The utility of arm and hand gestures in the treatment of aphasia

The Key Role of Gestures in Spatial Tasks for Students With Intellectual Disability

The gestures produced by children with intellectual disability (ID) in spatial tasks are rarely considered, although they have a supporting role in the formation of thought. In this research study, we analyzed the number of gestures, the type of gestures, and their role in the expression of knowledge of students with ID. Twenty students (12-17 years old) with ID and 40 students with typical development (TD) matched on visual-spatial level (n = 20) and on language level (n = 20) participated in the research. Students with ID made significantly more gestures in relation to the number of words spoken compared to their peers with TD. Thirty percent of the expressive communication of students with ID came from gestures alone, and 60% of the responses contained at least one gesture. Finally, the higher the level of task difficulty, the more gestures the students made.

The Communication Success Screener: A Preliminary Investigation of Perceived Communicative Success Across Modalities, Environments, and Demands

PURPOSE

Behavioral intervention targeting speech, language, and communication concerns is an established therapeutic approach for patients with communication concerns across a range of acquired neurogenic disorders. The multidimensional factors that contribute to a person's self-identified communication challenges and strengths in their daily communication needs must be considered to provide functional and person-centered care. While assessments grounded in clinician observation or client self-report exist, there is a direct need for a screening tool that comprehensively evaluates the roles of modality (verbal, text, gesture) and environment (in-person, virtual) on self-reported success across communicative demands. In this study, we describe a preliminary approach to monitoring the progression of receptive and expressive communication skills in people with chronic poststroke aphasia in the context of communication practices of the 21st century, culminating in the development and exploratory implementation of a novel clinical instrument: the Communication Success Screener (COMSS).

METHOD

Thirty-three participants with aphasia due to stroke were recruited to complete and evaluate the COMSS via an online survey. Quantitative responses and open-ended participant feedback were collected to validate and propose adaptations to the COMSS. Group-level analyses and case presentations were used to highlight COMSS features and outcomes.

RESULTS

Participant responses to the COMSS questionnaire suggest that this screening tool creates differentiated communicative success profiles based on self-report. Participant feedback also indicated that the COMSS appropriately evaluates self-reported success across modalities of verbal, text, and gesture in the context of in-person and virtual environments.

CONCLUSIONS

The communication concerns experienced by people with aphasia are often heterogeneous and vary as a function of their daily activities of living, preferred language modalities, and environmental supports. We present preliminary feasibility analyses of the COMSS as a potential tool to support the monitoring of functional change by evaluating self-reported communicative success across form, modality, environment, and task demand.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24521044.

The role of manual gestures in second language comprehension: a simultaneous interpreting experiment

Manual gestures and speech form a single integrated system during native language comprehension. However, it remains unclear whether this hold for second language (L2) comprehension, more specifically for simultaneous interpreting (SI), which involves comprehension in one language and simultaneous production in another. In a combined mismatch and priming paradigm, we presented Swedish speakers fluent in L2 English with multimodal stimuli in which speech was congruent or incongruent with a gesture. A picture prime was displayed before the stimuli. Participants had to decide whether the video was related to the prime, focusing either on the auditory or the visual information. Participants performed the task either during passive viewing or during SI into their L1 Swedish (order counterbalanced). Incongruent stimuli yielded longer reaction times than congruent stimuli, during both viewing and interpreting. Visual and audio targets were processed equally easily in both activities. However, in both activities incongruent speech was more disruptive for gesture processing than incongruent gesture was for speech processing. Thus, the data only partly supports the expected mutual and obligatory interaction of gesture and speech in L2 comprehension. Interestingly, there were no differences between activities suggesting that the language comprehension component in SI shares features with other (L2) comprehension tasks.

Temporal Overlap Between Gestures and Speech in Poststroke Aphasia: Is There a Compensatory Effect?

PURPOSE

If language production is impaired, will gestures compensate? Evidence in favor of this prediction has often been argued to come from aphasia, but it remains contested. Here, we tested whether thought content not present in speech due to language impairment is manifested in gestures, in 20 people with dysfluent (Broca's) aphasia, 20 people with fluent (Wernicke's) aphasia, and 20 matched neurotypical controls.

METHOD

A new annotation scheme was created distinguishing types of gestures and whether they co-occurred with fluent or dysfluent/absent speech and were temporally aligned in content with coproduced speech.

RESULTS

Across both aphasia types, noncontent (beat) gestures, which by their nature cannot compensate for lost speech content, constituted the greatest proportion of all types of gestures produced. Content (i.e., descriptive, referential, and metaphorical) gestures were largely coproduced with fluent rather than dysfluent speech and tended to be aligned with the content conveyed in speech. They also did not differ in quantity depending on whether the dysfluencies were eventually resolved or not. Neither aphasia severity nor comprehension ability had an impact on the total amount of content gesture produced in people with aphasia, which was instead positively correlated with speech fluency.

