Several million people are treated with neuroleptic medications in North America each year. A large percentage of these patients develop a chronic neurologic disorder-tardive dyskinesia-characterized by abnormal movements of the voluntary muscles. Most cases are permanent and there is no known treatment. Evidence has been accumulating that the neuroleptics also cause damage to the highest centers of the brain, producing chronic mental dysfunction, tardive dementia and tardive psychosis. These drug effects may be considered a mental equivalent of (...) tardive dyskinesia. Relevant data are derived from human autopsies, brain imaging , neurophysical tests, and clinical research. That the neuroleptics can damage higher brain centers is confirmed by their known neurotoxicity and neurophysiological impact, animal autopsies, and a comparison to diseases that mimic neuroleptic effects, such as Huntington's chorea and lethargic encephalitis. Patients and the public should be informed of the danger of both tardive dyskinesia and tardive dementia. The mental health professions should severely limit the use of neuroleptics and develop safer and better alternatives to these dangerous substances. (shrink)

The view that female mammals are more docile appears to arise in part from imposing human values on animal studies. Many reports of sexual dimorphism in physical aggression favouring the male in laboratory rodents appear to select circumstances where that expectation is supported. Other situations that favour the expression of conflict in females have been (until recently) relatively little studied. Although female rodents generally do not show the “ritualised” forms of conflict that characterise male sexual competition, they can use notably (...) damaging strategies (especially if they are of short duration). Such considerations might weigh in the selection of strategies by our own species. (shrink)

Pains that persist long after damaged tissue hasrecovered remain a perplexing phenomenon. Theseso-called chronic pains serve no useful function foran organism and, given its disabling effects, mighteven be considered maladaptive. However, a remarkablesimilarity exists between the neural bases thatunderlie the hallmark symptoms of chronic pain andthose that subserve learning and memory. Bothphenomena, wind-up in the pain literature andlong-term potentiation (LTP) in the learning andmemory literature, are forms of neuroplasticity inwhich increased neural activity leads to a longlasting increase in (...) the excitability of neuronsthrough structural modifications at pre- andpost-synaptic sites. Moreover, the synapticmodifications of wind-up and LTP share a commonmechanism: a glutamate N -methyl-D-aspartate(NMDA) receptor interaction that initiates a calciummediated biochemical cascade that ultimately enhancessignal processing at the -amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid (AMPA) receptor. This paper arguesthat chronic pain, which has no adaptive value, canbe accounted for in terms of the highly adaptivephenomenon of activity-dependent neural plasticity;hence, some cases of chronic pain can beconceptualized as a memory trace in spinal neurons. (shrink)

This book offers practical advice for legal professionals to optimize cognitive fitness and protect their brain from the damaging effects of chronic stress. Drawing on the latest research in neuroscience and psychology, it provides actionable information to help readers thrive amidst the demands and stressors of the legal profession.

This article reviews the potential use of visual feedback, focusing on mirror visual feedback, introduced over 15 years ago, for the treatment of many chronic neurological disorders that have long been regarded as intractable such as phantom pain, hemiparesis from stroke and complex regional pain syndrome. Apart from its clinical importance, mirror visual feedback paves the way for a paradigm shift in the way we approach neurological disorders. Instead of resulting entirely from irreversible damage to specialized brain modules, (...) some of them may arise from short-term functional shifts that are potentially reversible. If so, relatively simple therapies can be devised—of which mirror visual feedback is an example—to restore function. (shrink)

Neuroimaging studies of brain-damaged patients diagnosed as in the vegetative state suggest that the patients might be conscious. This might seem to raise no new ethical questions given that in related disputes both sides agree that evidence for consciousness gives strong reason to preserve life. We question this assumption. We clarify the widely held but obscure principle that consciousness is morally significant. It is hard to apply this principle to difficult cases given that philosophers of mind distinguish between a (...) range of notions of consciousness and that is unclear which of these is assumed by the principle. We suggest that the morally relevant notion is that of phenomenal consciousness and then use our analysis to interpret cases of brain damage. We argue that enjoyment of consciousness might actually give stronger moral reasons not to preserve a patient's life and, indeed, that these might be stronger when patients retain significant cognitive function. (shrink)

