When you speak, your brain is hard at work. Different parts of your brain activate to help you understand words, make sense of their meanings, and control the muscles that move your mouth.
This process is even more complex for people who know more than one language. For them, the brain has to manage not just one language system but several. So when someone who speaks multiple languages has a stroke, it can make things even more challenging.
A stroke happens when blood flow to a part of the brain is cut off, which damages brain cells. This can lead to many problems, one of which is called aphasia. Aphasia is when a person has trouble speaking clearly or understanding language. It’s most often caused by a stroke, but it can also happen because of brain injuries or diseases.
According to the American Stroke Association, about 2 million people in the United States live with aphasia, mostly due to stroke. It’s hard to say how many of these people are bilingual or multilingual, but around 20% of the U.S. population speaks a language other than English at home. That means many people with aphasia might struggle with more than one language.
Dr. Swathi Kiran, who leads the Center for Brain Recovery at Boston University, says the number of people with bilingual aphasia is expected to grow, especially as the Hispanic population in the U.S. increases.
She pointed out that by 2030, the Hispanic population could reach 71 million, and stroke rates are expected to rise the most among Hispanic men. But aphasia isn’t limited to the U.S.—it’s a global issue. According to Dr. Kiran, most people in the world speak more than one language, which means multilingual aphasia is a worldwide concern.
Language isn’t just about speaking; it’s about understanding words, grammar, and even the tone of voice. There isn’t just one area in the brain that handles language. Instead, different parts work together.
In people who speak more than one language, these brain areas do even more work, managing multiple languages like different software programs running on the same computer. Dr. Kiran explains that it’s not like one part of the brain handles English while another handles Spanish. All languages share the same brain networks.
When a stroke happens, it affects everyone differently. The most common kind of stroke is called an ischemic stroke, which happens when a blood vessel that supplies blood to the brain gets blocked. The area most often affected is the left middle cerebral artery. This artery brings blood to the brain regions that manage speech and language.
If the main artery is blocked, it can cause “global aphasia,” where a person has trouble speaking, understanding, reading, and communicating. If only a smaller branch of the artery is affected, the problems might be less severe.
For example, if the stroke affects the frontal lobe, the person may have trouble speaking fluently but still understand what others are saying. If another part is affected, the person might speak well but struggle to understand what others are saying.
For people who speak more than one language, aphasia usually affects all their languages, not just one. Dr. Mira Goral, a professor of speech-language-hearing sciences at Lehman College, explains that this is because the same brain areas manage all languages. The damage caused by a stroke affects the whole language network, making it hard to switch between languages.
Sometimes, the first language a person learned comes back first. Other times, the language they used the most before the stroke returns more quickly. Dr. Kiran notes that research suggests if someone used both languages a lot before the stroke, both might be equally affected.
Interestingly, there’s some debate about whether being bilingual can help protect against conditions like dementia or even aid recovery after a stroke. The idea is that switching between languages builds mental strength and helps with thinking skills.
While more research is needed, it’s a hopeful sign that speaking more than one language might give the brain a little extra resilience.
Recovery from aphasia is possible, especially with speech therapy. Dr. Goral says many people improve in the weeks and months after a stroke, and therapy can help them regain many of their communication skills. However, in the U.S., most speech therapists only speak English, which makes it hard for people who are more comfortable in another language to get the right kind of help.
There’s ongoing research to find out whether therapy works best in a person’s first language or the one they used most before the stroke. So far, the results show that therapy can help in any language, but it’s not always clear if improving one language helps the others. For example, someone might get better at speaking English but still struggle with Spanish, or vice versa.
Helping people recover all their languages is important, Dr. Goral says, because language is tied to culture and identity. For many people, speaking their native language is deeply connected to who they are. That’s why it’s crucial to support people in all the languages they value, not just the ones that are easiest for therapists to work with.
This includes helping people who naturally switch between languages in conversation—a common habit among bilingual people. For example, many Spanish-English speakers in New York mix both languages when they talk, sometimes even in the same sentence. Dr. Goral believes that therapy should recognize this way of speaking instead of trying to separate the languages.
Unfortunately, there are not enough speech therapists who can work with patients in languages other than English. This is a growing problem as more multilingual people face the effects of strokes and other brain injuries. Dr. Kiran’s research aims to improve this situation by using technology to understand how the brain learns, forgets, and recovers languages.
Her team is working on building a “digital twin” of the brain’s language networks to help therapists understand how to better treat multilingual aphasia. This technology could help make speech therapy more effective and accessible for people who speak multiple languages.
In summary, aphasia is a serious condition that affects language and communication after a stroke. For multilingual people, the challenge is even greater.
Recovery is possible with the right therapy, but more needs to be done to make treatment available in all the languages people speak and value. As our world becomes more multilingual, improving therapy for people with aphasia in all their languages is more important than ever.
If you care about stroke, please read studies that diets high in flavonoids could help reduce stroke risk, and MIND diet could slow down cognitive decline after stroke.
For more health information, please see recent studies about antioxidants that could help reduce the risk of dementia, and tea and coffee may help lower your risk of stroke, dementia.
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