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Cited by 27Neurobiology of Language and BilingualismLanguage Development and DisordersStroke Rehabilitation and Recovery

Cross-language generalization of language treatment in multilingual people with post-stroke aphasia: A meta-analysis

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Goral, Mira, Norvik, Monica I., Antfolk, Jan, Agrotou, Ioulia, Lehtonen, Minna·2023·Brain and Language
DOI 10.1016/j.bandl.2023.105326
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Abstract

Studies on the efficacy of language treatment for multilingual people with post-stroke aphasia and its generalization to untreated languages have produced mixed results. We conducted a systematic review and a meta-analysis to examine within- and cross-language treatment effects and the variables that affect them. We searched PubMed, PsycINFO, CINAHL, and Google Scholar (February 2020; January 2023), identifying 40 studies reporting on 1573 effect sizes from 85 individuals. We synthesized effect sizes for treatment outcomes using a multi-level model to correct for multiple observations from the same individuals. The results showed significant treatment effects, with robust within-language treatment effects and weaker cross-language treatment effects. Age of language acquisition of the treatment language predicted within-language and cross-language effects. Our results suggest that treating multilingual people with aphasia in one language may generalize to their other languages, especially following treatment in an early-acquired language and a later-learned language that became the language of immersion.

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  • In Goral et al. (28), the inability to account for language use and exposure meant that in cases driving their strongest results, late-learned languages had often become primary due to pre-stroke immersion, suggesting that language use modulated AoA effects and may explain why AoA emerged as a significant factor in their analysis.

    “Additionally, their inability to account for language use and exposure meant that in cases driving their strongest results, late-learned languages had often become primary due to pre-stroke immersion, suggesting that language use modulated AoA effects and may explain why AoA emerged as a significant factor in their analysis.”

    From Machine Learning Predictions of Recovery in Bilingual Poststroke Aphasia: Aligning Insights With Clinical Evidence (2025) · cites this paper as [28]

  • A recent meta-analysis of 85 multilingual persons with aphasia found that both treated language improvement and cross-language generalization were most strongly influenced by the age of acquisition of the treated language, with the greatest effects when the treated language was acquired in adulthood.

    “Crucially, a recent meta-analysis of 85 multilingual persons with aphasia found that both TLI and CLG were most strongly influenced by the AoA of the treated language, with the greatest effects observed when the treated language was acquired in adulthood.”

    From Machine Learning Predictions of Recovery in Bilingual Poststroke Aphasia: Aligning Insights With Clinical Evidence (2025) · cites this paper as [28]

  • The findings diverge from a recent meta-analysis that reported the age of acquisition of the treated language as the primary influence on cross-language generalization, with no influence of aphasia severity on either treated language improvement or cross-language generalization.

    “While we found that aphasia severity in the treated and untreated languages predicted TLI and CLG, respectively, the aforementioned study28 reported the AoA of the treated language as the primary influence on CLG, with no influence of aphasia severity in either TLI or CLG.”

    From Machine Learning Predictions of Recovery in Bilingual Poststroke Aphasia: Aligning Insights With Clinical Evidence (2025) · cites this paper as [28]

  • Our inclusion of AoA within a principal component that encompasses other aspects of bilingual experience contrasts with Goral et al. (28) in the use of discrete life-stage ranges, potentially contributing to divergent findings.

    “Furthermore, our inclusion of AoA within a principal component that encompasses other aspects of bilingual experience contrasts with 28 in the use of discrete life-stage ranges, potentially contributing to divergent findings.”

    From Machine Learning Predictions of Recovery in Bilingual Poststroke Aphasia: Aligning Insights With Clinical Evidence (2025) · cites this paper as [28]

  • The same meta-analysis found that neither language proficiency nor aphasia severity affected treated language improvement or cross-language generalization.

    “Surprisingly, neither language proficiency nor aphasia severity affected TLI or CLG28.”

    From Machine Learning Predictions of Recovery in Bilingual Poststroke Aphasia: Aligning Insights With Clinical Evidence (2025) · cites this paper as [28]

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Authors
Goral, M., Norvik, M. I., Antfolk, J., Agrotou, I., & Lehtonen, M.
Affiliations
  • The Graduate Center, CUNY (US)
  • University of Oslo (NO)
  • Åbo Akademi University (FI)
  • University of Turku (FI)
Corresponding author
Goral, Mira
ORCID
Venue
Brain and Language
Publisher
Elsevier BV
Published
2023-11
Volume
246
Pages
105326
ISSN
0093-934X (ISSN-L)
DOI
10.1016/j.bandl.2023.105326
OpenAlex
W4388039602
Cited by
27
References
85
Citations by year
2026: 11 · 2025: 15 · 2024: 1
FWCI
1.01
Type
journal article
Language
en
Open access
Licence
Locations
  • Brain and Language (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Åbo Akademi University Research Portal (publishedVersion, cc-by-nc-nd)
  • UTUPub (University of Turku) (submittedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc-nd)
Funders
Norges Forskningsråd (223265)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neurobiology of Language and Bilingualism
  • Social Sciences › Psychology › Developmental and Educational Psychology › Language Development and Disorders
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Keywords
post-stroke aphasia, multilingualism, language intervention, cross-lingual generalization, age of language acquisition, stroke rehabilitation, bilingual aphasia
MeSH terms
Aphasia, Humans, Language, Language Development, Treatment Outcome, Multilingualism

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