Charlie Chaplin and gesture training in severe aphasia: a randomized double-blind single-case experimental design

Abstract Background. Aphasia following a stroke is a frequent and disabling condition that decreases quality of life. The use of gesture has been proposed as a way to enhance aphasia recovery. Objective. We aimed to explore whether 2 types of gesture interventions could improve communication in individuals with severe aphasia. Methods. This was a pilot study performed at home in routine care by an outreach team. The study had a controlled double-blind single-case experimental design (SCED): a controlled multiple baseline design across 3 participants and 2 behaviors (gesture and naming). Three male patients with stroke-induced severe chronic aphasia, non-functional perseverative speech and severe associated impairments underwent a passive gesture intervention, in which participants watched movies selected for their intensive use of gesture, and an active gesture intervention, in which they actively practiced gestures by using Visual Action Therapy. The main outcome measures were naming score, gesture score and non-verbal subscale score of the Lillois Test of Communication, with 3-month follow-up. Results. In all 3 participants, gesture interventions improved the ability to gesture a list of words (Tau-U = 0.38-0.67 for combined gesture intervention effect) and increased non-verbal communication activity. Benefits were maintained at 3-month follow-up. Conclusions. Mute films that use intensive non-verbal communication may be a useful add-on to speech therapy for individuals with aphasia. Improving naming in severe and chronic aphasia may not be feasible, and more effort could be devoted to improving gesture-based and non-verbal communication.