neurogenic communication disorders

cultural responsively and battle’s characterizations

1. The impact of culture for effective and efficient communication

2. all individuals view and interpret the world from the perspective of their own cultural lens

• In your other courses you have learned about the typical and pathological aging process.

• This information is important as we think about the ___________ that exist in the United States populations and non-US populations

health disparities

There are identified differences in the ____________ and actual _________ that are driven by _____ and ______

neuropathophysiologic changes and actual recovery patterns; race and ethnicity

We use _______________ to accommodate for the cultural competence of the health professional within its framework - - this assumes reflection on _______ values and practices in the ____________ process for the patient and their family

Think about there may be the potential for _______ here between the clinician’s values/beliefs and those of the adult patient and their family

evidence based clinical practice; socio cultural ; clinical decision making

mismatch

when clinicians have an understanding of cultural differences, they are better able to see the …

value of providing culturally relevant care

Service providers that provide culturally relevant care to the best of their ability are likely to see more __________, potentially more ________ from the patient for treatment, and improved _______

patient participation; compliance; follow-up

• With the aging diverse population of the US, we expect a significant increase in the number of older adults with _________ and _____________

• ASHA (2010) estimates that there about ___ Americans from culturally and linguistic diverse backgrounds that have some kind of _________________

• More than ________ Latinos need speech/language and hearing services, approximately __% of those are over the age of __ years old

• Approximately __ in every ____ African Americans between the ages of ___ and __ years old are living with some kind of communication disorder

• “burden” of communication disorders is greater in these populations because of the high prevalence of chronic diseases such as _____, _______, and ______

• communication and swallowing difficulties

• 6.2; communication/swallowing disorder

• 2.3 million; 69%; 18 years old

• 21 in every 1000; 45 and 65

• heart disease, hypertension, and diabetes

________, _______, and ____ in general tend to show a prevalence of ________ lesions that impact small arteries such as those located in the subcortical and midbrain areas

____________ tend to show a prevalence of ________ lesions that impact the carotid arteries.

African Americans, Japanese individuals and women; intracranial

white males; extracranial

• ___________ (30%) had a greater incidence of strokes related to ______ than the ____ participants (16%) or the _______ participants (15%)

• ___________ were found between the strokes in terms of being related to hemorrhagic, atherothrombotic, or other types of stroke

• Indigenous Americans; lacunes; white; hispanic

• No differences

• Rate of strokes in the US is __% of the population per CDC information (2010)

• The prevalence of stroke varies by _______, ____, ______, and _________ of the United States

• Identified risk factors for education level include _____, lack of ___________, ___________, and the cultural views of _______

• 2.6%

• education level, race, ethnicity and geographic region

• poverty, lack of economic opportunity, social isolation, and the cultural views of diet/exercise

Per data from the CDC (2010) who may die from strokes at a younger age than White males and females?

• African Americans

• Hispanic Americans

• Indigenous Americans/Alaska natives

• Asians

• Pacific Islanders

It is suggested that because of the potential increased risk of chronic diseases that these groups may have a higher risk for ______ and subsequent ___________ and ________ issues

strokes; communication and swallowing issues

There are several types of dementia including the most common, __________ which makes up approximately _____% of dementia cases and _______ that makes up about _____% of cases of dementia

Alzheimers Dementia ; 50-80%

vascular dementia; 20-30%

Per the course text, different _______ may have different ___________ data for dementia; ex: __ per 1000 Japanese adults studied between the ages of 70-74 showed a higher rate of dementia for men than women; another study (Raina et al. 2008) studied the Kashmiri in India and found and identified an incidence of __ per 1000 individuals 60 years and over.

ethnic groups; incidence/prevalence

2.8; 5.3

_________ and _______ age 71 years and older are more likely to have ___ than older ___ individuals (what are the percentages?)

african americans and hispanics; AD; white

(21.3% of African Americans vs. 11.2% White individuals)

Per our text, the high incidence rates may be due to higher occurrence of chronic conditions such as __________ and ________ in these groups which are identified as risk factors for developing ___

high blood pressure and diabetes; AD

__________ may vary from caregiver to caregiver, thus, healthcare professionals must be sensitive to these ________ in order to have successful interactions and treatment

Cultural values; belief systems

Bourgeois & Hickey (2009) found:

Psychosocial variables have been shown to hinder dementia treatment such as:

• caretakers relationship with the person with dementia

• gender

• ethnicity

• social stigma and feelings of failure

• lack of knowledge of services

• fear of the cost of services

• possibility of patient refusal

• lack of transportation

Other barriers include __________ and differences in opinions about the _____ and _____of caregiving tasks between the caregiver and professionals tend to affect the quality of care a person with _______ receives.

