Assessment Of Language Dominance Research Articles

33 Pre-Surgical Evaluation of Bilingual Epilepsy Patients; A Case Study Demonstrating the Importance of Bilingual Assessment

Objective:In the US, >20% of individuals aged 5 years and older speak a language other than English at home, with rates of bi- and multilingualism increasing. Providing linguistically- and culturally- competent care to increasingly diverse populations is a necessary task for neuropsychologists. The need for close attention to bilingualism is even more glaring in the context of neurosurgical interventions, such as in intractable epilepsy. Pre-surgical epilepsy evaluations serve as a baseline for post-surgical change, inform lateralization and localization, and help determine cognitive risks associated with surgery. The importance of evaluating bilingual status and assessing cognitive abilities in both languages, if needed, in presurgical epilepsy evaluations is examined. We present the neuropsychological profile of a 10-year-old bilingual male with intractable epilepsy participating in a pre-surgical epilepsy evaluation.Participants and Methods:This right-handed male is a sequential language learner, exposed to Spanish at birth and English when he began kindergarten. His parent reported he was primarily English speaking. Developmental milestones were met within expected timeframes. Seizures began at age 5. He is prescribed Vimpat and Lamictal. vEEG during admission revealed right temporal-onset seizures. Neuropsychological assessment was conducted in English based on parent report; however, expressive language testing revealed significantly higher performance in Spanish (average) compared to English (exceptionally low). Subsequently, a bilingual provider was consulted, and supplemental Spanish verbal reasoning and verbal memory measures were administered.Results:The patient’s neuropsychological profile captured a significant difference between English and Spanish verbal abilities. WISC-V Similarities scaled scores (ss) were 5 and 11 in English and Spanish, respectively. Vocabulary scaled scores were 8 and 15 in English and Spanish, respectively. Regarding verbal memory, list learning was below average in English (ss = 5), but low average in Spanish (ss = 6). Contextual verbal memory was only administered in Spanish; scores were average (ss = 10). Verbal Fluency administered in English was low (phonemic fluency ss = 5, categorical fluency ss = 6). fMRI verbal tasks were performed in English and revealed left-sided language lateralization.Conclusions:In pre-surgical epilepsy evaluations of bilingual children, consideration of language is essential. Assessment of language dominance is a minimum requirement in bilingual families, followed by full bilingual evaluation if necessary. In this case, starkly different conclusions regarding lateralization and localization may have been made if the child had not been evaluated in both languages. In English, a significant split between verbal and non-verbal cognition was apparent, possibly suggesting involvement of the dominant left hemisphere. With Spanish testing, this split disappeared, with high average verbal skills. While a growing proportion of children in the US are bilingual, bilingual assessments are not commonly conducted in pre-surgical epilepsy evaluations. In fact, very little work has been done examining language functioning in bilingual epilepsy patients, particularly in children. With both epilepsy-and language-related factors at play in a developing brain, we encourage closer attention to these issues, particularly in the context of neurosurgical procedures.

Predicting language dominance in Spanish/English bilingual adults based on relative speech-in-speech recognition scores

Purpose: Multiple dimensions of language dominance, such as language proficiency and demand for language use, can be reflected in bilinguals’ speech-in-speech recognition scores. This paper explores the feasibility of using a novel measure to estimate language dominance for bilinguals: relative speech-in-speech recognition thresholds (SRTs) or the within-person difference in SRTs between their two languages. Method: Participants were 25 Spanish/English bilingual adults ( Mage = 30 years). SRTs for sentence recognition in a language-matched two-talker masker were measured in English and in Spanish using an adaptive, open-set task. Relative SRTs were calculated by subtracting the Spanish SRT from the English SRT. Language dominance and proficiency were assessed by established measures. Analysis: Spearman correlations were used to assess the association between measures. Findings: Relative SRTs were correlated with dominance scores derived from both a questionnaire ( rs = −.80) and standardized testing ( rs = −.80). Originality: We tested and validated a novel measure, relative SRTs, to predict language dominance in bilingual adults. This time-efficient method could be used by bilingual researchers interested in assessing language dominance for descriptive or experimental purposes. Significance: Relative SRTs show promise as a valid method to assess language dominance in Spanish/English bilingual adults.

