As part of a long-term follow-up study of aphasic patients, we investigated the extent of improvement seen in scores on the Standard Language Test for Aphasia (SLTA) in patients having wide lesions which extended to the frontal, temporal, or parietal lobe according to findings by CT scan.
    The subjects were 32 aphasic patients who met the abovestated conditions and who showed a lapse of more than 3 years since the onset of aphasia. Their SLTA scores at the so-called maximun improvement level (after an extended follow-up, a mean of 7. 0 years) ranged widely from “extremely mild” to “severe. ” When they were classified according to age of onset, those with an age of onset of 40 years or below, in comparison to those who suffered after 40 years, produced singificantly higher mean points, both in the comprehensive scores and in all individual test items. Those patients whose onset was under 40 years and showed satisfactory improvement produced mean scores much below the -1 standard deviation for non-aphasic individuals in two test items (“oral command” and “oral repetition of sentences”).
    These findings suggest that prognostic differences according to age of onset should be taken into consideration when implementing rehabilitation programs.

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     A case of amnesic aphasia due to impairment of so-called “categorical attitude” (Goldstein) was reported. The patient was a 59-year-old right-handed woman who suffered aphasia by left temporal lesion due to herpes simplex encephalitis. She initially showed clinical evidence of Gogi (word-meaning) aphasia, followed by amnesic aphasia. The following characteristics were observed in object naming or action description. (1) The patient could describe the usage or details of objects, and sometimes even utter the target word itself during description, but could never name the objects in isolation. (2) She maintained a fixation on the individuality of each object. (3) She tried to describe objects or events as minutely as possible, and could never describe them succinctly. (4) She was inclined to express her impressions of the objects or events. These characteristics and the results of the sorting test suggested that the basic disturbance of this case lies in the process of categorization. The fact that gesture cues had certain effects in prompting appropriate response supported this hypothesis.

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     The study investigated the written discourse in a case of aphasia following left putaminal hemorrhage. The materials consisted of cartoon-like picture descriptions in SLTA and connected sentences in response to a given theme, “autumn. ” For the former, some descriptions with errors were written initially, then descriptions were produced for each picture. After 24 months post-onset, sentences were connected and discourse was formed as a whole. For the latter, well-structured discourse of about 300 letters was produced. There were no grammatical errors but some residual orthographic errors in both tests. Results suggest that an aphasic has the ability to produce written discourse despite some errors. It is supposed that improvement of the patient's language disturbances, writing habits prior to stroke, preservation of verbal thought and a positive attitude toward writing are underlying factors. Further studies are required.

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     A case of confabulation caused by hypoxic encephalopathy is reported. The patient was a 47-year-old right handed male. Neuropsychologically, he presented retrograde and anterograde amnesia, good immediate memory, preserved intelligence, and remarkable confabulation. The confabulation was characterized by connection with past episodes in the patient's life and the citing of unrelated events as the patient's own personal experience. He exhibited serious disturbance in remembering past events, and also presented interesting behaviours associated with confabulation. For example, after watching an historical play on television, he would go to look for the characters. Probable factors influencing the characteristics and development of the confabulation and related behaviours are discussed.

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     Pure anarthria is known to occur after a lesion of the inferior precentral gyrus. However, anarthria caused by a localized lesion is often transient, suggesting a compensatory mechanism by the contralateral homologous cortical area.
    A right-handed 60-year-old male who suddenly became mute on the job came to our hospital. Neurological examination revealed severe anarthria and mild right facial weakness. Mild dysgraphia was initially noted but improved in three months. Severe anarthria associated with dysprosody persisted. Magnetic resonance imaging of the brain revealed bilateral cerebral infarctions : a left-side lesion extending from the inferior to the medial portion of the precentral gyrus, and a right-side lesion extending from the inferior precentral gyrus to the foot of the middle frontal gyrus and to the opercular portion of the inferior frontal gyrus. Repeated X-ray computed tomographies revealed that the right hemispheric lesion was older than the left hemispheric one.
    From studies of anarthric cases with bilateral frontal lesions, two hypotheses have hitherto been proposed as to the compensatory mechanism for articulatory disturbances : Nielsen (1946) suggested that the role of the right hemispheric area is homologous with the Broca's area, while Levine et al. (1979) stressed the importance of the left hemispheric residual region around the Broca's area.
    The clinical findings of the present case do not support the hypothesis of Levine et al. because severe anarthria persisted despite a well-circumscribed lesion in the left inferior precentral gyrus. On the other hand, Nielsen's theory perhaps explains the persistence of anarthria ; i. e., the lesion in the right inferior precentral gyrus is thought to interrupt the compensatory mechanism of the right hemisphere.

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     The psychological adjustment in a group of spouses whose partners had incurred cerebrovascular injury was investigated through a questionnaire. The respondents in the study included 38 wives and 14 husbands whose partners had suffered a stroke. Among the patients, 28 had right brain damage (18 with neglect, 10 without) and 24 had left brain damage (18 with aphasia, 6 without). The questionnaire mailed to each spouse consisted of 38 items to assess the respondent's adjustment in terms of l) role change, 2) emotional aspect and 3) communication. The responses of the spouses were analyzed using chi-square tests.
    The results were as follows. 1) With respect to role changing, greater difficulties in adjustment were experienced in spouses whose partners had higher brain function disorders as compared to those of patients free from disorders in higher brain function. 2) In the emotional aspect, spouses of patients with neglect manifested notably negative emotions toward their partners. 3) In the aspect of communication, both patients with left brain damage and those with right brain damage seemed to have problems in communication to some degree.

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     Using a case of pure word dumbness, we experimentally performed training in nonverbal oral movements and in speech in order to clarify their mutual influence. Training consisted of two periods. During the first, we trained nonverbal oral movements ; during the second, we trained oral naming of pictures by electro-palatography. Each period included 10 sessions.
    Results showed that the rate of correct responses of both trained nonverbal oral movements and untrained speech rose significantly during the first period. The rate of correct responses of both trained and untrained speech rose significantly during the second period ; at the same time the rate of correct responses of untrained oral movements also rose significantly.
    These results indicate that when training of either nonverbal oral movements or speech is provided, another untrained modality will also improve. From the above, we concluded that a strong relation exists between nonverbal oral movements and speech disorders in the present case.

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     We have already reported the prognosis of language in LKS. We divided the prognosis of acquired aphasia in LKS into two types : 1) transient and 2) chronic.
    The present case belongs to the latter.
    This report emphasizes the linguistic features of the recovery course of LKS in a 7-year-old boy who first suffered mutism after onset. His development of speech was normal. At 4.11 years old, he experienced an akinetic seizure followed by irritability and hyperkinetic behavior. From the onset of seizures, his receptive and expressive language initially decreased, then he became mute. In the course of language recovery, he demonstrated babbling like jargon, verbal stereotyping echolalia, baby talk and sentences consisting of two or three words, in that order. The contents of verbal stereotyping and echolalia reflected his favorite comic characters. After one year, he recovered his language, that is, he regained normal speech, reading and writing for his age.
    We were especially interested in the subject's verbal stereotyping and echolalia in the early stage of language recovery. Echolalia was recognized as transcortical sensory aphasia. In the recovery course of LKS.

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