Nonverbal communication remains untouched: No beneficial effect of symptomatic improvement on poor gesture performance in schizophrenia

Hypoconnectivity networks in schizophrenia patients: A voxel-wise meta-analysis of Rs-fMRI

In recent years several meta-analyses regarding resting-state functional connectivity in patients with schizophrenia have been published. The authors have used different data analysis techniques: regional homogeneity, seed-based data analysis, independent component analysis, and amplitude of low frequencies. Hence, we aim to perform a meta-analysis to identify connectivity networks with different activation patterns between people diagnosed with schizophrenia and healthy controls using voxel-wise analysis.

METHOD

We collected primary studies exploring whole brain connectivity by functional magnetic resonance imaging at rest in patients with schizophrenia compared with healthy controls. We identified 25 studies included high-quality studies that included 1285 patients with schizophrenia and 1279 healthy controls.

RESULTS

The results indicate hypoactivation in the right precentral gyrus and the left superior temporal gyrus of patients with schizophrenia compared with healthy controls.

CONCLUSIONS

These regions have been linked with some clinical symptoms usually present in Plea with schizophrenia, such as auditory verbal hallucinations, formal thought disorder, and the comprehension and production of gestures.

Using virtual reality to assess gesture performance deficits in schizophrenia patients

Introduction

Gesture performance deficits are prevalent in schizophrenia patients and are strongly associated with poor social communication skills and community functioning, affecting their overall quality of life. Currently, video-recording technology is widely used in clinical settings to assess gesture production deficits in schizophrenia patients. Nevertheless, the subjective evaluation of video-recordings can encumber task assessment. The present study will aim to use virtual reality to examine its potential use as an alternative tool to objectively measure gesture performance accuracy in schizophrenia patients and healthy controls.

Methods

Gesture performance in the virtual reality setting will be based on the well-established Test of Upper Limb Apraxia. Participants will be immersed in a virtual environment where they will experience themselves being embodied in a collocated virtual body seen from a first-person perspective. Motion trackers will be placed on participants' hands and elbows to track upper body movements in real-time, and to record gesture movement for later analysis. Participants will see a virtual agent sitting across from them, with a virtual table in between. The agent will perform various types of gestures and the participants' task will be to imitate those gestures as accurately as possible. Measurements from the tracking devices will be stored and analyzed to address gesture performance accuracy across groups.

Discussion

This study aims to provide objective measurements of gesture performance accuracy in schizophrenia patients. If successful, the results will provide new knowledge to the gesture literature and offer the potential for novel therapeutic interventions using virtual reality technologies. Such interventions can improve gesturing and thus advance social communication skills in schizophrenia patients.

Gesticulation in individuals with at risk mental states for psychosis

Nonverbal communication (NVC) is a complex behavior that involves different modalities that are impaired in the schizophrenia spectrum, including gesticulation. However, there are few studies that evaluate it in individuals with at-risk mental states (ARMS) for psychosis, mostly in developed countries. Given our prior findings of reduced movement during speech seen in Brazilian individuals with ARMS, we now aim to determine if this can be accounted for by reduced gesticulation behavior. Fifty-six medication-naïve ARMS and 64 healthy controls were filmed during speech tasks. The frequency of specifically coded gestures across four categories (and self-stimulatory behaviors) were compared between groups and tested for correlations with prodromal symptoms of the Structured Interview for Prodromal Syndromes (SIPS) and with the variables previously published. ARMS individuals showed a reduction in one gesture category, but it did not survive Bonferroni's correction. Gesture frequency was negatively correlated with prodromal symptoms and positively correlated with the variables of the amount of movement previously analyzed. The lack of significant differences between ARMS and control contradicts literature findings in other cultural context, in which a reduction is usually seen in at-risk individuals. However, gesture frequency might be a visual proxy of prodromal symptoms, and of other movement abnormalities. Results show the importance of analyzing NVC in ARMS and of considering different cultural and sociodemographic contexts in the search for markers of these states.

