A thesis submitted in partial fulfilment of - Queen Margaret University

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5.17 SUMMARY The first part of this chapter reported findings that established that people with aphasia were able to learn new vocabulary despite differing levels of severity of aphasia. All twelve participants took part in the four training and immediate recall sessions. The abilities of participants to demonstrate learning of the new vocabulary varied from learning all 20 new words to no new words for cold recall assessments (both spoken and written). Due to the nature of aphasia some participants were unable to demonstrate their learning in spoken and /or written form. However, the various assessments based on the cognitive neuropsychology approach facilitated the demonstration of this learning in ways other than spoken or written recall and provided evidence that every participant learned some of the new vocabulary. Learning abilities ranged from 15% to 99% of information learned about the new words for immediate recall tasks (i.e. raw score total of 49 to 318 from a total maximum score of 320 with the exception of P3 whose maximum score was 280). These assessment tasks were repeated three to five days following the final training session to measure the extent of information that was retained in long-term memory (delayed recall). Ten participants partook in delayed recall assessments (C10 and C11 declined) and performance indicated that retention of original information learned ranged from 49% to 83% (i.e. raw score total of 56 to 263.5 from a total maximum score of 320 with the exception of P3 whose maximum possible score was 280). The profiles of the 12 participants were then presented individually. As can be seen in the preceding personal profile tables (see sections 5.5 to 5.16), there was a broad range of age, educational and employment experience among participants. Furthermore, there was a wide variety of severity of aphasia and a range of language abilities. The cognitive abilities and emotional status of participants also varied considerably. Predictions were made regarding the positive and negative impact of various factors on the ability of participants to learn the new vocabulary based on the literature. However, there were many 217
influencing factors (for example, age, education, emotional and cognitive status) and with the exception of the severity of aphasia it was difficult to objectively identify which of these factors impacted upon the ability to learn and to what degree. The severity of aphasia appeared to negatively impact upon assessment performance. Participants who were unable to speak or write were unable to complete tasks that required spoken or written responses, appearing to place them at a disadvantage compared to more verbal participants. Table 5.2 (see section 5.3) presents participant scores obtained from all tasks not requiring spoken and written responses. The ranking of C1, C5, C8, C9, C10, C11 remained the same despite C9-C11 having the most severe language impairment of the 12 participants. The scores of participants whose ranking changed as a result of the removal of spoken and written assessment scores only varied by 2-6%. Therefore, the original immediate recall total (i.e. including spoken and written tasks) was considered reflective of the overall ability to learn the new vocabulary by participants. As the severity of aphasia did not explain the wide variation in participant performance in demonstrating the new learning it was important to evaluate other factors in an attempt to explain this variation. It was decided to evaluate if those factors considered to impact upon recovery from aphasia also impacted upon the ability to learn new vocabulary. The next section of this chapter examines the total raw scores from participants’ immediate recall performance in order to observe if particular clusters or groups of participants emerge who learned the new vocabulary equally as well as each other. If so, hypotheses will be formed to evaluate the possible variables that divide these groups of participants (e.g. personal attributes, cognitive abilities and severity of aphasia). The tasks and stimuli that were employed in the main investigation were also appraised in terms of their contribution to the scores. Reliability between the four learning sessions is also recorded. 218
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
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written form again without the aid
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vocabulary than younger participant
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was non-fluent with many repetition
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emembering 49% of information origi
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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 193 and 194: 5.8.1.1 Personal attributes C3 was
Page 195 and 196: C3’s narration of the Cinderella
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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
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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 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
Page 237 and 238: SPOKEN WORD PICTURE WRITTEN WORD Au
Page 239: Table 5.31 C11’s detailed perform
Page 243 and 244: each participant’s relevant data,
Page 245 and 246: Table 5.32 Hierarchical cluster ana
Page 247 and 248: for months post-stroke, severity of
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
Page 265 and 266: education that an individual experi
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
Page 281 and 282: 6.3.4.1 Pre-training language scree
Page 283 and 284: abilities of each participant and a
Page 285 and 286: person with aphasia only ever produ
Page 287 and 288: 6.4.2 Methodology As previous resea
Page 289 and 290: 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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A thesis submitted in partial fulfilment of - Queen Margaret University

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