ACQ Vol 13 no 3 2011

Cultural diversity

Clinical insights Home-based speech pathology rehabilitation for an African stroke survivor Katy Stewart

Gloria Gloria (a pseudonym) consented to participate in this case study, a larger research study, and for her photo to be published, all of which have approval from the relevant Ethics Committee. Gloria is a 56-year-old female who presented with a sudden onset of mild-moderate dysarthria and oral-pharyngeal dysphagia and was diagnosed with an acute right hemisphere ischaemic infarct. She was an inpatient in a stroke unit for six days before being referred to Rehabilitation in the Home (RITH) for an early supported discharge with hospital substitution services. Prior to her stroke, Gloria was fit and well. She was independent with self care and was an active member of her family taking part in childcare, cooking, gardening, and going to the markets for groceries. Gloria is part of the Kissi ethnic group and was born in the Republic of Liberia. Gloria lived in Liberia during the Liberian Civil Wars and recently moved to Australia through family sponsorship. Liberian refugees often have a rural background with exposure to war, flight, and refugee camp life (Schmidt, 2009). Gloria speaks Kissi with her family and it is her first language. She had been attending basic English classes but her English was limited to simple social greetings and counting. Gloria lived with her two granddaughters, and her son lived next door. When asked about her priorities for rehabilitation, Gloria reported that she wanted to be as healthy as before, for her face to be normal, and for her speech in Kissi and in English to be better. Gloria was motivated to receive therapy and wanted to return to English classes but not until her speech improved. Gloria’s speech, phonation, and swallowing were assessed by the RITH speech pathologist 15 days post stroke. Initially, Gloria presented with imprecise articulation, poor respiratory control with low volume, reduced pitch range, harsh vocal quality, and hypernasality. Prior to therapy, Gloria’s swallowing was abnormally slow and she showed inconsistent signs of aspiration. Intervention Gloria was verbally provided with information and education about stroke recovery, dysarthria, and dysphagia. Intervention followed standard procedures such as oral motor exercises, articulatory drills with resonance, respiration and phonation training, and behavioural intervention for dysphagia. Gloria completed regular home practice and accepted eight sessions of therapy over 22

This paper discusses culturally sensitive home-based management for a limited English proficient (LEP) African stroke survivor within the context of an early discharge program. Positive outcomes with speech, vocal quality and swallowing were achieved through a culturally modified program. The cultural competence of the speech pathologist and the skills of the interpreter were essential to enhance the therapy process. The challenges involved are discussed, along with suggestions for speech pathologists. P eople who do not share the language of the health care provider suffer from poorer health (Albin, 2006, as cited in Hadziabdic, Heikkilä, Albin, & Hjelm, 2009) and have decreased use of health services (Hu and Covell, 1986). With global migration on the rise, speech pathologists need to work increasingly with disordered foreign speech and languages, be culturally competent, and provide relevant, culturally sensitive services to all patients (Riquelme, 2007). Due to the limited representation of non- English-speaking participants or participants with limited English proficient (LEP) being included in research (Frayne, Burns, Hardt, Rosen, & Moskowitz, 1996), there are few published studies which report on the outcomes when using interpreters in speech pathology management. This limited availability of empirical research makes the provision of evidence based speech pathology difficult. Providing culturally appropriate therapy for patients with LEP in the home environment can pose extra challenges, such as the choice of appropriate assessments and therapy targets, the variability of different cultural environments, and the efficient and effective use of interpreters. This paper uses a case example (Gloria) to illustrate the challenges associated with home-based management of a culturally and linguistically diverse patient. The aims of this paper are to (a) discuss the provision and adaptation of management with a LEP African stroke survivor, (b) explore the challenges in the provision of culturally and linguistically appropriate speech pathology management in the home setting, and (c) outline suggestions for working with patients with LEP.

Keywords DYSARTHRIA DYSPHAGIA INTERPRETER NON-ENGLISH SPEAKING

Katy Stewart

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ACQ Volume 13, Number 3 2011

ACQ uiring Knowledge in Speech, Language and Hearing