Issues and Principles in Service Delivery to Communicatively Impaired Minority Bilingual Adults in Neurorehabilitation

ABSTRACT

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.

Minority adults - aphasia - bilingualism - service disparities

REFERENCES

• 1 U.S. Census Bureau .Annual Demographic Supplement to the March 2002 Current Population Survey. Washington, DC; U.S. Census Bureau 2002
• 2 U.S. Census Bureau .Nearly 1-in-5 speak a foreign language at home. U.S. Census Bureau News, Report CB03–157. Washington, DC; U.S. Census Bureau 2003
• 3 U.S. Census Bureau .An older and more diverse nation by midcentury. U.S. Census Bureau News, Press Release CB08–123. Washington, DC; U.S. Census Bureau 2008
• 4 U.S. Census Bureau .U.S. Hispanic population surpasses 45 million, now 15 percent of total. U.S. Census Bureau News, Press Release CB08–67. Washington, DC; U.S. Census Bureau 2008
• 5 Centeno J G. Multidisciplinary evidence to treat bilingual individuals with aphasia.  Perspect Commun Disord Sci Cult Ling Diverse Popul. 2008;  15 66-71
• 6 National Institute of Neurological Disorders and Stroke .NINDS stroke disparities. Available at: http://www.ninds.nih.gov Accessed January 31, 2008
• 7 Centers for Disease Control and Prevention .Racial/ethnic and Socioeconomic Disparities in Multiple Risk Factors in Heart Disease and Stroke—United States 2003. Available at: http://www.cdc.gov/mmwr Accessed January 31, 2008
• 8 Federal Inter-agency Forum on Aging .Older Americans 2008. Available http: at://www.agingstats.gov Accessed May 14, 2008
• 9 Rosenfeld M. Report on the ASHA Speech-Language Pathology Health Care Survey. Rockville, MD; American Speech-Language-Hearing Association 2002
• 10 Wallace G L. An introduction to multicultural neurogenics. In: Wallace GJ Multicultural Neurogenics. San Antonio, TX; Communication Skill Builders 1997: 3-20
• 11 Fiscella K. Assessing Health Care Quality for Minority and Other Disparity Populations (AHRQ Pub. No. 03–0047-EF). Washington, DC; U.S. Department of Health and Human Services 2003
• 12 Brozgold A, Centeno J G. Sociocultural, societal, and psychological aspects of bilingualism: variables, interactions, and therapeutic implications in speech-language pathology. In: Centeno JG, Anderson RT, Obler LK Communication Disorders in Spanish Speakers: Theoretical, Research, and Clinical Aspects. Clevedon, United Kingdom; Multilingual Matters 2007: 67-81
• 13 National Alliance for Hispanic Health .Delivering Health Care to Hispanics. Washington, DC; Estrella Press 2007
• 14 Kohnert K, Kennedy M RT, Glaze L, Kan P F, Carney E. Breadth and depth of diversity in Minnesota: challenges to clinical competency.  Am J Speech Lang Pathol. 2003;  12(3) 259-272
• 15 Roseberry-McKibbin C, Brice A, O'Hanlon L. Serving English language learners in public school settings: a national survey.  Lang Speech Hear Serv Sch. 2005;  36(1) 48-61
• 16 American Speech-Language-Hearing Association .2003 Omnibus Survey Caseload Report: SLP. Rockville, MD; American Speech-Language-Hearing Association 2003
• 17 Wiener D, Obler L K, Taylor-Sarno M. Speech/language management of the bilingual aphasic in a U.S. urban rehabilitation hospital. In: Paradis M Aspects of Bilingual Aphasia. Tarrytown, NY; Elsevier 1995: 37-56
• 18 Jackson C J, Furnham A. Designing and Analyzing Questionnaires and Surveys: A Manual for Health Professionals and Administrators. London, United Kingdom; Whurr 2000
• 19 Centeno J G. Serving bilingual patients with aphasia: challenges, foundations, and procedures.  Rev Logop Fon Audiol. 2009;  29 30-36
• 20 Life Participation Approach to Aphasia Project Group . Life participation approach to aphasia: a statement of values for the future. In: Chapey R Language Intervention Strategies in Adult Aphasia. 4th ed. Baltimore, MD; Lippincott Williams & Wilkins 2001: 235-245
• 21 World Health Organization .International Classification of Functioning, Disability, and Health (ICF). Geneva, Switzerland; World Health Organization 2001
