One of the main factors that determine functional outcome in patients with aphasia is sites and extension of lesions. To clarify the effect of resection of tumor close to a “language area”, we performed intraoperative functional mapping in patients with gliomas using electrostimulation and examined the long-term outcome of language functions after surgery. Each patient had very restricted language areas where electrostimulation induced language impairment. Resection of gliomas with individually determined language areas being spared resulted in no gross language dysfunction, even when classical “Broca's area” was resected. But, resection of the inferior part of the precentral gyrus caused mild but persistent anarthria. Thus language functions could be preserved as far as language areas in each subject were spared, although some critical nodes could not be resected without minor impairments.

View full abstract

   We studied the cerebral blood flow with positron emission tomography (PET) in poststroke aphasics to elucidate the participation of the brain regions in the recovery from aphasia. Cerebral blood flow (CBF) in a resting condition were compared with the aphasia scores in 64 right-handed aphasics with left-hemisphere infarction (mean age 62 ± 11 years). The first PET examination and the assessment of aphasia were performed on 85 days in average after onset. Language function was reassessed on 318 days. The follow-up aphasia scores correlated with the mean hemispheric CBF in both side, a higher correlation was obtained in the left hemisphere. Regional CBF was correlated with the degree of recovery from aphasia predominantly over the left hemisphere. The left and the right cortices were associated with the recovery in patients with good recovery, whereas less significant relationship was observed in patients with poor recovery. The aphasia score evaluated within 90 days after onset closely correlated with the left cortical CBF, whereas that evaluated between 90 and 180 days correlated more closely with the right cortical CBF. Patients younger than 55 years showed close correlations between aphasia scores and mean CBF in both hemispheres, in contrast, no correlation was obtained in patients older than 70 years. The aphasia scores correlated with the CBF over the left hemisphere in male aphasics, whereas those correlated with the CBF in both hemispheres in female. The results show that time interval after onset, age and sex may influence long-term outcome of aphasia. It is concluded that the recovery of language function seen in aphasics was significantly related to the severity of the initial neurological deficit. It suggested that early recovery after stroke may be related to the dominant hemisphere. Non-dominant hemisphere may play a compensatory role in subsequent and the long-term recovery from aphasia.

View full abstract

   The relationship of recovery and treatments of aphasia was discussed from the standpoint of a speech therapist. The experience of speech therapy for a severe fluent aphasic patient in his stages of recovery after brain damage was reported. Also, the effectiveness and problems of the cognitive neuropsychological approach for lexical deficits in aphasia were discussed. The subject was suffering from severe word-sound deafness, and his speech discrimination remained poor after direct treatment. However, auditory word-to-picture matching, auditory lexical decision and word repetition improved. It suggested that treatments that strengthen the top-down control from semantics of words could improve auditory comprehension to some extent. In speech production, the activation of word-form was extremely difficult and was not improved by the treatments that facilitate the normal route for word retrieval. The patient's oral word reading in both Kanji and Kana improved. So we carried out treatments including compensatory reorganization of word retrieval and measured the therapy efficacy in single-subject design. It revealed that oral reading after written naming in Kana was effective as a substitutive strategy for oral picture naming. In the stages of recovery after brain damage, treatments, which maximally exploit and facilitate natural recovery of nerve systems, seem to be effective. Therefore, an inclusive approach that activates the whole verbal-processing system is needed as well as strategic treatments targeting certain functions. Understanding the natural processes of recovery at the neural and cognitive levels is necessary for effective speech therapy for aphasia.

View full abstract

   The Behavioural inattention test (BIT) is a standardized test battery for unilateral spatial neglect. The BIT conventional test consists of the cancellation, the copying, the line bisection, and the drawing subtests, which have long been used for clinical diagnosis of neglect. Each subtest has the cut-off score that was determined in the standardization process of the BIT, Japanese version. When patients with right-hemisphere damage show abnormal scores even in one subtest, their test performances and daily activities should be scrutinized for the presence of neglect. Chronic patients with neglect may achieve the normal score in the cancellation tests with compensatory searching strategy,which often takes longer duration. Evaluation of the time spent for the BIT cancellation subtests may improve detection of neglect in the chronic stage.The tasks adopted in the BIT conventional test have been modified and applied to the study to approach the mechanisms of neglect. The present paper reviewed some of these studies and discussed on the attentional mechanism of neglect in relation to the perceptual and motor interaction.

