The clinical neuropathological report on Leborgne and Lelong by the French surgeon Paul Broca (1824-1880) in the 19th century contributed greatly to the foundation of “aphasiology” or “neuropsychology of language” in the present age. He studied one of the frontal gyr (iprobably the third gyrus) “une circonvolution frontale (probablement la troisième) ” as “the locus of articulation and language (le siège de langage articulé) .” The specific loss of speech (perte de la parole) induced by partial injury of this area was named by Broca as “aphémie.”
  Brocaʼs aphémie was later renamed by Armand Troussea (1801-1867) as aphasie/aphasia. Then, Carl Wernicke (1848-1905) used the terms “sensorische Aphasie” (sensory aphasia) and “Leitungsaphsie” (conduction aphasia) , followed by proposal of the classical aphasia theory by Ludwig Lichtheim (1845-1928) through his aphasia scheme “Wernicke-Lichtheimʼs Aphasie-Scheme (1884) .” Thus, Brocaʼs aphasia came to be positioned and widely recognized as “cortical motor aphasia (kortikale motorische Aphasie) ,” slightly differing from the speech-pathological view initially proposed by Broca.
  The aphasiological issue, derived from Brocaʼs unique research, has not yet been decisively resolved, and still, until date, remains the most important topic of research on aphasia.

  Studying classical cases promotes understanding of the process of identifying and classifying neuropsychological signs and re-evaluating the significance of these signs. As apraxia theory is associated with controversial problems, it is important to study the first case reported by Liepmann, a pioneer of apraxia studies, and re-evaluate his ideas about apraxia theory.
  In this article, I report the contemporary and personal background of Liepmann, and introduce medical records of the first case he reported and assessed. In addition, I consider Liepmannʼs reports after describing the initial case and his apraxia theory. Finally, I point out problems regarding the first case. According to Liepmannʼs apraxia theory, this case may have been unique, presenting with three problems: apraxia of his right hand, various action disorders not solely due to apraxia, and the combination of apraxia and aphasia.

  The focus of apraxia studies has expanded from brain injury, reported by Liepmann, to neurodegenerative diseases. It is necessary to return to the starting point and re-evaluate apraxia theory.

  In 1953, a 27-year-old man suffering from epileptic seizures for many years underwent experimental surgery to remove the medial temporal lobes on both sides. The operation was successful in that it reduced his seizures, but it left him with a severe memory loss. In 1957, when the report of this case was published, memory was not thought to have localization in the brain. The results of this case established that memory is a distinct cerebral function and the medial temporal lobe is important for memory. This case is remarkable because only one patient overturned common sense at the time, not only brought out the elucidation of the memory system but also became the beginning of further exploration. As a case H. M., this man will be engraved with his name forever in the history of neuropsychology.

I  n 1944, Paterson and Zangwill reported on the case of a patient who had suffered a penetrating wound of the right cerebral hemisphere. The patient developed a symptom that today would be called unilateral neglect. Paterson and Zangwill were not the first to report the symptom, but their report showed some remarkable points. They identified the lesion as a circumscribed disruption of the inferior parietal lobe, and they attempted to assess the preserved and impaired capacities of the patient. On the basis of their observations and experiments, they quantified and analyzed the disorder of the patient objectively. We will learn many things through careful reading of their report, which may lead to the development of contemporary models of unilateral neglect.

  For persons with organic brain syndrome, excessive social behavioral disorder often brings severe difficulties in daily life or social life resulting in e.g. isolation or criminal acts. To reduce such difficulties remains urgent problem to be solved in the nation-wide project for supporting persons with higher brain dysfunctions. A researcher group organized by Health Labour Sciences Research Grant begins a field study to investigate actual condition and to calculate real figure of such patients, finally intends to construct a community model for supporting system involving psychiatric hospitals.

  Disturbance of social behavior is an impairment of behaviors occurring in a group of individuals of the same species. When the social behavior is disturbed without social cognition deficiency, it is called “Personality change due to other medical conditions” in DSM-5. However, in many cases, it is supposed that disturbance of social behavior is caused by a disorder of social cognition. In such case, it is categorized into “neurocognitive disorder” in DSM-5. A main component of social cognition is a process of emotional stimulus. In this article, the processing stage of emotional stimulus is divided into three steps, that is, recognition, reaction, and expression. In addition, brief explanations of the disorders are presented in relation to each of the steps. This way of understanding might be useful in the treatment and handling of disturbance of social behavior because it leads to correct understanding about seemingly similar symptoms caused by different pathogenesis.

