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Language recovery patterns after brain injury

[By Humphrey M. Kapau]

The rains drummed on the old iron roof like mad spirits poisoned by the intoxicating cup of vengeance served at the ceremony of vengeance.

The roof whined and wobbled in relentless protest to the unforgiving downpour.

As all this was happening, Mrs Meleki was in her own world, thinking about her husband who was having language difficulties because of a stroke. For the few moments that she would board a shuttle to the conscious world of the living, she would hear her own occasional sighs thunder in her thoughts and explode through the nose in brief, involuntary burst like puffs of smoke from Cecil Rhodes’ coal-powered locomotives.

“My husband Mr. Meleki has difficulties expressing himself, and has trouble understanding speech. He is also finding it hard to read KiKaonde and English – the two languages he knew before the stroke,” Mrs Meleki had lamented to her neighbour Mrs Foloko earlier that day.

“He will be fine,” Mrs Foloko had responded to the visibly worried Mrs Meleki – a mother of two and wife to the only blacksmith in Kabici Village.

Mrs Meleki’s husband is an example of many people who display disability in language(s) they were previously proficient in before suffering some damage to some regions of the brain responsible for language. The clinical term for such language disability is ‘aphasia’. Aphasia can be defined as a communication disorder that can hinder an individual’s ability to use and understand spoken or written words as a result of damage to the side of the brain dominant for language (Malmkjaer, 1991; Crystal, 1991). Aphasia is not a disease but a symptom of brain damage and for this, people who study language and the brain (neurolinguists) tend to refer to it as a neurological disorder.

Some of the causes of aphasia include: an injury to the brain, stroke, brain tumour or an infection. Language recovery in aphasic patients is possible and it may be facilitated by several factors including: severity of damage to the part of the brain that handles language processing, patient’s age, language used before aphasic insult/attack and during therapy, and educational attainment (Laska, 2001; Leff, 2009).

Today, I will talk about language recovery patterns in people who knew two or more languages (i.e. bilinguals) before they became aphasic due to, say, a stroke. To address the topic, I will take you to clinical linguistics – an area in linguistics that applies linguistic analysis and methods to language disorders in humans such as in bilinguals (people who know two or more languages). It is worth clarifying beforehand that, although the term ‘bilingual’ strictly connotes people with mastery of two languages while ‘multilingual/polyglot’ implies those with mastery of many languages (i.e. ‘bi’– two; ‘multi’– many), for convenience, linguists usually prefer using the term ‘bilingual’ to refer to anyone who speaks two or more languages while ‘multilingual(ism)’ is usually reserved for the idea of society having many languages (Francis, 1999; Aaron, 2005). Below are the recovery patterns:

Parallel recovery

This is the type of recovery where a patient who had premorbid (medically, ‘premorbid’ means ‘before the occurrence of symptoms of a disorder’) competence in two or more languages recovers the languages at the same rate regardless of the degree of impairment. In other words, parallel recovery is simultaneous. For example, if Mr Meleki loses both KiKaonde and English due to a stroke but his recovery pattern involves recovering the two languages at the same rate, such a pattern is said to be parallel.

Differential recovery

This is where “[one] language is recovered much better than the other compared to premorbid [i.e. prior to symptoms of a disorder] abilities” (Lorenzen and Murray, 2014:305). Other scholars have noted that differential recovery involves recovery of languages at different rates relative to their labels prior to the aphasic insult/attack. Using the illustration of Mr Meleki, his recovery pattern would be termed differential if the languages are being recovered at different rates, where KiKaonde appears to be recovered much better than English when compared to the state of his competence in both languages before the disorder (premorbid). It is worth noting that ‘differential’ connotes two things in this case: varying rate of recovery; and varying scope of recovered linguistic competence in relation to prior presence of symptoms of the disorder in a patient (i.e. premorbid) and after the patient showed symptoms of such a disorder (i.e. post-morbid).

