Aphasia
Service Delivery

Provider

External Scientific Evidence

Evidence-Based Practice Guidelines

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

The speech-language pathologists should be involved in training volunteers working with individuals with aphasia. Training should focus on increasing volunteers’ understanding of aphasia and use of communication techniques (Level A Evidence). 

 

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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

• Aphasia recovery is more significant in patients treated by a speech-language pathologist (Grade B Evidence).
• Incorporation of trained volunteers as part of treatment is supported (Grade B Evidence). 

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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

Aphasia treatment incorporating the use of trained volunteers is supported (Grade B Evidence). 

 

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Evidence-Based Systematic Reviews

Speech and Language Therapy for Aphasia Following Stroke Brady, M. C., Kelly, H., et al. (2012). Cochrane Database of Systematic Reviews, 5, CD000425. This review meets the criteria for a high-quality evidence-based systematic review. Added: October 2012

Description
This is an update of an original systematic review by Greener et al. (1999) and subsequent review by Kelly et al. (2010) investigating the effects of speech language therapy intervention in adults with stroke-induced aphasia.

Conclusions

• No evidence of a difference was found in functional communication or receptive and expressive language skills with intervention provided by a speech-language pathologist versus intervention facilitated by a volunteer. 


• The authors reported the findings to be "unsurprising as the volunteers providing the SLT [speech and language therapy] interventions were trained...given access to the relevant therapy materials and the plan for therapeutic interventions was developed by (or under the direction of) the professional therapist" (p. 35).

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Evidence-Based Review of Stroke Rehabilitation Teasell, R. W., Foley, N. C., et al. (2011). Retrieved from http://www.ebrsr.com.   This review meets the criteria for a high-quality evidence-based systematic review. Added: October 2012

 

Description

This is an update of the Teasell et al. (2009) evidence-based review investigating the effectiveness of pharmacological and non-pharmacological interventions for stroke rehabilitation. Of particular interest to speech-language pathologists are the modules specific to aphasia, dysphagia, perceptual disorders and cognitive disorders. The levels of evidence used to summarize the review findings are based on the United States Agency for Health Care Policy and Research (AHCPR) criteria:  

• Level 1a: Strong evidence supported by a meta-analysis or two or more randomized controlled trials (RCTs) with at least “fair” quality.
• Level 1b: Moderate evidence supported by at least one RCT of “fair” quality.
• Level 2: Limited evidence supported by at least one controlled trial with a minimum of 10 participants in each arm of the study.
• Level 3: Findings supported by expert consensus opinion in the absence of evidence.
• Level 4: Conflicting evidence based on disagreement between the findings of at least two RCTs. Where there are more than four RCTs, conclusions are based on the results of the majority of studies, unless conflicting results are reported in a higher quality study.

Conclusions

• Strong evidence (Level 1a) suggests that trained volunteers can serve as an effective adjunct to aphasia treatment provided by a speech-language pathologist.
• Based on findings from one fair quality study, moderate evidence (Level 1b) suggests that in-home programs administered by trained volunteers improves language outcomes at the impairment and functional levels. 

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Rehabilitation of Aphasia: More Is Better Bhogal, S. K., Teasell, R. W., et al. (2003). Topics in Stroke Rehabilitation, 10(2), 66-76. Added: May 2012

 

Description

This is a review of studies investigating the effects of aphasia speech and language therapy on individuals post-stroke. 

 

Conclusions

Strong evidence suggests that use of trained volunteers is beneficial when providing aphasia therapy and is equivalent to treatment provided by speech-language pathologists. 

 

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Effect of Treatment for Bilingual Individuals with Aphasia: A Systematic Review of the Evidence Faroqi-Shah, Y., Frymark, T., et al. (2010). Journal of Neurolinguistics, 23(4), 319-341.   This review meets the criteria for a high-quality evidence-based systematic review. Added: May 2012

 

Description

This review examines the impact of providing treatment in the primary or secondary language for bilingual individuals with neurologically-induced aphasia. 

 

Conclusions

No studies were found investigating the effect of a language broker on the treatment of individuals with aphasia. 

 

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