Bilingualism and aphasia

Question 1

Define bilingualism

Answer 1

The use of two or more languages or dialects in their daily lives
- Can also be used to refer to multilingual and polyglots

Question 2

Issues to consider in bilingualism

Answer 2

• Most bilingual people have unequal proficiency
• May differ according to modality (written vs verbal), linguistic components (semantics vs syntax vs morphology, vs phonology),
• Complementary principle: each language used for certain purposes in specific situations
• Instability over time: therefore L1 not always the strongest
• Agrammatism in aphasia might not be recognised if people thought they weren’t proficient in the language
• Age of acquisition: during the sensitive period may obtain native-like proficiency
• Dialects: 2 dialects may be considered bilingual

Question 3

Cultural considerations of bilingualims

Answer 3

• Need to consider client’s views in clinical process: attitudes towards, health, disability, role of family, religious views/practices, etc
• Interpret client’s behaviour in context, eg. eye contact, gestures
• Acculturation: adopting culture of new country, eg. migrants

Question 4

Acquisitional and communicative experiences in bilingualism

Answer 4

Could be difficult to discriminate between aphasic errors and L2 errors
- Present of accent
- Using L1 sentence structure/syntax when using L2
- Code switching: phonemic paraphasia, neologism or L2 consequence?
- Code-switching could be used to overcome WFDs

Question 5

Recovery patterns in bilingualism (5) and clinical implications

Answer 5

• Parallel: both recover at same rate and degree of premorbid level
• Differential: 1 recovers better than the other
• Successive: 1 doesn’t begin to reappear until the other has maximally recovered
• Selective: only 1 shows improvement
• Antagonistic: as 1 improves, the other regresses

Clinical implications
- Not a stable or predictable process
- Post-stroke language ability may not match pre-morbid function
- Native language doesn’t always show least impairment

Question 6

Assessment of bilingual abilities/history

Answer 6

1. Establish baseline level of functioning in both language
2. Use a Bilingualism Interview Form to probe knowledge of language use and communication partners
3. Informal conversation sampling
   - Case history
   - Bilingualism Interview Form: establish proficiency, situations each is used for, people used with, situations when monolingual/bilingual, type of mixing, translation abilities

Consider:
- Bilingualism history
- Informal conversation sampling
- Formal testing: take care interpreting results
- Sometimes good to have family member rather than interpreter as they know whether a person’s speech has changed

Question 7

Assessment of bilingual aphasia

Answer 7

• Briefing with interpreter
• Provide specific, detailed info about common responses by bilingual individuals and individuals with aphasia and importance of these responses in the assessment and treatment
• Standardised ax in each language: eg. WAB, BDAE in English + formal ax in other language
• Beware of translation of assessments
• Informal assessments
• Bilingual Aphasia Test: over 70 languages, culturally appropriate vocab/pictures

Question 8

Treatment of bilingual aphasia

Answer 8

Goal setting
- Meaningful and relevant
- 1 language or both? Which? Which modalities?
- Treatment goals should reflect premorbid use and proficiency
- Find out what you can about the language, eg. alphabet, tonal
- Find a bilingual SLP
- Monolingual treatments can also be used and treatment may generalise from one to the other

Question 9

Therapy tasks for bilingual aphasia

Answer 9

• Importance of picture stimuli/gesture: written stimuli may not be appropriate due to literacy issues
• Personal portfolios/comm books
• Words retrieval activities +/- translation
• Semantic therapy: likely to have central storage for both languages so may strengthen both