JCPSLP Vol 19 No 1 March 2017

Communication and connection: Valuing Aboriginal and Torres Strait Islander perspectives

Assessment and treatment of aphasia in Aboriginal Australians Linguistic considerations and broader implications for cross-cultural practice. Elizabeth Armstrong, Graham McKay, and Deborah Hersh

This paper discusses the notion of language difference related to aphasia assessment and treatment in the context of differences between Standard Australian English and Aboriginal English. While cross-cultural and cross-linguistic differences and their effects on clinical approaches have been an important focus of discussion in the field of aphasiology due to the increasing diversity of clinical populations, literature related to language variation within the one language is sparse. This paper discusses Aboriginal English, a dialect of English that differs from Standard Australian English, in relation to conceptual-cultural frameworks, and social- pragmatic patterns of language use in Aboriginal Australians, along with their potential impact on clinical practice. Aspects such as grammatical and lexical features of Aboriginal English, event and story schemas, and pragmatic features serve to highlight differences between Aboriginal English and Standard Australian English. Reference to the variety of Aboriginal languages will also be made, along with discussion of interpreting issues. Variations described in the paper are highlighted in terms of their significance for potential misdiagnosis of pathological patterns of language use and the careful consideration required to accurately assess communicative competence in non-dominant languages and dialects. I nter-cultural assessment and treatment presents numerous challenges to speech-language pathologists around the world. Clinicians must face issues such as dealing with languages other than their own, assessing what is “normal” and “pathological” against a background of cross-cultural pragmatic differences, and attempts to assess and treat with (and sometimes without) the assistance of interpreters or culturally/linguistically appropriate tools. Though discussion of explicit cross- cultural and cross-linguistic issues can be found in the

literature, little has been written about the challenges faced when the aphasia clinician encounters different varieties of their own language – for the purposes of this paper - English. For many years now, different varieties of English have been acknowledged as valid variants of English rather than sub-standard versions of English. It is becoming increasingly common to hear reference to British English, American English, Australian English, Singaporean English, with systematic phonological, grammatical and semantic variations acknowledged as characterising particular types. However, while the dominant form of English is often discussed, for example, in the media of a country, relatively little is heard of the non-dominant (non-standard) varieties. This paper explores this issue in the Australian context, contrasting Standard Australian English (SAE) with another variety within Australia, Aboriginal English (AE), and examines implications for the assessment and treatment of Aboriginal Australians with aphasia. Eades (2004) defines Aboriginal English as “the name given to dialects of English spoken by Aboriginal people throughout Australia, which differ from Standard Australian English (SAE) in grammar, phonology, lexicon, semantics and pragmatics” (p.491). Variation ranges from the “heaviest” (i.e., most different from SAE) in remote areas to relatively “light” in urban/metropolitan areas. While according to the 2011 Australian census, “English” is the only language used by 83% of Indigenous people across Australia (ABS, 2011), this finding could be misinterpreted because of the failure to distinguish between Aboriginal English and Standard Australian English. Issues related to language difference are significant for clinical aphasiology practice in Australia, given the high incidence of stroke and other forms of brain damage in Aboriginal Australians (and hence the potential for aphasia) (Katzenellenbogen et al., 2010; Jamieson, Harrison, & Berry, 2008). The age at onset of stroke for Aboriginal Australians is significantly younger than their non-Aboriginal counterparts (Katzenellenbogen et al., 2010; Katzenellenbogen et al., 2016), and Aboriginal stroke patients are also more likely to be dependent at discharge compared to non-Aboriginal patients (Kilkenny, Harris, Ritchie, Price, & Cadhilac, 2012). Higher incidence of stroke exists in the context of higher risk factors and co-morbidities in Aboriginal Australians, i.e., hypertension, diabetes, cardiovascular disease (Australian Institute of Health and Welfare, 2016). This situation exists in the context of a relative lack of knowledge about this group, with only a few published studies to date exploring

KEYWORDS ABORIGINAL ABORIGINAL ENGLISH CROSS- CULTURAL PRACTICE DIALECT INDIGENOUS

THIS ARTICLE HAS BEEN PEER- REVIEWED

Elizabeth Armstrong, Graham McKay, and Deborah Hersh

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JCPSLP Volume 19, Number 1 2017

www.speechpathologyaustralia.org.au