Despite their importance in clinical practice, cliniciansʼ communication skills, both verbal and non-verbal, continue to decline, with predictable consequences for the quality of clinician-patient communication. Even more than half a century since Tsunero Imura (1962) outlined the critical significance of non-verbal empa thy, the non-verbal aspects of communication seem to be failing to attract due attention. This article attempts, first, to roughly locate various communication-related verbal and non-verbal phe nomena in a continuous spectrum, secondly, to summarise notable research findings on the non-verbal as pects inherent in language per se, and, thirdly, to introduce the ʻhypersonic effectsʼ identified by Oohashi, Nishina et al. (2003, 2013) , which relate to the physiological changes caused by the normally inaudible high-frequency sound components perceived through the body surface that induce brain responses. A new neuropsychological understanding of emotions (Yamadori 2002, 2008, 2011) is discussed with reference to the non-verbal aspects of emotions and their clinical implications. It is then suggested that, in order to overcome the mounting emotional difficulties encountered in clinical practice (Takei 2006) and better serve patients, multifaceted and intricate endeavours to refine both verbal and non-verbal communication remain a sine qua non for all clinicians alike.
Forensic neuropsychology bridges neuroscience and law. One should bear in mind that neuropsycho logical evaluations conducted in a legal context often involve different issues that are never taken into con sideration in medical practice. On the other hand, lawyers too often misunderstand neuroscientific findings: Accepting monolithic brain explanation of complex behavior (Brain overclaim syndrome and Christmas tree effect) and hierarchical mind in brain (Mind-mind dualism) are two such examples. Foren sic neuropsychologist should have sufficient professional knowledge to understand the relevant legal mat ters and conduct an evaluation that addresses the specific legal issues. Moreover, they have an ethical obli gation to adhere to the principle of honesty and to strive for objectivity in conducting evaluations.
Symposium III : Frontotemporal lobar degeneration and confusable neuropsychiatric conditions
Semantic dementia (SD) is a clinical subtype of the frontotemporal lobar degeneration (FTLD) . The most salient symptom of the SD patients with the left temporal dominant atrophy is Gogi (word meaning) -aphasia. Clinical pictures of Gogi-aphasia due to SD are as follows;clearly confirmed by the re sponses resulting a loss of lexical meanings in both confrontation naming and picture-word matching tasks. Itʼs also confirmed by the reading performances with the pattern of surface dyslexia. The core of these symptoms is a loss of known feelings of unfamiliar or atypical representations of objects. Resemble pattern of impairments in the knowledge of words or object were rarely but surely observed in the patients with atypical language subtypes of Alzheimerʼs disease (AD) associated with the left anterior temporal lobe atro phy. In this study, we demonstrated two late-onset and high educational background patients who devel oped Gogi-aphasia. They shared several common features as Gogi-aphasia in neuropsychological tests for words or object meanings. The differences between two, however, could be revealed under a careful ex amination. We found two major differences. At first, the consistency of impaired items between two tasks of naming and word to picture matching were more robust in case 2, while those of case 1 were more fluctu ated. Secondly, there also could be found differences in the attitudes of patients in case of confrontation with unfamiliar objects. Case 1 accounted unfamiliar object for unusual usage because he could not sure of its category. It may call loss of abstract or categorical attitudes representative for amnesic anomia. While case 2 at similar situation said only ʻI donʼt knowʼ. We clinically concluded respectively as follows: language symptoms of case1 was identified as amnesic anomia due to AD with temporal lobe atrophy, and those of case 2 were regarded as Gogi-aphasia of semantic dementia. We supposed that the comorbidity and distri bution of the TDP-43 protein abnormality in AD may cause such SD-resembling language symptoms among AD patients.
Frontotemporal dementia (FTD) is a neurodegenerative disorders, which is genetically, pathologically, and clinically heterogeneous. FTD is considered to be related to MAPT, GRN, C9orf72 gene mutation, and Tau, TDP-43, FUS histopathology. This heterogeneity makes it difficult to develop disease specific bio marker, such as Aβ protein of Alzheimerʼs disease. Cortical atrophy according to brain imaging is also heterogeneous, and executive dysfunction according to cognitive testing is not disease specific. Thus, as sessing neurobehavioral symptoms such as disinhibition, apathy, lack of empathy, stereotypic behavior, and eating abnormalities, which is described in the recent consensus criteria, is most important in the diagnos tic procedure. FTD can be misdiagnosed as other neurodegenerative disease and psychiatric disease, and we have to be careful for both over-and under-diagnosis of FTD.