CONCLUSIONS

Together, these results suggest that gestures are unlikely to have a role in compensating for linguistic deficits and to serve as a representational system conveying thought content independent of language. Surprisingly, aphasia rather is a model of how gesture and language are inherently integrated and aligned: Even when language is impaired, it remains the essential provider of content.

Exploring How People with Expressive Aphasia Interact with and Perceive a Social Robot

People with aphasia need high-intensive language training to significantly improve their language skills, however practical barriers arise. Socially assistive robots have been proposed as a possibility to provide additional language training. However, it is yet unknown how people with aphasia perceive interacting with a social robot, and which factors influence this interaction. The aim of this study was to gain insight in how people with mild to moderate chronic expressive aphasia perceived interacting with the social robot NAO, and to explore what needs and requisites emerged. A total of 11 participants took part in a single online semi-structured interaction, which was analysed using observational analysis, thematic analysis, and post-interaction questionnaire. The findings show that participants overall felt positive towards using the social robot NAO. Moreover, they perceived NAO as enjoyable, useful, and to a lesser extent easy to use. This exploratory study provides a tentative direction for the intention of people with mild to moderate chronic expressive aphasia to use social robots. Design implications and directions for future research are proposed.

Semantic Versus Orthographic Preferences in Aphasia: Behavioral Evidence

In this study, we compared the orthographic and semantic preferences of healthy adults and age and gender matched adults with aphasia, an acquired language disorder. Previous research in word retrieval and word associations has addressed semantic and phonological connections, but it has not as often included analyses of orthographic skills. We matched (on age and gender) 10 neurotypical adults and 11 older adults with aphasia and administered to both groups a lexical discrimination task requiring them to select, from 18 choices, those words that were most different from three words (daughter, laughter, son). Among the choices were foil words (e.g., daughter), orthographic similarities (laughter) and semantic similarities (son). Results revealed that individuals with aphasia focused on orthographic differences, while healthy adults chose semantic differences. Further studies should further explore this orthographic focus to develop treatment strategies, using behavioral and objective measures, for word-finding deficits in aphasia.

What is Functional Communication? A Theoretical Framework for Real-World Communication Applied to Aphasia Rehabilitation

Aphasia is an impairment of language caused by acquired brain damage such as stroke or traumatic brain injury, that affects a person’s ability to communicate effectively. The aim of rehabilitation in aphasia is to improve everyday communication, improving an individual’s ability to function in their day-to-day life. For that reason, a thorough understanding of naturalistic communication and its underlying mechanisms is imperative. The field of aphasiology currently lacks an agreed, comprehensive, theoretically founded definition of communication. Instead, multiple disparate interpretations of functional communication are used. We argue that this makes it nearly impossible to validly and reliably assess a person’s communicative performance, to target this behaviour through therapy, and to measure improvements post-therapy. In this article we propose a structured, theoretical approach to defining the concept of functional communication. We argue for a view of communication as “situated language use”, borrowed from empirical psycholinguistic studies with non-brain damaged adults. This framework defines language use as: (1) interactive, (2) multimodal, and (3) contextual. Existing research on each component of the framework from non-brain damaged adults and people with aphasia is reviewed. The consequences of adopting this approach to assessment and therapy for aphasia rehabilitation are discussed. The aim of this article is to encourage a more systematic, comprehensive approach to the study and treatment of situated language use in aphasia.

Suggestions for Improving the Investigation of Gesture in Aphasia

Purpose When we speak, we gesture, and indeed, persons with aphasia gesture more frequently. The reason(s) for this is still being investigated, spurring an increase in the number of studies of gesture in persons with aphasia. As the number of studies increases, so too does the need for a shared set of best practices for gesture research in aphasia. After briefly reviewing the importance and use of gesture in persons with aphasia, this viewpoint puts forth methodological and design considerations when evaluating gesture in persons with aphasia. Method & Results We explore several different design and methodological considerations for gesture research specific to persons with aphasia, such as video angle specifications, data collection techniques, and analysis considerations. The goal of these suggestions is to develop transparent and reproducible methods for evaluating gesture in aphasia to build a solid foundation for continued work in this area. Conclusions We have proposed that it is critical to evaluate multimodal communication in a methodologically robust way to facilitate increased knowledge about the relationship of gesture to spoken language, cognition, and to other aspects of living with aphasia and recovery from aphasia. We conclude by postulating future directions for gesture research in aphasia.

The Effectiveness of Verbal-Gestural Treatment on Verb Naming in Acute Inpatient Rehabilitation

Purpose The purpose of this study was to investigate the effectiveness of verbal-gestural treatment on verb production in patients with acute aphasia. Method Treatment was delivered during inpatient stay to four participants using a single-subject design. Results All patients demonstrated improvements in verbal expression. Some patients' improvements generalized to untrained verbs and nouns. Conclusions This study indicates verbal-gestural treatment can be an effective treatment model for acute aphasia in a hospital environment. Concurrent deficits resulting from stroke may impact the success with verbal-gestural treatment at this acute phase of recovery.

