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Prediction and Prognosis
19
JCPSLP
Volume 18, Number 1 2016
Journal of Clinical Practice in Speech-Language Pathology
Keywords
acute
aphasia
intervention
stroke
Thisarticle
has been
peer-
reviewed
Natalie Ciccone
(top) and Erin
Godecke
Speech pathology
service delivery in the
acute hospital setting
Dominique Ferreira, Natalie Ciccone, Asher Verheggen, and Erin Godecke
result of time constraints (Armstrong, 2003; Enderby &
Petheram, 2002; Lalor & Cranfield, 2004), reduced funding,
and service provider organisational policies (Verna, Davidson,
& Rose, 2009). Dysphagia referrals as well as the time
spent managing swallowing function in the acute setting
has increased (Enderby & Petheram, 2002). For example,
Rose, Ferguson, Power, Togher, andWorrall (2014) reported
dysphagia management was the main caseload for 89% of
the acute hospital clinicians who participated in their study.
Within the same study, 7% of the acute hospital clinicians
reported managing individuals with aphasia was their main
caseload. While aphasia referrals to speech pathology
departments have increased, the time spent working with
people with aphasia has decreased (Enderby & Petheram,
2002; McCooey-O’Halloran, Worrall, & Hickson, 2004).
The Australian National Stroke Foundation (2010) clinical
guidelines for the management of stroke provide a set of
evidence-based statements regarding the management of
stroke across the recovery continuum. These guidelines
recommend that all patients be screened for a potential
communication impairment post-stroke and that a
communication assessment be completed by a speech
pathologist if communication impairment is indicated. For
people with aphasia post-stroke, direct aphasia therapy
should be commenced as soon as can be tolerated and
individuals should receive as much active therapy as they
can tolerate.
Studies investigating the amount of aphasia therapy
provided in the acute hospital setting are limited. Lalor and
Cranfield (2004) found over 75% of people with aphasia
who were appropriate candidates for aphasia therapy,
within an acute stroke setting, did not receive intervention,
encompassing aphasia assessment, direct aphasia therapy,
counselling or aphasia education, for the duration of
their in-hospital stay. People who received therapy were
provided an average of 14 minutes of therapy per week
(Godecke et al., 2011). An Australian-based survey found
that only 9% of speech pathologists reported providing
daily therapy during their patients’ stay in the inpatient
acute hospital setting (Verna et al., 2009).
The present study investigated speech pathology service
provision to people with aphasia during the early post-
stroke recovery phase. Specifically it aimed to examine the
frequency, length, and clinical focus of speech pathology
occasions of service.
Method
Setting
Participants were identified from patients admitted to Royal
Perth Hospital (RPH) during a 5-week period between
Current research highlights the significance
of providing early and intensive aphasia
therapy to enhance communication gains.
However, acute speech pathology service
delivery in Australia does not consistently
meet best practice standards recommended
by the National Stroke Foundation for stroke
management. This study aimed to investigate
the amount and clinical focus of speech
pathology services provided for patients with
aphasia within an acute hospital setting. People
admitted to an acute-care metropolitan
Australian hospital with confirmed stroke were
screened for aphasia using the Frenchay
Aphasia Screening Test during a 5-week
period. All speech pathology occasions of
service were recorded during their inpatient
stay. Thirty-one people were admitted with a
confirmed stroke, 23 were screened for
aphasia, and of the nine people with aphasia,
eight were deemed eligible for therapy and
received aphasia assessment. Four of these
patients received aphasia therapy in the acute
setting. Additionally, four of these individuals
were assessed for dysphagia and of these
two received treatment for dysphagia. While
dysphagia management was compliant with
national guidelines, speech pathology
aphasia management was not delivered
according to best clinical practice standards.
T
he Australian National Stroke Foundation (2010)
proposed that early intervention results in superior
communication outcomes for individuals with
aphasia. This is supported by Robey (1998) who found
that the commencement of aphasia intervention during the
first three months post-stroke results in treatment effects
which are nearly twice that of spontaneous recovery.
Other studies have concluded aphasia therapy should be
provided for at least two hours per week within the first
two to three months post-stroke to yield greatest gains
in communication (Bhogal, Teasell, & Speechley, 2003;
Godecke, Hird, Lalor, Rai, & Phillips, 2011).
In recent years, the role of the speech pathologist within
the acute hospital setting has transformed dramatically as a