The Bilingual Brain: Bilingual Aphasia

Brain and Language 79, 201–210 (2001) 

doi:10.1006/brln.2001.2480, available online at http://www.idealibrary.com on 

The Bilingual Brain: Bilingual Aphasia 

Franco Fabbro 

IRCCS ‘‘E. Medea’’ and University of Udine, Udine, Italy 

Since most people in the world know more than one language, bilingual aphasia is an important 

line of research in clinical and theoretical neurolinguistics. From a clinical and ethical 

viewpoint, it is no longer acceptable that bilingual aphasics be assessed in only one of the 

languages they know. Bilingual aphasic patients should receive comparable language tests in 

all their languages. In the present work, language recovery of 20 bilingual Friulian–Italian 

aphasics was investigated. Thirteen patients (65%) showed a similar impairment in both languages 

(parallel recovery), four patients (20%) showed a greater impairment of L2, while three 

patients (15%) showed a greater impairment of L1. Despite the many hypotheses advanced to 

account for nonparallel recovery, none of them seems to provide satisfactory explanations. 

The study of bilingual aphasics with parallel impairment of both languages allows us to verify 

the hypothesis whereby grammatical disorders in aphasia depend on the specific structure of 

each language. As far as rehabilitation programs for multilingual aphasics are concerned, several 

questions have been raised, many of which still need a satisfactory answer. © 2001 Academic 

Press 

Key Words: bilingual aphasia; language assessment; language recovery; language treatment. 

Describing Bilingualism 

According to current linguistic, psychological, and neurolinguistic approaches, the 

term ‘‘bilingual’’ refers to all those people who use two or more languages or dialects 

in their everyday lives (Grosjean 1994). In this presentation, dialects are subsumed 

under the term ‘‘language.’’ Actually, at the linguistic level no objective criteria to 

distinguish between languages and dialects have been proposed so far (Pinker 1994), 

and at the neurolinguistic level the question whether the structural distance between 

two languages or two dialects or between a language and a dialect may affect their 

respective cerebral representation is still under debate (Paradis, 1995). 

Several neuropsychological studies suggest that it is not correct to consider bilingual 

subjects as ‘‘two monolinguals in one person’’ (Grosjean, 1989). Indeed, bilinguals 

do not necessarily need to have a perfect knowledge of all the languages they 

know to be considered as such. The extremist view of the ‘‘perfect’’ bilingual derives 

from a language culture which is essentially monolingual. Bilinguals acquire and use 

their languages for different purposes, in different domains of life and with different 

people. For example, a Canadian born in Quebec may acquire Quebecois as mother 

tongue (L1) and use it with his or her family and friends; standard French as a second 

language (L2), being the official language of education; and English as a third (L3) 

language, the latter not being used everyday but, for example, to write scientific 

manuscripts or give lectures at international congresses. Irrespective of the degree 

Address correspondence and reprint requests to Franco Fabbro, Neurolinguistic Unit, Scientific Institute 

‘‘E.Medea,’’ 33078 San Vito al Tagliamento (PN), Udine, Italy. E-mail: fabbro@sv.Lnf.it. 

201 

0093-934X/01 $35.00 

Copyright © 2001 by Academic Press 

All rights of reproduction in any form reserved.

202 FRANCO FABBRO 

of knowledge this person has of these three languages, he or she should definitely 

be considered a bilingual. 

Given these methodological premises, at present more than half of the world population 

is multilingual (Grosjean 1982, 1994). As a direct consequence, multilingual 

individuals suffering from developmental or acquired speech or language disorders 

do not represent isolated and exceptional cases—as one might be inclined to think 

when reading the specialized literature—but rather the majority of clinical cases 

(Paradis, 1998a). 

The Assessment of Bilingual Aphasia 

A systematic assessment of all the languages known by an aphasic patient is an 

essential prerequisite for both clinical procedures (diagnosis, rehabilitation program, 

assessment of progress in recovery, etc.) and neurolinguistic research on multilingualism. 

For this reason, Michel Paradis and associates (Paradis & Libben, 1987; 

Paradis, 2001a) developed the Bilingual Aphasia Test (BAT), which consists of three 

main parts: part A for the evaluation of the patient’s multilingual history (50 items), 

part B for the systematic and comparable assessment of language disorders in each 

language known by the subject (472 items in each known language), and part C for 

the assessment of translation abilities and interference detection in each language 

pair (58 items each). The BAT is currently available in 65 languages (part B) and 

160 language pairs (part C). Parts B and C of this test have not been simply translated 

into different languages, but rather adapted across languages. For example, when 

adapting the BAT verbal auditory discrimination test into Friulian, English items 

were not simply translated. In fact, for each item the authors had to find four Friulian 

words that differed from each other by only one initial phoneme and could also be 

easily represented by a picture. Thus, the English stimuli ‘‘mat, cat, bat, hat’’ became 

‘‘cjoc, çoc, poc, toc’’ (drunk, log, chicory, piece). 

