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Seiko Kuroda, Kiyoshi Imamura, Izumi Itoh, Isao Takimoto
2002 Volume 43 Issue 4 Pages
375-385
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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The authors examined and report on the changing aspects of mother-infant communication during infancy and speech and language structural acquisition in a case of visual-hearing impairment with agenesis of the corpus callosum and parents of profoundlysevere hearing impairment, in relation to mother-infant intervention.
The results were as follows. 1) It was confirmed that by attaching importance to mother-infant recognition of a handicap, changes affected the state of mother-infant communication and caused good communication between them. Also, daily management and care for wearing of hearing-aids and eyeglasses were performed effectively by the mother; hence a home-training program for this type of case can achieve a certain level of effectiveness. 2) As a result of the foregoing, the patient acquired and mainly used speech-language more than Japanese sign-language, and the acquisition level reached the border-line of a normal infant. 3) On the other hand, the patient's speech-language exhibited some retardation in and an inclination toward acquisition and usage of particles and sentence structures, and also showed a tendency toward imperfect acquisition of language concepts. 4) It seemed that a certain level of achievement in the patient's speech-language was caused by early wearing of hearing-aids, and by the ability of the hearing-impaired mother's speech-language. 5) It seemed that the problems were compounded by the patient's difficulty at visual scanning of moving objects, fear of new situations and restricted experiences.
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Masaki Nishio, Seiji Niimi
2002 Volume 43 Issue 4 Pages
386-390
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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The effectiveness of the pointing speech method was investigated in 47 dysarthric speakers. The following major results were recorded.
1. Intelligibility was significantly better when the first letter was presented than when it was not presented.
2. In each severity level group, intelligibility was significantly better when the first letter was presented than when not presented. This difference was particularly significant in the moderately and severely dysarthric groups.
3. For each type of dysarthria, intelligibility was improved by presentation of the first letter. The improvement was more significant in types where intelligibility was poorer in the absence of first letter presentation.
4. No significant difference was observed between 3-mora and 4-mora words.
On the basis of these findings, we discussed the clinical effectiveness of the pointing speech method in use with dysarthric speakers.
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Kazuya Sakamoto, Akira Uno
2002 Volume 43 Issue 4 Pages
391-395
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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Many adult bilingual aphasics have been reported, but few reports have been released on childhood onset. Here, we report the symptoms and recovery process of bilingual aphasia caused by cerebral infarction after an STA-MCA anstomosis operation for Moyamoya disease in a 10-year-old right-handed boy who previously spoke both Japanese and English. He moved to the United States at the age of 3 years and 11 months and attended school there for four years. He showed no symptoms of neurology. With respect to characteristics of his language disorder, spontaneous speech was fluent but he exhibited verbal paraphasia suggestive of a comprehension disorder. From these character-istics, the type of aphasia in this case was considered to be Wernicke's aphasia. We hypothesized that the correspondence between his lesion and the characteristics of his language disorder resembled that of adult aphasia. One year and 11 months after onset, we evaluated him using both the Japanese and English versions of the Western Aphasia Battery (WAB) . The English version revealed more serious aphasia symptoms than the Japanese version.Factors of non-parallel recovery are thought to be related to native language, the more familiar language, and the language environment after onset.
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Yuka Sobue, Noriko Haruhara, Akira Uno
2002 Volume 43 Issue 4 Pages
396-401
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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We report on a 52-year-old male aphasic patient who exhibits omission of the initial mora of a word spoken in isolation. The omission occurs in confrontation naming, reading aloud of Kanji and Kana words, and repetition of words and nonwords. The mechanism of this phenomenon seemed to be common in all modalities of spoken output. The patient showed apraxia of speech (AOS) . Generally AOS is manifested by omission of the initial consonant of a word, but not the initial mora. When the patient omitted an initial mora, we were unable to observe any articulatory movements. The phenomenon did not appear to be related to semantic factors, because the omission occurs in both word and nonword repetitions. He could identify the number of moras of target words, though he omitted the initial mora of a word. He made a small number of errors with initial consonants of residual words for which he omitted the initial mora. These findings suggest that the patient somehow recognizes the existence of the initial mora of words.
