One-Handed Simplified Signs 1
Memory and Recall of One-Handed Signs:
The Development of a Simplified Sign System for Aphasic Patients with Hemiplegia
Alexandria K. Moore
Distinguished Majors Thesis
University of Virginia
April 25, 2011
Advisor: John D. Bonvillian
Second Reader: Filip Loncke
One-Handed Simplified Signs 2
Abstract
A one-handed simplified sign system is proposed to augment the communication
skills of persons who have become aphasic and who also experience partial motor
movement loss. Based on a previously developed two-handed system, manual signs were
modified or created. The memorability of those signs was established through systematic
testing of undergraduate students. These signs were presented together with their English
translations in sets of six lists of twenty word-sign pairs. Following the presentation of
each list, participants were asked to recall each sign after they were cued for recall with
each sign’s English translation equivalent. Sign recall accuracy was evaluated based on
the four components of each sign: movement, location, handshape and orientation. All
signs recalled perfectly by at least 70% of the participants were added to the simplified
sign lexicon. Signs that did not meet this criterion were redesigned.
One-Handed Simplified Signs 3
Acknowledgment
I would like to extend a heartfelt thanks to Professor John Bonvillian for the
generous amount of time he put into advising on this project. Without his continued
support and enthusiasm completing this DMP would not have been possible. I would like
to thank my second reader, Filip Loncke, and the DMP seminar leader, Gerald Clore, for
taking time to assist me with this project. Additionally, I would like to thank my four
fantastic undergraduate research assistants, Brigette Suijk, Katherine Becker, Kelly
Flynn, and Kira Bolton for all of their time, ideas, patience and hard work. Thanks also
are extended to Henry Matthews for his work on redesigning signs that have not met
criteria. I would like to thank all of my friends and family who have always been so
supportive, and specifically for allowing me to put their charades’ skills to the test.
One-Handed Simplified Signs 4
Roughly one hundred thousand new patients are diagnosed with aphasias
annually, part of the one million who already suffer from this language disorder.i
Several different types of aphasia exist, each having specific identifying characteristics in
conjunction with a wide array of individual differences, but all reflect a disorder that
impairs traditional spoken (or written) language despite other intact intellectual
capabilities. This language deficit, typically caused by damage to the left hemisphere
resulting from trauma such as stroke, tumor or other injury, does provide a unique
opportunity for researchers to study how specific brain areas relate to language use.
One aspect of aphasia research that has greatly impacted the psycholinguistic field
involves studying Deaf patients who used a signed language as their primary means of
communication prior to suffering trauma. After research in the last fifty years provided
strong linguistic evidence that American Sign Language included all the components of a
grammatically and syntactically rich language, researchers questioned if the different
modality required different underlying brain areas to function. Studies that compare Deaf
signers who develop aphasia to hearing aphasic patients with aphasia allow researchers to
examine how similar deficits affect language output despite the difference between a
verbal and signed mode of communication. The results surprised many, revealing that
Deaf people show similar errors and deficits as their hearing counterparts, providing
evidence to support at least partially overlapping mechanical structure for language
output across modalities. While many similar deficits have been found, one interesting
distinction existed in terms of less common right hemisphere deficits. This side of the
brain has fewer associations with language in hearing patients, but contributes more to
One-Handed Simplified Signs 5
language production in Deaf patients, because the grammar of sign language depends on
spatial abilities. This difference may be the key to developing a treatment method that,
while not able to cure the aphasia, could provide the patient with a basic supplemental or
alternative form of communication.
Several studies have tested the effectiveness of using signs to help aphasiac
patients regain some form of effective communication. While the results of these studies
have been promising, many researchers concur that a feasible system, involving iconic,
easy to produce gestures should be designed and tested. Thus this research proves
important not only for studying how areas of the brain support language but providing at
least some members of a large group of affected aphasic patients an opportunity to regain
a critically important human skill, the ability to communicate effectively with others.
In this paper I will begin by providing background information about aphasia that
will provide details about the affected population and the constraints persons with aphasia
face when considering treatment options. Subsequently, I will highlight some major
research studies using aphasic patients with language deficits. Studies of aphasia such as
these investigations suggest possible approaches to treatment. One potential treatment
method that seems feasible based on these studies involves utilizing gestural
communication to help facilitate or supplement spoken language skills; there has been
some prior research examining the effectiveness of this course of action. However, as
will become apparent from reviews of other studies, no gestural based system currently
available adequately meets the needs of the aphasic population because the systems were
not designed or tailored to the needs of this group. The present study aims to take the first
One-Handed Simplified Signs 6
steps in creating such a communication system, one that features one-handed signs with
the most basic handshapes and movements representing a core vocabulary of words.
Understanding A pha sia
According to the National Aphasia Association, between twenty-five and forty
percent of stroke survivors will develop an aphasia. ii This high percentage rate, coupled
with the increased survivability because of improved medical care, explains why strokes
are the leading cause of aphasia. This also reveals why elderly patients form the majority
of aphasics, because nearly three quarters of stroke victims are over sixty-five years old.
iii
Brain tumors provide another internal source of aphasias, if the tumors are located in
and damaged the left hemisphere. External trauma may also cause this language defect.
Car accidents or even falling affect people of all ages and can also lead to aphasia.
Another example of a specific population potentially affected with this condition includes
members of the military who suffer injuries caused by explosions, shrapnel and similar
hazards that they might encounter in a war zone. With the United States actively engaged
in conflicts overseas, the number of people at risk for this language disorder rises.
Psychologists, linguists, speech therapists and other specialists aim to help all of
these different groups regain their communicative abilities regardless of the source of the
damage. Initially, some of these researchers used imaging studies to enrich the scientific
community’s understanding of the underlying brain structures that support language with
great success and exciting results. In recent years the primary focus in this body of
research shifted to testing different methods of improving the patients’ communication
skills. With intellectual capabilities intact, not being able to express basic wants and
needs leads to obvious frustrations and even depression in some patients. Since language
One-Handed Simplified Signs 7
defines most human interaction, helping these patients regain that critical ability
underscores the importance of this area of research. While some patients will make a
recovery, if quick progress in regaining normal language capabilities does not occur the
resulting damage will likely become permanent and alternative communication systems
become more important.
A wide array of individual differences, depending on the location and extent of
the injury, causes the deficits to range from jumbled speech to a total lack of
understandable communication. There are several types of aphasia, all resulting in
various impairments of language output. There have been dozens of ways to describe
different types of aphasia, but the National Institute of Health’s National Institute on
Deafness and Other Communication Disorders offers these guidelines for a general
aphasia diagnosis: “The examination includes the person’s ability to speak, express ideas,
converse socially, understand language, read, and write, as well as the ability to swallow
and to use alternative and augmentative communication.”iv From this general definition,
further study of the specific types of deficits and language errors a particular patient
displays would indicate the type of aphasia. The three most often observed aphasias
include Broca’s aphasia, Wernicke’s aphasia and global aphasia. The first two types,
named after the areas of the brain predominantly damaged, show nearly opposite
language issues. Broca’s aphasic patients generally use words in an understandable order,
but tend to rely solely on nouns and verbs. Their speech is characterized by long pauses,
and an apparent struggle to come up with the correct word. In contrast, Wernicke’s
aphasic patients appear to have grammatically fluid speech, but closer inspection reveals
the unintelligibility of the content. Both of these aphasias derive from damage to very
One-Handed Simplified Signs 8
specific areas in the brain that then provides the name for the aphasia. Global aphasia
occurs with the destruction of a larger area of the left hemisphere. The extent of the
damage corresponds to severe problems with language production. Most patients have
little to no spoken or written language, and comprehension seems equally devastated.
In addition to all the variations among aphasia types, a wide variety of individual
differences exist reflecting the fact that the damage each patient suffers differs. Even
within types, patients will show variation in their language capabilities. This might
impact the decision to use a particular treatment over another to most benefit a specific
patient, reflecting their individual capabilities and deficits. Additionally, besides language
impairment, aphasias often co-occur with weakness or paralysis of the extremities,
typically those on the right side of the body. This condition, known as hemiplegia, does
not occur in all aphasic patients, but happens enough to make it an important limitation to
consider when assessing possible augmentative or alternative communication systems for
a patient.
Aphasia Pa tients and Deficit Studi es
Before addressing possible treatments for aphasic patients, I will explore some of
the literature on how the study of aphasic patients has greatly contributed to our
understanding of language, particularly signed language in comparison with its spoken
counterpart. Deficit studies have often played a prominent role in mapping the functions
of different areas of the brain, and the study of language particularly benefits from these
unfortunate accidents. This particular type of research occurs when someone sustains a
brain injury and then researchers subsequently determine the specific areas damaged and
One-Handed Simplified Signs 9
the nature of the resulting impairment. For example in studies of language deficits,
comparing the grammatical, syntactical, phonological and semantic aspects of a patient’s
language production with that of someone without any brain injuries might suggest that a
certain area of the brain contributes to that specific component of language output. More
specifically, this section will address studies focused on sign language with the dual goals
of identifying which brain structures contribute to signed language and the similarities
and differences between the areas used in verbal and signed communication. These
studies support relatively recent claims that signed language meets the requirements of a
full and rich language by using many of the same areas of the brain as spoken languages.
The differences in brain structure use might suggest a way for patients who have lost
their traditional verbal language skills to regain communication via a different language
modality.
Before examining how deficit studies might suggest a treatment for aphasic
patients through the brain’s differences in processing signed languages, it is important to
establish the similarities with its verbal counterpart. It has been widely recognized that
damage to the left hemisphere greatly impacts verbal language output. Only recently has
interest in signed language prompted scientists to attempt to determine if the effects are
similar for a Deaf person who used signed language as their primary or only means of
communication. Finding someone who was both a native signer and suffered from a
relatively uncommon brain lesion proved to be a challenge in the conduct of these
studies, however, because very few people would fall into both categories.
In some ways, the case studies that have been carried out meet expectations by
showing a similar pattern of language damage in Deaf aphasics as compared with spoken
One-Handed Simplified Signs 10
language users. For example, in a recent study, a man who had been Deaf since infancy
and a fluent user of Japanese Sign Language suffered a left occipital lobe lesion and
experienced sign language aphasia (Saito, Otuski, & Ueno, 2007). As a result of his
injury, the man could follow a few very basic signs, but lost all ability to fingerspell, a
technique found in sign languages around the world where each letter in the alphabet
corresponds to a handshape and these handshapes are then signed in sequence to spell a
word that does not have a traditional sign, such as a proper noun. Like hearing aphasics,
this patient’s ability to comprehend written words also suffered. He could not correctly
read a sentence that he had written down himself. His sign production included manual
phonological errors that mimic those that occur in the spoken language counterpart.
Verbally, patients might substitute one phoneme they hear for a similar one while this
patient would often mistake similar looking handshapes. This supports the argument that
damage to the left hemisphere affects signers and speakers of oral languages in similar
ways and that the brain structures in that area support language regardless of modality.
The authors of the study did note some obvious structural differences in this case study,
primarily the fact that this man’s damage occurred in the occipital lobe. The study
acknowledges that while sign language does appear to rely on many language structures
shared across modalities, signed language is an inherently visual language and thus does
involve some different areas of the brain. In this particular instance, damage to the
occipital region was seen as being critical to signed language in the same way a lesion to
the auditory cortex would impact a hearing person’s language.
This finding supports an earlier literature review published in 2000 that provides
a broad overview of these types of deficit studies and addresses not only the similarity in
One-Handed Simplified Signs 11
structural function but also the importance of the differences in right hemisphere use in
signers versus hearing people. Ronberg, Soderfeldt and Risberg (2000) described signers
whose aphasic symptoms match those demonstrated in hearing patients diagnosed with
Broca’s or Wernicke’s aphasia. For example, posterior left-hemisphere lesions led to
“fluent” looking signs but with issues in sentence comprehension and sign recognition.
