Communicative Gesture

 
 

What do we study?

The short-term goal of this line of research is to understand how gestures improve communicative competence, which is the ability to successfully participate in the world using any verbal and non-verbal means. The long-term goal is to build assessments that enable quantification of gesture’s role in improving communication over time. Gesture appears to be remarkably intact in most individuals with aphasia, even in the presence of limb weakness or paralysis. The literature makes clear that when individuals with aphasia speak, they gesture more frequently than neurotypical peers.



Research from our lab

My research has shown that gesturing, like spoken discourse, is shaped by context. In her undergraduate honors thesis, Caroline Cofoid compared iconic gesture use between two discourse tasks in individuals with aphasia from AphasiaBank (Stark & Cofoid, 2021). Iconic gestures are semantically related to speech, and we therefore hypothesized that iconic gesture frequency would differ by task given that speech differs by task. We found that iconic gestures occurred less frequently and at a lower rate during a picture sequence description compared to a procedural narrative. We interpreted this to mean that individuals with aphasia drew more upon gesture when spatial language was required, as in a procedural discourse. This hypothesis aligns with the Gesture-for-Conceptualization and the Gesture As Simulated Action theories.

To extend on Caroline’s work, undergraduate Grace Oeding, for her Honors project, further coded iconic gestures’ functional relationship to speech. Gestures were coded as either redundant or supplementary. Supplementary gestures add, disambiguate or replace speech. For supplementary gestures, she further coded whether that gesture was essential for understanding the meaning of the utterance. We then examined which demographic, neuropsychological, and speech variables best predicted the frequency and rate of gesturing (Stark & Oeding, 2024). On average, we identified that most iconic gestures were supplementary to speech, and of those, a further 38% were essential to understanding the speech. This finding underlines the importance of iconic gestures in improving communication for speakers with aphasia. We identified that more severe anomia (word finding impairment) associated with a higher proportion of supplementary and essential iconic gestures, whereas non-neuropsychological variables, like word count, associated with the frequency of redundant iconic gestures. The findings for gesture rate were complementary: severe anomia and aphasia, neuropsychological variables, were associated with a higher rate of supplementary and essential gestures while younger age, a demographic variable, was associated with a higher rate of redundant gesturing. These findings stress that iconic gestures improve communication, especially in cases of more severe anomia and aphasia. This evidence provides strong support for aphasia rehabilitation techniques that train multimodal production and consider multimodal components, like gesture, when writing goals.

In a study spearheaded by PhD student Katelyn Urena (Urena & Stark, 2024), we found that individuals with moderate-severe traumatic brain injury (TBI) used iconic gestures during procedural narratives (at a much lower frequency and rate than we have observed in studies of gesturing in aphasia) and that gesturing was relatively stable from three to 24 months post-TBI. A case study within the TBI dataset suggested that, when language is more impaired (i.e., the individual with TBI tests as having clinical aphasia), more iconic gestures were used, and those iconic gestures were used to supplement speech. These findings complement the findings from Grace Oeding’s project in aphasia.

Finally, my colleagues from the University of Essex (Dr. Anna Caute) and City University London (Drs. Lucy Dipper and Abi Roper) and I evaluated the extent to which gesture is integrated by speech therapists into assessment and therapy, “Gesture Assessment and Therapy for Neurogenic Communication Disorders: an international survey of practice.” The survey had three primary research questions: (1) what gesture assessment practices, and (2) what gesture treatment practices, are employed by Speech and Language Therapists (SLTs) internationally; and (3) what are the factors that influence these practices? An online survey of practice using Qualtrics was piloted and then disseminated to practising SLTs working with people with neurogenic communication disorders. In addition to descriptive statistics summarizing across the three research questions, statistical comparisons were made for two independent groups: primary work setting (research vs. clinical), and primary work setting considering years of experience specific to neurogenic communication disorders (research, high; research, low; clinical, high; and clinical, low).  N=130 international SLTs completed at least the demographic section of the survey. 50% of respondents reported assessing gesture sometimes/for some clients, with only 5% reporting that they never assessed gesture. Nearly 70% of respondents reported never using a published test to evaluate gesture, with qualitative results suggesting a lack of formal assessments. This was further highlighted by the most prominent barrier being a lack of published tests (50% of respondents said this). The primary reason for evaluating gesture was to assess nonverbal communication. There was no significant difference in gesture assessment practices across comparison groups. The research group, and those within the research group with most years of experience, tended to target gestures during treatment and write treatment goals containing gesture more than other respondents. The most common facilitator to assessing or treating gesture was that the family or individual prioritized gesture for enhancing communication (53.1% of respondents). No group differences were identified for barriers/facilitators. Findings indicate that whilst gesture is a critical nonverbal communicative behaviour, there is an unmet need for empirical and standardised methods for assessing gesture in speech and language clinical practice and there is a lack of gesture-specific treatment resources​. SLTs working in research settings may feel more able, or have more resources, to include gesture during treatment. Essential next steps include creating empirical and standardised methods for assessing gesture in speech and language clinical practice.  

My colleague Dr. Jeanne Gallée (University of Washington) and I are refining a patient-report tool that measures the frequency and success of verbal and non-verbal skills across in-person and virtual environments, in order to address this problem (the Communicative Success Screener; Gallée, Tilton-Bolowsky & Stark, 2023). This tool will provide a metric of gesture’s influence on patient communicative competence, and as we continue to refine and validate it, it will ideally reflect changes in communicative competence after therapy and over time.

Altogether, this line of research suggests a highly important role for gesture in improving communication when language is impaired and demonstrates the value of transdiagnostic research in drawing more robust conclusions about gesture’s role in communication.

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