review article aphasia therapy in the age of globalization...

Review ArticleAphasia Therapy in the Age of GlobalizationCross-Linguistic Therapy Effects in Bilingual Aphasia

Ana Ineacutes Ansaldo12 and Ladan Ghazi Saidi1

1 Centre de Recherche de lrsquoInstitut Universitaire de Geriatrie de Montreal 4565 Queen Mary Road Montreal QC Canada H3W 1W52 Speech-Language Pathology and Audiology Department Faculty of Medicine University of Montreal Pavillon 7077 Avenue du Parclocal 3001-1 Montreal QC Canada H3N 1X7

Correspondence should be addressed to Ana Ines Ansaldo anainesansaldoumontrealca

Received 15 January 2013 Accepted 14 July 2013 Published 11 March 2014

Academic Editor Jubin Abutalebi

Copyright copy 2014 A I Ansaldo and L G SaidiThis is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

Introduction Globalization imposes challenges to the field of behavioural neurology among which is an increase in the prevalenceof bilingual aphasia Thus aphasiologists have increasingly focused on bilingual aphasia therapy and more recently on theidentification of themost efficient procedures for triggering language recovery in bilinguals with aphasiaTherapy in both languagesis often not available and thus researchers have focused on the transfer of therapy effects from the treated language to the untreatedone Aim This paper discusses the literature on bilingual aphasia therapy with a focus on cross-linguistic therapy effects fromthe language in which therapy is provided to the untreated language Methods Fifteen articles including two systematic reviewsproviding details on pre- and posttherapy in the adult bilingual population with poststroke aphasia and anomia are discussed withregard to variables that can influence the presence or absence of cross-linguistic transfer of therapy effects Results and DiscussionThe potential for CLTof therapy effects from the treated to the untreated language depends on theword type the degree of structuraloverlap between languages the type of therapy approach the pre- and postmorbid language proficiency profiles and the status ofthe cognitive control circuit

1 Introduction

11 Bilingualism Is a Distinctive Feature of GlobalizationContemporary society is characterized by a bilingual ormultilingual mode of communication Whether for historiceconomic or migration reasons bilingualism is no longerexceptional but most often the rule Whereas some coun-tries have a history of bilingual and polyglot modes ofcommunication the era of globalization has contributed tothe promotion of bilingualism around the world Nowa-days bilingualism provides better career opportunities inall sectors of the economy and human activity a fact thathas motivated a wider interest in second language learn-ing Parents are increasingly choosing bilingual educationas a result of evidence suggesting that bilingual childrenmay develop specific cognitive advantages [1 2] includingenhanced intellectual development greater creativity andflexibility and openness to cultural diversity For all of these

reasons social educational healthcare and political policiesare expected to adapt to such multilingual and multiculturalsocieties

12 Bilingual Aphasia Aphasia is an acquired language dis-order resulting from brain damage It refers to a breakdownin the ability to formulate retrieve or decode the arbitrarysymbols of language It is usually acquired in adulthood [3]

The bilingual population is large and growing world-wide therefore bilingual aphasia is becoming more andmore frequent The complexity of the behavioural patternsobserved in bilingual aphasia is big since it concerns two(or more) languages whose recovery does not always followequivalent patterns Moreover given the almost endlesspossible combinations of language pairs the issue of bilingualaphasia therapy is a big challenge Thus even the mostavant-garde educational policies aimed at training bilingual

Hindawi Publishing CorporationBehavioural NeurologyVolume 2014 Article ID 603085 10 pageshttpdxdoiorg1011552014603085

2 Behavioural Neurology

speech-language pathologists are likely to provide only partialsolutions to the clinical management of this population [4 5]Consequently the study of cross-linguistic-language-therapyeffects is likely to become an unavoidable topic in the field ofaphasiology in the years to come

From a neurorehabilitative perspective bilingualismimposes a certain number of challenges regarding theassessment and intervention provided to bilingual clinicalpopulations particularly those that suffer from cognitiveimpairmentThe complexity of this issue extends well beyondthe linguistic knowledge required to interact with the patientso as to detect impaired language abilities Beyond languagethere is communication that is the ability to decode the prag-matics that characterize a specific linguistic community Thisis essential for the proper understanding of communicativebehavior meaning what is normal and what is not in thecontext of a given culture

The issue of language impairment in bilinguals hasinterested cognitive neuroscientists for more than a centuryIn particular the study of bilingual aphasia first focusedon the variety of aphasia patterns characterizing bilingualclinical populations [5ndash8] Furthermore the development oftesting procedures that take into consideration the linguisticparticularities gave raise to bilingual aphasia tests for a varietyof language pairs among which the BAT [9 10] developedfor more than 59 languages and the Multilingual AphaisaExamination developed in six languages [11] along with testsnormalized in several languages such as the Aachen Aphasia[12ndash14] and the BostonDiagnosticAphasia Examination [15ndash18] These tests provide a linguistically valid assessment ofbilingual aphasia

More recently aphasiologists have focused on the com-plex issue of bilingual aphasia language therapy with thepurpose of developing the most efficient procedures fortriggering language recovery in this population This is arelatively new field and a complex one given that it requiresjuggling the complexities of bilingual language processingwhich amounts to more than simply the additive processingof two languages

2 Aims

The purpose of this paper is to discuss the literature onbilingual aphasia therapy with a focus on the cross-linguisticeffects that language therapy provided in one of the twolanguages of the patient may (or may not) have on theuntreated language

This paper will discuss a number of factors with CLTpotential (a) word category (cognates versus non-cognates)(b) language distance (same versus distant language families)(c) pre and post morbid proficiency in either languageand (d) the impact of cognitive control issues on transferof therapy effects Finally the main clinical implicationsof research findings on cross-linguistic transfer of therapyeffects (CLTE) in bilingual aphasia therapy will be discussedwith the purpose of proving intervention efficacy in bilingualpopulations with language impairment while optimizinghealth care efficiency in terms of resource training and allo-cation This research will contribute to intervention efficacy

in bilingual populations with language impairment whileoptimizing health care efficiency in terms of resource trainingand allocation

3 Methods

The evidence discussed in this paper was collected from thefollowing databasesMedline ASHA Cochrane AphasiologyArchive Evidence-Based Medicine Guidelines NHS Evi-dence and PsycBite et Speechbite The key words bilingualaphasia cross-language generalization cognates namingtreatment and transfer guided the search This resulted infifteen articles two of which received the largest weight inthe analysis since they were systematic reviews [19 20] withan A-level recommendation that witnesses for good qualitypatient-oriented research according to the AFF taxonomy[21] The remaining articles report case series or single-case design studies whose level of evidence is much lowerhowever all of these were selected because they respected anumber of criteria that allowed some degree of generalizationof the reported findings Specifically the inclusion criteriaconsisted the following

(a) provide details on pre- and posttherapy bilingualaphasia profiles

(b) describe therapy procedures in sufficient detail tomake them replicable

(c) provide information on therapy frequency(d) discuss a number of variables that may have influ-

enced the presence or absence of cross-linguistictransfer effects

(e) reported evidence which concerns the adult popula-tion with acquired language impairment

(f) reported that patient speaks at least two Indo-European languages with different degrees of profi-ciency across languages before brain damage

(g) focused mostly on therapy for word-retrievaldeficits namely anomia which constitutes the mostwidespread aphasia symptom across all aphasia types

4 Results

41 Cross-Linguistic Effects in Bilingual Healthy and BrainDamaged Populations Understanding the mechanisms thatrule cross-linguistic transfer in bilingual healthy populationshighlights the functioning of the bilingual language system

