This paper investigates the grammatical knowledge of 3 Japanese children, aged 9; 7-13; 3, with specific language impairment (SLI) concerning the grammatical Case, namely nominative, accusative and dative Case. In the investigation, an elicited production task was used. The obtained results are compared with data from 5 age-matched children with normal language development (NLD) . The overall results show that performance of the children with SLI was poorer than that of the children with NLD in relation to Case assignment. Moreover, the findings also demonstrated that their performance with scrambled sentences differed most substantially. The implications of their atypical performance with Case assignment are discussed in terms of compensatory strategies supported by declarative memory.

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First, we presented an overview of the definition, evaluation and diagnostic methods, and the cognitive hypothesis and biological base behind developmental dyslexia. Second, we discussed the cognitive function of developmental dyslexia in the Japanese language environment, from two aspects: one theoretical, the other practical through case and cross-sectional studies. Our findings suggested that the phonological hypothesis which serves as the cognitive hypothesis of developmental dyslexia in English-speaking countries might not apply to the Japanese environment. Rather, in addition to phonological disorder, in the case of Japanese a visual information-processing disorder may also play an important role.

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We investigated the sensitivity of the Standardized Comprehension Test of Abstract Words (SCTAW) to detect developmental disorders of spoken language understanding, a subtype of SLI (specific language impairment) . In SCTAW, the subject is auditorily given an abstract target word (e.g., “kindness”) and asked to choose the picture corresponding to the target word from among six pictures (two semantic, two phonological and one unrelated foil, in addition to the target picture) . We applied SCTAW to a total of 1, 477 normal primary and junior high school students, as well as 445 normal adults. Although no significant difference in the number of correct answers was observed between the normal adults and the junior high school students, performance was significantly lower in the primary school children, even sixth graders, than in the normal adults.
The primary school children made more phonological than semantic errors compared to the normal adults. We conducted SCTAW on six children with developmental disorders of spoken language understanding. Their scores were more than 2SD below the mean score of their age-matched normal children. The findings suggest that SCTAW is sufficiently sensitive to detect developmental disorders of spoken language understanding in children.

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The purpose of this research was to learn whether irradiation of normal vocal cords affects their sound. The subject was a patient who received an average 67.6 Gy irradiation of the larynx for cancer near the larynx, as opposed to glottic cancer. We performed acoustic analysis, phonogram and stroboscopy, and determined maximum phonation time (MPT) . These inspections were conducted before radiotherapy, and at 1, 3, 6, 12 and 24 months after radiotherapy. Stroboscope inspection served to estimate the membrane wave motion of the vocal cords. The result was that all values worsened one month after radiotherapy; however, within 6 to 12 months after radiotherapy, all values returned to their state before irradiation. For the foregoing reason, it appears that with a common dosage the influence of irradiation on normal vocal cords is temporary.

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What should be the working relationship between laryngologists and speech language pathologists?
An explosion in diagnosis and treatment options in laryngology, logopedics and phoniatrics has become available. In part this is due to technology, but an even greater contribution has been due to application of multidisciplinary approach to the patient with voice and swallows complaints. The multi-disciplinary clinic approach to patients with voice and swallowing disorders brings in contributions from basic scientists, speech language pathologists and laryngologists. In their own right each specialty brings contributions based on professional training and clinical pathways to care for voice and swallow disorders. In aggregate, the contribution to team care of the patient is greater than the separate parts. We will explore in this paper some of the added benefits to care of professional and non-professional voice users by such a team approach.
While the physician (phonosurgeons or phoniatricians) is primarily the medical specialist invested with the authority and responsibility for medical care of the patient with voice and swallow complaints, they also carry the mandate from society for co-ordination of care once the medical issues are no longer relevant. In this regard, management of functional deficits in voice and swallow are to be championed primarily by someone with medical training (i.e., physician) . A physician must be involved in the therapy and rehabilitation of voice and swallow to provide a comprehensive approach to achieve optimum results. The model used in laryngology and voice care specialty is modeled after other established relationships between disciplines such as orthopedic surgery and physical therapy and pulmonary medicine and respiratory therapy. Speech language patholo-gists interested in providing voice therapy should achieve: a) defined professional stan-dards, b) understand their scope of practice, and c) demonstrated area of clinical expertise. Patient safety, increased efficiency, and value to patient care must be demonstrated. Training must be based on systems practice using didactic and clinical patient based teaching.
In our voice center we use speech language therapists extensively in a variety of ways in counseling and direct care. Our clinicians are primarily responsible for a) objective and perceptual evaluation of promontory function before and after interventional treatment, b) pre-operative counseling in pre and post operative voice use surrounding phono-surgery, management of functionally based benign lesions of the larynx (nodules, contact granuloma, muscle tension dysphonia, presbyphonia, puberphonia, and voice enhancement), c) evaluation and management of functional voice disorders such as psychogenic dysphonia, dysphonia for secondary gain and conversion voice disorders and d) optimizing the power, source, and filter system to improve phonatory function by voice rehabilitation. The swallow therapists' primary role is to do functional assessment of swallow, assist in performing fiberoptic evaluation of swallow function, administer modified barium swallow, perform swallow therapy and alaryngeal speech, and evaluate for electro stimulation. The physician is the primary diagnostician, medical and surgical treatment specialist and co-coordinator of overall care while the therapist functions as specialists in rehabilitation, diagnosis of functional deficit, and treatment of functional loss.
The optimum model of care for patients with voice and swallow disorders is a multi-disciplinary approach that addresses both functional and medical aspects of care.

