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Decision-making and aphasia Open Access


Other title
Type of item
Degree grantor
University of Alberta
Author or creator
Suleman, Salima
Supervisor and department
Hopper, Tammy (Communication Sciences and Disorders)
Kim, Esther (Communication Sciences and Disorders)
Examining committee member and department
Singhal, Anthony (Psychology)
Bremault-Phillips, Suzette (Occupational Therapy)
Fujiwara, Esther (Psychiatry)
Mayer, Jamie (Allied Health and Communicative Disorders)
Faculty of Rehabilitation Medicine
Rehabilitation science
Date accepted
Graduation date
2017-06:Spring 2017
Doctor of Philosophy
Degree level
BACKGROUND. Making one’s own decisions is an important component of autonomy and expression of one’s identity. After an individual has a stroke or other neurological injury, he or she may experience a disruption to their ability to speak, understand, read, and or write (aphasia). Furthermore, people with aphasia may experience a disruption to their cognitive abilities (e.g., ability to temporarily remember things, ability to pay attention, and their ability to think and reason). Disruptions to language and cognition could negatively impact an individual’s ability to make decisions and/or the individual’s ability to demonstrate their ability to make decisions. However, little is currently known about the true decision-making abilities of people with aphasia. PURPOSE. The purpose of this study was twofold: 1) to compare performances between people with and without aphasia on decision-making tasks; and, 2) to test a theoretical framework of impaired and intact cognitive decision-making in people with and without aphasia. METHODS. The performance of people with aphasia (n = 16) and age- and education-matched controls (n = 16) was compared on three measures of decision-making; one linguistic, and two non-linguistic. While participants completed the IGT, we used an eye-tracker to concurrently collect pupil size data. Eye-tracking data provided real-time information about cognitive and emotional arousal. Participants with and without aphasia also completed a neuropsychological test battery consisting of behavioural measures of language, working memory, and executive function. The data collected in this study were used to: 1) compare performance between people with and without aphasia on different measures of decision-making using a quasi-experimental design; and, 2) explore associations between measures of cognition and measures of decision-making using an exploratory research design. RESULTS. People with aphasia performed worse than control participants on a linguistic test of decision-making. Language impairments largely accounted for the differential performance between people with and without aphasia. The results of this study were inconclusive regarding non-linguistic measures of decision-making. Therefore, the idea that non-linguistic decision-making is impaired in people with aphasia is neither refuted nor endorsed based on these data. Performance on linguistic and non-linguistic decision-making was predicted by performance on tasks of inhibition, attention, and problem solving. Further investigation is necessary. RECOMMENDATIONS. Decision-making is an important part of daily living and life engagement, and should be addressed and supported in rehabilitation by speech-language pathologists and other healthcare professionals. Assessments of decision-making capacity should include communication supports for people with acquired communication disorders; further investigation in the area of decision-making and aphasia is needed.
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
Citation for previous publication
Suleman, S., Chaouki, R., Kim, E., (2014). Decision-making in a person with aphasia: A case study. Alberta College of Speech Language Pathologists and Audiologists Annual Conference. Calgary, Alberta. (Poster Presentation). November 6-7, 2014.Suleman, S. & Hopper, T. (2013). Decision-making capacity assessment and aphasia: SLP perspectives. Alberta College of Speech Language Pathologists and Audiologists Annual Conference. Edmonton, Alberta (Poster Presentation). October 24-25, 2013.Suleman, S. & Hopper, T. (2015). Assessing decision-making capacity in older adults with aphasia. Canadian Association on Gerontology Annual Scientific and Educational Meeting. Calgary, Alberta. (Poster presentation). October 23-25, 2015.Suleman S., & Hopper, T. (2016). Decision-making capacity assessment and aphasia: Speech-language pathologists’ perspectives . Aphasiology, 30(4), 381-395. DOI: 10.1080/02687038.2015.1065468Suleman, S., & Kim, E. (2015a). Decision-making and aphasia: A review and theoretical framework. Aphasiology, 29(12), 1409-1425 DOI: 10.1080/02687038.2015.1049584Suleman, S. & Kim, E. (2015b). Non-verbal decision-making in two people with aphasia: A preliminary investigation. American Speech and Hearing Association Convention. Denver, Colorado. (Poster presentation). November 12-14, 2015.Suleman, S., Kim, E.S., and Hopper, T. (2015). A comparison of processing load during non-verbal decision-making in two individuals with aphasia. Front. Psychol. Conference Abstract: Academy of Aphasia 53rd Annual Meeting. doi: 10.3389/conf.fpsyg.2015.65.00064

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