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

Gesture's Role in the Communication of Adults With Different Types of Aphasia

PURPOSE

Adults with aphasia gesture more than adults without aphasia. However, less is known about the role of gesture in different discourse contexts for individuals with different types of aphasia. In this study, we asked whether patterns of speech and gesture production of individuals with aphasia vary by aphasia and discourse type and also differ from the speech and gestures produced by adults without aphasia.

METHOD

We compared the amount, diversity, and complexity of speech and gesture production in adults with anomic or Broca's aphasia and adults with no aphasia (n = 20/group) in their first- versus third-person narratives.

RESULTS

Adults with Broca's aphasia showed the lowest performance in their amount, diversity, and complexity of speech production, followed by adults with anomic aphasia and adults without aphasia. This pattern was reversed for gesture production. Speech and gesture production also varied by discourse context. Adults with either type of aphasia used a lower amount of and less diverse speech in third-person than in first-person narratives; this pattern was also reversed for gesture production.

CONCLUSIONS

Overall, our results provide evidence for a compensatory role of gesture in aphasia communication. Adults with Broca's aphasia, who showed the greatest speech production difficulties, also relied most on gesture, and this pattern was particularly pronounced in the third-person narrative context.

A scoping review of transcription-less practices for analysis of aphasic discourse and implications for future research

BACKGROUND

It is important to capture a comprehensive language profile from speakers with aphasia. One way to do this is to evaluate spoken discourse, which is language beyond a single simple clause used for a specific purpose. While the historical trend in aphasiology has been to capture performance during isolated language tasks, such as confrontation naming, there is a demonstrated need and benefit to collecting language information from tasks that resemble everyday communication. As a result, there has been an increase in discourse analysis research over time. However, despite clinicians' and researchers' desire to analyse spoken discourse, they are faced with critical barriers that inhibit implementation.

AIMS

To use scoping review methodology to identify transcription-less tools developed to analyse discourse from individuals with aphasia. The review addressed the following question: 'What transcription-less tools and analysis procedures are available to assess discourse in people with aphasia?' and included several sub-questions to further characterise the type of discourse and tool being used, participants on whom the tool was used to rate discourse abilities, tool users (raters), and psychometric properties.

METHODS

The scoping review was conducted between the months of October 2022 and January 2023, concluding 30 January 2023, on PubMed/NCBI, Academic Search Complete and Linguistics and Language Behavior Abstracts. Major inclusion parameters included peer-reviewed papers written in English; that the tool was used to analyse discourse elicited by individuals with acquired aphasia; and that the tool was not a part of a standardised battery or assessment. Perceptual discourse analysis was defined as any analysis which primarily relied on listener impressions and did not numerically quantify specific language behaviours. 'Transcription-less' analysis was defined as any discourse analysis which did not require a written record of the discourse sample in order to be completed. A total of 396 abstracts were screened and 39 full articles were reviewed, yielding 21 papers that were included in the review.

MAIN CONTRIBUTION

An overview of the state of transcription-less tools for aphasic discourse analysis is provided, and next steps are identified to facilitate increased implementation of discourse analysis in clinical and research settings.

CONCLUSION

Transcription-less tools have many benefits for analysing multiple levels (e.g., linguistic, propositional, macrostructural, pragmatic) of discourse, but require more research to establish sound psychometric properties and to explore the implementation of these tools in clinical settings.

WHAT THIS PAPER ADDS

What is already known on this subject Individuals with aphasia prioritise treatment outcomes at the discourse level such as being able to engage in conversations with friends and family about important topics and participating in social and leisure activities. However, discourse is rarely used as a treatment outcome measure in clinical practice due to multiple barriers. When speech-language pathologists do assess discourse, they often make perceptual judgements without transcribing the discourse sample. Transcription-less analysis procedures may improve clinical implementation of discourse assessment, which would better match treatment outcome measurement to clients' desired outcomes. However, little is known about the current state of transcription-less discourse analysis, blocking progress. What this paper adds to existing knowledge This study provides an overview of currently available transcription-less discourse analysis procedures that are not part of published standardised aphasia assessments. Transcription-less measures are available to evaluate discourse at all levels (i.e., lexical, propositional, macro-structural/planning, and pragmatic) and most measures include items that assess discourse abilities across multiple levels. Additionally, there are transcription-less measures available for both structured (e.g., picture scene description) and spontaneous (e.g., conversation) discourse tasks. However, current transcription-less procedures are lacking psychometric data including information about validity and reliability. What are the potential or actual clinical implications of this work? Transcription-less analysis methods may provide an avenue for increased implementation of discourse measurement into clinical practice. Further research is needed to determine the clinical utility of transcription-less discourse analysis to better monitor clients' desired treatment outcomes.

