This article explores the various ways in which aphasia rehabilitation might be improved through deliberate and purposeful pairing of speech-language therapy with physical therapy that targets – in particular – functional use of the hands and upper limbs. Rather than reporting on original research, the authors review the literature on studies, experiences, and observations of others regarding this topic. The goals of this review article are to assemble and systematize findings that may suggest new ways of combining speech-language-communication rehabilitation and upper limb and hand rehabilitation, in efforts to identify and characterize previously untapped rehabilitation synergies in individuals with cooccurring post-ictal aphasia and upper limb motor deficits.
To identify initial candidate articles, the authors conducted a PubMed literature search using multiple combinations of ‘Limb’, ‘Arm’, ‘Motor’, ‘Gesture’, ‘Speech’, ‘Language’, ‘Aphasia’, and similar terms. Those searches yielded altogether 652 articles for closer scrutiny. Of these, the authors identified 268 articles that addressed cortical and functional synergies between language and hand-arm or motor functioning across a wide range of disciplines, while excluding 384 as directed towards other aspects of language and motor rehabilitation. A majority of the 268 articles (139) focused in particular on the relationship between motor function and the processing and/or production of action verbs naming those motor functions (e.g., ‘touch’, ‘lift’, ‘turn’). Rather than exhaustively characterizing all the articles, this current review covers a representative selection of them.
Various conceptual points of departure inform discussions in the selected articles, leading to a mosaic of perspectives. Some, for example, proceed from the hypothesis that language evolved historically from the need for joint actions among early man, with language used to coordinate collaboration. Other articles are ontogenetically oriented, looking at language development in individual children as related to developments in manual praxis. Yet others examine the use of gesture and sign language in adults as combining language use and hand use. From the domain of formal aphasia interventions, Visual Action Therapy is brought into the discussion. In each instance, the authors suggest, brain imaging could broaden our understandings cerebral mechanisms underlying associations that are found.
The authors conclude with a list of recommended topics for further investigation. These range from studying natural histories of recoveries in the two modalities, to experimenting with differential effects on language of training dominant versus non-dominant limbs in rehabilitation. The concluding appeal of the authors is for researchers to acknowledge the potential value of studying hand/arm – language synergies via targeted and focused research.
For further reading: Susan Wortman-Jutt and Dylan Edwards. 2019. Poststroke aphasia rehabilitation: why all talk and no action? Neurorehabilitation and Neural Repair, 1–10. https://doi.org/10.1177/1545968319834901