Rehabilitating an attrited language in a bilingual person with aphasia

ABSTRACT

Language difficulties can arise from reduced exposure to any given language (e.g. attrition) or after brain damage (e.g. aphasia). The manifestations of attrition and aphasia are often similar so differentiating between their effects on language loss and recovery is challenging. We investigated treatment effects for an English-Hebrew bilingual person with stroke-induced aphasia who had minimal contact with his Hebrew for over 14 years. We asked whether his attrited language could be rehabilitated, how effects of attrition and aphasia can be dissociated, and how such dissociation aids our understanding of the mechanisms involved in language recovery in aphasia. We administered a verb-based semantic treatment in Hebrew three times a week for six weeks (totalling 29 hours of therapy) and assessed changes in both Hebrew and English comprehension and production abilities across a variety of language tasks. Quantitative analyses demonstrated improvement in Hebrew production across language tasks, including those involving lexical retrieval processes that were trained during treatment. Improvement to English occurred in these same lexical retrieval tasks only. We interpret these results as indicating that the participant’s attrited language (Hebrew) could be rehabilitated with both specific treatment and general exposure to Hebrew contributing to improvement. Furthermore, treatment effects transferred to the untreated English. Qualitative analyses indicated that an interaction among aphasia, incomplete mastery of Hebrew pre-stroke, and attrition contributed to the participant’s language difficulties post-stroke. We conclude that partially shared underlying mechanisms of attrition and aphasia drive language processing and changes to it with treatment.

KEYWORDS:

• Aphasia
• attrition
• multilingual
• pre-stroke proficiency
• language rehabilitation

Acknowledgments

We thank the participant for his participation in this study. We also thank our three New York-based research assistants – Lian Kisner, Rifka Stark, and Cheyanne Lawrence, for their help with assessment, treatment and/or analysis of the data. Thanks also to Dr. Lisa Edmonds for her invaluable contributions to the larger study from which this paper derives and her helpful comments on an earlier draft of this manuscript. The paper has also benefited from suggestions by two anonymous reviewers.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Notes

¹ This study was conducted on data collected from a larger study on multilingual people with aphasia, and this participant was labelled as EH02 (Lerman et al., 2019). We therefore use the same label in this manuscript. EH02 is labelled as Participant 1 in the first author’s doctoral thesis (Lerman, 2020).

² The Hebrew version of the WAB-R used in this study was a version adapted by the first author based on a previously adapted version by the Speech Therapy Department in Reut hospital, Israel.

³ The REHAB is a revised version of a subsection of a previously unpublished multilingual aphasia battery by Miral Goral and Katy Borodkin

⁴ We also administered a second treatment block in English, attempting to re-assess English and Hebrew immediately post-English-treatment and 1-month post-English-treatment. However, only a subset of data was collected at these time-points due to declining motivation and low compliance. We note trends in this data but only report the results anecdotally because they likely do not fully reflect actual language abilities.

Additional information

Funding

This work was supported by the Graduate Center, CUNY under The Graduate Center Dissertation Year Award.