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

National clinical guideline for stroke
B In the early stages of stroke (immediate and up to 4 months) patients identified as
having aphasia as the cause of the impairment should be given the opportunity to
practise their language and communication skills as tolerated by the patient.
C Beyond the early stages of stroke (immediate and up to 4 months), patients with
communication problems caused by aphasia should be reassessed to determine
whether they are more suitable for more intensive treatment with the aim of
developing greater participation in social activities. This may include a range of
approaches such as using an assistant or volunteer, family member or communication
partner guided by the speech and language therapist, computer-based practice
programmes and other functional methods.
D Patients with impaired communication should be considered for assistive technology
and communication aids by an appropriately trained clinician.
E Patients with aphasia whose first language is not English should be offered assessment
and communication practice in their preferred language.
F Education and training of health/social care staff, carers and relatives regarding the
stroke patient’s communication impairments should be provided by a speech and
language therapist. Any education and training should enable communication
partners to use appropriate communication strategies to optimise patient engagement
and choice, and the delivery of other rehabilitation programmes.
G Any person with stroke at home who has continuing communication difficulty due to
aphasia and whose social interactions are limited by it should be provided with
information about any local or national groups for people with long-term aphasia,
and referred to the group as appropriate.
6.20.1.2 Sources
A Brady et al 2012; Bowen et al 2012a; Bowen et al 2012b; consensus
B Bowen et al 2012b; Brady et al 2012; de Jong-Hagelstein 2011; Godecke et al 2011;
Young et al 2012
C Brady et al 2012; consensus
D–E Consensus
F Kagan et al 2001; consensus
G Consensus
6.20.2 Dysarthria
Dysarthria refers to the vocal consequences of impaired control over the muscles
responsible for producing intelligible speech, usually described as slurred or blurred.
Yorkston (1996) defined dysarthria as neurologic motor speech impairment that is
characterised by slow, weak, imprecise and/or uncoordinated movements of the speech
musculature and may involve respiration, phonation, resonance, and/or oral articulation.
It is common in the early stages of stroke, and is often associated with dysphagia
(swallowing difficulties).
98 © Royal College of Physicians 2012