Tuesday, December 23, 2008
Thursday, November 20, 2008
ASHA Convention Chicago Nov. 20-22, 2008
Collaborative Communication in Multicultural Aphasia Intervention Panel
Serving Aphasia Patients in Multicultural Environments: Clinical, Research, and Social Needs
José G. Centeno, Ph.D., CCC-SLP
St. John’s University, Queens, NY
Kathryn Kohnert, Ph.D., CCC-SLP
University of Minnesota, Minneapolis, MN
Demographic and Epidemiological Scenario
- Demographic and epidemiological reports underscore the imperative need to develop sound clinical services for bilingual individuals in post-stroke rehabilitation (Centeno, 2008).
- Linguistic and cultural diversity has increased markedly in the country:
47 million (17.9%) individuals speak a language other than English at home, an increase of 15 million people since 1990 (U.S. Census Bureau, 2002; 2003).
U.S. ethnic/racial minorities, presently estimated to be 34% (102.5 million) of the total population, are expected to be the majority by 2042 and reach 54% (235.7 million) by 2050 (U.S. Census Bureau, 2008a, b).
- The number of minority adults, many of them bilingual, is expected to increase in post-stroke rehabilitation programs.
Strokes, the third leading cause of death and the leading cause of long-term disability in the U.S., are quite prevalent in racial/ethnic minorities.
Though stroke is not a disorder limited to older individuals, the incidence of stroke increases with age. Thus, the number of minority elders in post-stroke rehabilitation is estimated to increase markedly. By year 2050, the older population 65 years and over in the U.S. will consist of Whites (60%), Hispanics (17%), African-American (12%), Asian (8%), and Other racial groups (3%) (FIFA, 2008).
Challenges in Multicultural Neurorehabilitation Services: The Case of Aphasia Intervention in Bilingual Speakers
- Aphasia is the most frequent communication impairment in both monolingual and bilingual adults receiving speech services in health care settings (Centeno & Kohnert, in preparation; Rosenfeld, 2002).
- Yet, serving bilingual aphasic patients involves theoretical and clinical challenges (Centeno, 2007; 2008; Kohnert, 2008).
· Internal diversity in bilingual speakers as a group
Demographic, sociolinguistic, and sociocultural/acculturative factors
· Special expressive features used by bilingual speakers
Proficiency, code-switching, and cross-linguistic transfer
· Diversity in post-stroke language recovery patterns in bilingual speakers
Parallel vs. non-parallel language recovery patterns
· Understanding aphasic profiles in monoligual speakers of the target languages spoken by the bilingual or multilingual aphasic patient
e.g., differences in agrammatic profiles in each language
· Limited diagnostic and therapeutic resources
- Current proposals suggest that aphasia is a biopsychosocial rather than a purely linguistic phenomenon. In aphasia, a neurological lesion has emotional, cognitive, linguistic, and social consequences.
Thus, treatment requires broad theoretical foundations that, while enhancing language, thought processes, and communicative skills, ultimatetly aim to facilitate social re-adaptation (Byng et al., 2003; Centeno, 2007, in press; Centeno et al., 2007; LPAA, 2001; Threats, 2007).
- For bilingual persons, accuracy and effectiveness in aphasia rehabilitation would benefit from multidisciplinary conceptual grounds that acknowledge the complex interactions among culture, cognition, language, and communication in bilingualism (Centeno, 2007, in preparation; Kohnert, 2008; see also Paradis, 2004; Walters, 2005).
A multidisciplinary conceptual base would facilitate two main goals in services for bilingual aphasic persons:
· The differential diagnosis between genuine disorders (resulting from the neurological damage) from experiential behaviors (resulting from life experiences, including bilingual/multilingual histories)
· The design of plausible intervention contexts, based on linguistic, cultural, cognitive, and social variables, that would enhance linguistic recovery, minimize the extent of the disability, and promote social functioning (Centeno, 2007; 2008; LPAA, 2001; WHO, 2001).
Current Scenario in Aphasia Services with Bilingual Persons
- Compared to bilingual children and their monolingual aphasic counterparts, there has been very limited clinical discussions and research that would enhance the understanding of the various factors that impact service delivery with bilingual persons with aphasia.
- Limitations in the knowledge bases and available clinical tools may impact on the quality of care rendered and result in service disparities.
- Very few studies have assessed the quality of aphasia services in bilinguals
Socioeconomic circumstances, limited proficiency in English, and the lack of SLPs fluent in the client’s non-English language seem to interact to result in limited recovery, based on a select group of bilingual aphasic patients receiving speech services at a private clinical setting (Wiener et al., 1995).
SLPs working with bilingual adults report being minimally trained to work with this population. Theoretical knowledge and training to work with bilingual clients focuses on children (ASHA, 2003; Centeno & Kohnert, in preparation; Rosenfeld, 2002).
SLPs serving bilingual aphasic persons report lacking testing and therapy materials but using compensatory strategies (i.e., interpreters, informal assessment procedures, independently created materials, and consulting with bilingual colleagues) to overcome conceptual and clinical limitations (Centeno & Kohnert, in preparation)
For those clinicians working with both bilingual children and adults, there is great interest in increasing knowledge on neurogenic communication impairments in bilinguals (Centeno & Kohnert, in preparation; Kohnert et al., 2003).
