I have been practicing group rehabilitation of people with brain injuries with the staff since 2008. I thank Professor Tanemura Rumi who gave me the opportunity to give a lecture. My sonʼs traffic accident triggered me such a job. Our model is The Oliver Zangwill Centre for Neuropsychological Rehabilitation (OZC) . We have learned about the rehabilitation by the publications of the centre and participations to the lecture given there. It is also influenced by the movement of the therapeutic community which was commenced by Maxwel Jones. We try to share the information with every staff as much as possible and work together. The number of clients in group rehabilitation at our clinic never exceeds 15 people, but the staff is 6 to 7 people. It is profound when compared with the criteria of large-scale psychiatric day care on Japanese medical insurance system. As far as this condition is continued, group rehabilitation of higher brain dysfunction will not grow in the future in this country. Our staff is a psychiatrist, nurses, occupational therapists, speech therapists, a physical therapist, a psychiatric social worker, a clinical psychologist, other staff menbers (ceramics, chorus etc.) . At the end of the test, we provide the contents to the client and the family and explain the results. Outline of group rehabilitation at our hospital is reports of previous week among members, skill memorization training, confirmation techniques, understanding of brain injury, attention training, group activities, etc. Clients will engage in competitive activities (boccia, patter golf, darts and card game etc.) . In addition, I described Headway Sakai, a facility that performs moderate rehabilitation, which seems to be insufficient in Sakai city.
Unilateral spatial neglect is one of the higher brain dysfunction frequently found in right cerebral hemisphere disorders. It is a generic term for symptoms not noticed by objects or people in one side space. Its pathological condition is diverse, and its influence on daily life is also wide. However, the mechanism of that is not well understood. I introduce papers that have been reported as the origin of unilateral spatial neglect. I will give an overview of what is “unilateral spatial neglect” and introduce what has been reported so far about the origin and transition of its rehabilitation. On the topic of rehabilitation of unilateral spatial neglect, I introduce the outline quoted from the stroke treatment guidelines 2015, introduce Prism adaptation, Transcranial magnetic stimulation and Mirror therapy where the results are reported, and treatment experience of mirror therapy introduce about.
Executive dysfunctions are behavioral disorders, which are connected directly to daily life. From the perspective of the cortical brain network, lesions in the paralimbic areas and high-order (heteromodal) association areas give rise to executive dysfunctions related to information processing of the internal milieu and extrapersonal space. From the perspective of behavior, formulating goals, planning, carrying out plans, and effective performance are difficult for people with executive dysfunctions, but their disorders are relative due to variability of social factors such as environment or roles. For rehabilitation of executive dysfunctions, it is necessary to formulate concrete and appropriate goals, have objective criteria that can be understood by both the people with executive dysfunctions and their therapists, and dedicate enough time on acquiring the required skills for daily life. People with executive dysfunctions tend to be isolated from their social community because they cannot perform effectively daily tasks although intelligence and word articulation are intact. In order to prevent their isolation, it is important to create a peaceful living environment by obtaining recognition of their presence from the community. Daily lifeoriented rehabilitation for people with executive dysfunctions can help achieve this goal.
I doubt that generally a person with cognitive disorder is fixed to recipient of support. All most the people with cognitive disorder lose the confidence. When they can do the successful experiences at their daily lives in spite of disabilities, they recover the confidences and their subject appear. So they can make effort toward a little higher level of their abilities and a cognitive disorder improves every year. By further action they who accept the supports can become supporters.
When supporting the community transition of persons with higher brain function, therapists need to recognize the difference in roles and policies of hospitals and community care settings.In the community care setting, therapist places the most importance on clientʼs wishes, and not only their lifestyle but share how the person wants to live in their community. Since the life in the community lasts for a long-term, it is necessary for the therapist to establish the environment in order to provide the support which can be adapted to changes of personʼs conditions. In addition to cooperation with medical organization, it is imperative that therapists build a good collaborative partnership with relevant organizations in the clientʼs living community.
Long-term support is important for people with higher brain dysfunction. How should we professionals develop support, I considered with examples of support by the community activity support center ʻWakaba (takarazuka, Hyogo) ʼ. We investigated needs of Wakabaʼs members and their families, the results were that families had set membersʼ goals for concrete activities rather than recovery and enjoying themselves positively, and members themselves also had placed importance on living happily. Although we professionals tend to look at “symptoms”, the main subjects are the parties and families. It is necessary to focus on the “life activities” that parties and families hope, and to help them to feel “helpful”. For that purpose, I presume that “support system that can be involved for a long time”, “concrete life support from a professional point of view”, and “support for changing parties and families” are important.
Kobe city has established a local law to build a dementia-friendly community and has just started a public expenditure system for the diagnosis to dementia on January 2019. Additionally, Kobe city has started a compensation system of accidents caused by or involving dementia people on April 2019. The cost of these two systems are covered with an additional tax counting 400 yen per year per one citizen. These systems are called “Kobe model for realizing dementia-friendly community” and gathering considerable attention from other local governments. This review aims to introduce the Kobe model and to indicate some issues to be solved for establishing a real dementia friendly community.
