A thesis submitted in partial fulfilment of - Queen Margaret University

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the new words as those further along in their recovery. This implies that cortical plasticity may not only occur in the acute stages of stroke but also in the chronic stages. These findings are consistent with those studies that demonstrate the restitution of language by those people in the chronic stages of aphasia and refute the idea that language rehabilitation for those in the chronic stages of stroke should only incorporate compensation strategies rather than facilitation of further restitution of language. 6.6.2 Learning and aphasia rehabilitation The findings from this investigation suggest that the rehabilitation process should draw on approaches and concepts of learning. The main investigation employed a number of different strategies from the literature on learning, which were successfully employed in the training of new vocabulary. This procedure has direct implications for a theory of rehabilitation and therapeutic approaches. The preliminary study findings highlighted the different learning styles of the normal population where participants had individual preferred learning methods, which did not appear appropriate for other participants’ learning. Qualitative data indicated that the variation in learning methods used by participants with aphasia mirrored those used by the normal population. Theories and models have been developed which guide and inform the assessment process in defining the exact nature of language impairment. Without a theory to guide rehabilitation clinicians currently rely on clinical experience and single case studies to select appropriate therapeutic materials and approaches to facilitate the restitution of language. While single case studies have indicated that aphasia therapy is efficacious, clinicians are unable to predict which approaches or tasks would be most successful at targeting particular aspects of aphasia for rehabilitation. Additionally, they cannot explain why people with apparently similar characteristics of language impairment respond differently to rehabilitation efforts. The differing approaches by main investigation participants to learning the new vocabulary suggests that individuals approach the learning 277
experience in different ways and choose methods most suited to their particular learning techniques, supporting the literature advocating single case studies. Therefore although the same stimuli might be used in rehabilitation, the differing approaches to learning may provide an explanation for the differences found in the recovery of aphasia. This information could be fundamental to the success of language rehabilitation in that problems in facilitating restitution of language may not be caused by the particular tasks employed but rather the manner in which they are presented to individual patients. Perhaps discovering the optimum learning strategy for each individual before embarking on the therapeutic process would identify the best methods and processes to use during their rehabilitation process. The use of learning concepts could revolutionise the rehabilitation of aphasia and promote the identification and establishment of optimum methods of learning to facilitate the highest potential restitution of language and thereby the reduction of any harmful or redundant therapy tools or methods, having a corresponding effect on the reduction of maladaptive neuronal connections. The incorporation of learning theory in future investigations could examine the constraining factors of new learning by people with aphasia, which appear to reflect the constraints experienced by those people whose language is not restored as completely as others. The literature has demonstrated that without therapeutic intervention maladaptive cortical connections can be made (see section 2.5.4). The rehabilitation of aphasia may therefore be that structured experience-dependent process required for providing the optimal experiential guidance for language recovery. It has been previously suggested that language rehabilitation does not address this neurological level (Davis, 1993). However in order to eliminate such possible maladaptive cortical connections in the language area of the brain which would impact upon functional communication and possibly create connections that block or prevent further successful restitution, aphasia rehabilitation must begin to address the impact of its processes on the creation 278
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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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for months post-stroke, severity of
Page 249 and 250: Table 5.33 Correlation co-efficient
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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
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
Page 299: theory of rehabilitation and in rel
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Page 305 and 306: the investigation of people with po
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
Page 349 and 350: 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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