We are proud and excited to share our two key clinical resources – an Object Naming Test and an Action Naming Test (BOATIM). Both tests were designed, standardised and clinically tested to enable accurate assessment of speech and language of native English speakers diagnosed with a brain tumour. The test material comprises a set of 115 objects and 86 actions, which is described in detail in this Acta Neurochirurgica paper, and is freely accessible through the survey link below.
To provide some context, in the highly specialised procedure of awake brain surgery that our work contributes to, patients remain conscious during part of their operation, allowing the neurosurgical team to test and preserve critical language functions in real time as brain tumours are removed. For this to be done safely and effectively, surgical teams require precise and standardised tools that enable accurate assessment of speech and language functions prior to, during, and after surgery. Until now, clinical teams in the UK had to rely on translated tests or locally adapted materials which lack linguistic and clinical consistency, and are prone to risk causing life-altering language impairments (you can read more about this aspect in this post). Our open-access resource – BOATIM – addresses this critical gap by offering the first language tests designed specifically for awake brain surgery, which are both culturally and linguistically tailored to the patients in the UK.
Both tests are freely available for clinical and research use through the survey link above. They comprise over two hundred 2D coloured images along with matching scoresheets. We believe in open access to key, evidence-based resources, however, if you are able to, please consider a donation to our local charity, Brain Tumour Support, by clicking their logo below.
Welcome to the Brain, Language and Behaviour Lab! In this post, we introduce our multidisciplinary team working together towards a common goal, while across different areas of expertise and sites around Bristol, UK.
Core Team
Dr Anna Piasecki is an Associate Professor of Psycholinguistics and the academic lead of the Brain, Language and Behaviour Lab. Anna has expertise in bilingualism, first and second language acquisition and adult language processing. Her investigations have spanned various areas of linguistics – including vocabulary, phonology and syntax – as well as the intersection between language, memory and cognition. The main focus of her current work is on applied research, with defined benefits for vulnerable and underrepresented populations.
Mr Neil Barua PhD, FRCS(SN) is a Consultant Neurosurgeon specialising in brain tumour surgery at Southmead Hospital in Bristol, Visiting Professor at UWE Bristol, and the clinical lead of the Brain, Language and Behaviour Lab. His research interests include awake craniotomy, brain/computer interfaces, drug delivery to the brain and quality of life studies. He completed his PhD in Neuroscience at the University of Bristol and has experience of pre-clinical, translational and clinical research. Along with Dr Anna Piasecki and Prof Fiona Cramp he co-supervises PhD students undertaking a range of projects with the ultimate aim of improving quality of life in brain tumour patients.
Mr Will Singleton PhD, FRCS(SN) is a Consultant Paediatric Neurosurgeon at theBristol Royal Hospital for Children, which a Tessa Jowell Paediatric Neurooncolgy Centre of Excellence. As the paediatric lead at Brain, Language and Behaviour Lab, Will’s clinical expertise lies in paediatric neuro-oncology, epilepsy and functional paediatric neurosurgery, including deep brain stimulation and awake craniotomy. His research interests include paediatric neuromodulation and translational neurosurgery – specifically developing methods of direct central nervous system drug delivery and investigating their utility as novel therapeutic strategies.
Dr Kris Kinsey is a Senior Lecturer in Psychology and member of the Psychological Science Research Group (PSRG) at UWE. His previous research focused on identifying biological and cognitive markers of development related disorders, examining the neural systems that subserve vision, attention and language processing. Kris’s recent multidisciplinary work concerns health and technology with an aim towards developing applied solutions for diagnosing, monitoring and navigating health related issues. In his role at the BLB Lab, Kris supports the team with his expertise in imaging techniques, including MEG, fMRI, EEG, infrared eye-tracking and traditional psychophysical measures.
Hajira Mumtaz is a PhD student at the BLB Lab. Her project focuses on the design of intraoperative tests with increased sensitivity and that can allow for more personalised, comprehensive and valid evaluation of speech function that is beyond single word testing. With a more specific and sensitive battery of language tests as the outcome of her project, Hajira hopes to contribute towards introducing intraoperative tests that can positively impact the quality of life of patients requiring brain tumour surgery. Prior to this, Hajira did an Erasmus Mundus joint MSc degree in Clinical Linguistics (EMCL+) at the Universities of Groningen, Potsdam and Eastern Finland.
T. R. Williamson (Tom) is a PhD student in the BLB Lab. His research is centred around understanding what the nature of neurosurgical language tests should be, and, consequently, what kinds of novel tests can be conceived to better preserve linguistic abilities postopertatively for more diverse patient profiles. To this end, Tom’s work has concentrated on preserving the most basic communicative abilities of patients with more severe neurocognitive, tumour-induced, symptoms, and the more complex linguistic abilities that current tasks do not have the sophistication to reach. Tom has also lectured and supervised undergraduate students at UWE, and does research at Oxford and the University of Southern California.