There is convergent evidence on the fact that the speechof a bilingual person reflects the influence of one languageon the other [22 page 5] This influence which results fromsimilarities and differences between the target language andany other previously acquired language is referred to as cross-linguistic influence or cross-linguistic transfer (CLT) [22 page27] Similarities and differences can be observed at differentlevels of language processing namely the word level thesyntax and phonology levels as well as the proficiency levelThus the study of CLT effects among healthy bilinguals

Behavioural Neurology 3

provides clues about the mechanisms that rule CLTE someof which have been exploited in bilingual aphasia therapy

411Word Type Cognates Clangs andNoncognates There isextensive evidence on CLT effects with cognates and clangsas opposed to noncognates [23 24] Cognates are formallyequivalent words whosemeaningsmay be identical or almostso [25 page 73] (eg ldquotigerrdquo (1015840 tıgJr) and ldquotigrerdquo (tigr))whereas clangs (or homophones) are phonologically similarwords with different meanings (eg ldquobellrdquo b120576l metal objectthat makes a ringing sound when struck Sonnette in French)in English and ldquobellerdquo in French (b120576l meaning beautiful)Finally noncognates are translation equivalents that sharesemantics but not phonology such as ldquobutterflyrdquo in Englishand its Spanish equivalent ldquomariposardquo

Evidence for the effects of CLT is reflected in fasterresponse times for cognates as compared to noncognates inpicture naming [23 26ndash31] as well as in word recognitionand word translation [30 32ndash34] It has also been argued thatcognates are processed as efficiently as monolinguals processmother tongue [35 36] Accordingly cross-linguistic therapyeffects with cognates in cases of bilingual aphasia havebeen examined Roberts and Deslauriers [30] showed thathighly proficient bilinguals with aphasia could better namecognates than non-cognates and they also produced distincterror types for each target Specifically errors with cognateswere no response and target descriptionmdashthe latter havinga communicative valuemdashwhereas noncognates resulted insemantic errors as well as language switching errors [30]

Finally although the evidence of a cognate effect inbilingual aphasia therapy is not unanimous [30 37 38]a generalization of therapy effects with cognates has beenreported in a case of Spanish-English bilingual aphasiaThus Kohnert [37] reported cross-linguistic generalizationof therapy effects from treated L1 (Spanish) to untreated L2(English) for cognates only Language treatment consisted oflexical semantic retrieval strategies such as word recognitionsemantic association and cueing [37] Conversely Kurlandand Falcon [38] report an interference effect with cog-nates following intensive language therapy with a semanticapproach in a case of a Spanish-English bilingual withchronic and severe expressive aphasiaThis interference effectcan be explained by reference to Abutalebi and Greenrsquos model[39] The patient presented a lesion in the basal ganglia acomponent of the corticosubcortical network sustaining theinhibition of the nontarget language this network includesthe left precentral cortex the anterior cingulate the inferiorparietal lobule and the basal ganglia [39]

Clangs or homophones also share phonological sim-ilarities with mother tongue words but unlike cognatesclangs refer to different concepts The evidence of a clangeffect in bilinguals is not convergent thus some authorsargue that both orthographic and phonological similarityare required to facilitate word recognition [40 41] whereasothers claim that processing clangs imposed an extra cog-nitive load resulting from the inhibition of the nontargetsemantic representation [42 43] In line with this claim arecent functional connectivity study shows that healthy adults

recruit a cognitive control network to process clangs [44]The extent to which clangs may facilitate cross-linguistictherapy effects in bilinguals with aphasia has not yet beentested however the findings within healthy populations [42ndash45] suggest that clangs may become particularly difficult incases of bilingual aphasia given that brain damage entailsdecreased cognitive resources [46]

There is also a lack of convergence regarding CLTE withnoncognates Kurland and Falcon [38] reported successfulCLTE for noncognates only after therapy with a semanticapproachHowever with a similar therapy approach Kohnert[37] failed to report such an effect and instead found one withcognates It is not easy to draw any conclusions given thatsuch a small number of studies have compared cognates andnoncognates particularly because factors other than wordtype may have influenced therapy results in either languageincluding lesion location and extension as well as cross-linguistic similarities and differences

412 Structural Similarities and Differences across LanguagesThe degree of structural overlap across languages plays amajor role in the potential for CLTE [19 20] For exampleGoral et al [47] described the case of a trilingual speakerwith mild chronic aphasia who was treated in English (L2)first on morphosyntactic skills (ie pronoun and genderagreement) and then on language production rate Measure-ments in the treated language (English) as well as in the twonontreated languages (Hebrew (L1) and French (L3)) werecollected after each treatment block

An improvement in pronoun and gender agreement inthe treated language (L2) as well as in the nontreated L3 wasobserved following the treatment block on morphosyntacticskills in English Also there was an improvement in speechrate in English and in French following the second block butno changes were observed in HebrewThe authors concludedthat selective CLT from L2 to L3 resulted from the structuralsimilarities between English and French as compared to alack of similarity between English and Hebrew

SimilarlyMiertsch [48] administered semantic therapy inFrench (L3) to a trilingual participant with Wernickersquos apha-sia Transfer was observed from L3 (French) to L2 (English)but not to L1 (German)These findingswere interpreted as theresult of structural similarities between French and Englishas compared to French and German However there is alsothe possibility that the results in German reflect a plateaueffect resulting from the fact that poststroke proficiency inGerman was higher than in the other two languages [48]As discussed by Faroqui et al [19] the years to come willyieldmore studies on the impact of cross-linguistic structuralsimilarities and differences on CLTE

413 Pre-Morbid and Post-Morbid Proficiency in Either Lan-guage A number of studies provide evidence for cross-linguistic transfer of therapy effects (CLTE) from the treatedless proficient second language to the untreated and betterpreserved mother tongue Kiran and Iakupova [49] admin-istered semantic therapy in L2 (English) and measurednaming on trained and untrained words both in L2 and L1


(Russian) Following therapy the participant showed 100accuracy in both treated and untreated items thus reflectingsuccessful CLTEThe authors [49] suggest that CLTE reflectsthe strengthened connections between the weaker (English)language and the stronger (Russian) language

Likewise CLTE was reported following intensive seman-tic therapy in L2 (English) in the case of a native Spanishbilingual individual with chronic severe expressive aphasia[38] particularly on naming tasks The authors argued thatalthough CLTE from premorbid less proficient language(L2) to premorbid more proficient language (L1) had beensuccessful all gains considered that the patient benefitedmore from therapy in L1 than from therapy in L2

There is evidence that balanced bilingualism contributesto CLTE [27 50 51] and in cases of unbalanced bilingualismtransfer is observed from the less proficient language to thedominant language Specifically parallel recovery in bothlanguages was observed in a premorbid balanced bilingualwoman (Flemish L1Italian L2) suffering from chronicaphasia after 2 weeks of picture-naming training throughrepetition and reading of names of pictures in L2 [51]Similarly Edmonds and Kiran [50] investigated the CLTof gains achieved following therapy with Semantic FeatureAnalysis to treat naming deficits by examining three English-Spanish bilinguals with aphasia all of whom received asemantic therapy in Spanish (Participant 1) and in Englishand Spanish (Participants 2 and 3)Therapy effectswere testedon treated items untreated items and translations resultsshowed that both within- and cross-language therapy effectswere related to premorbid language proficiency SpecificallyParticipant 1 a premorbid balanced bilingual showed CLTEto the untreated English items whereas Participants 2 and3 (who were more proficient in English) showed within-language generalization to semantically related items butno CLT to the untreated Spanish items Moreover thoughfollowing treatment in Spanish Participants 2 and 3 did notshow any within-language generalization they did show CLTto English their dominant languageThus this data supportsthe idea that better CLTE is observed from the less proficient(L2) to the more proficient language (L1)