Essentially the syntactical structure seemed to be intact but the content of the sentences
made no sense, as is typical for a person with a Wernicke’s aphasia. Signers with anterior
left hemisphere brain damage had non-fluent production, characteristic of the short,
choppy sentences of Broca’s aphasia, and few comprehension problems.
While these findings do support the critical structural connection between spoken
and signed languages, the Ronberg et al. review goes on to emphasize the structural
differences between the two languages. As noted in the Saito et al. article, signed
language depends on visual rather than auditory input, and some different brain structures
must be used to process this information. The ways in which the right-hemisphere
contributes to signed language comprehension are still being studied. One documented
phenomenon includes differing patterns of right hemisphere activation between signers
and speakers. In people who use signing as their mode of communication, homologous
areas of the brain are activated on the left and right side, while spoken language users
show a distinct proclivity for the left hemisphere alone. Additional difference in brain
activity demonstrated that signers process language input differently from other gestural
or spatial input in the right hemisphere. One case study reviewed in the Ronberg et al.
article describes a Deaf patient with a right-hemisphere lesion that resulted in radically
impaired artistic non-language skills but had no impact on her ability to use American
One-Handed Simplified Signs 12
Sign Language. As this case study and others reveal, the spatial cues such as mapping
and complex perspective taking inherent in signed language impact the use and strength
of various brain areas, owing to neural plasticity (though without precise neuroimaging,
the brain areas involved in language use both before and after the trauma cannot be
pinpointed). These strengthened right hemispheres in signers allow for some of their
native linguistic components to remain intact even when other non-linguistic spatial
components or the left hemisphere is damaged. The authors suggest that this new
understanding of the right hemispheres capacity for some aspects of language might point
to a potential treatment for the more typical hearing aphasic patients.
A group of British researchers have furthered these claims and focused particular
attention on Deaf aphasics by distinguishing between signs and gestures, as well as by
using sign to cue a spoken language (Marshall, Atkinson, Woll, & Thacker, 2005). As the
title suggests, “Aphasia in a user of British Sign Language: Dissociation between sign
and gesture” details one aphasic patient’s ability to understand non-linguistic gestures but
not signs. It would seem plausible that gestures and signs would be processed in the brain
in the same way because they are both visual, uses the hands, and contain movement to
communicate some type of information, however rudimentary. This study features a Deaf
man with a clear case of anomia, a deficit in word retrieval (also found in hearing
patients). Despite suffering from a severe aphasia, his ability to understand and repeat
nonverbal gestures was intact. Regardless, the brain damage he sustained made it
impossible for him to produce a particular sign when prompted, even if he could easily
imitate a very similar gesture. Despite their apparent similarities, gestures and signs
One-Handed Simplified Signs 13
register in the brain differently, which might impact the possible types of treatments
considered for persons with aphasia.
The most illuminating deficit study, in terms of its clear implications for possible
treatment, also comes from Marshall and her colleagues. She and her fellow researchers
located a Deaf woman who knew English in addition to British Signed Language
(Marshall, Atkinson, Smulovitch, Thacker, & Woll, 2004). Like previous case studies,
this woman developed her aphasia after suffering a left hemisphere trauma. As a result,
she essentially lost her capability to understand both languages suggesting a shared
central area for semantic processing. Despite the severity of her language loss, the
researchers found one promising area, not for recovery, but for re-establishing some kind
of minimal language use. The study found that if she was cued with a BSL sign then she
could be prompted to say an English word. This did not apply if nonverbal gestures
replaced BSL signs as the cue. Despite the fact that the cuing findings only applied to
nouns, this opens up a new approach for improving aphasics’ language abilities. As I will
discuss in the following section on treatment studies, a major concern with using signed
language to help patients communicate is the fear that doing so would eliminate any
chance of spoken language recovery. This study demonstrates that in fact the two
different languages, when used in conjunction, may actually help improve language skills
rather then hinder them in a particular modality.
All of the above deficit studies do have limitations that should be addressed when
considering the implications of their findings, despite being a commonly used research
method. First, the majority of these studies follow only a single participant. They feature
a case study format that does not meet the requirements of an experimental design;
One-Handed Simplified Signs 14
therefore it is impossible to definitively say that brain damage to a certain area causes a
certain type of deficit. Additionally, as a result of the individual differences between
injuries, these studies are very difficult to replicate with precision. Most of the consensus
across studies occurs when patients have injuries to the same general area of the brain,
such as Broca’s or Wernicke’s. Yet the severity and exact boundary of the damaged area
in the studies cannot be controlled. This makes the linking of a specific linguistic
component with an equally specific area of the brain very difficult, if not impossible.
Gestural Co mmunicatio n a s a Treatment for Aphasia
As mentioned earlier, if rapid improvement over a matter of weeks in impaired
language faculties does not begin soon after the brain damage occurs, then the chances
for making a full recovery decrease dramatically. In the weeks and months following the
initial diagnosis, patients typically begin courses of treatment focused specifically on
regaining verbal communications. Unfortunately, some of these programs have seen very
limited success. Despite these setbacks, scientists continue to look for methods to assist
patients in regaining some type of communication skills.
The findings from deficit studies of Deaf aphasics, such as the ones covered in the
previous section, suggest a possible avenue for treatment. A change in communication
modality may enable some persons with aphasia to use unimpaired areas of their left
hemisphere. Moreover, as stated before, the right hemisphere plays a more robust role in
the processing of signed languages than in oral languages. Patients that have severely
damaged left hemispheres may be able to access at least some of the components of
languages by tapping into the modality favored in the other hemisphere. This means
One-Handed Simplified Signs 15
using some form of gestural communication, with its visuospatial orientation. The
literature does not suggest teaching patients formal American Sign Language, or its
equivalents, because the grammatical complexities would require more support than the
damaged resources of the left hemisphere could provide. However, any form of
communication, regardless of how limited in scope and normal fluency, could improve
the quality of life for patients with no or few alternatives. The focus of this area of
research includes establishing gestural communication as a possible treatment course and
then specifically what type of system would be most appropriate to teach to patients.
The initial results from research using signed language with aphasic patients looks
promising, and E. James Moody’s (1982) article “Sign language acquisition by a global
aphasic” explores possible reasons why signs may be effective, as well as noting the
drawbacks to this approach. Global aphasics typically have the most severe and
widespread trauma of aphasic patients and, consequently, a grim prognosis for language
recovery. Moody postulated that despite the severe damage to the left hemisphere,
patients could understand words and make the connections necessary to use them through
the right hemisphere even if they lacked the capability to express them verbally. To
compensate for the inability to produce coherent verbal output, Moody suggested that a
communication system consisting of gestures or signs might fill this gap. He offers
several reasons why this approach proves more feasible than a verbal treatment. First, as
already suggested, the brain areas, such as centers for processing visual input, remain
intact and signs would utilize these areas whereas verbal communication could not.
Second, teaching a patient how to use gestural communication would be much easier than
trying to help them re-learn verbal communication, for several reasons. Signs have a
One-Handed Simplified Signs 16
longer production duration than spoken words, so for a patient who needs more time to
process input, this may prove useful. In terms of the patient’s sign production, a
researcher or teacher can easily help shape the hand to form a sign correctly. Most verbal
phonological sounds made by various positions of the mouth and tongue cannot be easily
shaped with external help. Signs, some of which are one handed, could circumvent the
oral apraxia typical of global aphasia that makes speaking difficult as well as largely
avoiding any hemiplegia in one arm. Finally, while most signs do not represent their
meaning, in these treatment scenarios iconic signs can be selected or created. These
would be easier to learn and use, especially since the right hemisphere typically processes
more concrete things.
Moody put these ideas to use in a case study involving a global aphasic. The
patient was exposed both to signs and speech in a Total Communication approach, which
entails using verbal production and signs simultaneously. Not surprisingly, given the
severity of the patient’s injury, speech attempts failed. Moody did find, however, that the
patient had some communicative success with a limited number of signs. For a global
aphasic to regain any form of communicative ability marks a huge advancement,
regardless of the limited scope of his or her signing. Despite the relative success, there
were some notable limitations. Moody’s patient acquired nouns better then verbs and had
to avoid cognitively similar words, particularly if the signs looked similar. For example,
the patient struggled with the signs for knife and spoon, cognitively similar in function
and sign production. While the patient could correct some of his own mistakes, he still
worked best when paired with a researcher speaking to him in order to prompt the signs.
One-Handed Simplified Signs 17
While Moody’s results with a particularly severe case look promising, the issue of
individual differences remains a problem.
Another important early study not only consisted of an experiment testing gestural
communication with a large number of participants for this type of research, but also
looked at how the severity of the aphasia impacted the participants’ ability to use such an
approach (Kelsch, Daniloff, Noll, Fristoe, & Lloyd, 1982). Fifteen aphasic patients were
involved in this experiment, making it one of the largest studies of its kind. The
experimenters divided the patients into three groups of five, based on the severity of their
diagnosis. It should be noted, however, that even the highest functioning group did not
include people with the most severe aphasic diagnosis. All of the patients suffered from
unilateral left hemisphere cerebral damage: in most instances, this was caused by cerebral
vascular accidents or strokes, though a few cases were caused by head trauma. Unlike
most experiments in this field, this design did not use a spoken language component on
the part of the experimenter or patient. Instead the researchers showed each patient a card
with four simple line drawings on it in black and white in an effort to elicit a signed
response. One of the images was the target, the image that the patient ideally recognized
and then made the corresponding gesture, the second was a foil similar to but not the
target, and two unrelated drawings. There were twenty-four cards, half depicting objects
and half depicting actions. The selection of the images used related to the basic needs of
patients, in order to produce attempts at relevant communication. The patients produced
their response using gestures from American Indian Sign, also known as AmerInd,
chosen because of its high proportion of iconic signs, which while not as extensive as
One-Handed Simplified Signs 18
initially thought, far outnumber the proportion of iconic signs in languages such as ASL
(Daniloff, Lloyd, & Fristoe, 1983).
The results from this study indicate that, within a certain range, the severity of the
aphasia does not impact the patients’ ability to use the AmerInd signs. Rather then
severity, factors such as the patients’ listening ability correlated substantially to the
ability to produce more signs in the correct context. This suggests that, unlike previously
thought, that even patients with moderate brain damage might benefit from this treatment
approach. This experiment also excluded patients with the most severe impairments, so
that this study provides little insight on the effectiveness of this type of approach with
that specific population. Unlike the Moody study, Daniloff and her colleagues found that
patients more easily identified action pictures than the object pictures. These results stand
out in this body of research because most researchers find that nouns tend to be more
memorable. A possible explanation for these results might be found in the study’s design.
This study used a recognition paradigm rather than a recall based experiment. While the
15 patients in this study represent a large sample size using a gestural communication
system, carrying around a series of cards to prompt responses may not be feasible beyond
the lab setting.
While Danlioff’s study successfully used gestures, many patients and their family
members primarily focus on reestablishing spoken communication. In some cases this
might be incredibly difficult to achieve and others might be able to make only a
minimum amount of progress. While ultimately gesture based communication might be
the most effective way to regain any type of effective communication skills, some people
hesitate to pursue this course of action for fear that it will prevent any spoken language
One-Handed Simplified Signs 19
recovery. The literature suggests that this does not occur, and in fact, gestures or signed
language actually support spoken communication.
