Case 1: 90-year-old female.		Overall picture at 4 weeks after onset of right cerebral infarction (M1) Problems and responses in the second week after admission to a convalescent rehabilitation ward
① Clinical features		Hypertension for a long time, 1 month ago, paramedic noticed left palsy, transported to extra-cerebral, left hemiplegia with right M1 obstruction, aspiration pneumonia and urinary tract infection 3 weeks ago, explained that he was scheduled for treatment when discharged, 2 weeks ago, entered a rehabilitation ward, neurological JCS (Japan Coma Scale) 1-digit, left hemiplegia, oxygen and intranasal tubes.
② Psychological aspects		Housewife; hobbies include niwabushi recitation and watching sports (she was a gymnast in her youth); opens her eyes at the sound of a voice and immediately closes them.
③ Environmental aspects		Lives with eldest son’s family and grandchildren; needs nursing care I (walks alone indoors, uses cane outdoors, bathes 3 times a week at day care); family members wish for her independence in using the toilet.
④ Functional impairment issues		Left hemiplegia (hypertonic with occasional voluntary movements), shows understanding of long sentences from word level, nodding to smiling, but tilts backwards in sitting position, no self-extraction of nasal tubes.
⑤ Issue identification	Awareness of the issues	How to intervene in a 90-year-old woman one month after onset of mild arousal disorder?
	Response on the day Intervention points	No fever in the last 3 days, no oxygen, increased speech, now is the time to increase activity. AMs with low arousal hold a sitting position with cervical and trunk forward tilt and forearm support. PMs with good arousal hold standing with contact support on the non-paralyzed side. Today I brushed my own hair and walked five meters on the parallel bars. “Thanks to all of you.”
	Three-day reflection Best practice	What is competency as a rehabilitator: through the case of a patient who was unaided and dementia-free before the illness and will be treated for a mild wakefulness disorder one month later. The ability to find challenges on one’s own: questioning the treatment plan at the time of acute discharge and prematurely - Expectations based on brain imaging and present illness at the time of admission to the gyration rehabilitation unit (also considers loss of motivation due to damage to the caudate nucleus head) - No oxygen and fever for 3 days, now is the perfect time. PT-OT-ST integrated practical skills: reading facial expressions and encouraging conversation; stabilizing the sitting position and encouraging upper limb activities; shifting the centre of gravity in the standing position and encouraging walking.
⑥ Goal setting		Chair sit-to-stand weaning at half day after 1-week, indirect swallowing after 2 weeks, reduced transfer assistance after 3 weeks, and reduced assisted walking after 4 weeks.
⑦ Communication		The competencies of the rehabilitation profession are clinical practice skills, including knowledge, skills, attitudes, and values (Lessons learned).