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Bilingualism, Brain & Aphasia 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). 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. 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 every day but, for example, to write scientific manuscripts or give lectures at international congresses. Irrespective of the degree of knowledge this person has of these three languages, he or she should definitely be considered a bilingual. Speakers of more than one L2 are called polyglots (especially in the aphasic literature). Aphasia The word for the partial or total loss of the ability to speak, aphasia, was first listed in 1867. This word is based on the Greek word aphatos, which is a combination of the prefix a- not and phatos spoken or speakable. 'Aphasia' is a condition which affects the brain and leads to problems using language correctly. People with aphasia make mistakes in the words they use, sometimes using the wrong sounds in a word, choosing the wrong word, or putting words together incorrectly. Aphasia also affects speaking and writing in the same way. Many people with the condition find it difficult to understand words and sentences they hear or read. Why does aphasia happen? Aphasia is caused by damage to parts of the brain responsible for understanding and using language. Common causes include:

stroke, thought to be the most common cause, around one in three people experience some degree of aphasia after having a stroke severe head injury brain tumour progressive neurological conditions (conditions that over time cause progressive brain and nervous system damage, such as Alzheimers disease)

A stroke that affects the left side of the brain may lead to aphasia, a language impairment that makes it difficult to use language in those ways. Aphasia can have tragic consequences. People with aphasia:

May be disrupted in their ability to use language in ordinary circumstances. May have difficulty communicating in daily activities. May have difficulty communicating at home, in social situations, or at work. May feel isolated.

Scientists and clinicians who study how language is stored in the brain have learned that different aspects of language are located in different parts of the left hemisphere. For example, areas in the back portions allow us to understand words. When a stroke affects this posterior part of the left hemisphere, people can have great difficulty understanding what they hear or read. Imagine going to a foreign country and hearing people speaking all around you. You would know they were using words and sentences. You might even have an elemental knowledge of that language, allowing you to recognize words here and there, but you would not have command of the language and couldnt follow most conversation. This is what life is like for people with comprehension problems. People with comprehension problems:

Know that people are speaking to them. Can follow some of the melody of sentences realizing if someone is asking a question or expressing anger. May have great difficulty understanding specific words. May have great difficulty understanding how words go together to convey a complete thought. Aphasia


People with serious comprehension difficulties have what is called Wernickes aphasia. In this form of aphasia the ability to grasp the meaning of spoken words is chiefly impaired , while the ease of producing connected speech is not much affected . Therefore Wernicke's aphasia is

referred to as a 'fluent aphasia.' However, speech is far from normal. Sentences do not hang together and irrelevant words intrude-sometimes to the point of jargon, in severe cases. Reading and writing are often severely impaired. Victims of Wernickes Aphasia:

Often say many words that dont make sense. May fail to realize they are saying the wrong words; for instance, they might call a fork a gleeble. May string together a series of meaningless words that sound like a sentence but dont make sense. Have challenges because our dictionary of words is shelved in a similar region of the left hemisphere, near the area used for understanding words.

Broca's Aphasia When a stroke injures the frontal regions of the left hemisphere, different kinds of language problems can occur. This part of the brain is important for putting words together to form complete sentences. Injury to the left frontal area can lead to what is called Brocas aphasia. In this form of aphasia, speech output is severely reduced and is limited mainly to short utterances of less than four words. Vocabulary access is limited and the formation of sounds by persons with Broca's aphasia is often laborious and clumsy. The person may understand speech relatively well and be able to read, but be limited in writing . Broca's aphasia is often referred to as a 'non fluent aphasia' because of the halting and effortful quality of speech. Survivors with Broca's aphasia:

Can have great difficulty forming complete sentences. May get out some basic words to get their message across, but leave out words like is or the. Often say something that doesnt resemble a sentence. Can have trouble understanding sentences. Can make mistakes in following directions like left, right, under, and after.

