A systematic review of rehabilitation interventions to prevent and treat depression in post-stroke aphasia

Abstract

This study found some interventions that may improve depression outcomes for those with mild depression or without depression in post-stroke aphasia. Future research is needed to address methodological limitations and evaluate and support the translation of stepped psychological care across the continuum. Implications for Rehabilitation Stepped psychological care after stroke is a framework with levels 1 to 4 which can be used to prevent and treat depression for people with aphasia. A range of rehabilitation interventions may be beneficial to mood at level 1 for people without clinically significant depression (e.g., goal setting and achievement, psychosocial support, communication partner training and narrative therapy). People with mild symptoms of depression may benefit from interventions at level 2 (e.g., behavioral therapy, psychosocial support and problem solving). People with moderate to severe symptoms of depression require specialist mental health/behavioral services in collaboration with stroke care at levels 3 and 4 of stepped psychological care.

Counselling training for speech–language therapists working with people affected by post‐stroke aphasia: a systematic review

“…The development and evaluation of counselling training for Levels 1 and 2 stepped psychological care approaches (Baker et al . , Kneebone , NHS Improvement—Stroke ) relevant to speech–language therapists is required. Further, current information of self perceived benefits of counselling training can be strengthened with evaluations from trained others (observers) and consumer evaluations of the effects of counselling in post‐stroke rehabilitation outcomes.…”

“…At this level, behavioural therapy, psychosocial support and problem‐solving have been identified as reducing symptoms of mood disorder in people affected by post‐stroke aphasia (Baker et al . ).…”

“…Goal‐setting, problem‐solving, peer support, motivational interviewing, stress management, routine assessment and review of mood are also recommended at Level 1 (Baker et al . , Kneebone ). For people with post‐stroke aphasia, biographic‐narrative therapy, communication partner training, aphasia choir, self‐management workbooks and goal‐setting were found to enhance mood (Baker et al .…”

“…Key interventions at Level 1 of the stepped psychological care model that may enhance mood and prevent mood disorders include active listening, normalizing, and providing psychological advice and information to facilitate adjustment. Goal-setting, problem-solving, peer support, motivational interviewing, stress management, routine assessment and review of mood are also recommended at Level 1 (Baker et al 2018, Kneebone 2016. For people with post-stroke aphasia, biographic-narrative therapy, communication partner training, aphasia choir, self-management workbooks and goal-setting were found to enhance mood (Baker et al 2018).…”

“…Goal-setting, problem-solving, peer support, motivational interviewing, stress management, routine assessment and review of mood are also recommended at Level 1 (Baker et al 2018, Kneebone 2016. For people with post-stroke aphasia, biographic-narrative therapy, communication partner training, aphasia choir, self-management workbooks and goal-setting were found to enhance mood (Baker et al 2018). Level 2 psychological interventions in stroke may include relaxation training, advice and information for adjustment, goal-setting and brief psychological interventions, for example, motivational interviewing, problem-solving, behavioural activation and cognitive-behavioural therapy (Kneebone 2016, NHS Improvement-Stroke 2011.…”