An assessment of language dominance among Turkish-English bilinguals: The case of the Ahıska Turks in the Us

Today living in ten different countries, the Ahıska Turks have had to leave their lands and immigrate to different places. As a consequence of these migrations they did compulsorily or sometimes voluntarily as in the case of their migration to the US, they have encountered different cultures and languages/dialects. Some of the Ahıska Turks, today, live in the US. Since they have been living in the US for more than a decade, they have adjusted to the way of life in the US culturally and linguistically alike. Thanks to their previous experiences, they have learned English and become bilingual/multilingual. The aim of this study was to measure the language dominance among the Ahıska Turks. 125 Ahıska Turks (nfemale = 42 and nmale = 83), living in the United States of America, Ohio, consisted of the sample of the survey. The Bilingual Language Profile was employed to measure the language dominance and the SPSS was used to analyze the data obtained. According to the findings, the level of education, employment, age, language use, language proficiency, and language attitude of the participants were significant for the dominant language. The results were discussed within the framework of the existing literature on language dominance and suggestions for the Ahıska Turks living in the United States of America were put forward.

Preoperative Assessment of Language Dominance through Combined Resting-State and Task-Based Functional Magnetic Resonance Imaging.

Brain lesions in language-related cortical areas remain a challenge in the clinical routine. In recent years, the resting-state fMRI (RS-fMRI) was shown to be a feasible method for preoperative language assessment. The aim of this study was to examine whether language-related resting-state components, which have been obtained using a data-driven independent-component-based identification algorithm, can be supportive in determining language dominance in the left or right hemisphere. Twenty patients suffering from brain lesions close to supposed language-relevant cortical areas were included. RS-fMRI and task-based (TB-fMRI) were performed for the purpose of preoperative language assessment. TB-fMRI included a verb generation task with an appropriate control condition (a syllable switching task) to decompose language-critical and language-supportive processes. Subsequently, the best fitting ICA component for the resting-state language network (RSLN) referential to general linear models (GLMs) of the TB-fMRI (including models with and without linguistic control conditions) was identified using an algorithm based on the Dice index. Thereby, the RSLNs associated with GLMs using a linguistic control condition led to significantly higher laterality indices than GLM baseline contrasts. LIs derived from GLM contrasts with and without control conditions alone did not differ significantly. In general, the results suggest that determining language dominance in the human brain is feasible both with TB-fMRI and RS-fMRI, and in particular, the combination of both approaches yields a higher specificity in preoperative language assessment. Moreover, we can conclude that the choice of the language mapping paradigm is crucial for the mentioned benefits.

The MINT Sprint: Exploring a Fast Administration Procedure with an Expanded Multilingual Naming Test.

The present study examined if time-pressured administration of an expanded Multilingual Naming Test (MINT) would improve or compromise assessment of bilingual language proficiency and language dominance. Eighty Spanish-English bilinguals viewed a grid with 80 MINT-Sprint pictures and were asked to name as many pictures as possible in 3 min in each language in counterbalanced order. An Oral Proficiency Interview rated by four native Spanish-English bilinguals provided independent assessment of proficiency level. Bilinguals also self-rated their proficiency, completed two subtests of the Woodcock-Muñoz, and a speeded translation recognition test. We compared scores after 2 min, a first-pass through all the pictures, and a second-pass in which bilinguals were prompted to try to name skipped items. The MINT Sprint and a subset score including original MINT items were highly correlated with Oral Proficiency Interview scores for predicting the degree of language dominance - matching or outperforming all other measures. Self-ratings provided weaker measures (especially of degree of balance - i.e., bilingual index scores) and did not explain any unique variance in measuring the degree of language dominance when considered together with second-pass naming scores. The 2-min scoring procedure did not improve and appeared not to hamper assessment of absolute proficiency level but prompting to try to name skipped items improved assessment of language dominance and naming scores, especially in the nondominant language. Time-pressured rapid naming saves time without significantly compromising assessment of proficiency level. However, breadth of vocabulary knowledge may be as important as retrieval speed for maximizing the accuracy in proficiency assessment.

