Since 1990s education for children with hearing impairment in Japan has gradually tried to utilize manual communication. It is now necessary to understand theories of language acquisition, background and practice. After an explanation of definitions of manual communication systems and sign languages, studies related to language acquisition and language background for people with hearing impairment are reviewed in terms of theoretical backgrounds and future directions. Studies in foreign countries on sign language acquisition and early sign language practices indicate that children with hearing impairment can develop language and cognition abilities by communicating with others from early childhood. It is expected that teachers in schools for the deaf, researchers, parents of children with hearing impairment, and deaf adults in Japan will examine the environment in which children are raised and educated, and improve that environment in the future.

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This study investigates the efficacy of three techniques for facilitating the swallowing reflex. The three techniques are: (1) pushing up and pressing on the hyoid bone, (2) rubbing up and down externally on both sides of the larynx, and (3) rubbing both sides of the larynx lightly. Each of these techniques was applied to thirty-four women showing no abnormalities. The number of swallowing reflexes exhibited during the period of stimulation was compared with that exhibited pre-stimulation. The results were as follows. Two of the three techniques facilitated the swallowing response. In these two cases, the effects continued throughout the two minutes of stimulation. It was concluded that these two techniques give afferent information to surface or deep sensory receptors and chemoreceptors innervated by glossopharyngeal and/or superior laryngeal nerves.

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This study investigated the relationship between speech production and phonological awareness in preschool children. Thirty children of three to five years of age participated in two tasks. The first was a speech production task, and the second a phonological segmentation task. Speech responses were analyzed in terms of error frequency, syllable structure, etc. Phonological segmentation responses were categorized according to the types of phonological units (syllable, mora) which children used when carrying out the segmentation task. The study shows that there was a significant correlation between the number of correct speech sounds produced and the number of segmentation responses that were consistent with mora. This suggests that awareness of mora in children three to five years of age might influence their phonological representation and other language information processes, and enable children to produce speech sounds with greater accuracy.

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This study investigates the degree of intelligibility and abnormality in the speech of normal children and the speech of children with cleft palate who have problems with glottal stops. Seventy-eight children four to six years of age and sixty-four college and graduate students listened to twelve words and six sentences spoken by three children with repaired cleft palate and by three normal children. Glottal stops and hypernasality or hoarseness characterized the speech of the children with repaired cleft palate. Sentences were made up of two parts: subject/topic and predicate. For the children with repaired cleft palate, the initial words contained glottal stops but the final words none. The main findings were as follows. (1) All listeners judged the intelligibility of the speech of the children with cleft palate as lower than that of normal children. (2) Children aged four to six could not understand the speech of children with cleft palate as well as adults. (3) Adults could understand more cleft palate speech in sentences than in words. (4) Adults and children six years of age felt cleft palate speech to be more abnormal than did children of four and five years of age.

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This paper presents the findings of a survey of the conditions regarding speech therapy services in Tokyo for adults with communication disorders. The questionnaire was answered by speech-language therapists working at forty-six local health and social care facilities. The findings are as follows. Ninety-eight percent of the speech therapists are working as part timers. Many facilities accept adults with communication disorders without any age or term limitations. Transportation services are provided at seventy percent of the facilities. A range of services is offered: individual assessment, individual therapy, group therapy, extracurricular activities, and so on. The purpose of the services is not only to improve communication abilities but also to reduce the psychological and social problems the clients face.

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Thirty-one patients with chronic and severe aphasia were given long term art therapy through dominant hand exchange in the context of group speech therapy. The patients had suffered a stroke on an average of 2.8 years before and were suffering a quite low quality of life (QOL) when the therapy began. A questionnaire about QOL was filled out by twenty-eight patients and family members after an average of 6.3 years in therapy. The questionnaire revealed significant improvements in psychological attitude and in daily life activities. Eleven patients, whose SLTAs could be followed up, showed a continuing improvement in speech functions as well.

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To consider the role of speech therapists within the hospital system, the following problems encountered in one hospital are presented: (1) the shortening of the time of hospitalization, (2) more complex language problems emerging with the rise in the number of older patients, (3) an increasing need to train speech therapists to help patients with dysphasia, and (4) the need to cooperate with other professionals in the local community. Given these problems, I propose that speech therapists should: (1) treat patients based on a long term prognosis of the process of the recovery of language and communication functions, (2) further cooperation with related professionals in the hospital, (3) encourage networking in the community among related professionals, (4) start new activities and services, as well as a system of evaluation and feedback, related to the needs of people with speech disorders, and (5) establish ways to enhance and monitor speech therapists' professionalism.

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This paper reports on the methods and effectiveness of the multi-dimensional assistance given by the Chofu City General Welfare Center to people with aphasia. The following three approaches were found to be effective in helping people with aphasia to live with satisfaction in their local communities. (1) To support aphasic patients through a multi-dimensional team approach by making use of various social services and resources to improve their speech function, living environment, independence, ADL, hobbies, social life, and the help provided by caregivers. (2) To provide individual therapy focusing on language function, psychological support, feedback on group therapy, self-management, family guidance, deficit-recognition, and deficit-acceptance. (3) To utilize group therapy to help solving long standing psychological problems. However, because of a reduction in the welfare budget and the introduction of a new insurance system, there is growing concern that chances for carrying out this effective, multi-dimensional approach will diminish.

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At the request of the Ministry of Education, Tokyo Metropolitan Nanao School for Handicapped Children conducted trial consultations about early education in 1997 and 1998. The purpose was to give advice concerning the developmental patterns among mentally disadvantaged children so that parents and supervisors at kindergartens and nursery schools could deepen their understanding of each child with a developmental disability and thereby become better able to advise, guide, and educate children in the best manner possible. In order to respond to a range of questions and problems, we assembled a staff based on the recognition that not just teachers but also experts in speech and psychology would be needed to take part in the consultations. Communication problems are an inevitable part of daily life. This study shows that speech therapists should play an important role in conveying information about speech and be able to take the initiative in a variety of situations.

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This paper reports on the problems faced by the few speech therapists in Japan attempting to operate a private practice. Following a description of the present situation of the treatment office established by the author, the characteristics and special problems of private practice are discussed. The importance of the private practice in offering therapy to children in middle childhood is stressed. Also discussed are the difficulties in expanding to meet a growing demand, the problems with the present medical welfare system, and the role of the speech therapist in private practice in improving the system. It is argued here that in place of large-scale treatment organizations which are facing various difficulties, a new treatment system needs to be created where private practitioners with different specializations form treatment teams to respond to different situations. From the perspective of social finances, it is also argued that it is necessary to increase privately funded private practices for the sake of the financial health of municipalities.

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The Nozomi Clinic has been concentrating its efforts on systematizing and bringing into practice a way of thinking which might be termed “speech is one of the developmental domains of a child.” We refer to the method we are developing as a “multi-dimensional approach” to the treatment of communication disorders in children. In order to synthesize our basic ideas, we are putting into practice two training procedures: (1) the NC Program and (2) horse-riding therapy. Both of these procedures have been fairly successful thus far in actualizing cooperation among a variety of specialists and in emphasizing the necessity of a total interdisciplinary approach (based on the idea of “a child as a developmentally total being”) to children with speech and language problems.

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