Enhancing Communication in Aphasia through Gesture Jane Marshall

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Enhancing Communication in Aphasia through
GestureJane Marshall
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Overview

• What is Gesture?
• Why do we do it?
• The communicative hypothesis
• The word retrieval hypothesis
• Uses of gesture in aphasia
• Uses of gesture in aphasia therapy
• Our Project

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What is Gesture?

• Gesticulation ? Pantomime ? Emblems ? Sign
  Language

Beats
Iconics
Metaphorics
Pointing
McNeill (2000)
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The Communication Hypothesis

• Gestures help us to get our message across
• When Speech cannot be heard
• In collaboration with speech
• Listeners integrate information from gestures and
  speech (Cocks et al 2010)
• Mismatches between gesture and speech impair
  communication (McNeill et al 1994)

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But

• People gesture when they cannot be seen, eg on
  the telephone
• Blind people gesture, even when speaking to each
  other
• (Iverson and Goldin-Meadow 1998)
• This suggests that gestures are produced for
  the speaker as well as the listener

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The Lexical Retrieval Hypothesis

• Gestures help us to access words
• More gesture seen in spontaneous than rehearsed
  speech (Chawla and Krauss 1994)
• Inhibiting gesture
• Raises failure rates in naming to definition
  tasks
• (Frick-Horbury and Guttentag 1998)
• Decreases TOT resolutions
• (Beattie and Coughlan 1999)

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Interim Summary and Implications for Aphasia

• Gestures have external (communicative) and
  internal (speaker) functions
• Gesture may play a useful role in aphasia therapy
• To assist communication
• To support word retrieval

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Is Gesture Available in Aphasia?
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Positive Evidence

• Individuals show
• Gesture gt naming (Marshall et al 2004)
• Spontaneous use
• In conversation (Wilkinson et al 2010)
• By people with severe aphasia (Goodwin 1995, Parr
  2007)
• Gestural facilitation of word finding in
  conversation (Lanyon and Rose 2009)

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Evidence of Gesture Impairment

• Severity of aphasia correlates with severity of
  gesture impairment
• Gesture impairments mirror speech impairments
• (Duffy et al 1975 Duffy and Duffy 1981 Duffy
  and Watkins 1984)

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Role of Co-Morbidity

• Limb Apraxia
• (Rothi and Heilman 1997, Wang and Goodglass 1992
  although see Lausberg et al 2000 for counter
  evidence)
• Executive Function
• (Purdy and Koch 2006)

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Interim Summary

• Many people with aphasia make productive use of
  gesture alongside or in place of speech
• But
• Gesture impairments are also evident. These may
  be due to a central symbolic disorder, apraxia,
  or executive problems

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Uses of Gesture in Aphasia Therapy
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Rose (2006)

• Review of Gesture in Aphasia Treatment
• 18 studies used gesture compensation
• All report positive outcomes
• Variable designs (often not experimental)

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Daumuller and Goldenberg 2010

• 35 people with severe aphasia
• 25 received gesture therapy
• 10 controls
• 3 hours therapy needed to train each gesture

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Does Gesture Therapy cue Speech?
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Rose (2006) Review

• 14 studies aimed to cue speech with gesture
• Variable outcomes
• Variable designs (not all experimental)
• All combined gesture with speech

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Enhancing Communication in Aphasia through
Gesture

• Based at City University and UCL
• Grant-holders Jane Marshall, Wendy Best,
  Madeleine Cruice, Naomi Cocks, Julie Hickin, Tim
  Pring
• Research Therapist Anna Caute
• Funded by Stroke Association

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Research questions

• Can people with severe aphasia learn gestures?
• Can people with severe aphasia learn words?
• How does learning of gestures compare with
  learning of words?
• Is there any cross modality generalisation? e.g.
  does gesture therapy cue speech?
• Can participants use acquired gestures /or words
  to convey messages and stories to other people?