In “Verbal and Simplified Sign System Treatments in Adults with Anomia of
Speech”, (Morgenstern, Braddock, Bonvillian, Steele, & Loncke) looked at a multimodal
approach with three aphasic patients with Alzheimer’s disease. The researchers used two
treatments, a verbal communication approach and a simplified sign approach. The
simplified sign system, originally developed by John Bonvillian and Nicole Kissane to
help children with autism, consists primarily of signs taken from various sign languages
throughout the world and new signs created specifically for this system. The signs strive
to incorporate only the most simple handshapes and movements to achieve iconic, easy to
form signs. There are over 1,000 signs in the simplified sign system, but it intentionally
lacks the necessary components needed to qualify as a language. Instead, the system is
designed to supplement users with poor verbal skills, and for the most severe cases, stand
in as a mode of communication when the user cannot learn a full language. In this study,
the patients each received both treatments in reverse order. The most important finding of
this study is that the signs helped to fill in the gaps with speech and promoted the use of
speech. In no way did the simplified signs seem to prevent speech. One limitation of this
research, which occurs in many of these treatment programs, involves generalizing the
lessons beyond the laboratory setting. Sitting with a researcher, a limited number of
words or signs might be produced but eliciting the same responses elsewhere proves to be
more difficult. Additionally, while some patients seem to benefit more from simplified
signs, others do not and respond better to a speech-based intervention. Determining the
best candidates for simplified sign use out of the larger pool of aphasic patients will
One-Handed Simplified Signs 20
eventually become an important area of study. While this is something to be addressed in
future research, it is important to remember that even if the results are limited, it is better
for these patients to have a few critical words or signs with which to communicate than
none at all.
Conclusions a nd Future Research
The study of signed language and aphasia patients proves to be a rich field,
providing new and interesting data benefiting everyone from neuroscientists to the
patients themselves. Data from deficit studies provides biological information to support
the linguistic conclusion that American Sign Language meets the criterion for a fullfledged language by suggesting that some brain structures support language function
regardless of modality. Signed languages do take greater advantage of the right
hemisphere than spoken language, which illuminates a potential pathway to
communication for people with damage to the left hemisphere. A variety of treatment
options exists for patients suffering from aphasia, many of which utilize some form of
signed language to complement or supplement oral language. These treatments, while
limited to a finite number of words, provide some relief for patients who, despite serious
language impairments, have not lost their intellectual capabilities.
The present study focuses on developing a sign-based approach that can be easily
implemented outside of the laboratory. As previous researchers, such as Moody, have
recognized, no current signed language adequately meets the needs of this population.
American Sign Language and other genuine signed languages used by Deaf persons
feature too many non-iconic signs and often use difficult to form handshapes and
One-Handed Simplified Signs 21
complex series of movements. Some studies have used AmerInd, as developed by
Skelly, but this is a small and limited system of only 236 signs.
The Simplified Sign System (Bonvillian, Kissane, Dooley, & Loncke, in press)
used in the Morganstern study, provides the framework for attempting to develop a better
fitting system. This system uses many iconic signs, single gestures, and basic handshapes,
and focused on a core, functional, vocabulary. Modifications were made to many of the
signs to use this system with aphasic patients. These modifications were made because of
the hemiplegia that often co-occurs with patients’ language disabilities. Some of the
original signs are one handed and remain the same in the present system. Others were
two-handed symmetrical, meaning both hands use the same handshape and motion
simultaneously; these signs will be retested to see if they can be performed with only one
hand and retain their ease of recall. Still other signs in the Simplified Sign System do not
fit into either of these categories, meaning that they use two hands doing two different
things. For these signs, serious modifications were made in sign formation and
completely new signs were devised.
The present study tests the memorability and ease of formation of these signs, by
asking non-impaired undergraduate students if they can recall the signs after being shown
a list of signs. If the majority of the participants can perfectly recall the sign, then it will
be saved for use with aphasic patients. If there are errors, the sign will be redesigned and
tested again. The present study examines the results from testing of the first 240 words in
the system. Ultimately, future research will be needed to finalize the remaining signs, test
the signs with actual aphasic patients, and determine which members of this group would
benefit the most from undergoing a sign treatment option. This pursuit of an effective
One-Handed Simplified Signs 22
one-handed sign system would require multiple steps, but could potentially help in the
treatment of many aphasic patients. With a surprisingly large number of individuals with
aphasia affected, both in the U.S. and overseas, it is critical that psychologists, linguists,
and others continue to pursue the best avenue of communication therapy for this language
disorder.
Methods
Participants
The participants were 29 undergraduate students from the University of Virginia.
The results from 28 of these participants were used in data analysis. Approximately twothirds of the participants were female. They participated in order to earn credit for
research participation in their introductory psychology course. As part of the prescreening process, only students who stated that they were unfamiliar with a signed
language were invited to participate in the study. None of the participants had an obvious
disability that would have prevented them from seeing or reproducing any of the signs.
Each person participated in an individual session that lasted approximately forty-five
minutes. One student was not included because of an obvious sign production error on
the part of the experimenter.
Materials
The first step in developing this one-handed version of the simplified sign system
was determining which signs needed to be tested. Of the slightly over 1,000 entries in the
original Simplified Sign System, almost 400 were already one-handed and were not
tested again. The remaining signs needed to be redesigned and then retested to ensure
One-Handed Simplified Signs 23
they did not lose their ease of formation and memorability in their new form. Many of the
remaining signs were two-handed symmetrical, meaning that both hands used the same
handshape, motion, location and orientation and mirrored each other. Those signs were
all retested using one hand, but the components of the sign stayed the same. The rest of
the signs were two-handed asymmetrical, and required more effort to modify them into a
one-handed version. Because of the constraints of this approach, some signs bear
relatively little or no resemblance to their two-handed counterparts.
Those signs that were created specifically for use in the one-handed system were
designed with some general guidelines. First, signs had to have simple, predominantly
unitary movements. Second, signs were intended to be iconic, in that the form and
meaning of each sign was clearly related to its referent. Third, all signs were intended to
be easily distinguishable from other signs in the system, though signs with conceptually
similar meanings tend to take similar forms. Finally, the handshapes of the signs were
primarily limited to those that are the easiest to form, including the A-hand, B-hand, 5hand, C-hand, O-hand, baby O-hand, and G-hand (index finger). Two sets of 120 signs
were composed from the large lexicon of potential one-handed simplified signs.
Each set of 120 signs was divided into six lists of twenty words. The lists were
designed to reflect a variety of sign forms and meanings. This helped to prevent signs
from being presented close to others that were conceptually similar, causing increased
difficulty for the participant to recall a sign accurately. Within each list, signs were
placed in a random order with the constraint of trying to avoid having similar formations
demonstrated one after the other. Six signs from the original system, unaltered because
One-Handed Simplified Signs 24
they were already one-handed, were used as a practice set for each participant to
familiarize them with the procedure of the experiment.
Procedure
Data from 14 participants were examined for each set of signs. Each set of signs
was presented to the participant in an individual session by an experimenter. The
experimenter who presented the signs was not involved in rating the accuracy of each
sign’s production. The participants were asked to recall the signs in a completely
different order than they had been shown.
The participants were informed that the study involved recall of one-handed signs
and heard specific instructions about the task they were being asked to complete. The
study was conducted in an office-like setting. The experimenter and the participant sat in
chairs facing each other, while a rater sat to the side of the experimenter. The participants
were informed that they would be viewing several lists of signs and that they would be
asked to recall the signs they had seen, when prompted with the signs’ English translation
equivalents, at the end of each list. The experimenter asked the participants that while
they were being shown the lists that they not move their hands in attempts to mimic the
signs. The participants were told that each sign would be demonstrated to them twice, but
that during recall they only needed to produce each sign once (Appendix A).
The components of the scoring procedure were explained to each participant.
They were told the four aspects of each sign that the rater would be examining; location,
movement, handshape and orientation. At that time, one sample sign was shown, and the
experimenter reviewed each of the four components with the participant, demonstrating
what would constitute the correct formation of each aspect for that sign, and what would
One-Handed Simplified Signs 25
not. The rater looked at all of these components when determining the general score
received for each sign, which could be either perfect, almost correct, wrong sign or no
response (Appendix B). Signs that received a perfect rating were those that were identical
to the sign presented by the experimenter. Almost Correct indicated that a sign produced
by a participant was very similar to the presented one, but varied in one of the four
components in a minimal way. The Wrong Sign category was reserved for signs that
varied substantially from the one that had been demonstrated. This included signs that
varied in two or more of the components, or in rare cases, signs that varied so much in
one component that the sign was unrecognizable. A no response score meant that the
participant failed to recall a given sign. Participants were instructed at the onset of the
experiment that they could say “No Response” at any point during their attempt at sign
recall, but were also encouraged to guess because there was no penalty for doing so.
After showing each participant the sample sign, demonstrating signs from the
practice list, and answering any of the participant’s questions, the experimenter began by
presenting the first list of twenty signs. Signs and their English counterparts were
presented approximately every five seconds. The participants heard the English
translation equivalent one time, and were shown the sign twice. After going through each
list, each participant was immediately asked to recall the sign when cued with the English
word. The participant had ten seconds to attempt the sign before the rater gave a “No
Response” score. After completing all six lists, the participant was debriefed about the
study and any questions about the nature or purpose of the study were answered
(Appendix C).
One-Handed Simplified Signs 26
While the experimenter spent a considerable amount of time practicing the signs
prior to the experiment, a video of all the signs was created to run simultaneously during
the experiment. Only the experimenter could see this video; it was placed in a position
that ensured the participant could not view the content. The video helped ensure that a
high level of accuracy during presentation was maintained throughout the task, which
required a lot of concentration and attention to detail. Additionally, the video helped
maintain a consistent presentation time across participants.
During recall, a separate rater scored each sign made by a participant. Over the
course of the experiment, four different raters were used. An intense period of training
occurred before each set prior to data collection to ensure an acceptable level of interrater agreement. Of the four raters, only one had significant experience with signed
language, so this training period involved teaching the raters how to produce the signs.
Each rater was given a written description of the signs. They had access to a video of the
experimenter performing each sign that they used to study, in addition to meeting in
person to practice each sign. In order to practice the scoring of sign formation, volunteers
were solicited from friends and family members of the research team. These volunteers
followed the same procedure as that of the actual experiment, including being provided
with the informed consent agreement and the debriefing form. The raters practiced both
individually and as a group. They practiced scoring the first set of word-sign pairs for
nearly two months before formal data collection began to reach an acceptable level of
inter-rater agreement in regards to the scoring of each of the different sign parameters. In
general, an approximately 75% agreement between raters was established before data
collection could begin. This number reflects the fine level of detail required to rate this
One-Handed Simplified Signs 27
task, which exceeds that which would be required in a real life setting. Additionally, the
raters had a higher level of agreement for some components, such as location, than
others, such as handshape. Again, this reflects the difficulty of the task, as participants
were often not as accurate in discriminating between certain sign parameters as the
experimenter.
After each set of 120 signs was tested on 14 participants, the results were
analyzed. If 10 or more participants signed a word perfectly, the sign was added to the
Simplified Sign lexicon. If 8 or 9 participants performed the sign perfectly, then the sign
was retested without any changes being made in its formation. If fewer than 8
participants recalled the sign perfectly, the sign was redesigned, based on the type of
errors made by participants as recorded by the raters. Two sets consisting of a total of 240
word-sign pairs were tested in this study and each was placed into one of three
categories: Met Criteria, Almost Met Criteria, and Failed to Meet Criteria (Appendix D).
After changes are made to the signs that failed to meet the 70 percent or higher recall
accuracy criterion, the signs, will be retested on 14 new participants in future word sets.
The written description of each sign that met the criteria was added to a one-handed
simplified sign system dictionary created by the experimenter (Appendix E).
After creating the initial concepts for the signs that needed to be tested,
modifications were made to signs that did not meet the goal of having 70% or more of
participants recall them perfectly for re-testing with subsequent sets of participants.
One-Handed Simplified Signs 28
Results
Sign Production and Recall Accuracy: Overall Findings
For this study two sets, each containing 120 word-sign pairs for a total of 240,
were tested for recall accuracy. For each set, the percentage of signs that met selection
criteria, almost met selection criteria, and failed to meet criteria were calculated. To meet
criteria, ten or more of the fourteen participants needed to perform the sign perfectly. To
be included in the almost met criteria category, a sign had to have eight or nine
participants form the sign correctly. The signs that fall into this category will be retested
on fourteen new participants without being modified. If a sign had fewer than 8 people
form it correctly, or not form the sign at all, resulting in a rating of “no response,” the
sign was included in the failed to meet criteria category; this sign will be redesigned for
testing in subsequent sets. Below are the scores for both sets and information pertaining
to the overall percentage of signs that met criteria. (Table 1).
