Dramatic improvement of non-fluent speech by mora-by-mora finger counting method in four cases of aphasia was reported. Case1 (aphemia) : a 61-year-old right-handed male. Both spontaneous speech and repetition were severely non-fluent with much effort. Phrase length was extremely short (often only a single mora). Articulation was poor with distortion, substitution, and repetition of verbal sound. Case2 (severe Broca's aphasia) : a 67-year-old right-handed male with right hemiparesis. His verbal output was limited to “Uurr, Mamama” . Case 3 (severe Broca's aphasia) : a 51-year-old right-handed male. His verbal output was limited to “Urrnto, ehrrto” . Case 4 (severe Broca's aphasia) : a 39-year-old right-handed male with right hemiparesis. Verbal output was strictly null. Only a slight change of facial expression was noted. Results of speech therapy by mora-by-mora finger counting method are summarized as below. 1) Articulating with finger counting resulted in amelioration of effortful speech, the increase of the number of moras connected with each other, and the decrease of phonological paraphasia. 2) Even during articulation with finger counting, the speed of articulation sometimes fluctuated in words or sentences. It is concluded that somatosensory facilitation by finger counting method can ameliorate the poor articulation in non-fluent aphasics.

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    Communication behavior of the case that presents total aphasia caused by cerebral hemorrhage was described from the following viewpoint. 1) Contexts of communication : The context based on environment around the patient such as some persons that interact with the patient, the life space of the patient and the life styles (called “external context” ). The context primarily based on physical and/or emotional conditions are called “internal context” . It is hypothesized that an internal context may be formed by the interactions with an external context. 2) Message : Messages are classified into the next three. First, it is such message that maintains and continues the relation between the partisipants (interactive). Second, messages convey the intention or desire etc. of a sender (communicative). And, situation is changed by this sort of messages. Third, there are such messages that convey the feeling, experience or knowledge of a sender (informative). 3) Means of communication : The most primitive means are the body expressions such as posture or tension, and the emotional expressions such as crying, laughing or phonation. It is the sensory-motor means to contact a person and to operate a thing. Facial expressions and variable utterances may be also included. Indications —presenting or pointing— are other means of communication. A most useful and most effective means are language.
    Our patient, a 48-years old woman, was able to maintain interactive only with a particular person. She was always based on an internal context —physical and emotional condition. It was difficult for her to take an external context in to her internal context. So, she often fell into a panic in the communication with unfamiliar persons. She repeated vomiting when she was brought to unknown places. This suggests that the means of her communication are on physical-emotional level. This is a ditailed report of the course of her communication behavior.

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    Fifty-five chronic aphasic patients were investigated as to their “adaptation” . The subjects included 23 Wernicke's aphasics, 17 Broca's aphasics, and 15 anomics. The study focussed on how aphasic patients cope, that is, behavior directed at the resolution of a problematic situation.
    The results were as follows :
    1) There was no distinct relationship between the SLTA score and the CADL score and “favorable” adaptation.
    2) There were at least four factors which were characteristic of “favorable” adaptation : subjective understanding of one's situation, premorbid personality, support given by families, and change in character due to brain damage.
    3) In the group of patients who understood their situation subjectively, the most important factor in these patients's “favorable” adaptation was their cyclothymic personality.
    4) On the other hand, in the group of patients whose subjective understanding of their own conditions was not sufficient, the most important factors behind a “favorable” adaptation were the full support given by their families and character changes due to brain damage. Though change in character is generally considered a negative factor, it can have a positive effect at times.
    It was suggested that when we think about adaptation, speech therapists must take into consideration not only language function, but also factors such as subjective understanding of one's situation, family support, character change due to brain damage and premorbid personality.

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    In the recent practices of speech therapy for the aphasic patients, it has been often claimed that the goal of language intervention should be to help the patients accepting their own disabilities, challenging their handicaps, and attaining more participation in their daily lives. This claim reasonably means that speech therapists should actively play an important role to reduce a variety of barriers the patients might meet in each phase of their rehabilitative efforts.
    This paper first presents a view point that any individual keeps his/her daily living in relation with others, and therefore an acquired illness might not only bring negative effects but also pose a substantially positive meaning to the life of patient. Second, from a perspective of speech therapist responsible for supporting aphasic patients to recover the worth of living, possible strategies for involving volunteers into the ordinary intervention practices are illustlated from our experiences with both outpatient and inpatient aphasic individuals. Also described is an example of voluntary activity by aphasic patients themselves to play music with tone-chimes in the community. Finnaly, implications of volunteer activities beyond the limitation of medical treatment are considered for the future practices in language intervention with aphasic patients.

