Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter Mouton January 7, 2021

Gesture, prosody and verbal content in non-fluent aphasic speech

  • Gaëlle Ferré EMAIL logo
From the journal Multimodal Communication


Non-fluent aphasia is characterized by frequent word search and a much slower speech rate than non-aphasic speech. For patients with this type of aphasia, communication with those around them is therefore made difficult and is often severely impaired. One of the therapeutic proposals to improve the quality of life of these patients is to re-educate them with more multimodal alternatives. This of course assumes that gestures represent possible alternative means of communication for patients, and that their gestures are not affected in the same way as their speech. This article therefore proposes to study the gestures of 4 aphasic people and to compare them to the gestures performed by non-aphasic people, but also to establish correspondences between those gestures, intonation contours and the way people with aphasia develop their discourse. Results show that although gesture rate is not different in the two groups of participants, the gesture-to-speech ratio is higher for people with aphasia (PWA) than for non-aphasic people (NAP). Considering the fact that PWA also gesture more than NAP during silent pauses, which are longer but not more frequent than in NAP’s speech, and the fact that their gestures coincide less often with a lexical word, we believe that PWA use their gestures as compensation strategies for deficient speech. Yet, their speech impairment is also reflected in their gesturing: more gestures are prepared but abandoned before the stroke in this group and pre-stroke holds are longer, which means that PWA hold their gestures in the hope that they will better coincide with the word they are supposed to accompany and which takes more time to be uttered than in non-pathological speech. Their gestures are also less linked to each other than in the NAP group which goes hand in hand with the fact that they tend to utter independent syntactic phrases with no cohesive marker between them. This is also reflected in their less frequent use of flat and rising tones in intonation, which generally indicate that two sentence parts are dependent one upon the other, as well as their less frequent use of gestures showing discourse organization. In terms of gesture types, the PWA in this study perform many rhythmic beats and rely much on conventional gestures to compensate for their speech impairment rather than on their own creativity. Globally, this means that if multimodal therapies may benefit PWA to improve their communication with other people, speech therapists nevertheless need to be aware that life-long habits of gesture-speech alignment and synchronization may not be so easy to overcome for patients.

Corresponding author: Gaëlle Ferré, English Department, Université de Poitiers UFR Lettres et langues, Poitiers, France, E-mail:


This research received no specific grant from any funding agency in the public, commercial or nonprofit sectors. I would therefore especially like to thank B. MacWhinney and D. Fromm for giving me access to AphasiaBank, as well as all the speakers who accepted to be recorded in this database. AphasiaBank provides valuable information on aphasic speech by making available to researchers multimodal recordings that are otherwise difficult to collect. The gesture annotations made for this particular study have been shared and are freely available on the AphasiaBank database. I am also grateful to two anonymous reviewers for their constructive comments on a previous version of this paper.


Table 3:

Number of gestures performed by the two groups of speakers.

AbortedBeatsDiscourseEmblemslconicsMetaphoricsPointingsWorld searchTOTAL
BROCA 1127156110143
BROCA 256022191582415168
TMC 115612212193235160
TMC 2223223004559
Control 109706211035
Control 2215280392172114
Control 309372537063
Control 402525251011179


Ahlsén, E. (1991). Body communication as compensation for speech in a Wernicke’s aphasic—a longitudinal study. J. Commun. Disord. 24: 1–12.10.1016/0021-9924(91)90029-ISearch in Google Scholar

Ahlsén, E. (2015). Gestures used in word search episodes – by persons with and without aphasia. In: Jokinen, K. and Vels, M. (Eds.). The 2nd European and the 5th Nordic symposium on multimodal communication. Tartu, Estonie, pp. 9–15.Search in Google Scholar

Akhavan, N., Göksun, T., and Nozari, N. (2018). Integrity and function of gestures in aphasia. Aphasiology 32: 1310–1335.10.1080/02687038.2017.1396573Search in Google Scholar

Bates, D., Maechler, M., Bolker, B., and Walker, S. (2014). Linear mixed-effects models using eigen and s4. Computer program: in Google Scholar

Beeke, S., Beckley, F., Johnson, F., Heilemann, C., Edwards, S., Maxim, J., and Best, W. (2015). Conversation focused aphasia therapy: investigating the adoption of strategies by people with agrammatism. Aphasiology 29: 355–377.10.1080/02687038.2014.881459Search in Google Scholar

Blom Johansson, M. (2012). Aphasia and communication in everyday life: experiences of persons with aphasia, significant others, and speech-language pathologists, Phd. Uppsala, Department of Public Health and Caring Sciences.Search in Google Scholar