The persons administering the test are not required to make any judgment: they 

simply write down the answers given by the patient, which will then be processed 

by means of a computerized program indicating for each part (B and C) the absolute 

number and the percentage of correct answers for each linguistic skill (comprehension, 

repetition, judgment, lexical access, propositionizing, reading, and writing) and 

for each linguistic level (phonology, morphology, syntax, lexicon, and semantics). 

For some parts of the test, such as spontaneous speech, description of a short story 

illustrated by pictures, and spontaneous writing, a thorough neurolinguistic analysis 

on the basis of strict, objective criteria is required. Assessment of bilingual aphasics 

by the BAT provides a quantification and classification of language disorders for 

each language, thus allowing a direct comparison of performances in the different 

languages known by the patient. Before the BAT, bilingual aphasia was studied using 

different test instruments; for this reason it was very hard to compare different studies 

(cf. Paradis, 1983, 1993). Therefore, previous findings should be seen as a useful 

starting point for a more thorough and systematic neurolinguistic analysis (Fabbro, 

1997). 

As pointed out by Grosjean (1989, 1998) and stipulated in the implementation 

manual (Paradis & Libben, 1987), when assessing residual language abilities in bilingual 

aphasics, a series of methodological precautionary steps should be taken: each 

language should be assessed on a separate day and the code-switching habits of the 

patient before pathological onset should be thoroughly described, e.g., asking relatives 

and friends for relevant information. Indeed, in some bilingual communities 

code switching is sociolinguistically accepted and quite common during everyday 

conversation (e.g., among English–French bilinguals in Montreal, Canada), whereas

BILINGUAL APHASIA 203 

it hardly ever occurs in other bilingual environments (e.g., Friulian–Italian bilinguals 

in Friuli, cf. Francescato & Salimbeni, 1976). If the patient exhibits frequent pathological 

switching and/or mixing, L1 should be assessed by a person not knowing the 

patient’s L2 and, vice versa, L2 should be assessed by someone not knowing L1, so 

as to avoid confusing any pathological behavior with deep-rooted habits. On the other 

hand, assessment of translation abilities should be made by someone knowing all the 

languages at issue. 

Clinical Aspects of Bilingual Aphasia 

Several clinical studies have shown that bilingual aphasics do not necessarily manifest 

the same language disorders with the same degree of severity in both languages. 

For this reason, it is no longer ethically acceptable to assess aphasic patients in only 

one of their languages (Paradis 1995). In addition, the clinical assessment of both 

monolingual and bilingual aphasics should take into account three different phases 

in time: (1) the acute phase, which generally lasts 4 weeks after onset; (2) the lesion 

phase, which lasts for several weeks and perhaps even up to 4–5 months postonset; 

and (3) the late phase, beginning a few months after onset and continuing for the 

rest of the patient’s life (Alexander, 1989; Fabbro, 1999a). 

During the acute phase a regression of the diaschisis occurs, i.e., a regression of 

the functional impairment effects in structurally unaffected cerebral regions of the 

ipsilateral and/or contralateral hemisphere which are functionally connected to the 

brain area where the damage occurred. These effects were highlighted by tests based 

on the quantitative assessment of the regional glucose metabolism by means of positron 

emission tomography (Cappa, 1988). During the acute phase, several dynamic 

language disorders were observed, such as temporary mutism with preserved comprehension 

in both languages (Aglioti & Fabbro, 1993; Fabbro & Paradis, 1995b), severe 

word-finding difficulties alternately in one language with concurrent relative fluency 

in the other language and good comprehension in both (the so-called alternating antagonism; 

cf. Paradis, Goldblum, & Abidi 1982; Nilipour & Ashayeri, 1989), and 

severe impairment of the language acquired during childhood with complete preservation 

of the one learned at school (‘‘selective aphasia’’; cf. Paradis & Goldblum, 

1989). The study of these dynamic phenomena is also useful for setting up theoretical 

neurofunctional models of brain functioning in multilinguals (Green, 1986; Paradis, 

1993a), though it does not allow us to draw unequivocal conclusions about the relationship 

between linguistic functions and neuroanatomical structures. 

