Interpreters

7.14 Where the speech pathologist is not proficient in a language of the person with aphasia, a trained and qualified interpreter, knowledgeable with the specific requirements for speech pathology, should be used.

Reference: Babbitt et al., 2022: Qualitative study; Brisset et al., 2013: Systematic review of 61 qualitative studies; Flores, 2005: Systematic review of 36 studies; Huang et al., 2019: Systematic review of 10 studies (5 single-case reports, 4  surveys, 1 single-case qualitative study); Kambanaros & Van Steenbrugge, 2004: Case study; Karliner et al., 2007: Systematic review of 28 studies (4 qualitative, 24 quantitative); Larkman et al., 2023: Scoping review of 20 studies (10 descriptive papers, 8 surveys, 2 interview studies); Roger & Code, 2011: Qualitative study; Siyambalapitiya & Davidson, 2015: Discussion paper.

NHMRC level of Evidence: Qual

Rationale: The use of trained and qualified interpreters improves quality of clinical care, reduces communication errors, and increases patient satisfaction (Flores, 2005; Karliner et al., 2007), and  should be considered essential when the speech pathologist and the person with aphasia do not speak the same language (Larkman et al., 2023).

Trained and qualified interpreters may not have specific knowledge or training regarding aphasia and speech pathology assessment and treatment procedures. Speech pathologists should share their professional knowledge with the interpreter, specifically about the way in which a person’s aphasia may affect typical language use. This information is essential for valid diagnosis and treatment (Kambanaros & Van Steenbrugge, 2004; Roger & Code, 2011). Pre- and post-session briefings may therefore facilitate aphasia sessions with an interpreter (Huang et al., 2019; Larkman et al., 2023).

Speech pathologists should also educate themselves on the role and practices of interpreters, and be aware that working with people with aphasia is fundamentally different from how interpreters usually work. For example, interpreters often ask clarifying questions, which may result in prompting or cueing during aphasia assessment. They are also trained to convey meaning rather than linguistic/grammatical form, and so may require specific instruction about the type of information needed by the speech pathologist (e.g., language errors made; Babbitt et al., 2022; Roger & Code, 2011). Aphasia assessment, treatment, and education is likely to require more time in this cohort, due to time needed to establish rapport, to liaise with interpreters, to create informal assessment and therapy resources, and for clinical reasoning (Siyambalapitiya & Davidson, 2015). 

The use of untrained or unqualified interpreters such as family members or other employees of the organisation (e.g., healthcare or other staff) raises ethical issues of privacy and confidentiality and may compromise the autonomy of the person with aphasia (Brisset et al., 2013). However, the person with aphasia’s choice and preference for the use of family or friends as interpreters must always be considered. Please refer to statement 7.7 for more information about working with interpreters for Aboriginal and Torres Strait Islander clients.

References:

1. Babbitt, E. M., Ginsberg-Jaeckle, M., Larkin, E., Escarcega, S., & Cherney, L. R. (2022). Classifying Interpreter Behaviors During Aphasia Assessments: Survey Results and Checklist Development. American Journal of Speech-Language Pathology, 31(5S), 2329–2347. https://doi.org/10.1044/2022_AJSLP-21-00306
2. Brisset, C., Leanza, Y., & Laforest, K. (2013). Working with interpreters in health care: a systematic review and meta-ethnography of qualitative studies. Patient education and counseling, 91(2). doi: 10.1016/j.pec.2012.11.008
3. Flores, G. (2005). The impact of medical interpreter services on the quality of health care: a systematic review. Medical Care Research and Review, 62(3), 255-299. doi: 10.1177/1077558705275416
4. Huang, J.R., Siyambalapitiya, S., & Cornwell, P. (2019). Speech pathologists and professional interpreters managing culturally and linguistically diverse adults with communication disorders: A systematic review. International Journal of Language and Communication Disorders, 54(5), 689-704. DOI: 10.1111/1460-6984.12475
5. Kambanaros, M., & van Steenbrugge, W. (2004). Interpreters and language assessment: confrontation naming and interpreting. Advances in Speech Language Pathology, 6(4), 247-252.
6. Larkman, C.S., Mellahn, K., Han, W., & Rose, M.L. (2023). Aphasia rehabilitation when speech pathologists and clients do not share the same language: A scoping review. Aphasiology, 37(4), 635-657, DOI: 10.1080/02687038.2022.2035672
7. Karliner, L. S., Jacobs, E. A., Chen, A. H., & Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research, 42(2), 727-754. doi: 10.1111/j.1475-6773.2006.00629.x
8. Roger, P., & Code, C. (2011). Lost in translation? Issues of content validity in interpreter-mediated aphasia assessments. International Journal of  Speech-language Pathology, 13(1), 61-73. doi: doi:10.3109/17549507.2011.549241
9. Siyambalapitiya, S. & Davidson, B. (2015). Managing aphasia in bilingual and culturally and linguistically diverse individuals in an Australian context: Challenges and future directions. Journal of Clinical Practice in Speech-Language Pathology, 17(11).