Communicative Adaptations After Laryngectomy: Syntactic Complexity and Gesture Use.

backgroundTotal laryngectomy (TL) results in the loss of natural voice, requiring alternative speech rehabilitation strategies such as tracheoesophageal speech. While voice and intelligibility outcomes after TL are well studied, less is known about the complexity of spoken language production and the role of co-speech gestures in this group.

aimThis study aimed to systematically investigate the complexity and function of spoken language, as well as the use of co-speech gestures, in TL patients compared with matched controls. The key research question was whether TL patients differ from healthy controls in their syntactic structures and gesture use during structured communicative tasks.

methodsForty-two participants took part: 21 TL patients using tracheoesophageal speech and 21 gender-, age-, and education-matched controls. Participants watched and retold two animated videos and described the "cookie theft" picture. Audio and video recordings were transcribed and analyzed for syntactic complexity (C-units, subordinate clauses, canonical word order, reduced structures) and typical spoken-language disfluencies (mazes, fillers, silent pauses). Co-speech gestures were annotated by type (iconic, metaphoric, deictic, beats, emblem) and function. Word count differences were controlled by normalizing data to 100 words per participant. Outcomes were analyzed using non-parametric Wilcoxon Rank-Sum tests with correction for multiple comparisons.

resultsCompared with controls, TL participants produced significantly fewer fillers (W = 108, p = 0.019) and mazes (W = 109, p = 0.019), but significantly more short pauses (W = 356, p = 0.001). No significant differences were found between groups for measures of verbal syntactic complexity, except for one omnibus measure (words per C-unit). Similarly, groups did not differ in gesture frequency, type, or function.

conclusionsTL patients demonstrated differences in typical spoken-language disfluencies. However, their use of co-speech gestures was comparable to that of healthy controls. These findings suggest that while TL impacts spoken language disfluency as part of more careful planning, syntactic complexity is relatively unaffected and gesture use remains intact and may serve as a valuable communicative resource. Clinically, this underscores the importance of recognizing gestures as well as pauses as a compensatory strategy in rehabilitation and counseling following TL. WHAT THIS PAPER ADDS: What is already known on this subject Total laryngectomy (TL) affects voice and speech, with rehabilitation often focusing on intelligibility and voice quality. Little is known about broader aspects of spoken language complexity and the role of co-speech gestures in communication after TL. What does this study add to existing knowledge TL patients differ from healthy controls in their use of fillers, mazes, and pauses, indicating managing the spoken-language disfluencies, while leaving syntactic complexity at similar levels than the controls, except for a slight difference in the number of words per C-unit. Despite these changes, TL patients use co-speech gestures in ways comparable to healthy controls. This suggests that gestures remain a stable communicative resource even when spoken language is affected. What are the potential or actual clinical implications of this work? Clinicians should recognize the preserved use of gestures as a compensatory strategy for communication after TL. Rehabilitation may benefit from explicitly integrating and training disfluencies and gestures into therapy and counseling to support communicative effectiveness.