Multilingual Patients Research Articles

A - 147 Patient-Centric Considerations for Selecting the Language of Procedure Administration in Candidates for Epilepsy Surgery: Implications for Data Interpretation, Prognostication and Outcomes

Abstract Objective Selecting the language of pre-surgical neuropsychological testing (NPT), intracarotid amobarbital procedure, and intra/extra functional language mapping (ESM) in bi−/multi-lingual patients is a high-stakes neuropsychological decision point. Though a patient’s self-selection of language is an integral consideration, both patient and provider must fully understand the potential implications of language selection on a patient’s data interpretation and overall case conceptualization. Method A 26-year-old, right-handed, bilingual (L1 = Mandarin-, L2 = English-speaking) female received pre-operative NPT, Wada test, and ESM to guide resective surgery targeting medically-refractory epilepsy involving the right superior temporal gyrus (STG) and mesial (MTL) temporal lobe. All procedures were conducted in English at the patient’s request with alternate forms of verbally-mediated NPT administered in Mandarin. Results Confrontation naming and verbal fluencies were impaired in both English and Mandarin. Wada testing administered in English revealed bilateral language and greater left hemisphere memory support. Following considerable psychoeducation regarding possible functional language loss in Mandarin post-operatively, the patient agreed to ESM in L1 with auditory and picture naming disruption after right STG stimulation. Conclusion Despite strong English-language fluency, assessment in Mandarin was of critical importance, as eloquent cortices essential for tonal language production may have been resected if mapping procedures were completed in English-only, as requested. Balancing factors informed by functional and structural neuroanatomy, patient worldview, and cross-cultural neuropsychology requires a tailored, patient-centric approach to case conceptualization.

Awake surgery in neurooncology. Part 2. Functional intraoperative mapping

Awake surgery is usually used to save patient’s speech. Various tests are applied for this purpose, whish selection depends on tumor location. In multilingual patients verbal centers usually have different position. Location of each of them is necessary to keep patient’s communication capabilities after operation.To study vision, tests with presentations of color points or pictures on the screen divided on 4 parts are used. Such testing allows to estimate vision and speech simultaneously.Mapping of motor area in awake patients allows to evaluate this function more comprehensively including motion planning, proprioceptive control and balance. Stimulation of sensory area in awake patients gives opportunity to differ various types of sensitivity.Mapping and keeping of cognitive functions, memory, attention and ability of calculation increases chance to save professional skills and quality of life after operation.

Supporting multilingual children with language impairment in a multilingual environment: experience and perspectives from speech and language therapists in Switzerland

ABSTRACT This work reports the results of a survey study conducted with French-, German-, and Italian-speaking speech and language therapists (SLTs) in Switzerland. In this survey we asked respondents about their language background, training in multilingual matters, and practices with multilingual patients, as well as their opinions on the current SLT provisions for multilingual children in Switzerland. The main results showed that despite high levels of SLT multilingualism in Switzerland, there is often a mismatch between the additional languages spoken by the SLTs and the heritage languages spoken by their patients. To circumvent the challenges of assessing a multilingual child, SLTs across Switzerland reported using a variety of assessment tools and methods, although therapeutic options are still missing. The results also revealed some differences based on linguistic region, with SLTs working in French-speaking region having the highest number of multilingual caseloads but those working in the German-speaking region receiving the most training on multilingualism. Conclusions drawn are that across Switzerland there is still a need for SLTs to be better trained to work with multilingual children and for suitable tools for assessing and especially treating multilingual patients to be developed. Full results are reported and discussed.

