Aphasia therapy and mobile stroke units become standard of care
The latest updates to our living stroke guidelines strongly recommend speech and language therapy for aphasia, and mobile stroke units for those eligible for reperfusion.
Along with seven other topics, these updates were formally approved by the National Health and Medical Research Council (NHMRC) on 5 August 2022.
Based on work published by the international RELEASE collaboration, the aphasia guidelines now recommend speech and language therapy to improve functional communication, reading comprehension, auditory comprehension, general expressive language and written language. Early aphasia therapy should start within the first 4 weeks post-stroke, to maximise language recovery.
Mobile stroke units have also been shown to improve outcomes for people with acute ischaemic stroke. Researchers involved with Melbourne’s own pioneering stroke ambulance contributed to a publication that identified the benefits for patients in major cities who have suspected stroke, and are potentially eligible for reperfusion therapies.
Other recommendation changes address depression and anxiety, which have major impacts on the quality of life of people with stroke. Antidepressant medication may be used to prevent post-stroke depression, and psychological therapy or non-invasive brain stimulation may be used for those who have depression.
These updates were all made based on newly published research, which was assessed by our guidelines’ Content Working Group, and put out for public consultation prior to being submitted to NHMRC. Thank you to all who provided their feedback during the consultation process, and contributed to these valuable results.
The full list of updates is:
- Pre-hospital care (Chapter 1) – new recommendation for mobile stroke units.
- Assessment for rehabilitation (Chapter 3) – clarified wording in practice point (not subject to public consultation)
- Aphasia (Chapter 5 Rehabilitation) – new recommendations for speech and language therapy, including timing and intensity, and updated weak recommendation against brain stimulation.
- Dysarthria (Chapter 5 Rehabilitation) – updated recommendation with more detail about interventions.
- Prevention of depression (Chapter 6 Managing complications) – changed from weak recommendation against to weak recommendation for antidepressant medication.
- Treatment for depression (Chapter 6 Managing complications) – recommendation for SSRIs changed from strong to weak, plus new and updated recommendations for psychological therapy, structured exercise programs, and non-invasive brain stimulation.
- Treatment for anxiety (Chapter 6 Managing complications) – new consensus-based statement on good practice.
- Personality and behaviour (Chapter 6 Managing complications) – new consensus recommendation.
- Pressure injury (Chapter 6 Managing complications) – reinstated topic with new practice point.
These and all previous changes can be found in Living guidelines updates on InformMe.