We present a Japanese patient with aphasia who exhibited lexicalization errors in Kana nonword reading. The patient noticed her lexicalization errors by herself and she could correct them through character-by-character reading; nevertheless, when she tried to read whole words again, she showed lexicalization errors again. In addition to systematic language assessment, we administered several tasks to examine background factors underlying her reading disorder. As a result, she was able to read Kana words correctly, but her responses were delayed in a serial Kana character reading task. In addition, correct percentages of visual lexical decision and mora blending/deletion tasks declined. Based on these results, we analyzed her reading disorder on the basis of the dual-route cascaded model (Coltheart et al., 2001). From her delayed responses in serial Kana character reading and her poor performance in mora blending/deletion tasks, we concluded that her nonlexical character-sound conversion was insufficient. Her lexicalization errors in Kana nonwords were thought to be related to activation of the orthographic lexicon and phonological lexicon in the lexical route, which were relatively spared compared with her nonlexical character-sound conversion system. Concerning her good performance in character-by-character reading, this processing made nonlexical character-sound conversion sufficient to avoid lexicalization errors, despite its inefficiency. This outcome suggests that when the patient tried to read nonword scripts again, the relatively spared lexical route incorrectly activated real word representation and this led to a second lexicalization, the same process as in the first lexicalization.

Objective: To determine which of two Japanese texts of "The North Wind and the Sun" is suitable for cepstral analysis.
Participants: Forty-five healthy Japanese native speakers (21 men and 24 women, mean age 21.5 years, SD 2.0 years).
Method: Two types of Japanese texts of “The North Wind and the Sun” (Appendix 1 and 2) were read aloud twice at random and recorded. All recorded voice samples were subjected to acoustic analysis using the Analysis of Dysphonia in Speech and Voice (ADSV) program (KayPENTAX) for cepstral peak prominence (CPP), Cepstral Spectral Index of Dysphonia (CSID), low/high spectral ratio (L/H ratio) and duration.
Results: The intra-rater reliability, inter-rater reliability and intraday reproducibility for all parameters in both Japanese texts showed a high correlation exceeding 0.9.
Comparing the mean values of all parameters in the first trial of the two texts showed significant differences between the two texts. The measured values of CPP and L/H ratio were significantly larger in the second text (Appendix 2), while CSID was significantly smaller. Furthermore, there was a moderate positive correlation between CPP, L/H ratio and rate of the voiced sound appearance in the second text (Appendix 2).
Conclusion: We concluded that the second text (Appendix 2), which has a higher voiced sound appearance rate than the first text (Appendix 1), is more suitable for cepstral analysis.

We developed a shortened version of Vocal Function Exercises (VFE) which consists only of vocal continuous practice at specific heights and vocal continuous practice, and we examined its efficacy in healthy people. A total of 29 normal female adults were divided into 3 groups: continuous vocalization group, chest voice group, and falsetto group; and voice training was undertaken for 10 days. Before and after the training, we examined maximum phonation time (MPT), aerodynamics, physiological voice range, acoustics and subjective evaluation. The results showed that in the chest voice group, extension of MPT, expansion of physiological voice range, and decrease of amplitude perturbation quotient (APQ) were recognized to a significant degree. From this study we concluded that our newly devised shortened version of VFE could enable a shorter training period and shows promising efficacy as a modality of voice therapy.

We investigated vocal functions one year after the completion of Vocal Function Exercises (VFE) for presbyphonia. The study included 5 patients -2 males and 3 females- who underwent VFE for difficulty in vocalization at the Department of Otolaryngology-Head and Neck Surgery of Kobe University Hospital between February 2014 and August 2016. Average age was 72.2 years old, ranging from 68 to 78. Certain levels of improvement were observed at the completion of VFE, and although improved vocal functions continued after one year in some cases, in others they failed to continue. These results suggest difficulty in maintaining vocal functions on a long-term basis, possibly due to physical changes and functional decline due to aging. In order to maintain the efficacy of VFE on presbyphonia over the long term, we postulate it is necessary to continue the base program for a longer period of time and encourage more vocal opportunities.

This study investigates the qualitative characteristics of naming deficit in two chronic cases of amnestic anomia caused by lesion in the left temporal lobe. One case involved a 53-year-old right-handed woman who had been diagnosed with glioma of the left temporal lobe and had the anterior left temporal lobe excised. The second case was a 70-year-old right-handed woman who had suffered a cerebral hemorrhage in the left temporal-parietal lobe. Both patients exhibited positive auditory perception. Although speech was fluent, difficulty in recalling words (anomic aphasia) was observed. The following characteristic symptoms of naming deficit common to both cases were observed: (1) lack of familiarity with words affected by naming deficit (recognition disorder), (2) induction of another word with an identical initial sound due to phonemic cuing, and (3) poor phonemic cuing effect. In terms of lexical comprehension, both patients exhibited decreased abilities in language and language-related tasks such as audible word comprehension or similarity judgment of nouns. These findings suggest the possibility that a deficit in lexical comprehension may cause anomia.

