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Aphasiology

ISSN: 0268-7038 (Print) 1464-5041 (Online) Journal homepage: http://www.tandfonline.com/loi/paph20

Codeswitching and discourse markers in the narratives of a bilingual speaker with aphasia Yael Neumann, Joel Walters & Carmit Altman To cite this article: Yael Neumann, Joel Walters & Carmit Altman (2016): Codeswitching and discourse markers in the narratives of a bilingual speaker with aphasia, Aphasiology, DOI: 10.1080/02687038.2016.1184222 To link to this article: http://dx.doi.org/10.1080/02687038.2016.1184222

Published online: 17 May 2016.

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Date: 17 May 2016, At: 14:22

APHASIOLOGY, 2016 http://dx.doi.org/10.1080/02687038.2016.1184222

Codeswitching and discourse markers in the narratives of a bilingual speaker with aphasia Yael Neumanna, Joel Waltersb and Carmit Altmanc a

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Department of Linguistics and Communication Disorders, Queens College, City University of New York, Queens, NY, USA; bDepartment of English Literature and Linguistics, Bar-Ilan University, Ramat Gan, Israel; c School of Education, Bar-Ilan University, Ramat Gan, Israel ABSTRACT

ARTICLE HISTORY

Background: Codeswitching and discourse markers are proposed as potentially compensatory means to promote fluency in bilingual people diagnosed with nonfluent aphasia. Aim: This paper examined four linguistic markers of aphasia and fluency—grammaticality, complexity, codeswitching, and discourse markers—in the narratives of a bilingual speaker, in order to assess whether and to what extent these phenomena are manifested in the two languages of a person with aphasia. Methods & Procedures: Sixteen narratives per language were collected, using a cue word procedure, from a 59-year-old Yiddish– English bilingual with diagnosed moderate nonfluent aphasia. Analyses of frequency and locus of ungrammaticality, sentence complexity, codeswitching, and discourse markers were conducted as well as motivations for codeswitching. Outcomes & Results: Findings showed more ungrammaticality in English (L2) than Yiddish (L1), relatively similar levels of complexity, and very similar use of discourse markers in both languages. Codeswitching was more prevalent in Yiddish (L1), motivated by lexical access difficulties, whereas in English (L2), codeswitching was motivated both by lexical access and cross-linguistic lexicalization differences. Conclusions: Differential use of codeswitching across the languages of a bilingual person with nonfluent aphasia shows that different strategies are used to enhance fluency and compensate for ungrammaticality in each language. Clinically, the study shows the importance of assessment in both languages, and suggests that intervention in both languages should be considered pending further investigation.

Received 6 December 2015 Accepted 25 April 2016 KEYWORDS

Codeswitching; discourse markers; fluency; bilingual aphasia; narratives

Introduction The aim of this paper is to examine a range of markers of aphasia and fluency in a Yiddish–English bilingual speaker in order to compare whether these markers are manifested in one or both of a bilingual person’s languages, and if manifested in both, whether they play themselves out in the same ways in both languages. This investigation was conducted in the framework of narrative production, which allows CONTACT Yael Neumann

[email protected]

© 2016 Informa UK Limited, trading as Taylor & Francis Group

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examination of a wide range of linguistic markers in a relatively natural context. By comparing both languages in a bilingual person with aphasia (PWA), this study contributes to an understanding of both bilingualism and fluency as they are manifested in aphasia. In adopting this strategy, the study makes a contribution to the evaluation and intervention of bilingual PWA, where limitations in standardized assessment have led to the use of more complex, multilevel, and integrated analyses of lexical, grammatical, discourse and pragmatic elements in the language samples of PWA (e.g., Altman, Goral, & Levy, 2012; Andreetta, Cantagallo, & Marini, 2012; Marini, Andreetta, Del Tin, & Carlomagno, 2011). Four features were examined in the narratives of a PWA. Two have shown evidence for impairment in aphasia: grammaticality and complexity (Altman, Goral, & Levy, 2012) and two have potential for improving fluency: codeswitching and discourse markers (Altman, Raveh, Poulus, Walters, & Gil, 2014; for aphasia; Smirnova et al., 2015; for schizophrenia).

Grammaticality Grammatical deficits that occur in PWA have been studied crosslinguistically for points of linguistic similarities and differences. For example, one comparison across the languages of English, Italian, and German found that in PWA word order is retained whereas grammatical morphology is selectively vulnerable. This is so, even though the languages differ distinctly in the relative importance of these two grammatical features (Bates, Friederici, & Wulfeck, 1987a, 1987b; Bates, Friederici, Wulfeck, & Juarez, 1988). However, crosslinguistic distinctions have also been established indicating that the particular cue validity, i.e., the strength of sentential cues, for a given language, will influence how PWA perform on grammatical judgment tasks in that given language. More specifically, findings demonstrated that English-speaking PWA attended more to word order, a highly reliable aspect of sentence meaning for English speakers, whereas Italian-speaking PWA attended more to agreement markers, a sentential aspect with high cue validity for Italian speakers (Wulfeck, Bates, & Capasso, 1991).

