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ACQ Volume 13, Number 3 2011 145
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