Sonia Mariotti is a PhD student in the BLB Lab and Associate Lecturer at UWE. Her work is devoted to improving the quality of life of brain tumour patients through the preservation of their communicative abilities. Her research in awake craniotomy language testing focuses on bilingual patients and how to isolate and preserve bilingual components for successful communication. Sonia has previously worked in NHS stroke rehabilitation services, supporting patients with language and cognitive impairments. Her research activities at the BLB Lab are a continuation of her desire to bridge the gap between academia and clinical practice, to aid both practitioners and patients.
Madeleine Farrow is a Highly Specialist Speech and Language Therapist working with patients with brain tumours at Southmead Hospital, Bristol. She sees neuro oncology patients at diagnosis, as part of a prehabilitation service, provides pre-, intra-, and postoperative language assessment for patients with high grade brain tumours requiring awake language mapping and supports patients in the community through to end of life. As well as awake language mapping, her clinical interests include dysphasia, cognitive communication difficulties and prolonged disorders of consciousness
Dr Margaret Newson, PhD, CPsychol, is a Consultant Clinical Neuropsychologist who recently joined the Brain, Language and Behaviour Lab as an honorary Visiting Fellow after retiring from North Bristol NHS Trust. Her clinical work focused on diagnostic assessment, cognitive assessment during awake brain surgery and predicting neurosurgical outcomes. During her career, she has enjoyed working in various clinical teams with excellent colleagues, including Neurologists, Neurosurgeons, Neuropsychiatrists, Nurses, Speech and Language Therapists and Occupational Therapists. Her research interests include improving measurement of cognitive functions, early diagnosis of dementia, and optimising outcome following brain surgery.
Molly Cree is a Speech and Language Therapist with over 10 years of experience working with patients who have acquired communication and swallowing impairments. Among other areas, she has worked within stroke rehabilitation, neuro-oncology and neurosurgery to assess, diagnose and treat various communication difficulties in a holistic, person-centred way. She has worked closely with the team at UWE to implement testing materials with patients undergoing awake craniotomies and continues to have a keen interest in this area of Speech and Language Therapy.
The clinical team at Southmead comprises other key people, including many registrar neurosurgeons, neurophysiologists, anaesthetists and oncology nurses. We will be adding their details in due course.
Our Honorary Research Associates and Assistants
Our work is frequently supported by students at different stages of their academic journeys. From undergraduate student volunteers and interns, through to postgraduate researchers and international collaborators, they all contribute in so many key ways to our overarching mission. Some of them are featured here but there are many more, current and past, and we are very grateful they continue to support our work.
Filipa Da Costa Gaspar is our absolutely brilliant illustrator, who has with the utmost creativity, patience and professionalism, created many hundreds of images for our clinical resources; first and foremost for BOATIM. Filipa studied BA(Hons) Animation at UWE and is now a self-employed production designer, 2D artist and illustrator.
Joshua Barraclough is a research assistant and volunteer at the BLB Lab. Utilising his speech analysis expertise, Josh is working alongside Hajira Mumtaz and supports our IMPACT project. The groundbreaking details and insights from this project will be revealed shortly.
Lydia Wiernik is an Honorary Research Associate at the BLB Lab. In her role, she helps out with stimuli creation, data analysis, and study design, and is always happy to contribute insight from her knowledge of signed languages. Her interests are in neurolinguistics and sign language linguistics, and especially the intersection of the two. While collaborating with the BLB Lab, Lydia has completed her undergraduate degree at the University of Edinburgh, focusing on the influence of sign language acquisition on cognitive strategies for non-linguistic perspective taking, and the relationship between embodiment, multimodality, and the brain.
Bailey Ajayi is a recent UWE Psychology graduate and a research assistant in the BLB Lab. Under the supervision of Sonia Mariotti, he supported EEG data collection and participant coordination for a project exploring bilingualism. He also completed a dissertation investigating perceptual learning using transcranial direct current stimulation (tDCS). Bailey has a strong interest in consciousness and cognitive neuroscience and will be pursuing an MSc in Cognitive and Clinical Neuroscience at the University of Sussex. His time in the lab has strengthened his research skills and deepened his passion for brain-based science.
Aleksandra (Sasha) Trepalenko was an international student enrolled in the Erasmus Mundus European Master’s in Clinical Linguistics (EMCL++) programme. As part of that programme, Sasha spent her final semester at the BLB lab working on her internship and thesis alongside Tom Williamson. For her internship, Sasha worked on annotation of gesture experiment materials, which deepened her knowledge of non-verbal means of communication. Using these new insights, Sasha’s thesis went on to explore a new multitasking paradigm for potential use in awake brain surgeries. We designed a new combination of tasks and tested it in healthy native British English speakers.
