This paper describes rehabilitation for traumatic brain injury, drawing upon the infrastructure provided by a state-wide, coordinated network of clinical services in New South Wales, Australia. The first part of the paper provides a contextual background of traumatic brain injury covering the incidence, neuropathology, characteristic patterns of impairment and the recovery process. The second part describes the clinical services, with a particular emphasis placed on the community rehabilitation approach used at the Liverpool Hospital service. Specific therapy programs for neuropsychological and social impairments are described, along with the PsycBITE^TM resource (the Psychological database of Brain Impairment Treatment Efficacy), available at http://www. psycbite. com. PsycBITE^TM is an interactive database of all the published reports of nonpharmacological treatments for the psychological consequences of acquired brain impairment. The availability of PsycBITE^TM facilitates the identification of evidence-based interventions.

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[in Japanese]

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   To avoid postoperative unexpected neurological disorders in brain tumor surgery, we have developed tumor resection under awake condition. Intraoperative electrical stimulation of speech and parietal association areas was performed in 19 patients with brain tumors. Stimulation of speech areas such as Broca and Wernicke areas induced speech arrest. Electrical stimulation of the areas adjacent to speech centers resulted in perseveration of speech. Intraoperative stimulation of the parietal lobe such as supramarginal and angular cortices induced constructional apraxia and ideomotor apraxia. Tumor resection with the electrical stimulation of the cortical areas under awake condition can contribute to safe and accurate surgery for brain tumor.

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   We investigated neuropsychological function of frontal lobe and basal ganglia. Regarding frontal lobe, we concluded as followings : central executive function is related to the middle frontal gyrus, and the common role of the frontal lobe is temporal arrangement of information such as phonology. Regarding basal ganglia, we showed the result of fMRI evidencing the relation of the caudate head with procedural memory function. The characteristics of mirror writing indicated that basal ganglia has a stabilizer function as executing movement according to the information of right-left free.

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   Using cortical electrical stimulation, we investigated localization of language functions in patients with intractable epilepsy. Essential areas for various language functions were quite localized, but with considerable individual variation. Both anterior and posterior language areas were related to speech production and perception of language.
   The presence of a basal temporal language area is indicated by cortical electrical stimulation, but aphasia is not elicited by lesions in this area. We examined the basal temporal language area by cortical stimulation and event-related potentials using subdural electrodes. Aphasic symptoms in a patient occurred during stimulation of the basal temporal area, which were always associated with intrastimulus remote discharges in the posterior language area. This finding suggested a close functional relationship between the basal temporal area and posterior language area. Electrocorticograms from the bilateral basal temporal cortices were recorded during lexical-decision and picture-naming tasks. Task-related high γ-Band activity was observed bilaterally during the naming task. In contrast, there was left dominance in the lexical-decision task. Distribution of high γ-Band activity was varied depending on the language task used.
   Detailed mapping of language functions by cortical electrical stimulation and electrocorticograms is mandatory to explore the network for language in individual subjects and to prevent postoperative language deficits.

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   We reported recent neuroimaging studies on conduction aphasia, unilateral spatial neglect and dressing disability generally following parietal lobe lesions. In patients with conduction aphasia, X-ray CT and/or MRI finding revealed left parietal lesion, commonly involving left supramarginal gyrus, whereas PET and/or SPECT results exhibited more extensive hypoperfusion in left perisylvian regions and its surrounding left frontal, parietal, and temporal regions. The findings suggest that lesions involving not only left parietal but left frontal and temporal regions can induce conduction aphasia. The right hemisphere is predominantly involved in spatial attention. Patients with unilateral spatial neglect following unilateral hemisphere stroke were tested with behavioural inattention test, and were studied with SPECT to examine cerebral blood flow. The severity of left unilateral neglect correlated with hypoperfusion in the right superior temporal lobe, right precuneus, and right superior occipital gyrus. Right unilateral spatial neglect with left-hemisphere lesions has a strong relationship with hypoperfusion in extensive left hemisiphere regions and in right parietal regions. We speculate that right parietal lobe may be important for emergence of right and left unilateral spatial neglect. Dressing was disrupted by cognitive deficits subsequent to parietal lobe damage. SPECT studies disclosed that dressing disability after left-hemisphere stroke was closely associated with right medial frontal hypoperfusion. Recovery in dressing performance was related to increase of cerebral blood flow in bilateral frontal and occipital regions and in right temporal-parietal regions in patients with left-hemisphere lesions. For those with right-hemisphere lesios, increase of cerebral blood flow was seen in bilateral frontal and parietal regions and in the left occipital regions. The results suggest that both cerebral hemispheres may play a role in recovery from dressing disability.

