"Working together… I can't stress how important it is": Indigenous Health Liaison Officers' insights into working with speech-language pathologists and Aboriginal and Torres Strait Islander peoples with stroke and TBI

PURPOSE

Providing culturally safe speech-language pathology services to Aboriginal and Torres Strait Islander peoples with acquired communication disorders (ACDs) may be challenging for non-Indigenous speech-language pathologists (SLPs). Indigenous Health Liaison Officers (IHLOs) may share common histories and culture with patients, and provide valuable insights about cultural safety. The study aim was to explore IHLOs' experiences of working with Aboriginal and Torres Strait Islander adults post-stroke or traumatic brain injury (TBI), and with the SLPs who provide services to these peoples.

METHOD

Using an interpretive description collaborative research design informed by culturally responsive principles, IHLOs (n = 7) participated in interviews facilitated by Aboriginal researchers and the principal investigator. Data were analysed using qualitative content analysis, informed by perspectives of Aboriginal researchers.

RESULT

Two themes, Connection and Spirit and Emotion, and six interdependent categories described how Aboriginal and Torres Strait Islander peoples have, and need, strong connections to family, country, health professionals, and ACD practices. Without these connections, patients' wellbeing may be deeply affected.

CONCLUSION

SLPs must collaborate with IHLOs and patients' family members and draw on their cultural knowledge, expertise, and guidance when working with Aboriginal and Torres Strait Islander peoples and ensure connections are created. These connections contribute to culturally safe and responsive speech-language pathology practice.

Comparing acute hospital outcomes for people with post-stroke aphasia who do and do not require an interpreter

BACKGROUND

People with communication differences are known to have poorer hospital outcomes than their peers. However, the combined impact of aphasia and cultural/linguistic differences on care and outcomes after stroke remains unknown.

OBJECTIVES

To investigate the association between cultural/linguistic differences, defined as those requiring an interpreter, and the provision of acute evidence-based stroke care and in-hospital outcomes for people with aphasia.

METHODS

Cross-sectional, observational data collected in the Stroke Foundation National Audit of Acute Services (2017, 2019, 2021) were used. Multivariable regression models compared evidence-based care and in-hospital outcomes (e.g., length of stay) by interpreter status. Models were adjusted for sex, hospital location, stroke type and severity, with clustering by hospital.

RESULTS

Among 3122 people with aphasia (median age 78, 49% female) from 126 hospitals, 193 (6%) required an interpreter (median age 78, 55% female). Compared to people with aphasia not requiring an interpreter, those requiring an interpreter had similar care access but less often had their mood assessed (OR 0.50, 95% CI 0.32, 0.76), were more likely to have physiotherapy assessments (96% vs 90% p = 0.011) and carer training (OR 4.83, 95% CI 1.70, 13.70), had a 2 day longer median length of stay (8 days vs 6 days, p = 0.003), and were less likely to be independent on discharge (OR 0.54, 95% CI 0.33, 0.89).

CONCLUSIONS

Some differences exist in the management and outcomes for people with post-stroke aphasia who require an interpreter. Further research to explore their needs and the practical issues underpinning their clinical care pathways is required.

Assessment and rehabilitation of acquired communication disorders in Aboriginal and Torres Strait Islander adults with stroke or traumatic brain injury: a retrospective chart review

PURPOSE

Speech-language pathologists' (SLP) management practices for Aboriginal and Torres Strait Islander adults with acquired communication disorder (ACD), following stroke or traumatic brain injury (TBI), are not well understood. This study explores SLPs' management approaches for ACDs for Aboriginal and Torres Strait Islander adults post-stroke or TBI.

MATERIALS AND METHODS

SLPs' documented notes were analysed from a two-year retrospective medical record review of Aboriginal and Torres Strait Islander adults (≥18 years), admitted to a regional Queensland hospital with principal diagnoses of stroke or TBI.

