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in Communication Disorders
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Aphasia
Treatment

Language-Oriented Therapy

 


 

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
  • For individuals with receptive language difficulties primarily at the level of speech sound perception, treatment should focus on improving discrimination of speech sounds. Treatment targeting spoken word comprehension should focus on improving access to word meanings Intervention should also consider changing the individual’s communication environment to support auditory comprehension (Level B Evidence).
  • For individuals with expressive language difficulties, treatment should include tasks involving semantic processing (e.g., semantic cueing, semantic judgments, categorization and word-to-picture matching) (Level B Evidence).
  • Intervention should include tasks that focus on spoken output or accessing phonological word forms such as phonemic cueing, cueing spoken output with written letters, repetition, rhyme judgment and reading aloud (Level 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
For individuals with aphasia, treatment targeting specific aspects of language should be considered (e.g. phonological and semantic deficits, reading, writing, sentence comprehension) based on models derived from cognitive neuropsychology (Grade C 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
For individuals with aphasia, treatment targeting specific aspects of language should be considered (e.g. phonological and semantic deficits, reading, writing, sentence comprehension) based on models derived from cognitive neuropsychology (Level C Evidence)
 
 
 
 

Evidence-Based Systematic Reviews

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 moderate (Level 1b) evidence that task-specific semantic therapy and task-specific phonological therapy improves semantic and phonological language activities respectively in aphasia.

  • There is moderate (Level 1b) evidence that cognitive linguistic treatment with both semanitc and phonological elements may improve semantic and letter fluency.

  • No evidence was found to determine the benefits of target-specific treatments for individuals with global aphasia.
  
 
 

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.
 
 
 
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