Carbumpboom! This is not a complete sentence, but it certainly expresses an important idea. Sometimes these individuals will say a word that is close to what they intend, but not the exact word; for example they may say car when they mean truck. A speech pathologist friend mentioned to a patient that she was having a bad day. She said, I was bitten by a dog. The stroke survivor asked, Why did you do that? In this conversation, the patient understood the basic words spoken, but failed to realize that the words of the sentence

and the order of the words were critical to interpreting the correct meaning of the sentence, that the dog bit the woman and not vice versa. Global Aphasia This is the most severe form of aphasia, and is applied to patients who canproduce few recognizable words and understand little or no spoken language. Global aphasics can neither read nor write. Global aphasia may often be seen immediately after the patient has suffered a stroke and it may rapidly improve if the damage has not been too extensive. However, with greater brain damage, severe and lasting disability may result. When a stroke affects an extensive portion of the front and back regions of the left hemisphere, the result may be global aphasia. Survivors with global aphasia:

May have great difficulty in understanding words and sentences. May have great difficulty in forming words and sentences. May understand some words. Get out a few words at a time. Have severe difficulties that prevent them from effectively communicating.

Mixed non-fluent aphasia:This term is applied to patients who have sparse and effortful speech, resembling severe Broca's aphasia. However, unlike persons with Broca's aphasia, they remain limited in their comprehension of speech and do not read or write beyond an elementary level. Remember, when someone has aphasia:

It is important to make the distinction between language and intelligence. Many people mistakenly think they are not as smart as they used to be. Their problem is that they cannot use language to communicate what they know. They can think, they just cant say what they think. They can remember familiar faces. They can get from place to place. They still have political opinions, for example. They may still be able to play chess, for instance.

The challenge for all caregivers and health professionals is to provide people with aphasia a means to express what they know. Through intensive work in rehabilitation, gains can be made to avoid the frustration and isolation that aphasia can create.

Anomic aphasia: This term is applied to persons who are left with a persistent inability to supply the words for the very things they want to talk about-particularly the significant nouns and verbs. As a result their speech, while fluent in grammatical form and output is full of vague circumlocutions and expressions of frustration. They understand speech well, and in most cases, read adequately. Difficulty finding words is as evident in writing as in speech. Other varieties of aphasia: In addition to the foregoing syndromes that are seen repeatedly by speech clinicians, there are many other possible combinations of deficits that do not exactly fit into these categories. Some of the components of a complex aphasia syndrome may also occur in isolation. This may be the case for disorders of reading (alexia) or disorders affecting both reading and writing (alexia and agraphia), following a stroke. Severe impairments of calculation often accompany aphasia, yet in some instances patients retain excellent calculation in spite of the loss of language. Paradoxical aphasia Some cases are truly mysterious and go under the name paradoxical aphasia. In these cases, the patient doesnt recover his or her main language immediately, but begins recovery by speaking a language the patient had been exposed to through religious services or only long ago and had not used recently. For example, in one case the patient was a Catholic priest whose L1 was French, but who also knew Latin, classical Greek, and basic biblical Hebrew. After the stroke, he could speak French, but his sentences consisted largely of a subject noun and a verb and nothing more. However, he continued to serve Mass and one day the researcher attended a service and was surprised to hear the patient speaking quite fluent Latin which was free from errors (Fabbro, 1999: 128). Characteristics of Expressive Aphasia Speaks only in single words (e.g., names of objects) Speaks in short, fragmented phrases Omits smaller words like "the," "of," and "and" (so message sounds like a telegram) Puts words in wrong order Switches sounds and/or words (e.g., bed is called table or dishwasher a "wish dasher") Makes up words (e.g., jargon) Strings together nonsense words and real words fluently but makes no sense

Characteristics of Receptive Aphasia Requires extra time to understand spoken messages (e.g., like translating a foreign language)

Finds if very hard to follow fast speech (e.g., radio or television news) Misinterprets subtleties of language-takes the literal meaning of figurative speech (e.g., "it's raining cats and dogs") Is frustrating for the person with aphasia and for the listenercan lead to communication breakdown

