A thesis submitted in partial fulfilment of - Queen Margaret University

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with aphasia can demonstrate the learning of new vocabulary incorporating both new word forms and new meanings. This investigation aims to address this gap in our knowledge by facilitating the learning of new vocabulary and assessing the ability of people with aphasia to demonstrate this new learning. This information will contribute towards a theoretical account of aphasia rehabilitation. New words will be taught to people with aphasia using optimal learning techniques from learning approaches – preexposure, self-judgement and an errorless learning paradigm will be followed. The cognitive neuropsychological information-processing model of single word processing will be used to inform the design of the learning and assessment procedures (see section 2.9.3) and optimal techniques from theories of learning will be used (see section 2.9.2). The investigation will take both a top-down approach where active participation will be an integral part of the procedure ensuring to recruit attention gating (see section 2.6.3.3) and bottom up procedures will be utilised to facilitate repetition and rehearsal of learning with less errors invoked (see section 2.9.2) suggesting less maladaptive neuronal connections being made for the new vocabulary. The learning performance of each participant will also be evaluated in terms of the contributing factors that influence language recovery (see section 2.6) to hypothesise if predictions could be made about the ability of people with aphasia to learn affected by such influencing factors. As this is a pioneering study the stimuli and procedure will be developed and evaluated in preliminary studies in Chapter 3 and the piloting of the final methodology with healthy and post-stroke adults in Chapter 4. The main investigation will be presented in Chapter 5 where the results of each participant will be presented in the form of a case series. A discussion of the findings and its relevance to aphasia rehabilitation will be presented in Chapter 6. 71
Chapter 3 Preliminary Studies 3.1 INTRODUCTION As discussed in Chapter 2, there have been a small number of investigations, which evaluated the learning of vocabulary by healthy adults with no history of brain damage, adults with memory impairment and adults with aphasia (see section 2.8.5 and subsections). These investigations mainly focused on the comparison of the effectiveness of various learning techniques in new learning. The investigations employed various stimuli to observe and assess vocabulary learning – foreign words, native language words considered to be unfamiliar to participants and non-words. However, these investigations essentially evaluated the ability of participants to pair or associate new information with already held representations rather than assessing the ability of participants to acquire new vocabulary representations (i.e. new word form and new meaning). As discussed (see section 2.7), there is currently no theoretical account or model of aphasia rehabilitation which makes the process(es) involved in the rehabilitation of aphasia explicit, and therefore it is not known if aphasia rehabilitation merely accesses already stored but currently inaccessible memory traces of language, or if new cortical connections are being made through new learning. A first step in addressing this area of knowledge is to establish if adults with aphasia can in fact demonstrate learning of new vocabulary despite residual language difficulties, which is what this investigation aimed to do. As this is a pioneering investigation there is currently no normative data from the adult population on the acquisition of this type of new vocabulary (number of items learned, strategies used etc.) or the appropriate type of stimuli to employ. Therefore preliminary studies were carried out with two main objectives. Firstly, the ‘learnability’ of the newly created stimuli (i.e. new word forms with novel meanings) were evaluated by adults with normal language and cognitive processes also providing normative data. Secondly, a number of methodological matters in preparation for the main investigation were addressed. 72
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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
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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
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Appendices 2.1 Main representative
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5.2 Raw and percentage scores for n
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Figures 2i Cognitive neuropsycholog
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Younger people who are having and s
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Chapter 2 Review of the literature
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sentences. As aphasia also affects
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continue to experience significant
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noted that there were three areas t
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natural reaction to the loss of abi
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2.3.3 Impact of aphasia on the fami
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facets of a person’s life as well
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with the literature regarding the l
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Page 129 and 130: 4.3 TRAINING SESSION PROCEDURE Each
Page 131 and 132: 4.3.2.1 Training of stimuli: phonol
Page 133 and 134: assessments was administered both i
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Page 139 and 140: Table 4.4 Pilot Study One Total raw
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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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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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