Can gesture observation help people with aphasia name actions?

The effects of symbolic gestural training on enhancing recovery of spoken naming in people with aphasia: A systematic review and meta-analysis

PURPOSE

This study aimed to evaluate the effects of symbolic gestural training on enhancing recovery of spoken naming in people with aphasia (PWA) using a systematic review and meta-analysis.

METHOD

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, article search was conducted from four databases: Web of Science Core Collection, Medline, PsycINFO, and EBSCO. A total of 45 participants from four studies investigating the symbolic gestural training effects on PWA and outcome measures of spoken naming were included.

RESULT

The meta-analysis showed a medium overall effect of symbolic gestural training on enhancing recovery of spoken naming in PWA. Subgroup analysis also revealed that the training effect was more remarkable in the gesture + verbal training paradigm than in the gesture-only training paradigm. However, the differences in the training effects between short and long duration, and training supplied with and without feedback, were nonsignificant.

CONCLUSION

This study illustrates the current state of the literature on symbolic gestural training in PWA, and serves as a reference for clinicians, patients, and health policy-makers regarding the application of symbolic gestural training in clinical or rehabilitation programs.

Shared and distinct routes in speech and gesture imitation: Evidence from stroke

Dual-route models of high-level (praxis) actions distinguish between an "indirect" semantic route mediating meaningful gesture imitation, and a "direct" sensory-motor route mediates meaningless gesture imitation. Similarly, dual-route language models distinguish between an indirect route mediating production and repetition of words, and a direct route mediating non-word repetition. Although aphasia and limb apraxia frequently co-occur following left-hemisphere cerebrovascular accident (LCVA), it is unclear which aspects of these functional-neuroanatomic dual-route architectures are shared across praxis and language domains. This study focused on gesture imitation to test the hypothesis that semantic information (and portions of the indirect route) are shared across domains, whereas two distinct dorsal routes mediate sensory-motor mapping. Forty chronic LCVA and 17 neurotypical controls completed semantic memory and language tasks and imitated 3 types of gesture stimuli: (1) labeled/"named" meaningful, (2) unnamed meaningful, and (3) meaningless gestures. The comparison of accuracy between meaningless versus unnamed meaningful gestures examined the benefits of semantic information, while the comparison of unnamed meaningful versus named meaningful imitation examined additional benefits of linguistic cueing. Mixed-effects models examined group by task interaction effects on gesture ability. We found that for patients with LCVA, unnamed meaningful gestures were imitated more accurately than meaningless gestures, suggesting that semantic information was beneficial, but there was no benefit of labeling. Reduced benefit of semantic information on gesture accuracy was associated with lesions to inferior frontal and posterior temporal regions as well as semantic memory performance on a pictorial (non-gesture) task. In contrast, there was no relationship between meaningless gesture imitation and nonword repetition, indicating that measures of direct route performance are not associated across language and action. These results provide preliminary evidence that portions of the indirect semantic route are shared across the language and action domains, while two direct sensory-motor mapping routes mediate word repetition and gesture imitation.

Embodying Language through Gestures: Residuals of Motor Memories Modulate Motor Cortex Excitability during Abstract Words Comprehension

There is a debate about whether abstract semantics could be represented in a motor domain as concrete language. A contextual association with a motor schema (action or gesture) seems crucial to highlighting the motor system involvement. The present study with transcranial magnetic stimulation aimed to assess motor cortex excitability changes during abstract word comprehension after conditioning word reading to a gesture execution with congruent or incongruent meaning. Twelve healthy volunteers were engaged in a lexical-decision task responding to abstract words or meaningless verbal stimuli. Motor cortex (M1) excitability was measured at different after-stimulus intervals (100, 250, or 500 ms) before and after an associative-learning training where the execution of the gesture followed word processing. Results showed a significant post-training decrease in hand motor evoked potentials at an early processing stage (100 ms) in correspondence to words congruent with the gestures presented during the training. We hypothesized that traces of individual semantic memory, combined with training effects, induced M1 inhibition due to the redundancy of evoked motor representation. No modulation of cortical excitability was found for meaningless or incongruent words. We discuss data considering the possible implications in research to understand the neural basis of language development and language rehabilitation protocols.

Nonverbal Semantics Test (NVST)-A Novel Diagnostic Tool to Assess Semantic Processing Deficits: Application to Persons with Aphasia after Cerebrovascular Accident

Assessment of semantic processing capacities often relies on verbal tasks which are, however, sensitive to impairments at several language processing levels. Especially for persons with aphasia there is a strong need for a tool that measures semantic processing skills independent of verbal abilities. Furthermore, in order to assess a patient’s potential for using alternative means of communication in cases of severe aphasia, semantic processing should be assessed in different nonverbal conditions. The Nonverbal Semantics Test (NVST) is a tool that captures semantic processing capacities through three tasks—Semantic Sorting, Drawing, and Pantomime. The main aim of the current study was to investigate the relationship between the NVST and measures of standard neurolinguistic assessment. Fifty-one persons with aphasia caused by left hemisphere brain damage were administered the NVST as well as the Aachen Aphasia Test (AAT). A principal component analysis (PCA) was conducted across all AAT and NVST subtests. The analysis resulted in a two-factor model that captured 69% of the variance of the original data, with all linguistic tasks loading high on one factor and the NVST subtests loading high on the other. These findings suggest that nonverbal tasks assessing semantic processing capacities should be administered alongside standard neurolinguistic aphasia tests.

The Role of Gesture in Communication and Cognition: Implications for Understanding and Treating Neurogenic Communication Disorders

When people talk, they gesture. Gesture is a fundamental component of language that contributes meaningful and unique information to a spoken message and reflects the speaker's underlying knowledge and experiences. Theoretical perspectives of speech and gesture propose that they share a common conceptual origin and have a tightly integrated relationship, overlapping in time, meaning, and function to enrich the communicative context. We review a robust literature from the field of psychology documenting the benefits of gesture for communication for both speakers and listeners, as well as its important cognitive functions for organizing spoken language, and facilitating problem-solving, learning, and memory. Despite this evidence, gesture has been relatively understudied in populations with neurogenic communication disorders. While few studies have examined the rehabilitative potential of gesture in these populations, others have ignored gesture entirely or even discouraged its use. We review the literature characterizing gesture production and its role in intervention for people with aphasia, as well as describe the much sparser literature on gesture in cognitive communication disorders including right hemisphere damage, traumatic brain injury, and Alzheimer's disease. The neuroanatomical and behavioral profiles of these patient populations provide a unique opportunity to test theories of the relationship of speech and gesture and advance our understanding of their neural correlates. This review highlights several gaps in the field of communication disorders which may serve as a bridge for applying the psychological literature of gesture to the study of language disorders. Such future work would benefit from considering theoretical perspectives of gesture and using more rigorous and quantitative empirical methods in its approaches. We discuss implications for leveraging gesture to explore its untapped potential in understanding and rehabilitating neurogenic communication disorders.