dissatisfaction with services; focus and intensity; dementia

In Western culture great value is placed on

independence and individualism

As people in the Western cultural age, ___________ continues to be of the utmost importance until a ____ requires a change in priorities

independence; crisis

People “naturally prefer to avoid the subject of their decrepitude” (p. 35), and there is a significant value placed on _____ and continuing to look _____ in Western culture

youth and continuing to look young

“While modern medicine allows people to live longer and healthier lives than ever before, it also provides things like cosmetic surgery that support the appearance of looking young. The notion of _______ as long as possible is ingrained in the dominant culture, with advertisers touting products that help to keep people looking and feeling _____, despite the fact that ____ itself cannot be stopped.”

delaying aging; young; aging

in Western culture

Caregiving in mainstream culture may be in the form of ____, _______, or may be _____ or ______ providing unpaid caregiving

hired, paid caregivers, or may be family or friends providing unpaid caregiving

western culture

Studies report high levels of caregiver ______, ____, and ____ in Caucasian caregivers in the United States, along with high levels of _______.

burden, stress, and strain; depression

Research supports the notion that mainstream culture in the US is more likely to view caregiving as a ____________, associated with _____ and _____

disruption of the life course; stress and burden

sometimes perceived as the American way by non-mainstream cultures

Institutionalizing elders

there are higher levels of institutionalization for ________ individuals with ________

Caucasian individuals with dementia

This is consistent with a more recent 2001 American Association of Retired Persons survey indicating that Caucasians are less likely to…

care for older relatives in the home

Overall, individuals with ___________ comprise a larger percentage of the population receiving home care, adult day services, and nursing home care in the US

Alzheimer’s disease

Some Hispanic caregivers perceive dementia as a _______________ and refer to dementia as “________”

natural result of living a difficult life; “tragic losses”

Other Hispanic caregivers have ___ beliefs related to the cause and prognosis of dementia. Dementia-based behaviors such as wandering away or hallucinating may be perceived as ________ to the community and will bring _____ to the family.

folk; embarrassing; shame

Mahoney and colleagues (2005) report the phrase “____” for craziness is often used since dementia is commonly considered a ______ illness rather than a ______ disease

“el loco”; mental; physical

While beliefs between groups of families may differ, studies have found that most people within the Hispanic culture also adhere strongly to __________ (Castro, et al., 1984). A combination of cultural beliefs and values with westernized medical interpretations concerning dementia indicates a ____________.

medical interpretations; complex belief system

Healthcare professionals should be aware and supportive of _________ to facilitate successful implementation of treatment goals

cultural beliefs

• The role of caregivers also _____ between cultures.

• Many caregivers and family members may refrain from upsetting the person with dementia until _________, such as ________ occur.

• Gallagher-Thompson and colleagues (2003) report another reason caregivers have been reluctant to seek out services is due to the ________ of dementia among some _______ and _____ families.

• Barriers such as limited access to available _______ (e.g., day care programs and support groups) and very limited availability of __________________ may hinder Hispanic and Latino caregivers from seeking treatment outside the community.

• varies

• safety concerns; wandering incidents

• social stigma; Hispanic and Latino

• resources; trained bilingual and bicultural health care providers

There is a strong cultural aversion to nursing homes or institutional care facilities

Hispanic and Latino families

supporting a person with dementia is considered a family obligation until death

hispanic and latino cultures

the Spanish word ________ refers to the importance and value of the family unit over the individual, in which reliance for support is on __________ and ______ family members

familismo; immediate and extended

People have reported that they, “fear that their children will forget their ________ of caregiving and adopt what they believed to be the ________ of institutionalizing elders...”

cultural traditions; American way

hispanic and latino culture

Dementia is viewed as a mental illness to which culturally related stigma is attached

chinese and hispanic culture

may purposely hide the problems associated with dementia to avoid community awareness

chinese and hispanic culture

report delaying or avoiding obtaining professional help independently

some Chinese Americans

Research points to the cultural value of filial piety as influencing the role of caregivers

in Chinese culture

According to this _________, parents provide love and respect to their children. In return, there is an expectation that members of the family should respect and take care of their elders physically, financially, and socially to maintain harmony in the family system

bidirectional value; chinese culture

chinese american caregivers bring their parents to the United States to care for them, and may view _______ and _________ conditions as the _______ cause of dementia

immigration and stressful environmental; subsequent

in chinese families, who should act as the primary caregivers for aging parents, regardless of the type of illness?

