A thesis submitted in partial fulfilment of - Queen Margaret University

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Sarno (1993) reminds us that the use of a speech code in communication exists only in humans and aphasia therefore assaults that very component which defines our humanness. Code and Herrmann (2003) reiterate the importance of intact communication abilities in developing and maintaining social relationships and state that the experience of aphasia results in a sudden and devastating incapacity to participate in many day-to-day activities. Aphasia impacts upon leisure, occupational, social and family activities (Code and Herrmann, 2003; Gainotti, 1997), which reflect a person’s quality of life. Sarno (1997) states that at least four domains are assessed when a person’s quality of life is considered. These include emotional and social functioning, daily living activities and the ability to actively engage in pleasurable pursuits. Perceptions of lifestyle satisfaction are an important component of quality of life and handicap measurements (Hinckley, 1998). In contrast to studies for the general stroke population, Hinckley (1998) reports that hemiparesis did not predict lifestyle satisfaction for the aphasic population. She suggests that communication impairment could have a stronger effect on quality of life perception than persisting motor impairment within the aphasic population. Le Dorze and Brassard (1995) concur stating that language disabilities are the major cause of handicap in society as they negatively impact upon all communication situations, where interpersonal relationships are changed and the person is left feeling stigmatised with a loss of personal autonomy. Overall, a person’s ability to communicate and in particular a person with aphasia’s communication predicted their psychological well-being and social wealth. However, not all data agree with these reports and some indicate that aspects other than the severity of their language affect the person with aphasia’s quality of life (Ross and Wertz, 2003). One study evaluated 24 facets proposed by the World Health Organisation Quality of Life Group (1996), which best differentiated the aspects that affect the quality of life for individuals with aphasia (n=18) and non-aphasic individuals (n=18) (Ross and Wertz, 2003). This study 9
noted that there were three areas that affected the person with aphasia’s quality of life. Firstly a person’s level of independence and their ability to carry out their daily activities, to be mobile and to return to employment were priorities for these participants. Secondly, social relationships were impacted upon where participants prioritised having satisfaction with support from their friends and also in their intimate relationships. Finally, in the environmental domain the importance of information accessibility, health services, and transportation were a priority for those participants with aphasia. These results concur with previous reports of loss of independence (Herrmann and Wallesch, 1990) and the inability to work being priorities for people with aphasia, other than their communication disability (Herrmann and Wallesch, 1990; Kinsella and Duffy, 1979; Sarno, 1993). However, the following discussions will reveal that many of the priorities mentioned above are impacted upon as a direct result of having impaired communication abilities, where aphasic individuals may even settle for a more limited quality of life because of their expectations of living with a disability (Ellis- Hill and Horn, 2000). It is not only the person with aphasia whose life experiences change following their stroke. Therefore, the review of the literature reporting the impact of communication impairment on a person with aphasia will also encompass the negative impact on family and friends within their interpersonal relationships and communication with the person with aphasia, their increased responsibilities (in many cases) and adaptations to their work and leisure activities. Four areas of quality of life will now be explored – the emotional impact of acquiring and living with aphasia, the adaptation of social functioning as a direct result of a communication impairment, the impact of aphasia on the family unit, and its affect on their ability to actively engage in pleasurable activities. 10
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: continue to experience significant
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
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et al. (2001) evaluated the ability
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of new vocabulary where both the wo
Page 89 and 90:
syllables in each word, therefore t
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vocabulary; facilitate the demonstr
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methodology developed and used in t
Page 95 and 96:
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
Page 105 and 106:
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
Page 113 and 114:
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
Page 125 and 126:
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
Page 133 and 134:
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
Page 165 and 166:
the immediate recall was not the sa
Page 167 and 168:
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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Page 195 and 196:
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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Page 207 and 208:
any other fictional stories so he w
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the reading task. C5 matched eight
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Page 213 and 214:
some word-finding difficulties with
Page 215 and 216:
Page 217 and 218:
pathways), spell words and non-word
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(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
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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
Page 235 and 236:
Page 237 and 238:
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
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
ecency and primacy effect, however,
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drawing skills and the ability to l
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with the creation of new neuronal c
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5.8.2.1). Secondly, the participant
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6.3.1.1 The impact of age on the le
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education that an individual experi
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unethical, even perhaps illegal, to
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assessment and treatment of emotion
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theories on the negative effects of
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(CLQT) was developed as a screening
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6.3.3.2 The impact of memory on the
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(executive scores of moderate, mild
Page 279 and 280:
320). Additionally, the CLQT indica
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6.3.4.1 Pre-training language scree
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abilities of each participant and a
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person with aphasia only ever produ
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6.4.2 Methodology As previous resea
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assessing the learning of new vocab
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provided flexibility not only for s
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presentation. It was proposed that
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participants also lexicalised the n
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module and how it communicates with
Page 299 and 300:
theory of rehabilitation and in rel
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experience in different ways and ch
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upon language rehabilitation, for e
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the investigation of people with po
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Further statistical analyses with a
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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
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Appendix 3.1 Preliminary study one:
Page 331 and 332:
Appendix 3.2 (continued) Preliminar
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Appendix 3.4a Preliminary study two
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Appendix 3.6 Stimuli used for the m
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Appendix 3.6 (continued) Stimuli us
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Appendix 4.1 Methods of learning ne
Page 341 and 342:
Appendix 4.2 Hospital Anxiety and D
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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
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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
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
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A thesis submitted in partial fulfilment of - Queen Margaret University

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