Task-Specific Iconic Gesturing During Spoken Discourse in Aphasia

PURPOSE

In persons living with aphasia, we will explore the relationship between iconic gesture production during spontaneous speech and discourse task, spoken language, and demographic information.

METHOD

Employing the AphasiaBank database, we coded iconic gestures in 75 speakers with aphasia during two spoken discourse tasks: a procedural narrative, which involved participants telling the experimenter how to make a sandwich ("Sandwich"), and a picture sequence narrative, which had participants describe the picture sequence to the experimenter ("Window"). Forty-three produced a gesture during both tasks, and we further evaluate data from this subgroup as a more direct comparison between tasks.

RESULTS

More iconic gestures, at a higher rate, were produced during the procedural narrative. For both tasks, there was a relationship between iconic gesture rate, modeled as iconic gestures per word, and metrics of language dysfluency extracted from the discourse task as well as a metric of fluency extracted from a standardized battery. Iconic gesture production was correlated with aphasia duration, which was driven by performance during only a single task (Window), but not with other demographic metrics, such as aphasia severity or age. We also provide preliminary evidence for task differences shown through the lens of two types of iconic gestures.

CONCLUSIONS

While speech-language pathologists have utilized gesture in therapy for poststroke aphasia, due to its possible facilitatory role in spoken language, there has been considerably less work in understanding how gesture differs across naturalistic tasks and how we can best utilize this information to better assess gesture in aphasia and improve multimodal treatment for aphasia. Furthermore, our results contribute to gesture theory, particularly, about the role of gesture across naturalistic tasks and its relationship with spoken language. Supplemental Material https://doi.org/10.23641/asha.14614941.

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 City Gesture Checklist: The development of a novel gesture assessment

BACKGROUND

People with aphasia rely on gesture more than healthy controls to get their message across, but use a limited range of gesture types. Gesture therapy is thus a potential avenue of intervention for people with aphasia. However, currently no gesture assessment evaluates how they use gesture. Such a tool could inform therapy targets and measure outcomes. In gesture research, many different coding categories are used to describe gesture forms and functions. These coding methods are prohibitively time-consuming to use in clinical practice. There is therefore a need for a 'quick and dirty' method of assessing gesture use.

AIMS

To investigate current practice among UK-based clinicians (speech and language therapists) in relation to gesture assessment and therapy, to synthesize gesture-coding frameworks used in aphasia research, to develop a gesture checklist based on the synthesized coding frameworks suitable for use in clinical practice, and to investigate the interrater reliability (IRR) of the checklist among experienced and unfamiliar users.

METHODS & PROCEDURES

The research team synthesized seven gesture-coding frameworks and trialled three resulting prototype checklists at a co-design workshop with 20 clinicians. Attending clinicians were also consulted about their current clinical gesture practice using a questionnaire. A final City Gesture Checklist (CGC) was developed based upon outcomes and feedback from the workshop. The IRR of the CGC was evaluated between the research team and 11 further clinicians within a second workshop. Both groups used the CGC to count gestures in video clips of people with aphasia talking to a conversation partner.

MAIN CONTRIBUTION

A total of 18 workshop attendees completed the current practice questionnaire. Of these, 10 reported assessing gesture informally and five also used formal assessment. Gesture-coding synthesis highlighted six main categories of gesture form. Clinicians at the co-design workshop provided feedback on prototype checklists regarding the relevance and usability of the gesture categories, layout, use of images and instructions. A final version of the CGC was created incorporating their recommendations. The IRR for the CGC was moderate between both the researchers and clinicians.

