A thesis submitted in partial fulfilment of - Queen Margaret University

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and evaluating the severity of each participant’s presentation of aphasia. It supported the various tasks and procedures for the training sessions and the assessment procedure facilitating the measurement of baseline performance and the demonstration of new learning. Predictions were made for each participant on their performance on spoken and written tasks and error analysis facilitated predictions derived from qualitative data. All predictions for the learning characteristics of the new words were supported except where the new words became established as real words or strong representations in the lexicons of participants. An example of this was where participants had difficulty spelling non-words in baseline measures and it was predicted that the new words (originally non-words) would also contain spelling errors. This prediction was supported for many of the participants, however some participants demonstrated a marked reduction in the number of spelling errors with the new stimuli with closer responses to the target words than pre-training abilities for spelling non-words. This could be considered as a type of target-related neologism where representations of new words are established but not fully accessible. While the limitations of the cognitive neuropsychology model are acknowledged, particularly in terms of the dynamic process involved in learning, the model fulfilled the criteria for this investigation, i.e. to establish whether people with post-stroke aphasia could learn new language representations. While the findings of this investigation were not dependent on the validity of the model used, the cognitive neuropsychological model proved useful as an instrument to demonstrate change. 6.6 CLINICAL RELEVANCE The main investigation has established that young adults with post-stroke aphasia can learn new vocabulary despite residual language impairments. This knowledge has significant clinical relevance in terms of the development of a 275
theory of rehabilitation and in relation to the procedures employed in the process of therapeutic intervention by speech and language therapists. 6.6.1 New learning It has been established that despite cortical damage all 12 participants demonstrated some learning of the new vocabulary. As the literature indicates that learning invokes cortical plasticity (see section 2.5.2) and that this also occurs in brains damaged by stroke (see sections 2.5.3 and 2.5.4), the findings of this investigation suggest that cortical plasticity was likely to have occurred during the process of learning the new vocabulary. This suggestion of cortical plasticity related to new learning was supported not only by participants who recalled the new vocabulary without error but also those who made targetrelated neologisms in both spoken and written formats. These findings contribute to current knowledge about the rehabilitation of people with aphasia, and strongly suggest that language rehabilitation could incorporate the process of new learning where new synaptic connections and patterns are established. Therefore the process of aphasia rehabilitation may involve both the facilitation of accessing already held information or neuronal connections, which were inaccessible as a result of stroke as well as the process of new learning perhaps of previously known but now ‘forgotten’ words. Participants in the main investigation demonstrated that the newly learned vocabulary was retained in long-term memory for later retrieval indicating that appropriate approaches to language rehabilitation can induce long-term benefits. In the main investigation participants with aphasia presented with a wide range of recovery stages spanning from five to 146 months post-stroke. Participants both in the acute and chronic stages of post-stroke recovery demonstrated the ability to learn new vocabulary. However the number of months post-stroke was significantly correlated to the learning of the new words suggesting that those participants in the acute stage of stroke did not learn as much information about 276
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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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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
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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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Page 249 and 250: Table 5.33 Correlation co-efficient
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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
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: module and how it communicates with
Page 301 and 302: experience in different ways and ch
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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
Page 323 and 324: Nation, I. S. P. (1983) Teaching an
Page 325 and 326: Scheibel, A., Conrad, T., Perdue, S
Page 327 and 328: Warrington, E. K. and McCarthy (198
Page 329 and 330: Appendix 3.1 Preliminary study one:
Page 331 and 332: Appendix 3.2 (continued) Preliminar
Page 333 and 334: Appendix 3.4a Preliminary study two
Page 335 and 336: Appendix 3.6 Stimuli used for the m
Page 337 and 338: Appendix 3.6 (continued) Stimuli us
Page 339 and 340: Appendix 4.1 Methods of learning ne
Page 341 and 342: Appendix 4.2 Hospital Anxiety and D
Page 343 and 344: Appendix 4.2 (Continued) Hospital A
Page 345 and 346: 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
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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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