Clinical characteristics of frontotemporal lobar atrophy, specifically behavioral variant frontotemporal dementia (bvFTD) , include various personality changes, repetitive and stereotypic behaviors, emotional abnormalities and psychiatric symptoms. It is needless to say that we should appropriately diagnose bvFTD from other primary dementias and organic diseases of other etiologies. However, from the resembrance of clinical features, it is often very difficult to differentiate bvFTD from variable psychiatric disorders. It has been well recognized that depression occasionally mimicks bvFTD in the sense of lack of spontaneity and loss of vividness. Specifically, ʻlate catatoniaʼ should be carefully ruled out from bvFTD, which initially begins in the presenile/senile age with depressive/apathetic state, subsequently emerged catatonic excitement and/or stupor, and progressed into severe negativism and stereotypic behaviors. In addition, manic state of bipolar disorders, schizophrenia, and obsessive-compulsive disorder may resemble some clinical aspects of bvFTD. Recently, developmental disorders including Aspergerʼs syndrome attracts attention to have similarities with bvFTD. Individuals whose developmental problems emerged in the presenile/senile age may be misdiagnosed as having bvFTD. However, it is also plausible that developmental disorder has some genetic/biological similarities with bfFTD.
Some diseases remain difficult to treat and easily become chronic, and these are the kind of diseases that are now referred to as intractable (http://www.nanbyou.or.jp/entry/1360) . According to the definition set out in the Principles of policy for intractable diseases published in 1972, “nanbyo” refers to: (1) diseases that have resulted from an unidentifiable cause and, without a clearly established treatment, have a considerably high risk of disability, and (2) diseases that chronically develop and require a significant amount of labor for the patientʼs care, causing a heavy burden on other family members of the patient, both financially and mentally. With increasing the number of diseases and patients, the new low for caring intractable diseases was in force on January 1 in 2015. The treatment of 306 of these diseases is now subsidized from public expense. Behavioral variant frontotemporal dementia (bvFTD) and semantic dementia were included in these intractable diseases. Distinctive unusual behaviors and activity of a younger person are serious obstacles to managing and caring for patients with FTLD. The subsidies for medical care might be very helpful for young-onset patients and their carers. Due to the lack of information and statistics about the cases of these rare and intractable diseases, a nationwide study on has been needed.
Symposium IV : Rehabilitation related to electronic devices
Recently, the progress of everyday technology (ET) like home electronics is noticeable, that have multifunctional, high functionally and convenient value. On the other hand, there are less benefits for the patients with cognitive impairments due to the distance pace of progress of ET. They are confused of how to use these ET, therefore it increases the care burden of caregivers. We have visited the elderly people and the clients with higher brain dysfunctions /dementia at their own home, and researched the usage conditions of ET by using Everyday Technology Use Questionnaire (ETUQ) that was developed by Rosenberg and Nygård. We have found that even normal elderly have trouble with new ET, and there were two reasons of discontinuing using these ET;one of them is the change of their lifestyles and the other one is the decrease of their cognitive functions. The people with dementia are unable to the procedure of using ET and a lot of them were using the old ET. Furthermore we have researched usage of ET of the case of Gersmannʼs syndrome for over 4 years by ETUQ. She still has difficulties with the ET which are necessary to understand the meaning of the numbers or letters for operating. Through our survey to the patients with cognitive impairments, we had introduced Assistive technology such as;easy-to-use TV remote control, loitering prevention sensor and memory aid application.
The opportunity of using a personal computer is increasing in everyday life and, accordingly, the impact of typing disorder on our social activities is becoming a serious issue. To investigate the neural substrate of typewriting and to detect the crucial lesions for typewriting disorder, we have intensively examined a case with isolated typing impairment, and conducted a functional magnetic resonance imaging (fMRI) study in healthy volunteers.〈Case〉A 78-year-old right-handed man, who suffered from stroke, showed isolated typewriting disorder without aphasia, apraxia, hemispatial neglect, or sensory-motor deficit. The history of present illness, the MRI findings, and the detailed neuropsychological examinations suggested that the typing impairment was attributable to disturbances of the phoneme-grapheme conversion and the graphemic buffer resulted from the left posterior part of the left superior/middle frontal lesion.〈fMRI study〉To investigate the neural substrate of typewriting, we conducted a fMRI study in 16 healthy skillful touch typists. As a result, two brain regions were activated during both the typing and the writing tasks: the left superior parietal lobule ranging to the left supramarginal gyrus, and the left premotor cortex. Furthermore, direct comparison between the typing and the writing task revealed greater activation of left posteromedial intraparietal cortex in the typing task.
It is suggested that typewriting is a complex cognitive process that involves multiple brain regions including the writing centers and the left posteromedial intraparietal cortex. Accordingly, it is supposed that the different brain lesions might cause different types of typing disorders. Further study is needed to establish the symptomatology and the training methods for typewriting disorders.
Individuals with cognitive impairment have difficulties operating electronic devices due to a wide variety of functions in those devices. The operation of electronic devices requires interaction among several cogni tive domains, that is, linguistic, praxis, memory, visual/visuospatial, and executive functions. In this article, we focus on visuospatial function and studied on ability to operate electronic devices among persons with Bálint syndrome. Our study found that those with Bálint syndrome had difficulties in inputting a digit se quence on electronic devices. In particular, those with mild Bálint syndrome have poor performance as the number of digit sequence increased, i.e., more than five digits. Persons with mild Bálint syndrome also re vealed difficulties using automated teller machines in a bank, which also required input of digit sequences. These findings indicate that visuospatial function might play a crucial role in operating electronic devices. We also discuss specific methods to operate electronic devices for those with visuospatial deficits.