Neuroimaging studies of brain-damaged patients diagnosed as in the vegetative state suggest that the patients might be conscious. This might seem to raise no new ethical questions given that in related disputes both sides agree that evidence for consciousness gives strong reason to preserve life. We question this assumption. We clarify the widely held but obscure principle that consciousness is morally significant. It is hard to apply this principle to difficult cases given that philosophers of mind distinguish between a (...) range of notions of consciousness and that is unclear which of these is assumed by the principle. We suggest that the morally relevant notion is that of phenomenal consciousness and then use our analysis to interpret cases of brain damage. We argue that enjoyment of consciousness might actually give stronger moral reasons not to preserve a patient's life and, indeed, that these might be stronger when patients retain significant cognitive function. (shrink)

The ipsilesional arm of stroke patients often has functionally limiting deficits in motor control and dexterity that depend on the side of the brain that is lesioned and that increase with the severity of paretic arm impairment. However, remediation of the ipsilesional arm has yet to be integrated into the usual standard of care for upper limb rehabilitation in stroke, largely due to a lack of translational research examining the effects of ipsilesional-arm intervention. We now ask whether ipsilesional-arm training, (...) tailored to the hemisphere-specific nature of ipsilesional-arm motor deficits in participants with moderate to severe contralesional paresis, improves ipsilesional arm performance and generalizes to improve functional independence. We assessed the effects of this intervention on ipsilesional arm unilateral performance [Jebsen–Taylor Hand Function Test ], ipsilesional grip strength, contralesional arm impairment level [Fugl–Meyer Assessment ], and functional independence [Functional independence measure ]. Intervention occurred over a 3 week period for 1.5 h/session, three times each week. All sessions included virtual reality tasks that targeted the specific motor control deficits associated with either left or right hemisphere damage, followed by graded dexterity training in real-world tasks. We also exposed participants to 3 weeks of sham training to control for the non-specific effects of therapy visits and interactions. We conducted five test-sessions: two pre-tests and three post-tests. Our results indicate substantial improvements in the less-impaired arm performance, without detriment to the paretic arm that transferred to improved functional independence in all three posttests, indicating durability of training effects for at least 3 weeks. We provide evidence for establishing the basis of a rehabilitation approach that includes evaluation and remediation of the ipsilesional arm in moderately to severely impaired stroke survivors. This study was originally a crossover design; however, we were unable to complete the second arm of the study due to the COVID-19 pandemic. We report the results from the first arm of the planned design as a longitudinal study. (shrink)

The search for causes of perinatal brain damage needs a solid theoretical foundation. Current theory apparently does not offer a unanimously accepted view of what constitutes a cause, and how it can be identified. We discuss nine potential theoretical misconceptions: (1) too narrow a view of what is a cause (causal production vs. facilitation), (2) extrapolating from possibility to fact (potential vs. factual causation), (3) if X, then invariably Y (determinism vs. probabilism), (4) co-occurrence in individuals vs. association in (...) populations, (5) one cause is all that is needed (single cause attribution vs. multicausal constellations), (6) drawing causal inferences from very small numbers of observations (the tendency to generalize), (7) unstated causal inferences, (8) ignoring heterogeneity, and (9) failing to consider alternative explanations for what is observed. We hope that our critical discussion will contribute to fruitful research and help reduce the burden of perinatal brain damage. (shrink)

It has long been known that brain damage has important negative effects on one’s mental life and even eliminates one’s ability to have certain conscious experiences. It thus stands to reason that when all of one’s brain activity ceases upon death, consciousness is no longer possible and so neither is an afterlife. It seems clear that human consciousness is dependent upon functioning brains. This essay reviews some of the overall neurological evidence from brain damage studies and concludes (...) that our argument from brain damage has been vindicated by such overwhelming evidence. It also puts forth a more mature philosophical rationale against an afterlife and counters several replies to the argument. -/- 1. Philosophical Background -- 2. The Dependence of Consciousness on the Brain: Some Preliminary Evidence -- 3. Brain Damage, Lesion Studies, and the Localization of Mental Function - 3.1 Perception - 3.2 Awareness, Comprehension, and Recognition - 3.3 Memory - 3.4 Personality - 3.5 Language - 3.6 Emotion - 3.7 Decision-Making - 3.8 Social Cognition and Theory of Mind - 3.9 Moral Judgment and Empathy - 3.10 Neurological Disorders and Disease - 3.11 The Unity of Consciousness -- 4. Objections and Replies - 4.1 Souls, Minds, and Energy Fields - 4.2 The Instrument Theory - 4.3 The Embodied Soul Alone is Affected -- 5. Conclusion. (shrink)