Gesture, communication, and adult acquired hearing loss

Nonverbal communication, specifically hand and arm movements (commonly known as gesture), has long been recognized and explored as a significant element in human interaction as well as potential compensatory behavior for individuals with communication difficulties. The use of gesture as a compensatory communication method in expressive and receptive human communication disorders has been the subject of much investigation. Yet within the context of adult acquired hearing loss, gesture has received limited research attention and much remains unknown about patterns of nonverbal behaviors in conversations in which hearing loss is a factor. This paper presents key elements of the background of gesture studies and the theories of gesture function and production followed by a review of research focused on adults with hearing loss and the role of gesture and gaze in rehabilitation. The current examination of the visual resource of co-speech gesture in the context of everyday interactions involving adults with acquired hearing loss suggests the need for the development of an evidence base to effect enhancements and changes in the way in which rehabilitation services are conducted.

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.

The Production of Gesture and Speech by People With Aphasia: Influence of Communicative Constraints

Purpose People with aphasia (PWA) use different kinds of gesture spontaneously when they communicate. Although there is evidence that the nature of the communicative task influences the linguistic performance of PWA, so far little is known about the influence of the communicative task on the production of gestures by PWA. We aimed to investigate the influence of varying communicative constraints on the production of gesture and spoken expression by PWA in comparison to persons without language impairment. Method Twenty-six PWA with varying aphasia severities and 26 control participants (CP) without language impairment participated in the study. Spoken expression and gesture production were investigated in 2 different tasks: (a) spontaneous conversation about topics of daily living and (b) a cartoon narration task, that is, retellings of short cartoon clips. The frequencies of words and gestures as well as of different gesture types produced by the participants were analyzed and tested for potential effects of group and task. Results Main results for task effects revealed that PWA and CP used more iconic gestures and pantomimes in the cartoon narration task than in spontaneous conversation. Metaphoric gestures, deictic gestures, number gestures, and emblems were more frequently used in spontaneous conversation than in cartoon narrations by both participant groups. Group effects show that, in both tasks, PWA's gesture-to-word ratios were higher than those for the CP. Furthermore, PWA produced more interactive gestures than the CP in both tasks, as well as more number gestures and pantomimes in spontaneous conversation. Conclusions The current results suggest that PWA use gestures to compensate for their verbal limitations under varying communicative constraints. The properties of the communicative task influence the use of different gesture types in people with and without aphasia. Thus, the influence of communicative constraints needs to be considered when assessing PWA's multimodal communicative abilities.

Differential roles of gestures on spatial language in neurotypical elderly adults and individuals with focal brain injury

Gestures might serve communicative functions by supplementing spoken expressions or restorative functions by facilitating speech production. Also, speakers with speech deficits use gestures to compensate for their speech impairments. In this study, we examined gesture use in speakers with and without speech impairments and how spoken spatial expressions changed when gestures were restrained. Six patients with speech problems and with left frontal and/or temporal lesions and 20 neurotypical controls described motion events in 3 different conditions (spontaneous gesture, only speech, and only gesture). In addition to the group analyses, we ran case analyses. Results showed that patients used more gestures compared to controls. Gestures served both communicative and restorative functions for patients whereas controls only used gestures for communicative purposes. Case analyses revealed that there were differential patterns among patients. Overall, gesture production is multifunctional and gestures serve different functions for different populations as well as within a population.

Embodied Semantics in a Second Language: Critical Review and Clinical Implications

The role of the sensorimotor system in second language (L2) semantic processing as well as its clinical implications for bilingual patients has hitherto been neglected. We offer an overview of the issues at stake in this under-investigated field, presenting the theoretical and clinical relevance of studying L2 embodiment and reviewing the few studies on this topic. We highlight that (a) the sensorimotor network is involved in L2 processing, and that (b) in most studies, L2 is differently embodied than L1, reflected in a lower degree or in a different pattern of L2 embodiment. Importantly, we outline critical issues to be addressed in order to guide future research. We also delineate the subsequent steps needed to confirm or dismiss the value of language therapeutic approaches based on embodiment theories as a complement of speech and language therapies in adult bilinguals.

When Speech Stops, Gesture Stops: Evidence From Developmental and Crosslinguistic Comparisons

There is plenty of evidence that speech and gesture form a tightly integrated system, as reflected in parallelisms in language production, comprehension, and development (McNeill, 1992; Kendon, 2004). Yet, it is a common assumption that speakers use gestures to compensate for their expressive difficulties, a notion found in developmental studies of both first and second language acquisition, and in theoretical proposals concerning the gesture-speech relationship. If gestures are compensatory, they should mainly occur in disfluent stretches of speech. However, the evidence is sparse and conflicting. This study extends previous studies and tests the putative compensatory role of gestures by comparing the gestural behavior in fluent vs. disfluent stretches of narratives by competent speakers in two languages (Dutch and Italian), and by language learners (children and adult L2 learners). The results reveal that (1) in all groups speakers overwhelmingly produce gestures during fluent speech and only rarely during disfluencies. However, L2 learners are significantly more likely to gesture in disfluency than the other groups; (2) in all groups gestures during disfluencies tend to be holds; (3) in all groups the rare gestures completed in disfluencies have both referential and pragmatic functions. Overall, the data strongly suggest that when speech stops, so does gesture. The findings constitute an important challenge to both gesture and language acquisition theories assuming a mainly (lexical) compensatory role for (referential) gestures. Instead, the results provide strong support for the notion that speech and gestures form an integrated system.

