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

Department of Veterans Affairs; Department of Defense; American Heart Association / American Stroke Association

VA/DOD Clinical Practice Guideline for the Management of Stroke Rehabilitation
Management of Stroke Rehabilitation Working Group. (2010).
Veterans Health Administration, Department of Defense, 150 pages.

AGREE Rating: Highly Recommended

Description:
This guideline provides recommendations for the assessment and management of adult patients (18 years or older) with post-stroke functional disability receiving services in the Veteran's Health Administration (VHA) or Department of Defense (DoD) healthcare system. The target audience of this guideline is VHA and DoD health care professionals providing treatment in primary care, specialty care, long-term care or community settings. Of particular interest to speech-language pathologists is a section on the management of communication impairments (aphasia, dysarthria, apraxia), cognitive impairments and swallowing. Recommendations are graded A, B, C, D or I based on the following criteria: 

  • Grade A: A strong recommendation that clinicians provide the intervention to eligible patients based on good evidence that the intervention improves important health outcomes and benefits substantially outweigh harms.

  • Grade B: A recommendation that clinicians provide the intervention to eligible patients based on at least fair evidence that the intervention improves health outcomes and benefits outweigh harms.

  • Grade C: No recommendation for or against the provision of the intervention. At least fair evidence was found that the intervention can improve health outcomes, but concludes that the balance of benefits and harms is too close to justify a general recommendation.

  • Grade D: Recommendation against providing the intervention based on at least fair evidence that the intervention is ineffective or that harms outweigh benefits.

  • Grade I: Information insufficient to recommend for or against providing the intervention. Evidence that intervention is effective is either lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

Recommendations:

Aphasia

  • Assessment/Diagnosis/Screening

    • Assessment Areas

      • Comprehensive Assessment

        • For individuals with aphasia, assessment areas should address listening, speaking, reading, writing, gesturing, and pragmatics and include standardized testing and procedures (Grade B Evidence).

  • Treatment

    • General Findings

      • Language treatment is effective and efficacious for individuals with aphasia (Grade A Evidence).

    • Augmentative Alternative Communication (AAC)

      • Augmentative alternative communication can be used to improve functional communication (Grade B Evidence).

    • Computer-Based Treatment

      • Computer-based treatment is effective for individuals with aphasia (Grade A Evidence).

  • Service Delivery

    • Dosage

      • Aphasia treatment should be provided at a higher intensity rather than a lower intensity (Grade B Evidence).

    • Timing

      • Early language treatment is more effective than treatment delivered later (Grade A Evidence).

    • Format

      • Language treatment delivered in a group setting is supported (Grade B Evidence).

    • Provider

      • Aphasia treatment incorporating the use of trained volunteers is supported (Grade B Evidence).

Keywords:
Aphasia, Stroke, Swallowing Disorders, Dysarthria

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