Given the existence of “marginal human cases”, it is often argued that we must either acknowledge that some human beings have less moral status than some non-human animals, or commit to the idea that moral status is held by humans qua human. In this paper, the moves available on both sides are shown to be unsatisfactory, and an argument for moral status that avoids both of the standard positions is suggested. Ultimately, it is argued that the discussion of moral status (...) is confused when marginal human cases are seen as posing a unique, rather than a general, theoretical problem. (shrink)

The right hemisphere syndrome refers to various disturbances in patients’ relationships with space and body due to right hemisphere lesions. While the psychological aspects of this syndrome have been discussed at length in the literature, the relevance of the Lacanian psychoanalytic notion of specular image has not yet been considered. The present study is an attempt to evaluate, in a case report, whether the right hemisphere syndrome has subjective coherence regarding the pathology of the specular image. The patient described here (...) exhibited anosodiaphoria, hemineglect, and personification of his hand. From the words and self-portrait of the patient, gathered during semi-directive interviews, we concluded that the patient’s specular image was split into an "hemi-injured" image and an object-like hemibody deprived of its symbolic value. In this case, anosodiaphoria and hemineglect seem to contribute in different ways to the repression of this intrusive appearance of the real body. (shrink)

How do people with brain damage communicate? How does the partial or total loss of the ability to speak and use language fluently manifest itself in actual conversation? How are people with brain damage able to expand their cognitive ability through interaction with others - and how do these discursive activities in turn influence cognition? This groundbreaking collection of new articles examines the ways in which aphasia and other neurological deficits lead to language impairments that shape the production, (...) reception and processing of language. Edited by noted linguistic anthropologist Charles Goodwin and with contributions from a wide range of international scholars, the articles provide a pragmatic and interactive perspective on the types of challenges that face aphasic speakers in any given act of communication. Conversation and Brain Damage will be invaluable to linguists, discourse analysts, linguistic and medical anthropologists, speech therapists, neurologists, psychiatrists, psychologists, workers in mental health care and in public health, sociologists, and readers interested in the long-term implications of brain damage. (shrink)

Cognitive deficits were produced in rats by different methods of damaging the brain: chronic ingestion of alcohol, causing widespread damage to diffuse cholinergic and aminergic projection systems; lesions (by local injection of the excitotoxins, ibotenate, quisqualate, and AMPA) of the nuclei of origin of the forebrain cholinergic projection system (FCPS), which innervates the neocortex and hippocampal formation; transient cerebral ischaemia, producing focal damage especially in the CA1 pyramidal cells of the dorsal hippocampus; and lesions (by local injection of (...) the neurotoxin, colchicine) of the granule cells of the dentate gyrus. Following chronic alcohol or lesions of the FCPS, transplants of cholinergically rich fetal brain tissue into the terminal areas (neocortex and/or hippocampus) restored performance almost to control levels, with a time course consistent with growth of the transplants and integration with host tissue; transplants of cholinergically poor fetal tissue (hippocampus) were without effect, as were transplants of cholinergically rich tissue into the region containing the nuclei of origin of the FCPS. Grafts of primary cells enriched in glia and cultured neuroblastoma cells into the terminal areas of the FCPS were equally effective, suggesting that there are multiple mechanisms by which neural transplants can restore cognitive function following diffuse cholinergic damage. In contrast, after ischaemia- or neurotoxin-induced damage to CA1 or dentate granule cells respectively, cholinergically rich fetal transplants into the damaged hippocampal formation were ineffective in restoring performance. After ischaemic damage, however, performance was restored by suspension grafts of CA1 cells but not by transplants containing CA3 pyramidal cells or granule cells; and after colchicine damage it was restored by solid grafts containing granule but not CA1 pyramidal cells. Furthermore, electrophysiological evidence has demonstrated functional, graft type-specific host-graft functional neuronal connectivity. Thus, restoration of cognitive function by neural transplants is possible after damage to either diffuse (cholinergic) or point-to-point (intrahippocampal) forebrain systems, but the transplant must be appropriate to the damage to be repaired. Because the different types of brain damage studied provide analogues of human alcoholic dementia, Alzheimer's disease, and heart attack, these results are encouraging with regard to the eventual application of neural transplant surgery to the treatment of cognitive deficits in humans. (shrink)

