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

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.
AGREE Rating: Highly Recommended
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.
  • Assessment/Diagnosis
    • Comprehensive Assessment
        • A comprehensive assessment should be completed to determine the communication strengths and weaknesses of the individual with aphasia. Assessment should identify the nature and extent of the communication disorder; level of preserved abilities; functional and pragmatic aspects of communication abilities; psychosocial well-being; perception of communication impairment from the individual with aphasia and family; identify treatment goals based on the specific needs of the individual and establish a baseline to measure improvement (Level B/C Evidence).
        • Assessment should consider the individual’s cultural factors, their ability to use strategies to compensate for communication impairments in real-life environments and assess the communication partner’s ability to facilitate strategies (Level C Evidence).
        • For spoken language comprehension, the evaluation should assess auditory processing and consider speech sound discrimination, spoken word recognition and spoken word comprehension abilities. Assessment should consider the linguistic context and communication environment and the identification of processing difficulties at the sentence level(Level B Evidence). Assessment may include tests of verb and sentence comprehension, analyses of verb, sentence and narrative production and the ability to integrate syntactic form with meaning (Level B Evidence). 
        • For spoken language expression, the evaluation should assess spoken language production. A range of tasks and tests should be used to identify different aspects of spoken word production. Examples include tests of semantic processing (e.g., word-to-picture matching, synonym judgment), tests of access to spoken word-forms (e.g., spoken picture naming, rhyme judgment, homophone judgment), and tests of word repetition (Level B Evidence).  Assessment should consider an individual’s speech production abilities in various conditions, including narrative, conversation and constrained conditions (e.g., picture description) (Level B Evidence).
        • Reading should be evaluated and consider orthographic, phonological and semantic processing of written words (Level B Evidence). Assessment may include letter and word recognition, reading aloud and reading comprehension, using letters, non-words and words. Therapists should consider how the individual uses reading in everyday life (Level B Evidence).
        • Assessment of writing should consider semantic, orthographic and phonological processing of written words. Therapists should consider how the individual uses written language in everyday life (Level C Evidence).        
    • Assessment Measures
      • The speech and language evaluation may incorporate a range of assessment measures including assessment at the conversation level and use of formal and informal measures (Level C Evidence).
      • Conversation analysis should be considered to assess the conversation/interaction patterns of the individual with aphasia with their caregiver (Level B Evidence).
  • Treatment
    • Language
      • Conversation Partner Training Approaches
        • Treatment should involve communication partners to promote generalization of learned strategies (Level B/C Evidence).
        • Treatment should focus on training the conversation partner on verbal and non-verbal strategies to improve communication interactions and functional communication abilities of individuals with aphasia (Level B Evidence).
      • Computer-Based Treatment - Computer-based treatment should be considered to improve receptive and expressive language (Level A Evidence).
      • Multi-Modal Treatment
        • Non-verbal communication strategies should be considered to facilitate and improve functional communication (Level B Evidence).
        • Spared language capacities should be considered to improve communication effectiveness. This includes the use of writing to bypass spoken production and the use of spoken output to compensate for writing difficulties (Level B Evidence).
      • Language-Oriented Therapy
        • 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).
      • Reading Treatment - For individuals with reading impairments, treatment should focus on training the impaired component or incorporating strategies to compensate for impairment (e.g., semantic approach, improving speed and efficiency of letter identification) (Level B Evidence).
      • Writing Treatment
        • 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).
  • Service Delivery
    • Format
      • In addition to individual speech and language treatment, individuals with aphasia should have opportunity to participate in group treatment (Level A Evidence).
    • Provider
      • The speech-language pathologists should be involved in training volunteers working with individuals with aphasia. Training should focus on increasing volunteers’ understanding of aphasia and use of communication techniques (Level A Evidence).

Aphasia, Stroke

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