Very often, a person with aphasia has both expressive and receptive difficulties to varying degrees. Bilingual Aphasia Worldwide, there are about 300,000 new cases of aphasia every year. Of these, 40,000 may be cases of bilingual aphasia (M. Paradis, 2001). There is more study of bilingual aphasia than ever, partly because most studies are conducted in the Western nations that have seen a good number of immigrants, either bringing bilingualism with them or developing it in their new homes. Bilingual Aphasia and its Implications for Cerebral Organization and Recovery (Bruce E. Porch and Jonathan de Berkeley-Wykes Veterans Administration Medical Center, Albuquerque, New Mexico) Although approximately 80% of the world is bilingual, and approximately 75% is illiterate (UNESCO, 1965) the current state of knowledge on the cerebral organization of language is based almost entirely on research conducted with literate monolinguals. There is, therefore, a need for empirical investigation of the cerebral organization of language in non-literate and partially literate polyglot and bilingual samples. Even if bilinguals have both of their languages in the same language centers in the brain that seem to function for monolinguals, what happens to the different languages of bilinguals when their apparent language areas are damaged? The notion that the cerebral organization of language in bilinguals may not be the same as in monolinguals is not new, however, (Paradis, 1977). In the late nineteenth century, Ribot (1883) and Pitres (1895) proposed 'rule of primacy' and 'rule of recency' respectively. Implicit in the formulations of Pitres and Ribot is the notion that in bilingual aphasic patients, languages are differentially damaged or impaired. The three comprehensive reviews of the literature on bilingual and polyglot aphasia (Minkowski, 1963; Paradis, 1977; and Albert and Ohler, 1978) offer evidence to support both the rule of primacy and the rule of recency. Even after subjecting 108 cases, Albert and Ohler (1978) were unable to

unequivocally establish a pattern of deficit in the languages of bilinguals following brain damage. Factors that may affect Cerebral Organization of language(s) From her comprehensive review of some 500 clinical and experimental studies, Galloway (1983) concluded that following factors affect the cerebral organization of language in bilinguals and therefore affect the patterns of deficit that appear following brain damage: (a) Manner of language acquisition, (b) Degree of proficiency, and (c) The sociocultural setting of the use of the languages Another factor which has remained a controversial issue in the literature is whether literacy contributes to the cerebral organization of language. While one study suggests that illiterates have cerebral organization which is different from that of literates (Cameron, Currier, and Haerer, 1971) another reports no differences (Damasio, Castro-Caldas, Grosso and Ferro, 1976). Since Weber (1904) there has been speculation that acquisition of reading and writing skills contribute to left hemisphere dominance for language (Bogen,1975; Geschwind, 1972; Sperry, 1973). In B. E. Porch and J. de Berkeley-Wykes study, Degrees of differential impairment and abilities in the two languages (English, Spanish) of a sample of 44 patients were clearly related to premorbid differences in literacy, age of acquisition, proficiency, and usage. These factors appeared to be linked to years of education, and to the language in which that education had taken place. Contrary to the usual, expected severity levels, the left-hemisphere damaged patients were less involved than would have been predicted in such a random sample, and the right hemisphere damaged patients were more involved than expected. One interpretation might be that the bilingual brain tends to use both the left and the right hemispheres for language processing. Therefore, patients with left hemisphere lesions may have extra language areas in the right hemisphere to assist the damaged left side of the brain, and consequently, left lesion patients may either have fewer deficits or better recovery than is typical. In contrast, bilingual patients with right hemisphere lesions should have more deficits or poorer recovery than usual, since the right hemisphere is partially responsible for communicative processing.

The Assessment of Bilingual Aphasia A systematic assessment of all the languages known by an aphasic patient is an

essential prerequisite for: Clinical procedures (diagnosis, rehabilitation program, assessment of progress in recovery, etc.) Neurolinguistic research on multilingualism. Bilingual Aphasia Test (BAT) 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 patients 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) Part C for the assessment of translation abilities and interference detection in each language pair (58 items each) How to Administer BAT Patients are asked questions Answers are noted without making any judgment Answers are processed by means of a computerized program indicating the percentage of correct answers for each linguistic skill

Benefits of BAT Assessment of bilingual aphasics by the BAT provides Quantification and classification of language disorders for each language Allows a direct comparison of performances in the different languages known by the patient Clinical Aspects of Bilingual Aphasia
The clinical assessment of aphasics should take into account three different phases: (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 45 months postonset (3) the late phase, beginning a few months after onset and continuing for the rest of the patients life
Treatment Approaches for Aphasia There are some modern approaches for the treatment of aphasia. Output focused Therapy

Most speech/language pathologists still use the technique known as stimulation-response or direct retraining of deficit, as one aspect of their therapy program. First, the aphasic deficit is identified and, then, repetitive drill through several modalities (e.g, reading or repetition) is encouraged. An endless array of sophisticated modifications of this traditional approach has been developed.