Organizing Variables Affecting fMRI Estimates of Language Dominance in Patients with Brain Tumors.

Numerous variables can affect the assessment of language dominance using presurgical functional magnetic resonance (fMRI) in patients with brain tumors. This work organizes the variables into confounding and modulating factors. Confounding factors give the appearance of changed language dominance. Most confounding factors are fMRI-specific and they can substantially disrupt the evaluation of language dominance. Confounding factors can be divided into two categories: tumor-related and fMRI analysis. The tumor-related confounds further subdivide into tumor characteristics (e.g., tumor grade) and tumor-induced conditions (aphasia). The fMRI analysis confounds represent technical aspects of fMRI methods (e.g., a fixed versus an individual threshold). Modulating factors can modify language dominance without confounding it. They are not fMRI-specific, and they can impact language dominance both in healthy individuals and neurosurgical patients. The effect of most modulating factors on fMRI language dominance is smaller than that of confounding factors. Modulating factors include demographics (e.g., age) and linguistic variables (e.g., early bilingualism). Three cases of brain tumors in the left hemisphere are presented to illustrate how modulating confounding and modulating factors can impact fMRI estimates of language dominance. Distinguishing between confounding and modulating factors can help interpret the results of presurgical language mapping with fMRI.

Prior Neurosurgery Decreases fMRI Estimates of Language Laterality in Patients with Gliomas within Anterior Language Sites.

The impact of previous surgery on the assessment of language dominance with preoperative fMRI remains inconclusive in patients with recurrent brain tumors. Samples in this retrospective study included 17 patients with prior brain surgery and 21 patients without prior surgery (38 patients total; mean age 43.2, SD = 11.9; 18 females; seven left-handed). All the patients were left language dominant, as determined clinically. The two samples were matched on 10 known confounds, including, for example, tumor laterality and location (all tumors affected Brodmann areas 44/45/47). We calculated fMRI language dominance with laterality indices using a whole-brain and region of interest approach (ROI; Broca’s and Wernicke’s area). Patients with prior surgery had decreased fMRI language dominance (p = 0.03) with more activity in the right hemisphere (p = 0.03) than patients without surgery. Patients with prior brain surgery did not display less language activity in the left hemisphere than patients without surgery. These results were replicated using an ROI approach in the affected Broca’s area. Further, we observed no differences between our samples in the unaffected Wernicke’s area. In sum, prior brain surgery affecting Broca’s area could be a confounding factor that needs to be considered when evaluating fMRI language dominance.

Preoperative assessment of language dominance through combined resting-state and task-based functional magnetic resonance imaging

Preoperative assessment of language dominance through combined resting-state and task-based functional magnetic resonance imaging

Using the Interpersonal Relationship Communication Approach to Assess Language Dominance in both Written and Oral Communication among Multilinguals

Copious research works have attempted to assess language dominance among bilinguals. However, very little empirical research has been conducted to determine the concept among multilingual by using interpersonal relationships communication domains such as families, friendships, and acquaintances. This is crucial because the choice of language use between two interlocutors in any domain depends on the level of social relation that exists between them. Therefore, this current study aims to determine language dominance for oral and written communication at different domains of interpersonal relationships such as family, friends, and acquaintance. Each domain size was used as a proxy to measure language dominance among different groups of multilingual living in the Southern part of India. As part of this study, a structured sociolinguistics questionnaire that probes the use of the Facebook Friend Lists feature was adopted to determine each domain size and language use in each domain. The questionnaire was administered among forty-three multilingual postgraduate students. The result showed that the dominant language for oral and written communication in the entire geographical setting is the first language (L1) and English, respectively. This suggests that the interpersonal relationship communication approach is practical to determine language dominance in a community.

Language Dominance in Patients With Malformations of Cortical Development and Epilepsy.

