We developed a new test to assess comprehension of abstract words for the purpose of detecting mild deficits in comprehension in aphasics. The test includes abstract words, which are said to be more difficult for aphasics to understand. We established a standard score using 445 normal individuals. Then we compared the scores of 32 aphasics who performed relatively well on the comprehension tests of SLTA with those of the normal individuals. We also asked the aphasics or their family members if they had any problems in daily life due to deficit of comprehension. In addition, we asked their speech therapists for information on the degree of deficit of comprehension in their patients. We found that the aphasics could understand abstract words as well as the normal controls when the target words were shown visually.Some aphasics had a score of auditory comprehension on this test of below - 2 SD of normal. The results of this test were consistent with the degrees of difficulty in daily life due to deficit in comprehension as rated by the aphasics and/or their family members and as assessed by their speech therapists.

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[in Japanese]

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This is a study on cooperation between the education and medical staff in support of children with learning disabilities. We analyzed questionnaires administered to teachers of speech impediment classes (“kotoba-no-kyoshitsu”) in public primary schools in C prefecture. Results revealed there has been little actual cooperation between staff although necessity awareness was high. Teachers who have experience in supporting children with learning disabilities are more positive toward learning and testing for learning disabilities than inexperienced teachers. They had confidence in teaching and more information about medical facilities with which they can cooperate.In path analysis, we observed a significant relationship between“requests for assistance from educational to medical staff”and“positive participation in training courses about learning disabilities”, “active conferences with parents or class teachers”, “frequency of assessment”, and“strong will to obtain knowledge”. However, we also found a negative correlation with“lack of self-confidence to support children with learning disabilities”. There was also a significant path from“requests for assistance from educational to medical staff”to“bidirectional cooperation with educational and medical staff”. These results suggest that an important factor which promotes cooperation between educational and medical staff in C prefecture is providing many opportunities to take lectures on training children with learning disabilities or to support teachers who can perform assessment appropriately.

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This study was designed to investigate the difference in the rate of occurrence of stuttering between words beginning with consonants and those starting with vowels, in Korean and Japanese stuttering children. The subjects were 15 Korean stuttering children (average age: nine years, one month) and 20 Japanese stuttering children (average age: nine years) . Their spontaneous utterances in explaining a set of pictures and in free conversation with the experimenter were tape-recorded and analyzed. The results were as follows. 1) Both in the Korean and Japanese children, the rate of stuttering occurrence was slightly higher in words beginning with vowels than in those starting with consonants. 2) Based on comparison of repetition units in repetition type stuttering, the number of units consisting of a nucleus with or without onsets was significantly higher than that of units consisting of only onsets and those consisting of rhymes (a pair of nucleus and coda) with or without onsets, in both the Korean and Japanese children. These results were different from those of previous studies on English-speaking children. This difference indicates that stuttering occurs in close relationship with the linguistic characteristics of an individual language, such as syllable structure.

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An electronic Japanese sign language dictionary, in which sample sign sentences illustrating the meanings of basic sign words are presented along with video pictures, was constructed in order to assist learning of sign language. Total of 250 kinds of basic sign words were selected for inclusion in the dictionary based on two criteria: high frequency of occurrence and usage characteristic of sign language. Then, the meanings involved in each of the basic words were categorized, sample sign sentences corresponding to the meaning categories were composed, and a display was devised for each basic word. About 1, 400 sign sentences were accommodated. For the signing gestures, in addition to display of video files, analytical descriptions of body movements relevant to each sign gesture were provided according to five items: 1) label of the sign word, 2) head, upper extremities and torso movements, 3) eyebrow shapes, 4) eye shapes, and 5) mouth shapes. Grammatical explanations of the sign words were also provided when necessary. The operating environment of this electronic dictionary is as follows: OS: Windows XP, 2000 (Me and 98) ; memory: more than 128 MB: CPU: Pentium III or faster, usable area of HDD: more than 5 GB; distributed media: DVD.

