Stroke and aphasia

Annually, 15 million strokes occur worldwide.

Up to 38% of stroke survivors can have aphasia. 

Every 6 seconds a stroke will result in the reduced quality of life of an individual due to ongoing disability ^[1].

Aphasia is a common sequelae of stroke, occurring in up to 38% of stroke survivors ^[2] and has significant implications for an individual’s functioning and quality of life ^[3].  Aphasia is a communication disability caused by damage to the language centres of the brain. Associated with increased mortality, reduced likelihood of returning to employment and reduced rates of functional recovery ^[4], aphasia post stroke affects an individual's ability to understand, speak, read and write. 

Aphasia impacts quality of life

A study by Lam and Wodchis ^[5] evaluated the impact of 60 diseases and 15 conditions on health-related quality of life using the minimum data set Health-Status Index.  Of these conditions, aphasia was found to have the largest negative relationship to the quality of life index, followed by cancer and Alzheimer’s disease.  The significant repercussions aphasia has for an individual’s quality of life indicates the importance of ensuring optimal healthcare provision for this vulnerable population.

Aphasia rehabilitation

Stroke rehabilitation occurring early post-onset has been shown to have benefits over spontaneous recovery ^[6].  Approximately 70% of potential language recovery occurs in the first three months ^[7] and Robey ^[8,9] found that treated individuals had almost twice the recovery effect size of untreated individuals when therapy was commenced within this first three month period.

Formalising patient care is one way to directly improve the quality of patient management and optimise outcomes ^[10]. Whilst there have been many systematic reviews of different aspects of aphasia management, there is no defined resource which provides clinicians, people with aphasia and their family and friends with comprehensive recommendations and best available evidence for aphasia rehabilitation across the entire continuum of care.

Speech pathologists have recognised this evidence-practice gap and the need for enhanced access to evidence-based information in order to provide best service. A recent telephone focus group of  acute care speech pathologists revealed that a ‘lack of applicable and packaged evidence-based therapy resources’ was seen as a barrier to providing optimal early aphasia treatment ^[11]. As evidence-based practice become progressively more important for effective health delivery, increased research use within aphasia rehabilitation is paramount.

• Watch this YouTube video to learn more about aphasia

Acknowledgements

Alexia Rohde for her contribution to this section through her article "Systematic review of the quality of clinical guidelines for aphasia in stroke management (2013)" 

References

1. Mackay, J. & Mensah, G. A. (2004) The Atlas of Heart Disease and Stroke. Geneva: World Health Organization.
2. Pederson, P. M., Jorgensen, J. S., Nakayama, J., Raaschou, H. O. & Olsen, T. S. (1995) Aphasia in acute stroke: incidence, determinants, and recovery. Annals of Neurology, 38, 659–666.
3. Worrall, L. & Holland, A. L. (2003) Editorial: quality of life in aphasia. Aphasiology, 4 (17), 329–332.
4. Engelter, S. T., Gostynski, M., Papa, S., Frei, M., Born, C., Ajdacic-Gross, V., Gutzwiller, F. & Lyrer, P. A. (2006) Epidemiology of aphasia attributable to first ischemic stroke: incidence, severity, fluency and thrombolysis. Stroke, 37, 1379–1384
5. Lam, J. M. C. & Wodchis, W. P. (2010) The relationship of 60 disease diagnoses and 15 conditions to preference-based health-related quality of life in Ontario hospital-based long-term care residents. Medical Care, 48, 380–387.
6. Godecke, E., Hird, K., Lalor, E. E., Rai, T. & Phillips, M. R. (2012) Very early poststroke aphasia therapy: a pilot randomized controlled efficacy trial. International Journal of Stroke, 7(8), 635–644. doi:10.1111/j.1747-4949.2011.00631.x.
7. Lazar, R. M., Minzer, B., Antoniello, D., Festa, J. R., Krakauer, J. W. & Marshall, R. S. (2010) Improvement in aphasia scores after stroke is well predicted by initial severity. Stroke, 41, 1485–1488.
8. Robey, R. R. (1994) The efficacy of treatment for aphasic persons: a meta-analysis. Brain and Language, 47, 582–608.
9. Robey, R. R. (1998) A meta-analysis of clinical outcomes in the treatment of aphasia. Journal of Speech, Language and Hearing Research, 9, S27–S36.
10. Grimshaw, J. M. & Russell, I. T. (1993) Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluation.Lancet, 342, 1317–1322.
11. Power, Godecke, O’Halloran & Worrall, 2011