Centre for Clinical Research Excellence
Good practice points
International Classification of Functioning, Disability and Health
National Health and Medical Research Council
RAND/UCLA Appropriateness Method
Randomised control trial
Speech language therapy
Acute stroke unit: Stroke units with a focus on acute care and early aspects of rehabilitation, with varying degrees of intensity and follow-up. Stroke units share the following characteristics:
Aphasia: Aphasia is an acquired communication disability caused by damage to the language processing centres of the brain. It relates to a "loss of ability to communicate orally, through sign or in writing, or a reduced ability to understand such forms of language" (Darley, 1982). The best practice statements relate to aphasia post-stroke.
Aphasia-friendly: aphasia-friendly material is material adapted for people with aphasia. It includes the use of simple vocabulary, simple syntax, short sentences, large and standard font, relevant pictures, appropriate layout and low reading grade level.
Can: Where the evidence is less clear or where there was significant variation in opinion, the word "can" has been used. Individual patient factors should always be taken into account when considering different intervention options.
Chronic aphasia: Aphasia that persists beyond the acute stages. There is no clear time-frame to define acute versus chronic, however for the purpose of the statements, it can be defined as ongoing language difficulties six months post stroke.
Client: The person with aphasia is referred to as a 'client' when receiving services post-hospital care
Communication training or Communication Partner Training: is an intervention directed at people other than the person with aphasia with the intent of improving the language, communication, participation, and/or well-being of the person with aphasia. Communication partners are people in the environment with whom the person with aphasia might interact, including, but not limited to, family members, friends, volunteers, or health care providers.
Constraint-induced language therapy: Constraint-induced language therapy (CILT) or constraint-induced aphasia therapy (CIAT) is an intensive therapy model based on the forced use of verbal oral language as the sole channel of communication, while any alternative communication modes such as writing, gesturing or pointing are discouraged.
Discourse treatment: treatments that focus on naturally occurring (real-life) conversations and those that focus on improving linguistic performance by treating within a structured discourse context.
Dynamic assessment: are considered to undertake an experimental approach in the sense that they attempt to identify the effects of factors (e.g., strategies, task modifications, context factors, environmental supports) that may influence performance (Coelho et al., 2005)
Early supported discharge describes pathways of care for people transferred from an inpatient environment to a primary care setting to continue a period of rehabilitation and recuperation at a similar level of intensity and delivered by staff with the same level of expertise, as they would have received in the inpatient setting.
FAST mnemonic: The FAST mnemonic stands for Face, Arm, Speech and Time and has used to help raise the identification of stroke.
Formal vs. informal assessment: formal assessments as described here are those used for the purposes of replication, for example, when the purpose of the assessment is to compare the person with aphasia to a normative reference standard or to compare their performance over time. Informal assessment processes are those used for the purposes of developing an in-depth understanding of an individual's performance and difficulties in relation to their identified needs and the scope of the assessment (e.g. to design therapy, to consider decision-making capacity). For these reasons, Ferguson (2008) has suggested the adoption of the term 'individualised' when describing this latter approach to assessment
Frenchay Aphasia Screening Test (FAST): is a communication screening tool for non-speech pathologists.
Gesture therapy: Gestures can be used as a compensatory communication modality in the event of verbal language failure. In addition, gestures have been advocated as a means to facilitate restoration of language skills. Gestures come in many types, including beats, deictics, iconics, pantomimes and emblems (McNeill, 2005). Compensatory communication relies primarily on symbolic gestures that express some type of meaning, such as iconics (e.g., hand shaped as an object, such as house), emblems (e.g. familiar actions used within a culture, such as thumbs up or salute) and pantomimes (e.g. use of objects or actions such as fork/eating).
Goal setting: Goal setting has been defined as "the process during which patient and clinical members of the multidisciplinary team make a collective decision, following an informed discussion, of how and when to carry out rehabilitation activities".
Good practice points (GPP): refers to when there was no robust Level I, II, III or IV evidence available but there was consensus within the statements working group, or documented expert opinion.
High technology communication devices: electronic computer-based communication devices used to support or replace verbal/written communication.
International Classification of Functioning, Disability and Health (ICF): is a classification of health and health-related domains. These domains are classified from body, individual and societal perspectives by means of two lists: a list of body functions and structure, and a list of domains of activity and participation. Since an individual’s functioning and disability occurs in a context, the ICF also includes a list of environmental factors.
Multidisciplinary team: A multidisciplinary team (MDT) is composed of members from different healthcare professions with specialised skills and expertise. The members collaborate together to make treatment recommendations that facilitate quality patient care.
Non-systematic review: Provides a synthesis of studies on a particular topic but may not have involved the systematic location, selection and appraisal of evidence.
Patient: The person with aphasia is referred to as 'patient' during the hospital admission
Prognosis: The prediction of the likely outcome of one's current condition
Randomised controlled trial: the unit of experimentation (e.g. people, or a cluster of people) is allocated to either an intervention (the factor under study) group or a control group, using a random mechanism (such as a coin toss, random number table, computer-generated random numbers) and the outcomes from each group are compared.
Should: In general, where the evidence is clear and trusted, or where there is consensus on the basis of clinical experience and expert opinion, the word "should" has been used to indicate that the intervention should be routinely carried out. Where the evidence is less clear or where there was significant variation in opinion, the word "can" has been used. Individual patient factors should always be taken into account when considering different intervention options.
Subacute services: Sub-acute care has many definitions, depending on the context in which it is considered. At its simplest, sub-acute care is about goal oriented (and in many instances time-limited) interventions aimed at assessing and managing often complex conditions to maximize independence and quality of life for people with disabling conditions.
Systematic review: systematic location, appraisal and synthesis of evidence from scientific studies.
Transitions: refers to the movement of patients among healthcare locations, providers, different goals of care, and across the various settings where healthcare services are received.
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Professor Linda Worrall