Boersma, P. and Weenink, D. (2009). Praat: doing phonetics by computer (Version 5.1.05). Computer program: in Google Scholar

Cicone, M., Wapner, W., Foldi, N., Zurif, E., and Gardner, H. (1979). The relation between gesture and language in aphasic communication. Brain Lang. 8: 324–349.10.1016/0093-934X(79)90060-9Search in Google Scholar

Cocks, N., Dipper, L., Pritchard, M., and Morgan, G. (2013). The impact of impaired semantic knowledge on spontaneous iconic gesture production. Aphasiology 27: 1050–1069.10.1080/02687038.2013.770816Search in Google Scholar

Danly, M. and Shapiro, B. (1982). Speech prosody in Broca’s aphasia. Brain Lang. 16: 171–190.10.1016/0093-934X(82)90082-7Search in Google Scholar

De Beer, C., Carragher, M., van Nispen, K., Hogrefe, K., de Ruiter, J.P., and Rose, M.L. (2017). How much information do people with aphasia convey via gesture? Am. J. Speech Lang. Pathol. 26: 483–497.10.1044/2016_AJSLP-15-0027Search in Google Scholar

De Beer, C., de Ruiter, J.P., Hielscher-Fastabend, M., and Hogrefe, K. (2019). The production of gesture and speech by people with aphasia: influence of communicative constraints. J. Speech Lang. Hear. Res. 62: 4417–4432.10.1044/2019_JSLHR-L-19-0020Search in Google Scholar

De Beer, C., Hogrefe, K., Hielscher-Fastabend, M., and de Ruiter, J.P. (2020). Evaluating models of gesture and speech production for people with aphasia. Cognit. Sci. 44: e12890.10.31219/ in Google Scholar

De Ruiter, J.P. (2006). Can gesticulation help aphasic people speak, or rather, communicate? Int. J. Speech Lang. Pathol. 8: 124–127.10.1080/14417040600667285Search in Google Scholar

Dipper, L., Pritchard, M., Morgan, G., and Cocks, N. (2015). The language–gesture connection: evidence from aphasia. Clin. Linguist. Phon. 29: 748–763.10.3109/02699206.2015.1036462Search in Google Scholar

Ferré, G. (2011). Functions of three open-palm hand gestures. Multimodal Commun 1: 5–20.10.1515/mc-2012-0002Search in Google Scholar

Feyereisen, P. (1983). Manual activity during speaking in aphasic subjects. Int. J. Psychol. 18: 545–556.10.1080/00207598308247500Search in Google Scholar

Goldin-Meadow, S. (2007). Gesture with speech and without it. In: Duncan, S.D., Cassell, J., and Levy, E.T. (Eds.). Gesture and the dynamic dimension of language. Essays in honor of David McNeill. John Benjamins Publishing Company, Amsterdam, Philadelphia, pp. 31–49.10.1075/gs.1.05golSearch in Google Scholar

Goodwin, C. (1995). Co-constructing meaning in conversations with an aphasic man. Res. Lang. Soc. Interact. 28: 233–260.10.1207/s15327973rlsi2803_4Search in Google Scholar

Goodwin, C. (2000). Gesture, aphasia, and interaction. In: McNeill, D. (Ed.). Language and gesture. Cambridge University Press, Cambridge, pp. 84–98.10.1017/CBO9780511620850.006Search in Google Scholar

Graham, T.A. (1999). The role of gesture in children’s learning to count. J. Exp. Child Psychol. 74: 333–355.10.1006/jecp.1999.2520Search in Google Scholar

Hanlon, R.E., Brown, J.W., and Gerstman, L.J. (1990). Enhancement of naming in nonfluent aphasia through gesture. Brain Lang. 38: 298–314.10.1016/0093-934X(90)90116-XSearch in Google Scholar

Hogrefe, K., Ziegler, W., Weidinger, N., and Goldenberg, G. (2013). Gestural expression in narrations of aphasic speakers: redundant or complementary to the spoken expression? In: Proceedings of the Tilburg Gesture Research Meeting (TIGER). Tilburg University, The Netherlands, pp. 1–4. in Google Scholar

Kendon, A. (2004). Gesture. Visible Action as utterance. Cambridge University Press, Cambridge.10.1017/CBO9780511807572Search in Google Scholar

