This paper reports the assessment of communication partner training for better use of Augmentative and Alternative Communication (AAC). The training was conducted twice for a total of three hours with a school teacher who was in charge of a 10 year-old schoolboy with cerebral palsy. The effectiveness of the training was assessed by 1) analysis of videotaped interaction between the teacher and the child, 2) a questionnaire and an interview with the teacher. The following results were obtained: 1) the child began to use AAC more frequently, 2) the child became spontaneous in the interaction and the new custom was finally established between the two, 3) the teacher had a better understanding of the child through using AAC.

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The purpose of this longitudinal study is to analyze data of a case (child A) with cerebral palsy (CP) from 23 to 46 months, and to investigate the developmental process of demonstratives. His data was compared with that of 28 ordinary children and another CP patient, child B. The main results were as follows: 1) The use of “kore” (this) is related to the augmentation of the ability to point and reach objects clearly. 2) Child A first acquired “kore”, while the ordinary children first acquired demonstrative use of words such as “mama” (mother). This use requires awareness of physical and psychological distance between mothers and children. 3) The emergence of “koko” (here), “ima” (now), “boku” (I), and so-series demonstratives were both delayed in children A and B. Thus, the development of language in children with CP seems highly related to the disorder of physical movement and the development of self-other consciousness.

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This article presents the results of a questionnaire completed by 292 members of Genyukai (self help group of stuttering). The survey was about their present condition and their need for professional treatment and support with stuttering. There were three significant results. First, about a third of the members had experience of professional treatment for speech-language disorders in the classroom in public schools or with speech-language therapists, and the satisfaction rating of these persons was low. Second, there is a high potential need for professional treatment, and third there are various needs not restricted to the speech perspective.

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A child with cleft palate, who had an operation at 1 year 5 months, showed good shape of soft palate but poor velopharyngeal closure (VPC) function and had cleft palate speech (nasal articulation and glottal stops). She was poor at speech production and articulation in comparison with normal speech comprehension. After the age of four, her VPC function became normal and at that time she could pronounce explosive consonants (/p, t, k/) constantly instead of glottal stops. However, she had difficulties of intentional oral movement and imitative speech production. Her condition was similar to that of a child normally diagnosed as having “Specific Language Impairment (SLI)”. It is suggested that SLI affected her acquisition of VPC function more than 3 years after the surgery.

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Speech and language proficiency of two children whose main complaint was unintelligible speech was evaluated. Case 1 was a boy with Noonan syndrome. He showed nasopharyngeal articulation and immature articulation at the age of 5. However, his speech was characterized by hyper-hyponasality, hoarseness, and distorted /i/ sounds at eight. Additional examinations revealed that he had minor malformation of pharynges. Case 2 was a 6 year-old boy with inconsistent phonemic errors. He was found to have some disturbances in auditory information processing and phonological handling in speech. After phonological and semantic approach through hiragana letters for 8 months, he showed remarkable improvement in his speech. The two case studies suggested that factors in unintelligible speech should be identified case by case.

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Two patients with abnormal writing behavior are reported, and the neuropsychological mechanisms for their writing deficits are discussed. Case 1 is a right-handed Wernicke's aphasic, who showed prominent jargonagraphia written in kanji and kana. Kinethetic images of characters stored in the left hemisphere are considered to run on freely without control from the language area in the right hemisphere, causing jargonagraphia. In addition, this patient tried to use writing to compensate for his speech disturbances, and he kept a diary and showed it to care staff. These abnormal behaviors seem to be related to anosognosia for writing deficits. His productive writing seems to partly resemble hypergraphia, observed in right-brain-damaged patients. Case 2 showed increased writing with prominent perseveration with abnormal grasping phenomenon due to diffuse subcortical lesions in the bilateral frontal lobes. His hypergraphic activity was triggered by the appearance of the writing tools. This abnormal writing behavior is interpreted as utilization behavior relatively limited to writing tools. Deficits of inhibitory mechanisms from the frontal to the parietal lobe might have released writing activities in this patient.

