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Summary of Clinical Practice Guideline

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.
 
*Recommendations from the 2002 publication have been updated.  Please see the 2007 proposed review for conclusions from the new evidence.
AGREE Rating: Highly Recommended

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:

  • Assessment/Diagnosis
    • Comprehensive Assessment
      • Individuals with stroke-induced aphasia should be referred to speech therapy for assessment and management of aphasia (Grade B Evidence).  
    • Assessment Areas
      • Swallowing
        • Ongoing swallowing status monitoring should be conducted as part of nutritional monitoring after a stroke (Grade D Evidence).
        • Patients with dysphagia persisting for more than one week should be evaluated for a rehabilitative swallowing therapy program. It is important to consider the nature of the underlying swallowing impairment and the patient’s motivation and cognitive status (Grade D Evidence).
      • Speech - "Patients with dysarthria should be referred to an appropriate speech and language therapy service for assessment and management” (Grade D Evidence) (p. 26).
      • Cognition
        • General Findings - "Stroke patients should have a full assessment of their cognitive strengths and weaknesses when undergoing rehabilitation or when returning to cognitively demanding activities such as driving or work” (Good Practice Point) (p. 22).
        • Visual Neglect - “Patients with visuospatial neglect should be assessed and taught compensatory strategies” (p. 24).
  • Treatment
    • Cognition
      • Visual Neglect Treatment - “Patients with visuospatial neglect should be assessed and taught compensatory strategies” (p. 24).
    • Language
      • General Findings - Individuals with stroke-induced aphasia should be referred to speech therapy for assessment and management of aphasia (Grade B Evidence).  
    • Swallowing
      • Biofeedback Treatment - "Biofeedback and positioning techniques (as used by physiotherapy and speech and language therapy) should support management of patients who experience drooling problems” (Good Practice Point) (p. 29).
      • Compensatory Treatment
        • An oropharyngeal swallowing rehabilitation program for patients with dysphagia should include restorative exercises, compensatory techniques, and diet modification (Grade B Evidence).
        • “Biofeedback and positioning techniques (as used by physiotherapy and speech and language therapy) should support management of patients who experience drooling problems” (Good Practice Point) (p. 29).
      • Dietary Modification - An oropharyngeal swallowing rehabilitation program for patients with dysphagia should include restorative exercises, compensatory techniques, and diet modification (Grade B Evidence).
      • Oral-Motor Treatment - An oropharyngeal swallowing rehabilitation program for patients with dysphagia should include restorative exercises, compensatory techniques, and diet modification (Grade B Evidence).
  • Service Delivery
    • Dosage
      • For individuals with aphasia who are sufficiently well and motivated, a minimum of two hours per week of treatment is recommended (Grade B Evidence).
      • Where appropriate, length of aphasia treatment may require a minimum of six months (Good Practice Point).

Keywords:
Stroke, Aphasia

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