The basic mechanism of unilateral spatial neglect is the rightward bias of spatial attention in the bodycentered reference frame. The left-side objects or the left parts of the objects, to which patients with neglect do not attend, are not treated with conscious awareness. They stop drawing when they copy the right half of a daisy, and believe the rightward point as the center when bisecting a line. Their recognition of the whole depends mainly on the attended right side or parts. The presence (e.g., the longer left extent of the bisected line) or absence (e.g., the lacking left petals of the copied daisy) on the left side does not enter the conscious processing of the outside world. Patients with neglect feel no sense of loss for the left side of space or objects, and seem to believe that they see the outside world normally. However, verbal strategies developed by the left hemisphere may modify the expression of unilateral spatial neglect.
Vertebrates including primates can recognize biologically relevant stimuli for survival such as specific visual objects (predators, preys, and foods), sounds, and pheromones without learning when they encounter such stimuli for the first time, or just after birth. This suggests that the nervous system for innate recognition is genetically encoded. In primates, the extrageniculate visual system, which consists of the retina, superior colliculus, pulvinar, and amygdala (or associate cortices, etc.), is involved in innate recognition. Neurons in these brain areas have been shown to respond to face-like patterns and snake images. Response characteristics of these neurons suggest that the extrageniculate visual system is involved in coarse and rapid information processing of face and snake images for raid detection of these stimuli.
To ascertain the primary recovery mechanism in speech therapy, we applied factor analysis to the im provement scores for 26 subtest items on the Standard Language Test of Aphasia (SLTA) of 267 aphasic patients. The improvement score was defined the difference between the subtest score at the beginning of speech therapy and at the second evaluation. Our factor analysis extracted six improvement factors, none of which was considered as corresponding to so-called general factor. Factor 1 was determined as represent ing “non-converting” language production and complex language information processing. Each one of Fac tors 2-6 was identified primarily by a particular modality, leading us to presume that Factor 2-6 represent modality converting faculties or relatively simple language information processing faculties. As Factor 1 appears to embody the entirely of the human language function and to manage symbols creatively and independently, we recognized this Factor as “the core factor of improvement in a recovery from aphasia”. We could consider the improvement of Factor 1 as essential in speech therapy for aphasic patients, and if we interpret this according to “logogen model”, in the language mechanism of the person who had the core semantic system, the improvement of voluntary output from the semantic system and capacity for complex information processing in the semantic system were essential.
In this study, we thought back to the initial stage of the speech-language therapy and conducted reexamination of the spontaneous recovery progress from untrained aphasia in foreign countries, as well as untrained case in Japan, that is, the progress of aphasia which could not have enough speech-language therapy due to absence of speech-language therapy therapists. Recovery from aphasia involves the age of onset, severity of illness, gender, pathology, past history of cerebral stroke, type of aphasia, size of lesion, and localization, etc. However, these are only the examination of trained case, and the examination of untrained case is not clear considering the prior research both in foreign countries and in Japan. In other words, spontaneous recovery from aphasia has large individual difference and there is no unity trend. Though it may be difficult to show evidence of the speech therapy for aphasia, its effectiveness is not only for the language but also for the contribution to improve patientsʼ communication ability.
In conjunction with our study concerning time-course analysis of language function in aphasics, we made a broad examination of the following existing reports.. We investigated long-term follow-up data for lesions of 270 right-handed aphasics with left lateral damage. We also studied 37 aphasics whose language functions declined in their general scores on the Standard Language Test of Aphasia (SLTA), examining functional change in the various factors affecting those scores. We then compared the function maintenance group with the functional decline group. Function maintenance was seen in 36 cases showing no decline in language function over the long term. We exam ined the progress of lower items irrelevant to SLTA general scores of both groups. Furthermore, in 248 aphasics we investigated factors that have an influence on the general scores of SLTA, which serves as an indicator of function recovery. The results were as follows. 1) Depending on the lesion site and age at onset, recovery of aphasia symptoms varies in course greatly; however, many aphasic cases show recovery over long terms of at least six months or more. 2) Functional restoration of language by therapy is not stable but rather fragile. 3) Some lower items that are not related to general scores on SLTA supplement general scores on SLTA. We postulate that these can serve as indicators of changes in the aphasia symptoms. The items are “following oral commands,” “sentence repetition,” “word finding” and “kanji writing.” 4) The lesions that influenced prognosis were as follows: insula, postcentral gyrus, middle temporal gyrus and inferior temporal gyrus. The presence or absence of the following diffuse lesions was related also: cortex atrophy and lacunar infarction.
The aim of this article is to present the influence of intelligence on aphasia. The first, we investigated the relationships between intelligence and recovery from the aphasia by using the effect size. 196 convalescence individuals with aphasia who receiver standard speech therapy for 4 or 6 month were performed Ravenʼs picture colored matrices (RCPM) and aphasia tests before and after intervention. They were classified into four groups according to their RCPM score. The effect size of each group was more than 0.3 which meant moderate effect, this result supported previous studies that intelligence was not influence to recovery from aphasia. In addition, this research showed the limitation of recovery for the groups of low score of RCPM. The second, we analyzed the effect of two kinds of speech interventions; Promoting aphasics communication Strategies and group therapy for the individuals with decline of intelligence and dementia. The effect size of slight decline of intelligence was 0.5 which meant big effect. Those of moderate and severe decline of intelligence didnʼt showed any effect, however they revealed significant improvement of basic communication such as attention for others and motivation to activities. The evidences of these interventions may vulnerable, however they implicit that the value of our clinical ingenuity of speech therapy for the individuals with decline of intelligence and dementia.
