1. Introduction to the Technique
Aphasia is an acquired language disorder that affects a person's ability to communicate effectively. Intervention for aphasia typically targets specific language impairments rather than relying solely on the diagnostic classification.
Developed by Nancy Helm-Estabrooks and Patricia Fitzpatrick (2014), Treatment for Wernicke’s Aphasia (TWA) is an intervention designed to address severe word-level auditory comprehension difficulties.
TWA is based on the concept of reauditorization (Jones & Wepman, 1961), which proposes that spoken word understanding is supported by the ability to internally repeat words. The technique systematically uses preserved reading skills and spoken feedback to facilitate the rebuilding of auditory comprehension.
2. Patient Population
This treatment approach is appropriate for individuals who experience severe word-level auditory comprehension deficits and moderate-to-severe repetition impairments, as commonly seen in Wernicke's aphasia
3. Prerequisites & Contraindications
This approach is most suitable for individuals who can accurately read and comprehend at least some single printed words with appropriate prosody during oral reading, but is generally not recommended for those with severe global aphasia.
4. Materials with Illustrated Examples
Treatment of Wernicke's Aphasia (TWA) requires a carefully selected therapy set consisting of printed word cards and corresponding picture stimuli. Target words should be chosen based on the client's baseline performance and may be graded according to characteristics such as frequency, imageability, and regularity. Printed word cards should use a clear, bold, and easily readable font.
For each target word, a corresponding picture card and five semantically unrelated foil pictures are required. These six-picture arrays are used during the reading comprehension and auditory comprehension tasks. For example, if the target word is "shirt", the picture array may include a shirt along with five foil items such as a fish, cash, key, cupboard and watch.
- Illustration 1: Printed word cards
.png)
- Illustration 2: Six-picture array containing the target picture (shirt) and five foil pictures
.png)
5. Step-by-Step Procedure
TWA is administered hierarchically using four tasks for each target word.
Using the target word "shirt" as an example, the clinician first presents the six-picture array and the printed word shirt. The client is asked to identify the matching picture (Step 1: Reading Comprehension). If the response is inaccurate, the clinician provides feedback, records the error, and the word is reserved for retraining in the next session.
If successful, the client proceeds to Step 2: Oral Reading, where the printed word is read aloud. Next, the printed stimulus is removed and the clinician verbally presents the word for Step 3: Repetition. Finally, in Step 4: Auditory Comprehension, the six-picture array is presented again and the client identifies the target picture following a spoken auditory stimulus. Any cueing provided should be documented in the outcome recording sheet. Words that are unsuccessful at any step are revisited in the next session, beginning again from Step 1 rather than from the point of breakdown.
6. Video Demonstration
7. Sample Outcome Recording Sheet
| Target Words | Foils Presented | Step 1 (Reading Comp) | Step 2 (Oral Reading) | Step 3 (Repetition) | Step 4 (Auditory Comp) | Remarks |
Shirt | watch, keys, cash, cupboard, fish | |||||
Watch | keys, bed, cash, shirt, cupboard | |||||
Fan | house, banana, cash, bed, fish |
8. Home-Based Activity
1. Read–Listen–Point Practice
The caregiver presents a six-picture array containing one target picture and five foil pictures. The client reads a printed target word card (e.g., shirt) and identifies the matching picture. The printed word is then removed, and the caregiver says the target word aloud. The client is asked to identify the picture again based only on the spoken stimulus. Feedback is provided by verbally labelling the correct picture when needed. Responses can be recorded as independent or assisted. This activity reinforces the association between written words, spoken words, and their meanings, consistent with the principles of TWA.
2. Functional Object Identification
To promote generalization, the caregiver places real household items corresponding to trained vocabulary (e.g., shirt, cup, spoon, key, book) on a table. The client first matches a printed target word to the appropriate object. The caregiver then removes the printed word and verbally presents the target word, prompting the client to identify or hand over the correct object. As performance improves, the activity can be incorporated into daily routines such as dressing, meal preparation, or household tasks (e.g., “Show me the shirt” or “Give me the spoon”). This activity encourages the transfer of improved auditory comprehension skills to everyday communication contexts.
References
Helm-Estabrooks, N., Albert, M. L., & Nicholas, M.
(2014). Manual of aphasia and aphasia therapy. Pro-Ed, An International
Publisher.
Helm
.png)
.png)