American Speech-Language-Hearing Association

EBP Compendium: Summary of Systematic Review

Ministry of Health and Long Term Care of Ontario; Heart and Stroke Foundation of Ontario; Canadian Stroke Network
Evidence-Based Review of Stroke Rehabilitation

Teasell, R. W., Foley, N. C., et al. (2009).
Retrieved from http://www.ebrsr.com.

Indicators of Review Quality:

The review addresses a clearly focused question No
Criteria for inclusion of studies are provided Yes
Search strategy is described in sufficient detail for replication Yes
Included studies are assessed for study quality Yes
Quality assessments are reproducible Yes

Description: This is a review of published research studies and consensus opinion investigating the effectiveness of pharmacological and non-pharmacological interventions for stroke rehabilitation.  

Question(s) Addressed:

Question not specifically stated.

Population: Patients undergoing stroke rehabilitation.

Intervention/Assessment: Interdisciplinary inpatient and outpatient stroke rehabilitation. Interventions/assessments specific to SLPs: cognitive rehabilitation, language therapy for aphasia, and dysphagia assessment and therapy.

Number of Studies Included: Almost 956

Years Included: Through August 2009

Findings:

Conclusions:

  • Assessment/Diagnosis
    • Assessment Areas
      • Cognition
        • Individuals post stroke may experience cognitive deficits with impaired attention and speed of processing.
      • Swallowing
        • The authors report that individuals with dysphagia be evaluated by a speech-language pathologist.
        • "All stroke survivors should remain NPO until a trained assessor has assessed swallowing ability" (p. 1 Module 15).
    • Assessment Instruments
      • Cognition
        • General Findings - No gold standard exists for assessing cognitive deficits for individuals with stroke.
      • Swallowing
        • Videofluoroscopy - The authors indicate that modified barium swallow studies "are the only sure way of diagnosing dysphagia and aspiration" (p. 2 Module 15).
  • Treatment
    • Cognition
      • General Findings - Currently no evidence exists supporting or refuting the remediation of executive functioning and problem solving post-stroke.
      • Compensatory Memory Treatments - Although few studies included stroke survivors, the authors conclude that strong evidence exists for the use of compensatory strategies (e.g. imagery-based training and electronic memory aids) to improve memory outcomes post brain injury.
      • Computer-Based Treatment - Limited evidence suggests that "computer-assisted training of attention tasks may improve performance of specific attention tasks" (p. 30 Module 12).
    • Language
      • Word Finding Treatment
        • "Phonological and semantic cueing may improve naming accuracy in aphasics with word-finding deficits" (p. 2 Module 14).
        • "Task-specific semantic therapy and task-specific phonological therapy improves semantic and phonological language activities respectively in aphasia" (p. 2 Module 14). The authors indicated that target-specific therapy did not improve language performance.
      • Computer-Based Treatment - "Computer-based aphasia therapy results in improved language skills and may improve functional communication" (p. 1 Module 14).
      • Constraint-Induced Language Treatment - "Forced-use aphasia therapy can result in improved language function and everyday communication in chronic aphasics"(p. 1 Module 14).
      • Reading Treatment - "Therapy specific to alexia in aphasic patients improves language functions" (p. 2 Module 14).
    • Swallowing
      • General Findings - The authors indicate that "A short course of formal dysphagia therapy may not alter clinical outcomes" (p. 1 Module 15).
      • Compensatory Treatment - There is limited evidence that head rotation can improve swallowing function.
      • Oral-Motor Treatment - There is limited evidence that lingual exercises can improve swallowing function.
      • Thermal Stimulation - "There is moderate evidence that thermal stimulation does not improve swallowing function post stroke"(p. 44 Module 15).
      • Diet Modification - Consensus opinion suggests that individuals with dysphagia receive modified diet to reduce the risk of aspiration.
      • Tube Feeding - Consensus opinion suggests that enteral tube feeding may be necessary to reduce the risk of aspiration.
  • Service Delivery
    • Dosage
      • Intensity - "Language therapy is efficacious in treating aphasia when provided intensely for the first 3 months; less intensive therapy given over a longer period of time does not provide a statistically significant benefit, although clinical benefits can be achieved" (p. 1 Module 14).
    • Setting
      • Community-Based Treatment - Community-based language programs may improve functional language performance.
    • Provider
      • Trained Volunteer - "Trained volunteers can provide an effective adjunct to speech language pathologists’ treatment" (p. 1 Module 14).
      • Communication Partner - The authors also found that training communication partners to provide supported conversation may result in increased social participation and conversational skills.
    • Format
      • Group-Based Treatment
        • Evidence suggests that group treatment "may result in communicative and linguistic improvements" (p. 1 Module 14).
        • "There is moderate (Level 1b) evidence, based on one “good” RCT (PEDro = 6), that group therapy results in less improvement in graphic (writing) elements of aphasia when compared to individualized therapy" (p. 14 Module 14). 


Keywords: Stroke, Aphasia, Swallowing Disorders

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Added to Compendium: March 2012

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