言語聴覚士として大切なのは、まず心を開いて接すること。
Q：言語聴覚士への道をめざしたのはいつ頃からでしょうか。
出身は、福井県です。祖母が助産師だったこともあり、自宅には赤ちゃんや幼児を連れたお母さんたちがよく相談にきていました。学校から帰ると小さな子どもたちの相手をする機会が多く、そのころから子どもへの関心をもつようになりました。大学では児童学を専攻し、子どもに関する心身の発達、心理、医療、福祉、教育、文学、音楽など広く学びました。大学卒業後は、地元に戻り大学で障害児教育を学ぶ専攻科に進学しました。そこで、特別支援学校教諭の免許を取得し、障がいのある子どもたちにかかわる道を歩み出したと言えます。教員としての道も決まっていたのですが、いろいろ考えて福井県こども療育センターのリハビリテーション課に勤めることになりました。当時はまだ、「言語聴覚士」は国家資格として定められてはいませんでしたが、センターには難聴幼児の通園施設があり、その言語聴覚士として臨床をスタートすることになりました。
Q：臨床の現場というのは、はじめてだったのですね。
言語聴覚士としての基礎的な知識もスキルも何もなくいきなり飛び込んだ世界でしたから、すごく戸惑いました。難聴幼児通園施設に通ってくる難聴のお子さん以外にも、脳性まひ、知的障害、発達障害などいろいろな障がいをかかえる子どもさんに接する時に、親御さんたちともお話していきます。でも自分はまだ経験も乏しく、子どもさんの訓練を考えることで精一杯で、親御さんから相談されることに十分応じることができませんでした。親である立場を十分に理解することができていなかったと思います。それから、研修に出たり、先輩にアドバイスをいただいたりして、一つひとつ学びながら実践して今日に至ります。 臨床では親御さんの目の前で、子どもが変わる（できる）ところを見せる、つまり子どもが持っている力を発揮させることによって、親御さんが気づかないこと、それから親御さんだからこそできることを私たちが側面から支えるというのが、言語聴覚士の大切な役目であり、そこが大事なポイントだと思います。それ以外にも、この臨床経験で、実に様々なことを学ぶことができました。
Q：具体的には、そこで、どういうことを学んだのでしょうか。
小児領域の言語聴覚療法の対象年齢は、だいたい15歳くらいまでの子どもたちです。相談の多くは2～3歳のお子さんを持つ親御さんで、ことばが少ない、発音が気になる、ことばがけになかなか応じないというものですが、中には生後間もない難聴の赤ちゃんもいました。近年は新生児聴覚スクリーニングによって生後まもなく聴覚検査ができます。聴こえに問題が疑われた時には、一刻も早く専門機関で精密検査を受け、難聴の診断がついたらできるだけ早く補聴器をつけ訓練を開始します。それを親御さんに説明し、理解していただくようお話をするのも言語聴覚士の役割です。親御さんの多くは、まだおしゃべりもしない赤ちゃんが難聴と診断を受けてもなかなか受け入れられなくて戸惑いを感じる方が多いです。定期的な聴覚検査をとおして、赤ちゃんの反応を親御さんに返しながら、相手の立場になって根気よく説明をします。そこには、医師との連携も重要になってきます。
また、医療的なことだけではなく福祉的な支援もしていましたから、家庭や生活環境などの相談にも対応していました。地域を支える保健師さんをはじめ、子どもの通園先の保育園や学校の先生方への説明も必要です。その子が生まれ持った能力を最大限に発揮できるよう、ハビリテーションを提供することと、子どもにかかわる専門職の連携が長期的にできるよう努めたいと思っています。それには自分の学識や技術を常に磨いていく努力がいくつになっても必要だと思いますし、言語聴覚士はとてもやりがいのある職業だと思います。
Q：大学での教育活動では、どういうことをめざしていますか?
大学院で勉強を始めることができたのは40代でした。恩師の勧めもあり、言語聴覚士として実践してきたことを、理論立てて、体系化することで、あらためて子どもの言語・コミュニケーションの発達に即した指導法を身につけたいと思ったからです。
学生さんたちに伝えていきたいのは、今大学で学んでいる知識や技術は臨床で出会う患者様をみるときに、客観的に理論立ててみる力につながっているということです。実際に働き始めると言語聴覚士として自分に何ができるか、ということに直面します。知っていること、できることを確実に習得して、臨床実習に出ていってほしいと思います。そこで自分が「今何ができるか」ということを自覚し、社会に出る時までに一段一段と成長していってほしいと思っています。本学科では1年生の夏休みに病院や施設で働く言語聴覚士の仕事を見学します。みなさん、はじめはとまどっているようですが、一歩一歩地道に、目標に向かって歩き出し、多くの人と心を開いて接していけば、立派な言語聴覚士になれると信じています。そのために、私の経験が少しでも活かされればと心から願っています。まずは、元気な声出しから。挨拶は、会話の第一歩ですから。
Q：最近の研究活動について教えて下さい。
専門は子どもの発達領域です。近年、ことばの発達や行動面の発達、また社会性の発達に関して気になる子どもさんをお持ちの保護者の方、担任の先生方と小集団の療育教室の活動をしています。お子さんの保育を担う保護者と先生、つまりジェネラリストの連携を言語聴覚士の立場から支援しています。その中で、子どもの発達と保護者の育児ストレスについて、現在の研究テーマにしています。
Associate Professor Hashimoto Kahoru
In this edition of “Tell Us Teacher,” we asked Dr. Hashimoto Kahoru all about her clinical practice. Dr. Hashimoto is a speech pathologist who teaches the importance of establishing close relationships with children and communicating with an open mind.