  Designated as the core support hospital to deal with higher brain dysfunction in 2004, our hospital has since served as a center for the examination and treatment of higher brain dysfunction in the east of Nagano Prefecture. In our hospital, the main department which provides clinical and support services differ, depending on the stage which is to be dealt with, physiatrists are involved in the whole process. When it comes specifically to disordered social behaviors among patients with higher brain dysfunction, the role played by the Department of Psychiatry is also important. Now that it is difficult to perfectly deal with problems caused by disorders in social behavior, there are many cases in which clear-cut solutions may hardly be worked out. In our hospital, however, medical support is rendered ① by properly performing treatment and support, ② by having access to cooperation from other departments and multidisciplinary staffers, but ③ not by giving up the clinical procedure halfway and ④ by continuously keeping an eye on any change in the patientsʼ condition. In the social behavior disorder support, it is important that we are together with the patients and their family, we are troubled with them and we perform it hard as much as we can at the time.

  We analyzed 139 continuous cases of higher brain dysfunction patients from April 1, 2007 to March 31, 2016. There were 81 cases (58.3%) without social behavioral disorders, 38 cases (27.3%) with social be havioral disorders which are problematic in social life, and 20 cases (14.4 %) who social life became difficult due to social behavioral disorders. Characteristics of difficult cases are young at a mean age of 35.9, male is four times that of women, traumatic brain injury was more frequent as a causative disease. In difficult cases, there were 16 cases with strong impulsivity, 6 cases with impulsivity and intellectual decline, and 4 cases with hallucination and delusion. In difficult cases, drug therapy and coordination with psychiatry were conducted, group training and employment support etc were offered. In more severe cases, psychiatric inpatient treatment, psychiatry day care, visiting nursing, public health nursing etc. were cooperated.
  In addition, difficult cases in the consultation project of the support center are found in 1.9%, and in the psychotic disorder following traumatic brain injury there is a report of several%, which is not rare at all.

  Shiga is one of the few prefectures in Japan where social welfare corporations are entrusted to function as support agencies. Such agencies can be characterized as offering no medical treatments, providing support to individuals who remain members of society, and that offer their services over an extended period of time in accordance with the recipientʼs various life stages. Here, we report a case in which the individual repeatedly committed various infractions of the law after being involved in a traffic accident that caused violent changes in his personality, disinhibition, and difficulty in self-examination. Through this case we examine what a social welfare corporation serving as a support agency has been able to do for individuals who manifest strong social behavioral disorders, and consider issues needing to be addressed in the future.

  The essence of neuropsychological rehabilitation is to help people achieve personally relevant goals and participate in personally valued activities. Clients who are at the “floor” or “ceiling” level on standard measures may still benefit from personalized rehabilitation programs. They will be able to become more independent and enjoy better quality of life by learning to use memory aids, and gain knowledge to better understand the nature of their problems. We have been closely following two families in which one member has suffered from neuropsychological impairments, including memory difficulties, for nearly 20 years after onset. We actively listened to “stories” experienced in everyday life from both the clients and family members during these years and identified specific incidents that require professional intervention. We developed various coping strategies to tackle the identified problems. In the final section, we present appeals from family members to medical professionals: i.e., even after 20 years, clientsʼ family members recognize that struggling with the sequelae of brain damage never ends, and they hope that medical professionals will pay more attention to the realities of neuropsychological impairments that affect ordinary life.

There are still a number of patients and their families suffering from serious disappointment and depressive states as their rehabilitation training course had inevitably been closed although severe disabilities caused by stroke were remaining and no follow-up support had been provided. To support such patients and their families, aphasia peer circle and peer-supporting groups were formed, and group trainings as well as exhibitions were organized. These activities were aimed to continuously support patients and families to make friends, communicate each other, self-study at home, calligraph and paint. As a consequence of the activities, in most cases improvements in various functions including the speech mechanism were observed in patients, while significant revitalizations in mind and body were identified in patients and their families. The purpose of this paper is to report types and methods of supports we conducted, and to demonstrate the potentiality of chronic severe aphasia patients, who are often regarded to be extremely difficult to recover, by referring to three patients which we have been supporting for ten to twenty years and notes were provided by their family. As the conclusion we argue the usefulness of an appropriate long term support to discover and cultivate such potentiality.