Distressing Discussions in Pediatric Interpreted Medical Encounters: A Qualitative Study of Medical Interpreter Perspectives on Clinician Communication Practices

This study explores pediatric medical interpreters' perspectives on clinician communication practices in medical encounters characterized by distressing content and difficult discussions. In this interpretative phenomenological analysis, 13 Spanish-English interpreters at a midwestern pediatric hospital were purposively recruited and, in 2021-2022, completed a demographic survey and semistructured interview on communication in distressing interpreted medical encounters. Participants described clinician practices for effective cross-cultural interpreted communication. Practices align with recommendations on prebriefing, debriefing, jargon, stakeholder positioning, and teamwork. Novel findings relate to encounters with multiple parties, multilingual patients with monolingual parents, and coordination among clinicians. Findings corroborate recommendations for interpreted communication best practices, extend them to distressing pediatric encounters, and offer recommendations for clinicians using interpreting services in distressing encounters. Participants' insights are distilled into a series of clinician best practices for high-quality interpreted communication during difficult discussions and for strengthening language access services in pediatric medical settings.

A Qualitative Study to Explore the Perception regarding Challenges and Prospects of Empowerment among Nursing Students in a Selected College of Tamil Nadu

Empowerment of nursing students is vital in ensuring positive prospect towards future nursing domain. Empowering nurses early in their learning era ensures building of a competent, knowledgeable, confident nurses pool with excellent decision-making, critical-thinking and problem-solving skills. Descriptive qualitative research was undertaken among BSc and Diploma nursing students to explore their perception regarding challenges and prospects of empowerment. A focus group discussion was conducted for students selected through purposive sampling technique. Audio-recording of the discussion occurred after participants’ informed consent was obtained. The audio-recorded data was transcribed verbatim and analysed using Braun and Clark’s thematic analysis. Interview notes were also used to gain further insights. The data revealed that nursing students' empowerment is hindered by educational, academic, experiential learning and clinical setting. Perception of empowerment varied among the students. Multilingual patients and prodigious patient load are an asset as well as a liability. Short staffing in hospital ward hinders efficiency, thereby precluding opportunities to disseminate knowledge regarding advanced clinical procedures and practices. Self-motivation, initiation to achieve knowledge, and awareness about facilities available play a huge role in nurses’ empowerment.

Silent EEG classification using cross-fusion adaptive graph convolution network for multilingual neurolinguistic signal decoding

Brain–computer interface (BCI) based multilingual silent reading electroencephalography (EEG) decoding technology provides a convenient and fast communication method for multilingual patients with language disorders. Developing a silent reading EEG signals decoding method that can be applied to multiple languages, it is necessary not only to select the appropriate feature channels for each language but also to distinguish the spatial and temporal relationships between each channel. The existing graph convolution network that learns the characteristics and connections of each node on a fixed graph is inadequate to capture both the temporal and spatial relationships between each channel. Therefore, we use a feature matrix and its adaptive graph to represent each EEG signal and propose a Cross-fusion Adaptive Graph Convolution Network (CFA-GCN) for decoding. We collect novel EEG signal datasets of a subject who silently read 7 Chinese and 9 English words over 26 days, which can be used for further research and development of BCI systems. The proposed method achieves state-of-the-art performance with 45.30% and 47.62% decoding accuracy for silent reading EEG signals of English and Chinese words, respectively. This work demonstrates the feasibility of decoding silent reading EEG signals from bilingual words. The CFA-GCN demonstrates the potential of utilizing Brain–computer Interface (BCI) systems to facilitate effective communication for patients with multilingual impairments.

Improving Access to Medical Information for Multilingual Patients using Pipelined Ensemble Average based Machine Translation

Machine translation has shown potential in improving access to medical information and healthcare services for multilingual patients. This research aims to enhance machine translation accuracy in the medical field, specifically for translating from Hindi to English. The study introduces a new approach that dynamically allocates decoding parameters using regression models, overcoming the limitations of fixed parameters in the decoder. A comprehensive dataset is created to address limited data availability, enabling regression models to predict optimal pruning parameters. The main motivation for the study is the introduction of a regression method for optimizing pruning parameters, which is a novel approach in this context. The proposed approach outperforms existing methods, achieving improved translation accuracy. Standard metrics such as the BLEU score are used to evaluate translations. Ensemble average and pipeline approaches further enhance performance. The improved performance of the proposed models can be attributed to the ensemble of diverse models (Extra Trees, LightGBM, XGBoost, and Random Forest) that employ various techniques to reduce overfitting, enhance prediction accuracy, and improve translation by correcting prediction errors. The study contributes to facilitating the translation and sharing of medical literature, promoting collaboration and knowledge exchange across languages. The research demonstrates the effectiveness of the regression method for optimizing pruning parameters in machine translation, leading to improved translation accuracy in the medical field. The proposed models offer promising results, paving the way for enhanced machine translation systems and promoting collaboration and knowledge exchange in the medical domain. The source code is available at https://huggingface.co/debajyoty/statistical-regression-Based-MT/tree/main/Statistical-Regression-SMT.

