Groundbreaking brain mapping with a bimodal bilingual patient

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Post by Lydia Wiernik

Recent work carried out in our Lab has supported the intra-operative language testing of a hearing adult CODA – a child of deaf adults. Like many CODAs, this patient is a bimodal bilingual, meaning they use both British Sign Language (BSL) and English. In the first report of its kind, “Awake craniotomy with English and British sign language mapping in a patient with a left temporal glioblastoma reveals discordant speech-sign language maps” published in Acta Neurochirurgica, we find evidence that, at least for hearing bimodal bilinguals, signed and spoken language modalities map onto different areas of the brain.

The following post accompanies our paper and intends to provide an introduction to signed languages and the d/Deaf community. It will present some general background on signed languages, address misconceptions, discuss who uses signed languages, and then conclude with some further reading on signed languages and sign language linguistics by d/Deaf and hearing scholars as well as resources for learning BSL.

Following Kusters (2012), a researcher’s hearing status is “not irrelevant” to their study (or discussion) of d/Deaf communities (p.28). Thus, before beginning, it’s necessary I state my positionality as a hearing disabled researcher studying the neurobiology of signed languages. As a hearing person I am not the authority on the d/Deaf experience, and this blog post does not attempt to summarise it. Rather, it acts as a (non-exhaustive) sign language SparkNotes, if you will, to introduce all interested readers to the basics of signed languages and the d/Deaf community. Readers should look to the conclusion of this post if they are interested in learning more about the d/Deaf community and sign language linguistics.

A brief history of signed languages

Signed languages have only been recognised as languages in the past 60 years. Of course, they existed long before then, but biases towards spoken language (and misconceptions about signed ones) meant that signed languages were not equally considered as natural, human languages. This began to change in 1960, when William Stokoe, a hearing researcher at Gallaudet University, published his dissertation proving that American Sign Language (ASL) was indeed a language with grammatical structure and form distinct from that of spoken English.

The bias towards spoken languages and the tendency to equate human language to speech is deeply ingrained in linguistics. Hockett’s design features, one of the most influential and well-known concepts in the field, have significantly contributed to this view. Hockett’s works (1958; 1959; 1960) were the first to characterise human language and separate it from animal communication, but have a “clear, and explicitly stated, bias” towards spoken language (Wacewicz and Żywiczyński, 2015, p.37). Figure 1 outlines Hockett’s original design features, almost all of which are illustrated as involving oral language or auditory perception.

Fig. 1: Hockett’s original 13 design features. Reproduced from Hockett (1960)

Though we have come a long way since both Stokoe’s and Hockett’s works in 1960, access barriers remain, and misconceptions about signed languages are still prevalent. Though Stokoe’s work legitimised ASL (and other signed languages) as a language, recognition stopped there; ASL has no official or federal recognition, though 45 US states formally recognise ASL in their state law. BSL was only legally recognised as a language in 2003, and made an official language in Scotland in 2015 and in England and Wales just two years ago, in 2022. Clearly, the recognition of signed languages as languages and the rights of signers are contemporary issues. Learning about signed languages and the d/Deaf community is a great way to counteract negative biases and ideologies, dispel myths about signed languages, and to become more aware of how all people use language. This blog post hopes to help you get started.

What are signed languages?

Signed languages are visual-manual languages which use the hands, body, and face to communicate. They are fully-fledged, richly descriptive languages used by over 150,000 d/Deaf and hearing people in the UK (British Deaf Association, 2022), 7 million d/Deaf and hearing people in America (Mitchell & Young, 2022) and approximately 70 million worldwide (World Federation of the Deaf, 2021). There are approximately 300 different signed languages used today, and BSL is the primary signed language used in the UK.

Signed languages are every bit as complex as spoken ones. They have dialects and accents as spoken languages do (Stamp et al., 2015; Palfreyman et al., 2016; see also The Black ASL Project), as well as regional variation. For example, the BSL sign for “green” is signed differently in Belfast than it is in Birmingham (Figure 2).

Fig. 2: Signs for GREEN in Belfast BSL (left) and Birmingham BSL (right). Reproduced from BSL SignBank (Fenlon et al., 2014).

