General practitioners' perceptions of their communication with Australian Aboriginal patients with acquired neurogenic communication disorders.

OBJECTIVE: Aboriginal people have high rates of stroke and traumatic brain injury (TBI), often with residual, chronic communication deficits and multiple co-morbidities. This study examined general practitioners' (GPs') perceptions of their communication with Aboriginal patients with acquired communication disorders (ACD) after brain injury. Effective communication underpins good care but no previous research has explored this specific context. METHODS: A qualitative descriptive approach was employed using interviews and focus groups with 23 GPs from metropolitan Perth and five regional sites in Western Australia. Data were analysed thematically. RESULTS: GPs reported low visibility of Aboriginal patients with ACD in their practices, minimal training on neurogenic ACD, and difficulty distinguishing ACD from cultural-linguistic factors. They had few communication resources, and depended on families and Aboriginal Health Workers to assist in interactions. They rarely used formal interpreting services or referred to speech pathology. They reported communication (dis)ability having low priority in consultations. CONCLUSION: GPs report difficulty recognising ACD and their lack of prioritising assessment and treatment of communication ability after brain injury potentially compounds the disadvantage and disempowerment experienced by many Aboriginal people. PRACTICE IMPLICATIONS: GPs require further communication and cultural training. Improved access to speech pathology and formal interpreting services would be beneficial.

Early Development of Emotional Competence (EDEC) Assessment Tool for Children With Complex Communication Needs: Development and Evidence.

Purpose: This article introduces and provides initial data supporting "The Early Development of Emotional Competence (EDEC): A tool for children with complex communication needs (CCNs)." The EDEC was developed to raise awareness about the relation of language and emotional competence and to maximize the likelihood that intervention includes language to discuss emotions in ways that are consistent with the values and goals of the family. Method: First, the theoretical and clinical foundations of the EDEC development were discussed. Then, a description of preferred translation practices was provided, with examples of Korean and Mandarin Chinese translations. Finally, initial data from a pilot study with two sociocultural communities (i.e., 10 American and 10 Korean mothers of children developing typically) were presented to demonstrate the potential of the tool. Results: The pilot test offered preliminary support for the sensitivity of the EDEC. The tool solicited responses reflecting cultural differences between American and Korean mothers' perception of a child's emotional skills and mother-child conversation about emotions as predicted based on many cross-cultural studies in emotion. Conclusions: The information elicited from the EDEC shows promise for enabling culturally natural conversation about emotions with appropriate vocabulary and phrases in their augmentative and alternative communication systems. Supplemental Materials: https://doi.org/10.23641/asha.5643076.

Development of the Aboriginal Communication Assessment After Brain Injury (ACAABI): A screening tool for identifying acquired communication disorders in Aboriginal Australians.

PURPOSE: Acquired communication disorders (ACD), following stroke and traumatic brain injury, may not be correctly identified in Aboriginal Australians due to a lack of linguistically and culturally appropriate assessment tools. Within this paper we explore key issues that were considered in the development of the Aboriginal Communication Assessment After Brain Injury (ACAABI) - a screening tool designed to assess the presence of ACD in Aboriginal populations. METHOD: A literature review and consultation with key stakeholders were undertaken to explore directions needed to develop a new tool, based on existing tools and recommendations for future developments. RESULT: The literature searches revealed no existing screening tool for ACD in these populations, but identified tools in the areas of cognition and social-emotional wellbeing. Articles retrieved described details of the content and style of these tools, with recommendations for the development and administration of a new tool. The findings from the interview and focus group views were consistent with the approach recommended in the literature. CONCLUSIONS: There is a need for a screening tool for ACD to be developed but any tool must be informed by knowledge of Aboriginal language, culture and community input in order to be acceptable and valid.

The complexities of designing therapy for Maori living with stroke-related communication disorders.

Stroke-related communication disorders can have a substantial impact on Maori whanau (extended family). Timely and appropriate speech-language therapy is required, but there are many challenges in providing this. In this article we discuss the need for a kaupapa Maori approach to speech-language therapy that is designed by Maori for Maori, and undertaken in a Maori way. We report the results of a literature review that revealed a small but significant body of literature describing Maori experiences of stroke, aphasia and speech-language therapy, and evidence that a Maori-specific therapy programme can improve outcomes for people with stroke. We then consider the social and political context that impacts the design and delivery of such an approach. Informed by the literature, we propose a hierarchy of skill and resource acquisition for speech-language therapists, in which they learn why to be culturally safe, how to be culturally safe, and how to interact before creating resources to build relationships, resources for education and for therapy. The creation of a kaupapa Maori speech-language therapy approach should bring together people with stroke, whanau members and service providers to create therapy that crosses sectors and disciplines and acknowledges the wider social and political context.