Complexity Although grammaticality can be considered “relatively” straightforward and dichotomous (grammatical vs. ungrammatical), complexity is not. Both constructs take into account sentences, clauses, and a range of linguistic features, including measures of length and lexis (e.g., content/function words, lexical variation and richness), aspects of morphosyntax, complex syntax (e.g., subordination) and discourse cohesion (e.g., temporal and tense reference, connectives). One approach to the analysis of grammaticality and complexity is Saffran, Berndt, and Schwartz’s (1989) Quantitative Production Analysis (QPA), which takes into account a range of lexical and syntactic information, including the proportions of well-formed sentences, words in sentences, closed-class words overall, determiners, pronouns, verbs (inflected/not inflected) as well as structural elaboration of sentences and auxiliaries. Rochon, Saffran, Berndt, and Schwartz (2000) used this framework and found neurologically healthy individuals had a higher proportion of closed-class words, a

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Table 1. Five levels of structural complexity of AS units. AS unit rating

Definition

1 = Incomplete 2 = Simple and complete

Not a syntactic AS unit, e.g., sub-clausal, single word, no verb. Single AS unit consisting of one clause. Not necessarily semantically felicitous or grammatical, but should contain a noun, verb, and object if obligatory 3 = Incomplete coordinate or AS unit consisting of two clauses, at least one of which is an incomplete coordinate subordinate clause or subordinate clause 4 = Complex coordinate AS unit consisting of two complete clauses 5 = Complex subordinate AS unit with a subordinate clause or reported speech

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Source: Altman, Goral, And Levy (2012).

higher proportion of well-formed sentences and used more structural elaboration than individuals with aphasia. Another approach has been to focus on the presence of syntactic errors, wherein studies of aphasia findings have shown reduced grammaticality scores (Andreetta et al., 2012; Ulatowska, Hildebrand, & Haynes, 1978). For analysis of complexity, Foster, Tonkyn, and Wigglesworth’s (2000) Analysis of Speech Units (ASU) has been used as a basis for analyzing structural complexity in narratives. ASUs are fundamentally syntactic clauses, but take into account intonation when the syntax is not decisive. Using this unit of analysis, Altman, Goral, and Levy (2012) developed a five-point rating scale, where the lowest level consists of single words, the next level up of a single clause, the third level as consisting of two clauses at least one of which is incomplete, the fourth level as two complete clauses, and the highest level as including at least one subordinate clause. Table 1 gives the definitions for each level. In an intervention study with a trilingual (Hebrew–English–French) PWA, Altman, Goral, and Levy (2012) found an increase in complexity as well as an increase in grammatically complex units for all three languages (even though treatment was only in English). Altman et al. (2014) examined narratives of 48 healthy adults (monolingual and bilingual) and eight cases of PWA (monolingual and bilingual) and found higher levels of complexity among PWA than among healthy adults. They interpreted this result as a trade-off between grammaticality and complexity, where PWA used more complex units at the expense of higher levels of ungrammaticality. Thus, use of linguistic dysfluencies may have come from attempts to produce grammatical and complex utterances, which may have affected the flow of the narrative as well as grammaticality.

Bilingual codeswitching Codeswitching has linguistic, sociolinguistic, pragmatic, and psycholinguistic properties. Linguistically, codeswitching occurs on words, phrases, utterances, and across speaking turns. It is most frequently observed in switches on nouns and NPs (e.g., Backus, 1992; Deuchar, 2005; Myers-Scotton, 2005). In the present study, codeswitching is defined as the use of two languages in a single utterance including any continuous segment of speech bounded by a pause. Sociolinguistically, codeswitching is a reflection of a speaker’s awareness of social factors, such as setting, topic, and language background of the people addressed. From a pragmatic/psycho-linguistic perspective, codeswitching is used to indicate focus and emphasis, to mark shifts in topic, to maintain fluency, or to compensate for difficulties in lexical access, and to mark cross-linguistic lexicalization differences. Altman, Schrauf, and Walters (2012) classify motivations for codeswitching

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into two main categories: psycholinguistic and sociopragmatic, the former including fluency difficulties and cross linguistic lexicalization differences, the latter switches indicating changes in setting role, or topic, to express affect or to show focus, emphasis, and contrast. For the present study, fluency/word retrieval and cross-linguistic lexicalization differences (words or phrases which exist in one language but which are not lexicalized or are less frequent in the other language) are the motivations of main interest. The nature and use of codeswitching in bilingual PWA is complicated by aphasic disruptions in linguistic performance. In a review of polyglot aphasia cases, Perecman (1984) reported that codemixing (CM) (at the lexical level) is characteristic of the speech of individuals both with and without aphasia; however, codeswitching (at the utterance level) is typically pathological and is characteristic of aphasia. Grosjean (1985) acknowledged that pathological codeswitching can occur in aphasia, but argued that Perecman’s cases lacked enough information regarding both the pre-morbid language background of the PWA, i.e., proficiency, attitudes toward the languages, and frequency of use prior to injury, and the conditions of testing, i.e., the linguistic competence and behavior of the examiner. This view of codeswitching as pathological, however, is not a generally held view, as studies have shown that the types of switching in aphasia are comparable to those in normal speech. Muñoz, Marquardt, and Copeland (1999) compared the narratives of four bilingual (Spanish–English) PWA and four neurologically healthy bilingual speakers from the same speech community. Using Myers-Scotton’s (1993) Matrix Language Frame model, the authors demonstrated similarities in language mixing; however, ungrammatical switches were only produced by bilingual PWA, and there was a greater frequency of codeswitching patterns in the bilingual PWA as compared to the healthy bilingual speakers. These findings indicate that there is greater reliance on both languages postneurological injury, and that PWA adapt codeswitching patterns as an attempt to enhance communicative success. Furthermore, in another study investigating the effects of conversational demands on lexical retrieval in the narratives of bilingual PWA, Muñoz and Marquardt (2004) showed that the language context in which the information is gathered (monolingual vs. bilingual) influences whether language impairment is exhibited.

