Cognitive function has various effects on the preparatory stage of the swallow. When cognitive disorders are caused due to brain damages, the preparatory stage is also ruined. The damaged preparatory stage disturbs three stages of the swallow-oral, pharyngeal and esophageal stages. Therefore cognitive disorders may cause or aggravate dysphagia. They may also reject to apply some techniques of swallowing therapy.
    The dysphagic patients with cognitive disorders must be treated with appropriate techniques in “tailor made” surroundings. They have to be closely supervised and sometimes assisted. To manage the dysphagic patients with cognitive disorders, we should evaluate and treat precisely both their dysphagia and cognitive disorders.
    We, speech-language-hearing therapists have been involved cognitive rehabilitation for long years. We are also intensively educated for anatomy, physiology and pathology of oropharynx and larynx.
    It is inevitable that many speech-language-hearing therapists come to grips with dysphagia rehabilitation. Swallowing therapy is a rather new part of speech-language pathology. It is neither derivative nor additional duty of us. We need to integrate and develop our knowledge and therapy techniques for cognitive dysfunction and motor speech disorders.

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    Since the end of the 19th century, aphasia has been classified into several types from the perspective of syndromes, i. E., sets of symptoms. Wernicke's aphasia is one of those syndromes. From the standpoint of planning the best intervention strategies for individual aphasic subjects, classification of aphasia by syndrome is insufficient, however. In this paper, it is emphasized that definition of aphasia subtypes based on the mechanisms underlying symptoms is most important for arriving the optimum choice of training method. The six-year course of rehabilitation and recovery of a typical subject who satisfied the definition of Wernicke's aphasia from the standpoint of underlying mechanisms was presented. It was revealed that Wernicke's aphasia shows long-term recovery with appropriate intervention during the recovery stages in which the underlying mechanisms continue to change. Finally, the psychiatric aspects of Wernicke's aphasia which must not be overlooked in the course of rehabilitation were discussed.

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    Developmental phonological dyslexia is assumed to be caused by the delayed development of phonological awareness in the English speaking countries. Its incidence is reported to be as high as about 10% of the population.
    Four cases of developmental phonological dyslexia, observed from their early primary school ages to middle school ages or adolescence were presented. The characteristics of their hiragana, kanji and alphabet learning were discussed and error analyses of reading and writing of these three characters were made. It was suggested that the underlying problems causing dyslexia in these 4 cases were, firstly, the dysfunction of coding between orthography and phonology and, secondly, the delayd development of phonological awareness. It seemed that, for the hiragana and kanji learning coding dysfunction was the most influential, while for the alphabet learning, the delayed development of phonological awareness was.
    It was also discussed that the most effective intervention strategy in learning hiragana and kanji for these 4 cases was to let them acquire the learning strategy of transferring orthography to and phonology or vice versa via meaning.

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    This paper covers the current technical limitations of communication aids, reasons why people hesitate and/or reject using them, the limitations in using communication aids for people with cognitive disabilities, and the effects of using such systems. Although there are some technical limitations, techniques have been developed for coping with the limitations so that such systems could be helpful for people with cognitive disabilities.
    The biggest problem tends to be the lack of knowledge among rehabilitation and education staff of how to communication aids could be used by people with cognitive disabilities.
    In addition, this paper discusses future trends in the development of communication aids. Information Technology (IT) makes possible not only face-to-face and voice-based communication, but also communicating while not face to face, and communication via text. Internet technology may make it possible to incorporate words and messages automatically into a communication. These types of technology would be useful for people with disabilities, but also might be of help for everyone.

