Disclaimer: this resource is intended for speech and language therapists and students of this profession. If you require therapy for aphasia please contact a speech and language therapist.
Gesture and Naming Therapy
Summary: An approach in which two modalities, gesture and verbal naming, are targeted separately in therapy. Gesture and Naming Therapy builds on research, e.g. Rao & Horner (1983) & Hoodin & Thompson (1983), which found that training understanding and use of gestures can facilitate verbal naming ability. It has been shown to support gesture and naming skills amongst clients with severe aphasia as well as improve their ability to convey simple messages and narratives (see below). Due to its focus on naming and gesturing, it is an example of a therapy that is both impairment-based and functional in nature.
Example:
The following is taken from the treatment protocol used in Marshall et al.’s study (2012).
Treatment begins with comprehension tasks (e.g. gesture to picture matching, word to picture matching) before progressing to production tasks (e.g. repeating gestures or words, picture naming using gestures or words). Half of each session should focus on gesture therapy and half on naming therapy.
Gesture therapy:
Comprehension tasks
Production tasks
Production tasks are divided into three levels, in each of which the client is supported to produce target gestures using the following cueing hierarchy:
1) Spoken cue for hand-shape (e.g. “imagine you are turning a steering wheel”)
2) Modelling the initial hand-shape of a gesture
3) Delayed copying of therapist-modelled gesture
4) Simultaneous copying of therapist-modelled gesture
5) Gesture moulding (i.e. the therapist gives hand-over-hand support to show the client how gestures are produced)
The level of cueing required by the client is determined and slowly reduced during treatment.
Naming therapy:
Naming therapy follows the structure of the gesture therapy outlined above, progressing from spoken/written word comprehension tasks to production tasks. Written naming can be used in place of spoken naming if this is the preferred modality of the client.
The cueing hierarchy used in naming therapy is as follows:
1) Verbal prompt (e.g. “It’s a …”)
2) Semantic definition cue (e.g. “It’s an animal… it barks… they’re used to help people who are blind”)
3) Semantic sentence completion cue (e.g. “I walked the …”)
4) Minimal phonological cue (i.e. initial phoneme)
5) Maximal phonological cue (e.g. initial syllable)
6) Model of word for client to repeat
The following is taken from the treatment protocol used in Marshall et al.’s study (2012).
Treatment begins with comprehension tasks (e.g. gesture to picture matching, word to picture matching) before progressing to production tasks (e.g. repeating gestures or words, picture naming using gestures or words). Half of each session should focus on gesture therapy and half on naming therapy.
Gesture therapy:
Comprehension tasks
- The client is shown five pictures and is asked to match each with a gesture performed by the therapist. If this is too challenging the therapist should reduce the number of pictures.
- Once the client is able to match all five pictures to their corresponding gestures, the therapist introduces semantic distractor pictures and repeats the task.
- Once the client is consistently able to match all pictures to their corresponding gestures in the presence of semantic distractor pictures (or after three attempts to match each target picture to its corresponding gesture have taken place), treatment progresses to gesture production tasks.
Production tasks
Production tasks are divided into three levels, in each of which the client is supported to produce target gestures using the following cueing hierarchy:
1) Spoken cue for hand-shape (e.g. “imagine you are turning a steering wheel”)
2) Modelling the initial hand-shape of a gesture
3) Delayed copying of therapist-modelled gesture
4) Simultaneous copying of therapist-modelled gesture
5) Gesture moulding (i.e. the therapist gives hand-over-hand support to show the client how gestures are produced)
The level of cueing required by the client is determined and slowly reduced during treatment.
- Level 1: The client is shown a picture and supported to produce the corresponding gesture.
- Level 2: The client is shown a picture (not visible to the therapist) and is asked to communicate this using gesture so that the therapist can select the target from a selection of unrelated pictures.
- Level 3: As level 2 but the selection of pictures from which the therapist must choose are semantically related.
Naming therapy:
Naming therapy follows the structure of the gesture therapy outlined above, progressing from spoken/written word comprehension tasks to production tasks. Written naming can be used in place of spoken naming if this is the preferred modality of the client.
The cueing hierarchy used in naming therapy is as follows:
1) Verbal prompt (e.g. “It’s a …”)
2) Semantic definition cue (e.g. “It’s an animal… it barks… they’re used to help people who are blind”)
3) Semantic sentence completion cue (e.g. “I walked the …”)
4) Minimal phonological cue (i.e. initial phoneme)
5) Maximal phonological cue (e.g. initial syllable)
6) Model of word for client to repeat
Evidence Base: Marshall et al. (2012) delivered Gesture and Naming Therapy to 14 participants with severe aphasia over 15 one hour sessions. Significant improvements were noted in gesturing and naming trained targets following therapy. Improvements in gesture were relatively modest (with an average of just under 2 gestures learnt per 7.5 hours of gesture therapy) while, for the majority of participants, improvements in naming was more marked (an average of 8 words learnt per 7.5 hours of naming therapy). However, the authors caution against overlooking the potential of gesture therapy for clients as three participants showed improvement in gesture whilst showing no improvement in naming. No generalisation was found to untrained items. Interestingly, items that were targeted in gesture therapy did not result in corresponding improvements in naming for that item. Likewise, items targeted in naming therapy did not result in improvements in gesturing.
