ACQ Vol 11 No 1 2009

MULTICULTURALISM AND DYSPHAGIA

Based on Isaac’s (2002) discussion regarding the interpreter– speech pathologist interaction when dealing with the bilingual patient, and from the first author’s experience working with Arabic patients, the following points are suggested to be considered: n The speech pathologist needs to discuss with the interpreter any issues in relation to the Arabic culture that may arise when using the tools and procedure of the session, to know if any of it may be inconvenient or inappropriate to be used with the Arabic patient. n As there are many dialects across the Arabic-speaking world, it is crucial to make sure that the interpreter and the patient are able to understand each other’s Arabic dialect. n Some Arabic families may feel uncomfortable dealing with an interpreter who knows them or has a close friendship with the family. It is useful for the speech pathologist to know about Arabic cultural nutritional behaviours, the main celebration events during the year, and some information about the patient’s country of origin. That information may help the clinician to initiate and maintain a conversation with the patient. Also, the relative ages of the patient, interpreter and speech pathologist may need consideration. Some older Arabic individuals may refuse to deal with a young speech pathologist or interpreter. Treatment issues One of the most important points that speech pathologists need to consider when working with bilingual patients is which language is to be chosen for treatment. It has been suggested that the speech pathologist should aim to arrange intervention in the language used by the client in his/her daily repertoire, particularly the client’s home language (Battle, 2000; Isaac, 2002; Paradis & Libben, 1987; Roger, 1998). Duncan (1989) suggested that intervention for children in their home language has positive effects on the development of the second language. This belief has been supported by another study by Rousseau, Packman & Onslow (2004), who used her bilingualism in English and French to study and treat a 7-year-old bilingual boy with severe stuttering. From her research, Rousseau concluded that speech in both languages improved, although no treatment was conducted in English. Paradis (1993) considered that many basic questions remain unanswered in relation to therapy with bilingual or multilingual patients with aphasia. These included: n whether or not therapy should be conducted in two or more languages simultaneously; n whether there is a transfer of benefit from a treated to a non-treated language, and what determines the degree to which this might occur; n whether translation should be used or specifically avoided; n whether various therapy techniques are equally helpful in different languages. For an Arabic aphasic patient, the following treatment strategies may assist in treatment process: n language training provided at home by one of his/her family members; n tasks that seem overly simple may anger or upset an older Arabic patient, especially one who is highly educated; the use of multiple repetition tasks may also be rejected; n it may be a high priority for the Arabic person to re-learn how to do his/her daily prayer and how to pronounce his/her prayer texts; thus, using texts from the Holy

more about the Arabic language and cultural background particularly in relation to the provision of health care, for example, the Health Care Providers’ Handbook on Muslim Patients (Islamic Council of Queensland, 1996). Assessment issues Typically, speech pathologists attempt to assess a speaker’s communication difficulties by examining their first or most often used language. While there is a general acceptance in the current literature that caution is required when using tests that have been standardised against other populations (Baker, 1995, Roberts,1998), informal testing procedures designed ‘“on the run’” by speech pathologists working with inter­ preters may be inadequate. As with other language groups, Arabic speakers may differ greatly in their proficiency as ‘“bilingual’” or ‘“multilingual’” speakers. The speech pathologist needs to take the same care to seek valid assessment procedures across the languages being assessed. Roberts (1998) suggests that more research is needed to investigate topics that have been neglected in the bilingualism research such as the clinical assessment and treatment of bilingual aphasic adults. There are limited options for speech pathologists seeking to conduct aphasia assessments in Arabic. Some available tests include: The Bilingual Aphasia Test (Jordanian Arabic version) (Paradis & El-Halees, 1989) and the CAT ( Comprehensive Aphasia Test ) translated by El-Rouby (2007). When assessing a person with aphasia in English, it is important to ascertain the individual’s premorbid com­ municative style and ability (Davis, 1983). Equally, as Dronkers, Yamasaki, Webster Ross, and White (1995) have highlighted, it is just as important when assessing the Arabic speaker to carefully document their premorbid competence in each of their languages and to be sensitive to particular dialects or varieties of language. However, there is widespread acceptance in the field of aphasia assessment generally that assessments need to cover more than linguistic features, and to include the assessment of communication needs. We suggest that aphasia assessments based on functionally focused interviews could more validly be administered via an interpreter than more traditional linguistic-based assessments (Al-amawi, Ferguson & Hewat, 2008). For example, functional assessments such as the Inpatient Functional Communication Interview (O’Halloran, Worrall, Toffolo, Code & Hickson, 2004) and the Functional Communication Therapy Planner (Worrall, 1999) use an interview format that is highly compatible with interpreter-mediated assessment. However, the use of an interpretor brings its own challenges (as discussed in the next section). Use of interpreters There are many potential traps which cause difficulties for those undertaking speech pathology sessions with interpreters (Isaac, 2002). These can include inaccurate interpretation due to inappropriate paraphrasing, use of professional jargon, lack of linguistic equivalents between the original and target languages, dialect mismatch, register mismatch, ignoring non-verbal signals, independent intervention by the inter­ preter, cultural mismatch between patient and interpreter, and assumptions of cultural similarity between interpreter and patient or between professional and patient (Isaac, 2002). Isaac (2002) emphasised that the interpreter has to know exactly what the speech pathologist needs from the session, the goals and intended outcomes and suggests that this will only be possible if both the speech pathologist and interpreter set aside time to discuss these matters before the session.

ACQ uiring knowledge in sp eech , language and hearing , Volume 11, Number 1 2009

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