We conducted a questionnaire survey on postoperative effects on the socio-economic status of 243 subjects who received total laryngectomy between January 2003 and June 2018 at the University of Yamanashi Hospital and other hospitals. A total of 140 responses became available for statistical analysis. Almost all the patients use tracheoesophageal (TE) shunt speech after laryngectomy. Ninety percent of the subjects have experienced inconveniences and speak less frequently in postoperative daily life. About half of the subjects changed, rotated or lost (retired from) their job and their income decreased, clearly indicating that they were put in a disadvantageous position socio-economically. These results are similar to those found by a similar survey Hirano et al. conducted forty years ago which targeted laryngectomized subjects who used esophageal speech or artificial larynx for voice restoration. In the future, we need to continue to focus on postoperative effects on the socio-economic status of laryngectomized subjects and devote attention to improving their postoperative quality of life, in addition to conducting research on new therapies and voice restoration techniques.

This study investigated the impact of voice therapy on vocal fold nodules with long-term symptoms before therapeutic intervention. Ten patients who underwent voice therapy for vocal fold nodules with over 6 months of symptomatic durations were incorporated. All patients were female, and the mean symptomatic duration was 28.3±20.6 months. Vocal hygiene instruction, laryngeal manual therapy, semi-occluded vocal tract exercises, and Vocal Function Exercises were utilized as the therapeutic options of voice therapy. Significant improvements in maximum phonation time, jitter, shimmer, and Voice Handicap Index (VHI) were observed after voice therapy. Furthermore, disappearance or size reduction of the nodal lesions was observed in 70% of the patients after voice therapy. In those patients with less than 36 months of symptomatic durations before voice therapy, improvements in lesion size were observed in 87% of the patients, and VHI improvement was observed even in the patients whose nodules did not show any change in size. Two patients required surgical intervention after voice therapy; however, most vocal parameters showed improvements after voice therapy even in these patients. Additionally, both patients were young, and experienced transient deterioration of their voice due to their occupational vocal abuse during voice therapy. Our study supported the idea that voice therapy could achieve satisfactory improvement of vocal functions even in patients with long-term symptoms before therapeutic intervention.

In Japan, very few ENT clinics have speech-language-hearing therapists (ST). This study sought to answer two questions: (1) what needs for support by an ST exist in the communities around ENT clinics?; and (2) what are the roles of the ST at ENT clinics? The research method was a retrospective analysis of our medical records. Our ENT clinic patients had problems mainly of delayed language development, articulation disorder, stuttering, and hearing loss due to aging. The ST at ENT clinics requires a wide range of expertise. In most cases our patients visited us after checking our websites and signboards spontaneously. There were some cases in which patients came from remote places for speech therapy. Our results showed that there is strong demand for an ST working at the ENT clinic. The ST at an ENT clinic should be easily accessible, capable of responding to various needs, and able to liaise with more specialized institutions. Collaborations between ENT doctors and the ST can improve the quality of medical care. Therefore, it is necessary to increase the number of STs working in ENT clinics. There are various issues needing to be resolved in order to employ an ST at an ENT clinic: e.g., equipment, costs, ST training system, etc.

The purpose of this study was to investigate the attainment level and cognitive abilities of first graders in reading/writing of Hiragana characters (special characters) when the number of characters does not correspond with the number of syllables. The stimuli we used are characters serving as you-on, hatsu-on, soku-on and chou-on, and words including them. Typically developed children showed frequency effect with you-on characters and significantly lower correct responses for soku-on and you-on than for chou-on and hatsu-on in word reading. In word writing, correct responses of soku-on were the lowest, and you-on and chou-on showed significantly lower scores than hatsu-on. The results of multiple regression analysis indicated that word repetition in reverse order, figure copying and vocabulary size predicted word reading. Word reading including special characters, non-word repetition and immediate figure recall predicted word writing. We concluded that phonological abilities, visual cognition and vocabulary size affect word reading including special characters, and word reading affects word writing in first graders.

Tongue protrusion (tongue thrust) is a characteristic symptom caused by involuntary protrusion of the tongue during speaking only. We see many reports outside Japan in which botulinum toxin injections are used to treat tongue protrusion as a type of focal dystonia. In Japan the number of reports is quite limited, however, and there have been no reports of botulinum toxin injections used in liaison with speech-language-hearing therapists. We report 3 cases of tongue protrusion for which we achieved excellent results using botulinum toxin injections in conjunction with articulation training by speech-language-hearing therapists. In stable periods, all 3 cases improved to a speech intelligibility rating of 1 and speech naturalness rating also of 1. Furthermore, "over-teeth" tongue protrusion of the kind seen at maximum prior to treatment was no longer in evidence. We concluded that tongue protrusion in our 3 cases was focal dystonia, and use of botulinum toxin injections in tandem with articulation training by speech-language-hearing therapists was an effective method of treatment.