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PubMed2005

Impact of language proficiency and orthographic transparency on bilingual word reading: an fMRI investigation.

The purpose of the present functional magnetic resonance imaging (fMRI) investigation was to examine how language proficiency and orthographic transparency (letter-sound mapping consistency) modulate neural activity during bilingual single word reading. Spanish-English bilingual participants, more fluent in their second language (L2; English) than their native language (L1; Spanish), were asked to read words in the two languages. Behavioral results showed that participants were significantly slower in reading words in their less proficient language (Spanish) than in their more proficient language (English). fMRI results also revealed that reading words in the less proficient language yielded greater activity in the articulatory motor system, consisting of supplementary motor area/cingulate, insula, and putamen. Together, the behavioral and fMRI results suggest that the less practiced, hence less proficient, language requires greater articulatory motor effort, which results in slower reading rates. Moreover, we found that orthographic transparency also played a neuromodulatory role. More transparent Spanish words yielded greater activity in superior temporal gyrus (STG; BA 22), a region implicated in phonological processing, and orthographically opaque English words yielded greater activity in visual processing and word recoding regions, such as the occipito-parietal border and inferior parietal lobe (IPL; BA 40). Overall, our fMRI results suggest that the articulatory motor system is more plastic, hence, more amenable to change because of greater exposure to the L2. By contrast, we propose that our orthography effect is less plastic, hence, less influenced by frequency of exposure to a language system.

Adult↗
PubMed2006

Native and non-native reading of sentences: an fMRI experiment.

The processing of syntactic and semantic information in written sentences by native (L1) and non-native (L2) speakers was investigated in an fMRI experiment. This was done by means of a violation paradigm, in which participants read sentences containing either a syntactic, a semantic, or no violation. The results of this study were compared to those of a previous fMRI study, in which auditory sentence processing in L1 and L2 was investigated. The results indicate greater activation for L2 speakers as compared to L1 speakers when reading sentences in several language- and motor-related brain regions. The processing of syntactically incorrect sentences elicited no reliably greater activation in language areas in L2 speakers. In L1 speakers, on the other hand, syntactic processing, as compared to semantic processing, was associated with increased activation in left mid to posterior superior temporal gyrus. In response to the processing of semantically incorrect sentences, both L2 and L1 speakers demonstrated increased involvement of left inferior frontal gyrus. The results of this study were compared to a previously conducted fMRI study, which made use of identical sentence stimuli in the auditory modality. Results from the two studies are in general agreement with one another, although some differences in the response of brain areas very proximal to primary perceptual processing areas (i.e. primary auditory and visual cortex) were observed in conjunction with presentation in the different modalities. The combined results provide evidence that L1 and L2 speakers rely on the same cortical network to process language, although with a higher level of activation in some regions for L2 processing.

Adolescent↗
PubMed2006

Bilingual brain organization: a functional magnetic resonance adaptation study.

We used functional magnetic resonance adaptation (fMRA) to examine whether intra-voxel functional specificity may be present for first (L1)- and second (L2)-language processing. We examined within- and across-language adaptation for spoken words in English-French bilinguals who had acquired their L2 after the age of 4 years. Subjects listened to words presented binaurally through earphones. In two control conditions (one for each language), six identical words were presented to obtain maximal adaptation. The remaining six conditions each consisted of five words that were identical followed by a sixth word that differed. There were thus a total of eight experimental conditions: no-change (sixth word identical to first five); a change in meaning (different final word in L1); a change in language (final item translated into L2); a change in meaning and language (different final word in L2). The same four conditions were presented in L2. The study also included a silent baseline. At the neural level, within- and across-language word changes resulted in release from adaptation. This was true for separate analyses of L1 and L2. We saw no evidence for greater recovery from adaptation in across-language relative to within-language conditions. While many brain regions were common to L1 and L2, we did observe differences in adaptation for forward translation (L1 to L2) as compared to backward translation (L2 to L1). The results support the idea that, at the lexical level, the neural substrates for L1 and L2 in bilinguals are shared, but with some populations of neurons within these shared regions showing language-specific responses.

Adult↗
PubMed2004

A case of psychogenic fugue: I understand, aber ich verstehe nichts.

Psychogenic fugue is a disorder of memory that occurs following emotional or psychological trauma and results in a loss of one's personal past including personal identity. This paper reports a case of psychogenic fugue in which the individual lost access not only to his autobiographical memories but also to his native German language. A series of experiments compared his performance on a variety of memory and language tests to several groups of control participants including German-English bilinguals who performed the tasks normally or simulated amnesia for the German language. Neuropsychological, behavioral, electrophysiological and functional neuroimaging tests converged on the conclusion that this individual suffered an episode of psychogenic fugue, during which he lost explicit knowledge of his personal past and his native language. At the same time, he appeared to retain implicit knowledge of autobiographical facts and of the semantic or associative structure of the German language. The patient's poor performance on tests of executive control and reduced activation of frontal compared to parietal brain regions during lexical decision were suggestive of reduced frontal function, consistent with models of psychogenic fugue proposed by Kopelman and Markovitsch.

