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.