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PubMed2006

Dissociating language and word meaning in the bilingual brain.

How do bilingual (or multilingual) persons keep different languages apart and switch between them as needs arise? Crinion et al. have used an ingenious method to dissociate brain regions sensitive to word meaning from those sensitive to the combination of meaning and language. This work should stimulate further research examining the role of subcortical areas in language processing and in context-appropriate language production.

Brain↗
PubMed2002

Lateral frontal cortex oxygenation changes during translation and language switching revealed by non-invasive near-infrared multi-point measurements.

The organisation of language in the brain of multilingual people remains controversial. Using a high temporal resolution 12-channel near-infrared continuous wave spectroscopy system, we have demonstrated that it is possible to monitor non-invasively, comfortably and, without the interferences due to intrinsic limitations of positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), cortical oxygenation changes in the Broca's area in response to translation of short sentences and language switching. Eight Dutch students proficient in English translated aloud from their native language into English or vice versa or alternating (switching) short visually presented sentences. These tasks provoked, in the left inferior frontal cortex which includes the Broca's area, a consistent and incremental rise in oxyhaemoglobin accompanied by a smaller decrease in deoxyhaemoglobin. The investigated cortical areas surrounding the Broca's area showed no uniform and consistent oxygenation changes upon the three different translation tasks. These results confirm that Broca's area is involved in the translation process and its so called activation is unaffected by the direction of the translation. In addition, these results strengthen the role of near-infrared multi-point measurements as a powerful tool for investigating the spatial and temporal features of the cortical oxygenation changes during language processing.

Adult↗
PubMed2004

Everyday functioning in relation to cognitive functioning and neuroimaging in community-dwelling Hispanic and non-Hispanic older adults.

The purpose of this study was to examine how a specific informant-based measure of everyday functioning, the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE; Jorm & Korten, 1988) relates to cognition and structural neuroimaging in a large multicultural, multilingual sample of Caucasians and Hispanics. Cognitive variables included selected subtests from the Spanish and English Neuropsychological Assessment Scales (SENAS; Mungas et al., 2000): Verbal Memory, Object Naming, Verbal Attention Span, Verbal Conceptual Thinking, and Pattern Recognition. The association between the IQCODE and selected neuroimaging variables, hippocampal volume and white matter hyperintensity, was evaluated in a subsample of English- and Spanish-speaking Hispanic individuals. The cognitive variables showed strong bivariate relationships with the IQCODE, although only Verbal Memory and Object Naming independently predicted level of functional ability. Verbal Memory was the strongest predictor of functional status, accounting for 23% of the variance in the IQCODE. White matter hyperintensity was also independently related to the IQCODE, accounting for 18% of the variance. Hippocampal volume was related to the IQCODE in a simple bivariate analysis, but was not an independent predictor of reported functional status after controlling for age. The relationships between cognitive variables and functional status, as well as between the imaging variables and the IQCODE, did not differ across language-ethnic groups.

Activities of Daily Living↗
PubMedDate not supplied

Barriers to the use of interpreters in emergency room paediatric consultations.

OBJECTIVE: To identify barriers to the use of trained interpreters in emergency department (ED) paediatric consultations. METHODS: A cross-sectional survey of non-English-speaking-background (NESB) carers who presented a child aged 14 years or less to the Fairfield Hospital ED during a 3-month period was undertaken using a multilingual postal questionnaire or a phone interview with interpreter assistance. RESULTS: Of the 1388 paediatric consultations during the study period, 406 of the carers were registered as being of NESB, with 316 being eligible for study inclusion. Of the 278 (88%) respondents who completed the questionnaires, assistance with interpretation was required by 131 (47%) respondents: 55 (20%) used ad hoc interpreters, 47 (17%) used a trained interpreter and 21 (8%) did not receive the required assistance. Fifty-four (41%) carers who required interpreter assistance were identified as having this requirement at clerical registration in the ED, but only 18 of these were provided with a trained interpreter during the consultation. Limited English proficiency was self-reported by 127 (46%) respondents, with these respondents being more likely to need interpreter assistance (odds ratio (OR) 44.2; 95% CI 21.6-90.7), to have impaired understanding of the consultation (OR 8.2; 95% CI 4.7-14.1) and to consult a language concordant general practitioner (OR 10.1; 95% CI 5.1-19.4) compared with English proficient respondents. CONCLUSIONS: Barriers to the use of interpreters in ED paediatric consultations include poor identification of the need for and provision of an interpreter in the ED, and a preference for NESB carers to use ad hoc interpreters or no interpreter. Recommendations include the implementation in the ED of strategies to improve identification of NESB carers, as well as to improve awareness, access and use of trained interpreters during paediatric consultations. There is also a need to explore the experience of ED staff in accessing and using trained interpreters.

