Abstract
The relationship of recovery and treatments of aphasia was discussed from the standpoint of a speech therapist. The experience of speech therapy for a severe fluent aphasic patient in his stages of recovery after brain damage was reported. Also, the effectiveness and problems of the cognitive neuropsychological approach for lexical deficits in aphasia were discussed. The subject was suffering from severe word-sound deafness, and his speech discrimination remained poor after direct treatment. However, auditory word-to-picture matching, auditory lexical decision and word repetition improved. It suggested that treatments that strengthen the top-down control from semantics of words could improve auditory comprehension to some extent. In speech production, the activation of word-form was extremely difficult and was not improved by the treatments that facilitate the normal route for word retrieval. The patient's oral word reading in both Kanji and Kana improved. So we carried out treatments including compensatory reorganization of word retrieval and measured the therapy efficacy in single-subject design. It revealed that oral reading after written naming in Kana was effective as a substitutive strategy for oral picture naming. In the stages of recovery after brain damage, treatments, which maximally exploit and facilitate natural recovery of nerve systems, seem to be effective. Therefore, an inclusive approach that activates the whole verbal-processing system is needed as well as strategic treatments targeting certain functions. Understanding the natural processes of recovery at the neural and cognitive levels is necessary for effective speech therapy for aphasia.
