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Gesture Training

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Gesture training is a valuable strategy used to compensate for decreased communication in dementia .  Gestures are nonverbal cues- body language- used to communicate something.  We use gestures all the time in our daily lives to emphasize spoken language.  Incorporating gestures into our therapeutic interventions is a grossly underused technique for improving communication for persons with Alzheimer’s.

Because aphasia and apraxia are two of the Big A’s in Alzheimer’s disease, verbal communication alone is not adequate to foster comprehension in someone with Alzheimer’s disease.  The words “stand up” spoken to someone with Alzheimer’s disease are rarely effective by themselves.  Coupling the words with the demonstrated action packs a bigger punch.  It is important to remember that aphasia is not just an inability to understand spoken language, it also includes written, diagrammed, and symbolic language use too.

Sometimes affirmation or positive feedback can only be relayed through gestures- like a “thumbs up” or an “ok” when a movement is performed correctly by a person with significant aphasia.

So what is gesture training?

Well it really depends on what field you’re working in.  Scientists train robots to use gestures.  Teachers instruct sign language gestures to hearing impaired kids.  Corporations teach “Gesture Training” as a component of cultural sensitivity  in the global marketplace.

For researchers working with the neurologically impaired, gesture training is broken down in specifics including transitive and intransitive gestures, pantomime, and imitation…. all in attempt to determine how to assess the degree of aphasia and/or apraxia, which centers of the brain are affected, the most effective techniques to improve comprehension, etc…

But for us, caregivers of patients with Alzheimer’s, gesture training is really the consistent use of body language specific to a certain task.  Two of the most functional areas of the brain- the centers not affected by Alzheimer’s until later in the disease- are the visual cortex and the motor cortex.  So it follows logic that we should work hard to build connections between those two areas.

A combined gesture with a motor behavior is easier to teach than a verbal command instructing a certain movement.

Over time, it is possible to instruct a gesture (usually a demonstration of the specific movement or task) and elicit the correct response with little to no verbal instruction.  Theoretically, you could get the person’s attention, make a toothbrushing gesture, demonstrate standing up, and wave the person toward the bathroom.  Those three gestures have more meaning for someone with aphasia than a wordy, three-step verbal command like, “Hi Mrs. Jones, stand up and let’s go into the bathroom and brush your teeth.”

You’ll get Mrs. Jones the job done more quickly if you use gestures instead of words.

Try it for yourself- but give several weeks consistent practice before deciding if it helps or not.

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Posture Recognition in Alzheimer’s Disease.  Maria Mozaz et al, published in Brain and Cognition 2006.http://www.sc.ehu.es/ptwgalam/art_completo/alzeimer.pdf

The transitive/intransitive gesture training method was investigated by Smania and colleagues 69in 22 individuals at least two months post onset of a left hemisphere stroke with subsequent ideomotor limb apraxia. Treatment focused on the training of transitive and intransitive gestures. Transitive gesture training consisted of three phases in which the individual was (1) shown use of common tools, (2) shown a static picture of a portion of the transitive gesture and asked to produce the pantomime, and (3) shown a picture of common tool and asked to produce the associated gesture. The intransitive gesture training also consisted of three phases in which the individual was (1) shown two pictures, one illustrating a context and the other showing related symbolic gesture, and asked to reproduce the gesture (2) shown the context picture alone, and asked to reproduce the gesture (3) shown a picture of a different but related contextual situation and asked to reproduce the gesture. Fifty-minute treatment sessions were administered three times per week for approximately 10 weeks, with the number of total treatment sessions ranging from 30-35. A control group was administered aphasia treatment only for a similar intensity and duration. Results indicated there was a difference between the two groups post-treatment, with the gesture training method resulting in improved performance on an IMA test (U=69.00, p= .016), a gesture comprehension test (U=64.00, p= .018) and an ADL questionnaire (U=53.50, p<.01). Importantly, patients and caregivers reported more independence in ADLs following treatment. Nine patients showed maintenance of gains at two months post treatment.

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