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14 Participants

• Severe aphasia (lt20 on CAT spoken and written
  naming subtests)
• At least 6-months post-onset
• Regular conversation partner (friend/family/partne
  r)
• English-speaker before neurological injury
• Able to match objects to pictures/photos
• All show evidence of limb apraxia

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The Design
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• Assessment and Therapy Stimuli

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Stimuli

• 60 items
• 30 standard
• 30 personal

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30 standard items

• Examples

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30 personal items

• Chosen by person with aphasia and family member
• Stimuli mostly Google images, some digital
  camera
• Common themes
• Interests, health, food/drink, feelings,
  functional objects

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60 items

• Divided into 3 groups
• 20 for gesture therapy
• 20 naming therapy (speech or writing)
• 20 untreated

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• Assessment

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Tests

• At each assessment point
• Gesturing 60 items from pictures
• Naming 60 items from pictures
• Conveying 30 messages
• Conveying 3 video narratives

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Gesture and Naming Tests
What is this? Show me with your hands and face
Tell me the name of this
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Scoring gestures

• Videos shown to student raters
• 1st Raters guess blind
• 2nd Raters guess from choice of 4 options
  target, semantic distractor, gesture distractor,
  unrelated distractor (but related to gesture
  distractor)

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What do you think is being gestured?
Please write on your answer sheet
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Select condition A. Salt B.
Vinegar C. Money D. Wallet
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Message assessment

• Question Can participants use acquired gestures
  and words to convey messages to their partner?
• 2 messages for each item
• Questions, comments, commands, requests

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Messages- examples

• Lock the door!
• Would you like a beer?

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Message Administration

• Each message shown to the aphasic person (partner
  not present)
• Aphasic person attempts to convey message to
  partner.
• Partner writes down their understanding of the
  message
• 30 messages administered at each assessment point
  (10 from each group)

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Message task- scoring

• Scripts are shown to 2 raters, blind to time of
  assessment
• Raters compare partners script to target and
  rate each message out of 4 (against given
  criteria)

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Video narratives

• Question Can participants use acquired gestures
  and words to tell a story to their partner?

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Videos

• 3 silent videos shown at each assessment point
• Treated repeated
• Untreated repeated
• Untreated unrepeated

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Videos-administration

• Partner sits with back to screen
• Participant watches video, then tells partner
  about story
• Can use speech, writing, drawing, gesture
• Partner writes script
• Partner can ask questions to clarify

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Videos- scoring

• Partner scripts shown to 2 raters who are blind
  to time of assessment
• Raters compare with list of 10 main events
• Score each event out of 4 (against given
  criteria)

• E.g. Restaurant
• Reading menu
• Waitress takes order
• Chatting
• Drinking wine
• Eating food- disgusting
• Complaining to waiter
• Waiting for food
• New food arrives- ok, eating
• Paying bill
• Get up and leave

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• Therapy

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Therapy

• A
• 15 hours
• 1 hour x 2 per week
• Conversation partner not involved in therapy
• ½ naming, ½ gesture
• Single items

• B
• 15 hours
• 1 hour x 1 per week
• Conversation partner attends all sessions
• Messages, narratives, strategies, personal goals

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Therapy A

• Comprehension of gesture/word
• Production
• Barrier task
• One block (5 items) per session, unless all tasks
  completed

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Therapy A- cues for production

• Gesture
• Verbal (e.g. Imagine you are driving a car)
• 1st position
• Delayed copying
• Copying
• Simultaneous copying
• Moulding
• Establish baseline, then reduce cues

• Speech
• Its a ___
• Verbal- definition
• Semantic closure
• 1st phoneme
• 1st syllable
• Copy
• Start with minimal cue, then increase

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Therapy Example
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Therapy B

• Selection
• Availability
• Motivation
• Motivation and availability of partner

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Therapy B

• In-depth interview
• Personalised goals
• Strategy work
• Strategies practised in tasks- different levels
  of difficulty and structure
• Coaching in strategy use

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Results
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Gesture Results (blind select)
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Naming Results
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The Play Off Gesture (blind) vs Naming
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Messages

• Message scripts scored by blind raters (0 4)
• Scores expressed as

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Message Results
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Video Narratives

• Partner scripts scored against proposition list
• Raters blind to time of assessment
• Each proposition scored 0 4
• Max score per video 40

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Video Narrative Results
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Video Narrative Results
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Conclusions

• People with severe aphasia can make significant
  gains on gesture production in response to
  gesture therapy
• People with severe aphasia can make significant
  gains on word production in response to naming
  therapy
• There is no cross modality generalisation from
  either types of therapy
• Gains from naming therapy are greater than gains
  from gesture therapy
• There are modest benefits for communication,
  which are not specific to treated items

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But

• We still need to
• Explore individual data (e.g. for those who
  did/did not improve in naming)
• Conduct separate analyses for those who did/did
  not receive therapy B
• Examine baseline predictors of change
• Perform qualitative analyses on the message and
  narrative data

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Thanks to

• The Stroke Association
• Research Therapist Anna Caute
• Support therapists and students Gemma Bulcock,
  Gemma Creek, Alice Lockhart- Mummery, Nina
  Mathews
• All participants in the project