The lesion phase is the period of greatest interest for brain–behavior relationships 

because during this period language disorders can be more clearly correlated with 

the site and extent of the lesion. Since such disorders are also more stable, it is far 

more convenient to carry out a complete assessment of the patients’ residual language 

abilities in this phase by taking into account all the languages he or she knew before 

the insult. Aphasic disorders may or may not vary across languages in one and the 

same patient; they may be classified as typical of a single aphasic syndrome, though 

with different degrees of symptomatic severity according to the language (Fabbro & 

Paradis, 1995b; Yiu & Worral, 1996). On the other hand, the hypothesis of the existence 

of a clinical picture of differential aphasia (Albert & Obler, 1978; Silverberg & 

Gordon, 1979), namely a type of aphasia in one language (e.g., Wernicke’s aphasia) 

and another type (e.g., Broca’s aphasia) in another language, still lacks sufficient 

corroborating data (Paradis, 1998b). 

In the late phase different patterns of recovery can be observed in multilingual 

patients. Sometimes, this phase may hardly differ from the previous one since recovery 

or even improvement do not always occur. Language recovery phenomena are


thought to be due to the ‘‘takeover’’ of linguistic functions by the contralateral hemisphere 

or by undamaged areas within the same hemisphere (Bychowsky, 1919/1983; 

Cappa, 1998). Improvement in communication skills may probably depend on the 

application of explicit compensatory strategies (Paradis, 1994; Paradis & Gopnik, 

1997). Recovery, either spontaneous or following rehabilitation, may continue also 

during the late phase, though generally less intensively than during the lesion phase. 

Patients should be periodically reassessed so as to reexamine recovery patterns and 

possibly revise the rehabilitation program. The most common patterns of recovery, 

described by Pitres (1895) in the first monograph on bilingual aphasia ever published, 

are (1) parallel recovery, when both languages are recovered simultaneously; 

(2) selective recovery, when only one language slowly comes back and the other is 

never recovered; and (3) successive recovery, when one language improves before 

the other(s). 

Language Recovery in Polyglot Aphasics 

When bilinguals or polyglots suffer a brain insult affecting language areas, they 

may lose the ability to use all languages they knew and exhibit the same type of 

aphasia in all languages. Subsequent recovery may be parallel in all languages. In a 

study on the literature of bilingual aphasia published in 1977, Paradis stated that 40% 

of the reported cases of polyglot aphasics exhibited parallel recovery of languages. 

It should be noted, however, that these statistics are based on clinical case histories 

which have been published and, thus, are the most atypical. Paradis put forward the 

hypothesis that this type of recovery is even more frequent because descriptions of 

single clinical cases of polyglot aphasics with parallel language recovery are very 

rare, since neurologists and neuropsychologists tend to describe ‘‘exceptional’’ cases 

only, as they can more easily be published (Paradis, 1977). This is one of the reasons 

why over 10 years ago Paradis started an international project on bilingual aphasia 

in Canada, which is still operative and sees the participation of numerous researchers 

from all over the world. This study also includes bilingual aphasic patients with any 

type of language disorders so as to have a large number of subjects and, thus, more 

reliable statistical data. 

In some cases, aphasia affects only one of the languages known by the patient. In 

his study of 1895, Pitres was the first to draw attention to the fact that the dissociation 

of the languages affected by aphasia was not an exceptional phenomenon, but rather 

ordinary. Pitres described seven clinical cases of patients exhibiting differential recovery 

of the two languages they spoke. On the basis of the frequency of dissociation, 

Pitres put forward hypotheses on the causes that might determine a better recovery 

in one language. He suggested that patients tended to recover the language that was 

most familiar to them prior to the insult. This hypothesis was subsequently called 

Pitres’ rule. In proposing his theory, Pitres referred to a work by Ribot in which it 

was claimed that, in the case of memory disorders, the general rule held that the new 

deteriorates earlier than the old. Subsequently, numerous neurologists compared and 

contrasted the so-called Pitres’ rule (recovery of the most familiar language) with 

‘‘Ribot’s law’’ (recovery of the native language), but it should be noted that none of 

the two authors ever formulated a ‘‘rule’’ on language recovery in bilingual aphasics. 

