I applied the case formulation analysis based on Wilson et al. (2009) . The apraxic behaviors of a patient with ideomotor apraxia (case 1) was analyzed by classical error analysis, and interventions on temporal and spatial organization of hand actions were effective. The cognitive neuropsychological model of action (Rothi et al. 1988) were applied to a conceptual apraxic patient (case 2) , and teaching semantic knowledge on object and tool of an action were effective to his difficulties of ADL. The case 3 showed Bálintʼs syndrome, Gerstmannʼs syndrome and depression. Adjusting location and direction of her body and objects were effective, and this strategy were applied to her ADL. Applying case formulation to the patient with neuropsychological disorders seemed to be useful to comprehensive intervention in neuropsychological rehabilitation.
Neuropsychological rehabilitation is concerned with enabling people with cognitive, emotional or behavioural difficulties after brain injury to achieve their maximum potential in the domains of psychological, social, vocational, leisure and everyday functioning. This paper will trace, from a Western perspective, the origins of the influences that have shaped contemporary practice in neuropsychological rehabilitation. Although the impact of injury to the brain on mental functions was described some 3000 years ago by the ancient Egyptians, it was not until the 20th Century that systematic approaches to rehabilitating people with brain injury emerged. Wars between nations have been important in stimulating the development of rehabilitation, particularly because of the large numbers of soldiers with brain injuries. The contributions of key practitioners such as Goldstein, Zangwill and Luria will be discussed. These ʻgrandfathersʼ of neuropsychological rehabilitation have directly influenced contemporary practitioners such as Ben Yishay, Prigatano, Christensen and Wilson who have developed the techniques that we use today. Contemporary holistic neuropsychological rehabilitation practice will be described, illustrating both the historical influences, but also the new developments that continue to transform practice to better meet the needs of people with brain injury.
Numerous group studies have been conducted on neuropsychological research methods. In such investigations, patient categories such as aphasia types are averaged and compared as units. In contrast, cognitive neuropsychological research methodology has traditionally placed emphasis on single case studies. The latter approach focuses on the particulars of a distinct case, and it has been thought that this technique can identify the disorder mechanisms of particular occurrences of a condition. Congruently, research in this field in Japan is also often based on single case studies. However, reports from case series investigations conducted overseas have increased over the last decade. The present paper intends to perform a detailed survey of cases of different types and severity and to identify each case within the distribution of symptoms. Case series studies from overseas are introduced in combination with domestic case histories, and the paper contends that these methods yield more interesting findings on the relationship between semantic disorder and surface dyslexia and on the relationship between phonological disorder and non-word repetition. Additionally, the advantages of amalgamating the use of the single case study method with case series studies are elucidated.
Naming disturbance and word finding difficulty are core symptoms for aphasics, but their mechanisms are not on the same level. Lambom Ralph et al. (2002) explained the naming disturbance for damage of two representations, phonology and semantics. The multiple regression analysis was used to calculate criterion variable for naming performance, explanatory valuable for semantic association task and nonword reading. As a result, explanation rate (R2) was 0.55. The result would suggest the importance of the close examination for the extent of phonogical/semantic disturbances to understand which would be the core disturbance, and to plan the therapy program. Actually, phonology and semantic would be often presented at the same time in the therapy (pictures, letters, speech sounds) , it might be difficult to distinguish between phonology and semantics. However, it would be important to specify the target of therapy. 2 cases were presented, one was focused on phonology, other was on focused on semantics.
It is generally known that persons with aphasia often retain their pragmatic ability despite their language functional disorder. The author tried to analyze the discourse of aphasic persons engaged in group sessions in order to visualize the communication competence of participants in sessions focusing on their pragmatic ability. The study subjects consisted of 4 persons belonging to the “mild-moderate” group and 6 persons to the “mild” group. The task was conversation for making a barbecue plan. The taped conversation of 2 groups were transcribed, from which 5-minute transcriptions were extracted and analyzed both quantitatively and qualitatively. The pragmatic ability of aphasic persons was assessed using the Japanese Version of the Pragmatic Rating Scale. The quantitative analysis found that members of the mild group actively communicated with each other compared to the mild-moderate group. The results of qualitative analysis showed a difference between the two groups about intended reference involved in speech. In the pragmatic rating, high scores indicated a high appearance ratio of symptoms while low scores indicated a low appearance ratio of symptoms. It seemed that the former symptoms were associated with language dysfunction caused by aphasia, and the latter suggested cognitive retention. In the context of assessment of communication skills of persons with aphasia, the findings suggest that pragmatic measurement is very important as well as formal functioning aspects of language ability.
