Summary of the Clinical Practice Guideline

Article Citation

Best Practice Guidelines for the Management and Rehabilitation of Stroke in the North West Region of Cameroon

NWR Best Practices in Stroke Rehabilitation Group. (2013).
International Centre for Disability and Rehabilitation, University of Toronto, 44. Retrieved November 16, 2020 from http://icdr.utoronto.ca/wp-content/uploads/2015/05/Best-Practice-Guideline-Stroke-rehabilitation-for-NWR-Final-.pdf.
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Sponsoring Body

Bamenda Coordinating Centre for Studies in Disability and Rehabilitation (Cameroon); International Centre for Disability and Rehabilitation, University of Toronto (Canada)

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Article Details

Description

This guideline from the NWR Best Practices in Stroke Rehabilitation Group provides best practice recommendations regarding the assessment, management, and rehabilitation of individuals in the North West Region of Cameroon who have experienced stroke. At the time of the writing of these guidelines, the authors noted that speech-language pathologists and speech-language pathology services were unavailable in this region, but they highlighted the need for speech-language professionals to be involved in stroke care.

Evidence Ratings for This Document

Level of evidence was rated using international standards as follows:
  • Evidence Level A: Evidence from randomized controlled trials (RCT) or meta-analyses of RCTs. Desirable effects clearly outweigh undesirable effects, or vice versa.
  • Evidence Level B: Single RCT or well-designed observational study with strong evidence; or well-designed cohort or case-control analytic study; or multiple time series or dramatic results of uncontrolled experiment.
  • Evidence Level C: At least one well-designed, non-experimental descriptive study (e.g., comparative studies, correlation studies, case studies) or expert committee reports, opinions, and/or experience of respected authorities, including consensus from development and/or reviewer groups.
  • Evidence Level D: Expert opinion, formal consensus.

Recommendations from This Guideline

What are Recommendations?

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Treatment

Individuals who have experienced a stroke and who have aphasia should be taught supportive conversation techniques (Evidence Level A).

Keywords: Stroke, Supported Communication Treatments (e.g. Conversation Partner Training), Aphasia, Conversation Partner Training

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Assessment

Individuals who have experienced a stroke should be assessed with valid assessment tools for the patient’s stroke-related impairments and functional status (Evidence Level C). Recommendations for different care settings include:
  • Acute stroke patients in the inpatient setting should be assessed by at least one rehabilitation healthcare provider as soon as possible after admission (Evidence Level A), preferably within the first 24-48 hours (Evidence Level C). Assessment should include dysphagia. 
  • Acute stroke patients who were not admitted to a hospital should undergo outpatient assessment for functional impairments including cognition to evaluate the need for rehabilitation treatment (Evidence Level A), preferably within 2 weeks (Evidence Level C). 
  • Community-based rehabilitation assessment should include dysphagia or balance as needed. 
Survivors of a severe or moderate stroke should be reassessed at regular intervals for their rehabilitation needs (Evidence Level C). Comprehensive, individualized plans should be developed and regularly updated to reflect the severity of stroke and the patient’s needs and goals (Evidence Level C).

Keywords: Provider (SLP/Caregiver), Setting, Timing, Provider, Setting (e.g. Acute/Outpatient), Timing, Comorbid Disorders and Diseases, Acquired Brain Injuries (e.g. Concussion/Stroke), Follow-Up/Timing, Provider, Dysphagia, Hearing Loss/Balance Disorders, Stroke

Service Delivery

Individuals who have experienced a stroke should be assessed with valid assessment tools for the patient’s stroke-related impairments and functional status (Evidence Level C). Recommendations for different care settings include:
  • Acute stroke patients in the inpatient setting should be assessed by at least one rehabilitation healthcare provider as soon as possible after admission (Evidence Level A), preferably within the first 24-48 hours (Evidence Level C). Assessment should include dysphagia. 
  • Acute stroke patients who were not admitted to a hospital should undergo outpatient assessment for functional impairments including cognition to evaluate the need for rehabilitation treatment (Evidence Level A), preferably within 2 weeks (Evidence Level C). 
  • Community-based rehabilitation assessment should include dysphagia or balance as needed. 
Survivors of a severe or moderate stroke should be reassessed at regular intervals for their rehabilitation needs (Evidence Level C). Comprehensive, individualized plans should be developed and regularly updated to reflect the severity of stroke and the patient’s needs and goals (Evidence Level C).

