A thesis submitted in partial fulfilment of - Queen Margaret University

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inherently more complex neuronal system, environmental studies reveal the importance of a stimulating environment for shaping cortical development. Robertson (1999) suggests that education nurtures a better-connected network of neurones and as a result the patterns of skills and memories are less easily destroyed. He stated that one of the great benefits of education is that you actually learn how to learn and this involves skills of thinking, remembering, planning and problem solving. Due to this education process a more densely connected network of neurones evolves from the increased number of brain cells that have become wired together through firing together. It is therefore more likely that skills and memories woven into these wired connections can be recovered following damage. De Riesthal and Wertz (2004) assert that years of education as a prognostic factor in recovery from aphasia is debatable. Smith (1971) reports that a person with more years’ education tends to make more improvement following aphasia therapy. Tompkins (1990) however observed that variables such as education are poor predictors of improvement in aphasia. De Riesthal and Wertz (2004) also noted that the number of year’s education was not significantly correlated with recovery. 2.6.1.3 Cognitive Reserve The variability in both the severity and duration of aphasia, and the successful recovery of language following cortical damage has been discussed (see section 2.4.1). Variation is also observed in the severity of cognitive functioning despite individuals presenting with similar neurological damage. This phenomenon is often explained with the hypothetical concept of ‘cognitive reserve’ (Staff, Murray, Deary and Whalley, 2004; Whalley, Deary, Appleton and Starr, 2004; Kesler, Adams, Blasey and Bigler, 2003). This hypothesis suggests passive and active factors which are thought to influence the capacity of the brain to withstand cognitive decline/ damage to a predetermined threshold after which cognitive deficits appear (Staff et al., 2004). The size of a person’s brain is one such passive factor hypothesised to influence cerebral reserve, suggesting that 35
larger intracranial capacity could withstand more brain ageing (or injury) before cognitive impairment becomes detectible than smaller intracranial capacity (Kesler et al., 2003). Active processes considered to be factors involved in accumulating cerebral reserve include the intellectual challenges experienced throughout our lifetime, such as intelligence, education and occupational levels (Staff et al., 2004; Whalley et al., 2004; Kesler et al., 2003; Plassman, Welsh, Helms, Brandt, Page, Breitner, 1995). Some studies have attempted to evaluate the impact of ageing on cognitive decline. One such study in Scotland replicated the Scottish Mental Survey of 1932 (school children aged 11) with 235 of the same participants (aged 77 at follow-up) comparing the findings to the data of 1932 and also provided MRI data for 98 of these participants (Staff et al., 2004). Unlike Kesler et al. (2003) cerebral size was not supported as a passive factor in cognitive reserve. It was reported that childhood intelligence contributed to non-verbal reasoning abilities at age 77 years and both education and a cognitively complex occupation predicted higher cognitive ability in old age. Additionally, relationships were found between memory and education, memory and occupation, as well as reasoning and occupation. An interesting trend in this replicated study indicated a substantial stability in the rank-ordering of human intelligence across the life span where children who scored highly in assessments at age 11 tended to score highly at age 77 and vice versa. A cross-sequential study in Seattle also recorded the intellectual and cognitive capacity of a population from childhood to adulthood (over 5000 participants) (Schaie, 1994). This study reported a decline of intellect with ageing in areas of inductive reasoning, spatial orientation, perceptual speed and verbal memory, however, there was much less age related decline in verbal and numerical ability. It is however difficult to establish baseline measures of active factors such as pre-morbid intelligence and cognitive status, to enable comparison with a 36
Page 1 and 2:
An Investigation into the Ability o
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Abstract Recent studies have establ
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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: Studies have not always found age t
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
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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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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
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References Alexander, M. P. (1994)
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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
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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
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Warrington, E. K. and McCarthy (198
Page 329 and 330:
Appendix 3.1 Preliminary study one:
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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
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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
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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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