Social care in community-based rehabilitation is necessary to support persons with aphasia. It is not sufficient to give them language practice in medical facilities in order to promote social participation by aphasic people. By 2025 a structure called the “Community-based Integrated Care System” will be established. Under this system, livelihood support, residents` associations, volunteer groups, NPOs, etc. will function usefully to support the community life of the people. Conversation partners who study about aphasia and learn how best to communicate with aphasic persons will help to eliminate communication barriers for aphasic persons trying to participate in social activities. Since the training program for conversation partners was started in 2000 by NPO Waon, several local governments, including those of Itabashi City and Musashino City, have adopted the program. Local governments have carried out the training program under the Community-based Integrated Care System, or Support Services for Persons with Disability, implemented by the Ministry of Health, Labor and Welfare. Conversation partners have made significant contributions to improving the quality of life of persons with aphasia and realizing a barrier-free society. The training program of communication supporters for persons with aphasia started as a nation-wide public service in 2018. This paper presents an outline of the training program of conversation partners and the activities performed by conversation partners as volunteers in their community.
The thalamus and medial temporal lobe are anatomically interconnected and work as an integrative functional unit for episodic memory. There are two distinct memory-related thalamo-medial temporal circuits: the first is the mammillary body-anterior thalamic nuclei-hippocampus circuit (Papez circuit) and the other is the rhinal cortex-mediodorsal thalamic nuclei-prefrontal cortex circuit. Recent rodent neurophysiological studies suggest that the mammillary body-anterior thalamic nuclei-hippocampus circuit plays a central role in integrating information about space, objects and action that are generated thorough subjective experience into individual mnemonic events. The rhinal cortex-mediodorsal thalamic nuclei-prefrontal cortex circuit are hypothesized to represent the relationship, or context, among mnemonic events that are formed through previous learning.
Previous studies have developed the methods of effective memory rehabilitation. In this article, I briefly reviewed those methods and provided two ideas based on the recent studies from the cognitive neuroscience approaches to human memory. The first perspective highlights the memory functions in the medial parietal areas, which include the precuneus and the retrosplenial cortex. Particularly, the encoding / retrieval flip could be a key phenomena for considering the effect of memory rehabilitation. The second perspective regards the possibility of physical exercise and the sensitivities to autonomic bodily changes (interoception) on memory performance. Finally, I summarized to propose the idea that the development of effective memory rehabilitation methods could be based on the indirect cognitive functions besides memory processing.
Prospective memory (PM) is to remember the future intentions or plans in every day life. The dual pathway model in PM proposes spontaneous retrieval and intentional retrieval. Some conditions are related to PM retrieval. They are types of PM tasks such as time-based task and event-based task, retrieval modalities such as remembering to remember and remembering the contents, and motivation and meta-memory. Spontaneous retrieval is easier because PM cues are included in ongoing tasks, and intentional retrieval requires active recognition of cues by strategic monitoring. We carried out PM training to an amnesic patient and a patient with dysexecutive syndrome. The former showed improvement in encoding and strategic monitoring, and the latter showed some improvement in strategic monitoring. The results suggest that PM training could improve retrieval process.
“Ninchisho Chienowa net” is a website developed by us to collect experiments related to care for patients with dementia from all over Japan. On the website, we ask family or professional caregivers throughout Japan to submit their care experiences, including what happened（what types of behavioral and psychological symptoms of dementia（BPSD））, the management method used, and whether the method improved the BPSD（effective or ineffective）to this website. Then, we make a group of the care experiences with both the same kind of BPSD and the same kind of management method. In this group, this management method is effective in some care experiences, and ineffective in others. Then, we calculate the success rate for these care experiences. Memory impairment is a common symptom that appears frequently in patients with dementia and is a major obstacle to daily life. The number of the care experiences related to memory impairments was the most in 12 categories of BPSD on Ninchisho Chienowa net. “Forgetting to make medicine” is one of the major obstacle to daily life. Three representative management methods for the obstacle were “Putting the medicine in the box on which the date was written”, “Using the calendar”, and “Creating a system to hand over the medicine to the patient”. The success rates for the three management methods were 40, 55.3, and 92%, respectively. The success rate of “Leaving the dishes unclean after meals” for “forgetting to eat a meal” was 66.7%. We confirmed that the success rates calculated on Ninchisho Chienowa net were similar to those calculated in the actual clinical scene.
Emotional facial expressions are primary media for human emotional communication. However, the psychological and neural mechanisms underpinning the processing of such facial expressions remain unclear. This article reviews the findings of our psychological and neuroscientific studies, which demonstrated the following: (1) that the emotional processing of facial expressions is accomplished unconsciously and is associated with amygdala activity at about 100 ms ; (2) that the perception of emotional facial expressions is more rapid than that of neutral expressions and is associated with enhanced activity in the visual cortices at about 200 ms ; and (3) that facial expressions automatically elicit facial mimicry and that this motor processing is related to activity in the inferior frontal gyrus at approximately 300 ms. These data suggest that few hundred ms needed to process processing of emotional facial expressions involve multiple psychological dimensions, including feeling, seeing, and mimicking, as well as widespread neural activities in the amygdala, visual cortices, and inferior frontal gyrus.