RESULTS

SLPs frequently used informal approaches to assess ACDs. English-language formal assessment tools were also used in conjunction with the informal approaches. ACD diagnosis was more common in stroke than TBI patients. One-third of patients with ACD received inpatient rehabilitation at the study site. SLPs infrequently documented cultural or linguistic adaptions to assessment or interventions.

CONCLUSIONS

Informal approaches to assess ACDs were commonly employed which may be because they are perceived to be more culturally appropriate. Clinical guidelines for stroke and TBI should accommodate the diversity of cultures and languages. Better consideration of Aboriginal and Torres Strait Islander communication styles and incorporation of these into SLP ACD management approaches may facilitate accurate diagnosis and culturally safe rehabilitation services.Implications for RehabilitationInformal approaches for assessment and intervention of ACDs, that incorporate yarning and salient tasks, are likely to be more culturally appropriate and safe for Aboriginal and Torres Strait Islander peoples.More flexibility and guidance in the use of culturally and linguistically appropriate alternative assessment approaches are required in the National stroke guidelines for Aboriginal and Torres Strait Islander peoples.The adoption of enhanced models of culturally secure ACD service provision, that incorporate frequent SLP engagement with an Aboriginal or Torres Strait Islander support person during assessment and rehabilitation, are needed.There is an imperative for health professionals to actively account for culture and language difference in rehabilitation practices to ensure Indigenous peoples worldwide receive equitable and culturally-responsive services.

The nature of inpatient rehabilitation for people with aphasia from culturally and linguistically diverse backgrounds: a scoping review

BACKGROUND

Due to language and cultural barriers, people with aphasia from culturally and linguistically diverse (CALD) backgrounds are at risk of disadvantage in their access to comprehensive care. They are at higher risk of poorer inpatient outcomes in addition to challenges in receiving appropriate aphasia assessment and intervention.

OBJECTIVES

This study aims to examine the extent and nature of what is known about the inpatient phase of aphasia rehabilitation for CALD stroke survivors and identify potential research gaps in the literature for investigation.

METHODS

A scoping review with systematic search was conducted in September 2020 following the PRISMA Scoping Review checklist. Five electronic databases were searched using a combination of terms pertaining to "aphasia," "inpatient care" and "CALD." Key variables were extracted from studies that met the inclusion criteria for analysis.

RESULTS

Eighteen studies were yielded. Data regarding the inpatient phase of care indicate that CALD people with aphasia do not always receive comprehensive assessment or intervention in all their languages that may impact their discharge destination and access to community services. Speech-language pathologists (SLPs) report numerous barriers to service provision for this population. No studies investigated the degree and nature of differences in outcomes between CALD and non-CALD stroke survivors with aphasia.

CONCLUSIONS

CALD stroke survivors with aphasia inconsistently access SLP services in hospital. Assessment is unlikely to be conducted in patient primary languages and therapy is usually provided in the language of SLPs. Further research is required to determine whether this impacts functional outcomes and health services.

Language intervention in bilingual children with developmental language disorder: A systematic review

BACKGROUND

Although there is a growing body of literature on cognitive and language processing in bilingual children with developmental language disorder (DLD), there is a major gap in the evidence for language intervention. Critically, speech-language therapists are often required to make clinical decisions for language intervention on specific domains, such as phonology, vocabulary, morphosyntax and literacy.

AIMS

To examine evidence for language intervention and cross-language transfer effects in bilingual children with DLD. Specifically, the study aimed to review intervention evidence targeting non-linguistic cognitive skills and six areas of language: phonology, vocabulary, morphosyntax, pragmatics, narrative skills and literacy.

METHODS & PROCEDURES

We carried out searches in five electronic databases: CINAHL, Scopus, Psychinfo, Proquest and Sciencedirect. Data from selected papers were extracted and organized into the three following categories: study information, participant information and intervention information. Critical appraisal for selected papers was conducted using a quality assessment tool (QAT).

OUTCOMES & RESULTS

We included 14 papers in the review. The majority indicated evidence for vocabulary intervention. There was limited evidence for intervention targeting phonology or morphosyntax. Cross-language generalization effects were evident for vocabulary, but in some instances also reported for morphosyntax and literacy.

