Fluent Aphasia Treatment Guide (Free Questionnaire)

Where do you begin with a speech therapy patient who doesn’t understand language?

In this beginner’s guide to fluent aphasia treatment (also known as receptive or Wernicke’s aphasia), you’ll find this answer and more.

You’ll learn:

• How to assess a patient’s level of comprehension
• How to start receptive aphasia treatment
• How to progress receptive aphasia treatment

How To Do Fluent Aphasia Treatment?

You completed a thorough language assessment and determined that your patient has fluent (aka receptive) aphasia.

Now what?

In this step-by-step treatment guide, you’ll learn how to progress a patient from a severe receptive language impairment to a milder impairment.

Let’s start with step 1.

1. Assess The Level of Comprehension

Before getting started, you’ll need to know your patient’s level of comprehension.

To do that, review their assessment results and use the questionnaire below to get a general idea of the severity of their receptive aphasia.

Informal Language Comprehension Questionnaire

Instructions:

• Answer each question with either Yes or No
• Give 1 point for Yes and 0 points for No
• The lower the score, the more severe the aphasia

Can the patient:

1. Follow 1-step commands? (“Point to your shoe”)
2. Follow 2-step commands? (“Point to your shoe, then look at the door”)
3. Follow multi-step (3+ step) commands? 
4. Comprehend without cues or gestures for support?
5. Read and understand at the single-letter level? (single letter identification)
6. Read and understand at the word level?
7. Read and understand at the phrase level?
8. Read and understand at the sentence level?
9. Read and understand without visual supports (e.g. pictures)?
10. Identify written numbers?
11. Identify auditory numbers?
12. Match objects?
13. Match pictures?
14. Match sentences?  

Once you determine their general level of comprehension, it’s time for treatment!

More Popular Articles

• Nonfluent Aphasia Treatment Activities
• 55 Aphasia Activities
• Aphasia Treatment Approaches

2. Keep Aphasia Treatment Functional

Though you may need to start with basic drills, your speech therapy treatment can still be functional and meaningful. 

Here’s how:

• Focus on safety-related language (nurse call light, oxygen tubing, medication bottle)
• Complete activities of daily living (utensils, clothing)
• Choose meaningful activities (a message from a birthday card, hobbies)

Read 11 Cognitive Tasks for functional speech therapy ideas.

3. Use A Cueing Hierarchy

A cueing hierarchy is how you’ll increase or fade cues during treatment. Use one to give your patient the just-right level of challenge in every session.

There are some structured cueing hierarchies out there. But most will be made up by you, on the spot! Use the cueing hierarchies in this guide, or make your own.

Read the Helpful Guide To Cueing In Speech Therapy for more on cueing.

And now, here are some simple yet effective fluent aphasia tasks!

4. Object to Object Matching

Start with matching tasks if your patient’s assessment and questionnaire showed severe receptive language impairment.

Below is a guide to matching treatment.

Materials you need:

For this task, you’ll match objects to objects. 

• Use functional objects (pen, sock, brush)
• Have 5-10 pairs of matching objects (two pens, two tissues, etc.)

Object to Object Matching Instructions:

1. Set out 3 objects: 2 that match, 1 that does not.  
2. Point and ask, “Which two objects are the same?” 
3. If your patient can’t match the two objects, say the objects that match. 
4. Point again and ask, “Which two objects are the same?” 
5. If your patient still can’t identify which are the same, point to the two matching objects.
6. Point again and ask, “Which two objects are the same?” 
7. If they still can’t identify which are the same, move the two matching objects together and say, ‘These match. They’re the same.”
8. Continue this task with the other pairs.

How to Make This Task Harder:

• When your patient can match 3 total objects at a time (2 matching, 1 not) increase the number of objects set out during the task. 
• Match with paper-pencil tasks.

5. Object to Written Word Matching

Your patient can now match object to object. Great! Time to progress to matching words to objects.

Materials you need:

For this activity, you’ll need picture cards and a word list

Each word should be printed on a notecard or otherwise able to be separated individually.

You can use the Picture Cards and make out your own word list. Or use the premade worksheets in the Aphasia Workbook.

