The Bilingual Brain: Bilingual Aphasia

208 FRANCO FABBRO
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