The comprehensibility of pantomimes produced by people with aphasia

BACKGROUND

People with aphasia (PWA) use pantomime, gesture in absence of speech, differently from non-brain-damaged people (NBDP).

AIMS

To evaluate through an exploratory study the comprehensibility of PWA's pantomimes and to find out whether they can compensate for information PWA are unable to convey in speech.

METHODS & PROCEDURES

A total of 273 naïve observers participated in one of two judgement tasks: forced-choice and open-ended questions. These were used to determine the comprehensibility of pantomimes produced to depict objects by PWA as compared with NBDP. Furthermore, we compared the information conveyed in pantomime with the information in speech. We looked into factors influencing pantomime's comprehensibility: individual factors, manner of depiction and information needed to be depicted.

OUTCOME & RESULTS

Although comprehensibility scores for PWA's pantomimes were lower than for those produced by NBDP, all PWA were able to convey information in pantomime that they could not convey in speech. Comprehensibility of pantomimes was predicted by apraxia. The inability to use the right hand related to slightly lower comprehensibility scores. Objects for which individuals depicted its use were best understood.

CONCLUSION & IMPLICATIONS

Our findings highlight the potential benefit of pantomime for clinical practice. Pantomimes, even though sometimes impaired, can convey information that PWA cannot convey in speech. Clinical implications are discussed.

How Much Information Do People With Aphasia Convey via Gesture?

PURPOSE

People with aphasia (PWA) face significant challenges in verbally expressing their communicative intentions. Different types of gestures are produced spontaneously by PWA, and a potentially compensatory function of these gestures has been discussed. The current study aimed to investigate how much information PWA communicate through 3 types of gesture and the communicative effectiveness of such gestures.

METHOD

Listeners without language impairment rated the information content of short video clips taken from PWA in conversation. Listeners were asked to rate communication within a speech-only condition and a gesture + speech condition.

RESULTS

The results revealed that the participants' interpretations of the communicative intentions expressed in the clips of PWA were significantly more accurate in the gesture + speech condition for all tested gesture types.

CONCLUSION

It was concluded that all 3 gesture types under investigation contributed to the expression of semantic meaning communicated by PWA. Gestures are an important communicative means for PWA and should be regarded as such by their interlocutors. Gestures have been shown to enhance listeners' interpretation of PWA's overall communication.

Communicative effectiveness of pantomime gesture in people with aphasia

BACKGROUND

Human communication occurs through both verbal and visual/motoric modalities. Simultaneous conversational speech and gesture occurs across all cultures and age groups. When verbal communication is compromised, more of the communicative load can be transferred to the gesture modality. Although people with aphasia produce meaning-laden gestures, the communicative value of these has not been adequately investigated.

AIMS

To investigate the communicative effectiveness of pantomime gesture produced spontaneously by individuals with aphasia during conversational discourse.

METHODS & PROCEDURES

Sixty-seven undergraduate students wrote down the messages conveyed by 11 people with aphasia that produced pantomime while engaged in conversational discourse. Students were presented with a speech-only, a gesture-only and a combined speech and gesture condition and guessed messages in both a free description and a multiple-choice task.

OUTCOMES & RESULTS

As hypothesized, listener comprehension was more accurate in the combined pantomime gesture and speech condition as compared with the gesture- or speech-only conditions. Participants achieved greater accuracy in the multiple-choice task as compared with the free-description task, but only in the gesture-only condition. The communicative effectiveness of the pantomime gestures increased as the fluency of the participants with aphasia decreased.

CONCLUSIONS & IMPLICATIONS

These results indicate that when pantomime gesture was presented with aphasic speech, the combination had strong communicative effectiveness. Future studies could investigate how pantomimes can be integrated into interventions for people with aphasia, particularly emphasizing elicitation of pantomimes in as natural a context as possible and highlighting the opportunity for efficient message repair.

Pantomime Production by People With Aphasia: What Are Influencing Factors?

PURPOSE

The present article aimed to inform clinical practice on whether people with aphasia (PWA) deploy pantomime techniques similarly to participants without brain damage (PWBD) and if not, what factors influence these differences.

METHOD

We compared 38 PWA to 20 PWBD in their use of 6 representation techniques (handling, enact, object, shape, deictic, and other) when pantomiming objects, and determined whether PWA used the same defaults as PWBD. We assessed the influence of (non-)dominant arm use, ideomotor apraxia, semantic processing, aphasia severity, and oral naming.

