Miranda Rose

The comparative effectiveness of gesture and verbal treatments for a specific phonologic naming impairment

Background: Arm and hand gesture has been considered a potential facilitator of word production (Skelly, Schinsky, Smith, & Fust, 1974), and gesture is often considered as a therapeutic modality for the treatment of aphasia (Rao, 1994), but there is limited empirical evidence of the efficacy of gesture-based treatments. Models of the relationship between word production and gesture production have been developed (Hadar & Butterworth, 1997; Krauss & Hadar, 1999) but they are currently under-specified and provide little guidance as to whether gesture might be an efficacious treatment for word production deficits arising from particular underlying levels of impairment. Aims: This study had two main aims: First, to examine the comparative facilitation effects of gesture production and visualisation processes on object naming skills, and second, to compare the effectiveness of three types of treatment, gesture, verbal, and combined verbal plus gesture, for word production deficits arising from impairment at the level of phonological access and encoding. Methods & Procedures: A 68-year-old female, AB, participated in the study. AB sustained a single, left, frontoparietal, subarachnoid haemorrhage 6 months prior to the study, which resulted in a highly specific, mild, phonologic access and encoding impairment. AB initially participated in a trial comparing the relative effectiveness of gesture and visualisation processes for facilitating oral picture naming. A controlled multiple-baseline single-case experiment was then carried out comparing the three naming treatments. Outcomes & Results: The use of iconic gesture was found to significantly facilitate picture naming. Pointing, visualisation, and cued articulation produced negligible change from baseline rates. Clinically and statistically significant treatment effects were found for all three treatment conditions, with only marginal differences between conditions. Improvements made in picture naming were maintained at 1 and 3 month follow-up assessments and generalisation of enhanced object naming was found with novel stimuli and during spontaneous conversation. Conclusions: The results supported Krauss and Hadars (1999) model of speech and gesture production, suggesting frank interaction between the kinesic monitor of the gesture production system and the formulator of the word production system. The results caution clinicians to question the long-held axiom of the superiority of multi-modality treatments, and encourage clinicians to consider the underlying knowledge and processes generated by particular treatment protocols, rather than simply the modality in which the treatment is transmitted.

The differential facilitatory effects of gesture and visualisation processes on object naming in aphasia

This study investigated the differential facilitation effects of gesture and visualisation processes on object naming in individuals with aphasia. Six participants with word production deficits resulting from varying levels of impairment in the word production system, underwent a series of naming trials. Baseline measures of naming were compared to those obtained following instructions to point, visualise, and produce gesture. The results supported the superiority of iconic gesture as a facilitator of object naming in aphasia. In particular, individuals with phonological access, storage, or encoding difficulties demonstrated significantly enhanced naming abilities with the use of iconic gesture as compared to individuals with a semantic impairment or an apraxia of speech. Pointing, cued articulation, and visualisation processes did not significantly enhance naming skills in these individuals. These results are discussed within the model of lexical gesture and word production proposed by Krauss and Hadar (1999).

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

People with aphasia frequently rely on communicative “devices” other than their impaired language system. This article focuses on arm and hand gesture as one such “device” or modality. Speech-language pathologists face the daily challenge of clinical reasoning choices and management plan decisions for selecting and advising about therapeutic methods and modalities for a wide range of people with aphasia. This article aims to synthesize the relevant information about gesture in aphasia that is otherwise published in a disparate range of sources or with less clinical and more theoretical goals in mind. A description of the types of arm and hand gestures commonly seen in humans and a summary of the debate surrounding their origins and functions is provided as background information. Recent models of gesture production are explored, especially as they relate to the interaction between gesture, speech and language, and to the use of gesture as a therapeutic option in aphasia rehabilitation. The latter also involves understanding the role of limb apraxia in gesture production and gesture-based therapies. Research detailing the gesture abilities of people with aphasia (both receptive and expressive) is reviewed and finally the evidence concerning gesture as a therapeutic agent in aphasia therapy is critiqued.

Aphasia rehabilitation in Australia: Current practices, challenges and future directions.

