復職に至った純粋語聾の1例に対するリハビリテーションの経験

Rehabilitation for Pure Word Deafness and Returning to Work : A Case Report

はじめに

　両側または一側の聴放線，聴皮質の損傷によりWernicke領野に至るまでの聴覚情報が途絶されると，純音聴力が保たれているにもかかわらず，言語音に特異的な認知障害を引き起こす．この病態を純粋語聾と呼ぶ^1,2）．純粋語聾は，聴理解困難である点から家庭生活への復帰はできても，対面，電話等のコミュニケーションを要する職場への社会復帰が難しい．仮に社会復帰するとしても，複雑な会話の少ない作業を中心とするような職種に限定されてしまう．今回，我々が経験した症例では，患者の障害教育・指導による病識向上と代用手段の活用に留意したリハビリテーション（以下，リハ）を進めた結果，過去の症例報告に比し，発症早期より，日常対面会話に支障のない程度まで改善し，教師として社会復帰に至った．しかし，純粋語聾患者は，社会福祉制度における障害認知の理解が低く，就労支援に乏しい等の問題も抱えており，これらを踏まえて症例報告をする．

Abstract : We report a 47-year-old right-handed male patient with pure word deafness after suffering an intracerebral hemorrhage. He had been working as a high school teacher before the onset of his stroke. He was emergently admitted to our hospital due to left putaminal hemorrhage and treated conservatively after admission. The patient's neurological findings showed that although his auditory comprehension was severely impaired, he was still able to communicate using written language. Puretone audiometry didn't detect any sensorineural hearing impairment. After the diagnosis of pure word deafness was clinically made, we educated the patient and his family, as well as the associated medical staff at our department, about this condition so that they could understand his pathological situation. In addition, we introduced a rehabilitation program for lip-reading and showed him a technique for using articulatory voice production in usual conversation. As a result of our attempts, he developed the ability to communicate using lip-reading skills after 2 months of rehabilitation and successfully returned to his previous work because of the communicative competence he acquired. We also make some proposals for helping other patients with auditory agnosia to return not only to their regular daily activities but also to return to gainful employment, as patients with this condition seem to have special difficulties benefiting from the present welfare service system in Japan.