Background: Language function may be reorganized in patients with malformations of cortical development (MCD). This prospective cohort study aimed in assessing language dominance in a large group of patients with MCD and epilepsy using functional MRI (fMRI).Methods: Sixty-eight patients (40 women) aged 10–73 years (median, 28.0; interquartile range, 19) with MCD and epilepsy underwent 1.5 T MRI and fMRI (word generation task). Single-subject image analysis was performed with statistical parametric mapping (SPM12). Language lateralization indices (LIs) were defined for statistically significantly activated voxels in Broca's and Wernicke's areas using the formula: LI = (VL – VR)/(VL + VR) × 100, where VL and VR were sets of activated voxels on the left and on the right, respectively. Language laterality was considered typical if LI was between +20 and +100 or atypical if LI was between +19 and −100.Results: fMRI signal was elicited in 55 of 68 (81%) patients. In 18 of 55 (33%) patients, language dominance was typical, and in 37 of 55 (67%) patients, atypical (in 68%, right hemispheric; in 32%, bilateral). Language dominance was not influenced by handedness, electroclinical, and imaging features.Conclusions: In this prospective study on a large group of patients with MCD and epilepsy, about two-thirds had atypical language dominance. These results may contribute to assessing risks of postsurgical language deficits and could assist in planning of “cortical mapping” with intracranial electrodes in patients who undergo presurgical assessment.

Measuring Language Dominance in Early Spanish/English Bilinguals

This paper analyzes the comparability of language dominance assessments with the purpose of determining whether they yield similar results. Language dominance is an important construct in the field of bilingualism as it allows for a more thorough classification of bilinguals and is thought to play a role in both bilingual production and perception. Yet, there is no unified methodology for assessing language dominance. To that end, we ask the following research question: Do different language dominance measures predict the results of one another? Twenty-nine Spanish/English early bilinguals completed four language dominance assessments. Results indicate that three of the four assessments are highly correlated with each other while the fourth, a repetition task, is not significantly correlated with any of the assessments. Further, twenty of the participants were categorized differently across the individual measures; the more “balanced” a bilingual was, the greater likelihood of being categorized differently. These results indicate that certain language dominance assessments are not comparable with one another and suggest that it could be the case they do not even measure the same variable.

Language Proficiency and Dominance Considerations When Working With Spanish-English Bilingual Adults.

Purpose As the Hispanic population continues to increase within the United States, there is a pressing need to incorporate rigorous and efficient clinical assessments of language dominance and proficiency when working with Spanish-English bilingual patients. The purpose of this study was to begin addressing this need by evaluating the association between language dominance and language proficiency. Method The association between scores for the English Versant Test (Pearson Education, 2010), an automated assessment of spoken language proficiency, and dominance and proficiency scores obtained using the Bilingual Language Profile, a self-report questionnaire was evaluated. Results The results indicated that half of the variance in the English Versant Test was explained by the response to a single question included in the Bilingual Language Profile. Conclusion These data support the inclusion of asking patients to not only indicate how many languages they speak but, for those patients that speak more than 1 language, to also ask how well they understand each of the languages.

What Defines Language Dominance in Bilinguals?

This article focuses on the construct of language dominance in bilinguals and the ways in which this construct has been operationalized. Language dominance is often seen as relative proficiency in two languages, but it can also be analyzed in terms of language use—that is, how frequently bilinguals use their languages and how these are divided across domains. Assessing language dominance is important because it has become clear that the level of bilinguals’ proficiency in each language and the relative strength of each language affect performance on tasks. A key distinction is made between direct measures of language dominance, which assess an aspect of language proficiency (e.g., vocabulary or grammar), and indirect ones, which measure variability in exposure to different languages and bilinguals’ use of them. The article includes an evaluation of the extent to which the latter can be interpreted as a proxy for the former.

