Clinical Guidelines for Acute Stroke Management - Living on the EDge

The first step in planning management <strong>for</strong> people with
aphasia is the identification and diagnostic process. The
presence of aphasia may be determined through a
screening process prior to a full assessment that will
guide management. An audiology assessment may also
be useful as hearing loss is particularly common in the
elderly population and can impact on assessment. 292
Reviews of studies evaluating assessment and
management techniques have found the following:
> One systematic review examined six screening tools
and found the Frenchay Aphasia Screening Test was
the most thoroughly evaluated and widely used
measure with sensitivity of 87% and specificity of
80%. 293 The Frenchay Aphasia Screening Test was
developed in the UK to be used by non speech
pathologists and includes references specific to
European countries. This must be taken into account
when using the tool in the Australian setting.
Likewise, while there was a range of other screening
tests reported in the literature, further evaluation of
their reliability, validity and practical application is
needed. 293
> A large number of more detailed assessment tools
have been described in the literature and these are
often used not only to diagnose aphasia but also to
guide management choices. However, no gold
standard test is universally acknowledged. While it is
not within the scope of this guideline to discuss these
tests in detail it is noted that all detailed assessment
tools are normally administered and interpreted by a
speech pathologist trained in the use of such tools.
> Evidence <strong>for</strong> therapy <strong>for</strong> communication deficits is
limited with most trials having methodological
shortcomings and small numbers. 294 It is also noted
that during the acute phase, therapy often focuses
on dysphagia and communication therapy is often
delayed. However, evidence from reviews of RCT
and non randomised trials seems to indicate that
therapy is more effective when intense therapy is
commenced early. 295, 296 Evidence of interventions <strong>for</strong>
aphasia, verbal dyspraxia and dysarthria remain
consistent with that included in the <strong>Clinical</strong> <strong>Guidelines</strong>
<strong>for</strong> <strong>Stroke</strong> Rehabilitation and Recovery and readers
are directed to that document <strong>for</strong> details.
> While it is important to provide in<strong>for</strong>mation to patients
and carers, communication deficits need to be
carefully considered. One study found that the
reading level <strong>for</strong> those with aphasia was well below
the level of that provided in written material. 50 Small
case series studies have found that modifying written
materials using aphasia-friendly principles
significantly improves the comprehension of the
materials <strong>for</strong> people with aphasia.
297, 298
> Although evidence is scarce, augmentative and
alternative communication devices should be
considered <strong>for</strong> those with severe aphasia 7 although it
may not be appropriate <strong>for</strong> all aphasic patients (e.g.
those with receptive difficulties).
> Small RCTs have demonstrated some benefits in
training others (volunteers or family members) in
supportive communication techniques.
299, 300
However, even if carers are not <strong>for</strong>mally trained in
specific techniques it is good practice <strong>for</strong> speech
pathologists to advise them on the communication
deficits found on assessment and strategies to
improve communication between the patient and
their family/carer.
Section 5 Assessment and <strong>Management</strong> of the Consequences of <strong>Stroke</strong>
5.6 COMMUNICATION GRADE LEVEL
a) All patients should be screened <strong>for</strong> communication deficits using a validated C Level I 293
screening tool.
b) Those with suspected communication difficulties should receive <strong>for</strong>mal ✓ –
assessment by a speech pathologist.
c) Patients with communication difficulties should be treated as early and as C Level I 296 &
frequently as possible. Level III-2 295
d) All written health in<strong>for</strong>mation should be available in an aphasia friendly <strong>for</strong>mat. D Level IV 298
e) The speech pathologist should advise staff and family/carers of appropriate C Level II
299, 300
communication techniques.
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