To make higher brain dysfunction patients return to their daily life or work, we need a supporting system which can navigate them according to a level of cognitive disability. It is required to recognize / understand their behaviors and environment and evaluate their cognitive ability to adapt to actual daily life and work. This paper introduces a case study of a prototype system which can navigate them cooperatively using a wearable camera. In addition, it is needed to improve their anosodiaphoria and promote their awareness and willingness for cognitive rehabilitation which can make their cognitive ability and adaptability better. We have had a reha bilitation which improves their awareness and willingness by a reflection support system. It shows experi ence video / supervised video, task achievement rate, and cognitive function evaluation index to the pa tients. This paper reports some case studies based on the current reflection support system.
Workshop II : A new strategy for rehabilitation in the sense of agency paradigm : from motor impairments to cognitive dysfunctions
In neuropsychological disorders, self-consciousness could be deteriorated in terms of insight, autobio graphical memory, body perception, body-schema and voluntary actions. However, it is hard to study “self-consciousness” in neuropsychology, because self-consciousness represents subjective experiences and can be described only from a first-person perspective of patients. Here, we introduced sense of owner ship and agency paradigm in order to investigate self-disturbances in schizophrenia. Sense of ownership and agency paradigm would be a promising approach for dealing with self-consciousness in line with neu roscience.
It is well known that patients with chronic hemiplegia following brain damage often face difficulties in improving motor function, owing to maladaptive changes to cortical representation of the affected limbs. However, frequent training of paretic limbs enlarges their cortical representation by use-dependent plastic ity. Nevertheless, these processes interact to produce a downward learning, providing negative feedback from paretic limbs, which results in further 'learned nonuse'. This sensory disturbance leads to a gradual alteration of the representation of the body in the brain;consequently, there is a failure to generate efficient motor output. This review describes several kinds of treatment to break this negative loop and to overcome this learned nonuse phenomenon underlying a number of disorders of body representation related to sensory and motor impairment using non-invasive techniques, boosting their multisensory capabilities, weakened by brain damage. We also introduce the effects of illusory ownership, the conscious experience of altered internal body representation induced by patterns of multisensory stimulation, on imitative movement performed by participants from a first-person perspective just after experiencing the crossmodal illusion as an example of therapeutic applications. These clinical applications illustrate the potential of neurorehabilitation for restor ing the maladaptive alterations of body representation corresponding to decreased frequency of usage caused by damage of peripheral or central nervous system.
A Japanese girl aged 11 years and 5 months complained difficulty in learning Kanji. There were no obvious reasons to prevent her from acquiring oral and written language such as an intellectual disorder or sensory disabilities. Neuropsychological examinations revealed her delay in reading aloud, and difficulty in writing Kanji. She also showed difficulty in discourse when trying to describe a picture. We developed and conducted a Japanese sentence syntax test to investigate her syntax proficiency. The test consisted of pages, each containing a sentence and two pictures with two characters (Triangle and Circle) . The sentence described what the characters are doing (e.g. Triangle is hit by the ball that Circle threw) without the case particles. Task requirement was to fill in case particles to complete the sentence correctly. Her performance was compared with that of chronological age-matched children (CA group) and that of vocabulary age-matched children (VA group) . Results revealed that the girl had difficulty in using case particles while the CA and VA groups did not. She had no difficulty in using case particles when the sentence was composed in basic order (SOV) ;however, she failed to use the case particles correctly when the sentence was composed in scrambled order (OSV) and the agent was not obvious (causative or passive form) . She applied case particles in basic order in Japanese “ga”-“ni”-“wo”, when it had to be changed to “ni”-“ga”-“wo” to be grammatically correct. We assumed that she had not only developmental dyslexia but also specific language impairment in Japanese syntax. We emphasize the importance of checking the oral language disability behind learning disorder, and suggest the new test for proficiency of Japanese syntax.
Williams syndrome (WS) is a neurodevelopmental disorder caused by a hemizygous deletion in chromo some 7. Individuals with WS generally show a socio-cognitive trait known as “hypersociability”, and are relatively preserved in perceiving facial stimuli. However, little is known about long-term memory for faces and its disturbance in WS. In the present study, we investigated short-term memories (STM) and long-term memories (LTM) for faces in a case with WS. In the STM tasks for faces, a case of WS showed higher scores than participants with intellectual disabilities
Impaired social cognition after brain injury is regarded as a contributor to poor social participation and vocational outcomes of brain-injured individuals. The present research aimed to investigate whether social perception deficits experienced in chronic brain-injured participants can be successfully remediated through group treatment using “Social Cognition and Interaction Training: SCIT.” Also, we attempted social skills training including role-play and video feedback on the same participants. The subjects consisted of three patients with traumatic brain injury and one with subarachnoid hemorrhage. The measures of facial expression and KiSS18 were used as the main outcome measurements. These measures were conducted before and after the group treatments. Results indicated that participants improved in judging facial expressions and evaluating their interpersonal skills. These results give us an insight into optimal rehabilitation dealing with social cognition deficits in chronic brain-injured individuals.