Eimear McKnight studied linguistics as an undergraduate and master’s student at the University of Cambridge. Their interests span theoretical syntax and phonology, Chinese, and sign language syntax. In the BLB Lab, Eimear has assisted with the annotation and analysis of corpora, and has enjoyed learning more about the neuropsychology of language. They have worked in the medical publishing sector as an Editorial Coordinator, and have recently taken up doctoral studies at the QMUL.
Rachel Peal was a research assistant at the BLB Lab. Working with Tom Williamson, she supported the development of materials, study design, data analysis, and acting as a confederate, Rachel has been crucial to data collection. As a graduate UWE Psychology student, she is interested in the psychological mechanisms underlying multimodal communication and provides a psychological perspective to conceptualisation and theory development. Rachel has enjoyed developing her research design and analysis skills, which will benefit her in many future endeavours and chosen career path.
Get in touch with us on BLB.Lab@uwe.ac.uk us if you have any questions or are keen to join our team!
At the Brain, Language and Behaviour (BLB) Lab, we are a group of researchers and clinicians united by one common goal: improving the quality of life of brain tumour patients. Based at the University of the West of England, the BLB Lab was born out of Anna Piasecki and Neil Barua’s vision to create a team and space for interdisciplinary and evidence-based translational research.
Translational research focuses on turning scientific discoveries into practical applications that improve human health and wellbeing, aimed at real-world application in (for us) clinical settings. In the context of language and cognitive mapping in awake brain surgery, our team works towards the development of novel tasks and interventions, that clinicians can use to assess and preserve their patients’ language and communication skills.
The starting point: brain tumour treatment
In the UK only, 34 people are diagnosed daily with a primary brain cancer (Cancer Research UK). This number does not include diagnoses of secondary brain cancer or non-cancerous tumours, such as low-grade gliomas, which can adversely affect survivors’ quality of life.
There can be many devastating consequences of living with a brain tumour. For instance, some people may develop language and cognitive impairments, which can lead to difficulties participating in work or social and familial life. Feelings of exclusion and depression are also common among this patient group, as is a reduced life expectancy. These all can lead to an impoverished quality of life.
While treatment for brain tumours is increasingly more effective, the gold standard surgical technique for tumour removal is awake brain surgery (craniotomy, in medical terms), along with adjuvant therapies, such as radio- or chemotherapy.
Fig. 1 Awake brain surgery setting in the operating room. The patient is woken from anaesthesia and performs language tests, such as naming the picture of the kangaroo, while the neurosurgeon stimulates the brain.
During an awake craniotomy (see Fig. 1), the patient is woken from sedation to complete several motor, cognitive and language tasks while the neurosurgeon stimulates the brain with direct electrical stimulation. This process guides the mapping of key brain areas for motor, cognitive and language skills, separating those areas from cancerous brain tissue to be cut out. In this way, the tumour can be removed as much as possible, while preserving brain areas that are fundamental to a person’s ability to speak, think, move, and interact with others.
A brief history of language testing in awake craniotomy
Awake language mapping has been performed for nearly a century (Fig. 2 below), starting as early as the late 1920s with Wilder Penfield pioneering cortical stimulation and evolving through the 1980s, when George Ojemann refined language mapping methods.
Fig. 2 Timeline of developments in awake brain surgery throughout the last century.
In the last two decades, neuroimaging techniques (functional magnetic resonance imaging, fMRI, and, diffusor tensor imaging, DTI) and technological advances (virtual and augmented reality) have offered more precise insights into brain structure and function. Similarly, the tasks used for language and cognitive mapping – starting historically with simply counting from 1 to 10 or reciting the months of the year – have also (thankfully!) evolved. How many of us count to ten on a daily basis; unless, of course, you’re an accountant? Nowadays, several language skills are being tested, for example naming pictures of objects and actions, completing sentences, producing sounds, and many more. But there is still a lot to do – and that’s how our work fits in!
Awake brain surgery worldwide and in the UK
You may be wondering, what brain tumour treatment is available where you live in the UK, or rather across the different NHS Trusts? Well, we had the same question and thought it would be important for our work to know the current status quo of language testing practices in this country, especially given the diverse range of practices across the world that have been reported in recent years. For this purpose, we launched a national survey to clinical practitioners working with brain tumour patients in the UK, asking about their approach to language testing, the challenges they face, and if there were any aspects of patient care that would need improvement (click on the picture below to read the paper).
Click the paper header to read the open access article, from Neuro-Oncology Practice.
