The local government of Fukushima prefecture has started the services of Training and Dispatch of Communication Supporters for People with Aphasia since 2019. Although there are regional differences in expanding this project, corporation of three ; Japanese association of Speech-Language-Hearing Therapists, Aphasic peopleʼs organizations, and the government is indispensable. In this report, we introduced our practice of the project supporting the people with aphasia in Fukushima prefecture. (1) Training course for the supporter for people with aphasia : the number of the people who completed the course was 22 in 2019, and 10 in 2021. In 2021 under the influence of COVID-19, we held the training course using separate 4 venues focusing on the regional balance. (2) Supports of the organization of Aphasic people : we held the party every year, and under the influence of COVID-19, we tried to hold a concert for mingling and also practical training for the course. We also tried a meeting online. (3) Corporation with the government : Within the framework of realization of symbiotic society, we held lecture and information session for the residents of Fukushima prefecture. For further development of this project, we would like to make system for dispatch, following up the people who completed the course, and raising awareness for expanding regional network.

  In Hiroshima Prefecture, a training program for communication supporters for people with aphasia was conducted in FY2018. Including those who completed the training for aphasia supporters in FY2019, there are currently 39 registered supporters in Hiroshima Prefecture. The main activity of the supporters is to support conversations at aphasia salons. Before and after the conversation support, they also provide support for transportation from home to the venue and support for the use of individual recreational facilities. The training of the conversation supporters consisted of individual feedback on the conversation support by the STs after the support, and involvement in the evaluation of the trainees at training sessions and training courses. The number of active conversational supporters was 10.7 per session, or 27% of the total registered participants. A questionnaire was sent to the conversation supporters with the aim of clarifying future activity issues. The active conversation supporters requested training sessions, mutual exchange within the group, and dissemination of their activities outside the group. For the future, it was considered necessary to make a slow transition from training to conversation support activities, and to take into consideration the factors for continuing conversation support activities. On the other hand, the fact that the conversation supporters born from the general public are aware of the problems of aphasia and are taking action is considered to be significant for this project.

  Aphasia day center plays a major role as a regional support base for aphasia. It is not only a place to provide intensive training and social approach, but also a place to think about and organize “live with aphasia”. As colleagues with the same disabilities gather and gain new experiences with professionals, their suffering gradually subsides and new possibilities emerge. It is also a resource to reach out to the community through activities such as friendsʼ associations and aphasia cafes. This is one of the essential regional resources for the realization of a society that is friendly to aphasic people. In addition, communication support projects for the aphasic and community rehabilitation activities are indispensable resources for aphasia support. In the future, it will be vital to create an area in which community resources will be effectively and continuously utilized. To achieve this goal, professionals must face a “live with aphasia” seriously and work with the aphasia patients and their families, as well as the ability to produce results in community planning.

  Stroke/cerebrovascular disease and cardiovascular disease are the second leading causes of death next to cancer in Japan. Furthermore, Stroke/cerebrovascular disease and cardiovascular disease are one of the most common causes of long term treatment and/or care. The medical costs of these diseases account for more than 20% of the total medical costs, which is one of the largest proportion of those in Japan. Therefore, we have to manage the measures of the stroke/cerebrovascular disease and cardiovascular disease.
  The Stroke/Cerebrovascular and Cardiovascular Disease Control Act, a Japanese national law, was promulgated by a legislative act on December, 2018, and enacted on December, 2019. On the basis of the law, the Ministry of Health, Labour and Welfare, Japan, prepared the Japanese National Plan for Promotion of Measures against Cerebrovascular and Cardiovascular Disease, and the National Plan was released on October 27, 2020.
  Based on the National Plan, each prefecture prepares their cerebrovascular and cardiovascular disease countermeasure promotion plan to promote measures against these diseases.
  This article explains the outline of the past and current measures against stroke/cerebrovascular and cardiovascular disease in Japan.

  In December 2018, the Stroke and Cardiovascular Disease Control Act was enacted to promote the prevention of stroke, myocardial infarction, and other cardiovascular diseases. Every prefecture have established Cardiovascular Disease Control Promotion Council and the Japanese National Plan for the Promotion of Measures against Cardiovascular Diseases have been drawn up. The Yamanashi Association of Speech-Language-Hearing Professionals has made a request for the assignment of rehabilitation professionals to the Council for Promotion of Cardiovascular Disease Countermeasures since 2019, as a result, one person has been assigned. I had an opportunity to submit our opinions to the Yamanashi prefecture through the activities of the Yamanashi Association of Speech-Language-Hearing Professionals and introduce them here.

  The clinical neuropsychologist certification was established in 2019. In the history of neuropsychological research, language function has been the main area of interest since ancient times. Speech-language-hearing therapists who work in the rehabilitation of language functions naturally need to be proficient in neuropsychology. The following is a list of neuropsychological concepts that may be important when considering the rehabilitation of aphasia. One is a vertical neuropsychological hierarchy and a horizontal structural model of language functions. The other is the concept of negative and positive symptom. Through a case study, I discussed the importance of developing a treatment strategy that anticipates the neuropsychological disturbances that underlie language symptoms. For those involved in the treatment of brain injury, neuropsychology is a necessary discipline to improve the quality of life of patients. By obtaining this certification, I hope that they will work on building a more analytical and strategic treatment process.