Signed languages also have internal phonological variation. Here, phonology is defined not as speech sounds, but as handshape, location, and movement (Sandler, 2012). In ASL, “surgery” can be signed with two different handshapes, one using the “Y” letter handshape and one using the “A” letter handshape, which can be thought of as similar phonological variation to the UK-US colour/color variation (Lapiak, 2015; Figure 3).

Fig. 3: Phonological variation in the ASL sign for SURGERY. Images reproduced from Lapiak (2015)

However, signed languages should not only be understood through comparison with spoken language. Though it can be helpful to get to know a new modality through a more familiar one, or contrast linguistic features cross-modally, this can also limit an understanding of signed languages in their own right. The study and understanding of signed language needs not be legitimised by the context of spoken language; relying on this contextualisation inherently positions spoken language as the norm from which all other types of languaging diverge, and thus may overlook important features of signed language not present in spoken language. What insights might arise about signed and spoken languages if signed languages were the basis of comparison instead?

What are signed languages not?

It is important to understand that signed languages are not simply manual equivalents of the spoken languages used in the same locales. For example, BSL and English are two different languages, making people who know BSL and English bilingual. It is also important to understand that unlike British English and American English, BSL and ASL are also different languages and thus not mutually intelligible; someone using BSL cannot automatically understand someone using ASL.

Signed languages are also not the same as gesture. We all gesture in our daily lives for various reasons, whether it be snapping our fingers to try to recall a memory or pointing to indicate a location. Though these gestures are meaningful, unlike signed languages they are not linguistically structured or standardised, and can vary greatly depending on the cultural context. For example, in the United States, pointing is done with the index finger, but in Japan, you’d point with your entire hand, and using your index finger would be considered rude (Tidwell, 2017). Signed languages, on the other hand, are meaningful and linguistically structured. Pointing signs can function grammatically as pronouns, for example (Sandler & Lillo-Martin 2006), though of course linguistic structure differs depending on the sign language itself.

Who signs?

Millions of people sign. Some are members of the d/Deaf community. I have been using this term – d/Deaf – throughout this post to refer to the community. But what does it mean? Little-d deaf refers to a person who is deaf but may not identify as culturally deaf or a part of the community, whereas big-D Deaf people do. Additionally, big-D Deaf people are born deaf or became deaf prelingually, whereas little-d deaf people became deaf later in life (Project Easier, 2023; SignHealth, 2020). It is important to note, however, that though these terms can help to understand some aspects of d/Deaf identity, the d/Deaf community is large and varied, and the categories of little-d and big-D are too narrow to fully capture its diversity. Not all d/Deaf people fit into these roles, or they may identify differently. It is also worth mentioning that not all d/Deaf people sign. Some prefer to use a spoken language, an augmentative and alternative communication (AAC) device, or tactile sign, among others.

Additionally, not all people who sign are d/Deaf. A large portion of the signing community are Children of Deaf Adult(s), or CODAs. A CODA typically refers to a hearing child born to d/Deaf parents, who often acquires their parents’ signed language as their first language. The CODA experience is unique from both the hearing and deaf experience, described by CODA Luana Sales as being “a backpack filled with two cultures, two languages and two experiences in one single being” (Gala, 2022). The identity of the CODA community was explored in a 2022 project by Julia Pichler, a CODA, and educational policy lecturer Dr Hadas Eidelman. Pilcher began the project after noting the lack of depth of prior research on CODA experiences. Prior research focused primarily on non-normative developmental trajectories or language delay and ‘dysfunction,’ using medical models that associate “typical” or “normal” development with abled development, and perceiving disabled-adjacent identity or development as atypical. To rectify this, Pichler & Eidelman’s project set out to share CODA stories and focus instead on “identity, sense of belonging, and the navigation between the two cultures of the hearing world and the deaf world” (Boudreau & Ruggero, 2022). Pichler & Eidelman sent out a survey to CODAs around the world, the results of which have highlighted individual experiences and the diversity and richness of the community. You can read more about their work here.

