A thesis submitted in partial fulfilment of - Queen Margaret University

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person’s current cognitive status (Staff et al., 2004; Starr, Nicolson, Anderson, Dennis and Deary, 2000). One difficulty in assessing and estimating pre-morbid intelligence is that the measurement of intelligence is only as good as the assessment used, not all intellectual capabilities can currently be measured, for example, creativity or wisdom and there is not a general consensus as to what intelligence actually is (Deary, 2001). Starr et al. (2000) note the difficulty in the accurate measurement of cognitive impairment and intelligence following a stroke as many assessments are inappropriate for use with people post-stroke and also that pre-morbid cognitive function usually needs to be estimated after the stroke has occurred. The impact of stroke could impair test performance particularly when related to linguistic and visuospatial deficits therefore someone with aphasia may not be able to demonstrate their intellectual capabilities where verbal responses are required. 2.6.2 Biological limitations As already discussed (see section 2.5) recovery following stroke and the potential for recovery is limited by the capabilities and limitations of the physical brain. However, this is not a straightforward relationship. Research on the different aetiologies of stroke, i.e. infarct versus haemorrhage, and their effect on recovery is rare and has produced conflicting results (Basso, 1992). Other studies have attempted to evaluate the location and extent of the lesion on recovery. However, it is difficult to assess this factor independently from the initial severity of aphasia which in turn is directly associated with location and extent of lesion (Basso, 1992). 2.6.2.1 Lesion size and site As discussed (see section 2.5.1) a minimal ‘critical mass’ of neurone cells are required to survive if neuronal repair and reconnection is to occur (Robertson, 1999; Robertson and Murre, 1999). This suggests that the greater the damage, the less chance of this minimal number of neurones surviving with the possible 37
permanent loss of particular skills. Naeser and Hayward (1978) report that small lesions appeared to correlate with mild aphasia types. Kertesz, Harlock and Coates (1979) reported that larger lesions produce more lasting language impairment finding a positive correlation between lesion size and recovery of comprehension. They advise that the size of lesion is more significant in determining the degree of aphasia than its location with anomic aphasia, however in contrast to this a small lesion positioned in Wernicke’s area may produce severe aphasia. Basso (1992) states that the effect of the magnitude of a lesion on the initial severity of aphasia is unquestionable but that once the initial severity has been accounted for the effect of lesion size on recovery of language is ambiguous. Ludlow, Rosenberg, Fair, Buck, Schesselman and Salazar (1986) reported a 15-year follow-up study and reported that the size of the lesion was not a predictor in itself however, where both the anterior and posterior language areas were damaged language showed less recovery. According to Basso (1992), Naeser, Helm-Estabrooks, Haas, Auerbach and Sprinivasan’s (1987) is the only study that directly studies the effect of the location of lesion and its relation to recovery. Their results indicated that a large or posterior lesion initially causes severe aphasia but, as with lesion size, the effect on the amount of recovery is not clearly demonstrated. Basso (1992) states that the location of the lesion has more influence on the initial severity of aphasia than on the degree of recovery. In summary, the relationship between the magnitude and location of brain lesions is complex and appears to be interlinked with the initial severity of aphasia. Additionally, the relevance of size and site of lesions may have different relevance for function; for example, a small lesion in the language area of the brain is more disruptive for language than is a large lesion in the frontal lobes (Basso, 1992). 38
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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
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 and 58: Studies have not always found age t
Page 59: larger intracranial capacity could
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
Page 109 and 110: 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.,
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Fillingham, J. K., Sage, K. and Lam
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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
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Scheibel, A., Conrad, T., Perdue, S
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Warrington, E. K. and McCarthy (198
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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:
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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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