CONCLUSIONS & IMPLICATIONS

The CGC can be used to assess the types of gesture that people with aphasia produce. The IRR was moderate amongst both experienced users and new users who had received no training. Future research directions include investigating how to improve IRR, evaluating intra-rater reliability and sensitivity to change, and exploring use of the CGC in clinical practice. What this paper adds What is already known on the subject People with aphasia rely on gesture more than healthy speakers, yet use a more limited range of gesture types. Gesture therapy is used by clinicians with the aim of helping people with aphasia to compensate for their language impairment and/or to facilitate speech. What this paper adds to existing knowledge This study explores current gesture assessment practice among UK-based clinicians and synthesizes the coding categories used in the literature about gesture research in aphasia. It describes the development of a novel outcome measure, the CGC, and preliminary testing of its IRR. What are the potential or actual clinical implications of this work? This 'quick and dirty' tool enables clinicians to analyse and record the types of gesture produced by people with aphasia without the need for gesture coding. Preliminary findings suggest that clinicians can use it with a fair degree of reliability by following the checklist's written instructions.

The relationship between co-speech gesture production and macrolinguistic discourse abilities in people with focal brain injury

Brain damage is associated with linguistic deficits and might alter co-speech gesture production. Gesture production after focal brain injury has been mainly investigated with respect to intrasentential rather than discourse-level linguistic processing. In this study, we examined 1) spontaneous gesture production patterns of people with left hemisphere damage (LHD) or right hemisphere damage (RHD) in a narrative setting, 2) the neural structures associated with deviations in spontaneous gesture production in these groups, and 3) the relationship between spontaneous gesture production and discourse level linguistic processes (narrative complexity and evaluation competence). Individuals with LHD or RHD (17 people in each group) and neurotypical controls (n = 13) narrated a story from a picture book. Results showed that increase in gesture production for LHD individuals was associated with less complex narratives and lesions of individuals who produced more gestures than neurotypical individuals overlapped in frontal-temporal structures and basal ganglia. Co-speech gesture production of RHD individuals positively correlated with their evaluation competence in narrative. Lesions of RHD individuals who produced more gestures overlapped in the superior temporal gyrus and the inferior parietal lobule. Overall, LHD individuals produced more gestures than neurotypical individuals. The groups did not differ in their use of different gesture forms except that LHD individuals produced more deictic gestures per utterance than RHD individuals and controls. Our findings are consistent with the hypothesis that co-speech gesture production interacts with macro-linguistic levels of discourse and this interaction is affected by the hemispheric lateralization of discourse abilities.

Language and iconic gesture use in procedural discourse by speakers with aphasia

Background: Conveying instructions is an everyday use of language, and gestures are likely to be a key feature of this. Although co-speech iconic gestures are tightly integrated with language, and people with aphasia (PWA) produce procedural discourses impaired at a linguistic level, no previous studies have investigated how PWA use co-speech iconic gestures in these contexts. Aims: This study investigated how PWA communicated meaning using gesture and language in procedural discourses, compared with neurologically healthy people (NHP). We aimed to identify the relative relationship of gesture and speech, in the context of impaired language, both overall and in individual events. Methods & Procedures: Twenty-nine PWA and 29 NHP produced two procedural discourses. The structure and semantic content of language of the whole discourses were analysed through predicate argument structure and spatial motor terms, and gestures were analysed for frequency and semantic form. Gesture and language were analysed in two key events, to determine the relative information presented in each modality. Outcomes & Results: PWA and NHP used similar frequencies and forms of gestures, although PWA used syntactically simpler language and fewer spatial words. This meant, overall, relatively more information was present in PWA gesture. This finding was also reflected in the key events, where PWA used gestures conveying rich semantic information alongside semantically impoverished language more often than NHP. Conclusions: PWA gestures, containing semantic information omitted from the concurrent speech, may help listeners with meaning when language is impaired. This finding indicates gesture should be included in clinical assessments of meaning-making.