JCPSLP Vol 18 No. 1Mar 2016

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.

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

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

20

JCPSLP Volume 18, Number 1 2016

www.speechpathologyaustralia.org.au