1013 - Post-Traumatic Bilingual Language Reorganization

A 46-year-old bilingual, Spanish-dominant male presented following a scooter-versus-car collision resulting in multiple facial fractures, epidural hematomas, subarachnoid hemorrhage, and subdural hematoma. He initially arrived with a GCS of 3 and Rancho level IV, then underwent stabilization and multiple neurosurgical procedures before subsequently being admitted to inpatient rehabilitation. During recovery, his communication was marked by impaired intelligibility and comprehension. Given his documented Spanish language dominance, he worked with a bilingual speech therapist; however, during speech therapy sessions, the patient consistently responded in English with written language exercises. Attempts to elicit Spanish production, including reading and copying written Spanish, were unsuccessful, with responses exclusively produced in English.


Discussions: Language recovery in bilingual patients following a TBI is inadequately characterized in current literature. While stroke and aphasia studies suggest variable recovery patterns depending on dominance, age of acquisition, and neuroplasticity, TBI literature has primarily focused on motor, cognitive, and ADL outcomes rather than bilingual cognitive-linguistic reorganization. Our patient represents a unique case of language switching, emerging from a severe TBI with regained communication capacity in a non-dominant language as opposed to his primary language. This suggests selective neural network reorganization, potentially influenced by language exposure, cortical representation, or injury distribution. The inability to independently produce or copy written Spanish despite intact English output underscores the complexity of bilingual language recovery.

Conclusions:

This case highlights the underrecognized challenge of bilingual cognitive-linguistic rehabilitation in the setting of a TBI. Emergence of a non-dominant language post-injury introduces barriers in patient-family communication and clinical care, underscoring the need for further research into bilingual language recovery mechanisms. Greater understanding of these dynamics may inform individualized therapy and optimize rehabilitation outcomes in bilingual populations.