Effects of Gesture Plus Verbal Treatment (GVT) in Cantonese Speakers With Aphasia

Contrasting Effects of Verbal Treatment and Gesture Plus Verbal Treatment for Word Retrieval in Cantonese Speakers With Aphasia

This research aims to explore the relative efficacy of Verbal-only and GVT on naming difficulty in Cantonese-speaking people with aphasia (PWA).

The primary research question in this study is: "For Cantonese-speaking people with aphasia, what are the relative effects of verbal treatment compared to gesture plus verbal treatment (GVT) on verbal and gesture naming at different levels?"

People with aphasia will be engaged in a repeated measures experimental design. Participants will be engaged in two phases of training. In the first phase, participants will be assigned to receive verbal-only treatment. To minimize and prevent the carry-over effects caused by the first intervention, a one-month washout period will be implemented before the start of the second phase. After a washout period, participants will switch to GVT in the second phase.

Study Overview

• Status: Recruiting
• Conditions: Aphasia; Gestures
• Intervention / Treatment: Behavioral: Verbal treatment; Behavioral: Gesture plus verbal treatment

• Study Type: Interventional
• Enrollment (Estimated): 90
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Annie Zhiyao Hu; Phone Number: 852-6068-8312; Email: annie920@connect.hku.hk

Study Locations

• Hong Kong
  • Hong Kong, Hong Kong
    • Recruiting
    • The University of Hong Kong
    • Contact: Annie Zhiyao Hu; Phone Number: 852-6068-8312; Email: annie920@connect.hku.hk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Diagnosed with aphasia
• Demonstrate Word finding Difficulty (WFD)
• Able to repeat single words
• Normal (or corrected) vision and hearing
• Aphasia resulting from a unilateral left hemisphere stroke
• Premorbidly fluent in spoken Cantonese
• Without significant cognitive impairments
• Chronic aphasia resulting from a unilateral left hemisphere stroke

Exclusion Criteria:

• A history of other neurological disorders
• With the above moderate to severe or severe motor speech impairment
• With moderate to severe apraxia of speech
• With very mild or very severe aphasia

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Verbal-only; This is a within-subject comparison study where each participant receives both interventions sequentially. During the first phase, participants receive verbal-only therapy (VT). In the subsequent phase, they receive Gesture verbal treatment (GVT). The order of interventions is fixed, and each participant acts as their own control to compare the effects of the two interventions.	Behavioral: Verbal treatment; This study will involve the following naming interventions: 1) Semantic Features Analysis, 2) Modified Ortho-phonological cueing therapy and Phonological Component Analysis, and 3) Repetition with Cueing Hierarchy.
Active Comparator: Gesture plus Verbal; This is a within-subject comparison study where each participant receives both interventions sequentially. During the first phase, participants receive verbal-only therapy (VT). In the subsequent phase, they receive Gesture verbal treatment (GVT). The order of interventions is fixed, and each participant acts as their own control to compare the effects of the two interventions.	Behavioral: Gesture plus verbal treatment; This study will involve the following interventions: 1) Combined Semantic and Gesture treatment, 2) Combined Phonological and Gesture treatment, and 3) Combined Repetition and Gesture treatment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in the scores of the Naming Probes	The treatment effects on naming will be assessed through verbal naming and gesture production using the black and white drawing naming task. Responses will be counted as correct if they can be identified by the rater as the target word in verbal naming and convey the depicted concept through gesture production, even if the articulation or hand and arm movements are slightly distorted.	From enrollment to the end of treatment at 4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in the scores of the Cantonese Aphasia Battery	The Cantonese Aphasia Battery was conducted to evaluate improvements in various linguistic measures (e.g., question comprehension, step commands, repetition, etc.). The minimum and maximum values are 0 and 100, respectively, with higher scores indicating a better outcome.	From enrollment to the end of treatment at 4 weeks
Changes in the scores of the Comprehensive Aphasia Test	The Comprehensive Aphasia Test will be conducted to evaluate improvements in various cognitive and linguistic measures (e.g., semantic memory, word fluency, auditory comprehension, etc.). There are different subtests in the assessment, with a minimum value of 0, and maximum values ranging from 70 to 130, with higher scores indicating a better outcome.	From enrollment to the end of treatment at 4 weeks
Changes in the scores of the Cantonese Boston Naming Test	The Cantonese Boston Naming Test will be conducted to evaluate the generalization effects on naming ability. The minimum and maximum values are 0 and 30, respectively, with higher scores indicating a better outcome.	From enrollment to the end of treatment at 4 weeks
Changes in the number of main concepts and gestures in discourse production tasks	Discourse samples were collected from participants through various monologues. The discourse elicitation tasks included Main concept analysis, procedural (Ham and Egg Sandwich), narrative (Telling of the story "Tortoise and Hare"), and personal narrative (Sharing of an important event). This will help in assessing their word retrieval abilities at both the sentence and discourse levels, and their verbal and non-verbal communication skills in realistic contexts. Regarding discourse assessment, all samples will be video recorded using a camera. After that, the samples will undergo discourse analysis based on Chinese Linguistics Communication Measures, where conversational speech will be transcribed, and the linguistic index will be calculated and compared. Finally, the number of various types of gestures will also be computed and compared.	From enrollment to the end of treatment at 4 weeks
Changes in the scores of the Functional Communication questionnaire	Improvements in functional communication will be evaluated using the Functional Assessment of Communication Skills questionnaire. There are different subtests in the assessment, with minimum values of 0, and maximum values ranging from 35 to 147, with higher scores indicating a better outcome.	From enrollment to the end of treatment at 4 weeks