In his work, Pitres proposed a reasonable explanation of language recovery in 

aphasics. He maintained that the recovery pattern could occur only if the lesion had 

not destroyed language centers, but only temporarily inhibited them through pathological 

inertia. In Pitres’ opinion, the patient generally recovered the most familiar 

language because the neural elements subserving it were more firmly associated. If 

the patient had become aphasic owing to ‘‘functional inertia’’ of the language areas,


these inhibitory pathological phenomena should have affected to a greater extent the 

languages that exhibited weaker associations between the neural elements subserving 

them. These hypotheses were both supported and opposed. To date, no unequivocal 

evidence supports a rule applicable to all clinical cases. 

Language Recovery in 20 Friulian–Italian Bilingual Aphasics 

In recent years I have had the opportunity to assess 20 right-handed bilingual aphasics 

using the Bilingual Aphasia Test—BAT (Paradis and Libben 1987, 1999) in the 

two versions of Friulian (Paradis & Fabbro, 1993) and Italian (Paradis & Canzanella, 

1989). Table 1 shows patients’ percentages of correct tasks in the BAT linguistic 

levels both in L1 and L2. All the patients presented with aphasia following a left 

hemisphere lesion. Seventeen patients were native Friulians and three patients were 

native Italians (OM, AS, and CM in Table 1). For all patients L2 was learned between 

5 and 7 years of age. Before the insult all patients used both languages in their everyday 

lives. They could write and read only in Italian. 

A battery of standardized neuropsychological tests for the assessment of orientation 

in time and space, attention, detection of agnosia, apraxia, verbal and spatial 

short-term memory deficits, and verbal long-term memory deficits was administered 

to all patients (Spinnler & Tognoni, 1987). Furthermore, patients received a standard 

neurologic examination and a neuroimaging study was performed with CT scan or 

MRI to define the characteristics of the lesion (site, extent, and type, see Table 1). 

Eighteen patients (except for KB and CM) also received the Italian version of the 

Aachener Aphasie Test—AAT (Luzzati et al., 1992) to determine the type of aphasia 

which had affected each patient (see Table 1). 

Thirteen patients (65%) showed a similar impairment in both languages (parallel 

recovery) (subjects 1–13, Table 1), four patients (20%) showed a greater impairment 

of L2 (subjects 14–17, Table 1), while three patients (15%) showed a greater impairment 

of L1 (subjects 18–20, Table 1). These percentages are in line with a recent 

review on language recovery in polyglot aphasics (Paradis, 2001b). Several factors 

have been proposed to explain parallel language recovery vs differential recovery in 

bilinguals. The native language, the most familiar to the patient at the time of the 

insult, the most socially useful or the most affectively loaded, or, still, the language 

of the environment do not recover first or best. Nor does it seem to be a matter of 

whether the two languages were acquired and used in the same context as opposed 

to different contexts, at different times of development (Paradis 1977, 1998, 2001b). 

Still, the type of aphasic syndrome, the type of lesion (tumor, infarction, or cerebral 

hemorrhage) or the site of the lesion (cortical vs subcortical, frontal lobe vs temporal 

lobe, etc.) do not seem to be directly responsible for parallel language recovery vs 

differential recovery. So far, empirical studies have not provided tenable explanations 

for the presence of parallel recovery in some bilingual aphasic patients and of differential 

recovery in others. 

Grammatical Errors in Bilingual Aphasic Patients 

Grammatical deficits in aphasia are dependent on the way the system can break 

down and, therefore, on the structure of the language system. When the system is 

placed under stress it can only break down at those junctures allowed by the system 

(Paradis, 1988). Given this assumption, if inflectional morphology is vulnerable, a 

language with this feature will show outstanding signs of agrammatism (Alajouanine, 

1968). Grammatical disorders typical of aphasia are dependent on the structure of 

each language. Their various manifestations are only trivially (and predictably) differ-


TABLE 1 

Linguistic Levels (Percentages of Correct Answers) 