RESULTS

PWA used various pantomime techniques. Enact, deictic, and other were used infrequently. No differences were found for the use of shape techniques, but PWA used fewer handling and object techniques than PWBD and they did not use these for the same objects as PWBD did. No influence was found for (non-)dominant arm use. All other variables correlated with the use of handling, object, and defaults.

CONCLUSION

In our study, PWA were able to use various pantomime techniques. As a group, they used these techniques differently from PWBD and relied more heavily on the use of shape techniques. This was not influenced by a hemiparesis, but seemed dependent on semantic processing. Clinical implications are discussed.

Group therapy as a social context for aphasia recovery: a pilot, observational study in an acute rehabilitation hospital

BACKGROUND

Individuals with aphasia often receive therapy from a speech-language pathologist during acute rehabilitation. The literature demonstrates that group-based therapy provides a natural, social environment for language rehabilitation in mild-moderate and/or chronic aphasia; however, the communication of persons with acute, severe non-fluent aphasia during group treatment has not been fully explored.

OBJECTIVE

This observational study investigated patient communication during acute rehabilitation. The primary objective was to determine whether participants initiate more communication during group therapy sessions when compared to individual therapy sessions.

METHOD

Ten participants with severe non-fluent aphasia were observed during one individual and one group session during their stay in an acute, inpatient rehabilitation facility. Communicative initiations were tallied and categorized based on type, target, and purpose.

RESULTS

Participants initiated communication more often during group sessions than during individual sessions. During groups, participants used more vocalizations and facial expressions to communicate, and the purpose was more often for social closeness than in individual sessions. Participants produced fewer different, real words in group vs. individual sessions, but other measures of communication skill did not differ significantly between the two settings.

CONCLUSION

In the aphasia group treatment described in this study, participants initiated more communication, with greater diversity of expressive modalities and more varied communicative purposes. Participants in group therapy also showed an increased tendency to communicate for the purpose of social closeness. These findings suggest that there are important differences in the communication of patients participating in group vs. individual speech therapy for treatment of acute, severe non-fluent aphasia.

Comprehension of Co-Speech Gestures in Aphasic Patients: An Eye Movement Study

BACKGROUND

Co-speech gestures are omnipresent and a crucial element of human interaction by facilitating language comprehension. However, it is unclear whether gestures also support language comprehension in aphasic patients. Using visual exploration behavior analysis, the present study aimed to investigate the influence of congruence between speech and co-speech gestures on comprehension in terms of accuracy in a decision task.

METHOD

Twenty aphasic patients and 30 healthy controls watched videos in which speech was either combined with meaningless (baseline condition), congruent, or incongruent gestures. Comprehension was assessed with a decision task, while remote eye-tracking allowed analysis of visual exploration.

RESULTS

In aphasic patients, the incongruent condition resulted in a significant decrease of accuracy, while the congruent condition led to a significant increase in accuracy compared to baseline accuracy. In the control group, the incongruent condition resulted in a decrease in accuracy, while the congruent condition did not significantly increase the accuracy. Visual exploration analysis showed that patients fixated significantly less on the face and tended to fixate more on the gesturing hands compared to controls.

CONCLUSION

Co-speech gestures play an important role for aphasic patients as they modulate comprehension. Incongruent gestures evoke significant interference and deteriorate patients' comprehension. In contrast, congruent gestures enhance comprehension in aphasic patients, which might be valuable for clinical and therapeutic purposes.

Co-verbal gestures among speakers with aphasia: Influence of aphasia severity, linguistic and semantic skills, and hemiplegia on gesture employment in oral discourse

The use of co-verbal gestures is common in human communication and has been reported to assist word retrieval and to facilitate verbal interactions. This study systematically investigated the impact of aphasia severity, integrity of semantic processing, and hemiplegia on the use of co-verbal gestures, with reference to gesture forms and functions, by 131 normal speakers, 48 individuals with aphasia and their controls. All participants were native Cantonese speakers. It was found that the severity of aphasia and verbal-semantic impairment was associated with significantly more co-verbal gestures. However, there was no relationship between right-sided hemiplegia and gesture employment. Moreover, significantly more gestures were employed by the speakers with aphasia, but about 10% of them did not gesture. Among those who used gestures, content-carrying gestures, including iconic, metaphoric, deictic gestures, and emblems, served the function of enhancing language content and providing information additional to the language content. As for the non-content carrying gestures, beats were used primarily for reinforcing speech prosody or guiding speech flow, while non-identifiable gestures were associated with assisting lexical retrieval or with no specific functions. The above findings would enhance our understanding of the use of various forms of co-verbal gestures in aphasic discourse production and their functions. Speech-language pathologists may also refer to the current annotation system and the results to guide clinical evaluation and remediation of gestures in aphasia.

LEARNING OUTCOMES

None.