Discourse markers Discourse markers (e.g., so, well, uh, um, you know) have been studied under various labels, including: discourse connectives, discourse operators, discourse modifiers, discourse particles, discourse adverbials, phatic connectives, pragmatic markers, pragmatic particles, interjections, fillers, parentheticals, focus particles, filled pauses, among others. Syntactically, discourse markers come from different classes, e.g., adverbials (e.g., anyway, finally, right), conjunctions (e.g., and, for, so), interjections (e.g., um, uh), causal elements (e.g., because, therefore, then), verbs (e.g., let’s say), and questions (e.g., right?). They have been claimed to be syntactically detachable (Brinton, 1996; Fraser, 1996; Schiffrin, 1987; Schourup, 1999) and optional (Fuller, 2003; Schourup, 1999). Semantically, discourse markers do not contribute to the truth-value of the utterance (Bazzanella, 1990; Blakemore, 2003; Brinton, 1996; Downing, Liu, & Kanwisher, 2001;

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Erman, 2001; Fraser, 1996; Fried & Östman, 2005; Fuller, 2003; Schourup, 1999), but rather focus on speaker meaning. Pragmatically, they are primarily a feature of oral discourse (Brinton, 1996) and can be multifunctional (Fox, Tree, & Schrock, 2002; Schiffrin, 1987). Based on this literature, the research in the present paper examined three functions of discourse markers: structural, pragmatic, and fluency. Structural discourse markers can be used as temporal and causal connectors to summarize, comment on, or specify. These are fundamentally textual and referential functions (in the sense of Halliday & Matthiessen, 2004). In narrative discourse, discourse markers are used primarily as temporal connectors. Discourse markers that are primarily pragmatic are used for emphasis, focus, and elaboration. Discourse markers are also used to maintain fluency, to gain time in utterance formulation, to keep the floor in a conversation. These include hesitation markers, self-corrections, and repetitions. Whereas structural discourse markers serve textual or meta-textual function, pragmatic and fluency markers are fundamentally social/interactional, indicating the speaker’s awareness or desire to make his/ her utterance clearer to the listener.

Research questions The central question of this paper is: To what extent do the narratives of a bilingual speaker with moderate nonfluent aphasia differ across languages? In order to assess the performance, a wide range of variables, including verbal productivity (length of narratives), grammaticality, complexity, codeswitching, and discourse markers, were examined. In addition to these measures, in order to assist in the formulation of the hypotheses and interpretation of the quantitative data, the speaker’s pre- and poststroke use of the two languages was taken into consideration, where relevant. This is important as the linguistic performance on the narratives may be influenced by any changes in preference and use of the two languages due to the effects of aphasia. The following hypotheses guided the study:

Hypotheses Verbal productivity (narrative length) Yiddish (L1) is expected to show longer narratives than English, in large part because Yiddish was the speaker’s primary and preferred language prior to his stroke. Thus, it is expected that the more dominant language (L1) would result in higher productivity. Grammaticality We predict high levels of ungrammaticality due to the type and severity of aphasia and more ungrammaticality in English (L2) than in Yiddish (L1) narratives, since English was the less preferred language premorbidly. Complexity Complexity levels are expected to be dependent on linguistic proficiency and related to impairment, on the desire to maintain fluency, and frequency of use. In terms of proficiency and use, narratives in Yiddish are expected to be less complex in large

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part, because Yiddish has been less used since the time of the stroke. English narratives are expected to be more complex due to greater use post-stroke with the participant’s increased family involvement and his therapeutic interactions in English.

Codeswitching More codeswitching is predicted in English narratives than in Yiddish narratives, as a means to compensate for difficulties in grammaticality and fluency. Furthermore, motivations for codeswitching are expected to differ across the two languages.

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Discourse markers Greater use of discourse markers is predicted in English than in Yiddish narratives, also as a means to compensate for difficulties in grammaticality and fluency codeswitching, and discourse markers are hypothesized to be linguistic devices to enhance fluency. Thus, their joint use is expected to be greater in English than in Yiddish narratives.

Method Participant A 59-year old, right-handed Yiddish–English bilingual speaker with a moderate, nonfluent aphasia participated in the study. He was born in New York and has resided continuously in the US for his entire life. The participant had a high school education, no history of psychiatric illness, and adequate hearing and vision (corrected). He experienced a single left-hemisphere cerebrovascular accident (CVA), followed by two transient ischemic attacks (TIAs) within the first year of his CVA. The exact location of the CVA was not available. This study was conducted 8 years post aphasia onset. His aphasic profile at the time of this study (approximately 8 years post CVA) was based on performance on the Yiddish and English versions of the Bilingual Aphasia Test (BAT; Paradis & Libben, 1987), conducted in each language by proficient speakers, as well as a speech-language pathologist’s (SLP) report conducted in English by a native speaker of English. The SLP report included informal assessment of receptive and expressive language skills, analysis of a connected speech sample using the Stuttering Severity Instrument-4 (SSI-4; Riley, 2009), and results of the Quick Assessment for Apraxia of Speech (Tanner & Culbertson, 1999). From the results of the BAT and the SLP’s assessment, the participant presented with a moderate nonfluent aphasia, characterized by good comprehension, telegraphic, agrammatic, and effortful language output comprised of short utterances, moderate neurogenic stuttering, and mild-moderate apraxia of speech, especially in multisyllabic words. The present study focuses on aphasia and does not include stuttering and apraxia data. The participant’s speech displayed adequate fluency and proficiency in both Yiddish and English to maintain a conversation in each language for at least one and a half hours. On the Bilingual Aphasia Test (BAT; Paradis & Libben, 1987), for the comprehension assessment, the participant scored high (80–100%; see Appendix for test scores) in both Yiddish and English on the pointing, simple and semi-complex commands, verbal auditory discrimination, semantic categories, and listening comprehension subtests. He scored moderately (70%) in both Yiddish and English on the grammaticality judgment