In another study the authors [27] provided semantictherapy in Spanish to two Spanish-English bilinguals oneof them English dominant and the other one a balancedbilingual Therapy in Spanish resulted in CLTE for bothparticipants whereas therapy in English was followed byCLTE in the balanced Spanish-English participant only

Thus some studies [27 38 49ndash51] provide evidence thatpremorbid proficiency in either language modulates CLTEarguing that CLTE occurs more easily from a less proficientlanguage to the dominant language in unbalanced bilingualswhereas balanced bilingualism facilitates CLTE no matterwhich language is treated Thus it has been shown that theless proficient L2 relies upon the stronger L1 lexicon whereasat high proficiency levels L1 and L2 lexicons are mostlyoverlapping [19 52] Nevertheless it is difficult to draw a finalconclusion as some of these studies did not report poststrokeproficiency states [27 50]

A different point of view on the impact of proficiency ispresented by Goral [53] who claims that it is postmorbid

proficiency that determines the extent of CLTE Evidencefrom four different case studies demonstrating successfulCLTE with different patterns in multilingual participantswith aphasia included (a) CLTE in L1 (Hebrew) followingtreatment of L2 (English) (b) CLTE in L4 (German) fol-lowing treatment of L5 (English) (c) CLTE in L3 (French)following treatment of the strongest language L2 (English)and (d) CLTE in L2 (German) following treatment of mostrecovered L3 (English) In all cases CLTE occurred when thetherapy was offered in the language with higher postmorbidproficiency regardless of premorbid proficiency This is alsothe case in the limited (only for cognates) CLTE in an L1 andL2 premorbidly highly proficient Spanish (L1) and English(L2) bilingual suffering from nonfluent aphasia reportedby Kohnert [37] This patient showed improvement afterreceiving therapy in both languages however CLTEwas seenonly when therapy was administered in the language withhigher postmorbid proficiency (L1)

Similarly Croft et al [54] examined five English-Bengalibilinguals with aphasia and anomia who received a phono-logical approach and a semantic cueing approach bothin L1 and L2 While phonological cueing resulted in nosignificant CLTE semantic cueing led to CLTE for threeout of five patients In all cases CLTE occurred only whentherapy was offered in L1 [54] In observing the data on theparticipantsrsquo aphasia profiles one notes that for all cases inwhich successful CLTE was reported the language of therapyhappened to be the stronger post-morbid language As thispostmorbid more proficient language also happened to beL1 the authors took these results as evidence for successfulCLTE from L1 to L2 despite the fact that not all participantswhowere treated in L1 showed successful CLTEAnother caseof unsuccessful CLT despite the balanced proficiency bothat premorbid and postmorbid proficiency was reported byAbutalebi and colleagues [55] Thus no CLTE was observedfollowing L2 treatment in a case of fluent aphasiaThe patientwas a highly proficient balanced Spanish (L1) Italian (L2)bilingual who had become severely anomic in both languagesfollowing aphasia and involuntary language interferencewas observed Treatment in L2 was successful but did notshow any CLTE Unsuccessful CLTE in this case may resultfrom the therapy approach chosen (phonological approach)however another possibility is that involuntary languageswitching and unsuccessful CLTE resulted from damage toareas involved in cognitive control

414 Cognitive Control and Transfer of Therapy Effects Ithas been shown that damage to the cognitive control circuitcan prevent CLTE However there is also evidence thatchoosing an appropriate therapy approach (ie Switch BackThrough Translation) can result in CLTE even when damageto the cognitive control circuit is observed [56] This can beaccomplished by implementing a strategy of translation ofinvoluntary switches which allows bypassing the effects ofimpaired inhibitory abilities resulting from damage to thecognitive control circuit

In the case reported by Abutalebi et al [55] the Spanish(L1) and Italian (L2) bilingual anomic patient had damage to


the left lenticular nucleus and surrounding areas He showedselective L1 recovery at T0 and when asked to name picturesin L2 he would unintentionally name in L1 However afterreceiving therapy in L2 the selective pattern changed infavor of L2 and thus when asked to name in L1 he wouldunintentionally name in L2

The change of selective recovery pattern and the fact thatEM was unable to translate together with the presence of alesion within the cognitive control circuit lead Abutalebi andcolleagues [55] to conclude that EMrsquos behavior supports theDynamic Model on Recovery Patterns in Bilingual Aphasiaproposed by Green and Abutalebi [57] According to thismodel [57] the same neural network supports L1 and L2processing however the processing of the weaker language(usually L2) may as well involve the left prefrontal cortex thebasal ganglia and the anterior cingulated cortexas a functionof proficiency level

Based on Green and Abutalebi [57] one can argue thatthe recovery pattern will depend on the integrity of thecircuits normally involved in language control also it maybe hypothesized that damage to that circuit can affect CLTEThus cognitive control encompasses controlling languageselection and its impairment may result in involuntarylanguage mixing and language switching [56] However aspreviously discussed the evidence shows that it is possibleto compensate for this deficit by choosing an appropriatetherapy approach that can be designed by reference to acomprehensive model of bilingual language processing [56]Precisely CLTE can be triggered by stimulating both lan-guages simultaneously in the context of a therapy approachthat includes translation tasks even when therapy is providedprimarily in one language Ansaldo et al [56] reported thecase of a Spanish-English bilingual who suffered from patho-logical language mixing which caused alternation betweenSpanish (L1) and English (L2) utterances in the contextof communicating with monolingual Spanish speakers Theauthors [56] analysed this behaviour within the frameworkof Greenrsquos model [46] and developed a procedure calledSBTT (Switch Back Through Translation) based on the factthat translation from English to Spanish would provide aneconomic strategy to switch back to the target languageas opposed to inhibiting the nontarget (English) languagea lost ability resulting from brain damage to the languagecontrol circuit [56] The therapy was primarily administeredin Spanish and resulted in significant improvement in namingnouns and verbs in Spanish but moreover CLTE to Englishwas as well observed both with nouns and verbs Usingtranslation may favour CLTE by stimulating cognitive pro-cesses that are common to the two languages of the bilingualindividual (ie cognitive control of language selection)Further studies are required to explore this hypothesis indepth

42 Promoting CLTE in Bilingual Aphasia Therapy MainClinical Implications of Research Findings Despite the factthat more work is needed research on CLTE in bilingualaphasia provides some cues as to the best approach of thisclinical population

In particular the evidence suggests that language therapyfocused on cognates facilitates CLTE Thus forming a listof cognates consulting dictionaries developed for specificlanguage pairs (eg Spanish-English DOCmdashDictionary ofCognates and the RDOCmdashReverse Dictionary of Cognates[58 59]) can help clinicians focus language therapy on stimuliwith CLTE potential communicative and social relevancefor the patients their families and caregivers Furthermorethe MDOC project which aims at joining the cognatematches for five language pairs (httpwwwcognatesorg)will become an important resource in the managementof bilinguals with aphasia As for clangs the evidence inhealthy populations shows that their processing impliescomplex interactions with distinct semantic representationsthat share L1-L2 phonological forms which may becomeparticularly challenging for individuals with brain dam-age Further research is required to shed light on thisissue