Keywords: Provider (SLP/Caregiver), Setting, Timing, Provider, Setting (e.g. Acute/Outpatient), Timing, Comorbid Disorders and Diseases, Acquired Brain Injuries (e.g. Concussion/Stroke), Follow-Up/Timing, Provider, Dysphagia, Hearing Loss/Balance Disorders, Stroke

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Screening

Prior to initiating oral intake of medications, fluids, or food, individuals who have experienced a stroke should have their swallowing ability screened using simple, valid, and reliable bedside testing protocol (Evidence Level B). "Patients who are not alert within the first 24 hours should be monitored closely and dysphagia screening performed when clinically appropriate" (Evidence Level C; p. 25).

Keywords: Dysphagia, Stroke

Assessment

Individuals who have experienced a stroke and who have dysphagia should receive swallowing therapy and reassessment as needed (Evidence Level A).

Keywords: Dysphagia, Stroke

“Patients with stroke presenting with features indicating dysphagia or pulmonary aspiration should receive a full clinical assessment of their swallowing ability by an appropriately trained specialist who should advise on safety of swallowing ability and consistency of diet and fluids” (Evidence Level A; p. 25). “Assessment of nutritional status should include the use of validated nutrition assessment tools or measures” (Evidence Level C; p. 25).

Keywords: Provider (SLP/Caregiver), Provider, Dysphagia, Stroke

Individuals who have experienced a stroke should be assessed with valid assessment tools for the patient’s stroke-related impairments and functional status (Evidence Level C). Recommendations for different care settings include:
  • Acute stroke patients in the inpatient setting should be assessed by at least one rehabilitation healthcare provider as soon as possible after admission (Evidence Level A), preferably within the first 24-48 hours (Evidence Level C). Assessment should include dysphagia. 
  • Acute stroke patients who were not admitted to a hospital should undergo outpatient assessment for functional impairments including cognition to evaluate the need for rehabilitation treatment (Evidence Level A), preferably within 2 weeks (Evidence Level C). 
  • Community-based rehabilitation assessment should include dysphagia or balance as needed. 
Survivors of a severe or moderate stroke should be reassessed at regular intervals for their rehabilitation needs (Evidence Level C). Comprehensive, individualized plans should be developed and regularly updated to reflect the severity of stroke and the patient’s needs and goals (Evidence Level C).

Keywords: Provider (SLP/Caregiver), Setting, Timing, Provider, Setting (e.g. Acute/Outpatient), Timing, Comorbid Disorders and Diseases, Acquired Brain Injuries (e.g. Concussion/Stroke), Follow-Up/Timing, Provider, Dysphagia, Hearing Loss/Balance Disorders, Stroke

Treatment

Individuals who have experienced a stroke and who have dysphagia should receive swallowing therapy and reassessment as needed (Evidence Level A).

Keywords: Dysphagia, Stroke

Service Delivery

“Patients with stroke presenting with features indicating dysphagia or pulmonary aspiration should receive a full clinical assessment of their swallowing ability by an appropriately trained specialist who should advise on safety of swallowing ability and consistency of diet and fluids” (Evidence Level A; p. 25). “Assessment of nutritional status should include the use of validated nutrition assessment tools or measures” (Evidence Level C; p. 25).