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Nozomi Tanaka, Eiichi Harada, Claude Roberge
2002 Volume 43 Issue 4 Pages
402-406
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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We report the case of a girl aged 6 years and 1 month who suffers from congenital sensorineural profound deafness of unknown cause. Before her operation, she attended a school for the deaf and used cued speech. She could perceive the sounds of a telephone and an intercom at a distance of 2 or 3 meters, but she could not identify any speech sounds. At the age of 4 years 9 months, she was operated for a cochlear implant in the left ear. Her hearing at the time of the operation averaged 108 dB for the right ear and 118 dB for the left. Mapping management was performed one month post-operation. Two months after the operation, she came to our institute and we began hearing and articulation training using a vibrator 45 minutes once a week. Six months after the operation, she began to attend an ordinary kindergarten. The results of her training with a vibrator were better than expected. Based on the scores of our hearing and articulation tests, in which the possibility of lip reading was eliminated, we concluded that the vibrotactile sense can aid perception and articulation of speech sounds in a deaf child having a cochlear implant.
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—3 Preliterate Case Studies—
Takeshi Toukawa
2002 Volume 43 Issue 4 Pages
407-415
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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In this report, communication boards and communication books used for language and communication intervention were examined from the perspective of communicative functions. Three cases were studied: the target subjects were preliterate preschoolers who suffered from cerebral palsy (confined to wheelchair) and intellectual disabilities (moderate to severe) . Their language comprehension was at the 18-23 month level, but they expressed no or few significant words. (1) They used communication boards, communication books and unaided signs concurrently, in compensating roles. (2) One case used communication boards only for request functions, while another used them for giving information as well as making requests; usage depends on their interpersonal relations and range of communicative functions. (3) Use of communication cards to support for comprehension (input) was effective for the case exhibiting low motivation toward communication and resistance to changes. (4) Two cases, who exhibited high motivation toward communication, used communication books as reminders of past events. The findings suggest that use of communication books as a reminder is an effective strategy for giving information about past events in the young users.
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Ryoko Sagara, Noriko Haruhara, Akira Uno
2002 Volume 43 Issue 4 Pages
416-422
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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We reported a right-handed patient without aphasia after infarction of a large area in the left hemisphere. She exhibited severe agraphia and limb apraxia. Although she could comprehend the meaning of speech prosody, her speech was flat and monotonal in all modalities of oral output. The dysprosody seemed to be similar to aprosodia. These results suggest that in this case, while the left hemisphere plays a dominant role in writing and higher motor functions, the right hemisphere plays a dominant role in oral language functions. In addition, she is likely to represent a case in which language functions exist separately in both hemispheres.
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Shoogo Ueno
2002 Volume 43 Issue 4 Pages
423-429
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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Magnetoencephalography (MEG) by SQUID, fMRI, and transcranial magnetic stimulation (TMS) are useful tools for understanding the functional organization of the human brain, such as memory and cognition. Although fMRI is a useful and popular method to visualize higher brain function, it does not reveal the dynamic neuronal connectivities of the brain and it offers low temporal nesolution. MEG is problematic in that inverse problems need to be solved to understand brain activation, but it can measure electrical neuronal activity directly and brain function with very high temporal resolution. TMS has the ability to control the neuronal activity of the brain non-invasively. Both MEG and TMS are suitable for dynamic imaging of the brain. This article discusses these various techniques and shows examples of measurement of cognitive functions by MEG.
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[in Japanese]
2002 Volume 43 Issue 4 Pages
430-431
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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Kiminori Sato
2002 Volume 43 Issue 4 Pages
432-437
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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Atrophy is a decrease in the size and function of a cell, a tissue, and/or an organ. Vocal fold atrophy can therefore be defined as a decrease in the size and function of the vocal folds. Vocal folds have a layered structure consisting of the epithelium; the superficial, intermediate, and deep layers of the lamina propria; and the vocalis muscle. Accordingly, vocal fold atrophy can also be defined as a diminution in the size of each portion of the layered structure and function of the vocal folds.
