121 stroke patients with the dominant hemispheric lesions were classified by the Minnesota classification of aphasia and investigated with CCT. 1) Euphasics (n=10) and aphasics, minimal (n=6) : The small confined lesions to the basal ganglia and the internal capsule were noted. 2) Dysarthria (n=10) : The lesions wers small, bilateral and scattered. 3) Group 1 (n=30) : The low density areas were found in the basal ganglia, the internal capsule, F3, T1, the supramarginal gyrus etc. No predilection area was found. 4) Group 3 (n=6) : The low density areas were definitely found in F3 (Broca's area) and distributed to the surrounding cortical and deeper structures. 5) Group 4 (n=6) : The lesions in CCT were small and limited compared with the severity of language disturbance. 6) Group 5 (n=15) : The wide spread low density areas including F3, T1, the insula, the supramarginal, the angular gyrus and the deeper structures were recognized. 7) Minor A (n=18) : The low density areas of T1 (Wernicke's area) and its surrounding stracture were present. 8) Minor B (n=6) : The small low density areas were found in the basal ganglia and/or the internal capsule or the frontal operculum. 9) Combined syndromes of Minor A and Group 3 (n=3) : Cases of this group had the syndromes of severely affected oral language comparing written one. The site of the lesions in CT was combination of F3 and T1. 10) Others (n=11) : No common site and spread of the lesions in CCT were found.
The locus and extent of the lesions in the the brain for 124 cases with various types of aphasia due to cerebrovascular accident were examined by the computerized axial tomography. The relationship between the loci of the lesions and the diagnostic types of aphasia was investigated with the following results: 1. A figure of the lateral view of the brain illustrating the lesion site was made from the horizontal tomogram for each patient. Figures thus obtained for all the patients in each diagnostic type of aphasia were superimposed on each other with the following findings. a) The accumulated site of aphasia-producing lesions for the entire group of aphasic patientsextended to the whole area of the brain supplied by the left medial cerebral artery. b) The highest frequency of the involvement was observed at the lower part of the pre-Rolandic gyrus. c) The patients with simple aphasia (amnestic aphasia) showed no consistent locus of the lesion. d) The patients with “nonfluent” or “motor” type of aphasia (i.e., aphasia with sensorimotor impairment and aphasia with persistent dysfluency), as well as the patients with “pure” apraxia of speech, showed a highly frequent involvement at the postero-inferior part of the frontal lobe, i.e., Broca's area. e) The patients with “sensory” type of aphasia (i. e., aphasia with intermittent auditory imperception), showed a highly frequent involvement at the upper part of the temporal lobe, i.e., Wernicke's area. f) The patients with global phasia showed an extensive involvement of the brain with no specific lesion site. g) The patients with conduction aphasia showed the involvement highly limited to the supramarginal gyrus of the brain. 2. Differential diagnosis of aphasia using the statistical technique based upon the data for the lesion site showed a hit rate of 62%. The majority of the non-hit cases were those with simple aphasia characterized by a poor lesion-site/diagnostic type correspondence. For the rest of the patients with other diagnostic types of aphasia, the rate of correspondence between the lesion site and the diagnostic type was highly reliable.
The extent of the lesions of aphasia patients was determined by CT-Scan, and the findings were compared with the degree of recovery from aphaia. The following results were seen: 1) The lesions were classified into three groups according to the extent of the lesion. 2) Recovery can be well expected when the extent of the leasion is less than 10% (Group I) . 3) In many cases of motor aphasia, recovery can be expected when the extent of lesion is 10-30% (Group II) . 4) In cases with the extent of lesion being more than 30%, the expectancy of recovery is low. 5) The earlier the training was started, the better was the recovery. 6) It can be considered that the extent of the lesion is closely related to the prognosis of aphasia.