Although the use of ECT has declined dramatically from its inception, this decrease has recently shown signs of leveling out because of ECT's powerful therapeutic effect in severely ill depressed individuals who either do not respond to pharmacologic alternatives or are too ill to tolerate a relatively lengthy drug trial. Notwithstanding its therapeutic benefits, ECT has also remained a controversial treatment modality, particularly in the eye of the public. Given the unsavory qualities associated with the word “electroconvulsive,” claims of possible, (...) probable, or even certain brain damage with ECT have easily found listeners. A careful, nonselective assessment of data covering the areas of pathology, radiology, electrophysiology, biochemistry, and neuropsychology leads both to certain conclusions and to certain unanswered questions. ECT is not the devastating purveyor of wholesale brain damage that some of its detractors claim. For the typical individual receiving ECT, no detectable correlates of irreversible brain damage appear to occur. Still, there remains the possibility that either subtle, objectively undetectable persistent deficits, particularly in the area of autobiographic memory function, occur, or that a rarely occurring syndrome of more pervasive persistent deficits related to ECT use may be present. Clearly, more research directed toward answering these questions needs to be carried out so that the role of ECT can be more rigorously defined. While such research is pending, however, we cannot expect that the conditions that predispose to clinical referrals for ECT will disappear. Given the misery, anguish, and risk of death by suicide, starvation, or debilitation associated with severe depressive illness, for example, it still appears that ECT, at least for the present, must continue to be available. (shrink)

In this essay, I home in on the difficulties with group-to-individual (G2i) inferences in neuroscience and how they impact the legal system. I briefly outline how cognitive shortcutting can distort legal decisions, and then turn my attention to G2i inferences, with a special focus on issues of intellectual disability and brain damage. I argue that judges and juries are not situated to appreciate the nuances in brain data and that they are required to make clinical decisions without clinical (...) training. As a result, they effectively ignore those responsibilities and simply decide cases in virtue of what they already believe to be true. How judges actually make decisions in highstakes criminal cases is troubling, but they are also hamstrung in a variety of ways. (shrink)

Background and aims: Recent investigations have highlighted the value of neuropsychological testing for the assessment and screening of Alcohol-Related Brain Damage. The aim of the present study was to evaluate the suitability of the Addenbrooke’s Cognitive Examination and the Repeatable Battery for the Assessment of Neuropsychological Status for this purpose. Methods: Comparing 28 participants with ARBD and 30 alcohol-dependent participants without ARBD we calculated Area Under the Curve statistics, sensitivity and specificity values, base-rate adjusted predictive values, and likelihood ratios (...) for both tests. Results: High levels of screening accuracy were found for the total scores of both the ACE-III and RBANS at multiple cut-off points. Removing participants with a history of polysubstance from the samples improved the diagnostic capabilities of the RBANS substantially, while only minor improvements to the ACE-III’s accuracy were observed. Conclusions: Overall, both the ACE-III and RBANS are suitable tools for ARBD screening within an alcohol-dependent population, though the RBANS is the superior of the two. Clinicians using these tools for ARBD screening should be cautious of false-positive outcomes and should therefore combine them with other assessment methods and more detailed neuropsychological testing before reaching diagnostic decisions. (shrink)

Overall mean performance on intelligence tests by brain-damaged patients with focal lesions can be misleading in regard to localization of intelligence. The widely used WAIS has many subtests that together recruit spatially distant neural but individually the subtests reveal localized functions. Moreover, there are kinds of intelligence that defy the localizationist approach inferred from brain damage.