  We discussed the necessity of “Clinical Neuropsychologist^®”, a certification established jointly by the Japanese Society of Higher Brain Dysfunction and the Japanese Society of Neuropsychology, from the standpoint of a physiatrist. In team rehabilitations, team members conduct an assessment of the patient appropriately and develops a diagnosis, a clinical evaluation, and a therapeutic planning. The clinical neuropsychologist must be able to perform neuropsychological tests efficiently, and identify the patient based on not only the score, but also consider the medical status and condition of the patient while understanding the patientsʼ social background and diseases. Additionally, they needs the skills to apply a lot of clinical information to the advice of daily life and social activities.

  Because clinical neuropsychologists are experts, who have knowledge and skills related to neuropsychology, and have advanced specialist training as a human service professional, the license seems to be a professional qualification in the higher rank of certified psychologist. Becoming a clinical neuropsychologist is a good opportunity for certified psychologists to learn the knowledge of neuropsychology and intervention techniques for higher brain dysfunction. Certified psychologists, engaged in the medical field, have reported that they have been expected to provide their professional assessment using psychological examination and that they prefer to improve knowledge and skills about higher brain dysfunction and dementia. In education of neuropsychology, the clinical neuropsychologists could be suitable instructors with their career in extensive clinical experience. Their knowledge and skills of neuropsychology enable the certified psychologists not only to improve their ability of assessment but also to contribute to the interdisciplinary approach to health care. The expertise of the clinical neuropsychologists is expected to be involved in the improvement of the social status of the certified psychologists and the development of neuropsychology in future.

  Many neurological disorders have neuropsychological problems. Cerebrovascular diseases, dementia, limbic encephalitis, epilepsy, and many other diseases can cause higher brain dysfunction. It is also known that motor neuron diseases and hereditary muscular diseases also show intellectual developmental disorders and cognitive dysfunction. Neuropsychological knowledge is therefore essential for the assessment of symptoms in neurological diseases, but many neurologists are good at assessing motor and sensory disorders but are not familiar with detailed neuropsychological symptoms such as agnosia and apraxia, and have few opportunities to learn about them. In this regard, the clinical neuropsychologist certification program provides an excellent opportunity for young neurologists to learn neuropsychological assessment effectively. In addition, certified psychologists, occupational therapists, and other health professionals will gain knowledge of neuropsychological symptoms and assessment methods through this program, and will be able to recognize patientsʼ neuropsychological problems and provide feedback to physicians and patients.

  Occupational therapists are rehabilitation professionals who support the lives of people with disabled. For people with higher brain dysfunction, occupational therapists evaluate their symptoms with neuropsychological tests and behavioral observations in their daily life, interpret the evaluation results, and provide appropriate therapeutic program based on the interpretation. Young occupational therapists, however, often struggle with these processes in occupational therapy. Clinical neuropsychologist is positioned as a specialist with specialized knowledge and skills related to neuropsychology, as well as ability and ethics as an interpersonal support profession. I therefore believe that obtaining this certification will help occupational therapy practice for people with higher brain dysfunction. In this article, I gave my personal opinion on the advantages of occupational therapists acquiring the certification of clinical neuropsychologist, after introducing the training program of occupational therapists and the problems faced by young occupational therapists.

  The author described a classification of acquired alexia and agraphia from a viewpoint of neuropsychology or lesion-to-symptom-based neuroanatomy. Cognitive neuropsychology divides alexia into a central type (impairment at a level of lexical or phonological processes from visual recognition) and a peripheral type (impairment of visual recognition) . The central type alexia is further divided into phonological dyslexia, surface dyslexia and deep dyslexia. Similarly, agraphia is divided into a centra (llinguistic) type (impairment of lexical or phonological processes) and a periphera (lmotor) type (impairment at a level of converting visual and kinesthetic information into spelling movement) . The central type agraphia consists of phonological agraphia, lexical agraphia and deep agraphia, whereas the peripheral agraphia consists of apraxic agraphia and allographic agraphia. Neuroanatomically, alexia and agraphia consist of pure alexia, alexia with agraphia and pure agraphia, each is divided into subtypes.
  In addition, the authors recently reported a patient with selective on-reading impairment and on-reading predominance over kun-reading in semantic dementia patients. These findings demonstrate the double dissociation between on-reading pathway and kun-reading pathway.

  There are two types of apraxia affecting tool-use actions : apraxia of actual tool-use, and pantomime apraxia. These two types could be distinguished depending on the task condition : with real tool holding or not. Holding a real tool gives rise to tactile sensation followed by somatosensory feedback, and which can play an important role in activating the system necessary for actual tool-use. In the study, focusing the difference between these two conditions, I suggest some mechanical implications of apraxia of actual tool-use, and pantomime apraxia.