Atrophic portions of vocal fold tissue are different in each disease. 1) The size of the vocalis muscle decreases in recurrent laryngeal nerve paralysis. 2) The size of the superficial layer of the lamina propria of the vocal fold mucosa decreases in sulcus vocalis. 3) Vocal fold tissue decreases in size after irradiation by laser or other radiation source. 4) The lamina propria of the vocal fold mucosa and vocalis muscle derease in size in geriatric vocal folds. The decrease in the size of the lamina propria, especially the superficial layer, of the vocal fold is related chiefly to atrophy of the geriatric vocal folds.
Understanding of the histologic structures of the vocal fold and the histopathology of the vocal fold atrophy are important for understanding the concepts behind treatment of atrophic vocal folds.
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Akihiro Shiotani
2002 Volume 43 Issue 4 Pages
438-443
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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To assess the potential of gene therapy for vocal fold atrophy associated with atrophy of the thyroarytenoid muscle after recurrent laryngeal nerve injury or by aging, we examined the myotrophic effect of sustained local IGF-I production achieved by IGF-I gene transfer into denervated rat thyroarytenoid muscle. A muscle-specific non-viral vector containing α-actin promoter and the IGF-I gene was used in formulation with a polyvinylbased delivery system and injected into denervated rat thyroarytenoid muscle. Four weeks after IGF-I gene transfer, the IGF-I transfected animals exhibited significant improvement in muscle fiber diameter and motor endplate morphology. We also examined the myotro-phic effect of a high level of expression of IGF-I protein achieved by a newly developed Sendai virus vector. The introduction of the Sendai virus vector carrying the IGF-I gene into the rat leg muscle yielded a significant increase in regenerationg and split myofibers indicative of hypertrophy, and also an increase in the total number of myofibers in comparison to that in the control muscle. These results demonstrate that IGF-I gene therapy may have great potential for treatment of vocal fold atrophy by prevention or reversal of atrophy of the thyroarytenoid muscle.
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Niro Tayama
2002 Volume 43 Issue 4 Pages
444-449
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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Vocal fold augmentation is one of the surgical treatments available for vocal fold atrophy. With this technique, fat and atero-collagen are most often injected, and fascia is transplanted to the sulcus vocalis in laryngo-micro surgery. Atero-collagen is used as the medical material due to its ease of injection enabling use with various surgical approaches. However, it has some disadvantages in terms of absorption rate and allergic reactions. Fat and fascia are safe because they are autologous tissue, but surgical processes are complicated. They also have absorption rates of the same degree. Generally, if material has affinity with tissue, it has a high rate of absorption. At present, we do not have ideal material for augmentation of the vocal fold, and its development is awaited. Clinically, material and method should be selected on a case-by-case basis. This paper aims to introduce a practical technique for collagen injection.
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Etsuyo Tamura, Satoshi Kitahara
2002 Volume 43 Issue 4 Pages
450-457
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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Silicone, collagen and autologous tissue such as fat have been used for vocal fold augmentation in Japan. Here, we studied histological findings and influences on vibration after augmentation surgery using these various materials.
Although long and substantial foreign body reaction to a silicone injection into the vocal fold has not been reported, injection into the lamina propria layer may disturb vibration movement. With collagen, problems include a high absorption rate after injection, allergy reaction due to use of heteroprotein, and risk of unknown infection. With autologous tissue, use of fat tissue or fascia cause problems involving absorption after injection, but use of neither material has shown significant foreign body reaction. However, injection of fat tissue into the lamina propria layer rarely disturbs vibration during phonation. With respect to absorption of fascia augmentation, we have not reached a certain conclusion yet, and further study is needed.