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and semantic acceptability subtests. On the remaining comprehension subtests of complex commands, syntactic comprehension, synonyms, and antonyms, he performed moderately in Yiddish (60–75%) and poorly in English (20–40%). For the production assessment, the participant scored high (80–100%) on the repetition of words and nonsense words and lexical decision, series, verbal fluency, and naming subtests in both Yiddish and English, and on the sentence construction, derivational morphology, and mental arithmetic subtests only in Yiddish. He scored moderately (60%) on the semantic opposites subtest in both Yiddish and English, and on the sentence construction subtest (75%) only in English. He performed poorly with repetition of sentences in both Yiddish and English, and on the derivational morphology and mental arithmetic subtests only in English. On the reading assessment, the participant’s scores ranged from 80–100% on the “reading words,” “paragraph reading and comprehension,” and “reading comprehension for words” subtests in both Yiddish and English, and on the reading sentences subtest only in Yiddish. He scored moderately (70%) on reading sentences in English, and poorly (50% and below) on the reading comprehension for sentences subtests in both Yiddish and English. On the writing assessment, the participant’s scores were at ceiling on the copying and dictation subtests, yet he had great difficulty (20%) in both languages on the “dictation of sentences” subtest. With regard to language use, the participant is a native speaker of Yiddish and bilingual in English from the age of six. Prior to his stroke, Yiddish was his most prevalently used language outside the home in the educational institution where he taught and for the religious studies he participated in. English was used most frequently at home with his wife and children. Following the stroke, English became dominant, since he spent most of the time at home, and therapy was conducted in English. At the time of testing for this study, the participant was living with his wife and adult daughter (both primarily English speakers). His six other married children use both Yiddish and English in communicating with him.

Materials and procedures Stimulus words and the cue word technique were adapted from Schrauf and Rubin (1998). Thirty-two stimulus words, sixteen words per language were selected to elicit narratives. All sessions were digitally recorded on an iPhone 4 using the Voice Memos Application© and transferred electronically for transcription. Brief written notes were recorded as well during the course of the sessions. The first session was conducted in English (L2). The participant was first screened by phone to ensure that he could participate in an informal conversation in both languages. He agreed to participate in the study voluntarily and was informed that the study would be conducted in five sessions in his home. Prior to the background interview and testing, he was ensured of confidentiality and signed an informed consent form approved by the Institutional Review Board at Queens College of the City University of New York. The first author, a bilingual speaker of Yiddish and English, and a certified American Speech-Language and Hearing Association (ASHA) speech language pathologist (SLP), conducted the interview and testing. The participant answered questions related to his background and completed a language background questionnaire regarding language preference and use prior to and following the stroke.

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In this questionnaire, the participant reported his primary and preferred language to be Yiddish, that his understanding in Yiddish was better than English, and rated his speaking abilities as poor in both languages. The Mini-Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1975) was also administered to screen for normal cognitive functioning. The participant scored 27 out of 30 points, indicating normal cognition. For narrative elicitation, the participant was asked to tell stories about concrete and specific personal memories throughout his life, which were elicited by cue word prompts. Two sessions were conducted, the first in English and the second in Yiddish. For both sessions, the participant was presented with 16 cue words, one at a time, and asked to talk briefly about a concrete and specific memory for each cue word. To ensure that he understood the task, the experimenter gave examples of possible responses that would be appropriate and inappropriate, followed by two practice items. The same bilingual experimenter conducted all sessions, with the accompaniment of a Yiddishdominant Yiddish–English bilingual adult who sat with the first author opposite the participant to facilitate the Yiddish components, as needed. Each session lasted approximately 90 minutes with 2–3 days intervening between sessions.

Data analyses The narrative data were transcribed, coded, and checked separately for each language by native speakers of English and Yiddish. Data were analyzed for grammaticality, complexity, codeswitching, and discourse markers. In order to ensure comparability across languages, ASUs were used as the unit of analysis (Foster et al., 2000). An ASU is defined as “an independent clause or sub-clausal unit, together with any subordinate clauses.” It takes into account syntactic and fluency phenomena and has been used for analysis of narratives in studies of aphasia (e.g., Altman, Goral, & Levy, 2012; Edmonds & Kiran, 2006; Kempler & Goral, 2011). Table 2 gives an overview of the length of the narratives for both languages. Twenty percent of the data were re-transcribed by a second coder, a native or proficient speaker of each respective language, and inter-rater percent agreement was calculated. Percent agreement ranged between 92–97%. Similarly, a total of 20% of the data were re-scored by a second rater and inter-rater, point-by-point percent agreement was calculated. Percent agreement for ASU complexity and grammaticality was 97%, for CS motivation 89%, and for discourse markers analysis 95%. Discrepancies found in transcription and coding were resolved by discussion among the raters and changes were applied consistently to all other data collected. Additionally, intra-rater reliability was calculated by the second rater. Percent agreement for ASU complexity and grammaticality was 98%, for CS motivation 97%, and for discourse markers analysis 95%. Each ASU was coded as grammatical/ungrammatical as well as judged for complexity using a 1–5 rating scale (see Table 1). Each instance of codeswitching from English to Table 2. Length of narratives in tokens and ASUs. Tokens ASUs ASUs/tokens

Yiddish 2,797 402 .15(SD = .02)

English 1,524 211 .14(SD = .03)

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Yiddish in English narratives and from Yiddish to English in Yiddish narratives, was identified and coded for length (short vs. long segment, where a long segment was defined as a clause, a complex NP, or a verb phrase (VP) involving more than a verb and a NP), and for the locus of the switch (N-NP, V-VP, other). Additionally, the motivations for the instances of codeswitching were examined, namely the frequency and proportion of psycholinguistic (PL) and sociopragmatic (SP) motivations. Discourse markers were identified and coded as structural, fluency, or pragmatic based on Walters (2005).

Results Table 3 presents the frequencies and percentages of ASUs for grammaticality, complexity, codeswitching, and discourse markers.