Abstract This study reports on current aphasia rehabilitation practices of speech-language pathologists in Australia. A 30-item web-based survey targeted approaches to aphasia rehabilitation, education, discharge, follow-up practices, counselling, interventions to improve communication access, community aphasia support services, and challenges to practice. One hundred and eighty-eight surveys were completed representing ˜ 33% of the potential target population, with 58.5% urban and 41.5% rural participants across all states and territories. Respondents reported embracing a wide variety of approaches to aphasia rehabilitation; however, significant challenges in providing aphasia management in acute and residential care were identified. Low levels of knowledge and confidence were reported for both culturally and linguistically diverse clients and discourse approaches. Group and intensive services were under-utilized and clinicians reported inflexible funding models as major barriers to implementation. Few clinicians work directly in the community to improve communicative access for people with aphasia. Despite the chronic nature of aphasia, follow-up practices are limited and client re-entry to services is restricted. Counselling is a high frequency practice in aphasia rehabilitation, but clinicians report being under-prepared for the role. Respondents repeatedly cited lack of resources (time, space, materials) as a major challenge to effective service provision. Collective advocacy is required to achieve system level changes.

Interviewing people with aphasia: Insights into method adjustments from a pilot study

Background: An increasing number of researchers are using qualitative methods to study the impact of aphasia. However, there is a paucity of published research outlining if and how qualitative interview methods are altered with participants with aphasia, and how potential modifications impact on the rigour of such research. Aims: In a qualitative, pilot study we investigated (1) What services do males in Victoria with mild chronic aphasia perceive could be provided by the Australian Aphasia Association? (2) How is qualitative in‐depth interviewing method altered to accommodate the communicative difficulties experienced by people with aphasia? This paper reports on the second aim. Methods and Procedures: A qualitative phenomenological approach was adopted. Purposeful sampling was used to obtain four participants with mild chronic aphasia across the variables of geographical location and employment status at time of stroke. An interview guide was devised and refined with a fifth pilot participant. Interviews were videotaped to allow for transcription of total communication strategies and 20% of transcriptions were verified by an expert in aphasia. Outcomes and Results: When using the traditional open‐ended, non‐directive approach to qualitative interviewing, very little information was obtained from the pilot participant. The results from four further participants revealed that with participants with aphasia, the researcher is required to step out of the traditional role of the qualitative interviewer by altering questioning style, offering ideas to participants, and using supportive conversation techniques. Strategies used by participants require that interviews be videotaped so that the meaning of the total communication strategies used can be verified. Conclusions: Valuable data can be obtained from participants with aphasia when the interview method is altered appropriately to meet their communicative needs. The study highlights implications for enhancing rigour in qualitative interviews with people with aphasia.

Treating a semantic word production deficit in aphasia with verbal and gesture methods

Background: Anomia is a common and pervasive word production deficit following stroke. One type of word production deficit concerns primary impairment at the lexical‐semantic level. Overall, there is a lack of published studies reporting the effects of therapy for specific semantic‐level impairments (Nickels, 2002), and the results from the few existing studies focusing on verbal treatments have varied considerably. Arm and hand gestures have also been suggested as a possible treatment method/modality for word production impairments (Rao, 2001; Rose, Douglas, & Matyas, 2002; Skelly, Schinsky, Smith, & Fust, 1974). Multi‐modality treatments have been promoted as being more efficacious than single‐modality treatments in the field of speech language pathology, but there is minimal empirical evidence to support this proposal. Overall, speech‐language pathologists have little evidence on which to base their choice of gesture or verbal treatment methods. We gratefully acknowledge the generous and patient participation of JB in this research. Thank you to Lisa Byrne and Donna McNeil‐Brown for inter‐rater agreement work and Professor Tom Matyas, La Trobe University for expert statistical assistance. This research was partly carried out while the first author was the recipient of an Australian Government Post Graduate Aware, and further supported by a La Trobe University Faculty of Health Sciences Aims: This study aimed to investigate the relative efficacy of gesture, verbal, and combined verbal plus gesture treatments for an individual with chronic, mild, aphasic word production difficulties arising from lexical‐semantic impairment. Methods & Procedures: JB, a 51‐year‐old female, participated in the study. JB sustained a singe, left, discrete peri‐sylvian infarction 40 months prior to the study, which resulted in a mild category‐specific anomic aphasia. JB participated in a controlled multiple‐baseline single‐case experiment comparing the efficacy of the three treatments in the context of carefully balanced sets of words selected from the categories of tools, animals, and musical instruments. Outcomes & Results: Large, statistically significant, and clinically relevant treatment effects were found for all three treatment conditions and there were no significant differences between conditions. Improvements made in word production were maintained at both the 1‐month and 3‐month follow‐up assessments. Generalisation of enhanced word production was found for untrained exemplars of trained items, and for some untrained items, as well as to use in procedural discourse tasks. Conclusions: The results support the potency of a semantic feature analysis type treatment for lexical‐semantic impairment. However, the results caution clinicians to question the superiority of combined gesture and verbal treatments for semantic‐level word production impairments. Consistent with our previous work (Rose & Douglas, 2001, 2002, in press), it is suggested that the underlying treatment strategy, in this case knowledge about object shape and function, was a more potent factor in treatment outcome than the modality (gesture versus verbal) in which the strategy was presented.

