Abstract
Background
Communication disorders and dysphagia are debilitating sequelae associated with stroke. Speech and Language Therapy (SLT) has a pivotal role in stroke rehabilitation, and in improving outcomes. The research into dysphasia, dysphagia, and dysarthria post-stroke is extensive. In comparison, the research into cognitive-communication difficulties post-stroke is still emerging. Cognitive-communication difficulties (CCDs) are communication impairments resulting from underlying cognitive deficits due to neurological impairments1. The aim of this audit was to review SLT referrals in an Irish Stroke Rehabilitation Unit.
Methods
Single-centre retrospective review of all stroke admissions from January to December 2018. Communication outcomes were assessed using the Functional Independence Measure and Functional Assessment Measure (FIM+FAM)2 a 7-point disability rating scale. Standard Bayesian statistics were employed for analysis.
Results
SLT received referrals for 66% (n=41) of all stroke admissions (n=62). Mean age was 68 years (SD+/-14), compared with 70 years (SD+/-14) for patients not referred. 65% were female and 35% male. Patients requiring SLT had significantly longer length of stay (p=0.0072). 83% of referrals were for communication, 12% dysphagia, and 5% inappropriate. Of communication referrals, primary diagnoses were as follows: 17.5% dysarthria (n=6), 26.5% dysphasia (n=9) and 56% CCD (n=19). Patients with dysphasia showed greater improvement in FIMFAM scores (x̄=1.3) than those with CCD (x̄=0.9) or dysarthria (x̄=0.7). Patients with CCD comprised the largest cohort who required SLT on discharge (68%).
Conclusion
CCDs are highly prevalent and represented the largest subtype of communication disorders in this cohort. FIMFAM scores appear useful in assessing CCDs however they display insufficient sensitivity in capturing change within this population. This audit highlights the need for further interdisciplinary research, education and training into cognitive-communication difficulties with post-stroke populations.
Self-managed, computerised speech and language therapy for patients with chronic aphasia post-stroke compared with usual care or attention control (Big CACTUS): a multicentre, single-blinded, randomised controlled trial
