City Research Online City, University of London Institutional Repository Citation: Cocks, N., Dipper, L., Middleton, R. & Morgan, G. (2011). What can iconic gestures tell us about the language system? A case of conduction aphasia. International Journal of Language and Communcation Disorders, 46(4), pp. 423-436. doi: 10.3109/13682822.2010.520813 This is the unspecified version of the paper. This version of the publication may differ from the final published version. Permanent repository link: https://openaccess.city.ac.uk/id/eprint/1200/ Link to published version: https://doi.org/10.3109/13682822.2010.520813 Copyright: City Research Online aims to make research outputs of City, University of London available to a wider audience. Copyright and Moral Rights remain with the author(s) and/or copyright holders. URLs from City Research Online may be freely distributed and linked to. Reuse: Copies of full items can be used for personal research or study, educational, or not-for-profit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. City Research Online: http://openaccess.city.ac.uk/ publications@city.ac.uk Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 What can iconic gestures tell us about the language system? A case of conduction aphasia. Authors: Naomi Cocks, Lucy Dipper, Ruth Middleton and Gary Morgan Abstract Background: Speech and language therapists rarely analyse iconic gesture when assessing a client with aphasia, despite a growing body of research suggesting that language and gesture are part of either the same system (e.g. McNeill, 2000) or two highly integrated systems (e.g. Kita & Özyürek, 2003). This may be because there has been limited research which has systematically analysed iconic gesture production by people with aphasia. Aim: The aim of this study was to determine whether a participant with conduction aphasia’s iconic gesture production was able to provide information about her language system. Methods and Procedures: To do this we analysed the iconic gestures produced by a participant with conduction aphasia (LT) and five control participants produced during the retelling of a cartoon. In particular we compared the iconic gestures Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 produced during lexical retrieval difficulties (co-TOT 1 gestures) with the iconic gestures produced during fluent speech (co-speech gestures) Outcomes and Results: The study found that LT produced 57 co-speech gestures that were similar in form to the co-speech gestures produced by the control participants (M=34.2, SD= 22.2). LT also produced an additional eleven co-TOT gestures that were unlike her co-speech gestures and unlike the co-speech gestures produced by the control participants. While the co-speech gestures depicted events, the co-TOT gestures depicted ’things’ (e.g. objects and animals). Furthermore, all but one of the co-TOT gestures produced by LT was classified as a shape outline gesture, whereas co-speech gestures were rarely classified as shape outline gestures. LT also produced a new type of gesture that has not previously been described in the literature, a homophone gesture. This co-TOT homophone gesture depicted the homophone of the target word. The iconic gestures produced by LT suggest that she had an intact semantic system but had difficulties with phonological encoding, consistent with a diagnosis of conduction aphasia. This raises the possibility that iconic gesture production can provide evidence about the level of breakdown in the language system. Keywords: gesture, tip of the tongue, conduction aphasia, iconic gesture 1 We coin the term “co-TOT” for these gestures which occur alongside episodes of word-finding difficult where LT was in a ‘tip-of the tongue’ (or TOT) state. Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 What this paper adds? Very little is known about the semantic content of gestures produced by people with aphasia. This study describes the iconic gestures produced by a participant LT who has a diagnosis of conduction aphasia. Specifically the study looks at two types of gesture that she produces, gestures produced during fluent speech (co-speech iconic gestures) and gestures produced during word-finding difficulties (co-TOT gestures). The results indicated that the iconic gestures produced by the participant reflected the level of breakdown of her language system. It is concluded that a larger study exploring the gestures produced by participants with aphasia is required. Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 Main Text: Communication involves both speech and gesture. Psychologists and linguists have long debated the relationship between language and gesture (see McNeill, 2000 for debate) and have proposed a variety of different models of this relationship. While there is an extensive debate about the exact details of the relationship, what all researchers agree is that gesture and language are either part of one system or two highly integrated systems (Kita & Özyürek, 2003; McNeill, 1992). Yet despite this, there has been limited research which has examined the gestures produced by people with language impairments such as aphasia. Furthermore, the most regularly used aphasia assessments do not include or have limited assessment of gesture, suggesting that speech and language therapists rarely analyse gesture in any detail, except to simply indicate whether the person with aphasia can gesture or not. The analysis of gestures produced by a person with aphasia are likely to be informative about their language system, thus gesture analysis would be an important and useful addition to the speech and language therapist’s assessment battery. Understanding the relationship between gesture and language impairment in aphasia may also shed light on whether particular therapy approaches will be more effective than others. There is some evidence to suggest that using gesture when having wordfinding difficulties is a successful strategy for some people with aphasia (Lanyon & Rose, 2009). In a series of therapy studies, Rose and colleagues (see Rose, 2006 for review; Rose & Douglas, 2001; Rose & Douglas, 2006, 2008; Rose, Douglas, & Matyas, 2002; Rose & Sussmilch, 2008) have explored whether encouraging people with aphasia to gesture when having word-finding difficulties improves retrieval. Their findings suggest that this therapy approach was most successful for participants Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 with phonological difficulties rather than semantic difficulties. In the treatment protocol for these studies participants were encouraged to use iconic gesture when experiencing word-finding difficulties and when participants had difficulty producing a gesture the therapist produced a model for them. However, there was no analysis of what gestures people with aphasia used spontaneously during discourse pre-therapy. This information could tell us more about the person with aphasia’s impairment. There are a number of different types of gestures that are produced during communication (for a more detailed description of these gestures and how they are further classified see Appendix A). Each of these gesture types are linked to the language system in different ways and to different degrees. Analysing gesture production by people with aphasia is therefore not straightforward. Different types of gesture will be informative about different aspects of the communication system and therefore the types of gesture that are most suitable to be analysed will be dependent on the type and severity of aphasia. For example, there are gestures that occur in the absence of verbal language such as pantomimes and emblems. Assessing these gestures therefore would be suitable for determining whether gesture can be used as an alternative means of communication for a person with severe aphasia with limited verbal output (e.g. Helm-Estabrooks, Fitzpatrick, & Barresi, 1982). However, because they occur in the absence of verbal language, it is uncertain what an analysis of these types of gesture may tell us about the verbal language system. Equally they are unlikely to be of any use to people with mild-moderate aphasia whose communication is largely via verbal language. Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 Analysis of gestures that co-occur with verbal language may be more informative and useful when assessing people with mild-moderate aphasia. These gestures include beats and co-speech iconic gestures. Beats are rhythmical movements that consist of two parts, for example left/right or up/down movements and usually co-occur with stressed syllables (McNeill, 1992). They are therefore closely tied to the linguistic and affective prosody of the verbal language, and as such their analysis may be informative for types of aphasia in which prosody is impaired, such as Broca’s aphasia (Danly & Shapiro, 1982). Co-speech iconic gestures differ from beats in that they “bear a close formal relationship to the semantic content of speech” (p12, McNeill, 1992). For example, when describing a person throwing a ball, the speaker gestures the action of throwing a ball. It has been proposed that co-speech iconic gestures in particular, are closely integrated with the verbal language system (Kita & Özyürek, 2003) or are part of the same system (McNeill, 1992). This is confirmed in a number of studies which have analysed the co-speech iconic gestures produced by unimpaired speakers when describing a Sylvester and Tweety Bird Cartoon they have just watched (Kita, 2000; Kita & Özyürek, 2003; D. McNeill & Duncan, 2000). All researchers have found that the co-speech iconic gestures produced during the speakers’ description depict events that have occurred in the video and are directly related to the meaning depicted by the corresponding language. This direct relationship with language suggests that an analysis of iconic gestures in aphasia may provide useful information about the semantic systems of people with aphasia. There is limited research which has described iconic gesture production in aphasia and the majority has focused on the frequency of gesture production (Carlomagno & Cristilli, 2006; Cicone, Wapner, Foldi, Zurif, & Gardner, 1979; Feyereisen, 1983; Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 Hadar, Burstein, Krauss, & Soroker, 1998; Lanyon & Rose, 2009; Orgassa, 2005; Pedelty, 1987). The findings suggest that participants with word retrieval difficulties (both semantic and phonological) use more gesture than healthy participants or participants with conceptual difficulties (Hadar, Wenkert-Olenik, Krauss, & Soroker, 1998; Hadar & Yadlin-Gedassy, 1994) but those participants with phonological difficulties used less iconic gesture than those with semantic difficulties (Hadar, Wenkert-Olenik, Krauss, & Soroker, 1998). The frequency studies often report only limited information about the participants’ communication system, for example, in Orgassa (2005) the participant was described as anomic but it was not clear whether they had a semantic or phonemic impairment. The study therefore could not shed any light on whether gesture production was informative about the participants’ language system. Carlomagno and Cristilli (2006) made a significant contribution to this area by classifying the gestures produced by ten adults with aphasia (five Broca’s and five Wernicke’s) according to Beattie and Shovelton’s categorisation scheme (1999) which included semantic information, for example shape versus direction. However, like nearly all the previous research on gesture production in aphasia, they did not separate gestures that occurred during fluent versus non-fluent phases. Non-fluent speech is often an indication of language breakdown, and so an analysis of gestures produced at this point and a comparison with those produced during fluent speech is particularly important for participants with aphasia that have non-fluent and fluent phases of speech, such as conduction aphasia. While Hadar et al. (1998) reported that iconic gestures frequently occurred during hesitant speech for people with semantic difficulties, they did not provide descriptions about the gestures that occurred during Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 fluent versus non-fluent speech or remove these gestures from their overall frequency count. Only Orgassa (2005) and Lanyon and Rose (2009) examined the differences in frequency of gestures that occur during fluent speech compared to the frequency of gestures that occur during lexical retrieval difficulties or non-fluent speech. Their results differed slightly, while Lanyon and Rose (2009) found that more meaningladen gestures were produced during occurrences of word retrieval difficulty than fluent speech, Orgassa (2005) found that more pragmatic gestures were produced during word retrieval difficulties than fluent speech. This difference is probably due to individual variation in their participants, while Lanyon and Rose (2009) examined the gestures of 18 different participants with aphasia, with different aphasia sub-types, Orgassa (2005) examined the gestures of just one participant with aphasia. While the findings of both Orgassa (2005) and Lanyon and Rose make an important contribution to the literature, they both used very broad categories of gesture, for example, iconic gestures versus beats. A comparison of the form and semantic content of specifically iconic gestures produced during lexical retrieval difficulties as compared to those produced during fluent speech may be more informative about why they are having lexical retrieval difficulties and also provide information about the level of language breakdown, for example whether their language breakdown is at the semantic or the phonemic level. Gestures that occur during non-fluent speech, speech failure or tip of the tongue states (TOTs) are referred to as “Butterworths” (McNeill, 2000). In their papers on gesture Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 production in aphasia Orgassa (2005) and Lanyon and Rose (2009) both proposed that Butterworths should be split into two groups, those that are non-iconic which serve a pragmatic function of holding one’s turn and those that are iconic gestures which depict semantic information about the target word. We take-up Orgassa and Lanyon and Roses’ proposals in this paper and refer to the iconic gestures that occur during TOTs as co-TOT gestures. Co-TOT gestures are similar to co-speech gestures in that they are iconic and depict semantic information but they occur in non-fluent phases of speech, when the language system is breaking down. Co-TOT gestures have not previously been described in the literature in any detail and as already indicated they have often been grouped together with co-speech iconic gestures, so we know very little about what they may be able tell us about the language system and more specifically whether they can tell us anything different to co-speech iconic gestures. Perhaps the reason that very little attention has been given to gestures that occur during TOTs is because healthy speakers rarely experience them (Brown, 1991). Furthermore, when unimpaired speakers do experience TOTs it is often for proper nouns (Burke, MacKay, Worthley, & Wade, 1991), for example the name of a city or a person. Proper nouns are not easily gestured, for example it is difficult to gesture “London”. However, TOTs are frequently experienced by individuals with aphasia, specifically by those with disorders at the phonological encoding level such as conduction aphasia (Kohn, 1984) and are therefore of interest and importance in the field of aphasia research. Three different theories have been proposed about the purpose of these iconic gestures that are produced during TOTs and their relationship to the language system. Research which includes participants with aphasia may also Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 shed light on which of these theories more accurately depicts the relationship and purpose of these gestures. De