Kita, S. and Özyürek, A. (2003). What does cross-linguistic variation in semantic coordination of speech and gesture reveal?: evidence for an interface representation of spatial thinking and speaking. J. Mem. Lang. 48: 16–32.10.1016/S0749-596X(02)00505-3Search in Google Scholar

Kita, S. and Özyürek, A. (2007). How does spoken language shape iconic gestures? In: Duncan, S.D., Cassell, J., and Levy, E.T. (Eds.). Gesture and the dynamic dimension of language. Essays in honor of David McNeill. John Benjamins Publishing Company, Amsterdam/Philadelphia, pp. 67–73.10.1075/gs.1.07kitSearch in Google Scholar

Krahmer, E. and Swerts, M. (2007). The effects of visual beats on prosodic prominence: acoustic analyses, auditory perception and visual perception. J. Mem. Lang. 57: 396–414.10.1016/j.jml.2007.06.005Search in Google Scholar

Kroenke, K.-M., Kraft, I., Regenbrecht, F., and Obrig, H. (2013). Lexical learning in mild aphasia: gesture benefit depends on patholinguistic profile and lesion pattern. Cortex 49: 2637–2649.10.1016/j.cortex.2013.07.012Search in Google Scholar

Kurowski, K. and Blumstein, S.E. (2016). Phonetic basis of phonemic paraphasias in aphasia: evidence for cascading activation. Cortex 75: 193–203.10.1016/j.cortex.2015.12.005Search in Google Scholar

Louis, M. (2003). Étude longitudinale de la dysprosodie d’un cas d’Aphasie progressive primaire: analyse des variables temporelles, PhD Thesis. Université d’Aix en Provence, Aix en Provence.Search in Google Scholar

Macauley, B.L. and Handley, C.L. (2005). Gestures produced by patient with aphasia and ideomotor apraxia. Contemp. Issues Commun. Sci. Disord. 32: 30–37.10.1044/cicsd_32_S_30Search in Google Scholar

MacWhinney, B., Fromm, D., Forbes, M., and Holland, A. (2011). AphasiaBank: methods for studying discourse. Aphasiology 25: 1286–1307.10.1080/02687038.2011.589893Search in Google Scholar

Marshall, J., Best, W., Cocks, N., Cruice, M., Pring, T., Bulcock, G., Creek, G., Eales, N., Mummery, A.L., Matthews, N., et al.. (2012). Gesture and naming therapy for people with severe aphasia: a group study. J. Speech Lang. Hear. Res. 55: 726–738.10.1044/1092-4388(2011/11-0219)Search in Google Scholar

Mayberry, R.I. and Jaques, J. (2000). Gesture production during stuttered speech: insights into the nature of gesture-speech integration. In: McNeill, D. (Ed.). Language and gesture, language, culture & cognition. Cambridge University Press, Cambridge, pp. 199–214.10.1017/CBO9780511620850.013Search in Google Scholar

McNeill, D. (2005). Gesture and thought. University of Chicago Press, Chicago and London.10.7208/chicago/9780226514642.001.0001Search in Google Scholar

Mol, L., Krahmer, E., and van de Sandt-Koenderman, M. (2013). Gesturing by speakers with aphasia: how does it compare? J. Speech Hear. Res. 56: 1224–1236.10.1044/1092-4388(2012/11-0159)Search in Google Scholar

Mustafaoglu, R., Yildiz, A., and Bardak, A.N. (2017). Does speech disorder (aphasia) affect respiratory muscle strength in stroke? Eur. Respir. J. 50(Suppl 61), in Google Scholar

Nyström, M. (2006). Aphasia – an existential loneliness: a study on the loss of the world of symbols. Int. J. Qual. Stud. Health Well-Being 1: 38–49.10.1080/17482620500501883Search in Google Scholar

Orgassa, A. (2005). Co-speech gesture in anomic aphasia. Toegepaste Taalwet. Artikelen 73: 85–97.10.1075/ttwia.73.09orgSearch in Google Scholar

Preisig, B.C., Eggenberger, N., Zito, G., Vanbellingen, T., Schumacher, R., Hopfner, S., Nyffeler, T., Gutbrod, K., Annoni, J.M., Bohlhalter, S., et al.. (2015). Perception of co-speech gestures in aphasic patients: a visual exploration study during the observation of dyadic conversations. Cortex 64: 157–168.10.1016/j.cortex.2014.10.013Search in Google Scholar

Preisig, B.C., Eggenberger, N., Cazzoli, D., Nyffeler, T., Gutbrod, K., Annoni, J.M., Meichtry, J.R., Nef, T., and Müri, R.M. (2018). Multimodal communication in aphasia: perception and production of co-speech gestures during face-to-face conversation. Front. Hum. Neurosci. 12: 200.10.3389/fnhum.2018.00200Search in Google Scholar