A scene refers to a specific environment or a view of a specific place in a meaningful way. Objects are not the only stimuli containing in the scene. Gist, or an overall meaning, and layout are also important elements to understand the scene. That is, multiple and complex information are contained in a scene with mutual relevance. In order to grasp a visual scene, there is a flow from a physiological level of sense-perception to a higher cognitive function level to recognize what kind of scene you saw. Therefore, viewing a scene is reported to be an active process in which visual world and memory are integrated. This paper briefly reviewed researches on basic theories how a scene was perceived and recognized, and the relationship between scene perception and cognitive functions, focusing on scene perception tasks and scene description tasks of persons with dementia and the elderly population. Some studies reported that the performances of scene recognition in Alzheimerʼs disease were deteriorated. Also, language abilities such as discourse in Alzheimerʼs disease were known to decline. Scene description task is regarded as a task combining scene perception and discourse ability, therefore it is not only to evaluate discourse ability but to implicate how the perceived scene and higher cognitive system are processed interactively.
We examined relationships between a quantitative analysis of facial expressions and the questionnaire or behavior rating scale of 38 patients with right hemisphere damage, 34 patients with left hemisphere damage, and 12 patients with bilateral hemisphere damage. The Facial Expression Coding System (FACES) was used to evaluate facial expressions and the Japanese version of the Apathy Evaluation Scale Informant version (AES-I-J) , Clinical Assessment for Spontaneity (CAS) , and Neuropsychiatric Inventory (NPI) were used for evaluate motivation and psychiatric symptoms. Patients with right hemisphere damage showed a significant loss of motivation compared with patients with other hemisphere damage. The expression on FACES were highly correlated with the motivation or psychiatric symptom scores of AES-I-J, CAS, and NPI, as seen in the following pairs: sadness (FACES) and depression (NPI) , happiness (FACES) and euphoria (NPI) , indifference (FACES) and total score (AES-I-J) , indifference (FACES) and total score (CAS) , indifference (FACES) and indifference (NPI) . The expressions on FACES were highly correlated with rating scales of motivation and psychiatric symptoms. Consequently, FACES could be useful for evaluating emotional states after cerebral damage. Patients with right hemisphere damage showed high scores for surprise, happiness, and indifference. Patients with left hemisphere damage showed high scores for sadness only. The results suggest that patients with right hemisphere damage show positive emotional valence, whereas those with left hemisphere damage show negative emotional valence on FACES.
A 57-year-old right-handed man had left hemispatial neglect, constructive disturbance, and dressing apraxia 4 weeks after the onset of right parieto-occipital subcortical hemorrhage. His brother had a history of correcting his left-handedness. The patient had normal ability in verbal comprehension, verbal expression, and reading, but had difficulty in Kanji writing. His errors in the task of writing Kanji letters included no response, partial response, and non-existing letters similar to an actual Kanji, which suggested pure agraphia. In addition to those, his errors also included poor spatial arrangement in the whole components of a Kanji letter, which indicated constructional agraphia. In the task of dictating and copying 51 Kanji letters that were randomly chosen from those taught in the 1st, 2nd, and 3rd grades of Japanese elementary school, the responses consistent to pure agraphia were decreased markedly in copying, but the frequencies of the responses corresponding with constructional agraphia were similar between dictation and copying. In his constructional agraphia, some letters had a disarranged placement of larger parts of a Kanji letter (Bushu［radicals］of a Kanji) , and some letters had a disarranged placement of major components within a radical. Some authors recently reported patients with constructional agraphia after right hemisphere damage. Constructional agraphia may be caused by lesion in the right hemisphere with an atypical lateralization, as well as left parietal lesion.
The present study aimed to report the effect of an intervention focusing on the qualitative errors of tooth-brushing action in a patient with ideational apraxia. A 60-year-old right-handed man was admitted four months after cerebral hemorrhage in the left cerebral hemisphere. Neurological findings included motor paralysis, sensory impairment, and hypertonia on the right side, whereas neuropsychological findings included motor aphasia, buccofacial apraxia, ideational apraxia, ideomotor apraxia, and attention deficit. Tooth-brushing activity in this patient disclosed “mislocation,” “perplexity,” “clumsiness,” and “omission.” This study was conducted using the single-case design. Interventions were designed as error-free learning focusing on specific qualitative errors and were performed step-by-step with appropriate feedback. Tau-U was used for statistical analysis. Qualitative errors such as “perplexity,” “clumsiness,” and “mislocation” were significantly decreased in the intervention phase compared with the baseline phase. The results of this study suggest that graded intervention for qualitative errors and feedback affected the degree of improvement in this specific patient.
Recently, the Stroke Driversʼ Screening Assessment Japanese Version (J-SDSA) , a cognitive function test for the evaluation of driving ability, was developed. However, the performance characteristics of this test for those possessing a Japanese driverʼs license have not been examined. Therefore, in this study, we investigated the behavioral characteristics of this test in young and healthy participants with a car driverʼs license and analyzed the correlations between the scores on the J-SDSA and neuropsychological tests and between the scores on the J-SDSA and driving experience. Participants were 80 healthy individuals aged 20-35 years. They were assessed using the J-SDSA and several neuropsychological tests. Participantsʼ performance on the J-SDSA in this study was compared to those of the normal elderly people in the manual. Furthermore, the correlation between the results of the subtests of the J-SDSA and those of the neuropsychological tests was analyzed. The effect of driving experience on J-SDSA score was also examined. The results revealed that all participants performed well on the subtests of J-SDSA, indicating that participants were “able to drive.” In addition, the results of all subtests correlated with those of the neuropsychological tests, implying that visual cognitive functions and driving experience affect the scores on some subtests of the J-SDSA.