The results highlighted that language testing practices in awake craniotomy vary across the country, with clinicians advocating for more updated and comprehensive tasks to test patients with diverse linguistic skills and languages, such as bilingual patients, sign language users, and people who communicate with impaired speech and language. Equally, clinicians in the UK were calling for a more joined up approach across the Trusts and practices, as well as quicker and better support for patients after their surgery. And these are exactly the things we have started and continue to address, as you can see across the different posts in our blog.
If you ever had an idea you wanted to pursue, make a comment about our work, or if you wanted to join our mission or research team, do get in touch (BLB.Lab@uwe.ac.uk)!
Two years in a row now, the BLB Lab team rallied the troops to raise funds alongside our localBrain Tumour Support charity – a cause very close to our hearts. The events, held at a local venue in Bristol, bring together individuals passionate about making a difference in the lives of those affected by brain cancer.
During the first fundraiser we learned about the deep-rooted connection between the Southmead Neuro Team and Brain Tumour Support. It was a very touching moment. Since the charity’s inception, the Southmead Neuro Team has been working hand in hand with Brain Tumour Support to ensure that no one faces the daunting journey of a brain tumour diagnosis alone.
In April 2023, the Southmead Neuro Team embarked on a groundbreaking six-month early intervention pilot program with Brain Tumour Support. This innovative initiative ensured that patients received vital support from the moment of diagnosis, leading to remarkable outcomes. Over 100 patients were referred to the charity, and there was a staggering 50% reduction in emotional support calls to the neuro team. This success has cemented the program as standard practice at the hospital, underscoring the importance of continued funding and support.
The first fundraiser set out a friendly team competition, featuring challenges such as biking, hanging from a bar, and crossfit exercises. This spirited competition not only fostered camaraderie among attendees but also served as a reminder of the collective effort needed to support those affected by brain tumours.
The bar was raised for the second fundraiser where, as a team, we set ourselves the challenge to bike, row and ski not one but three marathons in total! Despite our best efforts and high spirits, we were glad to be joined by regular cross-fitters after the first two hours of the challenge.
Both events emphasised to us the crucial link between physical wellbeing and overall health, including the importance of nutrition in maintaining a balanced lifestyle, so we can continue to support those who need it most.
Who knows what challenge will be set for 2026! Join us for it, if you can.
To learn more about Brain Tumour Support and how you can contribute to their vital work, visit their website.
Earlier this month, a few members of the BLB Lab flew to Spain for the International Symposium on Bilingualism (ISB15). Anna, Sonia and Lydia were honoured to join forces with Anna Gasa Roqué, their collaborator from the Bellvitge University Hospital in Barcelona, and present a four-part symposium entitled “The unexplored power of translational research: Applying insights from awake brain surgery to our current understanding of the bilingual mind”.
To give you some context, ISB15 is a biennal conference that has grown to be the most significant event in the field of bilingualism. This year it focused on multidisciplinary research output from a range of fields, including linguistics, neuroscience, and psychology, which lie at the core of the BLB Lab research. What’s more, the conference took place in beautiful Donostia-San Sebastián, at the heart of the Spanish Basque Country, where the bilingual heritage is alive across all aspects of society.
The symposium presenters: Anna Piasecki, Anna Gasa Roqué, Sonia Mariotti and Lydia Wiernik.
The BLB-organised symposium on translational research offered a deep dive into the fascinating world of intraoperative language testing and management of bilingual brain tumour patients. Designed to guide attendees through this complex field, the symposium began with Anna Piasecki providing a comprehensive introduction to the procedure and laying the groundwork with essential concepts and terminology. From there, the presentations gradually zoomed in, taking the audience on a journey that span from bilingualism’s role in shaping the brain to the challenges of preserving language skills of bilingual patients.
After the introduction, Anna Gasa-Roqué explored the effects of bilingualism in brain tumour patients, showing how being bilingual changes both the structure and functionality of the brain. Sonia Mariotti then focused on the important role of cognitive flexibility involved in switching between languages, and how this ability should be preserved in bilingual brain tumour patients. Finally, the symposium ended with Lydia Wiernik, who presented a compelling case study on bimodal bilingualism, showing that both spoken English and British Sign Language can be tested and preserved during awake surgery.
Each presentation built on the last, creating a layered and immersive experience that reflected the depth and diversity of research in this area. Feedback from the audience resonated with this aspect, and fellow academics expressed genuine enthusiasm for the symposium, describing it as both intellectually enriching and clinically vital. Many highlighted the lab’s work as not only fascinating but also deeply important – pushing the boundaries of what we understand about the bilingual brain.