Set
Table 1: Percentage of Sign Recall Classifications
(The raw score is first and the percentage follows.)
Met Criteria Almost Met Criteria
Failed to Meet
Criteria
1
50 (41.67%)
8 (6.67%)
62 (51.67%)
2
38 (31.67%)
25 (20.84%)
57 (47.5%)
All Sets
88 (36.67%)
33 (13.75%)
119 (49.58%)
Total Scores for
121 (50.42%) Included in data with
those that remain
Met Criteria
(Met +Almost Met)
vs. Failed to meet
119 (49.58%)
One-Handed Simplified Signs 29
Out of the 240 words, 50 words met the criteria for inclusion in the one-handed
lexicon from Set 1 and 38 words passed from Set 2. While the number of words that
passed from Set 2 is lower than those from Set 1, 25 words from Set 2 were almost
perfect compared with only 8 words from Set 1. Overall, 58 words from Set 1 and 63
words from Set 2, for a total of 121 words, will remain in the study at the present time.
These numbers are a combination of those word-sign pairs that passed the selection
criteria and those word-sign pairs that were close to meeting the selection criteria. These
latter word-sign pairs will remain in the lexicon as originally designed unless otherwise
precluded by future testing. This means that just over 50% of the word-sign pairs that
were tested in this experiment will remain in the one-handed sign lexicon while the other
half will require extensive editing and retesting. Sixty-two word-sign pairs from Set 1 and
57 words from Set 2 fall into the failed to meet criteria category and are currently being
redesigned for future testing.
Criteria for Addition to Lexicon
In order for a sign to be added to the one-handed simplified sign system lexicon it
must be recalled perfectly by at least 70% of the participants. For each set of words, data
from fourteen participants were included. Since 70% of 14 is 9.8, 10 or more participants
needed to perform the sign perfectly for it to be included. Of the 240 word-sign pairs, 88
were recalled perfectly by 70% or more of the participants. It is felt that these signs were
highly iconic and quite easy to perform. That is, they had an easily made handshape and a
single movement. An additional category of “almost met criteria” also was included.
These 33 word-sign pairs received 8 or 9 perfect recall scores; this number was just
below the score of 10 needed for immediate inclusion in the lexicon. Since these signs
One-Handed Simplified Signs 30
were just under the threshold for inclusion, the researcher decided to continue testing the
unaltered signs again in future research to determine if the sign should be included in the
lexicon. This was done because there were many signs that would have met criteria had
several participants not chosen not to respond when prompted to repeat the sign.
All signs in both sets that were rated as being performed as almost perfect, wrong
sign or no response by over 30% of the participants (but did not fall into the category
where 8 or 9 of the 14 participants tested accurately recalled the sign) were not added to
the lexicon at this time. Information from scoring about the specific types of errors
manifested was recorded for each sign that participants made incorrectly. This
information was examined for patterns of errors that could indicate possible corrections
to the sign. For example, the data from the sign AMPUTATE indicated that while the
demonstration of the sign showed the flat hand moving back and forth across the arm, the
majority of participants who produced this sign incorrectly held the flat hand stationary in
the correct location. Therefore, in future sets the sign for AMPUTATE will be tested
without the movement component to see if that improves recall. For signs that were
recalled incorrectly but lacked a consistent type of error, entirely new forms of the sign
were considered and will be retested in subsequent sets. See Appendix A for a list of all
the signs, in the order in which they were tested, and whether they received scores that
met selection criteria, almost met criteria, or failed to meet criteria.
Discussion
The results of this study are important for laying the groundwork for the
development of a one-handed sign system for aphasic patients. Much future work,
One-Handed Simplified Signs 31
however, remains to be done before the system can be introduced and tested with the
target population of persons with aphasia. Since the system being developed in the
present study is based on a previous research project, I will compare the two projects.
The research conducted by Kissane and Bonvillian (2001) aimed to develop a
predominantly two-handed sign system, featuring iconic, easy to form signs. In that effort
they were largely successful. As in the present study, Kissane tested her signs with
undergraduate participants and the differences in results between that work and the
present study broadly reflect the unique challenges encountered in developing a onehanded system. Next, I will discuss one of the greatest challenges and strengths of the
present study by addressing the issue of inter-rater agreement. Inter-rater agreement was
something I strove to achieve so that the resulting system could be as useful as possible,
but this effort in turn may have tempered our results. This leads to the subsequent issues
of the “Almost Perfect” results, which were included in the data in order to account for
human error in the experiment, and consist of a large portion of our data. Finally, I will
address general limitations to the study and what steps should and will be taken in the
future in order to complete the one-handed sign system.
The One-Handed System versus the Two-Handed System
Reviewing the data from the study published on the two-handed system suggests
that initial tests requiring undergraduate students to remember and produce two-handed
signs were more successful for that version than they were for the present study. Kissane
(2001) reported that the mean percentage of word-sign pairs that received a perfect rating,
based on six sets of words, was 82.98. This percentage is noticeably higher than the rate
found for the testing of two sets of words in the one-handed version. Since Kissane ran
One-Handed Simplified Signs 32
more sets of words, it would appear possible that she simply had some sets that were
more successful and increased the mean of the data overall. However, her set with the
lowest mean percent of word-sign pairs with a perfect score was 75.67, considerably
higher than the rate found in the present study. There are at least several reasons this
could be true. First, word-sign pairs that did not initially receive perfect recall scores
were redesigned and retested in later sets included in the data that she presents. Since the
signs are redesigned based on insight from the mistakes participants made in original
testing, it is not surprising that the second time these signs were tested that they are more
likely to be successful and would contribute to an overall higher score. Kissane discusses
this factor, which is also consistent with the fact that her last set of word-sign pairs
received the highest mean recall percentage receiving a perfect score.
More importantly, the differences in the number of words receiving perfect scores
can be attributed to the increased challenge of performing signs one-handed. These signs
are not as likely to be iconic as their two-handed predecessors, simply because the
parameters of the sign are severely limited when the one-handed constraint is added. If
the signs are less iconic, they are less likely to be remembered. Additionally, there are a
decreased number of combinations that can be made with one hand (in terms of how and
where a sign is formed) that still fit the standard of using the most basic handshapes and
the simplest movements. It was important to not have signs look the same (though to
some extent signs with cognitively similar meanings will look more similar, particularly
if the researchers are striving to have them be as iconic as possible.) This constraint led to
signs being altered formationaly to distinguish them from one another, but may have
made it harder for participants to see how a sign was iconic. For example, many signs in
One-Handed Simplified Signs 33
the two-handed system use a flat, stationary hand as a base for the primary movement of
the sign on the other hand. This could be an arm or a hand representing a table, plate,
piece of paper or other similar surfaces with which the action of the other hand, in
conjunction with the first, makes it clear what the sign is supposed to signify. In the onehanded version it is much more difficult to establish these types of locations, which in
turn may make it more difficult to understand the meaning of the sign. This is why it is so
important to test the signs on undergraduate participants, because they show which signs
are likely to be remembered and their errors may be indicative of a better way of
producing the sign.
It is important to note that in Kissane’s thesis, the signs that she tested came from
existing signed languages from around the world. It would make sense that signs being
used as part of an existing language are easy to remember, compared with signs that,
once modified to be one-handed, do not always resemble a sign being used elsewhere.
Additionally, as more signs were added to the two-handed version (Bonvillian, Kissane,
Dooley & Loncke), many of them had to be created by the investigators, much like in the
present study. Overall, for the slightly over 1,000 signs n the two-handed version, about
2/3 of the signs that were tested met the selection criteria.
The Problems and Importance of Inter-rater Agreement
The biggest challenge, and one of the greatest strengths of this experiment, was its
commitment to establishing and maintaining a high level of inter-rater agreement. A total
of four research assistants, three each semester that data were collected, coded the sign
formation data. Much like the people who will ultimately be using this system, their
previous experience with sign language reflected a wide range of backgrounds from no
One-Handed Simplified Signs 34
prior experience to multiple years of formally studying American Sign Language. Prior to
beginning data collection, this lab group spent multiple weeks practicing coding sign
production as both individuals and as a group, to ensure that similar errors were being
coded in a uniform manner. This process revealed many things about the sign system.
First, it became apparent that some aspects of coding were easier to agree upon than
others. For example, coding the location for a sign is relatively easy because it is easy to
ascertain where a sign was performed. Accurately coding for handshape and orientation
proved to be relatively more challenging. The differences we were looking for often were
quite small. In many instances, the line between a sign being performed perfectly and
almost perfectly was slight. For example, a hand might be tilted slightly further than the
written definition for the demonstration to be deemed “perfect.” Often times these
differences, while important in coding, would not inhibit the typical user from
understanding the sign. To compare it with spoken word production, these differences
would often be unnoticed differences in articulation that most listeners in a conversation
would not really focus on. More noticeable differences did not alter the meaning of the
sign, for example repeatedly bending the fingers of the V-hand in RABBIT (as if
accentuating the hopping motion of the animal in the fingers that represent its ears). In
the larger picture, this is roughly equivalent to people from different regions saying a
word with different accents. People generally would not have an issue understanding the
sign, but it deviated noticeably from their own way of producing it. When these situations
arose, the signs were coded as almost perfect and the specific errors noted. If the sign did
not meet criteria overall, then these notes were used to help redesign the sign.
One-Handed Simplified Signs 35
The greatest difficulty in coding is that people, particularly those unfamiliar with
signed language as the participants were, are incredibly sloppy signers. There are several
handshapes that are distinct from others by very few elements. For example, the fivehand is a hand held out with all of the fingers extended and a flat-hand is the hand held
out with the fingers together. The only difference is the arrangement of the fingers. Often
when participants were asked to sign a word that involved these handshapes what they
produced was somewhere in between the two, meaning that the fingers were neither fully
together nor fully spread apart. This made coding quite difficult. Since the coders were
specifically told to be aware of these issues, they rated these elements very strictly, which
may account for our lower percentage of perfectly recalled signs. However, it means that
words that did meet criteria passed a very rigorous testing procedure and will likely hold
up in future testing and use.
The Almost Perfect Selection Criteria Category
After reviewing the data, there were several words that just barely missed meeting
the criteria for being included as a a sign in the lexicon. Taking into consideration the
level of detail with which we coded the data and the difficulty of the task, it is possible
that testing the unaltered sign on a second set of participants would demonstrate that it
was worthy for inclusion into the system. As discussed in the previous section, the
difference between almost perfect and perfect could be very slight and, in practical use,
would have little impact on a person’s ability to understand the meaning of the sign.
Since a total of 33 word-sign pairs fell into this category, demonstrating that this could
potentially be a relatively common phenomenon, it seemed reasonable to retest the words
rather than trying to recreate them.
One-Handed Simplified Signs 36
Given the difficulty of creating new signs that are both iconic and easy to form, I
felt that it is more important to focus on redesigning signs where the vast majority of
participants did not recall the sign or those who did recall the sign did poorly so that they
were given a score of “Wrong Sign.” However, it will be important to restest the signs
with an additional fourteen participants to ensure that these signs meet the standards
applied to the other signs in the one-handed version.
General Limitations
Probably the most pertinent limitation to this study involves the differences
between the population being tested in this experiment and the population the system is
ultimately designed to benefit. For the initial testing of the signs, a convenient sample
was used. Undergraduate students, who participated in exchange for psychology credit,
were readily available. Additionally, it is practical to test the initial designs on a high
functioning population first, with the understanding that many of those signs would not
meet criteria. If a young person with no apparent mental or physical deficits has trouble
remembering or executing a sign, then a patient with aphasia who is jointly suffering
from a brain injury and a recently incurred motor impairment would presumably have
even greater recall or performance difficulties. As will be discussed in the section on
suggested future research, once all of the signs have met the criteria from testing with
undergraduates, it will be necessary to see if any unforeseen difficulties arise when the
system is tested on actual patients with aphasia or traumatic brain injuries.