Morphol- 

Phonology ogy Syntax Lexicon Semantics Total 

Aphasic 

Subjects S A Edu TL Ls Ass Sy L1 L2 L1 L2 L1 L2 L1 L2 L1 L2 L1 L2 

1 (KB) F 15 8 I FT 96 TM 95 95 65 69 88 93 91 95 93 87 86 88 

2 (CB) F 71 5 I BG 4 B 81 76 52 43 51 55 61 66 42 55 57 59 

3 (EM) M 56 11 H BG 28 B 79 82 13 69 50 56 65 68 47 42 51 63 

4 (OR) M 63 5 I BG-I 3 W-B 75 78 43 43 53 50 63 68 50 71 57 62 

5 (PB) M 39 18 Tu Th 3 A-B 96 95 91 78 75 77 90 92 82 92 87 86 

6 (DC) M 50 13 H BG 1 B 82 85 56 73 58 57 73 68 76 50 69 67 

7 (AT) F 77 5 I T 1 B 71 67 26 17 58 50 61 60 53 55 54 50 

8 (DD) M 48 13 I FT 3 B 51 62 0 68 66 56 66 72 57 77 47 66 

9 (FV) M 67 5 I BG 2 W-A 81 73 52 21 58 59 67 69 60 60 64 56 

10 (ATM) M 62 5 I Ins 1 B-A 95 82 78 86 95 90 97 92 96 95 92 89 

11 (OM) M 72 8 I T 1 G 76 76 65 65 69 70 74 74 74 74 71 72 

12 (AS) M 51 19 I BG 7 B 87 79 78 78 78 71 81 81 77 77 80 77 

13 (CM) F 25 13 H PT 13 A 93 100 95 65 89 91 91 87 100 95 94 87 

14 (LM) F 67 5 Tu Th 1 TM 95 95 86 56 91 80 93 88 100 82 93 80** 

15 (LT) F 54 5 I BG 1 A 89 89 86 65 86 78 89 88 88 73 88 78** 

16 (LV) M 54 8 I P 4 G 61 39 56 17 44 39 59 51 62 55 56 40*** 

17 (AM) M 48 17 H BG-FT 1 G 48 45 13 4 55 51 55 53 53 53 45 41** 

18 (RT) M 53 5 I PT 24 TS 67 89 17 17 50 54 67 76 73 87 55 64** 

19 (VD) F 78 8 I PT 1 W 59 62 30 60 60 56 68 72 65 77 56 65** 

20 (AL) M 77 5 I F 1 G 48 61 0 39 36 38 30 49 12 26 25 42* 

Note. S sex; A age; Edu years of education; TL type of lesion (tumor, infarction, hemorrhage); LS lesion site (F: frontal lobe; T: temporal lobe; 

P: parietal lobe; BG: basal ganglia; Th: thalamus; Ins: insula); Ass interval between the onset of the lesion and language assessment; Aphasic Syndrome (B: 

Broca’s aphasia; W: Wernicke’s aphasia; G: global aphasia; A: anomic aphasia; TM: transcortical motor aphasia; TS: Transcortical Sensory Aphasia). Bold entries 

are related to the language that showed a significantly better recovery. 

* p 0.7. 

** p .05. 

*** p .01.


ent in different languages. Grammatical disorders observed in aphasics speaking different 

languages are such only at the surface level, but their nature seems to have a 

universal character and follow the rule whereby aphasia impairs all grammatical aspects 

of a language, even if at varying degrees of severity. 

The study of bilingual aphasics with parallel impairment of both languages allows 

us to confirm the hypothesis whereby grammatical disorders in aphasia depend on 

the language structure. Therefore, in ‘‘agrammatic’’ patients who know two morphology-rich 

languages such as Friulian and Italian grammatical errors will probably be 

similar in both languages and will be different only at the junctures where the two 

languages differ. With regard to the first four patients shown in Table 1 the percentage 

of morphosyntactic errors in obligatory contexts in L1 and L2 was calculated over 

a 5-min spontaneous speech sample (see Table 2). They all presented nonfluent aphasia 

with parallel recovery of the two languages. A comparison of errors made by 

patients in the two languages revealed that the most significant difference was the 

percentage of omissions of obligatory pronouns in Friulian (38.25%) vs Italian 

(1.25%). This is probably due to the peculiar grammatical structure of the two languages, 

as in Friulian the subject is always accompanied by an obligatory pronoun 

(Il frut al bef, literally: The boy he drinks), whereas in Italian the subject can be 

omitted (‘‘the child drinks’’ or ‘‘drinks’’). Therefore, in Italian aphasic patients can 

TABLE 2 

Percentage of Morphosyntactic Errors in Obligatory Contexts 

(during a 5-Min Sample of Spontaneous Speech) 

1 (KB) 

2 (CB) 3 (EM) 4 (OR) 