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Selection and indications of phonosurgical techniques differ among disorders. Here, we describe indications for and selection of surgical techniques for vocal cord polyps, unilateral laryngeal paralysis, Reinke's edema, and vocal code nodules that are frequently treated by surgery. Vocal cord polyps, excluding those in the early stage, are indicated for surgery. The surgical techniques are f iberscopic surgery performed at an outpatient clinic and laryngomicrosurgery performed after admission. Surgical methods are selected in consideration of the polyp location and form, anesthesic method, and the patient's preference. For unilateral laryngeal paralysis, voice therapy and surgery are performed alone or in combination. There are a number of surgical methods, and the method appropriate for the condition of each patient should be selected. For Reinke's edema, vocal hygiene including smoking cessation intervention is important. Surgery is indicated in severe cases complicated by respiratory disorder. Vocal cord nodules are treated by a combination of voice therapy and surgery. Before treatment, patients are given an explanation of possible recurrence after surgical treatment when performed in isolation. As the foregeing indicates, physicians should provide information on standard treatment methods, complications, and postoperative courses and give advice appropriatefor each patient. Patients themselves render the final decision on the treatment method to be adopted.

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In order to achieve ideal results in the treatment of voice disorders, cooperative work between otolaryngologists and speech therapists (STs) is highly essential, since voice disorders are often caused by both organic and functional factors combined complicatedly. Among the typical therapeutic approaches to voice disorders, STs are responsible for voice therapy including instruction of vocal hygiene and voice training. Shared knowledge and mutual agreement between otolaryngologists and STs on the indication, method and setting goal of voice therapy are indispensable, and therapy should be started after obtaining informed consent from the patient. An absolute indication of voice therapy serves for functional voice disorders including psychogenic dysphonia, while a combination of surgery and voice therapy is often effective for laryngeal paralysis. In the case of vocal cord nodules, voice therapy should be recommended as the first choice. In this presentation, the role of STs in the treatment of laryngeal paralysis and vocal cord nodules is discussed together with their contribution to training of alaryngeal speech.

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The aim of laryngomicrosurgery of a vocal fold polyp is to normalize the vocal fold vibration by resecting the polyp. As the lesion of the vocal fold polyp is restricted to the superficial layer of the lamina propria of the vocal fold membrane histologically, the principle of the surgery should be not only to avoid leaving the lesion (under-surgery) but also to prevent impairment of the wound-healing (defect, scar formation, adhesion, etc.) by excessive removal of the normal membrane (over-surgery) . Restoration is difficult in cases of over-surgery, although possible by re-operation in casesof under-surgery.
Two different representative techniques were introduced. One involves use of forceps as presented by Hiroyuki Fukuda (Tokyo Voice Center, International University of Health and Walfare), and the other entails use of a scalpel as presented by Yasuo Hisa (Department of Otolaryngology, Kyoto Prefectural University of Medicine) . Although the principle of the surgery is the same, the operative technique is diametrically opposed.

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[in Japanese]

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Phonosurgery is one of the most suitable indication of day surgery. Under local anesthesia, 260 cases have undergone functional videoendoscopic laryngeal surgery at the Nishi Kobe Medical Center. The transoral approach was adopted for endoscopic monitoring of the vocal folds and voice during surgery. In 225 of these cases, the operative procedure was fully accomplished. In 40 laryngeal polyp cases, good vocal function was obtained postoperatively. Clinical Pathway process has been used for patients and medical staff members at the Day Surgery Unit of Kyoto University Hospital since 2000. Interviews of the patients were conducted by a nurse pre- and post-oper-atively. The most common complaint was limitation of phonation for 3 to 7 days after operation. In cases with unfavorable postoperative vocal function, medication and/or voice therapy were applied. Informed consent with explanation of the operative procedure and postoperative clinical course is most important for avoiding medical problems with patients. For the best phonosurgery treatment program, a voice care team should be organized to include a speech therapist, anesthesiologist, nurse, and others under the leadership of the otolaryngologist.

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