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in Communication Disorders
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Aphasia
Service Delivery

Timing

 


 

External Scientific Evidence

  

Evidence-Based Practice Guidelines

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 with persistent aphasia at six months should be referred for further speech and language treatment in a group or one-to-one setting
 
 
 
 
 
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

Treatment initiated early is more effective than treatment initiated later (Grade A 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
Early language treatment is more effective than treatment delivered later (Grade A 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
Aphasia treatment should be initiated as early as possible and as can be tolerated (Grade B Evidence)
 
 
 
 
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
Aphasia treatment should be initiated as early as possible and as can be tolerated (Level B Evidence).
 
 
 
 

Evidence-Based Systematic Reviews

Language Rehabilitation in Chronic Aphasia and Time Postonset: A Review of Single-Subject Data
Moss, A., & Nicholas, M. (2006).
Stroke, 37(12), 3043-3051
.
Added: May 2012
 
Description
This is a review of studies which provide outcomes of aphasia treatment with a specified time post-onset, in order to determine if there is a relationship between treatment response and time post-onset of stroke
 
Conclusions
The authors suggest that individuals with aphasia benefited positively from aphasia treatment regardless of time post-onset and conclude that the “expectations of how well individuals will respond to aphasia treatment, which are based solely on time post-onset, are not warranted" (p. 3051)
 
 
 
 

Clinical Expertise/Expert Opinion

 
Consensus Guidelines  
No consensus guidelines were found. 
 
 
 
 

Client/Patient/Caregiver Perspectives

 
Is Anyone Speaking My Language?
Horton, S., Mudd, D., et al. (1998).
International Journal of Language & Communication Disorders, 33(Suppl), 126-31
.
Added: May 2012
 
Description
This is a retrospective study of 18 individuals with aphasia and their careers (n = 12). This study examines how individuals with aphasia and their family members perceive speech and language treatment and what aspects of treatment they feel need improvements
 
Conclusions
  • Individuals with aphasia and their family members reported mixed findings pertaining to the timing of SLP treatment.
  • Family members recommended that treatment be initiated earlier, while individuals with aphasia generally felt that therapy could be delayed to allow time "to clear the fog" (p. 130)
 
  

 
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