wo theoretical frameworks could be postulated in organizing memory rehabilitation ; one in the process of goal formation and the other in the process of realizing actual interventions. In planning goals of rehabilitation for memory impaired individuals, therapists should focus on the patients' daily problems (disabilities) rather than on their impairments. Considering severity and characteristics of each patient's memory problems in everyday life, therapists should integrate various techniques including direct trainings, mnemonics and external memory aids to optimize patient's abilities. The other framework is valid throughout the process of goal-oriented rehabilitation interventions. Therapists should bear in mind that errorless learning techniques have been shown to be particularly effective for training amnesic subjects, which is quite different from try-and-error type learning in normal individuals. Prevention of errors during acquisition of information leads to better memory than does learning under errorful conditions. However, active participation of the patients is also another important factor. An advantage of a new version of errorless learning was demonstrated, which encourages patient's active participation. Twelve amnesic patients showed significantly better memory performance via the use of fragment-type perceptual identification than seen under standard errorless conditions. This finding highlights the value of encouraging patient's cognitive efforts to optimize their new learning.

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   As is indicated by the title, two different themes are discussed. Firstly, we speculate that amelioration of chronic aphasia is mostly due to functional re-organization or formation of neural bypass, based on our past experimental therapeutic interventions. We also discussed the drawing capacity of severe aphasics whose right hemisphere was considered disinhibited by the damaged language-dominant left hemisphere. This theory is a reverse analogy of left unilateral spatial neglect which is interpreted as a positive symptom of the left hemisphere. Based on these data and interpretations, our views of therapeutic interventions are presented.
   The largest factor interfering with aphasics' social participation is aphasia itself. However, if aphasics consider it their social mission to disseminate the knowledge about aphasia and aphasics, they may contribute effectively to social welfare. I reported two examples : One is a severely aphasic man who drove alone around the eastern half of Japan for 40 days, and the other is a dialogue between aphasics and students studying to become speech and audiology therapists.

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   Recovery in apraxic and agnosic behavior will be accomplished by facilitating or reorganizing the route to the semantic memory of the objects. I applied the cognitive neuropsychological models to analyze the disabled processes. Problems in real life among apraxic and agnosic patients were surveyed, and I observed much problems and adaptive behavior. Educating coping strategies and supplying environmental supports were evaluated as effective to the disabilities in real life.

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   The term “rehabilitation” refers not training to restore functions, but refers to a process aimed at enabling persons with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychiatric and/or social functional levels. It includes any measures to compensate for the lost functions. Dementia is not attributable to a simple aging process, but is an acquired, persistent impairment of a broad range of once developed intellectual function produced by organic brain diseases. Each organic brain disease has specific symptomatology, pathophysiology, and prognosis, so that accurate diagnosis of the underlying illness is particularly important for any therapeutic intervention including rehabilitation.
   It is almost impossible to restore cognitive functions in patients with degenerative dementing illnesses such as Alzheimer's disease. Although studies approaching the feasibility of cognitive training in patients with Alzheimer's disease are limited, cognitive training cannot be justified as a principal technique in the rehabilitation due to the low efficiency and high effort. In order to overcome the functional limitation of patients with dementia, a caregiver education program would be the most indicated. As patients themselves are supposed to have a lack of insight and/or severe memory impairment, they cannot be the main targets for the educational intervention. In the program, the caregivers should be informed about the diagnosis of the causative disease, the skills necessary to cope with behavioral problems and to maintain the activities of daily living, and social support services. The caregiver burden, which is reportedly a significant predictor for the poor outcome of patients with Alzheimer's disease, can be used as an index of the success of the caregiver education program.

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[in Japanese]

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   Higher brain function associated with language was studied in the patients treated by neurosurgery. In arteriovenous malformations (AVMs), handedness and dominancy of language and memory are tend to shift to the contralateral side, suggesting that genetic change is associated with decision of laterality in these function. In resection for epileptogenic area or brain tumor within dominant temporal lobe, basal temporal language area as well as lateral area should be studied by using subdural electrodes. Subtemporal approach is useful to preserve basal temporal language area.

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   Neuropsychological studies of 8 neuro-Behçet disease patients revealed memory impairment of various degree as a common abnormality in all cases. As the characteristics of the memory disturbance, delayed recall in both verbal and visual modalities are affected. Four out of these 8 cases also showed executive dysfunctions of frontal type. Personality change was noted only in one patient.
   Although SPECT of the brain revealed extensive areas of hypofunction corresponding well to the neuropsychological disturbances, brain MRI showed much smaller areas of structural damage than expected from the clinical findings.
   It was implied from our findings that the neuropsychological abnormalities seen in the neuro-Behçet disease were caused not only by the lesions in thalamus, basal ganglia and brain stem but also by the dysfunction of frontal and temporal cortex.

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   In order to understand the particular effect of word familiarity and orthographic validity on reading disorder, we undertook a case study of a 52-year-old, right-handed male patient with phonological dyslexia.
   The patient (A. K.) had undergone a clipping for treatment of SAH in March of 1999. Afterwards, he developed an aphasia and right hemiplegia because of succeeding cerebral infarction. After having taken language training at two medical institutions, he visited the outpatient clinic of Chigasaki Chuo Hospital in December of the same year. Brain CT scan disclosed a low density area in the frontal lobe, caudate nucleus, anterior limb of the internal capsule and a parietal lobe on the left side. He could read aloud single kana characters quite well. However, his ability to read aloud kana spelling which had no meaning was markedly impaired.
   To determine the mechanism of this phenomena, we carried out with the patient two kinds of tests to read aloud real words written in kana characters by changing the orthography. We found that the patient could satisfactorily read aloud the words which had high “word familiarity”and high “orthographic validity” (namely, the words which had high familiarity of “visual word form”) . On the other hand, when the patient was asked to read words of low orthographic validity, he tried to use a strategy of letter-by-letter reading by which he converted kana words to phonemes one by one. During this test, however, the patient frequently substituted the word for another one which could be correctly associated with the phoneme converted by him.
   From these results, it was revealed that “the processing of reading aloud kana words”in this patient was antedated by the discrimination of the familiarity of “visual word form in character strings”. In addition, the words which had higher familiarity and higher orthographic validity passed successfully through the “route of word form processing”presented by Warrington et al (1980) , while those of lower familiarity passed through the route of “letter-by-letter reading.”We concluded that in this patient the “letter-by-letter reading route”was selectively impaired.

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