Yuki Hara

Speech Rehabilitation after Total Laryngectomy

The outcome of speech therapy for 65 laryngectomees at Kitasato University Hospital is reported and what needs to be done in order to establish a better system for laryngectomee rehabilitation in Japan is discussed. Of the 65 patients, 53 were trained for both esophageal and electrolarynx speech, 8 for electrolarynx speech only and 4 for esophageal speech only. Of the 57 patients who were trained for esophageal speech, 38 continued the training for a period of >6 months. Of these 38, 36 (94.7%) could produce one-syllable sounds at the first session. For the production of 5-6 syllables, a median of 6 sessions was necessary for the total laryngectomee group and 10 sessions were necessary for the pharyngo-laryngo-esophagectomee group but the difference was not significant. The study showed that for the production of a single esophageal sound the training period in our hospital was much shorter than that reported in other Japanese studies. Of the 65 patients, 27 (41.5%) acquired practical esophageal speech and 59 (90.8%) acquired either esophageal or electrolarynx speech. Six (9.2%) could not acquire any alaryngeal speech and this percentage was lower than that reported in other studies from Japan (12.5-33%) and from other countries (8.5-40%).

Effects of a prosodic control approach for patients with motor speech disorders

For patients with motor speech disorders, the Lee Silverman method (Ramig, 1997) has been known as an effective voice therapy method. In our clinical experiences, however, some Japanese patients could not easily produce very loud voice required in the method, presumably due to the cultural background. Therefore, in this study, a prosodic control approach called ‘‘the intonation emphasis therapy’’ was used as well as the Lee Silverman method for three types of patients. The disorder types were amyotrophic lateral sclerosis (ALS), Parkinson’s disease (PK), and olivo‐ponto‐cerebellar atrophy (OPCA). Acoustic analyses revealed wider F0 ranges after the intonation emphasis therapy than the Lee Silverman method for three types of the patients. In the perceptual judgments by speech therapists regarding articulation, voice quality, intonation, and abnormal impression of speech, better ratings were obtained for the intonation emphasis therapy than for the pretherapy speech and the Lee Silverman method in the patie...