A thesis submitted in partial fulfilment of - Queen Margaret University

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5.15 PARTICIPANT C10 Participant C10’ s personal profile is presented in Table 5.28. She was widowed and lived alone with carers visiting daily and regular contact from her family. C9 presented with upper and lower hemiparesis (dominant) and mobilised with a wheelchair. This was C10’s second stroke (previously 10+ years ago). She was occasionally tearful reportedly still grieving for her husband. Table 5.28 C10’s personal, medical, language and cognitive data Personal details Language screening Word N-word scores Gender F Listening lexical decision 8 7 Age 60;02 Repetition 8 5 Education (yrs) 9 Reading lexical decision 5 7 Pre-morbid employment - Read aloud 4 0 Factory worker Months post-stroke 146 Spelling 0.5 0 Stroke details – Categorisation 15 10 12 Left intra-cerebral haemorrhage HADs anxiety 16 Naming 9.5 HADs depression 16 CLQT language 18 Severe Independent learning 55mins Aphasia score 91 68.4% Cognitive sub-test scores on CLQT Stepping-stone Route Attention Memory Executive function Visuospatial skills Clock drawing Non-linguistic learning 126 117 23 72 8 6 Mild Moderate Mild Mild Moderate 33% 5.15.1 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 C10 with reference to the data in Table 5.28. 207
5.15.1.1 Personal attributes C10 was aged 60;02 at the time of the investigation and was one of the oldest participants. She had spent nine years in education and was previously employed as a factory worker involving light manual work and requiring good concentration skills and the performance of accurate and speedy repetitive tasks (www.learndirect-advice.co.uk - profile 811). C10’s HADs scored the highest possible ‘abnormal’ score indicating high emotional status for both anxiety and depression, some of which may be related to her bereavement. She was 146 months post-stroke. Due to C10’s age, level of education and developed skills as well as high levels of anxiety and depression it was predicted that her personal attributes would negatively impact upon her ability to learn new vocabulary. 5.15.1.2 Cognitive abilities and the capacity to learn The cognitive sub-tests of the CLQT indicated that C10 had mild attention, executive function and visuospatial skill impairment and moderately impaired memory and clock drawing skills. C10 demonstrated adequate visuospatial skills to engage in the training and assessment tasks by drawing detailed pictures of the creatures and copying the new words accurately. The severity of C10’s memory impairment would predict a difficulty learning and recalling the new vocabulary (see section 2.6.3.3) and she also had difficulty learning the nonlinguistic task only achieving 44% on immediate recall and 22% on delayed recall indicating a poor capacity to learn new information. 5.15.1.3 Severity of aphasia The language sub-test of the CLQT suggested that C10 had severe language difficulties. Her language screening scores are displayed in Table 5.28 for each task and mapped on to a cognitive neuropsychology model in Figure 5xii below. 208
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
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to match the name and skill present
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4.4.3 Results of P1’s post-traini
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Table 4.4 Pilot Study One Total raw
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session. This reflected the general
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4.4.5 Summary of pilot study one Pi
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4.5.2 Results of P2’s performance
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P2 recalled 14 (70%) of the new wor
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demonstrate this learning during im
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4.6.3 Methodological issues A numbe
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would be asked not to repeat the wo
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4.8 CHAPTER SUMMARY The three pilot
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Chapter 5 Main Investigation 5.1 IN
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- The medical stability of particip
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The methodology for the training an
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(i.e. C1, P3 and C2) remained the t
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the immediate recall was not the sa
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Table 5.5 Characteristics of error
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scores (Zigmond and Snaith, 1983) a
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expected that younger participants
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5.4.2.3 Severity of aphasia While t
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5.5 PARTICIPANT C1 Participant C1
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SPOKEN WORD PICTURE WRITTEN WORD Au
Page 179 and 180: written form again without the aid
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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
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
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Page 215 and 216: 5.12 PARTICIPANT C7 Participant C7
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: assessments indicated that she had
Page 233 and 234: naming. C10 had some difficulties c
Page 237 and 238: SPOKEN WORD PICTURE WRITTEN WORD Au
Page 239 and 240: Table 5.31 C11’s detailed perform
Page 241 and 242: influencing factors (for example, a
Page 243 and 244: each participant’s relevant data,
Page 245 and 246: Table 5.32 Hierarchical cluster ana
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Page 249 and 250: Table 5.33 Correlation co-efficient
Page 255 and 256: ecency and primacy effect, however,
Page 257 and 258: drawing skills and the ability to l
Page 259 and 260: with the creation of new neuronal c
Page 261 and 262: 5.8.2.1). Secondly, the participant
Page 263 and 264: 6.3.1.1 The impact of age on the le
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Page 267 and 268: unethical, even perhaps illegal, to
Page 269 and 270: assessment and treatment of emotion
Page 271 and 272: theories on the negative effects of
Page 273 and 274: (CLQT) was developed as a screening
Page 275 and 276: 6.3.3.2 The impact of memory on the
Page 277 and 278: (executive scores of moderate, mild
Page 279 and 280: 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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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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