Auditory processing disorder (APD) is a disease that demonstrates hearing difficulties even though the process of central auditory perception shows no peripheral hearing impairment. The concept of APD is still sometimes confused in clinical practice areas such as diagnosis and intervention. A girl aged 11 years and 8 months was referred to our hospital complaining of hearing difficulty under noisy circumstances. SPECT imaging revealed local blood flow insufficiencies in the bilateral temporal lobes, and her monosyllable and lexical perception scores on the dichotic listening test (DLT) were significantly low. Severe difficulties in the competitive sound test (CST) were also experienced at S/N 0 dB. Precise diagnosis of APD requires combinations of multiple diagnostic methods including imaging, audiological tests and neuropsychological tests. Optimized tests for the Japanese language are indispensable for diagnosis of and interventions for APD among Japanese-language users.

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We investigated the effectiveness of feeding and swallowing therapy, and analyzed factors that potentially influence its effectiveness. The subjects were 30 disuse syndrome patients with dysphagia who received treatment at Tonami General Hospital during the three-year period between April 2004 and March 2007. The patients underwent therapy for muscular strength and swallowing function improvement.
Therapeutic value was generally favorable: 23 cases achieved ingestion, and only 7 cases were in a fasting state. Although all patients were fasting before therapy, 23 of the 30 patients (76.7%) began to feed after therapy.
We analyzed nine factors for their potential influence on effectiveness: sex, age, period from onset or operation to beginning of therapy, therapy period, presence of dementia, bodily function before admission, bodily function on discharge, change in bodily function between admission and discharge, and level of dry swallowing. Only the level of dry swallowing was found to influence effectiveness (p=0.015), because more than half of the patients without dry swallowing were unable to feed at all. It is thus useful to introduce therapy before dry swallowing is lost.

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A 23-year-old female patient with microglossia and micrognathia was report-ed with respect to articulation. The case was treated by gradual expansion of the mandibular dental arch followed by double-jaw orthognathic surgery.
1. As before treatment, /t, d, n, r/, sounds were distorted and almost like palatalized articulation; they were made with the tongue and the posterior part of the palate. Her /s, dz, is/, sounds were distorted and almost like /f, v, pf /, in this instance made with the upper teeth and the lower lip. Both before and after treatment, no changes were seen in articulation place or manner.
2. Single-mora intelligibility had declined at 6 months after surgery. However, at 9 months after surgery it was improved to a level as good as that before the total treatment.
3. Sentence intelligibility had declined at 6 months after surgery. However, at 1 year and 3 months after surgery it was improved to a level as good as that before the total treatment. The tendency of mishearing was also the same as before the total treatment.
4. Masticatory function had also improved. In this treatment, improvement was achieved in both occlusion and mastication without any damage in articulatory function.

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We present the case of a patient with dysphagia after dyspnea and tracheostomy complicated by neuro-psychological disorders such as memory and understanding dysfunctions. The patient was a male aged sixty-three with a history of cardiac myopathy, asthma and hepatic cirrhosis. He became afflicted with hypoxic brain due to pneumonia and was tracheostomized, and after the operation he presented with dysphagia. Three months later he was admitted to our facilities for treatment of the dysphagia. Pharyngo-esophagography at admission showed light aspiration when the larynx was elevated, and neuro-psychological examination revealed dysfunctions in memory and understanding. Indirect therapy was conducted to improve fatigability and expectoration of his hypopharynx. However, the patient was unable to understand the importance of indirect therapy and instead insisted on oral ingestion. Thus, direct therapy was reluctantly conducted with careful observation during meals. Although he had fever due to pneumonia twice during the direct therapy, he ultimately succeeded in removing the gastric tube. We found it is important to evaluate both physical and neuro-psychological functions before beginning rehabilitation. Therefore, we should try to make patients understand what is necessary for therapy, even if they have memory and understanding disabilities.

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