The clinical aspects of speech therapy for dysphasia caused by cerebral vascular accident are broad and encompass the acute, convalescence and chronic stages. For each stage therapy has its own focus and aims, but foremost are the preservation and improvement of function based on suitable checks. For patients in the acute stage, the approach consists not only of avoiding aspiration pneumonia but also of helping in the recovery of consciousness with mental rehabilitation, in order to provide the patient with the necessary understanding and ability to facilitate recovery. The convalescence stage is the main stage of rehabilitation. Many important therapies exist for this stage, and numerous speech therapists have hospital affiliations to treat this stage. Nowadays, it is not rare to meet patients who have changeable conditions of consciousness, and we must pay attention to the patient’s condition especially early in the therapy. For seriously affected patients who cannot be fed orally, we initially use indirect therapy, followed by direct therapy in tandem with their recovery. For patients in the chronic stage, the role of speech therapists is to improve the patient’s condition and to support the patient and the patient’s family by ensuring a better quality of life. For this stage, today attention is focusing on improving oral function and nutrition, and cooperation with rehabilitation professionals is desirable. This paper first outlines the speech therapist’s role in each of the abovementioned stages and then presents an actual case study of a patient in the recovery stage.
Singers often do not show any noticeable vocal problem during ordinary voice evaluations at an ENT clinic, mainly because the tests administered are usually performed to evaluate simple and easy phonation. Singers, however, in general use their voice under more effortful conditions during their performances, and therefore more appropriate methods are necessary for evaluating the singing voice of singers. The present paper proposes the use of two types of voice-map for clinical evaluation of a singing voice. In addition, a videoendoscopic surgical technique using a newly designed knife is introduced. The first voice-map is Voice-Map E-L, comparing flow rate during phonation as an indication of expiratory function with voice pitch as an indication of the pattern of laryngeal control. The second is Voice-Map L-V, comparing the estimated vocal tract configuration with laryngeal control in terms of degree of glottal closure estimated by electroglottography (EGG). The use of these two maps appeared to be effective for obtaining an objective evaluation of singers’ vocal abilities. The second part of the paper describes a videoendoscopic surgery technique using a newly designed surgical knife and its usefulness for day surgery to treat small benign lesions of the vocal fold.
Otolaryngologists should take part in the medical treatment of swallowing disorders in view of their expertise as a specialist. Also, ENT clinics should consider their intervention and role in the medical treatment of swallowing disorders as a part of community health care (regional medicine). One approach is for the ENT clinic to treat swallowing disorder patients in cooperation with other hospitals or other departments in the field of medical care. Otolaryngologists should actively take part in applying their expertise in community health care for swallowing disorders.
Auditory signals coded by a hearing prosthesis (hearing aid or cochlear implant) are non-physiologic and contain less acoustic information. Higher brain function in patients with sensori-neural hearing loss is reorganized to perceive these degraded signals. Situations under which accurate auditory perception is difficult bring about intervention of visual information processing, and successful auditory perception is achieved by integrating multiple sensory inputs. Conversely, there are situations in which disorders in higher order brain function affect the efficacy of prosthetic hearing. Cases with brain injury and congenital cytomegalovirus infection are presented to demonstrate such situations. Understanding the relationships between hearing impairment, prosthetic hearing and higher brain function is important for appropriate treatment planning and selection of communication mode in hearing-impaired patients.
In order to facilitate the acquisition of language in children with speech and language disorders, it is important to obtain basic findings on the language acquisition of typically developing children. The hypothesis has been proposed that the nominative case is licensed by the functional category "T" in Japanese. It postulates that the case marker "ga" is not produced before tense morphemes appear. However, there has been little empirical evidence to support this postulation. Moreover, it is a controversial question what is an indicator of the realization of "T" in Japanese. In this study, we focused on the appearance of the tense morphemes "ru" and "ta" and the case marker "ga". We analyzed the longitudinal speech data of seven typically developing children aged 1 to 2. The results were as follows. In all children, the case marker "ga" appeared after production of both of the tense morphemes "ru" and "ta". This finding suggests that the appearance of both "ru" and "ta" is an indicator of the realization of "T" in Japanese, and therefore, as the hypothesis above postulated, the case marker "ga" is not produced before tense morphemes appear.
This study investigated the development of comprehension of spatial vocabularies and verbs during the early language acquisition period of a child with Down syndrome. We collected data on comprehension of the spatial vocabularies "in", "on", "here", "there" and "under" in the daily life of the child from 2 years 2 months old to 3 years 3 months old. After comprehension of verbs such as "walk", "get", "give", "eat", "bring" and "carry", the child began to understand the spatial vocabularies. Comprehension of the spatial preposition "in" developed parallel with that of the verbs "sit", "show" and "drop". Comprehension of "here" was parallel with that of the verb "jump". Regarding "there", the verbs "push" and "take" were understood in the same period. The spatial preposition "under"was comprehended in the period of understanding more verbs. These findings suggested that early comprehension of spatial vocabularies in this child with Down syndrome developed in daily activities such as movements and exercises conducted under parental verbal command.
The optimal care of professional singers with a vocal emergency should be provided in those institutions where a full clinical voice evaluation and laryngeal examination including videostroboscopy can be performed. The purpose of this article is to design a guide for the treatment of professional singers with acute vocal problems. At the same time, we reported and examined statistically our cases suffering from voice disorder due to acute inflammation from January through December 2010 at Tokyo Voice Center. Medication, voice therapy and nebulizer are the essential treatment for professional singers. Appropriate antibiotics should be prescribed if bacterial infection is clinically suspected. For vocal fold edema, steroids can be used to overcome the edema effectively and facilitate performances in acute settings. Among several methods for administering steroids, intravenous steroids, oral steroids or inhaled steroids should be considered, depending on the severity of the edema. A total of 176 patients were involved in this study and 56 (31.8%) were professional singers. Inhaled steroids were prescribed for 37 singers (66.1%), intravenous steroids for 8 (14.3%) and oral steroids for 7 (12.5%). Stroboscopic findings were considered to be very important, and severe vocal fold edema should be treated with intravenous steroids first, followed by oral steroids.
Hormonal dysphonia is induced by hormonal therapy using virilizing agents. A woman 48 years of age was given mixed hormones of estragiol and testosterone (Dihormon depot®) for dysmenorrhea at age 17. She immediately developed dysphonia and her habitual pitch lowered. When she was first seen at age 18, the pitch was B3. Estimating from the habitual pitch of her identical twin who had not been given any drugs, the original pitch was thought to be D4. Her habitual pitch has thus lowered by 3 semitones. She trained her voice using a piano at her home but without any effect, and her voice never recovered. The pathology and care for hormonal dysphonia were discussed.
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