The National Center for Evidence-Based Practice
in Communication Disorders
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Writing Treatment



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

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
  • For individuals with writing difficulties, treatment should focus on training the impaired component or incorporating strategies to compensate for impairment (e.g., grapheme to phoneme training, use of anagrams, pictorial or first letters cues, oral spelling) (Level B Evidence).
  • The clinician should consider use of computer technology to facilitate functional writing (Level B Evidence).  

Evidence-Based Systematic Reviews

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

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 morr than four RCTs, conclusions are based on the results of the majority of studies, unless conflicting results are reported in a higher quality study.
Moderate evidence (Level 1b) suggests that writing treatment in group setting is less beneficial compared to individual treatment
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
This is a review of studies investigating the effects of aphasia speech and language therapy on individuals post-stroke
Moderate evidences suggests that group aphasia treatment for writing is less beneficial compared to individual treatment

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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