NISE

NISE Bulletin
Educational Board
NAKAMURA Hitoshi

ATSUMI Yoshikata

NAKAZAWA Megue

CHIDA Kouki

OOUCHI Susumu

GOKAMI Tetsuo

SASAMOTO Ken

KIMURA Nobutaka

YASUDA Osamu

Vol. 9CONTENTSARTICLESORIGINAL ARTICLESTOKUNAGA Akio

1

The attempt of the practical application ofInternational Classification of Functioning,
Disability, and Health (ICF) as a tool forcollaboration among various professionals:
A perspective on its applicability to“individualized educational support plan”

SUGAI Hiroyuki

25

Support for teachers of education forchildren with multiple disabilities throughschool consultation

CHIKURINJI Takeshi

37

A study on teaching schoolchildren withintellectual disability

SAWADA Mayumi

51＊
Approach to teaching adventitiously
blinded persons with difficulty in reading braille:
Comparison of the degree of ease in reading
between braille characters of two sizes

MATSUMURA Kanyu, MAKINO Yasumi

65

History of and perspective on education
for children with speech and speechlanguage disorders in japan

Vol. 9NISHIMAKI Kengo（Chairman）

NISE Bulletin
NISE BulletinVol. 9 November 2008

ISSN 0389-9012

A－9

INVESTIGATIVE REPORTNOTEKOBAYASHI Michiyo

November 2008

Published by
The National Institute of Special Needs Education
5-1-1 Nobi, Yokosuka, Kanagawa, 239-8585 Japan＊（＊ Translated from the “Bulletin of The National Institute of Special Education”）

Abstracts of “Bulletin of The National Institute of Special Education”
Vol. 32

79

Vol. 33

83

November 2008＊

The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA AkioNISE Bulletin Vol.9: 1-26 November 2008

ORIGINAL ARTICLE

The attempt of the practical application of International
Classification of Functioning, Disability, and Health (ICF) asa tool for collaboration among various professionals:
A perspective on its applicability to “individualized
educational support plan”

TOKUNAGA Akio
Department of Educational Support, National Institute of Special Needs Education (NISE), Yokosuka, Japan

Abstract: This report describes attempt regarding to the practical application of the International Classification of Functioning,
Disability, and Health (ICF) as a tool for collaboration among various professionals in the field of education for children
with disabilities, while putting its application to individualized educational support plans into perspective. In concrete terms,
with respect to five pupils attending a special school, their class teachers performed the following tasks: ① evaluation using
a Japanese version of the ICF checklist, ② confirmation of the various professionals involved with the pupil based on thecreation of a life map, ③ organization of the overall situation making a model figure based on the results described in ① ;subsequently, on the basis of the results obtained, the class teachers held discussions with various professionals in and outside
the schools regarding the present status of and issues concerning the pupil as well as the future policy. As a result, it was
found that the discussion aimed at collaboration could be carried out efficiently and effectively through the series of tasks
using ICF, indicating that ICF is a useful tool for collaboration among various professionals. The results also indicated that,for the practical application of ICF to an individualized educational support plan, further research on the relationship between
ICF and the individualized teaching plan is required, and a manual on how to use ICF should be produced.
Key Words: ICF, Various professionals, Collaboration, Individualized educational support plan, Checklist
I. Introduction
With respect to the education for children withdisabilities, it has been strongly recognized that
education cannot be completed within a school or with
the involvement only of teachers, but that collaboration
among various professionals is required, as indicated in,for example, the “Individualized educational support plan”8found in the “Nature of special needs education in the future(final report)” (2003). According to statistics from special
schools, with respect to Activities to Promote Independence,
which is one of the major issues of the curriculum, there
is collaboration with medical institutions and welfareorganizations in 83.8% of all schools.2 Moreover, in the“5-year plan of the priority policy” in the basic plan forthe disabled, which was published in December 2002, it isclearly stated that individualized support plans should be
drawn up at special schools by fiscal year 2005,3 supporting
the necessity of collaboration among various professionals.

Tokunaga investigated attempts at applying theInternational Classification of Functioning, Disability, andHealth (ICF), one objective of which is its use as a common
language between the individual in question and the various
professionals involved, for the purpose of collaboration
among various professionals. As a result, he reported that
ICF is an effective means of collaboration among various
professionals, and that the application of ICF can lead topractical effects in teaching. It has also been clarified that,among the issues to be resolved, the complexity of the
ICF procedures should be reduced, and that ICF should be
integrated into the school system, such as in individualizedteaching plans, so that it can be used continuously.9, 13This report describes an attempt at the practicalapplication of ICF as a tool for collaboration among various
professionals which will be increasingly required fromThe attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA Akio
now on. In particular, to examine its degree of practicality
as a tool to be widely applied in actual school situations, I
carried out this investigation while putting the applicationof ICF to individualized educational support plans into
perspective.
II. Objectives and Methods of Study
1. Objectives
To examine the possibility of the practical application of
ICF as a tool for collaboration among various professionals,
this study is aimed at the clarification of the possibilities
and problems of ICF through the examination of casestudies.
2. Methods(1) Subjects
To examine the possibility of the practical applicationof ICF to various case studies, it was investigated thecases of five pupils attending a special school in Japan
with the cooperation of class teachers and other schoolstaff members, as well as of the pupils themselves, family
members, and various professionals involved. The fivecases and their major characteristics are as follows.
• A case wherein collaboration among various professionals
within the school was attempted.
• A case of at-home education, in which there were
multiple contacts between family members and various
professionals on a routine basis.
• A case of a high school department wherein consideration
is given to transition into after-graduation life.
• A case wherein differences in understanding among
various professionals were exposed.
• A case of a facility-affiliated school where collaboration iscarried out well among various professionals on a routine
basis.
(2) Procedure
Tasks were performed using the following procedure incooperation with teachers at the respective schools (hereafterreferred to as research collaborators).
In the following steps 1) to 4), while there was discussion
with the author whenever necessary, the actual tasks werecarried out mainly by the respective research collaborator.
In step 5), the information obtained in the previous
steps 1) to 4) was integrated and the future direction
was examined. Meanwhile, to promote the researchcollaborators’ understanding of ICF itself, the author
explained ICF in reference to publications such as “ICF:International Classification of Functioning, Disability, andHealth ?Revised Version of International Classification of
Impairments, Disabilities, and Handicaps-,” edited by theSociety for the Study of Welfare for People with Disabilities

NISE Bulletin Vol.9: 1-26 November 2008
(2002).
1) Evaluation using ICF checklist
The author have translated the “ICF CHECKLIST version
2.1a Clinician Form”15 of the World Health Organization(hereafter abbreviated WHO). Then the modifications listed
below were made to facilitate practical application in actual
school situations, and each item was evaluated mainly by
the class teachers.
• A space for remarks was added at the end of eachcategory, so that specific points can be described.
• Regarding “Capacity” in “Activity and participation,”
evaluations were performed for both states with andwithout personal or physical support.
These two modifications were confirmed in all the cases.
Furthermore, it was also confirmed that other modifications
to facilitate the use of the checklist in each case could
be made, and that evaluation was to be performed
with reference to “ICF: International Classification of
Functioning, Disability, and Health -Revised Version ofInternational Classification of Impairments, Disabilities,
and Handicaps-” when necessary.
2) Preparation of life map
With the aim of clarifying the presence of professionals
as collaborators of the class teacher and visually confirming
these professionals quickly, a life map was preparedin which people and organizations involved with therespective children were presented. Here, depending on
the school, a similar figure had already been prepared in
the individualized teaching plans; in such a case, that figure
was used as the life map.
3) Preparation of model figure
A model figure representing the relationship among items
was prepared using the evaluation results of checklist (1),with the aim of visually confirming the overall situationof the case quickly. The model figure was drawn by therespective class teachers referring to the “figure showing
Health Condition(disorder or disease)

Body Functions
and, Structures

Activities

Environmental Factors

Participation

Personal Factors

FIGURE 1 Interaction between the components of ICF

The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA Akio
interactions between the components of ICF”5 by WHO (Fig.
1), but also with their own modifications.
4) D iscussion with the various professionals
involved
Using the materials created as described in 1)-3) above,
discussion with the various professionals involved was
conducted regarding, for example, the confirmation of theactual condition of each case, the sharing of roles amongprofessionals, and future direction, and the contents of the
discussion were recorded.
5) D iscussion and summation by researchcollaborators
The author and the research collaborators who had
carried out steps 1)-4) discussed the achievements andissues of this examination and its future direction. On thebasis of the contents of this discussion as well as various
other materials, the author summarized the study on thepractical application of ICF as a tool for collaboration
among various professionals.
III. Evaluation of Each CaseWith respect to each of the five cases, the processes
and results of the evaluation using the checklist and the
preparation of a life map and model figure are reported.
At the same time, the usability of these examinations andproblems are investigated, and some discussion is added.
1. A case of applying ICF to collaboration withdormitory coaches and other school staff
Wi t h t h e t e r m “ c o l l a b o r a t i o n a m o n g v a r i o u s
professionals,” professionals outside the school may cometo mind, but a school is essentially a collective of various
professionals such as teachers, school nurses, clerical staff,
and dieticians,7 among whom collaboration is naturally very
important. Here, I investigated the collaboration between aclass teacher and dormitory coaches whose work practices
were different, although they both belonged to the sameorganization and worked in the same place.
(1) Outline of this case
Boy A is in the 6th grade of elementary school. Becauseof cerebral palsy, he has physical disabilities accompaniedwith mental retardation. He requires assistance inmaintaining a sitting position and in moving around in awheelchair. He shows interest in toys with sound and cangrab the toy to play with it. He lives in a dormitory in a
nearby city from Monday to Friday and returns home on
weekends. Various professionals in addition to Boy A’s
class teacher are involved with him, including dormitory
coaches, staff at a horseback-riding club, in which heparticipates on weekends, and physical therapists (hereafter,

NISE Bulletin Vol.9: 1-26 November 2008abbreviated as PTs) from a self-training organization.
(2) Actual tasks
The class teacher held discussions with the parents aswell as PTs, but collaboration with the dormitory coaches
is mainly described here. In the following, the description
is given in the order of the tasks actually performed, i.e.,1) evaluation using the checklist, 2) preparation of the life
map, 3) preparation of the model figure, and 4) discussion.
A similar procedure is applied in other cases.
1) Evaluation using checklist
The class teacher performed an evaluation while
consulting with the parents regarding life-related issues,
and with the PT who has been involved with Boy A for along time regarding physical issues. According to the classteacher, while the overall situation of Boy A can be broadly
evaluated using the checklist, which is a favorable point, thefollowing issues needing improvement exist with respect tothe practical application of ICF.
The first point is related to evaluation criteria. The classteacher indicated that since the evaluation criteria were
not clear, the teacher was sometimes unsure about theevaluation. The teacher commented that the establishmentof clear criteria, which are not swayed by the subjectivityof the evaluator, is desired. This indicates the necessity ofcreating an overall manual including such criteria.
The second point is related to the insufficient numberof items listed in the checklist. In concrete terms, during
the discussion with the PT, a necessity to include items“d415: Maintaining of Body Position” and “b445: Hand
and Arm Use” in “Activity” for the evaluation of Boy A
was indicated, and these items were added. Originally,
the checklist items consisted only of major items in the
ICF, so that the addition of necessary items for each caseis allowed. However, to do this, it is necessary to know
not only the items included in the checklist, but also all theitems included in ICF. This suggests that evaluation using
only the checklist is sometimes difficult at this stage.
2) Preparation of life map
A life map is not included in the individualized teachingplan of the special school which Boy A involved. However,I requested that Boy A’s life map be prepared with the aimof clarifying the status of individuals involved with him(Fig. 2). The preparation of the life map is effective not
only for understanding with whom one needs to collaborate,
but also for confirming what daily situations are consideredin the tasks taken up by the school. Consequently, theclass teacher has indicated the necessity of the life map asmaterial in the future individualized educational support plan.

The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA AkioNISE Bulletin Vol.9: 1-26 November 2008

Contents of involvement(Frequency)

Individuals involved
Hospital: Orthopedic surgery

Center X: Orthosis and wheelchair construction

Boy A

Improvement of material environment

primary doctor of Boy A

Medical care

Hospital
Medical care
Pediatric department(twice a year)
Cerebral surgery department(twice a year)
Pediatric neurology department(once every three months)
Dentistry (as needed)

Volunteers (occasionally)
Horseback-riding therapy: Park X (occasionally)
Volunteers
Friends
Physical movement, leisure activity

Facility X (once every three months)

Horseback-riding therapy: Park X (once a week)
Instructors

Teacher X

Friends

Eating

PT: Self-training group (monthly)

Physical movement, leisure activity

Teacher X

Physicalmovement

Other friends
SchoolClass teacher

Dormitory
CoachesHome
Mother and father

Overall life, physicalmovement, learning,
human relations

Overall life

Overall life

Aunt and grandmother(occasionally)

School secretary
Human relations, learning

FIGURE 2 Life map of Boy A
3) Preparation of model figure
After the preparation of the model figure by the classteacher based on the evaluation using the checklist, I
asked the dormitory coaches to mark the contents thatthey thought were their responsibility (Fig. 3). Here, after
discussion with the dormitory coaches, class teacher also
held discussions with the guardians and PTs and revised
the model figure. However, the original figure used for the
discussion with the dormitory coaches is shown here.
Symbols shown in the figure have the following
meanings.

• The first (left) of two arrows (e.g., ↓↓) inside each item of“Activity” and “Participation” indicates actual performance inthe present life, and the second arrow (right) indicates capacity
without the support of another person or of equipment. The
direction of these arrows indicates the score of the ICF
evaluation criteria determined by WHO: ↑ for 0-2 points, and ↓for 3 points or more. Similar representations are used for “Bodyfunctions” and “Body structures.”
Score 0: No problem (none, absent, negligible…) 0-4%
Score 1: Mild problem (slight, low…) 5-24%
Score 2: Moderate problem (Medium, fair…) 25-49%
Score 3: Severe problem (high, extreme…) 50-95%
Score 4: Complete problem (total…) 96-100%
Score 8: Not specified
Score 9: Not applicable
The combinations of the arrows represent the following:(Actual performance↑/ capacity without support↑); the child has
an ability regarding this item.
(Actual performance↑/ capacity without support↓); item where
support is appropriate.
(Actual performance↓/ capacity without support↓); item which is
not carried out practically.
• Among the “environmental factors,” “barriers” which negatively
affect daily life by their presence are represented with “－”, and“facilitators” which positively affect daily life are represented
with “+”.
• O ther items related to each “environmental factor” areconnected by lines with respective meanings noted in the
figure.

• Physical exercise ↓↓• Language ↓Acceptance of spoken words withgestures and expression such as
vocalization are possible

FIGURE 3 Model figure for Boy A• Support and attitude of healthcarerelated staﬀ (+)(PT, staﬀ responsible for eating
instruction)• Use of a wheelchair and standwalker (+)• Support and attitude of family members (+)• Support and attitude of friends (+)• Support and attitude of staﬀ at the special
school (+) (−)• Moving around ↑↓Achieved by being pushed in thewheelchair and stand walker withassistance• Going out ↑↓Possible with assistance.
Use mainly of a car• Means of moving to the bathroom in his house (−)• Environment of the toilet in his house (−)• Environment of the toilet at school (+)• Environment with few slopes (+)• Elevators in the apartment building(+)

Environmental factors• Human relations ↓↓Showing increasing eﬀort to relate withfriends, The time required to becomeacquainted with new people is decreasing• Eating ↑↓Currently practicing to select which food to eat,to cut it by biting, to mash it by grinding, tochew it, and to eat it using his hands• Self-care ↓↓Currently practicing to urinate by himself byassuming a sitting position and leaning forward,
Assistance is necessary to maintain sitting
position while bathing• Group of horseback-riding club

• Involved at the special school
No interaction with other schools in theresidential area, There is a network in
the area such as a self-training group

Participation

Relationship with healthcare-related staﬀ
Relationship with family members, friends,
and school staﬀ
Relationship with tools and equipment
environment
OthersTOKUNAGA Akio

• Joints and body trunk
Tend ency of lateral spinal curvature,
dislocation of the left hip joint, bent ﬁnger
joints, hip joints and left side of the trunk are
difﬁcult to relax• Muscle tone ↓Hypotone, tone with bent lower Extremity,
toes and ﬁngers

Body structures

scissors gait, wind swept, clonus• Lower extremity ↓• Verbal expression and nonverbal
expression ↓↓Sometimes it is hard to understand theexpression of yes or no• Higher-level cognition ↓Decision making is sometimes possible infavored activities

The duration for which the sitting position
can be maintained by his own strength is short
Movement of hands: Currently practicing
pulling movement without putting his hands
to his mouth•Verbal and nonverbal communication ↓↓Spoken words with gestures are understandable
depending on the case

Activities• Attention ↑Tends to be distracted by other sounds andmoving objects

Body functions

Health condition• Body weight management (maintaining thecurrent body weight)
Weight loss increases his ability to support
himself

The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
NISE Bulletin Vol.9: 1-26 November 2008The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA Akio
By preparing the model figure, the following was clarified.
① Contents to be included in the model figure
Items to be selected from the checklist are left to the
choice of the person who prepares the figure. For example,
the “barriers” added to the current model figure by the classteacher are those which may be taken up as tasks and which
can be changed to (+) “facilitators” in the future. On thebasis of the aims of the preparation of model figure s, andin terms of the practical wide-range application of ICF in
the future, it is necessary to determine how to evaluate andcope with differences in the choice of contents to be added
between creators.
② “Activities” and “participation”
With respect to “activities” and “participation” used in
combination in the checklist, the class teacher indicated adifficulty in their differentiation in the figure. In concreteterms, according to “ICF: International Classification of
Functioning, Disability, and Health ?Revised Version ofInternational Classification of Impairments, Disabilities,
and Handicaps-,” there are four cases of differentiation.6
However, the class teacher indicated that it was still difficult
to understand how to differentiate them.
③ How to present easy-to-understand figures
Because family members, friends, dormitory coaches,
and teachers are contained in a single frame within
environmental factors, it is impossible to indicate theirrespective tasks by lines. In contrast, for the overall
relationships, as the number of frames increases, theconnecting lines become more complex, resulting in greaterdifficulty in looking at the entire picture. Therefore, it isdifficult to show the details of the assignment of tasks in a
one-page format. Accordingly, the class teacher indicatedthat it may be appropriate to make detailed figure s by
selecting necessary items when requested in addition to theoverall picture.
4) D iscussion between class teacher and otherprofessions
The outcomes obtained and issues to be resolved basedon the comments by the class teacher after the discussion
using the checklist and model figure are summarized below.
① Clarification of roles
As a result of the discussion, the class teacher ’srecognition regarding the roles of the dormitory coaches
became clear. In concrete terms, the class teacher
could clearly recognize that items such as body-weight
management under “health condition” and involvement ineating and human relations under “activity” are significant
tasks of the dormitory coaches.
② Promotion of efficiency in discussion
In the discussion, each role could be confirmed withina short time of approximately 10 minutes. As a reason
for this, the class teacher indicated that information could

NISE Bulletin Vol.9: 1-26 November 2008
be visually understood easily from the model figure used.
Because it is usually not easy to secure sufficient time fordiscussion, the above finding reveals that the model figure
is effective in promoting efficient discussion.
③ Effects of sharing tasks
The class teacher indicated the following: in thediscussion with the dormitory staff members, by asking thestaff members to write down their responsibilities directlyon the model figure, mutual understanding of respectiveroles was facilitated; in addition, in the discussion withPTs, by asking PTs to write down items that are their areasof specialty, such as body functions and body structures,
directly on the model figure, the actual condition and task
consciousness from the viewpoint of PTs became moreeasily understandable. In contrast, documents with toomuch detail appeared to be difficult for other members tocorrect or add information.
(3) Overall evaluation of current caseA series of attempts at utilizing ICF has led to smoothpromotion of discussion with dormitory coaches inside theschool, showing the efficacy of ICF as a collaboration tool.
In addition, the possibility of applying ICF to collaboration
among various professionals outside the school in theindividualized educational support plan as well as toindividualized teaching plans inside the school has been
simultaneously suggested. By connecting these plans, thedevelopment of more effective guidance is also expected.
2. A
 case of at-home education with close contact
between family members and various professionals
on a routine basis
In cases of at-home education, class teachers are
frequently in contact with family members and various
related professionals; accordingly, tasks cannot be achievedsmoothly without their collaboration. I investigated therelationship between the class teacher and two occupational
therapists belonging to different organizations (hereafter,
abbreviated as OTs; one OT belongs to a hospital, and theother OT visits the home for at-home rehabilitation).
(1) Outline of caseGirl B is in the 3rd grade of elementary department at
special school. Because of lissencephaly, she has physicaldisabilities accompanied with mental retardation. She
requires assistance in maintaining a sitting position andin moving around. She loves to be around people and isable to understand simple spoken messages. Because herhome is located far from the special school, she is judged
as unable to commute because of her low physical strength.
Thus, she belongs to the at-home class of the special school.
Lessons are carried out twice a week at her home, and she
also attends school several times a year. She is involved

The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA AkioNISE Bulletin Vol.9: 1-26 November 2008
[X hospital]
Hospital to be taken
to in case of emergency
the primary physician
from X hospital willrush to attendance

Leisure hours

Other teachers

SchoolPupils in theelementary department

Head of the instruction
department: X
School nurse: X
Other teachers

School[X Special school]
former teacher: X
current teacher: X
current subteacher: X
current subteacher: X
Secretary of the elementary
department: X

Motherʼs family home
grandmother and aunt
(stay for 3-4 days
per month)[X hospital]
Dr. XXXXX(primary physician)(once a year)

Girl B (3rd grade)
Father, mother, elder sister[X elementary school]
School in the residential area
Pupils in the Xth grade
Pupils in the special classClass teacher: X and Y

Classmates of GirlBʼs elder sister
Other pupils

Administration

grandfather, grandmother[X village]
Educationboard[X village]
Public healthnurse[X medical center]
Center presidentʼs rounds(once every semester)
Orthopedist: Dr. XXXX
Dentist: Dr. XXXXX
Pediatrician: Dr. XXXX
→ Preparation of medication(once every three months)

PT: X
OT: X
(once every two
weeks)

At-homerehabilitation
OT: X(once a month)[X hospital]
Medical doctor of
orthopedics
health nurses(once every 3-4 months)

Medical care

Medical care

[Medical and healthcare apparatus]
Buggy, electric wheelchair,chair for maintaining sitting
position, standing board,assistive devices

WelfareMedical care

FIGURE 4 Life map for Girl B
with a number of professionals on a routine basis throughhospital visits, at-home rehabilitation, and visits with publichealth nurses at the town office.
(2) Actual tasks
1) Evaluation using checklist
The class teacher performed the evaluation. Because
there were some unclear points regarding physical issues,
the class teacher asked OTs about these issues and madeadditions.
2) Preparation of life map
The life map of Girl B prepared by the class teacher
is shown in Fig. 4. Because the teacher routinely visits
her home, we can see that the teacher is well acquainted
with her life. The class teacher realized anew that Girl B
interacts with various people, but at the same time felt thatfurther promotion of collaboration was necessary.
On the other hand, Girl B regularly goes to a certain
hospital located several tens of kilometers from her home,
to which a one-day round trip is impossible; however, thephysical distance and the sense of mental burden to GirlB as well as to her family members cannot be expressedon the map. To relate the life map to actual guidance, thestatus of daily life should be represented realistically indetail; this is a future issue to be resolved.
3) Preparation of model figure
The class teacher prepared a model figure by selecting
items which he/she felt to be important for the promotion of

educational activities on the basis of the evaluation scoresin the checklist as well as points relating to Girl B written
in the remarks space in the evaluation stage (Fig. 5). As
concrete contents, the class teacher adopted those related to
his/her hope that Girl B will develop greater communication
skill because she is receiving at-home education.
This may suggest that the individualized teaching plan,
which had already been produced with emphasis put onteaching to improve communication, affects the selection of
the items in the model figure.
Symbols in Fig. 5 have the following meanings.
• Arrows connecting constitutive elements represent respective
correlations.
• T he arrows (e.g., ↑,↓) inside each item have the same
meanings as in case A (Fig. 3).
• While the above rule is essentially applied, these arrows also
represent the class teacher’s hope that “actual performance
would change if more support by people or equipment could
be provided.” The details of this wish were communicated torelated persons during the discussions.
• Because environmental factors are related to many items, it
was judged that connecting them all would make the figure
too complex; therefore, they were not directly connected.
“Environmental factors” are recognized to be the foundation of
the life of Girl B according to the class teacher.

The class teacher feels that there is a problem when
considering the actual guidance for Girl B given thatthe connections among the related professionals are notFIGURE 5 Model figure for Girl B• Use of wheelchairand buggy (+)• Use of support apparatus formaintaining posture (+)• Environment withmany slopes (−)• Home environment (+)
Barrier free, spaciousness
of corridor, toilet,
and bathroom

Environmental factors• Daily life ↓↓She is not conscious of taking care of herself
but she can perform many things with assistance• Physical exercise ↑↓The duration for which a stable sitting posture can be
maintained is short
Increased operability of the left handMoves around by crawling or creeping on her belly• Watching and listening ↑↓Her capacity to observe is increasing, and thefrequency of obtaining information through her own
eyes has increased
She still cannot always be selective in what she hears• Communication ↑↓Increased comprehension of spoken words,
Expresses her feelings using signs and photo cards• Human relations ↑↓Is fond of interacting with people, and frequency ofinteracting with people of her own accord has increased

Activities• Rhythm of daily life ↓Not yet established• Support and attitude offamily members (+)• Support and attitude of staﬀ
at the special school (+)• Support and attitude ofneighbors (+)

Anticonvulsant (+)• Moving around ↑↓Achieved by being pushed in theelectric wheelchair and buggy withassistance, use of a private car• Going out ↑↓Possible with assistance. Difﬁcult
when lodging is involved• Attends to residential elementary
school
1-2 times per semester• Belongs to the special school(at-home education) ↑↓Lessons at home twice a weekattends school 1-2 times per year

Participation

TOKUNAGA Akio

• Support and attitude of healthcarerelated staﬀ (+)
Provision of training (PT, OT)• Body trunk ↓Holding up the trunk
Development of the left upper extremity
Development of the pelvis and lower
extremities• Muscle tone ↓Hypotone, diﬃculty in maintaining asitting position by herself when not
feeling well

Body structures• Exercise tolerance ↓Fatigues easily and lies down frequently• Attention ↓Tends to be distracted by small sounds• Cognition ↑Can make decisions on simple matters
Various senses (such as vision andauditory sense) are beginning to beraised to higher levels• Language ↑Understanding simple spoken messages
Is beginning to feel joy of vocalization

Body functions

Health condition• Epileptic seizure ↑↓Controlled by anticonvulsant
The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
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The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA Akio
expressed in the model figure. Both the OT from thehospital (hereafter abbreviated as hospital OT) and the
OT who visits Girl B’s home for at-home rehabilitation(hereafter abbreviated as visiting OT) indicated a difficultyin expressing the actual condition of the child in a single
model figure, as well as a concern about the difficulty ofunderstanding a figure containing too much description. In
concrete terms, their comments are as follows.
The hospital OT pointed out the relationship among items
under “body functions” and “body structures;” however,
if all related items are connected by arrows, the figure will
become too complex and will be difficult to understand.
In addition, the hospital OT indicated a limitation in theexpression using ↑↓ arrows inside the items and also that“things that Girl B cannot do or cannot do well” and “things
that Girl B can do or do well” were haphazard in the model
figure, causing confusion. Consequently, the hospital OT
pointed out the necessity of a technique of identifying tasks
from the former weak points. In contrast, the class teacher
expressed a desire to more highly value the things that Girl
B was good at in order to develop her educational activity.
Meanwhile, only the visiting OT indicated the meritof representing a rough overall picture of Girl B in asingle figure such that the overall picture of Girl B could
be confirmed and the division of roles of the related
professionals could be considered. The visiting OT said
that the figure provided a better understanding of his/her
responsibilities within the overall picture and of matters inwhich he/she should collaborate more with people in otherfields. He/she also indicated that to compensate for issues
that were not expressed in the figure, it may be desirable foreach individual to consider measures for the clarification of
the actual conditions and tasks in greater detail.
4) D iscussion between class teacher and otherprofessions
The class teacher prepared the model figure (Fig. 5) on
the basis of the evaluation using the checklist and held
separate discussions with the two OTs, referring to themodel figure. The results obtained are summarized below.
① Effects of the model figure
Both OTs expressed fundamental understanding of
the technique of collaboration through discussion using
the model figure; in particular, the visiting OT positively
evaluated the ease of initiating collaboration between
different fields using the model figure. Since the visiting OT
actually performs occupational therapy at Girl B’s home,he/she seemed to realize the importance of environmental
factors. He/she also made in-depth comments on the use of
the model figure, beyond the class teacher’s expectations,so that the class teacher had a very good opportunity to re-

NISE Bulletin Vol.9: 1-26 November 2008
assess his/her own position within the overall picture.
② Division of roles
The class teacher asked the OTs to fill out the parts
where they were involved, and confirmed that the roles ofboth OTs partly overlapped with the contents of teachingby the class teacher. How to evaluate and deal with theseoverlapped parts are future issues to be resolved, but
gaining an awareness of such parts is the outcome of thisstudy. As a future direction concerning the overlapped
parts of guidance given by various professionals, those
involved agreed that they would exchange information
while continuing their own involvement with Girl B,
and they recommended that, in the future, each healthrelated professional should continue to handle his/her
specialization.
(3) Evaluation of overall current caseIn the case of at-home education where a staff member
has many opportunities to meet family members andother professionals, issues such as how and what kinds ofprofessionals are associated with Girl B were confirmed,
and discussion among various professionals was realized.
As a result, a mutual understanding of each role wasestablished. Thus, the applicability of ICF as a tool forcollaboration was again indicated by this case.
3. A case of high school department whereconsideration is given to transition into life after
graduation
In a high school department, it is important to instruct
students while considering their plans after graduation.
To cultivate the skills required for life after graduation,
we investigated the collaboration with staff membersof facilities that students are expected to frequent after
graduation, as well as collaboration with many teachers ofdifferent subjects in the high school department.
(1) Outline of case
Boy C is a student in the high-school department of
the special school. He has been diagnosed as intellectual
disabilities. He is able to have daily conversations without
any problems, although slowly, and he can associate withfriends. Similar to Boy A, Boy C lives in a dormitory
5 days a week. His parents wish him to have a naturaland varied life in the local area, so they often take him
horseback riding and swimming on holidays.
(2) Actual tasks
1) Evaluation using checklist
The class teacher indicated the following as merits ofthe checklist. With the KJ method that is one of method
to classify some information , which is frequently used in
the preparation of individualized teaching plans, problems10

The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA AkioNISE Bulletin Vol.9: 1-26 November 2008

are clarified by the subjective judgment of the teacher
who prepares the plan. In contrast, with the checklist,a wide range of issues concerning overall life are listed
and prefixed; therefore, a more objective and systematicarrangement is possible. In the case of Boy C, the use ofthis checklist evaluation revealed the importance of theexistence of individuals as “environmental factors,” which
had not been apparent before, according to the class teacher.
In addition, the class teacher indicated that the recognitionof many unknown issues (which can be identified byasking) and those which are difficult to understand (difficult
to interpret) is significant in itself. It is also considered that
contact with various professionals is generated from thefeeling of “wanting to ask about issues because they are notknown well.”

where Boy C was involved, the life map has already been
prepared. Figure 6 shows an extract from the life map
in the teaching plan. Unlike the other cases, detailed
descriptions of individuals and professionals are not givenin the map; however, the figure characteristically depicts
Boy C’s current life and his life after graduation, which isconsidered to be useful for guidance related to his future.
3) Preparation of model figure
To create a model figure that is easier to understand, theclass teacher modified some usage of terms; instead of using
2nd-level terms listed in the official Japanese translationof the checklist (each item of the checklist), the teacher
used expressions adopted in daily life which were easier tounderstand and put them in brackets [ ] for each item. In
addition, specific conditions of Boy C were marked by thesymbol ◇ and listed below the parenthetical terms (Fig. 7).

Meanwhile, the following problems with the checklist
that must be solved to enable its practical application wereindicated.
• Evaluation criteria are not always clear, and therefore,
when many individuals perform an evaluation, they may
be confused.
• When the evaluation items in the second level alone areused, the range involved in this level may be too broad toenable appropriate evaluation. There are some items thatshould be evaluated on the third level; however, whether
a mixture of items evaluated at different levels can beallowed is a difficult problem.
• For some items, “it is difficult to understand what is being
asked.”• There are items that are considered to be important but
which are not listed in the checklist. For example, “el30:
Products and technology for education” is an essential
item in the school.