The effects of semantic and gesture treatments on verb retrieval and verb use in aphasia

Background: Previous research has suggested that semantic plus gesture treatments are effective for aphasic noun retrieval deficits. However, there is a paucity of evidence concerning the efficacy of semantic or gesture treatments for aphasic verb retrieval deficits. As both verbs and arm/hand gestures represent movement concepts, gesture may well be a potent treatment for verb retrieval deficits. Aims: This study investigated the comparative effects of semantic, gesture, repetition, and combined semantic plus gesture treatments for verb retrieval deficits associated with chronic Brocas aphasia. Methods & Procedures: Three women with chronic Brocas aphasia and significant verb retrieval deficits participated in single‐subject multiple‐baseline across conditions designs. Two participants primarily evidenced a word‐form verb retrieval deficit and one a semantic deficit. A total of 100 verb pictures were balanced for relevant lexical factors and divided into five groups of 20 items. Following 10 baseline trials, 20 treatment sessions aimed at improving verb production were completed. Three treatment conditions were simultaneously compared. Treatment of incorrectly named items involved production of an associated noun and the movement and location characteristics of the target verb. Gesture conditions involved production of an iconic gesture. Outcomes & Results: The participant with semantic‐based verb retrieval deficit (MT) showed minimal response to any of the three treatments. Two participants with word‐form impairments (KC and MW) demonstrated significantly improved verb retrieval skills and large treatment effects following all three treatments. KC and MW correctly used treated items in picture description and conversation tasks, and there was a modest amount of generalisation to untreated items. Combined semantic plus gesture treatment was superior for MW, but all three treatments were equally efficacious for KC. Conclusions: The findings support the use of multi‐modal semantic treatments to improve verb retrieval in individuals with aphasic word‐form verb retrieval deficits. Replication is required to achieve a stronger evidence base. Baseline error patterns may be useful in predicting response to treatment.

The efficacy of repetition, semantic, and gesture treatments for verb retrieval and use in Broca's aphasia

Background: Verb production difficulties are well documented in individuals with aphasia. Yet there remains limited evidence regarding the efficacy of treatments for verb retrieval in these individuals. While previous studies have generally demonstrated positive treatment outcomes in improving single-verb production on confrontation naming tasks, few studies have attempted to examine therapy outcomes in more natural communicative contexts. Aims: This study aimed to evaluate and compare the effects of repetition, semantic, and combined semantic and gesture treatments for verb retrieval and use in individuals with chronic Brocas aphasia. Methods & Procedures: Two individuals with severe and moderate Brocas aphasia participated in this single-participant, multiple-baseline across conditions design. Participant GF presented with mixed levels of verb retrieval deficits and significant apraxia of speech. Participant PF evidenced verb retrieval impairment arising primarily from the output phonological level. A total of 100 action pictures drawn from various sources were balanced for relevant linguistic factors and individual error rates during baseline naming. Treatments were carried out sequentially. Each treatment condition lasted for ten sessions. Semantic treatments involved the production of various features that were semantically associated with the target verb, including associated nouns, and the movement and location characteristics of the target verb. Gesture treatments involved the production of hand and arm movements representative of the target verb. Outcomes & Results: Both participants differed in their response to treatments. GF exhibited increased verb-naming accuracy following repetition-orthographic and combined semantic and gesture treatments; while PF displayed significant increase in naming accuracy following repetition-only and semantic treatment conditions. For both participants, treatments that resulted in significant increase in naming accuracy were shown to be equally efficacious. Both GF and PF also demonstrated increased verb production in narrative and conversation tasks. PF further evidenced improvements in sentence production on a picture description task post-treatment. Conclusions: These findings highlighted the responsiveness to therapy in two individuals with severe and moderate aphasia in the chronic stages. However, there was no significant change in specific lexical, syntactical and morphological linguistic production in conversation. Future research could explore the incorporation of single verb therapy in sentences and/or more natural communicative environments, to further enhance changes at the discourse level.