Or, you can use physical objects with the word cards instead.

Object to Written Word Matching Instructions:

1. Select one pictured object and 2 written words. 1 word will match the object.
2. Point to the picture and ask, “Which word matches the picture?”
3. If your patient can’t match the picture to the word, give a semantic or phonemic cue. For example, “It starts with ___” or, “You use this for ___”
4. Point again and ask, “Which word matches the picture?”
5. If they still can’t identify correctly, name the picture. “Hand”
6. Point again and ask, “Which word matches the picture?”
7. If they still can’t identify correctly, point to the word and then point to the matching object/picture. Say, “These match. They are the same.”
8. Continue this task with the other pairs.

How to Make This Task Harder:

• Once your patient has mastered identifying objects to words when given 2 words, move on to 3 or more words.

6. Picture to Phrase Matching

Congrats to you and your patient for arriving at the phrase level! You can also progress this task to the sentence level, multi-sentence level, and beyond.

Materials you need:

For this activity, you’ll use picture cards and a phrase list.

Use the Picture Cards to make your own phrase list. Or use the premade worksheets in the Aphasia Workbook.

Picture to Phrase Matching Instructions:

1. Point to the picture and ask, “Which phrase matches the picture?”
2. If your patient can’t match the picture to the phrase, give a semantic or phonemic cue. For example,  “It starts with ___” or, “You use this for ___”
3. Point again and ask, “Which phrase matches the picture?”
4. If they still can’t identify the correct answer, say the written phrase that matches the picture.
5. Point again and ask, “Which phrase matches the picture?”
6. If they still can’t identify the correct answer, point to the picture, then point to the matching phrase. Say, “These match. They are the same.”

How to Make This Task Easier:

• Simplify this task by starting with 1 picture and 2 phrases (1 phrase that matches and 1 that doesn’t).
• Once they can match a picture to the correct phrase, move on to 3 or more phrases.

How to Make This Task Harder:

• To make this task more complex, move on to a picture scene with 2 sentences to choose from
• Once your patient masters this level, move on to multiple-sentence options with the pictured scene
• Next, work on reading comprehension at the paragraph level
• Remove visual cues

7. Auditory Comprehension Tasks

Most patients with receptive aphasia benefit from visual cues. This is because auditory tasks are often more challenging, especially without the support of pictures, gestures, or cues.

In this task, you and your patient will work on improving their auditory comprehension.

Materials you need:

For auditory tasks, collect lists of:

• 1-step directions
• Yes/No questions
• 2-step directions
• Multiple-step directions. 

You can find premade lists designed for speech therapy professionals in our shop.

Auditory Task Instructions:

When doing auditory tasks, you can follow a simple cueing hierarchy.

Here’s how, starting with 1-step directions:

1. Give the direction without any cues.
2. If they can’t follow the direction, add gestures.
3. If they still can’t follow the direction, provide a written copy of the direction for them to read.
4. If they still can’t follow the direction, model the direction and have them imitate the action.
5. Continue this for the rest of the 1-step directions.

How to Make This Task Harder:

After your patient can follow 1-step directions, use the same hierarchy for:

• Simple yes/no questions
• Complex yes/no questions
• 2-step directions
• Multi-step directions

As their language comprehension improves, expand this auditory task to:

• Sentences
• Multiple sentences
• Paragraph

More Receptive Aphasia Treatment Approaches

• Supported Conversation for Adults with Aphasia
• Augmented Input
• More Aphasia Treatment Approaches

The Aphasia Workbook

Download the Aphasia Pack for evidence-based worksheets made for your speech therapy patients.

References

• Clinical Centre of Research Excellence in Aphasia Rehabilitation Working Group. (2014). Brisbane (Australia): University of Queensland, Retrieved August 8, 2016 from http://www.aphasiapathway.com.au/.
• Wallace, S. E., Patterson, J., Purdy, M., Knollman-Porter, K., & Coppens, P. (2022). Auditory Comprehension Interventions for People With Aphasia: A Scoping Review. https://doi.org/23814764000300140072