Nonsymbolic movement training to improve sentence generation in transcortical motor aphasia: A case study

Abstract

Background: Nonfluent verbal production in individuals with transcortical motor aphasia (TMA) relates primarily to impaired initiation of verbalisation. Luria (1973) proposed the notion of gestural reorganisation, limb movements used to provoke verbalisations, as a means to improve verbal initiation in aphasia. In particular, movements performed with the left hand in left space may engage right frontal mechanisms to enhance verbal initiation (Crosson, Singletary, Richards, Koehler, & Rothi, 2000). However, little evidence is available as to the effects of this type of treatment for nonfluent verbal production in TMA. Aims: We administered a treatment in which we incorporated nonsymbolic limb movements during production of sentences and evaluated the effects on verbal fluency in our participant, MP, who had TMA. Methods & Procedures: We used a single-participant experimental treatment design across behaviours. During training, MP tapped with his left hand in left space as he practised production of sentences for polysemous words (e.g., bank: money, river). In daily probes, we measured percent correct sentences generated and time to produce correct sentences for trained and untrained polysemous words, as well as number of words generated per minute in a control letter category fluency task. Outcomes & Results: Sentence-generation accuracy improved in two trained sets and one untrained set when movement was included during treatment. Little change was evident in the control letter category fluency task. Following training, MP produced increased numbers of words and well-formed utterances in connected speech samples as well. Conclusions: These findings suggest that movement training had some benefit for MP's sentence generation, perhaps due to recruitment of alternative frontal regions to enhance verbal initiation and fluency. Replication is needed with similar subjects who undergo treatment in conjunction with functional neuroimaging to evaluate this possibility.