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Cognitive rehabilitation was performed for a case of traumatic brain injury (TBI) for about three years from one year after the traffic accident. In this case, researchers collected information about the general state of higher brain function, including problems in daily living. For this purpose, the cognitive functions using neuropsychological tests such as Wechsler Adult Intelligence Scale-Revised (WAIS-R), Wechsler Memory Scale-Revised (WMS-R), Miyake Memory Test, General Aptitude Test Battery (GATB) etc., as well as notebooks for communication between rehabilitation staff and family were evaluated. Through three years' rehabilitation, the results of neuropsychological tests showed improvement in intelligence and memory. On the other hand, psychological problems which resulted from disorder of executive function or thinking process were revealed through communication notebooks. These problems could not be clarified by neuropsychological tests. Accordingly, it was very useful for cognitive rehabilitation to inquire into these psychosocial problems of family in addition to using neuropsychological tests.

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The newly approved Speech and Auditory Therapist Law which follows long-standing pattern of Disqualifying Clauses horrified people so much that it has given impetus to the rise of the movement to eradicate Disqualifying Clauses. In 2001 the clauses to disqualify persons with auditory disabilities from pharmacist's licenses were deleted. A state examination for the license to practice medicine provided reasonable accommodation for a person with a visual disability for the first time. The concept that some fields are too dangerous or impossible for persons with disabilities has been undoubtedly changing. As more than 40 countries have Anti-Discrimination Law for persons with disabilities, there is a growing tendency to enact Anti-Discrimination Law in Japan. To eradicate Disqualifying Clauses means not only changing the law system but also changing society's attitude and framework toward the disabled. Under the new law, the disabled will neither be labeled inferior nor be segregated. They will be able to study and work with necessary supports, and will strive forward jointly, sharing information across the boundaries of positions as professionals and activists.

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The movement which freed disabled persons had negative ideas about rehabilitation, because rehabilitation compulsorily carried out functional recovery training and attempted to reduce disabilities. In short, the disability itself was denied. Recently, however, there has been a change in approach, which focuses on maintaining the body function. The same approach is adopted for language training and communication. Even though it is still difficult to communicate effectively, and I for example am often in trouble, the Communication Assist is useful in communication situations. I hope for the expansion of such activities.

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I have experienced both agony and joy for 20 years since my husband had his first attack of aphasia. My husband and I established the meeting and art activities of an aphasic patients' group. We attend to these activities cooperatively. I describe such agony and joy as a family member (spouse). From these experiences, I learned that it is important to support the family members mentally and that it is also important for patients to live with a role as a society member. In the future, we hope to develop a sheltered workshop and to train conversation partners. The final goal is the realization of a barrier free society in language and communication.

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Although nursing support staff and speech-language therapists (ST) are working in close areas, each has a quite different job. The problems of communication and swallowing have not been appropriately positioned in actual care plans, so all staff should be made aware of these problems in the training programs. It is desirable that nursing support staff and STs raise mutual recognition and understanding. Within the nursing care insurance, there is a field, which covers communication and swallowing, for which STs should perform their role. The professional barrier existing between the nursing support staff and the STs should be broken down so that the support system of the users is made to respond to the requirement of the users. It is hoped that the needs of the aged and disabled can be prioritized in the cooperation between the two professional groups.

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A Communication Assist Network (CAN) has been formed. The purpose of the network is twofold. First, CAN promotes the human rights of language and/or hearing handicapped persons. Second, it assists with the participation of these persons in society. CAN is a non-profit organization (NPO) and is open to anybody who adheres to these two objectives. CAN holds seminars for job related people, and advocacy symposiums for citizens. CAN also does research and produces publications. Conventionally the work of speech therapist has only been thought of as training the communication handicapped persons in various facilities. CAN recognizes an additional vocation for speech therapists in these two objectives.

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