Additionally, as was discussed in the Kissane study, the results from this
experiment are limited by the fact that participants were tested in a laboratory setting
using a cued recall procedure. Seeing a total of 120 novel word-sign pairs over a period
One-Handed Simplified Signs 37
of less than an hour and then being asked to recall them does not accurately reflect the
way that potential patients would use the system. Signs would have to be taught over
time, and patients would be using them in context to facilitate or supplement
communication, rather then recalling seemingly random signs or gesture in a vacuum, as
the participants in this study were asked to do. Additionally, this can be a very
cognitively demanding task so hopefully, gradual, daily practice would lead to better sign
production overall.
Future Work
As has been suggested previously, there are many additional steps that need to be
taken before the one-handed sign system is complete. Roughly 300 word-sign pairs still
need to be tested in their proposed forms. Additionally, all of the signs that did not meet
criteria in this study need to be redesigned and retested to see if the changes help
participants recall the sign perfectly. After this process has been completed, a sample of
patients with aphasia will need to be gathered to see if there are unforeseen issues with
this system that should be modified before opening up the system to a broader aphasic
population.
Another issue that will certainly need to be addressed is determining which
patients would benefit most from this system. As described in the introduction, there are a
variety of different types of aphasias and a wide array of individual differences among
patients suffering from the same type of aphasia. It will be important to investigate what
types of patients would most benefit from this proposed one-handed sign system as
opposed to other treatment options that are currently available. No one treatment system
is going to benefit every patient, and it will be important to focus limited resources on
One-Handed Simplified Signs 38
those with a certain aphasia type or severity that will most likely benefit from this
approach. Additionally, some patients and their families may be opposed to using a sign
system, fearing that it may prevent any recovery of spoken language. While previous
research suggests that signing often facilitates spoken language rather than hinders it, a
study examining this specific system in that context may help reassure wary patients and
their families.
i
The National Aphasia Association, “Frequently Asked Questions”.
The National Aphasia Association.
iii
Washington University in St. Louis School of Medicine, “The Internet Stroke Center”
iv
The National Institue on Deafness and Other Communication Disorders Website,
“Aphasia”.
ii
One-Handed Simplified Signs 39
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One-Handed Simplified Signs 42
Appendix A
Script to be read to each participant during the experiment.
Researcher: Hello, thank you for coming in today to participate in our experiment. Before
we begin, please read and sign the informed consent agreement in front of you. Take as
much time as you need and feel free to ask me any questions.
Thank you. Today we are going to test your recall of one-handed signs. This
means that each sign will only be produced with one hand, and the other arm remains
inactive, unless otherwise indicated. Each sign will be demonstrated twice as I say the
English translation. I ask that you listen and watch carefully, but keep your hands still.
You will hear the English translation and see the signs for several words in a list.
At the end of each list, I’ll ask you an English word and give you 10 seconds to
demonstrate the sign. There are four components of each sign that we will rate. These are
hand-shape, location, movement, orientation. I will show you a sample sign now, and
demonstrate these four components.
(Show sample sign FUTURE and breakdown what makes up each of the four
components.)
When asked to recall the signs, do your best to reproduce the sign accurately. If you
can’t remember a sign, you will not be penalized, just say that you can’t recall the sign
and we will continue with the rest of the list. You will also not be penalized if you guess
on the formation of a sign. You will see many words today, and you may feel that you
only partially recall some, but feel free to guess. If you do not recall the sign at all, it is
perfectly ok to say that you do not recall the sign.
We will do one practice list so that you can see how the experiment will work. Do
you have any questions at this point?
(PROCEED WITH PRACTICE LIST)
Any questions before we start the lists?
(PROCEED WITH EXPERIMENT LISTS)
We have now completed the experiment. In front of you is a debriefing form that
provides additional information about this study, including who to contact if you have
questions later. Do you have any questions now? Thank you for your participation.
One-Handed Simplified Signs 43
Appendix B
Sign Recall Scoring Sheet that the research assistants used to code the experiment.
1
Perfect
Almost Correct
2
Perfect
Almost Correct
3
Perfect
Almost Correct
4
Perfect
Almost Correct
5
Perfect
Almost Correct
6
Perfect
Almost Correct
7
Perfect
Almost Correct
8
Perfect
Almost Correct
9
Perfect
Almost Correct
10
Perfect
Almost Correct
11
Perfect
Almost Correct
12
Perfect
Almost Correct
13
Perfect
Almost Correct
14
Perfect
Almost Correct
15
Perfect
Almost Correct
16
Perfect
Almost Correct
17
Perfect
Almost Correct
18
Perfect
Almost Correct
19
Perfect
Almost Correct
20
Perfect
Almost Correct
L: Location
M: Movement
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
Wrong Sign
L M HS O
HS: Handshape
No Response
No Response
No Response
No Response
No Response
No Response
No Response
No Response
No Response
No Response
No Response
No Response
No Response
No Response
No Response
No Response
No Response
No Response
No Response
No Response
O: Orientation
One-Handed Simplified Signs 44
Appendix C
Memory and Recall of One-Handed Sign s: Debriefing Statement
Thank you for your participation in our study.
The long-term goal of our investigation is to develop a one-handed manual sign
communication system for hearing persons who are unable to produce useful spoken
language. Many of these people suffer from debilitating strokes that not only impair their
ability to use spoken language but may have also left them partially paralyzed. These
patients need a simple, one-handed manual sign system so they can communicate with
health care professionals and loved ones.
The project in which you just participated is one part of our long-term project.
The manual signs you viewed were either modified from an existing simplified sign
system created by John Bonvillian to benefit a larger variety of individuals, including
those living with autism or an intellectual disability, or new signs created specifically for
this study. Since many of the signs from the simplified system were changed to fit the
one-handed need of our target audience, we needed to test them to see that they were still
easy to recall and perform.
Your responses (and those of the other participants) will help us in our sign
selection process. If you (and other participants) remembered or reproduced a particular
sign, then it is likely that that sign will be kept in our collection of hundreds of possible
signs. If you forgot a sign or reproduced it inaccurately, then that sign will likely be
dropped from our collection of potential signs or further modified and retested.
Additional Readings (if desired)
Bonvillian, J. D., & Nelson, K.E. (1982). Exceptional Cases of Language
Acquisition. In K.E. Nelson (Ed.), Children’s Language (Vol. 3, pp. 322-391). Hillsdale,
NJ: Erlbaum.
Kilma, E. S., & Bellugi, U. (1979). The Signs of Language. Cambridge, MA:
Harvard University Press.
Skelly, M. (1982). Amer-Ind Gestural Code Based on Universal American Indian
Hand Talk (3rd ed.). New York: Elsevier.
Wilbur, R. B. (1987). American Sign Language: Linguistic and Applied
Dimensions (2nd ed.). Boston: College Hall.
One-Handed Simplified Signs 45
Appendix D
This list contains all of the words tested in this experiment and the category they
belong too after being tested on 14 participants. If 10 or more participants recalled the
sign perfectly it was coded as Met Criteria, meaning it will be included in the lexicon as
tested. If 8 or 9 participants recalled the sign perfectly it was coded as Almost Met
Criteria, meaning the sign would not be changed but would be retested. If 7 or fewer
participants recalled the sign perfectly, it was coded as Failed, meaning that the sign
needed to be redesigned before being retested.
Set 1
Information - Failed
Faucet - Met Criteria
Ketchup - Failed
Quote - Failed
Constipated - Almost Met Criteria
Laundry - Failed
Tape - Met Criteria
Rabbit - Almost Met Criteria
Nail Polish - Met Criteria
Pants - Failed
Tree - Met Criteria
Gasoline - Met Criteria
Help - Met Criteria
Arithmetic - Met Criteria
Umbrella - Met Criteria
Slap - Met Criteria
Return - Failed
Safe on Base - Met Criteria
Bible - Met Criteria
Orange - Failed
Diaper - Failed
Video - Met Criteria
Dizzy - Met Criteria
Undress Ones Self - Failed
Quarantine - Met Criteria
Contact Lens - Met Criteria
Rifle - Failed
Cake - Failed
Pain - Met Criteria
Valley - Met Criteria
X-Ray - Failed
Wednesday - Failed
One-Handed Simplified Signs 46
Pizza - Failed
Sad - Failed
Jump - Failed
Boat - Met Criteria
Walker - Failed
Iron - Failed
Dismount - Failed
Edge - Failed
Unite - Failed
Who? - Failed
Newspaper - Almost Met Criteria
In Favor Of - Failed
Die - Met Criteria
Massage - Met Criteria
List - Failed
Sky - Met Criteria
Teach - Failed
Amputate - Failed
Baby - Met Criteria
Turtle - Met Criteria
Here - Failed
Sick - Met Criteria
Gardening - Failed
Hug - Failed
Narcotic - Failed
Compare - Failed
Year - Failed
Farsightedness - Met Criteria
Toothpaste - Failed
Socks - Failed
Turn - Met Criteria
Uncover - Failed
Eight - Met Criteria
Inspect - Met Criteria
Fall - Met Criteria
Dollar - Failed
Scooter - Failed
Wait - Almost Met Criteria
Stand - Met Criteria
Deep - Failed
Rectangle - Met Criteria
Same - Failed
Dive - Failed
One-Handed Simplified Signs 47
Stretch - Met Criteria
Vagina - Met Criteria
Earrings - Met Criteria
Pie - Failed
Rain - Failed
Maybe - Met Criteria
Tea - Met Criteria
Measure - Failed
Pancake - Met Criteria
Halloween - Met Criteria
Reach - Failed
Hallway - Failed
In Front Of - Failed
Marker - Failed
Tumor - Met Criteria
Paperclip - Failed
Saturday - Failed
Table - Almost Met Criteria
Napkin - Failed
Kidney - Met Criteria
Melon - Failed
Love - Met Criteria
Open - Failed
Jaw - Almost Met Criteria
Save - Failed
Tear - Failed
Ocean - Met Criteria
Try - Met Criteria
Medical Marijuana - Met Criteria
Owl - Almost Met Criteria
Palm - Met Criteria
Tease - Met Criteria
Hip Joint - Met Criteria
Mean - Met Criteria
Jelly - Failed
Pantyhose - Failed
Slide - Met Criteria
Helmet - Failed
Throw Away- Failed
Read - Failed
Hang - Met Criteria
Knife - Failed
Insomnia - Failed
One-Handed Simplified Signs 48
Narrow - Almost Met Criteria
Ice - Failed
Set 2
Dance - Failed
Make the Bed - Failed
Now - Failed
Sunday - Failed
Headphones - Met Criteria
Monster - Met Criteria
Stuffed Animal - Failed
Devil - Met Criteria
Woman - Failed
Squirrel - Failed
Vacation - Met Criteria
Circus - Failed
Frown - Almost Met Criteria
Piano - Met Criteria
Freezer - Failed
Lock - Almost Met Criteria
Boots - Failed
War - Met Criteria
Lungs - Almost Met Criteria
Lobster - Failed
Ring - Met Criteria
Grass - Failed
Paint - Almost Met Criteria
Music - Met Criteria
Itch - Met Criteria
Dress - Failed
Penguin - Met Criteria
Enter - Failed
CD - Met Criteria
Sweetheart - Met Criteria
Weekend - Failed
Either - Met Criteria
Violin - Met Criteria
Time - Met Criteria
Chicken - Failed
Hurry - Failed
Butterfly - Failed
Do Not Want - Failed
One-Handed Simplified Signs 49
Diarrhea - Failed
Salad - Failed
Weak - Almost Met Criteria
Notice - Failed
Carrot - Almost Met Criteria
Rice - Almost Met Criteria
Stare - Almost Met Criteria
Berries - Failed
Sweater - Failed
Exercise - Met Criteria
Want - Failed
Spaghetti - Failed
Camera - Failed
Bicycle - Failed
Celebrate - Almost Met Criteria
Heavy - Failed
Heart - Met Criteria
Middle - Met Criteria
Wine - Failed
Dress - Failed
Swollen Glands - Met Criteria
Calm Down - Failed
Afternoon - Failed
Eye Glasses - Met Criteria
Drum - Met Criteria
Computer - Met Criteria
Nine - Met Criteria
Poison - Met Criteria
Cookie - Almost Met Criteria
World - Almost Met Criteria
CPR - Met Criteria
Diabetes - Failed
Hallucination - Almost Met Criteria
Birth - Failed
Battery - Failed
Surprise - Failed
Bracelet - Met Criteria
Important - Failed
Bathroom - Failed
Memorize - Failed
Again - Almost Met Criteria
Vary - Almost Met Criteria
One-Handed Simplified Signs 50
Coat - Failed
Smile - Met Criteria
Argue - Almost Met Criteria
Sandwich - Failed
Nearsightedness - Failed
With - Failed
Never - Failed
Kick - Met Criteria
Shampoo - Met Criteria
Clouds - Failed
Gather - Failed
Trashcan - Met Criteria
Rupture - Almost Met Criteria
Donkey - Failed
Parking - Almost Met Criteria
River - Met Criteria
Backpack - Failed
Reflex - Failed
Cast - Failed
Parallel - Failed
Fight - Met Criteria
Immigration - Met Criteria
Dark - Almost Met Criteria
Gorilla - Met Criteria
Clip Nails - Almost Met Criteria
Noisy - Failed
Elbow - Met Criteria
Doll - Almost Met Criteria
House - Almost Met Criteria
Worship - Failed
Microwave - Failed
Swim - Almost Met Criteria
Breathe - Almost Met Criteria
Twist - Almost Met Criteria
Necklace - Met Criteria
First - Almost Met Criteria
Attic - Failed
Bra - Met Criteria
Fence - Failed
Hamburger - Met Criteria
One-Handed Simplified Signs 51
Appendix E
DMP Simplified Sign One-Handed Descriptions for signs that Met Criteria or Almost
Met Criteria.