Validity and Reliability of the Turkish Version of the Spirituality Instrument-27 (SpI-27©).

Introduction: This methodological study aimed to adapt the Spirituality Instrument-27 (SpI-27©) to the Turkish language and culture. Design: The psychometric study was carried out with 267 individuals who were hospitalized in the cardiology clinic and who were diagnosed with a chronic disease. Data collection tools were the demographic questionnaire and the SpI-27©. The Statistical Package for Social Sciences was used for data analysis and confirmatory factor analysis. Results: The Kaiser-Meyer-Olkin index was 0.848 and Bartlett's test of sphericity was statistically significant (p = 0.000). The root mean square error of approximation was 0.05, the standardized root mean squared residual was 0.04, the adjusted goodness-of-fit index was 0.87, the goodness-of-fit index was 0.92, the nonformed fit index was 0.91, and the comparative fit index was 0.90. Connectedness with others accounted for 38.24 of the total variance, self-transcendence accounted for 11.71, self-cognizance accounted for 10.56, and conservationism and belief accounted for 9.82 of the total variance (total variance was 70.34%). The highest item factor loading of the scale was 0.812 and the lowest one was 0.398. Cronbach's alpha coefficient of the scale was 0.927. Conclusion: This measurement tool will enable researchers to plan and implement nursing interventions accurately and effectively by assessing the spiritual needs of individuals with nonmalignant chronic diseases. The use of this tool in different languages can help diagnose the spiritual needs of nurses working with multicultural and multilingual patients.

Does Functional Imaging Play a Role in Pre-Operative Diagnosis of Brain Tumours?

Although there is a large variability in the neural organization of language function between individuals, there is an ongoing debate about functional imaging as a standard procedure in the preoperative setting of brain tumors. Brain mapping of the language centers differs from individual to individual in multilingual patients and changes in its architecture may occur as a result of neuroplasticity induced by a mass lesion. This article discusses the role of functional imaging in the preoperative setting.

Intraoperative Testing During the Mapping of the Language Cortex.

Intracranial lesions, particularly in the language-eloquent areas of the brain, can affect one's speaking ability. Despite advances in surgery, the excision of these lesions can be challenging. Intraoperative neurophysiological monitoring (IONM) during awake craniotomies can help identify language-eloquent areas and minimize postoperative impairments. Preoperative language testing is performed to establish a baseline before intraoperative language testing. This involves subjecting patients to predetermined tasks in the operating room to evaluate their phonological, semantic, and syntactic capabilities. The current state and future directions of intraoperative language testing procedures are discussed in this paper. The most common intraoperative tasks are counting and picture naming. However, some experts recommend utilizing more nuanced tasks that involve regions affected by infrequently occurring tumor patterns. Low-frequency bipolar Penfield stimulation is optimal for language mapping. Exception cases are discussed where awake craniotomies are not feasible. When dealing with multilingual patients, the patient's age of learning and skill level can be accounted for in terms of making informed task choices and mapping techniques to avoid any damage to language areas.

Functional differences in brain networks involved in language processing and control: evidence from awake brain mapping in multilingual patients

Functional differences in brain networks involved in language processing and control: evidence from awake brain mapping in multilingual patients

Intraoperative Brain Mapping in Multilingual Patients: What Do We Know and Where Are We Going?

