JCPSLP Vol 18 No. 1Mar 2016

Prediction and Prognosis

Speech pathology service delivery in the acute hospital setting Dominique Ferreira, Natalie Ciccone, Asher Verheggen, and Erin Godecke

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

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

Keywords acute aphasia intervention stroke Thisarticle has been peer- reviewed

Natalie Ciccone (top) and Erin Godecke

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JCPSLP Volume 18, Number 1 2016

Journal of Clinical Practice in Speech-Language Pathology