CODAs are also unique from deaf signers and hearing nonsigners on a neurobiological level. Interestingly, Emmorey & McCullough (2009) found that CODA bimodal bilinguals’ neural activation patterns for language processing were unlike either deaf signers or hearing nonsigners, but instead comprised a unique middle ground. Kovelman et al. (2014) also argue that “the bimodal bilingual experience changes the brain bases of language,” including in areas important for sign language processing, such as left temporoparietal regions (Emmorey et al., 2007). Our recent study in Acta Neurochirurgica gives further support to these earlier discoveries.

Concluding thoughts

Clearly, there is great diversity and variation in the language use of the d/Deaf and signing community. This diversity is important to represent in research, not only to be inclusive of all kinds of languaging, but to make our work more robust. Are we saying anything about language at all if we are only looking at one form of it?

I hope that this post has helped to inform about signed languages and the people who use them. Even if you do not study signed languages specifically, learning about them may help you consider questions in your own research from another perspective. To challenge your own perceptions of non-spoken languages and consider how the bias in linguistics towards spoken language contributes to the reproduction of inequities against signers and other non-normative language users, I recommend Henner & Robinson’s (2023) Crip Linguistics manifesto:

Henner, J., & Robinson, O. (2023). Unsettling Languages, Unruly Bodyminds: A Crip Linguistics Manifesto. Journal of Critical Study of Communication & Disability, 7-37 Pages. https://doi.org/10.48516/JCSCD_2023VOL1ISS1.4

Additionally, a non-exhaustive selection of works on BSL spanning multiple subfields of linguistics is listed alphabetically below (d/Deaf authors bolded).

Emmorey, K. (2021). New Perspectives on the Neurobiology of Sign Languages. Frontiers in Communication, 6, 748430. https://doi.org/10.3389/fcomm.2021.748430


Fenlon, J., Schembri, A., Rentelis, R., & Cormier, K. (2013). Variation in handshape and orientation in British Sign Language: The case of the ‘1’ hand configuration. Language & Communication, 33(1), 69–91. https://doi.org/10.1016/j.langcom.2012.09.001


Hodge, G., Ferrara, L. N., & Anible, B. D. (2019). The semiotic diversity of doing reference in a deaf signed language. Journal of Pragmatics, 143, 33–53. https://doi.org/10.1016/j.pragma.2019.01.025

Hodge, G., & Goswell, D. (2023). Deaf signing diversity and signed language translations. Applied Linguistics Review, 14(5), 1045–1083. https://doi.org/10.1515/applirev-2020-0034

Kusters, A., & Lucas, C. (2022). Emergence and evolutions: Introducing sign language sociolinguistics. Journal of Sociolinguistics, 26(1), 84–98. https://doi.org/10.1111/josl.12522

Kusters, A. (2017). Special Issue: Deaf and hearing signers’ multimodal and translingual practices. Applied Linguistics Review. https://doi.org/10.1515/applirev-2017-0086

MacSweeney, M., Woll, B., Campbell, R., McGuire, P. K., David, A. S., Williams, S. C. R., Suckling, J., Calvert, G. A., & Brammer, M. J. (2002). Neural systems underlying British Sign Language and audio-visual English processing in native users. Brain: A Journal of Neurology, 125(Pt 7), 1583–1593. https://doi.org/10.1093/brain/awf153

Stamp, R., Schembri, A., Fenlon, J., & Rentelis, R. (2015). Sociolinguistic Variation and Change in British Sign Language Number Signs: Evidence of Leveling? Sign Language Studies, 15, 151–181. https://doi.org/10.1353/sls.2015.0001

Sutton-Spence, R., & Woll, B. (1998). Linguistics of British sign language: An introduction. Cambridge university press.

Trettenbrein, P. C., Papitto, G., Friederici, A. D., & Zaccarella, E. (2021). Functional neuroanatomy of language without speech: An ALE meta-analysis of sign language. Human Brain Mapping, 42(3), 699–712. https://doi.org/10.1002/hbm.25254

Read some deaf people’s posts

Further, there are many resources available to learn BSL, including books, online courses, YouTube videos, and apps. Below is a list of resources across different mediums, including both free and paid options.