Selective recovery

As the name implies, selective recovery happens when one or more languages recover while others do not, hence the name ‘selective’. Lorenzen and Murray (2014:305), citing Fabbro (2001a) and Paradis (2004), have defined selective recovery as one where there is “[language] loss only in one language with no measurable deficit in the other.” For example, our patient Mr Meleki’s recovery pattern would be termed ‘selective’ if he recovers in KiKaonde but loses his English language; or, assuming he knew more than two languages, recovers in KiKaonde and English but his knowledge and use of Tswana, Nkoya, Ushi and Lungu are lost.

Antagonist recovery

In this type of recovery, a patient manages to recover in one language to a certain extent and starts regressing when another language begins to recover. The recovering languages keep opposing each other in the recovery process, thus the coinage ‘antagonist’ (see Fabbro, 2001a; and Paradis, 2004). For example, Mr Meleki’s linguistic recovery pattern would be coined ‘antagonist’ if, after recovering in KiKaonde, he begins to lose the KiKaonde the moment he begins to recover the English language. Therefore, his recovery of KiKaonde is in antagonist (rivalry) relation with that of the English language.

Successive recovery

The fifth major type of recovery is termed successive recovery. As the name implies, this happens when a bilingual aphasic recovers his/her languages in successive order (one after the other). After recovering in one language, the patient then begins to recover in the next language, the other and so forth. The timeline recovery of each language is subject to the linear recovery of a previous language. For instance, if Mr Meleki first recovers his KiKaonde language and thereafter begins to recover his English language, his recovery pattern is successive (i.e. one after the other).

Mixed/Blended recovery

The sixth and last common type of linguistic recovery pattern in bilingual aphasics is called mixed/blended recovery. This is where the recovery of languages get mixed. In mixed/blended recovery, the recovering aphasic person exhibits “uncontrollable mixing of words and grammatical constructions of two or more languages even when attempting to speak in only one language. This should not be confused with the common bilingual practice of code switching” (Lorenzen and Murray, 2014:305).

From the recovery patterns above, it is evident that bilingual aphasics do not display the same disorders of language with same degree of severity. Evidence of this has emerged from two major experiments conducted on bilinguals who suffered injury to their brain. The first was conducted in 1770 by a German classical scholar named Johann Gesner. Before the brain injury, Johann’s bilingual patient was good at both Italian and German. However, after an aphasic insult (i.e. ‘insult’ means ‘an attack’ in medicine), the patient could only read Italian. Later in 1843, Jacques Lordat (a professor of anatomy and physiology from Montpellier) reported a case of a bilingual priest who knew Occitan and French languages prior to brain damage. During recovery, the priest was first able to speak both languages. However, after some time, his Occitan was not affected though it suffered massive selectivity in linguistic attributes (Pearce, 2005).

Owing to this, two laws have emerged regarding an aphasic bilingual’s recovery of his first language (L1) and second language (L2). The first law is known as Pitres’ law (named after Albert Pitres, a French physician) and states that: after suffering a language-affecting injury to the brain, “recovery comes first and most completely in the language most used just before the injury, whether or not it is the patient’s mother tongue” (see Pitres, 1983:26–49). A contrast to Pitres’ law is Ribot’s law (named after Theodule-Armand Ribot, a French psychologist) which states that “recovery comes first in the person’s mother tongue…” (Ribot, 1882:np). Which of the two laws have you experienced in someone you know?

Let me know your thoughts and experiences on today’s topic through the contact details provided below. Join me next week Friday for another interesting topic. NB: Due to its multidisciplinary nature, this article was reviewed by both linguists and medical doctors. My special thanks go to Mrs Eunice Mukonde-Mulenga, a psycholinguist in the Department of Literature and Languages at the University of Zambia (UNZA); and Dr Dickson Munkombwe (a medical doctor), for providing additional insights to the topic.

The author is a systemic functional linguist and Special Research Fellow (PhD) at the University of the Western Cape, South Africa. His other research fields include neurolinguistics, forensic linguistics, psycho-linguistics, semiotics, corpus linguistics, cognitive linguistics, African languages and literature. He has also taught language at UNZA.

Contact: hmksettings@rocketmail.com, WhatsApp: +260 976 879148.

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