American Speech-Language-Hearing Association

Information For:

EBP Compendium: Summary of Clinical Practice Guideline

National Stroke Foundation
Clinical Guidelines for Stroke Rehabilitation and Recovery
Arnott, B., Abbott, R., et al. (2005).
Melbourne (Australia): National Stroke Foundation, 91 pages.

AGREE Rating: Highly Recommended

Description:

This guideline addresses care after the acute phase of stroke and provides recommendations for rehabilitation. The guidelines are intended for use by health professionals and policy makers. Each is graded Level I, II, III, or IV or suggested as a clinical practice point, based on the level of evidence. Level I evidence is obtained from a systematic review of randomized controlled trials (RCT). Level II evidence is obtained from one or more properly designed RCTs. Level III- evidence is obtained from one or more pseudo-RCTs (1), comparative cohort, case-control, or interrupted time-series with group (2), or comparative studies with a historical control, or an interrupted time-series without a parallel control group (3). Level IV evidence is obtained from case series. Clinical practice points are based on clinical experience and expert opinion. 

Recommendations:

  • Treatment
    • Cognition
      • General Findings
        • “Cognitive therapy may be used in rehabilitation of attention and concentration deficits” (Level I Evidence) (p. vi).
        • “There is insufficient evidence to guide recommendations regarding interventions for agnosia” (p. vi). 
      • Compensatory Memory Treatments - “External cues may be used to help prompt memory in people with memory difficulties” (Level II Evidence) (p. vi). 
      • Compensatory Executive Function Treatments - “External cues, such as a pager, may be used to initiate everyday activities in people with impaired executive functioning” (Level II Evidence) (p. vi).
      • Visual Neglect Treatment - “People with unilateral spatial neglect may benefit from cognitive rehabilitation (for example, scanning training)” (Level I Evidence).
    • Speech
      • Apraxia Treatment
        • “Strategy training in conjunction with conventional therapy to improve ADL may help people with apraxia in the short term (<5 months) to improve planning and task execution” (Level II Evidence).  
        • “Interventions for the treatment of dyspraxia of speech may include modeling, visual cueing, integral stimulation and articulatory placement cueing” (Level III-3 Evidence) (p. vii).
        • "People with severe apraxia of speech may benefit from augmentative and alternative communication devices used in functional activities” (Clinical Practice Point) (p. vii).
      • Augmentative and Alternative Communication (AAC) Treatment
        • “People with severe apraxia of speech may benefit from augmentative and alternative communication devices used in functional activities” (Clinical Practice Point) (p. vii).
        • “People with severe dysarthria may benefit from augmentative and alternative communication devices used in functional activities” (Clinical Practice Point) (p. vii).
      • Biofeedback Treatment - Several interventions for the treatment of dysarthria are presented, including biofeedback or voice amplifier to increase loudness and change intensity (Level IV Evidence).
      • Compensatory Treatment - Several interventions for the treatment of dysarthria are presented, including:
        • the use of a voice amplifier to increase loudness and change intensity (Level IV Evidence).
        • Strategies such as decreased rate, overarticulation, and gesture (Clinical Practice Point).
      • Oral-Motor Treatment & Prosthetic Treatment  - Several interventions for the treatment of dysarthria are presented, including oral-motor exercises (Clinical Practice Point) (p. vii).
    • Language
      • General Findings
        • The guideline suggests several interventions that may be used to treat individuals with aphasia. These include treatment of phonological and semantic deficits based on cognitive neuropsychology models (Level II Evidence), constraint-induced therapy (Level II Evidence), and the use of gesture (Clinical Practice Point) (p. vi).
        • Therapy may be enhanced for individuals with aphasia by means of trained volunteers using supported conversation techniques (Level II Evidence) and computer-based therapy programs (Level II Evidence) (p. vii).
        • “Aphasia therapy should be commenced as early as possible following a stroke” (Clinical Practice Point) (p. vii).
      • Augmentative and Alternative Communication (AAC) Treatment - "People with severe aphasia may benefit from augmentative and alternative communication devices used in functional activities” (Clinical Practice Point) (p. vii). 
      • Constraint-Induced Language Therapy - The guideline suggests several interventions that may be used to treat individuals with aphasia. These include treatment of phonological and semantic deficits based on cognitive neuropsychology models (Level II Evidence), constraint-induced therapy (Level II Evidence), and the use of gesture (Clinical Practice Point) (p. vi).
    • Swallowing
      • Compensatory Treatment & Dietary Modification - “Compensatory strategies such as positioning, therapeutic manoeuvres or modification of food and fluids to facilitate safe swallowing may be provided for people with dysphagia” (Level IV Evidence) (p. vii).
      • Electrical Stimulation, Oral-Motor Treatment & Thermal Stimulation - Several methods are suggested to facilitate resolution of dysphagia, including “Shaker” therapy (Level II Evidence), thermo-tactile stimulation (Level II Evidence), and electrical stimulation (Level III-3 Evidence) (p. vii).
      • Tube Feeding
        • “Early enteral tube feeding via a nasogastric tube may be used for people who require alternative feeding methods as a consequence of dysphagia (Level II Evidence) (p. viii).
        • “NG rather than PEG feeding should be used routinely during the first month post-stroke for people who do not recover a functional swallow" (Level II Evidence) (p. viii).
        • “Decisions regarding long-term enteral feeding for people who do not recover a functional swallow should be made in consultation with the person with stroke and the family” (Clinical Practice Point) (p. viii).
        • "If a decision is taken for long-term enteral feeding, a PEG or similar permanent feeding tube should be used” (Clinical Practice Point) (p. viii).
  • Service Delivery
    • Format
      • Group-Based Treatment - “People with aphasia may be considered for group therapy” (Level II Evidence) (p. vii). 

Keywords: Stroke; Aphasia; Swallowing Disorders

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Added to Compendium: October 2011

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