Missing voices: Profile and extent of acquired communication disorders in Aboriginal and non-Aboriginal adult stroke survivors in Western Australia using linked administrative records.

BACKGROUND: Limited data exist on the extent of specific functional sequelae, including acquired communication disorder, among Aboriginal stroke survivors, making planning of multidisciplinary services difficult. AIMS: To obtain estimates of the extent and profile of acquired communication disorder in Aboriginal and non-Aboriginal adult stroke survivors in Western Australia and investigate potential disparities in receiving in-hospital speech pathology services among survivors with acquired communication disorder. METHODS: Stroke cases surviving their first stroke episode during 2002-2011 were identified using Western Australia-wide person-based linked hospital and mortality data, and their five-year comorbidity profiles determined. The mid-year prevalence of stroke cases with acquired communication disorder was estimated for 2011. Regression methods were used to investigate determinants of receiving speech pathology services among acquired communication disorder cases. RESULTS: Of 14,757 stroke survivors aged 15-79 years admitted in 2002-2011, 33% had acquired communication disorder (22% aphasia/dysphasia) and 777 (5.3%) were Aboriginal. Aboriginal patients were more likely to be younger, live remotely, and have comorbidities. A diagnosis of aphasia was more common in Aboriginal than non-Aboriginal patients 15-44 years (p = 0.003). A minimum of 107 Aboriginal and 2324 non-Aboriginal stroke patients with acquired communication disorder lived in Western Australia in 2011. Aboriginal status was not associated with receiving in-hospital speech services among acquired communication disorder patients in unadjusted or adjusted models. CONCLUSIONS: The relative youth, geographical distribution, high comorbidity prevalence, and cultural needs of Aboriginal stroke patients with acquired communication disorder should inform appropriate service design for speech pathology and rehabilitation. Innovative models are required to address workforce issues, given low patient volumes.

Speech-language pathology practices with Indigenous Australians with acquired communication disorders.

PURPOSE: Little is known about the needs of Indigenous Australian adults with acquired communication disorders (ACD) following stroke or brain injury and how these needs are met by speech-language pathology (SLP) services. In order for the profession to respond to the challenges of providing culturally appropriate, well-tailored and accessible services, more information on current practice and SLPs' concerns and attitudes is required. METHOD: This paper reports on a national survey with completed responses from 112 SLPs, who worked with adult neurological populations, about their levels of contact with Indigenous clients, cultural competency training and potential sources of support. RESULT. Of the total respondents, 63 SLPs reported clinical contact with Indigenous clients and :they also answered questions on their assessment, intervention and discharge practices; liaison with family; and involvement with Aboriginal Health Professionals and interpreters. This group reported insufficient knowledge about Indigenous culture, lack of support and lower levels of confidence overall in working with these clients as compared to non-Indigenous clients. They wanted more flexible services for their Indigenous clients, good access to interpreters and culturally appropriate assessments and treatments delivered in culturally appropriate settings. CONCLUSION: This research provides a useful starting point towards understanding SLPs' perspectives and practice at a national level.

A geographical analysis of speech-language pathology services to support multilingual children.

The speech-language pathology workforce strives to provide equitable, quality services to multilingual people. However, the extent to which this is being achieved is unknown. Participants in this study were 2849 members of Speech Pathology Australia and 4386 children in the Birth cohort of the Longitudinal Study of Australian Children (LSAC). Statistical and geospatial analyses were undertaken to identify the linguistic diversity and geographical distribution of Australian speech-language pathology services and Australian children. One fifth of services offered by Speech Pathology Australia members (20.2%) were available in a language other than English. Services were most commonly offered in Australian Sign Language (Auslan) (4.3%), French (3.1%), Italian (2.2%), Greek (1.6%), and Cantonese (1.5%). Among 4-5-year-old children in the nationally representative LSAC, 15.3% regularly spoke and/or understood a language other than English. The most common languages spoken by the children were Arabic (1.5%), Italian (1.2%), Greek (0.9%), Spanish (0.9%), and Vietnamese (0.9%). There was a mismatch between the location of and languages in which multilingual services were offered, and the location of and languages spoken by children. These findings highlight the need for SLPs to be culturally competent in providing equitable services to all clients, regardless of the languages they speak.

Culture and listeners' gaze responses to stuttering.

