Speech and language therapy concise guide for stroke 2016

Speech and language therapy concise guide for stroke 2016

4.16.1J People with stroke should be considered 5.9.1.1C People with stroke should be provided
for gastrostomy feeding if they: with the contact details of a named healthcare

Speech and language therapy concise

> need but are unable to tolerate nasogastric professional (e.g. a stroke co-ordinator) who can
tube feeding; provide further information and advice.
> are unable to swallow adequate food and fluids
orally by four weeks from the onset of stroke;
> are at high long-term risk of malnutrition.
5.9.1.1D People with stroke should be helped to
develop their own self-management plan. guide for stroke 2016
This profession-specific concise guide contains recommendations extracted from the National Clinical Guide-
4.16.1K People with stroke who are discharged End-of-life (palliative) care
from specialist treatment with continuing prob- line for Stroke, 5th edition, which contains over 400 recommendations covering almost every aspect of stroke
2.15.1C Decisions to withhold or withdraw life-
lems with swallowing food or fluids safely should prolonging treatments after stroke including management. The reference number of each recommendation is provided so that they can be found in the
be trained, or have family/carers trained, in the artificial nutrition and hydration should be taken main guideline www.strokeaudit.org/guideline. The recommendations below have direct implications for
management of their swallowing difficulty and be in the best interests of the person and whenever speech and language therapists. This concise guide should not be read in isolation, and as members of the
regularly reassessed. possible should take their prior expressed wishes stroke multidisciplinary team, speech and language therapists should consider the guideline in full.
into account.
4.16.1L People with stroke receiving end-of-life
(palliative) care should not have burdensome re- Rehabilitation approach - goal improve quality of life.
2.15.1D End-of-life (palliative) care for people with
strictions imposed on oral food and/or fluid intake stroke should include an explicit decision not to setting
if those restrictions would exacerbate suffering. impose burdensome restrictions that may exac- 2.17.1B Staff caring for people with stroke in care
2.10.1A People with stroke should be actively
erbate suffering. In particular, this may involve homes should have training in the physical, cogni-
involved in their rehabilitation through:
tive/communication, psychological and social ef-
Life after stroke - further a decision, taken together with the person with > having their feelings, wishes and expectations fects of stroke and the management of common
rehabilitation stroke, those close to them and/or a palliative care for recovery understood and acknowledged;
specialist, to allow oral food and/or fluids despite activity limitations.
5.9.1.1A People with stroke, including those living > participating in the process of goal setting un-
a risk of aspiration.
in a care home, should be offered a structured less they choose not to, or are unable to because
of the severity of their cognitive or linguistic im- Acute stroke care
health and social care review at six months and
1 year after the stroke, and then annually. The pairments; 3.10.1E Patients with acute stroke should have
review should consider whether further interven- > being given help to understand the process of their swallowing screened, using a validated
tions are needed, and the person should be re- goal setting, and to define and articulate their screening tool, by a trained healthcare
ferred for further specialist assessment if: personal goals. professional within four hours of arrival at hospital
> new problems are present; and before being given any oral food, fluid or
medication.
> the person’s physical or psychological condition, Rehabilitation approach - intensity of
or social environment has changed. therapy
3.10.1.G Patients with swallowing difficulties after
2.11.1A People with stroke should accumulate acute stroke should only be given food, fluids and
5.9.1.1B People with stroke should be offered at least 45 minutes of each appropriate therapy medications in a form that can be swallowed
further therapy if goals for specific functions and every day, at a frequency that enables them to without aspiration.
activities can be identified and agreed and the meet their rehabilitation goals, and for as long as
potential for change is likely. they are willing and capable of participating and
showing measurable benefit from treatment. Work and leisure
4.1.4.1B People who wish to return to work after
2.11.1D Healthcare staff who support people with stroke (paid or unpaid employment) should:
11 St Andrews Place,
Regent’s Park stroke to practise their activities should do so > have their work requirements established with
London NW1 4LE under the guidance of a qualified therapist. their employer (provided the person with stroke
Tel: +44 (0)20 3075 1378 agrees);
Email: stroke@rcplondon.ac.uk > be assessed cognitively, linguistically and practi-
People with stroke in care homes cally to establish their potential for return;
www.rcplondon.ac.uk 2.17.1A People with stroke living in care homes > be advised on the most suitable time and way
should be offered assessment and treatment to return to work, if return is feasible;
from community stroke rehabilitation services
> be referred through the job centre to a specialist
to identify activities and adaptations that might
in employment for people with disability if extra

Compiled by Mrs Rosemary Cunningham and Prof Sue Pownall on behalf of the Intercollegiate Stroke Working Party
Speech and language therapy concise guide for stroke 2016

