Does Gesture Improve the Communication Success of People with Aphasia?: A Systematic Review

Figures & data

Figure 1. PRISMA flow diagram of search method. Template adapted from Page et al. (2021).

Table 1. Characteristics of People with Aphasia.

		Total # participants	# male	Age: mean (SD); min, max	Years of education mean (SD)	Aphasia severity: mean (SD); min, max	Months post stroke: mean (SD); min, max	Limb apraxia: mean (SD); min, max	Hemiparesis/ Hemiplegia:# participants
Q1	Duffy et al. (1984)	2 (A & B)	2	n/a; A = 28 and B = 66		A = 1^a B = 1^a	A = 26 B = 1	Not reported	A = right hemiplegia B = none
	Nispen et al. (2018)	38	26	58.74 (9.56); min = 32 max = 74		33.13 (14.36) min = 2 max = 50^b	13.3 (14.7) min = 3 max = 64	40.37 (13.44) min = 4 max = 53^c
	Hogrefe et al. (2017)	30	22	50.8 (9.5) min = 34 max = 68		≤ 2 (mode=1) min = 0 max = 2^d	46.89 (42.72) min = 2 max = 191	40.33 (13.76) min = 6 max = 54^c	Hemiparesis = 21 Residual = 3 None = 6
Q2	de Beer et al. (2017)	10	7	55.1 (11.5) min = 37.8 max = 76.3		66.9 (9.21); min = 49, max = 80.1^e	66.6 (36.02) min = 12, max = 109.2
	Rose et al. (2017)	13	9	67.6 (9.86) min = 47.2 max = 80.9	15.15 (2.54)	64.7 (21.1) min = 17 max = 89.5^e	113.6 (107.1) min = 9, max = 360		Hemiplegia = 9 Hemiparesis = 3 No = 1
	Hogrefe et al. (2013)	16	9	48.44 (12.05) min = 29 max = 67		2.31 (1.14) min = 0 max = 4^d	34 (20.89) min = 2, max = 124	45.43 (7.41) min = 24 max = 53^c	Hemiparesis = 6 Residual = 4 No = 6
Q1 & Q2	Mol et al. (2013)	25	16	56.92 (10.86) min = 37 max = 71	10.56 (3.14)	22.56 (11.65) min = 10, max = 43^f	25.6 (40.16) min = 1, max = 152	13.27 (5.12) min = 2 max = 18^g	Severe hemiplegia = 9 Moderate hemiplegia = 7 None = 6 not reported = 3

Note. Blank cell indicates that it was not assessed/reported; A= participant nonfluent, B = participant fluent in Duffy & Duffy (1984); ^a= Boston Aphasia Severity Rating Scale (Goodglass et al., 1972); ^b = Akense Aphasia Test (Graetz et al., 1991); ^c = pantomime to command task (Goldenberg et al., 2003, 2007); ^d = Akense Aphasia Test verbal communication subtest (Graetz et al., 1991); ^e = WAB-R = Western Aphasia Battery – Revised (Kertesz, 2007); ^f = ANELT -Amsterdam-Nijmegen Everyday Language Test; ^g = “clinical assessment”, assessment measure not reported.

Table 2. Distribution of Aphasia Syndromes.

		Broca	Wernicke	Conduction	Global	Anomic	Trans cortical	Residual	Non classifiable	Unknown	Total sample
Q1	Duffy & Duffy (1984)	1	1								2
	Nispen et al. (2018)	16	4		7	5			6		38
	Hogrefe et al. (2017)	4	7		16		3				30
Q2	de Beer et al. (2017)	5	2	3							10
	Rose et al. (2017)	5		6		1	1				13
	Hogrefe et al. (2013)	3	5		1	4	1	1	1		16
Q1 & Q2	Cicone et al. (1979); Duffy et al. (1984); Mol et al. (2013)	3	3	1	7	1			6	4	25
Total % sample Q1		24 (25.3%)	15 (15.8%)	1 (1%)	30 (31.6%)	6 (6.3%)	3 (3.2%)		12 (12.6%)	4 (4.2%)	95
Total % sample Q2		16 (25%)	10 (15.6%)	10 (15.6%)	8 (12.5%)	6 (9.3%)	2 (3.1%)	1 (1.6%)	7 (10.9%)	4 (6.3%)	64
Total % sample Q1 & Q2		37 (27.6%)	22 (16.4%)	10 (7.5%)	31 (23.1%)	11 (8.2%)	5 (3.7%)	1 (0.7%)	13 (9.7%)	4 (3%)	134

Table 3. Healthy control participant characteristics.

	# Control participants	Age (years): mean (SD)	Age range (years)	# male	Recruitment source
Duffy & Duffy (1984)	4	22, 24, 56, 60		4
Nispen et al. (2018)	20		32 to 65	5
Hogrefe et al. (2017)	16	51.1 (11.3)	33 to 72	7
Mol et al. (2013)	17	54.06 (11.09)	33 to 77	9	Tilburg University

Note. Blank space indicates information was not reported.