A newer technique, called melodic intonation therapy (MIT), is neuro-behaviorally based. Through its Therapeutics and Technology Assessment Subcommittee, the American Academy of Neurology has identified MIT, currently in use worldwide, as an effective form of outputfocused language therapy. Melodic intonation therapy is a formal, hierarchically structured treatment program based on the assumption that the stress, intonation, and melodic patterns of language output are controlled primarily by the right hemisphere and, thus, are available for use in the individual with aphasia with left hemisphere damage. Melodic intonation therapy, in essence, consists of intoning normal language with exaggerated rhythm, stress, and melody. The subcommittee determined that MIT was effective for patients with Broca's aphasia, if used in its full and formal manner. Treating Related Neurobehavioral DeficitsCognitive Neuro-rehabilitation A newer approach to aphasia therapy is based on the idea that the ability to communicate is dependent not only on linguistic competence but also on related neurobehavioral functions, such as attention and memory. The assumption is that brain damage that produces aphasia also produces disturbance in other, language-related cognitive functions, and that treatment of these other cognitive deficits can facilitate communication. Holland outlines the strengths and limitations of this approach. For example, virtually all individuals with aphasia develop perseveration, which interferes with communicative capability. In 1988 Helm-Estabrooks and colleagues introduced Treatment for Aphasic Perseveration, and demonstrated that cognitive therapy focused on related neurobehavioral deficits, in this case perseveration, can improve language function in individuals with aphasia. McNeil and colleagues have long argued that individuals with aphasia suffer a deficit in allocation of attentional resources and proposed an "integrated attention theory of aphasia," asserting a relation among attention, arousal, and language processing. This argument receives support from contemporary research in cognitive neuroscience, in which a left hemisphere attentional system linked to language has been described by Posner. Indirect evidence exists that attempts to treat attentional dysfunction in individuals with aphasia may ameliorate the language disorder; and experimental studies are just beginning to test this hypothesis. Computer-Aided Therapy Of the many attempts to benefit individuals with aphasia by means of computer-aided therapy, perhaps the most creative was introduced by Baker and colleagues in the middle of the 1970s and further developed by them and by Weinrich and colleagues over the next 20 years. Computerized visual communication (or C-VIC) was designed as an alternative communication system for patients with severe aphasia and is based on the notion that those with severe aphasia can learn an alternative symbol system (alternative to the symbol system used in natural language) and can use this alternative system to communicate. Pictures or icons, representing meaningful concepts or things, are developed and loaded into a computer. The patient with aphasia learns to manipulate these icons on the computer screen for purposes of communication. According to Weinrich and colleagues most patients with severe aphasia whom they tested could master the mechanics of the system, learn icons for proper and common nouns, and use them in simple sentences, although they produced their sentences agrammatically. Nevertheless, teaching

patients with severe aphasia to communicate by computer, even with agrammatic output, is a remarkable achievement. Treating the Whole PersonPsychosocial Aspects and Pragmatics Martha Taylor Sarno, one of the pioneers of modern aphasia therapy, has also been one of the staunchest supporters of the effort to manage the whole patient, to help the patient recover functional communication using all techniques possible in a comprehensive therapy program. She says that "the condition of aphasia should not be limited by a definition which separates the language pathology from the person." One of the most active movements in current aphasia therapy is related to Sarno's cautions. Group treatment, focusing on regaining conversational skills, and on developing alternative strategies for communicating despite aphasia, is becoming increasingly popular. Interpersonal social contexts for developing effective supported communication are themselves the focus of treatment. One technique that has gained considerable popularity is Promoting Aphasics' Communicative Effectiveness (or PACE). In this program the emphasis is on enhancing communicative ability, nonverbal as well as verbal, in pragmatically realistic settings. Use of compensatory strategies is encouraged, with less of a focus on relearning a lost or deficient linguistic skill, and more on improving communication by any means possible.

Recovery According to Green (2005), increased migration and mobility of labor mean that there are increased numbers of bilingual and multilingual individuals. Increasingly then, aphasia which is one of the commonest outcomes following stroke, will be found in bilingual and multilingual individuals. Such an increase poses a challenge for support services and a challenge to researchers to improve theoretical understanding of the various patterns of language recovery in order to develop effective treatments. Green (2005) points out, we need to understand bilingual aphasic recovery patterns in order to challenge current accounts of how language is represented in the brain, and we also need to understand better the patterns that aphasics show in recovery in order to have principled rehabilitation programs. Some of these patients recover their speech and some recover only partially. But the fact that the different languages in a bilingual aphasics repertoire may be affected differently is evidence for the claim that languages are supported by different subsystems, not by a single common system (Fabbro, 2001). Psycholinguists who study aphasia almost necessarily are expected to propose a theory of how language is organized in the brain. That said, in spite of much research since the late 1800s,

