normal limits and he was 39 months post-stroke. It was predicted that C2’s personal attributes would contribute favourably to the learning of new vocabulary. 5.7.1.2 Cognitive abilities and the capacity to learn The cognitive sub-tests of the CLQT indicated that C2’s cognitive abilities were within normal limits with the exception of memory (moderately impaired). Such impairment would predict a difficulty learning and recalling the new vocabulary (see section 2.6.3.3). However, it was felt that the CLQT score did not give an accurate reflection of C2’s memory. Firstly, the CLQT only accepted spoken responses – C2 gave accurate gesture and written responses to the tasks (being unable to do so in spoken form – see section 5.7.1.3). Secondly, he demonstrated the capacity to recall newly learned information by recalling 100% of the non-linguistic task for both immediate and delayed recall. These issues will be addressed in the discussion chapter. 5.7.1.3 Severity of aphasia The language sub-test of the CLQT suggested that C2 had severe language difficulties. His language screening scores are displayed in Table 5.12 for each task and mapped on to a cognitive neuropsychology model in Figure 5iv below. 164
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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3.2.1.4 Delayed recall Approximatel
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written recall assessment task (par
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indicates a large reduction of item
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ehearsal taking place prior to the
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one were discussed with each partic
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Graph 3.2 Comparison of number of i
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As with preliminary study one, part
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during the training session, some p
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3.5 PRELIMINARY STUDY FOUR This stu
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Fifty four percent of participants
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preliminary studies the British Nat
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where main investigation participan
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perhaps reduce the number of items
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preliminary studies as described in
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emember the route taking them from
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4.3 TRAINING SESSION PROCEDURE Each
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4.3.2.1 Training of stimuli: phonol
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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 and 152: 4.6.3 Methodological issues A numbe
Page 153 and 154: would be asked not to repeat the wo
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: emembering 49% of information origi
Page 189 and 190: GOB pathways). C2’s speech was ch
Page 191 and 192: assessment tasks (see Table 5.2), w
Page 193 and 194: 5.8.1.1 Personal attributes C3 was
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
Page 203 and 204: achieved 100% recognition on the li
Page 207 and 208: any other fictional stories so he w
Page 209 and 210: the reading task. C5 matched eight
Page 213 and 214: some word-finding difficulties with
Page 217 and 218: pathways), spell words and non-word
Page 219 and 220: (reading) words she made 15 false p
Page 223 and 224: and PLC pathways). C8’s speech wa
Page 227 and 228: C9’s data (see Table 5.26 and Fig
Page 229 and 230: assessments indicated that she had
Page 231 and 232: 5.15.1.1 Personal attributes C10 wa
Page 233 and 234: 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
Page 325 and 326:
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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Page 363 and 364:
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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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