L1 L2 L1 L2 L1 L2 L1 L2 

OFGM 

Articles 4 4 7 15 80 29 — 1 

Prepositions — — 5 3 16 27 5 5 

Conjunctions — — 5 — 4 7 10 — 

Obl. Pron. 38 — 43 3 42 — 30 2 

Aux. Verbs 15 — 18 10 40 100 26 24 

Full Verbs 2 — 3 1 16 25 2 1 

SBGM 

Verbs 3 1 5 3 — — 3 11 

Adjectives — 1 7 2 — — — — 

Nouns — — 2 — — 2 — — 

SFGM 

Articles — 2 — — 30 4 — 3 

Prepositions — 4 — — 8 27 1 7 

Conjunctions — — — — — — — — 

Obl. Pron 1 2 1 — — — — 2 

Aux. Verbs — — — — 13 — — — 

AGMIC 

Articles — 2 3 — — — 3 2 

Prepositions — — — 6 — — 3 2 

Conjunctions — — — — — — 2 — 

Obl. Pron. — 5 — — — — — — 

Aux. Verbs — — — — — — — — 

Note. OFMG Omission of free grammatical morphemes; SBGM Substitutions 

of bound grammatical morphemes; SFGM Substitutions of free 

grammatical morphemes; AGMIC Addition of grammatical morphemes 

in inappropriate contexts. Bold entries refer to the number of omissions of 

bound grammatical morphemes in L1.


easily avoid structures requiring obligatory pronouns while in Friulian they cannot 

(Fabbro & Frau 2001). 

The analysis of morphosyntactic errors made by the first four patients with nonfluent 

aphasia confirms the hypothesis that the so-called agrammatism is—as suggested 

by Miceli and Mazzucchi (1990)—a theoretical construct and not a natural category. 

In both languages these patients made omissions of free-standing grammatical morphemes 

and substitutions of bound grammatical morphemes (errors that are reported 

to be typical of agrammatism), but also a small percentage of errors came from substitutions 

and additions of free grammatical morphemes, which are considered specific 

to paragrammatism. 

Rehabilitation of Bilingual Aphasics 

A consistent rehabilitation program for aphasic monolinguals and bilinguals requires 

a systematic assessment of language disorders. As far as rehabilitation programs 

for multilingual aphasics are concerned, several questions have been raised, 

many of which still need a satisfactory answer, namely (1) Is it enough to rehabilitate 

one language in bilingual aphasics or do all languages known by the patient have to 

be treated? (2) If the decision is taken to rehabilitate one language only, what are 

the criteria behind this choice? (3) Does rehabilitation in one language also have 

beneficial effects on the untreated languages? (4) Do potentially beneficial effects 

transfer to structurally similar languages (Italian and Spanish) only or also to structurally 

distant languages (Italian and Japanese)? (Paradis, 1993b). 

Unfortunately, research on language rehabilitation in bilingual aphasics is still at 

an early stage (cf. Fabbro, 1999b). So far researchers have mainly analyzed individual 

cases and, generally, they have not carried out a proper pre- and postrehabilitation 

assessment of language disorders. Indeed, very few research studies assessed the 

patients’ linguistic abilities before and after rehabilitation with a test equivalent in 

both languages. Conclusions drawn from these research studies are thus still speculative, 

and further studies are needed if more detailed information is to be acquired. 

At present, only one language is generally rehabilitated, especially if the patient 

shows mixing or switching phenomena, so as not to confuse the patient and waste 

time. Should two languages be simultaneously rehabilitated, sessions would increase 

from three to six per week; similarly six languages would require nine sessions, and 

so on. With regard to the selection criteria, no clear-cut answers are provided: Some 

researchers claim that the mother tongue is preferable, others claim that it is the least 

impaired language which should be treated, others, still, claim that the language that 

is worst impaired should be targeted. 

In the case of the bilingual aphasic patients I observed, selection of the language 

to be rehabilitated was based on two parameters: (a) a systematic assessment of the 

patient’s linguistic disorders through the BAT in the languages the patient knew and 

(b) an interview with the patient and his/her relatives was carried out during which 

neurolinguistic data were collected (neurological data, results of the BAT in the languages 

known by the patients, etc.) and sociolinguistic issues concerning the patient 

and his or her family were discussed (which language they preferred to rehabilitate 

both for affective and for business reasons). 

Therefore, except for highly complex neurolinguistic situations (for instance, aphasia 

with paradoxical recovery of one language), the choice of the language to rehabilitate 

depends on the patient and his or her family’s decision, since it was proven that 

generally the benefits of rehabilitation in one language tend to extend to the untreated 

languages (Fredman, 1975; Junqué, Vendrell, Vendrell-Brucet, & Tobeña, 1989). 

This ‘‘mass effect’’ does not seem to be due to the degree of structural similarity


between languages since it is effective not only in the case of structurally similar 

languages, but also with structurally different languages (Fabbro, De Luca, & Vorano, 

1997). 

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The Bilingual Brain: Bilingual Aphasia

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