Speech is performed through movements involving the facial, oral, and pharyngolaryngeal muscles. The motor system consists of upper motor neurons, lower motor neurons, neuromuscular junctions, and muscles. This pathway is regulated by several systems such as basal ganglia circuits and the cerebellar system, which results in smooth motor function. When any pathway is damaged, dysarthria occurs. In terms of segmental diagnosis, dysarthria is classified into pyramidal, extrapyramidal, ataxic, and flaccid types. Pyramidal dysarthria is caused by upper motor neuron damage, which exhibits spastic paralysis. Extrapyramidal dysarthria is caused by basal ganglia damage, which manifests as hypokinetic or hyperkinetic disorders. Ataxic dysarthria is caused by cerebellar system damage. Flaccid dysarthria is caused by impairment to lower motor neurons, neuromuscular junctions, and muscular disorders.
We examined voice therapy strategies for difficult cases of vocal fold nodules and polyps. In the treatment of difficult cases of vocal fold nodules, it is important for laryngologists and voice therapists to manage properly the inhibitors of voice therapy and to check whether the nodules have not reached fibrosis. Also, voice therapists need to investigate more efficient and effective voice therapies. It is suitable to apply laryngomicrosurgery as the first line of treatment with vocal fold polyps. Voice therapy may also work effectively to modify vocal behavior in difficult cases at pre-operation and may lead to favorable functional recovery at post-operation. Laryngologists and voice therapists need to coordinate and cooperate in all cases.
We reviewed the literature on rehabilitation for patients with dysarthria and classified the various approaches adopted according to the framework of the International Classification of Functioning, Disability and Health (ICF). For the body function and impairment domain, approaches are implemented to improve motion range and speed, as well as strength of the speech organs and muscles needed for speech production. For the activity and disability domain, approaches are taken to utilize existing function and to maximize communication; improvement of speech intelligibility is also vital, and augmentative and alternative communication (AAC) is used for some cases. For the participation domain, approaches are conducted to promote the patient's social participation and to enhance motivation for speech treatment. In this manuscript, behavioral approaches conducted by speech-language-hearing therapists are presented mainly with regard to the systems and organs of speech production. In addition, based on systematic review reports we discuss what we need to do further in order to improve QOL in patients with dysarthria.
Cochlear implants for children are steadily increasing as an outgrowth of the spread of newborn hearing screening and the effectiveness of their usage. As a result, cochlear implants have come to be used even in various difficult cases, especially in patients with labyrinth morphological abnormalities.
We examined five cases in which cochlear implants were used in our department in patients with internal canal stenosis (ICS). In all cases, it was necessary to change parameters and increase the quantity of the electric charge. Sound perception was achieved in all cases, but in many cases a long period of time was required for a reaction to appear, the longest duration being four-and-a-half years. Because speech hearing was poor, we used total communication in all cases.
If there was even a slight preoperative improvement in hearing reaction, we considered this as an indication for cochlear implant.
In the case of cochlear implant surgery for children with ICS, we believe adequate conformed consent preoperatively is necessary in view of the lengthy amount of time required to achieve a reaction, the possibility of a poor reaction, and inherent limits to the degree of conversation achievable via cochlear implant. We also believe appropriate mapping needs to be performed as early as possible after surgery.
This study investigated the vocabulary characteristics in Japanese children with delayed expressive language, who are labeled late talkers (LTs), by comparing the vocabularies of LTs at 24 months with age-matched (AM) and vocabulary-matched (VM) peers. Using the Japanese version of Communicative Development Inventories, children's vocabularies were classified into vocabulary categories (e.g., animals, vehicles, toys) and semantic categories (e.g., common nouns, predicates, social words, onomatopoeia). The results indicated that the vocabulary categories of LTs closely resembled those of their VM peers. The results of the semantic categories revealed that the proportions of common nouns and predicates are higher in AM peers, while those of social words and onomatopoeia are higher in the LT and VM peers. Moreover, the vocabularies of AM peers showed a larger proportion of common nouns than the other categories. These findings indicate that Japanese children who are LTs acquire vocabularies in similar patterns as their typical peers, although their acquisition is delayed.
MDVP is widely utilized for acoustic analysis but rather expensive. On the other hand, Praat is a software available for free download. In this study, we analyzed 60 normal voice samples (30 male and 30 female) and 73 pathological voice samples (41 male and 32 female) of the sustained vowel /a/ using both MDVP and Praat. Each sample was digitized and a stable portion approximately 1 second in duration was stored for analysis. These were fed to the two softwares to measure fundamental frequency (F0), jitter, shimmer, and harmonics-to-noise ratio (HNR). The authors compared the measurements of these parameters as derived by the two softwares. All parameters showed a linear correlation between respective measurements. F0 showed agreement between the measurements. Jitter as measured by Praat was significantly smaller than that measured by MDVP, and HNR as measured by Praat showed a significantly greater value than that measured by MDVP. No significant difference was found between shimmer measurements. These results suggested that normal values of acoustic parameters should be examined on the basis of the software used by each laboratory. Furthermore, it is recommended that whenever acoustic measurements are presented, the environment of the voice recording and analysis, including the specific facilities for voice recording and software utilized, should be clearly indicated.
There is no clear definition of functional dysphonia even among clinicians. Causes may vary from inadequate phonation to emotional distress. In the present paper, we investigated demographic data regarding the onset of functional dysphonia among 65 patients who visited our clinic. All cases were diagnosed as muscular tension dysphonia. We examined the time of onset, perceived cause of the onset, life events within half a year before and after the onset, and the State-Trait Anxiety Inventory (STAI). The results were compared with those of a control group consisting of 32 patients with organic problems in vocal cords. The results were as follows: 1) the age of onset was between 20 and 29 in half of the patients in each group; 2) more than half of the patients in each group exhibited a high anxiety level (IV or V) in the STAI; 3) the subject group showed higher perceived distress than the control group. However, 32% of the subject group reported no awareness of any cause behind the onset, and 64% of those experienced a life event inducing emotional distress within half a year before or after the onset. These findings suggest that emotional distress may influence the onset of muscular tension dysphonia in functional dysphonia whether patients are aware or not.
The purpose of this study was to examine the effect of letter properties on katakana reading and writing acquisition. To clarify this issue, we examined the relationship between letter property and rank of katakana reading and writing accuracy in 5-year-old toddlers. The ranks of katakana reading and writing accuracy were obtained from the dataset of the National Institute of Japanese Language, and as parameters we included letter frequency in picture books, order of appearance in the katakana fifty-sound table, visual complexity of letters, and hiragana reading and writing accuracy rank. For reading, we found weak but significant correlations with letter frequency and hiragana reading and writing rank, implying that katakana letters of high frequency tend to be easily acquired. In addition, katakana writing showed a weak correlation with letter frequency and order in the fifty-sound table. To reveal which letter properties significantly predict katakana reading and writing accuracy, we conducted additional analysis using ordered logistic regression analysis. Letter frequency significantly predicted katakana reading accuracy; however, we found no letter frequency that predicted katakana writing accuracy. In addition, correlation and model accuracy were lower than for hiragana reading/writing obtained in previous research. These results imply that exposure to letters in picture books plays an important role in katakana reading acquisition; however, the contribution is smaller than in the case of hiragana reading.