BACKGROUND: It is frequently observed that listeners demonstrate gaze aversion to stuttering. This response may have profound social/communicative implications for both fluent and stuttering individuals. However, there is a lack of empirical examination of listeners' eye gaze responses to stuttering, and it is unclear whether cultural background plays a role in regulating listeners' eye gaze response to stuttering. AIM: To examine listeners' eye gaze responses to stuttering speech relative to fluent speech in three cultural groups. METHODS & PROCEDURES: Eighteen African-American, 18 European-American and 18 Chinese adults were audiovisually presented with three stuttering and three fluent speech samples, when an eye-tracking device simultaneously recorded their gaze behaviours. The targets of listeners' eye gaze included four regions of interest (ROIs) on the speaker's face: eyes, nose, mouth and outside (i.e., everything else). Listeners' per cent of gaze time, gaze fixation count and average duration of gaze fixation were analysed with repeated-measures ANOVAs regarding each ROI as functions of the speaker's fluency status and listeners' cultural background. OUTCOMES & RESULTS: When observing stuttering speech, listeners tended to reduce gaze fixation duration on the speaker's eyes and increase their gaze time on the mouth. However, different from the two American groups, the Chinese group reduced their gaze time on the speaker's mouth. In addition, the Chinese participants' gaze behaviours were more focused on the ROI of outside, whereas the two American groups showed a similar focus on the ROIs of eyes and mouth. CONCLUSIONS & IMPLICATIONS: All groups of listeners responded to stuttering with gaze aversions mainly contributed to by a reduction in gaze fixation duration rather than gaze fixation number. This pattern of gaze aversion suggests that stuttering oppresses listeners with an emotional and/or cognitive overload. Attention shift and compensation strategies for speech signal degradation may also account for listeners' gaze responses to stuttering. Cultural differences in eye gaze responses to stuttering were observed mainly between Chinese and American listeners.

Communication intervention in children with severe disabilities and multilingual backgrounds: perceptions of pedagogues and parents.

Increasing global population movement has resulted in a corresponding increase of children with severe and multiple disabilities and complex communication needs who at home are exposed to languages different from the language used at school. The aim of this study was to highlight facilitating as well as limiting factors for effective communication intervention for these children both in school and within the family. Based on observations, qualitative research interviews and analysis in the tradition of grounded theory the results indicate that the quality of parent-teacher-interaction is central to effective communication intervention and culturally sensitive use of communication aids. Challenges for teachers as well as parents to achieve a mutually satisfying interaction are addressed, and issues regarding the language use with children with severe disabilities and a multilingual and multicultural background and the inclusion of their parents in school based activities are discussed.

The complexity of social/cultural dimension in communication disorders.

There has been growing recognition in the field of communication disorders concerning the importance of multicultural and diversity issues. This discussion needs to move beyond the theoretical and descriptive stage to the clinical use of this knowledge to improve the communicative functioning of diverse populations. This paper argues that the tenets of evidence-based practice and the International Classification of Functioning, Disability and Health (ICF) by the World Health Organization can be used to advance the scholarship and service concerning diversity issues. Both evidence-based practice and the ICF are client-based approaches that can facilitate the achievement of culturally relevant rehabilitation outcomes. This article discusses the use of evidence-based practice and the ICF for providing assessment and intervention that address the social and cultural complexities of the persons we serve. In addition, the author states that work on diversity issues can also be used to discover crucial underlying knowledge regarding communication and communication disorders.

Considerations in working successfully with culturally/linguistically diverse families in assessment and intervention of communication disorders.

The framework of the International Classification of Functioning is used to explain the importance of understanding cultural behaviors, values, and beliefs when assessing and providing intervention for communication impairments in persons from culturally/linguistically diverse backgrounds. The use of skilled dialogue in developing anchored understanding of a family's culture is described. By using their anchored understanding, professionals can create a 3rd space as a way to integrate the differing perspectives of families and professionals to provide culturally/linguistically appropriate assessments and interventions.

Issues and principles in service delivery to communicatively impaired minority bilingual adults in neurorehabilitation.

Demographic and epidemiological trends coupled with health-care needs in minority populations highlight the imperative need to develop effective, culturally appropriate clinical approaches for minority adults with communication impairments. The steady increase in linguistic and cultural diversity in the country includes a large number of bilingual adults, which is estimated to continue. Because strokes are quite prevalent in racial/ethnic minorities, the number of bilingual adults with acquired communication disorders will similarly increase. However, members of minority groups presently confront disparities in health-care services compared with the general population that translates into reduced health outcomes. This article discusses the current clinical needs and complexities in service delivery to communicatively impaired minority adults, with a special focus on bilingual adults with aphasia.

Mental health considerations for speech-language services with bilingual Spanish-English speakers.

