A thesis submitted in partial fulfilment of - Queen Margaret University

2.6.3 Initial functional severity
2.6.3.1 Initial severity of aphasia
Robey (1998) performed a meta-analysis of various aphasia rehabilitation
studies and found that (with a limited amount of evidence) recovery following
intervention with people with moderate and severe aphasia was not
encouraging. However he states that many single case studies have shown
positive therapeutic outcomes with large gains being achieved by people with
severe aphasia when treated by speech and language therapists. There is
general agreement that the initial severity of aphasia is significantly related to
outcome (De Riesthal and Wertz, 2004; Pedersen et al., 2004; Basso, 1992;
Shewan and Kertesz, 1984). In fact, Pedersen et al. (1995) state that this initial
severity is the single most influencing factor for ultimate language function. This
has been confirmed whenever the level of initial severity was included in studies
evaluating recovery and whichever language performance was studied (Basso,
1992). Therefore, people with aphasia whose language problems are initially
less severe appear to regain a higher level of function than those with more
severe impairment.
2.6.3.2 Emotional status
As previously discussed (see section 2.3.1) one of the impacts of post-stroke
aphasia is emotional disturbances, such as apathy (Starkstein, Fedoroff, Price,
Leiguarda and Robinson, 1993), anxiety and depression, both in the acute and
chronic stages of recovery (Robinson, 2003; Spalletta et. al. 2002; Keppel and
Crowe, 2000; Beblo et al., 1999; Kauhanen et al., 1999; Shimoda and Robinson,
1998; Astrom et al. 1993; Sarno, 1993 and Bolla-Wilson, Robinson, Starksein,
Boston and Price, 1989). Robinson (2003) reports a lack of standardised
methods and criteria for diagnosing post-stroke depression but according to
DSM-IV depressive-like episodes are acceptable for diagnosis. He reports that
using this criterion 19.3% of people who experience stroke present with major
depression and 18.5% with minor depression. While it is difficult to assess
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