The neuropathology of cerebral cortical damage in the perisylvian region is described, and a discussion is presented on plasticity in congenital and acquired brain lesions. Cortical malformations are diagnosed early by brain imagings and genetic examinations, and their localization and extent of influence on mild or profound neurological symptoms vary widely. Functional brain imagings and molecular neuropathology demonstrate compensatory reconstruction of cerebral functions and plasticity for brain damage. These findings should be utilized for the development of therapeutic, rehabilitational and educational treatments. In Down syndrome children and adults, neuronal plasticity and compensatory activation are found over long durations, and therefore long-term intervention is important.
An overview is presented of a study of deglutition, electroencephalographic arousal and respiratory phase patterns during sleep. During sleep, swallowing was infrequent and absent for long periods. The mean number of swallows per hour during the total sleep time was 2.4±1.0. The mean longest deglutition-free period was 68.8 minutes. Most deglutition occurred in association with spontaneous electroencephalographic arousal. Deglutition was related to the sleep stage. The deeper the sleep stage, the lower the mean deglutition frequency. The deeper the sleep stage, the lower the mean arousal frequency, and the lower the mean ratio of arousal with deglutition to arousal. Approximately 60% of swallows were followed by arrested breathing and approximately 25% by expiration. Clearance of the pharynx and esophagus by sleep-related deglutition was reduced. However, the pharyngeal stage of sleep-related deglutition was almost always followed by arrested breathing and expiration, reducing the risk of aspiration. Deglutition was infrequent and displayed a unique pattern in patients with obstructive sleep apnea syndrome during sleep. Most deglutition occurred in association with respiratory electroencephalographic arousal after apnea or hypopnea. Approximately 70% of swallows were followed by inspiration. CPAP therapy improves not only apnea-hypopnea during sleep and sleep structure but also sleep-related deglutition, especially respiratory phase patterns associated with deglutition.
The purpose of this article is to evaluate the effectiveness of voice therapy for vocal fold polyp. Among 20 patients, 18 had chronic vocal abuse. In pre and post-voice therapy, G, R scale significantly improved and subjective symptoms improved in 90% of the patients. As to polyp size, the polyp disappeared in 5 patients, was reduced in 6 patients, and was unchanged in 9 patients. Patients with low perceptual score tended to demonstrate polyp disappearance or reduction, and this was the tendency also with edematous polyps around which a mucosal wave was detected. These results suggest that voice therapy might be tried before an operation in patients having chronic vocal abuse, low perceptual score, or an edematous polyp with a mucosal wave.
Objective: Glottal closure and symmetrical thyroarytenoid stiffness are two important functional characteristics of normal phonatory configuration. In the treatment of unilateral vocal fold paralysis, vocal fold adduction improves closure, facilitating entrainment of both vocal folds for improved phonation. In addition, reinnervation is purported to maintain vocal fold bulk and stiffness. A combination of adduction and reinnervation would therefore be expected to improve vocal function better than adduction alone or a combination of adduction with medialization. Methods: A retrospective review was undertaken of pre- and postoperative voice analysis in all patients who underwent arytenoid adduction alone (adduction group) or arytenoid adduction combined with type I thyroplasty (adduction combined with thyroplasty group) or arytenoid adduction combined with ansa cervicalis to recurrent laryngeal nerve anastomosis (adduction combined with ansa group) between September 1999 and June 2008 for the treatment of unilateral vocal cord paralysis. Aerodynamic and acoustic analyses were performed preoperatively and at intervals of 1, 6, and 12 months postoperatively. Maximum phonation time (MPT) and mean airflow rate during easy phonation (MFR) were measured. Jitter, shimmer, harmonics-to-noise ratio and voice profile were also measured. Results: There were 5 patients in the adduction group, 10 in the adduction combined with thyroplasty group and 10 in the adduction combined with ansa group. Statistically significant improvements in MPT and MFR were observed. In the adduction with thyroplasty group and the ansa group, all parameters of acoustic analysis were significantly improved after the surgery. In the adduction group, no significant change was observed in acoustic analysis at 6 and 12 months postoperatively. Conclusions: The potential benefits of improved phonatory function following type I thyroplasty or ansa cervicalis to recurrent laryngeal nerve anastomosis with arytenoid adduction were observed.
From April 2006 to April 2008, 65 children who were selected for further examination at the time of their health checkup at age 3 visited the Fukushima Rehabilitation Center for Children. Follow-up examination led to a new diagnosis of autism in 5 children, HFPDD (high-functioning pervasive developmental disorder) in 2, MR (mental retardation) in 4, dysarthria in 11, and hearing loss in 5. Further follow-up was performed in these cases. Treatment of exudative otitis media in 3 of the 5 children with hearing loss improved their language development delay and dysarthria. In 1 child with moderate conductive hearing loss, guidance on the use of a hearing aid and listening ability training were begun, resulting in good language development. In 1 child with unilateral sensorineural hearing loss, hearing deterioration in the good ear was detected and a hearing aid fitted. At 4 years and 6 months, 1 child with dysarthria showed natural improvement whereas 4 others began dysarthria training. The remaining 6 children were not followed up. In cases of developmental disability and MR, treatment began with nursing guidance, followed by guidance for kindergarten and introductions to child day-care services, and an increase in IQ was observed in most cases.
We analyzed errors in writing to dictation of Kanji words in 708 children with normal development and 21 children with developmental dyslexia using the Screening Test of Reading and Writing for Japanese Primary School Children (STRAW). The 21 children with dyslexia had disorders in both phonological and visual information processing. As a result, the dyslexic group showed more no-responses than the normal group, and it had a tendency to write morphologically different letters. The children with developmental dyslexia showed error patterns dissimilar to those of the normal group, commonly leaving a wide space between each component of Kanji characters and writing letters at a slant. Furthermore, in the dyslexic group there were significant correlations between correct rate and imageability of words, and number of strokes. These results suggest that deficit of visual information processing is likely to affect the Kanji writing of children with dyslexia.
We conducted reading tasks in Japanese children with developmental dyslexia under controlled experimental conditions in order to reveal the effect of the colour factor, using coloured overlays, on reading speed. We evaluated the duration time of reading tasks of hiragana words, katakana words, hiragana non-words, katakana non-words, and sentences in Japanese-speaking children (18 normal, 21 with developmental dyslexia). The duration time of the reading tasks was measured with and without coloured overlays and neutral density overlays. In this study, we controlled the experimental conditions with regard to luminance, distance between participant and stimuli, word attributes, instruction, order effect, and placebo effect. All participants did not show a significant difference in reading duration under the three conditions. Our results suggest that changing the background colour using coloured overlays does not improve reading speed in Japanese children with developmental dyslexia.
Two hundred thirty-one preschool children received language disorder screening in school medical examinations. Pre-screening by speech-language-hearing-therapists found 47 children were suspected to have language disorders, and medical examination by an otolaryngologist led to a diagnosis of language disorder in 31 children. Among children not suspected of having a language disorder during pre-screening, no language disorder was diagnosed. This finding suggests that screening by a speech-language-hearing-therapist before a medical examination is helpful for otolaryngologists to determine language-impaired preschool children. Fourteen language-impaired preschool children found during language disorder screening received a detailed examination, and all except one required language training. This finding suggests that language disorder screening performed properly gives unidentified language-impaired children the opportunity to receive language training.