CONCLUSIONS & IMPLICATIONS

The present review indicates that there is a significant gap in the literature regarding language intervention for several key language areas such as morphosyntax, narrative skills and literacy. There are only limited data for the effects of cross-language generalization indicating that more research is needed in this area specifically for skills beyond vocabulary.

WHAT THIS PAPER ADDS

What is already known on the subject Previous studies have examined the effects of bi- and monolingual intervention in bilingual children with DLD. Although the results indicated superior effects for bilingual compared with monolingual intervention, language intervention evidence in specific language domains (e.g., vocabulary, literacy) has not been investigated. What this paper adds to existing knowledge This study will add intervention evidence specific to language domains such as phonology, vocabulary, morphosyntax, pragmatics, narrative skills and literacy. Additionally, we have synthesized intervention evidence on non-linguistic cognition given that these skills are often impaired in bilingual children with DLD. The review has also demonstrated evidence for the effects of cross-language transfer beyond vocabulary skills, especially when the intervention was provided in the home language. What are the potential or actual clinical implications of this work? Although there was a lack of intervention evidence in language domains such as pragmatics, the results indicated some evidence for intervention targeting vocabulary. However, positive effects of cross-language generalization were not constrained to vocabulary but were also reported for intervention targeting mean length of utterance and literacy in the home language. This result indicates an interactive nature of the two languages, as well as provides further evidence for supporting home language(s) in intervention. Finally, intervention targeting non-linguistic cognition may yield additional cross-domain generalization to language skills specifically for bilingual children with DLD.

Speech pathologists and professional interpreters managing culturally and linguistically diverse adults with communication disorders: a systematic review

BACKGROUND

Speech pathologists who work with culturally and linguistically diverse (CALD) adults with acquired communication disorders (ACDs), in predominately English-speaking countries, are legally and ethically bound to work with professional interpreters to overcome language barriers and provide equitable services. As levels of migration and ageing populations continue to rise globally, there will be an increasing need for speech pathologists to work with professional interpreters to manage the growing numbers of CALD adults with ACDs. Speech pathologists and professional interpreters face unique challenges when working together due to the need to focus on the intricacies of communication.

AIMS

This systematic review explores how speech pathologists and professional interpreters work together to manage CALD adults with ACDs by investigating the existing research context and the challenges and strategies reportedly used by these professions.

METHODS & PROCEDURES

A systematic quantitative literature review methodology was used to guide the review process, along with relevant items from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Five online scholarly databases (CINAHL, PubMED, Scopus, ScienceDirect and Web of Science) were searched using key search terms. Study inclusion criteria were: (1) original research reported in English; (2) informed our understanding of speech pathologists and professional interpreters working together; (3) focused on the management of ACDs; and (4) focused on working with CALD adults.

OUTCOMES & RESULTS

Ten studies that met inclusion criteria were identified and included in the review. Half of the studies were conducted in Australia. Study designs were either surveys or single-case designs (e.g., case reports or qualitative case studies). Most participants were monolingual, female speech pathologists. Interpreter participants were mainly involved in assessment tasks using face-to-face service delivery. Common challenges reported by participants were speech pathologists being unsure of the accuracies of interpretations by interpreters, and unclear role expectations from both professions. Pre-session briefings and training of both professions were the primary strategies used and recommended.

CONCLUSIONS & IMPLICATIONS

This review identified emerging research relating to speech pathologist and professional interpreter interactions, which were limited predominantly to the perspectives of speech pathologists. Several challenges were reported. While strategies to facilitate interprofessional practice were proposed, the efficacy and utility of the strategies has not been investigated to date. Further in-depth studies are needed to examine how the professions work together, and to explore feasibility and effectiveness of implementing proposed strategies to optimize service delivery to CALD adults with ACDs.