Keywords: Provider (SLP/Caregiver), Provider, Dysphagia, Stroke

Individuals who have experienced a stroke should be assessed with valid assessment tools for the patient’s stroke-related impairments and functional status (Evidence Level C). Recommendations for different care settings include:
  • Acute stroke patients in the inpatient setting should be assessed by at least one rehabilitation healthcare provider as soon as possible after admission (Evidence Level A), preferably within the first 24-48 hours (Evidence Level C). Assessment should include dysphagia. 
  • Acute stroke patients who were not admitted to a hospital should undergo outpatient assessment for functional impairments including cognition to evaluate the need for rehabilitation treatment (Evidence Level A), preferably within 2 weeks (Evidence Level C). 
  • Community-based rehabilitation assessment should include dysphagia or balance as needed. 
Survivors of a severe or moderate stroke should be reassessed at regular intervals for their rehabilitation needs (Evidence Level C). Comprehensive, individualized plans should be developed and regularly updated to reflect the severity of stroke and the patient’s needs and goals (Evidence Level C).

Keywords: Provider (SLP/Caregiver), Setting, Timing, Provider, Setting (e.g. Acute/Outpatient), Timing, Comorbid Disorders and Diseases, Acquired Brain Injuries (e.g. Concussion/Stroke), Follow-Up/Timing, Provider, Dysphagia, Hearing Loss/Balance Disorders, Stroke

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Service Delivery

Individuals who have experienced stroke should be referred for interdisciplinary rehabilitation. In addition to physicians and nurses, the interdisciplinary team should include healthcare providers with experience in stroke such as a speech-language pathologist, physiotherapist, occupational therapist, and social worker as well as the patient and their family/caregiver(s) (Evidence Level A). The team should meet weekly to discuss progress, any problems, goal status, and discharge plans (Evidence Level B).

Keywords: Provider, Timing, Adults, Stroke

Go to Map

Screening

“Patients with stroke presenting with features indicating dysphagia or pulmonary aspiration should receive a full clinical assessment of their swallowing ability by an appropriately trained specialist who should advise on safety of swallowing ability and consistency of diet and fluids” (Evidence Level A; p. 25). “Assessment of nutritional status should include the use of validated nutrition assessment tools or measures” (Evidence Level C; p. 25).

Keywords: Provider (SLP/Caregiver), Provider, Dysphagia, Stroke

Prior to initiating oral intake of medications, fluids, or food, individuals who have experienced a stroke should have their swallowing ability screened using simple, valid, and reliable bedside testing protocol (Evidence Level B). "Patients who are not alert within the first 24 hours should be monitored closely and dysphagia screening performed when clinically appropriate" (Evidence Level C; p. 25).

Keywords: Dysphagia, Stroke

Assessment

Individuals who have experienced a stroke and who have dysphagia should receive swallowing therapy and reassessment as needed (Evidence Level A).

Keywords: Dysphagia, Stroke

Individuals who have experienced a stroke should be assessed with valid assessment tools for the patient’s stroke-related impairments and functional status (Evidence Level C). Recommendations for different care settings include:
  • Acute stroke patients in the inpatient setting should be assessed by at least one rehabilitation healthcare provider as soon as possible after admission (Evidence Level A), preferably within the first 24-48 hours (Evidence Level C). Assessment should include dysphagia. 
  • Acute stroke patients who were not admitted to a hospital should undergo outpatient assessment for functional impairments including cognition to evaluate the need for rehabilitation treatment (Evidence Level A), preferably within 2 weeks (Evidence Level C). 
  • Community-based rehabilitation assessment should include dysphagia or balance as needed. 
Survivors of a severe or moderate stroke should be reassessed at regular intervals for their rehabilitation needs (Evidence Level C). Comprehensive, individualized plans should be developed and regularly updated to reflect the severity of stroke and the patient’s needs and goals (Evidence Level C).

Keywords: Provider (SLP/Caregiver), Setting, Timing, Provider, Setting (e.g. Acute/Outpatient), Timing, Comorbid Disorders and Diseases, Acquired Brain Injuries (e.g. Concussion/Stroke), Follow-Up/Timing, Provider, Dysphagia, Hearing Loss/Balance Disorders, Stroke

Treatment

Individuals who have experienced a stroke and who have dysphagia should receive swallowing therapy and reassessment as needed (Evidence Level A).