Courses, dictionaries, and apps
https://www.british-sign.co.uk/ (from £3)
https://bslsignbank.ucl.ac.uk/ (free)
Doncaster Deaf Trust (free)
Spread the Sign (£3)

YouTube channels & other videos
Commanding Hands
○ A YouTube channel which aims to provide openly accessible BSL learning resources. Led by Daniel Ryan, a CODA, and Melanie Morris, a Deaf BSL user.
RNID
○ The YouTube channel of the UK’s national charity supporting the 12 million people in the UK who are deaf, have hearing loss or tinnitus. Their channel provides basic phrases in BSL to help hearing people communicate with deaf people and dispel negative societal ideologies towards the d/Deaf community.
BSL Learning with Mel
○ Melanie, a Deaf BSL user, provides hundreds of videos of her signing in BSL, including a series called “Learn 3 BSL Signs Everyday” where she teaches you BSL signs ranging from the very basic to the more advanced.
● JazzyWhipps (YouTube/TikTok)
○ Like Mel, Jazzy is a Deaf BSL user who makes videos in BSL, which is helpful to follow along with and see BSL in everyday conversation. She additionally makes videos about d/Deaf culture and life.
BSL Zone
○ BSL Zone is the British Sign Language Broadcasting Trust’s (BSLBT) television channel running only programmes made in BSL, by BSL users.

Want to chat about this blog post, or have questions? Email Lydia.Wiernik@uwe.ac.uk.  

References

Boudreau, E., & Ruggero, C. (2022). The Complexity of the CODA Experience | Harvard Graduate School of Education. https://www.gse.harvard.edu/ideas/news/22/08/complexity-coda-experience
British Deaf Association. (2022). Help & Resources for Sign Language. British Deaf Association. https://bda.org.uk/help-resources/
Deaf or Deaf? (2023). Project Easier. https://www.project-easier.eu/news/2021/08/11/deaf-or-deaf/
Gala, A. S. (2022, April 20). Do you know what it is like to be a CODA? https://www.handtalk.me/en/blog/coda/
Kovelman, I., Shalinsky, M. H., Berens, M. S., & Petitto, L.-A. (2014). Words in the bilingual brain: An fNIRS brain imaging investigation of lexical processing in sign-speech bimodal bilinguals. Frontiers in Human Neuroscience, 8. https://doi.org/10.3389/fnhum.2014.00606
Kusters, A. (2012). Being a deaf white anthropologist in Adamorobe: Some ethical and methodological issues. In U. Zeshan & C. De Vos (Eds.), Sign Languages in Village Communities (pp. 27–52). DE GRUYTER. https://doi.org/10.1515/9781614511496.27
Lapiak, J. (2015). Language variation in sign language. https://www.handspeak.com/learn/111/
Mitchell, R. E., & Young, T. A. (2022). How Many People Use Sign Language? A National Health Survey-Based Estimate. The Journal of Deaf Studies and Deaf Education, 28(1), 1–6. https://doi.org/10.1093/deafed/enac031
Palfreyman, N., Aikhenvald, A., & Dixon, R. (2016). Typology of sign languages. https://www.semanticscholar.org/paper/Typology-of-sign-languages-Palfreyman-Aikhenvald/c4a2dab830d367aa305940cbbbe4dd409ccbd8d1
Stamp, R., Schembri, A., Fenlon, J., & Rentelis, R. (2015). Sociolinguistic Variation and Change in British Sign Language Number Signs: Evidence of Leveling? Sign Language Studies, 15(2), 151–181. https://doi.org/10.1353/sls.2015.0001
Tidwell, C. (2017). Non-Verbal Communication Modes. https://www.andrews.edu/~tidwell/NonVerbal.html
What is the difference between deaf and Deaf? (2020). The Deaf Health Charity SignHealth. https://signhealth.org.uk/resources/learn-about-deafness/deaf-ordeaf/#:~:text=We%20use%20Deaf%20with%20a,language%20as%20their%20first%20language.
World Federation of the Deaf. (2021). WFD. https://wfdeaf.org/our-work/

Bridging disciplines: BLB Lab PhD students shine at UWE’s School of Arts research showcase

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On the 24th of January 2024, the Brain, Language, and Behaviour (BLB) Lab at UWE Bristol took a significant step in sharing its interdisciplinary research by participating in the School of Arts Research Showcase. This event, held at Bristol’s harbourside MShed, hosted a convergence of diverse talents and expertise, providing a platform for the BLB Lab to present their ground-breaking work alongside other researchers and postgraduate students from UWE’s School of Arts.