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Verbal productivity (narrative length) The data show that the Yiddish narratives were twice as long as the English narratives, both in terms of tokens/words as well as ASUs. Thus, for cross-language comparisons, frequencies were converted to percentages of ASUs. In both languages the ASUs were predominantly ungrammatical; only 35% of ASUs were grammatical in Yiddish and only 18% in English. Most of the ASUs were at the two lowest levels of complexity, 92% for Yiddish and 85% for English. Codeswitching was more frequent in Yiddish: almost 80% of the ASUs contained switches to English, whereas in English 35% of ASUs contained codeswitching to Yiddish. Approximately equal frequencies of discourse markers were produced in the two languages, 26% in Yiddish, and 24% in English.

Grammaticality Only one-third (.35) of the ASUs in Yiddish were grammatical and even fewer were grammatical in English (.18). Examples (1)–(6) illustrate ungrammaticality in Yiddish and Table 3. Percentages (frequencies) of grammatical ASUs, ASUs at five levels of complexity, and ASUs that included codeswitching (CS) and discourse markers (DMs) in Yiddish and English. Grammatical ASUs/Total ASUs Ungrammatical ASUs/Total ASUs Complexity of ASUs Level 1 Level 2 Level 3 Level 4 Level 5 CSed ASUs CS N-NPs/ASU CS V-VPs/ASU CSing of long segments DMs/ASUs Structural DMs/ASUs Fluency DMs/ASUs Pragmatic DMs/ASUs

Yiddish % (frequency) .35(147) .65(255)

English % (frequency) .18(42) .82(169)

.30(119) .62(250) .05(19) .02(8) .01(6) .56(229) .40(162) .22(87) .81(260) .26 (103) .11(46) .11(45) .02(9)

.29(62) .56(118) .08(17) .05(10) .02(4) .30(63) .21(45) .06(12) .65(48) .24(50) .10(21) .11(24) .02(5)

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English utterances for different levels of complexity. Each example is followed in parentheses by the language of the session (Y = Yiddish; E = English), the cue word, and the level of complexity (C1–C5). Literal glosses follow Yiddish examples.

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(1) de croyn macht a roses {in-}in uhm leaves greena bleter “the crown make the roses {in} in {leaves}–green leaves” (2) de boym iz fine oon de graz oon de country “the tree is good and the grass and the country” (3) I studied al-algebra ninth grade (4) special place chair lift (5) The problem is:: the streets is {packed}. . .{packed} jam packed (6) I remember:: {he was} {my} my daughter was eight years old was uh ang-angry:: was crying

(Y, crown, C2) (Y, green, C2) (E, failure, (E, chair, (E, city, (E, table,

C2) C1) C3) C3)

Complexity Complexity is an indirect measure of discourse formulation. As seen in Table 3, there was a generally similar pattern of complexity in Yiddish and English narratives, with most of the ASUs falling in Levels 1 and 2 for both languages (92% and 85%, respectively). There were more ASUs at higher levels of complexity (levels 3, 4, and 5) for English (15%) than for Yiddish (8%). Excerpts (7)–(17) show examples of the different levels of complexity. (7) kvurah iz geveizen Eisav (Y, burial, C1) “burial was Esau” (8) oyf geshtanin dray azeiger (Y, lie, C2) “woke up at 3:00” (9) usually de seuda fun shvius iz {e-}esen milchiks| (Y, custom, C3) “usually the meal on Shavuos dairy is eaten” (10) de chesorn iz no minyan der malah iz a minyan kashreh essen (Y, village, C4) “the disadvantage is no quorum the advantage is quorum kosher food” (11) doctor zuckt change {the} the matter- {the} the menu (Y, salad, C5) “doctor said change the menu” (12) Four days no stars, cloudy and rain (E, star, C1) (13) December twenty-three. . .Monday afternoon (E, street, C1) (14) I have:: {to sue the doctor} {sue the doctor} {have} to sue doctor (E, doctor, C2) (15) Problem is:: kl-kl-{the} {watch-}the clock was stuck (E, sleep, C3) (16) and that’s why:: I didnt then:: spill the wine for twenty years (E, punishment, C4) (17) I told my daughter:: don’t worry it happened (E, punishment, C5)

Codeswitching Overall, codeswitching was widespread in the narratives, with almost twice as much codeswitching in Yiddish (57%) as in English (30%). In addition, long segments of codeswitching occurred in 81% of Yiddish ASUs and 65% of English ASUs. In both

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languages, codeswitching primarily involved nouns and NPs: 40% for Yiddish and 21% for English. Codeswitching in verbs and VPs accounted for 22% and 6% of ASUs in Yiddish and English, respectively. It should be noted that the percentages here do not sum to 100%, since there was considerable overlap, e.g., VPs also contained nouns and NPs, NPs contained adjectives, etc. Examples (18)–(21) show single word switches, and examples (22) and (23) illustrate longer segment codeswitching. (18) de croyn macht a roses {in-}in uhm leaves green a bleter “the crown make the roses {in} in {leaves}–green leaves” (19) royt in green in vaas “red and green and white” (20) Took my grandchildren. . .chol hamoed to the ocean (21) that’s the masseh (story) (22) iz geveizen derf’l toyt depressed no people is was village dead depressed people (23) if zoonte in-z-intergang make sure if the car breaks if sun down make sure if:: the car breaks

(Y, crown, C2) (Y, crown, C1) (E, ocean, C2) (E, accident, C2) (Y, village, C1) (Y, sunset, C3)

In terms of motivations for codeswitching, in Yiddish all 229 switches were used to compensate for difficulties in lexical access, whereas in English codeswitching motivations were split between lexical access (36 instances) and cross linguistic lexicalization differences (28 instances). The examples from the data above (18–23) in Yiddish include single word switches to English as well as longer segments of speech, all for reasons of lexical access. The examples in English, on the other hand, include switches for lexical access difficulties (nisht “no”, maaseh “story”) as well as cross language lexicalization for culturally based words and phrases (erev rosh hashana “the day before New Year, shl’mazel ‘loser’, chol hamoed ‘intermediate holy days’”).