Here, The following points are listed as other characteristics
of Fig. 7.
• The arrows inside the boxes indicate the connection to moredetailed lower-level items; below such arrows, details of thecontents on the 3rd or lower levels are described.
• The thickness of the large arrows that connect each boxed item
represents the strength of the relationship between the items.
• Environmental factors are considered to support the overall
life of Boy C; accordingly, they are not directly connected withother items.
• “ Sucking” and “nail biting,” which were judged by theclass teacher as impor tant although they are not listed in
the checklist, are described under “Health condition” after
uncertainty on where to place them.
• In addition to representing the current condition, contents basedon the assumption of the status after graduation are describedunder “Participation.”

To cope with points such as these, it is necessary to
examine the creation of a manual regarding the use ofchecklist. Considering that the checklist is to be used in
actual situations, the manual should have a certain degree of
flexibility.

The class teacher gave the following explanation
regarding the aims of preparing this model figure.

2) Preparation of life map
In the individualized teaching plans of the school
Present

With mother

Future(after graduating from high school department)
Hobby

Hobby

Horseback riding
Swimming pool

Horseback riding
Swimming pool↗

↗
School ← Home → Shopping
By carWith family

FIGURE 6 Life map for Boy C

Group home
Home helper ↓↖

Workshop ← Home → Shopping
Train, bus

By himself,with home helpers

FIGURE 7 Model figure for Boy C

Dormitory (+)

Home (+)

Environmental factors

No speciﬁc comments

Friends (+)

Conversation:･ He communicates his intention by words

Watching/listening:･ He often loses his attention and is cautioned about it･ He talks to others about what he is interested in

Changing clothes:･ He does not change his clothes when he sweats
and thus, he catches cold
･ He does not care that his shirt is hanging out fromhis pants

Eating:･ He can eat a meal by himself without assistance･ He does not prepare meals by himself at home

Walking:･ No problem in walking itself
��Safety, travel within a speciﬁed time･ It is difﬁcult to walk about in town

Life after graduation:･ Goes to the regional workshop
��Will he be able to go there by himself?
･ More self-supportive and objective-oriented life

Regional resources (care-related facilities, etc.) (+)

Teachers (+)

･ Horseback riding: He may be able to do this by himself･ Swimming pool: Will he be able to go to the pool byhimself?
･ Shopping; He likes to go shopping; it is easy to have
objectives

Leisure:��Helping his family about household tasks
Father and mother who often ask him to go out･ More self-supportive and objective-oriented life

Domestic life:･ He tends to be addicted to Video games

��He can clean up and go to other classrooms by himself

School life:･ Undertaking a single task

Telephone:･ He feels uncomfortable when calling thejunior-high school department
��Eﬀorts to improve this in the activity of“individual learning,”･ He can phone home by himself

Participation･ He is capable of performing social activities

Activities
Greeting:･ He can give a greeting in the morning when heenters the classroom
��No greeting at the horseback-riding club in themorning･ He learns to give a greeting through repeated daily
activities

TOKUNAGA Akio

Body structures

Language:･ There are not many things he wants to do･ Tends to be distracted by surrounding
movements

Motivation:･ There are not many things he wants to do･ Tends to be distracted by surrounding
movements

Attention:･ Continuation is difﬁcult･ Tends to be distracted by surrounding
movements･ Not used to making and carrying out a plan･ Repetition makes him acquire things

Prospects:

Body functions

Health conditions
Development:･ Sucking･ Nail biting � Aﬀects skilled movements in daily life

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NISE Bulletin Vol.9: 1-26 November 2008

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The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA Akio
“I consider that the model figure is a collaboration tool; therefore,
it is important that the figure be easy to read and understandvisually. It was difficult to decide whether to make a single
figure or multiple figure s for different situations, but I decided
to make a single one. This is because, for collaboration among
various professionals, the important thing is that by looking at themodel figure, the actual conditions and problems in the overall
life of the boy can be elucidated, so that we are able to know
how the child’s overall life is, and where we will be able to playa role. Therefore, I consider it better not to initially draw arrows
connecting environmental factors; rather, the arrows should be
inserted after discussion with related organizations. In this way,
important issues that should not be omitted in the education of
Boy C become clear.”With regard to the outcome of creating the model figure,the class teacher reported author the following.
“First, by preparing the model figure, skills that are considered tobe connected to the social life (social participation) were clarified.
Boy C has no physical-structural problems related to walking,but he is not allowed to walk about by himself in town because
he is often distracted by things he sees (problem in maintaining
his attention), or because he does not have a strong will to arriveat the destination within a certain time (motivation). After his
graduation, he intends to enter the regional workshop; however,if this situation does not change, he needs to be accompanied bya parent to and from the workshop. As a result of creating themodel figure, this problem has been structurally represented.
Next, I had a discussion with teachers using the ICF model, andwe were able to provide special 3-hour learning sessions for
Boy C. As a result, by repetition, he became able to walk to thebus stop, take a bus into town for shopping, and then return toschool. To go to the workshop, Boy C is expected to take a train
and a bus; he may progress to being able to take a train. In thisactivity, the task to be achieved by Boy C was obvious and thesteps to be taken were apparent; therefore, cooperation amongstaff members was easily obtained.”

Furthermore, the class teacher indicated that there are
two styles in the preparation of a model figure. One is that
subjects in education became clear during the preparationof the model figure. The other is that the model figure iscreated on the basis of clear intentions. The class teacher
explained that he/she created the model figure from theviewpoint of its use in the individualized teaching plan andindicated the importance of the viewpoint in selecting items
from the checklist for the preparation of the model figure.
That is, the class teacher selected the latter style.
As the reason behind his/her selection, he/she indicatedthe following: this research was initiated in the middle ofthe fiscal year, thus it was conducted during the practical

NISE Bulletin Vol.9: 1-26 November 2008
execution of the individualized teaching plan in which theeducational issues were clear; accordingly, this research
was clearly affected by being carried out under suchcircumstances.
While the class teacher indicated a difficulty in
distinguishing between “participation” and “activity,” he/she
also indicated that classification became easy if issues wereviewed from the “participation” point of the student. The
viewpoint in which importance is placed on “participation”
is essential specifically in high school department, where
the students are to enter society in the near future.
4) D iscussion between class teacher and otherprofessions① Discussion within high school department
In a high school department and junior high school
department, teachers of guidance often differ from thehomeroom teacher. Accordingly, the class teacher is often
unable to monitor the students during learning activities, ora teacher of guidance is not able to sufficiently understandthe attitudes of the students during other learning activities.
To compensate for this situation, this class teacher held adiscussion with other teachers while referring to the ICF
model figure (Fig. 7) and attempted to examine teachingpolicies and other issues.
Such collaboration between teachers has conventionallybeen carried out on the basis of an individualized teachingplan. However, because the high school department of thisschool has a large population of over 60 students, it wasnecessary to investigate effective means of collaboration
within a limited time. Through the use of the model figure,in which tasks in individualized teaching plans were plainly
structured, it became easier during discussion to focus onteaching goals, and to predict the educational setting thatshould be prepared for the student and his/her future image
after completing the educational activities.
② Discussion with staff members of the workshop
where Boy C expects to work after graduation
The model figure using ICF was favorably evaluated by
the staff of the workshop as being easy to read comparedwith the conventional individualized teaching plan thatcomprises predominantly a textual description, and “it iseasy to understand what kinds of activities are requiredin accordance with the actual conditions;” therefore, thediscussion of activities aimed at supporting daily life after
graduation could be effectively carried out. Within the
background of criticism from outside the school that theactivities being performed in the school are not clear, it ishighly significant that, by presenting the model figure, theevaluation that “we now can understand matters on which

The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA Akio
importance was placed in school” was obtained.
(3) Evaluation of overall current case
The use of the ICF model figure resulted in the smoothexchange of opinions among staff members inside theschool as well as with various professionals outside theschool. In addition, in the discussion with the parents,
the usefulness of ICF as a collaboration tool has also
been indicated by, for example, the favorable evaluation
regarding the presentation of the cause-and-effectrelationship by extracting core sections from individualizedteaching plans.
4. A case in which differences in understanding
among various professionals were exposed
When opinions and policies among various professionals
involved with a child differ, the child becomes confused
and the goals of each professional are difficult to achieve;
therefore, collaboration, including coordination among theprofessionals, is important. On this basis, collaborations
mainly between the class teacher and the mother andbetween the class teacher and the PT are investigated in thiscase.
(1) Outline of case
Boy D is in the 1st grade of elementary school
department. He was diagnosed as having hypoplasia of thecallosal body and West syndrome, as well as severe mental
retardation and physical disability. However, when he isgreeted or called by name, he sometimes responds throughfacial expression and gestures. His mother takes him toschool by car. In addition, he has been continuously goingto multiple medical facilities since before he entered special
school.
(2) Actual tasks
1) Evaluation using checklist
After the evaluation, the class teacher asked Boy D’s
mother mainly about life-related matters that were difficult
to clarify. As a result of the involvement of the mother,
the class teacher indicated the following outcome. First,
although there were some points which were difficult tounderstand in the evaluation criteria and contents of thequestions, a common understanding with the mother was
deepened during the explanation of such evaluation criteria
to her. Second, the class teacher was able to obtain not
only the requested information, i.e., issues about Boy D thatwere recognized as being unknown, but also a great amountof completely new information during the conversation withthe mother.
Among the checklist items considered to be the field ofPTs, the class teacher evaluated “b7: Neuromusculoskeletal

NISE Bulletin Vol.9: 1-26 November 2008
and movement- related functions” under “Body functions”
and “s1: Structure of nervous system” and “s7: Structure
related to movement” under “Body structures” and thenasked the PT to confirm the evaluation; as a result, thefollowing was indicated. First, the evaluation criteria are
difficult to follow; further lower-level evaluations are
required for more precise judgment, which requires indepth reading of the “ICF: International Classification of
Functioning, Disability and Health ?Revised Version ofInternational Classification of Impairments, Disabilities
and Handicaps-.” Second, differences in evaluation
scores may be reduced by having multiple evaluators
perform the evaluation. In particular, items with large
differences in evaluation scores are considered to haveambiguous evaluation criteria; accordingly, the necessityof reexamining the items themselves was indicated. Third,
there are items that are insufficient to describe the stages of
infants and early development.
Through the above activities, the following unexpected
outcome was obtained as a result of differences in the
viewpoints of evaluators. Namely, when there aredifferences in evaluation scores, we tend to see the negative
aspect of the presence of errors; however, in this case, thedifferences in understanding by each professional and in theattitude of the child in different situations were mutually
recognized by the various professionals, as evidenced by
the differences in evaluation scores.
2) Preparation of life map
Figure 8 shows the life map for Boy D prepared by theclass teacher. Boy D has been continuously involved withmultiple medical facilities since before he entered special
school; the strength of the connection is indicated by thekind of line connecting the items. Similar to the case of
Boy B, Boy D as well as all of his family members areshown in the center of the figure. Strictly speaking, thisrepresentation should be re-arranged in terms of whether
this means support only for Boy D or support for the entire
family.
3) Preparation of model figure
After the evaluation using the checklist, the classteacher prepared the model figure shown in Fig. 9 and held
discussions; then, using the results of the discussion, theclass teacher attempted to modify the model figure so that it
could be used more easily.
The following are the characteristics of the original figure
in Fig. 9.

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The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA AkioNISE Bulletin Vol.9: 1-26 November 2008

Degree of connection Frequent

Facility attended before
entering special school
Boy D uses this facility
for short stays so that
there are some staﬀ
members involved
with Boy D
Community
Attends festivals, takes
walks near his house,
unnamed people
Motherʼs friend
The friend takes care of
Boy D when his mother has
some minor errands (since
the She has moved, thefriend has become
somewhat estranged)

RegularOccasionally

RarelyRespite care (X association)
Delivery to and from school,taking care of Boy D whileparents are absent(average 5.5 h per month)

Short stay
For therapeutic stays
for educational purposes
during long vacation
periods (approximately
10 days a year),

X hospital (irregular)
primary doctor inpediatric department
Dr. X (once a month)

Boy D(1st grade in elementary
school department)
father, mother,elder brotherGrandmother(once a month)

Close-knit family
Parents and two boys
(elementary school pupils)
go on trips together,occasionally spend holidays
together

X Hospital
pediatrician Dr. X
OT (once a month)

Classmates
Boy X
Girl Yand others

Friends at afﬁliated schools
X elementary school(twice a year)
X elementary school(twice a year)

X Hospitalorthopedist Dr. X
PT (once a week)
Manufacturer of
support equipment
Mr. X
X Special School
Class teacher
X (almost every day)teachers of learning classes
X, Y (2 hours per week)
other learning classes
X, Y, Z (1 hour per week)
School nurses
X, Y

FIGURE 8 Life map for Boy D• The arrows (↑↓) in the box for each item of the constitutive
elements show the capacity and actual per formance inthis order from the left; the upward arrow ↑ indicates thoseconsidered to be positive items for Boy D, and the downward
arrow ↓ indicates those considered to be negative items for
Boy D.
• In the boxes, specific forms and conditions are also described.
• Lines connecting each of the constitutive elements show therespective relationships.

After the discussion using the original model figure, theclass teacher indicated the following.
• Because each item is described briefly in the figure, it
is more easily understood than text references, and theoverall relationship could be easily explained by following
the flow of the figure.
• The figure was created as a tool for discussion; however,understanding the figure may be difficult when theunderstanding of ICF itself is lacking.
• T here are terms such as “undertaking tasks” and“nonverbal messages” whose meanings are difficult tounderstand; improvement is required.
• Because the individualized teaching plan had already been
made, contents that were considered necessary for Boy D
were selected from the teaching plan and made into thefigure. If an individualized teaching plan had not been

available at the time immediately after entering the school,
creating a model figure might have been more difficult.
Points indicated by the mother and the PT regarding theactual conditions of Boy D were then corrected, and lines
expressing the relationships between items were changed.
Item names were expressed such that they could be easily
understood. The modified model figure is shown in Fig.
10. Such modifications were not made for other cases;
the modified model figure was a result of seeking ease ofunderstanding and ease of use.
4) D iscussion among class teacher, family member
and other professions① Difference in opinion
During the discussion with the mother, the following
difference in opinion was clarified. Namely, the classteacher considered the medical care with “differences inpolicies among health-related professionals” as “barriers.”
While the mother agreed with this, she also wished toconsider favorably that the same primary physician and thesame rehabilitation staff were continuously in attendance
and to categorize this state under “facilitators.” From
this, the following necessity has been clarified: namely,
we should recognize that the total evaluation score for theentire area of medical care should not be set at ±0, but thatFIGURE 9 Model figure No. 1 for Boy D↑• Self-care (toilet use) ↑↑Under toilet training
If he can urinate by himself whenurged to do so, then he himself will
feel comfortable• Medical relations
Guidance policies among health-related
professionals sometimes diﬀer• Social environment
There are few appropriate supportive
environments (−)• Nonverbal messages ↓↑He can communicate using manymeans to express himself• Self-care (eating) ↑↑He needs to acquire swallowing
function and to take in foods using
his upper lip
Aims at improvement of generaleating function• Family
Attitude and support of family members (+)
Attitude and support of acquaintance (+)
Neighborhood of residence, mobility,
environment (+)

Environmental factors

Boy D can relate to people at afﬁliatedschools, community residents near theschool, and people met on ﬁeld trips• Activity in the special school• Comprehension of spoken
messages ↑↓He reacts to certain words and cantake action• Undertaking tasks ↑↑In certain situations, he can takeactions by making choices andthinking↓

Events at the childrenʼs club are notsuitable for Boy D• Participation in regional society• Activity outside the school ↓There are few situations in which
he can participate

Participation

TOKUNAGA Akio

• Movement ↓Moving by himself is increasing
if he could the tension in his body andknow how to use his body

• Physical functions ↓He cannot control his head position
Asymmetric tonic cervical reﬂex remains
Because he has lateral spinal curvature,
it is diﬃcult to maintain a sitting position
If he can maintain his posture (sitting
position or laying position) and is able
to move, the number of possible
activities will increase

Body structures• Willingness ↑He has willingness towards activity
He expresses anxiety when he has no
idea what will happen next

• Language ↑He can understand many words
He responds by facial expression to
spoken messages

Activities• Sensory functions ↓To what extent he can see is unknown
He closes his eyes to adjust to theenvironment
He is sensitive to tactile stimulation• Observes with attention ↓↑He often conﬁrms his surroundings
by observation
If he could see, hisunderstanding ofa situation may become easier• He is ﬁne and almost never catches
cold ↑

Health condition• Cognitive functions
Able to understand simple cause-andeﬀect relationships

Body functions

The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
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15

FIGURE 10 Model figure No. 2 for Boy D• Medical relations
Support and attitude of medical experts (+)
diﬀerences in opinion among school andhealth-related professionals (−)

Diﬀerence in guidance policies among
health-related professionals (−)• Self-care (toilet use) ↑↑Under toilet training
If he can urinate by himself when urged to
do so, then he himself will feel comfortable• Movement ↓If he could the tension in his body andknow how to use his body, then the partsof his body that can be moved willfully
may increase

Participation

Undertaken mainly byschoolUndertaken mainly byfamilyImportance placed onconnection to family

Importance placed onconnection to PT

Meaning of the lines• Social environment
There are few appropriate supportive
environments (−)• Family and surrounding people
Attitude and support of family members (+)
Attitude and support of acquaintance (+)
Neighborhood of residence, mobility,
environment (+)(−)

Environmental factors• Activity in the special school ↑Boy D can relate to people at afﬁliatedschools, community residents near theschool, and people met on ﬁeld trips• Participation in regional society ↓Events at the childrenʼs club are not suitablefor Boy D• Activity outside the school ↓There are few situations in which he canparticipate

TOKUNAGA Akio

Environmental
factors• Self-care (eating) ↑↑He needs to acquire swallowing function
and to take in foods using his upper lip
Aims at improvement of general eating
function• Means of expression ↓↑He can communicate by many means to
express himself• Comprehension of spoken messages ↑↓He reacts to certain words and can takeaction• Status concerning tasks ↑↑In an appropriate environment, he can takeaction by making choices and thinking• To observe ↓↑He often conﬁrms his surroundings byobservation
If he could see, his understanding of asituation may become easier

Activities• He is ﬁne and almost never catches cold ↑Health condition• Physical functions ↓He cannot control his head position
Asymmetric tonic cervical reﬂex remains
Because he has lateral spinal curvature,
it is difﬁcult to maintain a sitting position
If he can maintain his posture (sitting
position or laying position) and is able tomove, the number of possible activities
will increase

Body structures• Willingness ↑He has willingness towards activity
He expresses anxiety when he has no
idea what will happen next

• Language ↑He can understand many words
He responds by facial expression to
spoken messages• Sensory functions ↓(vestibule-speciﬁc sensation and others)
To what extent he can see is unknown
He closes his eyes to adjust to theenvironment
He is sensitive to tactile stimulation• Cognitive functions ↑Able to understand simple cause-andeﬀect relationships

Body functions

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The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA Akio
“barriers” and “facilitators” are found in combination in thesame medical-care area. Furthermore, when a differencein policy is made apparent, there is no place to seek advice,
which is considered a “barrier.” This is an important
viewpoint and an issue to be examined in the future.
Meanwhile, a difference in the opinion with the PT was
also clarified during the discussion. As a concrete example,
for the item “Observes with attention,” opinions of the PT
and the class teacher are presented below.
PT:“I consider that it may be difficult for Boy D to observe withattention. Even if he does observe, considering his actual
condition, he is probably at the stage of understanding not themeaning of what he sees, but only that there is an object.”
Class teacher:“I think that Boy D understands an object visually under certain
limited conditions. We can see that Boy D moves his eyes towatch the object being presented, and that he confirms the object
visually.”

A difference in opinion does not necessarily mean
misunderstanding by either party. Similar to adults,
children are considered to differ in their facial expressions
and actions depending on location, partner, and time. The
recognition of such differences by each professional may
lead to deeper mutual understanding, which is considered
to be linked to more extended teaching and therapy beyond
the temporal treatment.
② Division of roles
On the basis of the model figure, the overall pictureof Boy D was confirmed and roles undertaken by eachprofessional were discussed; the PT also proposed theissue of the roles of rehabilitation, school, and home. I cansay that the outcome of the study is that we could sharethe viewpoint of various professionals undertaking theirrespective roles.
(3) Evaluation of overall current case
The point to be noted in this case is the differences in the
viewpoints between evaluators. When there is a differencein evaluation scores, we tend to consider the error as anegative aspect. However, here the error leads to a common
understanding regarding the differences in the opinions andin the child’s condition depending on the situation.
I also paid attention to differences in the understandingof ICF itself. The current s tudy focus es on thecharacteristics of ICF as a common language. However,ICF is not everybody’s common language. Health-related
professionals in medical care and health and welfare, forNISE Bulletin Vol.9: 1-26 November 2008
example, have many opportunities to become familiar
with ICF or its former International Classification of
Impairments, Disabilities, and Handicaps (ICIDH) during
their training or in their actual workplaces; accordingly, it
is easy for them to gain a common understanding by using
ICF. However, the parents’ standpoint is not necessarily
the same. Therefore, in actuality, a simple reference thatfacilitates the understanding of ICF is required. Similar
points are indicated in cases A and B as well.
5. A case of a facility-affiliated school wherecollaboration is carried out well on a routine basis
In some special schools affiliated with medical andwelfare facilities, communication between the facility andthe school is well maintained; however, there are cases
in which activities are not mutually known by the facility
and the school. In this case, communication among staff
members is carried out routinely. I investigated the methodof collaboration in this case.
(1) Outline of caseGirl E is in the 6 th grade in special school. She isphysically handicapped and has mental retardation due tocerebral palsy, but she can move around by herself in awheelchair and communicate in everyday conversation.
She stayed in a facility for children with physical/motor
disabilities and attends the affiliated special school. She
returns home only several times a year, so that the facility
and the school are her major place of living. Because theschool and the facility in this case were established by thesame founder, communication among staff members isfrequent; for example, activities to promote independence
performed jointly by the facility and the school are includedin the curriculum of the school.
(2) Actual tasks
1) Evaluation using checklist
First, the class teacher performed the evaluation, then theclass teacher asked another teacher who was also in chargeof Girl E regarding points that were difficult to understandconcerning Girl E as well as points to be confirmed, andthen finalized the evaluation. The class teacher indicatedthat this process led to a deepening of mutual understanding.
As a result of this evaluation, the class teacher indicated thefollowing.
First, the teacher noted evaluation scores and theirlater application. In the current evaluation method, items
presenting almost no problem or items that are favoritesof the child are expressed by the score of 0 (excluding“Environmental factors”). Accordingly, positive aspectsof the case are not apparent. Considering the actual
subsequent teaching program, contents focusing only on

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Center (theraputic facility)(Medical care)
Head doctor (doctorʼs rounds)
Primary doctor Dr. X, Dr. X
NursesMr. X, etc.

SchoolFormer class teacher X

Girl E

Current class teacher X
X

Mother elder sister(family)

Assisting staﬀ
Other teachers(Medical care as outpatient)
Department of dermatology(hospital visit)(Rehabilitation)
PT Mr. X(activities to Promote
Independence of the school,
physical therapy at the center)
Other PT and OT(pool therapy, sports therapy)(Staﬀ for child-care)
Ms. X and XX, etc.
(daily life)
Ms. X (related to graduation)

FIGURE 11 Life map for Girl E
negative aspects can hardly be said to be good ones. Items
which can be made use of as hints in actual teaching are not
only the scores, but also information such as that describedin concrete terms in the notes, for example, “what kind ofdifficulties actually exist?” and “in what situation can thechild perform the activity? ”.

With respect to the symbols used in Fig. 12, those which
differ from other model figures are listed below.

The second point is related to a blind spot hidden behindthe fact that a wide variety of items are included. Whileevaluation using a checklist enables the clarification of abroad view of aspects which had not been previously noted,
we should not forget that we are not able to understandeverything about the child from these items. In earlier
studies concerning the use of ICF, specific difficulties andthe wishes of guardians were elucidated for the first timethrough communication with the guardians and the use of
information from other organizations.9

The class teacher indicated a difficulty in selecting fromthe evaluation items in the checklist when preparing thefigure. If the number of selected items is too small, many
items will be omitted; however, if the number is too large,
it will become difficult to read the figure. Similarly, if
all the necessary constitutive elements are connected byarrows, the figure will again become too difficult to see.
A reduction in the number of items and modification of
the type of lines is required to secure ease of reading of
the figure. The class teacher suggested making two typesof figure: a figure showing the entire picture, and a figure
focusing on certain items; he/she also proposed the use ofdifferent lengths of the arrows (↑↓) in each item to express
the evaluation scores.

2) Preparation of life map
Figure 11 shows a life map for Girl E prepared by theclass teacher. In this case, as individuals involved withGirl E, mainly staff members of the school and the facility
to which she belongs are presented. Because she returns
home infrequently, there is no description of her homeneighborhood.

3) Preparation of model figure
Figure 12 shows the model figure prepared by theclass teacher on the basis of the evaluation using thechecklist. Compared with the figures in the other cases,
this figure is characterized by the connection between eachenvironmental factor and related items, as indicated by thelines.

• T he arrows (↑↓) in each box indicate that the actual
performance is higher than the capability of Girl E.
• The correlation between “environmental factors” and otheritems is expressed by the arrow →.

4) D iscussion between class teacher and otherprofessions
Discussion of this case was conducted with the PT who
was in charge of training at the facility, the staff member incharge of daily life, and the nurse in charge of medical care.
The discussion using the model figure of ICF (Fig. 12) was
held in August. In Girl E’s school, staff members involved
with the children meet at the beginning of each fiscal
year, and they communicate routinely; accordingly, thediscussion in August was held with the aim of determining
the changes in the actual condition of Girl E after the initialstaff meeting and reconfirming the respective roles of thestaff members. As a result, the aim was achieved and theFIGURE 12 Model figure for Girl E• Support and attitude ofhealthcare-related staﬀ (+)
Medical consideration, support
in all aspects of daily life,
provision of training andequipment• Use of wheelchair and PC
walker (+)• Use of shoes that compensate
for the leg length diﬀerence (+)• Flat landscape (+)• Equipment inside the buildingof the school and center (+)
Handrail in the toilet, ﬂoors
without steps

Environmental factors• Mobility ↑↓Moving around a short distance and indoors
using the PCW outings using the wheelchair,needs assistance for long-distance travel andat steps• Walking ↑↓Use of PCW• Self-care ↑↓Toilet use, dressing, and washing of the bodycannot be performed completely by herself,
but can be performed with assistance• Control of feeling, language, and attitude in
human relations• Reading ↓Able to read more than half of the 50
hiragana characters when read one by one• Writing ↓Able to trace 2-3 simple hiragana characters• Calculation ↓Activities• Support and attitude offamily members (+)• Support and attitude offriends (+)• Support and attitude of thestaﬀ members of the special
school (+)• Anti-allergy agent (+)• laxative (+)• Anticonvulsant (+)• Exchange with nearby
elementary school ↑↓Use of taxi and wheelchair• Outings (shopping,leisure activity) ↑↓Outings are possible withassistance; it is limited in the lifeat the school and center• Life in the center
She actively participates intraining, she often watches TV
and listens to music during
leisure time

• Life in the special school
She is eager to participate inlearning and pupil committee
activities

Participation

TOKUNAGA Akio

• Dislocation of the hip joint• Diﬀerence in the lengths oflower limbs• Displacement of the pelvis

Body structures• Defecation and urination ↓Diﬃcult to control• Sensation of pain
In the hands and legs ↓In particular, pain in the hands
when walking with a Postural
Control walker (PCW)• Higher-level cognition ↓Abstract thinking; complex goaloriented activities such as time
management are difﬁcult• Emotion ↓Occasionally unstable

Body functions

Health condition• Epileptic seizure ↑↓Controlled with anticonvulsant

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discussion was conducted more effectively, according to theclass teacher. The figure was considered to be effective not
only in the midyear meeting described, but also in the staff
meeting at the beginning of the fiscal year.
(3) Evaluation of overall current case
As in this case, even when good communication among
various professionals is carried out routinely, the seriesof attempts using ICF had the effect of reconfirming theoverall situation of the child and deepening the mutual
understanding about their respective roles. To lead casessuch as this one in a better direction, in which discussion
for collaboration has already been carried out, we must
investigate in detail the objectives ICF can achieve in
concrete terms in the future. In addition, some of the staff
members of the facility became interested in ICF itself
through the current discussion. This suggests the possibilityof ICF creating new forms of collaboration not only basedon proposals from schools, but also based on the schoolstaff working together.
IV. Comprehensive Discussion
In this section, the results of investigating the fivecases and the findings obtained through discussions withresearch collaborators are combined and organized, and thepossibility of and issues in the practical application of ICF
as a tool for collaboration among various professionals are
considered in relation to individualized educational support
plans. In addition, I will state my opinion regarding what
collaboration among various professionals is and what itshould be.
1. Towards practical application(1) ICF checklist
In this study, the “ICF CHECKLIST version 2.1a
Clinician Form” was translated with reference to its official
Japanese translation, and on the basis of this checklist,
class teachers evaluated each case. Through the processof such evaluations, the efficacy of and problems in the
ICF checklist as a tool for collaboration among various
professionals were clarified.
1) V iewpoint of covering entire daily life
In all instances of cases, positive comments that theitems listed in the checklist cover broad regions of theoverall daily life were submitted. Among the comments,
a frequently noted characteristic was that, compared with
the issue-relationship figure of the KJ method, which isfrequently used during the preparation of individualizedteaching plans and in which the subjectivity of the creatorof the figure is often dominant so that some aspects are notcompletely clarified, the overall daily life is covered by thecurrent checklist.