Regarding pre- or postmorbid proficiency it is not easyto draw an absolute conclusion Some studies [27 38 49ndash51]suggest that premorbid proficiency matters and that trainingthe premorbid weaker language appears to facilitate CLTEgiven that treating the weaker language has a greater effecton the stronger than the reverse This has proven to be truefor premorbidly unbalanced bilinguals and also for balancedbilinguals who after a stroke showed an unbalanced lan-guage profile with distinct degrees of impairment in L1 andL2 On the other hand other cases suggest that postmorbidproficiency is the determinant factor for successful CLTE[53] Therefore both premorbid and postmorbid proficiencyshould be considered when deciding the language of therapyand to do so a thorough assessment of bilingual aphasia is amust

Moreover using translation as a CLT strategy mayenhance the effects of therapy provided in one language tothe untreated language Translation equivalents are stronglylinked a factor that may facilitate CLTE This approach maybe particularly useful when damage excludes the cognitivecontrol circuit which supports the ability to switch betweenL1 and L2

With respect to the anomia therapy approach evidencesuggests that Semantic Feature Analysis or a combinationof this approach with phonological cueing may contributeto CLTE Semantic Feature Analysis capitalizes on sharedsemantic representations across languages and it has beenshown to facilitate CLTE in bilinguals with aphasia [27]Furthermore the evidence withmonolinguals shows that thisapproach triggers neuroplasticity in cases of severe anomiaresulting from extensive brain damage [60]

Also the impact of semantic and phonologicalapproaches depending on the degree of L1-L2 cognateand clang density or global structural overlap needs to beexplored Hence the evidence on healthy populations showsthat processing structurally distant (ie unsimilar) languagesentails greater cognitive demands [45] Considering thisevidence it is likely that brain damage will hinder CLTEin bilinguals speaking distant languages who suffer fromaphasia

Table 1 summarizes all studies discussed in Section 4


Table1

Cognates

L1L2

L3Lang

uage

family

Lang

uage

profi

ciency

Therapy

approach

Lang

uage

oftherapy

Successfu

ltransfero

ftherapy

toun

treated

lang

uage

L1L2

L3L1

L2L3

Robertsa

ndDeslauriers(19

99)

[30]

timesFrench

English

NA

Roman

Germanic

NA

Pre-H

Pre-H

NA

NA

NA

NA

Kohn

ert(2004)

[37]

timesSpanish

English

NA

Roman

Germanic

NA

Pre-H

Post-

IPre-H

Post-

LNA

Lexical

semantic

retrieval

strategies

L1Cognateso

nly

Kurla

ndandFalcon

(2011)[38]

timesSpanish

English

NA

Roman

Germanic

NA

Pre-H

Post-

IPre-I

Post-

LNA

Semantic

L2Non

cogn

ates

only

Goraletal(2010)

[47]

NA

Hebrew

Englis0

068

French

Canaanite

Germanic

Roman

Pre-H

Post-

HPre-H

Post-

IPre-H

Post-

L

Morph

o-syntactic

skillsa

ndlang

uage

prod

uctio

nrate

L2L3

only

Miertsch(200

9)[48]

NA

German

English

French

German

Germanic

Roman

Pre-H

Post-

HPre-H

Post-

IPre-H

Post-

ISemantic

L3OnlyL2

KiranandIaku

pova

(2011)[49]

NA

Russian

English

NA

Slavic

Germanic

NA

Pre-H

Post-

HPre-I

Post-

INA

Semantic

L2L1

Marangoloetal

(200

9)[51]

NA

Flem

ishIta

lian

NA

Germanic

Roman

NA

Pre-H

Post-

IPre-H

Post-

INA

Picture-

naming

training

L2yes

Edmon

dsand

Kiran(200

6)[50]P1

NA

English

Spanish

NA

Germanic

Roman

NA

Pre-H

Post-

NR

Pre-I

Post-

NR

NA

Semantic

feature

analysis

L2No

Edmon

dsand

Kiran(200

6)[50]P2andP3

NA

English

Spanish

NA

Germanic

Roman

NA

Pre-H

Post-

NR

Pre-I

Post-

NR

NA

Semantic

feature

analysis

L1andL2

yes

Edmon

dsand

Kiran(200

6)[50]

bp1

NA

English

Spanish

NA

Germanic

Roman

NA

Pre-H

Post-

NR

Pre-I

Post-

NR

NA

Semantic

feature

analysis

L2andL1

From

L1to

L2on

ly

Edmon

dsand

Kiran(200

6)[50]

bp2

NA

Spanish

English

NA

Roman

Germanic

NA

Pre-H

Post-

NR

Pre-H

Post-

NR

NA

Semantic

feature

analysis

L1andL2

From

L1to

L2on

ly

Goral(2012)

[53]

P1NA

Hebrew

English

French

Canaanite

Germanic

Roman

Pre-H

Post-

HPre-H

Post-

IPre-H

Post-

L

Mod

ified

constraint-

indu

ced

therapy

L2L1

Goral(2012)

[53]

P2NA

Persian

German

English

Iranian

Germanic

Germanic

Pre-H

Post-

LPre-H

Post-

IPre-H

Post-

H

Mod

ified

constraint-

indu

ced

therapy

L3L1and

L2From

L2to

L3on

ly


Table1Con

tinued

Cognates

L1L2

L3Lang

uage

family

Lang

uage

profi

ciency

Therapy

approach

Lang

uage

oftherapy

Successfu

ltransfero

ftherapy

toun

treated

lang

uage

L1L2

L3L1

L2L3

Goral(2012)

[53]

P3NA

English

Hebrew

NA

Germanic

Canaanite

NA

Pre-H

Post-

HPre-I

Post-

INA

Mod

ified

constraint-

indu

ced

therapy

L2L1

butN

egative

Goral(2012)

[53]

P4NA

Catalan

Spanish

French

Roman

Roman

Roman

Pre-H

Post-

HPre-H

Post-

HPre-I

Post-

I

Mod

ified

semantic

feature

analysis

sentence

generate-on

L4G

erman

Pre-IPo

st-I

L5E

nglish

Pre-I

Post-

I

Croft

etal(2011)

[54]P1ndash

5NA

Beng

ali

English

NA

Germanic

NA

Post-

Hfor3

PsPo

st-L

for2

PsNA

Phon

ological

andsemantic

cueing

L1andL2

Forsem

antic

cueing

only

Abutalebietal

(200

9)[55]

NA

Spanish

Italian

NA

Roman

Roman

NA

Pre-H

Post-

LPre-H

Post-

LNA

Phon

ological

training

L2No


5 Conclusion

Globalization imposes a number of challenges to the fieldof neurorehabilitation including challenges in the clinicalmanagement of bilinguals with aphasia In recent decadesthe assessment and intervention techniques available tobilingual clinical populations have become a major clinicaland research topic

The study of intervention with bilingual aphasia popu-lations has evolved from a descriptive perspective mainlyfocused on case reports to a neuropsychological and neu-rofunctional perspective aimed at unveiling the cognitiveand neural mechanisms underlying the behavioral pat-terns that characterize bilingual aphasia and its recoveryMore and more this avenue is focusing on disentan-gling the mechanisms that allow for transferring therapyeffects from the treated to the untreated language Mostresearch has focused on anomia themost widespread aphasiasign