Adult↗
PubMed2004

Language switching mechanisms in simultaneous interpreters: an ERP study.

Recent event-related potential (ERP) and neuroimaging studies suggest that bilingual individuals are able to inhibit the processing of a non-target language while speaking or reading in another language. The neural mechanisms subserving code switching still remain matter of debate. The aim of the present study was to shed some light on the neurofunctional bases of such mechanisms. ERPs were recorded in native Italian simultaneous interpreters and monolingual controls during a semantic processing task in which the subjects had to evaluate the sensibleness of final words of incomplete sentences. All participants were strictly right-handed. Interpreters knew at least four languages (from four to eight) at a professional level, from among 11 European and Asian languages, and had an excellent command of English (L2). Four hundred short sentences were presented visually; half of them had an unexpected final word, producing a semantic incongruence. Sentences could be entirely in Italian or in English (unmixed); alternatively, the body of the sentence could be in English and the final word in Italian or vice versa (mixed). ERPs were time locked to the onset of the final word. Both reaction times (RTs) and electrophysiological data indicated a lesser degree of hemispheric lateralization for linguistic function during L2 rather than L1 processing in interpreters. The first effect of lexical switching and code switching was recorded in the time window between 140 and 200 ms at left anterior sites. At N400 level, ERPs were significantly larger to L2 than to L1 words only in the mixed and not in the unmixed condition. No effect of language was observed in the unmixed condition, thus suggesting that the difference in L1/L2 processing was not related to a difference in proficiency, but rather to a different functional organization of semantic integration systems due to the later age of acquisition of L2 compared to L1. Interpreters were faster at reading and comprehending sentences in English ending with an Italian word than vice versa (L2 --> L1 switch).

Adult↗
PubMed2006

Syntax production in bilinguals.

We used fMRI to examine the functional correlates of syntactical processing in the first (L1) and second (L2) languages of non-proficient, late bilinguals. Subjects either covertly read words or produced sentences from them. Syntactical production during sentence production activated regions including left inferior frontal (LIFG) gyrus and the supplementary motor area in both languages. Analyses performed on the LIFG activation identified on a subject-by-subject basis revealed greater activation in L2 compared to L1 during sentence production and during word reading, consistent with previous work suggesting that greater cognitive effort may be subserved by less well-tuned neural representations that require greater neuronal activity. Remarkably, there was a greater separation in the LIFG activations in L1 versus L2 in less compared to more proficient bilinguals during syntax production, suggesting a functional reorganisation of regions involved in syntactical production as a function of syntactical proficiency.

Adult↗
PubMed2006

Sex determines the neurofunctional predictors of visual word learning.

This study used functional MRI and an artificial language training paradigm to explore sex differences in the processing of a new writing system and how sex determines the optimal neural resource recruitment for visual word learning. Results indicated that males and females achieved equal learning outcome, and their learning curve followed a similar power function. They also showed similar overall activation in the fusiform cortex, a region that has been associated with visual word processing. Despite the absence of sex differences in averaged behavioral performance and neural activation, males and females were found to have different neural predictors of visual word learning. As predicted, left-lateralized fusiform activation predicted visual word learning for males, but not for females, whereas bilateral fusiform activation predicted visual word learning for females, but not males. These results suggest that male and female brains operate differently to achieve the best performance in visual word learning. The individual-differences approach adopted in the present study provides a new and useful perspective to sex differences.

Adult↗
PubMed2006

Recovery from aphasia as a function of language therapy in an early bilingual patient demonstrated by fMRI.

Knowledge about the recovery of language functions in bilingual aphasic patients who suffer from left-hemispheric stroke is scarce. Here, we present the case of an early bilingual patient (German/French) with chronic aphasia. Functional magnetic resonance imaging (fMRI) was used to investigate neural correlates of language performance during an overt picture naming task in German and French (a) 32 months after stroke to assess differential recovery of both languages as a function of the preceding language therapy that was provided exclusively in German and (b) after additional short-term intensive (German) language training. At the first investigation behavioral performance confirmed selective recovery of German naming ability which was associated with increased functional brain activation compared to the French naming condition. Changes in behavioral performance and brain activation pattern as disclosed by fMRI after an additional experimental treatment were confined to the trained (German) language and indicate bilateral neuroplastic reorganization. No generalization to the untrained (French) language was observed. The present case results demonstrate use and/or training-dependent differential recovery of expressive language functions and an enhanced pattern of brain activation as a function of the rehabilitation efforts that were focussed exclusively on the patient's German language abilities.

