Introduction

Evaluation and Diagnosis of Aphasia

Aphasia is an acquired language disorder that occurs due to brain injury on the language-dominant hemisphere 1. A thorough evaluation is crucial in making diagnosis of aphasia, as well as determining appropriate aphasia treatment, including treatment focus, frequency, and length 2,3. The American Speech-Language-Hearing Association recommended that speech-language pathologists (SLPs) complete a thorough evaluation by collecting valid and reliable information from multiple sources, including direct testing, observations, and reports 3. Following a systematic review of clinical practice guidelines for aphasia rehabilitation, Shrubsole and colleagues proposed (in relation to the evaluation of aphasia) that SLPs: (a) ensure the validity and reliability of assessment tools, (b) collect information that will lead to the development of meaningful and relevant treatment goals, and (c) actively communicate with families, caregivers, co-workers and other healthcare professionals to determine the severity, needs and issues faced by individuals with aphasia in various situations4.
Based on the World Health Organization’s International Classification of Functioning, Disability and Health Framework (WHO ICF), it was recommended that SLPs focus on multiple facets during aphasia evaluation, such as the individual’s background, levels of language capabilities, impacts of communication impairment, and factors that facilitate or impede recovery of aphasia 3. While it is important to cover all facets of the framework when evaluating people with aphasia (PWA), it is important to note that aphasia is characterized by language skill deficits 5. PWA has difficulties in comprehending and producing language at various linguistic levels (i.e., lexical-semantic, syntax, and discourse), which may be associated with impaired language processing 1. Language impairment of aphasia occurs regardless of the modalities used for transmitting or receiving language, including auditory-verbal/spoken, textual, and sign language modes2. Due to difficulties in comprehending and producing language in various modalities, communication of PWA with other are negatively affected and requires compensatory support6. Language functions may be improved through direct intervention that is based on evaluation findings of language functions7.

Language Evaluation in Culturally and Linguistically Diverse Contexts

When conducting language and communication assessments involving people with diverse background, previous studies have reported that SLPs face challenges in accumulating reliable and valid assessment findings. Impact on reliability and validity of assessment findings may arise due to multiple languages used by the client 8. In other circumstances, clinicians may be unable to speak languages and/or appreciate beliefs, customary practices and cultural etiquette of clients and their families 9. These limitations may result in biased judgment that may lead to inappropriate treatment programs for individuals with communication disorders10.
Malaysian population consists of multiple ethnic groups, including Malays, indigenous people, Chinese, Indians, and Eurasians11. Malays and indigenous people have occupied the Malaysian regions for centuries, while those with Chinese, Indian, and Eurasian backgrounds are the descendants of immigrants during the colonial period 12. Since the independence of the nation, the Malay language has been employed as the national language and formally taught in schools; however, this language is mainly used for formal government-related affairs and for communication among the Malays 13. Variations of Chinese dialects, Tamil, English and more than 80 indigenous languages are continued to be used throughout the nation by various ethnic groups 13,14. In addition, various ethnic groups preserve their unique customs and etiquettes 15. Interestingly, some values are being shared across cultures due to co-existence of different ethnicities for many years 16.
Due to cultural and linguistic diversity in Malaysia, SLPs are likely to experience difficulties in ensuring the validity of finding from language and communication evaluations. Previous research demonstrated a lack of psychometrically sound assessment tools in Malaysian local languages 17,18. A lack of appropriate tools for local populations was reported to be a common challenge across various disorders 19. To reduce the dearth of resources for aphasia evaluation, Van Dort and colleagues adapted the Boston Naming Test into the Malay language; however, in the adapted Malay version, only 48.3% of the original items were found to be culturally appropriate for the Malaysian Malay population 20. Other items were found to be less relevant to Malaysian experiences (e.g., pretzel, acorn, and wreath).
In order to improve the present situation, we aim to uncover general practices of Malaysian SLPs in conducting evaluation of aphasia within the Malaysian contexts, in terms of the components of aphasia evaluation, methods to gather language-based data, and contexts in which aphasia evaluation was conducted. In addition, we aim to determine the extent to which diversity-related challenges act as a barrier for successful evaluation of aphasia.