Presenting at ISB15 was an incredible opportunity to share the BLB Lab research with the intenational academic community. We hope that our perspective on translational research inspires more interdisciplinary collaboration between linguists, neuroscientists, and clinicians to improve intraoperative care for everyone.
Today, our Brain, Language and Behaviour (BLB) Lab played host to a landmark event in the field of brain tumour surgery: the 2025 Awake Craniotomy Symposium. Organised in collaboration with the North Bristol NHS Trust and the Tessa Jowell Brain Cancer Mission, the symposium brought together a community of more than a hundred neurosurgeons, speech and language therapists, neuropsychologists, physiotherapists, anaesthetists, and researchers to explore the latest advancements and challenges in awake brain surgery. Scroll down to see the photo gallery from the event!
The day began with a warm welcome from organisers, and our BLB Lab’s co-leads, Anna Piasecki and Neil Barua, setting the tone for a programme rich in interdisciplinary insight and clinical innovation. The first session focused on preoperative planning, featuring talks on cutting-edge techniques such as Navigated Transcranial Magnetic Stimulation (nTMS) by Jose Pedro Lavrador, and Diffusion Tensor Imaging (DTI) by Puneet Plaha and Natalie Voets. Neil Barua also introduced the role of mixed reality in surgical planning, highlighting how immersive technologies can support surgical approaches with the whole multidisciplinary team’s involvement. All attendees were then invited to explore some of these technologies for themselves at the featured sponsor stands throughout the day, including wearing VR goggles, which created a high level of interest and excitement.
Session two shifted the spotlight to intraoperative test selection. Hajira Mumtaz presented the first outcome of her research at the BLB Lab: the world’s first standardised and clinically tested resource for English-language object and action naming testing, freely available to clinicians (gain access to our BOATIM material here). This was followed by a compelling trio of perspectives on cognitive and sensorimotor testing during surgery—from physiotherapy, neuropsychology, and neurosurgery—delivered by Charly Moran, Margaret Newson, and Francesco Vergani respectively. Their insights underscored each discipline’s contribution in preserving complex brain functions during the surgery.
Following the morning sessions, clinical teams from across the UK and international delegates presented some of their innovative practice over joint lunch-poster session conversations. The winning poster was collectively decided by the symposium delegates and was awarded to the clinical team from the North Midlands and North Staffordshire Combined Healthcare Trust, sharing an evaluation of their originally designed Awake Craniotomy Video Leaflet for patients.
After lunch, the afternoon resumed with Sonia Mariotti and Clare Toner, who provided an overview of clinician and patient experience of awake brain surgery practices in the UK (see here and here for their respective work), setting the scene for two subsequent panel discussions. These two interactive sessions involved the attendees in a lively conversation with a multidisciplinary panel of experts, discussing the need for consensus on test selection and follow-up protocols. The conversations revealed both the diversity of current practices across the UK and a shared desire for more unified approaches to patient care and research.
The final session, “Directions for Networking and Collaboration,” featured a series of flash talks that showcased innovative projects and case studies. Highlights included Aimun Jamjoom’s introduction of Map-OR, a digital platform for intraoperative language testing, and Sonia Mariotti’s exploration of bilingual patient testing. Tom Williamson presented on the challenges of testing multiple linguistic modalities, while Will Singleton addressed the unique considerations of awake craniotomy in paediatric patients.
The symposium concluded with reflective feedback and closing remarks, followed by a well-earned dinner at PepeNero, where conversations continued informally among colleagues and new collaborators.
The 2025 Awake Craniotomy Symposium was more than a meeting of minds—it was a celebration of the collaborative spirit that drives progress in brain surgery and cognitive science. By bridging clinical practice with research and technology, the event highlighted the importance of interdisciplinary dialogue in improving patient care and advancing our understanding of the brain. And the overwhelmingly positive feedback from delegates reaffirmed just that – followed by requests for further iterations of our symposium that helps bringing this key community together. So, watch this space!
Photo Gallery
Anna Piasecki and Neil Barua kick off the SymposiumNatalie Voets and Puneet Plaha discuss DTIHajira Mumtaz launches BOATIMMargaret Newson presents neuropsychological testingFrancesco Vergani explains motor cognitionCharly Moran gives a physiotherapist’s perspectiveNetworking over lunchClare Toner and Sonia Mariotti open the discussionsPanel discussionsTom Williamson presents a sign language casePoster session Will Signleton explores awake craniotomy with paediatric patients
Immigration and global citizenship are topics that often dominate political debates, but they can sometimes leave individuals feeling unwelcome in countries they call home. Despite this, the contributions of a global workforce are indispensable, especially in sectors like healthcare, where the absence of diverse talents can put further pressure on healthcare teams. This post explores how an NHS with a global citizenship can make a real difference—both for individuals and for the communities they serve.
