De Europese Richtlijn voor afasiebehandeling is onlangs verschenen. Vanuit Nederland heeft Ineke van der Meulen hier aan meegewerkt.
Je vindt de volledige richtlijn in deze link (free access).
Engelse samenvatting en aanbevelingen
A third of stroke survivors develop aphasia resulting in problems speaking, understanding speech, reading and writing. Aphasia is associated with depression and poorer stroke recovery. This guideline addresses important questions to support optimal speech and language therapy for aphasia rehabilitation. We considered the available evidence and analysed data from 45 trials. We make the following recommendations and multidisciplinary expert consensus statements to support aphasia rehabilitation clinical decisions.
In people with aphasia post-stroke to improve language, communication and quality of life
- we recommend speech and language therapy interventions of ≥ 20 hours (rehabilitation dose).
- we suggest speech and language therapy ≥ 4 days per week (rehabilitation frequency).
- we suggest ≥ 3 speech and language therapy hours per week (rehabilitation intensity).
- we suggest that speech and language therapy can be delivered in-person or digitally (digital rehabilitation).
- we suggest using either one-to-one or group speech and language therapy. The decision on the format of the therapy intervention may be made with reference to the health service context and resources available (rehabilitation context).
- we suggest that speech and language therapy should be tailored to the person with aphasia so that it is functionally relevant and at the right level of language difficulty for their rehabilitation needs (tailoring rehabilitation).
- we suggest that augmentation of in-person speech and language with digital therapy should be offered (in-person or digital therapy).
Where research information was lacking, and clinical uncertainties remained we developed the following expert consensus statements to guide clinical decision making
- where access to one-to-one therapy is constrained by resource availability, we suggest that group therapy delivered in addition to one-to-one speech and therapy may facilitate increased therapy time, provide additional opportunities to use language in a social context, and enhance communication confidence. We also suggest that the therapy timing and format should follow other recommendations in this clinical guideline, aiming to enhance language recovery, communication, participation, and quality of life (augmenting dose).
- we suggest that in the clinical context, speech and language therapy should be delivered alone rather than with transcranial direct current stimulation. Further evidence is required of the effectiveness of SLT with such brain stimulation. Individualised approaches to the brain stimulation rehabilitation delivery protocol for people with aphasia may be beneficial, but again, further evidence is required (brain stimulation and speech and language therapy).