Many moons ago (Over 20 years ago), I was once a bilingual diagnostician. My job for the school system was to assess school age children In Spanish and compare it to the English assessment done by a monolingual SLP. In many situations, the child was found to have a language difference, not a disorder.
Education was provided to the student’s SLP. When I worked at the schools prior to that job, I felt like I was in the business of discharging from therapy. I knew something was wrong with what many SLPs knew about language differences and/or bias’ coming into the profession.
That was my first experience of cultural bias as an SLP and it was just the beginning.
Fast forward many years later, it’s still a thing. Since I transferred to working in an acute care hospital and outpatient, I often see the reluctance of using an accessible interpreter by physicians and clinicians and assuming that their language is “good enough”. Here are some common mistakes and considerations in rehab:
“Patient has slow processing and there is a delay in response”
Consideration: Have you assessed the patient in his native language? Patients sometimes say they’re bilingual but it’s not 50/50. This can affect response time, performance and processing time.
“The patient is not cooperative and doesn’t want to participate in therapy”
Consideration: Are you allowing them to communicate in their preferred language? Are you meeting their needs?
Bite Sized Take Home
We could be treating a typical person that deserves the comfort of their native language to help them gain “therapeutic alliance”. The principles of neuroplasticity will support you when therapy is salient and patient has autonomy .
Here is more information about neuroplasticity:
https://www.neuroskills.com/brain-injury/neuroplasticity/ten-principles-of-neuroplasticity/
Most of the time our patients are not typical and their speech, language and cognition may be altered. The same considerations apply to achieve a sound diagnosis when taking their language proficiencies into account.
I understand, the productivity struggle is real but, when we are pushed to the limit, let’s be mindful of our biases to provide the most patient centered focus; your therapy will achieve all the neuroplasticity markers and have better outcomes.
Below you will find some resources including an amazing article. This is a personal testament regarding a language despairty in healthcare.
Our therapy will be more person-centered if we are aware of our own biases.
I took this test and it helped me have more awareness of my own bias so that I can adapt and learn about my own biases. Let’s give our patient a set a the table to so that we can do what we do best.
https://edib.harvard.edu/implicit-association-test-iat
Kuzmina E, Goral M, Norvik M, Weekes BS. What Influences Language Impairment in Bilingual Aphasia? A Meta-Analytic Review. Front Psychol. 2019 Apr 4;10:445. doi: 10.3389/fpsyg.2019.00445. PMID: 31024369; PMCID: PMC6460996.
