Gestural Facilitation of Naming (GES)

What is GES?

Gestural Facilitation of Naming (GES) is a compensatory approach that focuses on improving word retrieval in patients with aphasia (Raymer, 2012). The goal of GES is to facilitate verbal naming by training the use of pantomime-style gestures. GES is based on research that shows language and action are very closely linked in the brain (Raymer, 2012). In patients with aphasia, the typical semantic-phonologic pathways involved in word retrieval may be damaged. This strategy aims to engage intact cognitive processes, such as gesture, to support impaired word retrieval and increase verbal expression (Raymer, 2012). GES also helps increase the use of gestures, providing the client with an additional communication strategy to supplement their natural speech.

Who should I use GES with?

This strategy is most frequently used with patients with Broca's aphasia, but it can be beneficial for any patient who demonstrates word-finding difficulties and is able to understand the gestural training component (Raymer, 2012). In order to learn the strategy, patients must also have relatively intact cognitive abilities.

As aphasia can often co-occur with limb apraxia, it is important to consider how this factor affects a patient's ability to produce gestures. Research has evaluated this relationship and found that GES can be effective in patients with limb apraxia. Results showed that even individuals with severe limb apraxia improved their ability to produce recognizable gestures (Raymer 2012).

What goals does GES address?

Improves word-retrieval and increases verbal expression
- Example: When presented with a gestural cue, the client will name ten common household objects with 80% accuracy across three sessions as measured by SLP data collection.
Increases use of gestures to supplement communication
- Example: The client will use gestural word-finding strategies during conversations to facilitate communication in 4 out of 5 opportunities across 3 communication partners as measured by self-monitoring.

Data Collection:

Any data collection system preferred by the clinician that can track:
- the client's ability to verbally name trained objects when given a gestural cue
- the client's ability to verbally name untrained objects when given a gestural cue (to assess generalization)
- the frequency and type of prompting needed for the client to successfully name the object

Guide to Intervention:

The clinician presents an image of a target action or object
The clinician models appropriate gesture and verbal form of target
The client attempts the gesture (the clinician may need to manipulate or guide the client’s limbs)
The client practices the verbal form of the target word with additional modelling and cues from the clinician as necessary
The client performs gesture and verbal target simultaneously 3 times
After a delay, the clinician asks the client to perform the gesture with the verbal target once more

From (Raymer, 2015)

Evidence-Based Practice

Functional neuroimaging studies have demonstrated a close connection between gestures and words (Raymer, 2012). The figure to the right represents the interaction between lexical and gestural processing mechanisms. GES is based on the principle that gesture may provide an alternative activation of lexical retrieval pathways (Raymer, 2012).

Several studies have demonstrated positive effects of gestural training in individuals with aphasia. In a 2012 study conducted by Raymer et al., researchers compared the effects of drill-based errorless naming therapy (ENT) and GES on word-retrieval in patients with aphasia. Results showed that both treatments led to improvements in naming measures and even patients who did not show improvement in their verbal skills demonstrated an increased use of gestures following GES (Raymer et al., 2012). However, additional studies have shown that patients who receive GES do not demonstrate generalization to untrained words (Rodriguez et al, 2006).

References

Gestural facilitation of naming (GES). Lingraphica. (2020, July 31). Retrieved December 17, 2022, from https://www.aphasia.com/aphasia-resource-library/aphasia-treatments/ges/#:~:text=Gestural%20Facilitation%20of%20Naming%20(GES,be%20linked%20with%20specific%20words.e with traumatic brain injury

Raymer, A.M., 2015. Clinical diagnosis and treatment of naming disorders. In: Hillis, A.E. ed. The handbook of adult language disorders. 2nd ed. Hove: Psychology Press, 161-185

Raymer, A. M., McHose, B., Smith, K. G., Iman, L., Ambrose, A., & Casselton, C. (2012). Contrasting effects of errorless naming treatment and gestural facilitation for word retrieval in aphasia. Neuropsychological Rehabilitation, 22(2), 235–266. https://doi.org/10.1080/09602011.2011.618306

Rodriguez, A. D., Raymer, A. M., & Gonzalez Rothi, L. J. (2006). Effects of gesture+verbal and semantic‐phonologic treatments for verb retrieval in aphasia. Aphasiology, 20(2-4), 286–297. https://doi.org/10.1080/02687030500474898

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