A thesis submitted in partial fulfilment of - Queen Margaret University

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the oldest person in the study had dendritic measures well above average. This supports some smaller studies that suggest that the number of dendrites actually increases with age (Buell and Coleman, 1981). Their study found significantly larger dendritic trees in adults, aged 68-92 than in younger adults (aged 44-55). Johansson (2000) asserts that the dendritic loss of ageing is compensated to some extent by dendritic growth where a post-mortem examination demonstrated that neurological healthy 80 year olds had longer dendritic trees than those of 51 year olds. Bagg, Pombo and Hopman (2002) advise that age has been identified as a prognostic factor in recovery following stroke in a number of studies reporting associations between age and poor outcome. The data however is equivocal, with some studies showing that younger patients had a more favourable outcome than older ones (Kalra, 1994; Holland, Greenhouse, Fromm and Swindell, 1989; Shewan and Kertesz, 1984; Marshall and Phillips, 1983; Marshall, Tompkins and Phillips, 1982) whereas other studies suggested that age is not a prognostic factor (Bagg et al., 2002; Pedersen, Jørgensen, Nakayama, Raaschou and Olsen, 1995). Robertson and Murre (1999) state that although neuronal plasticity is evidenced in the adult population the potential for recovery is greater for younger adults. Bagg et al. (2002) aimed to discriminate between the influences of age itself and various factors that are associated with ageing on functional outcome. They found that age alone showed a small but significant effect on functional outcome. However they stress the small size of the effect stating that the association between poor outcome and age could be explained by additional disabilities or co-morbidities that the people presented with. They advise that age itself could be associated with lower functional outcome because of a limited physical tolerance to intense rehabilitation, slower functional recovery or both. 33
Studies have not always found age to be a prognostic factor (Basso, 1992; Poeck, Huber and Willmes, 1989). Basso (1992) also states that if there were clear age differences in recovery it would only indicate that changes occur with age, without suggesting the possible causes of these changes. However Alexander (1994) advises that on the whole older people present with a worse functional outcome than younger people. Pedersen et al. (1995) found the influence of age on recovery was significant but minimal. Pedersen, Vinter and Olsen (2004) found an age difference between Broca’s and Wernicke’s aphasia one year after stroke but not in the initial acute stages. They suggested that the ‘true’ aphasia is initially masked by diaschisis and felt that age was not a predictor of recovery. De Riesthal and Wertz (2004) advise that many studies vary in terms of communication measures used (impairment-based or functional) and method of measuring amount of change or improvement. Nakayama, Jørgensen, Raaschou and Olsen (1994) advise that age does not independently influence stroke outcome neurologically but rather in aspects of activities of daily living, suggesting a poorer compensatory ability in elderly stroke patients. 2.6.1.2 Years of education As discussed, the acquisition of skills and information contributes to the complexity of neuronal connections in the brain (see section 2.5.2) therefore the more education that a person experiences, the greater the complexity and number of neuronal patterns are present in the language areas of the brain (Jacobs, Schall and Scheibel, 1993). Education refers not only to the formal education system but also to the long-term intellectual experiences resulting from that education (Jacobs et al., 1993). Jacobs et al. (1993) found that the more education that an individual experienced the more complex and interconnected neural connections they possessed compared to less educated individuals. While it was not possible to prove whether the more complex number of neurones existed as a result of attending university, or whether participants were more predisposed to attending higher education because of an 34
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: ehabilitation, function can be limi
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
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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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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:
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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
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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
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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
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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
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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
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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
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Appendix 4.2 Hospital Anxiety and D
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Appendix 4.2 (Continued) Hospital A
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Appendix 4.4 Non-linguistic learnin
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Appendix 4.5 Language screening ass
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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
Page 355 and 356:
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:
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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