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Abstract

Background
Language is multimodal and situated in rich visual contexts. Language is also incremental, unfolding moment-to-moment in real time, yet few studies have examined how spoken language interacts with gesture and visual context during multimodal language processing. Gesture is a rich communication cue that is integrally related to speech and often depicts concrete referents from the visual world. Using eye-tracking in an adapted visual world paradigm, we examined how participants with and without moderate-severe traumatic brain injury (TBI) use gesture to resolve temporary referential ambiguity.

Methods
Participants viewed a screen with four objects and one video. The speaker in the video produced sentences (e.g., “The girl will eat the very good sandwich”), paired with either a meaningful gesture (e.g., sandwich-holding gesture) or a meaningless grooming movement (e.g., arm scratch) at the verb “will eat.” We measured participants’ gaze to the target object (e.g., sandwich), a semantic competitor (e.g., apple), and two unrelated distractors (e.g., piano, guitar) during the critical window between movement onset in the gesture modality and onset of the spoken referent in speech.

Results
Both participants with and without TBI were more likely to fixate the target when the speaker produced a gesture compared to a grooming movement; however, relative to non-injured participants, the effect was significantly attenuated in the TBI group.

Discussion
We demonstrated evidence of reduced speech-gesture integration in participants with TBI relative to non-injured peers. This study advances our understanding of the communicative abilities of adults with TBI and could lead to a more mechanistic account of the communication difficulties adults with TBI experience in rich communication contexts that require the processing and integration of multiple co-occurring cues. This work has the potential to increase the ecological validity of language assessment and provide insights into the cognitive and neural mechanisms that support multimodal language processing.