the first-born son and his wife

Other report that the expectation to display _____ exists for all children in the Chinese culture family

filial piety

In your classes you have learned that dysarthria is a _________ that results in impairment to the motor execution of speech. This impairment often is a result of damage to the ______ and/or ____

neurogenic motor speech disorder; CNS and/or PNS

__ types of dysarthria have been identified based on their neural etiology and site of lesion or damage. Each type is associated with damage to a specific neuroanatomical location, which leads to a variety of impairments in fine and gross motor/muscle control and movement execution. Each type of dysarthria can affect a person's speech in terms of strength, speed, range, tone or accuracy of movement, and may affect respiration, phonation, resonance, articulation, & prosody

7

hwo many studies exist regarding the universal characteristics of dysarthria?

very few studies

there are a few studies from other languages that show commonalities across different types of dysarthria in comparison to English

• Cross sectional study examined the speech of 66 Bengali speakers with dysarthria

• Looked specifically at how the patients' dysarthria affected speech across the domains of ______, ______, _______, ______, and ______

• The authors analyzed speech using perceptual analysis of a nine-sentence conversationally read text that included all Bengali ______ and _________

• The study found that much like in English studies pertaining to dysarthria, the presence of __________ were one of the most prominent speech irregularities occurring across patients – impacting intelligibility of overall speech.

• respiration, phonation, articulation, resonance and prosody.

• consonant and vowel phonemes

• imprecise consonants

• The author details four studies regarding the dysarthria of ______ or ______ speakers with _____.

• Across the studies, patients were found to have several ___________ similar to English speaking patients with Cerebral Palsy.

• In terms of segmental and tonal errors, similar to English speakers Cantonese speakers showed the most impaired accuracy in __________, followed by ________ and ______, resulting from difficulties with articulatory, velopharyngeal and laryngeal control (articulation, resonance and phonation).

• These similarities were also seen with Cantonese speakers in terms of ____________

• Also similar to studies of English speakers, Mandarin speakers with dysarthria had difficulties in controlling the ______ and ________ of their articulators.

• Cantonese or Mandarin speakers with Cerebral Palsy

• dysarthric manifestations

• initial consonants; final consonants and vowels

• single word intelligibility.

• timing and spatial control

Why is learning about these universal characteristics of dysarthria important?

• Mandarin and Cantonese are _____ languages, does is surprise you that there are still ____________ to English is terms of the speech characteristics of those with dysarthria?

• Research in the field is beginning to look at the effect of dialect in the perception of speech intelligibility. For example, in a dissertation study Stallworth (2012) explored whether or not dialectical differences in the dysarthric speech of African American and Caucasian Americans affected the perception of intelligibility and comprehensibility. The study found that ________ tended to give _________ to speakers of their own ethnicity

• tonal; many similarities

• perceptual raters; higher ratings

Western culture approaches treatment through a ________ that makes implicit assumptions that disability is a ________ and ______ phenomenon that is _____ and requires ______.

medical model; physical and individual; chronic; fixing

do all cultures view dysphagia through the medical model?

no

This can cause miscommunications in the diagnosis and treatment of dysphagia

Some cultures, such as within Vietnam and Mexico, view disease as a _______ and _____ phenomenon that is _______ and must be ______

spiritual and group; time-limited; accepted

potential assumptions that the SLP may bring to their patient

• That the foods used in clinical evaluation and treatment resembles the patient's normal food preferences.

  • Vanilla pudding, graham crackers

• That patients and their families will understand and follow diet texture changes.

• Patients will give up foods they are familiar with and enjoy in order to be able to swallow safely.

• Patients will understand texture descriptions like "pudding," "nectar," "puree" and be able to apply it to their own cultural foods.

• That people prefer to eat with a spoon or fork and drink with a straw.

common barriers in treatment of dysphagia with CLD populations

• Cultural differences between patient and healthcare provider.

• Lack of access to familiar foods, or inability to adapt familiar foods to required consistency.

• Differences in vocabulary and naming of foods and textures (i.e. different interpretations of “custard”).

• Changes in look and consistency of food.

• Changes in smell and taste.

• Uncomfortable/unfamiliar with using certain utensils for eating (i.e. fork vs. hand vs. chopsticks).

cultural considerations in dysphagia:

For some families, food can be an expression of caring and connecting

USA

cultural considerations in dysphagia:

Patients with dysphagia may experience grief around changes in eating, loss of appetite, and lack of interest in food.