NISE Bulletin Vol.9: 1-26 November 2008
Meanwhile, because the range of items was so broad, it
was also clarified that in all cases, even the class teacher
does not know about many of the items. In particular,
it seems that many of the “environmental factors” suchas “e5: Service, policy” were not known. With respect
to these items, positive opinions were stated, such as “itwas good to know that there were matters I did not know
about,” and “to ask about what I do not know is important;”
however, considering the application in actual schools, thepossibility of generating the feeling of “being ashamed of
not knowing” or “getting things done within what I know”
cannot be denied.
The author should also note that knowing everything is
not necessarily good. From the standpoint of the children
themselves as well as their families, they do not necessarily
want teachers and staff to know everything about thechildren, and data must be collected with special care fromthe viewpoint of protecting personal information. However,according to the reports of the current five cases, the classteachers indicated that they had a good chance to reconsider
issues and tasks from the standpoint of a class teacher
or the school through the processes of knowing the total
situation of the children to some extent, with the consent of
the guardians, while receiving additional information fromvarious professionals; in this regard, the guardians did not
express any negative opinions.
From these findings, knowing a broad range of the entire
daily life through the use of the checklist is suggested tobe effective in promoting collaboration among various
professionals.
2) Problems with items: Selection of items
The current ICF checklist has been prepared by selecting
major second-level items from among the constitutive
elements of ICF; accordingly, not all items of ICF are
included, and naturally some are omitted. As an case fromthis study, in case A, the item “d415: Maintaining posture”
was added to “Activity” in the checklist. The addition of
items which originally are not in the checklist is allowedwith reference to ICF itself when necessary. However, todo this, one is required to know the entirety of ICF, which
may be difficult to accomplish with the current checklist
alone. To solve this problem, investigation is currently
under way in using the “ICF: International Classificationof Functioning, Disability and Health ?Revised version ofInternational Classification of Impairments, Disabilities andHandicaps-” as a complement, and using simpler methods
including the use of electronic tool.
Meanwhile, the school teacher in case C indicated thenecessity of “e130: Product and technology for education,”

The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA Akio
and the school teacher in case D indicated the necessity of“b510: Ingestion function.” The lack of these items in ICF
differs from the lack of “d415: Maintaining posture.” The
former omission means that ICF itself does not sufficiently
cover students in their childhood and early developmental
stages. To cope with this, a study aiming at the creationof a children’s version of ICF is now under way, 4 andcurrently the author also is conducting an investigation in
the direction of supporting such studies.
3) Problems with items: difficulty of evaluation
Here I describe the reasons behind the difficulty inconducting the evaluation in terms of two separate
problems: a problem concerning evaluation criteria
and a problem concerning the difficulty in evaluating
collaboration partners.
One problem with the evaluation criteria is that there
are difficult-to-understand terms for both the evaluatorsthemselves and for collaborating partners, such as “d210:
Undertaking a single task,” which was pointed out incases D and E. In addition, in case C, for “Walking,”
the following problem was indicated: while its definition
presents no problem in the second level of ICF describedin the checklist, at the third level, the range of definitionis extended so that making a decision on the evaluation
became difficult. Finally, an ambiguity in evaluation scores
was indicated. For example, regarding the differences inthe degree of difficulty of “Activity” and “Participation,”
there are the descriptions “mild difficulty” and “moderatedifficulty” corresponding to 5-24% and 25-49%,
respectively. However, actual judgment is difficult and may
depend on subjectivity of evaluators. This problem should
be solved promptly to enable the practical application of
ICF.
Meanwhile, concerning the difficulty in evaluating
collaboration partners, the difficulty exists in numericallyevaluating those involved in a case under “Environmental
factors.” For example, in “e3: Support and relationship,”
it is, in fact, very difficult to categorize the attitudes ofcollaborative partners and guardians as “barriers.” A
research collaborator proposed that the evaluators should
fill in the evaluation column not by themselves but together
with research collaborators because collaboration is theaim.
4) Toward actual teaching
In this checklist, because a scale including negative
meanings is used, the condition wherein no difficulties exist
is evaluated as a score of 0; therefore, things the child isgood at are not readily apparent. Accordingly, guidance topromote those things the child is good at is difficult, andNISE Bulletin Vol.9: 1-26 November 2008
information related to such guidance is difficult to find.
Therefore, in this study, space for notes was provided in
the checklist, and we attempted to use the information inthis space in actual guidance. Furthermore, in “Activity”
and “Participation,” capacity evaluation is divided into thecapacity with the support of people and equipment, and thecapacity without support, so that differences compared withperformance can be clarified and used as hints for guidance.
(2) Preparation of life maps
In one of the five cases, a life map had already been usedin the individualized teaching plan at the school. In theother four cases, similar figures were prepared in the study
to confirm collaborating partners. As a result, the classteachers who prepared the figures, as well as collaborators
who had discussions with the class teachers, indicated that
it was useful to confirm their mutual presence. Meanwhile,
because the life map figure basically only shows the namesof the individuals and organizations involved, the actual
relationships among them, including physical, temporal andpsychological distances, cannot be presented.
Here I note the blind point of this map figures as a futureissue. When this figure is used in collaboration, there is arisk that support to the child will tend to be considered only
within the range of the figure. Essentially, the priority is
not individuals and organizations, but that there are issues
that require support. Without this recognition, new ideas
such as “let’s find new individuals and organizations,” or“let’s exclude these individuals and organizations on thebasis of judgments made concerning the issue” may not be
generated.
(3) Preparation of model figures
Because model figures were created with the aim ofusing them as materials for discussion, they were madeto represent the entire situation of the child on the basisof the evaluation items in the checklist. Using the model
figure, the actual conditions and issues could be visually
understood quickly and future policies could be efficiently
discussed; thus, the efficacy of the model figure as acollaboration tool was noted both by the class teachers who
prepared them and by the partners who discussed them.
In contrast, all the class teachers who prepared themodel figures indicated that it was difficult to determine
the items to select from the checklist. The most frequently
used viewpoint in such selection was based on the child’s issues noted in his/her individualized teaching plan that
had already been prepared. In the future, when considering
the practical incorporation of ICF into an individualized
educational support plan, it will be necessary to reorganize
the correlation between not only the model figure, but also

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the series of tasks performed in the current study, and thecurrent individualized teaching plan.
Many comments were also made concerning thepresentation of the figures. The most frequently indicatedcomment was that the incorporation of a large amount of
information in a single figure makes the figure difficult tounderstand, but a reduction of items results in the omissionof information. In this regard, because the aim of the model
figure in this study was to use it as a tool for discussion, theconsensus that a rough, easy-to-understand presentation of
the overall situation is sufficient was obtained. There wasalso the opinion that to compensate for the rough figure,
multiple figures of specific situations and objectives could
be prepared, such as “a model figure related to the guidanceof activities to promote independence.”
In this study, I asked those who prepared the figures touse arrows and symbols as they deemed appropriate andto classify “Activity” and “Participation” as they saw fit;accordingly, various representations were made in eachcase. To date, although I have not yet obtained any unified
representation on the whole, I intend to examine such
unification in the future.
(4) In discussions
Through the use of model figures, efficient discussions
were achieved with various professionals from outside theschool and with staff members inside the school. The merit,
as noted by one class teacher, may be a result of points suchas “this child may have this kind of problem in this situationin daily life” becoming clear from the relationships between
items and each professional. Thus, ideas regarding what
each professional should target can be easily obtained.
Furthermore, it was also reported that, in addition to thepresentation of materials made by the class teacher andasking questions about the actual condition of the child,by sharing tasks such as evaluation using the checklist
and the preparation of the model figure during discussion,a more proactive attitude of the partners can be obtained,
and the collaboration itself, in addition to the discussion,
can be performed more smoothly. In contrast to this, theexistence of differences in the understanding of ICF, whichshould function as a common language, was also indicated;to compensate for this, the document shown in Fig. 13
was made for case A to promote understanding among thecollaborators, and it led to smooth discussion, according to
the report.
As an issue to be resolved, the scheduling of discussions
was noted. In the five cases in this study, each of theclass teachers arranged a discussion by his/her effort,

NISE Bulletin Vol.9: 1-26 November 2008
such as visiting the collaborative partners during summer
holidays. In the case E, the discussion with the staff ofthe affiliated facility, which was physically close to theschool, was included in the annual plan. In contrast,
because of the managerial problem that discussion alone
does not warrant any medical or technical service payment,
participation by PTs and OTs was difficult. Considering
practical applications in the future, systematically ensuring
discussion will be a key issue. Furthermore, in the caseof residence in a remote area or of a child going to distantfacilities, it will be difficult to meet the individuals involved
directly. Ways of holding meetings in such cases, or the
adoption of other methods, such as the Internet, should be
investigated as well.
(5) R elationship with individualized educational
support plan
To practically apply collaboration with various
professionals in the school, I consider that use of the ICF
checklist together with an individualized educational
support plan is necessary. In this study, in the five cases,
various professionals attempted the following tasks: gain acommon understanding of the actual condition of the child,and confirm their roles in the future from their respective
standpoints. However, how to carry out the actual tasks
after understanding and confirmation were achieved was
not considered. Therefore, the author proposed that theypresent their roles and policies in writing as a “support teamsheet,” as recommended by Ishikuma and Tamura,1 andthen evaluate them later. However, the class teacher in case
E and the OTs in case B indicated that such things were notnecessary as a team, and that occasional examinations of
the respective plans and evaluations might be sufficient.
The author nevertheless feels that some kind of writtenmaterial is necessary for a practical joint application withindividualized educational support plans. Under thecircumstance that a concrete image of the individualized
educational support plan is sought at present, whilereorganizing the comments indicated, I will attempt toresolve this issue and address the production of a manual
for the entire process.
2. Again considering the meaning of “collaboration”
Thus far, I have investigated the methodology ofpromoting collaboration among a various professionals.
Here I once again consider “collaboration” itself.
(1) Is “collaboration” really necessary?
First, I ask if “collaboration” among various professionals
is really necessary. In this report, I have stated the necessityof “collaboration” at the point of education of children withdisabilities, which recently is noted quite often.

The attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
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What is ICF?
• ICF: International Classiﬁcation of Functioning, Disability and Health• ICF, adopted in May of 2001 at the General Assembly of WHO, is a revised
version of the International Classiﬁcation of Impairments, Disabilities,
and Handicaps (ICIDH) regarding the functional impairments and social
handicaps published in 1980 by WHO as a supplement of the International
Classiﬁcation of Disease (ICD).
☆Diﬀerence from ICIDH
ICIDH
Mainly based on the idea ofclassifying functional impairment
in daily life because of physicalfunctions

ICF
Focuses on activity, participation,and environmental factors☆Constitutive elements• Body functions: physiological functions of body systems (including
psychological functions)• Body structures: anatomical parts such as organs and limbs and theircomponents• Impairments (including structural disorders): problems in body functions
or structures such as a signiﬁcant deviation or loss
• Activity: the execution of a task or action by an individual• Participation: involvement in a life situation• Activity limitation: difﬁculties an individual may have in executing activities• Participation restriction: problems an individual may experience ininvolvement in life situations• Environmental factors: factors in physical, social and attitudinal
environment in which people live and conduct their lives☆When visualizing the interaction between components
Health condition(abnormal condition or disease)

Body functions,
Body structures

Activity

Environmental factors

Participation

Personal factors

Source: WHO: ICF International Classiﬁcation of Functioning, Disability, and Health

FIGURE 13 Explanatory chart of ICF

As mentioned in “I. Introduction,” the author has
searched for what the collaboration between the teachersat the special school affiliated with a facility and the staff
at the affiliated facility should be, and what the efficientdivision of roles should be.10, 11, 12, 14 I originally had the ideathat many professionals involved with each child should
not teach them separately or inefficiently. The researchstarting from that point has led to efficient and effective
teaching that has been well accepted by the staff involved

and by the guardians. However, this is our thought as aservice provider, not the thought of individuals involved as
major players in collaboration.
In contrast, the starting point of “collaboration” among avariety of professionals, which I previously reported (2003),
was the earnest desire of a mother, who requested “lateralcollaboration” because of her sense of heavy burden. 9
The mother was solely responsible for managing all the

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professionals and organizations involved with her childso that she had to repeat the same explanations over andover again. The various professionals involved to someextent hesitated to share information to protect private
information, but after they received the mother’s approvalto share information, each professional attempted to devise
a successful “collaboration.” As a result, respective
effective approaches were obtained.

*With respect to the descriptions of the cases in thisstudy, the consent of the guardians and related individuals
was obtained through the research collaborators. Consent
was also obtained for the content of the text, after thecontent was reviewed by the research collaborators. In
addition, consent was obtained for listing the names
and affiliations of the research collaborators in theacknowledgement below.

Among the current cases, the guardians in case D werereported to be confused by differences in the policies ofvarious professionals, and there was no place for them to
ask for advice. To avoid such a situation, collaboration
among various professionals is truly required.

Acknowledgements: I express my sincere appreciation to
the following people for their generous cooperation during
this study: Ms. Ranko Amemiya (teacher at Yamanashi
Prefectural Kofu Special School), Mr. Hisashi Ito (teacher
at Nagano Prefectural Ina Special School), Ms. Naoko
Ookubo (teacher at the National Kurihama Special School),
Ms. Rieko Tanaka (teacher at Nagasaki Prefectural IsahayaHigashi Special School), Ms. Kayo Furuya (teacher at
Yamanashi Prefectural Yamabiko Special School) (inJapanese alphabetical order); those who cooperated in
the study through these teachers, including the children
themselves, family members, staff at the schools, andindividuals involved with the children. In addition, I
express my great appreciation to Mr. Hisao Sato, professor
at the Japan College of Social Work, who extended to us
complete guidance and support in the application of ICF. I
also thank the staff members of WHO for consenting to theJapanese translation of the ICF checklist.

The attempt at “collaboration” starting from theviewpoint of service providers and guardians has provided,
or is expected to provide, successful outcomes. However,
the intentions of the children themselves, who are themain players in this “collaboration,” have not yet been
sufficiently heard. Their intentions should be respected asmuch as possible, and the “collaboration” should start fromthere. On the basis of this thought, I asked the class teacher
in case C to investigate a policy in which the child himself
can participate maximally. The result has not yet reached astage to be reported, but I consider this to be an important
aspect that should be investigated further.
(2) What is considered to be “collaboration” and whatis the goal?
Although this may be repetitive, the necessity ofcollaboration among professionals has been muchmentioned in the process of special needs education. To
date, in a facility-affiliated special school, “collaboration
with the facility” has always been noted as the important
issue. Where the necessity of collaboration is mentioned
as an inevitable factor, the kind of situation that can bereferred to as “collaboration” in concrete terms and the stateof successful “collaboration” are not at all obvious.
Collaboration itself is not a goal. It is only a means ofachieving something, for example, with collaboration, more
effective teaching is possible for the children in front of us.
In addition, as can be seen from the five cases, the desired“collaboration” varies depending on the case. What is
important is to clarify the goals set for each child, what weshould ask for in “collaboration” as a means of achieving
those goals, and to what extent those goals are expected
to be achieved in each case. After clarifying the causes offailure to reach the desired state of “collaboration” and how
to resolve them, I plan to continue the investigation on theroles of ICF as an tool of resolving such issues.

References
1. I shikuma, T., & Tamura, S.: Introduction to teamsupport using Ishikuma/Tamura support sheet, Practicein school psychology. Toshobunka, pp.32-46. 2003. (inJapanese)
2. N ational Institute of Special Education: Survey on
actual condition regarding teaching of activities topromote independence in special school in Japan. 2003.
(in Japanese)
3. Cabinet Office: Basic plan for the disabled, 5-year planof the priority policy. p.7. 2002. (in Japanese)
4. Rune J. Simeonsson: Developing the ICF version forchildren and youth; status report. North American
Collaborating Center 9th Annual Conference on ICF,
Presentation material, 2003. (in Japanese)
5. The Society for Study of Welfare for the Handicapped:
ICF international classification of functioning,disability, and health: Revised version of internationalclassification of impairments, disabilities andhandicaps. Chuohoki Publishers, Co. Ltd., p.9. 2002. (inJapanese)
6. The Society for Study of Welfare for the Handicapped:
ICF international classification of functioning,disability, and health: Revised version of internationalclassification of impairments, disabilities andThe attempt of the practical application of International Classification of Functioning, Disability, and Health (ICF) as a tool for collaboration among various professionals
TOKUNAGA Akio
handicaps. Chuohoki Publishers, Co. Ltd., pp.225-228.
2002. (in Japanese)
7. Takisaka, S. : Partnership required in the special school.
IEP Japan, 8, 4-9,23. 2002. (in Japanese)
8. M eeting for Survey Collaborators on the Nature ofSpecial Needs Education: Nature of Future Special
Needs Education (Final Report), 2003. (in Japanese)
9. Tokunaga, A. : Special education program for students
with physical disabilities through a community support
network: Case study of social resource management
at special schools. Research Bulletin of the National
Institute of Special Education, 30, 81-91. 2003. (inJapanese)
10. Tokunaga, A. : Guidance of special education programn in the facility-affiliated school: Through teaching of“special education program at classes” in the curriculum
for the 1 st grade of elementary school considering
the transition to activities to promote independence.
Material for Problem Proposal in the 36 th Kyushu
Research Meeting of Education for Children with
Physical/Motor Disabilities, 1999. (in Japanese)
11. Tokunaga, A. : Division of roles between teacher and
PT/OT expected in activities to promote independence
in facility-affiliated school. Proceedings of the 39 th
Research Meeting of the Japanese Association ofSpecial Education, 2001. (in Japanese)

NISE Bulletin Vol.9: 1-26 November 200812. Tokunaga, A. : Division of roles between teacher and
PT/OT expected in activities to promote independence
in facility-affiliated school II: Using case-study
investigation of application of new internationalclassification of impairments, disabilities, andhandicaps. Proceedings of the 40th Research Meeting of
the Japanese Association of Special Education, 2002. (inJapanese)
13. Tokunaga, A. : Considering the collaboration withvarious professionals in activities to promoteindependence in the school for children withphysical/disabilities: From case-study investigation of
application of ICF and attempts in various regions inJapan. Proceedings of the 41st Research Meeting of theJapanese Association of Special Education, 2003. (inJapanese)
14. Tokunaga, A. : Team-approach system theory in special
education program. Proceedings of the 2nd Research
Meeting of the Nagasaki Prefectural Research Meetingof Education for Children with Physical/Motor
Disabilities, 1996. (in Japanese)
15. WHO: ICF checklist version 2.1a clinician form.
—Received June 28, 2004; Accepted May 26, 2008—25

Support for teachers of education for children with multiple disabilities through school consultation
SUGAI Hiroyuki

NISE Bulletin Vol.9: 27-36 November 2008

ORIGINAL ARTICLE

Support for teachers of education for children with multiple
disabilities through school consultation

SUGAI Hiroyuki*
Miyagi University of Education, Sendai, Japan

Abstract: An important issue in the education of children with disabilities in contemporary Japan is the enhancement of
measures to deal with the severity, pluralization, and diversification of disabilities. This requires an improvement in teachers’
expertise at schools for children with disabilities. As part of the effort to support such an improvement in the expertise ofteachers, we addressed the issue of school consultation, organized this concept, reported the actual situation in schools forchildren with disabilities, and assessed the significance of school consultation. Specifically, the following items were assessedand discussed: 1) whether school consultation is a cooperative effort with teachers and teachers’ organizations to make the bestuse of shared expertise in resolving problems; 2) the effectiveness of consultation in specialized training through practicalefforts; and 3) the importance of on-site training (training in the classroom) based on school consultation in improving
teachers’ expertise.
Key Words: Multiple disabilities, School consultation, Teacher's expertise, On-site training, Collaboration
I. Introduction
A transition from conventional “special education”
to “special-needs education” has recently begun to be
implemented. In this transition, schools for the blind,deaf, and other disabled that have conventionally played aleading role in the education of children with disabilities
have been expected to continue their role in accordance not
only with the types of disabilities in which they previously
specialized, but also in a flexible manner according tolocal situations and the state of children’s disabilities. The
severity and pluralization of disabilities in schoolchildren
attending these schools have increased. For this reason,
the schools should take leading roles in educating
schoolchildren with severe and pluralized disabilities with
substantial needs for educational support including highlevel expert guidance, facilities, and equipment. The
schools are also expected to play other supportive roles suchas providing consultation and advice regarding educationand guidance for schoolchildren as well as for students inregular elementary schools and junior high schools who
require special educational support. Particularly in specialneeds education, the provision of special educational
support according to individual educational needs is
advocated. To achieve this, teachers in charge will be＊～ 2005.3 Clinical Center for Children with Special Needs, National Institute ofSpecial Education (NISE)

required to have greater expertise.
It has been reported that the expertise of teachers incharge of children with disabilities has been ensured, toa certain degree, by the licensing system. However, theratio of teachers having special education licenses remains
insufficient, and since the types of disabilities covered by
the licensing system are specified, it does not accommodate
the diversification and pluralization of disabilities.
Regarding teachers who provide special educational support
in regular elementary schools and junior high schools, theratio of those who have special education licenses is much
lower. Consequently, it can hardly be said that adequate
expertise has been ensured.1, 2
The improvement of teachers’ expertise can be achieved
through training. National and local government training
sessions, original activities planned and held by individual
schools, and seminars and workshops held by private
research organizations have been provided so far. It has
been pointed out, however, that unsatisfactory results havebeen obtained from such training sessions and workshops.
For example, the Third Report (1999) from the Educational
Personnel Training Council under the former Ministry of
Education acknowledges the inadequacy of training for inservice teachers and the necessity of introducing a training
selection system and participatory training. Indeed, many

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Support for teachers of education for children with multiple disabilities through school consultation
SUGAI Hiroyuki
training sessions/workshops/seminars have focused on
lectures or skill exercises for specific disabilities andspecific teaching methods, while there have been few thathave directly focused on the resolution of problems faced
by individual children. The subject matter of most training
has been general and abstract, and concrete application
has been left to the individual teachers who attended thecourses. In terms of style, the training mainly comprises
reports and lectures. Inagaki & Sato (1996)3 reported thatsuch training should be modified into one based on the“case study” method, in which practical cases are studied.
In addition, Inagaki (1998)4 indicated the need to introduce“training on the basis of teachers’ needs and self-initiative”
and the “vitalization of practice and exchange by adoptingcase studies” rather than depending solely on administrative
training. For training to become effective, many hurdles,
mainly inappropriate methodology and content, must be
overcome.
II. Teachers’ Needs and Problems in the Classroom
What teachers need most in the classroom is to resolve
individual, specific problems and to deal with the problems
of individual students by incorporating an expert’s
viewpoint. In a nationwide survey on the conditions ofdeafblind children with multiple disabilities conducted by
the author and coworkers (Department of Education for
Multiply Disabled, National Institute of Special Education,2000),5 teachers in charge of deafblind children in schools
for the blind, deaf, and other disabled were asked about
the content of training they would like to receive. Many
teachers cited items such as “having experts visit the schoolor facility to consider and deal with educational issues
together” and “training in the use of educational materials
and supportive devices,” more often than items such as“lectures by experts” and “receiving training at a specialized
institution.” These results showed that training focused on
specific subjects was strongly desired. Simply attending a
lecture away from the classroom is insufficient for resolving
specific individual problems. Rather, it is necessary fortraining in the classroom to be further developed. Whatcontribution can researchers and experts outside school
make? The author believes that one contribution can betheir participation in resolving individual and specificissues in cooperation with the school. Outside experts havebeen intervening in school teaching for quite some time.
However, in many cases, only temporary advice was given
or objective observation was made for theoretical validation,and few experts have conducted collaborative studies
with schools to resolve routine issues in the classroom.
However, in an era when school education is facing
many difficulties with the changing times and new efforts
are required to solve individual and specific problems,
it is necessary for external experts and investigators to

NISE Bulletin Vol.9: 27-36 November 2008
participate in educational studies, not as conventional
objective observers or researchers, but as problem-solving
partners who work in collaboration with the school to solve
issues faced by the school. It is necessary to establish a
direction toward problem resolution by sharing resources
and influences.
To develop this level of collaboration, “school
consultation” is considered effective. An outside
researcher and expert (consultant) works with the teachers’organization (consultee) at a school that educates and leads
schoolchildren with problems (clients) and participates inproblem solving in the classroom.
III. Concept and Characteristics of School Consultation
It is said that Caplan established the consultation
method (1970). He stated that “Consultation is a processof interactions between two professional persons, theconsultant, who is a specialist and the consultee, who
invokes his help in regard to a current work problem withwhich the latter is having some difficulty, and which hehas decided is within the former’s area of specializedcompetence”1 In other words, consultation and support
are provided to the consultee who has a direct relationshipwith the clients instead of dealing directly with the clients.
This is unlike counseling, which is the main method of
conventional consultation. Consultations offered at schools
are referred to as “school consultation,” and in this case,consultees are teachers, assistant principals, principals,
and teachers in charge of children with disabilities. Many
consultants are researchers and psychologists having
educational and psychological expertise. Consultants may
also be professionals in the medical, healthcare, or social
welfare areas. In general, consultation and support offeredby persons with experience to those with less experience
is referred to as supervision. In school consultation,
many consultants have teaching experience, and hence,school consultation may take on a supervisory nature insome cases. The consultation relationship is basically the
relationship among a variety of professionals.
Erchul & Martens (1997) stated, “School consultation
is a process for providing psychological and educational
services in which a specialist (Consultant) works
cooperatively with a staff member (consultee) to improve
the learning and adjustment of a student (client) or groupof students. During face to face interactions, the consultant
helps the consultee through systematic problem solving,social influence, and professional support. In turn,the consultee helps the client(s) through selecting andimplementing effective school-based interventions. In allcases, school consultation serves a remedial function and has
the potential to serve a preventive function.” 2 Consultations
are generally classified into four types (Caplan, 1970).1

Support for teachers of education for children with multiple disabilities through school consultation
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They are listed as follows, incorporating Yamamoto’scomments (2000a).9 1) Client-focused case consultation: themost common type of consultation, in which a consultee’s problem with a client is assessed in order to understandit and to seek a method of resolving it. The consultee is
responsible for handling the problem with the client, while
the consultant provides support. 2) Consultee-centeredcase consultation: a consultant works in collaboration
with a consultee to objectively analyze, clarify, and solve
the consultee’s particular problem. The ultimate goal is
to correct insufficiencies in the consultee’s expertise. 3)
Administrative consultation centered on remedial measures:
although resembling consultant-centered case consultation,
this consultation concerns the measures themselves. A
consultant offers specific opinions and expertise withregard to the approach to a new program and organizational
functions. 4) Administrative consultation centered on the
consultee: consultation aimed at improving the professionalrole of organizational administrators. School consultationis thought to consist of these four categories. However,
Takahashi & Tokunaga (2002)6 separately classified school
consultations into two types according to who requests
the consultation. In case-induced consultation, the client
and the parents request consultation at the school, and theconsultant, as one of the case supporters, has information
for clarifying the case and meets with the consultee at theparents’ request to provide consultation. In school-driven
consultation, school officials, not the client’s parents,
request consultation. The consultant clarifies the case on
the basis of indirect information from the classroom teacher
and other sources and provides consultation.
Ya m a m o t o ( 2 0 0 0 b ) 1 0 c i t e d t h e f o l l o w i n g f o u rcharacteristics of consultation: 1) The consultation
relationship is based on mutual free will. 2) Consultants
are outsiders, and they are impartial towards consultees.
3) The consultation relationship has a time restriction.
The consultant should prevent the consultee frombecoming dependent and provide assistance while
maintaining a certain distance. 4) The formation of theconsultation relationship is centered on the problem to besolved. Consultation is undertaken with the main aim ofunderstanding the case objectively and without touching on
the emotions of the consultee regarding the case.
The above four characteristics are also appropriate forschool consultation. In a relationship based on mutual freewill, however, consultation may, in some cases, begin witha principal’s or study leader’s request and is thus not always
initially based only on free will, although it may take onthat nature in the course of development.

NISE Bulletin Vol.9: 27-36 November 2008
Ⅳ . Special-needs Education and School Consultation
As described earlier, the circumstances of education forchildren with disabilities are undergoing great changes. In
particular, schools for the blind, deaf, and other disabled are
expected to serve as local centers, which is predicated onschoolteachers for the blind, the deaf, and people with otherdisabilities having a certain level of expertise. Therefore,
it is important to maintain and develop the knowledge andexperience accumulated thus far at schools for the blind,deaf, and other disabled. No previous proposals or reports
have presented adequate methods for improving teachers’
expertise.
School consultation can lead to an improvement inteachers’ expertise in special-needs education. There havenot been many studies that deal directly with consultationin this field. This is probably because, although joint
studies with outside investigators have already been
conducted, no framework incorporating consultation has
been established. In 1996, a study aimed at the constructionof a “consultation system supporting education for thedevelopmentally disabled” was compiled by a researchteam from Tokyo Gakugei (Arts and Sciences) University
as a specific research project supported by the Ministry of
Education. The need for the “construction of a consultation
system directly supporting the classroom” 7 was pointed
out. More recently, Hamatani (2002), 8 from the Tokyo
Research Association of Development Consultation,
reported on the practical side of developmental clinicalconsultation at nursery schools and kindergartens. The
report covered various practical issues, including trainingtype consultation. Symposia on consultation have been
held at congresses of special education associations andthose of educational psychology during the past few years.
Ⅴ . Actual State of Consultation at Schools Providing
Special-needs Education
1. Efforts by schools for the physically disabled
In 2001, it was agreed that our institute would cooperatewith the Research Department and Activity for independent
Department of K School for the Physically Disabled byestablishing a cooperative research organization, wherein
they would report on the details of teaching practices andour institute would support the school in its efforts focusedon activities for independent. This cooperative relationshipwas based on the research project, “Practical study on
educational activities under the new education guidelines
at schools for the blind, deaf, and other disabled; focusing
on self-care activity” and on “Study on expert training
support to teachers in education of the multiply disabledthrough school consultation,” supported by a grant-in-aid
for Scientific Research, for which the author (H. Sugai)
was the study leader. K School is a large school with more

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Support for teachers of education for children with multiple disabilities through school consultation
SUGAI Hiroyuki
than 1,000 students and around 100 teachers with an annual
personnel transfer of more than 10 teachers. This school
consists of elementary, junior, and senior high schools,
with each school divided into three to four guidance groups
depending on the educational curriculum. The subjectsof consultation were limited to those of a guidance group(about 30 teachers) based on an educational curriculum
consisting chiefly of activities for independent in theelementary division. The author participated as a training
consultant concentrating on classroom study at K School
to collaboratively substantiate training and to compile
a report on the results of the efforts directed at trainingbased activities for independent. In each training session,a specified person (teacher) from K School served as theintermediary to maintain close contact between the Instituteand K School in writing, by telephone, and by e-mail, andthe details of the activity were reported to the principal aswell as to the entire school staff.
2. Consultees’ initial problems
During the four years starting from 1998, school building
renovation coincided with an increase in the number ofstudents. Because of the limited space, a situation continued
in which there was little chance of observing students inother classrooms and grades and in which there was little
exchange of information on teaching content and methods.
In the target guidance group, in which the teachers served
as the consultees, the condition of the children’s disabilities
had become increasingly severe, pluralized, and diversified
as each year passed, and it had become urgently necessary
to cope with this situation. In addition, since K School
was large, the rate of personnel transfer was high; nearly
10 of the approximately 30 teachers in this group weretransferred. Under such circumstances, it was difficult forthe consultant and consultees to continue a dialogue.
It was therefore decided, during talks with the consultant,
to clarify the problems and difficulties in daily teachingin order to develop a common understanding of these
problems among group members, and to set up occasions
to discuss problem solving. Specifically, the class study
should progress on the basis of the following three points:
1) daily teaching practices with the children should bereflected upon, 2) many opportunities to observe otherteachers’ teaching practices should be taken, and 3) viewson the relationship with the children should be exchanged
by many teachers and reflected upon.
Two actual cases were taken up and teachers available toobserve the class did so in every class study. The class wasvideotaped, and all the teachers in the group discussed thepresenter’s class while watching the videotape.

NISE Bulletin Vol.9: 27-36 November 2008
3. Progress of the efforts(1) Activities in the first year (2001)
Practices in classes taught by 16 teachers wereindividually reviewed and discussed using VTRs from May
2001 to February 2002.
The author attended approximately half of these classes
and participated directly in group workshops, gave advice
at the workshops, and provided consultation for the teachers
in charge before and after the workshops. The main topics
during the discussions were the teachers’ stance in getting
involved with the children and how to view children’s behavior (Table 1). Discussions were held from thefollowing five central viewpoints in the class study.
a. Respect children’s autonomy in self-determination andinitiative (decision making and taking action on theirown) and expand involvement starting with children’s
voluntary activity.
b. S tart with each child’s needs and extemporaneously
develop activity case by case in line with the child’ssituation.
c. P lace importance on the creation of mutuality(interactions).
d. Look at children’s needs multilaterally.
e. Implement class activities from events arising from theflow (context) of children’s behavior.
In addition, “communication” was frequently raised asa case study subject. In relation to this subject, since “allchildren possess their own language and communication
mode that they can use,” we tried to establish common
viewpoints to create an environment in which each child’s“language” is sufficiently developed and to ensure a meansfor each child to communicate what they want to say.
Consultation activities were assessed by asking allteachers who participated in the training to fill out aquestionnaire. Comments made by the participants
included the following: “Training with the VTR allowed me
to understand even the things that were not understandable
by only reading documents.” “I could learn about thevarious practices of other teachers.” “I could learn fromconsultation with the consultant concerning the methods ofsolving various problems.” Reflective comments were also
expressed: ”There were so many teachers in the group that
I found it difficult to express my views.” At the end of the
fiscal year, all teachers in the group filed a case report foreach person (or a case report for each class) and compiled
a collection of practice reports. The author presented
lectures at a local teachers’ workshop held at K School.
Nearly all the teachers from K School participated in thisworkshop to learn directly about the author and his views.
This contributed to promoting deeper understanding of theefforts of the group.

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NISE Bulletin Vol.9: 27-36 November 2008

TABLE 1 Content of group training, fiscal year 2001
MonthContent of Training (Details that served as the basis of consultations)

Apr.
May.

Discussion of this year’s study.
Respect individual children’s independent-minded movement and bring out this movement. Pay attention to things together with thechildren and share thoughts with them. How to view, regard, and interpret the children’s behavior.
Come into contact with and understand children’s interests. Conduct search activities with the children.

Jun.
Jul.
Sep.

Nov.

Sharing the emotion with children and two way communication. Communication methods other than the spoken language.
Guide the walking of children who can walk with support. Provision of information understandable to children. The way to pay
attention.
Link children’s words to their movement. Use of object cues. How to handle children’s actions or expressions and to respond tothem.
Develop learning activities based on the spread of children’s interest, receiving “Yes” and “No” signs and children’s needs.

Dec.

Concept of total communication.

Jan.

How to handle signs from children and to deal with them; limiting and switching activities.

Feb.

Children’s positions in which they can act with ease.

Mar.

Reflection on this year’s activities and confirmation of the course of activities in the next year.

Oct.

