Stroke patients ‘being short changed’

STROKE patients with speech problems are being short changed by the current system and are not receiving nearly enough therapy, according to a Scots academic.

Professor Marian Brady of Glasgow Caledonian University is the lead author of a new study that identified the best prescription for the maximum recovery after a stroke.

The findings will help revamp services for stroke survivors with language problems, known as aphasia, and inform clinical guidelines.

Around a third of people experience loss of language after a stroke and there are around 350,000 people living with aphasia in the UK.

Prof Brady, GCU stroke rehabilitation expert, said the research gives aphasia patients the evidence they need to demand a better service.

The international study, published in the American Heart Association Stroke Journal, involved data from nearly 1,000 aphasia patients and revealed the best dose for maximum recovery in patients with aphasia after a stroke was 20-50 hours overall of speech and language therapy. Results showed that when rehabilitation was delivered at an intensity of between two and four hours a week, the greatest gains were made in recovery of language and functional communication.

However, nine or more hours were needed for improved understanding of the spoken language.

The study also highlighted that practising rehabilitation tasks at home, outside of face-to-face time with the therapist, as well as guided support from family members and carers, was important to the best stroke recovery.

Prof Brady said that stroke rehabilitation services were always stretched, even more so now due to the Covid pandemic, and pre-pandemic levels of therapy were often insufficient to support optimal recovery, with an average of 6.3 hours in total over three months, and one-hour sessions being delivered once a fortnight.

She stressed that in the current pandemic, people with aphasia after a stroke are at risk of being short-changed with inadequate services, as therapists are diverted to other NHS services.

Many stroke patients are finding virtual sessions incredibly difficult.

Now Prof Brady hopes the findings in this study will also be fed into the UK’s new speech and language therapy guidelines, currently being revised as therapists experience huge limitations in access to resources and in the services offered to patients.

Prof Brady said: “The reason we carried out this study was to improve services for people with aphasia and to have more clarity about the level of therapy that should be delivered to maximise recovery across speaking and understanding of speech.

“The most recent UK guidelines, produced in 2016, recommend that people with aphasia should be seen by a speech and language therapist, but they don’t say what kinds of therapy, for how long or how often each week.

“This new research gives a clear indication of optimum therapy dosage or prescription for the best language recovery for people with aphasia, with the extended therapy showing an increase of 20 per cent in the understanding of language and reading, speech and the ability to communicate in real world conversations.”

The study was welcomed by stroke survivors, and speech and language therapists Sandra Hewitt, from NHS Highland and Emma Coutts, from NHS Grampian.

Ms Hewitt said: “This large-scale systematic review gives us clarity and context, and helpful comparisons of different types of treatment for post-stroke aphasia. It allows us to think differently about how we can develop and deliver services creatively.”

Ms Coutts added: “It has long been recognised that there has been a real need for more high-quality research within aphasia practice. It’s good to get some data on the effectiveness of approaches to treat the impairment itself, but we also must recognise that we aim to provide a holistic approach.”

Stroke survivors Brian Jackson, 74, and Lawson Hughes, 79, both from Edinburgh, felt strongly that the findings should be included in the new therapy guidelines.

Mr Jackson, a retired museum curator in mineralogy, had a stroke in 2014 and while his speech has improved, he said the service could have been better and turned to costly private speech therapy.

He said: “A one-size-fits-all approach does not work, aphasia sufferers are all different and need different strategies. More intense therapy would be better.”

Mr Hughes, a retired construction manager, praised the therapists who helped him after his stroke seven years ago, saying: “I hope that in the future people like me will benefit from more speech therapy – it really does help.”

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