ACQ Vol 13 no 3 2011

were present. Liberian culture typically follows a multi- generational, extended family structure which was evident in this case (Schmidt, 2009), with Gloria’s extended family and friends present at some sessions. The visits were often unplanned and the visitors often let themselves into Gloria’s home and waited for the session to finish. This made therapy difficult as Gloria appeared uncomfortable and the session was often cut short. During the final assessment, Gloria was babysitting her great-grandson who was a toddler. This may have indicated that Gloria was recovering well and returning to her role of a carer but the speech pathologist often needed to redirect focus back to therapy and multiple attempts at audio recordings were required due to background noise. At the end of therapy, Gloria reported that she preferred to have her therapy at home rather than to prolong her stay in hospital. Despite being referred on to an outpatient

days. As regular home practice is known to enhance treatment effectiveness for dysarthria (Robertson, 2001), Gloria was encouraged to complete a daily home program. Culturally appropriate therapy Appropriate linguistic targets were chosen and adapted based on Gloria’s goals and her daily activities. Functional practice targets were chosen in English and Kissi and included: serial and automatic speech, articulation drills and tongue twisters, and verbal generation of a shopping list. As Gloria wanted to return to her English lessons, some articulation drills were adapted to practise the social greetings that Gloria had been learning in class. The speech pathologist also used role-play to stimulate English and Kissi conversations. In an attempt to be culturally relevant, therapy exercises considered Gloria’s ethnic background. Kissi women often tend small vegetable gardens, trade in the market, and enjoy using music, whistling, drumming, and singing to communicate and when working in the fields (Sherman, 2011). Therefore, RITH treatment included: (a) incorporating African farming songs into phonation therapy, (b) singing while working in her vegetable patch, (c) whistling for facial symmetry and lip strength, (d) repeating and reading aloud a list of culturally appropriate foods (e.g., the root vegetable cassava), and (e) requesting foods in the market. Challenges Lack of culturally appropriate resources The lack of assessments and treatment resources for speech pathology in languages other than English makes working with LEP patients difficult (Clark, 1998). Due to Gloria’s LEP, the speech pathologist was unable to assess speech intelligibility, complete written quality of life questionnaires, or read aloud words and paragraphs. There is little available information about the Liberian and Kissi cultures and language which made cultural preparation for assessment and treatment difficult. The speech pathologist was required to learn as she went along, guided by Gloria, her family, and the interpreter. Family support and training Gloria’s son was concerned about her progress but did not take an active role in therapy. Politeness and respect for elders are highly valued in Liberian society (Dunn-Marcos, Kollehlon, Ngovo, & Russ, 2005) and as Gloria is the matriarch of her family it is possible that Gloria’s son wanted to respect the family boundaries. Gloria’s teenage granddaughter, “Jane”, was actively involved in therapy. The speech pathologist provided informal education and training to Jane and asked her to encourage and demonstrate the home practice. Jane attended high school and had exposure to formal education and was able to assist Gloria with her home practice and provide feedback to the speech pathologist. Gloria seemed to easily accept assistance from Jane, possibly because she was of the same gender and lived with Gloria. As soon as Jane was engaged as an informal assistant, immediate positive improvements in the

accuracy of home practice were noted. Home-based management

The experience in witnessing Gloria in her own setting was invaluable in increasing the speech pathologist’s cultural sensitivity and in establishing rapport but some obstacles

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ACQ Volume 13, Number 3 2011

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