Italian guidelines for speech and language therapy in patients with stroke or primary progressive aphasia. Recommendations from the Italian neuropsychological society

Background: Aphasia can be frequently observed after left hemisphere stroke, but also in neurodegenerative diseases, as in primary progressive aphasia (PPA). Aphasia strongly impacts on quality of life, and rehabilitation of People with Aphasia (PWA) presents clinicians with complex challenges. Aims: An ad-hoc Scientific Panel, including 20 members (neurologists, physiatrists, psychologists, therapists, nurses, PWA representatives), selected 4 questions not addressed by current international guidelines: (1) effectiveness of SLT for post-stroke aphasia provided by professionals vs non-specialized personnel; (2) effectiveness of SLT in the chronic phase vs no treatment; (3) effectiveness of non-invasive neuromodulation combined with SLT vs stand-alone SLT for PWA after stroke; (4) effectiveness of non-invasive neuromodulation combined with SLT vs stand-alone SLT for PPA patients. Methods: The Scientific Panel and experienced methodologists followed common guidelines for systematic reviews and the PICO framework for scrutinizing several databases (last search: March 2023). Recommendations were based on evidence analysis according to the GRADE methodology. Key findings. The Scientific Panel suggested one strong and three conditional recommendations, although quality of evidence was low or very low. Conclusions: The present guidelines, published by the Italian Higher Institute for Health on December 19, 2023, supplement the most recent international guidelines, particularly in tackling PPA.