  This case study examined a patient with nonaphasic misnaming who showed remarkable symptom changes after 6 months. The patient, a 54-year-old right-handed male, suffered from a severe language disorder caused by a subarachnoid hemorrhage. His ability to repeat was consistently intact during the clinical course. One-and-a-half months after the onset of the disease, his spontaneous speech was fluent. His speech production on visual confrontation naming was similar to neologistic jargon including many irrelevant words, neologisms, and monemic paraphasias. Seven-and-a-half months after disease onset, his language disorder was markedly improved; his speech comprised monemic paraphasias and irrelevant words, but not neologism. We considered his clinical course to be as follows. He had suffered from a transcortical sensory aphasia (TSA) as well as nonaphasic misnaming in the acute phase. After 6 months, both of the TSA and the nonaphasic misnaming were improved. However, since the TSA was improved earlier and better, the remained nonaphasic misnaming feature became clear. The neologisms in his speech at the acute phase, which appeared to be a series of irregular phonemes, consisted of combinations of monemes, namely monemic paraphasias. We considered that this process could be explained by the “hybrid lexical error” hypothesis of neologism proposed by Buckingham (1981) .

  We investigated the support necessary for persons with aphasia (PWA) by clarifying what PWA feel and expect regarding informed consent (IC) . Qualitative analysis using semi-structured face-to-face interviews was conducted on 21 community-dwelling PWA (mean age=60.4 years) . Transcripts data were analyzed using qualitative analysis by Satoh (2013) .
  Twelve categories consisting of 43 sub-categories were identified. PWA felt various anxieties, especially about life after discharge. They thought the explanation by medical staff about their rehabilitation was insufficient but that the explanation about speech disorders by their speech-language-hearing therapist was easy to understand. PWA, furthermore, were unable to ask questions to medical staff due to their speech disorders. They wanted communication support in considering IC, but were at a loss as to how to seek such support.
  The results suggested that health care workers should provide communication support of their own accord when explaining and confirming the PWAʼs choice on IC. For example, they should explain about medical rehabilitation in specific terms using drawings or pictures. In this respect the speech-languagehearing therapist can help health care workers to provide appropriate communication support for PWA. Providing concrete information about their daily living after discharge, in addition, may alleviate their anxieties about life after discharge. And the IC itself needs to be explained repeatedly when necessary.

  We reported a case of two-way anomia for verbs, and noted the progress of recovery between two assessment sessions.
  The patient was male in his 40s who showed fluent-type aphasia caused by left putaminal hemorrhage. He performed better for nouns than verbs, in both comprehension and production tasks. Although his scores improved at the second assessment point compared to the first, the advantage he showed for nouns was consistent. When describing an action from line-drawing action pictures, the patient often generated appropriate particles, whether or not he retrieved the verb. These results suggested that semantics of verbs and grammatical function have a close relationship but are independent of each other.

  No established method of therapeutic intervention is currently available for social behavior disorders in higher brain dysfunction. It has been reported that therapeutic approaches, such as behavioral and cognitive approaches, need to be modified for patients with behavioral disorders following a cerebral injury based on the level of the patientʼs recognition of their own conditions and self-control ability (Mimura 2009, Sohlberg et al. 2001) . However, it is difficult to measure the level of patientʼs recognition of selfcondition, and no indices have been established for selecting and altering treatment. In this case we retrospectively focused on coping utilization in a young patient who exhibited anger bursts and discussed the optimal timing for changing the relative emphasis given to each treatment approach. The results showed that the patient utilized coping skills learned during behavioral approach period and was able to adapt his behavior when he experienced anger. The period of autonomous coping utilization in situations such as social skills training, i.e., when the patient exhibited a motivation to correct his own inappropriate behavior, we were able to change the treatment focus from a behavioral approach to a cognitive approach.