American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

Scottish Intercollegiate Guidelines Network
Management of Patients with Stroke: Rehabilitation, Prevention and Management of Complications, and Discharge Planning

Scottish Intercollegiate Guidelines Network (2010).
Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN), SIGN Publication No. 108, 118 pages.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations for the management, rehabilitation, and prevention of complications for individuals up to one year post-stroke. The intended audiences for this review include health care professionals. Recommendations are graded A, B, C, D, or "Good Practice Point" based on the strength of supporting evidence. Grade A recommendations are based on evidence from systematic reviews and meta-analyses of randomized controlled trials that are directly relevant to the population. Grade B recommendations include high quality case control or cohort studies or high quality systematic reviews of those studies that are directly applicable to the population, or recommendations extrapolated from Grade A evidence. Grade C recommendations include well conducted case control or cohort studies or recommendations extrapolated from Grade B evidence. Grade D recommendations are based on evidence from non-analytic studies or expert opinion or recommendations extrapolated from Grade C evidence. Good Practice Points are recommendations based on the clinical experience of the guideline development group. 

Recommendations:

  • Assessment/Diagnosis
    • Assessment Areas
      • Swallowing
        • Ongoing swallowing status monitoring should be conducted as part of nutritional monitoring after a stroke (Grade D Evidence) (p. 6).
        • Patients with dysphagia persisting for more than one week should be evaluated for a rehabilitative swallowing therapy programme. It is important to consider the nature of the underlying swallowing impairment and the patient’s motivation and cognitive status (Grade D Evidence) (p. 28).
      • Speech - “Patients with dysarthria should be referred to an appropriate speech and language therapy service for assessment and management” (Grade D Evidence) (p. 26).
      • Cognition
        • General Finidngs - “Stroke patients should have a full assessment of their cognitive strengths and weaknesses when undergoing rehabilitation or when returning to cognitively demanding activities such as driving or work” (Good Practice Point) (p. 22).
        • Visual Neglect - “Patients with visuospatial neglect should be assessed and taught compensatory strategies” (p. 24).
  • Treatment
    • Cognition
      • Visual Neglect Treatment -  "Patients with visuospatial neglect should be assessed and taught compensatory strategies” (p. 24).
    • Swallowing
      • Biofeedback - "Biofeedback and positioning techniques (as used by physiotherapy and speech and language therapy) should support management of patients who experience drooling problems” (Good Practice Point) (p. 29).
      • Compensatory Strategies
        • An oropharyngeal swallowing rehabilitation programme for patients with dysphagia should include restorative exercises, compensatory techniques, and diet modification (Grade B Evidence) (p. 28).
        • “Biofeedback and positioning techniques (as used by physiotherapy and speech and language therapy) should support management of patients who experience drooling problems” (Good Practice Point) (p. 29).
      • Dietary Modification - An oropharyngeal swallowing rehabilitation programme for patients with dysphagia should include restorative exercises, compensatory techniques, and diet modification (Grade B Evidence) (p. 28).
      • Oral-Motor Exercises - An oropharyngeal swallowing rehabilitation programme for patients with dysphagia should include restorative exercises, compensatory techniques, and diet modification (Grade B Evidence) (p. 28).
  • Service Delivery
    • Dosage
      • General Findings - "Aphasic stroke patients should be referred for speech and language therapy. Where the patient is sufficiently well and motivated, a minimum of two hours per week should be provided” (Grade B Evidence) (p. 25). These treatments may require at least six months to be completely effective (Good Practice Point) (p. 26). 

Keywords: Stroke

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Added to Compendium: November 2010

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