A thesis submitted in partial fulfilment of - Queen Margaret University

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where therapy should target, a model of rehabilitation would similarity prove invaluable in determining the exact nature of therapy to use for a given impairment. To date however there is not yet a model or theoretical account that explains the dynamic therapist-patient interaction (Horton and Byng, 2000), what therapy actually is or the process involved in rehabilitating the damaged language component(s). In order to develop this theoretical account/ model of rehabilitation additional questions need to be addressed to determine how therapy works and to clarify what therapy is aiming to achieve (Byng, 1993) which in turn may help define exactly what therapy is (Basso, 1989). Ferguson (1999) discusses models of aphasia therapy that were identified by Horner, Loverso and Rothi (1994) and asserts that their specification does not inform us as to HOW the therapy process targets the impaired language function and achieves its outcomes. Speech and language therapists in the United Kingdom have begun to address what therapy is aiming to achieve through making the decision-making process of rehabilitation more explicit, overtly stating the aims (e.g. rehabilitative, curative, enabling) and goals of therapy, specifying tasks chosen to assess and treat people and the provision of evidence of therapy outcome (Malcomess, 2001; McCarthy, Lacey and Malcomess, 2001). However that process which guides the judgement of the speech and language therapist in choosing the actual form of the therapy is still not explicitly addressed (Byng and Black, 1995) and in contrast to theories about impairments, theories about the therapy process still remain largely under developed (Byng and Black, 1995). Currently therapists rely on their own and other therapists’ experience, skill and clinical judgement in choosing tasks and procedures to target identified language impairments (Wilson and Patterson, 1990). While these have been proven to be effective on the whole it is not possible to discern which approaches or tasks will be successful in rehabilitating which particular aspects of aphasia (Best and Nickels, 2000). Additionally, as previously discussed (see section 2.4.1), it is not currently understood why some 47
people with apparently similar characteristics of aphasia do not always gain equal restitution of language function (Best and Nickels, 2000). Davis (1993) suggests that there are four different levels at which to target treatment goals: behavioural, general cognitive, specific cognitive and neurological and that language rehabilitation addresses all but the neurological level. However, this should not be the case as language rehabilitation involves cortical plasticity (see section 2.5.4) and the importance of avoiding maladaptive connections has already been discussed (see section 2.5.4). In order to fully investigate the process of recovery from aphasia any theory of rehabilitation would have to address the neurophysiological level of the recovery process (Gordon, 1999). Ferguson (1999) states that only when the underlying process of language rehabilitation is ascertained and understood can it be appraised and improved. The constraints to this process may then help identify why some people are more amenable to rehabilitation than others (Howard, 1999). Where does one begin when trying to establish a theoretical account of therapy that identifies the underlying process(es) in language rehabilitation? The application of some prominent theories of learning could be applied to aphasia rehabilitation as they incorporate conditions that are necessary for shaping adaptive behaviours while extinguishing maladaptive behaviours, thus instating or reinstating neural pathways (Ferguson, 1999). Howard (1999) argues that the use of theories of learning is not enough in itself but agrees that in order to explain the theory of therapy the process of aphasia rehabilitation may involve different kinds of learning at various stages of recovery. He states that any theory of therapy would also have to address the question of how the process is effective in relation to the presentation of the language impairment. As indicated, any theory of rehabilitation would involve an interaction of the complexities of the brain’s normal response to damage (including cortical reorganisation); various theories of impairment and therapy; optimal timing; the 48
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
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5.15.1.1 Personal attributes 208 5.
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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 and 66: maintenance of permanent records of
Page 67 and 68: intensity aphasia rehabilitation wa
Page 69: 2.7 CURRENT THEORETICAL ACCOUNTS OF
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
Page 117 and 118: Fifty four percent of participants
Page 119 and 120: 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
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
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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:
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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