Table 4. Interpreter participant characteristics.

		# participant interpreters	# male	Age (years): mean (SD)	Age range (years)	Recruitment source
Q1	Duffy & Duffy (1984)	6	1
	Nispen et al. (2018)	273		21 (4)		Tilburg University and Hogeschool Rotterdam
	Hogrefe et al. (2017)	Unclear ~18 ??
Q2	de Beer et al. (2017)	60	4	22.72 (4.01)	min = 19 max = 42	Undergraduates – La Trobe University
	Rose et al. (2017)	67				Undergraduates – La Trobe University
	Hogrefe et al. (2013)	18	9	34 (?)	min = 21 max = 60	Not reported
Q1 & Q2	Mol et al. (2013)	109				Tilburg University

Note. Blank cell indicates information was not reported in article

Table 5. Outcomes.

	Task	Authors	Communication Success calculation	Conditions	Results
Q1	Picture naming	Duffy & Duffy (1984)	Percentage correctly guessed items for each producer.	PWA-s CONTROL-s	CONTROL accurate 97%, PWA accurate 55% and 57% (participant a & b respectively)
	Picture naming	Nispen et al. (2018)	MCQ: 3 judges per item, average correct per item, average of item average per individual; OQ: correct identification per item, average across items per individual	PWA-s CONTROL-s	CONTROL-s > PWA-s MCQ: F(1,56) = 33.30, p < .001, η2 = .31 OQ: F(1,56) = 56.95, p < .001, η2 = .50.
	Story retell	Hogrefe et al. (2017)	Number correctly guessed responses divided by total responses given per individual	PWA CONTROL CONTROL-s	PWA > CONTROL Mann Whitney U, Z = _2.6, p < 0.01 CONTROL-s > PWA Mann Whitney U, Z = _3.8, p < 0.001
	Scenario test	Mol et al. (2013)	Number correctly guessed responses divided by total responses given for each modality per individual	PWA CONTROL CONTROL-s	CONTROL > PWA (moderate aphasia) for clips presented in all modalities (visual F(1, 29) = 4.39, p < .05, h p2 = .13; audio F(1, 29) = 18.77, p < .001, h p2 = .39; audiovisual F(1, 29) = 18.71, p < .001, h p2 = .39) CONTROL-s > PWA (moderate aphasia) in all comparable modalities (visual-visual F(1, 29) = 69.53, p < .001, h p2 = .71; audiovisual-visual F(1, 29) = 13.56, p < .01, h p2 = .32)
Q2	Conversation	de Beer et al. (2017)	Percentage correctly guessed items for MCQ and OQ	Gesture + speech Speech only	G+S > S Z = −6.729, p = .00^a
	Conversation	Rose et al. (2017)	Total score on OQ or total number correct choices on MCQ for each producer	Gesture + speech Speech only Co-speech gesture	G+S > G G+S > S OQ: F(2, 132) = 91.84, p < 0.001, r = 0.64 S > G; MCQ: F(2, 132) = 12.60, p < .001, r = 0.04;
	Story retell	Hogrefe et al. (2013)	Mean communication success multiplied by mean confidence rating for each producer	Co-speech gesture Silently gesture Speech only	G < G-s t(15) = –3.40, p < .005 S ~ G-s (Spearman, rho = .55, p < .05)
	Scenario test	Mol et al. (2013)	Number correctly guessed responses divided by total responses given for each modality per individual	Gesture + speech Speech only	G+S > S *Severe aphasia: F(1, 28) = 12.54, p < .01, h p 2 = .31 ^Moderate aphasia: F(1, 28) = 11.12, p < .01, h p 2 = .28

Table 6. Relationship between measures of aphasia severity and communication success.

			Gesture + speech	Speech	Gesture	Gesture-silent restricted
Correlation	de Beer et al. (2017)	WAB-AQ	rs = −.055	rs = .146
	Rose et al. (2017)	WAB-AQ	OQ: rs = 0.57 MCQ: rs = 0.04	OQ: rs = 0.62 MCQ: rs = 0.64	OQ: rs = - 0.04 MCQ: rs = - 0.41
	Hogrefe et al. (2013)	AAT verbalcomprehension		rs = 0.85*	r = - 0.34	r = 0.25
	Hogrefe et al. (2017)	AAT naming & Token test			Naming: r = 0.34 Token Test: r = 0.11
Regression	Nispen et al. (2018)	AAT				Authors indicate severity was not a significant contributor in regression, however results not reported
ANOVA	Mol et al. (2013)	ANELT	F(1, 14) = 199.39, p < .001	F(1, 14) = 7.68, p < .02	F(1, 14) = 163.46, p < .001

Note. Bold text indicates significant correlation at p<0.05 level; * indicates significant at p<0.001 level. WAB-AQ = Western Aphasia Battery – Aphasia Quotient (Kertesz, 2007); AAT = Akense Aphasia Test (Graetz et al., 1991); ANELT = Amsterdam-Nijmegen Everyday Language Test; OQ = open ended question response format; MCQ = multiple choice question response format.

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