(2) Activities in the second year (fiscal year 2002) andthe third year (fiscal year 2003)
In the second year, a class study was established as inschool training. In addition, workshops in small groups
were proposed by those actively promoting the study at
K School. The workshops were aimed at improving theteachers’ understanding of the course of guidance andchanges in the children by having them give a presentation
twice yearly. Specifically, the teachers organized threesmall groups for every theme they were interested in,separate from the overall workshops in which the author
participated. Each small group underwent training, andrecords of the discussions held for the three groups werecompiled with other data prepared by the presenter, kept ina file, and circulated; thus the teachers were able to confirm
the details of discussions held by other groups.
The items listed below were selected as the new main
points in the second-year training.
a. “Expansion of exploratory activity” and “Structuration of
space:” how children perceive the learning environment,i.e., school and classrooms. “Importance of theenvironment,” that is, how teachers can improve theenvironment.
b. “Selection of activity” and “Children’s initiative:” whatsteps should be taken to promote children’s initiative,
self-selection, and self-determination.
c. “ Children’s eyesight (vision)” and “Color of teachingmaterials:” to insure that children can see the materials
clearly; the provision of information and educational
material on the basis of children’s seeing function.
Aiming at the mutual sharing of feelings with children,
the discussions became increasingly focused on devising
ways to improve the learning environment and learning
steps so that children’s initiative could be further promoted.
The author continued to observe the classes and to provide
consultation by citing specific scenes related to ways oflooking at and understanding children’s behavior, andholding discussions on improving teaching materials andtools and the setting of scenes.
In addition, the author organized a conference of theCommittee of Institute Project Study at K School. Thiswas helpful for the consultees in that K School’s efforts
could be viewed relative to the practices at other schools
after listening to the reports. The author asked the teacher
who served as a K School contact to make a presentation ata nationwide conference. This experience gave K Schoolan occasion to hear the comments and observations ofresearchers other than this author and of teachers from otherschools.
In the third year, the training style employed in theprevious fiscal year was continued. The author continued toparticipate in the class study and assisted K School teachers
in visiting and observing class studies held at other schools,
provided information, and accepted visitors for educational
consultation provided by the author at the Institute.
4. A
 ssessment and discussion of consultation at K
SchoolTo summarize the overall activities, the teachers
involved in this study over the three years were asked tomake comments on the class-study-centered training andconsultation. The responses are summarized as follows.
(1) Training using VTR
Few teachers had had any experience of a class study
conducted regularly using VTRs every month. In thissituation, the following responses were received: “Because
the class was being videotaped, I initially assumed adefensive attitude and worried about what scenes should bevideotaped.” “I had a sense of resistance to presenting mypractices and receiving other teachers’ comments.” With

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regard to undergoing the training course, however, manyteachers said “It allowed me to review my own involvement
objectively” and “Having discussions made me aware of
the children’s expressions and representations that I had
previously missed and made me recognize the need tofurther improve my way of relating to them; therefore, theclass study was useful for my practice.”
Many positive responses concerning the use of VTRs
were received since they contributed to information sharing
and expansion of the range of practices: “I could learn aboutchildren other than those in my charge and started to share
information about the children in my group and to relate
to them more carefully.” “Seeing other teachers’ practices
allowed me to incorporate their ideas into my practices.” In
addition, changes in teachers’ attitude were also reported:“I started to pay attention to even the slightest movement ofchildren, not only in actual contact with them but also when
watching the VTRs. In an effort to understand the meaningof the children’s movements, I even asked the group tofeature me in a discussion.”(2) Changes in the consultees (teachers)a. Consultees’ view of children
The teachers who participated in the training exhibitedthe following changes in their view of the children.
Regarding the discussions using VTRs, teachers gave many
responses: “I noticed, for the first time, children’s actions
and expressions which I had missed or which I had viewed
in a narrow sense, and found other ways of interpretingthem. This has enabled me to develop my relationshipwith the children.” “I have come to consider the meaningof even the slightest movement of children and to place
importance on each movement.” “I used to read children’s
thoughts from their spoken language and facial expressions,but came to realize that their hand, finger, and leg (foot)movements also had meaning. I now relate better to thechildren because of this realization.”
The discussion results indicated that the teachers in thegroup were able to confirm that “Every child has his/herwords,” “Children’s actions and expressions are always
meaningful,” “Interaction with children by carefully
watching the slight movements of their hands, fingers,
legs (feet), and line of sight is the key to further activating
the children’s actions and expressions and developing
interactions while encouraging the children’s initiative.”b. Teachers’ stanceSome teachers gave the following opinions: “Since weteachers are on the teaching side, I contemplated whether
we thought of only “making” the children do things,
disregarding their thoughts, under the idea that we must firstprepare teaching materials and tools in order to relate to

NISE Bulletin Vol.9: 27-36 November 2008
the children,” and “Perhaps we teachers related to children
by giving priority not to the child’s words but to our own
spoken words.” Another opinion was also expressed bymany teachers, “I came to repeat the interactive processof being attentively receptive to children’s actions andexpressions after confirming and interpreting them, and thenresponding to the children, although not yet adequately, andto interact with the children in consideration of a childrenled relationship.” The teachers’ outlook towards theinteraction with the children changed to the following: “Iwould like to aim for interaction with the children in which
their initiative is demonstrated,” and “I will make efforts toperform not unidirectional communication from the teacher
but interactive communication between the children and theteacher.”(3) Consultation and cooperation with the Institute
Teachers’ views on the advantages of consultation
included the following:“Receiving expert advice on routine guidance (interaction
with the children) is thought to have been very effective
in reviewing the teacher’s guidance based on his/her own
ideas. Receiving advice that even the slightest movementsof the children, which I had previously missed, has its own
meaning provided me with an opportunity to substantiallychange my views on the children.” “It was good to get an
objective view different from that of schoolteachers.” “Ilearned a lot from the expert advice. It was useful to carryout educational activities with a keen sense of consciousness
brought about by the presence of an outsider.” “It was
useful to be able to visit an advanced school through theInstitute.” “It was helpful that I could directly ask theconsultant for advice on teaching and that points raised in
discussion could be used immediately in practice.” “It waspossible to learn what practice and theories are currently
dominant and being developed independent of personal andin-school views. Undertaking training sessions using VTR,
which is an orthodox technique but difficult to actually do,on a regular basis, and receiving advice from the Institutestaff allowed me to reflect humbly on my practices. The
advice was always appropriate, and it was a valuable
experience that improved my expertise.”
Problems that must be reviewed upon included thefollowing: “After the confirmation and adjustment ofmutual schedules, training was arranged for a busy periodof work such as at the end of term, and this added to theteachers’ workload.” “I could not always ask what I wanted
to, partly because of the time restriction. I sometimes
wanted to ask something after I had received advice, but I
couldn’t from time to time.” “In this class study, the teacher
who acted as the liaison and took great pains to promotesmooth communication among the teachers in the group
was a major influence in the group. A teacher who canSupport for teachers of education for children with multiple disabilities through school consultation
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take on such a leadership role will probably be necessary incollaborations with specialized facilities in the future.” Insummary, it was indicated that there was the possibility thatsome consultees (teachers) were placed under an excessive
burden because of their role as a liaison or a coordinatorand because of the timing of meetings. Furthermore, someconsultees (teachers) failed to receive sufficient consultation
due to time constraints.
Ⅵ . Conclusions and Issues for the Future
1. Effectiveness of on-site training
Pursuing continuous reflection on daily interactions withchildren and considering the steps to take in the future
are thought to lead to an improvement in the accuracyof reading the signals sent out by the children and to
the development of interactions in which the children’s
initiative can be promoted, as demonstrated in the grouptraining at K School. With regard to teachers’ views on
the children, the outlook of teachers changed, as indicatedby answers to the questionnaire, such as “I should interact
with the children by paying attention to even the slightest
movement of the children.” The consciousness of thisfundamental relationship with the children became apparent
in their practices and training activities. The effect of the
training that covered practical daily situations is thought
to be behind the incorporation of this viewpoint. Merely
learning about communication methods of children withmultiple disabilities as knowledge does not lead to thedevelopment of practices, and knowledge gained in thismanner is rarely shared among teachers. When teachers
jointly consider specific practical issues, it is thought thatsuch issues will then be used in practice and will contributeto a common understanding among teachers.
As training to improve the teachers’ expertise, notonly training such as attending lectures where general
information are imparted, but also practical training thatallows teachers to tackle assignments on solving problems
concerning the children that they actually confront every
day is required. The activities at K School provided suchtraining. Problems actually faced at the school every day
were directly addressed, and the consultees (teachers)
worked on solving them together with an outside expert.
Such training that is set in the school deals with issues
familiar to the trainees and provides a high incentive toparticipate fully. I propose to refer to such training as onsite training.
The objective of on-site training is to solve specific,
practical problems by a case study approach. The method
described in this study, with the involvement of an outside
expert in case studies on practical issues, is that of school
consultation. The teachers, namely, the consultees,

NISE Bulletin Vol.9: 27-36 November 2008individually or as a team, make voluntary efforts to solve
problems in the course of consultation and can expect
to improve their practical ability as a result. School
consultation, which functions as on-site training, can lead tothe improvement of teachers’ practical skills.
2. E ducation for children with multiple disabilities
and on-site training
As described in the introduction, the increased severity
and pluralization of disabilities in recent years necessitatescompetent teachers with greater expertise. Up to now,
training to improve the expertise of teachers has failed tohave an adequate effect. Some possible reasons are given
below.
First, this type of education is targeted at children witha wide variety of disabilities, and therefore requires the
exploration of content and methods of education appropriate
for individual situations. Since many children with multiple
disabilities are not only mentally but also physicallydisabled, it is impossible to consider their condition in only
one way. In many cases, results from not only educational
research but also from related sciences are necessary.
Measures must be taken to implement the educational
content and methods appropriate for the actual individual
situation. Adaptability to the conditions of each individual
is a unique feature of this education, and it cannot be
fulfilled by the coursework-centered teaching program of
conventional training or by the training for daily livingthat has been provided from the viewpoint of helping thechildren to become socially well adjusted. The pursuit ofeducational content and methods adapted to the conditionsof each individual requires methods different from thosein studies of group learning based on a certain level ofintellectual and physical development. However, classstudies thus far have pursued general methods and skills
applicable to any class. Particularly in ordinary schools,
class studies are completely group-centered, althoughcase studies are sometimes conducted. Special education
also exhibits this tendency. In many cases, courseworkand daily-life learning depend on group-based teaching
methods, and the key element of such class studies has beengroups even if consideration was also given to individuals.
There has been a strong connection between class studies
and medical treatment, as demonstrated by the use of theexpression “treatment and education (rehabilitation)” fromthe outset. Partly because of this, class studies have beensystematized according to disabilities and diagnoses, forexample, a teaching program for children with Down’s
syndrome and cognitive learning for children with physicaldisabilities. Here too, methods applicable to the majorityof children with a given disability and diagnosis have been
pursued. As a matter of fact, the benefits of these methods

33

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Support for teachers of education for children with multiple disabilities through school consultation
SUGAI Hiroyuki
and techniques cannot be denied, but what is needed inpractical classes is the in-depth practical recognition of“individual and specific events and experiences” that canbe established only through regular involvement withindividuals. The “reflective practice” of class studies todeepen practical recognition is contraposed to the traditional“technical practice” (Inagaki & Sato, 1996),3 but it has not
yet become established.
Second, up to now, class studies and training havebeen mainly coursework and unit learning programs.
Educational interaction with children with severe multiple
disabilities starts with the establishment of a communicative
relationship with the educator on the basis of individual
differences and the characteristics of the disability. The
establishment of such a communicative relationship is often
the main issue to be solved. It is necessary to work on
initial communication issues including the recognition ofsubtle signals sent out by a child, distinguishing voluntary
behavior, and developing mutuality through responses tothe signals. When such a relationship is taken up as an
issue, conventional training involving coursework andunit learning is inapplicable, and the promotion of general
methods results in difficulties in learning for some children.
Neither the application of the existing methods nor the
production of teachers’ manuals is feasible. For manyteachers who have long been engaged in ordinary educationand those who have worked in conventional programs
or curriculum development, the concept of education
for children with multiple disabilities requires thinking
from a fundamentally different angle. Therefore, training
focusing on changing the methodological thinking and on
adapting educational content and methods to individual
cases is needed rather than lectures on establishedmethodologies. Studies in special education have notbeen without individual case studies. Indeed, many of
the studies of children with severe multiple disabilities
have been individual case studies. However, the failureof such studies to be applied at schools is attributable tothe following reasons: 1) the incomplete detachment fromsubject-based and program-related ideas; 2) the paucity oflong-term efforts because of frequent personnel changes,
even though long (several-year) involvement in education
for children with multiple disabilities is considered to benecessary before a certain degree of significance in the
results becomes apparent; and 3) the fact that a hypotheticalsystem supporting individual studies among practitioners is
not sufficiently established.
Under this status of education for children with multiple
disabilities, new training in pursuit of the practical
recognition of individual cases is considered necessary inaddition to conventional training. It is advisable that thisNISE Bulletin Vol.9: 27-36 November 2008
training be focused on studies of class teaching practices atschool in view of the need to take up individual cases and todeal with events occurring during routine practice. In otherwords, training should be on-site.

3. Issues for the future
From experience in school consultation with teachers incharge of education for children with multiple disabilities,
the author has realized that these teachers feel a need tobuild relationships with the children they teach and topractically recognize/understand actual events. Now thata large number of students with multiple disabilities isenrolled in schools for the blind, deaf, and other disabled
and that teaching with expertise is requested, it has become
difficult to meet these demands. The author proposes on-sitetraining as a measure to respond to this problem of teacher
training. The use of outside resources for on-site training
is effective in enhancing expertise. Cooperation with otherinstitutions has attracted attention in the movement toward
the formulation of an “individual educational support plan,”and school consultation is one form of cooperation withexternal institutions. School consultation in cooperation
with local universities, education centers, or other institutes
is a promising measure to improve the expertise of teachers.
In addition, on-site training can fulfill the function of
consultation. More specifically, a teacher explores his/her
own methodology and insight as a subject of research andtraining, sometimes using outside resources, not throughone-sided guidance given from an experienced person
to a less experienced person as in the case of generalsupervision. In schools, the practice of receiving guidancefrom an invited outside lecturer is already established.
Actually, some responses to the questionnaire concerning
consultation assessment in this study indicated thatsome teachers considered the author’s intervention to besupervisory. It will be possible for consultation to focus
on joint studies with teachers to develop theories adapted
to the classroom, even if guidance intervention cannot
be completely eliminated. As this is realized, the issue
in the future will be not to apply established theories ortechniques, but to analyze and pursue the theories that are
already effective in practice to achieve further practicaldevelopment.
References
1. Caplan, G. (1970): The theory and practice of mental
health consultation. Basic Books, N.Y.
2. E rchul, W.P., & Martens, B.K. (1997): School
consultation-conceptual and empirical bases ofpractice. Kluwer Academic/Plenum Publishers.
3. Inagaki, T., & Sato, M. (1996): Introduction to classSupport for teachers of education for children with multiple disabilities through school consultation
SUGAI Hiroyuki
study. Iwanami Shoten. (in Japanese)
4. I nagaki, T. (1998): Issues with teacher education.
Reconstruction of teachers’ image (pp. 260-282),
Iwanami Shoten. (Modern Education, Vol. 6) (inJapanese)
5. Department of Education for children with multiple
disabilities, National Institute of Special Education(2000): Report on an actual condition survey of children
and students with deafblindness. (in Japanese)
6. Takahashi, A., & Tokunaga, Y. (2002): School
consultation as guidance activity: Enrichment of a
support system for children with disabilities. National
Institute of Special Education, Educational Counselingand Guidance Annual Report, 23, 11-22. (in Japanese)
7. Special Education Research Laboratory, Department of
Education, Tokyo Gakugei University(1997): Individual
program development on an integrated system of
diagnosis and assessment and curative educationin special education: Aiming at construction of a
“ Consultation system supporting education for children
with developmental disabilities.” Report on StudyNISE Bulletin Vol.9: 27-36 November 2008
Results. (in Japanese)
8. Hamatani, N., & Tokyo Research Association on Child
Development (2002): Development clinical consultation
supporting child-care. Minerva Publishing Co., Ltd. (inJapanese)
9. Yamamoto, K. (2000a): Crisis intervention andconsultation. Minerva Publishing Co., Ltd. (in Japanese)
10. Yamamoto, K. (2000b): Supervision, consultation andinformation provision. In Fukazawa, M., & Ebata, R( Ed.), Modern esprit: Advancement of supervision/ consultation practice (pp. 55-63), Shibundo. (inJapanese)
This is an English translation of a paper partly rewrittenwith additions to and revisions of a previous paper entitled“Study on School Consultation and Staff Development for
Teachers of Pupils with Multiple Disabilities” (publishedin March 2004), supported by a Grant-in-Aid for Scientific
Research, 2001 to 2003 [Basic research (C) (2)] (Project
number 13610350).
—Received May 8, 2005; Accepted May 26, 2008—

35

37

A study on teaching schoolchildren with intellectual disability
CHIKURINJI Takeshi

NISE Bulletin Vol.9: 37-50 November 2008

ORIGINAL ARTICLE

A study on teaching schoolchildren with intellectual disability

CHIKURINJI Takeshi*
Hiroshima Prefectural Board of Education, Hiroshima, Japan

Abstract: The purpose of studies of classes for schoolchildren with intellectual disability is not only to improve such classes
but also to enhance the quality of the children’s school life. To explore a new approach to studies of classes for schoolchildren
with intellectual disability, first, previous relevant studies were reviewed. Next, the methodology used in the author’s study ofthe class for schoolchildren with intellectual disability that he taught was organized. Of previous related studies, “analyticalstudies” focused on the quantitative and qualitative assessments of classes by considering classes as a communication process
and “Pedagogic studies” focused on the learning process in view of information on the psychology of learning or on theassessment involving the examination of the guidance plan before the class, class observation and a review of the class afterclass. It was considered difficult for teachers working for the school to conduct class studies by the same approach as thoseused by researchers. A methodology of class studies that is easy to employ in schools and to achieve improvements in classes
was expected to be realized by devising and improving appropriate means of examining the guidance plan before the class andof reviewing the class after class.
Key Words: Intellectual disability, Studies of classes, Analytical studies, Pedagogic studies
I. Need for Studies on Teaching Schoolchildren withIntellectual Disability
Class studies have been defined as follows: “Studies ofactual classes for devising contrivances and improvements
in conducting classes.”1 If a class study is viewed along
a time axis, a progression from the preparation andreview of curriculum guidance plan to conduct a classwith class observation followed by holding a discussion
at a review meeting after the class seems to be the mostcommon pattern. The objective of class studies is to obtain
information for class improvement. The information
obtained is fed back to each teacher who participated in theclass study. This raises the teacher’s skill at guidance andability to understand the schoolchildren and hence leads tolesson improvement.
If classes are considered a purposeful activity conducted
as part of the overall school life, however, the essence ofclass studies for schoolchildren with intellectual disability
is not to obtain information for class improvement but to“provide daily classes and school life better suited to thechildren.” 2＊～ 2005.3 Department of Educational Support Research, National Institute ofSpecial Education (NISE)

In education for schoolchildren with intellectual
disability, it can be said that the principles of guidance arelearning through natural and necessary concrete experience
with learning focused on practical and specific activities
linked to daily life. To put it plainly, providing daily classes
and school life better suited to the children suggests a needto validate whether the classes indeed improve the qualityof school life and truly nurture life skills by questioning“whether there is practical and specific activity” and“whether the children are learning through natural andnecessary concrete experience.”
II. D
 omestic Studies on Teaching Schoolchildren withIntellectual Disability
Oota3 indicated that class studies have been conducted in
the education of schoolchildren with intellectual disability
by many schools but that few research papers have been
written by academic and other investigators. The following
reasons for this situation were given.
1) Investigators lack interest in the classes2) S ince the actual status of the children varies, it isdifficult to apply knowledge obtained from one classto other classes (class study results lack generality andapplicability)
The following presents an overview of the trends

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A study on teaching schoolchildren with intellectual disability
CHIKURINJI Takeshi
of studies on teaching schoolchildren with intellectual
disability.
1. Initiation of studies on teaching schoolchildren
with intellectual disability
Komiyama, the former principal of Seichyou School for
the Handicapped,4 commented, “The education guidelines
indicate only the contents and teaching objectives
appropriate for the education of children with intellectual
disability, with little reference to the teaching method,”
because of the limitations of the original education
guidelines, and remonstrated against perfunctory teachingin the name of merely providing life-unit learning. He
raised the issue of the importance of analyzing classes andreflecting on analytical results, saying “It is necessary toreflect carefully on what, when, and how schoolchildren
acquire experience, have it take root and help themselves,
instead of falling back on a general life-unit plan.” Hereiterated the importance of schoolchildren-centered classes
and of studies of the classes themselves, although studiesof educational contents and the teaching plan are also
necessary. He stated that a class study should pursue “thetrue profile of children acquiring effective experience” andproposed that the progress of classes should be recorded
from the following viewpoints over a long period.
1) What could children learn or not learn?
2) What changes appeared in their learning following what
was done at the beginning of or during the class?
3) What was easy or difficult for them to learn?
4) How were the lesson contents maintained or how did
they take root to exert a useful effect on the children’s
activities?
Oonishi et al. 5 & Murakami et al. 6 investigated theteaching styles of teachers by class analysis.
2. Trends of studies on class studies
Hirose7 systemized the trends of class studies in the in the
education of schoolchildren with intellectual disability andpointed out the following.
A. Practical and theoretical studies are necessary, and thepedagogic perspective is important.
T he pedagogic perspective involves the theoreticalgrounds that are used to clarify the educational direction(relational theory, including educational content theory,
methodology, teleology, subject theory, and assessment
theory).
B. In a practical class study at school, one problem is thedifficulty for teachers to carry out research activities(difficulty in securing time because of work conditions
and lack of motivation toward the study).
C. A small number of theoretical quantitative (analytical) andpedagogic studies have been reported, but assessments of

NISE Bulletin Vol.9: 37-50 November 2008
the role of and methodology for theoretical studies on the
education of schoolchildren with intellectual disability
are insufficient.
D. Very few reports on class studies appear among papers
published in the Japanese Journal of Special Education(1980 – 1990).
S tudies on teaching schoolchildren with intellectual
disability include a study on observation learning, 8 a
study focused on the distance between teachers andstudents, 9 and a class analysis study in which theutterances and behaviors of teachers and children wereanalyzed categorically.10
E. At the Congress of the Japanese Association of Special
Education, only the intellectual disability sector andthe delicate health and weakness sector have madepresentations on class studies.
He also pointed out the following issues that need to beresolved.
A. It should be understood that there is naturally a limit
to the benefit of class analysis by means of quantifying
teaching in which too much importance is placed ontechnical aspects.
B. Emphasis should be placed on lesson creation.
C. The subject principle and linguistic principle of merely
having students recite answers should be improved.
D. The joy of learning together should be valued highly.
The meaning of tutorial counseling should be confirmed,
and incautious tutorial counseling should be avoided.
E. T he pedagogic perspective should be given moreconsideration in class studies.
Oota 11 reviewed prior reports on class studies ofschoolchildren with intellectual disability and provided
the following summary. Class studies by class analysis
were started in the mid-1960s; teaching styles have beenassessed; and studies using communication analysis
began to be conducted in the 1980s. He pointed out theimportance of studies on teaching performance.
3. Analytical studies
Studies have been carried out in which analyticalsystems involving the classification and quantification of
students’ utterances and behaviors during class according
to categories devised from a specific point of view weredeliberated.
Nakayama 10 modified Flanders’s 12 mutual analyticalcategories to prepare class analysis categories andconducted class analyses of schools and special classes forschoolchildren with intellectual disability using the classanalysis categories. He reported that teacher-centered39

A study on teaching schoolchildren with intellectual disability
CHIKURINJI Takeshiclasses were often the norm, where the number of teachers’
utterances was much higher than the very few voluntaryutterances of the children. Another study of class analysis
using similar class analysis categories was reported by
Yanagimoto and Tsuzuki.13 These reports indicate that not
only quantitative analysis but also qualitative analysis isnecessary.
In a study aimed at qualitative analysis, Tsuge et al.14
developed an analytical system for analyzing not thefrequency of categorized behaviors but the relationshipbetween the progress of the class and the exchanges
between teachers and students to clarify their interaction.
Musashi et al. 15 conducted a continuous analysis ofclasses over two terms at a school for schoolchildren withintellectual disability using the analytical system describedby Tsuge. They reported that there were patterns ofinteractions between teachers and students and indicatedthat the development of a new system to facilitate themonitoring of teaching activities and its use in subsequentclasses should be addressed.
Nagoya16, 17 reported practical methods and recommended
their application. To qualitatively analyze a life-unitlearning class, it is necessary to consider and form
categories based on the class view of the unit; in the life
unit, in which the teacher performs activities with students,
the individual relationships between the teacher and thestudents must be clarified. Regarding the analysis of alife-unit-learning class, Fujine18 has reported a study oncommunication analysis.
Hirayama et al.19 have recently reported that a class study
using an ethnographic method developed in anthropology
is effective for qualitative study, although no report of theapplication of this method to a class study of children withintellectual disability has been published.
4. Pedagogic studies
Studies have been carried out in which the theoreticalgrounds for clarifying the educational direction (relational
theory, including educational content theory, methodology,
teleology, subject theory, and assessment theory) of a classhave been assessed. For instance, Miyamoto20-22 stated thatthe following were included in a class study: “Children’s activities, the teacher’s role, teaching materials and aids
to be used, and assessment from the point of view of whatshould be targeted, what should be expected, and what thechildren should have learned in a lesson.”
Taguchi23 assessed learning motivation in special classes
for schoolchildren with intellectual disability by creating

NISE Bulletin Vol.9: 37-50 November 2008
assessment items and reported that three types of classes
exist, as listed in Table 1.
TABLE 1 T y p e s o f c l a s s e s i n s p e c i a l c l a s s e s f o rschoolchildren with intellectual disability
Teachercentered type

The teacher plays a major role in driving theclass. The teacher provides a goal and plan
which children follow.
The teacher indicates children’s failures orprovides assistance when requested.
This type provides the least spontaneous
motivation to the children.

Child-centeredtype

The teacher helps the children to recall theirpast experiences so that the children will learn
actively. The teacher indirectly encourages thechildren to find a challenge and to make a planfor overcoming it.
The teacher prompts the children to becomeaware of their failures and, when assistanceis requested, does not immediately provide it.
There is little competition, praise, or scolding.
Although this type of class is considered tosatisfy spontaneous motivation, the children
learn little, since the teacher does not expect
much of the children.

Discrepancy type The teacher proceeds with class in a mannerwithout single
similar to the teacher-centered type, but theteaching styleteacher encourages the children to take theinitiative in learning. The teacher prepares adetailed plan before conducting the class.
The teacher expects children to set fairly difficult
goals and plans for themselves. The teacher
favors a child-centered class, but, since theclass falls into confusion, he/she is compelled
to lead the class and cannot proceed with theclass using a single teaching style.

Taguchi 24 examined the possibility of providing
discovery-based classes for schoolchildren with intellectual
disability, which he compared with explanation-basedclasses, as summarized in Table 2. He reported that little
difference was observed in the effect of teaching between
these two types despite differences in the teachers’
utterances during the classes, and that there were morevoluntary utterances by the children in the discovery-basedclasses.

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A study on teaching schoolchildren with intellectual disability
CHIKURINJI Takeshi

NISE Bulletin Vol.9: 37-50 November 2008

TABLE 2 P rocess of discovery-based and explanation-basedclasses
Discovery-based
class

Explanation-based
class

First stage

Observation
Provide conflicting
information

Observation
Provide consistent
information

Second stage

Prediction
Form tentative
theories and plan

Set a good example
Teach the basic
ideas

Third stage

Verification
Discover the basic
ideas

Confirmation
Confirm the basic
ideas

Fourth stage

Use in life
Adopt in one’s own life

Use in life
Adopt in one’s own life

Studies have been carried out regarding “guidance by
combining a scope and subject,” which is often developed
in classes for schoolchildren with intellectual disability.
Tanno 25 aimed to improve life-unit learning classes
and identified eight points to consider when guiding
schoolchildren that should lead to lesson improvement byanalyzing classes through the repeated viewing of VTRs.
Other studies on improving life-unit-learning classes
include those by Shinozaki and coworkers.26, 27 In recent
years, Sato et al.28 reported that class studies in learning
through tasks were characterized by guidance plan reviews
and class observation, both of which were centered on
the concept of the “creation of a class situation in which
schoolchildren can successfully complete tasks,” which isan inherent idea favored by teachers, and that these studies
were effective.
In other class studies, attention has been focused onclass observation and discussion at class study meetings,
which are thought to occupy a major part of class studies
in a school. Oota29 pointed out that in many studies theitems considered in class observation include educational
material and teaching aids, children’s activities, and thegoal of education, and that less experienced teachers
often conducted class observation with little regard to
the relationship between these items. Oota30 assessed theeffect of the review of a class in a class study at a schoolfor children with disability and found that a constructive
discussion of things to be improved, of which theteacher was previously unaware, on the basis of the classobservation led to an improvement of subsequent lessons.
Ootani31 also evaluated class reviews in a senior high schoolfor schoolchildren with intellectual disability from theviewpoint of a social adequacy assessment by reviewers.

5. T rends of special features of class studies in“Developmental Retardation and Education”(formerly Japanese Journal of Children withintellectual disability)
Document 1 lists the special features and articles on classstudies and lesson creation published in “Developmental
Retardation and Education,” the Journal of the Japanese
Association for the Study of Special Support Education.
This document was prepared from the listing posted on
the web page of the Japanese Association for the Study of
Education for the Developmentally Disabled.32
Fewer than 10 of more than 560 issues of this journal
appeared to feature class studies and lesson creation. The
study on teaching schoolchildren with intellectual disability
appears to be proceeding slowly, although it is true thatmany articles other than those in the special feature issues
also touched on topics related to class creation.
Articles regarding class studies written by Oota (2002)
and Ishizuka (2003) have been published recently. They aresummarized below.
Oota33 stated that teachers’ raison d’etre lay in the classand that class studies are necessary to improve the lesson, toenhance the teachers’ skills, and to improve the skills of theteachers participating in class study meetings. He proposedthat class studies should be used as active research, puttingemphasis on communications between the teacher and theobservers, as shown in Figure 1.

