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JCPSLP Volume 17, Number 1 2015 17
bicultural clients (Cheng, Battle, Murdoch, & Martin,
2001) and professional development for practising SLPs
in relation to assessment and management of bilingual
and CALD individuals (e.g., Kritikos, 2003).
• Advocate for the resources needed to provide appropriate
and equitable services to this population, for example,
additional time; more interpreters and adequate access
to their services; bilingual SLPs from various cultural
backgrounds who could act as consultants to the SLP
clinical community (e.g., see Hersh, Armstrong, Panak,
et al., 2014; Jodache et al., 2014a).
• Finally, it is evident that there is a pressing need for more
research relating to speech pathology management of
clients with aphasia who are bilingual or from a CALD
background. As Rose and colleagues (2014, p. 10)
noted in relation to CALD clients with aphasia, “such a
large discrepancy between case-load imperatives and
clinician preparedness/capacity needs urgent attention”.
Conclusion
This article outlined some of the key contextual issues and
challenges for SLPs working in an Australian context with
individuals who are bilingual or from a CALD background.
The unique linguistic environment in Australia and lack of
research in relation to management of aphasia in bilingual/
CALD individuals was discussed, along with some key
areas for consideration in delivering a speech pathology
service to this population. Areas for further research have
also been highlighted. Finally, recommendations for clinical
practice with individuals with aphasia who are bilingual or
from a CALD background have been provided to assist
SLPs currently working with this population.
References
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(2008). Language therapy and bilingual aphasia: Clinical
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Ansaldo, A. I., & Saidi, L. G. (2010). Model-driven
intervention in bilingual aphasia: Evidence from a case of
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Armstrong, E., Hersh, D., Hayward, C., Fraser, J., &
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Clinical recommendations
As the preceding review indicates, delivering speech
pathology services to individuals with aphasia who are
bilingual or from CALD backgrounds is currently, and will
remain for the foreseeable future, a challenging area of
practice for the speech pathology profession in Australia.
Some recommendations for clinical practice that may assist
with the management of this caseload are outlined below.
These recommendations are based on the available
research literature and the first author’s clinical and research
experience with this caseload.
• Use clear and consistent terminology to refer to clients
from culturally and linguistically diverse backgrounds to
facilitate effective service delivery.
• Obtain an accurate and comprehensive language history
and current language profile to assist with appropriate
diagnosis and goal setting with the bilingual/CALD
individual with aphasia (Lorenzen & Murray, 2008;
Roberts, 2008).
• Obtain initial assessment data in both or multiple languages
wherever possible to obtain an accurate indication of the
relative strengths and weaknesses in and across languages,
to assist with accurate diagnosis, and to provide a
baseline for treatment (Lorenzen & Murray, 2008).
• Beware of directly translating/interpreting English
aphasia assessments into other languages as this
may not account for cross-linguistic and cross-cultural
differences. Appropriate tools for assessment of bilingual
aphasia should be culturally adapted and linguistically
equivalent (Paradis, 2004).
• Where formal assessment in the other language(s) is not
possible, identify a set of informal language assessment
tasks that may assist with diagnosis of aphasia and
obtain interpreter assistance in administering these (e.g.,
tasks that assess fluency, comprehension and repetition
may assist with differential diagnosis of the type of
aphasia). Other recommendations include the collection
and analysis of language samples (Lorenzen & Murray,
2008), including narrative outputs (Kiran & Roberts,
2012 ), and verbal fluency tasks (Kiran & Roberts, 2012).
• Employ practices that will facilitate working with interpreters
(see Kambanaros & van Steenbrugge, 2004; Roger &
Code, 2011), for example, pre-session briefings to
explain the aim, purpose and format of the assessment;
education of inexperienced interpreters about typical
responses from people with aphasia; and the importance
of error information for assessment and diagnosis.
• Be familiar with relevant bilingual language processing
models and use these to facilitate understanding of
aphasia presentation in a bilingual person.
• Pool informal clinical resources for working with CALD
populations (that may have been developed by various
clinicians over time) in a central location that can be
accessed by SLPs nationally.
• Identify and use relevant existing internet resources,
for example, Cue Cards in Community Languages
; The Internet Picture Dictionary
); Life as a Bilingual (http://
).
• If therapy can be conducted only in English within the
clinical setting, try to use family members or other
volunteers to implement language tasks in the other
language(s) at home (see for example, Boles, 2000).
• Provide appropriate education and training for speech
pathology students related to management of bilingual/