Stroke is commonly perceived to be.a disease which causes physical disability, and its effect upon communication and language functioning is often overlooked. For example, while stroke is probably the most frequent single cause of impaired communication in adult life,' few community based surveys have investigated the size or natural history of the problem. Further, -there are often problems in interpreting the terminology used: in one survey2 " aphasia" was differentiated from " dysphasia", which was considered to include " difficulty in speech, slurred, bulbar or dysarthric speech". In this paper the term "aphasia" includes "dysphasia" and refers to language disturbance of all grades of severity. The term "dysarthria" refers to abnormal function confined to the articulatory muscles and innervation. Apraxia of speech, which may also cause misarticulation, was not specifically studied but if there was any associated language disturbance then this was studied.Various studies suggest that 21 %-24% of patients admitted to hospital with acute stroke are
In the average District General Hospital, patients with aphasia due to stroke make up a large proportion of the speech therapy caseload. Attempts to evaluate speech therapy have been beset with methodological weaknesses, such as a high degree of patient selection,' lack of controls,2 unrealistic amounts of treatment,3 or control and treatment groups which are not comparable.4 We report here on a study which was designed to answer the question of whether any improvement relating to speech therapy was associated with the specific skills and experience of the speech therapist, or was a consequence of the general stimulation and support which most therapeutic relationships provide. To this end, we compared the outcome in two groups of patients with aphasia following stroke: one group received "conventional speech therapy" and the other received stimulation and support from untrained volunteers.
MethodThe present study was a multicentre trial with fourteen participating speech therapy departments. All patients referred for speech therapy with a clinical diagnosis of stroke complicated by aphasia were eligible for the study. with the following qualifications: (1) their speech diagnosis was predominantly aphasia, (2) they had never received speech therapy at any time. (3) (4) they did not have associated disabilities (for example, deafness, blindness or confusion so severe that the cooperation required for assessment and treatment was not possible, (5) their aphasia was sufficiently severe to warrant treatment. This was the case when the two successive baseline assessments recorded using the Functional Communication Profile' (see below) were less than 85%.Following referral to a speech therapy department, no patient entered the study until at least three weeks from the stroke. This was designed to allow for a large part of the spontaneous recovery that follows a stroke, and which is thought to be quite independent of formal treatment.67 There was no restriction on late referrals as in our experience a sizeable minority of patients are referred some weeks or months after a stroke. Following random allocation to their treatment group, patients in the speech therapy group were seen individually by a qualified speech therapist. who gave them such treatment as she thought appropriate for 30 hours over a period of 15-20 weeks. Volunteers were recruited by advertisement and word-ofmouth. The only requirements were that they should be able to devote two hours per week to their patient, and should be reliable. Volunteers were given a detailed description of their own patient's communication problems based on his assessment results. For example, a patient might be described in the following way: "He has a lot of difficultv in understanding what is said to him, especially if you use long sentences or change the subject quickly. His speech is limited to single words which he produces with great effort and which are not always the ones he wants to say. He has a lot of difficulty in understanding what he' reads. he can only manage ...
Vitamin D deficiency and secondary hyperparathyroidism is common in community living older people who are hospitalised in Southern Tasmania and is associated with increasing age, poor physical function and activity and low reported sun exposure.
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