Author: Laleh Rej
Rej, Laleh, 2018 An Audit of Clinical Practice and the Implementation of Aphasia Language Impairment and Functioning Therapy (LIFT) in an Inpatient Rehabilitation Setting, Flinders University, College of Nursing and Health Sciences
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Background
Aphasia is a language disorder that can have devastating effects on an individual’s ability to communicate. There are currently many different forms of aphasia therapy techniques used by speech pathologists to treat this acquired disorder. Presently, there is no universally accepted treatment approach; however, there has been a growing interest in intensive programs.
Two studies were conducted to explore: (1) the service provision to patients with acquired aphasia post stroke and (2) the effectiveness of an intensive aphasia intervention in an inpatient rehabilitation centre.
Study 1 was a clinical audit of service delivery of aphasia rehabilitation in a metropolitan rehabilitation hospital in Australia. The aim of the study was to investigate adherence to the National Stroke Foundation (NSF) Clinical Guidelines and the Australasian Rehabilitation Outcomes Centre (AROC) database of benchmarks. The aim of the audit was to identify the average length of stay and average therapy provision time, and to investigate adherence to stroke and aphasia rehabilitation guidelines. It is important that clinical services align with the AROC benchmarks and only when they align, novel intervention can feasibly be explored.
The findings of the audit informed the appropriateness of implementing an Intensive Comprehensive Aphasia Program (Study 2) in the same rehabilitation hospital. This program was the Aphasia Language Impairment and Functioning Therapy (LIFT) and the clinical implications of its implementation in an inpatient rehabilitation setting were investigated.
Methods
Study 1 comprised a retrospective audit of 34 discharged patients with aphasia. The analysis of discharge reports, Functional Independence Measure (FIM) scores and staff clinical time statistics took place between March 2012 and July 2013.
Study 2 occurred from January to June 2016 and comprised a single subject design that included two participants. LIFT treatment comprised impairment-based language therapy, functional communication therapy, group and computer therapy. The treatment consisted of 3 hours of therapy intervention per day, 5 days a week, for 3 weeks; totalling 45 hours. The effects regarding language impairment, functional communication, intensity and quality of life (QOL) were investigated.
Results
Results from the clinical audit revealed that the mean length of stay for patients with aphasia was 60 days, significantly longer than the calculated average AROC benchmark of 32.8 days. Patients with aphasia received an average of 4.25 hours direct speech pathology therapy per week, more than twice the minimum amount of therapy time recommended by the NSF Guidelines.
Results of the LIFT study showed that Participant 1 demonstrated substantial, clinically meaningful improvements in the domains of language impairment, functional communication, and QOL. In particular, participant 1 demonstrated improved naming accuracy on both treated and untreated items, the Boston Naming Test (BNT), the naming subtest of the Western Aphasia Battery (WAB) and also in overall language function measured using the WAB Aphasia Quotient (AQ). She was able to cope with the high intensity of LIFT.
Participant 2 made clinically meaningful improvements in overall language recovery (WAB Aphasia Quotient), QOL measures and functional communication. However, he did not demonstrate improved naming accuracy in either the WAB, or the BNT. He was able to tolerate the high intensity of LIFT.
Conclusion
The clinical audit is the first speech pathology audit investigating adherence to stroke and aphasia rehabilitation guidelines set forth by the NSF clinical guidelines and AROC benchmarks in Australia. The average length of stay and service provision within a local hospital were established, which informed the appropriateness of the LIFT study to be implemented within the same hospital.
Results from the LIFT study were encouraging. Both participants demonstrated clinically meaningful improvements in overall language function. Furthermore, one participant showed greater improvement in naming accuracy beyond that expected by spontaneous recovery alone. The effect of spontaneous recovery was considered, however the overall findings demonstrated the effectiveness of the LIFT program in at least one participant, highlighting that the LIFT program could be considered as a service delivery option in an inpatient rehabilitation setting.
Keywords: Aphasia, stroke, intensive, therapy, rehabilitation
Subject: Speech Pathology thesis
Thesis type: Masters
Completed: 2018
School: College of Nursing and Health Sciences
Supervisor: Dr Willem van Steenbrugge