AAC: …And Then There Is Gesture!

Grandma and grandaughter hands with jewelry

Throughout grad school, my Clinical Fellowship Year, and on into my career in home health, skilled nursing facilities, and now private practice, I have met and worked with aphasia clients who could not benefit from a complex system of manual sign. I identified gesture as a potential treatment option in my first experience with a person with non-fluent aphasia, but I also recognized right away that formal American Sign Language (ASL) was not a viable option for the reasons set forth my previous blog, AAC: There Is Gesture… We needed a  more basic, potentially effective strategy, and my pre-treatment research led me to Amer-Ind Gestural Code Based on Universal American Indian Hand Talk by Madge Skelly (1979). Though the book was and is still out of print, I located a copy through Amazon, and it remains a highly valued addition to my clinical library!

Brief Background About American Indian Hand Talk.  The foundations of AmerInd date back many thousands of years. According to the Migration-Paleo-Indians website out of Tennessee Tech University, details regarding exact dates, modes, and locations of the migration of indigenous people into the Americas are disputed, with estimates of actual occurrence ranging from 33,000 BCE to 11,500 BCE.  In spite of these debated facts, researchers, anthropologists, archeologists, and Native Americans concur that:

•The Americas were originally populated by people migrating from somewhere else, and

•There is solid evidence that The Great Migration of Paleo-Indians occurred before 12,000 BCE.

Additionally, Skelly (1979) cites evidence that:

1. Native American societies had been firmly established in the Americas for thousands of years prior to the arrival of the first Europeans around the 15th century AD.

2. European explorers found approximately 2,200 distinct, fully developed languages among the tribes in all of the Americas. (p. 6)

3. More than 550 of those languages were specific to North America. (p. 6)

According to Skelly, citing Farb (1968), each of these languages was as unique as the difference between Swahili and English! Because the different tribes often interacted with each other, a universal, highly transparent, intuitive, concrete, non-symbolic, non-linguistic, action-based system was needed to facilitate quick and easy communication. American Indian Hand Talk evolved to satisfy that need.

Glossy Square Button "Sign Language"So, to compare and summarize:

•  ASL is a highly symbolic system, while AmerInd Gestural Code is action-based and derived from American Indian Hand Talk.

•  Whereas ASL is a language with a set structure and grammar, AmerInd Hand Talk developed over many centuries to bridge language barriers among Hand Gesture Setthe symbolic systems of many indigenous tribes in the Americas.

• Extensive training is required for both communicators and communication partners to achieve proficiency with ASL, while Hand Talk is informal and easy to learn.

Gesture in Action. I have used AmerInd Gestural Code in treatment of non-fluent expressive aphasia clients in a couple of different ways. For example, I particularly favor a multi-modal approach* that includes gesture therapy to facilitate improvement in severely non-verbal clients with aphasia. A few of the outcomes I have seen include increased:

•  Verbal vocabulary

•  Verbal Naming after spontaneous execution of trained gestures

•  Spontaneous utterances of untrained new words

•  Participation in and enjoyment of social interactions

•  Spontaneous singing with others and/or with television commercials

•  Use of communicative drawing, and

•  Client motivation

Sometimes, clients present many years post onset and with cognitive deficits that preclude implementation of a complex treatment plan. In these cases, using gesture as Augmentative and Alternative Communication (AAC) is more beneficial. Training the client and caregivers to execute and understand functional, action-based gestures can facilitate improved communication of daily wants/needs. For example, a non-verbal, hemiparetic client enjoyed a preserved ability to read that was limited by eternally out-of-sight/out-of reach eyeglasses. Acquisition of a simple gesture for glasses resulted in:

•  Decreased daily frustration

•  Improved quality of life, and

•  Increased spontaneous verbalization of untrained words

The Future…  We see news reports about the use and benefits of gesture in the treatment of people with expressive communication disorders with increasing frequency! Improved imaging technology is providing more information about how and where in the brain these treatment modalities work. Technological advances are exploding! Progress is being made in the development of sensory gloves to give voice to signed communication.  EnableTalk is an example of one such project launched by a group of Ukrainian students. I so look forward to seeing progress and results of current research and development in this area! It’s definitely awesome to be a professional in the field of Communication Sciences and Disorders in the 21st century!

funny wise monkeys

 *Multi-modal therapy includes treatments that provide stimuli through a combination of motor and sensory modalities — auditory, visual, tactile, and kinesthetic. As always, it must be emphasized and remembered that no guarantees may be made, and what works for one client may not work for another with a very similar history/presentation.


Skelly, M. (1979). AmerInd gestural code based upon American Indian hand talk. New York: Elsevier Science Publishing Co., Inc.

Farb, P. (1968). In Man’s rise to civilization as shown by the Indians of North America from primeval times to the coming of the industrial state. New York: Dutton.

Migration-Paleo-Indians. (n.d.). Retrieved October 18, 2012, from http://iweb.tntech.edu/kosburn/history-444/Migration-Paleo-Indians.html




Cynthia Williams Bowen, MS, CCC-SLP owns Bowen Speech-Language Therapy, LLC  in Clearwater, FL.  Cyndee provides quality, creative, collaborative treatment to adults and adolescents with communication, swallowing, Parkinson’s, and related disorders.

2 thoughts on “AAC: …And Then There Is Gesture!

  1. Hi! Where can I find pictures of Amerind signs or other hand signs? I’d like to use it on a highly apraxic client of mine with very little verbal output. Thanks!

    • Hi Lindsey. There is a book published on the topic in the late 1970s. I don’t believe it is still in publication, but several years ago I was able to buy a copy via E-Bay or Amazon or some such online vendor. I recommend you try that route or check with libraries. Here is an MLA citation:

      Skelly, Madge, and Lorraine Schinsky. Amer-Ind gestural code based on universal American Indian hand talk. Elsevier Science Ltd, 1979.

      Good luck!

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