小児難聴臨床における言語聴覚士の職能と臨床教育に関する展望

Prospect of professional services for children with hearing impairment by speech-language-hearing therapists, and special clinical education

　1970年代から今日までの小児難聴臨床を概観し，併せて筆者の言語聴覚士としての経験に基づいて，医療領域における難聴児指導と家族支援について検討し，今後の臨床教育の在り方について展望を試みた．本論は，1）医療・療育における難聴児指導の歴史，2）言語聴覚士による聴覚障害臨床の現状，3）言語聴覚士による小児難聴臨床と言語指導，4）医療における全人的支援（療育），5）小児難聴臨床に携わる言語聴覚士の対人支援職の基盤，6）医学教育に学ぶ，7）臨床家の生涯発達と難聴児支援，8）小児領域の言語聴覚士における専門性の継承とキャリア形成，9）小児難聴領域の言語聴覚士の職能，で構成した．今後，小児難聴領域の職能は，先進医療の開発に対応した専門性の高度化と，地域支援に根差したリハビリテーションを推進する専門職としての展開が期待される．そこで，言語聴覚士には難聴児の言語聴覚機能の発達支援，および児と家族の生活やQOL向上に向けた臨床教育と現職研修のいっそうの充実が要請されているといえよう．

　In this paper, the author presents an overview of the systems for evaluation, diagnosis, and therapy related to language/auditory development of children with hearing impairment(CHI)from the 1970s to the present, and the efficacy of such systems. Based on experience as a speech-language-hearing therapist(ST), the author investigates the support systems for CHI and their families in terms of medical care and discusses the outlook for clinical education in the future.　This paper is divided into the following nine parts:1)a history of therapy systems for CHI in hospitals, including early intervention, 2)the present situation of clinical support for CHI provided by STs , 3)the expertise of STs and support provided by them to CHI, 4)holistic support for CHI that is available under medical care, 5)the professional base of STs as providers of face-to-face support for CHI, 6)systems to be learned from medical education, 7)lifelong learning of clinicians and support for CHI, 8)the succession of expertise and career development of STs, and 9)the expertise of STs working with CHI.

　In the future, the expertise of professional service providers to CHI will include the ability to deal with the development of advanced medical technologies and to promote rehabilitation programs based on community support. It is suggested that further improvement is needed in the support for language/auditory development in CHI, as well as in the clinical education of ST students and in-service training programs aimed at improving the life and QOL of CHI and their families.