Ruiter (2000) claimed that difficulties with lexical retrieval are recognised by the conceptualiser which then leads to more of the communicative intention being depicted in gesture than the language. Alternatively, some researchers have proposed that iconic gestures in general have a role in lexical retrieval (Butterworth & Hadar, 1989; Hadar & Butterworth, 1997; Krauss, Chen, & Gottesman, 2000). There has been some debate over what that role is with some proposing they have a role in lemma retrieval (Butterworth & Hadar, 1989) and others proposing that they help maintain semantic information while phonological forms are retrieved (Krauss, Chen, & Gottesman, 2000). Hadar et al. (1998) proposed that there may be two types of gesture, those that are evoked as part of the speech production in general and those, like co-TOT gestures that are evoked in order to overcome lexical retrieval difficulties. We believe that it is specifically co-TOT gestures that may have a role in lexical retrieval. Therefore the analysis of the form of co-TOT gestures produced by a participant who has phonological encoding difficulties, such as in conduction aphasia, may shed light on the debate of whether or not gesture has a role in lexical retrieval. Conduction aphasia is a specific type of aphasia which is characterised by frequent phonemic paraphasias, frequent conduit d’approche where repeated, phonologically related attempts are made at a target word (e.g. ‘the /ka/ the /ke/ the /pu/ um pissy er pussy cat’) , poor word or sentence repetition but good comprehension (Kohn, 1984). While participants with conduction aphasia generally have fluent speech, they Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 frequently have difficulty at the phonological encoding level of processing (Kohn, 1984). The function of this level of processing “is to retrieve or build a phonetic or articulatory plan for each lemma and for the utterance as a whole….The result of phonological encoding is a phonetic or articulatory plan. It is not yet overt speech; it is an internal representation of how the planned utterance should be articulated- a program for articulation” (p.12, Levelt, 1989). Participants with conduction aphasia therefore frequently experience TOTs associated with non-fluent phases of speech. Very few participants with conduction aphasia have been included in studies which have investigated the gestures spontaneously produced during discourse. One participant was included in the study by Lanyon and Rose (2009) and three participants were included in the study by Hadar et al. (1998). Hadar et al. (1998) found that the participants with conduction aphasia produced a similar number of iconic gestures and had a similar distribution of gesture types to control participants. Lanyon and Rose (2009) reported that spontaneously produced gestures did not aid the participant with conduction aphasia’s word-retrieval. The same participant was included in a therapy study by Rose, Douglas and Matyas (2002), who suggested that gesture may be a more effective strategy for cuing shorter and more phonetically simpler words, as there is less likely to be phonological encoding errors. However, the paper by Rose et al. (2002) was a therapy study, and thus the gestures were not spontaneously produced alongside discourse. While all these studies make an important contribution, none of them investigated the semantic content and form of the iconic gestures produced. In order to have a fuller understanding of whether gesture is a useful strategy for word-finding difficulties, it is necessary to explore the Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 gestures that are spontaneously produced during word-finding difficulties in greater detail. In summary, there are a range of different gesture types that have different functions and different relationships with language. Those that co-occur with verbal language or are produced during lexical retrieval difficulties may be particularly informative about the person with aphasia’s language system. However, there has been limited research which has explored the relationship between gesture and language production or described the semantic content of the gestures produced by people with aphasia and those that have, have often failed to differentiate between those gestures produced during fluent speech compared to those produced during lexical retrieval difficulties. The current study In the current study, we aimed to determine whether gesture production is informative about the language system of a person with mild-moderate aphasia. To do this we carried out an extensive assessment of a participant with conduction aphasia in order to develop a clear understanding of their language system and to confirm our initial diagnosis of conduction aphasia which was essential if we were to determine whether gesture production was informative about language production. A participant with conduction aphasia was chosen for this study because they experience phases of both fluent and non-fluent speech therefore comparisons could be made between co-TOT and co-speech iconic gestures. This comparison was essential for our aim of furthering our understanding of the relationship between iconic gesture and language and more specifically whether this relationship changes when there are lexical Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 retrieval difficulties. As conduction aphasia does not specifically affect syllable stress patterns (Odell, McNeil, Rosenbek, & Hunter, 1991), beats were not analysed. There is limited published research which has investigated the gestures spontaneously produced during discourse by a participant with conduction aphasia. However, despite the limited data available on participants with conduction aphasia, clear predictions could be made about the semantic form of LT’s co-TOT iconic and cospeech iconic gestures based on our understanding of her language system and what we already know about the function of these gestures. LT’s gestures were compared to five control participants. We hypothesised that in the fluent phases of speech where LT had no evident phonological encoding difficulties, she would produce cospeech gestures that were similar to the gestures produced by the control participants. However, because she frequently experienced phonological encoding difficulties, we predicted that in addition to these co-speech gestures, LT would also produce co-TOT gestures during these lexical retrieval difficulties. Because of the different function of co-TOT gestures and co-speech gesture, we hypothesised that these two types of gesture would differ in form and because of their different relationships with the language system they would also differ in the information that they revealed about the language system. Instead of representing the events of the narrative, co-TOT gestures would represent the labels for ‘things’ (e.g. objects and characters) that the speaker was attempting to retrieve. We also hypothesised that her gesture production would reflect the profile of her impairment. As the semantic system is intact in conduction aphasia, we hypothesised that LT would firstly produce co-TOT gestures and secondly that these would depict semantic information about the target word rather than semantically unrelated information. As co-TOT gestures have not been described in detail before in the literature, we were also interested in identifying the Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 features that were common to gestures classified as co-TOT and the success of these gestures as a strategy for a participant with conduction aphasia. Method Participants LT was a 44 year old right handed English female who had an intra-cranial haemorrhage 18 years previously. CT scans indicated damage to the left parietal lobe. Following the haemorrhage she had speech and language therapy for 6 months working on production of verbs, production of adjectives, reading and writing. Prior to this study, she had never received speech therapy that promoted gesture production, and she reported that she was actively discouraged from using gesture immediately post-stroke by hospital staff. Prior to her haemorrhage, she completed 15 years of education and began a career as an Actress. Following her haemorrhage she has had a range of occupations including modelling and charity work. Nine control participants were recruited; however four were excluded as they did not gesture during data collection. All participants had English as their first language and had no history of psychiatric disorder or neurological illness or injury. The average age of control participants was 60.2 years old (SD=8.53) and they had an average of 15 years of education (SD=0.89). Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 Assessment Data Motor Assessment LT’s upper limb movement was assessed using the ARAT (Lyle, 1981). She did not present with any upper limb weakness. The Limb Apraxia Screen by Poeck (1986), in which LT was required to gesture in response to command, was carried out and LT did not present with any signs of ideomotor apraxia. This was also confirmed in the New England Pantomime Production Test (Duffy & Duffy, 1984) in which she received a score within the normal range. LT also reported that she did not have any difficulties with limb movement. See Table One for exact scores. Gesture Comprehension The assessment from Cocks, Sautin, Kita, Morgan & Zlotowitz (2009) was used to assess LT’s gesture comprehension. This assesses comprehension of gesture in isolation and the integration of information from gesture produced alongside speech. In the gesture-in-isolation task LT was required to watch a video in which an actor produced gestures which depicted actions. She was then required to point to the picture that best represented the action. In the integration-task, gestures that depicted actions were produced alongside speech and LT was required to select from four pictures, one that was the target, one that was a verbal foil, one that was a gesture foil and an unrelated item. The results indicated that LT was able to comprehend gestures-in-isolation on 100% of occasions. She had some mild difficulties with gesture and speech integration but this fell within the normal range of the control participants. See Table One for exact scores. Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 Language Assessments The Pyramids and Palm Trees (Picture Version) (Howard & Patterson, 1992) was used to determine whether LT had intact semantic knowledge. Her score on this assessment was within the normal range suggesting that her semantic system was unimpaired. This was further confirmed by the absence of semantic paraphasias in her discourse. The Action and Object naming test (Druks, 2000) indicated that LT had impaired naming of both actions and objects, with actions being slightly worse. On the Western Aphasia Battery (Kertesz, 1982) LT obtained an aphasia quotient of 74.2 and a profile of scores consistent with moderate conduction aphasia. See Table One for exact scores. Her discourse was characterised by conduite d’approche (multiple attempts at the same word with phonological errors), phonemic paraphasias and frequent word-finding difficulties. LT did not present with any muscle weakness or speech behaviours that would be consistent with a diagnosis of verbal dysarthria. She also did not present with any disturbance of prosody or intrusion of schwa that would be consistent with a diagnosis of verbal dyspraxia (McNeil, Robin, & Schmidt, 2008). -----------------------------------Insert Table 1 here----------------------------------- Procedure Participants were invited to take part in a project titled “The Describing Events Project”. They were told that the aim of the project was to determine whether aphasia impacts on the way events are described. They were not told that the experimenters were interested in their gesture production until the end of their involvement in the project. Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 The Tweety Bird and Sylvester “Canary Row” cartoon was split into 8 segments. Participants watched one segment at a time and were instructed to ‘watch the cartoon very carefully as after you have watched it I will ask you to tell me as much as you can remember. When you are describing what you saw, imagine you are talking to someone who has never seen the cartoon before’. After each segment they described what they had seen. This description was videotaped. Analysis The narratives were transcribed verbatim. The videos of participants were segmented and coded using the gesture and sign language analysis programme ELAN (Wittenburg, Brugman, Russel, Klassmann, & Sloetjes, 2006). Tip of the tongue states (TOTs) were defined as a “point in the narrative that the participant is experiencing word-finding difficulties”. TOTs were usually midsentence and accompanied by a pause, a filler e.g. “um”, conduit d’approche or verbal indication of word-searching behaviour, for example “it’s the um what is it again the um I can’t remember”. Co-TOT gestures were those iconic gestures that appeared during a TOT. The completion of the co-TOT gesture was defined as either when the participant said the hypothesised target (a “resolved TOT”) or when the participant appeared to move on in the narrative or “give up” (an “unresolved TOT”). All coTOT gestures were described in detail and grouped according to similarities. All iconic gestures were coded as either “co-TOT gesture” or a co-speech gesture and/or “Other”. “Other” was defined as clearly representative (i.e. iconic) but unclear as to what the gesture represented or conveyed e.g. where the participant appeared to be holding an object but it was unclear what the object was. The gestures that were Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 only classified as “other” and not as a co-TOT gesture or a co-speech iconic gesture were removed from the analysis. There were 20 ‘other’ gestures removed from LT’s transcripts and there were 42 ‘other’ gestures removed from the control participants’ transcripts (M=8.44, SD=11.99). To determine whether the co-TOT gestures depicted semantic features that were different to co-speech iconic gestures, each of the classifiable co-speech iconic gestures and co-TOT gestures were coded using a similar coding system to Kita and Özyürek (2003). An additional gesture that was not reported by Kita and Özyürek (2003), the shape-outline gesture, had to be added to complete the coding. Müller (1998) classifies these as moulding (whole hand or hands used to depict the outline of an object) and tracing (single finger used to trace the outline of an object) gestures. We classified these gestures together as semantically they depict the same information; an outline of the shape of the object. Co-speech iconic gesture and co-TOT gestures were therefore classified using the following headings: a) Shape-Outline Gestures- These included moulding and tracing gestures. Moulding gestures convey the shape of the object by appearing to ‘mould’ the object by touch. For example, the hands outline the square shape of a picture frame. Tracing gestures convey the shape of the object by drawing an outline of the object with an index finger. The shape outline gesture is not conflated with manner or trajectory e.g. finger outlines a circular shape to represent cake. Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 b) Attribute (not shape outline)- Conveys an aspect of the shape or size of the object but is conflated with trajectory or manner e.g. flat palm indicates the flatness and size of a box and moves the hands as though placing the box on a surface. c) Manner- Conveys the way in which action is carried out e.g. palms facing towards body and circling round each other to represent rolling d) Path- Conveys the direction in which an object/person moves e.g. hand moves in diagonal direction across the body indicates an object moved down a hill. Additionally, in order to determine if there was a relationship between the type of semantic information conveyed by co-TOT gestures and the linguistic classification of the hypothesised target word, co-TOT gestures were classified as ‘noun’ ‘verb’ or ‘Other’. This classification was dependent on the linguistic classification of the hypothesised target word. For example, when LT was in a TOT state she says “yeah the um sss the um sss I can’t even remember what the name of it is, not the pussy cat the…oh god what’s it called…the um…oh god what is it in the actual cage now and again”, she is clearly trying to access the word ‘bird’. The gestures that were produced during this TOT state were therefore classified as ‘noun’. Inter-judge Agreement All narratives were watched by two judges independently. One judge coded all gestures (both co-speech iconic and co-TOT gestures). The other judge was required to identify only the clearly iconic co-TOT gestures (this excluded the gestures that were only classified as “other” described above). There were three gestures that one judge classified as co-speech iconic and one judge classified as co-TOT gestures. Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 These gestures occurred in the shortest duration of all co-TOT gestures and so it was difficult to determine whether this was a hesitation to find the word or simply a short pause for breath. It was subsequently agreed that they should be classified as cospeech gestures. 14% of the iconic gestures from all participants were coded by a 3rd judge with 87.5% agreement as to their classification. This particular percentage of samples was chosen as it was in line with methodologies used in previous research which has examined gesture production in discourse (e.g. Cocks, Hird, & Kirsner, 2007). Results LT produced a similar number of co-speech iconic gestures (57) to the control participants (M=34.2, SD= 22.2). As predicted, she had many more tip of the tongue states (23) compared with the control participants (M=0.4, SD=0.54). The two control participants who experienced one TOT state each, both produced co-TOT gestures during those states. While LT experienced a TOT state on 23 occasions, she only produced co-TOT gestures during eleven of these. Differences in form between Co-Speech and Co-TOT gestures In order to determine whether co-speech iconic gestures were informative about LT’s communication system we compared the information that was conveyed in LT’s cospeech iconic gestures with the information that was conveyed in the co-speech iconic gestures of the control participants. We then compared these co-speech iconic gestures to the co-TOT gestures in order to determine whether there were differences in form and content of these two gesture types. As the control participants only Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 produced two co-TOT gestures we anticipated that comparisons between co-TOT gestures produced by the control participants and LT, would not be particularly informative. The majority of co-speech iconic gestures produced by the control participants (M= 12.6, SD= 10.85) and LT (17) conveyed aspects of Path. Co-speech iconic gestures produced by the control participants were rarely classified as shape-outline gestures (M=2.5, SD=1.91). While they were produced with slightly higher frequency by LT (7) they were less frequent than gestures that depicted Path or Manner. Whereas, ten of the eleven co-TOT gestures produced by LT, and both the co-TOT gestures produced by the two control participants were classified as shape-outline or shapeoutline + manner gestures. The only co-TOT gesture that was not coded as a shape outline or a shape-outline + manner gesture was for the target ‘tram’. During this TOT, LT moved both hands forward with her palms facing each other. While both judges coded this as a path + manner gesture, it could however be argued that this too was a shape-outline gesture, outlining the shape of the tram and/or the track that it travels down. The only two gestures that depicted an aspect of manner (bowling ball and catapult) began as a shape-outline gesture. See supplementary material available in the online version of the journal for a more detailed description of these gestures. Please find this material with the direct link to the article at: http//www.informaworld.com/(DOI number). In addition, see Figure 1 for a full breakdown of how gestures were classified. A Fisher’s exact test indicated that LT’s co-TOT gestures were classified as having an element of shape-outline (those classified as shape-outline and shape-outline + manner) more often than her co-speech iconic gestures, p<.001. Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 Further analysis of the co-speech iconic shape-outline gestures produced by LT, revealed that more than half (4/7) occurred during speech difficulties, with two occurring during description of the same event. Interestingly, three of these were the items that the judges who identified TOTs disagreed on. Additionally, three shapeoutline co-speech iconic gestures were produced alongside “gear”; a semantically non-specific noun that may well have been produced because LT was unable to access a specific noun (such as ‘tools’ or ‘equipment’). Similarly, of the ten co-speech iconic shape-outline gestures produced by the control participants, two also occurred during difficulties with lexical retrieval (see Table 2 for details) and one was produced alongside a non-specific noun ‘thing’, also suggesting lexical retrieval difficulties. While neither judge classified these as TOTs, it could be argued that they were produced when participants had speech difficulties. For an exact breakdown of the way in which the co-speech iconic gestures and co-TOT gestures were classified please see Figure 1. In addition to the form of the co-speech and co-TOT iconic gestures, we were also interested in the language they co-occurred with (in the case of co-TOTs this would be the hypothesised target word). All of the eleven co-TOT gestures produced by LT and the two co-TOT gestures produced by the two control participants co-occurred with hypothesised nouns. ---------Insert Figure 1 about here------------ ---------Insert Table 2 about here------------ Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 Other Interesting Findings In the analysis of both the co-TOT and the co-speech iconic gestures a number of additional features were apparent, features that were informative about LT’s language system and the relationship between gesture and the language system. Co-TOT gestures that were classified as “Other” but became more specific Three of the co-TOT gestures (bird, bowling ball and catapult) began as non-specific holding gestures and then became more specific shape outline gestures. None of the co-speech gestures were classified as other and became more specific. See supplementary material available in the online version of the journal for a more detailed description of these gestures. Please find this material with the direct link to the article at: http//www.informaworld.com/(DOI number). Gestures that depicted movements or objects not in the Cartoon. The co-TOT gestures corresponding to four targets (bird, drainpipe, ring and bowling ball) appeared to contain movements or aspects of objects that were not in the cartoon. None of the co-speech iconic gestures conveyed aspects that were not in the cartoon. These co-TOT gestures are described in Table 3. -------------------------Insert Table 3 about here------------------------- The homophone gesture One co-TOT gesture that LT produced was particularly informative about her language system. This was a gesture that has not previously been described in the Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 literature. When trying to retrieve the word “ring” for the telephone bell, LT gestured a ring (item of jewellery). We referred to this gesture as the homophone gesture. This homophone gesture suggested she had even processed as far as the lexeme. Gestures that depicted information