“As a speech pathologist, it is important to be open-minded.”
Q:When did you start to pursue a career as a speech pathologist?
I am from Fukui Prefecture. My grandmother was a midwife, and mothers with babies and toddlers often came to my home for advice. When I came home from school, I had many opportunities to work with small children, and that is when I began to take an interest in children. At university, I majored in child science and studied a wide range of subjects related to children, including physical and mental development, psychology, medicine, welfare, education, literature, and music. After graduating from university, I returned to my hometown and entered a university majoring in education for children with disabilities. There, I obtained a license to teach at a special-needs school and started my career in working with children with disabilities. I had already decided on a career as a teacher, but after much deliberation, I decided to work at the Rehabilitation Division of the Fukui Prefectural Child Rehabilitation Center. At that time, “speech-language pathologist” was not yet defined as a national qualification, but the center had a daycare facility for children with hearing loss, and I started my clinical career as a speech-language pathologist there.
Q:So that was your first experience in a clinical setting.
I jumped in without any basic knowledge or skills as a speech-language pathologist, so I was very confused at first. In addition to the children who attend preschools for children with hearing loss, I also interacted with the parents of children with various disabilities such as cerebral palsy, intellectual disabilities, and developmental disabilities. However, I was too inexperienced and occupied with thinking about the training of the children to be able to respond adequately to parents’ inquiries. I don’t think I was able to fully understand the position of the parents. Since then, I have attended training and received advice from my seniors, learning one thing at a time and putting it into practice until today. In clinical practice, we show the parents how their child has changed (or what they have become capable of doing) in front of their own eyes. In other words, by letting the child demonstrate their abilities, we support the parents by showing them things about their children that they may not have noticed and help them learn what they can do to support their children as parents. I think this is an important point. In addition to this, I have learned many other things through my clinical experience.
Q:Specifically, what did you learn through your clinical practice?
The target age group for pediatric speech and language therapy is children up to about 15 years old. Most of the consultations are with parents who have 2 or 3-year-old children who do not speak much and who are concerned about their child’s pronunciation. In other cases, the child may not respond to speech. Some babies have hearing loss soon after birth. In recent years, newborn hearing screening has made it possible to test hearing shortly after birth. If a hearing problem is suspected, the baby should be taken for a thorough examination at a specialized institution as soon as possible, and if a diagnosis of hearing loss is made, the baby should be fitted with a hearing aid and begin training as soon as possible. It is also the role of the speech pathologist to explain this to the parents and make sure they understand. Many parents find it difficult to accept a diagnosis of hearing loss in a baby who has not even begun to speak. Through regular hearing tests, I explain the baby’s reaction to parents while patiently put myself in their shoes. This is where cooperation with the doctor is also important.
Also, since I was providing not only medical but also welfare support, I had to provide consultation to families about their living environment. I also needed to instruct the public health nurses who supported the community, as well as the teachers at the schools and nurseries where the children go to school. I want to provide rehabilitation so that each child can maximize his or her natural abilities, and ensure long-term cooperation among the professionals involved. To do this, I think it is necessary to constantly strive to improve one’s knowledge and skills at any age. In the end, I think that being a speech pathologist is a very rewarding profession.
Q:What do you aim to achieve in your educational activities at KUAS?
I was in my 40s when I was able to start my graduate studies. With the recommendation of my mentor, I wanted to theorize and systematize what I had been practicing as a speech-language pathologist, so that I could develop new teaching methods that would be appropriate for children’s language and communication development.
What I would like to convey to my students is that the knowledge and skills they are learning at university will lead to their ability to objectively theorize about the patients they encounter in clinical practice. When they start working, they will be faced with the question of what they can do as a speech-language pathologist. I would like them to learn and understand what they can do for their patients, and then go out into the world ready to grow even more during their clinical practice. During the summer vacation of their first year, students in our department observe the work of speech-language pathologists working in hospitals and facilities. At first, all students are at a loss, but I believe that if they start walking steadily, step by step, toward their goals, and open their hearts and minds to many people, they will become excellent speech pathologists. I sincerely hope that my experience can be of some use to these students, and remind them that the first step in a conversation is to say hello with a cheerful voice.
Q:Please tell us about your recent research activities.
My specialty is in the area of child development. In recent years, I have been working with parents of children who are concerned about their speech development, behavioral development, and social development. Along with the parents, I also work with the children’s homeroom teachers in small group therapy and education classes. As a speech-language pathologist, I support collaboration between parents and teachers, or generalists, who are responsible for the care of children. In this context, I am working on my current research theme on child development and parenting stress in parents.