  In 2015, at the age of 61, I collapsed due to a left thalamic hemorrhage, resulting in aphasia and paralysis of the right side of my body. After a period of unconsciousness for about a month, I became slightly responsive. After that, training for oral intake and rehabilitation became the main daily treatment. I gradually began to speak and my walking distance increased with the use of foot orthotics. Eight months after the onset of the disease, I returned home and conducted interviews and EEG readings of patients at the hospital where I worked. At the same time, I started botulinum toxin injections to improve muscle contractures and transcranial magnetic stimulation to restore motor functions. About two and a half years after the onset of my illness, I retired from the hospital where I had been working, and is now in charge of outpatient psychosomatic medicine once a week at the Southern TOHOKU Medical Clinic. Although I am paralyzed on the right side of my body and have a slight difficulty speaking, I have no difficulty in daily conversation.

  We examined the effectiveness of naming therapy for a patient with semantic variant primary progressive aphasia (svPPA) using two types of Cues. One was an episodic Cue based on the patientʼs experience, and the other was a semantic Cue using dictionary definitions. We also evaluated the duration and generalization of the effect after eight weeks of naming therapy. We found improvement in the rates of correct answers with both Cue types after the eight weeks of therapy,but once the therapy ended the patientʼs performance gradually declined. Following therapy, the patient came to demonstrate use of episodic circumlocutions. Moreover, she seemed to develop motivation in her daily life. These findings suggest that episodic Cues could be continuously used as self-Cues in svPPA.

  To clarify the language behavior of patients with right hemisphere damage (RHD) , we evaluated the verbal behavior of persons with such brain damage using the “Discourse Analysis Rating Scales (DARS) ,” which is a subtest of Bryan (1995) ʼs “The Right Hemisphere Language Battery Second Edition,” and a “Behavior Observation List for Stroke Patients,” devised by us. Factor analysis using the DARS rating scales resulted in the extraction of three factors: “interpersonal communication,” “discourse structure,” and “inference of othersʼ intentions.” From these results, this evaluation method was thought to have captured verbal behavior from multiple perspectives in three aspects. Furthermore, comparing the results of the RHD and left hemisphere damage groups, the RHD subjects had difficulties with language behaviors, including “supportive routines” and “humor.” Next, we analyzed the relationship between DARS ratings and the presence or absence of behavioral findings for the item “lack of change in facial expression” on our “Behavioral Observation List for Stroke Patients.” The results revealed that the group with findings showed a significant decrease in performance on 7 of the 15 DARS items compared to the group without findings, suggesting that a decline in mental functions related to emotion and feelings affects verbal communication with interlocutors. We concluded that evaluation of the language behavior characteristics of persons with RHD using this method would provide important clues for the rehabilitation of such persons, who present various verbal and behavioral disorders.

  The present paper reports a case with word-meaning deafness who made use of dictation in kana as an alternative means of auditory comprehension. The case was in her fifties, right-handed, and diagnosed with Wernickeʼs aphasia due to stroke in the posterior region of the left superior and middle temporal gyri. Although her language impairment was quite improved after three months from the onset, auditory comprehension remained difficult. We examined her process of auditory comprehension in detail and confirmed that she presented typical word-meaning deafness, since her primary difficulty was comprehension of meanings of spoken words ; her capacities of phonological discrimination and auditory lexical decision were almost preserved. In addition, repetition of words and visual comprehension were intact. With respect to processing written words, she presented pure agraphia of kanji but was able to write and comprehended kana words without any problem. This enabled her to make strategic use of kana dictation for comprehending spoken words. The unique point about this caseʼs kana writing is that she was able to write nonwords correctly, unlike other cases of word-meaning deafness. However, on the basis of qualitative analysis, we concluded that she relied on the non-semantic lexical route for kana dictation just as other patients did.

  Extinction found in stereognosis is commonly investigated using complex tasks related to active touch ; however, consideration has not been paid to which levels of processing could fail to enable correct identification with one hand when objects are only presented simultaneously to both hands. In this study two stroke patients with well-marked tactile extinction were examined using a tactile recognition test of objects (complex stimuli) and two types of tactile tests: the classical tactile extinction test (simple stimuli) and a test for determining the presence or absence of a hand-held cube, in order to investigate extinction found in stereognosis from the qualitative standpoint. The results indicated that : 1) patients 1 and 2 were found to have marked extinction on both types of tactile tests and also showed significant extinction in response to complex stimuli ; 2) in patient 2 extinction found on the two types of tactile tests improved in parallel with extinction in response to complex stimuli ; 3) when stereognosis was simultaneously tested in both hands, noteworthy comments were obtained from both patients stating that nothing was felt in one hand. These results indicate that the stereognostic extinction observed in our two patients may derive at the same level of processing as tactile extinction processing.