Recovery, Evidence and Prognosis Flashcards
Approx how many people living in the UK currently living with aphasia?
376 000 :)
Recovery from aphasia
People who have aphasia from a stroke/TBI (non-progessive cause) usually improve to some degree.
When are improvements in language usually most obvious?
In the first 2-3 months post-onset.
Thereafter there’s slow, gradual improvements for months or even years.
Name the 3 recovery influences.
Spontaneous Recovery
Personal and Environmental factors
SLT input
These 3 variables interact.
Spontaneous Recovery
Lasts 2-6 months.
TBI and haemorrhagic stroke spontaneous recovery occurs over slighlty longer period of time than with ischaemic stroke.
Early improvement may be dramatic because of:
reduction in oedema and inflammation
Improvement of blood flow
Reduction in abnormal concentrations of neurotrasnmitters
Non-infarcted areas which have been temporarily dysfunctional recover.
What is gradual improvement due to?
Neurophysiological and neuroanatomical reactions to injury.
Surviving neurons near to infarct and other areas repair :)
Cerebral plasticity
Impaired functions may be supported by re-organisation of brain areas around the infarcted tissue and recruitment of undamaged areas in other parts of the brain- left and right.
What is the limit to spontaneous recovery?
After 6 months theres’s no more significant changes.
Should we delay SLT input until after spontaneous recovery is complete?
NO
Psychological and other benefits for PwA and family when initiated early
Some evidence that SLT enhances natural potential for improvement- helps drive cerebral plasticity
Spontaneous gains may be long term.
Personal and Environmental factors
Age lesion site and size medical status co-morbidities severity of impairment personality, mood and motivation handedness education family support socioeconomic support intervention
What is the most powerful predictor of recovery?
Severity of aphasia.
The greater the severity, the poorer the recovery.
By 90 days…
PwA will have improved to approx. 70% of their maximum potential recovery.
SLT input
Need more evidence.
However it can positively impact of PwA-
Improves standardised scores
Improved communication in real life situations
Increased confidence in speaking situations
Increased participation in speaking situations
Improved quality of life for PwA
Improved QoL for family
Better informed staff
Cochrane review
Found clinical and statistical benefits of SLT.
Not enough evidence for approaches, group v individual, computer mediated v SLT, trained volunteer v. SLT.
High intensity= better outcome, but more dropped out lol.
Duration and dosage
We don’t know optimum balance- but evidence is for high intensity stuff.
However many PwA aren’t fit enough for this