Gesture-speech synchrony in schizophrenia: A pilot study using a kinematic-acoustic analysis

Severe impairment of social functioning is the core feature of schizophrenia that persists despite treatment, and contributes to chronic functional disability. Abnormal non-verbal behaviors have been reported during interpersonal interactions but the temporal coordination of co-speech gestures with language abilities have been poorly studied to date in this pathology. Using the dynamical systems framework, the goal of the current study was to investigate whether gestures and speech synchrony is impaired in schizophrenia, exploring a new approach to report communicational skill disorders. Performing the first continuous kinematic-acoustic analysis in individuals with schizophrenia, we examined gesture-speech synchrony in solo spontaneous speech and in sensorimotor synchronization task. The experimental group consisted of twenty-eight participants with a diagnosis of schizophrenia and the control group consisted of twenty-four healthy participants age-gender-education matched. The results showed that spontaneous gesture-speech synchrony was preserved while intentional finger tapping-speech synchrony was impaired. In sensorimotor synchronization task, the schizophrenia group displayed greater asynchronies between finger tapping and syllable uttering and lower stability of coordination patterns. These findings suggest a specific deficit in time delay of information circulation and processing, especially in explicit functions. Thus, investigating intrapersonal coordination in schizophrenia may constitute a promising window into brain/behavior dynamic relationship.

Multimodal speech-gesture training in patients with schizophrenia spectrum disorder: Effects on quality of life and neural processing

Dysfunctional social communication is one of the most stable characteristics in patients with schizophrenia spectrum disorder (SSD) that severely affects quality of life. Interpreting abstract speech and integrating nonverbal information is particularly affected. Considering the difficulty to treat communication dysfunctions with usual intervention, we investigated the possibility to apply a multimodal speech-gesture (MSG) training. In the MSG training, we offered 8 sessions (60 min each) including perceptive and expressive tasks as well as meta-learning elements and transfer exercises to 29 patients with SSD. In a within-group crossover design, patients were randomized to a TAU-first (treatment as usual first, then MSG training) group (N = 20) or a MSG-first (MSG training first, then TAU only) group (N = 9), and were compared to healthy controls (N = 17). Outcomes were quality of life and related changes in the neural processing of abstract speech-gesture information, which were measured pre-post training through standardized psychological questionnaires and functional Magnetic Resonance Imaging, respectively. Pre-training, patients showed reduced quality of life as compared to controls but improved significantly during the training. Strikingly, this improvement was correlated with neural activation changes in the middle temporal gyrus for the processing of abstract multimodal content. Improvement during training, self-report measures and ratings of relatives confirmed the MSG-related changes. Together, we provide first promising results of a novel multimodal speech-gesture training for patients with schizophrenia. We could link training induced changes in speech-gesture processing to changes in quality of life, demonstrating the relevance of intact communication skills and gesture processing for well-being.

Neural Basis of Speech-Gesture Mismatch Detection in Schizophrenia Spectrum Disorders

Patients with schizophrenia spectrum disorders (SSD) exhibit an aberrant perception and comprehension of abstract speech-gesture combinations associated with dysfunctional activation of the left inferior frontal gyrus (IFG). Recently, a significant deficit of speech-gesture mismatch detection was identified in SSD, but the underlying neural mechanisms have not yet been examined. A novel mismatch-detection fMRI paradigm was implemented manipulating speech-gesture abstractness (abstract/concrete) and relatedness (related/unrelated). During fMRI data acquisition, 42 SSD patients (schizophrenia, schizoaffective disorder, or other non-organic psychotic disorder [ICD-10: F20, F25, F28; DSM-IV: 295.X]) and 36 healthy controls were presented with short video clips of an actor reciting abstract or concrete sentences accompanied by either a semantically related or unrelated gesture. Participants indicated via button press whether they perceived each gesture as matching the speech content or not. Speech-gesture mismatch detection performance was significantly impaired in patients compared to controls. fMRI data analysis revealed that patients showed lower activation in bilateral frontal areas, including the IFG for all abstract > concrete speech-gesture pairs. In addition, they exhibited reduced engagement of the right supplementary motor area (SMA) and bilateral anterior cingulate cortices (ACC) for unrelated > related stimuli. We provide first evidence that impaired speech-gesture mismatch detection in SSD could be the result of dysfunctional activation of the SMA and ACC. Failure to activate the left IFG disrupts the integration of abstract speech-gesture combinations in particular. Future investigations should focus on brain stimulation of the SMA, ACC, and the IFG to improve communication and social functioning in SSD.