The purpose of this study is to answer the question when speech therapy should be started for cleft palate children with defective articulation in spite of adequateve lopharyngeal closure after operation. Articulation tests at intervals of six months were administered to 190 cleft palate children with successful repair before the age of two years. The period of observation on speech ranged from one to five years. None of the children had received any speech therapy. The results are summarized as follows: 1) 89 cases showed defective articulation during observation. 2) Types of the defective articulation were categorized as palaterization, glottal stop, nasal articulation, pharyngeal fricative and others. The percentages of palatalization and glottal stop were approximately 50% and 30% respectively. 3) At least 50% of 89 cases improved their speech during observation but only 10% of the children achieved normal speech. 4) Spontaneous recovery from defective articulations was observed much more frequently in children under 4 years than others. 5) In cases of no improvement until age 4 or 4.5 years spontaneous recovery can hardly be expected. 6) Spontaneous recovery in palatalization and pharyngeal fricative was less than that in glottal stop and nasal articulation. 7) The results lead us to conclude that it is reasonable to start speech therapy after observing defective articulations until 4 to 4.5 years of age following operation.
To investigate the underlying mechanisms of language comprehension difficulties in aphasic patients, auditory identification tests of temporal duration and visual identification tests of stroke length for verbal and nonverbal stimuli were administered to a group of aphasic subjects and groups of young and aged normals. The results obtained can be summarized as follows: 1) In young normals, day to day changes in the accuracy of identification for the four test stimuli were almost parallel, indicating that the mechanisms involved in the identification of the four types of stimuli are similar or almost identical. 2) The aphasics showed an impaired performance only for verbal stimuli in the auditory modality. 3) An analysis of the probability of occurrence of the response errors indicated that the aphasics as a group may have had an impairment in their attention mechanism in the auditory modality, which is more dominant than their impairment in their responding mechanism.
The purpose of this study was to assess the comprehension abilities of aphasic patients in daily living situations. For the purpose of analysis results derived from the Standard Language Test of Aphasia (SLTA) were employed. In order to discuss its theoretical background we investigated two factors which were assumed to play important roles in daily communication; contextual information and means for responses. Findings were as follows: 1. SLTA Subtest 1 [Word Comprehension] is a sensitive tool when applied to aphasics with severer comprehension deficits, and Subtest 3 [Commands] is sensitive to aphasics with milder deficits. Whereas Subtest 2 [Sentence Comprehension] is sensitive to all degrees of severity manifested. 2. Those who easily comprehend daily conversation but who do not comprehend complex contents received at least four out of ten points on Subtest 2, but one point or less of the ten points available on Subtest 3. In Subtest 2, contextual information was abundant and the means for responses was easily manipulated by aphasics, whereas in Subtest 3, contextual information was less available and means for responses more difficult. The condition of each subtest was considered to correspond to simple daily conversation and complex conversation respectively. 3. In Subtest 2, a set of four pictures was presented to the examinees before a stimulus sentence was given. It was assumed to act as contextual information in assisting the aphasic patient in comprehending the stimulus sentence. This assumption was confirmed by results of the two examinations. One demonstrated that wrong responses were influenced by the elements presented in the drawings. The other demonstrated that test responses were poorer when a set of pictures was presented after a stimulus was given. 4. In conclusion it appears that test conditions, contextual information, and means for responses in the SLTA Subtests correspond roughly to distinct situations apparent in average daily communication. Therefore the results of the SLTA Subtests could be used as an indicator for predicting comprehension abilities of aphasic persons in living situations.
In the laryngograms taken during phonation and respiration, the figure of the tracheal portion itself remains unchanged. When both laryngeal figures are superimposed at the tracheal portion, movement of the vocal fold in the laryngeal cavity can be quantitatively mesured. This method was applied to the observation of the level of the glottis during phonation. The larynx is elevated during phonation, but the vocal fold moves downward in the laryngeal cavity. Therefore, the vertical movement of the vocal fold is radiographically considered in two ways; movement relative to the surrouding tissue and absolute movement in the laryngeal cavity. The latter movement was discussed in this study. 1) The level of the glottis during phonation is 3mm to 4mm lower than during respiration. 2) In male subjects, the higher the pitch ascends, the lower the glottis descends in the same register. In female cases, the same phenomenon is found only in the range of low voice. 3) At the same pitch, the level of the glottis during phonation of chest voice is lower than that of head voice.
In order to investgate the possibility of change in fundamental frequency of esophageal speech and artificial larynx, a series of listening tests and acoustic analyses were made on two-syllabled words uttered by laryngectomized patients. An additional study on the relation between the tension of rubber membrane of artificial larynx and the fundamental frequency was also performed. The results were as follows: 1) Pitch accents were evidently perceived in both esophageal speech and the voice through artificial larynx. 2) Acoustic analyses revealed that the main perceptive cue for pitch accent was the change in fundamental frequency. 3) Speech through artificial larynx was superior to esophageal speech in terms of pitch accent. 4) Rising pitch was easier to be pronounced than falling pitch in both esophageal speech and artificial larynx. 5) For widening the frequency range of artificial larynx, it was more advantageous to set the rubber membrane comparatively lax.
The Japanese College of Aphasiology has executed a nation wide research, as a part of its project in the fiscal year 1978, in order to grasp the present conditions of the aphasic patients and of their rehabilitation programme, namely speech therapy. Questionnaires were dispatched to 862 institutions throughout the country, and were answered by 268, of which 214 provided treatment for the aphasics. The following results were obtained: 1) Approximately 5000 aphasic patients visited hospitals and/or institutions during the past year. Their proportion to the whole brain damaged patients was 3.36%. 2) Of these cases, 73.2% were males and 26.4% were females, thus the proportion of males being higher. 57.7% were under the age of 60, indicating that aphasia is not necessarily an illness of the aged alone. The majority of the cases resulted from the cerebral vascular accidents (CVA) . 3) 120 institutions had the department of speech therapy, and 100 institutions reported to practise a systematic therapy. 4) Altogether 236 speech therapists were engaged in therapy at 113 institutions. The majority of the therapists had completed four-year college courses or higher education of various disciplines before undergoing therapeutic training courses at various schools or institutions. 5) 102 institutions had rooms exclusively for speech therapy. As many as 13 institutions had more than 5 such rooms. 6) A patient recevied on average a 30-60 minute session of speech therapy 3-5 times a week for a period of 3-6 months. Therapy included treatment of the patient's psychological problems and guidance of his family as well as evaluation of his speech and its actual training procedure. 7) The Standard Language Test of Aphasia (SLTA) was the most popular test used for aphasia, but many others were also in common use. 8) Difficulty with employment after discharge was anticipated from the fact that only 16.2% of the patients had returned to work. 9) Comparison with our researches in 1969 and in 1973 showed a steady increase in the number of institutions and therapists, hours spent for individual therapy, and so forth, while the principal causes for aphasia remained as they were then. This tendency appeared to continue in future.