37 aphasic patients due to cerebral vascular accidents were studied to determine the relationship between lesion size, as demonstrated by computed tomography and the aphasic svmntoms, as evaluated by Standard Language Test of Aphasia (SLTA) . The period of this study was covered in acute aphasic patients from the onset of illness to at least nine month after stroke. The lesions, as localized by CT scan, were superimposed onto composite lesion localization maps. The major results were as follows; 1) Aphasia, caused by putaminal hemorrhage, was primarily due to the obstruction of association fiber tract and this type showed good prognosis. 2) The long term CT scan by showing the size, location and number of lesions had a positive relationship with aphasia outcome. 3) In the language recovery, the receptive aspect preceded the expressive aspect regardless the size and type of lesion. 4) Difference of aphasic symptoms due to cerebral hemorrhage and cerebral thrombosis was discussed.
Authors examined four receptive aphasic cases due to cerebral vascular accidents by CT scan and identified the location and the extent of lesion in the brain with an apparatus we have newly developed to observe the CT scan three-dimentinally, The results were as follows: 1) The lesion of left superior temporal gyrus and surroundings, the so-called Wernicke's area, in the brain of two receptive aphasic cases was observed. 2) The lesion of right superior temporal gyrus and surroundings, also in the brain of two receptive aphasic cases was observed. This is inexplainable unless taken as exceptional case. 3) No special relationship between the extent of the lesion and the seriousness of the receptive aphasia was observed.
The learning processes of two children with severely disturbed hearing ability were anal-yzed by use of the daily observational records reported by their mothers. The main results were as follows: 1) In the case 1, the numbers of receptive vocabulary were 685 in written language (WL), 299 in lip-reading (LR), and 70 in oral language (OL) . In the case 2, they were respectively 1066, 106 and 641 in each modality. The numbers of expressive one were 685 in WL and 210 in OL in the case 1. In the case 2, they were 1066 and 401. 2) While the maximum length of receptive sentences was 6-word in WL and 4-word in LR in the case 1, it was 9-word and 6-word in the case 2. On the other hand, that of expressive sentense was 6-word in WL and 4-word in OL in the case 1, and 6-word and 5-word in the cese 2. 3) In these two cases, 14 courses from each modality of reception to the oral expression were observed. From these results we suggested: 1) It is most likely that there would be about 30 courses from auditory channel, lip-read ing or written words in order to acquire the ability to utter a word. 2) The course to acquire reception-expression routes varies according to cases and their aging. 3) For the hearing impaired children, a therapeutic (habilitation) program should be arranged depending upon each developement. 4) The learnings of reception-expression in written language proceeding to those in oral language promote the acquiring of oral language. 5) Conversion from written language to oral language in earlier age is necessary for hearing handicapped children to substitute their impaired hearing ability.
Palatoplasty for cleft palate is usually performed before 2 or 3 years of age when the speech starts developing. As the results, children with cleft palate speech has apparently decreased. Despite this progress in the treatment for cleft palte, not a few adult patients with cleft palate still have speech disorders to the extent that their social adjustment is thereby much disturbed. Speech pathologists or therapists have long been well aware of the fact that the speech disorders in adult patients are much more resistent to speech therapy than those in children. Our recent concentration speech therapy appears to change this dismal pattern of speech therapy in adults. Our speech therapy concentrated for 21 months, includes not only articulation training but also help for their social adjustment. Our speech therapy features in the following points. Emphasis on articulation training. Correct articulation, first of lip, is trained with the aid of tactil and visual sensations. Fricative sounds are induced by sustained fricative production with whispered voice, while difficult sounds requiring tongue adjustments are often induced by modification of other sounds. Puff up one's cheeks proved more useful for velopharyngeal closure training than blowing exercise. It should also be emphasized that the patients for speech therapy should be strictly selected on the basis of objective evaluations of V-P function; aerodynamic, inspectory, auditory and radiographic examination. Various methods have been applied to accelerate carrying the corrected sounds at the level of monosyllable or word over that of passage or conversation. They are singing a song, repe-tition of monosyllable, participation in a drama and frequent use of the sounds in their daily life conversation. Active counselling with the patients was also quite effective in promoting their social activity.