that was not conveyed verbally. An additional finding was that some co-speech gestures conveyed information that wasn’t conveyed verbally, for example, for the phrase produced verbally “hits him over the head” the gesture that occurred with this phrase added more information about the method of the hitting (Manner). Success of Gesture as a Strategy for Resolving TOTs There was no difference in the resolution of TOT states: 7/11 that co-occurred with gesture were resolved, whereas 9/12 not co-occurring were resolved (p>.05, Fisher’s exact test). Thus producing gesture did not appear to be a useful strategy for LT to resolve TOTs. Overall, there was no pattern for the types of gestures e.g. shape outline or manner used and whether the target was resolved. There was also no pattern for word frequency or phonetic complexity, however, all of the one syllable words that were accompanied with co-TOT gestures were resolved. For a full breakdown of tip of the tongue states that were resolved and the classification of their associated gestures see Table 4. -------------------------Insert Table 4 about here------------------------- Discussion Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 The main aim of this study was to determine whether an analysis of the semantic form of the iconic gesture produced by a participant with aphasia was informative about the impaired language system. We did this by analysing the iconic gestures produced by a participant with conduction aphasia (LT) and five control participants during fluent and non-fluent phases of speech. The results were as predicted. LT’s co-speech iconic gestures, which were produced during fluent speech, were similar in semantic form to the co-speech iconic gestures produced by the control participants. However, in addition to the co-speech iconic gestures produced by LT, she also produced 11 gestures during lexical retrieval difficulties (co-TOT gestures) which differed in form to the co-speech iconic gestures and were informative about her language system. The findings relating to co-speech iconic gestures indicate that LT’s co-speech iconic gestures were similar to healthy speakers’ co-speech iconic gestures. Previous research has found that the co-speech iconic gestures produced by healthy participants during the description of the Sylvester and Tweety Bird Canary Row cartoon, depict events (aspects of path + manner) and co-occur with verbs and verb phrases (Kita, 2000; Kita & Özyürek, 2003; McNeill & Duncan, 2000). This finding has been used to suggest that co-speech iconic gesture plays a role in packaging of conceptual information (Kita, 2000; Kita & Özyürek, 2003) and may arise along with speech from a single conceptual unit which McNeill and Duncan (2000) refer to as the Growth Point. The gestures produced by LT and the control participant often added more information about the cartoon, thus both co-speech iconic gesture and speech are used together to convey meaning. The observation that LT’s co-speech iconic gestures are similar to healthy speakers is consistent with her diagnosis of conduction aphasia, in that it suggests her semantic system is intact. Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 Where her gestures differed to the control participant was that in addition to 57 cospeech iconic gestures, LT produced eleven co-TOT gestures. These co-TOT gestures differed in form to the co-speech iconic gestures in that the majority were classified as shape-outline gestures where as co-speech iconic gestures were rarely classified as shape-outline gestures. Instead of depicting events, they represented ’things’ (characters and objects), and co-occurred when she was unable to access noun labels. In addition these co-TOT gestures sometimes depicted content that was not in the cartoon. Three co-TOT gestures evolved from having less detail to having more specific detail. These characteristics are not commonly associated with the reported co-speech iconic gestures produced by unimpaired speakers when describing the Sylvester and Tweety Bird Canary Row Cartoon and were not found in the cospeech iconic gestures produced by the participants in this study. Also, co-TOT gestures represented ’things’(e.g. cage) alongside speech exhibiting difficulty accessing nouns whereas the co-speech iconic gestures represented events (e.g. sneak through), alongside verb phrases. While co-speech iconic gestures tend to occur during fluent speech and have a communicative function, co-TOT gestures occur during non-fluent speech when an individual is having phonological encoding difficulties. The co-TOT gestures produced by LT therefore depicted the lexical items (or semantically or phonologically related items) that she was attempting to retrieve and not the events of the cartoon. As predicted these co-TOT gestures produced by LT reveal information about her communication system. Four of the co-TOT gestures produced by LT did not reflect what occurred in the cartoon. These included a gesture that depicted an individual Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 moving a cage, a gesture that depicted a drainpipe that was a different shape to the drainpipe in the cartoon, a gesture that depicted a homophone of the target ‘ring’ and finally a gesture that depicted the action of bowling. These gestures indicate that she had intact semantic knowledge about the target words, which is again consistent with a diagnosis of an intact semantic system but difficulties at the level of phonological encoding. One of the gestures (the homophone gesture) indicated that she had processed as far as the lexeme but was unable to encode that lexeme. These observations along with those made about her co-speech iconic gestures, suggest that the form of gestures reflects the level of breakdown of the language system. Some researchers have proposed that gestures may aid in lexical retrieval and there is some debate over the role that gesture plays in lexical retrieval. Butterworth and Hadar (1989) propose that gesture plays a role in lemma access. Whereas, Krauss et al. (2000) propose that gesture may help maintain semantic information about the target word in the mind while phonological forms are retrieved. The data from the current study lends support to Krauss’s version of the model. LT’s co-TOT gestures indicate she has intact semantic information about the target word suggesting access to the lemma. The homophone gesture indicates that LT even had information about the phonological form but had difficulties at the level of phonological encoding. This gesture therefore may have been produced in order to aid in phonological encoding of the lexeme. If this is the case, then the results are consistent with Krauss’s version of the model. Alternatively, De Ruiter (2000) proposed that when a TOT occurs the conceptualiser identifies that there is a problem and more of the communication intention is depicted Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 in the gesture than the language. This implies that the gestures that produced during TOTs would depict more information about the cartoon. Our results do not clearly support this proposal, as the gestures produced during the TOT state could not always be described as depicting more information about the cartoon. However, when LT had difficulty producing a word her gestures often depicted movements or objects that were not in the cartoon. Thus rather than more of the communicative intention being depicted in the gesture, the gestures provided information about her processing problem. Comparisons of success at retrieval between TOT states in which LT produced coTOT gestures and those that did not indicated that production of co-TOT gesture was not a particularly successful strategy for LT. In their study of gestures produced during discourse, Lanyon and Rose (2009) described a single case with a similar profile to LT, they also found that gesture did not aid lexical retrieval. In a therapy study using the same case, Rose et al. (2002) suggested