American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

The Stroke Council of the American Heart Association; Veterans Health Administration, Department of Defense
Management of Adult Stroke Rehabilitation Care: A Clinical Practice Guideline

Duncan, P. W., Zorowitz, R., et al. (2005).
Stroke, 36(9), e100–43.

AGREE Rating: Recommended with Provisos

Description:

These guidelines were developed from best available evidence and consensus-based opinion. They provide recommendations regarding the management and components of rehabilitation for individuals following stroke. These recommendations are intended to guide healthcare professionals working with individuals post-stroke. Recommendations are included pertaining to general rehabilitation management, cognition, communication, and swallowing. Each recommendation is graded as follows:

A: The intervention is always indicated and acceptable
B: The intervention may be useful or effective
C: The intervention may be considered
D: The intervention may be considered not useful or possibly harmful
I: Insufficient evidence to recommend for or against the intervention.

Recommendations:

  • Assessment/Diagnosis
    • Assessment Areas
      • Cognition
        • General Findings - "Recommend that assessment of cognition, arousal, and attention address the following areas: learning and memory, visual neglect, attention, apraxia, and problem solving” (p. e117).
        • Visual Neglect - “Recommend that stroke patients be assessed for visual and spatial neglects, as indicated” (Level C Evidence) (p. e134).
      • Language
        • General Findings - “Recommend that the assessment of communication ability address the following areas: listening, speaking, reading, writing, and pragmatics” (p. e117).
      • Swallowing
        • “If the patient’s swallow screening is abnormal, a complete bedside swallow examination is recommended. The examination should be performed by the SLP, who will define swallow physiology and make recommendations about management and treatment” (Level I Evidence) (p. e114).
        • “Recommend discussing food consistency with dietetics to ensure standardization, consistency, and palatability” (p. e114).
    • Assessment Instruments
      • Cognition
        • General Findings - "The Working Group does not recommend for or against the use of any specific tools to assess cognition. Several screening and assessment tools exist. Appendix D includes standard instruments for assessment of cognition” (p. e117).
      • Language
        • General Findings - “The Working Group does not recommend for or against the use of any specific tools to assess communication. Several screening and assessment tools exist. Appendix D includes standard instruments for assessment of communication” (p. e117).
      • Swallowing
        • Bedside Swallow Exam - Recommend that all patients have their swallow screened before initiating oral intake of fluids or food, utilizing a simple valid bedside testing protocol” (Level B Evidence) (p. e114).
      • FEES
        • “Recommend considering fiberoptic endoscopic examination of swallowing (FEES) as an alternative to VFSS” (Level C Evidence) (p. e114).
        • “There is insufficient evidence to recommend for or against fiberoptic endoscopic examination of swallowing with sensory testing (FEESST) for the assessment of dysphagia” (Level I Evidence) (p. e114).
      • Videoflouroscopy
        • “Recommend that all patients who have a positive bedside screening be tested using a videofluoroscopy swallowing study (VFSS)/modified barium swallow. Patients with a high risk for aspiration and/or dysphagia (eg, brain stem stroke, pseudobulbar palsy, and multiple strokes), regardless of screening results, should undergo VFSS” (Level B Evidence) (p. e114).
        • “Recommend considering fiberoptic endoscopic examination of swallowing (FEES) as an alternative to VFSS” (Level C Evidence) (p. e114)
  • Treatment
    • Cognition
      • General Findings - “Patients with multiple areas of cognitive impairment may benefit from a variety of cognitive retraining approaches that may involve multiple disciplines” (Level C Evidence) (p. e131).
      • Compensatory Memory Treatments - “Recommend the use of training to develop compensatory strategies for memory deficits in poststroke patients who have mild short-term memory deficits” (Level B Evidence) (p. e131).
      • Visual Neglect Treatment
        • Recommend that stroke patients be assessed for visual and spatial neglects, as indicated” (Level C Evidence) (p. e134).
        • “Recommend treatment for stroke patients with visual/spatial neglect that focuses on functional adaptation (eg, visual scanning, environmental adaptation, environmental cues, and patient/family education)” (Level B Evidence) (p. e134).
    • Language
      • General Findings
        • “Recommend that patients with communication disorders receive early treatment and monitoring of change in communication abilities in order to optimize recovery of communication skills, develop useful compensatory strategies, when needed, and facilitate improvements in functional communication” (Level B Evidence) (p. e126).
        • “Recommend that the SLP educate the rehabilitation staff and family/caregivers in techniques to enhance communication with patients who have communication disorders” (Level I Evidence) (p. e126).
    • Swallowing
      • Tube Feeding - “The literature supports the use of tube feeding for patients who cannot sustain sufficient oral caloric and/or fluid intake to meet nutritional needs. Limited evidence suggests that percutaneous endoscopic gastrostomy feeding compares favorably with nasogastric tube feeding” (Level B Evidence) (pp. 2051-2052). 

Keywords: Stroke

Access the Guideline

Note:

Evaluated with Bates, B., Choi J. Y., et al. (2005). "Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Adult Stroke Rehabilitation Care: Executive Summary." Stroke, 36, 2049-56. 

Added to Compendium: November 2010

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