Conducting a class / Observing the classChildrenʼs actual state(learning activity)

Teacherʼs review

Observers perceive what the children
experience during the class and know towhat degree they fulﬁll their aims

FIGURE 1 Flow of class study as active researchPrepared by the author on the basis of Oota’s description

In addition, Oota33 proposed two types of casual classstudy approach as described below:

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A study on teaching schoolchildren with intellectual disability
CHIKURINJI Takeshi

NISE Bulletin Vol.9: 37-50 November 2008
A. Class study attaching importance to teaching skill improvement

Assessment /Preparation of
guidance plan

Class for study(observation fromtwo directions)(1) Five-connected-viewpoint approach taken by ateacher by him/herself
The teacher reviews the lesson from the following five
points of view and the relationships between them.
A. Was the goal of the lesson clear?
B. How was the teaching carried out?
C. Were the educational materials and teaching aids
suitable for the children?
D. Was the children’s actual state observed by theteacher?
E. Was learning activity designed to achieve the goal of
the class?
(2) R OMAN process approach taken by a group ofteachers
The group progresses through the following five stages
by incorporating the above five-connected-viewpoint
approach:
A. Reading the guidance plan (Reading)
B. Observing the class (Observation)
C. Making memos (Memorandum)
D. Conducting an analysis (Analysis)
E. Speaking (Narration)
It was explained that this approach makes it easy to focus
on the main points of the discussion at a study meeting,since participants can read the guidance plan together andconsider the observation points while they observe theclass.
Ishizuka2 suggested that importance should be attached
to a preliminary examination of a class and a review of thevalidity of the aim and goal of the lesson by analysis of thebasis of the following six specific steps.
1) Selection of activity2) Plan of activity flow3) Provision of a playing field where schoolchildren can
engage in full activity with minimum constraint4) Preparation of suitable tools (easy-to-use tools, trend
toward realism)5) Selection of companions in activities (taking mutual
relationships into account)6) Teacher’s direct involvement in the activity (acting
together with the children)
III. Class Studies Experienced by the Author
The class studies experienced by the author as a teacher

Class analysis /SkillsClass review
meeting /Analysis of skillsof an elementary school class of schoolchildren withintellectual disability are described according to the style ofthe class study.
A. C
 lass study attaching importance to teaching skill
improvement
This class study was conducted for transferred and newly
appointed teachers, as described below.
It had been decided beforehand to consider the following
skills for the next lesson.
1) H ow to write the guidance plan (how to describe thephilosophy towards teaching, the subject matter, views on
lesson units, views of the children, the goal of the lesson, thelearning process, and points to remember
2) The ideal learning process (activity development)3) Questioning plan (teacher’s voice and wording when asking
questions and giving instructions, the teacher’s position andresponses)
4) Plan for using the blackboard (use of colored chalk, cards, andstrip blackboards)5) Use of educational materials and teaching aids (arrangementof data presentation and its effective use)
6) Classroom management (group formation, improvement ofclassroom environment, for example by posting bulletins)

It seems that the class study conducted for transferredand newly appointed teachers was designed to familiarize
them with the school’s style of writing the guidance planand to initiate them into the group of teachers.
Before the class review meeting, groups of about
five teachers submitted summarized analytical data foreach item. At the meeting, required improvements wereenumerated in detail, for example, the position of theblackboard and the content of the teacher’s utterances to thechildren.
The author himself became keenly aware of his poor
overall skills in the classroom and felt, from the remarks
at the meeting, that the participants were mutually trying
to improve their skills. A senior teacher of an age thatsuggested him to be a veteran and another teacher who had
been transferred to this school the previous year talked to42

A study on teaching schoolchildren with intellectual disability
CHIKURINJI Takeshi

NISE Bulletin Vol.9: 37-50 November 2008
B. Class study based on tentative class theories (class design)

Review(tentative class theories) /Preparation and examinationof guidance plan

Class for study(observation fromtwo directions)Class analysis /Validation oftentative theory

Class study meeting /Modiﬁcation oftentative theory

Content of lesson: Language, News report about sleighing

me casually after the class review meeting, and from theirwords, I could sense their confidence and pride in being
teachers.
B. Class study based on tentative class theories (classdesign)This class study was conducted as described below.
A study of tentative class theories was first carried out
by a teaching group (in this case, a group for teachers forclasses for handicapped children). The teaching groupexamined the tentative class theories, prepared a guidanceplan based on those theories, made proposals and discussed
them at a class study meeting, and modified the guidance
plan. For the class analysis, the teachers were divided into
groups of about five members. Each group examined thelesson on the basis of the tentative theories and prepared fordata presentation at the class study meeting.
The lesson was a language class. A news report about
sledding was used as material related to the theme of thelife unit, “Let’s go sledding.” The day after going on a bus
trip to go sledding, the schoolchildren wrote a story in theform of a news report on the basis of their memories of theevent.
The following three tentative class theories wereconsidered for each group.
1) Proper verbalization at the field trip site will make it easy torecreate the field trip later in class. Various clues, such as
certain items, movement, pictures, and VTR, will help prompt
the children to speak in class.
2) If a hand puppet appears and asks questions with the teacher,the children will repeat other children’s utterances in an
attempt to describe the field trip in detail.
3) T he children will be able to experience the joy of writing
something and communicating to others by immediately
presenting their writing in the form of a news report.

The following opinions on the tentative theories were
given at a meeting after the class.

Tentative t heory 1: The order of presentation to the children-watching a video → movement → pictures- ledsmoothly to their recalling the event and writing thenews repor t. The pictures provided clues to thechildren.
Tentative t heor y 2: The children expressed an interest in
the puppet, and the puppet par ticipated in thecommunication as a new companion. It was suggested
that the puppet might become a model for the children.
Tentative theory 3: So much time was spent on remembering
and writing that the children were unable to present
their news reports. The common-experience activity
was extended so much that each child had difficulty insummarizing it in writing. Moreover, the preparation ofwriting aids, such as examples that could be copied,
was insufficient.

In response to the above comments, the time allocation
was changed so that the children could focus on writing byrecalling, and paper with a grid was prepared to facilitate
copying.
The author realized that the consideration of the tentative
theories contributed to focusing on lesson creation and thesharing of the viewpoints of class observation.
C. C
 lass study aimed at guidance that emphasizes theindividual
Before this class study, a schoolwide study was
undertaken with the theme of an ideal lesson that draws out
each individual through group guidance. When a guidanceplan was prepared, selected children were considered (thechildren for whom teachers had prepared special teachingstrategies), and these strategies were also specified in theguidance plan.
The class comprised eight children with intellectual
disability, all of whom were enrolled in the study. The
guidance plan was examined before the start of the lesson,and the development of learning activities and teachingstrategies were discussed, similarly to class study style B.
In the class observation, teachers were organized into

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NISE Bulletin Vol.9: 37-50 November 2008

C. Class study aimed at guidance that emphasizes the individual
Preparation of
guidance plan(considerationof the selectedchildren)Class for study(observationfrom three
directions)Class analysis /Childrenʼs
activities /Teaching steps

Class study meeting /Consideration of theteaching strategies
for each individualContent of lesson: Arithmetic, Game scoresgroups of five or six members. Each group individually
recorded the selected children’s activities, held a discussion
after the class, and prepared data for a class study meeting
The class was an arithmetic class. The life unit was“Let’s hold a festival,” and it dealt with the tabulation andaddition of scores for games such as bowling and pinball.
In teaching the class of eight senior children, the children
worked in pairs to perform a number of activities (arranging
the bowling pins on the marks on the floor, counting from
1 to 5 and from 1 to 10, and adding up scores, including
consolidation operation, adding with counting, and theformulation of mathematical formulas) in accordance withthe children’s challenges, during which the relationships
between the children were observed by the teacher.
Target behavior

Assessment

Child’s utterancesand behavior

The child in charge of time○
informs the player of the startand the end of the game using anhourglass.

Counted the number of A balls(7 balls), B balls (3 balls),
and C balls (7 balls) verballyand drew the corresponding
number of circles.

The child counts the balls up to
ten using a counting slide○First, the child drew four circles
for B balls but corrected it tothree on his/her own.

And circles the corresponding
number in a table.

○

Counted the number of D balls(12 balls) up to 12 verbally but
drew 10 circles.

In the class analysis, the children’s activities andachievement were described and analyzed on the basis ofeach individual’s target behavior. An example for a pinballgame is shown below.
Matrices were made to illustrate the relationship between
the paired children (and their relationships with the otherchildren). Some children were unable to get responses fromtheir partner even though they actively tried to get theirattention. It became clear that it was necessary to devise
measures to allow the children to communicate, such as theteacher acting as a go-between.
Identifying each individual’s target (target behavior)and considering of the steps in the assessment of theguidance plan contributed to clarifying the assessment of
the individuals. Recording the relationships among thechildren and between the children and the teacher using thematrixes revealed relationship issues of which we had beenpreviously unaware.
D. Class study pursuing educational goals
Before this class study, schoolwide research on the theme“sensitivity cultivation” was carried out. In deciding thistheme, all the school personnel deliberated the concrete
educational goal that should be sought, and this became thestarting point of the class study.
All the school personnel were divided into groups ofabout five members, and the “Educational goal sought”
was discussed in a brainstorming session held for two days
during the summer holiday. Keywords were written on
cards, which were organized into various classifications.
The class study dealt with expression in physicaleducation. A circular process was assumed: “Noticing
something” → “Feeling it” → “Expressing it” → “Satisfyingit” → “Noticing something” → ---. The learning process
was envisioned as follows: noticing and feeling a sound,
expressing what was felt as a movement, the imitationof one child’s expression by the surrounding children toexperience the feeling together, and noticing something newfrom the surrounding children’s expressions. A guidanceplan was considered according to the above process. Afterthe class, the school staff separated into groups according to
the classification of the keyword cards, and they reviewed
the educational goal and discussed the ideal lesson structure(view of class). The results were discussed at a class study
meeting.
Sharing the process of exploring the research themes interms of the children’s actual state and putting these themesin order brought the staff closer to the research theme andenabled the integration of the research theme “sensitivity
cultivation” and the goal of educational research anddevelopment.

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NISE Bulletin Vol.9: 37-50 November 2008

D. Class study pursuing educational goal (the embodiment of education goals)
Sharing of educational
goal (organization using
cards) /Consideration of a
guidance plan

Class for Study(observation fromtwo directions)Class analysis /Supporting steps

Class study meeting /Validation of educationalgoal, Modiﬁcation ofview of classContent of lesson: Physical Education, “Letʼs play Transformation.”

The class study dealt not only with the achievement of
the teaching goal and the consideration of the teachingstrategies but also allowed teachers to discuss ideal
educational research and development to be targeted. As aconsequence, I realized that the promotion of class studies
leads to the qualitative improvement of educational researchand development.
Ⅳ . C onclusio n s – E f f e c t i v e C l a s s S t u d ies for
Schoolchildren with Intellectual Disability
Education for children with intellectual disability should
place emphasis on the following: “Learning through naturaland necessary concrete experience with learning activities
focused on practical and specific activities linked to thechildren’s daily life.”
Classes are conducted purposefully in overall school life.
Class studies for schoolchildren with intellectual disability
therefore must improve the quality of their school life andverify whether the classes foster the children’s vitality.
Some previous class studies for schoolchildren withintellectual disability were analytical ones based on thedevelopment and application of a system for a quantitativeor qualitative analysis by considering classes to be acommunication process among schoolchildren or between
schoolchildren and a teacher. Class studies, such as
pedagogic studies emphasizing lesson improvement basedon the lesson structure using knowledge of the psychologyof learning, the examination of guidance plans beforehandleading the teacher to review their view of the lesson, andthe observation and review of classes have also been carriedout.
Both analytical and pedagogic studies are expected
to provide insights into class improvement, but what iscommon to both is that the use of study methods employedby researchers that will entail extreme difficulty whenapplied in schools. Even if a class study is conductedin accordance with an annual plan, a study method that
requires much time and labor to collect and process data for
analysis will not gain support from teachers.
In one of the class studies experienced previously by
the author, tentative theories (policy and strategies oflesson design) were considered in the process of draftinga guidance plan, and, in class observation, these tentative
theories served as points of observation for collecting data.
In data collection, children’s activities based on target
behaviors and the relationships among the children andbetween the children and the teacher were described. At
the meeting after the class, analytical data were presented
and suggestions for improvements to lessons were madeby some groups. Furthermore, the staff discussed andshared educational goals on the basis of the reality of thechildren that was observed by each teacher, to seek the ideal
education in class, and to promote effective educational
practices.
In studies of classes for schoolchildren with intellectual
disability, making improvements in the class study system,
such as devising an appropriate way of examining theguidance plan before the class and an appropriate way ofreviewing the class, is considered to reveal an effective
approach to practical class studies, as pointed out by Oota30
and Sato28.
References
1. K youiku Shuppan. (1990): In Yokosuka, K (Ed.),
Class Study Terminology Dictionary (pp. 182-183). (inJapanese)
2. I shizuka, K. (2003): Improving one’s power of
executing practical skills: The importance and specificmethod of contemporary class study. Developmental
Retardation and Education, 555, 4-7. (in Japanese)
3. Oota, M. (1991): Class study on education for children
with intellectual disability. Bulletin of Kyoto Universityof Education. Ser. A, 78, 41-51. (in Japanese)
4. Komiyama, S. (1967): In Japanese association for the
study of special support education (Ed.), Class study on
education for children with intellectual disability (pp.
2-45). (in Japanese)
5. Oonishi, S., et al. (1964): Study of relationships between
a teacher and children in a class for the handicapped:
Through class analysis. Bulletin of the Department of
Education, Nagoya University, 11, 58-63. (in Japanese)
6. Murakami, E., et al. (1967): Study of teachers’ guidancetypes in classes for children with intellectual disability.

45

A study on teaching schoolchildren with intellectual disability
CHIKURINJI Takeshi
Japanese Journal of Educational Psychology, 15(2),75-84. (in Japanese)
7. H irose, N. (1991): Trends of and problems in classstudy on education for the handicapped: Expectationof educational practice and the possibility of its study.
Japanese Journal of Special Education, 29(3), 61-66. (inJapanese)
8. Matsumura, T. (1983): Study of observational learningfor children with intellectual disability. Japanese
Journal of Special Education, 21(2), 37-47. (inJapanese)
9. Iwai, K. (1986): Optimum space in education for thehandicapped: Optimum distance between children withintellectual disability and a teacher. Japanese Journal ofSpecial Education, 24(2), 35-42. (in Japanese)
10. N akayama, F. (1986): Study of class analysis in
education for children with intellectual disability.
Japanese Journal of Special Education, 23(4), 16-27. (inJapanese)
11. Oota, M. (1991): Class study in education for children
with intellectual disability. Bulletin of Kyoto Universityof Education. Ser. A, 78, 41-51. (in Japanese)
12. Flanders, N. A. (1972): Analyzing teaching behavior.
Addison- Wesley.
13. Yanagimoto, Y., & Tsuzuki, S. (1983): The basic studyof analyzing the verbal communication in the schoolfor handicapped children. Bulletin of Defectology, 7(2),56-62. (in Japanese)
14. Tsuge, M., Musashi, H., & Kobayashi, S. (1992):
Development of a class analysis system in education
for children with intellectual disability: Throughanalysis of the amount of information and the phaseof triad transition matrix. Japanese Journal of Special
Education, 30(1), 1-11. (in Japanese)
15. M usashi, H., Tsuge, M.,& Kobayashi, S. (1992):
Application of a class analysis system to education forchildren with intellectual disability: Example of a longterm class analysis of the amount of information bytriad analysis. Japanese Journal of Special Education,30(2), 1-11. (in Japanese)
16. N agoya, T. (1996): Analytical study of life-unit
learning (1): Considerations regarding class analysis
enabling qualitative assessment. Japanese Journalof Developmental Disabilities, 18(3), 209-217. (inJapanese)17. Nagoya, T. (1996): Analytical study of life-unit learning(2) – class analysis focused on measures encouraging
children’s subjective activity. Japanese Journal of
Developmental Disabilities, 18(4). (in Japanese)
18. Fujine, O. (1995): Analysis of life-unit learning classin a school for children with intellectual disability.
Japanese Journal of Special Education, 32(5), 15-20. (inJapanese)

NISE Bulletin Vol.9: 37-50 November 200819. H irayama, M., et al. (1997): Class study by thequalitative research method (pp. 285-293). Kitaooji
Shobo. (in Japanese)
20. M iyamoto, S. (1977): Class study and class plan.
Japanese Journal of Mentally Retarded Children, 224,
80-87. (in Japanese)
21. Miyamoto, S. (1977): Class study and class plan (II).
Japanese Journal of Mentally Retarded Children, 227,80-87. (in Japanese)
22. Miyamoto, S. (1977): Problems on the part of teachers
in class study. Japanese Journal of Mentally RetardedChildren, 228, 80-87. (in Japanese)
23. Taguchi, N. (1974): Actual condition of motivationin class for mentally retarded children. Bulletin of the
National Institute of Special Needs Education, 1, 3-17.
(in Japanese)
24. Taguchi, N. (1978): Comparative study of finding-basedclasses and explanation-based classes for mentallyretarded children. Japanese Journal of Educational
Psychology, 26(1), 12-22. (in Japanese)
25. Tanno, Y. (1972): Study of “life-unit learning” ineducation for mentally retarded children: Part 2. Class
analysis by the repeated VTR viewing method regarding
unit learning activity type a. Bulletin of the Departmentof Education, Utsunomiya University, 22(1), 37-107. (inJapanese)
26. S hinozaki, K., et al. (1981): Empirical study of class
improvement in life-unit learning: Part 1: Preparationof class diagnosis form. Proceedings of the 19 th
Conference of the Japanese Association of Special
Education, 150-151. (in Japanese)
27. S hinozaki, K., et al. (1982): Empirical study ofclass improvement in life-unit learning: Parts 4-5.
Proceedings of the 20th Conference of the Japanese
Association of Special Education, 140-143. (inJapanese)28. Sato, S. (2002): Methodological characteristics of classstudy in life-centered education. Proceedings of the40th Conference of the Japanese Association of Special
Education, 588. (in Japanese)
29. O ota, M. (1991): Viewpoint for class observation in
education for the handicapped: Education for children
with intellectual disability. Japanese Journal of Special
Education, 29(3), 29-37. (in Japanese)
30. Oota, M. (1995): Effect of class review in the stageof conducting classes. Japanese Journal of Special
Education, 33(1), 9-16. (in Japanese)
31. Ootani, H. (2002): Consideration of a class study inschool for children with intellectual disability: Studyof on-site training through class review, assessmentof schoolchildren, and assessment of reviewers’social appropriateness: Attempt at class improvement.
Japanese Journal of Special Education, 40(2), 5-242. (in46

A study on teaching schoolchildren with intellectual disability
CHIKURINJI Takeshi
Japanese)32. http://www.ne.jp/asahi/jasedd/2000/index.htm
33. O ota, M. (2002): Advancement of class study.
Developmental Retardation and Education, 539, 4-7. (inJapanese)
This is an English translation of a paper partly rewritten

NISE Bulletin Vol.9: 37-50 November 2008
with additions to and revisions of a previous paper entitled“Study of Teaching-Learning Process in Class Basedon Intrinsic Motivation for the Student with Intellectual
Disabilities,” (published in March 2004), supported by
Grant-in-Aid for Scientific Research 2001 to 2003 [Basic
research (C) (2)] (Project number 13680344).
—Received May 8, 2005; Accepted May 26, 2008—

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A study on teaching schoolchildren with intellectual disability
CHIKURINJI Takeshi

NISE Bulletin Vol.9: 37-50 November 2008

DOCUMENT 1 List of features and published papers regarding class studies in “Developmental Retardation and Education”
Issue
NumberDate of
Issue

Feature Title

Paper Title

Author143

Aug 1970

Practical study methods

Class analysis

Fujishima, G.

Case study methods

Kogo, T.

Schoolchildren observation methods

Amou, H.

Guidance records

Kosugi, C.

How to logically connect the class study methodology and school
system establishment internallyKato, S.

How to take and compile guidance records

Ooishi, M.

What appears in pictures drawn by mentally retarded children

Shoji, T.

Inner observation through compositions

Seichi, T.

Conditions of a good class for the mentally retarded

Hitomi, K., et al.

Life-unit learning class, “Athletic meeting”

Shiono, K.

Life unit of “Spring field trip”

Watanabe, Y., et al.

Class creation, “Enjoyable school”

Kawaguchi, K., et al.

Recent trends of class studies

Nagano, S.

201

Jun 1975

Class studies

224

May 1977

Class study and class plan

Miyamoto, S.

227

Aug 1977

Class study and class plan

Miyamoto, S.

228

Sep 1977

Problems of teachers in class study

Miyamoto, S.

350

May 1987

Drawing out children’s individuality in Focusing on personality and uniquenessclass and conditions for personality Providing every child with a situation which he/she can handle
development
Children should not be restricted by an existing program

Yunoki, F.

Steps taken to draw out each child’s personality in this classClass enabling every child to carry out life planning

Ishikawa, M.

Ensuring individuals can do what they are able to

Hokkaido Takasu Junior HighSchool for Handicapped
Children

Tailoring work activities, tools, work methods, etc., to individuals

Kurosawa, K.

Providing a place where individuals can be active

Takao, S.

Incorporating children’s wishes in learning activities

Iida, S., Tsuki, M.

Making use of pairs of good friends

Kato, C.

Emphasizing motivation and stepwise guidanceMatsubara, M.

Creation of a situation in which every child can work

Hizawa, T., Hachiya, M.

Tailoring the contents of learning to individuals and connecting
them to their daily life

Tsunetomo, T.

My view of class and my recommended class / Becoming
involved, enjoying, and creating / Classes: Starting from home
visit education based on the individual childNomura, S.

Creation together with children on the basis of their actual
situation: Practicing home visit education

Watanabe, M.

Class with a rigorous view of “learning (alteration)”

Ito, Y.

Total communication guidance for autistic children who give very
limited signals

Shiino, M.

Development of class designed to achieve vocational
independence

Taguchi, N.

Work learning “Making a miniature

Senda, K.

View of class appropriate for this education

Kuwahara, K.

Pursuit of a situation which the student can handle

Kukita, H.

Class in which any child enthusiastically takes the initiative

Nakatsubo, K.

Class progress of life unit “Let’s make an animal square in the
courtyard”: Respecting children’s voluntary activity

Tadokoro, A.

Activities, play equipment and tools
devised for this child in this class426



Jul 1993

Class progress

Nakatsubo, K.
Akiyama, K.

(Continued)

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A study on teaching schoolchildren with intellectual disability
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NISE Bulletin Vol.9: 37-50 November 2008

DOCUMENT 1 Continued
Issue
Number

481

492

495


Date ofIssue

Sep 1997

Aug 1998

Nov 1998

Feature Title

Class creation

Recommendation of practicalstudiesClass creation for
handicapped children

Paper Title

AuthorSpecial contribution “What is a class understandable toeveryone?”

Muto, T.

Expectation and proposals for class: “Why don’t you try it thisway?”

Kondo, G.

Aiming to live a better life

Takamatsu, T.

Finding what each child needs

Higashiyama, H.

Creating a situation where children move exuberantly

Fujishima, T.

Do what you have to do discretely

Matsunaga, M.

Why class creation is necessary now / class theories for current
education for handicapped children

Hirose, N.

Importance of discussions among leaders

Kato, M.

Symphony of various individual characteristics: Progress of ahandbell-based life unit (From practice in FY 1996)

Miyazawa, M.

Through the unit, “Newspaper reporters”

Tachibana, T.

Search for a better class: Consideration of the use of aids andsharing of roles

Sato, S.

Is a guidance plan necessary for work learning?

Yoshikawa, K.

Have kind eyes that watch what can be done

Ikeura, M.

Guidance plan with thorough support

Nakazawa, K.

Points in preparing a guidance planMiki, A.

My thoughts about class

Ooshiro, M.

Assessment of guidance plans

Sato, S.

Practical studies which improve today’s and tomorrow’s practice

Koide, S.

For a better class study

Ozaki, Y.

How to hold a class study meeting

Ishizuka, K.

Continuing class study meetings: Class study in department units

Kogo, A.

Class study returning to children: A class study of a class for thehandicapped

Wakamatsu, T.

Wanted advice and unwanted advice

Ozaki, Y.

Wanted guidance plan and unwanted guidance plan Class study:
Points to be valued

Ishizuka, K., Yoshizato, N.,
Saito, K., Ogiwara, N.,
Mitobe, T.

For a better curriculum

Oominami, H.

How can the whole school advance the study

Yusa, H.

Making a child-centered school life: Search for a better way of
support: A curriculum study

Yamada, S.

Plans which succeed easily and those which succeed withdifficultyEndo, Y.

Systems which succeed easily and those which succeed withdifficulty

Oominami, H.

Points of study carried out by the whole school

Tomonari, H., Watanabe, S.,
Misawa, J., Saeki, H.

Points of holding a study reporting meeting

Imura, Y.

Points in report and bulletin preparation

Ueoka, K.

Practical study, and assessment and testing

Ueoka, K.

How to write and how to take up a “case”

Imura, Y.

Practical study memo – part 3: Well-regarded workshop and illregarded workshop

Murase, M.

Practical study memo – part 3: Points in compiling a study report

Ikegami, S., Watabe, T.,
Tsuji, Y., Endo, M.

Class creation for handicapped children

Oominami, H.
(Continued)

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A study on teaching schoolchildren with intellectual disability
CHIKURINJI Takeshi

NISE Bulletin Vol.9: 37-50 November 2008

DOCUMENT 1 Continued
Issue
Number539

555

Date ofIssue

Jul 2002

Nov 2003

Feature Title

Recommendation of a class study

Class studies

Paper Title

AuthorMedical arrangement at educational sites Guidance for child M’s dressing and undressing taught by relating it to nursing andtraining guidance

Suzuki, Y., Sawai, H.

Selected nursing and training guidance for unstable child A

Isobe, Y., Chijiiwa, Y.,
Ishikawa, T.

Work learning of a mentally and visually impaired child: Inouesan working on reeling thread

Nagoya, T.

Aiming for connection with each class: Development and use of
a tutorial plan

Murano, K.

Visiting as a life-supporting lifestyle: From practical home-visit(at-home) education

Sugawara, M.

Experienced teachers: Practical side of home-visit education andschooling

Takahashi, S., Yamashita, M.

Pursuit of better hospital life for Child H

Sugimori, Y.

Attempt to guide children without expressive language incollaboration with an institution

Iida, K.

Specialized nature of multiply handicapped children

Gokami, T.

Only home-visit education will do

Hayashi, I.

Recommendation of class study

Ota, M.

Class study meeting conducted by local teachers in charge ofclasses for the handicapped

Koga, Y.

Valuing daily effort

Toya, M.

Consideration of class by utilizing VTR

Watanabe, S.

Use of IT in self-care activity

Kaji, M.

Crisis of class studies

Hirose, N.

What I think about class studies

Fukuda, T.

Class improvement through scrutiny of “assessment”

Yoneda, H.

Work and learning guidance plan for junior high school

Koga, Y.

Life-unit learning guidance plan for elementary schools for thehandicapped

Kono, T.

Improving one’s ability to execute practical skills: The importanceand a specific method of contemporary class study

Ishizuka, K.

Whole school effort to create a situation that upports childoriented classes

Ogura, K.

Class study making use of reading through curriculum guidanceplans

Kaguchi, K.

Class study by teachers of local special classes for thehandicapped with mutual support

Kosugi, S., Tsubokawa, S.,
Yamamoto, H.

Class study conducted with the teacher of a class forhandicapped children

Sakurai, Y.

From on-demand educational consultation to class study

Hamada, T.

Case study and class creation in collaboration with a clinicalpsychotherapist

Ota, M.

Class creation using a videoconference system

Sakuta, M.

Improving the class

Shiga, C.

“Tutorial plan” and “Class” activated by motivation

Kaburagi, O.

Effective class study for curriculum and guidance plan

Nagoya, T.

Approach to teaching adventitiously blinded persons with difficulty in reading braille
SAWADA Mayumi

NISE Bulletin Vol.9: 51-64 November 2008

INVESTIGATIVE REPORTApproach to teaching adventitiously blinded persons withdifficulty in reading braille: Comparison of the degree of easein reading between braille characters of two sizes

SAWADA Mayumi
Department of Educational Support, National Institute of Special Needs Education (NISE), Yokosuka, Japan

Abstract: Many of those who become visually impaired after learning normal characters (hereafter, adventitiously blindedpersons) can write Braille characters with comparative ease, but have difficulty in reading Braille by touch. The purpose ofthis study is to clarify the effect of the size of Braille characters on learning during the initial training of Braille reading foradventitiously blinded persons. In the first study, using two types of Braille character with different cell spacings (intervals
between Braille characters), we compared the reading speed, the number of misreadings, and the readability between sighted
persons inexperienced in Braille reading and Braille users proficient in reading, to examine the effect of cell spacing on Braillereading. In the second study, sighted persons inexperienced in Braille reading were divided into two groups, and Braillecharacters of different sizes, including dot size (hereafter, normal size and large size), were presented in a different reading
order, to compare their reading speed, number of misreadings, and readability. Thus, the effect of providing training materials
with large Braille characters on reading training was examined. The results of these two studies revealed that the use of
Braille with wide cell spacing and large Braille characters is an effective method for the initial training of Braille reading foradventitiously blinded persons with difficulty in reading.
Key Words: Adventitiously blinded persons, Initial training of Braille reading, Braille size, Braille reading

I. Background
1. Current status of Braille reading for adventitiously
blinded persons
Braille, which is an alphabet of characters that people
with visual impairments can read and write by themselves,is still insufficiently used, but certainly spreading in oursociety. For example, the following are available: Brailleballots for elections, bar, civil-service, and university
entrance examinations in Braille, and Braille instructions
on ticket-vending machines in stations, automatic teller
machines at banks and post offices, the handrails of stairs,
and in elevators. Thus, Braille is frequently seen in oursociety. Because we are now living in an informationsociety where obtaining information is becoming anecessity, Braille is an important means of obtaining
information for people with visual impairments.
On the basis of the “survey on actual conditions of
disabled children and persons” (2001) 3 conducted by
the Department of Health and Welfare for Persons with
Disabilities, the Social Welfare and War Victims’ Relief

Bureau of the Ministry of Health, Labor and Welfare, thenumber of people with visual impairments aged 18 years
or older is estimated to be 301,000, and the number ofsuch people under 18 is estimated to be 4,800. Focusing
on the level of impairment, out of the total 305,800 people
with visual impairments, 107,200 people are diagnosed
as having the severest first-grade level of impairment,
and approximately 30,000 of these people use Braille forreading and writing in their daily lives. Moreover, thestatistics on the causes of impairments and the ages of onset
of impairment reveal that many visual impairments are due
to adventitious causes.
For those who have relied on vision to obtain
information, it is very difficult to replace vision with touchas the main sense. Kan (1988) conducted an 8-year study
on the state of Braille reading for 197 adventitiously blindedpersons learning massage, acupuncture, and moxibustionat rehabilitation and relief centers. 1 In his study, therelationship between the number of characters a person canread in one minute and the years of using Braille was as

51

52

Approach to teaching adventitiously blinded persons with difficulty in reading braille
SAWADA Mayumi
follows. People in their twenties can read 100 characters bytouch per minute, and people in their thirties, 85 characters
per minute, after learning Braille reading for two and a halfyears. However, it takes four and a half years for people
in their forties to acquire the ability to read 85 charactersin one minute. For people in their fifties, it takes three anda half years to acquire the ability to read 60 characters per
minute. Thus, the older people become, the longer it takes
them to acquire the ability to read Braille. Moreover, in acomparison of the reading ability of adventitiously blindedpersons with that of nonsighted children, the reading speedof the former in their twenties was equivalent to that of thelatter in fourth grade. Although these results are naturalconsidering functional decline with age, it may cause
intense frustration to adventitiously blinded persons who
had relied mainly on vision to collect information.
Even in schools for the blind, few adventitiously blindedstudents have already acquired the Braille literacy required
for school lessons before enrolling in physiotherapy orother classes. Because coursework starts immediately
after enrolling in the school for the blind, a certain level ofBraille literacy is required. However, no sufficient time isspared for Braille training, leaving no other choice but tocarry out Braille training in parallel with the coursework.
We are currently struggling with this situation.
If adventitiously blinded persons feel reading Braille bytouch is difficult, their motivation concerning courseworkand the active gathering of information will decline.
Moreover, in association with the nonacceptance ofimpairment, some people may develop a strong aversion to
Braille. It is necessary to develop training programs andmaterials that can increase their motivation towards learning
Braille reading or enable the effective acquisition of theBraille reading ability while maintaining high motivation.
2. Training methods and materials
Braille training for adventitiously blinded persons, andparticularly the training method for improving reading bytouch efficiency, differ depending on the school for theblind or the rehabilitation center and Braille library where
the Braille training is carried out. In addition, there are few
training materials. Braille training is still on the level oftrial and error.
Nakamura (1993) reported that the Braille written using
the Perkins Brailler (Fig. 1) is more effective for the initialtraining of Braille reading than that written using Braillekits because of the wide dot spacing (1-4 dot spacing) andwide cell spacing (4-1 dot spacing).6 Figure 2 shows the
structure of Braille characters, including the dot spacing andcell spacing.

NISE Bulletin Vol.9: 51-64 November 2008

FIGURE 1 Perkins Brailler

1-4 dot spacing

1-2 dot
spacing

4-1 dot spacing

1

4

1

4

2

5

2

5

3

6

3

6

Dot size
FIGURE 2 Structure of Braille

Furthermore, Kan (1988) proposed the use of a text inwhich a blank cell is inserted between characters duringinitial training. 1 In the “Manual for Braille Learning”(1995) by the Ministry of Education (from 2001, Ministryof Education, Culture, Sports, Science and Technology),
the following statements are made. “For blind children
and students experiencing difficulty in reading Braille, itis effective to make a Braille text with a slightly widened
cell spacing to practice Braille. Then, the cell spacing
should be gradually narrowed so that they can gradually
become accustomed to normal Braille.” 5 Kuroda et al.
(1995) considered that the readability of Braille charactersby those who have not acquired proficient Braille literacy
and those who have a limited tactile function can be
improved by changing character size, cell spacing, and line
spacing.4 They examined the effect of cell spacing and line
spacing on the reading efficiency of subjects with different
degrees of Braille literacy. Subjects who had not acquireda proficient Braille reading ability said that Braille witha wider cell spacing and a wider line spacing was more

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Approach to teaching adventitiously blinded persons with difficulty in reading braille
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NISE Bulletin Vol.9: 51-64 November 2008

readable. However, the number of subjects was only three;therefore, to increase the reliability of the results, it will
be necessary to carry out such an analysis with a greaternumber of subjects.
The size of Braille characters differs among countries,and even within a country. It also differs depending on thetype of Braille kit, including those of Braille publishers
and Braille printers. In Europe and the United States, tofacilitate Braille reading for adventitiously blinded persons,a large-sized Braille called giant-dot Braille has beendeveloped, although the achievable size is limited. In Japan,
No.
1
No.1

there is only a slight difference in size between Brailleprinters and Braille writers of various manufacturers, and
it is impossible to freely change the dot size, line spacing,and cell spacing. However, printers supporting dot figure
printing and those supporting Braille of a size slightly larger
than the conventional size have recently been developed,
providing a wider selection range than before, although the
choices of printable character sizes are still limited.
Is it better then to enlarge the Braille size without limit?
The answer, naturally, is no. There are various related
factors, including the difference in the tactile ability of
No. 2
No.2

Let’s read various Braille characters.
Reader (Let’s read various Braille characters.

