Objective: In recent years, repetitive transcranial magnetic stimulation (rTMS) has shown promise in treating aphasia. While previous reports used the Standard Language Test of Aphasia (SLTA) for evaluation of language functions, the difficulty level of each task in SLTA varies. To show the effects of rTMS in more detail, it is necessary to use weighted values for the SLTA scores. This study aimed to assess the impact of high-frequency rTMS on aphasia using the deviation values of the SLTA.Methods: Thirty-one post-stroke aphasic patients participated in this study [mean (SD) age 58.0 (10.1) years, 15 infarction and 16 hemorrhage] from 2017 to 2021. The average (SD) duration from the onset of stroke to the intervention was 41.1 (31.1) months. Prior to admission, brain sites for rTMS were determined by detecting activation during the word-repeat task using functional MRI. A two-week inpatient treatment, including daily high-frequency rTMS and speech language hearing therapy (excluding Sundays), was conducted. In statistical analysis, SLTA scores were converted into deviation values, with participants grouped by rTMS sites (frontal lobe, temporal lobe, left/right hemisphere) for pre- and post-treatment comparisons.Results: rTMS sites included right frontal lobe (6 cases), left frontal lobe (10 cases), right temporal lobe (5 cases), and left temporal lobe (10 cases). Pre- and post-treatment comparisons showed significant improvements in overall mean scores and speech items in all groups. Additionally, significant enhancements in auditory comprehension items were observed in the right hemisphere and frontal lobe stimulation groups.Conclusion: High-frequency rTMS shows promise that it can improve language function regardless of the stimulation site, and auditory comprehension may be improved specifically by the right hemisphere and left frontal lobe stimulation. This suggests its potential as a valuable therapeutic intervention.

Many post-treatment cancer patients complain of persistent fatigue, which is known to have a significant impact on activities of daily living, quality of life, and reinstatement. We report a case of a 37-year-old man with acute myeloid leukemia (AML) who was able to return to work by performing High-Intensity Interval Training (HIIT) after the remission. The diagnosis of AML was made and the treatment started in January X, and the patient reached remission and discharged in June. However, he developed herpes zoster and was unable to return to his job. The patient was referred to our hospital for rehabilitation treatment in December X. The rehabilitation treatment included 40-min HIIT twice a week and commuting practice, as well as gradual support for return-to-work. Cardiopulmonary function improved from 19.2 to 25.7 mL/min/kg of oxygen uptake at anaerobic metabolic threshold, lower limb muscle strength improved from 0.47/0.48 to 0.60/0.55 kgf/kg of knee extension muscle strength ratio (right/left), physical function improved from 14 to 24 times in 30-second chair stand test, Cancer Fatigue Scale improved from 46 to 25 points, and the patient was able to work full time in May X＋1. HIIT improved cardiopulmonary function, muscle strength, physical function, and fatigue, and enabled the patient to return to work. Even after remission, some patients have difficulty returning to work. The results suggest that appropriate follow-up, exercise guidance, and rehabilitation therapy are necessary even after treatment.

Many post-treatment cancer patients complain of persistent fatigue, which is known to have a significant impact on activities of daily living, quality of life, and reinstatement. We report a case of a 37-year-old man with acute myeloid leukemia (AML) who was able to return to work by performing High-Intensity Interval Training (HIIT) after the remission. The diagnosis of AML was made and the treatment started in January X, and the patient reached remission and discharged in June. However, he developed herpes zoster and was unable to return to his job. The patient was referred to our hospital for rehabilitation treatment in December X. The rehabilitation treatment included 40-min HIIT twice a week and commuting practice, as well as gradual support for return-to-work. Cardiopulmonary function improved from 19.2 to 25.7 mL/min/kg of oxygen uptake at anaerobic metabolic threshold, lower limb muscle strength improved from 0.47/0.48 to 0.60/0.55 kgf/kg of knee extension muscle strength ratio (right/left), physical function improved from 14 to 24 times in 30-second chair stand test, Cancer Fatigue Scale improved from 46 to 25 points, and the patient was able to work full time in May X＋1. HIIT improved cardiopulmonary function, muscle strength, physical function, and fatigue, and enabled the patient to return to work. Even after remission, some patients have difficulty returning to work. The results suggest that appropriate follow-up, exercise guidance, and rehabilitation therapy are necessary even after treatment.

