The National Center for Evidence-Based Practice
in Communication Disorders
Home      Review-017

Summary of Systematic Review

Evidence-Based Review of Stroke Rehabilitation
Teasell, R. W., Foley, N. C., et al. (2011).
Retrieved from http://www.ebrsr.com.

This review meets the criteria for a high-quality evidence-based systematic review.

Indicators of Review Quality:

The review states a clearly focused question or aim No
Criteria for inclusion of studies are provided Yes
Search strategy is described in sufficient detail for replication Yes
Included studies are assessed for study quality Yes
Quality assessments are reproducible Yes
Characteristics of the included studies are provided Yes

Description:
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 more than four RCTs, conclusions are based on the results of the majority of studies, unless conflicting results are reported in a higher quality study.

Question(s)/Aim(s) Addressed:
Question not specifically stated.

Population:
Patients undergoing stroke rehabilitation.

Intervention/Assessment:
Interdisciplinary inpatient and outpatient stroke rehabilitation. Interventions/assessments specific to speech-language pathologists included: cognitive rehabilitation, language therapy for aphasia, and dysphagia assessment and therapy.

Number of Studies Included:
1,171

Years Included:
Through September 2011

Conclusions:

Aphasia

  • Treatment

    • General Findings:

      • There is conflicting (Level 4) evidence as to whether speech and language therapy (SLT) is efficacious in treating stroke-induced aphasia.

      • Based on the most recent meta-analysis, the authors "reported a consistent, though non-significant, benefit associated with the provision of SLT" (Module 14; p. 18). 

    • Computer-Based Treatment

      • Strong evidence (Level 1a) from two studies (one of fair and one of good quality) suggests that computer-based aphasia treatment can improve language skills at the impairment level.

      • Limited evidence (Level 2) suggests that improvements from computer-based treatment generalize to functional communication.

    • Constraint-Induced Language Treatment (CILT)

      • Moderate evidence (Level 1b) suggests that constraint-induced language therapy (CILT) is beneficial for treating individuals with chronic aphasia and results in improved language performance over a short period of time.

      • Limited evidence (Level 2) suggests that "improvements in language function are similar following CIAT [constraint-induced aphasia therapy], CIATplus and PACE therapies" (Module 14; p. 40).

    • Conversation Partner Training Approaches

      • Moderate evidence (Level 1b) suggests that Supported Conversation for Adults with Aphasia (SCA) can enhance conversational skills for individual with aphasia and their conversation partner.

      • There is limited evidence (Level 2) that training conversation partners improves social participation and well-being. However, the authors indicated that further research is required as the majority of studies were small and used single group designs.

    • Cueing Strategies (Semantic & Phonological)

      • Limited evidence (Level 2) suggests that phonological and semantic cueing strategies improve naming accuracy and word retrieval skills.

    • Language-Oriented Therapy

      • Moderate evidence (Level 1b) suggests that task-specific semantic therapy and task-specific phonological therapy improves semantic and phonological language activities respectively in aphasia.

      • Moderate evidence (Level 1b) suggests that cognitive linguistic treatment with both semantic and phonological elements may improve semantic and letter fluency.

      • No evidence was found to determine the benefits of target-specific treatments for individuals with global aphasia.

    • Reading Treatment

      • "There is insufficient evidence regarding the effectiveness of alexia specific therapy. Further research is required" (Module 14; p. 50).

    • Writing Treatment

      • Moderate evidence (Level 1b) suggests that writing treatment in group setting is less beneficial compared to individual treatment.

  • Service Delivery

    • Dosage

      • Based on the results of two meta-analyses, the authors conclude there is strong (Level 1a) evidence in support of intensive speech and language treatment (SLT) over less intensive, conventional SLT. Intensive treatment produced more significant benefits than conventional SLT (Module 14; p. 18). 

      • The authors conclude that "language therapy is efficacious in treating aphasia when provided intensely for the first 3 months; less intensive therapy given over a longer period of time does not provide a statistically significant benefit, although clinical benefits can be achieved" (Module 14; p. 18).

      • The authors also indicate that "intensive language therapy may be associated with improved language function for individuals with global aphasia" (Module 14; p. 70).

    • Format

      • Based on one fair quality study, moderate evidence (Level 1b) suggests that group aphasia treatment can improve performance on communication and linguistic measures for individuals with chronic aphasia.

      • Limited evidence (Level 2) suggests that participation in group treatment improves communication.

      • Moderate evidence (Level 1b) suggests that writing treatment in group setting is less beneficial compared to individual treatment.

    • Provider

      • Strong evidence (Level 1a) suggests that trained volunteers can serve as an effective adjunct to aphasia treatment provided by a speech-language pathologist.

      • Based on findings from one fair quality study, moderate evidence (Level 1b) suggests that in-home programs administered by trained volunteers improves language outcomes at the impairment and functional levels.

    • Setting

      • Limited evidence (Level 2) suggests that community-based aphasia programs improve language outcomes.

      • Limited evidence (Level 2) suggests that aphasia assessment delivered via telehealth is comparable to face-to-face assessment.

      • At this time, there is insufficient evidence regarding the delivery of speech and language treatment delivered remotely. "Preliminary case series have reported positive results for a program of naming therapy" (Module 14; p. 36).

Sponsoring Body:
Ministry of Health and Long Term Care of Ontario; Heart and Stroke Foundation of Ontario; Canadian Stroke Network

Keywords:
Stroke, Aphasia, Swallowing Disorders

» Access the Review