A case of a 60-year-old right-handed male patient with alexia with agraphia due to cerebral infarction was presented here. A CT scan and MRI of the brain revealed that a lesion was present in the left white matter and area of perforating arteries. On admission he showed difficulty in word finding and auditory comprehension, but one month later, these aphasic symptoms improved. The patient's chief complaint was his inability to read and write. Reading of Kana was more severely impaired than that of Kanji, but his reading significantly improved after 3 months. On the contrary, agraphia of Kana and Kanji remained. Substitutional errors were present in Kana writing, but not in Kanji writing. He showed difficulty in recalling the visual image of the target letter. A home practice program to improve his writing was devloped. The materials for this program consisted of pictures, a printed short sentences to describe the picture, and a tape recording of the sentence. The patient was instructed to look at the picture and the short sentence while listening to the tape, and to remember all of the sentence. During speech therapy, he was asked to recall the sentence and to write it. This traning proved to be effective in improving his agraphia. This suggested that the home therapy progrom activated neural pathways for recollection ability.

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One of services in the speech and audiology division of Yaizu Municipal Hospital is the fitting of hearing aids for hearing impaired people, especially for aged people. The purpose of this paper is to describe the present status of the hearing aid fitting programs in our clinic. The following results were obtained: 1) From 1985 to 1992, we had 162 consultations for hearing aids, of these 115 cases (71%) could benefit from using hearing aids. Seventy eight (69%) of the 113 cases who were over 70 years old benefited from amplification. Any difficulty arising in fitting of hearing aids not related to age. 2) The satisfaction ratio for amplification was lower in the group with mild hearing impairments rather than those of moderate to severe hearing impairments. These results seemed to be caused by the difference in expectation for hearing aids between the two groups. 3) There were more difficulties in fitting hearing aids for patients with high freqency hearing losses than those with flat audiometric losses. 4) Not a few of the patients who scored well on speech discrimination test could not wear hearing aids because of poor speech intelligibility in daily life, under various kind of noises. So it seems to be necessary to do testing with back ground noise as well as in quiet circumstances. 5) For elderly people, it is important to get the famillial support because of the deterioration of the total speech perceptual ability.

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