Co-designing a framework for the adaptation of aphasia therapy for diverse cultural and linguistic backgrounds

Introduction: International migration and global aging are resulting in increasing culturally and linguistically diverse (CALD) aphasia caseloads in post-stroke services worldwide. Speech pathologists (SPs) are required to provide rehabilitation to clients with whom they do not share a language or culture. Little is known about how rehabilitation is being provided when a language/culture mismatch arises between SPs and clients.

Aims/Hypothesis: 1) Systematically map the evidence related to aphasia rehabilitation when the SP and client do not share a language/culture; 2) Develop a framework for the adaptation of aphasia therapy for CALD clients.

Methods: A scoping review was conducted. A comprehensive database search was performed in September 2020. Twenty studies comprising surveys and/or interviews and descriptive publications were reviewed. A three-phase co-design study is in progress: 1) Semi-structured interviews with CALD people with aphasia (PWA) and interpreters about their experiences of therapy to inform a framework for the adaptation of aphasia therapy for CALD populations; 2) workshops with SPs and interpreters to adapt Verb Network Strengthening Treatment to Mandarin; 3) a focus group with SPs and interpreters to review the applicability of the framework to clinical practice.

Results: No therapy studies met criteria for inclusion as therapy was delivered in a shared language or by a multilingual therapist. SPs frequently report a lack of confidence, skill, and preparation to work with CALD PWA. There is a shortage of published evidence, guidelines, resources, and access to interpreters to support their practice.

Conclusions/Discussions: Further research is needed into aphasia rehabilitation when there is no shared language/culture between clients and SPs including: the therapy approach selected and adaptations required for the target language and culture; how SPs and interpreters work collaboratively; and the experiences of interpreters and clients.