Addressing Health Disparities in Neurorehabilitation: Aphasia Assessment for Spanish-English Bilingual Speakers

Abstract

This study addresses the need for accurate language assessment of Spanish-English bilingual speakers with aphasia. Aphasia is a condition of language impairment due to brain injury (stroke or neurodegeneration), causing challenges in understanding and speaking and impacting brain representations for words (lexicosemantics) or grammar (morphosyntax). There are only normed aphasia diagnostic assessments for monolingual speakers, not bilingual speakers. Since ⅕ of the U.S. population is bilingual, with Spanish-English as the largest proportion, improper diagnosis of bilinguals with aphasia causes a health disparity in neurorehabilitation for Hispanics/Latinos. We test 4 aims to address limitations in current assessments: (1) adequately detect aphasia, (2) detect morphosyntax (grammar) deficits, (3) detect lexicosemantic (words) deficits in Spanish-English speakers with aphasia, and (4) verify if the Quick Aphasia Battery (QAB) will identify those at risk for word level and grammatical level difficulties. Participants were tested on Spanish and English language tasks over Zoom for 5 hours. 115 neurotypical and 18 aphasic speakers’ scores were compared. The mean % accuracy of neurotypical speakers was more than that of aphasic speakers for all three batteries indicating that the assessments are sensitive to the effect of brain injury on language abilities. Aphasic participants’ QAB scores correlated with morphosyntax and lexicosemantic task scores were moderately strong. We will determine cut-off scores for aphasia diagnosis stratified by language proficiency, sensitivity/specificity, item difficulty, and the influence of cognates. We hope to test classification accuracy for bilinguals with primary progressive aphasia and make a computer-based adaptive language assessment in English with equity for bilinguals.