In this review, we evaluate the knowledge gained so far about the neural bases of multilingual language processing obtained mainly through imaging and electrical stimulation mapping (ESM). We attempt to answer some key questions about multilingualism in the light of recent literature evidence, such as the degree of anatomical–functional integration of two or more languages in a multilingual brain, how the age of L2-acquisition affects language organization in the human brain, or how the brain controls more than one language. Finally, we highlight the future trends in multilingual language mapping.

Satisfaction can co-exist with hesitation: qualitative analysis of acceptability of telemedicine among multi-lingual patients in a safety-net healthcare system during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic triggered unprecedented expansion of outpatient telemedicine in the United States in all types of health systems, including safety-net health systems. These systems generally serve low-income, racially/ethnically/linguistically diverse patients, many of whom face barriers to digital health access. These patients’ perspectives are vital to inform ongoing, equitable implementation efforts.MethodsTwenty-five semi-structured interviews exploring a theoretical framework of technology acceptability were conducted from March through July 2020. Participants had preferred languages of English, Spanish, or Cantonese and were recruited from three clinics (general medicine, obstetrics, and pulmonary) within the San Francisco Health Network. Both deductive and inductive coding were performed. In a secondary analysis, qualitative data were merged with survey data to relate perspectives to demographic factors and technology access/use.ResultsParticipants were diverse with respect to language (52% non-English-speaking), age (range 23-71), race/ethnicity (24% Asian, 20% Black, 44% Hispanic/Latinx, 12% White), & smartphone use (80% daily, 20% weekly or less). All but 2 had a recent telemedicine visit (83% telephone). Qualitative results revealed that most participants felt telemedicine visits fulfilled their medical needs, were convenient, and were satisfied with their telemedicine care. However, most still preferred in-person visits, expressing concern that tele-visits relied on patients’ abilities to access telemedicine, as well as monitor and manage their own health without in-person physical evaluation.ConclusionsHigh satisfaction with telemedicine can co-exist with patient-expressed hesitations surrounding the perceived effectiveness, self-efficacy, and digital access barriers associated with a new model of care. More research is needed to guide how healthcare systems and clinicians make decisions and communicate about visit modalities to support high-quality care that responds to patients’ needs and circumstances.

Language Assessment in Multilingualism and Awake Neurosurgery.

Multilingualism has become a worldwide phenomenon that poses critical issues about the language assessment in patients undergoing awake neurosurgery in eloquent brain areas. The accuracy and sensitivity of multilingual perioperative language assessment procedures is crucial for a number of reasons: they should be appropriate to detect deficits in each of the languages spoken by the patient; they should be suitable to identify language-specific cortical regions; they should ensure that each of the languages of a multilingual patient is tested at an adequate and comparable level of difficulty. In clinical practice, a patient-tailored approach is generally preferred. This is a necessary compromise since it is impossible to predict all the possible language combinations spoken by individuals and thus the availability of standardized testing batteries is a potentially unattainable goal. On the other hand, this leads to high inconsistency in how different neurosurgical teams manage the linguistic features that determine similarity or distance between the languages spoken by the patient and that may constrain the neuroanatomical substrate of each language. The manuscript reviews the perioperative language assessment methodologies adopted in awake surgery studies on multilingual patients with brain tumor published from 1991 to 2021 and addresses the following issues: (1) The language selected for the general neuropsychological assessment of the patient. (2) The procedures adopted to assess the dimensions that may constrain language organization in multilingual speakers: age and type of acquisition, exposure, proficiency, and use of the different languages. (3) The type of preoperative language assessment used for all the languages spoken by the patient. (4) The linguistic tasks selected in the intraoperative setting. The reviewed data show a great heterogeneity in the perioperative clinical workup with multilingual patients. The only exception is the task used during language mapping, as the picture naming task is highly preferred. The review highlights that an objective and accurate description of both the linguistic profile of multilingual patients and the specific properties of the languages under scrutiny can profitably support clinical management and decision making in multilingual awake neurosurgery settings.

