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The nine included studies were analysed and data extracted from them by categorizing the four components of rehabilitation; assessment, goal setting, intervention and reassessment [4]. The particular shared characteristics of assessment, intervention and reassessments are exemplified in Table 4. Goal setting is presented under sub-heading 3. Opportunities for and barriers to an optimal rehabilitation are interpreted and presented under the following headings; assessment and assessment tools, goal setting, interventions and reassessment.

A brief outline of the main positive and negative out- comes of rehabilitation of stroke patients with aphasia is presented in Table 5. Assessment tools that explore the whole person are useful for the rehabilitation of language [11] [19] [21] [22].

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In one study, the team members had a collective responsibility for person-centred assessment [11]. The inclusion of family members and next of kin is valuable for understanding the patient as a person [2] [11] [14] [19] [20] [23]. The ICF domains are fundamental for the development of new tools [19].

Assessment of activity, participation and environment is important [11] [14] [19]. A user-friendly. Table 2. Details of the included studies. Table 3. Methodological quality assessment of the included studies. Was the population from which the sample was drawn clearly defined? Were sampling methods adequate?

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Was it explained whether and how the participants who agreed to participate differed from those who refused? Was the response rate adequate? Were procedures for data collection standardized? Were measures shown to be reliable and valid? Were the statistical methods appropriate? Were ethical issues considered? Table 4. Categories extracted from the studies. Some assessment tools such as the ACAS were not appropriate for persons with severe aphasia [18].


Patients with aphasia are likely to be interpreted as having a passive role, therefore withdrawn patients require a more concerted effort [14]. Table 5. Positive and negative outcomes of rehabilitation for persons with aphasia. A variety of assessment tools were described in the included studies. Matos claims there is a need to develop a new assessment tool based on the ICF.

It is important to consider all ICF domains in the rehabilitation of stroke patients and their language ability. Healthcare professionals require tools that explore the whole person and the entire situation [19]. Stroke causes impairment in language, physical ability and emotions.


However, Matos claims that the social dimension is often disregarded in the assessment procedure. Tools such as Assessment for living with Aphasia and the Burden of stroke scale are suggested for exploring the situation of the whole person based on ICF domains [19]. However, such tools are not always appropriate for persons with aphasia.

The ACAS, which was developed for inpatients as well as for the home care service in The Netherlands, was found to be unsuitable for patients with severe aphasia because they could be left without rehabilitation goals and relevant interventions [18]. Even from the start, assessment of patients with communication impairments due to aphasia is likely to be poor.

Interdisciplinary team members interpret patients with aphasia to have a passive role [14]. A Post-stroke Checklist PSC was developed by international medical experts as a user-friendly tool for the identification of long term problems in stroke patients [20]. Assessment of persons with LIS prioritizes respiratory and nutritional status, communication skills and cognition. Family and next to kin are important for obtaining knowledge about the person [21].

The main language areas auditory, comprehension, verbal expression, reading and writing were assessed. Assessing mood, communication and cognition was deemed essential [22]. WHO goals pertaining to patient rights were not fulfilled, as a lack of information to patients with aphasia was revealed [14]. Important information on topics such as the causes and effects of stroke, recovery and prognosis, test results and the support available in the future was not provided to patients.

Those with aphasia received less information and communication time compared to stroke patients without aphasia [14]. Social and emotional well-being was incorporated in the goalsetting by including information and involving families [11]. The goal for patients with LIS is threefold; to establish and maintain optimal respiration, nutrition and communication [21]. Quality of life goals became more visible to the members of the interdisciplinary team through the PSC tool [20].

It is important to take cognition and fatigue into account to ensure effective interventions [18]. The PSC tool provides a common platform for performing quality of life interventions [20]. In order to constantly tailor the interventions they were negotiated both in structural meetings and on the spot [11]. In addition to life-supporting interventions, resources for communication and communicative skills such as eye winking should be included. A structural referral system to guarantee continuity in long term chronic care is recommended [18].

The PSC provided the interdisciplinary team with a common referral system to use in the reassessment [20]. Both formal and spontaneous reassessment continuously occurred in the form of close negotiations between the members of the interdisciplinary team in order to achieve appropriate goals and interventions. Furthermore, unplanned dialogue took place when it became necessary to reconsider agreed goals [11]. Reassessment should reveal the communication skills of patients with LIS, their adaptation to advanced technology and whether more support is needed to communicate.

Moreover, relevant competence should be harmonized with the needs of patients with LIS [21]. Interdisciplinary teamwork is a prerequisite for rehabilitation. The included studies highlight the variety of healthcare professionals involved in the rehabilitation of stroke patients with aphasia. Some studies described next to kin as useful collaborative partners. SLTs suggest that a broader interdisciplinary team is necessary to apply the ICF framework for patients with aphasia. FMs should be included to optimize the assessment of activity and participation.

In Portugal, SLTs traditionally focus on linguistic impairments and activity limitations, and have no tradition of involving FMs [19]. Matos points out that the British National Stroke guidelines suggest that allied health professionals, health or social care workers and volunteers should have an increased role in an interdisciplinary intervention at the chronicstage of aphasia after stroke.

The SLTs perceived such an intervention to be more valuable than previously appreciated. Matos stated that the assessment was performed by SLTs [19]. The four main areas of language were assessed by 51 SLTs in acute and rehabilitation in-patient settings [2]. GPs might make an important contribution by identifying prognostic characteristics [18].

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Psychologists could have a significant role in the interdisciplinary team due to the need to address the impact of the emotional changes that follow stroke and aphasia [19]. The close interdisciplinary collaboration in terms of sharing knowledge and skills facilitated negotiations opportunistic dialogue and led to the best problem-solving care in the rehabilitation of stroke patients. The sharing was both planned i. This collaboration went beyond the traditional features of teamwork and greatly benefitted the rehabilitation.

In the opportunistic dialoguethe team members experienced person-centred assessment and a collective concern about the person with aphasia, which is an absolute prerequisite for successful rehabilitation. All team members were considered valuable for achieving the rehabilitation goals. By including nurses the study demonstrates that rehabilitation is not only the responsibility of therapy experts [11]. Nurses are mentioned as an essential part of the team caring for patients with LIS, as their assessment of the daily care is important.

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The skilled interdisciplinary team set shared goals, organised follow-up and reassessed skills [21]. Stroke patients need health information in the acute stroke unit, where three out of seven informants described nurses as the main information providers [14]. Stroke nurses specialized in long term care after stroke were responsible for monitoring patients in the rehabilitation process.

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They set goals alone without involving the other healthcare professionals in the interdisciplinary team [18]. Nurses and senior care assistants are the main staff categories in the care of persons with stroke [23]. These nurses experienced working in isolation with few opportunities for teamwork and expressed a strong need for interdisciplinary cooperation to increase the quality of the rehabilitation [23].

Patients living at home and their caregivers were referred to different healthcare professionals by the SCCs, but a cooperation strategy in the rehabilitation process was absent [18]. The rehabilitation team at Sunnaas Hospital in Norway is interdisciplinary and encompasses the different skills needed in the rehabilitation process.

The team members considered interdisciplinary teamwork essential for successful rehabilitation. Patients with LIS constitute such a small group that even international teamwork is warranted to facilitate best practice in their rehabilitation [21].

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Joint dialogue-based cooperation strategies are dependent on co-location of core team members, as well as regular meetings with collective thinking and engagement [11]. Moreover, joint dialogue is problem-oriented and emerges spontaneously due to team members observing problems and seizing the moment to solve them, irrespective of interdisciplinary status.

The dialogue is also patient-oriented and closely linked to defined rehabilitation goals.

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