Tuesday, 19 November 2013
If we dig deeper, as Byron Bernal and Alfredo Ardila have done for a new review paper, we find a more complex, two-sided story. The extent to which language is dominated by the left hemisphere is not fixed. It increases through childhood and adolescence, and then this trend reverses in old age, with signs of greater sharing of language function across the brain hemispheres in later life. Moreover, by characterising people in binary fashion as having their language abilities housed either in their left or right hemisphere, we ignore those people for whom language is a genuinely "bilateral function," meaning that both brain hemispheres are substantially involved.
As Bernal and Ardila point out, a dramatic demonstration of this comes from the Wada test, named after Japanese neurologist Juhn Atsushi Wada. With the patient awake, anaesthetic is injected into the neck or head on one side to effectively shut down function in that side of the brain. Speech and language comprehension tests are conducted first with one hemisphere silenced, then the other. Looking at the results from 1,799 Wada tests, most of which were conducted with epilepsy patients prior to surgery, Bernal and Ardila found that 10 per cent of right-handers and 27 per cent of left-handers (and the ambidextrous) showed evidence that their language function was supported by both brain hemispheres.
The way that bilateral language function manifests in the Wada test varies from patient to patient. In some, shutting down one hemisphere has no effect on their language abilities, while shutting down the other only partially interferes with language. In other patients, shutting down one hemisphere completely impairs language, while shutting down the other also has a partial adverse effect. And in a final group, shutting down either hemisphere results in only a partial impairment to language.
The reason for these different patterns, Bernal and Ardila explain, is that there are various ways that language function can be shared between the hemispheres. Using brain scans from real life case studies, they show how in some people all functions of language are shared between the left and right brain, whereas for other people some sub-functions of language are bilateral, but not others. For instance, the faculties involved in language comprehension might be bilateral, but the faculties of language production are not, or vice versa (similar dissociations can be found for processing sound and meaning). Related to this, some people show evidence that the different steps of language function are distributed sequentially between the hemispheres (e.g. one stage processed on one side, the next stage on the other), so there is no redundancy, whereas other people show a kind of parallel arrangement where both hemispheres are able to perform the same steps of language processing.
We need to be cautious when extrapolating from patient studies to healthy people because it's possible that the brain has altered its function to adapt to disease. This caveat aside, Bernal and Ardila's fascinating review is a reminder of the brain's complexity. The factoid that in most people language is left-lateralized conceals a messy reality. "It is a frequent understanding that language lateralization is a matter of all or nothing," write Bernal and Ardila. "However, language dominance is mostly a matter of hemispheric advantage for a specific multi-modular cognitive function: language. As such, language in a strict sense is up to a certain point a bilateral brain function."
Byron Bernal and Alfredo Ardila (2013). Bilateral representation of language: A critical review and analysis of some unusual cases. Journal of Neurolinguistics DOI: 10.1016/j.jneuroling.2013.10.002
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Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.