• 22 Centeno J G. Bilingual development and communication: dynamics and implications in clinical language studies. In: Centeno JG, Anderson RT, Obler LK Communication Disorders in Spanish Speakers: Theoretical, Research, and Clinical Aspects. Clevedon, United Kingdom; Multilingual Matters 2007: 46-56
• 23 Zentella A C. Growing up Bilingual. Malden, MA; Blackwell 1997
• 24 Centeno J G. Considerations for an ethnopsycholinguistic framework for aphasia intervention. In: Ardila A, Ramos E Speech and Language Disorders in Bilinguals. New York, NY; Nova Science 2007: 213-234
• 25 Institute of Medicine .Addressing racial and ethnic health care disparities: where do we go from here?. http://Available at: www.iom.edu Accessed June 26, 2006
• 26 Salas-Provance M B, Erickson J G, Reed J. Disabilities as viewed by four generations of one Hispanic family.  Am J Speech Lang Pathol. 2002;  11 151-162
• 27 Myers H F, Lewis T T, Parker-Dominguez T. Stress, coping, and minority health. In: Bernal G, Trimble JE, Burlew AK, Leong FTL Handbook of Racial and Ethnic Minority Psychology. Thousand Oaks, CA; Sage 2003: 377-400
• 28 Zunker C L, Cummins J J. Elderly health disparities on the U.S.-México border.  J Cross Cult Gerontol. 2004;  19(1) 13-25
• 29 Pontón M. Hispanic culture in the United States. In: Pontón M, León-Carrión J Neuropsychology and the Hispanic Patient: A Clinical Handbook. Mahwah, NJ; Erlbaum 2001: 15-38
• 30 U.S. Department of Health and Human Services .Access to Quality Health Services (Progress Review, June 4). Rockville, MD; U.S. Department of Health and Human Services 2002
• 31 Centeno J G. From theory to realistic praxis: service-learning as a teaching method to enhance speech-language pathology services with minority populations. In: Wurr AJ, Hellebrandt J Learning the Language of Global Citizenship: Service-Learning in Applied Linguistics. Bolton, MA; Anker 2007: 190-217
• 32 Paradis M A. Neurolinguistic Theory of Bilingualism. Amsterdam, The Netherlands; John Benjamins 2004
• 33 Centeno J G. Neurolinguistic and neurocognitive considerations of language processing in adult bilinguals. In: Guendozi J, Loncke F, Williams MJ The Handbook of Psycholinguistic and Cognitive Processes: Perspectives in Communication Disorders. Oxford, United Kingdom; Taylor and Francis In press
• 34 Fabbro F. The Neurolinguistics of Bilingualism: An Introduction. East Sussex, United Kingdom; Psychology Press 1999
• 35 Obler L K, Centeno J, Eng N. Bilingual and polyglot aphasia. In: Menn L, O' Connor M, Obler LK, Holland A Non-Fluent Aphasia in a Multilingual World. Amsterdam, The Netherlands; John Benjamins 1995: 132-143
• 36 Roberts P M. Issues in assessment and treatment for bilingual and culturally diverse patients. In: Chapey R Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders. 5th ed. Philadelphia, PA; Lippincott Williams & Wilkins 2008: 245-275
• 37 Holland A L, Penn C. Inventing therapy for aphasia. In: Menn L, O' Connor M, Obler LK, Holland A Non-Fluent Aphasia in a Multilingual World. Amsterdam, The Netherlands; John Benjamins 1995: 146-155
• 38 Kohnert K. Language Disorders in Bilingual Children and Adults. San Diego, CA; Plural 2008
• 39 Gil M, Goral M. Nonparallel recovery in bilingual aphasia: effects of language choice, language proficiency, and treatment.  Int J Bilingual. 2004;  8 191-219
• 40 Juncos-Rabadán O, Pereiro A X, Rodríguez M J. Treatment of aphasia in bilingual subjects. In: Fabbro F Advances in the Neurolinguistics of Bilingualism: Essays in Honor of Michel Paradis. Udine, Italy; Forum 2002: 275-298
• 41 Edmonds L A, Kiran S. Effect of semantic naming treatment on crosslinguistic generalization in bilingual aphasia.  J Speech Lang Hear Res. 2006;  49(4) 729-748
• 42 Ansaldo A I, Marcotte K. Language switching in the context of Spanish-English bilingual aphasia. In: Centeno JG, Anderson RT, Obler LK Communication Disorders in Spanish Speakers: Theoretical, Research, and Clinical Aspects. Clevedon, United Kingdom; Multilingual Matters 2007: 214-230
• 43 Harris J L. Reminiscence: A culturally and developmentally appropriate language intervention for older adults.  Am J Speech Lang Pathol. 1997;  6 19-25