Understanding communicatively impaired minority individuals may involve going beyond strictly linguistic and communicative domains. In particular, considering the psychoemotional aspects impacting these clients may be extremely helpful for treating them and enhancing their response to therapy. This article provides an overview of issues on minority bilingual individuals that are relevant to professionals in mental health and speech-language pathology. We use Hispanics, the fastest growing minority in the United States, for illustration. The material discussed in this article highlights some of the benefits of collaborative communication between mental health professionals and speech-language pathologists (SLPs). Such communication would enhance SLPs' understanding of the interesting interconnections among emotions, culture, and language in immigrant and minority persons with valuable applications to therapeutic services with these individuals.

Toward model-driven interventions for African Americans with cognitive-communicative disorders.

African American adults have a disproportionately high incidence and prevalence of cognitive-communicative disorders, yet their use of speech-language pathology services does not reflect their need for clinical intervention. The purpose of this article is to issue a call to action aimed at moving toward the development of model-informed interventions for African American adults with cognitive-communicative disorders. We propose the development of model-driven interventions that are designed to reflect the values and preferences of many African American adults in terms of culturally distinctive opportunities for activities and participation within their communities. Examples of culturally distinctive activities and participatory roles are offered as a starting point for establishing social validity and empirical support for underlying assumptions. Constructs from the INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY, AND HEALTH and evidence-based practice are juxtaposed to suggest their mutual relevance to developing clinical services that resonate with the values and preferences of many African Americans.

Mexican immigrant mothers' perceptions of their children's communication disabilities, emergent literacy development, and speech-language therapy program.

PURPOSE: This qualitative study explored mothers' perceptions of their children's communication disabilities, emergent literacy development, and speech-language therapy programs. METHOD: Participants were 14 Mexican immigrant mothers and their children (age 17-47 months) who were receiving center-based services from an early childhood intervention program, located in a large urban city in the Midwestern United States. Mother interviews composed the primary source of data. A secondary source of data included children's therapy files and log notes. Following the analysis of interviews through the constant comparative method, grounded theory was generated. RESULTS: The majority of mothers perceived their children as exhibiting a communication delay. Causal attributions were diverse and generally medical in nature (i.e., ear infections, seizures) or due to familial factors (i.e., family history and heredity, lack of extended family). Overall, mothers seemed more focused on their children's speech intelligibility and/or expressive language in comparison to emergent literacy abilities. CONCLUSIONS: To promote culturally responsive intervention, mothers recommended that professionals speak Spanish, provide information about the therapy process, and use existing techniques with Mexican immigrant families.

A parent-report instrument for identifying one-year-olds at risk for an eventual diagnosis of autism: the first year inventory.

A parent-report instrument, the First Year Inventory (FYI), was developed to assess behaviors in 12-month-old infants that suggest risk for an eventual diagnosis of autism. The target behaviors were identified from retrospective and prospective studies. FYIs were mailed to 5,941 families and 25% (N = 1,496) were returned, with higher return rates for white families and for families with greater educational attainment. Ad hoc groups of questions afforded measurement of eight specific constructs, which were combined to establish a general risk index. Boys had higher risk scores than did girls. Maternal race and education influenced answers. A small percentage of infants appeared to be at notably elevated risk. Large-scale longitudinal research is warranted to determine whether the FYI can predict an eventual diagnosis of autism.

A Turkish perspective on communication disorders.

The population of Turkey is approximately 65 million people, and another 3 million people of Turkish descent live in Europe and the United States. The purpose of the present paper is to relay information that American or European clinicians who work with Turkish clients should know about their clients' country, including its language, education system, the current status of the profession and organization of professional services for communication disorders. The paper shows that the profession of speech-language pathology is young in Turkey; as a result, the roles of speech-language pathologists in this country are substantially different from those in the United States and in most European countries. It is envisioned that as the profession grows in Turkey its role will increasingly include direct provision of services, in-service training to service providers, and research on communication disorders.

Ethnicity, expressed emotion, and communication deviance in family members of patients with schizophrenia.

This study examined the relationships among expressed emotion (EE), communication deviance (CD), and ethnicity in a sample of 57 white, Latino, and black relatives of patients with schizophrenia. A new method of assessing CD from the Five Minute Speech Sample was also developed and evaluated against an existing method (the Camberwell Family Interview; CFI). As hypothesized, high expressed emotion rated (from the CFI) was associated with higher levels of CD, and the Five Minute Speech Sample and CFI methods of assessing CD were concordant. CD statements made by white family members focused most on patient behaviors/symptoms that reflected a lack of independent functioning. CD statements of Latino and black relatives, however, focused most on patient behaviors that interfered with the family's interdependent functioning. Family members may have particular difficulty communicating coherently when discussing patients' inability to uphold important values and behaviors that are sanctioned by their ethnic background.