The relationship of aphasia type and gesture production in people with aphasia

PURPOSE

For many individuals with aphasia, gestures form a vital component of message transfer and are the target of speech-language pathology intervention. What remains unclear are the participant variables that predict successful outcomes from gesture treatments. The authors examined the gesture production of a large number of individuals with aphasia-in a consistent discourse sampling condition and with a detailed gesture coding system-to determine patterns of gesture production associated with specific types of aphasia.

METHOD

The authors analyzed story retell samples from AphasiaBank (TalkBank, n.d.), gathered from 98 individuals with aphasia resulting from stroke and 64 typical controls. Twelve gesture types were coded. Descriptive statistics were used to describe the patterns of gesture production. Possible significant differences in production patterns according to aphasia type were examined using a series of chi-square, Fisher exact, and logistic regression statistics.

RESULTS

A significantly higher proportion of individuals with aphasia gestured as compared to typical controls, and for many individuals with aphasia, this gesture was iconic and was capable of communicative load. Aphasia type impacted significantly on gesture type in specific identified patterns, detailed here.

CONCLUSION

These type-specific patterns suggest the opportunity for gestures as targets of aphasia therapy.

Iconic gesture in normal language and word searching conditions: a case of conduction aphasia

Although there is a substantive body of research about the language used by individuals with aphasia, relatively little is known about their spontaneous iconic gesture. A single case study of LT, an individual with conduction aphasia indicated qualitative differences between the spontaneous iconic gestures produced alongside fluent speech and in tip of the tongue states. The current study examined the iconic gestures produced by another individual with conduction aphasia, WT, and a group of 11 control participants. Comparisons were made between iconic gestures produced alongside normal language and those produced alongside word-searching behaviour. Participants recounted the Tweety and Sylvester cartoon Canary Row. All gesture produced was analysed qualitatively and quantitatively. WT produced more iconic gestures than controls accompanying word searching behaviour, whereas he produced a similar frequency of iconic gestures to control participants alongside normal language. The iconic gestures produced in the two language contexts also differed qualitatively. Frequency of iconic gesture production was not affected by limb apraxia. This study suggests that there are differences between iconic gestures that are produced alongside normal language and those produced alongside word-searching behaviour. Theoretical and clinical implications of these findings are discussed.

Lexical learning in mild aphasia: gesture benefit depends on patholinguistic profile and lesion pattern

Gestures accompany speech and enrich human communication. When aphasia interferes with verbal abilities, gestures become even more relevant, compensating for and/or facilitating verbal communication. However, small-scale clinical studies yielded diverging results with regard to a therapeutic gesture benefit for lexical retrieval. Based on recent functional neuroimaging results, delineating a speech-gesture integration network for lexical learning in healthy adults, we hypothesized that the commonly observed variability may stem from differential patholinguistic profiles in turn depending on lesion pattern. Therefore we used a controlled novel word learning paradigm to probe the impact of gestures on lexical learning, in the lesioned language network. Fourteen patients with chronic left hemispheric lesions and mild residual aphasia learned 30 novel words for manipulable objects over four days. Half of the words were trained with gestures while the other half were trained purely verbally. For the gesture condition, rootwords were visually presented (e.g., Klavier, [piano]), followed by videos of the corresponding gestures and the auditory presentation of the novel words (e.g., /krulo/). Participants had to repeat pseudowords and simultaneously reproduce gestures. In the verbal condition no gesture-video was shown and participants only repeated pseudowords orally. Correlational analyses confirmed that gesture benefit depends on the patholinguistic profile: lesser lexico-semantic impairment correlated with better gesture-enhanced learning. Conversely largely preserved segmental-phonological capabilities correlated with better purely verbal learning. Moreover, structural MRI-analysis disclosed differential lesion patterns, most interestingly suggesting that integrity of the left anterior temporal pole predicted gesture benefit. Thus largely preserved semantic capabilities and relative integrity of a semantic integration network are prerequisites for successful use of the multimodal learning strategy, in which gestures may cause a deeper semantic rooting of the novel word-form. The results tap into theoretical accounts of gestures in lexical learning and suggest an explanation for the diverging effect in therapeutical studies advocating gestures in aphasia rehabilitation.

Gesturing by speakers with aphasia: how does it compare?

PURPOSE

To study the independence of gesture and verbal language production. The authors assessed whether gesture can be semantically compensatory in cases of verbal language impairment and whether speakers with aphasia and control participants use similar depiction techniques in gesture.

METHOD

The informativeness of gesture was assessed in 3 forced-choice studies, in which raters assessed the topic of the speaker's message in video clips of 13 speakers with moderate aphasia and 12 speakers with severe aphasia, who were performing a communication test (the Scenario Test). Both groups were compared and contrasted with 17 control participants, who either were or were not allowed to communicate verbally. In addition, the representation techniques used in gesture were analyzed.

