A thesis submitted in partial fulfilment of - Queen Margaret University

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evaluated and amended (when required) through the preliminary and pilot studies using normal and post-stroke participants (non-aphasic and aphasic). Fourteen participants were recruited for the main investigation from local speech and language therapists, young stroke groups and local college. Participant attrition involved two participants – one due to ill-health and one as a result of visual difficulties that impaired her ability to use the stimuli. Twelve participants took part in the main investigation, ten of whom also participated in delayed recall assessment tasks. Participant age ranged between 33;11-64;04 years. Participants also presented with a wide range of years in education (9-21.5 years), level of occupation (homemaker to pharmacist), severity of aphasia and cognitive abilities (mild to severely impaired) and were at different stages of recovery from their stroke (5-146 months post-stroke). Immediate recall scores revealed a range of learning abilities from the highest recall score of 99% to the lowest of 15% of information about the new words in terms of word form, word meaning and associated meanings. All ten participants retained some information about the new vocabulary at delayed recall with the highest recall score being 82% and the lowest of 17.5%. When the immediate and delayed recall scores were compared it was noted that participants retained from 49% to 83% of information from the training sessions. Qualitative data revealed similarities in errors made by the normal and aphasic population and also errors made by the aphasic population alone, suggesting the impact of factors other than normal variation on learning the new vocabulary (see section 5.3.1). Factors that are thought to affect the restitution of language function (see section 2.6) were examined to ascertain if they also impacted upon the ability to learn new vocabulary using Hierarchical Cluster analyses and Correlation statistics (see section 5.18 and sub-sections). The findings revealed that some of those factors that influence the recovery of language function also impact upon the ability to make new language representations, in particular, personal attributes, cognitive functioning (with the exception of the non-linguistic learning 287
task), severity of aphasia and amount of time spent rehearsing and consolidating the new learning. The group trends suggested that the individual most likely to recover from aphasia was a young, well-educated person, and possibly in a high occupation level who was able to plan and organise their own learning time. However individual case studies advise caution, as the group trends were not true for all participants. This highlighted the heterogeneity of the aphasic population and advocated the use of case studies or case series rather than group studies when investigating this population. This investigation has now established that adults under the age of 65 years can learn new vocabulary despite a range of severity of post-stroke aphasia and at various stages of their recovery. However there are still many questions unanswered. While the population sample was small it was adequate to answer the question whether new learning was possible with the aphasic population. However a larger sample would facilitate more powerful quantitative and richer qualitative analyses. This investigation evaluated the ability of participants to learn single words therefore further investigations are required which assess the ability of using new representations in conversational speech and compare perhaps the ability to learn and use other word classes for example, verbs. The demonstration of new learning by participants suggests that cortical plasticity related to new learning may have occurred in this investigation. Future studies could incorporate brain-imaging techniques to observe the impact of the extent and location of lesions on the ability to learn the new vocabulary in addition to the extent and location of cortical plasticity related to the acquisition of new representations of language. The findings have direct implications for the rehabilitation of language functioning. Firstly, future studies could ascertain if those lower scoring participants could learn more vocabulary if given fewer words to learn over the same period (i.e. four days) or if learned over a longer time period. The possibility of teaching people the best methods to learn new vocabulary and their impact on new learning needs to be investigated as this 288
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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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drawing skills and the ability to l
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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
Page 299 and 300: theory of rehabilitation and in rel
Page 301 and 302: experience in different ways and ch
Page 303 and 304: upon language rehabilitation, for e
Page 305 and 306: the investigation of people with po
Page 307 and 308: Further statistical analyses with a
Page 309: extend the examination of the abili
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
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Appendix 5.4 (continued) Hierarchic
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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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A thesis submitted in partial fulfilment of - Queen Margaret University

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