P.064 Preoperative mapping using fMRI and DTI: a multimodal approach to assessing language dominance

Background: Language mapping is a key goal in neurosurgical planning. With the discontinuation of the Wada test in Canada, neurosurgeons often rely on fMRI and intraoperative techniques for determining language lateralization. Recent studies have also evaluated the utility of diffusion tensor imaging (DTI) for preoperative language lateralization, but further research is needed to confirm its efficacy. We report a patient with a left frontal AVM. fMRI and DTI was used to localize language and motor functioning. Methods: The tasks included word reading, picture naming, pseudohomophones (e.g., dawg) and semantic questions. All fMRI analyses were performed using BrainVoyager. Tensors were tracked from 30-direction diffusion MR images using DSI-Studio. Results: The fMRI results revealed consistent Broca’s and Wernicke’s areas, confirming left hemisphere dominance. There was also a region of activation in the precentral gyrus near the surgical resection. The results were loaded onto the neuronavigation system to help determine safe surgical margins. The DTI results revealed that the left arcuate and uncinate -fasciculus had three times more tracts than the right hemisphere, further supporting left hemisphere dominance. Conclusions: This case highlights the value of a combined, multimodal approach for preoperative language localization, which will further enhance surgical safety by helping preserve regions for essential brain functions.

Lateralizing language function with pre-operative functional magnetic resonance imaging in early proficient bilingual patients

Research on bilinguals with brain lesions is complicated by high patient variability, making it difficult to find well-matched controls. We benefitted from a database of over 700 patients and conducted an analysis of pre-operative functional magnetic resonance imaging data to assess language dominance in 25 early, highly proficient Spanish-English bilinguals, and 25 carefully matched monolingual controls. Our results showed that early bilingualism is associated with greater bilateral hemispheric involvement, and monolingualism is associated with stronger left hemisphere lateralization (p=0.009). The bilinguals showed more pronounced right hemisphere activation (p=0.008). Although language dominance values were concordant in the bilingual group, there were a few (12%) atypical cases with different lateralization patterns in L1 and L2. Finally, we found distinct areas of activity in first and second language within the language network, in addition to regions of convergence. These data underscore the need to map all languages proficiently spoken by surgical candidates.

The role of digital subtraction cerebral angiography and the Wada test in the pediatric population

Catheter cerebral angiography in the pediatric population remains the 'gold standard' diagnostic modality for assess- ment of a number of neurovascular disorders. Although its use has declined due to advances in noninvasive imaging techniques, its ability to resolve and provide dynamic assessment of small vessels, vascular lesions and arteriovenous shunts/fistulae makes it an invaluable tool in the assessment and treatment planning for a number of cerebrovascular disorders. A number of subtle and significant differences exist between pediatric and adult cerebral catheter angiography, including methods of vascular access, catheter selection, contrast administration, and sedation requirements. Similarly, the indications for cerebral angiography are more varied compared with adults. Understanding the differences between pediatric and adult cerebral catheter angiography is essential to ensure safe and appropriate use of the investigation, and to minimize the associated risks. The selective intracar- otid administration of sodium amytal (Wada) test is a tool for assessment of language dominance and memory in a select group of patients for preoperative epilepsy surgery planning. In addition to discussing the principles of the test, indications and contra- indications, a number of specific issues pertaining to performing the Wada test in the pediatric population will also be addressed.

FMRI for language: how can it replace the Wada test?

Background: The goal of our project is to assess the feasibility of replacing the invasive Wada test considered as the gold standard with non-invasive fMRI test for assessment of language dominance preoperatively. Methods: fMRI test with three language paradigm tasks (verb generation, sentence completion and naming) were conducted on our cohort of patients. fMRI laterality indices (LI) were then defined as a ratio (L-R)/(L+R) between the number of activated voxels in the left and right ROIs for Anterior Language Area (ALA) and Posterior Language Area (PLA). fMRI results were divided into the right (LI < -0.2), left (LI > 0.2) or bilateral (-0.2 < LI <0.2) hemispheric language dominance and compared to the results of the Wada test. Results: 28 patients were studied. The concordance rate between Wada and fMRI tests for the ALA and PLA was 68.2% and 52.2% for sentence completion; 56% and 52% for verb generation and 25% and 35% for naming paradigm, respectively. Conclusions: Sentence completion and verb generation fMRI paradigms showed higher concordance with Wada test than naming paradigm. The higher discordance between the Wada test and fMRI was related to bilateral results suggestive of less stringent thresholds used for either test.