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    Higher brain functions are common sequelae of cerebrovasucular disease and other central nervous system disorders. Pharmacotherapy for higher brain dysfunction is a new still experimental and somewhat controversial topic. Attentional theories of the underlying neurological deficits in hemispatial neglect have led to different pharmacological rationales for therapy. TRH (thyrotropin releasing hormone) enhances cholinergic functions. And more important, TRH has been shown to improve mild consciousness disturbances in patients with cerebrovascular disease. We recruited four patients who showed left hemispatial neglect. The subjects received intravenous TRH for 10 days. Standard tests for hemispatial neglect including the copying and line bisections were performed three times, before and final days of the treatment, 10 days after the ceased of the treatment. Hemispatial neglect significantly improved during the treatment. Lesions of ascending dopaminergic pathways induce neglect in animals. Apomorphine, a dopaminergic receptor agonist, decreases the magnitude of neglect in rats. Fleet et al. treated two neglect patients with 15 mg of bromocriptine daily for 3 to 4 weeks. Tests for neglect that significantly improved on therapy and worsened after its withdrawal. Noradrenaline is one of the most important transmitters for the regulation of arousal systems. The clonidine, an adrenoceptor agonist, in low doses acts presynaptically to decrease noradrenaline release. Smith et al. reported the lapses of attention would increase following clonidine challenge. As for aphasia, Albert and colleagues reported a case in which speech fluency in an aphasic patient was partially restored by administration of a dopamine agonist, bromocriptine. Tanaka hypothesized that the damages to the left temporal lobe, causing fluent aphasia with anomia, produces a relative deficit in cholinergic activity, therefore that treatment with cholinergic agents will improve naming ability. This review concludes that when used as an adjunct to behavioral therapy, pharmacotherapy appears to have benefit.

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    To examine verb inflections in neologistic utterances in Japanese, verb generation tasks from pictures were administered to a fluent aphasic patient. The patient was required to generate three types of verb inflections of Teramura (1992), i. E., “KIHON-KEI” (non-past, dictionary form), “TE-KEI” (te-form : progressive form) and “MEIREI-KEI” (imperative form). Whereas approximately half of his utterances were neologistic, all of them were inferred as verbs since they were followed by appropriate inflections. In KIHON-KEI and MEIREI-KEI, phonemes at verb-stem final position were restricted to those of Japanese verbs, but this was not the case for TE-KEI. These results were, in large part, in accord with those of previous research on functional words in English neologisms as well as on past-tense generation of regular and irregular verbs, and demonstrated preserved verb inflections in Japanese neologisms. It may be concluded that preservation of verb inflections in neologisms reflects the difference in frequency between lexical and inflectional morphemes.

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    We reported a case of one-way disturbance of somesthetic transfer, from the left to right hand together with left tactile anomia but without left agraphia and left apraxia, after traumatic brain injury. From the viewpoint of brain mechanisms underlying cross-communication, we hypothesized that the patient had no deficit in the connection between the motor association cortex in both hemispheres, but did show a deficit in the connection between the somatosensory association cortex in both hemispheres. Lesions in the corpus callosum suggested that in the case of cross-communication from the left to right hand and left tactile naming, information might be transferred through the dosal part of the posterior truncus which connects the somatosensory association cortex in both hemispheres, while in the case of cross-communication from the right to left hand and writing with the left hand, information might be transferred through the anterior part of the posterior truncus which connects the motor association cortex in both hemispheres.

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    The case is reported of a patient with alexia and agraphia of kanji, and severe anomia after a subcortical hemorrhage in the right posterior inferior temporal area.
    A 73-year-old right-handed man suddenly developed an inability to read letters. On admission to our hospital, his spontaneous speech was fluent without difficulties or paraphasias. Auditory comprehension was also preserved. However he could not name any objects. Kanji reading was remarkably poor and kanji writing was impaired spontaneously and from dictation. On the other hand kana reading and writing was generally good.
    Detailed neuropsychological examination was performed in regard to naming and kanji reading abilities. The naming difficulty in the patient was found in visual and tactile sensory modalities. By contrast, he could name environmental sounds and his spontaneous word finding in conversation was preserved. We discussed the mechanism underlying the production of anomia, it is proposed that his naming difficulty could be interpreted as being caused by modality dependant naming disturbances.
    As to alexia, he could not read aloud of kanji words, also was unable to match kanji words to pictures. Kinesthetic facilitation was not effective in kanji reading. But he was able to match auditorily presented words to kanji words. It seemed that a written kanji word failed to evoke an appropriate word image (phonological form and meaning) when it was presented visually.
    These findings lead us to suggest that his alexia for kanji did not seem to be the so-called asymbolic type of alexia, because he could evoke the images of the letters in some channel. We further discussed kanji alexia with relation to naming difficulty.

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