Keywords: Dysphagia, Stroke

Individuals who have experienced a stroke and who have aphasia should be taught supportive conversation techniques (Evidence Level A).

Keywords: Stroke, Supported Communication Treatments (e.g. Conversation Partner Training), Aphasia, Conversation Partner Training

Once medically stable, individuals who have experienced a stroke should begin rehabilitation therapy as early as possible that addresses activities of daily living and that is promoted in the patient’s daily routine (Evidence Level A).

Keywords: Timing

Service Delivery

Individuals who have experienced stroke should receive rehabilitation services based on stroke severity (Evidence Level C). The intensity and duration of therapy should be appropriate for the patient’s needs and tolerance levels and be described in their individualized rehabilitation plan (Evidence Level A). After discharge from inpatient services, patients should continue to receive rehabilitation for the first year after stroke (Evidence Level A).

Keywords: Dosage (e.g. Frequency/Intensity), Timing

Individuals who have experienced stroke should be referred for interdisciplinary rehabilitation. In addition to physicians and nurses, the interdisciplinary team should include healthcare providers with experience in stroke such as a speech-language pathologist, physiotherapist, occupational therapist, and social worker as well as the patient and their family/caregiver(s) (Evidence Level A). The team should meet weekly to discuss progress, any problems, goal status, and discharge plans (Evidence Level B).

Keywords: Provider, Timing, Adults, Stroke

Individuals who have experienced a stroke and their families/caregiver(s) should receive timely, up-to-date information and education from their team of service providers (Evidence Level A).

Keywords: Provider, Education/Training

Once medically stable, individuals who have experienced a stroke should begin rehabilitation therapy as early as possible that addresses activities of daily living and that is promoted in the patient’s daily routine (Evidence Level A).

Keywords: Timing

“Patients with stroke presenting with features indicating dysphagia or pulmonary aspiration should receive a full clinical assessment of their swallowing ability by an appropriately trained specialist who should advise on safety of swallowing ability and consistency of diet and fluids” (Evidence Level A; p. 25). “Assessment of nutritional status should include the use of validated nutrition assessment tools or measures” (Evidence Level C; p. 25).

Keywords: Provider (SLP/Caregiver), Provider, Dysphagia, Stroke

Individuals who have experienced a stroke should be assessed with valid assessment tools for the patient’s stroke-related impairments and functional status (Evidence Level C). Recommendations for different care settings include:
  • Acute stroke patients in the inpatient setting should be assessed by at least one rehabilitation healthcare provider as soon as possible after admission (Evidence Level A), preferably within the first 24-48 hours (Evidence Level C). Assessment should include dysphagia. 
  • Acute stroke patients who were not admitted to a hospital should undergo outpatient assessment for functional impairments including cognition to evaluate the need for rehabilitation treatment (Evidence Level A), preferably within 2 weeks (Evidence Level C). 
  • Community-based rehabilitation assessment should include dysphagia or balance as needed. 
Survivors of a severe or moderate stroke should be reassessed at regular intervals for their rehabilitation needs (Evidence Level C). Comprehensive, individualized plans should be developed and regularly updated to reflect the severity of stroke and the patient’s needs and goals (Evidence Level C).

Keywords: Provider (SLP/Caregiver), Setting, Timing, Provider, Setting (e.g. Acute/Outpatient), Timing, Comorbid Disorders and Diseases, Acquired Brain Injuries (e.g. Concussion/Stroke), Follow-Up/Timing, Provider, Dysphagia, Hearing Loss/Balance Disorders, Stroke

Notes on This Article

Associated Article

Do Stroke Clinical Practice Guideline Recommendations for the Intervention of Thickened Liquids for Aspiration Support Evidence Based Decision Making? A Systematic Review and Narrative Synthesis
Read ASHA's Article Summary | Go to Article

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