The National Center for Evidence-Based Practice
in Communication Disorders
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Summary of Clinical Practice Guideline

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.
 
AGREE Rating: Highly Recommended

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:

  • Assessment/Diagnosis
    • Screening
      • Patients with left hemisphere damage should be screened for aphasia.  
    • Comprehensive Assessment
        • Individuals identified with aphasia through screening should receive a formal assessment of language and communication by a speech-language pathologist. The nature of the impairment should be explained to the patient, family and treatment team.
        • Re-assessment should be completed at appropriate intervals to determine the ongoing nature and severity of aphasia. Alternate means of communication such as gestures, drawing, writing and use of communication aids should be evaluated in individuals who exhibit aphasia persisting for more than two weeks.
    • Assessment Areas
      • Swallowing
        • Individuals with acute stroke should have their swallowing screened at admission by a trained professional prior to being given food, fluid, or medication orally. If the admission screen indicates a potential swallowing impairment, a specialist assessment should be conducted ideally within 24 hours and not more than 72 hours after admission. (pp. 140-141).
        • Individuals with suspected aspiration, requiring tube feeding or dietary modification should be reassessed and considered for instrumental evaluation after three days and should be referred for dietary advice (p. 141).
      • Speech
        • “Any patient whose speech is unclear or unintelligible so that communication is limited or unreliable should be assessed by a speech and language therapist to determine the nature and cause of the speech impairment” (p. 142).
        • “Any patient who has marked difficulty articulating words with adequate language function should be formally assessed for apraxia of speech and treated to maximize intelligibility” (p. 142).
    • Assessment Measures
      • Aphasia screening tools may include the Frenchay Aphasia Screening Test or Sheffield Aphasia Screening Test. 
  • Treatment
    • Speech
      • General Findings
        • Individuals with severe dysarthria that limits communication should be taught techniques to improve speech clarity and be assessed for alternative and augmentative communication aids (p. 142).
        • Family and staff who work closely with the dysarthric individual should be taught techniques to assist the individual in their communication (p. 142).
      • AAC Treatment
        • Individuals with severe dysarthria that limits communication should be taught techniques to improve speech clarity and be assessed for alternative and augmentative communication aids (p. 142).
        • The apraxic individual should be assessed for and provided appropriate augmentative and alternative communication aids if communication impairment is severe and cognition is reasonably intact (p. 142).
      • Apraxia Treatment - “Any patient who has marked difficulty articulating words with adequate language function should be formally assessed for apraxia of speech and treated to maximize intelligibility” (p. 142).
    • Language
      • General Findings - Individuals with aphasia should receive speech-language pathology treatment aimed at reducing specific language impairments.  
  • Service Delivery
    • Dosage
      • Early intensive treatment consisting of two to eight hours per week should be considered for individuals with aphasia.
    • Timing
      • Individuals with persistent aphasia at six months should be referred for further speech and language treatment in a group or one-to-one setting.

Keywords:
Stroke, Aphasia

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