Again
The tip of the index finger of the pointing-hand (the index finger is
extended from an otherwise closed hand), palm facing down and finger
pointing diagonally forward, hops up the inactive forearm, several times.
Again and again and again.
Argue
The pointing-hand (the index finger is extended from otherwise closed
hand), palm facing in and fingers pointing forward, is held about a foot in
front of the body. The hand arcs up and down several times. A frown or
angry facial expression is appropriate.
Wagging finger at someone.
Arithmetic
The stationary spread- or 5-hand (the hand is flat with fingers spread apart
and extended), palm facing out and fingers pointing up, starts in front of
the body. Starting with the thumb, the fingers are bent down one at a time,
while the hand remains stationary.
Using one’s fingers to do arithmetic.
Baby
One forearm is slightly bent at chest level, palm facing up and fingers
pointing to opposite sides, as the arms swing from side to side.
Cradling and rocking a baby in one’s arms.
Bible
The flat-hand (hand is flat with fingers together and extended), diagonally
palm facing in and fingers pointing up, starts at eye level. The hand is
then extended up, and the eyes follow the movement of the hand.
A holy book is read and then raised on high.
Boat
The tips of the fingers of the flat hand (each hand is flat with fingers
together and extended), palm facing up and fingers pointing diagonally
forward, (to opposite sides), moves forward in front of the body in a gentle
arcing movement.
The bow of a ship moving through the water.
One-Handed Simplified Signs 52
Bra
The tips of the fingers of the curved-hand (the fingers and thumb are
together and curved), palm facing up and fingers pointing across the body,
are in front of the body. The edge of the little finger rests on the chest
below the breast.
A bra provides support for the breasts.
Bracelet
The tip of the index finger of the pointing-hand (the index finger is
extended from an otherwise closed hand), palm and finger pointing down
and knuckles pointing diagonally forward, points from one side of the
inactive wrist to the other. (The finger may touch the wrist.)
Indicates the location of a bracelet on one’s wrist.
Breathe
The spread- or 5-hand (hand is flat with fingers spread apart and
extended), palm facing in and fingers pointing across the body, touches
the chest, slowly move forward a few inches, and then returns to the chest.
The rising and falling of the chest while breathing.
Carrot
The tip of the index finger of the pointing-hand (the index finger is
extended from an otherwise closed hand), palm facing down and finger
pointing diagonally forward, grazes the upper edge of the index finger of
the inactive hand. The action is repeated several times.
Peeling or grating a carrot.
CD
The tips of the fingers and thumb of the claw-hand (the fingers are spread
apart and bent), palm facing down and fingers pointing diagonally
forward, start at one side of the body. The claw-hand then moves a short
distance to the opposite side and then down slightly.
Picking up a CD/DVD and inserting it into a CD/DVD player.
Celebrate
The pointing-hand (the index finger is extended from an otherwise closed
hand), palm facing across the body and finger pointing up, moves in small
horizontal circles near the head. An enthusiastic smile or happy facial
expression is appropriate. (To indicate the meaning “Turn Around
(person),” make the sign with one hand and a neutral facial expression.)
Waving party favors in celebration of an event; motioning to a person to
turn around.
One-Handed Simplified Signs 53
Clip Fingernails
The tips of the index finger and thumb of the baby O-hand (the
index finger and thumb are curved and touch at their tips from an
otherwise closed hand), palm facing in and knuckles pointing diagonally
forward and down, pinch the tip of the thumb on the inactive hand. (To
indicate the meanings “Clip Toenails” or “Cut Toenails,” make this sign
and then point to a foot.)
Clipping one’s nails with a nail clipper.
Computer
The claw-hand (the fingers are spread apart and bent), palm facing down
and fingers pointing forward, is in front of the body at waist level. The
fingers wiggle as if typing.
Typing on a computer’s keyboard (or a calculator’s keys).
Constipated The index finger of the pointing-hand (the index finger is extended from
an otherwise closed hand), points to the bottom. The hand is then brought
to the front of the body and becomes the spread- or 5-hand (the hand is flat
with fingers spread apart and extended), palm facing out and fingers
pointing up.
The intestine is full; waste is stuck and cannot be passed.
Contact Lens The tip of the index finger of the pointing-hand (the index finger is
extended from an otherwise closed hand), palm facing down and finger
pointing diagonally forward, initially points into open space in front of the
body at chest level. The tip of the index finger then moves to touch or
nearly touch the face near one eye, rotating so that the palm faces in and
finger points diagonally up.
Putting a contact lens in one’s eye.
Cookie
The index finger and thumb of the G-hand (the index finger and thumb are
extended from an otherwise closed hand and are parallel), palm facing
down, fingers pointing across the body, make a circle on the back of the
inactive palm. The hand then rotates and goes back to the mouth. A
smiling or satisfied face is also appropriate.
Using a cookie cutter to shape cookie dough.
CPR
The fingers of the flat-hand (hand is flat with fingers together and
extended), palm facing down and fingers pointing across the body,
initially is located in front of the chest. The hand then moves down and
back up several times.
One-Handed Simplified Signs 54
Pressing down on a person’s chest to pump blood through the heart and
body.
Dark
The flat-hand (hand is flat with fingers together and extended), palm
facing in and held near the head and fingers pointing across the body,
initially is at the side of the head. It then arces diagonally down, passing
in front of the eyes, to the chest, ending with the fingers pointing down.
The sky becomes darker in the evening making it more difficult to see.
Devil
The knuckles and edge of the index finger of the pointing-hand (the index
finger is extended from an otherwise closed hand), palm facing out and
finger pointing up, rests on the temple (the side of the forehead). A fierce
or mean facial expression is appropriate.
Indicates the horns of a devil.
Die
Flat-hand (hand is flat with fingers together and extended), the palm
facing up fingers pointing forward, initially is in front of the body. It then
flips so that the palm is facing down.
Passing over to the other side: from life into death.
Dizzy
Spread- or 5-hand (the hand is flat with fingers spread apart and
extended), palm facing in and fingers pointing up, moves in small, vertical
circles in front of the face. A sick or nauseated facial expression is
appropriate.
The head sways when one is dizzy or lightheaded.
Doll
The flat-hand (the hand is flat with fingers together and extended), palm
facing in and fingers pointing diagonally up, hovers above the upper chest,
as if cradling a doll. The hand then moves up and down slightly a few
times, as if stroking the doll’s imaginary hair.
Stroking a doll’s hair.
Drum
The flat-hand (hand is flat with fingers together and extended), palm
facing down and fingers pointing diagonally forward, flips up and down in
front of the body at waist level.
Hitting a drum with one’s hands; drumming.
One-Handed Simplified Signs 55
Earrings
The knuckles of pointing-hand (the index fingers are extended from
otherwise closed hands), palm and fingers pointing down and knuckles
pointing in towards the face, touches the base of the ear. (Wiggling the
fingers is appropriate.)
Long earrings hanging from the ears.
Eight
Spread- or 5-hand (the hand is flat with fingers spread apart and
extended), with palm facing out and fingers pointing up, rests at chest
level in front of the body. The middle finger and the thumb both bend so
that the tips touch, while the hand remains stationary.
The ASL sign for eight.
Either
The tip of the index finger of the pointing-hand (the index finger is
extended from an otherwise closed hand), palm facing down and finger
pointing to the side and diagonally down, points to first one location in
front of the body and then another.
One or the other, but not both.
Elbow
The tip of the index finger of the pointing-hand (the index finger is
extended from an otherwise closed hand), palm facing in and finger
pointing to the side, touches the elbow of the inactive arm.
Indicates the elbow.
Eyeglasses
The tapered- or O-hand (the fingers are together and curved, with the
finger tips touching the thumb tip), palm facing across the body and
knuckles pointing up, are placed just in front of the eyes.
Indicates the shape of a pair of glasses.
Exercise
The fist (the hand forms a fist), palm facing up and knuckles pointing
forward, initially is held out in front of the body. The arm, from the elbow
to the hand, curls back in towards the body.
Lifting weights and exercising.
Fall
The tips of the index and middle fingers of the V-hand (the index and
middle fingers are spread apart and extended from an otherwise closed
hand in the shape of a “V”), palm and fingers pointing down and knuckles
pointing diagonally forward, initially hovers in space at chest level. The
One-Handed Simplified Signs 56
V-hand then arcs down, rotating so that the palm and fingers point up and
knuckles point down.
The V-shape represents a person’s legs going up in the air as he falls
down.
Farsighted(ness)
Bent-hand (the fingers are together and extended at right angles
with respect to the palms), palms and fingers pointing up and knuckles
pointing forward, are extended forward in front of the upper chest.
Squinting is appropriate.
A farsighted person often holds reading materials at a distance.
Faucet
Claw-hand (the fingers are spread apart and bent), palm facing down and
fingers pointing forward, initially are a few inches in front of the body.
The hand then twists. The action is repeated.
Turning on a water faucet; turning a spigot or valve.
Fight (physical)
The fist (hand forms a fist), palm facing across the body and
knuckles pointing diagonally up, initially are in front of the body at
shoulder level. It then makes several vertical circles before the fist is
quickly extended forward, palm facing down and knuckles pointing
forward.
Boxing; hitting a punching bag.
First
The fist (hand forms a fist), knuckles facing up and palm facing forward,
starts in front of and to the side of the body. The pointing finger then flips
up from the closed fist.
Indicates the first digit of the hand.
Frown
The tip of the index finger of pointing-hand (the index finger is extended
from an otherwise closed hand), palm facing in and finger pointing
diagonally up, initially touch the center of the lower lip. The finger then
arcs away from the center to the side of the mouth and down to the lower
edge of the jaw. A frown or unhappy facial expression is appropriate.
Drawing the lips into a frown.
Gasoline
The index finger of the pointing-hand (the index finger is extended from
an otherwise closed hand), palm facing out and finger pointing up, is bent
slightly as the hand tilts forward.
One-Handed Simplified Signs 57
Pouring gasoline from a container.
Gorilla
The fist (hand forms a fist), palm facing in and knuckles pointing across
the body, hits the chest several times.