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[in Japanese]

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    The long-term courses of 61 aphasic patients, whose postcritical periods ranged from 16 to 243 months, were studied for the three modalities evaluated by the Standard Language Test for Aphasia (SLTA) : oral description, repetition of sentences, and oral reading of sentences.
    Performance on SLTA revealed : 1) the attained performance level observed for repetition of sentences was lower than those observed for oral description and oral reading ; 2) profiles for performance in the three modalities at the optimum level achieved could be categorized into six patterns ; 3) the profile pattern for the optimum level achieved was not necessarily the same as the pattern after onset.
    It was further indicated that : 1) repetition of sentences was the most difficult task for aphasic patients ; 2) the three modalities of speech have different patterns of recovery depending on age of onset and the lesions localized.
    These findings have important implications for prognostic expectations of aphasia and for selection of the best modality for stimulation of speech.

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    We report a case of pure Gerstmann syndrome due to a lesion in the left frontal lobe. This 31-year-old, right-handed female showed finger agnosia, right-left disorientation, agraphia and acalculia after the removal of a brain tumor of the left frontal lobe. Neurologically she was otherwise normal, and her level of consciousness was alert. Her speech was fluent with normal prosody and articulation. Her comprehension was good and she experienced no difficulty in word finding. Repetition and reading abilities were normal. Constructional apraxia was not evident. An MRI revealed a focal lesion confined to the left middle frontal gyrus.
    A verbal test of finger naming and pointing revealed finger agnosia, but a non-verbal test showed no disability of recognition of her own fingers. Right-left discrimination was more difficult on the examiner's body than on her own. She showed disability in writing Kanji, while she was good at copying Kanji and did not show apraxic agraphia. Her acalculia was characterized by anarithmetia.
    The special feature of this case is Gerstmann syndrome which was caused by a focal lesion of the left frontal lobe but not accompanied by aphasic disorders or general mental dysfunction.

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    We reported a case of a 93 year-old right-handed woman who presented auditory agnosia with mild sensory aphasia following a left temporal infarction. She could not recognize spoken words, environmental sounds and music that had been familiar with her. Though she was able to speak fluently with some literal paraphasia, she could not sing her favorite Japanese folksongs. Her hearing ability was within normal on pure tone audiometry and ABR. MRI disclosed that the lesion was restricted mainly to the first temporal convolusion in the left hemisphere with bilateral periventricular abnormal findings. It is proposed that her auditory agnosia was consequent to the interruption of Wernicke's area and the auditory radiations from both of the right and left hemisphere. It is assumed that this interruption was due to the left temporal infarction. But in addition to this, the bilateral periventricular abnormal findings may play some significant roles on the mechanism of her auditory agnosia.

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    We report two cases of aphasia after infarctions restricted in the inferoposterior region of the left frontal lobe. The two patients showed clear differences in speech fluency and repetition capability despite nearly the same extent of lesion. Both became mute soon after onset. However, whereas case 1 showed an atypical nonfluent (mild anarthria, mild dysprosody, and short phrase length) aphasia with impaired oral repetition after six days, case 2 exhibited a mild transcortical sensory aphasia with relatively intact ability to repeat sentences within 20 days after onset. We speculate that the difference in deficits between the two cases was due to variation in transient dysfunction around the infarcted region, such as acute edema during the early phase. We suppose a subtle difference in involvement of the precentral gyrus was responsible for the observed language symptoms (articulation, repetition). In case 2, despite relatively good repetition performance, digit span was impaired, suggesting that syntactic processing is independent of phonological processing in a repetition task. Furthermore, the atypical nonfluent aphasia in case 1 demonstrated improvement toward a fluent aphasia approximately six months after onset, indicating that recovery is possible within a relatively short period of time, when lesion is circumscribed, even if the inferoposterior region in the left frontal lobe is damaged.

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    A 69-year-old right-handed man with a 4-year history of slowly progressive clumsiness of the right hand is described. There were no neurological findings of parkinsonism, motor weakness, abnormal involuntary movement, or sensory disturbance, except for hyperreflexia of the right extremities and the right Babinski sign. He was neither demented (WAIS-R IQ115) nor aphasic. There was no visuospatial impairment. His clumsiness was limited to the distal portion of his right arm, whereas his conventional gestures with the proximal portion of his arm were relatively good. His clumsiness was seen equally in manipulating objects and in pantomiming, and no dissociation was noted between automatic and intentional movements. These features are compatible with limbkinetic apraxia. MR imaging revealed mild atrophy of the left precentral area and bilateral frontal lobes without ischemic change. ^99mTc-ECD SPECT showed decreased blood flow in the left temporal lobe, the left precentral area, and bilateral superior and middle frontal gyri. The right-sided limbkinetic apraxia was attributed to the dysfunction of the left precentral area, and a clinical diagnosis of slowly progressive apraxia was concluded. Compared with hitherto reported cases, the present case is the purest one presenting a clinical picture of slowly progressive apraxia. Although a few autopsy cases in the literature have been diagnosed as Pick's disease, another possible diagnosis of the present patient could be corticobasal degeneration.

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