Until the time arrives when stroke patients truly recognize themselves as handicapped (living with their disabilities), it is well known that they usually pass through the five stages of grief, namely : denial, anger, bargaining, depression and acceptance. It is difficult to know which stage a patient is at, but we have found that a patient's writing, their letters, the occasional poem, etc are all of great use to identify the stage. Patients who are satisfied with their present lives are more able to accept their situation and therefore have fewer tendencies toward suicidal thoughts. The richness of their lives helps them to overcome their disabilities and enables them to return back to society. We should not force our patients, especially those in the denial or confusion stage, to accept their disabilities and rather must try to listen sincerely about their suffering and their stories. Most patients with brain strokes are encouraged to do their best “ganbare" by medical staff such as nurses, physical therapists, occupational therapists, speech language hearing therapists and doctors, and their family members and their friends. Usually, they are pleased to hear these words. However, some patients may perceive such encouragement as stressful, but if we know how to use these words in a supportive, positive manner, then they can be useful words in the care of stroke patients.

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Thalidomide embryopathy resulted in babies born with deformities such as phocomelia after their mothers took only a few tablets of thalidomide drug during 36 to 56 days after their last menstrual periods. There are two thalidomide embryopathy groups depending upon whether their hypoplasia is in the limbs or the auditory organs. In the limb group, deformities range from amelia to hypoplasia of the thumb. In the auditory group, the severity can be determined by the degree of deafness. This group is often associated with aplasia of the abducens and facial nucleus. Fifty years after the thalidomide scandal, the drug is still in use. It helps treat leprosy, multiple myeloma, AIDS and cachexia. As of June 2012, there are two hundred and ninetyfive victims still living in Japan. Disabilities include inadequate pinch and grasp, besides short reach. In the last two decades, the condition of these patients has worsened with chronic intractable pain due to overuse of hypoplastic skeletal muscles. They are now suffering from snapping fingers, stenosing tenosynovitis (trigger finger) and carpal tunnel syndrome. As their concomitant deformities or impairments include dislocation of the shoulder, droopy shoulders, hip dislocation, cervical block vertebrae, thoracic kyphosis, scoliosis, occult spina bifida, and L 6 lumbarization, these have become secondary etiologies for chronic pain, resulting in a dependent ADL condition. For these patients, physical exercise or recreation activities have become a viscous circle of ever increasing pain, weakness and fatigue. Furthermore, the resulting inactivity and weight gain has made ADL even more problematic. They also suffer from internal organ anomalies. Thus, a variety of problems including weakness and chronic intractable pain, which may be called post-thalidomide syndrome, has created an additional barrier for the surviving thalidomide embryopathy patients in social participation, as their aging is progressing.

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Although the Trail Making Test (TMT) Part A, B, Wisconsin Card Sorting Test-KFS version (WCST-KFS) and Miyake's Verbal Paired-Associate Learning Test (MVPLT) are simple tools to evaluate cognitive dysfunction in patients with traumatic brain injury, there is very little normative data for young persons available in Japan. Therefore, we evaluated 124 healthy persons who were from 15 to 30 years old with the three assessment tools. Median numbers of TMT Part A and Part B were 23.8 seconds and 49.0 seconds, respectively. Median numbers of achieved categories, perseverative errors of the Nelson type, and difficulties of maintaining set in the WCST-KFS were 5, 2 and 0, respectively. Median numbers of correct answers for related and unrelated pairs of MVPLT were 10 and 9 at the third trial, respectively. TMT Part B and perseverative errors of the Nelson type had a negative and weak correlation with age. And related pairs of MVPLT at the first trial had a positive and weak correlation with age. The normative values obtained in this study would be a useful standard for clinical assessments and acknowledgment of disabilities.

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