USA

cultural considerations in dysphagia:

This can take the form of loss of social connection, as many activities may involve food, and may create conflict within a family if the main avenue of caring for someone is through food

USA

cultural considerations in dysphagia:

typically eat three meals a day: breakfast, lunch and dinner. Snacking throughout the day and dessert can also be standard

USA

cultural considerations in dysphagia:

Historically, _______ has institutionalized people with disabilities. This is a practice that is slowly changing but is still a challenge in _______ as accessibility to services is a major barrier

Russia

cultural considerations in dysphagia:

Culturally, _______ are great hosts and love entertaining guests in their homes. They will set out more food for guests than can be eaten. Food is an important part of ____ culture and is important part of their everyday interactions with others

Russian

cultural considerations in dysphagia:

Generally three meals, breakfast, lunch and dinner, are eaten a day.

Russian

cultural considerations in dysphagia:

The ______ diet is influenced by the ingredients available in the region and by the many ethnic groups that make up it’s population. The diet is also influenced by the cold climate.

Russian

cultural considerations in dysphagia:

Liquids (thin, may be thickened as needed): tea, coffee, kefir, kvass (fermented bread beverage made from black or regular rye bread), broth without chunks of meat or vegetable

Russian

cultural considerations in dysphagia:

Purees (pureed, homogenous, and cohesive foods; should be pudding like with no coarse textures): Ryazhenka (a slightly soured milk, more yogurt consistency), yogurt, puree soup, mashed potatoes

Russian

cultural considerations in dysphagia:

Mechanical soft (moist soft textured foods with some cohesion): Goulash or other stews with soft meats and vegetables, soft fish, tvorog (a cottage cheese), ice cream, pelmeni (dumpling)

Russian

cultural considerations in dysphagia:

Regular (patient’s normal diet with no restrictions): kasha (cereal) , fish, chicken, borscht (beet soup), blini (type of pancake), piroshki (stuffed fried bun).

Russian

cultural considerations in dysphagia:

Eating is a social event, involving all family members. In most homes, especially in rural areas, cooking is done at home using local ingredients

Mexican

cultural considerations in dysphagia:

Cooking is often seen as women's work and traditionally girls were considered ready to marry when they were able to cook

Mexican

cultural considerations in dysphagia:

Food is an integral part of all traditional celebrations

mexican

cultural considerations in dysphagia:

Meals and dishes prepared for these celebrations are elaborate and often very time consuming.

mexican

cultural considerations in dysphagia

There are tradionally three main meals a day and a snack in the later morning

mexican

Liquids (thin, may be thickened as needed): water, coffee, horchata (a milky drink made from rice, tiger nuts or almonds), soft drinks, milk

Mexican

Purees (pureed, homogenous, and cohesive foods; should be pudding like with no coarse textures): blended fruit drinks, flan, smooth porridges, avocado

mexican

Mechanical soft (moist soft textured foods with some cohesion): enchiladas, burritos with sauce, tamales with mushy filling, beans, sweet potatoes, soft fish, mango, pineapple

mexican

Regular (patient’s normal diet with no restrictions): tacos, tortillas, burritos, tamales, meats, salads, sweet rolls, pastries

mexican

clinical implications in dysphagia:

• Brainstorm with family members and patients _________________________________ (i.e. invite someone to look at photo album/memorabilia, watch a movie, chat and play a board game or cards, go outside to a park, fishing, wood working).

• Brainstorm ideas with patient and family members for ____________________to bring to hosts or that friends/family can bring to the patient.

• Take into consideration how __________ may be viewed by the patient and their family.

• For example, purees may be viewed as _____ and ______

• Take into consideration the ____ and ____ needed to implement _______ strategies. Meals times may be ____ and eating _____ and the patient may feel __________about using __________ strategies in social

  situations.

• Consider the patient’s _______ needs, _____, and _______ when making recommendations.

• Be aware that there may be certain cultural traditions about ___ eats ____ and ________.

• Remember that the patient might not have _________ to assist with follow through of treatment.

• Patient and family may not _______ what dysphagia is or _________ your recommendations or the risks of eating.

• Patient and family might do an __________ and determine that they know what is best for them and disregard your advice. – this is not unique to dysphagia

• alternative ways for them to show “caring” that do not involve food (i.e. invite someone to look at photo album/memorabilia, watch a movie, chat and play a board game or cards, go outside to a park, fishing, wood working).

• non-food gifts

• diet modification

• baby food and demeaning.

• time and energy; compensatory strategies; longer; slower; self-conscious; compensatory

• nutritional needs, safety, and food culture

• who eats when and with whom.

• family nearby

• understand

• internet search