Parallel recovery in a trilingual speaker: the use of the Bilingual Aphasia Test as a diagnostic complement to the Comprehensive Aphasia Test

Using a translanguaging framework to examine language production in a trilingual person with aphasia

When language abilities in aphasia are assessed in clinical and research settings, the standard practice is to examine each language of a multilingual person separately. But many multilingual individuals, with and without aphasia, mix their languages regularly when they communicate with other speakers who share their languages. We applied a novel approach to scoring language production of a multilingual person with aphasia. Our aim was to discover whether the assessment outcome would differ meaningfully when we count accurate responses in only the target language of the assessment session versus when we apply a translanguaging framework, that is, count all accurate responses, regardless of the language in which they were produced. The participant is a Farsi-German-English speaking woman with chronic moderate aphasia. We examined the participant's performance on two picture-naming tasks, an answering wh-question task, and an elicited narrative task. The results demonstrated that scores in English, the participant's third-learned and least-impaired language did not differ between the two scoring methods. Performance in German, the participant's moderately impaired second language benefited from translanguaging-based scoring across the board. In Farsi, her weakest language post-CVA, the participant's scores were higher under the translanguaging-based scoring approach in some but not all of the tasks. Our findings suggest that whether a translanguaging-based scoring makes a difference in the results obtained depends on relative language abilities and on pragmatic constraints, with additional influence of the linguistic distances between the languages in question.

What Influences Language Impairment in Bilingual Aphasia? A Meta-Analytic Review

Patterns of language impairment in multilingual speakers with post-stroke aphasia are diverse: in some cases the language deficits are parallel, that is, all languages are impaired relatively equally, whereas in other cases deficits are differential, that is, one language is more impaired than the other(s). This diversity stems from the intricate structure of the multilingual language system, which is shaped by a complex interplay of influencing factors, such as age of language acquisition, frequency of language use, premorbid proficiency, and linguistic similarity between one's languages. Previous theoretical reviews and empirical studies shed some light on these factors, however no clear answers have been provided. The goals of this review were to provide a timely update on the increasing number of reported cases in the last decade and to offer a systematic analysis of the potentially influencing variables. One hundred and thirty cases from 65 studies were included in the present systematic review and effect sizes from 119 cases were used in the meta-analysis. Our analysis revealed better performance in L1 compared to L2 in the whole sample of bilingual speakers with post-stroke aphasia. However, the magnitude of this difference was influenced by whether L2 was learned early in childhood or later: those who learned L2 before 7 years of age showed comparable performance in both of their languages contrary to the bilinguals who learned L2 after 7 years of age and showed better performance in L1 compared to L2. These robust findings were moderated mildly by premorbid proficiency and frequency of use. Finally, linguistic similarity did not appear to influence the magnitude of the difference in performance between L1 and L2. Our findings from the early bilingual subgroup were in line with the previous reviews which included mostly balanced early bilinguals performing comparably in both languages. Our findings from the late bilingual subgroup stressed the primacy of L1 and the importance of age of L2 learning. In addition, the evidence from the present review provides support for theories emphasizing the role of premorbid proficiency and language use in language impairment patterns in bilingual aphasia.

Unusual recovery of aphasia in a polyglot Iranian patient after ischemic stroke

INTRODUCTION

Aphasia is a language disorder resulting from a lesion in the cerebral cortex. In this case report, we present a polyglot patient who recovered from aphasia by speaking his newly active learned language.

CASE REPORT

A 69 years old male referred with acute onset right hemiparesis and global aphasia. After imaging, he treated with 75 mg r-TPA (0.9 mg/kg). After the fourth day of hospitalization, he could name some objects and some short phrases but interestingly only in French language (although his mother language was Persian).

DISCUSSION

In our patient, recovery was first in the last learned language and his learning memory was recovered earlier than his native languages. As in our case, we can expect to have different recovery theory that means active learning language could be the first part of recovery in aphasia.

A Computational Account of Bilingual Aphasia Rehabilitation

Current research on bilingual aphasia highlights the paucity in recommendations for optimal rehabilitation for bilingual aphasic patients (Roberts & Kiran, 2007; Edmonds & Kiran, 2006). In this paper, we have developed a computational model to simulate an English-Spanish bilingual language system in which language representations can vary by age of acquisition (AoA) and relative proficiency in the two languages to model individual participants. This model is subsequently lesioned by varying connection strengths between the semantic and phonological networks and retrained based on individual patient demographic information to evaluate whether or not the model's prediction of rehabilitation matched the actual treatment outcome. In most cases the model comes close to the target performance subsequent to language therapy in the language trained, indicating the validity of this model in simulating rehabilitation of naming impairment in bilingual aphasia. Additionally, the amount of cross-language transfer is limited both in the patient performance and in the model's predictions and is dependent on that specific patient's AoA, language exposure and language impairment. It also suggests how well alternative treatment scenarios would have fared, including some cases where the alternative would have done better. Overall, the study suggests how computational modeling could be used in the future to design customized treatment recipes that result in better recovery than is currently possible.