View full abstract

[in Japanese]

View full abstract

   ICF (International Classification of Functioning, Disability and Health) was approved by World Health Assembly in 2001 as the revision of ICIDH (International Classification of Impairments, Disabilities, and Handicaps, 1980). Its purpose is firstly to provide a frame of reference to understand a person's life comprehensively, and secondly to be utilized as the ‘common language’ internationally and inter-disciplinarily, and also between professionals and people with disabilities. ICF has the advantage that it focuses onto the positive aspects (functioning) of the people with disabilities rather than their negative aspects (disability) and looks upon them both in three different levels (body functions/structure, activity and participation ; and impairment, activity limitation and participation restriction). This article deals with the introduction of the ICF model to the present National Health Insurance and National Long Term Care Insurance ; the characteristics of ICF ; the construction of its classifications ; coding process ; and finally its application to the clinical practice of higher nervous activity dysfunctions.

View full abstract

   We report a case of herpes encephalitis with right dominant temporal damage and bilateral ventromedial prefrontal damage, who after the acute phase developed a unique misidentification to person. Persons with strong emotional valence were misidentified as significant others, as in the case of his wife taken as his mother. On the other hand, persons with little emotional valence, as in hospital staff, were reduplicated, for example stating that he was seeing another doctor quite identical but perhaps a bit older than the one attending him presently. In recent face recognition models, it has been shown that two separate routes— the classical route for overt recognition, and a secondary route for covert recognition— are needed to explain manifestations such as prosopagnosia with intact SCR face discrimination, and Capgras delusion with impaired SCR face discrimination. To apply this model to the misidentification symptoms of this case, we have tailored a misidentification triggering test using photographs of his wife and hospital staff. The results showed that for photographs of his wife, multiple misidentifications as significant others were seen under conditions where the covert route is the dominant input, but only minimal reduplication when the overt route was the dominant input. For photographs of hospital staff, both reduplication and misidentification as significant others were minimally seen under both conditions. We propose this symptom as impaired integration of the two routes ; when encountered by a familiar person, the autonomic route for covert recognition becomes the dominant input route, whereby he can recognize the emotional valence of the person but cannot integrate it with the configurational processes of the overt route, resulting in misidentification as significant others, while upon encountering a person without strong emotional valence, the overt recognition becomes dominant, assuring intact configurational identification, but failing to integrate it with emotional recognition results in reduplication.

View full abstract

   Patients with landmark agnosia, a subtype of topographical disorientation,are specifically unable to recognize salient features of their environment, such as buildings and landscapes. Previous case reports suggested that these patients do not have perfectly intact visual perception, but there have been few detailed studies of the perceptual abilities of such patients. To investigate the mechanism underlying landmark agnosia, we examined the perceptual ability of FS, a 78-year-old female patient. Since suffering a cerebrovascular accident, the patient has exhibited landmark agnosic symptoms only in novel environments. Several subtests of the Visual Perception Test for Agnosia (VPTA) demonstrated preserved fundamental visual function and normal recognition for simply presented objects. However, FS also manifested marked deficits of visual perception in a series of tests that required large amounts of holistic processing. The patient could not integrate elements of stimuli and could not perceive their global configuration in complex visual conditions. When we construct largescale topographical representations, it is important to integrate partial information input successively as a whole. Therefore, FS's severe deficits of visual integration and configural processing demonstrated in holistic perception tests might be influencing the construction of representations of buildings and landscapes and, as a result, might be inducing to landmark agnosia.

View full abstract

   We report a 57-year-old right-handed male in whom developmental stuttering had almost been cured previously who suffered a recurrence after callosal infarction. The patient's stuttering was much more severe than he had ever experienced. Investigation of his speech revealed the following results. 1 ) The main feature of his stuttering was repetition of sounds and syllables ; preparation (hesitation or preparatory movement of the articulatory organs before starting to speak) and breaks (inappropriate pauses within a word or a phrase) were also observed. 2 ) His stuttering was associated with secondary phenomena such as tongue clicking and facial grimacing. 3 ) His stuttering demonstrated no adaptation benefit and no benefits from repetition or choral reading ; it also exhibited

View full abstract