The literature suggests that cross-linguistic therapy effectsare possible but depend on a number of factors For exampleboth pre- and postmorbid proficiency factors can affectCLTE Thus while treating the premorbid weaker languagecan show CLTE benefits [27 38 49ndash51] cross-linguistictransfer of therapy effects are as well reported for eight caseswhenever therapy is provided in the postmorbid strongerlanguage or when proficiency after stroke is equivalent inboth languages Regarding therapy approach the evidencefrom 16 studies reporting the type of therapy adminis-tered suggests that semantic approaches result in betterCLTE than phonological approaches [54 55] Finally as forword types cognates have better CLT potential than non-cognates [30 37] but the cognate advantage disappearswhen cognitive control circuits are damaged [38] Thisis the case probably because of reduced excitatory andinhibitory resources secondary to the damage in the cognitivecontrol circuit This impairment prevents correct selectionamong highly overlapping and competing lexical units (iecognates) Greenrsquos Activation Control and Resource Model[46 61] assumes that lexical selection of the target wordrequires sufficient inhibitory (to suppress the non-targetnode) and excitatory resources (to activate the target node)Furthermore 11 studies having reported CLT effects showno evidence suggesting that language distance could play arole on the potential for CLT in bilingual aphasia therapyThus among indo-European languages therapy effects cantransfer across languages regardless of what language fam-ily they belong to the Indo-European family of languages[37 47ndash49 51 53 54]

Major developments in the field can be expected inthe years to come By combining clinical aphasiology cog-nitive models of bilingualism functional neuroimagingand functional connectivity analysis it will be possible tobetter understand the mechanism that subserve CLT oftherapy effects and thus design bilingual aphasia therapyapproaches accordingly This will increase the probabil-ity of recovery from bilingual aphasia while optimizinghealth care efficiency in terms of resource allocation andtraining

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper

References

[1] E Bialystok ldquoCognitive complexity and attentional control inthe bilingual mindrdquo Child Development vol 70 no 3 pp 636ndash644 1999

[2] E Bialystok ldquoCognitive effects of bilingualism across thelifespanrdquo in BUCLD 32 Proceedings of the 32nd Annual BostonUniversity Conference on Language Development H Chan HJacob and E Kapia Eds pp 1ndash15 Cascadilla Press BostonMass USA 2008

[3] A LHolland ldquoLiving successfullywith aphasia three variationson the themerdquo Topics in Stroke Rehabilitation vol 13 no 1 pp44ndash51 2006

[4] J G Centeno ldquoBilingual development and communicationdynamics and implications in clinical language studiesrdquo inCommunication Disorders in Spanish Speakers TheoreticalResearch and Clinical Aspects J G Centeno R T Andersonand L K Obler Eds pp 46ndash56 Multilingual Matters Cleve-don UK 2007

[5] J G Centeno ldquoServing bilingual patients with aphasia chal-lenges foundations and proceduresrdquo Revista de LogopediaFoniatrıa y Audiologia vol 29 no 1 pp 30ndash36 2009

[6] A I Ansaldo K Marcotte L Scherer and G RaboyeauldquoLanguage therapy and bilingual aphasia clinical implicationsof psycholinguistic and neuroimaging researchrdquo Journal ofNeurolinguistics vol 21 no 6 pp 539ndash557 2008

[7] F Fabbro ldquoThe bilingual brain bilingual aphasiardquo Brain andLanguage vol 79 no 2 pp 201ndash210 2001

[8] F Fabbro ldquoThe bilingual brain cerebral representation oflanguagesrdquo Brain and Language vol 79 no 2 pp 211ndash222 2001

[9] M Paradis ldquoAssessing bilingual aphasiardquo in Handbook ofCross-Cultural Neuropsychology B Uzzell and A Ardila EdsLawrence Erlbaum Associates Mahwah NJ USA 2001

[10] M Paradis and G LibbenThe Assessment of Bilingual AphasiaLawrence Erlbaum Associates Hillsdale NJ USA 1987

[11] A L Benton A Sivan K Hamsher N Varney and OSpreenContributions toNeuropsychologyAssessment AClinicalManual vol 2 Oxford University Press New York NY USA1994

[12] P Graetz R de Bleser andKWillmesAkense Afasia Test Swetsand Zeitlinger Liss UK 1992

[13] W Huber K Poeck and D Weniger Achener Aphasie Test(AAT) Hogrefe Gottingen Germany 1983

[14] N Miller K Willmes and R de Bleser ldquoThe psychometricproperties of the English language version of the AachenAphasia Test (EAAT)rdquo Aphasiology vol 14 no 7 pp 683ndash7222000

[15] M Laine H Goodglass J Niemi P Koivuselka-Sallinen JToumainen and R Martilla ldquoAdaptation of the Boston diag-nostic aphasia examination and the Boston naming test intoFinnishrdquo Scandinavian Journal of Logopedics and Phoniatricsvol 18 no 2-3 pp 83ndash92 1993

[16] I Reinvang and R Graves ldquoA basic aphasia examinationdescription with discussion of first resultsrdquo Scandinavian Jour-nal of Rehabilitation Medicine vol 7 no 3 pp 129ndash135 1975


[17] Roberts and P Kiran S ldquoAssessment and treatment of bilingualaphasia and bilingual anomiardquo in Speech and Language Disor-ders in Bilinguals A Ardila and E Ramos Eds Nova ScienceNew York NY USA 2007

[18] O Spreen and A H Risser Assessment of Aphasia OxfordUniversity Press New York NY USA 2003

[19] Y Faroqi-Shah T Frymark R Mullen and B Wang ldquoEffect oftreatment for bilingual individuals with aphasia a systematicreview of the evidencerdquo Journal of Neurolinguistics vol 23 no4 pp 319ndash341 2010

[20] K Kohnert ldquoCross-language generalization following treat-ment in bilingual speakers with aphasia a reviewrdquo Seminars inSpeech and Language vol 30 no 3 pp 174ndash186 2009

[21] M H Ebell J Siwek B D Weiss et al ldquoStrength of rec-ommendation taxonomy (SORT) a patient-centered approachto grading evidence in the medical literaturerdquo The AmericanFamily Physician vol 69 no 3 pp 548ndash556 2004

[22] M L Albert and L K Obler Neuropsychological and Neurolin-guistic Aspects of Bilingualism Academic Press London UK1978

[23] A Costa M Santesteban and A Cano ldquoOn the facilitatoryeffects of cognate words in bilingual speech productionrdquo Brainand Language vol 94 no 1 pp 94ndash103 2005

[24] D Singleton and D Little ldquoThe second language lexicon someevidence from university-level learners of French andGermanrdquoSecond Language Research vol 7 no 1 pp 61ndash81 1991

[25] T Odlin Language Transfer Cross-Linguistic Influence in Lan-guage Learning Cambridge University Press New York NYUSA 1989

[26] A M B de Groot and G L J Nas ldquoLexical representation ofcognates and noncognates in compound bilingualsrdquo Journal ofMemory and Language vol 30 no 1 pp 90ndash123 1991

[27] L A Edmonds and S Kiran ldquoConfrontation naming andsemantic relatedness judgements in SpanishEnglish bilin-gualsrdquo Aphasiology vol 18 no 5ndash7 pp 567ndash579 2004

[28] S Kiran and L A Edmonds ldquoEffect of semantic naming treat-ment on crosslinguistic generalization in bilingual aphasiardquoBrain and Language vol 91 no 1 pp 75ndash77 2004

[29] M Meinzer J Obleser T Flaisch C Eulitz and B RockstrohldquoRecovery from aphasia as a function of language therapy in anearly bilingual patient demonstrated by fMRIrdquo Neuropsycholo-gia vol 45 no 6 pp 1247ndash1256 2007