RESULTS

Gestures produced by speakers with more severe aphasia were less informative than those by speakers with moderate aphasia, yet they were not necessarily uninformative. Speakers with more severe aphasia also tended to use fewer representation techniques (mostly relying on outlining gestures) in co-speech gesture than control participants, who were asked to use gesture instead of speech. It is important to note that limb apraxia may be a mediating factor here.

CONCLUSIONS

These results suggest that in aphasia, gesture tends to degrade with verbal language. This may imply that the processes underlying verbal language and co-speech gesture production, although partly separate, are closely linked.

Releasing the constraints on aphasia therapy: the positive impact of gesture and multimodality treatments

PURPOSE

There is a 40-year history of interest in the use of arm and hand gestures in treatments that target the reduction of aphasic linguistic impairment and compensatory methods of communication (Rose, 2006). Arguments for constraining aphasia treatment to the verbal modality have arisen from proponents of constraint-induced aphasia therapy (Pulvermüller et al., 2001). Confusion exists concerning the role of nonverbal treatments in treating people with aphasia. The central argument of this paper is that given the state of the empirical evidence and the strong theoretical accounts of modality interactions in human communication, gesture-based and multimodality aphasia treatments are at least as legitimate an option as constraint-based aphasia treatment.

METHOD

Theoretical accounts of modality interactions in human communication and the gesture production abilities of individuals with aphasia that are harnessed in treatments are reviewed. The negative effects on word retrieval of restricting gesture production are also reviewed, and an overview of the neurological architecture subserving language processing is provided as rationale for multimodality treatments. The evidence for constrained and unconstrained treatments is critically reviewed.

CONCLUSION

Together, these data suggest that constraint treatments and multimodality treatments are equally efficacious, and there is limited support for constraining client responses to the spoken modality.

Coverbal gestures in the recovery from severe fluent aphasia: a pilot study

This post hoc study investigated coverbal gesture patterns in two persons with chronic Wernicke's aphasia. They had both received therapy focusing on multimodal communication therapy, and their pre- and post-therapy verbal and gestural skills in face-to-face conversational interaction with their speech therapist were analysed by administering a partial barrier Referential Communication Task (RCT). The RCT sessions were reviewed in order to analyse: (a) participant coverbal gesture occurrence and types when in speaker role, (b) distribution of iconic gestures in the RCT communicative moves, (c) recognisable semantic content, and (d) the ways in which gestures were combined with empty or paraphasic speech. At post-therapy assessment only one participant showed improved communication skills in spite of his persistent language deficits. The improvement corresponded to changes on all gesturing measures, suggesting thereby that his communication relied more on gestural information. No measurable changes were observed for the non-responding participant-a finding indicating that the coverbal gesture measures used in this study might account for the different outcomes. These results point to the potential role of gestures in treatment aimed at fostering recovery from severe fluent aphasia. Moreover, this pattern of improvement runs contrary to a view of gestures used as a pure substitute for lexical items, in the communication of people with severe fluent aphasia.

LEARNING OUTCOMES

The readers will describe how to assess and interpret the patterns of coverbal gesturing in persons with fluent aphasia. They will also recognize the potential role of coverbal gestures in recovery from severe fluent aphasia.

Learning by doing? The effect of gestures on implicit retrieval of newly acquired words

Meaningful gestures enhance speech comprehensibility. However, their role during novel-word acquisition remains elusive. Here we investigate how meaningful versus meaningless gestures impact on novel-word learning and contrast these conditions to a purely verbal training. After training, neuronal processing of the novel words was assessed by blood-oxygen-level-dependent functional magnetic resonance imaging (BOLD-fMRI), disclosing that networks affording retrieval differ depending on the training condition. Over 3 days participants learned pseudowords for common objects (e.g., /klira/ -cap). For training they repeated the novel word while performing (i) an iconic, (ii) a grooming or (iii) no gesture. For the two conditions involving gestures, these were either actively repeated or passively observed during training. Behaviorally no substantial differences between the five different training conditions were found while fMRI disclosed differential networks affording implicit retrieval of the learned pseudowords depending on the training procedure. Most notably training with actively performed iconic gestures yielded larger activation in a semantic network comprising left inferior frontal (BA47) and inferior temporal gyri. Additionally hippocampal activation was stronger for all trained compared to unknown pseudowords of identical structure. The behavioral results challenge the generality of an 'enactment-effect' for single word learning. Imaging results, however, suggest that actively performed meaningful gestures lead to a deeper semantic encoding of novel words. The findings are discussed regarding their implications for theoretical accounts and for empirical approaches of gesture-based strategies in language (re)learning.

Gesture and naming therapy for people with severe aphasia: a group study

PURPOSE

In this study, the authors (a) investigated whether a group of people with severe aphasia could learn a vocabulary of pantomime gestures through therapy and (b) compared their learning of gestures with their learning of words. The authors also examined whether gesture therapy cued word production and whether naming therapy cued gestures.

METHOD

Fourteen people with severe aphasia received 15 hr of gesture and naming treatments. Evaluations comprised repeated measures of gesture and word production, comparing treated and untreated items.