Adolescent↗
PubMed1998

Towards culturally competent health care: language use of bilingual staff.

The presence of diverse language skills within health staff provides opportunities to better meet the needs of a multicultural population. A cross-sectional survey of all staff within the South Western Sydney Area Health Service was undertaken to compare language skills with population needs and examine the context of language use. Thirty-one per cent of staff (n = 964) were bilingual or multilingual, with the predominant languages spoken being Tagalog (Filipino), Cantonese, Hindi, Spanish, Vietnamese and Italian. Thirty-seven per cent of bilingual staff used their language skills at least weekly, predominantly in situations of simple conversation and giving directions. Bilingual staff are a valuable resource for the organisation and the presence of a similar overall proportion of bilingual and bicultural staff may engender tolerance and adaptability in providing care to a diverse population. However, supply does not directly match community demand. This mismatch will continue unless recruitment is focused towards identified language groups. The high proportion of staff who rarely used their language skills (37%) may be due to lack of opportunity or limited need, and suggests that further research needs to examine service models that locate bilingual workers close to client need. This study takes a crucial first step towards realising equitable and culturally appropriate care utilising the principles of productive diversity.

Adult↗
PubMed2006

Primary progressive aphasia in a bilingual woman.

Multilingual aphasias are common because most people in the world know more than one language, but little is known of these syndromes except in patients who have had a stroke. We present a 76-year-old right-handed woman, fluent in English and Chinese, who developed anomia at age 70 and then progressed to aphasia. Functional neuroimaging disclosed mild left temporoparietal hypometabolism. Neurolinguistic testing was performed in both English and Chinese, representing a unique contribution to the literature. Results revealed conduction-like aphasia that was comparable in the two languages, although English was slightly better preserved. Primary progressive aphasia has disrupted 2 languages in a similar manner, suggesting their close neuroanatomic relationship in this case.

Aged↗
PubMedDate not supplied

Providing an equitable service to bilingual children in the UK: a review.

BACKGROUND: The UK is a multicultural, multilingual society and the majority of paediatric speech and language therapists in England have at least one bilingual child on their caseload. There are many imperatives driving the profession to provide an equitable service for bilingual children. Evidence is beginning to emerge, however, that bilingual children with specific language impairment are not being identified and are, therefore, not accessing services. The situation facing clinicians in the UK is not unique: it is mirrored around the world. AIMS: This paper reviews the literature relating to speech and language services for bilingual children and begins by providing an overview of the forces driving the need to provide equity of service. All aspects of the therapeutic process are then examined, from referral to therapy, in order to identify features that are regarded as best practice. Whilst the focus is on delivery of services in the UK, research findings from around the world are considered. MAIN CONTRIBUTION: Certain themes emerged during the review and their implications are discussed. In particular, the need for assessment tools, training and research is highlighted. CONCLUSIONS: Features indicative of best practice are highlighted and tentative suggestions made that would enable services to address the challenges of serving bilingual paediatric caseloads.

Child↗
PubMedDate not supplied

Speech and language therapy service delivery for bilingual children: A survey of three cities in Great Britain.

BACKGROUND: Speech and language therapy (SLT) managers are expected to ensure that there are appropriate services available for bilingual and multilingual clients in order to ensure an equitable service to all clients. However, there is a paucity of data available to inform service planning. AIMS: To identify the level to which SLT services in three UK cities meet the recommendations of The Royal College of Speech and Language Therapists (RCSLT) Good Practice Guidelines. Socio-demographic information is provided about the number of children from ethnic minorities in the population and the proportion of (bilingual) children from ethnic minorities on the speech and language therapy caseload. Based on this information, it is estimated whether there is proportionate representation of bilingual children on SLT caseloads, and whether services are in place to meet the needs of those clients. METHODS & PROCEDURES: Population statistics were gathered from Census data and data were gleaned from Local Education Authorities. The study used a combination of interview and postal questionnaires to SLTs, with particular emphasis on the issues that may affect service provision. OUTCOMES & RESULTS: As in previous studies, it was difficult to find reliable data. However, two of the three cities studied appeared to be offering a proportionate service to both monolingual and bilingual children in terms of the relative numbers of children on caseloads. Only one city was confident that their SLT service was fully meeting the RCSLT Good Practice Guidelines on bilingualism, although all three cities were aware of them and appeared to be making an effort at varying levels to address the principles of those guidelines. CONCLUSIONS: There is a need for a change in how data on linguistic diversity in society are collected and disseminated, both at a national level and within SLT services, so that informed decisions can influence the future of quality services to minority groups.

