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ACQ
uiring knowledge
in
sp eech
,
language and hearing
, Volume 11, Number 1 2009
7
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.