In a setting that celebrated the fusion of art, science, and innovation, the BLB Lab PhD students, Hajira Mumtaz, Tom Williamson, and Sonia Mariotti, captivated the audience with their insights into the intersection of neurosurgery, linguistics, psychology, and clinical care. Their presentations shed light on the collaborative efforts aimed at understanding the complexities of brain function and behaviour, while also emphasising the practical applications of the lab’s research in clinical settings.

The BLB Lab showcase commenced with the trailer of ‘My Beautiful Broken Brain’, a documentary film about the life of 34-year-old Lotje Sodderland after she suffered a haemorrhagic stroke. As a result of her stroke, Lotje experienced aphasia, the complete loss of her ability to read, write, or speak coherently. The documentary shows the challenges of communicating with language impairments, followed by intensive rehabilitation on the journey to recovery, allowing the audience at MShed to empathise with survivors of acquired brain injury.

The team at the Showcase

Additionally, the showcase provided a unique opportunity for attendees to delve into the cutting-edge research in neurosurgical language testing. The PhD students were able to show how language testing is conducted with awake patients in the operating theatre, and attendees could even try firsthand some of the language tasks that are administered during the surgery. The opportunity to experience the BLB Lab research activity offered a glimpse into the intricate fields of psycholinguistics and neurolinguistics, pushing research efforts at the intersection of academia and clinical practice.

The Research Showcase also provided a platform for collaboration and exchange, fostering dialogue between researchers from diverse disciplines. The BLB Lab team engaged with colleagues from the School of Arts, exploring potential synergies and interdisciplinary initiatives that could further enrich their research endeavours. For instance, multidisciplinarity is a key component of the BLB Lab, whose members’ background spans from neurosurgery, speech and language therapy, to psychology, linguistics, and art.

The BLB Lab members are looking forward to the next event where they will present the their work in progress – stay tuned!

Our study day exploring Virtual Reality for the OR

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On 16th November 2023, our Brain, Language, and Behaviour (BLB) lab team held a cross-disciplinary study day at our collaborating NHS site at Southmead Hospital. A meeting of minds covering neurosurgery, speech and language therapy (SLT), palliative care, as well as linguistics and psychology, our group spent the morning digging deeper into the background to our wide-ranging projects, their common aims, and progress.

The team at Southmead Hospital

The day started with Neil Barua, Lead Consultant Neurosurgeon at Southmead, explaining how brain tumour patients’ best interests are prioritised throughout the entire process of awake brain surgery. Madeline Farrow, an SLT at Southmead, then presented her current practices for testing language functions before, during, and after surgeries with patients; identifying critical areas where the BLB team can make a real difference to patient outcomes and their quality of life. This led to individual presentations on research progress by the BLB lab’s three PhD students: Hajira Mumtaz, Sonia Mariotti, and Tom Williamson. We ended with Anna Piasecki’s vision for the BLB lab as its lead, who also holds posts as Associate Professor of Psycholinguistics and Director of Research and Enterprise at UWE, charting a course for future world-leading innovation at the intersection of interdisciplinary academic expertise and clinical practice.

A woman testing a virtual reality headset
One of the team members testing the headsets

To round off the day, several team members donned the virtual reality headsets that clinical teams use to visualise the exact size and location of a patient’s tumour prior to the surgery and to prepare their surgical removal approach! This technology relies on diffusion tensor imaging, which maps brain connections and shows the neurosurgeons exactly where a brain tumour is. It was truly enlightening for BLB team members to see images up-close of brain tissue that our research aims to better understand and preserve.


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