A Call for Transformative Intersectional LPAA Intervention for Equity and Social Justice in Ethnosocially Diverse Post-Stroke Aphasia Services.

The disproportionate health disparities in ethnoracial groups highlighted by the COVID-19 pandemic catalyzed a sociopolitical momentum for transformative approaches in health care. As the U.S. population progressively becomes more ethnoracially diverse and older, growing vulnerable ethnogeriatric groups of older individuals with contrasting ethnic/racial and social histories are estimated to experience age-related cardiovascular complications with resulting chronic disabilities, such as post-stroke aphasia. Grounded in principles of equity and social justice, transformative health care approaches use input from marginalized communities to inform service strategies to minimize health disparities. This article discusses the population scenario, principles, and possible strategies to support the call for stakeholder-informed intervention toward the social reintegration of ethnosocially mixed geriatric populations with aphasia in the United States. Based on the principles from the Life Participation Approach to Aphasia (LPAA) and intersectional narratives, we discuss how client and caregiver stories can inform culturally authentic individualized aphasia intervention for social readaptation. We conclude with future directions in aphasia education, research, and practice to promote stakeholder-informed strategies for culturally aligned social reintegration of older ethnosocially diverse aphasia populations in post-stroke care.

Focusing Our Attention on Socially Responsive Professional Education to Serve Ethnogeriatric Populations With Neurogenic Communication Disorders in the United States.

PURPOSE: This viewpoint discusses a plausible framework to educate future speech-language pathologists (SLPs) as socially responsive practitioners who serve and advocate for the burgeoning vulnerable ethnogeriatric populations with neurogenic communication disorders. METHOD: We provide an overview of the demographic, epidemiological, and biopsychosocial context that supports the implementation of equity-based, population-grounded educational approaches for speech-language pathology services in ethnogeriatric neurorehabilitation caseloads and discuss a plausible perspective based on the educational social determinants of health (SDOH) framework by the National Academies of Sciences, Engineering, and Medicine. RESULTS: The NASEM's three-domain SDOH educational perspective integrates education, community, and organization to create a self-reinforcing pedagogical coproduction that, grounded in the synergized partnerships of educational institutions, engaged communities, and organizational leadership, aims to address systemic drivers of health perpetuating ethnoracial disparities in health, care, and outcomes. CONCLUSION: Exponentially growing vulnerable ethnogeriatric populations with age-related neurogenic communication disorders warrant the implementation of health equity education strategies to train technically prepared, socially conscious SLPs as service providers and advocates.

Assessing services with communicatively impaired bilingual adults in culturally and linguistically diverse neurorehabilitation programs.

UNLABELLED: The combined effect of the steady increase in cultural and linguistic diversity and epidemiological factors in minority populations is estimated to continue having an impact on adult neurorehabilitation programs in the country, particularly in the number of bilingual individuals receiving clinical services. No comprehensive assessment of the present professional and clinical realities in service delivery to communicatively impaired adults in culturally and linguistically diverse (CLD) neurorehabilitation contexts has been conducted. The current survey research was undertaken to examine current professional training, clinical practices, and challenges in the services rendered to the steadily increasing numbers of communicatively disordered adults in CLD neurorehabilitation programs with a special focus on bilingual persons. A 36-question, 6-section survey was administered to health care-based SLPs working with adults to examine multiple factors regarding work setting and caseload, professional training, clinical tools and procedures, service delivery issues, and suggestions to improve clinical work with bilingual adults in CLD neurorehabilitation environments. Results support that SLPs presently make sensible decisions to serve communicatively disordered bilingual adults with neuropathologies despite training gaps and scant clinical resources. Responses additionally highlight critical areas to improve professional preparation and available resources. Results are discussed in terms of strengths and weaknesses as well as their implications to professional education and target research areas in order to minimize present gaps in service delivery with bilingual speakers in CLD adult neurorehabilitation programs. LEARNING OUTCOMES: As a result of this activity, the reader will be able to: (1) Discuss the demographic and epidemiological factors that suggest a continued increase in the number of communicatively impaired bilingual adults in CLD neurorehabilitation programs. (2) Describe current strengths and weaknesses in the diagnostic and therapeutic practices employed by SLPs with bilingual clients in CLD adult neurorehabilitation programs. (3) Describe possible strategies to improve current limitations in professional training and clinical resources that would strengthen the current services given to bilingual adults in CLD neurorehabilitation programs.