Adult↗
PubMed2006

Bilingualism as a protection against the onset of symptoms of dementia.

This study examined the effect of lifelong bilingualism on maintaining cognitive functioning and delaying the onset of symptoms of dementia in old age. The sample was selected from the records of 228 patients referred to a Memory Clinic with cognitive complaints. The final sample consisted of 184 patients diagnosed with dementia, 51% of whom were bilingual. The bilinguals showed symptoms of dementia 4 years later than monolinguals, all other measures being equivalent. Additionally, the rate of decline in Mini-Mental State Examination (MMSE) scores over the 4 years subsequent to the diagnosis was the same for a subset of patients in the two groups, suggesting a shift in onset age with no change in rate of progression.

Age of Onset↗
PubMed2005

Performance of the English and Spanish S-TOFHLA among publicly insured Medicaid and Medicare patients.

The objective of this study was to analyze the psychometric properties of the English and Spanish S-TOFHLA for three patient populations of interest. Despite being widely used, little is written about psychometric properties of the S-TOFHLA, particularly the Spanish version. Participants were Medicaid and Medicare patients: 936 non-Hispanic and 368 Hispanic patients completed the English S-TOFHLA; 1066 Hispanics completed the Spanish S-TOFHLA. Validity of both versions of the S-TOFHLA was supported by strong positive relationships with education and inverse relationships with age. Significant differences between scores for men and women remained after adjusting for level of education. Score differences occurred across numerous items. More research is needed on the S-TOFHLA and other health literacy instruments to determine why women score differently than men. Variability in literacy skills within subgroups of patients highlights the importance of healthcare providers being sensitive to patients' literacy levels in both spoken and written communications.

Adult↗
PubMed2004

Assessment of mutual understanding of physician patient encounters: development and validation of a Mutual Understanding Scale (MUS) in a multicultural general practice setting.

Mutual understanding between physician and patient is essential for good quality of care; however, both parties have different views on health complaints and treatment. This study aimed to develop and validate a measure of mutual understanding (MU) in a multicultural setting. The study included 986 patients from 38 general practices. GPs completed a questionnaire and patients were interviewed after the consultation. To assess mutual understanding the answers from GP and patient to questions about different consultation aspects were compared. An expert panel, using nominal group technique, developed criteria for mutual understanding on consultation aspects and secondly, established a ranking to combine all aspects into an overall consultation judgement. Regarding construct validity, patients' ethnicity, age and language proficiency were the most important predictors for MU. Regarding criterion validity, all GP-related criteria (the GPs perception of his ability to explain to the patient, the patient's ability to explain to the GP, and the patient's understanding of consultation aspects), were well-related to MU. The same can be said of patient's consultation satisfaction and feeling that the GP was considerate. We conclude that the Mutual Understanding Scale is regarded a reliable and valid measure to be used in large-scale quantitative studies.

Adolescent↗
PubMed2005

Chest pain: communication of symptoms and history in a London emergency department.

OBJECTIVE: To describe patient-provider interactions for patients in an emergency department with possible acute coronary syndrome (ACS) and to generate hypotheses about how communication might contribute to sociocultural disparities in cardiac care. METHODS: Qualitative analysis of observational data. Seventy-four consecutive patients presenting between 8 a.m. and 10 p.m. over a 4-month period. RESULTS: Participants were aged 40-85 years; 58% were male; 67% were white, 18% Afro-Caribbean, and 15% South East Asian. Observations revealed significant obstacles to communication for the majority of patients. The three most prominent impediments to effective communication were: the use of leading questions to define chest pain, patient-provider conflict as a result of, and contributor to, poor communication, and frank miscommunication due to language barriers and translational difficulties. CONCLUSION: This study documents aspects of the communication process that compromise the quality of the medical history obtained in emergency department patients with suspected ACS. Accurate diagnosis relies on an interaction that weaves both the patient's and the physician's perspective into a shared understanding of events that comprise a patient's history. When diagnostic short cuts are taken to overcome educational, cultural, or language barriers in the medical interview, they may contribute to health care disparities. PRACTICE IMPLICATIONS: Physicians should take a more attentive and careful approach to patient interviewing than was observed here and should be aware of the ways in which they shape the interview through their questions and focus. Good communication skills can be effectively taught at all levels of training and practice.

Adult↗
PubMed2006

Russian-American health care: bridging the communication gap between physicians and patients.