The value of linguistic diversity in healthcare
One key benefit of a multicultural healthcare staff is linguistic diversity. Linguistic diversity among professionals can be critical, particularly when supporting patients whose first language is not English.
This became particularly evident for us when our lab conducted a study on the practices of awake brain surgeries across the UK, encompassing England, Scotland, Wales, and Northern Ireland. A key finding was that a fair proportion of brain cancer patients were speakers of languages other than English. Among them, Polish speakers represented the largest group—a reflection of the most recent national census data.
In awake brain surgeries, the effects of the surgical procedure on a patient’s language facilities needs to be constantly monitored. However, without a diverse workforce, this can be a challenge. Additionally, with many of the language testing mechanisms only available in English, patients may be done a disservice (see our previous post on Bilingualism).
A case study of linguistic diversity in action in the healthcare sector
What is needed are tailored testing materials and, where possible, a multilingual healthcare sector to guide staff on how to interpret patients’ responses during awake brain surgeries accurately. A recent case brought this reality close to home for our lab. Anna, the academic lead of our team, has not only helped developing comprehensive linguistic testing resources for brain cancer patients but also brought her own global citizen identity to the forefront. As a native speaker of both German and Polish, and with an honorary contract with the North Bristol NHS Trust, Anna was uniquely positioned to assist with language testing when a Polish-speaking patient required bespoke support during an awake brain surgery. Her ability to bridge linguistic and cultural gaps ensured that the surgery could proceed smoothly, demonstrating the tangible benefits of a global perspective in healthcare.
The broader impact of global perspectives
Anna’s story is just one example of how global citizenship can transform healthcare delivery. It highlights the importance of recognising and leveraging the skills that individuals from diverse backgrounds bring to critical sectors. In this case, her linguistic and cultural expertise directly impacted a patient’s care, showcasing the profound advantages of having a global workforce.
For healthcare teams, embracing linguistic diversity is not just about meeting immediate needs; it’s about creating systems that support equitable and inclusive care for all patients. Whether through the development of testing materials or the involvement of language specialists, these practices underscore how global perspectives enhance patient outcomes.
Join the conversation
If you’re interested in learning more about the practices of awake brain surgeries and the innovative solutions clinical teams develop to support their patients, check our blog for the next update. Together, we can continue to celebrate the power of global citizenship in making a difference where it matters most.
Following on from our previous post on Bimodal Bilingualism and publication success of a related case report, our Lab members have been involved in supporting a further intra-operative language assessment of a bilingual patient, which required the design of a bespoke set of tasks (take a peek at the paper here, if it’s sparked your interest).
You may be wondering why bilingual language assessments require a bespoke task design, and so this blog post is going to address this question by debunking a few myths and letting you in on bilingualism’s best kept secret(s).
What is bilingualism and who counts as bilingual?
Bilingualism, broadly defined, involves the acquisition and use of two or more languages in daily life. There is no single definition of bilingualism since it can be seen as an evolving experience throughout one’s life. Yet, a common misconception persists that categorises bilinguals as having equal proficiency in both languages. This popular belief cannot be further from the truth. In reality, bilinguals know their languages to the extent they need them and often have one language that is more dominant than the other one.
Given such a broad (or vague) definition of the term, it may be no surprise that measuring bilingualism – that is, who counts or doesn’t count as a bilingual – is quite complex.
On the one hand, there are various skills involved in language that may need to be taken into account in such an assessment, such as reading, writing, speaking, and listening, as well as knowledge areas like vocabulary and grammar (see here for a discussion on the difficulty of counting bilinguals). Individuals often excel in some areas more than others, for instance, being able to hold a conversation in two languages equally easily but struggling, or even not being able, to write or read in one of their languages, especially if they were never formally taught to do that. Instances like this make it difficult to classify people strictly as monolingual or bilingual. Even lifelong bilinguals show variability in their language proficiency across the different skills and knowledge areas.
On the other hand, estimates of bilingualism are often influenced by attitudes towards it – and these attitudes vary by region. In Europe, for instance, high standards are set for who is considered bilingual, often expecting perfect knowledge and no accent across a bilingual’s two languages. In contrast, the United States have a more inclusive view of bilingualism, recognising the diverse language pairings and the fact that about 1 in 5 people across the country use two or more languages in their daily lives.
How many people then count as bilingual?
Now, here is the best bit: speaking more than one language is the norm rather than the exception and it is estimated that more than half the world’s population is bilingual (Grosjean, 2010). How can one explain such large numbers of bilinguals? One reason is simply that many countries house numerous languages: 722 in Indonesia, 445 in India, 207 in Australia and so on. Contact between communities means learning other languages or, at the very least, acquiring a common language of communication and hence being bilingual. Educational policies, political fluctuations, religious, social, and work-related choices of individuals and their families all contribute to the ongoing growth of bilingualism across the world.
