A new study reveals how multilingual people who lose their speech after suffering from a stroke can learn how to speak their languages again.
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1 Apr 2017 - 5:47 PM  UPDATED 1 Apr 2017 - 8:25 PM

Before mother-of-two Raghbir Kaur had a stroke, she was fluent in three languages: her first language Punjabi, English and Hindi.

"Yes [I spoke Hindi] like English, or some Punjabi … all languages," the Indian-Australian told SBS.

But two years ago, Raghbir, who moved to Sydney from Punjab in 2001, had a stroke following an aneurysm.

It injured the left hemisphere of her brain, which is typically responsible for controlling language, and caused a little-known impairment called aphasia.

Watch: Raghbir has been relearning how to speak her languages again

While aphasia does not affect intelligence, it does make it difficult to speak, listen, read or write.

In Raghbir's case, she lost her ability to speak and write in all three of her languages.

"[It was] very hard for me because I can't speak, and I can't talk with [my] family or friends, [I] just lost my job and ... just crying, crying, crying," she said, referring to the immediate aftermath of her stroke.

Raghbir and her husband Lakhwinder.

Aphasia is treated in monolingual speakers in Australia, but so far there has been very little research into how to treat aphasia in bilingual and multilingual people around the world.

However the first findings of a new Australian study provide some hope.

Dr Amanda Miller Amberber, a lecturer in speech pathology at the Australian Catholic University, is the lead investigator of the Bilingual Aphasia Language Treatment Study.

She told SBS the initial investigation looked at how up to 30 bilingual and multilingual Australian participants responded to treatment in their first and other languages.

It compared the effectiveness of providing aphasia treatment in their first language to their second language –English.

"The preliminary results show that treatment is effective for the language that is treated, so treatment provided in the first language results in improvement of language skills in that first language only," Dr Amanda Miller Amberber said.

"And treatment provided in English results in an improvement for English only."

Watch: Raghbir tells what it's like to have multilingual aphasia

It then determined whether treating a patient in one of their languages, such as English, would stimulate their other languages.

But so far she has found no evidence for that to be the case. 

This has led her to conclude that providing therapy in each of the languages a person speaks "is critically important".

Raghbir, who participated in the study, says she has benefited from the therapy. She estimated she has regained half of her capacity to talk in both Punjabi and English.

Watch: What is bilingual and multilingual aphasia?

Why we need to help people with multilingual aphasia recover

Strokes are the third leading cause of death in Australia, and 65 per cent of survivors experience a disability - 30 per cent of which will have aphasia.

With Australian Bureau of Statistics data indicating around half of Australia's population is multi or bilingual, Dr Miller Amberber estimated half of that 30 per cent are multi or bilingual across Australia.

"But this will be higher in some demographic areas where rates of bilingualism are much higher, for example, in Sydney, [in] Bankstown, Liverpool and Auburn, or in Melbourne, [in] Dandenong and Pascoe Vale."

Around 70,500 multi and bilingual people live with aphasia in Australia, a figure that is estimated to increase to 106,350 by 2032, based on overall figures of stroke from the Stroke Foundation.

If 15 per cent of 55,000 new or recurrent strokes per year have multilingual aphasia, there would be around 8250 new cases of people with multi or bilingual aphasia per year. 

"There is a very significant impact for bilingual and multilingual pepople with aphasia," said Dr Miller Amberber.

"On their economic participation on their social participation, both with their families, in the community, both the local and the broader community, and for their psychological health and wellbeing.

What multilingualism in Australia looks like

Australia is the ninth most multilingual country in the world, according to the World Economic Forum.

It's estimated that more than 260 languages are spoken in Australia, and 2011 Australian Bureau of Statistics data indicates nearly one in four, or more than 23 per cent, spoke a language other than English at home.

But according to Dr Miller Amberber this does not indicate how many people in Australia are bilingual or multilingual - she estimated more than half of Australia's population spoke a language other than English.

"What the Census figures don't capture are Australian-born multilingual speakers that speak English at home with their partner – quite often the case because the partner has a different set of languages that are their first, or first and second languages," she said.

The most-spoken languages in Australia
About 80 per cent of the population speak English at home, followed by Mandarin at 1.7 per cent, Italian at 1.5 per cent, Arabic at 1.4 per cent and Cantonese at 1.4 per cent.

Indian languages are some of the fastest growing in the country.

In the 2006 Census, there were just over 147,000 migrants born in India living in Australia. By 2011, that number had doubled to just over 295,900.

Who's speaking languages other than English
Nearly 50 per cent of longer-standing migrants and 67 per cent of recent arrivals spoke a language other than English at home.

Yet more than 50 per cent of longer-standing migrants reported they spoke English well, and 43 per cent of recent arrivals said they spoke well.

More than 50 per cent of first generation Australians spoke a language other than English at home, while 20 per cent of second-generation Australians did and only 1.6 per cent of third-plus generation Australians spoke another language.

Watch: How to get your languages back

How to rehabilitate people with multilingual aphasia

Rehabilitation for aphasia is already offered in English.

But Dr Miller Amberber advised that bilingual-allied health assistants help deliver speech and language treatment to aphasia survivors in their first language.

"It is essential to have improved access to speech pathology language treatment in the first language, as well as in English for bilingual and multilingual people with aphasia," she said.

Allied health assistants work under the direction of health care professionals, including speech pathologists and physiotherapists.

Bilingual allied health assistants would be able to deliver speech therapy programs under the direction of the speech pathologist in languages other than English.

Raghbir overlooks Sydney Harbour.

"This is a very effective way of delivering speech pathology programs and rehabilitation for bilingual and multilingual individuals," Dr Miller Amberber said.

"We also need opportunities for increased training and education for health professionals to provide people with multilingual aphasia and their families with information around these issues and accessing services."

In addition, she recommended expanding Australia’s interpreter service.

"We have a good system of health interpreters who provide a fabulous service but it's very stretched and generally they are not available to be providing services on an ongoing rehabilitation basis for treatment," she said.

If you are interested in participating in the study or would like more information about this research, please email Dr Amanda Miller Amberber at the Australian Catholic University at Amanda.MillerAmberber@acu.edu.au or phone +61 2 97392694.