Bridging Languages, Rebuilding Communication: Best Practices for Assessing and Treating Discourse for Bilingual People with Aphasia

A considerable proportion of the global adult population is bilingual; however, research on aphasia and language processing remains predominantly centered on monolingual speakers, leading to reduced understanding and guidance about bilingual aphasia. Bilingual aphasia is not equivalent to monolingual aphasia, as bilinguals process each language differently from monolinguals. As such, they are likely to have different error patterns and recovery processes. Best practice for assessing bilingual individuals with aphasia requires evaluating all languages they have sufficiently acquired. Because standardized normative tools are not available for many language combinations or even for numerous individual languages, clinicians can derive necessary insights into a bilingual patient’s linguistic strengths and impairments through systematic discourse sampling. Consequently, we provide best practice recommendations for assessing and treating discourse production in bilingual aphasia. We synthesize current practices in language assessment and treatment of discourse production for bilingual aphasia populations, and provide clinically applicable recommendations for selecting, administering, coding, and interpreting discourse assessments across languages. We also provide recommendations for selecting and adapting discourse interventions, treatment languages, and cross-language targets within the constraints of multilingual clinical service delivery.