A thesis submitted in partial fulfilment of - Queen Margaret University

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Chapter 1 Introduction to investigation Many professionals are involved in the rehabilitation of post-stroke individuals both at the acute and chronic phases of their stroke, including allied health professionals such as physiotherapists, occupational therapists and speech and language therapists. Their aim in rehabilitation is to return a person to their highest functioning potential as would be expected for their age, occupation and gender roles (Hinckley, 1998). The following evidence indicates that the incidence of people sustaining brain injury as a result of stroke is increasing yearly, particularly within the younger population. The prevalence of stroke is also increasing as more people are surviving stroke. Petheram and Enderby (2001) reported an increase in the population referred to a group of 11 speech and language therapy providers between 1987-1995. The most significant proportional increase in the caseload is related to referrals associated with stroke. These have increased from 534 (22.7%) in 1987 to 2098 (32%) in 1995 (Petheram and Enderby, 2001). While referrals for swallowing difficulties have increased during this time (0.94% of referrals in 1987 and 20.6% in 1995) referrals for aphasia have doubled in this same period (Enderby and Petheram, 2002; Petheram and Enderby, 2001). This increase in stroke referral is not particular to Britain. In an urban population of 250,000 in Sweden, stroke incidence increased between 1989 and 1998 while case fatality decreased with improved short and long-term survival following stroke (Pessah-Rasmussen, Engström, Jerntorp and Janzon, 2003). Data from three national health surveys in the United States have paralleled this trend of demonstrating consistent improvement of survival following stroke during the 1970s and 1980s. The number of stroke deaths among the population aged 25 to 74 years consistently declined between 1971 and 1994 from 81,000 to 44,000, a decrease of 47%. The prevalence of stroke in the United States increased by 30% between 1973 and 1991 and over the same period, the number of stroke survivors younger than 75 years increased by 930,000 (Muntner, Garrett, Klag, and Coresh, 2002). 1
Younger people who are having and surviving strokes may present with expectations for quality of life quite different from those of more elderly people. They may desire to return to employment or retrain for a different career, perhaps continue or undertake personal development in the form of life long learning in further education or leisure pursuits alongside their peers. All of these activities require the person to learn new information following their stroke. The question of the potential of the damaged brain to learn new information has not yet been adequately addressed. This thesis examines, in particular, new vocabulary learning for those people who have persistent language difficulties following a stroke. The main aim for this research was to address the question of whether young adults with post-stroke aphasia can learn new vocabulary. As this was the first investigation into the learning of new vocabulary by post-stroke adults with aphasia, the stimuli and methodology had to be developed. The investigation began with preliminary studies in which novel stimuli (new words with new meanings) were developed and evaluated for use in the main investigation. Next, investigation of the learning abilities of 75 adults with no history of brain injury and the strategies that they used to learn the new words contributed to the development of the learning procedure for the participants with aphasia. The completed methodology was evaluated with one adult with no cognitive or language impairments as well as with post-stroke adults with and without aphasia. The main investigation involved a case series of 12 post-stroke individuals (six male and six female) with a range of severity of aphasia to ascertain if young adults could learn new vocabulary despite having language impairments following a stroke. The individual performance of each person was evaluated and group analyses were undertaken to determine if predictions could be made regarding the ability of adults with post-stroke aphasia to learn new vocabulary. An analysis of the potential factors that could have facilitated or hindered this new learning was also carried out. 2
Page 1 and 2: An Investigation into the Ability o
Page 3 and 4: Abstract Recent studies have establ
Page 5 and 6: Christine Malcolm (Chief Speech and
Page 7 and 8: 2.6.2.1 Lesion size and site 37 2.6
Page 9 and 10: 3.6.1.2 Number and type of items to
Page 11 and 12: 4.8 Chapter summary 132 Chapter 5 T
Page 13 and 14: 5.9.1.1 Personal attributes 176 5.9
Page 15 and 16: 5.15.1.1 Personal attributes 208 5.
Page 17 and 18: 6.3.3.5 The impact of clock drawing
Page 19 and 20: Appendices 2.1 Main representative
Page 21 and 22: 5.2 Raw and percentage scores for n
Page 23: Figures 2i Cognitive neuropsycholog
Page 27 and 28: Chapter 2 Review of the literature
Page 29 and 30: sentences. As aphasia also affects
Page 31 and 32: continue to experience significant
Page 33 and 34: noted that there were three areas t
Page 35 and 36: natural reaction to the loss of abi
Page 37 and 38: 2.3.3 Impact of aphasia on the fami
Page 39 and 40: facets of a person’s life as well
Page 41 and 42: with the literature regarding the l
Page 43 and 44: Rehabilitation is not thought to al
Page 45 and 46: everything that we learn and experi
Page 47 and 48: eorganisation in hemiplegic stroke
Page 49 and 50: (Kasten and Sabel, 1995) and replic
Page 51 and 52: 1998), tingling, itching or painful
Page 53 and 54: Emission Tomography (PET) scans ana
Page 55 and 56: ehabilitation, function can be limi
Page 57 and 58: Studies have not always found age t
Page 59 and 60: larger intracranial capacity could
Page 61 and 62: permanent loss of particular skills
Page 63 and 64: depression in people with severe ap
Page 65 and 66: maintenance of permanent records of
Page 67 and 68: intensity aphasia rehabilitation wa
Page 69 and 70: 2.7 CURRENT THEORETICAL ACCOUNTS OF
Page 71 and 72: people with apparently similar char
Page 73 and 74: 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
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GOB pathways). C2’s speech was ch
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assessment tasks (see Table 5.2), w
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C3’s narration of the Cinderella
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errors with six out of the 20 new w
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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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Page 207 and 208:
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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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
Page 235 and 236:
Page 237 and 238:
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
Page 251 and 252:
Page 253 and 254:
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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
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
Page 313 and 314:
References Alexander, M. P. (1994)
Page 315 and 316:
Candia, V., Schafer, Th., Taub, E.,
Page 317 and 318:
Fillingham, J. K., Sage, K. and Lam
Page 319 and 320:
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
Page 347 and 348:
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
Page 361 and 362:
Page 363 and 364:
Page 365 and 366:
Appendix 5.5 (continued) Group corr
Page 367 and 368:
Appendix 5.5 (continued) Group corr
Page 369:
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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