RESULTS

Baseline measures were stable but improved significantly following therapy. Across the group, improvements in naming were greater than improvements in gesture. This trend was evident in most individuals' results, although 3 participants made better progress in gesture. Gains were item specific, and there was no evidence of cross-modality cueing. Items that received gesture therapy did not improve in naming, and items that received naming therapy did not improve in gesture.

CONCLUSIONS

Results show that people with severe aphasia can respond to gesture and naming therapies. Given the unequal gains, naming may be a more productive therapy target than gesture for many (although not all) individuals with severe aphasia. The communicative benefits of therapy were not examined but are addressed in a follow-up article.

A comparison of intention and pantomime gesture treatment for noun retrieval in people with aphasia

PURPOSE

The effects of intention gesture treatment (IGT) and pantomime gesture treatment (PGT) on word retrieval were compared in people with aphasia.

METHOD

Four individuals with aphasia and word retrieval impairments subsequent to left-hemisphere stroke participated in a single-participant crossover treatment design. Each participant viewed target nouns on a computer screen in 2 counterbalanced training phases. Training included paired verbal + gesture treatment strategies to elicit verbal and/or gestural productions of target nouns. Treatment effects were measured using daily picture-naming probes for verbal naming and gesture productions for trained and untrained words as well as pre-/posttreatment standardized aphasia tests. Outcomes and Results IGT resulted in immediate effects on the verbal productions of 2 participants but lacked carryover to untrained words. PGT resulted in improved verbal production for 2 participants and immediate effects on the gesture productions of 3 participants, with carryover of gesture production to untrained words in 1 participant. Improvements on standardized aphasia tests were evident in 2 participants.

CONCLUSION

IGT and PGT had positive treatment effects, but for contrasting communication modalities. Two individuals with mild-moderate aphasia improved verbal production with both IGT and PGT, and 2 individuals with severe aphasia improved gesture use with PGT.

Contrasting effects of errorless naming treatment and gestural facilitation for word retrieval in aphasia

We compared the effects of two treatments for aphasic word retrieval impairments, errorless naming treatment (ENT) and gestural facilitation of naming (GES), within the same individuals, anticipating that the use of gesture would enhance the effect of treatment over errorless treatment alone. In addition to picture naming, we evaluated results for other outcome measures that were largely untested in earlier ENT studies. In a single participant crossover treatment design, we examined the effects of ENT and GES in eight individuals with stroke-induced aphasia and word retrieval impairments (three semantic anomia, five phonological anomia) in counterbalanced phases across participants. We evaluated effects of the two treatments for a daily picture naming/gesture production probe measure and in standardised aphasia tests and communication rating scales administered across phases of the experiment. Both treatments led to improvements in naming of trained words (small-to-large effect sizes) in individuals with semantic and phonological anomia. Small generalised naming improvements were noted for three individuals with phonological anomia. GES improved use of corresponding gestures for trained words (large effect sizes). Results were largely maintained at one month post-treatment completion. Increases in scores on standardised aphasia testing also occurred for both ENT and GES training. Both ENT and GES led to improvements in naming measures, with no clear difference between treatments. Increased use of gestures following GES provided a potential compensatory means of communication for those who did not improve verbal skills. Both treatments are considered to be effective methods to promote recovery of word retrieval and verbal production skills in individuals with aphasia.

Proximal and distal. Rethinking linguistic form and use for clinical purposes

With clinical purposes in mind, a review of the proximal/distal opposition is carried out in order to define a universal parameter of variability in semiotic procedures. By taking into consideration different-although notionally inter-related-senses of the proximal/distal opposition, a cluster of semiotic properties is proposed, which initially permits one to characterize dimensions of variability in the form and use of gestures. The subsequent and central aim of this paper is, however, to demonstrate that the same, or homologous, properties can also serve to characterize variability in the use of language, by assuming a basic connection between gesturing and linguistic behaviour. The main focus of interest and the starting point for reflections are communicative impairments as manifested in apraxia and aphasia.

Gesture and aphasia: Helping hands?

BACKGROUND: The study of communicative gestures is one of considerable interest for aphasia, in relation to theory, diagnosis, and treatment. Significant limitations currently permeate the general (psycho)linguistic literature on gesture production, and attention to these limitations is essential for both continued investigation and clinical application of gesture for people with aphasia. AIMS: The aims of this paper are to discuss issues imperative to advancing the gesture production literature and to provide specific suggestions for applying the material herein to studies in gesture production for people with aphasia. MAIN CONTRIBUTION: Two primary perspectives in the gesture production literature are distinct in their proposals about the function of gesture, and about where gesture arises in the communication stream. These two perspectives will be discussed, along with three elements considered to be prerequisites for advancing the research on gesture production. These include: operational definitions, coding systems, and the temporal synchrony characteristics of gesture. CONCLUSIONS: Addressing the specific elements discussed in this paper will provide essential information for both continued investigation and clinical application of gesture for people with aphasia.