Conclusion: The Imperative Need for Collaborative Communication in Multicultural Aphasia Services
- Current demographic reports and health care demands combine with theoretical and clinical challenges to underscore the imperative need for valid clinical procedures that would enhance communicative recovery and social re-adaptation in aphasic bilinguals, especially from minority groups.
- The crucial link among research, quality of service, and communicative and social outcomes must be exploited. Clinically useful research evidence on minority adults, especially bilingual speakers, is critically needed.
- Collaborative communication among researchers, practitioners, people with aphasia and their families, health care administrators, and administrators of consumer-focused aphasia organizations provides a plausible approach that would facilitate the translation of research evidence into effective clinical practices in order to strengthen recovery and social functioning and, in turn, minimize service disparities in minorities.
American Speech-Language-Hearing Association. (2003). 2003 Omnibus survey caseload report: SLP. Rockville, MD: Author.
Byng, S., Parr, S., & Cairns, D. (2003). The science or sciences of aphasia? In I. Papathanasiou & R. De Bleser (Eds.), The sciences of aphasia: From therapy to theory (pp. 201-224). Oxford: Pergamon.
Centeno, J. G. (2007). Considerations for an ethnopsycholinguistic framework for aphasia intervention. In A. Ardila & E. Ramos (Eds.), Speech and language disorders in bilinguals pp. 195-212). New York: Nova Science.
Centeno, J. G. (2008, October). Multidiscipinary evidence to treat bilingual individuals with aphasia. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 15, 66-72.
Centeno, J. G. (In press). Serving bilingual persons with aphasia: Challenges, foundations, and procedures. Revista de Logopedia, Foniatría, y Audiología (Spain).
Centeno, J.G. (In preparation). Neurolinguistic and neurocognitive considerations of language processing in bilingual adults. In J. Guendozi, F. Loncke, & M. J. Williams (Eds.), The handbook of psycholinguistic and cognitive processes: Perspectives in communication disorders. Taylor and Francis.
Centeno, J.G., & Kohnert, K. (In preparation). Serving comunicatively-impaired linguistically and culturally diverse adults: Theoretical foundations and clinical needs.
Centeno, J. G., Obler, L. K., & Anderson, R. T. (2007). Introduction. In J. G. Centeno, R. T. Anderson, & L. K. Obler (Eds.), Communication disorders in Spanish speakers: Theoretical, research, and clinical aspects (pp. 1-10). Clevedon, UK: Multilingual Matters.
Federal Inter-agency Forum on Aging. (2008). Older Americans 2008. Retrieved on May 14, 2008 from http://www.agingstats.gov.
Kohnert, K. (2008). Language disorders in bilingual children and adults. San Diego, CA: Plural.
Kohnert, K., Kennedy, M. R. T., Glaze, L., Kan, P. F., & Carney, E. (2003). Breadth and depth of diversity in Minnesota: Challenges to clinical service competency. American Journal of Speech-Language Pathology, 12, 259-272.
Life Participation Approach to Aphasia Project Group. (2001). Life participation approach to aphasia: A statement of values for the future. In R. Chapey (Ed.), Language intervention strategies in adult aphasia (4th ed., pp. 235-245). Baltimore, MD: Lippincott, Williams and Wilkins.
National Institute of Neurological Disorders and Stroke. (2008). NINDS stroke disparities. Retrieved Jan. 31, 2008 from http://www.ninds.nih.gov.
Paradis, M. (2004). A neurolinguistic theory of bilingualism. Amsterdam: John Benjamins.
Rosenfeld, M. (2002). Report on the ASHA speech-language pathology health care survey. Rockville, MD: American Speech-Language-Hearing Association.
Threats, T. (2007). Access for persons with neurogenic communication disorders: Influences of personal and environmental factors of the ICF. Aphasiology, 21, 67-80.
U.S. Census Bureau. (2002). Annual demographic supplement to the March 2002 current population survey. Washington, DC: Author.
U.S. Census Bureau. (2003). Nearly 1-in-5 speak a foreign language at home. U.S. Census Bureau News, Report CB03-157. Washington, DC: Author.
U.S. Census Bureau. (2008a). An older and more diverse nation by midcentury. U.S. Census Bureau News, Press Release CB08-123. Washington, DC: Author.
U.S. Census Bureau. (2008b). U.S. Hispanic population surpasses 45 million, now 15 percent of total. U.S. Census Bureau News, Press Release CB08-67. Washington, DC: Author.
Walters, J. (2005). Bilingualism: The sociopragmatic-psycholinguistic interface. Mahwah, NJ: Lawrence Erlbaum.
Wiener, D., Obler, L. K., & Taylor-Sarno, M. (1995). Speech/language management of the bilingual aphasic in a U.S. urban rehabilitation hospital. In M. Paradis (Ed.), Aspects of bilingual aphasia (pp. 37-56). Tarrytown, NY: Elsevier.
