Please have a look at the latest issue
OBJECTIVE: To assess the effectiveness of enhanced communication therapy in the first four months after stroke compared with an attention control (unstructured social contact).
DESIGN: Externally randomised, pragmatic, parallel, superiority trial with blinded outcome assessment.
SETTING: Twelve UK hospital and community stroke services.
PARTICIPANTS: 170 adults (mean age 70 years) randomised within two weeks of admission to hospital with stroke (December 2006 to January 2010) whom speech and language therapists deemed eligible, and 135 carers.
INTERVENTIONS: Enhanced, agreed best practice, communication therapy specific to aphasia or dysarthria, offered by speech and language therapists according to participants` needs for up to four months, with continuity from hospital to community. Comparison was with similarly resourced social contact (without communication therapy) from employed visitors. OUTCOME MEASURES: Primary outcome was blinded, functional communicative ability at six months on the Therapy Outcome Measure (TOM) activity subscale. Secondary outcomes (unblinded, six months): participants` perceptions on the Communication Outcomes After Stroke scale (COAST); carers` perceptions of participants from part of the Carer COAST; carers` wellbeing on Carers of Older People in Europe Index and quality of life items from Carer COAST; and serious adverse events.
RESULTS: Therapist and visitor contact both had good uptake from service users. An average 22 contacts (intervention or control) over 13 weeks were accepted by users. Impairment focused therapy was the approach most often used by the speech and language therapists. Visitors most often provided general conversation. In total, 81/85 of the intervention group and 72/85 of the control group completed the primary outcome measure. Both groups improved on the TOM activity subscale. The estimated six months group difference was not statistically significant, with 0.25 (95% CI -0.19 to 0.69) points in favour of therapy. Sensitivity analyses that adjusted for chance baseline imbalance further reduced this difference. Per protocol analyses rejected a possible dilution of treatment effect from controls declining their allocation and receiving usual care. There was no added benefit of therapy on secondary outcome measures, subgroup analyses (such as aphasia), or serious adverse events, although the latter were less common after intervention (odds ratio 0.42 (95% CI 0.16 to 1.1)).
CONCLUSIONS: Communication therapy had no added benefit beyond that from everyday communication in the first four months after stroke. Future research should evaluate reorganised services that support functional communication practice early in the stroke pathway. This project was funded by the NIHR Health Technology Assessment programme (project No 02/11/04) and is published in full in Health Technology Assessment 2012;16(26):1-160.
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Please have a look at these articles. They compare the effectiveness of the McNeill Dysphagia Therapy Program, a systematic exercise-based rehabilitation framework for swallowing remediation, with traditional swallowing therapy techniques paired with surface electromyography (sEMG) biofeedback.
I am pleased to share that the next presentation to UHN and TIMS Dysphagia Interest Group will be by Jen Raman, Joanna Wong and Lisa Sokaloff from Baycrest. Jen, Joanna and Lisa are highly experienced Speech-Language Pathologists, specializing in inpatient and outpatient rehabilitation, complex continuing care. The topic of the presentation is “Dysphagia screening tools and outcome measures”
-To learn about screening and outcome tools for dysphagia
-To learn about preliminary results from a dysphagia quality improvement initiative on the Baycrest inpatient Rehabilitation Program
-To participate in a discussion about screening and outcome tools for dysphagia
Date: Thursday, 21 June 2012
Time: 3-4 pm (eastern standard time) Live Location: Baycrest.
Please see the details and instructions for Telehealth connections below:
How do you solve the problem of delivering speech-language therapy to stroke patients in northern Manitoba who are spread over 324,000 square kilometres in a region that does not currently have a full-time adult speech-language pathologist? The answer comes in the form of a partnership between the Burntwood Regional Health Authority, SpeechWorks Inc., MBTelehealth and the Manitoba Patient Access Network (MPAN). The $157,000 project, funded by Manitoba Patient Access Network, demonstrates that speech therapy delivered via telehealth and using iPads can be just as effective as in-person visits.
iPads have been tailored to fit each individual patient’s needs. The iPad has helped people regain organizational skills and reduce depression and anger associated with the inability to communicate. The region is very excited to see this project become part of a sustainable Stroke Strategy.