researchers still do not have clear answers to many basic questions regarding language loss in bilingual aphasia. The general idea that Pitres proposed in 1895 still seems like the best starting point. He suggested that when a language is lost, whether temporarily or permanently, it is not destroyed, but inhibited. On this view, the popular reference to language loss seems misdirected; the ability to speak may be lost, but the language may still be represented in the brain. But the big questions still remain. To date there is no reliable correlation between aphasia and sites in the brain affected, or for that matter correlation with the patients history of bilingualism (which language was acquired when and its pattern of use at the time of the injury). Thus, M. Paradis, one of the main figures in aphasia study, ends his 2001 survey of aphasia in reference to bilinguals with these rather basic questions: 1. Why does any particular bilingual aphasic patient have the particular pattern of language loss that he or she shows? 2. Why does this same bilingual aphasic show better language recovery in one of his or her languages than the other? (M. Paradis, 2001). A traditional localizationist view argued that loss of one language occurs because the bilinguals languages are represented in different brain areas or even in different hemispheres. A focal brain lesion within a language-specific area could then affect one language only leaving the other language intact (Albert & Obler, 1978). There is claim that different brain areas mediate syntax in L1 and in L2 lies within this tradition (e.g., Ullman, 2001; 2005). An alternative, dynamic view, attributes the different patterns of language recovery to alterations in the system of language control (e.g., Abutalebi & Green, 2007; Green, 1986; Green & Price, 2001; Paradis, 1998; 2004)1. In fact, Pitres himself (Pitres, 1895) proposed a dynamic explanation of language recovery in bilingual aphasia: language recovery could occur only if the lesion had not entirely destroyed language areas, but only temporarily inhibited them through a sort of pathological inertia. Patterns of recovery A number of different patterns of recovery have been described since the early work of the French neurologist Pitres (1895). The recovery of both languages in line with their premorbid proficiency may well be the most common (i.e., parallel recovery, Paradis, 1998; 2004) but published case reports indicate other patterns (Fabbro, 1999; Paradis, 2004). These include the differential recovery of the two languages with selective recovery of just one language as the extreme. Ribot (1882) supposed that the first acquired language would be least affected (rule of primacy) whereas Pitres (1895) proposed (rule of recency) that the language most used at the time of aphasia onset would be best recovered. But such conjectures cannot explain the full set of reported patterns. Recovery may also reveal a temporal pattern, viz: successive recovery (i.e.,

after the recovery of one language, the other language recovers), alternating recovery (i.e., the language that was first recovered is lost again due to the recovery of the language that was not first), alternating antagonistic recovery (i.e., on one day the patient is able to speak in one language while the next day only in the other). Finally, the aphasic individual may show pathological mixing of two languages (i.e., the elements of the two languages are involuntarily mixed during language production). Keep in mind that, in general, bilinguals make use of the same neural mechanisms as monolinguals; the results of brain damage are just complicated in bilinguals by the number of languages involved. Parallel recovery: The most common pattern is that both languages are impaired in the same ways and both are restored at the same rate. Differential recovery: Each language shows a different degree of impairment. Successive recovery: One language doesnt begin to recover until the other has been largely recovered. Antagonistic recovery: One language loses ground as the other one improves. Selective recovery: The patient doesnt regain any recovery of one of the languages. Blended recovery: The patient systematically, but inappropriately, mixes his or her languages at all or nearly all levels of language (pronunciation, word and sentence structure, vocabulary, and meanings). There are a number of generalizations regarding recovery process about bilingual aphasic patient. 1. Aphasic bilinguals do not necessarily recover both or all of their languages. If they do recover either language or both, it is not necessarily at the same rate or to the same extent. 2. The variation on patterns of bilingual aphasia and their recovery is surprising. In 1997, Paradis surveyed the world literature on this issue, classifying results into six basic patterns of recovery. Aphasia is especially complicated with bilinguals: One or two languages may follow the same path, but then a third isnt recovered at all or much later. So, even these basic patterns dont cover the entire scope of bilingual aphasia. Once more, there are a number of disorders having to do with translating problems. 3. Even though we can point to one type as most common (parallel recovery), if the numbers of recent cases are considered, you can see how spread out they are. Further, parallel recovery only accounts overall for 40 percent of the cases, according to Paradis (1997). To show how hard it is to generalize, Paradis (2001) categorizes the 132 cases of bilingual aphasia reported since 1978.

