A thesis submitted in partial fulfilment of - Queen Margaret University

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others. It would be useful to ascertain if intensive learning of the vocabulary would increase the performance of those low scoring participants where they would learn fewer words over the same period of time (four days) or have a longer period of time to learn the same set of items. This information would further inform therapy as to the different ways that patients interact with the rehabilitation process and highlight methods of ensuring that each individual is given the opportunity for optimal restitution of language before resorting to alternative communication methods. The impact of cognitive impairments on the acquisition of new vocabulary has been highlighted, however more in-depth assessments that are sensitive for people with aphasia are required for future research. Large-scale investigations that assess the effects of therapeutic intervention of cognitive impairment in people with aphasia and in particular in relation to language rehabilitation would be invaluable in informing the rehabilitation of aphasia. All participants in the main investigation demonstrated the ability to learn in the language domain. This suggests that new learning could be part of the underlying process of language rehabilitation. If so, this has implications for speech and language therapists. Further investigations could ascertain if it is possible to teach people the best method for learning, particularly those individuals with limited education experience. If so, the impact of success of therapeutic rehabilitation could be evaluated following such training and findings would inform the best therapy methods to adapt. In addition, as this investigation has demonstrated the ability of people with aphasia to learn new vocabulary, is the possibility of adapting therapy methods to promote new learning, which would be invaluable for speech and language therapists. The main investigation employed new single words in the form of common nouns. When new vocabulary is learned it is then extended from single word practise and incorporated into connected speech. Further investigation would 285
extend the examination of the ability to learn new vocabulary in isolation to analysing how these words would be incorporated into connected speech and the factors that may impact upon their use. Additionally, new vocabulary in the form of verbs could be examined and compared to the ability to learn and use common nouns. This would be of particular of interest for those people with grammatical impairments as a result of their stroke. 6.9 SUMMARY AND CONCLUSIONS At present there is no complete theory of rehabilitation in the language domain and it is not known if aphasia rehabilitation could incorporate new learning or if the rehabilitation merely involved facilitating the accessing of previously known but inaccessible memory traces. To begin to address this, people with poststroke aphasia must be able to demonstrate that they can learn new language related material. Prior to this investigation this was not known. While previous studies had demonstrated that people with aphasia have the general ability to learn, these studies involved paired stimuli with a familiar and matched novel component. The main aim of this investigation was bridge this gap in current knowledge and to establish if adults with post-stroke aphasia could demonstrate new learning in the language domain. As the investigation was original, the stimuli and procedure had to be designed and were evaluated during rigorous preliminary and pilot studies (see Chapter 3 and Chapter 4). The outcome was a vocabulary set of 20 new words encompassing novel word forms and novel meanings that were related to already known words in the participants’ vocabularies. The methodology of the investigation incorporated procedures based on evidence from the literature where possible, in order to facilitate and promote optimum learning by participants. Similar to the stimuli, the training procedure was developed, 286
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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
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Table 5.33 Correlation co-efficient
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ecency and primacy effect, however,
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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 and 298: module and how it communicates with
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Page 303 and 304: upon language rehabilitation, for e
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Page 307: Further statistical analyses with a
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
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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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