The National Center for Evidence-Based Practice
in Communication Disorders
Home      Aphasia-Assessment-Comprehensive-Assessment

Aphasia
Assessment

Comprehensive Assessment

 


 

External Scientific Evidence

  

Evidence-Based Practice Guidelines

Scottish Intercollegiate Guidelines Network
 
Management of Patients with Stroke: Rehabilitation, Prevention and Management of Complications, and Discharge Planning
Scottish Intercollegiate Guidelines Network. (2010).
Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN), SIGN Publication No. 108, 118 pages
.
Added: May 2012
 
Description

This guideline provides recommendations for the management, rehabilitation, and prevention of complications for individuals up to one year post-stroke. The intended audiences for this review include health care professionals. Recommendations are graded A, B, C, D, or "Good Practice Point" based on the strength of supporting evidence using the following criteria: 

  • Grade A: Recommendations  based on evidence from systematic reviews and meta-analyses of randomized controlled trials that are directly relevant to the population.
  • Grade B: Recommendations based on high quality case control or cohort studies or high quality systematic reviews of those studies that are directly applicable to the population, or recommendations extrapolated from Grade A evidence.
  • Grade C: Recommendations based on well conducted case control or cohort studies or recommendations extrapolated from Grade B evidence.
  • Grade D: Recommendations based on evidence from non-analytic studies or expert opinion or recommendations extrapolated from Grade C evidence.
  • Good Practice Points: Recommendations based on the clinical experience of the guideline development group
Recommendations
Individuals with stroke-induced aphasia should be referred to speech therapy for assessment and management of aphasia (Grade B Evidence)
 
 
 
 
Royal College of Physicians; Stroke Association; Broehringer Ingelheim; Merck Sharp & Dohme; Sanofi-Sythelapo & Bristol-Myers Squibb
 
National Clinical Guidelines for Stroke
Intercollegiate Stroke Working Party (2008).
London (United Kingdom): Royal College of Physicians, 3rd Edition, 187 pages
Added: May 2012 
 
Description
This guideline provides recommendations for the management of stroke across all populations. The audiences intended for this guideline include clinical staff, managers, commissioners involved in the purchasing of services, patients with stroke and their caregivers. Of particular interest to speech-language pathologists is a section on the management of swallowing and communication disorders. Specific recommendations were made based on the nature and strength of the evidence using a formal consensus approach by the guideline working group
 
Recommendations
  • Individuals identified with aphasia through screening should receive a formal assessment of language and communication by a speech-language pathologist. The nature of the impairment should be explained to the patient, family and treatment team.
  • Re-assessment should be completed at appropriate intervals to determine the ongoing nature and severity of aphasia.
  • Alternate means of communication such as gestures, drawing, writing and use of communication aids should be evaluated in individuals who exhibit aphasia persisting for more than two weeks
 
 
 
Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE)
 
Royal College of Speech and Language Therapists Clinical Guidelines: 5.12 Aphasia
Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd
Added: May 2012 
 
Description

This guideline provides recommendations for the assessment and treatment of individuals with aphasia. These guidelines are specific to speech-language pathologists. Levels of evidence recommendations are graded A, B or C based on the following criteria: 