Introduction：The relationship between the results of a driving simulator test and a paper-based evaluation of higher brain function were examined.Subjects：The subjects of this study were 203 patients with brain injury who received support to resume driving during hospitalization or outpatient treatment at our hospital between April 1, 2014 and December 31, 2018.Methods：The sex, age, and results of various higher brain function tests of the patients were investigated using medical records and the outcomes of the driving resumption support. The performance on a driving simulator test was compared between patients judged able to and those judged unable to resume driving.Results：In the group of 165 patients who passed the paper-based evaluation of higher brain function, 34 were judged unable to resume driving based on a driving simulator test. In the group that did not pass the paper-based evaluation of higher brain function, 4 patients were also judged unable to resume driving based on a driving simulator test. The results of the higher brain function evaluation were significantly better in the group permitted to resume driving compared with the group not permitted to resume driving in all items except for the Visual Reproduction subtest of the Wechsler Memory Scale-Revised.Conclusions：Evaluations of actual automobile driving using driving simulators or other means are important in assessing driving resumption. Driving requires the use of various higher brain functions and the results of this study suggest that a higher level of ability is required for safe driving.

COVID-19 spread from Wuhan City, People's Republic of China, in December 2019, followed by an explosion of infections worldwide. The number of infected people has also risen dramatically in Japan and has become a major social problem. Patients with severe disease require a long period to return to society due to significant physical weakness even after recovery. We report a patient in his 40s with a history of nephrectomy who was infected with COVID-19 and became critically ill.After being diagnosed with COVID-19 by PCR test, the patient was admitted to our hospital. His respiratory status rapidly worsened and he was temporarily managed by ECMO in the intensive care unit. At the time of his first contact with us (day 31 post-hospitalization), he was unable to hold himself in a standing position for a long time and required a walker. Initially, from the perspective of preventing the spread of infection, we instructed him in self-directed training rather than individual therapy. From day 49, he began to receive physical therapy. He was discharged on day 53 with independence in outdoor walking. He was instructed to consume protein after exercising and he was managed on an outpatient basis. He returned to work. His skeletal muscle mass increased by BIA and his respiratory and motor functions were restored.He received instructions on recovering from severe illness after COVID-19 infection, which focused on nutrition, voluntary training, and monitored individual therapy in accordance with rehabilitation therapy. He was able to return to society with no sequelae.

We provided inpatient rehabilitation treatment and return-to-school guidance to a junior high school student with medulloblastoma and pervasive developmental disorder (autism spectrum disorder). Here we describe the rehabilitation treatment for patients with physical and developmental disabilities. A 13-year-old boy who was diagnosed with pervasive developmental disorder at 4 years of age was able to perform activities of daily living independently and attend junior high school. However, he was admitted to our hospital with new-onset ataxia. Magnetic resonance imaging revealed a cerebellar tumor. After total tumor excision was performed, pathological analysis revealed medulloblastoma, which was treated initially with radiation therapy and then chemotherapy for 1 year. Rehabilitation was initiated 2 days post-surgery. We evaluated his communication abilities. He showed stereotypical behavior owing to the autism spectrum disorder；therefore, we performed low-intensity repetitive exercises. The functional independence measure score at discharge was 67/126 (motor 44/91, cognitive 23/35). We taught his teachers how to properly assist him, and he successfully returned to school post-discharge. Although this was a case in which the child had multiple disabilities, ataxia caused by the medulloblastoma aggravated his developmental disability. Thus, understanding the characteristics of communication and its strengths was vital in determining a treatment plan that enabled his return to school.

