In the late 1990s, people with impairments in higher-level cognitive functions due to disorders, such as traumatic brain injury and cerebrovascular disease, and their families started to make complaints that they would not be covered by any of the supporting frameworks in Japan.
   To appropriately respond to these complaints, the Minisitry of Health, Labor and Welfare launched “a five-year-model project for supporting persons with higher brain dysfunctions” in fiscal 2001 as a 5-year plan, clearly defined impairments as organic mental disorders, and formulated operational diagnostic criteria to distinguish them from endogenous psychosis and degenerative disorders. In addition, the Ministry developed a medical training program and support program for social rehabilitation that serve as standard programs.
   In accordance with enactment of Support for the Independence of Persons with Disabilities Act, this model project was succeeded by a higher brain dysfunction support promotion project to as a general project conducted throughout Japan. Furthermore, the Ministry recommended measures to build support networks that take into account the geographical conditions and social resources by prefectures to meet varied local circumstances. The core of recommendation is the local support base organization in each prefecture and support coordinators deployed at these bases.

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   We performed rehabilitation for a female patient with apperceptive visual agnosia and impaired semantic memory after cerebral hypoxia. Three types of training were performed in series : 1) visual search and discrimination, 2) colored picture matching, 3) errorless learning of identification after enumerating visual features of objects. After the training, she became able to search and discriminate the stimuli quickly and systematically. This effect was maintained in follow-up. Her performance of colored picture matching improved, generalized to include other colored pictures, and was maintained in follow-up. Her visual identification of the objects used in the training also improved, and part of the improvement was maintained in follow-up. On the other hand, visual identification of new objects which were not used in the training did not improve.
   However, she became accustomed to identifying objects after enumerating the visual features of objects in her daily life, and this habit improved her recognition of each object, after sufficient repetition. These results suggest that this training is available when we select objects having important roles in the daily life of the patient.

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