Hand used (Right Left Both))

Reader (Hand used (Right Left Both))The subject will read the lines of Braille characters. The Braille charactersin the two lines are of slightly different sizes. The lines are composed of aseries of two or three character units that have no meaning. Six characters,(i), (na), (ni), (me), (re), and (fu), are used.

The subject will read the lines of Braille characters. The Braille charactersin the two lines are of slightly different sizes. The lines are composed of aseries of two or three character units that have no meaning. Six characters,(i), (na), (ni), (me), (re), and (fu), are used.

If the subject reads a character correctly, circle the character. If it is misread,record how the character was misread. The time limit is l minute per line.
Everyone starts simultaneously. If the subject ﬁnishes reading the line within
one minute, note the time taken in seconds. After the subject ﬁnishes reading
the ﬁrst line, please wait.

If the subject reads a character correctly, circle the character. If it is misread,record how the character was misread. The time limit is l minute per line.
Everyone starts simultaneously. If the subject ﬁnishes reading the line within
one minute, note the time taken in seconds. After the subject ﬁnishes reading
the ﬁrst line, please wait.

Finally, ask the subject regarding the difference in the sense of touch between
the two types of Braille characters.

Finally, ask the subject regarding the difference in the sense of touch between
the two types of Braille characters.

First line

First line(me),(rei),(funa),(nii),(nanime),(meni),(nai),(reni),(meire)(meire)00000 sec

Second line(me),(reni),(nai),(rei),(funa),(nii),(nanime),(meni),

00000 sec(meire)Second line(me),(rei),(nanime),(nii),(meni),(nai),(funa),

00000 sec

(reni)(me),(reni),(meire),(nii),(meni),(nanime),(funa),(nani),(rei)

00000 sec

Question: Which Braille string was easier to read?

Question: Which Braille string was easier to read?

(First line, Probably ﬁrst line, No difference, Probably second line, Second line)(First line, Probably ﬁrst line, No difference, Probably second line, Second line)

FIGURE 3 Data forms and Braille cards (Study 1)

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Approach to teaching adventitiously blinded persons with difficulty in reading braille
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individuals to discriminate two adjacent dots, the ratio ofcell spacing to dot spacing, “reading experience,” and therelationship between size and reading speed. For example,
Braille with too wide a cell spacing is difficult to read.
When a character is expressed using two cells, such as
syllables with a voiced consonant and contracted sounds,
which is a characteristic of the representation of a Japanesecharacter in Braille, a cell followed by too wide a spacing
makes it difficult to detect the second cell and practicality
is lost. In addition, even if optimal Braille sizes could bespecified for the conditions of individual adventitiously
blinded persons, the technology of the current Brailleprinters is limited in terms of providing adaptable printers
for easy production of training materials of optimal Braillesizes at each educational site.
Under these circumstances, to examine the teachingapproach, it is considered significant to clarify the effect ofthe difference in Braille size (dot size, dot spacing, and cell
spacing) on the training of Braille reading for adventitiously
blinded persons, within the range of Braille size that can beproduced in texts at practical educational sites. We hopethat such clarification will lead to the provision of easy-toread texts and new ideas for developing an effective training
method.
II. Objective
The purpose of this study is to clarify the dependenceof learning effectiveness on the difference in Braillesize during the initial training of Braille reading foradventitiously blinded persons.
This study consists of two parts: Study 1 and Study 2.
In Study 1, the effect of the difference in cell spacing on
reading was examined. In Study 2, the readability of Braillecharacters of different sizes (hereafter, normal size and largesize), including dot size, was compared between groups to
examine the effect of using text with large-sized characterson reading. The realization of the objective of this research
was approached from these two studies.
III. Experimental Methods
Study 1Sighted persons who are beginner Braille touch readers
and totally blind persons who are expert Braille touch
readers (Braille users) were tested on reading two typesof Braille with greatly different cell spacings to compare
their reading speed, the number of misreadings, and thereadability.
(1) Subject
The subjects consisted of 32 sighted males and females(average age, 43 years) and 10 male and female Braille

NISE Bulletin Vol.9: 51-64 November 2008
users (average age, 39 years; average time using Braille, 25
years). The age range for both groups is from 23 to 58.
(2) Experimental reading material
Using six Braille characters “ (na), (ni), (i), (re),(me), and (fu),” which are comparatively easy to read bytouch, a series of meaningless units of two or threecharacters are combined with a blank cell to make four
patterns of 19-character strings on a line (Fig. 3). Twostring patterns were embossed in the international size andthe Californian size using the Braille printer “ET” (Enabling
Technologies, U. S. A.). Here, the international and
Californian sizes are the size names used by the
manufacturer of this printer. At the head of all lines, theBraille character “ (me)” was printed to indicate thestarting point of reading.
Table 1 shows the size specifications of international- andCalifornian-sized Braille. Both Braille characters have thesame dot size of 1.4 mm but differ greatly in cell spacing(4-1 dot spacing).
TABLE 1 Comparison of Braille size
Type of
BrailleDot size

1-4 dot
spacing

4-1 dot
spacing

1-2 dot
spacing

(mm)

(mm)

(mm)

(mm)

International size

1.4

2.38

4.17

2.34

Californian size

1.4

2.65

5.13

2.65

(3) Reading test
The decision of which hand and which fingers to use forreading and the reading method was left to the subject. The
subjects (in the case of sighted persons, their eyes werecovered) were given one minute to read aloud each of two
strings of Braille characters of different sizes to examine
their reading speed and number of misreadings. Afterreading two patterns, they rated which of the first or second
Braille string was easier to read on a scale of five (First
string, Probably first string, No difference, Probably second
string, Second string).
Study 2The sighted persons, who are beginner Braille touch
readers, were divided into two groups to whom the Braillecharacters of different sizes were presented in a different
order. By examining their reading speed, the occurrenceof misreading, and the readability of Braille characters,
the effect of the size of the Braille characters on reading
efficiency and that of the presentation order were compared
between the two groups.

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NISE Bulletin Vol.9: 51-64 November 2008

(1) Subjects
As subjects, 28 male and female sighted persons aged 24
to 69 were divided into two groups (A and B). The numberof subjects in each group and the average age are shown in
Table 2.
TABLE 2 Number and average age of subjects
Group

N

Average age(years old)

A

13

41.3

B

15

41.5

(2) Experimental reading material
Using eight Braille characters “ (u), (re), (me),(fu), (a), (i), (ni), and (na),” which are comparatively
easy to read by touch, four patterns - of 20-character strings
consisting of meaningless units of two characters and fourcharacters were prepared (Fig. 4). Two-character units werecombined such that each character was used at least once as
the first character and the last character of a unit in one
string. Four-character units were combined such that eachcharacter was used at least once as the first character, a
middle (second or third) character, and the last character ofa unit in one string. This was carried out for the following
reasons. As shown in Table 3, among the eight charactersin these reading samples, the characters “ (a),” “ (i),” “(ni),” and “ (na),” consist of dots only on the left side of
the cell; therefore, the spacing between one of thesecharacters and the subsequent character will be wide, which
may cause difficulty in detecting the actual cell spacing andhence affect reading efficiency.
TABLE 3 Eight characters used as reading samples

u

re

me

fu

a

i

ni

na

Four string patterns of two-character units and of fourcharacter units were prepared using the two character sizes
shown in Table 4, and each pattern was embossed on a card.
Normal- and large-sized characters were embossed using
the Braille printer “ESA721” (JTR company) and“ESA2000/L” (JTR company), respectively. At the head of
all lines, the Braille character “ (me)” was printed toindicate the starting point of reading.
TABLE 4 Comparison of Braille sizes

sized two-character units, large-sized two-character units,
normal-sized four-character units, and large-sized fourcharacter units in that order, whereas the subjects in group
B read the strings of large-sized two-character units,
normal-sized two-character units, large-sized four-character
units, and normal-sized four-character units in that order.
This sequence was used because the order of reading ofBraille of a different size may affect reading efficiency. The
decision of which hand and which fingers to use for reading
and the reading method was left to the subject. The sighted
subjects, whose eyes were covered, were given one minuteto read aloud each string of Braille characters of a different
size to examine their reading speed and the characters thatwere misread in each of four trials. They compared thereadability of normal-sized Braille with that of large-sized
Braille in two- and four-character units on a scale of five(First card, Probably first card, No difference, Probably
second card, Second card).
IV. Results and Discussion
Study 1For the 32 sighted persons who are beginner Braille touch
readers, the speed of reading one character of international
size and that of Californian size were compared, as shownin Fig. 5. The positive direction on the Y-axis indicatesa higher speed of reading (in seconds) one Californiansized Braille character than reading one international-sized
Braille character.
（sec）
20

15

10

5

0

-5
5

10

15

20

25

30 32（No.）

FIGURE 5 Comparison of reading speed per character

Type of
BrailleDot size

1-4 dot
spacing

4-1 dot
spacing

1-2 dot
spacing

(mm)

(mm)

(mm)

(mm)

Normal size

1.4

2.0

3.2

2.25

Large size

1.9

2.4

3.84

2.7

(3) Reading test
The subjects in group A read the strings of normal-

Next, 20 sighted persons who read all 19 characterswithin one minute in either the international size or
Californian size and 10 Braille users were classified interms of the size of the character read faster, the readabilityof Braille characters, and the occurrence of misreadings.
The results are shown in Tables 5-1 to 7-2.

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NISE Bulletin Vol.9: 51-64 November 2008

No.1
Let’s read various Braille characters.
Hand used

ReaderCard 1: Normal sizeAgeyears old

Right Left Both

Four Braille cards will now be distributed one by one. The Braillecharacters on each card are of slightly different sizes. The lines arecomposed of a series of meaningless units consisting of two or fourcharacters. Eight characters, (u), (re), (me), (fu), (a),(i), (ni), and (na), are used.
If the subject reads a character correctly, circle the character. If thecharacter is misread, record how the character was misread. The time
limit is 1 minute per card. Everyone starts simultaneously. When thesubject ﬁnishes reading, he/she should raise his/her hand. The time
taken will be announced, and the recorder should record it.

Card 2: Large size

After the subject finishes reading the first two cards, ask the subject
about the difference in the sense of touch of the Braille characters
between the two cards, and ask the same question in a similar fashion
after the fourth card is read.
Card 1
(me),

(ui),

(nau),(funa),(rea),

Card 2(me),(nare),(ua),(rei),(nii),(ire),(afu),

(ure)

(iu),

(ana),(nia),(rena)(nime),(mefu),(meni),(name),

Card 3: Normal size
00000 sec
(funi),
00000 sec

Question: Which Braille string was easier to read?
First card, Probably ﬁrst card, No difference, Probably second card, Second card
Card 3(me),(unareni),(iniume),Card 4(me),(meifua),(fuaiu)00000 sec(reanina),(meufui),(inaure),Card 4: Large size

(nafuare)(fuiame)(uninaa)

00000 sec

Question: Which Braille characters were easier to read?
First card, Probably ﬁrst card, No difference, Probably second card, Second card

No.2
Let’s read various Braille characters.
ReaderHand used

Card 5: Large size

Age

Right Left Bothyears old

Four Braille cards will now be distributed one by one. The Braillecharacters on each card are of slightly different sizes. The lines arecomposed of a series of meaningless units consisting of two or fourcharacters. Eight characters, (u), (re), (me), (fu), (a),(i), (ni), and (na), are used.
If the subject reads a character correctly, circle the character. If thecharacter is misread, record how the character was misread. The time
limit is 1 minute per card. Everyone starts simultaneously. When thesubject ﬁnishes reading, he/she should raise his/her hand. The time
taken will be announced, and the recorder should record it.

Card 6: Normal size

After the subject finishes reading the first two cards, ask the subject
about the difference in the sense of touch of the Braille characters
between the two cards, and ask the same question in a similar fashion
after the fourth card is read.
Card 5(me),(fua),(mere),
Card 6(me),(ina),(nafu),(una),(ire),(reu),(ai),(reni),(nime),(nime),(niu),(mei),(nafu),(uni),(are)(fua),(ani),

00000 sec

Card 7: Large size

(au),(fume)

00000 sec

Question: Which Braille string was easier to read?
First card, Probably ﬁrst card, No difference, Probably second card, Second card

Card 8: Normal size

Card 7(me),(afuime),(reinau),

Card 8(me),(naureni),(inifuna)(niremei),(inarefu),(nimeaf),(nafuau),

00000 sec(uanime),(aniui)

00000 sec

Question: Which Braille string was easier to read?
First card, Probably ﬁrst card, No difference, Probably second card, Second card

FIGURE 4 Data forms and Braille cards (Study 2)

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NISE Bulletin Vol.9: 51-64 November 2008

TABLE 5-1 Size of characters read faster and readability

TABLE 7-2 Readability and errors

Size of characters read faster
Californian
No
Internationalsize
difference
size

Braille users(n＝10)

Readability
Californian size, n (%)
No difference, n (%)
International size, n (%)

11 (55)
1 (5)
0 (0)

0 (0)
0 (0)
0 (0)

3 (15)0 (0)5 (25)

Errors, n (%)
Both sizes, n (%)
Californian size, n (%)
International size, n (%)

1 (10)
0 (0)
0 (0)

0 (0)
0 (0)
0 (0)

0 (0)
0 (0)
0 (0)

Total, n (%)

12 (60)0 (0)8 (40)

No error, n (%)

1 (10)

1 (10)

7 (50)

Sighted persons(n＝20)

Size of characters read faster(n＝10)

Californiansize

No
difference

International
size

Readability
Californian size, n (%)
No difference, n (%)
International size, n (%)

1 (10)
1 (10)
0 (0)

0 (0)
0 (0)
2 (20)

1 (10)0 (0)5 (50)

Total, n (%)

2 (20)

2 (20)

6 (60)

Sighted persons(n＝20)
Errors, n (%)
Both sizes, n (%)
Californian size, n (%)
International size, n (%)

3 (15)
1 (5)
3 (15)

0 (0)
0 (0)
0 (0)

2 (10)
4 (20)
1 (5)No error, n (%)

5 (25)

0 (0)

1 (5)

Total
14 (70)6 (30)TABLE 6-2 Size of characters read faster and errors
Braille users(n＝10)

Size of characters read faster
Californian
No
Internationalsize
difference size

Errors, n (%)
Both sizes, n (%)
Californian size, n (%)
International size, n (%)

0 (0)
0 (0)
0 (0)

0 (0)
0 (0)
0 (0)

1 (10)0 (0)0 (0)No error, n (%)

2 (20)

2 (20)

5 (50)Total
1 (10)

9 (90)TABLE 7-1 Readability and errors
Sighted persons(n＝20)

Size of characters read faster
Californian
No
Internationalsize
difference size

Errors, n (%)
Both sizes, n (%)
Californian size, n (%)
International size, n (%)

5 (25)
2 (10)
3 (15)

0 (0)
0 (0)
0 (0)

0 (0)
3 (15)
1 (5)No error, n (%)

4 (20)

1 (5)

1 (5)

9 (90)

Tables 5-1 and 5-2 show the relationships between thesize of the character read faster and readability for sighted
persons (Table 5-1) and Braille users (Table 5-2).

TABLE 6-1 Size of characters read faster and errors
Size of characters read faster
Californian
No
Internationalsize
difference size

Total
1 (10)

Figure 5 shows that 22 out of 32 sighted persons who are
not accustomed to Braille reading can read the Californiansized Braille, which has wider cell spacing, faster than theinternational-sized Braille.

TABLE 5-2 Size of characters read faster and readability
Braille users

Size of characters read faster
Californian
No
Internationalsize
difference size

Total
14 (70)6 (30)For 12 (60%) out of 20 sighted persons, the speed ofreading Californian-sized Braille was higher than that ofinternational-sized Braille, and all subjects answered that
the Californian-sized Braille was more readable, except
for one person answering that there was no difference inreadability. Although eight sighted persons (40%) had ahigher speed of reading international-sized Braille, someanswered that international-sized Braille was more readable
and others answered that Californian-sized Braille wasmore readable.
For six (60%) out of ten Braille users, the speed ofreading international-sized Braille was higher than thatof Californian-sized Braille, and they answered that theinternational-sized Braille was more readable, except for
one person who answered that Californian-sized Braille wasmore readable. The two Braille users who read both typesof Braille at the same speed answered that the internationalsized Braille was more readable. Of the two Braille users
whose speed of reading Californian-sized Braille washigher, one answered that the Californian-sized Braille wasmore readable and the other answered that there was nodifference.
Tables 6-1 and 6-2 show the classifications of subjects
in terms of the size of the Braille read faster and theoccurrence of misreadings. Fourteen (70%) out of 20
sighted persons misread characters. Five out of the six
sighted persons who did not misread any characters read theCalifornian-sized Braille faster.
In the case of Braille users, misreading was observedfor only one subject. However, there was no significant
difference in the occurrence of misreadings between Braillesizes for subjects who use Braille daily.

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NISE Bulletin Vol.9: 51-64 November 2008

Tables 7-1 and 7-2 show the classifications of subjects interms of the readability and the occurrence of misreadings.
In the case of sighted persons, four out of six subjects
who did not misread any characters answered that the
Californian-sized Braille was more readable, one answeredthat there was no difference, and the other answered that theinternational-sized Braille was more readable. Among the
14 sighted persons who misread characters, 10 answeredthat the Californian-sized Braille was more readable.
In the case of Braille users, seven out of nine subjects
who did not misread any characters answered that theinternational-sized Braille was more readable, and theremaining subjects answered that there was no difference orthat the Californian-sized Braille was more readable.
From the above results, it was found that theinternational-sized Braille is more readable and is read withfewer misreadings by Braille users who are accustomed
to Braille reading, whereas the Californian-sized Braille,
which has a wider cell spacing, is more readable andis read with fewer misreadings by sighted persons whoare inexperienced in Braille reading. Therefore, it wasdemonstrated that the adoption of Braille with a wide cell
spacing is effective for training adventitiously blindedpersons in Braille reading at the initial stage.
Study 2
Tables 8-1 to 9-2-b show the results on the size of theBraille character efficiently read (the size of the Braillecharacter read faster), the size of the Braille charactercorrectly read, and the readability of two- and four-character
units for groups A and B.
TABLE 8-1 Comparison of strings of two-character units (Group A)
Subject
number
1
2
3
4
5
6
7
8
9
10
11
12
13

Size of characters
efficiently read
L
L
L
L
L
L
L
L
L
L
L
L
L

Size of characterscorrectly read
L
L
L
L
Same
Same
L
Same
L
L
L
L
L

Readability
L
L
Probably L
L
L
Probably L
L
No difference
Probably L
L
L
Probably L
L

TABLE 8-1-a C omparison and summary for strings of twocharacter units (Group A) (N ＝ 13)Size of characters
efficiently readn (%)
L
13 (100)Same
0 (0)Normal0 (0)Size of characterscorrectly readn (%)
L
10 (77)Same
3 (23)
Normal0 (0)Readabilityn (%)
L
Probably L
No difference
Probably normal
Normal8 (62)
4 (30)
1 (8)
0 (0)
0 (0)

TABLE 8-2 Comparison of strings of four-character units (Group A)
Subject
number
1
2
3
4
5
6
7
8
9
10
11
12
13

Size of characters
efficiently read
L
L
L
L
L
L
L
L
L
L
L
L
L

Size of characterscorrectly read
L
L
L
L
Same
Same
L
L
L
L
L
L
L

Readability
L
L
L
L
L
NormalL
Probably L
Probably L
L
Probably L
L
L

TABLE 8-2-a C omparison and summary for strings of fourcharacter units (Group A) (N ＝ 13)Size of characters
efficiently readn (%)
L
13 (100)Same
0 (0)Normal0 (0)Size of characterscorrectly readn (%)
L
11 (85)Same
2 (15)
Normal0 (0)Readabilityn (%)
L
Probably L
No difference
Probably normal
Normal9 (69)
3 (23)
0 (0)
0 (0)
1 (8)



TABLE 9-1 Comparison of strings of two-character units (Group B)
Subject
number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Size of characters
efficiently readL
NormalNormalNormal
L
L
L
NormalL
NormalL
L
NormalL
L

Size of characterscorrectly readL
NormalL
NormalSame
L
L
NormalL
NormalL
L
NormalL
L

Readability
L
Probably normal
NormalProbably normal
L
L
L
No difference
Probably L
L
Probably L
L
No difference
Probably L
Probably L

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NISE Bulletin Vol.9: 51-64 November 2008

TABLE 9-1-b C omparison and summary for strings of twocharacter units (Group B) (N ＝ 15)Size of characters
efficiently readn (%)
L
8 (53)Same
1 (7)Normal6 (40)

Size of characterscorrectly readn (%)
L
7 (47)Same
3 (20)
Normal5 (33)

Readabilityn (%)
L
Probably L
No difference
Probably normal
Normal106 (40)
4 (27)
2 (13)
2 (13)1 (7)TABLE 9-2 Comparison of strings of four-character units (Group B)
Subject
number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Size of characters
efficiently read
NormalL
Normal
L
Same
Same
Same
L
Normal
L
L
L
NormalL
L

Size of characterscorrectly read
NormalL
Normal
L
Same
Same
Same
Same
Normal
Same
Same
L
Same
L
Same

Readability
L
L
Probably normal
No difference
L
L
Probably L
L
L
L
L
L
No difference
L
Probably L

TABLE 9-2-b C omparison and summary for strings of twocharacter units (Group B) (N ＝ 15)Size of characters
efficiently readn (%)
L
8 (53)Same
3 (20)
Normal4 (27)

Size of characterscorrectly readn (%)
L4 (27)Same
8 (53)
Normal3 (20)

Readabilityn (%)
L
Probably L
No difference
Probably normal
Normal

（sec）
12

8
6
4
2
0

1

2

3

4

5

6

7

8

9

10 11 12 13（No.）

FIGURE 6-1 C omparison of speeds of reading strings oftwo-character units (Group A)
（sec）
12
10
8
6
4
2

10 (67)
2 (13)
2 (13)1 (7)0 (0)Figures 6-1 to 7-2 show the differences in reading speed
between the normal-sized Braille and the large-sized
Braille for each group. The positive direction on the Y-axis
indicates a higher speed of reading (in seconds) one largesized Braille than reading one normal-sized Braille.

0

1

2

3

4

5

6

7

8

9

10 11 12 13（No.）

FIGURE 6-2 C omparison of speeds of reading strings offour-character units (Group A)
（sec）
12
10
8
6
4
2
0
-2
-4

1

2

3

4

5

6

7

8

9 10 11 12 13 14 15（No.）

FIGURE 7-1 C omparison of speeds of reading strings oftwo-character units (Group B)

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Approach to teaching adventitiously blinded persons with difficulty in reading braille
SAWADA Mayumi

NISE Bulletin Vol.9: 51-64 November 2008
TABLE 11-1 E xamples of misreadings of strings of two-character
units (Group B)

（sec）
12
10

Normal size

8

(i)

6
4
2
0
-2
-4

1

2

3

4

5

6

7

8

9 10 11 12 13 14 15（No.）

FIGURE 7-2 C omparison of speeds of reading strings offour-character units (Group B)
Next, examples of misreading two- and four-character
units in both normal and large sizes are shown in Tables
10-1 to 11-2 for group A (Tables 10-1 and 10-2) and group
B (Tables 11-1 and 11-2).

Number oferrors(i)

Large size

Number oferrors

Large size

→

(ni)

3

(fu) →(na) 3(fu) →(na)2(me) →

(re)

2

(a)

→

(u)

2

(ni) →(i)2(me) →

(fu)

1

(i)

→

(a)

2

(fu) →

(u)

1

(a)

→

(u)

2

(re) →

(me)

1

(u)

→

(a)

1

(ni) →

(na)

1

(u)

→

(na) 1(me) →(re)1(fu) →

(ni)

(u)

→

(a)

1

(u)

→

(me) 1(na) →

(ni)

1

(i)

→

(re)

1

1

TABLE 11-2 E xamples of misreadings of strings of four-character
units (Group B)
Number oferrorsNormal size

Number oferrors

Large size(na) →

(ni)

3

(u) →

(a)

3

(ni) →

(na)

3

(i) →

(ni)

2

Number oferrors

(i) →

(na)

3

(a) →

(u)

2

TABLE 10-1 E xamples of misreadings of strings of two-character
units (Group A)
Normal size

Number oferrors→(ni)4(re) →

(me)

2

(u) →

(a)

2

(i) →

(a)

2

(fu) →

(na)

1

(i) →

(ni)

1

(ni) →

(fu)

1

(u) →

(i)

1

(re) →(a)1(na) →

(fu)

1

(u) →

(i)

1

(a) →

(i)

1

(na) →(a)1(na) →(a)1(me) →(fu)1(me) →(re)1(fu) →(na)1(ni) →

(i)

1

(u) →

(a)

1

(me) →

(re)

1

(i) →

(na) 1(na) →(fu)1(me) →(i)1(fu) →(a)1(ni) →(na) 1TABLE 10-2 E xamples of misreadings of strings of four-character
units (Group A)
Number oferrorsNormal size

Number oferrors

Large size(fu) →

(na)

2

(i) →

(ni)

1

(i) →

(a)

2

(na) →(fu)1(ni) →(i)2(re) →(me)1(na) →

(ni)

2

(a) →

(na)

1

(u) →

(ka)

1

Table 12 shows all cases of misreading depending ongroup and Braille size.

Approach to teaching adventitiously blinded persons with difficulty in reading braille
SAWADA Mayumi

NISE Bulletin Vol.9: 51-64 November 2008
TABLE 12 Misreadings according to group and size
Large size

Normal size
Example of error

Group AGroup B

Group AGroup B

Total

3

2

2

11

3

5

3

9

(i)

→

(ni)

4

(ni)

→

(i)

2

(fu)

→

(na)

3

(na) →(fu)1(me) →

(re)

1

(re)

→

(me)

(u)

→

(a)

(a)

→

(u)

(na) →

(ni)

(ni)

→

(na)

(na) →

(a)

1

(a)

→

(na)

1

(i)

→

(a)

2

(a)

→

(i)

(i)

→

(na)

(fu)

→

(a)

(a)

→

(fu)

2

(me) →

(fu)

1

(u)

→

(i)

1

(i)

→

(u)

(re)

→

(a)

(u)

→

(na)

1

1

(fu)

→

(ni)

1

1

(ni)

→

(fu)

(u)

→

(me)

1

1

(i)

→

(re)

1

1

(fu)

→

(u)

(me) →

(i)

(u)

(ka)

→

3
2
2
1

1

2

3

3
2

3

4
4

8

4

4

4
4

6
1

1

5
2
1

3

4

6

1

1

1

4

1

1
2

1

2
1

1
1

1
1

1

1

1

1
1

1

5

1
1

61

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Approach to teaching adventitiously blinded persons with difficulty in reading braille
SAWADA Mayumi

NISE Bulletin Vol.9: 51-64 November 2008

As shown in Tables 8-1 to 8-2-a and Figs. 6-1 and 6-2,
for all subjects in group A, in which the test started withthe reading of the normal-sized Braille, the efficiency ofreading large-sized Braille was higher than that of reading
normal-sized Braille for both two- and four-character
units. The large-sized Braille was more frequently readcorrectly, in the case of two-character units, by 77% of
the subjects, and there was no difference in the number ofcharacters correctly read between Braille sizes for 23% of
the subjects. In the case of four-character units, the largesized Braille was more correctly read by 85%, and there
was no difference in the number of characters correctly readfor 15% of the subjects. Twelve subjects (92%) answeredthat “large size” or “probably large size” was morereadable for both two- and four-character units, whereas
the remaining 8% of subjects answered “no difference”
for the two-character units and “normal size” for the fourcharacter units. However, for all subjects who answered “nodifference” or “normal size,” the large-sized Braille wasactually read more efficiently.

sized Braille more efficiently. Furthermore, in the caseof four-character units, 12 subjects (80%) answered thatcharacters of “large size” or “probably large size” weremore readable, but seven out of these 12 subjects actually
read the large-sized Braille more efficiently. Seven percentof the subjects answered that those of “probably normalsize” were more readable, but they actually did read thenormal-sized Braille more efficiently. The subjects who
answered “no difference” in readability accounted for 13%,and the sizes of the characters efficiently read by them in
actuality included both normal and large sizes.

Next, in group B, for which the test started with thereading of the large-sized Braille, as shown in Tables 9-1
to 9-2-b and Figs. 7-1 and 7-2, 53% of the subjects read thelarge-sized Braille more efficiently than the normal-sized
Braille for both two- and four-character units. In the caseof two-character units, 40% of the subjects read the normalsized Braille more efficiently than the large-sized Braille,
and 7% of the subjects read both types of Braille at the same
efficiency. In the case of four-character units, 27% of thesubjects read the normal-sized Braille more efficiently and
20% of the subjects read both at the same efficiency. In thecase of two-character units, 47% of the subjects correctly
read large-sized Braille more frequently, 33% of the subjects
correctly read normal-sized Braille more frequently, andthe remaining 20% of the subjects correctly read both
Braille at the same rate. In the case of four-character units,
27% of the subjects correctly read large-sized Braille more
frequently, 20% of the subjects correctly read normalsized Braille more frequently, and the remaining 53% of
the subjects correctly read both Braille at the same rate.
Regarding readability, in the case of two-character units,
10 subjects (67%) answered that units of “large size” or“probably large size” were more readable, and eight out of
the 10 subjects actually read the large-sized Braille more
efficiently than the normal-sized Braille. Two out of sevensubjects who read the normal-sized Braille more efficientlyor read both at the same efficiency answered that the largesized Braille was more readable. Three subjects (20%)
who answered that characters of “normal size” or “probably
normal size” were more readable actually did read thenormal-sized Braille more efficiently. The subjects who
answered “no difference” (13%) actually read the normal-

between (fu) and (na) and between (u) and (a), 11
misreadings between (na) and (ni), 9 misreadings
between (me) and (re), and 7 misreadings between (i)and (a). This may occur because the cell spacings and thecells themselves were not detected by the fingertips.
Between (na) and (ni), misreadings were less frequent
for the large-sized Braille. This may occur because the dot
at position 2, which is difficult to detect in the case of thenormal-sized Braille, is more detectable in the large-sized
Braille.

Focusing on the misreading examples for each Braillesize shown in Tables 10-1 to 11-2, the number ofmisreadings of large-sized Braille was smaller than that ofnormal-sized Braille for both two- and four-character units
in group A. In group B, there was no difference in thenumber of misreadings between the normal- and large-sized
Braille. As shown in Table 12, the number of misreadings
between (i) and (ni), (i.e., read (i) instead of (ni) andvice versa) is as many as 16, followed by 12 misreadings

From these results, it was found that training materials
with large-sized Braille are effective in the initial training ofBraille reading for adventitiously blinded persons who havedifficulty acquiring the ability to read normal-sized Braille.
V. Conclusions and Remaining Issues
From the results of Studies 1 and 2, it was found that
Braille with wide cell spacing or large-sized Braille iseffective for adventitiously blinded persons who havedifficulty in reading normal-sized Braille by touch. As
stated in “Background,” it is not effective to simply increase
Braille size or cell spacing without limit, because there arevarious related factors. Moreover, there is a limitation in
printers that can support several Braille sizes. Kizuka (1999)
commented on Braille size as follows. “When it comesto problems of Braille size, not only the absolute size but
also the ratio of the spacing between dots in a cell to thespacing between cells become problems. In addition, theratio of dot spacing to dot diameter cannot be overlooked.”
2
Kizuka compared the ratio of cell spacing to dot spacing
among Braille systems of various countries. In comparative

Approach to teaching adventitiously blinded persons with difficulty in reading braille
SAWADA Mayumi
experiments in his study of reading Braille written withfoam ink, his subjects commented that Braille with theratio of 1.41 is the most readable and that Braille with theratio of 1.65 has too wide a cell spacing. Considering thesecomments, Kizuka stated that Braille with ratios ranging
from 1.4 to 1.8 is readable by ordinary users. What then
are the ratios for the Braille examined in our study, namely,international-, Californian-, normal-, and large-sized
Braille? The ratios for the Braille examined in our study
are shown in Table 13 together with Kizuka’s ratios forcomparison.
TABLE 13 R atios of cell spacing (4-1 dot spacing)
to dot spacing (1-4 dot spacing)Type of BrailleDot spacing(4 • 1) ÷ (1 • 4) = Ratio

Soviet Union
Czech Republic
BrazilTaiwanNakamura-made
Korea
Japan
China
FranceBraille Everyday
America
Perkins
Giant

3.93 ÷ 3.17 = 1.24
3.97 ÷ 3.00 = 1.32
3.53 ÷ 2.60 = 1.36
3.13 ÷ 2.27 = 1.38
2.98 ÷ 2.10 = 1.42
3.17 ÷ 2.17 = 1.46
3.27 ÷ 2.13 = 1.54
3.97 ÷ 2.53 = 1.57
3.80 ÷ 2.30 = 1.65
3.80 ÷ 2.30 = 1.65
4.05 ÷ 2.35 = 1.72
4.00 ÷ 2.30 = 1.74
6.70 ÷ 3.10 = 2.16

International size
Californian size
Normal size
Large size

4.17 ÷ 2.38 = 1.75
5.13 ÷ 2.65 = 1.94
3.20 ÷ 2.00 = 1.60
3.84 ÷ 2.40 = 1.60

Cited from the study by Kizuka (1999).4 Four Braille sizes are additionallylisted.

