American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

British Society of Rehabilitation Medicine; Department of Health Research and Development; Luff Foundation; Royal College of Physicians (United Kingdom)
Rehabilitation Following Acquired Brain Injury: National Clinical Guidelines

Turner-Stokes, L. (2003).
London (UK): Royal College of Medicine and the British Society of Rehabilitation Medicine, 81 pages.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations on the longer-term needs of adults with acquired brain injury. The target audiences of this guideline are healthcare professionals, and purchasers and providers of social services for individuals with acquired brain injury. Recommendations are provided in the management of swallowing disorders, communication and language interventions and cognitive management.

Recommendations:

  • Assessment/Diagnosis
    • Assessment Areas
      • Cognitive-Communication
        • “Conscious patients with communication difficulties should be assessed by a speech and language therapist who should work with staff and relatives to delineate appropriate communication techniques” (p. 32).
        • Speech and language therapists will determine the “suitability for intensive or regular speech and language therapy” (p. 42).
        • Individuals with severe communication impairments should be assessed for the use of augmentative alternative communication.
      • Swallowing
        • “To minimize the risk of aspiration, patients with any significant symptoms, signs or disability should be screened for swallowing impairment before given food or drink” (p. 28).
        • Patients with dysphagia or at risk for aspiration should be evaluated “by a suitably trained speech and language therapist who should assess further and advise the patient and staff on safe swallow and consistency of diet/fluids” (p. 29).
      • Hearing - “Individuals with acquired brain injury should have their hearing assessed by an audiologist and use of previous assistive aids, such as hearing aids, should be restored as appropriate" (pp. 33, 41).
    • Assessment Instruments
      • Videofluoroscopy/FEES - A diagnostic instrumental evaluation (videoflouroscopy or FEES) should be considered following bedside examination when “the risk/benefit ratio of proceeding with trial of food is poor” or “there is doubt about future management options or a need for clarification of diagnosis” (p. 29).
  • Treatment
    • Cognition
      • General Findings - Cognitive treatments should include management in a structured distraction-free environment, target executive difficulties, attention and information processing.
      • Compensatory Memory Treatments - Individuals with persistent cognitive deficits should be offered training in “compensatory techniques to overcome their everyday problems” and “the use of external memory aids to enhance independence” (p. 44).
      • Instructional Memory Treatments - "Trial-and-error learning should be avoided in patients with memory impairment” (p. 44).
    • Language  
      • General Findings - Language treatment should consider the patient's pre-morbid communication style, underlying cognitive deficits, provide opportunity for rehearsal of communication skills, include family and carers in strategy development, and consider the need for communication aids.
  • Service Delivery
    • Dosage
      • General Findings - Speech and language therapists will determine the “suitability for intensive or regular speech and language therapy” (p. 42).

Keywords: Brain Injury; Stroke; Cognitive Rehabilitation

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Added to Compendium: November 2010

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