  • Level A: Recommendations obtained from randomized controlled trials (RCT). 
  • Level B: Recommendations obtained from well-conducted clinical studies.
  • Level C: Recommendations obtained from expert opinion.  
Recommendations
  • A comprehensive assessment should be completed to determine the communication strengths and weaknesses of the individual with aphasia. Assessment should identify the nature and extent of the communication disorder; level of preserved abilities; functional and pragmatic aspects of communication abilities; psychosocial well-being; perception of communication impairment from the individual with aphasia and family; identify treatment goals based on the specific needs of the individual and establish a baseline to measure improvement (Level B/C Evidence).
  • Assessment should consider the individual’s cultural factors, their ability to use strategies to compensate for communication impairments in real-life environments and assess the communication partner’s ability to facilitate strategies (Level C Evidence).
  • For spoken language comprehension, the evaluation should assess auditory processing and consider speech sound discrimination, spoken word recognition and spoken word comprehension abilities. Assessment should consider the linguistic context and communication environment and the identification of processing difficulties at the sentence level (Level B Evidence).
  • Assessment may include tests of verb and sentence comprehension, analyses of verb, sentence and narrative production and the ability to integrate syntactic form with meaning (Level B Evidence). 
  • For spoken language expression, the evaluation should assess spoken language production. A range of tasks and tests should be used to identify different aspects of spoken word production. Examples include tests of semantic processing (e.g., word-to-picture matching, synonym judgment), tests of access to spoken word-forms (e.g., spoken picture naming, rhyme judgment, homophone judgment), and tests of word repetition (Level B Evidence). 
  • Assessment should consider an individual’s speech production abilities in various conditions, including narrative, conversation and constrained conditions (e.g., picture description) (Level B Evidence).
  • Reading should be evaluated and consider orthographic, phonological and semantic processing of written words (Level B Evidence).
  • Assessment may include letter and word recognition, reading aloud and reading comprehension, using letters, non-words and words. Therapists should consider how the individual uses reading in everyday life (Level B Evidence).
  • Assessment of writing should consider semantic, orthographic and phonological processing of written words. Therapists should consider how the individual uses written language in everyday life (Level C Evidence)
  
Catalan Agency for Health Technology Assessment and Research
 
Stroke: Clinical Practice Guideline (2nd edition)
Catalan Agency for Health Technology Assessment and Research. (2007).
Barcelona (Spain): Catalan Agency for Health Technology Assessment and Research, 112 pages
Added: May 2012 
 
Description

This guideline provides recommendations for the assessment, management, and rehabilitation of acute stroke in adults. The target audiences for this guideline include professionals, managers, and planners involved in the care of adults with acute stroke. Of particular interest to speech-language pathologists is the section on assessment and intervention for aphasia, dysarthria, cognitive disorders and dysphagia. Recommendations are graded A, B, C, D, or "Point of Good Practice" based on the strength of supporting evidence below: 

  • Grade A: Recommendations based on evidence from systematic reviews and meta-analyses of randomized controlled trials that are directly relevant to the population.
  • Grade B: Recommendations based on high quality case control or cohort studies or high quality systematic reviews of those studies that are directly applicable to the population, or recommendations extrapolated from Grade A evidence.
  • Grade C: Recommendations based on well conducted case control or cohort studies or recommendations extrapolated from Grade B evidence.
  • Grade D: Recommendations based on evidence from non-analytic studies or expert opinion or recommendations extrapolated from Grade C evidence.
  • Points of Good Practice: Recommendations based on the clinical experience of the guideline development group
Recommendations
  • Patients with left hemisphere damage should be evaluated for aphasia by a speech-language pathologist using valid and reliable methods (Grade C Evidence). 
  • Individuals with aphasia should receive treatment and periodic assessments as long as there are identifiable objectives and progress (Grade B Evidence).  
 
 
Department of Veterans Affairs; Department of Defense; American Heart Association / American Stroke Association
 
VA/DOD Clinical Practice Guideline for the Management of Stroke Rehabilitation
Management of Stroke Rehabilitation Working Group. (2010).
Veterans Health Administration, Department of Defense, 150 pages
Added: May 2012 
 
Description

This guideline provides recommendations for the assessment and management of adult patients (18 years or older) with post-stroke functional disability receiving services in the Veteran's Health Administration (VHA) or Department of Defense (DoD) healthcare system. The target audience of this guideline is VHA and DoD health care professionals providing treatment in primary care, specialty care, long-term care or community settings. Of particular interest to speech-language pathologists is a section on the management of communication impairments (aphasia, dysarthria, apraxia), cognitive impairments and swallowing. Recommendations are graded A, B, C, D or I based on the following criteria: 