[30] P M Roberts and L Deslauriers ldquoPicture naming of cognateand non-cognate nouns in bilingual aphasiardquo Journal of Com-munication Disorders vol 32 no 1 pp 1ndash22 1999

[31] J G vanHell andAM B deGroot ldquoConceptual representationin bilingual memory effects of concreteness and cognate statusin word associationrdquo Bilingualism vol 1 no 3 pp 193ndash211 1998

[32] I K Christoffels C Firk andN O Schiller ldquoBilingual languagecontrol an event-related brain potential studyrdquo Brain Researchvol 1147 no 1 pp 192ndash208 2007

[33] A Costa A Caramazza and N Sebastian-Galles ldquoThe cognatefacilitation effect implications for models of lexical accessrdquoJournal of Experimental Psychology Learning Memory andCognition vol 265 pp 1283ndash1296 2000

[34] T H Gollan K I Forster and R Frost ldquoTranslation primingwith different scripts Masked priming with cognates andnoncognates in Hebrew-English bilingualsrdquo Journal of Experi-mental Psychology LearningMemory and Cognition vol 23 no5 pp 1122ndash1139 1997

[35] I Anton-Mendez and T H Gollan ldquoNot just semantics strongfrequency and weak cognate effects on semantic association inbilingualsrdquo Memory and Cognition vol 38 no 6 pp 723ndash7392010

[36] J A Dunabeitia M Perea and M Carreiras ldquoMasked trans-lation priming effects with highly proficient simultaneousbilingualsrdquo Experimental Psychology vol 57 no 2 pp 98ndash1072010

[37] K Kohnert ldquoCognitive and cognate-based treatments for bilin-gual aphasia a case studyrdquo Brain and Language vol 91 no 3pp 294ndash302 2004

[38] J Kurland and M Falcon ldquoEffects of cognate status and lan-guage of therapy during intensive semantic naming treatment ina case of severe nonfluent bilingual aphasiardquo Clinical Linguisticsand Phonetics vol 25 no 6-7 pp 584ndash600 2011

[39] J Abutalebi and D Green ldquoBilingual language production theneurocognition of language representation and controlrdquo Journalof Neurolinguistics vol 20 no 3 pp 242ndash275 2007

[40] J E Gracia-Albea andM L Sanchez-Bernardos Test de Gracia-Para el diagnostic de la afasia Adaptaion Espanola EditorialMedica Panamericana Madrid Spain 2nd edition 1996

[41] E Lalor and K Kirsner ldquoThe representation of ldquofalse cognatesrdquoin the bilingual lexiconrdquo Psychonomic Bulletin and Review vol8 no 3 pp 552ndash559 2001

[42] K E Elston-Guttler T C Gunter and S A Kotz ldquoZoominginto L2 global language context and adjustment affect process-ing of interlingual homographs in sentencesrdquo Cognitive BrainResearch vol 25 no 1 pp 57ndash70 2005

[43] J F Kroll and E Stewart ldquoCategory interference in translationand picture naming evidence for asymmetric connectionsbetween bilingual memory representationsrdquo Journal of Memoryand Language vol 33 no 2 pp 149ndash174 1994

[44] L G Saidi V Perlbarg G Marrelec M Pelegrini-Issac HBenali and A I Ansaldo ldquoSecond language neural networks atlow and high proficiency levels a functional connectivity studyrdquoBrain and Language vol 124 no 1 pp 56ndash65 2013

[45] L Ghazi-Saidi and A I Ansaldo ldquoThe neural correlates ofphonological transfer effects across distant languagesrdquo in Pro-ceedings of the 18th Annual Meeting of the Organization forHuman Brain Mapping Beijing China June 2012

[46] D W Green ldquoControl activation and resource a frameworkand a model for the control of speech in bilingualsrdquo Brain andLanguage vol 27 no 2 pp 210ndash223 1986

[47] M Goral E S Levy and R Kastl ldquoCross-language treatmentgeneralisation a case of trilingual aphasiardquoAphasiology vol 24no 2 pp 170ndash187 2010

[48] B Miertsch J M Meisel and F Isel ldquoNon-treated languages inaphasia therapy of polyglots benefit from improvement in thetreated languagerdquo Journal of Neurolinguistics vol 22 no 2 pp135ndash150 2009

[49] S Kiran and R Iakupova ldquoUnderstanding the relationshipbetween language proficiency language impairment and reha-bilitation evidence from a case studyrdquo Clinical Linguistics andPhonetics vol 25 no 6-7 pp 565ndash583 2011

[50] L A Edmonds and S Kiran ldquoEffect of semantic naming treat-ment on crosslinguistic generalization in bilingual aphasiardquoJournal of Speech Language and Hearing Research vol 49 no4 pp 729ndash748 2006

[51] P Marangolo C Rizzi P Peran F Piras and U SabatinildquoParallel recovery in a bilingual aphasic a neurolinguistic andfMRI studyrdquo Neuropsychology vol 23 no 3 pp 405ndash409 2009


[52] D Jared and J F Kroll ldquoCognitive processes bilingual readingrdquoin Indyslexia Across Languages Orthography and the Brain-Gene-Behavior Link P McCardle J R Lee B Miller and OTzeng Eds pp 262ndash280 Brookes Publishing Baltimore MdUSA 2001

[53] M Goral ldquoCross-language treatment effects in multilingualaphasiardquo in Aspects of Multilingual Aphasia M Gitterman MGoral and L K Obler Eds chapter 7 Multilingual MattersBristol UK 2012

[54] S Croft J Marshall T Pring and M Hardwick ldquoTherapy fornaming difficulties in bilingual aphasia which language ben-efitsrdquo International Journal of Language and CommunicationDisorders vol 46 no 1 pp 48ndash62 2011

[55] J Abutalebi P A D Rosa M Tettamanti D W Green and SF Cappa ldquoBilingual aphasia and language control a follow-upfMRI and intrinsic connectivity studyrdquoBrain and Language vol109 no 2-3 pp 141ndash156 2009

[56] A I Ansaldo L G Saidi and A Ruiz ldquoModel-driven interven-tion in bilingual aphasia evidence from a case of pathologicallanguage mixingrdquoAphasiology vol 24 no 2 pp 309ndash324 2010

[57] D W Green and J Abutalebi ldquoUnderstanding the link betweenbilingual aphasia and language controlrdquo Journal of Neurolinguis-tics vol 21 no 6 pp 558ndash576 2008

[58] R M Molina Cognate Linguistics (Cognates) Kindle eBook2011

[59] R M MolinaThe Dictionary of Cognates Kindle eBook 2011[60] K Marcotte D Adrover-Roig B Damien et al ldquoTherapy-

induced neuroplasticity in chronic aphasiardquo Neuropsychologiavol 50 no 8 pp 1776ndash1786 2012

[61] D W Green ldquoMental control of the bilingual lexico-semanticsystemrdquo Bilingualism Language and Cognition vol 1 no 2 pp67ndash81 1998

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014


MEDIATORSINFLAMMATION

of


Behavioural Neurology

EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of



Computational and Mathematical Methods in Medicine

OphthalmologyJournal of


Diabetes ResearchJournal of



Research and TreatmentAIDS


Gastroenterology Research and Practice


Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom


speech-language pathologists are likely to provide only partialsolutions to the clinical management of this population [4 5]Consequently the study of cross-linguistic-language-therapyeffects is likely to become an unavoidable topic in the field ofaphasiology in the years to come