"… Trial and error …": Speech-language pathologists' perspectives of working with Indigenous Australian adults with acquired communication disorders

PURPOSE

This study explored speech-language pathologists' (SLPs) perspectives about factors that influence clinical management of Aboriginal and Torres Strait Islander adults with acquired communication disorders (e.g. aphasia, motor speech disorders).

METHOD

Using a qualitative phenomenological approach, seven SLPs working in North Queensland, Australia with experience working with this population participated in semi-structured in-depth interviews. Qualitative content analysis was used to identify categories and overarching themes within the data.

RESULT

Four categories, in relation to barriers and facilitators, were identified from participants' responses: (1) The Practice Context; (2) Working Together; (3) Client Factors; and (4) Speech-Language Pathologist Factors. Three overarching themes were also found to influence effective speech pathology services: (1) Aboriginal and Torres Strait Islander Cultural Practices; (2) Information and Communication; and (3) Time.

CONCLUSION

This study identified many complex and inter-related factors which influenced SLPs' effective clinical management of this caseload. The findings suggest that SLPs should employ a flexible, holistic and collaborative approach in order to facilitate effective clinical management with Aboriginal and Torres Strait Islander people with acquired communication disorders.

Improved word comprehension in Global aphasia using a modified semantic feature analysis treatment

Limited research has investigated treatment of single word comprehension in people with aphasia, despite numerous studies examining treatment of naming deficits. This study employed a single case experimental design to examine efficacy of a modified semantic feature analysis (SFA) therapy in improving word comprehension in an individual with Global aphasia, who presented with a semantically based comprehension impairment. Ten treatment sessions were conducted over a period of two weeks. Following therapy, the participant demonstrated improved comprehension of treatment items and generalisation to control items, measured by performance on a spoken word picture matching task. Improvements were also observed on other language assessments (e.g. subtests of WAB-R; PALPA subtest 47) and were largely maintained over a period of 12 weeks without further therapy. This study provides support for the efficacy of a modified SFA therapy in remediating single word comprehension in individuals with aphasia with a semantically based comprehension deficit.

Cross-sectional analysis of testosterone therapies in hypopituitary men on stable pituitary hormone replacement

OBJECTIVE

The last decade has seen a proliferation in options for testosterone replacement. However, little is known as to the benefits of different treatment modalities. Our objective was to determine the testosterone prescription pattern and to examine the impact on various outcome measures.

SUBJECTS AND METHODS

A total of 816 adult-onset hypopituitary males on stable pituitary replacement for at least 1 year were identified from the KIMS database. Patients were classified as either eugonadal (n = 106), or hypogonadal (n = 710) on intramuscular (IM, n = 558), oral (n = 74), transdermal (n = 61), and depot (n = 17) testosterone.

RESULTS

After 1 year of stable pituitary replacement therapy, body composition, cardiovascular parameters, GH replacement and quality of life were not significantly different in androgen-replaced hypogonadal patients compared to eugonadal patients. There were no differences in outcome variables within the hypogonadal group according to the testosterone replacement regimen used and no difference in response to GH therapy.

CONCLUSIONS

The majority of hypopituitary patients in the last decade have received IM testosterone. Body composition, cardiovascular parameters, GH replacement and quality of life were not different between eugonadal and hypogonadal patients and were not differentially affected by the mode of testosterone replacement. These findings are reassuring that there is no major difference in response to different testosterone replacement regimens.

Is diabetes a coronary risk equivalent? Systematic review and meta-analysis

AIMS

To determine whether patients with diabetes without prior myocardial infarction (MI) have the same risk of total coronary heart disease (CHD) events as non-diabetic patients with previous myocardial infarction.

METHODS

Using MEDLINE, EMBASE, Cochrane and MeSH in this systematic review and meta-analysis, extensive searching was carried out by cross-referencing from original articles and reviews. The study consisted of cohort or observational studies with hard clinical endpoints, including total CHD events (fatal or non-fatal myocardial infarction), stratified for patients with diabetes but no previous myocardial infarction, and patients without diabetes but with previous myocardial infarction. Studies with less than 100 subjects, follow-up of less than 4 years and/or without provisions for calculating CHD event rates were excluded. The review of articles and data extraction was performed by two independent authors, with any disagreements resolved by consensus.

