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Aphasia
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General Findings

 


 

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 with aphasia should receive speech-language pathology treatment aimed at reducing specific language impairments
 
 
 
 
 
 
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
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
Language treatment is effective and efficacious for individuals with aphasia (Grade A Evidence). 
 
 
 
 
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
The authors found some evidence for the effectiveness of speech and language treatment to improve functional communication, as well as receptive and expressive language skills in individuals with stroke-induced aphasia. General findings are as follows:

  • Nineteen studies comparing a variety of speech and language therapy [SLT] treatments (e.g., conventional SLT, computer-based treatment) to no treatment were found. The majority of included trials favored the provision of speech and language intervention over no treatment with significant differences reported in measures of functional communication as well as receptive and expressive language skills.

  • Limited evidence from seven studies suggests that individuals with aphasia may benefit from stimulation or social support to improve receptive and expressive language skills. However, the authors indicated that most of the data came from one small trial limiting the utility of the findings. Further research is warranted.

  • While 25 trials were found comparing two different types of speech and language intervention, the small number of participants and variety of treatments included, makes it difficult to draw any firm conclusions regarding the effectiveness of one treatment over another. Further research is needed.

» See full summary and quality ratings

 
 
 
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
  • There is conflicting (Level 4) evidence as to whether speech and language therapy (SLT) is efficacious in treating stroke-induced aphasia. 
  • Based on the most recent meta-analysis, the authors "reported a consistent, though non-significant, benefit associated with the provision of SLT" (Module 14; p. 18).
 
 
 

Clinical Expertise/Expert Opinion

 
Consensus Guidelines  
No consensus guidelines were found. 
 
 
 
 

Client/Patient/Caregiver Perspectives

 
Reconciling the Perspective of Practitioner and Service User: Findings From The Aphasia in Scotland Study
Law, J., Huby, G., et al. (2010).
International Journal of Language & Communication Disorders, 45(5), 551-60
.
Added: May 2012
 
Description
This is a qualitative study of 21 speech-language pathologists and 14 individuals with aphasia. This study examines the views and perspectives of service providers and patients in the treatment of aphasia
 
Conclusions
  • Respondents with aphasia "were generally positive about the SLT [speech and language therapy] and other services that they had received and the role that these played in their recovery" (p. 555).
  • Respondents indicated concern regarding the availability and timing of speech and language treatment which was perceived to be delivered at the convenience of the service provider, rather than the service user.
  • "There were more mixed views on the way in which services were introduced and withdrawn and the extent to which service users were included in the decision making process" (p. 555). The majority of respondents (90%) indicated that the clinician was independently involved in making treatment decisions, followed closely by the inolvement of SLP managers.  
 
 
 
Living Successfully with Aphasia: A Qualitative Meta-Analysis of the Perspectives of Individuals with Aphasia, Family Members, and Speech-Language Pathologists
Brown, K., Worrall, L. E., et al. (2012).
International Journal of Speech-Language Pathology, 14(2), 141-55
Added: May 2012
 
Description
This is a qualitative meta-analysis of studies investigating the perspectives of three groups (individuals with aphasia, carers and speech-language pathologists) regarding the treatment of aphasia
 
Conclusions
Individuals with aphasia identified the successful use of communication strategies as an important aspect of living successfully with aphasia. Participants also indicated the need to focus on strengths and improvements in aphasia treatment
 
 
 
 
Family Members' Report on Speech-Language Pathology and Community Services for Persons with Aphasia in Hong Kong
Kong, A. P. (2011).
Disability and Rehabilitation, 33(25-26), 2633-45
Added: May 2012
 
Description
This is a qualitative study of 37 family members of individuals with aphasia. This study examines treatments provided by speech-language pathology (SLP) services and the perspectives of SLP treatment provided from the family member's point of view regarding services delivered in inpatient, outpatient and community-based settings
 
Conclusions
  • Overall degree of satisfaction reported by family members with community support groups, inpatient and outpatient SLP services was 89%, 38% and 24% respectively.
  • Family reported dissatisfaction with hospital-based inpatient SLP services included:
    • Insufficient duration of training (53%), insufficient education regarding aphasia and language impairment and insufficient information regarding available treatment options (18%).
    • Specific feedback regarding training included poor training content (13%) and inadequate incorporation of daily communication needs of the patient (13%).
  • Family reported dissatisfaction with hospital-based outpatient SLP services included:
    • Insufficient duration of outpatient training (64%).
    • Insufficient family education and training regarding aphasia (19%).
    • Lack of referral for long term rehabilitation services (6%)
 
  
 
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 carers (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
  • Respondents indicated a high level of satisfaction with speech and language treatment.
  • A number of areas were recommended for improvement. These included the need for written and more frequent explanation of aphasia and treatment goals, more opportunities for asking questions, more counseling/education and clearer guidelines for family involvement in treatment
 
 

 
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