Toward Culturally Responsive Clinical Practice: Intercultural Speech-Language Pathology Services for Acquired Pragmatic Communication Disorders in Traumatic Brain Injury and Right-Hemisphere Damage

PURPOSE: Acquired pragmatic communication disorders following traumatic brain injury and right-hemisphere damage can disrupt patient-provider interactions that are essential for effective health care. This clinical focus article explores how these disorders intersect with sociocultural factors such as race, language access, and health literacy, contributing to disparities in health care engagement and outcomes to offer culturally specific considerations. METHOD: This clinical focus article integrates evidence from neurogenic communication disorders, intercultural pragmatics, and health disparities to inform assessment and intervention considerations for acquired pragmatic communication disorders across diverse cultural communication contexts and structural barriers in health care systems. RESULTS: Impairments in pragmatic communication can affect discourse management, conversational participation, and comprehension, reducing opportunities for shared understanding during clinical encounters. When these impairments intersect with cultural communication differences or limited health literacy, patients may experience greater difficulty navigating health care systems and participating in medical decision making. Current speech-language pathology assessment practices and rehabilitation models often fail to capture these contextual influences on communication. Considerations for speech-language pathology service improvements related to assessment and treatment are offered. CONCLUSIONS: Advancing equitable neurogenic rehabilitation requires integrating intercultural pragmatics and sociocultural perspectives into assessment and treatment. Approaches such as dynamic assessment, holistic assessment, and telehealth offer practical pathways to improve assessment practices for individuals with acquired social communication disorders.