Except for the Californian size, the ratios at which Brailleis readable by ordinary users are from 1.4 to 1.8, and areclose to the upper limit of the range. The ratio for the
Californian-sized Braille is higher than the upper limit but
lower than that for the giant-dot Braille, which is used foradventitiously blinded persons in Europe and the UnitedStates. Because the range of ratios reported by Kizuka was
not obtained from data on adventitiously blinded persons,this ratio range cannot be simply compared with our ratio
range. However, this ratio will be very helpful when
considering the gradual reduction of Braille size during
the stepwise training of Braille reading for adventitiously
blinded persons.
Sighted persons who adventitiously lose their vision
are also severely traumatized psychologically. Evensome period after losing their vision, they may still beemotionally unstable. In addition, many people experience
declining sensory function of their fingertips due to aging,and many people who adventitiously lose their vision
due to diabetic retinopathy, which is recently becoming

NISE Bulletin Vol.9: 51-64 November 2008a particularly common cause of loss of vision, also havedisorders of peripheral nerves. Therefore, the sensitivityof their fingertips is dulled, causing difficulty in identifying
an aggregation of points. This most likely decreases theirmotivation to learn Braille. Therefore, the initial training
stage is very important, and it is necessary to arrange theeducational environment such that adventitiously blindedpersons can gain confidence and motivation throughconcrete learning achievements, such as success in reading.
In the future, we will provide training materials with
Braille having a wide cell spacing or large-sized Braille,
the effectiveness of which was clarified in this study, in theinitial training of Braille reading for adventitiously blindedpersons having difficulty in learning Braille, and we will
demonstrate the effectiveness of this Braille learning system
in practice. In addition, we hope to develop such training
materials as instruction manuals, taking into consideration
the transition to normal-sized Braille.
Acknowledgement: This study was supported by a Grantin-Aid for Basic Scientific Research (C) (2) “Evaluationof appropriate Braille size for individual adventitiously
blinded persons and development of training programs andtraining materials for Braille reading” (Research number:
13610348, Chief researchers: Mayumi Sawada, fiscal year
2001-2003).
References
1. Kan, I.: People with visual impairments and Braille.
Fukushi Tosho Shuppan, pp.18-30, 1988. (in Japanese)
2. Kizuka, Y.: Development of comprehensive Braillelearning system for improving reading efficiency ofadventitiously blinded persons: Evaluation method
for Braille size. Braille embossing system supporting
various sizes, development of learning program and CAI,
National Institute of Special Education. pp.143-160,
1999. (in Japanese)
3. Department of Health and Welfare for Persons with
Disabilities, the Social Welfare and War Victims’ Relief
Bureau of the Ministry of Health, Labor and Welfare:
Outline of survey result on actual conditions of disabledchildren and persons. 2001. (in Japanese)
4. Kuroda, H., Sasaki, T., & Nakano, Y., et al.: Effect ofbraille size on reading efficiency. Proceedings of 21st
Sensory Substitution Symposium, 55-58, 1995. (inJapanese)
5. Ministry of Education, Culture, Sports, Science andTechnology: Manual for braille learning (Revised
version). Keio Tushin, pp.252-265, 1995. (in Japanese)
6. Nakamura, T.: Examination of braille training materials.
Proceedings of 2nd Visual Impairment Rehabilitation
Research, 34-37, 1993. (in Japanese)—Received June 28, 2004; Accepted May 26, 2008—

63

History of and perspective on education for children with speech and speech-language disorders in japan
MATSUMURA Kanyu, MAKINO Yasumi

NISE Bulletin Vol.9: 65-78 November 2008

NOTE

History of and perspective on education for children withspeech and speech-language disorders in japan

MATSUMURA Kanyu, MAKINO Yasumi
Department of Educational Support, National Institute of Special Needs Education (NISE), Yokosuka, Japan

Abstract: Education for children with speech and language disorders in Japan began in the form of remedial education forchildren with learning difficulties in reading and the correction of dialects in the speech-language arts class in the postwar
period. The influence of the introduction of speech pathology from the US improved this type of education. It has become
specialized to cater to the educational needs of children with speech-language disorders, and the content and methods of sucheducation have been established. This kind of training originally began ‘after-hours,’ that is, after the school day finished.
Subsequently, part-time special classes under the special class system were soon adopted, and at present, it is based on“tuukyu sidou,” which is a system of “resource-room training” that has been practiced for more than 30 years. Education forchildren with speech-language disorders in Japan has accumulated a history of research and movement in aspects of both the“development of content and methods” and the “development of the system.” Recently, the issues of such education related
to the development of the system of resource-room training and the certification of speech therapists have been highlighted.
In this paper, following the history of this education, we discuss management issues and the specialization of education andteachers in relation to current trends of society and education.
Key Words: Education for children with speech-language disorders, Tsukyu sidou (resource-room training), Speech-language
training class, Speech therapy class

I. Introduction
Education for children with speech-language disorders(1)in Japan began as remedial education for children withlearning difficulties in reading (2) and the correction of
dialects3 in the speech-languge training class or speechlanguage therapy class in the postwar period. The influenceof the introduction of speech pathology from the US
improved this type of education. It has become specialized
to cater to the educational needs of children with speechlanguge disorders, and the content and methods of sucheducation have been established. This kind of training
originally began ‘after-hours,’ that is, after the school day
had finished. Subsequently, part-time special classes(4) under
the special class system was soon adopted, and at present it
is based on “tuukyu sidou,” which is a system of “resourceroom training” that has been practiced for more than 30
years.
Education for children with speech-language disorders inJapan has accumulated a history of research and movement
in aspects of both the “development of content andmethods” and the “development of the system.”

Recently, the issues of such education related to thedevelopment of a system of resource-room training and thecertification of speech therapists(5) have been highlighted.
(1) What kinds of children are the students in the “speechlanguage training class(6)?”(2) What are the content and the methods of education forchildren with speech-language disorders?
(3) W hat qualifications are required for the teachers
involved in the education of children with speechlanguage disorders(7)?
These questions can be categorized into issues
concerning the role of the “speech-language training class”(management issues), the content and methods of education
for children with speech-language disorders (specializationof education), and the qualifications of the teachers(expertise of teachers).
In this paper, the various issues mentioned are discussed
after the history of this type of education in relation to thecurrent status of society and education.

65

66

History of and perspective on education for children with speech and speech-language disorders in japan
MATSUMURA Kanyu, MAKINO YasumiII. H istory of Education of Children with Speechlanguage Disorders
The education of children with speech-language disorders
in Japan germinated from the practical work of Rakusekisya established by Shuji Izawa in the Meiji era (1868-1912).
Rakuseki-sya developed mainly around training to remedy
stuttering, and divisions, branch offices, and local offices
were established during the Taisho era (1912-1926).
Rakuseki-sya accomplished achievements as a private
business in the Meiji and Taisho eras.
In school, classes for children who stuttered were
established in elementary schools of Tokyo City in the
Taisho era. Records indicate that such classes were
established in the Yanagawa Elementary School in
Fukagawa Ward and two schools in Shiba and Kanda in
1926. However, these practices were terminated by theonset of the Pacific War.
The current education of children with speech-language
disorders is based on the educational theory of Kenji
Hamasaki, adopted at the Sendai City Toricho Elementary
School in Miyagi Prefecture, and that of Kiyomatsu Okuma,
adopted at Ichikawa City Mama Elementary School in
Chiba Prefecture with the start of the new education
postwar.
1. Beginning as remedial education
Kenji Hamasaki began efforts in the education ofchildren with speech-language disorders after his researchon “correction of Tohoku accents using Roman letters”
and “training adapted to individual differences,” and heestablished the “speech-language training class” for children
with speech-language disorders in his school in 1953. This
class was mainly held as an extracurricular activity after theend of the school day.
Kiyomatsu Okuma began efforts in remedial trainingof Japanese reading after his research on “group training
catering to ability and individual differences,” and heestablished a “Japanese remedial class” based on the
resource-room system in 1953.
On the basis of this work, special classes for children
with speech-language disorders were established in the
Sendai City Toricho Elementary School in 1958 and in the
Chiba City Innai Elementary School in 1959. Thus, theeducation of children with speech-language disorders beganin public education in both name and reality.
(1) Work of Kenji Hamasaki
The training pioneered by Kenji Hamasaki was called the
Sendai method or Toricho method, and it had the following

NISE Bulletin Vol.9: 65-78 November 2008
features.
① The method is structured on the basis of research on
Japanese phonetics.
② Detailed step-by-step teaching of articulation is prepared.
③ Sufficient pathological research is conducted for eachtype of speech-language disorder.
④ Teachers are in close contact and coordination withmedical institutions.
⑤ The training method is constructed with emphasis on
functional training.
⑥ A solid record is prepared, training record sheets,
photographs, and audio and video recordings.
Hamasaki categorized the training of children as speechand speech-language therapy.(8) He indicated the necessityof avoiding games or hearing exercises in which theintention of the teacher was unclear, and that the appropriate
and necessary training should be carried out step by step,that the reason for the training should be clear, and that theresults of training should be evaluated objectively.
Hamasaki contended that speech-language disorders
are remediable and called the class for remedying suchdisorders a “speech-language training class.” He also held
to the principle of disclosing the therapy to the parents.
Furthermore, his remedial training for speech-language
disorders was not only conducted as individual training but
also often conducted in small groups with the intention of
not only pursuing training efficiency but also nurturing thechildren’s sociability, cooperativeness, and communication
skills (Hamasaki, 1988).1(2) Work of Kiyomatsu Okuma
The work of Kiyomatsu Okuma was based on the
research and practice of remedial training for children
having difficulty in reading. Subsequently, it progressedto the “training of speaking” on the idea that the basis ofreading is in hearing and speaking.
Because the children who received remedial speechtraining had disabilities such as articulation disorders,
stuttering, developmental delay of language, and mutism,
Okuma proposed that an organization in charge of theplanning and implementation of remedial training beestablished (cooperation with medical institutions and the
management of the class and school).
Moreover, Okuma focused on the relationship between
speech-language disorders and poor learning performanceand paid attention to understanding the actual conditionof the children, including poor learning performance, anddetermining the criteria for admittance into the specialclass.

History of and perspective on education for children with speech and speech-language disorders in japan
MATSUMURA Kanyu, MAKINO Yasumi
In the actual training, he took care of psychologicalaspects and communication by creating a pleasantatmosphere, promoting willingness to speak, stabilizing theemotional conditions of children, giving them confidence,and helping them make friends. The training materials werealso well designed by taking into consideration the interestsand concerns of children, as well as incorporating games inthe training (Okuma & Yamagishi, 1997)7.
(3) Development as remedial education
The practice of the remedial class (9) for children withdifficulties in language and delay in learning Japanese
was carried out throughout the country. The “Japanese
Association of Remedial Education” was established,
and the research and practice of remedial education wereexpanded to include arithmetic. (Later, the Study Group of
Speech and Language Disorders became independent of theJapanese Association of Remedial Education and developed
into the present “Japanese Association of Education
for Children with Speech and Language Disorders.”)
According to the list of remedial classes establishedacross the country created by the Japanese Association of
Remedial Education in 1954, remedial classes (the subjectsof which were Japanese, arithmetic, and speech-language
disorders) were established in 19 elementary schools in
the country. The Mama Elementary School where Okuma
carried out his training and the Toricho Elementary
School where Hamasaki conducted his training are on
the list. The practices of Okuma and Hamasaki started as
remedial education and then became the foundations of
the development of education for children with speechlanguage disorders.
2. D evelopment of special class for children withspeech-language disorders
The establishment of special classes for children
with speech-language disorders in Sendai City Toricho
Elementary School in 1958 and in Chiba City Innai
Elementary School in 1959 led to the development of suchspecial classes as the setting of remedial education forchildren with speech-language disorders.
(1) Expansion of special classes for speech-language
disorders
On the basis of the activities of the parents’ associations
in Toricho Elementary School in Sendai City and Innai
Elementary School in Chiba City, the “National Councilof the Association of Parents of Children with Speech andSpeech-language Disorders” was established in 1964, anda nationwide movement to establish special classes forchildren with speech-language disorders and the fosteringand certification system of teachers began.

NISE Bulletin Vol.9: 65-78 November 2008
The “NHK Special Speech-language Training Class(Sendai Broadcasting Station)” and “NHK Remedial
Speech-language Class (nationwide network),” which werebased on the practices of Hamasaki and Okuma, were also
aired to serve an illuminating role. Moreover, the teaching
curriculum for education of children with speech-language
disorders was established in teacher-training colleges acrossthe country. Such developments led to the rapid nationwide
establishment of special classes for children with speechlanguage disorders as sites of therapy for such children.
(2) Training system in special class for children withspeech-language disorders
Considering the system of special classes for children
with speech-language disorders, it is necessary for thechildren in the special class to stay and to be trained mainlyin that class. However, from the beginning of the adoptionof the special class, tuukyu system, which is a resourceroom system in which most of the training concerning
academic subjects and fields is given in regular classes andthe special training concerning speech-language disorders
is given in the special class, has been adopted for thefollowing reasons.
In Toricho Elementary School, in the first year of thespecial class, academic subjects were taught to a combinedclass consisting of three children in the third grade andfour children in the fourth grade. The speech and language
therapy was conducted in a class including children fromother elementary schools after school hours. It was pointed
out that the system was burdensome for the teacher ofthe class and children, as well as being inefficient. The“resource-room method” (called the “tsukyu method”
by Hamasaki) was adopted in the following year, 1959
(Hamasaki, 1988)1.
In Mama Elementary School, the resource-room system(called the tsukyu system in Mama Elementary School)
was adopted from the beginning of the “speech-language
therapy class.” The general reasons were as follows. ① It
was proved that the target children could derive educational
benefits from training for one to four hours per week. ②
Because the number of target children was large, the content
of the training must be narrowed in order for one teacher
to take charge. ③ The system was modeled after that in the
US. ④ It was necessary to clarify the difference between
the speech-language therapy class and the fixed specialclasses, most of which targeted mentally retarded children(Okuma & Yamagishi, 1997)7.
The special class for children with speech-language
disorders was established as a fixed class in the institutionalframework; however, the training was actually conducted

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History of and perspective on education for children with speech and speech-language disorders in japan
MATSUMURA Kanyu, MAKINO Yasumi
by the resource-room method until “resource-room training”
was legislated in 1993.
Various problems arose, such as those related to school
registration and the curriculum, because of the gap between
the system and the actual training method.
(3) Institutional characteristics of special class systemfor children with speech-language disorders andits practiceProblems in school registration and curriculum
While most of the training was conducted in regularclasses, the children had to be treated as belonging to thespecial class for speech-language disorders in the official
records such as the attendance book, school registration(curriculum guidance records), and health examination
reports. As for class enrollment, because it was necessarythat children who were enrolled and trained in a regularclass be transferred to the special class for speech-language
disorders, parental consent was required. In practice,sometimes the enrollment was not changed and the special
training was given as part of educational counseling. In
either case, there was a problem with the positioning of the
training of children within the educational curriculum.
Flexible operation of system
While there were various problems in the practice under
the special class system for children with speech-language
disorders, it was also pointed out that the system had somebeneficial characteristics.
The advantage was that a relatively flexible managementof the special class for children with speech-language
disorders was allowed. On the basis of the approvalto establish the class and obtaining a training space(classrooms) and teachers, training and support were given
to children other than those enrolled in the special class. Ina relatively relaxed management environment, the specialclass functioned as an educational resource that could
respond to the numerous needs of various children.
The ages of the children who received the training andsupport also varied. There were reports that training andsupport were given to infants, high-school students, andadults in some cases. Another advantage pointed out wasthat support, adapted to the individual needs of the children,
was provided regardless of the status of the class in which
they were enrolled; for example, speech-language training
could be given to children who were enrolled in the specialclass for mental retardation.

NISE Bulletin Vol.9: 65-78 November 2008
3. T raining in special class for children with speechlanguage disorders
The special class for children with speech-language
disorders, which was called the “speech-language trainingclass” in Toricho Elementary School in Sendai City andthe “speech-language therapy class” in Innai Elementary
School in Chiba City, was developed as the space for setting
remedial education for children with speech-language
disorders.
Behind the names chosen for the special class for children
with speech-language disorders, namely, “speech-language
training class” and “speech-language therapy class,” there
seemed to be an intent to show that the special class forchildren with speech-language disorders was different fromthe special classes for children with other disorders and thatthe setting of remedial speech-language training was in the
resource-room system (resource- room method).
While the special class for children with speech-language
disorders was established as the setting of speech-language
therapy, the target, content, methods, and views on training
were developed differently within practices in individual
areas.
(1) Change in target children
After the special classes for children with speechlanguage disorders were begun in Toricho Elementary
School in Sendai City in 1958 and in Innai Elementary
School in Chiba City in 1959, such classes became
established across the country.
The number of classes increased rapidly in the late 1970s
and in the early 1980s (Table 1). Changes in the status of
the disorders of the target children were also observed (Table
2).
TABLE 1 C hange in number of established special class forchildren with speech-language disorders and in
number of children enrolled
Fiscal year

Number ofclass (n)Number ofchildren (n)

1965

17

163

1970

277

2,075

1975

847

5,590

1980

1,198

7,177

1985

1,416

7,658

1990

1,429

6,614

Total number in elementary and junior high schools surveyed by the Ministry of
Education, Culture, Sports, Science and Technology

History of and perspective on education for children with speech and speech-language disorders in japan
MATSUMURA Kanyu, MAKINO Yasumi

NISE Bulletin Vol.9: 65-78 November 2008

TABLE 2 Change in status of disorders of target children
1973

1979

1985

1991

Articulation disorder (%)

27.4

25.4

31.7

36.1

Cleft palate (%)

11.2

7.1

4.9

3.5

Stuttering (%)

22.9

13.8

10.8

8.3

Hearing impairment (%)

17.7

16.9

15.8

13.4

Language development (%)

20.8

32.6

33.4

30.4

4.2

3.4

8.3

Others (%)

National survey on actual condition of special classes for children with hearing
impairment and speech-language disorders (National Institute of Special
Education )In actual status, the proportion of children withdisorders classified as language delay rapidly increased
during the period between the survey in 1973 and 1979.
(The classification “language delay” was treated as thegeneral term for children showing a delay in language
development. In the survey in 1985, this term was further
divided into “main problem in language,” “main problem
in emotion,” and “main problem in intellectual faculties”
on the basis of the characteristics of the delay. In thesurvey in 1991, language delay was replaced by the term“delayed language development” to emphasize that thisterm was not a diagnostic term. The term “others” hasbeen used since 1979. As for the condition of the childrenclassified under this term, autism, mutism, delayed mental
development, cerebral paralysis, learning disorders, andchildren returning from abroad were listed in the survey in1991. While the classification term “language delay” haschanged to the terms “delayed language development” and“others,” the number of children classified into these terms
has increased, suggesting that the conditions of the children
have diversified.)
These changes caused the training in the special class forchildren with speech-language disorders to shift from theconventional concept of remedial education (Kawashita,1987)2. Along with this shift, the special class for children
with speech-language disorders, once called “speechlanguage therapy class,” has gradually come to be called“speech-language training class” in many cases.
(2) C hange in concept of education observed atnational convention
From the list of national conventions held by the National
Public School Association of Education for Hearing andSpeech-language Disorders(10) every year, we can see that“issues of system and management” was the theme fromthe 1st Convention (Tokyo 1972) to the 11th Convention(Fukushima 1982). This indicates that the issues in thesystem and management were of concern at that time (Table
3).

TABLE 3 Titles of 1st–11th national conventions
Year, Host prefecture, Title of convention
1972, 1st, Tokyo
Desirable classes for children with hearing and speech-language
disorders in public school
1973, 2nd, Kanagawa
Desirable classes for children with hearing and speech-language
disorders in public school: Immediate issues and measures forthem
1974, 3rd, Fukuoka
Desirable classes for children with hearing and speech-language
disorders in public school: Immediate issues and measures forthem1975, 4th, Niigata
Desirable classes for children with hearing and speech-language
disorders in public school: Pursuing effective training
1976, 5th, Hyogo
Desirable classes for children with hearing and speech-language
disorders in public school: Aiming at consistent training fromearly childhood
1977, 6th, Tokyo
Desirable classes for children with hearing and speech-language
disorders in public school: Aiming at enhancing consistent
training from early childhood
1978, 7th, Yamaguchi
Desirable education for children with hearing and speechlanguage disorders: Pursuing the role and the position of theclassroom (class)
1979, 8th, Iwate
Desirable classes for children with hearing and speech-language
disorders in public school: Looking at the coming ten years on thebasis of the current situation
1980, 9th, Miyazaki
More desirable education for children with hearing and speechlanguage disorders: Aiming at specific management and training
in the future on the basis of current situation
1981, 10th, Saitama
More desirable education for children with hearing and speechlanguage disorders: Pursuing early detection of disorders andenrichment of consistent training system
1982, 11th, FukushimaMore desirable education for children with hearing and speechlanguage disorders: Pursuing class management and training
responding to actual status on the basis of the current situation

After the 12th Convention (1983), the themes started
to vary, such as “rich in mind and language,” “richin humanity,” and “looking for education with a new
viewpoint.”

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MATSUMURA Kanyu, MAKINO YasumiAt the 12th Convention (Aichi 1983), Osamu Miyawaki(the principal of Naka-Daiichi Elementary School in
Kakamigahara City in Gifu Prefecture at that time), in his
panel discussion entitled “Considering the desirable future
education of children with hearing and speech-language
disorders from a broad viewpoint-the standpoint of school
management-,” referred to the language relation diagramsuggested by Johnson. Focusing on the y and z axes, heindicated that speech-language disorders were problems inthe society surrounding the children rather than problemsof the children themselves, and that educators should pay
attention to this background. For this reason, he pointed out
the significance of school and class management (Miyawaki,1983)6.
At the 17th convention (Miyagi 1988), Kazuaki
Kawashita (a teacher at Higashi-nibancho Elementary
School in Sendai City and the head of the Research
Division of the Miyagi Association of Hearing and Speechlanguage Disorders at that time) commented on the subtitle“looking for education with a new viewpoint” following thetitle of the convention, saying, “The training methods arehighly diversified depending on the characteristics, process,and degree of language problems, and the acceptance of thisdiversity is the significance of the existence of the ‘language
training class.’ However, through its 30-year history,
the training methods have become fixed as if they were
established depending on the type of disorder. Namely, thetraining procedure is predefined and it is applied to every
child. -snip- Two major problems seem to relate to suchtraining. One is that the speech-language training class andthe teachers lose touch with the children’s actual school lifeand learning activities, which reduces the meaning of the
speech-language training classes in schools. Essentially,
the training in a speech-language training class must beorganized flexibly in accordance with the problems or
characteristics of the children. However, it seems that themore specialized the training becomes, the less flexible it
becomes in terms of its adaptability to the real status of thechildren” (Kawashita, 1988)3.
While the conventional education for speech-language
disorders aimed at alleviating the specific disorder of thechild (x axis), Miyawaki showed the necessity of focusing
on the surroundings of the children.
From the new viewpoint of education for children withspeech-language disorders, Kawashita shifted the basic
concept from the conventional one of remedial education to
the consideration of the child’s overall school life. He also
tried to confirm the significance of the existence of “speechlanguage training class” in schools. He is determined toreview the concept of remedial education which has been

NISE Bulletin Vol.9: 65-78 November 2008
TABLE 4 Titles of 12th–22nd national conventions
Year, Host prefecture, Title of convention
1983, 12th, Aichi
Pursuing desirable education for children with hearing andspeech-language disorders in the future: Aiming at thedevelopment of students rich in mind and language
1984, 13th, Aomori
Pursuing a concept of education for children with hearing,speech-language, and emotional disorders in the future: Conceptof class management and training for nurturing the mind andlanguage
1985, 14th, Tokyo
Pursuing desirable education for children with hearing andspeech-language disorders in the future: Training with the aim ofnurturing rich humanity
1986, 15th, Ibaraki
Pursuing a concept of education for children with hearing andspeech-language disorders in the future: Training with the aim ofnurturing rich humanity
1987, 16th, Nagano
Desirable education for children with hearing and speechlanguage disorders in the future: Pursuing a concept of training
and class management aimed at nurturing rich humanity
1988, 17th, Miyagi
More desirable education for children with hearing and speechlanguage disorders: Pursuing training with new viewpoints
1989, 18th, Tokyo
More desirable education for children with hearing and speechlanguage disorders: Pursuing class management and training witha new viewpoint
1990, 19th, Akita
Future direction of education for children with hearing andspeech-language disorders: Ideal class management and training
responding to requests from children
1991, 20th, Ehime
Promotion of education facing and nurturing each individual child:
Effective training method responding to disorders of each child
1992, 21st, Okayama
More desirable education for children with hearing, speechlanguage, and emotional disorders: Aiming at nur turingcommunication ability
1993, 22nd, Hokkaido
Ideal training on the basis of educational diagnoses of children
with speech-language disorders

continuously sustained in the education of children withspeech-language disorders and to look for new viewpoints.
After the 12th convention (Aichi 1983), the subjects

History of and perspective on education for children with speech and speech-language disorders in japan
MATSUMURA Kanyu, MAKINO Yasumi
were “rich in mind,” “mind and language” and “richin humanity,” which indicate a continuous focus onmind and humanity. The subject was “training with new
viewpoints” at the 17th convention (Miyagi 1988) and“class management and training with new viewpoints” at
the 18th convention (Tokyo 1989), reflecting the continuous
promotion of the transformation of education for children
with speech-language disorders. Moreover, the viewpointof understanding speech-language disorders as a problem
of communication was suggested at the 21st convention(Okayama 1992) (Table 4).
Behind these changes was the growing understanding ofdisorders promoted by the International Year of Disabled
Persons in 1981 and the publication of the International
Classification of Impairments, Disabilities, and Handicaps(ICIDH) by WHO in 1980.
With the comprehensive idea of dividing disorders
into three levels, namely, impairments, disabilities, andhandicaps, as shown by ICIDH, speech-language disorders
were also perceived from a new perspective. Whileconventional speech and language therapy was mainly basedon the idea of understanding speech-language disorders
as impairments and disabilities, when speech-language
disorders were understood from the aspect of handicaps,
the viewpoint arose of approaching them as problems incommunication using language and in communicationof relationships. This viewpoint became the basis of thesubsequent transformation of the training concept.
4. Establishing “resource-room training”
Since the establishment of the special classes for children
with speech-language disorders in Toricho Elementary
School in Sendai City in 1958 and in Innai Elementary
School in Chiba City in 1959, it has taken more than 35
years for training under the resource-room system to belegislated as an educational system.
While the education of children with speech-language
disorders has been developed under the system of specialclasses and has long been practiced in the form of training
under the resource-room method (resource-room system),the realization of a system corresponding to the actual statusof training has been required from the beginning of sucheducation. Various efforts and approaches were constantly
made by related organizations such as the National Public
School Association of Education for Hearing and Speechlanguage Disorders and the National Association of Parents
with Children with Speech and Speech-language Disorders.
In a circular (No. 380) entitled “Education for children
needing special treatment under the partial revision of the
School Education Law and its enforcement regulations”

NISE Bulletin Vol.9: 65-78 November 2008
from the head of the Elementary and Secondary Education
Bureau of the Ministry of Education in October 1962, it isstated that “children with speech-language disorders shouldbe educated in their own special class in accordance withthe characteristics and degree of their disorders, or theyshould be trained in a regular class with consideration of
their disorders.” This was the first time that the educationof children with speech-language disorders was clearlyspecified.
In 1978, in the report “Ideal school education for children
with mild mental-physical disorders” by a research andinvestigation committee for special education, it wassuggested that “children with speech-language disorders
should be trained in a special class for such children, in aresource room or by a visiting expert teacher, or in a regularclass with consideration of their disorders in accordancewith the characteristics and degree of the disorders.”
However, such a system has not yet been realized.
In 1987, “The third report on educational reform” waspublished by the Ad Hoc Council of Education. It suggested
that, “considering the actual status of disorders, further
efforts should be made in the development and enrichmentof the special classes in elementary and junior high schools,
including the training system in resource-room classes.”
The enrichment of “resource-room training” was alsomentioned in the report by the Curriculum Council in 1988.
As an outcome of the above activities, the summary of the
discussion of the Council of Researchers and Associates for
Resource Room Class, entitled “Measures for enrichmentof training in the resource room,” was published in 1992. In
the next year, 1993, training in the resource-room method
was clearly established as “resource-room training” in thepartial revision of the enforcement regulations of the School
Education Law.
5. Development of “resource-room training”(1) Issues related to transformation
The following issues have arisen in association withthe transformation from special classes for children withspeech-language disorders to the system of “resource-roomtraining” (National Public School Association of Educationfor Hearing and Speech-language Disorders, 1994)9.
① Placement of teachers
Because one teacher per about 10 children was set as thestandard, a difficulty arose in establishing special classes
in sparsely populated areas such as rural districts becauseof an insufficient number of children. This problem also
became a factor that promoted the diversification of thestatus of disorders in order to secure subject children.
② Subject children
Because the children in other special classes could

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MATSUMURA Kanyu, MAKINO Yasumi

NISE Bulletin Vol.9: 65-78 November 2008

not be trained in the resource room in the new system, it
became necessary to devise ways of providing care for suchchildren, such as educational counseling.
③ Number of subject children
Resource-room classes are widely known to be thetraining field for children enrolled in regular classes. The
advantage that children can be trained while they areenrolled in regular classes is recognized. As a result, theneed for the education of children with speech-language
disorders grew and the number of subject children
increased, which led to the need to assign multiple teachers
to one class.
④ Content of education and time of training
Because the content and time of training were specified
and it became difficult to secure time for studying academic
subjects, a necessity arose to be selective of the content oftraining and to adapt the training method.
(2) Development of resource-room training
Even with the issues associated with the transformationfrom the system of special classes for children with speechlanguage disorders, “resource-room training” spread rapidly(Table 5). “Special class training” was gradually replaced
by “resource-room training,” and the total number ofsubjects increased.
TABLE 5 C hange in number of children receiving “resourceroom training” and “special class training” (forspeech-language disorders)Year

Resource-roomtraining

Special class

Total

1993

9,645

5,285

14,9301994

11,183

4,162

15,345

1995

13,486

3,380

16,866

1996

16,6382,639

19,277

1997

19,217

1,821

21,038

1998

20,461

1,513

21,974

1999

21,944

1,298

23,242

2000

23,290

1,193

24,483

2001

24,8501,211

26,061

2002

26,453

1,166

27,619

Ministry of Education, Culture, Sports, Science, and Technology, materials on
special education

III. Changes after Establishment of “Resource-roomtraining” System
1. Change in status of children
Regarding the changes after the establishment of the“resource-room training” system, the rate of articulation
disorders among the subject children increased as a whole.
The improved usability of the resource- room system is
identified as the reason behind this trend.
language development (delay in language development)

and other disorders also still occur at high rates. The reason
may be the actual status of the resource-room system as asite for tutorial training of children with mild developmental
disorders who are enrolled in regular classes (National
Institute of Special Education , 1993, 1998 & 2003)5 (Table
6).
TABLE 6 Changes in disorders of target children
1991

1996

2001

Articulation disorder (%)

36.1

49.2

43.3

Cleft palate (%)

3.5

3.0

2.0

Stuttering (%)

8.3

8.3

8.4

Hearing impairment (%)

13.4

2.5

8.6

Language development (%)

30.4

30.7

29.9

Others (%)

8.3

6.4

7.7

National survey on actual condition of special class for hearing impairment andspeech-language disorders (National Institute of Special Education )The “resource-room training” system is a system fortreating children with mild disorders who are enrolled inregular classes. Teachers should be assigned and the site oftraining should be specified and managed as the “resourceroom-training class” for each disorder type.
Considering “resource-room training” in terms of thetype of disorders, speech-language disorders occur at a highrate (Table 7).
Because the number of resource-room-training classes
for hearing impairments and emotional disorders is small,children with hearing impairments and those with autism
receive training in the resource-room-training classfor speech-language disorders in many places where aresource-room-training class for these disorders has notbeen established. This is also a reason for the diversificationof subject disorders (Table 7).
2. Change in training(1) Responding to individual needs
The diversification of the status of children has changed
the perception of the content and method of training.
The themes of national conventions of the National
Public School Association of Education for Hearing
and Speech-language Disorders include “responding
to characteristics of individual disorders” for the 23rdconvention (Tochigi, 1994) and “responding to requests(needs) from children” for the 24th (Chiba, 1995) and 26th
(Oita, 1997) conventions.
The promotion of training that responds to the needsof individual children has become increasingly required.
The titles of recent conventions indicate that it has becomeHistory of and perspective on education for children with speech and speech-language disorders in japan
MATSUMURA Kanyu, MAKINO Yasumi

NISE Bulletin Vol.9: 65-78 November 2008

TABLE 7 R ates of disorders of children and students
receiving “resource-room training”
Fiscalyear

Speechlanguage
disorder (%)

Hearing
impairment(%)

Emotional
disorder(%)

Amblyopia
(%)

1993

78.8

9.3

10.9

0.9

1994

79.5

8.1

11.5

0.8

1995

80.8

7.2

11.1

0.8

1996

83.2

6.4

9.7

0.7

1997

84.0

6.0

9.0

1.0

1998

84.0

6.0

10.0

1.0

1999

85.0

5.2

9.0

1.0

2000

84.5

5.0

9.7

0.5

2001

84.1

5.0

10.4

0.5

2002

83.3

5.1

11.1

0.5

The number of children with physical disabilities and health impairments was
0.2% or lower. (Data on Special Education provided by the Ministry of Education,
Culture, Sports, Science, and Technology)

difficult to deal with children by merely typifying the statusof their disorders and categorizing them into predeterminedcases (Table 8).
At the time of those conventions, educational trends were
shifting from the conventional standardized education toeducation that respects individuality and caters to individual
differences. Following discussions of the Ad Hoc Councilof Education (from 1984 to 1987), the viewpoints ofrespecting individuality and education catering to individual
differences were presented in the discussion on “desirable
education in Japan looking toward the 21st century” at
the 15th and 16th Central Education Council meetings(from 1995 to 1997). These discussions are also part of thereasons for the change in content and method of training.
Because education for students with speechlanguage disorders had mainly been practiced as tutorial
training, research and development on the planning andimplementation of the “tutorial training program” wereconducted in some areas after the “resource-room training”
system was institutionalized.
In particular, “resource-room training” was considered
complementary training to the education in schools and wasaimed at responding to the individual needs of children,
their parents, and schools. The ideas of accountability andinformed consent, namely, explanation of and gaining
consent for the training content from the subject children,
their parents, and schools (classes), were introduced in thedetermination of the training content. These may also bepart of the reason for the change in the content and methodof training (Metropolitan Board of Education, 1997)8.

