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Thursday, November 20, 2008

ASHA Convention Chicago Nov. 20-22, 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).

Theoretical Challenges

· 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

Clinical Challenges

· 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.

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