Multimodal Comprehension in Left Hemisphere Stroke Patients
Hand gestures, imagistically related to the content of speech, are ubiquitous in face-to-face communication. In the first study with people with aphasia (PWA) investigating speech-gesture processing in the brain using lesion-symptom mapping, we investigated the brain regions as well as the lexical-semantic and gesture recognition abilities associated with benefits and costs of multimodal speech-gesture input. Twenty-nine PWA and 16 matched controls were shown a picture of an object/action and then a video-clip of a speaker producing speech-gesture pairs (congruent/incongruent) or only speaking or gesturing. Their task was to indicate, in different blocks, whether the picture and the word matched (Speech task), or whether the picture and the gesture matched (Gesture task). Multivariate lesion analysis with Support Vector Regression Lesion Symptom Mapping (SVR-LSM) showed that benefit for congruent speech-gesture was associated with 1) lesioned voxels in anterior fronto-temporal regions including inferior frontal gyrus (IFG), and sparing of posterior temporal cortex and lateral temporal-occipital regions (pTC/LTO) for the Speech task, and 2) conversely, lesions to pTC/LTO and sparing of anterior regions for the Gesture task. The two tasks did not share overlapping voxels. Costs from incongruent speech-gesture pairings were associated with lesioned voxels in these same anterior (for the Speech task) and posterior (for the Gesture task) regions, but crucially, also shared voxels in superior and middle temporal gyri, including the anterior temporal lobe. These results suggest that IFG and pTC/LTO contribute to extracting semantic information from speech or gesture respectively; however, they are not causally involved in integrating information from the two modalities. In contrast, regions in anterior STG/MTG are associated with performance in both tasks and may thus be critical to speech-gesture integration. These conclusions are further supported by associations between benefits/costs specific to each task and performance in tests assessing lexical-semantic processing and gesture recognition.