that gesture may be a more effective strategy for cuing shorter and more phonetically simpler words, as there is less likely to be phonological encoding errors. Visual inspection of our data for coTOT gestures indicates that all of the attempts to retrieve one syllable words were resolved when accompanied by a gesture. However, it is important to note that as there were only five of these and that there were also a similar number of one syllable TOTs that were resolved and did not co-occur with gesture. This suggests that single syllable words were easier to retrieve and that gesture did not necessarily aid in the retrieval. However, with such small numbers the data should be interpreted with caution. Further research should use larger discourse sample to investigate whether Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 more TOTs are resolved if they are accompanied with co-TOT gestures and if this is affected by phonetic complexity. A reasonable question, given LT’s language profile, is why the majority of her TOTs were for noun targets, particularly given that the assessment results indicated she also had difficulty with retrieval of verbs. Previous research has found differences between noun and verb production by participants with aphasia in confrontation naming tasks compared to production in narrative tasks (Pashek & Tompkins, 2002). In confrontation naming tasks, where participants are required to label a picture with a specific noun or verb, people with aphasia have significant difficulties. In narrative or sentence construction tasks however, people with fluent aphasia, such as conduction aphasia, who have difficulty retrieving specific verbs, can avoid them and instead use semantically light verbs e.g. “go” (Brandt, Haendiges, Mitchum, & Sandson, 1997; Gordon, 2008). This means that, in spontaneous speech, people with fluent aphasia may not experience TOTs for verbs very often. We note that LT frequently used ‘light’ verbs in her Canary Row narrative, for example, to describe Sylvester pacing up and down thinking, she says “he’s going round and round thinking”. This could therefore account for the low frequency of tip of the tongue states for verbs. The observation that LT’s co-speech iconic gestures are not dissimilar to the control participants’ or the healthy speakers’ co-speech iconic gestures, again indicates that her semantic knowledge of these verbs is intact and that it is ‘lower’ level processing that is difficult. In some scenarios, a similar strategy to that applied to verbs could be used when experiencing difficulty accessing nouns. That is, pronouns could be used instead of Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 the specific noun. However, in narratives that include more than one character or object, as is the case with the Sylvester and Tweety Bird cartoon in this research, there is a need to differentiate the characters or objects in order for the narrative to make sense. LT therefore frequently attempted to retrieve the specific noun rather than use the pronoun alternative. This resulted in LT’s tip of the tongue states tending to occur more frequently for noun retrieval and subsequently her co-TOT gestures tended to depict objects. The observation that ten of her eleven co-TOT gestures were produced when trying to retrieve a noun, may also explain why LT’s co-TOT gestures nearly all were classified as shape-outline. There are two ways in which one can depict an object through gesture. One can either depict its function or depict its shape. While for some objects a function gesture may be easier than a shape gesture e.g. scissors, in this narrative the functions of the objects are not easily gestured e.g. drainpipe. This could explain why LT’s co-TOT gestures were shape-outline gestures. Alternatively, the form of the co-TOT gesture could reflect LT’s thinking process; when she described what she did during a tip of the tongue state, she said she focussed her thought on the image of the object. Therefore the co-TOT gestures she produced could reflect her focus on the physical form, rather than the function. Similarly, the finding that LT’s co-TOT gestures became more specific also could indicate that as she attempted to retrieve the target she became more and more focused on the physical attributes of the target. When after focussing on the physical attributes she was still unable to retrieve the word she focussed in on the function of the object, as was the case when trying to retrieve “bowling ball”. Previous research has indicated that the act of visualisation itself does not aid in lexical retrieval for people with Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 aphasia (Rose & Douglas, 2001). Rose and Douglas (2001) compared the naming abilities of participants with phonological difficulties as a result of aphasia using iconic gesture, visualisation of object, visualisation of using the object, pointing and cued articulation strategies. They found that only iconic gesture was an effective strategy to improve naming. So it is the act of gesturing that is important. However, our findings suggest that gesturing was not an effective strategy for LT. While gesturing did not appear to be an effective strategy for resolving LT’s tip of the tongue states, it may have increased the communicative value of her message. Research by Tompkins, Scharp and Marshall (1982; 2006) found that gesture produced by people with aphasia when having difficulties with lexical retrieval aided the listener in understanding the speaker’s message. While this was not directly measured in this study, this should be a topic of future research. This study describes the gestures produced by a participant with conduction aphasia and more specifically, two types of gesture, co-TOT gestures and co-speech iconic gestures. The study found that analysis of both types of gesture revealed information about the participant with aphasia’s communication system. LT’s co-speech iconic gestures were similar to the control participants and speakers presented in previous research, consistent with a profile of an intact semantic system. However, in addition to the co-speech iconic gestures LT also produced 11 iconic gestures alongside periods of word-finding difficulty (co-TOT gestures), which differed in form from the co-speech iconic gestures and conveyed additional information that was not in the cartoon. These gestures also were consistent with LT’s language impairment profile: that is, an intact semantic system with difficulties at the phonological encoding level Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 of processing. These finding suggests that analysis of gesture may be a useful method of diagnosing level of breakdown in aphasia. While the findings support Krauss’s version of the Lexical Retrieval Hypothesis, they provide a challenge to the assumptions made by both Krauss et al (2000) and Butterworth and Hadar (1989) that co-speech iconic gestures and co-TOT gestures are the same and support the approach adopted by McNeill (2000) and Kita (2000) who have treated co-TOT gestures and co-speech iconic gestures separately. We therefore propose that co-TOT gestures and co-speech iconic gestures have different roles and should therefore be considered separately in the evaluation of past research and in the planning of new research. The findings of this research are limited to one participant with a distinct profile of communication difficulties and the gestures were produced in only one type of discourse. However, the findings suggest that research into gesture production in aphasia may be useful clinically. Therefore future research should explore whether co-TOT and co-speech iconic gestures share similar features to those described in this paper when produced by a range of participants with and without aphasia in a variety of types of discourse. The use of gesture analysis as an assessment tool for participants with aphasia with a range of presentations should also be explored in future research. Pre-publication copy. Published in INT J LANG COMMUN DISORD, JULY–AUGUST 2011, VOL. 46, NO. 4, 423–436 References BRANDT, R. S., HAENDIGES, A. N., MITCHUM, C. C., & SANDSON, J. (1997). Verb retrieval in aphasia 2: Relationships to sentence processing. Brain and Language, 56, 107-137. BROWN, A. S. (1991). A review of the tip-of-the-tongue experience. Psychological Bulletin, 109(2), 204-223. BURKE, D. M., MACKAY, D. G., WORTHLEY, J. S., & WADE, E. (1991). On the tip of the tongue: What causes word finding failures in young and older adults. Journal of Memory and Language, 30, 542-579. 