From a neurorehabilitative perspective bilingualismimposes a certain number of challenges regarding theassessment and intervention provided to bilingual clinicalpopulations particularly those that suffer from cognitiveimpairmentThe complexity of this issue extends well beyondthe linguistic knowledge required to interact with the patientso as to detect impaired language abilities Beyond languagethere is communication that is the ability to decode the prag-matics that characterize a specific linguistic community Thisis essential for the proper understanding of communicativebehavior meaning what is normal and what is not in thecontext of a given culture

The issue of language impairment in bilinguals hasinterested cognitive neuroscientists for more than a centuryIn particular the study of bilingual aphasia first focusedon the variety of aphasia patterns characterizing bilingualclinical populations [5ndash8] Furthermore the development oftesting procedures that take into consideration the linguisticparticularities gave raise to bilingual aphasia tests for a varietyof language pairs among which the BAT [9 10] developedfor more than 59 languages and the Multilingual AphaisaExamination developed in six languages [11] along with testsnormalized in several languages such as the Aachen Aphasia[12ndash14] and the BostonDiagnosticAphasia Examination [15ndash18] These tests provide a linguistically valid assessment ofbilingual aphasia

More recently aphasiologists have focused on the com-plex issue of bilingual aphasia language therapy with thepurpose of developing the most efficient procedures fortriggering language recovery in this population This is arelatively new field and a complex one given that it requiresjuggling the complexities of bilingual language processingwhich amounts to more than simply the additive processingof two languages

2 Aims

The purpose of this paper is to discuss the literature onbilingual aphasia therapy with a focus on the cross-linguisticeffects that language therapy provided in one of the twolanguages of the patient may (or may not) have on theuntreated language

This paper will discuss a number of factors with CLTpotential (a) word category (cognates versus non-cognates)(b) language distance (same versus distant language families)(c) pre and post morbid proficiency in either languageand (d) the impact of cognitive control issues on transferof therapy effects Finally the main clinical implicationsof research findings on cross-linguistic transfer of therapyeffects (CLTE) in bilingual aphasia therapy will be discussedwith the purpose of proving intervention efficacy in bilingualpopulations with language impairment while optimizinghealth care efficiency in terms of resource training and allo-cation This research will contribute to intervention efficacy

in bilingual populations with language impairment whileoptimizing health care efficiency in terms of resource trainingand allocation

3 Methods

The evidence discussed in this paper was collected from thefollowing databasesMedline ASHA Cochrane AphasiologyArchive Evidence-Based Medicine Guidelines NHS Evi-dence and PsycBite et Speechbite The key words bilingualaphasia cross-language generalization cognates namingtreatment and transfer guided the search This resulted infifteen articles two of which received the largest weight inthe analysis since they were systematic reviews [19 20] withan A-level recommendation that witnesses for good qualitypatient-oriented research according to the AFF taxonomy[21] The remaining articles report case series or single-case design studies whose level of evidence is much lowerhowever all of these were selected because they respected anumber of criteria that allowed some degree of generalizationof the reported findings Specifically the inclusion criteriaconsisted the following

(a) provide details on pre- and posttherapy bilingualaphasia profiles

(b) describe therapy procedures in sufficient detail tomake them replicable

(c) provide information on therapy frequency(d) discuss a number of variables that may have influ-

enced the presence or absence of cross-linguistictransfer effects

(e) reported evidence which concerns the adult popula-tion with acquired language impairment

(f) reported that patient speaks at least two Indo-European languages with different degrees of profi-ciency across languages before brain damage

(g) focused mostly on therapy for word-retrievaldeficits namely anomia which constitutes the mostwidespread aphasia symptom across all aphasia types

4 Results

41 Cross-Linguistic Effects in Bilingual Healthy and BrainDamaged Populations Understanding the mechanisms thatrule cross-linguistic transfer in bilingual healthy populationshighlights the functioning of the bilingual language system

There is convergent evidence on the fact that the speechof a bilingual person reflects the influence of one languageon the other [22 page 5] This influence which results fromsimilarities and differences between the target language andany other previously acquired language is referred to as cross-linguistic influence or cross-linguistic transfer (CLT) [22 page27] Similarities and differences can be observed at differentlevels of language processing namely the word level thesyntax and phonology levels as well as the proficiency levelThus the study of CLT effects among healthy bilinguals




































Table1

Cognates

L1L2

L3Lang

uage

family

Lang

uage

profi

ciency

Therapy

approach

Lang

uage

oftherapy

Successfu

ltransfero

ftherapy

toun

treated

lang

uage

L1L2

L3L1

L2L3

Robertsa

ndDeslauriers(19

99)

[30]

timesFrench

English

NA

Roman

Germanic

NA

Pre-H

Pre-H

NA

NA

NA

NA

Kohn

ert(2004)

[37]

timesSpanish

English

NA

Roman

Germanic

NA

Pre-H

Post-

IPre-H

Post-

LNA

Lexical

semantic

retrieval

strategies

L1Cognateso

nly

Kurla

ndandFalcon

(2011)[38]

timesSpanish

English

NA

Roman

Germanic

NA

Pre-H

Post-

IPre-I

Post-

LNA

Semantic

L2Non

cogn

ates

only

Goraletal(2010)

[47]

NA

Hebrew

Englis0

068

French

Canaanite

Germanic

Roman

Pre-H

Post-

HPre-H

Post-

IPre-H

Post-

L

Morph

o-syntactic

skillsa

ndlang

uage

prod

uctio

nrate

L2L3

only

Miertsch(200

9)[48]

NA

German

English

French

German

Germanic

Roman

Pre-H

Post-

HPre-H

Post-

IPre-H

Post-

ISemantic

L3OnlyL2

KiranandIaku

pova

(2011)[49]

NA

Russian

English

NA

Slavic

Germanic

NA

Pre-H

Post-

HPre-I

Post-

INA

Semantic

L2L1

Marangoloetal

(200

9)[51]

NA

Flem

ishIta

lian

NA

Germanic

Roman

NA

Pre-H

Post-

IPre-H

Post-

INA

Picture-

naming

training

L2yes

Edmon

dsand

Kiran(200

6)[50]P1

NA

English

Spanish

NA

Germanic

Roman

NA

Pre-H

Post-

NR

Pre-I

Post-

NR

NA

Semantic

feature

analysis

L2No

Edmon

dsand

Kiran(200

6)[50]P2andP3

NA

English

Spanish

NA

Germanic

Roman

NA

Pre-H

Post-

NR

Pre-I

Post-

NR

NA

Semantic

feature

analysis

L1andL2

yes

Edmon

dsand

Kiran(200

6)[50]

bp1

NA

English

Spanish

NA

Germanic

Roman

NA

Pre-H

Post-

NR

Pre-I

Post-

NR

NA

Semantic

feature

analysis

L2andL1

From

L1to

L2on

ly

Edmon

dsand

Kiran(200

6)[50]

bp2

NA

Spanish

English

NA

Roman

Germanic

NA

Pre-H

Post-

NR

Pre-H

Post-

NR

NA

Semantic

feature

analysis

L1andL2

From

L1to

L2on

ly

Goral(2012)

[53]

P1NA

Hebrew

English

French

Canaanite

Germanic

Roman

Pre-H

Post-

HPre-H

Post-

IPre-H

Post-

L

Mod

ified

constraint-

indu

ced

therapy

L2L1

Goral(2012)

[53]

