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AXIAL FMRI IMAGES SHOW PATTERNS OF NEURAL ACTIVATION IN TWO PATIENTS WITH BILINGUAL APHASIA, BOTH OF WHOM WERE MORE PROFICIENT IN ENGLISH THAN IN SPANISH PRIOR TO A LEFT-HEMISPHERE STROKE. AREAS ACTIVATED DURING WORD PROCESSING IN SPANISH AND ENGLISH ARE SHOWN IN BLUE AND RED, RESPECTIVELY; HORIZONTAL LINES AT RIGHT INDICATE THE SECTIONS OF BRAIN ILLUSTRATED. [6]
AXIAL FMRI IMAGES SHOW PATTERNS OF NEURAL ACTIVATION IN TWO PATIENTS WITH BILINGUAL APHASIA, BOTH OF WHOM WERE MORE PROFICIENT IN ENGLISH THAN IN SPANISH PRIOR TO A LEFT-HEMISPHERE STROKE. AREAS ACTIVATED DURING WORD PROCESSING IN SPANISH AND ENGLISH ARE SHOWN IN BLUE AND RED, RESPECTIVELY; HORIZONTAL LINES AT RIGHT INDICATE THE SECTIONS OF BRAIN ILLUSTRATED. [6]

Treatment and Rehabilitation of Bilingual Aphasia: An Annotated Bibliography

Introduction:

Aphasia is a group of language disorders caused by focal brain lesions that result, most frequently, from stroke or head injury. [1] Worldwide, stroke is known to be the third or even greater leading cause of chronic disability. [2] This, in turn, results in increasing incidence of various forms of aphasia.

Like in all other types of consequent disabilities in stroke affected patients, effective and timely rehabilitation is of paramount importance in management of aphasia. [3] There is evidence suggesting that existing Speech and Language Therapy methods are associated with improvement in functional communication, and receptive and expressive language skills in this group of patients. [4]

However, with the ever-expanding scope of globalization where more and more people are benefiting from the advantages of bilingualism, and multi-lingualism, there also lay some challenges in management and rehabilitation of clients with bilingual or multi-lingual aphasia. [5] With this annotated bibliography, I am presenting, in no particular order, some useful work done by colleagues all over the world in this challenging multi-disciplinary field.

1.         Marrero MZGolden CJEspe-Pfeifer P. Bilingualism, brain injury, and recovery: implications for understanding the bilingual and fir therapy. Clinical Psychology Review. 2002;22(3):465-80.

A literature review that finds the outcome of brain injury may be influenced by factors such as cerebral representation of a secondary language, method of language acquisition, age of acquisition, premorbid language proficiency, and style of learning. Examines the neuropsychological concepts that can explain these findings along with their implications for therapy, and rehabilitation. Recognises the existence of assumptions, and contradictions about which  language will show the least impairment or recover the best in bilingual aphasia.

2.         Kohnert, Kathryn. Cognitive and Cognate-Based Treatment for Bililingual Aphasia. (Case Study)  Brain and Language. 2004; 91(3):294-302.

A case study of a 62-year-old English-Spanish bilingual non-fluent aphasic accomplished by an assistant Professor. It studies the impact of two consecutive paired aphasia treatments: cognitive-based and lexically-based. Focuses on non-linguistic cognitive processing skills and lexical–semantic production. Contains a brief but comprehensive review of relevant literature. Serves as an exploratory work and encourages more similar research to establish better reliability in findings. A valuable contribution to the scarcely addressed clinical intervention of bilingual aphasia.

3.         Goral MRosas JConner PSMaul KKObler LK. Effects of language proficiency and language of the environment on aphasia therapy in a multilingual. Journal of Neurolinguistics 2012:  1;25(6):538-551.

Examines the relative proficiency of four languages (Spanish, German, French, English) of a multilingual speaker with aphasia.  Tests within and between-language changesfollowing two periods of language treatment. Finds that Cross-language treatment effects were linked to the language of the environment at the time of testing and to relative language proficiency.