A preliminary comparison of verb tense production in Spanish speakers with expressive restrictions.

Spoken verb tense use in three groups of Spanish speakers with expressive limitations, namely, children with specific language impairment, bilingual children with first language (L1) (Spanish) attrition and adults with agrammatism, was compared in order to examine the possible impact of conversational tense frequency on expressive production. Based on the notion that frequent language forms in typical discourse are preferred in contexts of expressive restrictions, we predicted that tenses with high spoken occurrence will be favoured by individuals in our expressively limited groups. The incidence of tense use by the participants was assessed in oral narratives and/or a sentence repetition task. Consistent with our prediction, the most frequent verb tenses in conversational Spanish--the present, followed by the preterite--were preferred by the participants thus supporting the proposal that a socio-cognitive factor linking discursive frequency to verb retrieval may be operating in tense preference in situations of expressive stress.

Assessing frequency effects on verb inflection use by Spanish-speaking individuals with agrammatism: theoretical and clinical implications.

The resistance of high-frequency linguistic elements to aphasic impairment suggests that frequency of occurrence may be implicated in verb use differences in agrammatic aphasia. The highly-inflected Spanish verb system allows for the examination of frequency of occurrence along two main metrics, daily usage frequency and paradigmatic frequency. In this study, we explored the role of those two frequency dimensions in verb repetition by Spanish speakers with agrammatism. Six native Spanish-speaking individuals with agrammatic oral expression were matched for age, education and Spanish dialect with six speakers with typical language. The speakers participated in a sentence repetition task involving simple verb tenses. Results revealed that high frequency in daily usage can have a stronger facilitating effect on verb repetition than paradigmatic frequency. Theoretical and clinical implications of the findings are discussed to highlight some plausible repercussions of typical discourse patterns in providing a socio-cognitive dimension to agrammatism theory and in supporting the use of frequency-based linguistic features in agrammatism therapy.

Issues and principles in service delivery to communicatively impaired minority bilingual adults in neurorehabilitation.

Demographic and epidemiological trends coupled with health-care needs in minority populations highlight the imperative need to develop effective, culturally appropriate clinical approaches for minority adults with communication impairments. The steady increase in linguistic and cultural diversity in the country includes a large number of bilingual adults, which is estimated to continue. Because strokes are quite prevalent in racial/ethnic minorities, the number of bilingual adults with acquired communication disorders will similarly increase. However, members of minority groups presently confront disparities in health-care services compared with the general population that translates into reduced health outcomes. This article discusses the current clinical needs and complexities in service delivery to communicatively impaired minority adults, with a special focus on bilingual adults with aphasia.

Applying cognitive neuropsychological principles to the rehabilitation of Spanish readers with acquired dyslexia.

Cognitive neuropsychological models (CNMs) have been useful to generate a theory of aphasia rehabilitation. In contrast to the traditional syndrome approach, CNMs employ cognitive accounts to interpret language disturbances after brain damage. In this article, we apply CNMs to monolingual Spanish and bilingual Spanish-English readers with acquired dyslexia whose first language is Spanish. Although there are many studies of acquired dyslexia (reading errors associated with aphasia), they primarily have focused on English and French readers. Similar investigations on Spanish readers are limited. Unlike the opaque orthographic systems of English and French (inconsistent grapheme-to-phoneme relationships), Spanish has a mostly transparent orthography (regular grapheme-to-phoneme relationships). Thus evaluating and treating dyslexia secondary to brain damage in Spanish readers may involve different strategies from those employed with English and French readers. The increasingly large numbers of Spanish speakers in aphasia rehabilitation worldwide underscore the critical need to develop plausible theoretically grounded clinical strategies to serve these individuals.