A Case for the Implementation of Cognitive-Communication Screenings in Acute Stroke

Abstract

The narrative is linked to the published literature and the importance of identifying and managing cognitive-communication impairments after stroke. A model of implementation science is presented as one way to consider the challenges clinicians face when attempting to implement evidence-based practices. The model and examples from other fields show avenues for further research.

Introducing the model of cognitive-communication competence: A model to guide evidence-based communication interventions after brain injury

“…The steps followed in developing the model of cognitivecommunication competence are presented in Figure 1. (1,2,40), concussion and mild brain injury (7,39,54), blast injury (25), stroke and aphasia (36,63), penetrating brain injury (89), hypoxic ischaemic brain injury (42,90), and encephalitis (29,91,92).…”

“…A number of evidence to practice gaps for those with communication impairment have been reported. First, while there are a range of evidence-based SLP interventions available, estimates indicate that fewer than 50% of individuals are in fact referred for SLP services (1,36,42). In a study of 11 226 adults receiving SLP services in outpatient rehabilitation programmes in the USA, more than 54.9% had not received SLP services before being admitted to an outpatient facility, some weeks to months after onset of brain injury (43).…”

“…Several reasons for lack of referral to SLP services have been postulated including lack of awareness of the full range of possible communication deficits (13); lack of understanding of available SLP treatments (1); unclear identification, screening, and referral systems (42,45); lack of physician awareness of SLP services (46); and a generalized underutilization of allied health expertise (47). Frequently, the more obvious communication impairments in motor speech, aphasia, fluency, or voice prompt referral for SLP intervention while the more prevalent, subtle, but equally debilitating cognitive-communication disorders are overlooked, thus depriving individuals of access to evidence-based interventions (1,36). Although social communication deficits have been noted in the majority of severely injured adults with ABI (48,49), referral rates to SLP for social or pragmatic treatment are as low as 3-5% in large US national data collection samples (43).…”

“…Communication deficits are underidentified due to use of screening and assessment measures that lack the sensitivity to detect subtle but functionally significant communication deficits (7,14,54,55). Also, referral processes and care pathways tend to focus disproportionately on swallowing or motor speech deficits to the exclusion of other equally pressing communication concerns (36,40,56). In addition, clinicians require guidance in selecting the most accurate, comprehensive, relevant, and ecologically valid assessment tools from a growing range of standardized tests, (7,51,57), activity, and participation measures (7,10,50,52,53,58-61).…”

“…SLP assessments have been shown to be helpful in detecting subtle but debilitating deficits (2,6,32,33) and in guiding return to school (14,16,34) and return to work (19,20). Evidence supports SLP involvement for individuals with ABI in acute care (35)(36)(37), inpatient rehabilitation (38)(39)(40), and community-based interventions including several years post injury (8,41).…”