Discourse markers Discourse markers were used at similar frequency rates in both languages, the percentage of use as a function of ASUs in Yiddish and English being .26 (N = 103) and .24 (N = 50), respectively. The similarity across languages in the present study held for all three categories of discourse markers (structural, pragmatic, and fluency), most used for structural (e.g., oon/Yid, and/Eng) or fluency (em/Yid, uh/Eng) purposes. The following examples of discourse markers (bolded) are illustrative: (24) koydem oys shluffen oyfvekt zext azeiger (Y, sleep, C2) “first rest get up 6:00” (25) az a em twenty. . .{drai en tzevantzig} {dr-}drai en tzevantzig yur (Y, sickness, C1) “then a um twenty. . .{three and twenty} {thr-} three and twenty year” (26) oon um scrap paper papers paper (Y, paper, C1) “and um scrap paper papers paper” (27) and built a house with h-h-wood in (means: with) n-n-nails (E, hammer, C2) (28) somebody uh destroyed the house (E, hammer, C3)

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Table 4. Percentages (frequencies) of ASUs that were ungrammatical, codeswitched (CS), and contained discourse markers (DMs) in Yiddish and English (all percentages divided by total ASUs). Ungrammatical ASUs CSed ASUs Total DMs/ASUs DMs in CSed ASUs CS in ungrammatical ASUs DMs/Ungrammatical ASUs CS and DMs in ungrammatical ASUs

Yiddish % (frequency)

English % (frequency)

.65(255) .56(229) .26 (103) .19(75) .36(146) .18(73) .14(55)

.82(169) .30(63) .24(50) .07(15) .27(58) .20(43) .06(12)

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Ungrammaticality, codeswitching, and discourse markers To summarize thus far, the data show more verbal productivity and more codeswitching in Yiddish than in English, more ungrammaticality in English, and similar patterns of complexity and discourse markers across the two languages. In order to clarify further the overlap of these factors, Table 4 displays the frequencies and percentages for the overlap of ungrammaticality, codeswitching, and discourse markers.

Ungrammaticality and codeswitching As noted earlier, there were proportionately more ungrammatical ASUs in English than Yiddish (.82 vs .65, respectively). In contrast, there were more codeswitched ASUs in Yiddish than in English (.56 vs. .30, respectively), and all codeswitched ASUs in Yiddish were motivated by difficulties in lexical access, whereas those in English were motivated by both lexical access (.17) and cross linguistic lexicalization differences (.13). The data for codeswitched ungrammatical ASUs clarify these Yiddish–English differences to some extent. For Yiddish, .36 (N = 146) of the ASUs were both ungrammatical and codeswitched, whereas for English the percentage was .27 (N = 58). It should also be pointed out that English codeswitching was motivated by both the need to improve lexical access as well as for cross linguistic lexical differences. Ungrammaticality and discourse markers As mentioned earlier, discourse markers were used with similar frequencies in both languages, .26 (N = 103) for Yiddish and .24 (N = 50) for English ASUs, respectively. For ungrammatical ASUs, there were also virtually the same percentages of discourse markers in ungrammatical ASUs in both languages (.18 and .20 for Yiddish and English, respectively; see Table 4). Codeswitching and discourse markers in ungrammatical ASUs The convergence of all three phenomena—ungrammaticality, codeswitching, and discourse markers—resulted in a higher percentage of ASUs for Yiddish (.14, N = 55) than for English (.06, N = 12). The following are examples of codeswitching and discourse markers in Ungrammatical ASUs: (29) take a pill nischt shluffen (Y, lie, C3) “took a pill:: didn’t sleep” (30) de bich was very{-ve} {zech-}zech-vichtig tze vinin de bich (Y, book, C2) “the book was very very important:: to find the book” (31) in English vus hertzach (in the meantime) and studied studied (E, failure, ungr, C1)

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Discussion The primary aim of this paper was to assess the extent to which the narratives of a Yiddish–English bilingual with moderate nonfluent aphasia differ across languages in terms of fluency and aphasia phenomena. Four main sources of data were examined to address this question: grammaticality, complexity, codeswitching, and discourse markers. In addition, differences in the speaker’s pre-stroke and post-stroke language use of the two languages informed the interpretation of the narrative data. The main findings showed greater verbal productivity in Yiddish narratives, more ungrammaticality in English, relatively similar levels of complexity in Yiddish and English, more codeswitching in Yiddish that was motivated by lexical access difficulties, less codeswitching in English motivated both by lexical access and cross-linguistic lexicalization differences, and similar use of discourse markers in Yiddish and English. Predictions regarding narrative length and grammaticality were confirmed. Results for complexity, codeswitching, and discourse markers were not. Findings concerning complexity and motivations for codeswitching showed evidence for details which were not included in the predictions. We first treat each of the measures separately and then discuss the overall picture in light of the speaker’s bilingualism.

Verbal productivity The greater length of the Yiddish narratives can be attributed to a combination of factors. First and foremost, Yiddish was the participant’s primary and preferred language prior to his stroke, the language he used most in his Talmudic learning, in his teaching and in his social discourse outside the home. ASUs were calculated as a way to appropriately compare across languages in spoken contexts where ungrammatical sentences and repetitions are common.