  • Grade A: A strong recommendation that clinicians provide the intervention to eligible patients based on good evidence that the intervention improves important health outcomes and benefits substantially outweigh harms.
  • Grade B: A recommendation that clinicians provide the intervention to eligible patients based on at least fair evidence that the intervention improves health outcomes and benefits outweigh harms.
  • Grade C: No recommendation for or against the provision of the intervention. At least fair evidence was found that the intervention can improve health outcomes, but concludes that the balance of benefits and harms is too close to justify a general recommendation.
  • Grade D: Recommendation against providing the intervention based on at least fair evidence that the intervention is ineffective or that harms outweigh benefits.
  • Grade I: Information insufficient to recommend for or against providing the intervention. Evidence that intervention is effective is either lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined
Recommendations
For individuals with aphasia, assessment areas should address listening, speaking, reading, writing, gesturing, and pragmatics and include standardized testing and procedures (Grade B Evidence)
 
 
 
Australian Government Department of Health and Ageing
 
Clinical Guidelines for Acute Stroke Management 2010
National Stroke Foundation (2010).
Melbourne (Australia): National Stroke Foundation, 167 pages
Added: May 2012 
 
Description

This guideline provides recommendations for the assessment and management of stroke and transient ischemic attack (TIA) in adults. These guidelines are primarily intended to assist health care workers in improving quality and effectiveness of service. Of particular interest to speech-language pathologists is chapter six which focuses on rehabilitation management for aphasia, dysphagia, dysarthria, apraxia and cognitive-communication deficits. Recommendations are graded A, B, C, D or "Good Practice Point" based on the following criteria: 

  • Grade A: Evidence can be trusted to guide practice.
  • Grade B: Evidence can be used to guide practice in most situations.
  • Grade C: Evidence provides some support, but care should be taken in application.
  • Grade D: Evidence is weak and should be applied cautiously.
  • Good Practice Point: Evidence based on clinical experience and expert opinion
Recommendations
  • Individuals with aphasia should receive a comprehensive assessment by a specialized clinician (Good Practice Point).
  • The nature and extent of aphasia should be documented and discussed with the patient and family (Good Practice Point).
  • In collaboration with the patient and carer, individualized goals and treatment plan should be developed and reassessed at appropriate intervals (Good Practice Point)
 
 
New Zealand Ministry of Health
 
New Zealand Clinical Guidelines for Stroke Management 2010
Stroke Foundation of New Zealand and New Zealand Guidelines Group (2010).
Wellington (New Zealand): Stroke Foundation of New Zealand, 347 pages
Added: May 2012 
 
Description

This guideline provides recommendations for the management of individuals recovering from stroke and transient ischemic attacks. The target audience of the guideline is all healthcare professionals providing services to persons with stroke and their family in the New Zealand context. Of particular interest to speech-language pathologists are the sections discussing communication (aphasia, apraxia, dysarthria), cognition and swallowing disorders. Levels of evidence recommendations are graded as A, B, C, D or "Good Practice Points" and defined as follows: 

  • Level A: Body of evidence can be trusted to guide practice.
  • Level B: Body of evidence can be trusted to guide practice in most situations.
  • Level C: Body of evidence provides some support for recommendation(s) but care should be taken in its application.
  • Level D: Body of evidence is weak and recommendation must be applied with caution.
  • Good Practice Point: Recommended best practice based on clinical experience and expert opinion
Recommendations
  • Individuals with aphasia should receive a comprehensive assessment by a specialized clinician (Good Practice Point).
  • The nature and extent of aphasia should be documented and discussed with the patient and family (Good Practice Point).
  • In collaboration with the patient and carer, individualized goals and treatment plan should be developed and reassessed at appropriate intervals (Good Practice Point)
 
 
 
 

Evidence-Based Systematic Reviews

No evidence-based systematic reviews were found.
 
 
 
 

Clinical Expertise/Expert Opinion

 
Consensus Guidelines  
No consensus guidelines were found. 
 
 
 
 

Client/Patient/Caregiver Perspectives

 
No information was found pertaining to client/patient/caregiver perspectives.
 
 
 
Use the image below to navigate to other sections of the Aphasia evidence map.