There is an interesting phenomenon often observed in brain injury survivors who were bilingual to the extent of fluency prior to their injuries. In these survivors who have post-injury language deficits the first (native) languages tend to return more quickly and fully than do their second languages. This is true even in survivors who were fully fluent in a second language and used that second language extensively in their everyday lives. As TLC is located in Texas, our staff tends to observe this phenomenon most often in Spanish-English bilingual patients. Many of these patients now contending with language difficulties who learned English later in life find it far easier to name objects or follow directions when Spanish is used, while prior to their injuries they would have been comfortable using either language.
This return of the first language sooner than a second language can have a number of practical consequences. Many survivors understandably become frustrated at an inability to speak that second language with the same skill once demonstrated. Being bilingual is often a point of pride and may have previously allowed the survivor to excel in activities (such as import-export business transactions) that the average person could not. This sudden significant skill gap may even prevent these survivors from returning to jobs in which a second language was utilized as a vital portion of everyday business life. Moreover, if the survivor was previously the primary translator for the family this may cause difficulties in the family’s ability to interact with the outside world. For example, the survivor may have previously served as point person to get information from school regarding a child’s performance as that survivor could easily speak to school officials (and the rest of the family may struggle with casual exchanges in English). If the survivor is now unable to converse fluently in English, the family may now face significant problems interacting with the school.
There are also practical therapy concerns when a survivor struggles with a second language if that second language is the primary language used in the larger community. In America, English is obviously the dominant language. As such, most pre-therapy evaluations are conducted in English. There are a limited number of health care professionals who are comfortable conducting evaluations in another language. However, if a survivor’s first language is not English and that survivor is significantly stronger in his or her first language, that first language will need to be the language used in evaluations so as to get the most accurate measurements of the survivor’s skills. The same is true in therapy. If a survivor understands therapy directions significantly better in a first language, then therapy should be conducted in the survivor’s first language. Additionally, therapists should always inquire as to which language is used in the home. If the survivor’s first language is different than the language used at home (seen when someone who speaks both Spanish and English marries a spouse who only speaks English), then that second language will need extra focus or alternative methods of communication (e.g. pictures or hand signals) may need to be introduced. At TLC, we have a number of Spanish-English bilingual staff and have a contract with a translation service if other help is needed. Overall, rehabilitation professionals must be aware of survivors’ language skills and adjust evaluations and therapy accordingly.
Learn about brain injury treatment services at the Moody Neurorehabilitation Institute! Visit us at: http://tlcrehab.org/