Objective：We aimed to examine the clinical validity of the Wechsler Adult Intelligence Scale (WAIS)-III for resuming automobile driving in patients with brain injury.Methods：A total of 71 patients who requested to resume driving after brain injuries were included, with 43 and 28 patients categorized in the resumed and non-resumed driving groups, respectively. Statistical analysis was performed by comparing the sub-items of the WAIS-III between the groups. The reference value of accurate determinants was estimated using receiver operating characteristic (ROC) curve analysis.Results：The results of the ROC curve analysis showed that the areas under the curves for full-scale intelligence quotient (FIQ), performance IQ (PIQ), and perceptual organization index (POI) were higher than 0.7 (with moderate predictive accuracy). The cutoff values were as follows with high specificity and low sensitivity：PIQ, 98.5；FIQ, 107；and PO, 107.Conclusion：The cutoff values of the FIQ, PIQ, and POI of the WAIS-III were inadequate predictors for resumption of driving in patients with brain injury. However, if patients had all three scores less than 70, it was suggested that they refrain from driving.

Introduction：In this study, we conducted a retrospective investigation to determine when patients with brain damage could be tested and permitted to resume driving and also assessed reasons for disallowance. Subjects：A total of 279 patients with brain damage were included in the study. These patients underwent an assessment for driving resumption between April 1, 2014 and March 31, 2020, either as in-patient in our hospital or attending as an outpatient. Method：Medical records were examined to ascertain details regarding timing of driving resumption, reason for disallowance, and number of outpatient training sessions. Results：Among the study participants, 233 patients were permitted to resume driving and 46 were not. Among permitted patients, 65 were hospitalized in our hospital at that time, 83 had been discharged from our hospital and were attending as outpatients, and 85 had been referred to our outpatient clinic from other hospitals. Among patients not permitted to drive, 6 were hospitalized in our hospital at the time, 17 had been discharged from our hospital and were attending as outpatients, and 23 had been referred from other hospitals. Conclusions：Evidence supporting driving resumption in patients who were brain damaged could not be determined while being hospitalized in convalescent rehabilitation wards. Hence, continued provision of outpatient rehabilitation therapy is important.

Introduction：In this study, we conducted a retrospective investigation to determine when patients with brain damage could be tested and permitted to resume driving and also assessed reasons for disallowance. Subjects：A total of 279 patients with brain damage were included in the study. These patients underwent an assessment for driving resumption between April 1, 2014 and March 31, 2020, either as in-patient in our hospital or attending as an outpatient. Method：Medical records were examined to ascertain details regarding timing of driving resumption, reason for disallowance, and number of outpatient training sessions. Results：Among the study participants, 233 patients were permitted to resume driving and 46 were not. Among permitted patients, 65 were hospitalized in our hospital at that time, 83 had been discharged from our hospital and were attending as outpatients, and 85 had been referred to our outpatient clinic from other hospitals. Among patients not permitted to drive, 6 were hospitalized in our hospital at the time, 17 had been discharged from our hospital and were attending as outpatients, and 23 had been referred from other hospitals. Conclusions：Evidence supporting driving resumption in patients who were brain damaged could not be determined while being hospitalized in convalescent rehabilitation wards. Hence, continued provision of outpatient rehabilitation therapy is important.

COVID-19 spread from Wuhan City, People's Republic of China, in December 2019, followed by an explosion of infections worldwide. The number of infected people has also risen dramatically in Japan and has become a major social problem. Patients with severe disease require a long period to return to society due to significant physical weakness even after recovery. We report a patient in his 40s with a history of nephrectomy who was infected with COVID-19 and became critically ill.After being diagnosed with COVID-19 by PCR test, the patient was admitted to our hospital. His respiratory status rapidly worsened and he was temporarily managed by ECMO in the intensive care unit. At the time of his first contact with us (day 31 post-hospitalization), he was unable to hold himself in a standing position for a long time and required a walker. Initially, from the perspective of preventing the spread of infection, we instructed him in self-directed training rather than individual therapy. From day 49, he began to receive physical therapy. He was discharged on day 53 with independence in outdoor walking. He was instructed to consume protein after exercising and he was managed on an outpatient basis. He returned to work. His skeletal muscle mass increased by BIA and his respiratory and motor functions were restored.He received instructions on recovering from severe illness after COVID-19 infection, which focused on nutrition, voluntary training, and monitored individual therapy in accordance with rehabilitation therapy. He was able to return to society with no sequelae.