Services and Support for Rehabilitation Outpatient Clinic…Nobuyuki KAWATE, Masazumi MIZUMA 379

Strategy for Rehabilitation for Patients with Traumatic Brain Injury, ranging from Subacute Rehabilitation to Vocational Rehabilitation in our Rehabilitation Hospital…Shigeharu AOKI 382

How does the Administration Support the Social Participation of Persons with Disabilities?…Toru TAKAOKA 387

From the Stand Point of Vocational Rehabilitation…Keiichi MATSUDA 389

Service Dogs and Employment…Tomoko HARA TAKAYANAGI 393

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Importance of Systematic Collaboration in the Rehabilitation Medicine…Naohisa KIKUCHI 396

A Study of the Liaison between an Acute Hospital and Convalescence Rehabilitation Ward in Traumatic Spinal Cord Injury—Cooperation in Rehabilitation in an Area Lacking a Special Center or Special Hospital—…Tomoko NAGATA, Hiroyasu ICHIMOTO, Minoru SAIKA, Toshiro KISA, Yasuo SAKAI 399

Role of Physiatrist for Children with Developmental Disorders in the Community…Yoshiko NOMOTO 404

Summary…Izumi KONDO 407

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This report presents the case of a patient treated with epiglottoplasty (Biller's laryngoplasty technique) for the pseudobulbar type of dysphagia associated with herpes simplex encephalitis (HSE). A 67-year-old man developed acute HSE with disturbance of consciousness and intractable aspiration. Oral intake was tried, but resulted in aspiration pneumonia and was therefore canceled at the patient's former institution. At 12 months following onset, the patient consulted our hospital and we judged that aspiration could not be controlled, and that surgical management would be needed. In order to both prevent aspiration and preserve phonation, epiglottoplasty was performed at 15 months following onset. Postoperatively, the patient was able to resume an unrestricted diet except for clear liquids. He also underwent voice rehabilitation with the support of his family and rehabilitation staff. These efforts finally enabled him to speak clearly. Epiglottoplasty is an effective treatment for intractable aspiration, but this procedure is not widely known to Japanese physiatrists. Careful patient screening and selection by the attending physiatrist is essential, as is providing adequate postoperative swallowing and voice rehabilitation.

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