Speech and language therapy concise guide for stroke 2016

support or advice is needed; and provided with information about aphasia > removal of excess secretions; 4.16.1D People with stroke with suspected aspira-
> be referred to a specialist vocational rehabilita- and communication practice in their preferred > application of lip balm. tion or who require tube feeding or dietary modi-
tion team if the job centre specialist is unable to language. fication should be considered for instrumental
provide the necessary rehabilitation. assessment (videofluoroscopy or fibre-optic
4.11.1B People with stroke who have dentures endoscopic evaluation of swallowing).
4.4.1.1F The carers and family of a person with should have their dentures:
Cognitive impairment communication problems after stroke, and health
> put in during the day;
and social care staff, should receive information 4.16.1E People with stroke who require instrumen-
4.3.1.1C People with communication impairment and training from a speech and language thera- > cleaned regularly using a toothbrush, tooth- tal assessment of swallowing (videofluoroscopy or
after stroke should receive a cognitive assessment pist which should enable communication partners paste and/or chlorhexidine dental gel; fibre-optic endoscopic evaluation of swallowing)
using valid assessments in conjunction with a to optimise engagement in rehabilitation, and > checked and replaced if ill-fitting, damaged or should only receive this:
speech and language therapist. Specialist advice promote autonomy and social participation. lost. > in conjunction with a specialist in dysphagia
should be sought if there is uncertainty about the
management;
interpretation of cognitive test results.
4.4.1.1G People with persistent communication 4.11.1C People in hospital or living in a care home > to investigate the nature and causes of aspira-
problems after stroke that limit their social activi- after stroke should receive mouth care from staff tion;
Aphasia ties should be offered information about local who have been trained in: > to direct an active treatment/rehabilitation
or national groups for people with aphasia, and > assessment of oral hygiene; programme for swallowing difficulties.
4.4.1.1A People with communication problems referred as appropriate.
after stroke should be assessed by a speech and > selection and use of appropriate oral hygiene
language therapist to diagnose the problem and equipment and cleaning agents; 4.16.1F People with swallowing difficulty after
to explain the nature and implications to the per- > provision of oral care routines; stroke should be considered for swallowing reha-
Dysarthria
son, their family/carers and the multidisciplinary > awareness and recognition of swallowing bilitation by a specialist in dysphagia manage-
team. Reassessment in the first four months 4.4.2.1A People with unclear or unintelligible difficulties. ment. This should include one or more of:
should only be undertaken if the results will affect speech after stroke should be assessed by a
> compensatory strategies such as postural
decision-making or are required for mental capac- speech and language therapist to diagnose the
changes (e.g. chin tuck) or swallowing manoeu-
ity assessment. problem and to explain the nature and implica- Swallowing
vres (e.g. supraglottic swallow);
tions to the person, their family/carers and the 4.16.1A People with acute stroke should have
multidisciplinary team. > restorative strategies to improve oropharyngeal
4.4.1.1B In the first four months after stroke, their swallowing screened, using a validated motor function (e.g. Shaker headlifting exercises);
people with aphasia should be given the screening tool, by a trained healthcare
> sensory modification, such as altering the taste
opportunity to practise their language and 4.4.2.1B People with dysarthria after stroke which professional within four hours of arrival at hospital
and temperature of foods or carbonation of flu-
communication with a speech and language limits communication should: and before being given any oral food, fluid or
ids;
therapist or other communication partner as > be trained in techniques to improve the clarity medication.
> texture modification of food and/or fluids.
frequently as tolerated. of their speech;
> be assessed for compensatory and augmen- 4.16.1B Until a safe swallowing method is es-
tative communication techniques (e.g. letter tablished, people with swallowing difficulty after 4.16.1G People with stroke who require modified
4.4.1.1C After the first four months, people with food or fluid consistency should have these pro-
communication problems after stroke should be board, communication aids) if speech remains acute stroke should:
unintelligible. vided in line with nationally agreed descriptors.
reviewed to determine their suitability for further > be immediately considered for alternative fluids;
treatment with the aim of increasing participa- > have a comprehensive specialist assessment of
tion in communication and social activities. This 4.4.2.1C The communication partners (e.g. fam- their swallowing; 4.16.1H People with difficulties self-feeding after
may involve using an assistant or volunteer, family ily/carers, staff) of a person with severe dysarthria stroke should be assessed and provided with the
> be considered for nasogastric tube feeding
member or communication partner guided by the after stroke should be trained in how to assist the appropriate equipment and assistance (including
within 24 hours;
speech and language therapist, computer-based person in their communication. physical help and verbal encouragement) to pro-
> be referred to a dietitian for specialist nutritional mote independent and safe feeding.
practice or other impairment-based or functional
assessment, advice and monitoring;
treatment.
Mouth care > receive adequate hydration, nutrition and
4.16.1I People with swallowing difficulty after
medication by alternative means.
4.4.1.1D People with communication problems 4.11.1A People with stroke, especially those who stroke should be provided with written guidance
after stroke should be considered for assistive have difficulty swallowing or are tube fed, should for all staff/carers to use when feeding or
technology and communication aids by an appro- have mouth care at least 3 times a day including: 4.16.1C Patients with swallowing difficulty after providing fluids.
priately trained, experienced clinician. > brushing of teeth and cleaning of gums with acute stroke should only be given food, fluids and
a suitable cleaning agent (toothpaste and/or medications in a form that can be swallowed
chlorhexidine dental gel), for which an electric without aspiration.
4.4.1.1E People with aphasia after stroke whose
toothbrush should be considered;
first language is not English should be assessed