A companion study to that outlined above, which tested the same 14 participants, examined the impact of Gesture and Naming Therapy on more interactive communication tasks (Caute et al., 2013). Findings indicated that Gesture and Naming Therapy resulted in significant gains in the ability of participants to convey simple messages and narratives. The degree of generalisation to messages or narratives that did not contain treated items was unclear, although the authors suggested that gains in interactive communication were indicative of the development of general communication skills rather than specific improvements for treated items.
Caute et al. also examined whether additional strategic therapy (similar to Conversational Coaching) aimed at developing participants’ use of gesture and ability to combine gesture with other modalities in communication would result in additional gains in their ability to convey simple messages and narratives. Participants who received Gesture and Naming Therapy + additional strategic therapy showed significantly improved ability to convey simple messages as compared to participants who received only Gesture and Naming therapy. However, no significant difference was found in ability to convey narratives between the participants who received Gesture and Naming Therapy + additional strategic therapy and those participants who received only Gesture and Naming Therapy.
A companion study to that outlined above, which tested the same 14 participants, examined the impact of Gesture and Naming Therapy on more interactive communication tasks (Caute et al., 2013). Findings indicated that Gesture and Naming Therapy resulted in significant gains in the ability of participants to convey simple messages and narratives. The degree of generalisation to messages or narratives that did not contain treated items was unclear, although the authors suggested that gains in interactive communication were indicative of the development of general communication skills rather than specific improvements for treated items.
Caute et al. also examined whether additional strategic therapy (similar to Conversational Coaching) aimed at developing participants’ use of gesture and ability to combine gesture with other modalities in communication would result in additional gains in their ability to convey simple messages and narratives. Participants who received Gesture and Naming Therapy + additional strategic therapy showed significantly improved ability to convey simple messages as compared to participants who received only Gesture and Naming therapy. However, no significant difference was found in ability to convey narratives between the participants who received Gesture and Naming Therapy + additional strategic therapy and those participants who received only Gesture and Naming Therapy.
References
Caute, A., Pring, T., Cocks, N., Cruice, M., Best, W., & Marshall, J., 2013. Enhancing communication through gesture and naming therapy. Journal of Speech, Language and Hearing Research, 56(1), 337-351
Hoodin, R.B. and Thompson, C.K., 1983. Facilitation of verbal labeling in adult aphasia by gestural, verbal, or verbal plus gestural training. In: Brookshire, R.H. ed. Clinical Aphasiology Conference Proceedings. Minneapolis, MN: BRK Publishers
Marshall, J., Best, W., Cocks, N., Cruice, M., Pring, T., Bulcock, G., Creek, G., Eales, N., Mummery, A.L., Matthews, N., & Caute, A., 2012. Gesture and naming therapy for people with severe aphasia: a group study. Journal of Speech, Language, and Hearing Research, 55(3), 726-738
Rao, P.R. & Horner, J., 1978. Gesture as a deblocking modality in a severe aphasic patient.
In: Brookshire, R.H. ed. Clinical Aphasiology Conference Proceedings. Minneapolis, MN: BRK Publishers
Caute, A., Pring, T., Cocks, N., Cruice, M., Best, W., & Marshall, J., 2013. Enhancing communication through gesture and naming therapy. Journal of Speech, Language and Hearing Research, 56(1), 337-351
Hoodin, R.B. and Thompson, C.K., 1983. Facilitation of verbal labeling in adult aphasia by gestural, verbal, or verbal plus gestural training. In: Brookshire, R.H. ed. Clinical Aphasiology Conference Proceedings. Minneapolis, MN: BRK Publishers
Marshall, J., Best, W., Cocks, N., Cruice, M., Pring, T., Bulcock, G., Creek, G., Eales, N., Mummery, A.L., Matthews, N., & Caute, A., 2012. Gesture and naming therapy for people with severe aphasia: a group study. Journal of Speech, Language, and Hearing Research, 55(3), 726-738
Rao, P.R. & Horner, J., 1978. Gesture as a deblocking modality in a severe aphasic patient.
In: Brookshire, R.H. ed. Clinical Aphasiology Conference Proceedings. Minneapolis, MN: BRK Publishers
|
|