Intra-operative mapping and language protection in glioma.

The demand for acquiring different languages has increased with increasing globalization. However, knowledge of the modification of the new language in the neural language network remains insufficient. Although many details of language function have been detected based on the awake intra-operative mapping results, the language neural network of the bilingual or multilingual remains unclear, which raises difficulties in clinical practice to preserve patients’ full language ability in neurosurgery. In this review, we present a summary of the current findings regarding the structure of the language network and its evolution as the number of acquired languages increased in glioma patients. We then discuss a new insight into the awake intra-operative mapping protocol to reduce surgical risks during the preservation of language function in multilingual patients with glioma.

Electrical Stimulation Mapping of Multilingualism

Language mapping is commonly practiced in brain tumors and epilepsy surgeries. It is done by direct electrical stimulation of the brain during awake craniotomy or by placing subdural electrodes on the brain's surface, or both. Studies of the language mapping in bi- or multi-lingual patients have concluded that they have both "language-specific areas," in which symptoms are evoked upon stimulation in one specific language and not in the other languages, and "common areas" or "overlapping areas," in which positive findings are evoked in all languages evaluated. The distribution of the pattern of language areas associated with each language, however, varies widely from patient to patient due to multiple factors such as the age of language acquisition, the language proficiency level, the amount of exposure to each language, the location of the lesions, the duration of the diseases, and other factors. Language mapping in bi- or multi-lingual patients should be done by screening all languages the patient speaks.

Abstract PO-012: Acceptance and refusal among multi-lingual safety net patients to participate in a trial comparing genetic counseling delivery modes

Abstract Introduction While still low, diversity among clinical trial participants has improved in recent years due to efforts to eliminate health disparities. Here we present and endeavor to explain participation rates in our multicenter partially randomized preference noninferiority trial comparing the effectiveness of phone, video, and in person genetic counseling among high-risk English-, Spanish-, and Chinese-speaking patients. Methods High-risk patients were identified using a family history screener in clinics and via physician referrals. After reviewing forms received, bilingual/bicultural clinical research coordinators (CRC) called patients considered eligible in their preferred language (English, Spanish or Cantonese, Mandarin or Toisanese). Patients were informed that their hospital was conducting the study in conjunction with an academic institution. The CRC went over each patient’s family history of cancer to confirm eligibility and to explain the study components, including free genetic counseling. Because previous research had significant refusals due to patients’ preferences for a single mode, our consented patients were asked if they would accept random assignment to phone, video, or in person counseling or if they had a strong preference. Patients who declined were asked their reasons. Results Out of 1,403 patients reached (70% English-, 26% Spanish-, and 3% Chinese- speaking), 86% agreed to participate. The highest acceptance rate was among Spanish-speakers (94%), followed by English-speakers (83%) and Chinese-speakers (67%). Among the 201 patients who declined, 49% did so upon contact, while 51% declined after eligibility was confirmed. Reasons for declining are available for 71% of decliners as follows: 22% not interested; 19% no time; 10% cited no benefit them or family members; 7% did not want to talk about cancer; 7% had too many other medical issues; and 6% provided a range of other reasons. Discussion and Conclusions We believe that our study’s high initial participation rate for patients contacted was due to the purpose which was particularly meaningful to those with a family history of cancer. Also, patients trusted their own hospitals which co- sponsored the study. It was helpful that providers in the 3 public hospitals strongly supported the research which provided much needed genetic counseling and pursued questions important to access to genetic services. Importantly, our study design addressed significant known barriers to minority and low SES participation in clinical trials through the use of bilingual/bicultural investigators, multi-language study materials, and strong, positive working relationships with gatekeeper medical and clinic support staff. Reasons given for declining may indicate the existence of a socio-economic structural ceiling for participation due to patient vulnerabilities and societal burdens, causes outside the investigative scope of our study that are likely to continue to hamper efforts to improve participation if not addressed. Citation Format: Robin Lee, Miya Frick, Celia Kaplan, Galen Joseph, Janice Tsoh, Selina Flores, Niharika Dixit, Heather Cedermaz, Lly Wang, Amal Khoury, Brittany Campbell, Rena Pasick, Claudia S. Guerra, Susan L. Stewart. Acceptance and refusal among multi-lingual safety net patients to participate in a trial comparing genetic counseling delivery modes [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-012.