OBJECTIVES: The objectives of this article are two-fold: (1) to gather in one place reliable information about Russian-Americans' past medical practices and their current outlook on health care and to provide health care professionals with an overview of the major afflictions suffered by this ethnic group; and (2) to educate Russian-speaking patients about the American heath care system and social services geared towards immigrants by locating and evaluating free, culturally appropriate patient education Web sites available in Russian. METHODS: In order to draw data on specific diseases and conditions affecting the Russian-speaking population, the author searched various scholarly health-related electronic databases. A number of well-established U.S. government consumer-health Web sites were searched to locate patient education resources that can be utilized by recent Russian immigrants. RESULTS: The author provides an overview of the major health problems encountered by the Russian-speaking population before emigration and potential health concerns for Russian immigrant communities. In addition, the author provides a scholarly exploration of patient education materials available in Russian. CONCLUSION: In this increasingly diverse society, physicians are faced with the challenge of providing culturally sensitive health care. Multicultural Web-based health resources can serve as a valuable tool for reducing communication barriers between patients and health care providers, thus improving the delivery of quality health care services. Recommendations for further research are indicated. PRACTICE IMPLICATIONS: The author offers recommendations for practitioners serving Russian-speaking immigrants. Suggestions on utilization of Web resources are also provided.

Acculturation↗
PubMedDate not supplied

Impact of language barrier on acute care medical professionals is dependent upon role.

Communication with patients is essential to providing quality medical care. The study was conducted to evaluate the effects of language barriers on health care professionals. It is hypothesized that these language barriers are commonly perceived by health care professionals and they are a source of workplace stress in acute care environments. We designed and distributed a survey tool of staff experiences and attitudes regarding the English-Spanish language barrier among patients in an acute care surgical environment of a tertiary medical center. Responses were anonymous, stratified by professional role and comparisons made using paired t tests. Sixty-one nurses and 36 physicians responded to the survey. Overall, 95% of nurses reported that the language barrier was an impediment to quality care, whereas 88% of physicians responded similarly (P = .0004). More nurses than physicians report experiencing stress (97% vs. 78%) and the degree of stress appears to be greater for nurses (P < .0001). The basis of stress was unique between the two groups. This study demonstrates that acute care hospital medical professionals perceive language barriers as an impediment to quality care delivery and as a source of workplace stress. Nurse and physician perceptions differ; therefore, strategies to address these language barriers should be specific to those professional roles. These barriers create a void in health care quality and safety that has effects on health care professionals.

Academic Medical Centers↗
PubMed2004

Translators and mediators: bilingual young people's accounts of their interpreting work in health care.

The interpreting work bilingual young people do in health care settings has largely been seen as a social problem, indicating deficiencies either in parents' language skills or in the provision of professional interpreting services. Little research has addressed this contribution young people make to health care work from their perspectives. This study explored the accounts of bilingual young people from four linguistic groups in London, including those from established minority groups and those more recently arrived. Young people reported extensive experience of interpreting in a number of settings, and identified a range of benefits to themselves and their families arising from their contributions, as well as some problems faced in achieving successful encounters. Focusing on young people's own accounts enabled their work to be conceptualised not as merely 'inappropriate and inadequate interpreting' but as a varied contribution to the informal economy of health care that ranged from simple translation to complex mediation between families, the wider community and the health care system.

Adolescent↗
PubMed2006

Interpreters as co-diagnosticians: overlapping roles and services between providers and interpreters.

This study examined medical interpreters' practice of the co-diagnostician role and further explored its practical, institutional, and ethical implications. Twenty-six professional interpreters (of 17 languages), 4 patients, and 12 health-care providers were recruited for this study, which involves participant observation and interviews undertaken in the Midwestern US. Constant comparative analysis was used to develop themes of interpreters' communicative practices. Interpreters justified their role performances by claiming the identity of a member of the health care team and their work as part of the team effort. Their communicative strategies as a co-diagnostician reflect their preconception of the social hierarchy of health-care settings and the emphasis on diagnostic efficacy. I have identified five strategies for the co-diagnostician role. These were assuming the provider's communicative goals; editorializing information for medical emphasis; initiating information-seeking behaviors; participating in diagnostic tasks; and volunteering medical information to the patients. Although many strategies can be attributed to interpreters' effort to conserve providers' time and to bridge the cultural differences, they also pose risks to patients' privacy, clinical consequences, and provider-patient relationships.

Communication↗
PubMed2004

Understanding bilingual memory: models and data.

Bilingual memory research in the past decade and, particularly, in the past five years, has developed a range of sophisticated experimental, neuropsychological and computational techniques that have allowed researchers to begin to answer some of the major long-standing questions of the field. We explore bilingual memory along the lines of the conceptual division of language knowledge and organization, on the one hand, and the mechanisms that operate on that knowledge and organization, on the other. Various interactive-activation and connectionist models of bilingual memory that attempt to incorporate both organizational and operational considerations will serve to bridge these two divisions. Much progress has been made in recent years in bilingual memory research, which also serves to illuminate general (language-independent) memory processes.

Humans↗