4.         Croft SMarshall JPring THardwick M. Therapy for naming difficulties in bilingual aphasia: which language benefits? International journal of language & communication disorders.2011:46(1);48-62.

Aims to address a number of question regarding naming therapy techniques in management of bilingual aphysia. Involves studying five aphasic participants who were bilingual in English and Bengali. Finds that that ‘typical’ naming treatments can be effective for some bilingual people with aphasia. Supports and suggests  the use of bilingual co-workers in therapy delivery.

5.         Swathi Kiran & Edmonds Lisa A. Effects of Semantic Naming Treatment on Cross-linguistic Generalisation in Bilingual Aphasia. Brain and Language. 2004; 91: 75-77.

Reports on the administration of a semantic-based naming treatment of bilingual aphasia in two English-Spanish bilingual subjects. Attempts to find out whether rehabilitation in one language has beneficial effects on the untreated language in bilingual aphasic patients. Presents the findings of the experiment in a sophisticated graphical manner. Demonstrates, both within and across languages, the effect on generalization related to pre-morbid language proficiencies and indicates the importance of premorbid language dominance in planning treatment for bilingual aphasics. Gives a good scientific explanation for the findings but uses a limited number of references.

6.         Galvez Ana & Hinckley Jacqueline J. Transfer Patterns of Naming Treatment in a Case of Bilingual Aphasia. Brain and Language, 2003; 87:173–174.

Monitors transfer patterns between two languages in picture naming treatment of a 71-year-old, 6 months post-onset, Spanish-English bilingual aphasic man. Has a good contribution from Jacqueline J Hinckley, an associate Professor who has done a considerable amount of research on the relationships between cognition and language, particularly in the rehabilitation environment. Argues that studies focusing on transfer patterns across languages may reveal relationships between language system components in bilingual aphasia and will affect the choice of treatment type and outcomes. Suggests that transfer patterns from one language to another may rely both on the method of learning and  the learning system that is activated. Concludes that although treatment in both languages did have positive effects, there was no or little transfer between two languages on the treatment probe. Not only lacks graphical illustration of the results, but also the tabulation of the findings is poor; however, it highlights the importance of considering both learning and memory considerations and language system organization in bilingual aphasia therapy.

7.         Fabbro Franco. The Bilingual Brain: Bilingual Aphasia. Brain and Language. 2001; 79:201-210.

Investigates language recovery in 20 bilingual Friulian–Italian aphasics with different degrees of impairment. Describes bilingualism and agrees with the Grosjean (1994) definition of the word. Uses the word “polyglot” as a synonym for bilingual, which can be argued against.  Subsumes dialects under language which, also, can be questioned in some cases (e.g Farsi and Tajiki). Contains a detailed commentary on assessment techniques of bilingual aphasia particularly the Bilingual Aphasia Test (BAT). Comments on clinical aspects of bilingual aphasia, referring to various scientific sources. Gives an objective explanation of language recovery in polyglot aphasics, taking into consideration the view points of a considerable number of researchers in the field of bilingual aphasia. Unlike many other rehabilitation studies, provides the reader with a detailed account of assessment procedures carried out on the patients: for example, neuropsychological tests, neuroimagings (CT & MRI), Aachener Aphasie Test (AAT), etc. Recognises that the grammatical disorders in aphasics are of universal character, but only at the surface level. Although the assessment data is shown in tables, the published report lacks any tabular or graphical illustrations of the results.

8.         Roberts Patricia M. & Deslauriers Louise. Picture Naming of Cognate and Non-cognate Nouns in Bilingual Aphasia. Journal of Communication Disorders, Vol 32(1):1-23.