A gorilla beating its chest.
Halloween
V-hand (the index and middle fingers are spread apart and extended from
otherwise closed hands in the shape of a “V”), palm facing in and fingers
pointing across the face, touch the face with the index finger above the eye
and the middle finger below.
Peering out through the holes of a Halloween mask.
Hallucination
The tips of the fingers of spread- or 5-hand (hand is flat with
fingers spread apart and extended), palm facing across the body and
fingers pointing up, initially touch the temple (the side of the forehead). It
then moves a short distance away, crossing in front of the eyes, with
fingers wiggling.
Imaginary perceptions and disordered thoughts often underlie
hallucinations and delusions.
Hamburger The C-hand (the fingers are together and curved, with the thumb opposite
the fingers), palm facing in and fingers pointing diagonally up, initially is
held in front of the chin. The hand then moves toward the mouth as the
mouth opens.
Holding and preparing to bite into a hamburger.
Hang
The tip of the index finger of the pointing-hand (the index finger is
extended from an otherwise closed hand), palm facing diagonally out and
finger pointing up, bends. The hand, at eye level, moves across the body.
Hanging up clothes on a bar. Also can mean closet.
Headphones The tips of the fingers and thumbs of C-hands (the fingers are together and
curved, with the thumbs opposite the fingers), palm facing across the body
and fingers pointing up, touch the sides of the head with the palms over
the ears. (This sign may also be made with the fingers slightly apart.)
Putting on headphones for a hearing test.
One-Handed Simplified Signs 58
Heart
The tip of the index finger of the pointing-hand (the index finger is
extended from an otherwise closed hand), palm facing in and fingers
pointing diagonally up to opposite sides, traces the shape of a heart on the
left side of the chest.
Indicates the stereotypical shape of the heart.
Help
The curved-hand (the fingers and thumb are together and curved), moves
to the inactive arm and lifts the limb several inches.
Helping to move the immobile limb.
Hip Joint
Fist (the hand forms a fist), palm facing in and knuckles touching the hip.
The hand then rotates back and forth.
Indicates the movement of a bone at a joint; cartilage covering a joint.
House
The tips of the fingers of the flat-hand (the hand is flat with fingers
together and extended), palm facing across the body at a slight angle and
fingers pointing forward, starts on one side of the body. The hand then
moves diagonally up several inches before rotating, palm facing to the
opposite side, and moves diagonally down. (To indicate the meanings
“City,” “Community,” “Neighborhood,” “Roofs,” “Town,” or “Village,”
repeat the sign as the hands move to the side.)
The roof of a house; the many roofs in a neighborhood or town.
Immigration The flat-hand (hand is flat with fingers together and extended), palm
facing in and fingers pointing up, initially is about a foot above the
shoulder with the arm raised to shoulder level and forearms upright. The
hand then bends until the fingers point back. The action is repeated.
Motioning someone to step forward for immigration processing.
Inspect
The tips of the index finger and thumb of the baby O-hand (the index
finger and thumb are curved and touch at their tips from an otherwiƒse
closed hand), palm facing down and knuckles pointing diagonally
forward, start in the space in front of the body. The baby O-hand then
moves straight up to eye level as the signer looks at it. Squinting is
appropriate.
Carefully inspecting or examining a small object taken from one’s hand.
One-Handed Simplified Signs 59
Itch
The tips of the fingers and the thumb of the claw-hand (the fingers are
spread apart and bent), palm facing down and fingers pointing diagonally
forward, slide across the upper thigh several times as the fingers move
slightly.
Scratching an itch.
Jaw
The tip of the index fingers of pointing-hand (the index finger is extended
from otherwise closed hands), palm facing across the body and fingers
pointing up, slides down the edge of the jaw from the base of the ear to the
chin.
Indicates a person’s jaw.
Kick
The pointing-hand (the index finger is extended from an otherwise closed
hand), palm and fingers pointing down and knuckles pointing forward, is
held in front of the body. The hand then rotates up until the index finger
points forward. (Alternatively, one may mimic the action of kicking with
one’s leg.)
One leg kicks forward.
Kidneys
The tip of the index finger of pointing-hand (the index finger is extended
from an otherwise closed hands), palm facing up and finger pointing
diagonally back, initially is to the side of the body at waist level. The
hand then moves to touch the lower back.
Indicates the location of the kidneys.
Lock
The tip of the index finger and thumb of the baby O-hand (the index finger
and thumb are curved and touch at their tips from an otherwise closed
hand), palm facing to the side and knuckles pointing up, initially touches
the inactive arm above the elbow. The active hand then twists forward so
that the knuckles point forward. (To indicate the meaning “Unlock,”
reverse the action of the sign.)
Turning a key in a lock.
Love
Pointing-hand (the index finger is extended from an otherwise closed
hand), palm down and finger pointing away from the body, is in front of
the body at chest level. The hand then traces the outline of a heart in the
air in front of the body.
The shape of a heart.
One-Handed Simplified Signs 60
Lungs
The tips of the fingers and thumbs of the claw-hand (the fingers are spread
apart and bent), palm facing in and fingers pointing across the body, touch
the upper chest and then slide down about a foot.
Indicates the location of the lungs.
Massage
Curved-hand (the fingers and thumbs are together and curved), palm
facing down and fingers pointing back, squeeze or press down on the top
of the shoulder several times. A smile or happy facial expression is
appropriate.
Kneading a person’s aching shoulder muscles.
Maybe
The tips of the fingers of the flat hand (each hand is flat with fingers
together and extended), start with the palm facing up in front of the body.
The hand then rotates so the palm is facing down. The action is repated.
Wavering in making a decision; things are iffy.
Mean
Pointing-hand (the index finger is extended from an otherwise closed
hand), palm and fingers pointing diagonally down, are held in front of an
eyebrow. A frown, scowl, or unhappy facial expression is appropriate.
Indicates the shape of the eyebrows while scowling.
Medical Marijuana The base of the baby O-hand (the index finger and thumb are
curved and touch at their tips from an otherwise closed hand), palm facing
down and knuckles pointing up, touch the lips.
Smoking medical marijuana.
Middle
The tip of the index finger of the pointing-hand (the index finger is
extended from an otherwise closed hand), palm and finger pointing in
toward the body and knuckles pointing to the side. Points at the upper
chest, then moves straight down, and stops around the navel.
Drawing an imaginary line down the middle of the body.
Monster
The claw-hand (the fingers are spread apart and bent), palm facing out and
fingers pointing up, initially are extended out to the side of the body at
head level with the arms bent slightly. The hand then bends forward from
the wrists several times. A fierce or mean facial expression is appropriate.
A monster making menacing gestures.
One-Handed Simplified Signs 61
Music
The pointing-hand (the index finger is extended from an otherwise closed
hand), palm facing down and finger pointing forward, initially is held in
front of the body. The hand then arcs to one side and back to the center
several times. (To indicate the meanings “Choir” or “Sing,” open the
mouth.)
Conducting the music of a choir or orchestra.
Nail Polish
The claw-hand (the fingers are spread apart and bent), palm facing in, is
held near the face. The hand moves back and forth in front of the mouth
while air is blown across the nails.
Blowing on freshly painted nails to help dry them.
Narrow
The index finger and thumb of the G-hand (the index finger and thumb are
extended from an otherwise closed hand and are parallel), fingers pointing
forward. The hand starts at shoulder height and moves down.
Showing with your hands the narrow width of something.
Necklace
The tip of the index finger of the pointing-hand (the index finger is
extended from an otherwise closed hand), palm facing in and finger
pointing diagonally up across the body, initially starts to one side of the
neck. The hand then moves down and across the neck to the other side,
tracing a semi-circle.
Showing off a necklace hanging around one’s neck.
Newspaper
The index and middle fingers of the V-hand (the index and middle fingers
are spread apart and extended from an otherwise closed hand in the shape
of a “V”), palm facing down and fingers pointing forward, starts at eye
level. The hand then moves across the horizontal plan a few inches before
moving down a few inches. The motion is repeated as the hand descends.
Reading a newspaper.
Nine
The hand, palms facing out and fingers pointing up, is held in front of the
upper chest. The hand starts as a spread- or 5-hand (the hand is flat with
fingers spread apart and extended). After pausing for a moment, the hand
changes into a spread- or 5-hand with its thumb tucked into the palm.
Nine fingers or digits are held up; 5 plus 4 equals 9.
One-Handed Simplified Signs 62
Ocean
Spread- or 5-hand (hand is flat with fingers spread apart and extended),
palm facing down and fingers pointing forward, is in front of the body. It
then arcs up and down while moving forward.
Waves rolling on the surface of an ocean or lake.
Owl
Pointing-hand (the index finger is extended from an otherwise closed
hand), palm facing in and finger pointing up, traces a small circle around
and in front of an eye.
Indicates the large eye of an owl.
Pain
Fingers close and make a fist, which is then bumped into the area affected
by the pain. A frown or pained facial expression is appropriate. (This
sign can be made on the part of the body that hurts. Alternatively, one can
make this sign and then point to the source of pain.)
Being bumped causes pain.
Paint
The backs of the fingers of the bent-hand (the fingers are together and
extended at a right angle with respect to the palm), palm and fingers
pointing diagonally in and knuckles pointing down, brush forward along
the forearm of the inactive arm. The bent-hand then flips open into a flathand, palm facing down and fingers pointing forward, and brushes down
the stationary arm. The action may be repeated.
Painting a surface with a paintbrush.
Palm
The flat-hand (the hand is flat with fingers together and extended), palm
facing up and fingers pointing diagonally forward is extended in front of
the body.
Indicates the palm.
Pancake
The fist (the hand forms a fist), palm facing to the side and knuckles
pointing down, starts in front of the body. The hand moves forward
slightly, then arcs up and back towards the body. The sign can be
repeated.
Flipping or turning over a pancake.
Parking
The flat-hand (the hand is flat with fingers together and extended), palm
facing down and fingers pointing to the side, initially is in front of and to
the side of the body. It then moves about a foot to the other side until it is
One-Handed Simplified Signs 63
in front of the body, turns so that the fingers point forward, moves forward
about six inches, and comes to a stop.
A car pulling into a parking space next to a wall.
Penguin
The arm is held straight down at the side of the body with a flat-hand
(hand is flat with fingers together and extended), palm and fingers
pointing diagonally down the side. Wiggling or shifting the body from
side to side in imitation of a penguin’s shuffling movement is appropriate.
(To indicate the meaning “Flippers,” flap the hands up and down slightly.)
A penguin’s flippers.
Piano
The fingers of a spread curved-hand (the fingers are spread apart and
curved), palm facing down and fingers pointing forward, wiggle as the
hand moves from side to side in front of the body.
Playing the piano.
Poison
The tip of the index finger of the pointing-hand (the index finger is
extended from an otherwise closed hand), palm facing the body and finger
pointing up, traces an X over the mouth. Shaking the head “No” and a
frown or unhappy facial expression are appropriate.
The crossbones of the poison symbol; something that should not be eaten
or swallowed.
Quarantine
The pointing-hand (the index finger is extended from an otherwise closed
hand), palm facing out to the side and finger pointing up, is fully extended
to the side at shoulder level. The head is turned away from the pointinghand.
A person in quarantine is separated from others.
Rabbit
The V-hand (the index and middle fingers are spread apart and extended
from an otherwise closed hand in the shape of a “V”), palm facing forward
and fingers pointing up, initially is chest level and close to the body. The
hand then arcs forward several times.
A rabbit hopping forward.
Rectangle
The edge of the index fingers of the pointing-hand (the index finger is
extended from an otherwise closed hands), palm facing down and fingers
One-Handed Simplified Signs 64
pointing forward, trace the outline of a rectangle vertically in front of the
body.
Indicates the general shape of a rectangle.
Reflex
The knuckles of the fist (the hand forms a fist), palm facing up and
knuckles pointing to the side, swing down to strike the knee. The knee
then moves up slightly in response.