Since its introduction in 1938, electroshock, or electroconvulsion therapy , has been one of psychiatry's most controversial procedures. Approximately 100,000 people in the United States undergo ECT yearly, and recent media reports indicate a resurgence of its use. Proponents claim that changes in the technology of ECT administration have greatly reduced the fears and risk formely associated with the procedure. I charge, however that ECT as routinely used today is at least as harmful overall as it was before these changes (...) were instituted. I recount my own experience with combined insulin coma - elcetroshock during the early 1960s and the story of the first electroshock "treatment." I report on who now is being electroshocked, at what cost, where, and for what reasons. I discuss ECT technique modifications and describe how ECT is currently administered. I examine assertions and evidence concerning ECT's effectivness and ECT-related deaths, brain damage, and memory loss. Finally I describe "depatterning treatment," a brainwashing technique developed in Canada during the 1950s, drawing a parallel between electroshock and brainwashing. (shrink)

The present and future rapid increase in the hospital population of geriatric patients is discussed with particular reference to the problem of advanced brain degeneration. The consequences of various clinical management options are outlined and it is suggested that extreme attempts either to preserve or terminate life are medically, morally and socially unacceptable. The preservation of life in senile patients has important economic consequences. In achieving a decision on the medical management of patients with advanced brain decay it (...) is suggested that substantial help would be derived from: knowledge of the previously declared wishes of individual patients; improvements in geriatric assessments; broader consultation with relatives, and greater use of inter-disciplinary discussion in the preparation of criteria for terminating medical efforts to maintain survival. (shrink)

This article reviews experimental evidence for a specific sensorimotor function which can be dissociated from higher level representations of space. It attempts to delineate this function on the basis of results obtained by psychophysical experiments performed with brain damaged and healthy subjects. Eye and hand movement control exhibit automatic features, such that they are incompatible with conscious control. In addition, they rely on a reference frame different from the one used by conscious perception. Neuropsychological cases provide a strong support (...) for this specific motor representation of space, which can be spared in patients with lesions of primary sensory systems who have lost conscious perception of visual, tactile or proprioceptive stimuli. Observation of these patients also showed that their motor behavior can be ''attracted'' by a goal only under specific conditions, that is, when the response is immediate and when no cognitive representation of this goal is elaborated at the same time. Beyond the issue of the dissociation between an implicit motor representation and more cognitive processing of spatial information, the issue of the interaction between these two systems is thus a matter of interest. It is suggested that the conscious, cognitive representation of a stimulus can contaminate or override the short-lived motor representation, but no reciprocal influence seem to occur. The interaction observed in patients can also be investigated in normals. The literature provides examples of interaction between sensorimotor and cognitive framing of space, which confirm that immediate action is not mediated by the same system as delayed action, and that elaborating a categorial representation of the action goal prevents the expression of the short-lived sensorimotor representation. It is concluded that action can be controlled by a sensory system which is specialized for on-line processing of relevant goal characteristics. The temporal constraints of this system are such that it can affect the action before a full sensory analysis of this goal has been completed. The performance obtained on the basis of this spatial sensory processing suggests that short-lived motor representations may rather be considered as real ''presentation'' of the action world, which share its metric properties. (shrink)

When circumscribed brain regions are damaged in humans, highly specific iimpairments in language, memory, problem solving, and cognition are observed. Neurosurgery such as "split brain " or hemispherectomy, for example has shown that encompassing regions, the left and right cerebral hemispheres each control human behavior in unique ways. Observations stretching over 100 years of patients with unilateral focal brain damage have revealed, withouth the theoretical benefits of "cognitive neuroscience" or "cognitive psychology," that human behavior is indeed controlled (...) by the brain and its neurons. (shrink)

