Original article| Volume 91, ISSUE 2, P196-202, February 2010

Download started.


Incidence and Profile of Inpatient Stroke-Induced Aphasia in Ontario, Canada


      Dickey L, Kagan A, Lindsay MP, Fang J, Rowland A, Black S. Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada.


      To determine the incidence rate of inpatient stroke-induced aphasia in Ontario, Canada, and to examine the demographic and clinical characteristics for stroke patients with and without aphasia.


      Age- and sex-specific incidence rates for aphasia in Ontario were calculated using the Ontario Stroke Audit. In addition, data collected from the Registry of the Canadian Stroke Network (RCSN) were used to determine the demographic and clinical characteristics for stroke patients with and without aphasia.


      All hospitals and regional stroke centers in Ontario, Canada.


      The Ontario Stroke Audit is a representative weighted sample of more than 3000 stroke inpatients admitted to emergency departments in all hospitals in Ontario within the 2004/2005 fiscal year. RCSN data included a cohort of more than 15,000 consecutive patients presenting with stroke at 12 regional stroke centers in Ontario from 2003 to 2007.


      Not applicable.

      Main Outcome Measures

      Presence of aphasic symptoms on admission to hospital and at discharge, age and sex, stroke type and severity, severity of disability, services received in hospital, length of stay, and discharge destination.


      Thirty-five percent (1131/3207) of adult patients admitted with a diagnosis of stroke in the province of Ontario during the 2004 to 2005 Ontario Stroke Audit had symptoms of aphasia at the time of discharge. This amounts to an incidence rate of 60 per 100,000 persons per year. Risk of aphasia increased significantly with age. In comparison with nonaphasic stroke patients, patients with aphasia were older, presented with more severe strokes on admission, had more severe disability, and were more frequently discharged to long-term care and/or rehabilitation (unadjusted results). Adjusting for stroke severity, age, sex, comorbidity, and stroke subtype, the presence of aphasia was found to be an independent predictor of longer hospital stays, increased use of rehabilitation services, and higher rates of thrombolytic therapy.


      A significant number of people with stroke experience aphasia, with advancing age associated with a higher risk. The profile and patterns for stroke patients with aphasia differed significantly from those who did not experience aphasia as a residual disability after stroke, particularly in relation to service usage. Given the personal and system cost associated with aphasia, best practices in the area of stroke should include recommendations on how to best serve this population throughout the clinical pathway.

      Key Words

      List of Abbreviations:

