発達障害児が通過した乳幼児健診システム : 出生時リスクがなかった症例

The enhancement of maternal and child health programs has enabled early detection and intervention in routine health examination for children. However, there are regional differences in the contents of children with mild developmental disorders who had no risks at birth but had developmental problems that were overlooked during infant health checkups. Case 1 was a child whose disability was noticed by the caregiver but who passed the health checkup and was unable to receive appropriate follow-up. The disorder was detected by a speech therapist through a community childcare support program. Case 2 was a child whose disability was not noticed by the caregiver and who passed the health checkup. The disorder was detected by a speech therapist through the consultation system at our department. Based on these two cases, the following problems concerning existing screening checklist systems were identified as the causes of failure to detect disorders during checkups: lack of screening items, low expertise of personnel conducting checkups, lenient criteria, and insufficient follow-up systems. Considering the necessity for early detection and intervention in children with disabilities and the importance of follow-up after checkups, it was considered necessary for speech-language-hearing therapists to be actively involved in the check up program

慢性期軽度運動性失語症者に対する訓練経過

We undertook speech therapy for functional and practical communication in patients with chronic mild aphasia. For the comprehension aspect, comprehension of long sentences using visual modalities was assessed. For the expression aspect, explanation of comics that aimed to improve word retrieval ability and discourse competence by approximating communication settings was undertaken. In addition, syntax training common to both of these aspects was provided. Our results showed no improvements in test outcomes, although the maintenance of functions was achieved. In addition, qualitative changes including fewer grammatical errors and decreased stammering were observed during the explanation of comics. However, function maintenance and qualitative changes were observed 2 years later suggesting that our interventions may have been effective to a certain degree. These findings indicate that function maintenance and improvements can be achieved, even during the chronic phase, by implementing training based on speech function assessments at that point and by providing both practical communication training and functional training

特別支援教育における教員と言語聴覚士との連携 : 発達性読み書き障害の1例を通して

This study investigated both the process and factors enabling successful establishment of a support system for a child with developmental dyslexia and dysgraphia undergoing rehabilitation as part of the "Hello" academic outpatient consultation system. The child had difficulties with study-related reading and writing due to developmental dyslexia and dysgraphia. Furthermore, his motivation fluctuated when tackling reading and writing tasks, and he complained of fatigue. To restore and maintain his motivation to study, cooperation was sought from his elementary school homeroom teacher. E-mail-based information exchanges took place between the speech-language pathologist and homeroom teacher for 9 months. Through close contact and information sharing, a consistent approach toward the child and his parents was achieved. The child advanced in school grade and was transferred to a special needs class. Exchange with the special needs homeroom teacher is ongoing. The following two factors enabled the establishment of a suitable support system: direct information sharing with the homeroom teacher and clarification of division of roles and the teacher\u27s understanding of special needs education. These findings indicate that a sufficient understanding of school education is required for speech language-hearing therapists to obtain cooperation in special needs education

質問-応答関係能力に向上が認められた広汎性発達障害の一例

In this study, a child with pervasive developmental disorder was given special training aimed at enabling the child to develop a `question-answer\u27 relationship. The result was the formation of a question-answer relationship in oral form at the word and phrase level. Re-evaluation confirmed the child\u27s improvement in test performance. The main factor in change in this case was likely the use of `pattern learning\u27 for interrogatives, given that strength in pattern learning is a characteristic of children with pervasive developmental disorder. As a result, answers at the word and phrase level were established, as were answers at the sentence level with the aid of visual information. These results suggest that pattern learning of interrogatives was generalized beyond the training to situations, such as test tasks. The formation of communication functions and ability to interact with others by expanding the topics of conversation are important in raising the quality of communication for children with delayed speech development. Therefore, it is recommended that the training described in this study be continued, and its validity confirmed through further application and testing

