What percentage of patients with major stroke require speech therapy follow-up in the chronic phase of stroke?

From the Guidelines

Approximately 21-40% of patients with major stroke require speech therapy follow-up in the chronic phase of stroke. This need for continued speech therapy stems from persistent communication disorders such as aphasia, dysarthria, or apraxia of speech that don't fully resolve during initial rehabilitation, as noted in studies 1. The chronic phase, generally considered to begin 3-6 months post-stroke, often reveals communication deficits that continue to impact daily functioning and quality of life.

Key Considerations

• Speech therapy during this phase typically involves 1-2 sessions weekly for several months, with frequency adjusting based on individual progress.
• Treatment approaches include constraint-induced language therapy, semantic feature analysis, script training, and technology-assisted communication strategies.
• Recovery potential varies significantly based on stroke severity, location, age, and pre-stroke language abilities, as highlighted in 1.
• Even years after stroke, many patients can still make meaningful improvements with appropriate therapy, though complete recovery becomes less likely as time progresses.
• Early identification and referral to speech-language pathologists is crucial for maximizing communication outcomes in these patients, as emphasized in 1.

Evidence-Based Recommendations

• The most recent and highest quality study 1 provides guidance on clinical performance measures for stroke rehabilitation, including the percentage of people with stroke with aphasia who receive speech-language therapy (SLT).
• This study outlines the numerator, denominator, period of assessment, and sources of data for measuring SLT for aphasia, providing a framework for evaluating and improving speech therapy outcomes in patients with major stroke.

From the Research

Speech Therapy Follow-up for Patients with Major Stroke

• Approximately one third of people who have a stroke experience aphasia, which affects some or all language modalities: expression and understanding of speech, reading, and writing 2.
• A study found that speaking ability at one month post-stroke was significantly better in patients who received early therapy, and the number of hours of early therapy was positively related to recovery at one year post-stroke 3.
• Another study showed that high-intensity occupational therapy services were associated with better cognitive outcome at discharge from inpatient rehabilitation after stroke, but neither high physical therapy nor speech-language pathology was significantly associated with cognitive outcome 4.
• Guideline adherence in speech and language therapy in stroke aftercare was analyzed using health insurance claims data, and the results indicated deficits in the implementation of guideline recommendations in stroke aftercare 5.
• A systematic review and network meta-analysis found that combined therapies of speech and language therapy with electroacupuncture or non-invasive brain stimulation generally outperformed speech and language therapy alone in improving language function in patients with post-stroke aphasia 6.

Percentage of Patients Requiring Speech Therapy Follow-up

• The exact percentage of patients with major stroke requiring speech therapy follow-up in the chronic phase of stroke is not directly stated in the provided studies.
• However, it is mentioned that approximately one third of people who have a stroke experience aphasia, which may require speech therapy follow-up 2.
• A study found that 90.3% of patients were diagnosed with speech impairments and swallowing disorders within the first year after the stroke, and 44.1% of patients received outpatient speech and language therapy aftercare 5.