Missing voices: Profile and extent of acquired communication disorders in Aboriginal and non-Aboriginal adult stroke survivors in Western Australia using linked administrative records

Abstract

The relative youth, geographical distribution, high comorbidity prevalence, and cultural needs of Aboriginal stroke patients with acquired communication disorder should inform appropriate service design for speech pathology and rehabilitation. Innovative models are required to address workforce issues, given low patient volumes.

“You felt like a prisoner in your own self, trapped”: the experiences of Aboriginal people with acquired communication disorders

“…Forty percent of Aboriginal people in WA live in metropolitan Perth, while approximately 38% live in remote or very remote communities, as defined by the Accessibility/Remoteness Index of Australia-Plus [28]. Our recent work [29] has revealed that 56.4% of Aboriginal people who have suffered traumatic brain injury live in remote or very remote areas, compared to 10.6% of the non-Aboriginal population. Rehabilitation services are largely centred in the Perth metropolitan area, with many people flown thousands of miles to Perth from rural and remote communities after their brain injury.…”

“…Aboriginal Australians are known to suffer acquired brain damage as a result of stroke or traumatic brain injury (TBI) at higher rates than non-Aboriginal Australians [1,2,3,4,5] and yet representation of Aboriginal people in ongoing brain injury rehabilitation services is low [6,7,8]. To date, little is known about Aboriginal peoples' ongoing experiences of the effects of brain injury on their own and their family's life.…”

General practitioners’ perceptions of their communication with Australian Aboriginal patients with acquired neurogenic communication disorders

“…Traumatic brain injury (TBI) is also found at much higher rates, particularly in association with assault [2,3]. Approximately a third of people following stroke and TBI have some level of persisting acquired communication disorder (ACD) [4,5]: aphasia (a disorder of language understanding and/or expression); dysarthria (speech disorder, often causing slowness and slurring); dyspraxia (problems with motor planning for speech); and cognitive communication disorder (difficulties with aspects of social communication, discourse and pragmatic skills, attention, memory, and executive functioning). In the clinical setting, an ACD can make it difficult for patients to contribute to decisions and can leave them in a disempowered position in health care encounters [6][7][8].…”

“…There are often multiple issues related to management of particular health conditions, (for example, the monitoring of blood sugar levels in diabetes, or the taking of medications), alongside concerns about psychosocial status, ability to undertake activities of daily living, long term recovery goals and quality of life [26][27][28][29]. In addition, histories of multiple strokes or head injuries, as well as complex pre-existing co-morbidities, are common [2]. For all these reasons, it is important to understand how GPs view their communication with Aboriginal patients with ACD, their ability to judge what these patients want, and to support their patients' involvement in health care decision-making.…”

Indigenous stroke care: differences, challenges and a need for change

“…Indigenous peoples internationally experience stroke at a higher rate and at a younger age than non‐indigenous peoples, yet relatively little is known about treatments in the acute stages post‐stroke, access to rehabilitation services or long‐term outcomes. European colonisation severely impacted indigenous cultural practices, identity and overall health of communities leaving large inequities between indigenous and non‐indigenous populations .…”