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[in Japanese]
2002 Volume 43 Issue 4 Pages
458-459
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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Ryuzaburo Higo, Niro Tayama, Takaharu Nito, Yasunori Fukatsu
2002 Volume 43 Issue 4 Pages
460-466
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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Videofluorography (VF) has to date been regarded as the best way to assess swallowing function. While of great usefulness, VF has some disadvantages, such as X-ray radiation. In this paper, we discussed various alternative methods, besides VF, to assess swallowing function. These methods divide into 4 categories, as follows:
1) screening tests to detect aspiration
2) endoscopic or echoic methods to assess swallowing function (non-X-ray methods)
3) sensory tests
4) new methods enabled by the technology advances.
Typical methods or tests were selected for each category, and their advantages and disadvantages were discussed. To use these methods in clinical assessments of dysphagic patients, standarization of normal limits is indispensable. To increase the reliability of the methods, more extended and follow-up studies will be also necessary.
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Hiroyuki Arai, Mutsuo Yamaya, Takashi Ohrui, Satoru Ebihara, Takae Ebi ...
2002 Volume 43 Issue 4 Pages
467-472
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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Pneumonia is a common cause of death among the elderly. A series of our studies have demonstrated that aspiration pneumonia is commonly a consequence of a variety of brain diseases due to disruptions specific to the central neurotransmitter system, including dopamine and substance-P. In particular, aspiration pneumonia is significantly more common in patients with unilateral or bilateral basal ganglia infarction than in those without them. These lesions may impair both swallowing and cough reflex that are essential to deglutition. Use of amantadine or angiotensin-converting enzyme inhibitors that are known to potentiate dopaminergic or substance-P neurons successfully and reliably redued the incidence of aspiration pneumonia. Furthermore, a simple oral care technique using a toothbrush also helped. It may be emphasized that these new strategies not only help prevent aspiration pneumonia but also contribute to reduce medical costs for the elderly. In Parkinson's disease, swallowing reflex was gradually impaired during the disease progression. In Alzheimer's disease, aspiration pneumonia is significantly associated with dementia severity, the presence of cerebrovascular disease and use of neuroleptics.
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Yasuhiro Samejima
2002 Volume 43 Issue 4 Pages
473-478
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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Surgical procedures for dysphagia include those by which laryngeal functions are preserved and those by which such functions are sacrificed. When laryngeal functions -especially, airway protection- are impaired and uncontrollable aspiration occurs, surgery that sacrifices other laryngeal functions, respiration and phonation, is necessary. In our 14 cases involving sacrifice of laryngeal functions due to intractable aspiration, tracheostomy was needed for frequent suctioning of the trachea before treatment. Moreover, some patients were unconscious and had progressive disease and severe dysarthria. On the other hand, there was one patient able to take a small amount of food orally, using a gastrostomy tube for entral nutrition and a tracheostomy tube for suctioning aspirated secretions. Relying on a tracheostomy tube or tracheal button for speaking, his phonation was preserved. Despite the short period of time during which he could eat, he and his family experienced a sence of satisfaction. It is important to consider the needs of both patient and family in the management of dysphagia.
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Keiko Kawahara, Fujiko Motomura
2002 Volume 43 Issue 4 Pages
479-484
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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Children with severe motor and intellectual disabilities, or “jusyo-ji” often exhibit a wide range of disabilities. These are not present simply at birth, but are complicated by growth and development.
Therefore, it is not enough to consider support of “jusyo-ji” only from the stand point of functional disabilities, focusing on the acts of eating and swallowing alone. It is also important to provide support in simpler and attainable ways in daily life continueing throughout their life. At the same time, environment should also be closely considered, including their family with whom they share sally life.
In this report, we present important considerations as speech-language-hearing therapists by introducing practical cases we have worked on for eating with assistance according to a child's ability.
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Gota Tsuda
2002 Volume 43 Issue 4 Pages
485-490
Published: October 20, 2002
Released on J-STAGE: June 22, 2010
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In this paper, the results of tests and investigations essential to dysphagial treatment were evaluated. Furthermore, the efficacy of the team approach involving numerous specialists adopted at our hospital and of the local dysphagial meetings actively promoted in our prefecture were presented.
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