Assessment and treatment of gesture in neurogenic communication disorders: an international survey of practice

Background: Gesture and speech collaborate in conveying meaning, and gesture is often leveraged by people with neurogenic communication disorders, such as aphasia, cognitive-communicative impairments and primary progressive aphasia, when words fail them. Because gesture is imagistic, transitory and holistic, there are inherent challenges when assessing and treating it. Aims: The survey had three primary research questions: (1) what gesture assessment practices, and (2) what gesture treatment practices, are employed by speech and language therapists (SLTs) internationally; and (3) what are the factors that influence these practices?. Methods and Procedures: An online survey of practice using Qualtrics was piloted and then disseminated to practising SLTs working with people with neurogenic communication disorders. In addition to descriptive statistics summarising across the three research questions, statistical comparisons were made for two independent groups: primary work setting (research versus clinical), and primary work setting considering years of experience specific to neurogenic communication disorders (research, high; research, low; clinical, high; and clinical, low). Outcomes and Results: A total of 130 international SLTs completed the first two parts of the survey. A total of 107 completed all four sections of the survey. Fifty percent of respondents reported assessing gesture sometimes/for some clients, with only 5% reporting that they never assessed gesture. Nearly 70% of respondents reported never using a published test to evaluate gesture, with qualitative results suggesting a lack of formal assessments. This was further highlighted by the most prominent barrier being a lack of published tests (50% of respondents said this). The primary reason for evaluating gesture was to assess nonverbal communication. There was no significant difference in gesture assessment practices across comparison groups. The research group, and those within the research group with most years of experience, tended to target gestures during treatment and write treatment goals containing gesture more than other respondents. The most common facilitator to assessing or treating gesture was that the family or individual prioritised gesture for enhancing communication (53.1% of respondents). No group differences were identified for barriers/facilitators. Conclusions and Implications: Findings indicate that whilst gesture is a critical nonverbal communicative behaviour, there is an unmet need for empirical and standardised methods for assessing gesture in speech and language clinical practice and there is a lack of gesture-specific treatment resources. SLTs working in research settings may feel more able, or have more resources, to include gesture during treatment. Essential next steps include creating empirical and standardised methods for assessing gesture in speech and language clinical practice. WHAT THIS PAPER ADDS: What is already known on the subject Gesture is a complex and crucial aspect of communication. It is a key part of the role of speech and language therapists (SLTs), as described in clinical guidelines, to assess people with aphasia's use of gesture and consider whether it could be enhanced through treatment. What this study adds to existing knowledge This is the first international survey of practice focusing on gesture assessment and treatment. It highlights the variety of methods used by SLTs to assess and treat gesture, the importance they attach to this area and the need for standardised assessment tools and treatment resources. What are the clinical implications of this work? This study provides a comprehensive overview of practices for assessing and treating gesture in neurogenic communication disorders, as well as a list of gesture resources being actively used by clinicians and researchers. These may be useful for clinicians looking to expand their understanding of approaches and resources for assessment and treatment in this domain. The study also reports on the reasons clinicians assess gesture and the barriers and facilitators they encounter which may inform clinical practice in this area.