APPENDIX A: EXAMPLES OF QUESTIONS USING LIKERT SCALES IN THE SURVEY STUDY

Frequency

17. Use the scale below to indicate the frequency with which you have worked with bilingual adult clients from the following ethnic/racial groups in the last 5 years.

Never	Infrequently	Sometimes	Frequently	Very Frequently
1	2	3	4	5

1. White   1   2   3   4   5

2. Hispanic/Latino(a)   1   2   3   4   5

3. Black (African American, Caribbean black, African)   1   2   3   4   5

4. Asian/Pacific Islander (Filipino, Chinese, Asian Indian, Hawaiian, Samoan, etc.)   1   2   3   4   5

5. Native American or Alaskan Native   1   2   3   4   5

6. Other (please specify): ____________________________   1   2   3   4   5

Extent of Preparation

19. On the scale below, circle the number that indicates the extent of preparation you received to work with bilingual clients during your professional training.

None or No Extent	Small Extent	Moderate Extent	Great Extent	Very Great Extent
1	2	3	4	5

Degree of Satisfaction

34. On the scale below, circle the number that indicates how satisfied you feel with the amount of information and resources available to enhance speech-language services with bilingual adults.

Very Dissatisfied	Dissatisfied	I Don't Know	Satisfied	Very Satisfied
1	2	3	4	5

Importance

38. Use the scale below to indicate the importance of the following items as possible areas that college training programs should emphasize to improve professional preparation to work with bilingual clients.

Very Unimportant	Somewhat Unimportant	Somewhat Important	Important	Very Important
1	2	3	4	5

• a. Language acquisition in bilingual children   1   2   3   4   5

• b. Language acquisition in bilingual adults/second language acquisition   1   2   3   4   5

• c. Understanding what language proficiency in bilingual speakers means   1   2   3   4   5

• d. Testing procedures with bilingual speakers   1   2   3   4   5

• e. Working with interpreters/translators   1   2   3   4   5

• f. Treating language disorders in bilingual speakers   1   2   3   4   5

• g. Understanding when there is a language difference, resulting from bilingualism, or a real language disorder, resulting from a genuine problem   1   2   3   4   5

• h. Understanding aphasia and other neurogenic communication problems in bilingual speakers   1   2   3   4   5

• i. Discussions on research on bilingual speakers that has clinical use in speech-language pathology services   1   2   3   4   5

• j. Course content on minority populations   1   2   3   4   5

• k. Other (please specify): _______________________________________________________________________________________   1   2   3   4   5

Extent of Interest

39. On the scale below, circle the number that corresponds to your extent of interest in participating in continuing education opportunities related to bilingual adults.

Not at All Interested	Mildly Interested	Moderately Interested	Quite Interested	Extremely Interested
1	2	3	4	5