Isobel Chick was awarded a Brain Research UK PhD studentship in 2021 to enable her to pursue research into non-verbal aspects of communication in people with aphasia following stroke.
Isobel is a speech and language therapist who knows first-hand how debilitating speech and language difficulties can be, having previously worked with adults with acquired neurological conditions such as stroke and traumatic brain injury. During her PhD she worked with supervisors Professor Gabriella Vigliocco and Professor Jeremy Skipper to advance understanding of how people with aphasia communicate, and to develop new, evidence-based interventions to improve the lives of people with aphasia.
Isobel was awarded her PhD in October 2025, and is now the Adult Speech and Language Therapy Lead at University Hospitals Coventry and Warwickshire (UHCW) NHS Trust.
Aphasia – an acquired communication disorder – is the second most common major impairment after stroke, affecting an estimated 350,000 people in the UK. It is a severely disabling disorder, causing profound frustration for those affected, and often leading to social withdrawal and depression. Many people with aphasia are unable to return to work, and relationships can suffer. As the population ages, aphasia prevalence is expected to increase, so effective rehabilitation is a healthcare priority.
Communication is multimodal – that is, it includes both speech and visual aspects, such as gestures, mouth-movements and eye-gaze. Previous research has shown that when young children see gestures alongside speech, it helps them understand and learn words more easily. However, research into aphasia has usually focused almost entirely on speech, with the visual aspects of communication receiving little attention.
In her PhD, Isobel explored how one specific visual aspect of communication – gestures – are affected in aphasia. Since speech comprehension and word-finding difficulties are almost universal in people with aphasia, she explored whether seeing and using gestures could help support language rehabilitation in people with aphasia too. She also explored whether certain people with aphasia benefit more from seeing and using gestures than others, and if so, why that might be. Finally, she explored these questions in as lifelike a way as possible – through real conversations.
To explore the role of gestures in aphasia, Isobel completed four inter-linked research studies.
First, she explored whether seeing and using gestures helped people with aphasia (PWA) to understand and use single words during conversations. She found that when PWA saw gestures it helped them to understand single words, but only if they were able to draw meaning from the gestures. PWA who could not do this – a condition known as ‘ideational apraxia’, which often occurs alongside aphasia – did not benefit from seeing gestures. She found that using gestures generally did not help PWA to produce words more easily, but seeing gestures did help certain PWA produce words – specifically, PWA with poorer working memory. This may be because seeing gestures made the words more distinctive, which held them in memory for longer.
Second, Isobel explored whether seeing and using gestures helped PWA understand longer phrases in conversations. She found that PWA with poorer visual attention abilities did not find gestures helpful for understanding, which may be because they struggled to retain visual information encoded in gestures long enough to integrate it with speech.
Third, because conversations always include at least two people, Isobel also wanted to explore whether the gestures used by PWA helped other people to understand them. She videoed PWA describing everyday objects and actions: in half the videos the PWA used gestures, and in half they did not. Isobel then asked neurologically healthy adults to watch the videos and guess what each PWA was describing. She found that neurologically healthy adults rated the descriptions easier to understand when PWA used gestures, but the effect was moderated by whether PWA had ‘ideomotor apraxia’, a condition which affects planning and production of skilled motor movements. PWA with more severe ideomotor apraxia made gestures which were less intelligible, which did not help watchers understand the descriptions.
Finally, Isobel wanted to explore whether combining gestures with speech in a therapy context could help PWA to relearn words. She ran an intensive online therapy programme with four PWA with significant word-finding difficulties to test this: she presented half the words with gestures, and half without. What she found was that gestures did support word relearning, but only if they were ‘transparent’, or obviously visually closely related in meaning to the words.
Taken together, the four studies in Isobel’s PhD highlight how important it is for clinicians to consider interactions between communication and other cognitive systems when planning aphasia therapy. Memory, attention and limb apraxia severity all impacted whether gestures supported speech comprehension and production in people with aphasia, along with features of the gestures themselves. These studies clearly show that one size does not fit all – especially in rehabilitation, and Isobel’s work has identified key cognitive factors that clinicians should consider when planning and delivering aphasia therapy.
Isobel’s results also shed light on wider theoretical debates on speech-gesture integration, particularly in terms of when and how gestures and speech interact in the process of communication.
Fisher E, Chick I, Fossey J, Spector A. Barriers and Facilitators to Implementing Cognitive Stimulation and Reminiscence Therapy for Dementia in Care Homes: Systematic Review. Int J Geriatr Psychiatry. 2025 Jul;40(7):e70124. PMID: 40650918; PMCID: PMC12255387. https://doi.org/10.1002/gps.70124
Chick I, Garrard P, Buxbaum L, Vigliocco G. (2023). Co-speech Gesture Production in Spoken Discourse Among Speakers with Acquired Language Disorders. Spoken Discourse Impairments in the Neurogenic Populations - A State-of-the-Art, Contemporary Approach (pp. 133-150). Springer International Publishing. https://doi.org/10.1007/978-3-031-45190-4_10
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