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May 13, 2019

ESOC-2019

COGNITIVE ASSESSMENT IN PATIENTS WITH POST-STROKE COMMUNICATION IMPAIRMENT - JOINT WORKING INVOLVING SPEECH AND LANGUAGE THERAPISTS IN A COMMUNITY NEUROREHABILITATION SETTING

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speech and language

aphasia

cognitive assessment

communication impairment

rehabilitation

Abstract

Abstract

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Keywords

speech and language

aphasia

cognitive assessment

communication impairment

rehabilitation

Abstract

Background and Aims: Current UK guidance advises cognitive assessment in conjunction with a speech and language therapist (SLT) for patients with post-stroke communication impairment. We sought to review its implementation. Methods: St Pancras Neurorehabilitation Unit London is a 17-bed community neurorehabilitation unit. We performed a retrospective review of consecutive SLT referrals from February 2017. All functional and paper-based assessments were reviewed. Results: Of 50 patients, mean age 75 years(SD 11), 60% female, communication impairment was present in 90%: dysarthria 23(46%), aphasia 22(44%), apraxia of speech 12(24%), and dysphonia 9(18%). Of 29(58%) who would have benefitted from joint cognitive assessment, SLT was present for either functional wash-and-dress/kitchen or formal cognitive assessment for 18(62%). SLT presence was more likely for paper-based (59%) than functional assessments (43%). Of 10 with moderate/severe aphasia who were able to undertake formal cognitive testing, nine were administered an aphasia-validated assessment. Of eight using the Oxford Cognitive Screen (OCS), five (63%) were unable to attempt the visual neglect and executive-function subtests, yet completed 58% of remaining subtests. Of 19 patients with communication impairment undertaking the OCS, fewer subtests were completed by the six who were assessed with SLT present. These six were more impaired than those assessed without SLT (median Patient Categorisation Tool 29.5 vs 27.5). Conclusions: Over half of patients were felt to benefit from joint SLT cognitive assessment but under two-thirds of them received this. Joint working happened more often for formal paper-based than functional assessments. Insufficient support for patients with communication impairment entails risk that extent of cognitive impairment is misdiagnosed.

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© Copyright 2019 Morressier GmbH.
All rights reserved.