Of these, 81 showed parallel recovery, 24 differential recovery, 12 blended language, 9 selective recovery, and 6 successive recovery. Representative cases The following is a case of what is called selective crossed aphasia. A polyglot patient (he spoke more than two languages) who at age 24 underwent a neurosurgical operation initially spoke his home language of Gujarati (a language in India). But he was born and had lived in Madagascar and so spoke Malagasy as well. At age six, he learned French, which he later used in his work as an accountant. Two weeks after the operation, he spoke French normally. He had trouble with Gujarati, but after four months he recovered Gujarati. At the same time, he had more difficulty in using Malagasy. Two years after the operation, tests showed his Gujarati was normal, but he had reduced fluency and made syntactic errors in Malagasy. Finally, four years after the operation, no disorders were detected in any of his languages (Fabbro, 1999: 1356). Just to illustrate another case, consider EG, who had a stroke at age 55 which affected the left temporal lobe. His L1 was Slovene and Italian was his L2. He also spoke Friulian (a Romance variety spoken in northern Italy) and English. After the stroke, he had semantic and syntactic problems with all of his languages (he suffered from what is called Wernickes aphasia). Furthermore, he mixed all of his languages. For example, in answer to the question (in English), Did you live in Germany? EG said, just think the wife, for [switching to Friulian] su e ju, su e ju, because would the problem here in [switching to Italian] Italia . . . (Fabbro, 1999: 154). Heres an example of a case of parallel recovery. This case involved a Korean-Japanese patient (Sasanuma and Park, 1995, cited in M. Paradis, 2001). The patient was raised in a monolingual Korean environment until age six. However, Korean and Japanese both figured in his education. His first nine years of schooling were only in Japanese and then his high school and college education was in Korean. For the two years before his stroke at age 62, he worked for a KoreanJapanese trading company. Also, he had maintained Japanese through yearly visits to Japan and by reading Japanese books and journals. Following his stroke, he could understand, read, and write both languages; but in speaking, he had more severe word-finding problems in Japanese than in Korean. Green suggests that certain patterns of recovery can be a function of problems in controlling the language systems, rather than of damage to them. Damage to different components of the control system may yield different outcomes. Or, the same outcome may be the result of different problems of control. For instance, selective loss of a language may arise because of an inability to inhibit the schema for producing speech in one language rather than another (Green, 1986) or to raise the activation of the alternative sufficiently (see, Paradis, 1998). On similar lines, as outlined by Paradis (1998), parallel recovery would then occur when both languages are inhibited to the same degree. When inhibition affects only one language for a period of time, and

then shifts to the other language (with disinhibition of the prior inhibited language) a pattern of antagonistic recovery occurs (Green, 1986). Pathological mixing among languages would occur when languages cannot be selectively inhibited (see Green & Abutalebi, in press, for an extended presentation on language control and bilingual aphasia). Further, Green points out that a basic question is the extent to which an L2 is processed differently from the L1. In proposing a second general explanation for aphasia, M. Paradis (2001) argues that patterns of recovery by aphasics support a subsystem hypothesis. Under this hypothesis, within the same cognitive system, there are subsystems for each language the bilingual speaks. Both languages have neural connections to this cognitive system, namely, the language system. In support of this hypothesis and against other views of how language is organized in bilinguals, Paradis states: only [the subsystem hypothesis] is compatible with all patterns of recovery as well as with the bilinguals ability to mix languages [code-switch] at each level of linguistic structure (2001: 81). The issue of problems with activation comes up in studies of brain-damaged bilinguals who no longer can speak both of their languages equally (or equally well). On this view, when both languages are impaired, this would mean that the linguistic system as a whole is impaired. And when only one language is impaired, this would indicate damage to only the subsystem supporting that language. Conclusion A detailed understanding of the causal basis of different patterns of recovery remains to be developed. However, current data are consistent with the view that the acquisition of another language involves adapting an existing network. Different languages are represented in shared neural areas with common organizing principles. It is also important to consider how individuals control the use of their languages. Certain patterns of deficit reflect problems of control rather than of deficits of representation. There is still a dearth of studies examining neural changes over the course of recovery and treatment studies also remain sparse. But there is every prospect that progress can be made by combining neuropsychological and neuroimaging techniques and using these to examine the adaptive response of the brain to recovery and to treatment. ------