Grammaticality High levels of ungrammaticality were found for both languages, due in large part to the nature of nonfluent aphasia, where agrammatism can be a defining feature (Davis, 2007). In addition, earlier we attributed the high levels of ungrammaticality in part to the nature of the task, a spontaneous, unrehearsed narrative, and noted that the levels were higher than research which made use of more controlled tasks for eliciting data from PWA (Andreetta et al., 2012; Rochon et al., 2000; Ulatowska et al., 1978). The fact that a higher level of ungrammaticality resulted for English narratives requires further interpretation. It is important to note that English was not the participant’s primary language prior to his stroke. Thus, the combination of impairment due to aphasia, lack of frequent and varied input, and possible incomplete acquisition prior to the stroke all contribute to the ungrammaticality seen in the English narratives. Two questions need to be addressed in light of this finding: (1) To what extent is ungrammaticality a function of the task, which encourages spontaneous, natural speech on a unrehearsed topic? (2) To what extent is ungrammaticality a function of aphasia and/or incomplete acquisition or attrition of one or both languages? By way of comparison, Goral (2012) reports on four bilingual/trilingual people with aphasia whose

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sentence grammaticality was assessed in a picture description task and from personal narratives. Results showed that grammaticality prior to treatment ranged from 0% to 80% depending on the task (higher levels of grammaticality for sentence description than for personal narratives) and language (English, German, Hebrew, Persian, Spanish). Additional research with a narrative task in response to a sequence of pictures (Altman et al., 2014) yielded 68–90% grammatical utterances for monolinguals with aphasia and 55–87% grammatical utterances for bilinguals with aphasia. Healthy monolinguals and healthy bilinguals had 95% and 90% grammatical utterances, respectively. The overall lower rate of grammaticality in both languages for the present case study can be attributed in part to the task, which did not provide picture stimuli and thus required more linguistic and cognitive effort to formulate a narrative on a topic which did not provide a great deal of prior context. Finally, the greater amount of ungrammaticality in English cannot be attributed to length, since both the number of words (tokens) per ASU was quite similar in both languages, 6.96 for Yiddish and 7.22 for English. Thus, despite the variability across task and languages in previous work, the present findings of low levels of grammaticality are clearly within the range of plausibility and serve as a starting point for distinguishing bilingualism from aphasia.

Complexity Lower complexity levels were found to be similar in both languages, though higher levels were found more in English than in Yiddish narratives, possibly due to attempts to formulate more complex utterances in English, the language more used in daily communication with family members post stroke. Following the stroke, and certainly at the time of data collection, English has become the primary language, since the home has become the center of social and verbal discourse. In addition, since therapy is conducted in English, the higher levels of complexity in English may reflect some effect of therapy or a desire to demonstrate his abilities to a clinician eliciting the narrative data. For this participant, it seems that the higher ungrammaticality in English may be explained (at least in part) by more attempts at sounding complex and therefore “paying the price” by lower rates of grammaticality. Crosslinguistic effects of therapy should be clarified in future research, as suggested by Gil and Goral (2004) who relate to language choice, language proficiency, and treatment in bilinguals.

Codeswitching Three measures of codeswitching were examined—frequency, locus in terms of parts of speech, and motivations. We predicted more codeswitching for English narratives based on the need to compensate for difficulties in grammaticality and fluency. We found, however, more codeswitching in Yiddish narratives, all of it motivated by the need to compensate for lexical access difficulties. Moreover, there was more long segment codeswitching and more codeswitching on verbs and VPs in Yiddish, showing a versatility that attests to the use of codeswitching as a strategy to enhance fluency. Also, the somewhat greater degree of codeswitching in ungrammatical Yiddish ASUs may point to the use of codeswitching as a means to compensate for ungrammaticality in the language, which had been the primary and preferred language but was now less

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frequently used since post-stroke, English was used almost exclusively both at home and for therapy. The prediction that motivations for codeswitching would differ across languages was confirmed. Every instance of codeswitching in Yiddish was motivated by lexical access difficulties, whereas English codeswitching involved both lexical access difficulties and crosslinguistic lexicalization differences. Of interest here is why the latter motivation emerged only for narratives in English. One explanation is that many of these switches from English to Yiddish involved concepts that either do not exist or are not as precise in English. More crucial, however, is the lower level of codeswitching in English, indicating less of a need to use this strategy to maintain fluency. This can be attributed in part to the nature of the participant’s sociolinguistic and therapeutic environment, which was primarily English. Thus, although he used codeswitching as a strategy for improving fluency in Yiddish, he used this strategy less frequently in English. Nevertheless, the more discriminating nature of codeswitching in English does show both metalinguistic and social awareness of the codeswitching phenomenon, an awareness which might be harnessed to improve speech fluency. It should be noted that the participant’s codeswitching in English was psycholinguistic, motivated only by lexical access difficulties and the need to maintain fluency. The question of codeswitching as a means to compensate for ungrammaticality is clear in Yiddish, since all instances were motivated by a need to improve lexical access. This is also the case for those instances of codeswitching motivated by lexical access difficulties in English. Thus, codeswitching can be seen as a means to compensate for ungrammaticality and breakdowns in speech where the basic purpose is to be understood and to get a message across.

Discourse markers The most salient (and unexpected) finding regarding discourse markers was their relative scarcity in the narratives of both languages (less than 4% of the word tokens). The percentage of discourse markers as a proportion of words—.037 and .033—was much lower here than the proportions of discourse markers found in other narrative corpora (e.g., Altman et al., 2014), where healthy bilinguals used on average 10.8% discourse markers per word token and bilingual PWA used 7.9% per word token. Moreover, this finding was consistent across languages as well as for both structural and fluency markers, which were more prevalent than pragmatic markers. In addition, ungrammatical utterances did not show a higher percentage of discourse markers, a further indication that discourse markers were not being deployed to compensate for impairment. This low level of use and consistency across languages may point to the possibility that the PWA has refrained from using discourse markers either because of a preconceived notion that they are substandard or because they have been proscribed in therapy. The somewhat lower frequency of ungrammatical English utterances which included both codeswitching and discourse markers supports this possibility, since English was the language of therapy and the primary language of social discourse at the time of data collection.

