A thesis submitted in partial fulfilment of - Queen Margaret University

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6.3.2 Biological limitations The literature review discussed the methodological difficulty in evaluating the impact of the biological factors independently. The relationship between the magnitude and location of brain lesions is complex and appears to be interlinked with the initial severity of functional deficit experienced (which in this case is aphasia) (see section 2.6.2). The provision of brain-imaging data of participants prior to and following the training of new vocabulary could inform as to the impact of size and/ or site of cortical damage in new vocabulary learning and related cortical plasticity. The prognostic influence of stroke aetiology has not been thoroughly researched, specifically the issue of infarct versus haemorrhage, and early results were conflicting (Basso, 1992). Four of the participants with aphasia in the main investigation had a history of multiple strokes – C3, C6, C10 and C11. As observed (see section 5.3), despite experiencing multiple strokes, C3 and C6 were ranked fourth and seventh respectively in their ability to learn the new vocabulary and both retained 80% of this information in delayed recall tasks. However C10 and C11 learned the least amount of new vocabulary and also experienced haemorrhagic in addition to multiple strokes – a combination of which may have affected their performance. Due to sample size and the absence of brain-imaging data it would not be prudent to speculate about either the effects of the type of stroke (i.e. infarct versus haemorrhage) or the number of strokes on the successful ability to learn new vocabulary. It would be informative in future research to ascertain the impact of aetiology, site and extent of brain damage on the ability to learn new vocabulary and related cortical plasticity. 6.3.3 Cognitive abilities and the capacity to learn The difficulty in measuring cognitive functioning has been acknowledged, particularly following a stroke, with many assessments considered as unsuitable for people with aphasia (particularly those requiring spoken and/ or written responses) (Starr et al., 2000). However the Cognitive Linguistic Quick Test 249
(CLQT) was developed as a screening assessment for adults with acquired neurological impairment (Helm-Estabrooks, 2001) and was therefore considered appropriate to screen the cognitive strengths and weaknesses of main investigation participants. The lack of depth in such a screening tool is acknowledged, however the deductions made from it in relation to new vocabulary learning was secondary to the main research question which aimed to ascertain whether people with aphasia could demonstrate the ability to learn new vocabulary. The factors considered under the heading of cognitive abilities were attention, memory, executive function and clock drawing skills. The evidence for the impact of attention, memory and executive functions on language recovery and the acquisition of new learning are discussed in the literature review (see section 2.6.3.3). The clock drawing task is thought to involve attention, memory, executive function, visuospatial and language skills and has been reported to be in itself useful as a mini-screening tool for cognitive abilities (Helm-Estabrooks, 2001). While the CLQT revealed visuospatial impairments in a number of participants, all had adequate visual skills to copy the stimuli (pictures and words). Therefore any visuospatial impairment did not affect participant ability to interact with the stimuli, questioning the robustness of the CLQT for the functional assessment of these skills. The cognitive capacity of each participant to learn was also evaluated by assessing the ability to learn and recall a non-linguistic route task devised by the researcher based on a previous study (Evans et al., 2000). The findings related to the cognitive abilities and the capacity to learn will now be discussed. 6.3.3.1 The impact of attention on the learning of new vocabulary The importance of attention in the processing of information has been discussed in the literature review (see section 2.6.3.3). The learning of new vocabulary required active participation in the training procedures and independent learning time in order to incorporate the new vocabulary into participants’ current knowledge. Active participation included tasks such as drawing and copying, 250
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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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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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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
Page 221 and 222: 5.13.1.1 Personal attributes C8 was
Page 223 and 224: and PLC pathways). C8’s speech wa
Page 225 and 226: 5.14 PARTICIPANT C9 Participant C9
Page 227 and 228: C9’s data (see Table 5.26 and Fig
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Page 231 and 232: 5.15.1.1 Personal attributes C10 wa
Page 233 and 234: naming. C10 had some difficulties c
Page 235 and 236: 5.16 PARTICIPANT C11 Participant C1
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
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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: theories on the negative effects of
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
Page 291 and 292: provided flexibility not only for s
Page 293 and 294: presentation. It was proposed that
Page 295 and 296: participants also lexicalised the n
Page 297 and 298: module and how it communicates with
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Page 307 and 308: Further statistical analyses with a
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Page 311 and 312: 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
Page 321 and 322: 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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