TABLE 8 Titles of 23rd–32nd national conventions
Year, Host prefecture, Title of convention
1994, 23rd, Tochigi
Desirable education for children with hearing and speechlanguage disorders in accordance with the characteristics ofindividual disorders: Aiming at accurate educational diagnosis
and its better practice
1995, 24th, Chiba
Better education for hearing and speech-language disorders:Class management responding to needs of children
1996, 25th, Nara
Better education for children with hearing and speech-language
disorders: Pursuing educational practice from a long-term
perspective
1997, 26th, Oita
Better education for children with hearing and speech-language
disorders: Aiming at classroom and class management andtraining that responds to needs of children and the local area
1998, 27th, Shizuoka
Better education for children with hearing and speech-language
disorders: Seeking desirable support towards individual selfrealization on the basis of the role of education for children withhearing and speech-language disorders
1999, 28th, Tokyo
Better education for children with hearing and speech-language
disorders: Desirable education with respect for individual children
2000, 29th, Yamagata
Pursuing desirable education on listening and speaking toenhance sound development of children: Seeking ways tounderstand and train children
2001, 30th, Shimane
Desired support for children to live their own lives
2002, 31st, Hokkaido
Desirable training based on educational diagnosis of children withspeech-language disorders
2003, 32nd, Gunma
Desirable education on language and listening to suppor trich communication: What is revealed by various forms ofcollaboration(2) E nrichment of life and establishment of selfidentity“Desirable support for children to live their own lives”
was featured in the title of the 30th national convention of
the National Public School Association of Education for
Hearing and Speech-language Disorders (Shimane 2001).
In the keynote proposal of the convention, Yoji Matsubara(a teacher at Matsubara Elementary School in Hamada

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NISE Bulletin Vol.9: 65-78 November 2008

City, Shimane Prefecture, at the time) proposed that, whileconventional training is aimed at the improvement andovercoming the disorder status of the children, it should
focus on the life of the children and devise “support
for children to live their own lives.” He brought up thenecessity of accepting the present status of the children,
not attributing difficulties in life to the children’s disability,and providing support for the enrichment of the children’s lives through relationships with the people around them(Matsubara, 2001)5.
In other words, instead of the viewpoint emphasizing
the overcoming of disorders and improvement of children’s ability, education focusing on individual initiative and thelives of children with disorders was suggested.

the issue of the diversification of disorders, has continued
since the late 1970s when the number of “speech-language
training classes” rapidly increased. The issue at the time
was predominantly dealing with children with delayed
language development. Currently, the issue has shiftedto dealing with children who, in regular classes, havedifficulties in learning and in life as part of a group.

In the Plan for People with Disabilities -- Seven-Years
Normalization Strategy, which was drawn up in 1995,“aiming at improving the quality of life (QOL)” wasconsidered as one of the seven aims for promoting measureson the basis of rehabilitation and normalization. “Thenecessity of improving the social life, including not only
activities of daily living (ADL) but also the cultural activity
and family life of disabled people” was also indicated. Suchchanges in the concept of measures for disabled people
has also stimulated changes in the concept of education forchildren with speech-language disorders.

These issues have also been presented as issues of“speech-language training class” management. There has
been discussion among those who regard the “speechlanguage training class” as a site of speech-language
therapy for children with speech difficulties and those who
regard it as a site for providing support to children who areenrolled in regular classes but have other needs. By analogy
to the education system in the US, whether the “speechlanguage training class” should be a “speech clinic” or a“resource room” was also discussed.

Ⅳ . Tentative discussion of issues in education forspeech-language disorders
Thus far, we have been following the course of education
for children with speech-language disorders from theviewpoints of the “education system” and the “ideas andcontent of education” considering the correlation between
these viewpoints.
Here, the changes are reexamined and a tentative
discussion on the various issues is proposed on the basisof the answers to the following questions. (1) What kindof children are the subjects of the “speech-language
training class?” (2) What are the content and the methodsof education for children with speech-language disorders?
(3) What qualifications are required of teachers providing
education for children with speech-language disorders?
1. W hat kind of children are the subjects of the“speech-language training class?”
The “speech-language training class” is established
as a forum of education responding to speech-language
disorders from an institutional viewpoint.
At the beginning, the “speech-language training class”
was established as a forum for speech-language therapy.
Since then, its function has been extended to respond to thevarious educational needs of children. This change, namely,

This change can be understood as an expansion of thecontent and function by shifting the focus from the aspectof speech to that of language and from the formal aspectof speech-language (speech-language training) to thefunctional aspect (communication) in the framework ofeducation for children with speech-language disorders.

There was divergence in the viewpoints of the parties
participating in the discussion in many cases; someemphasized desirable education for speech-language
disorders and its specialization while others focused on thedesirable function of the “speech-language training class.”
What we know from this discussion is that, in practice,
the “speech-language training class” has been managed
from both the viewpoints of speech-language therapy andsupport for children with various needs. Both viewpoints
have been emphasized and put into practice with regard to
local circumstances, the history of the establishment, andthe perspective of the parties concerned at the time.
2. W hat are the content and methods of education
for children with speech-language disorders?
Education for children with speech-language disorders
started as speech-language therapy. At first, on the basisof knowledge of speech pathology, the purpose of theeducation was mostly understood as improvement oflanguage skills of children with speech-language difficulties
through an educational method. It was often said that,“Speech-language disorders are curable disorders that canbe treated just as tooth decay is treated, and going to the
speech-language training class is similar to going to a dental
clinic.”History of and perspective on education for children with speech and speech-language disorders in japan
MATSUMURA Kanyu, MAKINO Yasumi
However, along with the diversification of the subject
children, the aspect of support for their development wasemphasized. The emphasis on the content and methodof training shifted from the aspect of teaching to thatof promoting speech-language activities of the children
in which the teacher is part of the environment, and thetraining has the function of developing the environment
surrounding the children and encouraging and supporting
those nurturing the children.
Recently, on the basis of knowledge obtained fromresearch on communication disorders, training and support
focusing on the relationship between two persons, namely,a child and a person who is part of the child’s environment,
are being carried out with the view that speech-language
disorders are not problems specific to the child but arecommunication disorders.
Educational support that emphasizes the enrichment of
the child’s life, not on the difficulty or delay in languageor the improvement of the child’s ability, is also being
attempted. Such support is provided from the standpoint offocusing on respecting the individual initiative of the childand on the improvement of the quality of the child’s life.
These old and new viewpoints can also be understood interms of the difference in the two standpoints concerning
the education of children with speech-language disorders.
One standpoint is that the education of children
with speech-language disorders involves “activities foralleviating the speech-language disorders of children by aneducational (not medical) approach,” and the second oneis that education comprises “activities for understanding
all aspects of the children with speech-language disorders
and for supporting the enrichment of their lives, selfestablishment, and self-realization.”Content and methods of training have been proposed
and practiced from each standpoint, which considers thecharacteristic differences.
What we should understand here is that education
for children with speech-language disorders has bothaspects described above, i.e., improving the disorders andsupporting children to enrich their lives. Each aspect has
been emphasized and put into practice at different times
depending on the actual status of the individual children,
the education and culture of the local area, and the viewconcerning speech-language and education of the teacher incharge.

NISE Bulletin Vol.9: 65-78 November 2008
3. W
 hat qualifications are required of the teachers
involved in educating children with speechlanguage disorders?
Efforts to improve the qualification of teachers involvedin educating children with speech-language disorders havebeen made for a long time within the framework of theissue of fostering and training teachers.
To date, the teaching curriculum for fostering teachers
involved in educating children with speech-language
disorders has been followed in teacher-training colleges
across the country. The national government, local
governments, and some research organizations havealso offered training. The qualification system for theseteachers has also been a concern. The development of alicensing system to ensure the expertise of teachers has
been suggested (Council of Researchers and Associates on
Improvement and Enrichment of Special Needs Educationthe 1st and 2nd reports-1998 and 1999).
Under these circumstances, discussion on the expertiseof teachers involved in educating children with speechlanguage disorders was triggered in 1998 by the legislationof the licensing system for speech therapists, which is anational certification. Various questions were raised in thediscussion: should teachers involved in educating children
with speech-language disorders obtain this qualification;
what is the difference between specialists (such as speechtherapists) and the teachers; what is lacking in the expertiseof these teachers compared with that of specialists (suchas speech therapists); and what is the expertise of teachers
involved in educating children with speech-language
disorders11?
The key to answering these questions is discussed below.
If teachers involved in educating children with speechlanguage disorders have the same expertise and role as
specialists (speech therapists), they would be replaced by
the specialists (speech therapists).
Teachers for the education of children with speechlanguage disorders are expected to have qualifications inboth “specialized content concerning speech-language
disorders” and “specialized content concerning education.”
The education of children with speech-language
disorders involves helping such children find theirindividuality, choose their own way of life, and achieveself-realization. The teachers involved in such educationmust have confidence in and be able to explain not only
their knowledge of speech-language disorders but also
their overall knowledge of the mind and development ofchildren, the life of the children at school, at home and in

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History of and perspective on education for children with speech and speech-language disorders in japan
MATSUMURA Kanyu, MAKINO Yasumi

NISE Bulletin Vol.9: 65-78 November 2008

the local community, the academic subjects and fields, andthe method of supporting children.

for individuals to participate in society” to “support forindividuals to live a rich life.”

Ⅴ . Conclusion
The education of children with speech-language disorders
has passed through a history of conscientious study andefforts by people in the aspects of both the “development ofcontent and methods of education” and the “development of
the system.” Moreover, its educational resources have beenenriched as well as modified according to current thought.

More than 40 years ago, our predecessors made efforts
to establish education for children with language disorders,focusing on individuals; now, education is again being
directed towards the “individual” with new meaning.

The education of children with speech-language
disorders began with the emphasis on the “individual”
and, along with the system of resource- room training, has
accumulated more than 40 years of history in its practiceand achievements.
In June 1997, the Central Education Council suggested
the “necessity of education that responds to individual
ability and aptitude” in a report on “desirable educationin Japan looking toward the 21st century.” Their concept
was described as follows: “Education is the activity of
supporting the ‘self-searching journey.’ Through education,
children acquire the foundations and basis to live insociety as well as find their individual characteristics andchoose a suitable way of life for themselves. During thesesuccessive procedures, children gain various experiences
through the process of trial and error and seek their selfrealization. Appropriate support for such children is themost important mission of education.” “Considering thenature of education, respecting individual characteristics assomething irreplaceable and trying to develop them shouldbe the basic concept behind educational reform.”
In March 2003, the Council of Researchers andAssociates on Desirable Special Needs Education in the
Future, in their report “Desirable Special Needs Educationin the Future (final report),” suggested a “transformationto ‘special support education’ that provides appropriate
educational support in response to the educational
needs of individual children with disorders,” reflecting
a transformation from mass education to education for
individual needs.
The trend in education is directed to the viewpoint of the“individual.”
The viewpoint of education is being shifted from “looking
at individuals from the eyes of society” to “looking atsociety from the eyes of individuals.”
The viewpoint of education for children with speechlanguage disorders is also being shifted from “support

The aspects of “individuals” and “society” are always
at opposing ends, and the viewpoint of education wavers
between them. Someday the viewpoint of education may
again shift in another direction. Education for children withspeech-language disorders should also change accordingly.
We believe that, even if the system of education
for children with disorders changes in the future, theeducational resources and culture developed through theeducation of children with speech-language disorders willcontinue and be further enriched and developed in line withthe trends and ideals of the coming age.
Notes(1) E ducation of children with speech-language
disorders
The education of children with speech-language disorders
is literally understood as the education of children withspeech-language disorders. However, it has a different
meaning from the education of children with disorders inother aspects in terms of system and content.
First, because speech-language disorders also occur inassociation with other disorders, the training concerning
speech-language disorders associated with other disorders
is given in the context of education for the major disorder.
Therefore, the education of children with speech-language
disorders is the education of children whose major problem
is speech-language disorder.
Second, because children with speech-language disorders
can learn academic subjects in a regular class, training in
the education of children with speech-language disorders
mainly consists of dealing with the speech-language
disorder.
Because of these institutional features, the education ofchildren with speech-language disorders is characterized
by the training concept emphasizing the “removal andreduction of the disorder.”(2) Remedial training
Remedial training is conducted for children withdifficulties in learning subjects. Occasions and opportunities
for tutorial training are designated separately from regularHistory of and perspective on education for children with speech and speech-language disorders in japan
MATSUMURA Kanyu, MAKINO Yasumi
classes. It is also conducted as special training with thecontent and methods devised in response to the difficulties
of individual children.
(3) Remedial education
In this paper, this term is used to denote the investigationof the cause of poor school performance and the proper
teaching of children showing poor school performanceprovided by specialist teachers. It does not indicate any
direct medical treatment.
(4) Resource-room system
Kiyomatsu Okuma started using this term in the fieldof education for children with speech-language disorders.
It is a form of training in which most of the education
concerning the teaching of academic subjects is given in
regular classes and the special training concerning speechlanguage disorders is given at a special site (such as in aspeech-language therapy class).
Until the legal establishment of the system of “resourceroom training,” the form of resource-room training wascalled the “resource-room system” or “resource-room
method” and was one type of training in special classes.
Kiyomatsu Okuma was the first to use the term “resourceroom system,” and Kenji Hamasaki, the term “resourceroom method.”(5) Speech therapist
The national certification system for speech therapists(Speech Therapists Law) was legislated in 1997. It is mainly
designed as the certification of specialists who are engaged
in medical and welfare support for people with speechlanguage and hearing disorders. As a transition measure
within five years after legislation, teachers who had engaged
in training for speech-language and hearing disorders in theschools were also qualified for the national exam for speechtherapists if they met certain conditions.
(6) Speech-language training class
The site for “resource room training (for speech-language
disorders)” is commonly called the “speech-language
training class.” Conventionally, this term had been used as
an alternative to the “special class for children with speechlanguage disorders.” The site for resource-room training is
also called the “resource-room-training class for children
with speech-language disorders” in many cases. However,there is no official provision on how to describe the site of“resource-room training.” Considering the current status
in which the system of the special class for children withspeech-language disorders coexists with the resource-roomsystem, we used the term “speech-language training class,”
which has been widely used for a long time.

NISE Bulletin Vol.9: 65-78 November 2008(7) Teachers of education for children with speechlanguage disorders
The term is used for the teachers involved in the
education of children with speech-language disorders.
In this paper, we used this term for the teachers of the“speech-language training class.” Some teacher-training
colleges have a teaching curriculum for fostering teachersof the “speech-language training class;” however, there
is no licensing system that ensures the expertise of suchteachers. Specialists in speech-language disorders are
qualified under the teacher’s licensing system for selfcare activity in schools for disabled children; however, thissystem is not designed for teachers who are responsible for“resource- room training (of children with speech-language
disorders).”(8) Speech-language therapy
Generally, “the process of promoting linguistic
improvement and interpersonal adaptation of a personwith speech-language disorders is called speech-language
therapy (Encyclopedia of Speech-language Disorders:
Iwasaki Academic Publisher).”(9) Therapy classThis term is used for the remedial training class forchildren having delay or difficulties in learning Japaneseand arithmetic. Aside from specialized teachers, the teachersof regular classes teach the class concurrently in somecases.
(10) National Public School Association of Educationfor Hearing and Speech-language Disorders
This is a nationwide association consisting of teachersof special classes for children with hearing disorders andchildren with speech-language disorders; it was establishedin 1971. It has promoted research on the content andmethod of training and has made efforts to improve theeducational conditions. National conventions are held
yearly in cooperation with related organizations across thecountry. It also publishes the journal “Kikoe-to-Kotoba(Listening and Speaking) (in Japanese).”(11) “Pioneering the 21st century: desirable education(support) for children with hearing and speechlanguage disorders” was discussed from various
viewpoints by the Promotion Committee for Training
and Management of the National Public School
Association of Education for Hearing and Speechlanguage Disorders.
References
1. H amasaki, K.: Until the birth of first special classfor speech-language disorder in Japan. Material for

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History of and perspective on education for children with speech and speech-language disorders in japan
MATSUMURA Kanyu, MAKINO Yasumi
education inspection at the convention of National
Public School Association of Education for Hearing
and Speech-language Disorders in Miyagi, 1988. (inJapanese)
2. Kawashita, K.: Issues and title of Miyagi convention.
Kotoba (Speaking), 25, Miyagi Association of Educationfor Speech-language Disorders, 1987. (in Japanese)
3. Kawashita, K.: Draft of 17th national convention of
National Public School Association of Education for
Hearing and Speech-language Disorders in Miyagi,
1988. (in Japanese)
4. National Institute of Special Education : Report on thenational survey of actual conditions in special class forhearing impairment and speech-language disorders,
1993, 1998 and 2003. (in Japanese)
5. Matsubara, Y.: Keynote proposal of the convention.
Minutes of 30th National Convention of National
Public School Association of Education for Hearing
and Speech-language Disorders in Shimane, 2001. (inJapanese)
6. Miyawaki, O.: Considering desired future education
for hearing and speech-language disorders in broad

NISE Bulletin Vol.9: 65-78 November 2008
viewpoint: From standpoint of school management.
Draft of 12th National Convention of National Public
School Association of Education for Hearing andSpeech-language Disorders in Aichi, 1983. (in Japanese)
7. Okuma, K., & Yamagishi, J.: Considering the future of
education for children with speech-language disorders.
Japan Society of Education for Children with Speechlanguage Disorders, 1997. (in Japanese)
8. M etropolitan Board of Education, Committee of
Educational Development for Mental and Physical
Disorders: Teaching materials for educational
development of people with mental and physicaldisorders in 1996. “Program for tutorial training
Q&A,” 1997. (in Japanese)
9. National Public School Association of Education for
Hearing and Speech-language Disorders: Current status
and issues of hearing and speech-language disorders:
Mainly considering issues of resource-room training
and teacher’s training. Kikoe-to-Kotoba (Listening andSpeaking), 12, 1994. (in Japanese)—Received June 28, 2004; Accepted May 26, 2008—

Abstract of Bulletin of The National Institute of Special Education Vol.32

Abstract of Bulletin of The National Institute of Special Education Vol.32

Tactile graphics in braille textbooks: Practical guidelines formaking tactile drawings
KANEKO Takishi, OOUCHI Susumu
Department of Policy & Planning
Abstract: Braille textbooks include not only Braille text but also tactile drawings. These text and drawings are edited andmade based on original ordinary textbooks. Among these ones, tactile drawings are not understood tactually unless they are
made with various ideas. In Japanese Braille textbooks, tactile drawings made by Braille dots has majority. So we aimed toinvestigate practical guidelines for making tactile drawings by dots in Braille textbooks. We mentioned these five points asfollows, giving examples with tactile drawings based on pictures and charts in ordinary textbooks. 1) Textbooks have picturesand charts that are not necessarily important from a viewpoint of its content. We have to appropriately choose pictures andcharts in textbooks to be made tactile drawings. Occasionally, we should substitute suitable text for pictures and charts. 2) In
tactile drawings by Braille dots, lines, surfaces as well as dots are made by dots. So tactile graphics by Braille dots has some
restrictions due to making tactile drawings by dots alone. 3) Tactile perceptions have some characteristics that are different
form visual perception. We need to make tactile drawings, following some criterions on the distance between two components,
number of components in some unit area and so on. 4) Textbooks include various pictures and charts. So we need appropriate
guidelines according to these ones. But, before we do so, it is effective that we classify various pictures and charts fromtwo viewpoints; whether exact form of these ones is important and which information has priority in these ones. 5) Detailed
explanatory notes in Braille should be added to tactile drawings. This promotes understanding of tactile drawings.
Key Words: Tactile drawing, Tactile drawing by Braille dots, Practical guidelines, Braille textbook, Visual impairments

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Abstract of Bulletin of The National Institute of Special Education Vol.32

The study of generalization about question-answering
behavior to the interrogative sentences for a child with autism
SATO Katsutoshi1, IMANAKA Hirofumi2, KOZONE Kazuko3, OKAZAKI Shinji4,and MAEKAWA Hisao41

Department of Educational Support Reseach, 2Tokyo-seitoku University, 3Hospital of Izuteishin,
4
Tsukuba University
Abstract: We studied about question-answering behavior of interrogative sentences for a child with autism. This training
applied the technique of matrix training. Two kinds of questions（behavior + whom and man + what）were asked to one
photograph stimulus. The card with which the name of a person or the behavior was given as a choice. By presenting aquestion sentence only an interrogative, it became possible it not only can to choose a card appropriately, but to answer inverbal languages. And it became possible to answer also about two kinds of questions, behavior + whom and mane + what.
We considered about the generalization of question-answering behavior to the interrogative sentences for a child with autism.
Key Words: Children with autism, Question- answering, Interrogative sentences, Generalization

Considerations on support systems in regular schools
designated as “The model schools project for LD”：
Through questionnaire on systems during and after the“The model project for LD”
HIROSE Yumiko1, TOJO Yoshikuni2, and II Tomoko3
1

Department of Educational Support Research, 2Ibaraki University, 3Chiba Meitoku Junior College

Abstract: In “A project for making a support system for children with Learning Disabilities substantial” put into practice in
2000-2002, 98 elementary and junior high schools were specified for the project. In this study, the actual conditions of thoseschools were researched. Results showed that how to make a committee for the support with LD in each school was classified
into 4 ways. The committee in each school acted according to the condition of each school. The cooperation with a team of
specialists and a consultant who made his rounds was important for school, but it was found difficult to adjust the schedulesof them. After the termination of the project the committee has kept up its action in about 75% of schools. To push on with theaction of committee in school, it is important to ① share information of child with all the staff, ② to act regularly according
to an annual plan, ③ to be adjusted by special support education coordinator, ④ to act independently without depending on
specialists, ⑤ to evaluate of its action.
Key Words: A support system in school, The model project for LD, A committee in school, Evaluate

Abstract of Bulletin of The National Institute of Special Education Vol.32

Early intervention in educational guidance of schoolfor the deaf
SATO D.S. Masayuki1, KOBAYASHI Michiyo2
1

Department of Educational Support Research, 2Clinical Center for Children with Special Needs

Abstract: The purpose of this present study is to investigate on the existing condition of early intervention in educational
guidance of school for the deaf.The investigation items are included the first session after hearing impairment diagnose,interpretation for parents on deaf and hard of hearing,estimate of hearing level through auditory assessment,coordination
on multi-disciplinary working and child care support. Concerning the first session after hearing impairment diagnose,it issuggested that the staff of educational guidance should be provide the environment which parents are apt to talk on theirthought and concentrate to listen to their talking. On the interpretation for parents on deaf and hard of hearing,communi
cation,deaf education,and usage of hearing aid is more important than physiological information of auditory region. On
the estimate of hearing level through auditory assessment,it is suggested that the staff of educational guidance should be
estimate the hearing level of infant through his/her behavior through hearing to sound with his/him parents and also should
be refer to parent's document on his/her behavior through hearing to sound on daily life on the estimation of hearing level.
Concerning coordination on multi-disciplinary working,the school for the deaf would be appeal to the authorities concernedon the function of school through school exhibition.It is necessary that the function of school is understand by the authorities
concerned. Finally, on the child care support, it is suggested that it is important to extend to primary child development except
to the deaf concerned on parent's angle.
Key Words: School for the deaf, Education guidance for infants and children, Early intervention

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Abstract of Bulletin of The National Institute of Special Education Vol.32

The concept of special educational needs and development ofspecial education in japan: A point of controversy about thisconcept in britain and the implication in japan
TOKUNAGA Yutaka
Department of Policy & Planning
Abstract: Britain introduced the concept of "Special Educational Needs" in special education by the Education Act 1981. The
special educational provision for children with special educational needs has been improved by using the concept "Special
Educational Needs" instead of the concept "Disabilities" since 1981. The concept of "Special Educational Needs" has spreadin European countries and international organizations as OECD and UNESCO, and became a central concept in the education
for children with disabilities. The purpose of this research is to examine details of the introduction of this concept, toconsider the problems and the critical points when 20 years passed afterwards in Britain. In addition, this research aimed
to consider the point which had to be noted when Japan will introduce a similar concept to develop special education. The
following points are given as problems which relate to this concept in Britain. ① Function of labeling, ② Original concept
for education, ③ Realities which exceeds the definition, ④ Revival of concept about disabilities, ⑤ Type division of needs
for explanation. It was pointed out that the concept of "Special Educational Needs" was improper in the following reason
when thinking about the development of special education in Japan. ① The implication of the concept "Special Educational
Needs" is not discussed, and "Disabilities" concept is not reexamined. ② "Needs" is used by a lot of different contexts,
therefore the confusion of the meaning is caused. It was considered that Special Educational Needs was not an appropriate
concept in the idea of the development of the special education in the future. It was discussed that it would be important that
"Educational Difficulties" and "Activity Limitation" were assumed to be key words in the future. This discussion suggests thatthese are Relative Concepts which arise from the interaction a child and his or her environment. "Educational Difficulties" and"Activity Limitation" do not always start from within the child.
Key Words: Special educational needs, Britain, Educational difficulties, Activity limitation, Relative concepts

Abstract of Bulletin of The National Institute of Special Education Vol.33

Abstract of Bulletin of The National Institute of Special Education Vol.33

The study for educational programs and instructional methods
for students with autism
SATO Katsutoshi1, KOREEDA Kiyoji2, SAITO Ukai1, TOKUNAGA Yutaka3, HIROSE Yumiko1,
CHIKURINJI Takeshi4, WAKUI Megumi1, and OSHIO Chikamori1
1
3

Department of Educational Support Research, 2Tokyo University of Social Welfare
Department of Policy & Planning, 4Hiroshima Prefectural Board of Education

Abstract: We made a sthdy on educational programs and instructional methods for students with autism in special schoolsof intellectual disabilities. For the purpose of our research, we asked for questionnaire investigation to teachers of special
schools. We categorized six categories about educational programs and four categories about instructional methods. From
the result of comparison among divisions of school（elementary, lower secondary and upper secondary）about educational
programs, we found there were differences about educational progroms among divisions of school. From the result ofcomparison among divisions of school about instructional methods, we found instructional methods in elementary divisions
were better than others. And from the results of comparison among situation of divisions, we discussed on importance ofschool organized activities.
Key Words: Students with autism, Questionnaire investigation, Educational programs, Instructional methods

Study on change in staff at the schools for visual impairment
in japan
OOUCHI Susumu1, KANEKO Takeshi1, TANAKA Yoshihiro2, and CHIDA Kouki2
1

Department of Policy & Planning, 2Department of Educational Support Research

Abstract: A reseach was conducted to take hold on the trend of changes in personnel at school for the visual impairment
in Japan. The data of past ten years from 1992 to 2001 on “annual survey on the actual situation on school for the visual
impairment in Japan” was usued in this reseach. From the overall standpoint, It was indicated that service years of personnel
in the school for visual impairment is several years on an average and as survice years wore on, the number of personnel
decreased with year. Number of years with the school of teachers on division of elementaly school, junior high school andhigh school were for five or less years. Dames of students residence and teachers of vocatioal course were relatively long-term
career.
Key Words: Change in personnel, Schools for visual impairment, Specially of a teacher

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Abstract of Bulletin of The National Institute of Special Education Vol.33

Idological genealogy in background of “individua educational
support plan”

NISHIMAKI Kengo1, SASAMOTO Ken2
1

Department of Educational Support Research, 2Department of Policy & Planning

Abstract: The conversion from "Special Education" to "Special support Education" is being accomplished in our country, andvarious revisions of the system of the education are done now for that. In the above-mentioned situation, it is assumed to be
one of the important elements to promote "Special Support Education" to make "Individual Educational Support Plan"．In
this research, the meaning of "Individual Educational Support Plan" was analyzed from historical and ideological viewpoints
in two areas of the education and welfare.
Key Words: Special education, Individual educational support plan, WelfareNISE

NISE Bulletin
Educational Board
NAKAMURA Hitoshi

ATSUMI Yoshikata

NAKAZAWA Megue

CHIDA Kouki

OOUCHI Susumu

GOKAMI Tetsuo

SASAMOTO Ken

KIMURA Nobutaka

YASUDA Osamu

Vol. 9CONTENTSARTICLESORIGINAL ARTICLESTOKUNAGA Akio

1

The attempt of the practical application ofInternational Classification of Functioning,
Disability, and Health (ICF) as a tool forcollaboration among various professionals:
A perspective on its applicability to“individualized educational support plan”

SUGAI Hiroyuki

25

Support for teachers of education forchildren with multiple disabilities throughschool consultation

CHIKURINJI Takeshi

37

A study on teaching schoolchildren withintellectual disability

SAWADA Mayumi

51＊
Approach to teaching adventitiously
blinded persons with difficulty in reading braille:
Comparison of the degree of ease in reading
between braille characters of two sizes

MATSUMURA Kanyu, MAKINO Yasumi

65

History of and perspective on education
for children with speech and speechlanguage disorders in japan

Vol. 9NISHIMAKI Kengo（Chairman）

NISE Bulletin
NISE BulletinVol. 9 November 2008

ISSN 0389-9012

A－9

INVESTIGATIVE REPORTNOTEKOBAYASHI Michiyo

November 2008

Published by
The National Institute of Special Needs Education
5-1-1 Nobi, Yokosuka, Kanagawa, 239-8585 Japan＊（＊ Translated from the “Bulletin of The National Institute of Special Education”）

Abstracts of “Bulletin of The National Institute of Special Education”
Vol. 32

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Vol. 33

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November 2008＊