To provide legal advice on cognitive dysfunction, we should evaluate each plaintiff with brain injury from a neutral viewpoint. In the neuropsychological test batteries, not only the total score such as IQs of the WAIS-III or memory quotients of the WMS-R but also the scores of the subtests need to be surveyed to find out the precise nature of the cognitive dysfunction. Expert opinions are also required concerning the relationship between the cognitive dysfunction and the lesion site(s) in the brain as well as the activities of daily living and the instrumental activities of daily living. We, as experts in rehabilitation medicine, should prepare ourselves to provide excellent legal advice to ensure that judges reach a proper decision.

For rehabilitation of patients with aphasia, the accurate diagnosis of aphasia and its type is very important. The types of aphasia are classified on the basis of the impairment pattern found in speech fluency, comprehension, and repetition. The aphasia types provide medical staffs with clues for how to best communicate with patients with aphasia. Physiatrists should grasp the language signs and symptoms of those patients and organize suitable rehabilitation. Standard medical practices in treatment of aphasia and recent methods to boost language recovery are also reviewed.

A questionnaire survey was undertaken to investigate the present state of education and clinical training for rehabilitation medicine in Japanese university hospitals. Seventy percent of the 80 university hospital rehabilitation departments or divisions responded to the questionnaire. The educational programs included systematic lectures on rehabilitation medicine and clinical clerkships in 76.8% and 82.1%, respectively, of the schools of medicine. However, only 35.7% of the medical schools surveyed have adopted rehabilitation medicine as an independent course in their clinical clerkships, for which 21.4% spend a one-week program. Most medical students reported finding some small significance of rehabilitation medicine in their clinical clerkships, which would not contribute to their decision on the career to pursue after graduation. For the fiscal years of 2006 to 2010, about 45 new doctors per year entered the various departments of rehabilitation medicine. The factors that contributed to gathering more new doctors appeared to be the independence of the department or division of rehabilitation, the ample staffing for teaching, and the incusion of an independent course of rehabilitation medicine in clinical clerkships. The results of the present survey suggest that more departments of rehabilitation medicine should be set up to raise the level of education and clinical training for rehabilitation medicine to better attract the attention of young doctors.

The aim of the present study is to characterize the burden of parents who care for their children with disabilities with the use of a Japanese version of the Zarit Caregiver Burden Interview (J-ZBI) that has been successfully used to quantify the caregiver burden for caring for the disabled elderly. We performed a survey in which questionnaires including the J-ZBI (adapted for the subjects of this study) were given to 135 parents of children in a school for the physically challenged. We obtained 69 valid responses. For the parents, the mean J-ZBI score was 25.6 points and the mean CES-D score was 10.8 points. A lowered QOL for these parents was suggested by the finding that the mean SF-36 score was lower than for other persons of the same year and age in Japan. The parents reported physical strain more frequently than mental stress as the main caregiver burden. According to the parent group's mean J-ZBI score, we classified them into either a heavier or a lighter burden group. The parents who were in a state of depression as judged by the CES-D were more frequently found in the heavier burden group, while those with children who showed complete or modified independence in more items of FIM were more frequent in the lighter burden group. Services to support the physical aspects of parents caring for children with disabilities would reduce their caregiver burden effectively.

Bilateral lesions damaging the primary auditory cortex or the auditory radiation may cause auditory agnosia. We describe a 67-year-old woman with auditory agnosia after bilateral thalamic hemorrhage. Initially, she showed subcortical deafness for words and environmental sounds. Pure tone audiometry showed a moderate-to-severe hearing loss (mean hearing level, right 56 dB ; left 57 dB), while the recording of auditory brainstem response was normal. Brain CT demonstrated a hematoma in the left thalamus and a narrow low density area suggesting a sequel of the right thalamic hemorrhage. Hearing training was begun using sound sources that were easily recognizable for the patient. Her recognition was better for words than for individual Japanese vowel or consonant-vowel sounds, and the use of lip reading contributed to her better recognition of words. After 2 months, she was able to communicate with medical staff and family members in daily conversation.