JCPSLP Vol 18 No. 1Mar 2016

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JCPSLP Volume 18, Number 1 2016 20
September and October 2012. RPH is a 640-bed hospital
with a 14-bed comprehensive stroke unit. There is a 1.0
FTE speech pathologist responsible for the stroke unit, the
neurology ward (28 beds), and a neurology outpatient
caseload (>40 patients). The majority of participants (89%)
recruited to the study were seen through the stroke unit or
neurology ward. One participant was on a general medicine
ward. Ethical approval was obtained from RPH’s and Edith
Cowan University’s human research ethics committees.
Participants
Individuals with a confirmed stroke diagnosis who were less
than 11 days post-stroke were eligible for inclusion in the study.
Procedure
Potential participants were identified via the hospital census
admission data list. The integratedmedical notes of all patients
with a provisional diagnosis of stroke, falls, confusion, delirium,
seizures, and transient ischemic attack were reviewed to
confirm a diagnosis of stroke. All patients with a confirmed
diagnosis of acute stroke were approached to participate in
the study. Patients who gave consent to participate were
screened by a member of the research team to determine
the presence of aphasia as identified on the Frenchay
Aphasia Screening Test (FAST; Enderby, Wood, Wade, &
Langton Hewer, 1987) and through the collection of a
monologic discourse sample. A clinical diagnosis of aphasia
was determined through the results on the FAST (Enderby
et al., 1987) or by word-finding difficulties noted in discourse
and patient self-report, as assessed by the researcher. The
results of the clinical screening process were documented
within the integratedmedical notes for each patient screened.
All participants identified as having aphasia were then
assessed by a member of the research team to determine
their potential to participate in aphasia therapy using
the inclusion criteria outlined by Godecke et al. (2011).
Specifically, participants (a) were able to maintain an alert
and wakeful state for a minimum of 30 minutes as assessed
by the research speech pathologist and (b) were conscious
and medically stable. The identification and screening of
participants was completed by the research team and
occurred in addition to usual ward care. The usual care
referral process and speech pathology management was
provided in parallel to participation within the study.
For the purpose of this study, all speech pathology
occasions of service for the duration of the patient’s
hospital stay were recorded. This included the disorder
being assessed or treated and the length and clinical focus
of each session. The clinical focus included assessment
and intervention, which encompassed direct therapy,
counselling, education to the individual or his or her
family, and planning. If participants with aphasia were not
provided with aphasia management, treating clinicians were
requested to record the rationale for this.
Statistical analysis
Descriptive analyses of the demographic data, clinical
stroke classification as related to the site of infarction
(Bamford, Sandercock, Dennis, Burn, &Warlow, 1991), the
incidence of aphasia, and details of the speech pathology
services provided were completed.
Results
Over five weeks of data collection at Royal Perth Hospital, a
total of 233 people were admitted with a possible diagnosis
of stroke. Stroke was confirmed for 31(13.3%) people and
of these 23 (74.2%) were screened for the presence of
aphasia. Of the 23 people screened, 9 (39.1%) were
identified as having aphasia. Eight of these people were
identified from scores on the FAST (Enderby et al., 1987)
and one person was identified through clinical diagnosis
and patient self-report of mild word-finding difficulties. On
average, screening occurred within 3.1 days (range 0–7
days) post stroke. Figure 1 outlines the number of cases
with confirmed stroke, the number of these with confirmed
aphasia, the number of participants with confirmed aphasia
deemed to be candidates for therapy (based on the study
selection criteria), and the number of these who received
intervention. Table 1 outlines the characteristics of
individuals with confirmed stroke.
Table 1. Characteristics of participants with a
confirmed stroke
People with
aphasia
n = 9
Peoplewithout
aphasia
n = 14
Total
n = 23
Meanage(range) 63.6(33–84) 66.5 (47–90) 65
(33–90)
Female (%) 3 (33) 3 (21) 6 (26)
Clinicalsyndrome
PACS (%) 5 (56) 4 (29) 9 (39)
TACS (%) 3 (33) 3 (21) 6 (26)
POCS (%) 1 (11) 6 (43) 7 (30)
LACS (%) – 1 (7) 1 (5)
LOS in days
(range)
11.5 (3–18) 7.6 (2–19) 9.55
(2–19)
Note. LOS= lengthof stay; PACS=partial anterior circulation
syndrome;TACS=totalanteriorcirculationsyndrome;POCS=
posteriorcirculationsyndrome;LACS=lacunarsyndrome(Bamford,
Sandercock, Dennis, Burn, &Warlow, 1991),
The number of, and time spent in, assessment and
therapy sessions was investigated. Of the 8 people
with aphasia who were deemed appropriate for aphasia
therapy, 8 (100%) were assessed for aphasia, 4 (50%) were
assessed for dysphagia, and 2 (25%) were assessed for
dysarthria, apraxia, and/or a voice disorder. On average
aphasia assessment took place within the first 2 days
(range 1–4) post-stroke. Four (50%) of the individuals
received aphasia therapy, 2 (25%) received therapy for
dysphagia, and 2 (25%) received therapy for dysarthria,
apraxia, and/ or a voice disorders. On average, aphasia
therapy was commenced within 4 days (range 3–6)
post-stroke. The frequency and length of assessment
and therapy sessions provided to people with aphasia,
who were deemed candidates for therapy (n = 8), was
investigated and is outlined in Table 2. The individuals
who received aphasia therapy (n = 4) received a mean of
2.5 (range 1–5) therapy sessions during their admission.
The mean length of each therapy session was 29 minutes
(range 10–60). By considering the average length of stay
for participants, the mean length of each session, and the
timing of these sessions across the hospital stay, people
with aphasia received approximately 44 minutes of aphasia
therapy per week during their acute hospital admission.
The proportion of occasions of service involving
assessment, therapy (see Figure 2) and the provision of