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X-ray stroboscopy is stroboscopy by X-ray pulse radiated from an angiography system which can be externally triggered by a trigger pulse in order to radiate the strobe light of a laryngostroboscope. Digital-subtraction X-ray stroboscopy is X-ray stroboscopy which digitally subtracts the image of the cervical vertebrae superimposed over the laryngeal image from the image obtained by X-ray stroboscopy.
The underlying principle of vocal fold vibration is a wave of the mucous membrane of the vocal fold traveling continuously from the internal-lower surface toward the external-upper surface of the vocal fold.
The crest of the traveling wave travels from the internal-lower surface toward the external-upper surface of the vocal fold during the opening phase, and divides into the two waves during the closing phase. The one continues to travel laterally as it attenuates, and the other returns to the opposite direction down ward and in ward.

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Adequate matching for video recording can be obtained by a rigid telescope in combination with a laryngostroboscope by properly adjusting the white balance for the strobe light connected to a CCD video camera and adapter lens with the proper magnification rate.
Care must be exercised in the adjustment of the white balance of the strobe light and the positioning of the light guide from the strobe light source because electronic video-endoscope manufacturers do not make laryngostroboescopes and they assume use of their own brand of light source, and the color temperature and brightness as well as the diameter of the hole for the light guide insertion are different from those of the strobe light.
Although the image quality obtained by a 1/3” type color 3CCD used in combination with a rigid telescope is superior to that of the extremely small color 1CCD located on the tip of today's video-electronic endoscopes, video-electronic endoscopes offer the advantage of providing close-up images by more closely approaching the vocal fold than a rigid telescope. It is therefore important to use both endoscopes while making best use of the characteristics of each.

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Aterocollagen is a heteroprotein originated from calf skin. Use of this material in Intracordal injections has disadvantages in the form of allergic reaction and a high absorption rate; however, it is easy to handle and is suitable for day surgery applying laryngeal endoscopy under local anesthesia. Given adequate anesthesia of the larynx, this method can be implemented in almost all cases of vocal fold atrophy.
The results of aterocollagen Intracordal injection are favorable for atrophy with vocal fold paralysis, especially in median vocal fold fixation. For other atrophic changes including the mucosal layer, voice improvement may be less noticeable. Because of the high absorption rate of the material, several aterocollagen injections are necessary in order to achieve stable effect.
Recently, elderly patients are on the increase in our voice clinic. They complain of hoarseness mainly caused by atrophic changes of the vocal folds. To treat cases of this nature, we hope for development of material optimally suitable for intracordal injections as well as wider adoption of this technique to treat these disorders.

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The purpose of this study was to evaluate differences in vocal function resulting from autologous fat injection laryngoplasty and framework surgery in patients with unilateral vocal fold paralysis. Fifty-seven patients received fat injection laryngoplasty while 45 patients underwent framework surgery (19 thyroplasty, 17 arytenoid adduction surgery, 9 thyroplasty+arytenoid adduction surgery) . Vocal function before and after both surgeries was examined by MPT, MFRc, PPQ, APQ and NNEa. Vocal function was evaluated before and after surgery using a paired t-test in both groups. Post-operative vocal function was monitored between 1 and 72 months after the surgery.The median period for voice examination after fat injection was 3 years and after framework surgery, 1 year. Statistical analysis of vocal function (fat injection vs.framework) was performed before and after the t-test.
The results showed that in both groups all parameters improved significantly after surgery as compared to before surgery. However, NIFRc, PPQ, APQ and NNEa were significantly better before fat injection than before framework surgery. Also, all parameters improved significantly after fat injection in comparison to after framework surgery. Sufficient vocal function after fat injection is thought to be attributable to harvesting of the fat cells without damage and placement of a surrounding meshwork of fine reticular fibers, possibly enabling improvement of the glottal gap.

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Calcium phosphate bone paste (BIOPEX^®) is a material for medical use that has a paste form when injected but changes with time to hydroxyapatite. BIOPEX^® offers many advantages as a material for injection into the vocal fold: it induces only slight foreign-material reactions; material absorption is minimal over a long period; preparation is easy; injection is non-invasive, safe and cosmetically excellent; and its usage allows phonation, eating and discharge one day after operation. A basic indication for this operative technique is unilateral vocal fold paralysis. The material is injected into a site between the thyroarytenoid muscle and thyroid cartilage or into the thyroarytenoid muscle. In patients with a large posterior glottal gap, the material is also injected into the lateral side of the vocal process. In the 3.5 years since the initiation of this technique, we have treated 38 patients and observed favorable clinical courses, without BIOPEX^® absorption, on CT images of all patients. We consider this operative technique, which aims at medial shift of the vocal fold by injection of a sclerotic agent into the lateral side of the vocal fold, as “type 1 thyroplasty performed from the pharyngeal lumen.”

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