[in Japanese]

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    In order to study interrelations among language modalities, a language facilitation experiment which is based on the deblocking method was carried out with 51 aphasic patients. A sequence of (1) language comprehension, (2) speech, and (3) writing was in the asending order of degree difficulty through facilitation patterns based on the deblocking method and in the improvement observed over the three months after the aphasia test.

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    Over the past 20 years, there have been significant advances in the cognitive analysis of agrammatism in aphasic patients. Investigators have understood agrammatism in terms of impairments to particular modules within a models of information-processing. Studies on asyntactic comprehension yielded some evidences about impaired modules in sentence comprehension process such as parsing sentences for their syntactic functions and assigning thematic roles to the parsed constituents. It was also suggested that aphasics use syntactic, heuristic and lexico-pragmatic routes to meaning, when they comprehend sentences. The results in those studies have contributed in developing treatment programmes for syntactic deficits in aphasics.
    This paper consisted of two sections : Firstly, studies on syntactic deficits in aphasics mentioned above were reviewed, and a way to develop treatment programme for syntactic deficits in aphasics was discussed based on the results of these studies. Secondly, results of the syntactic treatment for agrammatism in a Broca's patient were reported. This patient represented syntactic deficits in both sentence comprehension and production. His ability to parse syntactic functions was spared, but ability to map thematic roles to the parsed constituents was impaired. As the mapping processes were intensively stimulated, his performance in sentence comprehension and production improved systematically.

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    This paper introduced a manual of aphasia therapy which has been developed by the author. It includes some new devices which have not been seen in previously published manuals. In Japan most handbooks of aphasia therapy are based on the stimulation and/or the programmed learning methods developed in America. These methods have penetrated widely into Japan. However, there are very few manuals which give concrete advice to therapists on which materials to choose in the treatment of specified types of aphasia. The purpose of the present manual is to offer guidelines to aphasia therapists on 1) how to monitor symptoms, 2) how to classify them, 3) how to understand the underlying mechanisms of classified symptoms, 4) how to plan an effective menu for treatment, and 5) which modality is best stimulated. In addition, all processes have been computerized, so that therapists who use this manual would be able to diagnose their cases and choose effective materials for treatment automatically.

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    We reported four kinds of facilitaion methods, which are based on effects of following trainings, for speech improvement in aphasic patients: (1) The comparison of performance in oral naming after the training using Kanji writing and the training using repetition. (2) The comparison the oral naming method using Kanji or Kana reading aloud with using repetition. (3) The interaction between oral naming and Kanji reading aloud. (4) The interaction between repetition and Kana reading aloud. As the results, the language ability which was relatively spared improved more than more severely disordered ability. For example, auditory stimuli were not so effective as visual stimuli for patients with disorders of the auditory information processing, We found visual stimuli to be a useful for self-study materials for aphasia, even in the cases when auditory and visual stimulus showed almost the same effectiveness. These data suggest the importance of taking into account the cognitive neuropsychological mechanisms which underlying the language disorders in the selecting materials and training methods.

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This paper presents some treatment principles for the patients with apraxia of speech (AOS). It also provides a review of the treatment methods and the effectiveness of treatment, looking at findings in treatment research of AOS.

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    From the analysis of the symptom of 19 patients with Wernicke's aphasia, they were classified into following subtypes. 1) Disturbed repetition type-1 : Disturbance in repetition was prominent. Disturbed auditory comprehension became mild. Anomia disappeared rapidly. The lesion involved the left transverse temporal gyrus and auditory radiations. Disturbance of phonetic discrimination seemed to be responsible of this type. 2) Disturbed repetition type- 2 : Disturbance in repetition, auditory comprehension, and naming was prominent. Phonemic paraphasia and neologism was observed. The lesion involved the posterior half of the left superior temporal gyrus. Disturbance in phonemic recognition seemed to cause this type. 3) Disturbed semantic comprehension type : Auditory comprehension was disturbed despite preserved ability to repeat the word. Semantic paraphasia and neologism was observed. The lesion involved the anterior half of the left superior temporal gyrus and extensive region of the middle temporal gyrus. 4) Mixed disturbance type : Severe Wernicke's aphasia which had characteristic of both the “Disturbed repetition type-2” and the “Semantic comprehension type” . The lesion included both the left superior temporal gyrus and the middle temporal gyrus. 5) Mild disturbance type : Mild Wernicke's aphasia which could be classified neither into “Disturbed repetition type” nor “Disturbed semantic comprehension type” . 6) Transcortical sensory aphasia : Disturbance of auditory comprehension and naming was severe, but repetition was almost normal. Echolalia was often observed.
    Speech therapy of sensory aphasia should be done by the manner corresponding to these subtypes. Facilitation of discrimination, recognition, and retention of speech sound is necessary for 1) and 2). Facilitation of lexical or semantic recognition is essential for 3) and 6). Phonemic stimulation, then lexical or semantic facilitation is necessary for 4).

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    The Standard Performance Test of Apraxia is utilizable not only for the typical-classical apraxias but also for other executive or performance disorders such as “left hand apraxia”, “diagonistic dyspraxia”, “utilization behaviour”, “compulsive use of tools” or “kinetic melody impairments”.
    Many apraxias, especially buccofacial apraxia, have more or less some relationships with aphasias. However, according to my opinion, aphasia and apraxia may be the manifestations fundamentally at least of two different neural networks, even if these networks are partly overlapping.