Bilingualism is present on all continents, in all classes of society, in all age groups, so let’s put some more precise figures to this. Looking at Asia and Africa, to start with, we know that many people are bi- or multilingual although a definite estimate is still lacking. In North America, some 35% of the population in Canada is bilingual and although the percentage is smaller in the United States – close to 23% in 2018 – this still corresponds to an estimated 70 million inhabitants. Bilingualism in the US is very diverse, pairing English with Native American languages, older colonial languages, recent immigration languages, and so on (see here). This diversity is often characterised through the term ‘societal bilingualism’ and is also strongly manifested in Europe.
In Europe then, a bit more than half of the population is at least bilingual. As such, smaller countries such as Luxembourg, Switzerland, and The Netherlands house many bilinguals whereas larger countries such as France and the United Kingdom have fewer of them. In the UK, almost 40% of the adult population is reportedly able to hold a conversation in a second language (Languages for the Future Report, British Council, 2017), some of which are reflected in an ever-evolving landscape of the languages spoken in England and Wales (see Figure 1).
Figure 1 The top ten main languages spoken in England and Wales, excluding English (English or Welsh in Wales). Total usual resident population, aged three years and over, who speak each language as their main language (Office for National Statistics, 2022)
Moving closer to our city, Bristol, at least 91 different languages were spoken by its residents in 2022 (Insight, Performance and Intelligence Service), so you do the maths! It is no surprise then that the clinical teams we work with report having cared for patients with a range of different languages, as displayed in Figure 2, necessitating a very careful and bespoke task design for assessment of their language skills.
Figure 2 Languages spoken by bilingual brain tumour patients in the United Kingdom (Mariotti et al. under review).
What makes bilinguals different from the rest/so special?
There are many myths surrounding bilingualism. Apart from the ones already mentioned, we bring up a further three, but you can read more on this topic via the links we provide at the end of this blog.
Many people mistakenly believe that true bilinguals do not have accents in their languages and are excellent translators. This is far from being true. Having an accent does not affect one’s bilingualism, however, translating specialised language can prove incredibly difficult for many bilingual speakers.
Regarding children, there are several common misconceptions. One is that bilingualism delays language acquisition in young children. This was a popular myth in the first part of the last century, but there is no research evidence to that effect.On the contrary, research shows that bilingual children acquire language at the same rate as monolingual children. We also now know that early exposure to multiple languages brings about multiple advantages ranging from effective communication skills, enhanced development of working memory, and a delayed onset of cognitive decline typically observed in dementia.
Another misconception is that bilinguals always mix their languages. In reality, both bilingual children and adults adapt to their environment and the situation they’re in. When they interact in monolingual situations, e.g. with Grandma who doesn’t speak their other language, they will respond monolingually; if they are with other bilinguals, then they may well code-switch.
The bilingual paediatric patient that our team followed, fell into this latter category. He learned both English and Polish simultaneously during early childhood and grew up speaking both fluently. For him, as for many other bilinguals, the ability to alternate between these two languages is key for everyday life.
What is language switching and how does it work?
Bilinguals’ ability to change between languages, voluntarily or not, and depending on the context they find themselves in, is called language switching. Bilingual people manage two or more active languages in their brain (or ‘mental lexicon’), choosing to speak the appropriate one based on any given situation. For example, they might use English at work or school and their native language at home. Language switching also occurs within a conversation, when bilingual people are speaking with each other. They might use words or expressions in a different language that better convey the meaning of what they wish to say (see here for more content on language switching).
Language switching is not only key for effective communication but also has beneficial effects for bilingual people’s brain health, as their brain is constantly engaged in a process of suppressing an irrelevant language, while facilitating the relevant one. This recurrent process of managing multiple languages has been shown to enhance people’s cognition and executive skills, such as multitasking, focusing attention and problem-solving. Additionally, switching languages throughout a bilingual’s lifetime has been evidenced to boost their brain flexibility (neuroplasticity, in scientific terms), helping to protect against cognitive decline and dementia onset in older age.
Given the importance of language switching for so many facets of a bilingual’s life, it is imperative to protect such a skill, especially within a clinical setting. And that’s what our team’s ongoing work is trying to do.
Stay tuned for more updates on this and other aspects of our work!
This month, some of our Lab members visited our collaborators at the University Hospital Bellvitge in Barcelona/Spain, to attend the 7th Mapping Course and Neuropsychological Assistance Workshop.
The three-day event brought together academics and medical professionals from across Europe and other parts of the world working with brain tumour patients, all dedicated to advancing neuropsychological assistance in pre-, intra- and post-operative settings.
