Effects of treatment provided in both languages to a bilingual Sardinian-Italian speaker with aphasia: A case study

Abstract

The majority of people in the world speak more than one language, thus language and communication disorders among multilingual population is an increasing phenomenon. As a consequence, the interest in bilingual aphasia and in its recovery represents nowadays an important line of research. Nevertheless, little is known about the best practices for language and communication therapy in bilingual aphasia, since research in this field is still at an early stage. Among the various theories, it seems no longer acceptable that bilingual or polyglot aphasics are assessed and treated in only one of the languages they know, even if this is still the tendency that appears to be the most common. This is due to several reasons. One is the idea according to which bilingual therapy might lead to increased mixing and/or switching phenomena, determining confusion in the patient and the possibility of repressing the recovery of one language. Another reason, is the restricted availability of multilingual speech-language pathologists and bilingual co-workers as a support during the therapy sessions. Following the call for more reflection on bilingual aphasia in different languages, the current study aims to determine whether all languages spoken by an aphasic prior to a brain damage should be assessed and treated and if treatment conducted in all languages may facilitate the recovery. This paper reports the effects of treatment provided in both languages to a bilingual Sardinian-Italian speaker male with aphasia, who had suffered two strokes in 2015 and 2017, respectively. The therapy sessions were mediated by a bilingual co-worker, since no bilingual speech-language pathologists were available. Despite patient’s first-language was Sardinian, previous therapy following the first stroke was provided exclusively in L2 (Italian), mainly because this is the language spoken by most of the people in the region (Sardinia) where the patient has been living since his birth and in which it is not easy to find bilingual Sardinian-Italian speech-language pathologists. Pre-treatment assessment on the BAT, conducted after the second stroke, showed an almost equal impairment in both languages known by the patient, while the results of post-treatment assessment showed a mild improvement of oral expression in Sardinian. Nevertheless, in the informal context of the therapy sessions and domestic environment, concurrently with the progression of treatment, the patient’s performance in oral production appeared to be characterized by a higher level of accuracy than the one observed during the assessment on the BAT. What was observed is that he improved significantly better in Sardinian than in Italian (differential recovery), showing thus a partial recovery in at least one of the languages known before the brain damage. A similar outcome wasn’t reached when treatment was provided exclusively in one language (Italian). In that case, only auditory comprehension significantly recovered in both Italian and Sardinian and to the same extent, while the spontaneous speech output didn’t show any significant improvement in either language known. The results of this study confirmed the prediction according to which bilingual population with aphasia should receive a comparable assessment in all languages spoken prior to onset of symptoms, in order to determine the degree of impairments in either language, which is in turn the fundamental prerequisite to plan an adequate treatment. Another assumption proved to be exact, namely that treatment should be offered to all affected languages, since a therapy that purposely focuses on one language excluding the other might deprive bilingual aphasics of the possibility to reach a satisfying recovery.