It is often assumed that similar domain-specific behavioural impairments found in cases of adult brain damage and developmental disorders correspond to similar underlying causes, and can serve as convergent evidence for the modular structure of the normal adult cognitive system. We argue that this correspondence is contingent on an unsupported assumption that atypical development can produce selective deficits while the rest of the system develops normally (Residual Normality), and that this assumption tends to bias data collection in the field. (...) Based on a review of connectionist models of acquired and developmental disorders in the domains of reading and past tense, as well as on new simulations, we explore the computational viability of Residual Normality and the potential role of development in producing behavioural deficits. Simulations demonstrate that damage to a developmental model can produce very different effects depending on whether it occurs prior to or following the training process. Because developmental disorders typically involve damage prior to learning, we conclude that the developmental process is a key component of the explanation of endstate impairments in such disorders. Further simulations demonstrate that in simple connectionist learning systems, the assumption of Residual Normality is undermined by processes of compensation or alteration elsewhere in the system. We outline the precise computational conditions required for Residual Normality to hold in development, and suggest that in many cases it is an unlikely hypothesis. We conclude that in developmental disorders, inferences from behavioural deficits to underlying structure crucially depend on developmental conditions, and that the process of ontogenetic development cannot be ignored in constructing models of developmental disorders. Key Words: Acquired and developmental disorders; connectionist models; modularity; past tense; reading. (shrink)

Recent neuroscientific evidence brings into question the conclusion that all aspects of consciousness are gone in patients who have descended into a persistent vegetative state (PVS). Here we summarize the evidence from human brain imaging as well as neurological damage in animals and humans suggesting that some form of consciousness can survive brain damage that commonly causes PVS. We also raise the issue that neuroscientific evidence indicates that raw emotional feelings (primary-process affects) can exist without any cognitive awareness (...) of those feelings. Likewise, the basic brain mechanisms for thirst and hunger exist in brain regions typically not damaged by PVS. If affective feelings can exist without cognitive awareness of those feelings, then it is possible that the instinctual emotional actions and pain "reflexes" often exhibited by PVS patients may indicate some level of mentality remaining in PVS patients. Indeed, it is possible such raw affective feelings are intensified when PVS patients are removed from life-supports. They may still experience a variety of primary-process affective states that could constitute forms of suffering. If so, withdrawal of life-support may violate the principle of nonmaleficence and be tantamount to inflicting inadvertent "cruel and unusual punishment" on patients whose potential distress, during the process of dying, needs to be considered in ethical decision-making about how such individuals should be treated, especially when their lives are ended by termination of life-supports. Medical wisdom may dictate the use of more rapid pharmacological forms of euthanasia that minimize distress than the de facto euthanasia of life-support termination that may lead to excruciating feelings of pure thirst and other negative affective feelings in the absence of any reflective awareness. (shrink)

BackgroundWhether patients in the vegetative state (VS), minimally conscious state (MCS) or the clinically related locked-in syndrome (LIS) should be kept alive is a matter of intense controversy. This study aimed to examine the moral attitudes of lay people to these questions, and the values and other factors that underlie these attitudes.MethodOne hundred ninety-nine US residents completed a survey using the online platform Mechanical Turk, comprising demographic questions, agreement with treatment withdrawal from each of the conditions, agreement with a series (...) of ethical principles and three personality tests.ResultsMore supported treatment withdrawal from VS (40.2 % agreed, 17.6 % disagreed) than MCS (20.6 %, 41.2 %) or LIS (25.3 %, 35.8 %). Agreement with treatment withdrawal was negatively correlated with religiosity (r = −0.272, P < 0.001), though showed no significant relationship with need for cognition or empathy, and only a partial association with utilitarian judgment in a standard moral dilemma. Support for treatment withdrawal was most strongly associated with endorsement of the importance of patient autonomy, dignity, suffering, best interests. Distributive justice was not given significant weight by most. Importantly, agreement with treatment withdrawal was noticeably higher when considered from a first as opposed to third person perspective for VS (Z = −6.056, P < 0.001), MCS (Z = −6.746, P < 0.001) and LIS (Z = −6.681, P < 0.001).ConclusionLay attitudes to withdrawal of treatment in brain damaged patients are largely shaped by values similar to those central to the secular ethical debate. Neither traditional values such as the sanctity of life nor utilitarian values relating to resource allocation seem to play a central role. Far greater weight is given to autonomy, which may explain why participants were far more willing to endorse withdrawal of treatment when the issue was presented in the first person, or in relation to a concrete case involving a patient’s explicit wishes. Surveys focusing on abstract cases presented in the third person may not provide an accurate picture of lay attitudes to these critical ethical questions. (shrink)

