Recovery of gestures of persons with severe non-fluent aphasia and limb apraxia - longitudinal multiple case study

Title:
Recovery of gestures of persons with severe non-fluent aphasia and limb apraxia - longitudinal multiple case study

Background and aims:
The ability to substitute absent speech with gestures would be beneficial. However, effective use of meaning-laden gestures has been found to be insufficient for persons with severe non-fluent aphasia and limb apraxia (e.g. Hogrefe et al., 2013) and clinical experience shows that recovery often remains poor. Scientific knowledge about long-term recovery is scarce. This study follows recovery of gestures produced in a structured test up to three years post stroke.

Methods:
The study included seven participants, with a mean age of 69, with initially severe non-fluent aphasia due to a left hemisphere stroke. Gestures were examined using a gesture-to command task, the Florida Apraxia Screening Test - Revised which includes 30 emblems and pantomimes (Rothi & Heilman, 2015) that participants were required to perform after an oral request. The examination was videorecorded, and performance was rated on the degree of the comprehensibility of a gesture. The test was implemented five times during the follow-up. The auditory comprehension to yes/no questions was also assessed.

Results and main contributions:
Comprehensibility of gestures after an oral request improved significantly for five out of seven participants between the first and the last examinations. The most notable improvement occurred within 6 months post stroke but continued until 2- or 3-years. All the participants’ responses to yes/no questions were clearly better than performance in gesture-to-command task indicating that a lack of understanding did not explain the deficiency in gesture tasks.

Conclusions:
The ability to perform gestures can show recovery even at the chronic phase post stroke. Impaired speech comprehension due to aphasia does not explain poor performance of gestures of persons with severe non-fluent aphasia and limb apraxia.

Implications:
Because of the potentiality of recovery of gestures, training gestures should be actively included in rehabilitation for persons with non-fluent aphasia and limb apraxia.


References:

Hogrefe, K., Ziegler, W., Wiesmayer, S., Weidinger, N., & Goldenberg, G. (2013). The actual and potential use of gestures for communication in aphasia. Aphasiology, 27(9), 1070–1089.

Rothi, L. J., & Heilman, K. M. (2015). Apraxia: the neuropsychology of action.