Child↗
PubMed2004

Use of a corporate needs assessment to define the information requirements of an arthritis resource centre in Birmingham: comparison of patients' and professionals' views.

OBJECTIVES: Education and information are important components of the management of chronic disease, though provision of these in the routine clinic setting may be suboptimal. We carried out a corporate needs assessment, both to evaluate stakeholders' perceived usefulness of potential facilities that could be offered by a community-based arthritis resource centre in Birmingham and to compare the views of patients with rheumatological conditions and health professionals. METHODS: Rheumatology patients (n = 201 responders/309 contacted) and health professionals (n = 232/430) were asked to complete a questionnaire to assess both current rheumatology service provision and perceived needs for further information that could be offered within the proposed resource centre. Views of patients and professionals were compared using odds ratios. Logistic regression analysis determined patient characteristics associated with perceived usefulness of various information types. RESULTS: The overall response rate was 58%. Most patients were currently receiving medication but only 38% received written information on arthritis. Over 80% of responders felt that more information would be useful, particularly information in written leaflets. Compared with professionals, patients gave higher value to certain types of medical, non-medical, support and skills information, particularly individual information from trained volunteers, and specific information on benefits, diet and alternative therapy, and symptom management. Non-Caucasian patients gave higher value to the provision of material in different languages and the availability of multilingual volunteer staff. CONCLUSION: Rheumatology patients and professionals identified a relative lack of information for patients. There was wide interest in the provision of more information, with value placed on the provision of material in different languages, at an educational resource centre. This work has been used to develop the facilities currently offered at the Birmingham Arthritis Resource Centre. Further research is needed to investigate the effectiveness of the provision of good quality information to patients with arthritis.

Adolescent↗
PubMed2004

The future of language.

The world's language system is undergoing rapid change because of demographic trends, new technology, and international communication. These changes will affect both written and spoken communication. English may not be the dominant language of the future, and the need to be multilingual will be enhanced. Although many languages are going extinct, new ones are emerging in cities and extended social groups.

Cultural Evolution↗
PubMed1998

The study of child language in South Africa.

This paper describes some of the research into child language that has been conducted in South Africa over the past 20 years. It is written from a clinical perspective and it describes the influence of changing demographic, social, educational and political variables on the study of child language. Specifically, the influence of the multilingual and multicultural nature of the society will be considered. Among issues discussed are the increasing research base on the acquisition of normal language, the adaptation of assessment tools and language in education.

Child↗
PubMedDate not supplied

Generalizable outcomes of bilingual aphasia research.

A number of constructs developed to account for bilingual aphasia phenomena have been advantageously extended to increase our understanding of language representation, processing, breakdown and rehabilitation in unilinguals as well. In particular, focus on the right-hemisphere-based pragmatic component of verbal communicative competence, the activation threshold, the control of resources, the role of emotion in second language acquisition and that of procedural vs. declarative memory, has led to the suggestion that unilinguals are in fact at one end of a continuum, with multilinguals who speak genetically unrelated languages at the other end. No function is available to the bilingual speaker that is not already available to the unilingual, unidialectal speaker. The only difference seems to be the degree of use the speaker makes of each of the relevant cerebral systems.

Aphasia↗
PubMed1999

Interpreters: a double-edged sword in nursing practice.

The provision of health services for all Australians is based on equality of access to health care services, regardless of cultural origin or linguistic skill, and on the responsibility of the health system to respond appropriately. Lack of fluency in the English language and lack of bilingual or multilingual nurses are major sources of miscommunication, even with the use of interpreters and translated health information. Many immigrant women find the use of interpreters unacceptable. Nurses are concerned with legal issues. These two viewpoints make the use of interpreters a double-edged sword in practice. The findings of recent research and the literature in relation to language skills and the use of interpreters and translations in the Australian context are explored. Potential resolutions for transcultural nursing practice are provided.

Communication Barriers↗
PubMed1998

Profiling Hispanic deaf students. A first step toward solving the greater problems.