This article presents a review of the methods for assessing brain images of patients with dementia required in clinical diagnostic purposes. Each dementing disorder shows a different predilection with regard to brain lesions ; therefore, demarcation of the cerebral lobes and identification of the limbic system are necessary for accurate diagnosis. Pathologically, neuronal loss and reactive tissue changes, due to degeneration and accumulation of protein, are observed in atrophic lesions, which show reduced blood flow on single-photon emission computed tomography. Some diseases show abnormal high signals on magnetic resonance imagings (MRI) , on the basis of which clinical diagnosis is made. Pathological background of abnormal signal changes on MRI differs according to diseases. In future, use of imaging techniques for visualizing accumulation of degenerated protein in the brain tissue, for example tau-positron emission tomography, is expected in clinical setting.
The patient was a man in his 60s. In his youth, he suffered from mild stuttering, which healed naturally by speaking slowly. In his 50s, he experienced a left frontoparietal subcortical hemorrhage. His stuttering did not relapse at that time. However, 10 years later, he suffered a right thalamic hemorrhage, after which his stuttering returned. The following year, we attempted treatment using speech rate control, masking method, delayed auditory feedback, and frequency altered feedback, but the stuttering was unchanged. However, after he received low-frequency repetitive transcranial magnetic stimulation (rTMS) to improve movements in his right fingers, his stuttering symptoms during free conversation decreased. We considered why his stuttering had relapsed and then improved with rTMS. It is likely the right thalamic hemorrhage may have resulted in damage to the speech control function in the motor loop, overactivity in the right motor cortex, and breakdown in the coordinated activity between the hemispheres associated with speech, which may have then caused the relapse of the patientʼs stuttering. Low-frequency rTMS has been reported to suppress activity of the uninvolved side while stimulating the involved side. Thus, performing rTMS in the finger exercise region, which is close to the speech control function area on the right side of the brain, may have also suppressed the overactivity of the right motor cortex, with the result that the coordinated activity between the two hemispheres was repaired and the stuttering improved.
Visuo-constructive impairment is a characteristic of Alzheimerʼs disease (AD) and dementia with Lewy bodies (DLB) . Visuo-constructive impairment is often assessed with the cube copying test (CCT) and the pentagon copying test (PCT) . However, the performance of CCT and PCT is not always consistent in all patients. Thus, we investigated the specificity of the two tasks by analyzing the patients with neurocognitive disorders who succeeded solely in one of the two tasks. Subjects were 672 patients who were initially diagnosed with dementia or suspected of having dementia. Success and failure on the tasks were operationally determined. Of enrolled patients, 404 subjects (60.1% ) succeeded in both tasks, 103 subjects (15.3% ) failed in both. Fifty subjects (7.4% ) succeeded in CCT but not PCT, and 115 subjects (17.1% ) succeeded in PCT but not CCT. In VaD and FTLD, there were significantly more subjects who succeeded in PCT but not in CCT than subjects who succeeded in CCT but not PCT. In AD and DLB, there were no significant difference in the two groups.
We report a patient with vocal amusia who was not a musician. The patient was an 81-year-old right-handed woman whose singing ability decreased after infarctions in the right hemisphere. This change was not accompanied by dysarthria or dysprosody. On head MRI, cerebral infarctions were detected mainly in the cortex and subcortical region of the right precentral gyrus, and extended to the central region of the insula, cortex of the posterior end of the middle frontal gyrus, and a part of the medial cortex of the superior temporal gyrus. To define the characteristics of the disorder in this case and investigate the association with the developmental mechanism and lesions, receptiveness and expressiveness of music were compared between the patient and 8 control subjects. Music receptiveness had not declined in the patient, but abnormal pitch expression in music expressiveness and flattening to a lower pitch than the target sound were noted, in contrast to the control group. These changes suggest that disorder of pitch expression during singing was not caused by motor or music-receptive disorder, and that the main lesions in the motor-related area of the right frontal lobe and central area of the right insula were involved in pitch phonation control.
A patient presented with inability to orient the body due to Bálint syndrome and impaired distance judgment caused by damage to the bilateral parietal lobes from grade 2 subcortical hemorrhage. The patient was discharged home from a convalescent rehabilitation ward and continued to receive long-term support via long-term care insurance. Evaluation after 15 months of onset revealed that Bálint syndrome and impaired distance judgment still remained ; however, the patientʼs difficulty in sitting on a chair had decreased. Before sitting on a chair, the patient searched for and touched the seat surface with the upper limbs to estimate the seat width and distance between the patient and the chair. Next, the patient moved the buttocks toward the hand touching the seat surface. The patient also remarked, “I sat down while thinking,” and completed the action by way of conscious processing. Therefore, we recommend repetitive practice of motor output using a residual sensory modality based on somatic sensory information and by conscious processing using offline information processing, such as knowledge and memory. We believe that it is important to provide long-term support through collaborative medical care and nursing care in patients with inability to orient the body due to Bálint syndrome and anosognosia.