Something old, something borrowed, something new: frameworks to guide cultural adaptations and their documentation in aphasia treatments

Background and Aims: There is a crucial need to improve cultural and linguistic representation in the field of aphasia research and in clinical practice. One way to increase representation in the field of aphasiology is by adapting treatments to the diverse cultures and languages of the world. Adapting existing evidence-based interventions for diverse cultural contexts increases fit, acceptability, engagement, and access to aphasia interventions. However, such adaptations must be approached systematically and with careful documentation of the process. This paper aims to 1) present frameworks that can guide cultural and linguistic adaptations of aphasia treatments (i.e. bottom-up and top-down approaches), and 2) present a framework that can guide the documentation of critical elements that must be considered and reported when adapting aphasia treatments. Methods and Procedures: This discussion paper examines bottom-up and top-down approaches for adapting aphasia treatments to diverse linguistic and cultural contexts. It also introduces a practical framework to support researchers and clinicians in systematically documenting these adaptations. The arguments presented here are based on a critical review of the relevant literature. Illustrative examples are provided to demonstrate how these approaches and the framework can be applied. Outcomes & Results: The approaches and the framework discussed in this paper can help clinicians and researchers adapt evidence-based treatments for aphasia, document their adaptation process, and trace a path for future treatment modifications. This paper could provide much-needed support for increasing aphasia intervention development and research for diverse cultures and languages, thereby increasing access to appropriate interventions for all persons with aphasia and their care partners.