RESULTS

Thirteen studies were included involving 45,108 patients. The duration of follow-up was 5-25 years (mean 13.4 years) and the age range was 25-84 years. Patients with diabetes without prior myocardial infarction have a 43% lower risk of developing total CHD events compared with patients without diabetes with previous myocardial infarction (summary odds ratio 0.56, 95% confidence interval 0.53-0.60).

CONCLUSION

This meta-analysis did not support the hypothesis that diabetes is a 'coronary heart disease equivalent'. Public health decisions to initiate cardio-protective drugs in patients with diabetes for primary CHD prevention should therefore be based on appropriate patients' CHD risk estimates rather than a 'blanket' approach of treatment.

Age threshold for vascular prophylaxis by aspirin in patients without diabetes

OBJECTIVE

To determine an appropriate age threshold at which to prescribe aspirin for primary cardiovascular disease (CVD) prevention among men and women without diabetes.

DESIGN

Cross-sectional study.

SETTING

304 general practices in England and Wales contributing to The Health Improvement Network (THIN) electronic patient files.

PARTICIPANTS

Subjects aged between 30 and 75 years without diabetes, not prescribed any lipid-lowering treatment and with no previous history of CVD. Subjects had to have been registered by their practices for the whole of the preceding 12 months to be included in the analysis.

OUTCOMES MEASURES

Relation between age and coronary heart disease (CHD) risk, and the age threshold at which subjects without diabetes develop an estimated 10-year CHD risk of >or=10%.

RESULTS

The age transition from <10% to >10%, 10-year CHD risk for men and women without diabetes occurred at ages 47.8 for men and 57.3 for women.

CONCLUSIONS

In the absence of significant bleeding risks, aspirin should routinely be considered for all men and women without diabetes above the ages of 48 and 57 years, respectively, for primary CVD prevention. For subjects below these age thresholds or for those above the age of 75 years, the decision to initiate aspirin should be based on a patient's individual cardiovascular risk profiles. These proposed age thresholds aim to take into account a patient's gender, bleeding risk and the cardioprotective benefits of low-dose aspirin treatment.

Combining growth hormone releasing hormone-arginine and synacthen testing diminishes the cortisol response

OBJECTIVES

The GHRH/arginine test and short synacthen test (SST) have been validated as safe alternatives to the insulin tolerance test for the assessment of the GH reserve and hypothalamic-pituitary-adrenal axis integrity, respectively. However, these two tests are usually performed separately. The objective was to see whether the synacthen and GHRH/arginine tests could be combined to save time and blood samples and minimize inconvenience to patients.

PATIENTS/METHODS

Twenty-four consecutive patients with adult onset pituitary disease requiring pituitary function testing were randomized to receive sequentially and in random order a SST, a GHRH/arginine test, and a combined SST and GHRH/arginine test on three different visits separated by at least 1 wk.

RESULTS

There was no difference in basal cortisol or ACTH values for the SST done alone or during the combined test. However, when GHRH/arginine was given with synacthen, patients had a lower peak cortisol response with a mean difference of 116 nmol/liter (95% confidence interval, 52.54 to 179.37; P < 0.001), and one patient with a normal response on the SST had a subnormal cortisol response in the combined test. Similar lower peak cortisol responses were observed in males and females with combined test. The difference between the peak cortisol responses showed no significant correlation with age (r = 0.123; P = 0.58) or with the body mass index (r = -0.376; P = 0.09). There was no difference in GH measurements between the GHRH/arginine test done alone or in combination with the SST.

CONCLUSIONS

Combining the SST and GHRH/arginine test results in a lower cortisol response to synacthen. For this reason, the combined test cannot be recommended to assess the integrity of cortisol and GH reserve using current diagnostic criteria.