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   The cerebellum has traditionally been viewed as a structure that contributes primarily to motor coordination and control. However, beginning in the mid-1980s, anatomical, behavioral, and neuropsychological evidence began to suggest that the role of the cerebellum extends beyond a purely motor domain. Especially, electrophysiological and neuroimaging studies indicate that the cerebellum contributes to higher cognitive functions such as attention, memory, visuospatial cognition, planning and language. Clinically, several cognitive or psychiatric disorders, for example autism and attention-deficit hyperactivi ty disorder, have been reported to show neuropathological changes in the cerebellum, mainly volume reduction. In addition, there have been some reports about cognitive dysfunction caused by cerebellar lesions after stroke.
   The converging evidence has prompted generation of new theories to explain the contributions of the cerebellum to such functions. The emerging hypotheses include monitoring and feedback on inner thought, coordination and control of information processing, and internal control of timing. However, the results of studies and hypotheses about relationship between cerebellum and cognitive function remain controversial, because, in previous studies, there ware some problems to establish the critical evidence. Further productive approach to understanding the contribution of cerebellum to cognitive functions will be to work toward the accumulation of well-specified studies that address the problem from diverse points of view.

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   Amnesic syndromes and semantic memory impairments are distinct pathological manifestations of episodic memory and semantic knowledge in human explicit memory systems. The amnesic syndrome could be classified into the three clinical types such as bitempotal lobe amnesia, basal forebrain amnesia, and thalamic amnesia including Korsakoff's syndrome according to the site of brain lesions. For the neuropsychological examination of amnesic patients, it is critical to confirm whether short term memory, frontal function and global intellectual function are preserved or not. To understand the semantic memory disorder, it is important to focus on category-specificity in semantic knowledge and to discriminate the semantic memory impairment itself from associative visual agnosia and lexical disorder. In the present paper, I described that a patient with bilateral medial temporal lobes damages demonstrated a pure amnesic syndrome after Herpes Simplex Virus Encephalitis(HSVE). Furthermore, I commented on a patient with left anterior temporal lobe lesions following HSVE, who showed category-specific semantic deficits for living things and man-made foods.

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   Unilateral spatial neglect (USN) is a symptom to neglect the other side stimulation of the hemispheric brain damage and it is easy to occur with right brain damage. The often shown symptoms of the USN are rotating the face and the eyes to the right, being unable to recognize the things on the left side and the discourse disorder, etc. Tests like Behavioral Inattention Test (BIT) and Catherine Bergego Scale are used for the USN.
   There are mechanisms such as theories of inattention, directionality hypokinesis and symbolic disorder, etc. Moreover, the priming of the left visual stimulation was described. The lesions of the USN are the territory of middle cerebral artery, posterior cerebral artery and anterior cerebral artery, etc.
   As for the rehabilitation, training of the attention to the left and the compensative methods are reported. The key point of the training is to think out the emotional exchange, the stimulation method, and the way to improve motivation. It is necessary to correspond appropriately in the rehabilitation team.

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   Patients with severe auditory cognitive disorders who had bilateral lesions either to the auditory cortex and /or auditory radiations were studied audiologically with brain imaging. This auditory cognitive problem is called “auditory agnosia or cortical deafness”. Our study revealed that auditory information procession for pure tones, monosyllable discrimination, environmental sound perception, and auditory comprehension is commonly but differently affected by bilateral lesions of auditory cortex or auditory radiation. In summary, these patients can discriminate loudness of pure tones and some environmental sounds but cannot clearly perceive any sounds of monosyllables and sentences. Generally their residual hearing is useful for auditory awareness. However, the localization in brain for residual hearing is no found so far.

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   The purpose of this study was to investigate the relationship between social adjustment disorder and living situation after brain injury(ordinal worker group, student/welfare worker group, at-home group). Four hundred and four families having individuals with traumatic brain injury were asked to complete a questionnaire. The results of analysis of covariance suggested that social adjustment disorder was more in evidence among the ordinal worker group and student/welfare worker group than among the at-home group, while “difficulty in mutual understanding” was more clearly in evidence among the ordinal worker group, in particular, than among the at-home group.

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