Evidence-Based Position Paper on Physical and Rehabilitation Medicine Professional Practice for Persons With Stroke. The European PRM Position (UEMS PRM Section)
European Journal of Physical and Rehabilitation Medicine
Küçükdeveci, A. A., Stibrant Sunnerhagen, K., et al. (2018).
European Journal of Physical and Rehabilitation Medicine, 54(6), 957-970.
<div>This systematic position paper provides recommendations for physical and rehabilitation medicine (PRM) physicians regarding rehabilitation services for individuals with stroke. Only recommendations specifically relevant to speech-language pathology are included in this summary. </div>
Union of European Medical Specialists - Physical and Rehabilitation Medicine
<div>A collaborative, multi-professional rehabilitation team, led by the PRM physician, should include the PRM physician, nurses, physiotherapist, occupational therapist, speech and language therapist, clinical psychologist, social worker, and other disciplines as needed. Team members should have experience in stroke rehabilitation, including education and training in how to support effective communication. Clinical roles should be clearly communicated to the patient and their care provider (SoE: IV, SoR: A).</div>
<div>The multiprofessional rehabilitation team, led by the PRM physician, with the patient and care providers should determine the goals and preferences of a patient-centered and culturally-appropriate rehabilitation program (SoE: IV, SoR: A). The team should determine the length, duration, and intensity of treatment as well as discharge criteria "according to the specific needs and goals, and the condition of the [individual with] stroke ... in agreement with him/her and the family/caregiver" (SoE: IV, SoR: A; p. 965).</div>
<div>"Interventions can be administered in different settings depending on the phase after stroke (acute, post-acute, long-term) as well as the status of the [individual with] stroke ... in terms of rehabilitation needs: inpatient settings such as specialized stroke units, post-acute PRM departments in general/university hospitals, acute wards in general/university hospitals, post-acute general PRM units; outpatient settings such as facility-based outpatient clinics or day hospitals; community-based rehabilitation facilities such as early supported discharge teams for home rehabilitation or therapy-based rehabilitation at home" (SoE: IV, SoR: A; p. 961).</div>
<div>"All persons with stroke should receive rehabilitation health care as early as possible once they are determined to be ready for and able to participate in rehabilitation" (SoE: IV, SoR: A; p. 961).</div>
<div>Recommended rehabilitation interventions for the individuals with stroke may include "speech and language therapy, dysphagia management, ... cognitive interventions, ... vocational rehabilitation, and provision of education, training and support for the patient/family/caregiver" (SoE: IV, SoR: A; p. 962).</div>
<div>Swallowing assessment is recommended after stroke. Firstly, this should involve a clinical bedside assessment, and, if necessary, should include further assessment with videofluoroscopy or fiberoptic endoscopic examination. This is recommended "to identify dysphagia which can lead to aspiration pneumonia, malnutrition, dehydration or other complications" (SoE: IV, SoR: A; p. 962).</div>
<div>Restorative, oropharyngeal swallowing exercises and compensatory techniques to optimize the efficiency and safety of swallowing. Compensatory strategies may include, but are not limited to, position changes, dietary modifications, and oral hygiene should be administered for the management of dysphagia (SoE: IV, SoR: A).</div>
<div>Neuromuscular electrical stimulation may be considered as adjunct to swallowing therapies for post-stroke dysphagia (SoE: IV, SoR: A).</div>
<div>"All persons with stroke should be screened for communication disorders, which include aphasia, dysarthria, and speech apraxia" (SoE: IV, SoR: A; p. 963).</div>
<div>"All [individuals with] stroke ... with communication disorders should receive speech and language therapy, individually tailored according to their needs" (SoE: IV, SoR: A; p. 963).</div>
<div>"Computer-based therapies, constraint-induced therapy, group language therapies, communication partner training, repetitive transcranial magnetic stimulation ... can be useful for [individuals with stroke and] aphasia to improve speech and communication skills in addition to conventional speech and language therapy" (SoE: IV, SoR: A; p. 963).</div>
<div>"Augmentative and alternative communication devices and environmental modifications can be considered to enhance functional communication" (SoE: IV, SoR: A; p. 963).</div>
<div>"All persons with stroke should be screened for cognitive deficits including hemi-inattention (or unilateral neglect), and the impact of deficits on daily activities should also be assessed" (SoE: IV, SoR: A; p. 963).</div>
<div>"Rehabilitation interventions for unilateral neglect can include visual scanning training, phasic alerting, cueing, ... virtual reality, ... eye patching, prism adaptation, and repetitive transcranial magnetic stimulation" (SoE: IV, SoR: A; p. 963).</div>
<div>Cognitive skill training can be considered to target attention, memory and executive functioning deficits following stroke (SoE: IV, SoR: A). Internal and external compensatory strategies can be considered to improve memory functions after stroke (SoE: IV, SoR: A).</div>
<div>"Specific gestural or strategy training is recommended for apraxia following stroke" (SoE: IV, SoR: A; p. 964).</div>
<div>"Telemedicine technology modalities such as video, web-based support, and tele-rehabilitation [should be] considered to increase access to ongoing support and healthcare services and rehabilitation therapies following transitions from inpatient rehabilitation to community, particularly for patients in remote areas" (SoE: IV, SoR: B; p. 964).</div>
<div>"Vocational assessment and vocational rehabilitation services are offered to [individuals with] stroke ... who may be able to return to work" (SoE: IV, SoR: A; p. 964).</div>