Beyond basic communication: The role of the mother tongue in cognitive-behavioral therapy (CBT)

Immigration is a crisis-prone, complex process, often involving the need to acquire a new language, frequently at the expense of the mother tongue. Thus, the phenomenon of immigrants requiring various forms of mental health assistance while having limited fluency in the therapist’s language is widespread. Cognitive behavioral therapy (CBT) has become a widely prevalent therapeutic approach in many countries, including countries absorbing immigrants. This article reviews case studies that relate to the use of CBT with immigrants, both in individual and group sessions, focusing on the position of the patient’s mother tongue in the process. Research has persistently shown that the mother tongue is emotionally significant—using it, being exposed to it, expressing emotions and understanding emotions expressed in it, having access to it and to memories encoded in it, and the like. Given these dimensions, it plays a potentially important role in the therapeutic process. The pivotal question, then, is whether a therapeutic process that is essentially emotional can be effective if the mother tongue is not an inherent part of it. This article addresses this issue while examining the mother tongue’s position in CBT, the therapists’ awareness of these issues, the accommodations, if any, made in this regard, the therapists’ point of view, and suggestions for improving the use of CBT with immigrants. It is written to be of relevance to a diverse audience including researchers from varied disciplinary backgrounds, therapists who work with multilingual patients (especially immigrants or members of other minority groups) or are multilingual themselves. Our aims, therefore, are to contribute to the theoretical understanding of the mother tongue’s centrality in emotional processes and to offer some practical recommendations for therapists and training institutions.

Challenges Faced by Bilingual Stroke Survivors in the Healthcare System: Unique Considerations

The experiences of multilingual patients communicating with unilingual healthcare providers have been largely unexplored. The aim of this study was to investigate the experiences of bilingual stroke patients within the Canadian healthcare context. A secondary analysis was completed with data from a multiple case study of the experiences of seven, low-income bilingual Francophone stroke survivors living in a predominately English area. Data included semi-structured interviews, chart reviews and language proficiency assessments. Results demonstrated that bilingual survivors experience unique challenges, including limited French health vocabulary, use of non-standard French, and generally low health literacy levels in both languages. Participants with aphasia often used English and French interchangeably, leading to the potential for miscommunication when providers were not bilingual. The study highlights the importance of having bilingual healthcare providers when bilingual stroke survivors have communication or cognitive limitations.

Striking loss of second language in bilingual patients with semantic dementia.

Studies of bilingual or multilingual patients with neurodegenerative diseases that disrupt language like the primary progressive aphasias (PPA) may contribute valuable information on language organization in the bilingual brain and on the factors affecting language decline. There is limited literature on bilingual PPA and in particular on semantic dementia, a type of PPA with selective loss of semantic memory. We studied the nature and severity of naming and comprehension deficits across languages in bilingual patients with semantic dementia (SD). Sixteen bilingual patients with SD and 34 bilingual age-matched controls were administered the modified Boston Naming Test and components of Cambridge Semantic Battery. The patients' performance on picture naming and word comprehension was compared across languages and with controls. The most proficient language on self-rating was labelled as L1 and less proficient as L2. We observed striking loss of second language (L2) in SD for both receptive and expressive language, even in patients who were premorbidly fluent in their L2. Naming and comprehension in every patient's L2 were impaired relative to both their own first-language (L1) scores and controls' L2 scores. Furthermore, item-specific correct responses in each patient's L2 were a subset of their successes in L1. A striking contrast in performance between two languages in bilingual patients with SD indicates that a bilingual's L2 or less proficient language is more vulnerable to neurodegeneration. Our findings also support a common semantic network in the brain for the different languages of bilinguals.