The very first piece of work on bilingual anomic aphasia and its treatment conducted by an associate professor and her colleagues at the University of Ottawa. Investigates the effects of cognateness on verbal confrontation naming performance of 15 French-English bilingual aphasics and a control group of the same number of non-aphasic bilinguals. Lists the measures that have been taken into consideration in the study to ensure the reliability and validity of the findings. Make an intensive use of tables for presenting the relevant data used in the study, while only a textual report of the results is given. Finds out that cognate status does influence naming accuracy, as the cognate pictures are more often correctly named in both languages. Mentions and insists on at least three clinical implications of the study and claims that some naming behaviour and errors are unique to bilinguals. The work can be particularly useful for those working on developing treatment techniques for bilingual aphasia. The work has been already cited by a large number of research fellows.

9.           Marrero Madelin Z, Golden Charles J and Espe-Pfeifer Patricia. Bilingualism, Brain Injury, and Recovery, Implications for Understanding the Bilingual, and for Therapy. Clinical Psychology Review. 2002; 22(3):463-478.

Examines the relevant evidence in attempt to understand the likely outcome of brain injury and its therapeutic implications by identifying the factors influencing this outcome. Suggests a theoretical framework for understanding the linguistic and cognitive processes of a bilingual aphasic individual following the brain injury. Briefly reviews and analyses the relevant literature on lateralization and language acquisition, language loss and recovery in bilingual aphasics. Gives a valuable account of the anatomical localization and organization of languages in a bilingual brain, but fails to support it with objective or scientific evidence (e.g. Positron Emission Tomography or Functional Brain Imaging). Contains a detailed “discussion” covering all aspects of the literature and its hypothesis. Lists, and in some cases analyses, a number of case studies that are either consistent or in contradiction with the theory that the first language acquired is the least susceptible to damage and first to recover. Claims to have a number of clinical and rehabilitation implications for bilingual aphasia. The work is potentially a useful reference for research fellows in the field of rehabilitation of bilingual aphasia; however, the paper seems not to be cited by a noticeable number of researchers as of yet.

10.      Ku Aubrey MD, Lachmann Elisabeth A MD, and Nagler Willibald MD. Selective Language Aphasia from Herpes Simplex Encephalitis. Pediatric Neurology. 1996; 15(2): 169-171.

A case study by a number of MD doctors from physical medicine and rehabilitation. Reports on the rehabilitation of bilingual aphasia in a 16-year-old Chinese-English bilingual aphasic patient undergoing bilingual speech therapy. Describes a number of medical tests and prescriptions required for treatment of bilingual aphasia. Gives a very medical account of bilingual aphasia that might be less relevant for those who are studying the condition from a psychological or social perspective. Uses at least one MRI illustration of an aphasic brain in encephalitis. The work is of particular interest for medics who study the medical aspects of bilingual aphasia. The objectivity of the work can be questioned, however, as it places the emphasis solely on medical explanations.

References:

  1. Dromkers N, Pinker S, Damasio A. Language, Thought, Mood, and Learning and Memory. In: Kandel ER, Schwartz JH, Jessell TM. (eds.) Principles of Neural Science. 4th edition. New York. McGraw-Hill; 2000.p.1174-1175.
  2. Elkind MS. Epidemiology and Risk Factors. Continuum: Lifelong learning in neurology.2011;17(6):1213-32.
  3. Vidović MSinanović OSabaskić LHaticić ABrkić E. Incidence and types of speech disorders in stroke patients. Acta clinica Croatica. 2011: 50(4):491-4. Abstract available on line athttp://www.ncbi.nlm.nih.gov/pubmed/22649878 Accesssed on 12/12/2012.
  4. Brady MCKelly HGodwin JEnderby P. Speech and language therapy for aphasia following stroke.  The Cochrane database of systematic reviews. 2012 16;5:CD000425
  5. Marrero MZGolden CJEspe-Pfeifer P. Bilingualism, brain injury, and recovery: implications for understanding the bilingual and fir therapy. Clinical Psychology Review. 2002;22(3):465-80.
  6. Tricia Brick, Multilingual Miracles, Available online athttp://www.bu.edu/

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