      CI (confidence interval), RCSN (Registry of the Canadian Stroke Network), TIA (transient ischemic attack)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Laska A.C.
        • Hellblom A.
        • Murray V.
        • Kahan T.
        • Von Arbin M.
        Aphasia in acute stroke and relation to outcome.
        J Intern Med. 2001; 249: 413-422
        • Davidson B.
        • Worrall L.
        The assessment of activity limitation in functional communication.
        in: Worrall L. Frattali C. Neurogenic communication disorders: a functional approach. Thieme, New York2000: 19-34
        • Starkstein S.E.
        • Robinson R.G.
        Aphasia and depression.
        Aphasiology. 1988; 2: 1-20
        • Stern R.A.
        • Bachman D.L.
        • Valentino D.A.
        • Raymond P.M.
        Aphasia and mood disorders.
        J Clin Exp Neuropsychol. 1990; 12: 32
        • Kauhanen M.
        • Korpelainen J.
        • Hiltunen P.
        • et al.
        Aphasia, depression, and non-verbal cognitive impairment in ischaemic stroke.
        Cerebrovasc Dis. 2000; 10: 455-461
        • Worrall L.
        • Holland A.
        Quality of life in aphasia.
        Aphasiology. 2003; 17: 329-416
        • Cruice M.
        • Worrall L.
        • Hickson L.
        • Murison R.
        Finding a focus for quality of life in aphasia: social and emotional health, and psychological well-being.
        Aphasiology. 2003; 17: 333-354
        • Ross K.
        Assessing quality of life with aphasia: an annotated bibliography.
        Neurophysiol Neurogenic Speech Lang Disord: ASHA Special Interest Division 2. 2005; 15: 15-18
        • Elman R.
        • Ogar J.
        • Elman S.H.
        Aphasia: awareness, advocacy, and activism.
        Aphasiology. 2000; 14: 455-459
        • Albert M.L.
        Aphasia therapy works [editorial comment]!.
        Stroke. 2003; 34: 992-993
        • Berthier M.L.
        Poststroke aphasia: epidemiology, pathophysiology and treatment.
        Drugs Aging. 2005; 22: 163-182
        • Engelter S.T.
        • Gostynski M.
        • Papa S.
        • et al.
        Epidemiology of aphasia attributable to first ischemic stroke: incidence, severity, fluency, etiology, and thrombolysis.
        Stroke. 2006; 37: 1379-1384
        • Hier D.B.
        • Yoon W.B.
        • Mohr J.P.
        Gender and aphasia in the stroke data bank.
        Brain Lang. 1994; 47: 155-167
        • Pedersen P.
        • Vinter K.
        • Olsen T.
        Aphasia after stroke: type, severity and prognosis.
        Cerebrovasc Dis. 2004; 17: 35-43
        • Simmons-Mackie N.
        • Kagan A.O.'Neill Christie C.
        • Huijbregts M.
        • McEwen S.
        • Willems J.
        Communicative access and decision making for people with aphasia: implementing sustainable health care systems change.
        Aphasiology. 2007; 21: 39-66
        • Bhogal S.K.
        • Teasell R.
        • Speechley M.
        Intensity of aphasia therapy, impact on recovery.
        Stroke. 2003; 34: 987-993
        • Pound C.
        • Parr S.
        • Lindsay J.
        • Woolf C.
        Beyond aphasia: therapies for living with communication disability.
        Winslow Press, Bicester2000
        • Elman R.
        Social and life participation approaches to aphasia intervention.
        in: LaPointe L. Aphasia and related neurogenic language disorders. Thieme, New York2003
        • Simmons-Mackie N.
        Social approaches to aphasia intervention.
        in: Chapey R. Language intervention strategies in adult aphasia. Williams and Wilkins, Baltimore2001: 246-268
        • Segi M.
        Cancer mortality for selected sites in 24 countries (1950-57).
        Tohoku University of Medicine, Sendai1960
        • Waterhouse J.
        • Muir C.
        • Correa P.
        • Powell J.
        Cancer incidence in five continents.
        International Agency for Research on Cancer, Lyon1976
        • Lewis M.
        • Trypuc J.
        • Lindsay P.
        • O'Callaghan C.
        • Dishaw A.
        Has Ontario's stroke system really made a difference?.
        Healthc Q. 2006; 9: 50-59
        • Kapral M.K.
        • Hall R.E.
        • Silver F.L.
        • et al.
        Registry of the Canadian Stroke Network.
        Institute for Clinical Evaluative Sciences, Toronto2009
        • Anemaet W.K.
        Using standardized measures to meet the challenge of stroke assessment.
        Top Geriatr Rehabil. 2002; 18: 47-62
        • Cote R.
        • Hachinski V.
        • Shurvell B.L.
        • Norris J.W.
        • Wolfson C.
        The Canadian Neurological Scale: a preliminary study in acute stroke.
        Stroke. 1986; 17: 731-737
        • Cote R.
        • Battista R.
        • Wolfson C.
        • Boucher J.
        • Adam J.
        • Hachinski V.
        The Canadian Neurological Scale: validation and reliability assessment.
        Neurology. 1989; 39: 638-643
        • Statistics Canada
        Age and sex for the population of Canada, provinces, territories, census metropolitan areas and census agglomerations, 2001 and 2006 Censuses - 100% data (Table).
        (Accessed March 20, 2008)
        • Di Legge S.
        • Fang J.
        • Saposnik G.
        • Hachinski V.
        The impact of lesion side on acute stroke treatment.
        Neurology. 2005; 65: 81-86
        • Di Carlo A.
        • Lamassa M.
        • Pracucci G.
        • et al.
        Stroke in the very old: clinical presentation and determinants of 3-month functional outcome.
        Stroke. 1999; 30: 2313-2319
        • Di Carlo A.
        • European BIOMED Study of Stroke Care Group
        Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry.
        Stroke. 2003; 34: 1114-1119
        • Kapral M.K.
        • Fang J.
        • Hill M.D.
        • et al.
        Sex differences in stroke care and outcomes.
        Stroke. 2005; 36: 809-814
        • Lalor E.
        • Cranfield E.
        Aphasia: a description of the incidence and management in the acute hospital setting.
        Asia Pac J Speech Lang Hear. 2004; 9: 129-136
        • Marshall R.
        Aphasia treatment in the early post onset period: managing our resources effectively.
        Am J Speech Lang Pathol. 1997; 6: 5-11
        • Holland A.
        • Fridriksson J.
        Aphasia management during the early phases of recovery following stroke.
        Am J Speech Lang Pathol. 2001; 10: 19-28
        • Braun-Janzen C.
        • Sarchuk L.
        • Murray R.P.
        Roles of speech-language pathologists and nurses in providing communication intervention for nonspeaking adults in acute care: a regional pilot study.
        Can J Speech Lang Pathol Audiol. 2009; 33: 5-33
        • Ghose S.
        • Williams L.
        • Swindle R.
        Depression and other mental health diagnoses after stroke increase inpatient and outpatient medical utilization three years post-stroke.
        Med Care. 2005; 43: 1259-1264
        • Kauhanen M.
        • Korpelainen J.
        • Hiltunen P.
        • Brusin E.
        • Mononen H.
        • Maatta R.
        Poststroke depression correlates with cognitive impairment and neurological deficits.
        Stroke. 1999; 30: 1875-1880
        • Starkstein S.E.
        • Robinson R.G.
        Aphasia and depression.
        Aphasiology. 1988; 2: 1-19
        • Ross K.
        • Wertz R.T.
        Quality of life with and without aphasia.
        Aphasiology. 2003; 17: 355-364
        • Holland A.L.
        Why can't clinicians talk to aphasic adults?.
        Aphasiology. 1998; 12: 844-847
        • Legg C.
        • Young L.
        • Bryer A.
        Training sixth-year medical students in the use of supported conversation techniques in obtaining case-history information from adults with aphasia.
        Aphasiology. 2005; 19: 559-575
        • Kagan A.
        • Black S.
        • Duchan J.F.
        • Simmons-Mackie N.
        • Square P.
        Training volunteers as conversation partners using 'supported conversation for adults with aphasia': a controlled trial.
        J Speech Lang Hear Res. 2001; 44: 624-638
        • Kagan A.
        Revealing the competence of aphasic adults through conversation: a challenge to health professionals.
        Top Stroke Rehabil. 1995; 2: 15-28
        • Kagan A.
        • Kimelman M.D.Z.
        Informed consent in aphasia research: myth or reality?.
        Clinical Aphasiology. 1995; 23 (Accessed January 6, 2010): 65-75
        • Rowland A.
        • McDonald L.
        Evaluation of social work communication skills to allow people with aphasia to be part of the decision making process in healthcare.
        Soc Work Educ. 2009; 28: 128-144