Pritchard, M., Dipper, L., Morgan, G., and Cocks, N. (2015). Language and iconic gesture use in procedural discourse by speakers with aphasia. Aphasiology 29: 826–844.10.1080/02687038.2014.993912Search in Google Scholar

R Core Team. (2012). A language and environment for statistical computing. R foundation for statistical computing. Computer program: in Google Scholar

Rose, M.L., Mok, Z., Carragher, M., Katthagen, S., and Attard, M. (2015). Comparing multi-modality and constraint-induced treatment for aphasia: a preliminary investigation of generalisation to discourse. Aphasiology 30: 678–698.10.1080/02687038.2015.1100706Search in Google Scholar

Rose, M.L., Mok, Z., and Sekine, K. (2017). Communicative effectiveness of pantomime gesture in people with aphasia. Int. J. Lang. Commun. Disord. 52: 227–237.10.1111/1460-6984.12268Search in Google Scholar

Ruth-Hirrel, L., and Wilcox, S. (2018). Speech-gesture constructions in cognitive grammar: the case of beats and points. Cognit. Ling. 29: 453–493.10.1515/cog-2017-0116Search in Google Scholar

Sacks, H., Schegloff, E., and Jefferson, G. (1974). A simplest systematics for the organization of turn-taking for conversation. Language 50/4: 696–735.10.1353/lan.1974.0010Search in Google Scholar

Schlaug, G., Norton, A., Marchina, S., Zipse, L. and Wan, C.Y. (2010). From singing to speaking: facilitating recovery from nonfluent aphasia. Future Neurol. 5: 657–665.10.2217/fnl.10.44Search in Google Scholar

Sekine, K., Rose, M.L., Foster, A.M., Attard, M.C., and Lanyon, L.E. (2013). Gesture production patterns in aphasic discourse: in-depth description and preliminary predictions. Aphasiology 27: 1031–1049.10.1080/02687038.2013.803017Search in Google Scholar

Shafi, N. and Carozza, L. (2011). Poetry and aphasia: a clinical outlook. J. Poetry Ther. 24: 255–259.10.1080/08893675.2011.625208Search in Google Scholar

Shattuck-Hufnagel, S. and Ren, A. (2018). The prosodic characteristics of non-referential co-speech gestures in a sample of academic-lecture-style speech. Front. Psychol. 9: 1–13.10.3389/fpsyg.2018.01514Search in Google Scholar

Sihvonen, A.J., Leo, V., Ripollés, P., Lehtovaara, T., Ylönen, A., Rajanaro, P., Laitinen, S., Forsblom, A., Saunavaara, J., Autti, T., et al. (2020). Vocal music enhances memory and language recovery after stroke: pooled results from two RCTs. Ann. Clin. Transl. Neurol. 7: 2272–2287.10.1002/acn3.51217Search in Google Scholar

Sloetjes, H. and Wittenburg, P. (2008). Annotation by category – ELAN and ISO DCR. In: Proceedings of the 6th International conference on language resources and evaluation (LREC 2008). Marrakech, Marocco.Search in Google Scholar

Smith, L. (1987). Fluency and severity of aphasia and nonverbal competency. Aphasiology 1: 291–295.10.1080/02687038708248849Search in Google Scholar

Swerts, M. (1998). Filled pauses as markers of discourse structure. J. Pragmat. 30: 485–496.10.1109/ICSLP.1996.607780Search in Google Scholar

Tuller, B. (1984). On categorizing aphasic speech errors. Neuropsychologia 22: 547–557.10.1016/0028-3932(84)90019-8Search in Google Scholar

Van Nispen, K. (2016). What can people with aphasia communicate with their hands? A study of representation techniques in pantomime and co-speech gesture, PhD Thesis. Tilburg, Tilburg University.Search in Google Scholar

Wells, J.C. (1997). SAMPA computer readable phonetic alphabet. In: Gibbon, D., Moore, R., and Winski, R. (Eds.). Handbook of standards and resources for spoken language systems. Mouton de Gruyter, Berlin and New York.Search in Google Scholar

Wells, J.C. (2006). English intonation. An introduction. Cambridge University Press, Cambridge.Search in Google Scholar

Received: 2020-05-20
Accepted: 2020-12-16
Published Online: 2021-01-07

© 2020 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 1.12.2023 from
Scroll to top button