As the number of Hispanic individuals in the United States increases, so does the number of Hispanic hearing impaired children. This trend gives cause for concern within current educational systems because research suggests that Hispanic hearing impaired students demonstrate a lower rate of scholastic success than hearing and deaf peers (Bennett, 1988). One step toward solving this problem is to reexamine educational and assessment techniques employed with this diverse population. A logical first stage would include construction of demographic "profiles" or descriptions of student populations. The present study provides such information and identifies the unique characteristics of Hispanic students at the Texas School for the Deaf. The author discusses trilingual (ASL/English/Spanish) situations and problems related to multilingual home and school environments. A model is proposed for language instruction and support services programs.

Adolescent↗
PubMed1998

Lowering the language barrier in an acute psychiatric setting.

OBJECTIVES: The aim of this paper is to investigate the effectiveness of a training and policy strategy to improve communication opportunities in an acute inpatient unit for patients of non-English-speaking background (NESB) with low English proficiency. METHOD: A pre- and post-intervention design involved: (i) a survey of the multilingual skills of 80 clinical staff; (ii) recording of patients' ethnic background and proficiency; (iii) pre- and post-intervention data collection of the main outcome measure (communications with patients in a language other than English [LOTE]); and (iv) staff training, and active encouragement, in interpreter use. English proficiency was assessed using the population census proficiency question. RESULTS: Of 257 admissions, 33% were of NESB and 19% preferred to speak a LOTE. The staff survey yielded a 49% return rate and showed that, of 11 LOTEs spoken by patients, seven were also spoken by 17 of the staff. Twenty-nine percent of staff were not clinically proficient in these languages. Compared to the NESB population, a higher proportion of NESB patients rated low on proficiency. Following the intervention, interpreter bookings and booking duration increased significantly. CONCLUSIONS: A standard training package and a policy promoting interpreter use improved communication opportunities in an acute setting where language needs are typically poorly met. Failure to ensure effective communicate raises risks of misdiagnosis and inappropriate treatment. By measuring patients' proficiency directly, the present study identified a higher level of need for interpreter services than estimated by past reports.

Acute Disease↗
PubMed2000

Optical imaging of bilingual cortical representations. Case report.

The organization of language in the brains of multilingual persons remains controversial. The authors investigated language representations in a proficient bilingual patient by using a novel neuroimaging technique, intraoperative optical imaging of intrinsic signals (iOIS), and a visual object naming task. The results indicate that there are cortical areas that are activated by the use of both English and Spanish languages (superior temporal sulcus, superior and middle temporal gyri, and parts of the supramarginal gyrus). In addition, language-specific areas were identified in the supramarginal (Spanish) and precentral (English) gyri. These results suggest that cortical language representations in bilingual persons may consist of both overlapping and distinct components. Furthermore, this study demonstrates the utility of iOIS in detecting topographical segregation of cognitively distinct cortices.

Adult↗
PubMed2002

Foreign language knowledge can influence native language performance in exclusively native contexts.

In three experiments, we studied the influence of foreign language knowledge on native language performance in an exclusively native language context. Trilinguals with Dutch as their native and dominant language (L1), English as their second language (L2), and French as their third language (L3) performed a word association task (Experiment 1) or a lexical decision task (Experiments 2 and 3) in L1. The L1 stimulus words were cognates with their translations in English, cognates with their translations in French, or were noncognates. In Experiments 1 and 2 with trilinguals who were highly proficient in English and relatively low in proficiency in French, we observed shorter word association and lexical decision times to the L1 words that were cognates with English than to the noncognates. In these relatively low-proficiency French speakers, response times (RTs) for the L1 words that were cognates with French did not differ from those for the noncognates. In Experiment 3, we tested Dutch-English-French trilinguals with a higher level of fluency in French (i.e., equally fluent in English and in French). We now observed faster responses on the L1 words that were cognates with French than on the noncognates. Lexical decision times to the cognates with English were also shorter than those to then oncognates. The results indicate that words presented in the dominant language, to naive participants, activate information in the nontarget, and weaker, language in parallel, implying that the multilinguals' processing system is profoundly nonselective with respect to language. A minimal level of nontarget language fluency seems to be required, however, before any weaker language effects become noticeable in L1 processing.

Adolescent↗
PubMed1998

Natural language generation of surgical procedures.

The GALEN-IN-USE project has developed a compositional scheme for the conceptual representation of surgical operative procedure rubrics. The complex representations which result are translated back to surface language by a tool for multilingual natural language generation. This generator can be adapted to the specific characteristics of the scheme by introducing particular definitions of concepts and relationships. We discuss how the generator uses such definitions to bridge between the modelling 'style' of the GALEN scheme and natural language.

Humans↗