外来相談システムの運用状況の分析 (第2報) : 教育機関との連携にみる言語聴覚士の役割

We initiated cooperation with educational institutions using an outpatient consultation system in our department in April 2012. We analysed the use of this consultation system between April 2011 and September 2013. We investigated the cooperation methods used with educational institutions and discussed the roles of speech-language-hearing therapists (STs). These results revealed that consultation system activity of for school-aged children had increased year by year during fiscal years 2011 (N = 15), 2012 (N = 16) and 2013 (N = 24). A total of 24 school-age children were receiving continuous support under this consultation system, and cooperation with educational institutions was being implemented for 13 of these children (54.2%). Cooperation methods included information sharing in writing or by telephone and tours by teachers to the guidance settings of STs. In addition, as a meaningful practical method, STs may visit schools in some cases. To enable smooth cooperation, it is necessary for educational institutions to recognize STs as a "familiar" presence. In this respect, it was also considered as effective for STs to visit schools and to propose specific guidance plans that enable appropriate speech activities in educational settings

漢字書き取りに困難を示した発達性読み書き障害の一例

Herein, we present a with development dyslexia whose writing skills were analyzed in detail, and discuss future support options. The patient was a 10 year-old boy who was a found grader attending a regular elementary school. The results of the WISC-III, K-ABC, ITPA, PVT-R, DTVP, diagnostic reading tests and STRAW showed that the patient had difficulty writing kanji characters despite the absence of overall intellectual, psychological or social disorders. Hence, the writing skills of the patient were analyzed by asking the patient to write common kanji characters and differentiate the character shapes of kanji characters. The visual information processing process that is required for learning to write kanji characters involves: 1) visual recognition of model kanji characters; 2) visual memory and retention; 3) memory recall of kanji forms. The patient was able to differentiate the character shapes of kanji characters and recognize individual differences; however, his spatial arrangement skills were low. Furthermore, the results suggested that he had difficulty retaining visual memory, and he was not able to accurately recognize kanji characters that are visual pictorial forms. Therefore, it was deduced that the patient could not accurately ascertain kanji forms and had difficulty writing kanji characters. Although the patient was able to differentiate similar character shapes, assistive technology may be an effective auxiliary technique for alleviating learning difficulties due to dysgraphia

発達性読み書き障害児に対するATを用いた言語訓練

In the present study, we introduced an assistive technology (AT) for a child with developmental dyslexia and dysgraphia who demonstrated difficulty writing kanji characters, and reviewed the effects using the information processing model. The patient was an 11-year-old boy in the fifth grade at a regular elementary school. He had problems in the visual memory and retention stage of the information processing model and presented with kanji dysgraphia. Memory recall of kanji shape, which was poorly memorized and retained by the patient, was achieved through typing. As this method was therefore believed to be beneficial, the language training using computer-based AT commenced. Content over the year of training was divided into three phases: I, II, and III. Word input (three characters) typing speed was approximately 60 seconds in phase I, approximately 20 seconds in phase II and 3 to 5 seconds in phase III; as each training was repeated, speed gradually increased. The number of characters that could be typed also increased from monosyllables in phase I to words in phase II and short sentences in phase III. The above findings suggest that computer substitution in the area of difficulty for the patient provided an effective support method for dysgraphia

Rett症候群一例に対する言語聴覚療法の経過

We report our experience with a infant with Rett syndrome (RS) for whom we performed speechlanguage-hearing therapy on a weekly, with reference to the course of training and the importance of support for infants with RS.The infant was a 3-year-old girl who had been diagnosed with RS at the age of 1 year and 4 months, and began receiving speech-language-hearing therapy at our department at 2 years and 11 months.The infant followed a different course from that classic- RS, and showed developmental changes without regression of language and communication skills. With regard to language skills, the infant progressed from the word level to the word sequence level in terms of both comprehension and expression. As for communication skills, the infant became able to actively interact with others.These findings suggest that even in infants with disorders such as RS, developmental changes in language and communication skills can be achieved by performing individualized speech-languagehearing therapy that considers the child\u27s developmental stage from an early stage.Therefore, in order to support children with these disorders from an early stage, it is important in the future to actively report cases and to promote the recognition of the need for speech-language-hearing therapy