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.