A thesis submitted in partial fulfilment of - Queen Margaret University

More documents

Recommendations

Info

task also learned the least amount of new vocabulary. Perhaps a larger data set or more sensitive or more complex non-linguistic learning tasks would provide further information on this point. The intensity and timing of therapeutic intervention is a controversial topic. This investigation supports previous studies which advocate the significance of cortical plasticity in people in the chronic stages of recovery but has also indicated that those in the more acute stages of stroke also demonstrate new synaptic connections despite the brain recovering from the trauma of stroke. This study employed an intensive training regime over a period of four days and findings are consistent with the literature that advocates the benefits of intensive training. National clinical guidelines in Scotland (SIGN, 2002) advocate that where individuals are well and motivated enough that they receive a minimum of two hours of speech and language therapy per week however, this does not appear to be the general experience of NHS patients. As suggested by Meinzer et al. (2002), alternative options could involve training carers or perhaps use computer-based training programmes to provide daily intensive therapy in people’s own homes. Speculation about the impact of various prognostic factors highlights the requirement of caution for clinicians. In particular group trends indicate that individuals with the best prognosis for language restitution are young, well educated perhaps in a highly skilled occupation and with intact cognitive abilities. Does this suggest therefore that all other individuals should be refused language rehabilitation? Firstly, it is not often that someone would present with such a profile following a stroke. Secondly and more importantly, analysis of the individual data indicates that the group trends are not true for all individuals in the investigation. Caution should therefore be advised regarding blanket statements from group studies and supports those advocates of single case studies or case series over randomised control trials and other group studies for 281
the investigation of people with post-stroke aphasia. Additionally, perhaps the therapeutic process should be patient driven rather than therapist driven and a more flexible approach to individual participation in language therapy be established. 6.7 EVALUATION OF THE INVESTIGATION This investigation was original and therefore the stimuli and methodology had to be developed. The novel stimuli were created by the researcher and incorporated novel word forms with novel meanings as well as associations to already familiar words. The British National Corpus (1998) and 75 adults from the normal population established that these new words were original and unique. These stimuli were not only unique for the main investigation but is also the first new vocabulary that has been reportedly used to evaluate the capacity of adults with aphasia to learn new vocabulary. This had been a methodological issue with previous learning investigations with this population (see sections 2.8.6 and 2.9.1). The training methodology was based on optimum methods of learning from published research, in particular pre-exposure of stimuli providing a staggered learning experience, imagery techniques in the form of selfjudgement tasks and tasks based on the concept of errorless learning (see section 2.9.2). Previous studies used different methods of evaluating learning with some of them employing spoken and/or written responses alone. However this investigation employed a range of assessments to facilitate the demonstration of learning particularly by those participants unable to respond in spoken and /or written formats. The results suggested that the assessment tasks used to evaluate new vocabulary learning were sensitive enough not to disadvantage non-verbal participants (see Table 5.2 and sections 5.3, 5.17). The preliminary and pilot studies provided a robust evaluation of the stimuli and methodology and provided opportunity for enhancing the training and 282
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 and 24:
Figures 2i Cognitive neuropsycholog
Page 25 and 26:
Younger people who are having and s
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
Page 75 and 76:
information about a word (Harley, 2
Page 77 and 78:
(as in semantic dementia) as well a
Page 79 and 80:
esearchers (Breedin et al., 1998; W
Page 81 and 82:
As many adults have acquired a wide