Collaborators and Investigators

• Sponsor: Hong Kong University
• Investigators: Study Chair: Anthony Pak Hin Professor Kong, The University of Hong Kong

Publications and helpful links

General Publications

• Kong, A. P.-H., Hu, A. Z., Wong, C. C.-T., & Wong, C. W.-Y. (2025). Effects of modified word and sentence level gesture plus verbal treatment (GVT) in Cantonese speakers with aphasia. Aphasiology, 1-32. https://doi.org/10.1080/02687038.2025.2540297
• Yiu, E. M-L. (1992). Linguistic assessment of Chinese-speaking aphasics: Development of a Cantonese aphasia battery. Journal of Neurolinguistics, 7(4), 379-424. https://doi.org/10.1016/0911-6044(92)90025-R
• Lau, S. W. -H. (2001). The Cantonese FACS feasibility with aphasic patients in Hong Kong. Unpublished bachelor dissertation, The University of Hong Kong, Hong Kong.
• Kong, A. P.-H., & Wang, C. (2016). Main concept analysis (MCA) for oral discourse production. In. Hong Kong: The Commercial Press H.K Ltd.
• Kong, A. P.-H., & Ng, C. Y.-T. (2022). Psycholinguistic Considerations for Adapting the Cantonese Version of Comprehensive Aphasia Test (Cant-CAT): A Feasibility Study. Perspectives of the ASHA Special Interest Groups, 7(4), 1211-1222. https://doi.org/doi:10.1044/2022_PERSP-22-00044
• Kong AP, Law SP. A linguistic communication measure for monitoring changes in Chinese aphasic narrative production. Clin Linguist Phon. 2009 Apr;23(4):255-69. doi: 10.1080/02699200802673234.
• Cheung RW, Cheung MC, Chan AS. Confrontation naming in Chinese patients with left, right or bilateral brain damage. J Int Neuropsychol Soc. 2004 Jan;10(1):46-53. doi: 10.1017/S1355617704101069.

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2025
• Primary Completion (Estimated): September 1, 2028
• Study Completion (Estimated): September 1, 2028

Study Registration Dates

• First Submitted: February 24, 2026
• First Submitted That Met QC Criteria: March 2, 2026
• First Posted (Actual): March 6, 2026

Study Record Updates

• Last Update Posted (Actual): March 11, 2026
• Last Update Submitted That Met QC Criteria: March 8, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Rehabilitation; Aphasia; Gesture
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Communication Disorders; Language Disorders; Speech Disorders; Pathological Conditions, Signs and Symptoms; Behavior; Signs and Symptoms; Communication; Nonverbal Communication; Kinesics; Aphasia; Gestures
• Other Study ID Numbers: EA240609

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: According to the consent form approved by HREC, any information obtained in this study will remain strictly confidential (except as required by relevant legal authorities), and will be used for research purposes and clinical education use only. Videos, verbatim transcripts, and data will be uploaded to TalkBank Consortium (talkbank.org), allowing authorized researchers and educators from other institutions to view, analyze, and compare the data.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No