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Occur during word finding difficulties, can be iconic (co-TOTs) or non-iconic Are swift up and down movements that occur on stress syllables Iconic co-speech gestures co-occur with speech and “bear a close formal relationship to the semantic content of speech” (p12, McNeill, 1992). For example, when describing a person throwing a ball, the speaker gestures the action of throwing a ball. These can be further classified as Path, Manner, Attribute, Shape Outline or Other We are introducing this new terminology to classify iconic gesture that is produced during a tip of the tongue state, not during fluent speech, instead during hesitant speech or during a pause. For example, when trying to access the word ball the hands mould the shape of a ball. These can be further classified as Path, Manner, Attribute, Shape Outline or Other Indicates the direction in which an object moves. For example, the arm moves from left to right indicating the movement of an object. Indicates the method in which an action is carried out. For example, the right hand actions the process of moving a ball. Indicates an aspect of shape of an object but is not a shape outline gesture. For example, a flat hand indicating the flat side of a box. Either a moulding or tracing gesture that depicts the shape of an object. For example, both hands move in a circular movement to represent a circular cake. Unable to be classified as path, manner, attribute or shape outline but clearly iconic. Co-TOT Gesture Path Manner Attribute Shape outline Other Gesture production in a case of conduction aphasia 37 Table 1 LT’s Assessment Scores Assessment Subsection Scores Limb Apraxia Screen (Poeck, 1986) Meaningful Meaningless 10/10 10/10 ARAT Grasp Grip Pinch Gross Movement (for left and right upper limbs) 18/18 12/12 12/12 12/12 12/12 (Lyle, 1981) Pyramids and Palm Trees 49/52 (Howard & Patterson, 1992) Gesture Comprehension Cocks, Sautin, Kita, Morgan and In Isolation Integrated with Speech Zlotowitz (2009) 21/21 15/21 Pantomime Expression (Duffy & Duffy, 1984) 14.09/15 Gesture production in a case of conduction aphasia 38 Object and Action Naming Battery Action Naming Object Naming (Druks, 2000) 63% 85% Western Aphasia Battery Speech Comprehension Repetition Naming Aphasia (Kertesz, 1982) Fluency 9/10 7.7/10 7/10 3.4/10 Quotient 74.2/100 Gesture production in a case of conduction aphasia 39 100 90 80 70 Co-speech Controls Co-speech LT Co-TOT Controls Co-TOT LT 60 50 40 30 20 10 0 A M P SO M&SO M&A A&P M&P A, P & M Figure 1: The proportion of LT’s and the average proportion of the control participant’s co-speech iconic and co-TOT gestures classified as Attribute (A), Manner (M), Path (P), Shape Outline (SO), Manner + Shape Outline (M&SO), Manner + Attribute (M&A), Attribute + Path (A&P), Manner + Path (M&P) and Attribute, Manner + Path (A,P&M). The error bars represent the standard error of the mean for the control participants. Gesture production in a case of conduction aphasia 40 Table 2. Co-speech iconic gestures that were classified as shape outline but co-occur with questionable lexical retrieval difficulties Participant Co-occuring speech Description of Difficulty LT (LT19) “in the a bowling street into b In this example, LT was trying to describe the ball into the alley alley street um alley rolling into the bowling alley. The repeated attempts bowl oh ah oh ah ew the alley alley suggest she is having phonological encoding alley bally b whatever the alley”. difficulties (LT57) “on he’s his dror drawings”. The repeated attempts of ‘his’and then ‘drawing’ LT suggests she was having phonological encoding difficulties LT (LT31) “and finds the granny is in Two of these co-speech iconic shape outline gestures something, I can’t really remember”. during this description when LT was trying to describe Gesture production in a case of conduction aphasia 41 that the older woman character was in a bird cage. While she implies she is having memory difficulties at this point. It’s likely that was not a memory difficulty but also a word-finding difficulty with the word ‘cage’. C1 C1(6) ‘so he goes rolling down the When describing Sylvester who has swallowed a road with his um weight down by the bowling ball and is rolling down the street. The shape um cannonball inside him’ outline gesture was produced at the same time as filler suggesting an inability to clearly describe the situation with the vocabulary to hand. C2 C2(12) ‘the bird cage is a piece of When describing a cloth placed over a birdcage she has cloth’ used a grammatically incorrect statement. She either chose the wrong verb, so that although the syntax is appropriate “the cage is [something]” the semantics is Gesture production in a case of conduction aphasia 42 incorrect or she was aiming for another verb like ‘has’ and is missing the information that ‘has’ needs, that is the noun phrase and the prepositional phrase after it (e.g. [a piece of cloth] [on it]), so she may have misselected the verb and is also missing a prepositional phrase. This also suggests lexical retrieval difficulties. Gesture production in a case of conduction aphasia 43 Table 3 LT’s Co-TOT gestures that depicted movements or objects not in the cartoon Target Brief Description of Gesture The aspect of the gesture that isn’t depicted the cartoon Bird LT appears to move an object. In the cartoon the cage never moves from the windowsill. The size of the object is indicated by her hands. From the accompanying narrative context it is very likely that the object she appears to move is a bird cage. Drainpipe LT appears to outline the shape of a drainpipe. LT appears to gesture a drainpipe that is of a different shape to the drainpipe in Gesture production in a case of conduction aphasia 44 However, the shape outline is not standard, consisting as it does of the cartoon. two parts, an upward tall thin gesture, suggesting a pipe, and a square shape at the bottom, suggesting a drain cover. Ring LT gestures a ring (item of jewellery) whilst saying “ring” The entire gesture matches the (telephone bell) i.e. she gestures the homophone homophone of one of the lexical items in the accompanying speech “there was a ring up from the lobby”. Bowling Ball After accessing “bowling” LT outlines the shape of a bowling ball There is no action of bowling in the and then appears to carry out the action of bowling, and then cartoon. accesses “ball”. Gesture production in a case of conduction aphasia 45 Table 4 The success of the co-TOT gestures as a strategy to resolving tip of the tongue states Target Classification Resolved or Unresolved Bird Shape outline Resolved Drainpipe Shape outline Resolved Bowling Ball Shape outline Resolved Manner Catapult Shape outline Unresolved Manner Weight Shape outline Resolved Manner Telegraph Pole Shape outline Unresolved Rope Shape outline Resolved Tram Shape Resolved Gesture production in a case of conduction aphasia 46 Manner Suitcase (1) Shape outline Unresolved Manner Suitcase (2) Shape outline Unresolved Manner Ring Shape outline Resolved Gesture production in a case of conduction aphasia 47 Acknowledgements This research was funded by a City University London Pump-Priming Grant. The authors would like to thank Melanie Rowe and Jolene Lesneski for the help with data collection and analysis. They would also like to thank Jane Marshall and Nicola Botting for their helpful comments on earlier drafts of this paper.