Menstrual cycle corrupts reliable and valid assessment of language dominance: Consequences for presurgical evaluation of patients with epilepsy

PurposeFunctional transcranial Doppler sonography (fTCD) is a valid and non-invasive tool for determining language dominance, e.g. in the context of presurgical evaluations. Beyond this, fTCD might be an ideal tool to study dynamics in language dominance over time. However, an essential prerequisite would be a high test–retest reliability. This was addressed in the present study. MethodsTest–retest reliability of hemispheric hemodynamics during open speech was determined in 11 male and 11 female healthy volunteers using the Animation Description Paradigm. Expressive language dominance was assessed weekly over an interval of 4–5 weeks. ResultsInternal consistency of the four measurements was excellent (split-half reliability 0.85–0.95), but test–retest reliability of the lateralization index was poor to moderate (rtt=0.37–0.74). Controlling for gender, test–retest reliabilities were better in men (rtt=0.67–0.78) as compared to women (rtt=0.04–0.70). When arranging the assessments in women around day one of menstruation – all were on contraceptives – a significant shift from left hemisphere dominance toward bilaterality (t=2.2 p=0.04) was evident around menstruation with significant reversal afterwards (t=−3.4 p=0.005). ConclusionA high intraindividual variability of language dominance patterns is indicated in women when assessed repeatedly by fTCD. Menstrual cycle appeared to be the source of inconsistency. The finding challenges the use of non-deactivating methods for language dominance assessment in epilepsy. Support for this is demonstrated with a female patient with epilepsy in whom language dominance assessed by repeated fMRI and fTCD varied concordantly with cycle but not so the repeated intracarotidal amobarbital test.

Language dominance assessment in a bilingual population: validity of fMRI in the second language.

Assessment of language dominance using functional magnetic resonance imaging (fMRI) is a standard tool to estimate the risk of language function decline after epilepsy surgery. Although there has been considerable research in the characterization of language networks in bilingual individuals; little is known about the clinical usefulness of language mapping in a secondary language in patients with epilepsy, and how language lateralization assessed by fMRI may differ by the use of native or a secondary language paradigms. In this study we investigate language representation in a population of nonnative English speakers to assess differences in fMRI language lateralization between the first (native) and second language (English). Sixteen nonnative English-speaking patients with focal drug-resistant epilepsy underwent language fMRI in their first (native) language (L1) and in English (L2). Differences between language maps using L1 and L2 paradigms were examined at the single subject level by comparing within-subject lateralization indexes obtained for each language. Differences at the group level were examined for each of the tasks and languages. Group maps for the second language (English) showed overlapping areas of activation with the native language, but with larger clusters, and more bilaterally distributed than for the first language. However, at the individual level, lateralization indexes were concordant between the two languages, except for one patient with bilateral hippocampal sclerosis who was left dominant in English and showed bilateral dominance for verb generation and right dominance for verbal fluency in his native tongue. Language lateralization can generally be reliably derived from fMRI tasks in a second language provided that the subject can follow the task. Subjects with greater likelihood of atypical language representation should be evaluated more carefully, using more than one language paradigm.

Atypical cortical language organization in epilepsy patients: evidence for divergent hemispheric dominance for receptive and expressive language function.

The central goal of presurgical language mapping is to identify brain regions that subserve cortical language function to minimize postsurgical language deficits. Presurgical language mapping in patients with epilepsy presents a key challenge because of the atypical pattern of hemispheric language dominance found in this population, with higher incidences of bilateral and right-biased language dominance than typical. In this prospective study, we combine magnetoencephalography with a panel of tasks designed to separately assess receptive and expressive function to provide a sensitive measure of language function in 15 candidates for resective surgery. We report the following: 4 of 15 patients (27%) showed left hemisphere dominance across all tasks, 4 of 15 patients (27%) showed right hemisphere dominance across all tasks, and 7 of 15 (46%) showed discordant language dominance, with right-dominant receptive and left-dominant expressive language. All patients with discordant language dominance showed this right-receptive and left-expressive pattern. Results provide further evidence supporting the importance of using a panel of tasks to assess separable aspects of language function. The clinical relevance of the findings is discussed, especially about current clinical operative measures for assessing language dominance, which use single hemisphere procedure (intracarotid amobarbital procedure and awake intraoperative stimulation) for determining language laterality.