Do the hands have it? The facilitation effects of arm and hand gesture on word retrieval in aphasia

Background: There is considerable disagreement in the literature concerning the function of co‐verbal gesture. Studies of the relationship between speech and gesture have employed an array of methods to investigate the origin and functions of arm and hand gesture. Commonly, these studies have utilised an experimental design to examine possible speech facilitation effects. However there is a need to examine spontaneous gesture production and its effect on speech production, as evidence suggests that natural gesture production is distinct from that produced under test conditions. Aims: To investigate the possible facilitation effects of spontaneously generated arm and hand gestures during word retrieval difficulty in people with aphasia. Methods & Procedures: Conversational samples 20 minutes long were acquired from 18 participants with chronic aphasia. Verbal utterances were transcribed for word retrieval difficulty, resolved word retrieval difficulty, and fluent speech production. The transcription was augmented with all arm and hand gestures produced by the participants. Gestures were segmented into gesture units and classified into types. A second rater classified 20% of the samples for gesture type, occurrence of word retrieval difficulty, and whether the difficulty was successfully resolved or not. Consensus ratings were carried out where disagreement occurred. Variables were paired for comparison using a series of non‐parametric Wilcoxon Signed‐Ranks Tests. Outcomes & Results: Gesture production was significantly higher during instances of word retrieval difficulties. The resolution of word retrieval difficulty was significantly more frequent with a gesture present. Crucially, there was no significant difference between the amounts of gesture produced during resolved, as compared to unresolved, word retrieval difficulties. However performance in the group was variable. Five individuals produced over 50% more gesture during resolved word retrieval events than during unresolved. Post‐hoc examination of the linguistic characteristics of these five participants suggested they had a specific phonological level impairment. Conclusions: Gesture production is multifunctional for people with aphasia. People with mild aphasia, who have the majority of their linguistic resources still accessible, are likely to experience facilitation from gesture production, and hence gesture treatment maybe an appropriate and potent therapy focus. Some individuals with severe language impairment are capable of using many rich, communicative gestures. Such gesture expression should be explored as a viable component of a “total communication” therapeutic approach for those individuals.

The Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) 2016 Statement

Reporting guidelines, such as the Consolidated Standards of Reporting Trials (CONSORT) Statement, improve the reporting of research in the medical literature (Turner et al., 2012). Many such guidelines exist, and the CONSORT Extension to Nonpharmacological Trials (Boutron et al., 2008) provides suitable guidance for reporting between-groups intervention studies in the behavioral sciences. The CONSORT Extension for N-of-1 Trials (CENT 2015) was developed for multiple crossover trials with single individuals in the medical sciences (Shamseer et al., 2015; Vohra et al., 2015), but there is no reporting guideline in the CONSORT tradition for single-case research used in the behavioral sciences. We developed the Single-Case Reporting guideline In Behavioral interventions (SCRIBE) 2016 to meet this need. This Statement article describes the methodology of the development of the SCRIBE 2016, along with the outcome of 2 Delphi surveys and a consensus meeting of experts. We present the resulting 26-item SCRIBE 2016 checklist. The article complements the more detailed SCRIBE 2016 Explanation and Elaboration article (Tate et al., 2016) that provides a rationale for each of the items and examples of adequate reporting from the literature. Both these resources will assist authors to prepare reports of single-case research with clarity, completeness, accuracy, and transparency. They will also provide journal reviewers and editors with a practical checklist against which such reports may be critically evaluated.