Workshop organisers and attendees, including BLB Lab members, Hajira, Tom, Sonia and Anna.
Course Highlights
The course was led by renowned experts in Spain, including Dr. Gabarrós, Chairman of the Neurosurgery Department and Brain Mapping Program Director at Hospital Universitari de Bellvitge, and Dr. Anna Gasa-Roqué, neuropsychologist and researcher from the Neuropsychology Unit at the same institution. The workshop covered a wide range of topics essential for professionals involved in neuropsychological practices, such as language and cognitive assessment of glioma patients undergoing awake brain surgery, but also for professionals that provide other aspects of patient care, such as physiotherapists, oncologists and counsellors. Hands-on workshops focused on pre- and post-surgery evaluations for this bespoke patient group, comprising intraoperative mapping and monitoring of language, and provided an insight into the neuropsychological practice as it is conducted at the Bellvitge Hospital. Attendees were also part of discussions revolving around best and new practices in patient care, such as the organising team’s recent clinical case involving a patient whose chess-playing abilities were tested alongside language and cognitive skills (see here for a case report).
BLB Lab’s Experience
For the BLB Lab members, the course was an enriching experience where they engaged with leading professionals, participated in interactive sessions, and gained a deeper understanding of the standard of care in neuropsychological assistance outside of the UK. The workshop also offered the opportunity to expand our networks, engage in open exchange and international collaboration to help us collectively advance our knowledge through research and ultimately improve practice and patient care.
Not only workshop sessions, but also a concert!
The lab members were also treated to a unique evening concert, “Simfonia dels herois”, a project where clinicians and patients from Bellvitge Hospital come together to make music, produce songs and perform them to different audiences (have a look at the fascinating story behind the project and a documentary here). The concert, an initiative by Dr. Gabarrós, raises awareness of the impact of brain tumours on patients, and how much survival rates have increased in recent years thanks to research in improving surgical practice and techniques. A truly emotional experience!
Looking Ahead: Awake Craniotomy Symposium at UWE
The team returned from Barcelona inspired by the work of their Spanish peers and are excited to be part of the growing network of international collaborators with a common aim to advance neuropsychological research and practice.
We, for our part, are teaming up with the North Bristol NHS Trust and Tessa Jowell Brain Cancer Mission to contribute to this journey and invite you to the Awake Craniotomy Symposium 2025, which will be held at UWE Bristol on Friday 23rd May 2025.
We are incredibly excited to announce that our Lab has become one of the associated partners of the European Master’s in Clinical Linguistics (EMCL++). This partnership is based on the increasingly significant and relevant work our Lab conducts, as we strive to improve the standards of patient care nationally and internationally, as well as our current understanding of the neurobiology of language.
About the EMCL Programme
Co-funded by the Erasmus+ Programme of the European Union, the EMCL is an Erasmus Mundus Joint Master’s Degree (EMJMD) that has been running for over 20 years. With a strong emphasis on student mobility, the programme runs across three countries, Finland, Belgium, and The Netherlands, which allows students on this programme to immerse themselves in a rich academic and cultural experience.
At the University of Groningen, the emphasis is on crosslinguistic studies of language-impaired children and adults, language testing in neurosurgical settings, and the usage of neurotechnology and IT for the diagnosis and treatment of language impairments. At Ghent University, students are familiarised with advanced topics in statistics and psycholinguistics, including bilingualism, dyslexia, and eye tracking. Finally, at the University of Eastern Finland, the main focus is on speech technology and programming with Python, including both fundamental theory and methods, as well as their application to the assessment of, and adaptive solutions for, speech impairments.
EMCL also collaborates with over twenty associated partners, ranging from a diverse group of academic institutions that conduct research in related disciplines and have complementary expertise, to non-academic partners from the R&D (neurotechnology) and the clinical sector. Students are required to complete an internship at one of those associated partners and can choose to continue their work as part of a Master’s dissertation, with the possibility of securing future employment at one of these workplaces.
How This Partnership Came About
The focus of the work we pursue in our Lab is on applied, translational research, which has a wide appeal to academic researchers and clinical teams within and beyond the UK. Over the past two years, we have been growing our networks with those researchers and clinical teams in related disciplines across Europe and North America, including the EMCL programme, which has recognised us as a key stakeholder.
Let’s also not forget that our Lab’s first postgraduate researcher, Hajira, was a graduate from the EMCL programme and has been doing some fantastic work with us since!
Between January and July 2025, we will welcome a new EMCL student to our research team, Aleksandra, who will be doing an internship at the lab, followed by a research project and dissertation.
Stay tuned for more updates on Aleksandra’s work and further research & collaboration news!