P2NA

Persian

German

English

Iranian

Germanic

Germanic

Pre-H

Post-

LPre-H

Post-

IPre-H

Post-

H

Mod

ified

constraint-

indu

ced

therapy

L3L1and

L2From

L2to

L3on

ly


Table1Con

tinued

Cognates

L1L2

L3Lang

uage

family

Lang

uage

profi

ciency

Therapy

approach

Lang

uage

oftherapy

Successfu

ltransfero

ftherapy

toun

treated

lang

uage

L1L2

L3L1

L2L3

Goral(2012)

[53]

P3NA

English

Hebrew

NA

Germanic

Canaanite

NA

Pre-H

Post-

HPre-I

Post-

INA

Mod

ified

constraint-

indu

ced

therapy

L2L1

butN

egative

Goral(2012)

[53]

P4NA

Catalan

Spanish

French

Roman

Roman

Roman

Pre-H

Post-

HPre-H

Post-

HPre-I

Post-

I

Mod

ified

semantic

feature

analysis

sentence

generate-on

L4G

erman

Pre-IPo

st-I

L5E

nglish

Pre-I

Post-

I

Croft

etal(2011)

[54]P1ndash

5NA

Beng

ali

English

NA

Germanic

NA

Post-

Hfor3

PsPo

st-L

for2

PsNA

Phon

ological

andsemantic

cueing

L1andL2

Forsem

antic

cueing

only

Abutalebietal

(200

9)[55]

NA

Spanish

Italian

NA

Roman

Roman

NA

Pre-H

Post-

LPre-H

Post-

LNA

Phon

ological

training

L2No


5 Conclusion







References





































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of



















































Table1

Cognates

L1L2

L3Lang

uage

family

Lang

uage

profi

ciency

Therapy

approach

Lang

uage

oftherapy

Successfu

ltransfero

ftherapy

toun

treated

lang

uage

L1L2

L3L1

L2L3

Robertsa

ndDeslauriers(19

99)

[30]

timesFrench

English

NA

Roman

Germanic

NA

Pre-H

Pre-H

NA

NA

NA

NA

Kohn

ert(2004)

[37]

timesSpanish

English

NA

Roman

Germanic

NA

Pre-H

Post-

IPre-H

Post-

LNA

Lexical

semantic

retrieval

strategies

L1Cognateso

nly

Kurla

ndandFalcon

(2011)[38]

timesSpanish

English

NA

Roman

Germanic

NA

Pre-H

Post-

IPre-I

Post-

LNA

Semantic

L2Non

cogn

ates

only

Goraletal(2010)

[47]

NA

Hebrew

Englis0

068

French

Canaanite

Germanic

Roman

Pre-H

Post-

HPre-H

Post-

IPre-H

Post-

L

Morph

o-syntactic

skillsa

ndlang

uage

prod

uctio

nrate

L2L3

only

Miertsch(200

9)[48]

NA

German

English

French

German

Germanic

Roman

Pre-H

Post-

HPre-H

Post-

IPre-H

Post-

ISemantic

L3OnlyL2

KiranandIaku

pova

(2011)[49]

NA

Russian

English

NA

Slavic

Germanic

NA

Pre-H

Post-

HPre-I

Post-

INA

Semantic

L2L1

Marangoloetal

(200

9)[51]

NA

Flem

ishIta

lian

NA

Germanic

Roman

NA

Pre-H

Post-

IPre-H

Post-

INA

Picture-

naming

training

L2yes

Edmon

dsand

Kiran(200

6)[50]P1

NA

English

Spanish

NA

Germanic

Roman

NA

Pre-H

Post-

NR

Pre-I

Post-

NR

NA

Semantic

feature

analysis

L2No

Edmon

dsand

Kiran(200

6)[50]P2andP3

NA

English

Spanish

NA

Germanic

Roman

NA

Pre-H

Post-

NR

Pre-I

Post-

NR

NA

Semantic

feature

analysis

L1andL2

yes

Edmon

dsand

Kiran(200

6)[50]

bp1

NA

English

Spanish

NA

Germanic

Roman

NA

Pre-H

Post-

NR

Pre-I

Post-

NR

NA

Semantic

feature

analysis

L2andL1

From

L1to

L2on

ly

Edmon

dsand

Kiran(200

6)[50]

bp2

NA

Spanish

English

NA

Roman

Germanic

NA

Pre-H

Post-

NR

Pre-H

Post-

NR

NA

Semantic

feature

analysis

L1andL2

From

L1to

L2on

ly

Goral(2012)

[53]

P1NA

Hebrew

English

French

Canaanite

Germanic

Roman

Pre-H

Post-

HPre-H

Post-

IPre-H

Post-

L

Mod

ified

constraint-

indu

ced

therapy

L2L1

Goral(2012)

[53]

P2NA

Persian

German

English

Iranian

Germanic

Germanic

Pre-H

Post-

LPre-H

Post-

IPre-H

Post-

H

Mod

ified

constraint-

indu

ced

therapy

L3L1and

L2From

L2to

L3on

ly


Table1Con

tinued

Cognates

L1L2

L3Lang

uage

family

Lang

uage

profi

ciency

Therapy

approach

Lang

uage

oftherapy

Successfu

ltransfero

ftherapy

toun

treated

lang

uage

L1L2

L3L1

L2L3

Goral(2012)

[53]

P3NA

English

Hebrew

NA

Germanic

Canaanite

NA

Pre-H

Post-

HPre-I

Post-

INA

Mod

ified

constraint-

indu

ced

therapy

L2L1

butN

egative

Goral(2012)

[53]

P4NA

Catalan

Spanish

French

Roman

Roman

Roman

Pre-H

Post-

HPre-H

Post-

HPre-I

Post-

I

Mod

ified

semantic

feature

analysis

sentence

generate-on

L4G

erman

Pre-IPo

st-I

L5E

nglish

Pre-I

Post-

I

Croft

etal(2011)

[54]P1ndash

5NA

Beng

ali

English

NA

Germanic

NA

Post-

Hfor3

PsPo

st-L

for2

PsNA

Phon

ological

andsemantic

cueing

L1andL2

Forsem

antic

cueing

only

Abutalebietal

(200

9)[55]

NA

Spanish

Italian

NA

Roman

Roman

NA

Pre-H

Post-

LPre-H

Post-

LNA

Phon

ological

training

L2No


5 Conclusion







References





































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















Table1Con

tinued

Cognates

L1L2

L3Lang

uage

family

Lang

uage

profi

ciency

Therapy

approach

Lang

uage

oftherapy

Successfu

ltransfero

ftherapy

toun

treated

lang

uage

L1L2

L3L1

L2L3

Goral(2012)

[53]

P3NA

English

Hebrew

NA

Germanic

Canaanite

NA

Pre-H

Post-

HPre-I

Post-

INA

Mod

ified

constraint-

indu

ced

therapy

L2L1

butN

egative

Goral(2012)

[53]

P4NA

Catalan

Spanish

French

Roman

Roman

Roman

Pre-H

Post-

HPre-H

Post-

HPre-I

Post-

I

Mod

ified

semantic

feature

analysis

sentence

generate-on

L4G

erman

Pre-IPo

st-I

L5E

nglish

Pre-I

Post-

I

Croft

etal(2011)

[54]P1ndash

5NA

Beng

ali

English

NA

Germanic

NA

Post-

Hfor3

PsPo

st-L

for2

PsNA

Phon

ological

andsemantic

cueing

L1andL2

Forsem

antic

cueing

only

Abutalebietal

(200

9)[55]

NA

Spanish

Italian

NA

Roman

Roman

NA

Pre-H

Post-

LPre-H

Post-

LNA

Phon

ological

training

L2No


5 Conclusion







References





































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















5 Conclusion







References





































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of




































































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















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