World Health Organization. (2001). International classification of functioning, disability, and health, ICF. Geneva, Switzerland: Author.
Thursday, October 9, 2008
Aphasia is a possible result of a stroke. Here, we discuss the three forms this condition can take. Strokes from illumistream Effects Of Stroke (StrAphasia is a possible result of a stroke. Here, we discuss the three forms this condition can take. Strokes from illumistream Effects Of Stroke (Str
Tuesday, April 22, 2008
Few people over the age of 10 would list “Happy Birthday” among their favorite songs. But Harvey Alter, now 62, has a special fondness for it. It helped teach him how to talk.
One morning in June 2003, Mr. Alter, then a self-employed criminologist, was putting a leash on his dog, Sam, in preparation for a walk around Greenwich Village, where he has lived for 30 years. Suddenly he felt dizzy and disoriented.
“My thoughts were intertwined, not making sense,” he said in a recent interview. “I knew I was having a stroke.”
At St. Vincent’s Hospital, doctors diagnosed an ischemic stroke, caused by a blockage in blood flow to part of the left half of his brain. As a result, the right side of his body was temporarily paralyzed, the right side of his face drooped, and he had trouble coming up with the right words and stringing them into sentences — a condition called aphasia.
Within hours of his stroke, Mr. Alter met with Loni Burke, a speech therapist who now works at Lenox Hill Hospital. At first he was completely nonverbal; within a few days he could say small words.
“Mostly, he said, ‘No,’ ” Ms. Burke recalled, “because he was frustrated that he couldn’t speak.”
After three weeks in the hospital and two years of painstaking therapy, Mr. Alter’s paralysis had mostly disappeared and his smile was back to normal. But while he could communicate through small words and the help of a chalkboard, complex verbal communication remained elusive.
Using standard speech therapy techniques like reviewing lists of numbers and the days of the week, Ms. Burke helped her patient piece together short phrases. But they came slowly and sounded robotic.
Then one day, she asked him to sing.
“How can I ever sing? I can’t talk,” Mr. Alter recalled thinking. But as soon as Ms. Burke began to sing “Happy Birthday,” he chimed in.
“It sounded good,” he said. “Almost like I didn’t have anything wrong.”
The technique, called melodic intonation therapy, was developed in 1973 by Dr. Martin Albert and colleagues at the Boston Veterans Affairs Hospital. The aim was to help patients with damage to Broca’s area — the speaking center of the brain, located in its left hemisphere.
These patients still had relatively healthy right hemispheres. And while the left hemisphere is largely responsible for speaking, the right hemisphere is used in understanding language, as well as processing melodies and rhythms.
“You ask yourself, ‘What specifically engages the right hemisphere?’ ” said Dr. Gottfried Schlaug, a neurologist at Beth Israel Deaconess Medical Center in Boston, who studies music’s effect on the brain.
Melodic intonation therapy seems to engage the right hemisphere by asking patients to tap out rhythms and repeat simple melodies. Therapists first work with patients to create sing-song sentences that can be set to familiar tunes, then work on removing the melody to leave behind a more normal speaking pattern.
But relatively little research has been done to understand how this type of therapy affects the brain of a stroke patient.
In a study completed in 2006, Dr. Schlaug and colleagues at Harvard tracked the progress of eight patients with Broca’s aphasia as they underwent 75 sessions of melodic intonation therapy. M.R.I. scans taken when the patients were speaking simple words and phrases showed that activity in the right hemisphere had changed significantly over the course of treatment.
“The combination of melodic intonation and hand-tapping activates a system of the right side of the brain that is always there, but is not typically used for speech,” Dr. Schlaug said.
He recommends melodic intonation therapy for patients who have no meaningful form of speech, but can understand language and have the patience for therapy sessions.
Before music came back into his life, Mr. Alter had difficulty thinking of the words he wanted to use and forming them. For him, it seems, melodic intonation therapy was the key to retraining his brain to speak with tone and rhythm.
“After a stroke, the brain is learning to adapt,” said Dr. Albert Favate, stroke director at St. Vincent’s Hospital in New York. “For someone with Broca’s aphasia, melodic intonation therapy can allow them to get back their speaking patterns, which may improve speech spontaneity.”
Mr. Alter still speaks somewhat haltingly, with a noticeable lilt, but he no longer struggles so mightily to find the right word, and he will happily serenade anyone with conversation about his condition. While he attributes most of his success to melodic intonation therapy, Ms. Burke says it was only one tool she used among a host of others.
Still, she agrees that the therapy was crucial. “It may have caused an initial reaction of, ‘Wow, maybe I can speak,’ ” she said.
As he has recovered, Mr. Alter has devoted his life to increasing awareness about aphasia. He created the International Aphasia Movement two years ago and spends much of his time leading support groups for stroke survivors and their families and touring the world to speak for those who can’t speak for themselves.
And he is always happy to sing “Happy Birthday” with anyone who cares to join in. “But I don’t mind Christmastime either,” he said. “Because I know all of the carols.”
Thursday, March 6, 2008
the International Aphasia Movement
Free Group Therapy
and Harvey Alter, Aphasia Survivor