A thesis submitted in partial fulfilment of - Queen Margaret University

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greater impairment in activities of daily living than with depression alone with the period of depression being significantly longer and more severe (Shimoda and Robinson, 1998). Cognitive processes are complex and interrelated but their interactive relationships (for example, between attention, memory and executive function) are not clearly defined (Purdy, 2002). These processes are considered to be factors that impact upon the rehabilitation process of aphasia. The acquisition of information/ knowledge requires active participation to promote and facilitate cortical plasticity. If a person is unable to attend to the rehabilitation stimuli being presented they will fail to adequately process the information. As aphasia therapy involves the acquisition of information, methods and skills (similar to the learning process), memory processes must be intact to retain information or strategies learned (Helm-Estabrooks, 2002). Additionally, the presentation of post-stroke depression alongside aphasia further impacts upon a person’s cognitive ability and consequently their ability to participate in and benefit from aphasia rehabilitation. Kimura et al. (2000) suggest that the treatment of poststroke depression may be one of the most significant methods of promoting cognitive recovery. 2.6.4 Rehabilitation of language impairments 2.6.4.1 Intensity and timing of language rehabilitation The efficacy of language therapy intervention has already been discussed (see section 2.4.1), however the results from some studies have observed an association between intensive therapy and improved aphasia outcomes (Bhogal, Teasell and Speechley, 2003). Poeck et al.’s (1989) findings indicated that language recovery progressed as a result of intensive therapy even in the chronic phases of recovery. Additionally, Roby’s (1998) meta-analysis reports that people receiving high intensity aphasia rehabilitation recover twice as great as those not receiving any therapeutic input. Conversely, where only low 43
intensity aphasia rehabilitation was provided, improvement was only slightly greater than for those not receiving any therapeutic input. Pulvermüller et al. (2001) also concluded that the intense provision of their treatment procedure (constraint-induced aphasia therapy) provided a better outcome than the same amount of conventional therapy provided over a longer time period. Brindley, Copeland, Demain and Martyn (1989) also report that intensity of language intervention showed significant improvement whereas periods of non-intensive therapy resulted in no significant improvement. The intensity of aphasia therapy intervention can therefore be considered an influencing factor in the recovery of language. Unfortunately in many instances there are staffing and financial constraints in offering this mode of therapy and Brindley et al. (1989) assert that it is only when the current health system is reorganised by increasing resources (with an increased allocation of time to speech and language therapists) will aphasia therapy be effective, particularly for those people who present with chronic aphasia. Robey’s (1998) meta-analysis demonstrated that people should be seen as soon as possible after a stroke – when treatment was given at postacute stages the average effect size for individuals was smaller than for more chronic aphasia but was still 1.68 times more than those who did not receive any language therapy. Additionally, those in the chronic stages of recovery also showed more change when treated compared to those who were untreated. Outcomes were also reported to be greatest when treatment is begun in acute stages of recovery (Robey, 1998). 2.6.5 Summary The above studies, while not exhaustive, indicate the various factors that have been considered to impact upon the recovery from aphasia. Pre-morbid factors such as age and education have provided equivocal results. However many studies have employed different methods of assessing the impact of these elements on the recovery of aphasia and therefore it is difficult to compare outcomes. Biological limitations have also been discussed and the size and site 44
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
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2.6.2.1 Lesion size and site 37 2.6
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3.6.1.2 Number and type of items to
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4.8 Chapter summary 132 Chapter 5 T
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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 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: maintenance of permanent records of
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
Page 111 and 112: As with preliminary study one, part
Page 113 and 114: during the training session, some p
Page 115 and 116: 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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A thesis submitted in partial fulfilment of - Queen Margaret University

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