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Cultural diversity
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ACQ
Volume 13, Number 3 2011
ACQ
uiring Knowledge in Speech, Language and Hearing
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.
Katy Stewart
Keywords
DYSARTHRIA
DYSPHAGIA
INTERPRETER
NON-ENGLISH
SPEAKING