Speech and Language Therapists' Views and Experiences of Working With People With Wernicke's Aphasia: A Qualitative...

Wernicke's aphasia is a challenging communication disability to live with, characterised by fluent speech, impaired auditory comprehension and reduced self-monitoring. There is little literature addressing functional therapy approaches. For example, there is limited evidence for communication partner training (CPT) for this client group, despite research on its effectiveness more generally. It is not known how speech and language therapists (SLTs) understand and apply this limited and disparate evidence to their practice.

To explore how SLTs assess and treat people with Wernicke's aphasia (PwWA), specifically how SLTs engage with PwWA; work with the multi-disciplinary team to support PwWA; support significant others of PwWA, including through the provision of CPT.

In this qualitative interview study, SLTs were recruited through social media and professional newsletters. Interviews via videoconferencing followed a topic guide and were transcribed and analysed using Framework Analysis. Fifteen SLTs participated, with 1.5-34 years of experience, working in England and Wales across a range of inpatient and community settings.

SLTs described a range of issues when working with PwWA. Building a therapeutic alliance was considered important, but could take longer than in other types of aphasia. Informal assessment was required for many PwWA, with published language assessments deemed unsuitable by many. It was perceived that available outcome measures did not capture change. SLTs took differing views on which theoretical models they should use to guide impairment-based therapy. Treatment choices were sometimes driven by trial and error. SLTs offered CPT throughout the stroke pathway, reporting it to be clinically useful; however, there was uncertainty around which communication strategies to recommend. Many SLTs viewed working with PwWA negatively. They wanted to help but felt unsure about how to do so, and commented that the evidence base for treatment was limited. SLTs worked most closely with occupational therapists to manage Wernicke's aphasia. SLTs expressed concerns around the quality of decision-making capacity assessments completed by other members of the multidisciplinary team and access to psychological support for PwWA.

SLTs want evidence to guide their practice when working with Wernicke's aphasia. Further research is needed to inform CPT and outcome measures for PwWA. CPT should be supported by empirical research into interactions involving PwWA. There needs to be improved access to mental health support and high-quality decision-making capacity assessment for PwWA.

What is already known on this subject Impairment-based treatments for Wernicke's aphasia from varied theoretical perspectives are reported in the literature. There is little literature reporting on functional approaches and communication partner training for Wernicke's aphasia. It is not known how practising speech and language therapists (SLTs) assess and treat people with Wernicke's aphasia (PwWA). What this paper adds to existing knowledge SLTs found PwWA difficult to work with; they wanted to help but felt unsure about what to offer. SLTs are offering communication partner training for Wernicke's aphasia throughout the stroke pathway; however, they expressed differing opinions on which communication strategies to recommend. What are the potential or actual clinical implications of this work? SLTs would like more research evidence to guide them when managing Wernicke's aphasia. There is a need for assessments, treatments, outcome measures and psychological support that meet the unique needs of PwWA.