national-clinical-guidelines-for-stroke-fourth-edition

multiple skilled oral motor tasks that underlie successful talking). Aphasia, dysarthria and
apraxia of speech often co-occur and cannot be assessed/treated in isolation. Differential
diagnosis and detailed analysis of the contribution of each type of impairment are
important and ongoing issues should be considered for the holistic management of the
patient.
6.20.1 Aphasia
Aphasia/dysphasia refers to the specific impairment of language functions – the ability to
form and understand words whether communicated orally or in writing. About a third of
people with a stroke are likely to be aphasic. Aphasia can have a significant impact on all
aspects of an individual’s life, as well as that of their carers, often affecting mood, selfimage,
well-being, relationships, employment and recreational opportunities. Subtle
difficulties with communication can also occur following damage to the non-dominant
hemisphere.
Several methods of treatment have been evaluated (for example cognitive-linguistic
therapy, communication/conversation therapy, constraint-induced speech and language
therapy, drug therapy). There have been systematic reviews but there is a need for further
research in this area (Brady et al 2012). In order to strengthen the evidence, it is
important that any new interventions are incorporated into clinical trials.
Evidence to recommendations
Much of the research evidence in aphasia has been carried out with small groups or
single cases. Large-scale, randomised, controlled studies generally give little support
for specialist intervention but they mostly investigate one aspect of management –
impairment-based face-to-face ‘treatment’. Cochrane level evidence shows that some
intervention is better than none and that some patients may benefit from more
intense intervention but that no one type of intervention appears to be better than
another.
There is also little randomised, controlled study evidence to inform other aspects of
language rehabilitation such as promoting adaptation and compensation, changing the
context by training others, or adapting the environment, or concerning the effects of an
accurate assessment of the patient’s abilities. There is a cohort of well-designed caseseries
studies which support the use of semantic and phonological therapies for anomia
(Royal College of Speech and Language Therapists 2005) and there is evidence that
communication partner training can improve participation (Simmons-Mackie et al
2010).
6.20.1.1 Recommendations
6 Recovery phase from impairments and limited activities: rehabilitation
A All patients with communication problems following stroke should have an initial
assessment by a speech and language therapist to diagnose the communication
problem and to explain the nature and implications to the patient, family and
multidisciplinary team. Routine reassessment of the impairment or diagnosis in the
early stages of stroke (immediate and up to 4 months) should not be performed
unless there is a specific purpose, eg to assess mental capacity.
© Royal College of Physicians 2012 97