ABSTRACT

Background: Stroke causes communication impairments but we lack the real-world population-level data needed to inform inpatient and community services. Aims: To establish prevalence of aphasia and dysarthria within inpatient stroke survivors, describe those affected, the amount of therapy they receive and their outcomes.

Methods & Procedures: Secondary analysis of data from the Sentinel Stroke National Audit Programme, England, Wales and Norther Ireland, including inpatient stroke survivors after 72 hours, with completed National Institute of Health Stroke Scale data (communication items), excluding those already discharged, not conscious or with incomplete data.

Outcomes & Results: 64% of the 88,974 stroke survivors meeting our criteria were communication impaired: 28% had both aphasia and dysarthria, 24% had dysarthria only and 12% had aphasia only. Those in the older age range and with more severe stroke were more likely to have a communication impairment and had a worse outcome than those without communication impairment. On average, those with both communication impairments had a 21 day length of stay and 10 minutes of speech and language therapy for communication and/or dysphagia per day of stay.

Conclusions: Communication impairment is common during the inpatient phase of stroke care yet average therapy provision is below the recommended levels and is likely to include dysphagia assessment and intervention. Dysarthria is reported as more prevalent than aphasia at this early stage, although this is not necessarily diagnosed by a speech and language therapist. The most common presentation is to have a combination of aphasia and dysarthria for which there is limited clinical guidance.

摘要

背景：中风会导致沟通障碍，但我们缺乏告知住院和社区服务所需的真实世界人口水平数据。目的：确定住院卒中幸存者中失语症和构音障碍的患病率，描述受影响的人、他们接受的治疗量及其结果。

方法和程序：对来自英格兰、威尔士和北爱尔兰 Sentinel Stroke National Audit Programme 的数据进行二次分析，包括 72 小时后的住院卒中幸存者，以及完整的美国国立卫生研究院卒中量表数据（交流项目），不包括那些已经出院的患者，没有意识或数据不完整。

结果和结果： 88,974 名符合我们标准的中风幸存者中有 64% 有交流障碍：28% 有失语症和构音障碍，24% 仅有构音障碍，12% 仅有失语症。与没有沟通障碍的人相比，年龄较大且中风更严重的人更有可能有沟通障碍，结果更糟。平均而言，那些有两种沟通障碍的人住院时间为 21 天，每天住院时间为 10 分钟，用于沟通和/或吞咽困难的言语和语言治疗。

结论：在卒中护理的住院阶段，交流障碍很常见，但平均治疗提供低于推荐水平，可能包括吞咽困难评估和干预。据报道，在这个早期阶段，构音障碍比失语症更普遍，尽管这不一定由言语和语言治疗师诊断出来。最常见的表现是同时出现失语症和构音障碍，临床指导有限。