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Bilingualism and fluency The present study examined a range of features in the narratives of a Yiddish– English bilingual with aphasia in an attempt to shed light on fluency in bilingual aphasia. Two general issues are relevant, one related to bilingualism and one to fluency. Bilingual codeswitching was targeted as a potential feature to compensate for fluency difficulties, in particular problems in lexical access. Codeswitching indeed was found to serve this function, especially for Yiddish, the participant’s primary and preferred language prior to his stroke. One of the resources every bilingual has, even before learning a second language, is the first language. And one of the resources a bilingual with aphasia has, to help meet the challenges of language impairment, is also the first language. Codeswitching was shown in the present study to be systematic, used strategically to compensate for lexical access problems and differences in the way languages lexicalize certain concepts. In terms of processing, codeswitching enables the speaker to continue or recover the desired flow of speech. Fluency, the heart of the problem for many people with aphasia, has been investigated in a variety of fields (e.g., stuttering, second language acquisition, schizophrenia). Theoretically, it is a construct that has not received a lot of attention. Segalowitz (2010) has recently compensated for the lack of work in this line. He distinguishes among cognitive, utterance, and perceived fluency. Cognitive fluency focuses on the speaker’s resources; utterance fluency on the “objective” features of the speech signal (e.g., pauses, speech rate, repetitions, and substitutions); and perceived fluency is the listener’s perception of the speaker’s text. In this framework, fluency is an integral part of speaker abilities and resources, textual features, and listener perceptions and attitudes. Applying this framework to the present study, grammaticality and complexity are on the one hand properties of the utterances of the narrative, but they are also largely influenced by how they are perceived by listeners. Ungrammatical and noncomplex utterances are often perceived as substandard or not becoming of an educated person. But they do not necessarily have an adverse effect on meaning. In fact, grammaticality and complexity are largely independent of both sentence meaning and speaker meaning. And they do not contribute to utterance fluency. Rather, the need or desire to produce grammatical and complex utterances can interrupt the flow of fluent speech, appropriating linguistic and cognitive resources that can be dedicated to other things. Codeswitching and discourse markers, on the other hand, are used to maintain or enhance fluency, among other reasons. They are features of utterance fluency, like grammaticality and complexity, but their use is sensitive to the speaker’s awareness of his own speech as well as the listeners with whom he is communicating.

Clinical implications Based on the findings reported here of different patterns of language use in each language for our bilingual participant, diagnostic assessment should probably include evaluation in both languages, as has been reported previously (e.g., Lorenzen & Murray, 2008; Paradis,

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2004). Currently, there are a variety of aphasia tests that have versions in other languages for assessment and classification of aphasia (e.g., BAT (Paradis & Libben, 1987) and Aachen Aphasia Test (Huber, Poeck, Weniger, & Willmes, 1983) available in several languages). Following judicious clarification with family and therapist, it may be worthwhile considering intervention in Yiddish to complement treatment in English. This might include explicit instruction about how to use codeswitching and discourse markers strategically to improve fluency. Both codeswitching and discourse markers can be integrated into existing language tasks, to be preferred over practices that discourage or even sanction their use. Indeed, current clinical practice encourages the use of compensatory strategies, the use of one language to cue another, and/or the use of cognates or language mixing, as an effective means to promote cross-linguistic generalization (e.g., Goral, Levy, Obler, & Cohen, 2006; Lorenzen & Murray, 2008; Roberts & Deslauriers, 1999). Finally, the present study shows the advantages of narrative data for assessment, as has been reported previously (e.g., Altman, Goral, and Levy, 2012; Andreetta et al., 2012). Narratives are grounded in the speaker’s social world and provide multiple linguistic indicators in a single task, including information about pragmatics, discourse, lexis, grammar, and fluency. In light of the findings that some measures in the present study showed no differences across languages (verbal productivity, discourse markers) while others showed meaningful differences (grammaticality, codeswitching), it is important to examine a range of features. Future research should examine other measures of fluency, e.g., pauses, content words per minute, in conjunction with the variety of linguistic parameters used in this study, e.g., grammaticality, complexity, in order to address questions of efficiency and verbal productivity in narrative production in aphasia. Finally, an intervention study examining the effects of using discourse markers and codeswitching in therapy to enhance fluency would also be useful.

Acknowledgements We thank the participant and lab assistants at Queens College, in particular, Janice Rodriguez, Susie Barroso-Walker, and Erica Dela Santa.

Disclosure statement No potential conflict of interest was reported by the authors.

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Appendix. Bilingual Aphasia Test (BAT) scores on the Yiddish and English versions.

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BAT subtests Verbal comprehension subtests: Pointing Simple and semi-complex commands Complex commands Verbal auditory discrimination Syntactic comprehension Semantic categories Synonyms Antonyms Grammaticality judgment Semantic acceptability Listening comprehension Production subtests: Repetition of words and nonsense words and lexical decision Repetition of sentences Series Verbal fluency Naming Sentence construction Semantic opposites Derivational morphology Mental arithmetic Reading subtests: Reading words Reading sentences Paragraph reading and comprehension Reading comprehension for words Reading comprehension for sentences Writing subtests: Copying Dictation: words Dictation: sentences

Yiddish

English

100% 100% 67% 90% 57% 80% 67% 75% 70% 70% 100%

100% 90% 20% 90% 37% 80% 20% 20% 70% 70% 100%

100% 43% 100% 100% 85% 80% 60% 100% 87%

93% 30% 100% 100% 80% 75% 60% 30% 40%

100% 100% 90% 100% 50%

100% 70% 90% 100% 13%

100% 100% 20%

100% 100% 20%