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    The definition, the classification and the examination of ideomotor apraxia and ideational apraxia was reviewed. The definition and the classification was followed by Yamadori (1984) in this article. According to his definition and classification, both the transitive movement and the intransitive movement contain in ideomotor apraxia test and the subclass of ideomotor apraxia might be indicated. In terms of ideational apraxia, the differential diagnosis among semantic memory disturbances and multimodal agnosia must be needed and the precise clinical observation can differentiate these three categories.

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    We followed the progress of a patient of Broca's aphasia due to infarction of the right pre- and post-central gyrus. The patient, a 62-year-old, right-handed male, suddenly developed leftsided weakness and mutism. His auditory comprehension was mostly intact but he showed writing difficulty, predominantly in Kana letters. Despite his poor verbal output, he could sing well. Gradually he began to speak, but two years later his speech was hesitant, effortful and dysprosodic with literal paraphasias. Brain MRI confirmed an infarction of the right pre- and post-central gyrus extending partly to the insula.
    Recently, the left (language-dominant) central gyrus has been proposed as a critical site for persistent non-fluent aphasia. In crossed aphasics there are two groups, i. e. an anomalous type and a mirror image type of aphasia resulting from a left (language-dominant) hemisphere lesion. The lesion of the right hemisphere in our patient corresponded to the site of the left hemisphere which causes a typical non-fluent Broca's aphasia. We therefore postulate that crossed Broca's aphasia in our patient represents the mirror image type.

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    This study investigated the recovery processes of memory disturbance and cognitive function in patients with moderate or mild closed head injury. Included in the study were 4 patients with diffuse axonal injury (DAI), 3 patients with diffuse brain injury, and 4 patients with cerebral concussion. Ages ranged from 15 to 56 years old. All subjects were studied for memory and cognitive function using the Hamamatsu Higher Brain Function Scale from one day to three months after recovery from post-traumatic amnesia.
    All cases showed normal findings in immediate verbal memory at initial evaluation. Intermediate verbal memory was highly disturbed in the DAI and DBI cases at 2 ˜ 3 weeks, but gradually recovered after 2 ˜ 3 months. Patients with small frontal lesion showed impairment in prefrontal function, in spite of improvement in intermediate verbal memory.
    The recovery time of intermediate memory was seen to relate to the duration of post-traumatic amnesia. Patients with frontal lobe lesion continued to have impairment in cognitive function even after memory recovery.

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    We evaluated 7 right-handed aphasic patients with single infarctions including Broca's area (pars opercularis and/or pars triangularis of the left inferior frontal gyrus) in order to define the relationship of speech and language symptoms to specific localizations of small lesions. Magnetic resonance imagings (MRIs) were scored by anatomical checklists. Performances on the Japanese version of the Western Aphasia Battery (WAB) were used to rate articulation, prosody, phrase length, initiation of speech, grammatical form, syntactic comprehension, and paraphasias.
    The results were as follows: (1) All patients had a lesion including the pars opercularis of the left inferior frontal gyrus, and all demonstrated short phrase lengths and simplified grammatical forms in their spontaneous speech; (2) Patients with a lesion in the posterior part of the left middle frontal gyrus exhibited delayed initiation of speech and decreased amount of utterance ; (3) Patients with a lesion in the lower part of the left precentral gyrus showed distortion of speech, while patients with a lesion extending to the posterior part of the precentral gyrus showed severe and persisting speech disorder; (4) Phonemic paraphasias were found in patients with a deep white-matter lesion or precentral lesion, while semantic paraphasias were not correlated to any particular lesion; (5) Aphasic patients with a lesion restricted in or near Broca's area were classified as either “fluent” or “nonfluent” on the WAB. These results suggested that: (1) The pars opercularis of the left inferior frontal gyrus is related to syntactic aspects of language ; (2) The posterior part of the middle frontal gyrus is related to speech and language initiation ; and (3) The lower part of the left precentral gyrus is related to articulation.

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    Reading ability was examined in a case with left posterior cerebral artery infarct. He showed pure alexia in Kana, alexia with agraphia in Kanji, and optic aphasia. He was able to match Kanji words to pictures fairly well although unable to read aloud both of Kana and Kanji words. Experimental investigation consisted of following 7 tests; (1) discrimination between wrong letters (pseudo-letters) and true letters (2) grouping of letters according to the three types of Japanese script (Kanji, Hiragana and Katakana) (3) lexical decision test of Kana sequences (4) odd word out test of kanji words (5) sorting written Kanji words into semantic categories. (6) grouping of Kanji words on the basis of semantic association (7) maching auditorily-presented words to one of five written Kanji words.
    He performed well in test (1) and (2), which suggested a well preserved knowledge of letter configuration. In test (3), even without setting any time limit, he could not at all decide whether written Kana sequences were real words or not. It was presumed that an ability was lost by which Kana Words (familiar letter strings) were recognized as whole units. He performed well in test (4), (5) and (6). Therefore, he could derive a lot of semantic information from written Kanji words. In test (7), he performed well in the across-category condition in which five alternatives were belonged to different semantic categories. In the within-category conditions in which five altenatives belonged to the same semantic category, his performance was strikingly deteriorated, compared to the former conditions. This result showed that his ability to discriminate semantically simillar Kanji words was impaired.
    The theoretical implication of these results was discussed in relation to the dissociation of reading comprehension from oral reading which was observed in reported cases with pure alexia and to the pathogenesis of optic aphasia.

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