A doctor tests a patient’s reflexes by tapping the nerves by the knee. A
reflex is an involuntary movement in response to a stimulus.
Rice
The tips of the index and middle fingers of the H-hand (the index and
middle fingers are together and extended from an otherwise closed hand),
palm and fingers pointing down and knuckles pointing diagonally forward,
initially touch the forearm of the inactive arm. The H-hand then rotates so
that the palm and fingers point up and the tips of the index and middle
fingers touch the face just below or on the lower lip. The action is
repeated. An open mouth is appropriate.
Eating rice with chopsticks.
Ring
The pointing-hand (the index finger is extended from an otherwise closed
hand), palm facing in and finger pointing to the side, touches the base of
the ring finger of the hand of the inactive arm.
Indicates the placement of a diamond wedding ring.
River
The pointing-hand (the index finger is extended from an otherwise closed
hand), palm facing down and finger pointing forward, initially is in front
of the body. It then arcs up and down slightly while moving forward a
short distance.
Water flowing in a stream.
Rupture
The tips of the fingers and thumb of the tapered- or O-hand (the fingers
are together and curved, with the finger tips touching the thumb tip), palm
facing across the body and knuckles pointing forward, initially is in front
of the body. The hand then moves to the side as it opens into a spread- or
5-hand (the hand is flat with fingers spread apart and extended), palms
facing across the body and fingers pointing forward. (The larger the
rupture or explosion, the further away the hand should move.) Opening
one’s mouth or puffing out one’s cheeks as the hand moves to the side is
appropriate.
One-Handed Simplified Signs 65
Something that was held together ruptures or bursts apart.
Safe (on base)
Flat-hand (hand is flat with fingers together and extended), palm
facing down and fingers pointing diagonally forward, initially is in front of
the waist. The hand then sweeps quickly across the body.
An umpire calling a baseball player “safe” on base or at home plate.
Shampoo
The tips of the fingers and thumb of a spread curved-hand (the fingers are
spread apart and curved), palm facing in towards the head and fingers
pointing up, rub the sides of the head.
Washing one’s hair with shampoo.
Sick
The flat-hand (the hand is flat with fingers together and extended), palm
facing in and fingers pointing to the side, is held on the forehead. After a
pause, the hand, palm facing in and fingers pointing to the opposite side, is
held on the stomach. A frown or unhappy facial expression is appropriate.
The head and stomach hurt or do not feel well.
Sky
The spread- or 5-hand (the hand is flat with fingers spread apart and
extended), palm facing forward and fingers pointing straight up, starts
raised above and to the side of the head. The hand then arcs from one side
to the other. The signer should gaze up.
Indicates the sky; reaching up to touch the sky.
Slap
The active flat-hand (the hand is flat with fingers together and extended),
palm facing down and fingers pointing to the side, slaps the back of the
stationary flat-hand, where it rests at the side of the body. A pained facial
expression or mouthing the word “Ow” is appropriate.
A slap is painful.
Slide
The flat-hand (the hand is flat with fingers together and extended), palm
facing down and fingers pointing diagonally forward and down, initially is
at shoulder level, close to the body. The hand then arcs down and forward.
Sliding down a slide on a playground.
One-Handed Simplified Signs 66
Smile
The tip of the index finger of the pointing-hand (the index finger is
extended from an otherwise closed hand), palm facing in and finger
pointing diagonally up across the body, initially touches the center of the
lower lip. It then arcs to the sides of the mouth and up to the cheek. A
smile or happy facial expression is appropriate.
Drawing the lips into a smile.
Stand
The tips of the index and middle fingers of the V-hand (the index and
middle fingers are spread apart and extended from an otherwise closed
hand in the shape of a “V”), palm and fingers pointing down and knuckles
pointing diagonally forward, rests in the space in front of the body.
A person standing on her legs.
Stare
V-hand (the index and middle finger are spread apart and extended from
an otherwise closed hand in the shape of a “V”), palm down and fingers
pointing forward, initially is at the side of the head at eye level. The hand
then moves forward a short distance.
Interlocking eyes.
Stretch
The fist (the hand forms a fist), palm facing to the side and knuckles
pointing to the front, is formed in front of the body. The arm then extends
upward above the head and the hand turns into a spread- or 5-hand (the
hand is flat with fingers spread apart and extended), palm facing out and
fingers pointing up.
Stretching the body after resting.
Sweetheart
The flat-hand (the hand is flat with fingers together and extended), palm
facing in and fingers pointing diagonally up to the side, is placed on the
chest over the heart. A smile or happy facial expression is appropriate.
Holding a loved one or someone dear in one’s heart.
Swim
The curved-hand (the fingers and thumb are together and curved), palm
facing down and fingers pointing forward, initially is to the side of the
body. The hand then extends upward and forward in vertical arcs.
Swimming.
One-Handed Simplified Signs 67
Swollen Glands
The fist (hand forms a fist), palm facing in towards the body and
knuckles pointing up, is placed on the side of the upper neck. After a
moment’s pause, the fist moves to the other side of the neck. A frown or
sickly facial expression is appropriate.
The fist represents the swollen glands characteristic of certain diseases.
Table
The edge of the index fingers and thumbs of a flat-hand (hand is flat with
fingers together and extended), starts with the hand on the signer’s left,
palm facing across the body. The hand then moves up several inches, and
rotates so that the palm is facing down. The hand then moves across the
body and then rotates again, so that the palm is facing leftward across the
body. The hand then moves down several inches.
Indicates the general shape of a tabletop.
Tape
The index and middle fingers of the H-hand (the index and middle fingers
are together and extended from an otherwise closed hand), palm facing in
and fingers pointing across the body, start to the left of the mouth and
brush back across the lips.
Taping someone’s mouth shut.
Tea
The base of the baby O-hand (the index finger and thumb are curved and
touch at their tips from an otherwise closed hand), palm facing to the side
and knuckles pointing forward, initially rests in the space in front of the
body. The hand then arcs up to the side of the mouth, rotating so that the
knuckles point up. Opening one’s mouth slightly is appropriate.
Holding and taking a sip from a cup of tea.
Tease
The tip of the thumb of the spread- or 5-hand (hand is flat with fingers
spread apart and extended), palm facing out and fingers pointing up, touch
the ear as the hand flaps forward and back several times. Sticking out the
tongue is appropriate.
Teasing or making fun of someone.
Time
The tip of the index finger of the pointing-hand (the index finger is
extended from an otherwise closed hand), palm facing down and finger
pointing diagonally forward, touches the back of the wrist on the inactive
arm.
Pointing to one’s watch to indicate the time.
One-Handed Simplified Signs 68
Trashcan
The tip of the index finger of pointing-hand (the index finger is extended
from otherwise closed hand), palm facing across the body and finger
pointing down, starts at the side of the body at thigh level. The finger then
draws a circle, suggesting the opening of the trashcan.
Indicates the approximate size and shape of the upper part of a trashcan.
Tree
The fingers of the spread- or 5-hand (the hand is flat with fingers spread
apart and extended), palm facing out and fingers pointing up, wiggle
slightly, as the elbow extends forward from the body and rests in space.
(To indicate more than one tree or the meanings “Forest” or “Nature,”
make this sign and then move the arms a short distance to the side.)
Indicates the trunk, branches, and leaves of a tree; a forest has many trees.
Try
Fist (hand forms a fist), palm facing out and knuckles pointing up, initially
is held to the side of the head. The hand then gradually moves down until
it is at chin level.
Making a determined effort to complete a pull-up; pulling oneself up.
Tumor
The fist (the hand forms a fist), palm facing down and knuckles pointing
to the side, is placed on the back of the inactive arm.
Indicates a large growth or tumor.
Turn
Flat-hand (hand is flat with fingers together and extended), palms facing
across the body and fingers pointing forward, initially are in front of the
body. It then moves several inches straight forward and then makes a 90degree turn to one side. (To indicate the meaning “Turn Right,” one
should turn the hands to the right. To indicate the meaning “Turn Left,”
one should turn the hands to the left.)
Making a turn.
Turtle
The fist (the hand forms a fist), palm facing to the side and knuckles
pointing to the front, is formed in front of the body. The thumb of the fist,
may wiggle slightly as the whole hand moves forward slowly.
A turtle walking slowly.
One-Handed Simplified Signs 69
Twist
The fist (hand forms a fist), palm facing down and knuckles pointing
forward, initially is in front of the body. The fist then arcs forward across
the body, so that the knuckles face to the side. (To indicate the location of
a sprain or cramp, make this sign and then point to the affected area of the
body. To indicate the meaning “Spasm,” make this sign and then return
the hand to the original position. The sign may be made quickly.)
Twisting or wringing a cloth; the tightening of an area that occurs during a
cramp. The tightening and loosening of an area that occurs during a
spasm.
Umbrella
The tip of the index finger of the pointing-hand (the index finger is
extended from otherwise closed hand), palm facing down at chest level,
draws a “j” shape in the air. At the highest point, the hand rotates slightly
so that the tip of the index finger is pointing up and the palm is facing out.
Indicated the curved handle of an umbrella.
Vacation
The flat-hand (hand is flat with fingers together and extended), palm
facing forward and fingers pointing to the side of the body, is located
behind the lower part of the head as the head leans back slightly. A smile
or happy facial expression is appropriate.
Supporting the head while leaning back and relaxing on vacation.
Vagina
The index finger of the pointing-hand (the index finger is extended from
an otherwise closed hand) outlines a triangle in front of the lower
abdomen.
Indicates the approximate shape of the vulva or the external area
surrounding a woman’s vagina.
Valley
Flat-hand (each hand is flat with fingers together and extended), palm
diagonally to the side, facing across the body, and fingers pointing
forward, initially are at shoulder level. The hand then move diagonally
down to waist level, as far as is comfortable, before the hand rotates
slowly so that the palm is diagonally down but the fingers remain pointing
forward. The hand then moves back up to shoulder level, completing the
v- shaped path of the hand.
Indicates the sides of a valley
One-Handed Simplified Signs 70
Vary
The edge of the index finger of the pointing-hand (the index finger is
extended from otherwise closed hands), palm facing down and finger
pointing forward, starts at chest level to the side of the body. The hand
then moves up and down while also moving across the body.
Lines on a graph vary in height.
Video
The partially closed C-hand (the fingers are together and curved, with the
thumb opposite the fingers), palm and fingers facing forward, at elbow
level. The hand then moves forward several inches.
Taking a videocassette and inserting it into a VCR.
Violin
The fist (the hand forms a fist), palm facing down and knuckles pointing
diagonally forward, arcs from side to side in space, at shoulder level to
the side of the body. Head is titled to the side as if the chin is holding a
violin. (To indicate the meaning “Practice Music,” repeat the action
several times.)
Playing a violin; practicing music.
Wait
The knuckles of the fist (hand forms a fist), palm facing back, rest on the
side of the waist. The elbow is held out to the side of the body. (To
indicate the meaning “Impatient,” make this sign with a frown or unhappy
facial expression.)
Impatiently waiting.
War
The tip of the index finger of the L-hand (the index finger and thumb are
extended from an otherwise closed hand and forms a right angle), palm
facing in and finger pointing across the body and thumb pointing up, are in
front of the body. The finger then moves to point in several different
directions (This sign can also be made to emphasize the action of war
fighting by arcing the hand slightly, first to one side and then to the other.
This arcing movement may be repeated several times.)
A gun aimed at someone.
Weak
The tips of the fingers and thumb of the claw-hand (the fingers are spread
apart and bent), palm facing down and fingers pointing diagonally
forward, bend forward on the leg. A frown or fatigued facial expression is
appropriate.
One-Handed Simplified Signs 71
Knees buckling from weakness.
World
Curved-hand (the fingers and thumbs are together and curved), starts in
front of the body at chest level. The palm is facing across the body and
fingers are pointing forward. The hand then moves up and around in a
circle. The fingers are always pointing forward but the direction of the
palm rotates with the movement.
Indicates the spherical shape of a globe.