REVIEW QUESTION

Is speech and language therapy (SLT) effective in the management of aphasia following stroke?

TYPE OF REVIEW

This is a review of 57 randomized controlled trials (RCTs) involving 3,002 participants.

RELEVANCE FOR NURSING

Aphasia, an impairment of language use following damage to the brain, presents in up to one-third of people following stroke. Aphasia may affect verbal or written modalities across a range of severity-from only occasional difficulty finding the appropriate word to no effective verbal means of communication and limited understanding of spoken or written language.

Speech and language therapists assess, diagnose, and treat aphasia at all stages of recovery after stroke. They may work directly with the patient and/or with other health and social care professionals involved in the patient's care. It is unclear, however, whether SLT is effective in the management of aphasia and whether it is more or less effective than nonspecialist support.

CHARACTERISTICS OF THE EVIDENCE

A total of 57 RCTs that evaluated one or more SLT interventions designed to improve language or communication were included. The 3,002 study participants were all adults with acquired aphasia as a result of stroke.

The overall aim of SLT rehabilitation is to enable patients with aphasia to communicate their thoughts and ideas in everyday, real-life situations. Therefore, the choice of functional communication-the ability to successfully communicate via any modality including speech, writing, nonverbal means, or a combination of any of these-was the primary outcome of this review.

Three specific comparisons were made: (1) SLT versus no SLT; (2) SLT versus social support or stimulation; and (3) one SLT intervention versus another (comparisons of intensity, dosage, and duration of therapy). Overall, there was evidence that an SLT intervention provides improvement in functional communication ability compared with no SLT intervention. There was no evidence that social support or stimulation leads to any improvement in functional communication. The findings of the comparisons of two SLT interventions suggest there may be an advantage to high-intensity interventions (many hours of therapy over a short period) that are of longer duration. However, dropout rates were higher in the high-intensity groups. The authors conclude that timing of high-intensity interventions following stroke may be a factor in terms of both effectiveness and tolerance.

BEST PRACTICE RECOMMENDATIONS

To ensure that all people affected by stroke reach their maximum rehabilitation potential, the multidisciplinary team approach is essential. Nursing staff have a key role in supporting people with aphasia from the acute stages of stroke to long-term management in the community. Having knowledge of aphasia and being able to discuss with patients and family what they may expect from therapy is an essential part of providing patient-centered care. The findings of this review suggest that high-intensity input may help to improve the functional ability of patients with aphasia; however, since some interventions were conducted by volunteers who received specialist training, it may not be essential that this input be from a speech and language therapist.

RESEARCH RECOMMENDATIONS

The continuing challenge for SLT researchers is to improve the quality of SLT trials and to design and conduct larger trials. The aim for future research should be to establish the optimal approach, frequency, duration of allocation, and format of the provision of SLT in specific patient groups.

REFERENCE