1. A comparison of intention and pantomime gesture treatments for word retrieval in people with aphasia Neina F. Ferguson, M.S.*, Kelli Evans, Ph.D.*, & Anastasia M. Raymer, Ph.D.** University of South Alabama* & Old Dominion University** A comparison of intention and pantomime gesture treatments for word retrieval in people with aphasia Neina F. Ferguson, M.S.*, Kelli Evans, Ph.D.*, & Anastasia M. Raymer, Ph.D.** University of South Alabama* & Old Dominion University** Results Abstract Methods Participants Discussion Pantomime Intention Untrained Effect Size Chart** Intention and pantomime gesture treatments for noun retrieval remediation secondary to aphasia have not been compared. In a single-participant design, we investigated the effects of independent training on verbal and gestural productions following both gesture type treatments in four individuals with aphasia. P1 improved verbal productions post intention treatment for trained words only. P2 and P3 improved usage of pantomime gestures to communicate in lieu of verbal gains. P4 improved verbal productions post intention and usage of gestures post pantomime treatment. The most effective type of gesture for remediation of noun retrieval depends on the nature of word retrieval defects. P1P2P3P4 Gender Female Male Age 40627455 Neurologic Diagnosis L CVA (41 MPS)L CVA (22 MPS)L AVM (39 MPS)L CVA (37 MPS) Western Aphasia BatteryPrePostPre PostPrePostPrePost Fluency (max 10) 4 9 11 0 21115 Comprehension (max 10) 10 8.8 4.45 4.95 6.1 6.7 7.958.05 Repetition (max 10) 8.2 8.4 2.83.23.4 5.4 5.8 Naming (max 10) 7.78.21.51.82.93.67.59.1 Total AQ (max 100) 77.884.823.521.924.837.475.778.7 Aphasia Classification Transcortical Motor AnomicBroca's Conduction Boston Naming Test 4249219 12 54*56 Florida Apraxia Battery 83214 In this small group of people with chronic aphasia, both intention and pantomime gesture treatments were effective, but for contrasting communication outcomes. Intention gesture treatment resulted in improved naming of trained nouns without generalization to untrained nouns for P1. Pantomime gesture training was effective for improving use of gestures in participants with severely limited spontaneous verbal skills and impaired repetition abilities (P2 and P3). Pantomime gesture treatment resulted in improved non-verbal communication skills for trained and untrained nouns in these two participants. P2, a female diagnosed with an ischemic stroke and Broca’s aphasia, demonstrated greater use of pantomime gestures for communication than did P3, a male diagnosed with AVM and Broca’s aphasia. P4, diagnosed with fluent aphasia, responded differently to treatment than the three non-fluent participants. P4 improved verbal productions during intention treatment though he rarely utilized the intention gestures during probes. The reverse was true for pantomime treatment; he utilized the pantomime gestures frequently during the probes, but the treatment effect did not reach significance for verbal productions. These treatment effects were accompanied by improvements in standardized testing, suggesting that these gestural treatments have some broader impact on fluency of verbal skills, as seen especially in P1. Our data suggest that remediation of communication skills in aphasia using intention gestures requires training of specific, frequently used, functional nouns, despite the flexibility of this gesture type. Pantomime gesture training generalizes to untrained nouns regardless of gesture complexity and co- occurring limb apraxia. Further investigation is warranted to determine if the type of aphasia, nature of the word retrieval deficit, gender, and the nature of the neurologic insult impacts the efficacy of gestural treatments in aphasia. Participant P1P2P3P4P1P2P3P4 Pantomime Phase Intention Phase Treatment order2121 1212 Verbal Task Pantomime word set trained1.22 1.25*-0.542.04Pantomime word set untrained1.64-0.840.880.92 Intention word set untrained0.57-0.5-0.561.36Intention word set trained5.440.330.752.65 Untrained word set0.650*-0.480.99Untrained word set1.44-0.290.961.48 Gestural Task Pantomime word set trained0.899.676.709.69Pantomime word set untrained-0.440.91-0.07-0.6 Intention word set untrained-0.48-0.291.140*Intention word set trained-0.222.841.77-0.33 Untrained word set1.06-0.998.02-0.45Untrained words set04.020.11-0.69 Follow Up Phase Verbal TaskGestural Task Pantomime word set1.971*0.320.91Pantomime word set0.8710.070.81-0.6 Intention word set5.440.5-0.412.20Intention word set-0.872.602.570.22 Untrained word set1.230*0.641.48Untrained word set10.69.71-0.69 Legend  * Estimated standard deviationSmall effect size > 2.5  Bold numbers - Significant treatment effectLarge effect size > 5.8 ** *multiple error attempts prior to self-correction MPS = Months Post Stroke Treatment Design  Single-participant multiple base line  Intention treatment & Pantomime treatment; counterbalanced treatment order across participants Baseline and Daily Probes  Picture Naming / Gesture Production  Intention training - 20 nouns, Pantomime training - 20 nouns, Untrained nouns - 20 nouns  Baseline: Probe tasks administered in 3-6 sessions  Treatment phases: Probe tasks administered each session prior to TX; sessions 2-3 times weekly  Criterion 90% correct across three consecutive sessions to maximum 10 TX sessions  Intention Treatment 1.Picture presented, target word and non-symbolic left handed circular gesture modeled by clinician 2.Participant practices verbal production and gestural production 4 to 6 times. Hand-over-hand assistance used if indicated 3.After a 3 to 5 second interval, participant spontaneously produced noun and gesture 4.Step 3 was repeated 3 times  Pantomime Treatment 1.Picture presented, target word and pantomime gesture modeled by clinician 2.Participant practiced verbal production and gesture production 4 to 6 times. Hand-over-hand assistance used if indicated 3.After a 3 to 5 second interval, participant spontaneously produced noun and gesture 4.Step 3 was repeated 3 times