Workshop II : IT (Information Technology) for neuropsychology
We entered 21st century with emergence of internet, and following internet-premised mobile devices e.g. iPhone, wearbles and sensors, which utilize the the gigantic computing power called “cloud.” The availability of these technology and resources, we have changed our interaction with information. This is the story of our continuous change of our mind, through such time.
The current article reports usefulness of a new mass screening application for dementia, which is dubbed the Cognitive Assessment for Dementia, iPad version (CADi) . We administered the CADi at health checkups in 10 districts in 4 rural municipalities of Shimane prefecture, and 2,435 community-dwelling people were tested. Several iPads were operated in parallel during the checkups, and we could test 74 persons per day in average. We set the criteria for a further examination with the CADi score <= 5 or total reaction time > = 300 sec. Of the subjects (n = 91) judged as further examination required, 20 (22％) and 38 (42％) people were classified to “need treatment” and “need follow-up”, respectively. These results suggeste that the CADi have enough applicability to mass screening of dementia, but needs accuracy improvement.
Our cognitive functions decline with age. Cognitive declines in the elderly may make it more difficult to do daily living and social behaviors. Consequently, many researchers are interested in developing methods to maintain and improve cognitive functions in the elderly. In this paper, we introduce simplified cognitive training such as reading aloud and simple calculation training (learning therapy) and training using brain training games. Our studies using a randomized controlled trial have reported that cognitive training can improve executive functions and processing speed in the healthy elderly. These results suggest that cognitive functions in the healthy elderly would be improved by cognitive training. We discuss future directions in a field of cognitivetraining using brain training game.
Numerous applications (apps) have been developed since the initial market launch of the iPad in 2010. The author, employing the iPad, has endeavored to develop various clinical applications in the field of study encompassing higher brain dysfunction. In the present manuscript, the author has introduced a variety of uses for the iPad based on the extensive clinical and research experience. 1. When explaining disease conditions, the iPad enables us to talk while looking at the other personʼs face. 2. The iPad enables us to watch videos at the bedside by using it as a medium for both saving and storing various videos and then displaying them on a mobile video monitor. 3. The iPad enables us to manipulate the database by using the FileMaker Go 13 as a database app. 4. Introduction of other uses. The iPad can be used as a talking aid, a screening and training instrument for aphasia, an instructional instrument for dysphagia, an angle measuring instrument, and as aninstru ment for assessing hemispatial neglect. 5. The author has presented herein ways of searching for apps via the iTunes Store and Yahoo! JAPAN.
In order to clarify factors which have influences on aphasic patientsʼ auditory sentence understanding, we analyzed the article manipulation items (subtest 3) of the Standard Language Test of Aphasia (SLTA), an auditory sentence understanding examination that is especially difficult for aphasic patients. As a result of various tests on ten aphasic patients able to understand all the content words included in subtest 3 and ten healthy subjects as a control group, the following three points were clarified. 1) Auditory pointing span, which is normally regarded as important, does not correlate with the subtest 3 results. 2) The capability to process content words with regular speed correctly and continuously (we called it “performance of continuous word comprehension”) correlated closely with the subtest 3 results. 3) Ability to understand particles is almost not needed in subtest 3, except for the instrumental case. These results suggested that training in performance of continuous word comprehension may be able to improve auditory sentence understanding.
The present study reports a case of acalculia. The patient was a 72-year-old right-handed female. She had an old left angular gyrus infarction and a fresh infarction in the right postcentral gyrus and right superior parietal lobule. She initially presented the Gerstmann syndrome, but symptoms except constructional agraphia and acalculia disappeared early. Calculation process recovered by one month after the infarction and reproduction of arithmetical fact recovered by four months; however, disorder of zero positioning as a syntactic error in transcoding still remained twenty-two months later. We examined the conditions of this acalculia and the process of retrieval from the standpoint of the subsystems of working memory: phonological loop and visuo-spatial sketch pad. Our analysis suggested that acalculia in this case consists of degradation of the phonological loop and visuo-spatial sketch pad, the former being transient and due to diaschisis of the right postcentral gyrus and old left angular gyrus, and the latter due to a lesion of the right postcentral gyrus and right superior parietal lobule which causes disorders in forming and manipulating the mental images. Therefore, we postulate that acalculia is associated with subsystems of the right and left hemispheres of working memory.
We reported the case of a 83-years-old ambidextrous woman with somatoparaphrania, unilateral neglect, and anosognosia, which are examined usually due to the damage of non-dominant hemisphere, after left thalamic hemorrhage. Interestingly, she had supernumerary phantom limb which is rarely reported after a stroke. Her consciousness was clear, however there were severe hemiparesis and sensory loss in her right extremities. Her general cognition was nearly normal nonetheless very mild aphasia. In MRI, there was not any lesion except for left thalamus and internal capsula. The supernumerary phantom limb and somatopara phrania disappeared in about two months after the onset. On the other hand, anosognosia was remaining in six months after the onset. As the mechanism of these symptoms, the change of the lateralization of brain function, which was suggested from the background of the ambidexter. In other word, most of the right hemisphere function and a part of verbal function may be located at left hemisphere in this case. Single photon emission CT (SPECT) showed the wide range of hypoperfusion on the left cerebral hemisphere even though hemorrhage was localized to the thalamus. These hypoperfusion tended to improve three month after onset with the improvement of most of symptoms such as hemispatial neglect and somatopara phrenia. From this point, diaschisis after localized thalamic hemorrhage, which were caused by the discon nection of fibers that project to the temporal lobe and parietal lobe from the thalamus may have influence the decline of the cortical function.