Page 83 and 84:
healthy individuals as mentioned ab
Page 85 and 86:
et al. (2001) evaluated the ability
Page 87 and 88:
of new vocabulary where both the wo
Page 89 and 90:
syllables in each word, therefore t
Page 91 and 92:
vocabulary; facilitate the demonstr
Page 93 and 94:
methodology developed and used in t
Page 95 and 96:
Chapter 3 Preliminary Studies 3.1 I
Page 97 and 98:
for the main investigation by the n
Page 99 and 100:
3.2.1.4 Delayed recall Approximatel
Page 101 and 102:
written recall assessment task (par
Page 103 and 104:
indicates a large reduction of item
Page 105 and 106:
ehearsal taking place prior to the
Page 107 and 108:
one were discussed with each partic
Page 109 and 110:
Graph 3.2 Comparison of number of i
Page 111 and 112:
As with preliminary study one, part
Page 113 and 114:
during the training session, some p
Page 115 and 116:
3.5 PRELIMINARY STUDY FOUR This stu
Page 117 and 118:
Fifty four percent of participants
Page 119 and 120:
preliminary studies the British Nat
Page 121 and 122:
where main investigation participan
Page 123 and 124:
perhaps reduce the number of items
Page 125 and 126:
preliminary studies as described in
Page 127 and 128:
emember the route taking them from
Page 129 and 130:
4.3 TRAINING SESSION PROCEDURE Each
Page 131 and 132:
4.3.2.1 Training of stimuli: phonol
Page 133 and 134:
assessments was administered both i
Page 135 and 136:
to match the name and skill present
Page 137 and 138:
4.4.3 Results of P1’s post-traini
Page 139 and 140:
Table 4.4 Pilot Study One Total raw
Page 141 and 142:
session. This reflected the general
Page 143 and 144:
4.4.5 Summary of pilot study one Pi
Page 145 and 146:
4.5.2 Results of P2’s performance
Page 147 and 148:
P2 recalled 14 (70%) of the new wor
Page 149 and 150:
demonstrate this learning during im
Page 151 and 152:
4.6.3 Methodological issues A numbe
Page 153 and 154:
would be asked not to repeat the wo
Page 155 and 156:
4.8 CHAPTER SUMMARY The three pilot
Page 157 and 158:
Chapter 5 Main Investigation 5.1 IN
Page 159 and 160:
- The medical stability of particip
Page 161 and 162:
The methodology for the training an
Page 163 and 164:
(i.e. C1, P3 and C2) remained the t
Page 165 and 166:
the immediate recall was not the sa
Page 167 and 168:
Table 5.5 Characteristics of error
Page 169 and 170:
scores (Zigmond and Snaith, 1983) a
Page 171 and 172:
expected that younger participants
Page 173 and 174:
5.4.2.3 Severity of aphasia While t
Page 175 and 176:
5.5 PARTICIPANT C1 Participant C1
Page 177 and 178:
SPOKEN WORD PICTURE WRITTEN WORD Au
Page 179 and 180:
written form again without the aid
Page 181 and 182:
vocabulary than younger participant
Page 183 and 184:
was non-fluent with many repetition
Page 185 and 186:
emembering 49% of information origi
Page 187 and 188:
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:
Page 195 and 196:
C3’s narration of the Cinderella
Page 197 and 198:
errors with six out of the 20 new w
Page 199 and 200:
Page 201 and 202:
5.9.1.4 Rehearsal and consolidation
Page 203 and 204:
achieved 100% recognition on the li
Page 205 and 206:
Page 207 and 208:
any other fictional stories so he w
Page 209 and 210:
the reading task. C5 matched eight
Page 211 and 212:
Page 213 and 214:
some word-finding difficulties with
Page 215 and 216:
Page 217 and 218:
pathways), spell words and non-word
Page 219 and 220:
(reading) words she made 15 false p
Page 221 and 222:
Page 223 and 224:
and PLC pathways). C8’s speech wa
Page 225 and 226:
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 235 and 236:
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
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 251 and 252:
Table 5.35 Correlation co-efficient
Page 253 and 254: Table 5.39 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
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 and 300: theory of rehabilitation and in rel
Page 301 and 302: experience in different ways and ch
Page 303: upon language rehabilitation, for e
Page 307 and 308: Further statistical analyses with a
Page 309 and 310: extend the examination of the abili
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
Page 351 and 352: Appendix 4.8 Examples of written an
Page 353 and 354: APPENDIX 5.2 Participant consent fo
Page 355 and 356:
Appendix 5.3 (Continued) Narrations
Page 357 and 358:
Appendix 5.3 (Continued) Narrations
Page 359 and 360:
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
show all

A thesis submitted in partial fulfilment of - Queen Margaret University

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?