Best practice for aphasia in the acute sector: a consensus of expert opinions

Background Information Historically Speech and Language Therapy (SLT) intervention has been guided by a, sometimes bewildering, plethora of standards and guidelines. Publications such as those written by the Royal College of Physicians (2012), the National Institute for Health and Clinical Excellence (2013) and Bowen et al (2012), guide our input within the acute setting. In 2011, the SIG Aphasia Therapy published the results of a survey into the practices of 86 SLTs who worked in 55 different adult SLT trusts (Bixley et al, 2011). The results of the 2011 study suggested that 172 different and appropriate management options could be sorted into five categories. This current study was designed to investigate whether the hypothesised categories in the original research described current working practices.

Method Twenty two therapists, from 14 different NHS trusts, responded to a questionnaire that was distributed opportunistically through the SIG network. Thirteen (59%) had less than five years SLT experience and typically were on pay scale 5, 6 or 7. Four very experienced therapists (18%) who had worked for ten to twenty years were paid at band 8. Ten (45%) were employed full time. Fourteen (64%) worked in posts split between acute stroke units and the community. On average, the twenty two SLTs worked in departments of three therapists providing 17 sessions of acute aphasia care per week. Twenty one SLTs (95%) estimated that they spent on average 43% of their time in work providing aphasia management.

Results All twenty two therapists confirmed the five categories and twenty five intervention aims derived from the original research and eight therapists were able to estimate the time spent on each type of activity. Definitions were: 1) Assessment (32%) informal, formal, case history, outcome, screening, mental capacity 2) Multidisciplinary team working (MDT) (26%) writing guidelines and documentation, joint sessions, attending discharge and MDT meetings, goal setting 3) Therapy choices (23%) language therapy, establishing functional communication, low tech AAC, providing accessible environment, group work, computer therapy, outings 4) SLT administration (13%) plan discharge liaise and refer onwards, prioritise and make resources, write notes and keep statistics 5) Support training and education (STE) (6%) client, family, assistant practitioners, MDT.

Discussion This description of SLT management choices adds a classification system and a level of detail that is not available elsewhere in the literature. Detail and differentiation about SLT intervention is important in much the same way different doses of a drug affect pharmacological outcomes. Our findings confirm that assessment, STE and conversation therapy should be located firmly within the basic remit of SLT. Significantly 52/86 therapists (60%) in our initial investigation and 19/22 (86%) therapists in our follow up research suggested that they did not have enough time to provide therapy for people with aphasia in the acute setting.

References BIXLEY, M., BLAGDON, B., DEAN, M., LANGLEY, J. & STANTON, D. (2011) In search of consensus on aphasia management. Royal College of Speech and Language Therapists Bulletin, 2011, October, 18-20. BOWEN, A., HESKETH, A., PATCHICK, E., YOUNG, A., DAVIES, L., VAIL, A., LONG, A.F., WATKINS, C., PEARL, G., LAMBON RALPH, M. A. & TYRELL, P. Effectiveness of enhanced communication therapy in the first four months after a stroke for aphasia and dysarthria: a randomised controlled trial. British Medical Journal, 2012, 345, 1-15. INTERCOLLEGIATE STROKE WORKING PARTY. (2012) National clinical guideline for stroke, 4th edition. London: Royal College of Physicians. NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. (2013) Stroke rehabilitation: 2nd guideline consultation.