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:

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