Predicting bilingual aphasia treatment outcomes using digital twins: a double-blind randomized controlled trial.

Kiran, Swathi; Carpenter, Erin; Grasemann, Uli; Scimeca, Michael; Marte, Manuel J; Russell-Meill, Marissa; Peñaloza, Claudia; Tripodis, Yorghos et al. · NPJ Digit Med · 2026

rct · Level II

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Abstract

Bilingual aphasia rehabilitation faces the challenge of determining which language to target in therapy to maximize recovery across both languages. This double-blind randomized controlled trial (48 Spanish-English bilinguals with chronic aphasia; NCT02916524) evaluated whether the BiLex computational model could predict the optimal language for aphasia therapy. Participants received 40 h of semantic feature-based treatment in either the BiLex-recommended language or the opposite language. Both groups showed similar gains in treated-language naming, with no significant difference in proportion of maximal improvement (Difference (SE) = -0.03 (0.07); t = -0.46; p = 0.65). However, the model-opposite group showed significantly greater cross-language generalization (Difference (SE) = -0.16 (0.07); t = -2.38; p = 0.02), though with higher response variability. Further, when the participants were divided into subgroups according to performance, the model-assigned group had a significant advantage in all but the lowest performing subgroups. All these differences were consistent with BiLex model predictions.