The aim of cognitive neuropsychology is to articulate the functional architecture underlying normal cognition, on the basis of congnitive performance data involving brain-damaged subjects. Throughout the history of the subject, questions have been raised as to whether the methods of neuropsychology are adequate to its goals. The question has been reopened by Glymour [1994], who formulates a discovery problem for cognitive neuropsychology, in the sense of formal learning theory, concerning the existence of a reliable methodology. It appears that the (...) discovery problem may be insoluble in principle! I propose a modified formulation of Glymour's discovery problem and argue that a sceptical conclusion about the possiblity of cognitive neuropsychology as an empirical science is not warranted. (shrink)

This book covers all aspects of the disorder, from an historical survey of research to date, through the nature and anatomical bases of neglect, and on to review contemporary theories on the subject.

Despite some clinical promise, using fetal transplants for degenerative and traumatic brain injury remains controversial and a number of issues need further attention. This response reexamines a number of questions. Issues addressed include: temporal factors relating to neural grafting, the role of behavioral experience in graft outcome, and the relationship of rebuilding of neural circuitry to functional recovery. Also discussed are organization and type of transplanted tissue, the of transplant viability, and whether transplants are really needed to obtain functional (...) recovery after brain damage. (shrink)

Ethical dilemmas are common in the neonatal intensive care setting. The aim of the present study was to investigate the opinions of Swedish physicians and the general public on treatment decisions regarding a newborn with severe brain damage. We used a vignette-based questionnaire which was sent to a random sample of physicians (n = 628) and the general population (n = 585). Respondents were asked to provide answers as to whether it is acceptable to discontinue ventilator treatment, and when (...) it actually is discontinued whether or not it was acceptable to use drugs which hasten death unintentionally or intentionally. The response rate was 67 % of physicians and 46 % of the general population. A majority of both physicians [56 % (CI 50–62)] and the general population [53 % (CI 49–58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient’s symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. The study indicated that physicians and the general population have similar opinions regarding discontinuing life-sustaining treatment and providing effective drugs which might unintentionally hasten death but seem to have different views on intentions. The results might be helpful to physicians wanting to examine their own intentions when providing adequate treatment at the end of life. (shrink)

The ability to judge accurately whether or not an action can be accomplished successfully is critical for selecting appropriate response options that enable adaptive behaviors. Such affordance judgments are thought to rely on the perceived fit between environmental properties and knowledge of one's current physical capabilities. Little, however, is currently known about the ability of individuals to judge their own affordances following a stroke, or about the underlying neural mechanisms involved. To address these issues, we employed a signal detection approach (...) to investigate the impact of left or right hemisphere injuries on judgments of whether a visual object was located within reach while remaining still. Regarding perceptual sensitivity and accuracy in judging reachability, there were no significant group differences between healthy controls, right brain damaged and left brain damaged stroke patients. However, while healthy controls and RBD patients demonstrated a negative response criterion and thus overestimated their reach capability, LBD patients' average response criterion converged to zero, indicating no judgment tendency. Critically, the LBD group's judgment tendency pattern is consistent with previous findings in this same sample on an affordance judgment task that required estimating whether the hand can fit through apertures. Lesion analysis suggests that this loss of judgment tendency may be associated with damage to the left insula, the left parietal and middle temporal lobe. Based on these results, we propose that damage to the left ventro-dorsal stream disrupts the retrieval and processing of a stable criterion, leading to stronger reliance on intact on-line body-perceptive processes computed within the preserved bilateral dorsal network. (shrink)

This study examined the effects of computer-assisted cognitive rehabilitation in a group of 16 brain-damaged patients. Therapeutic effectiveness was assessed by improvement on computer tasks, the results of neuropsychological tests and quality of life ratings. Participants suffered from mild to moderate attention and memory problems or aphasia. The procedure involved baseline assessment, a 15-week course of therapy conducted twice a week and posttest. Neuropsychological tests assessing attention, memory and language problems and quality of life ratings were administered twice: in (...) pre- and posttests. Twelve healthy controls were also examined twice using the same battery of neuropsychological tests. The RehaCom program and the Polish computer therapy program for aphasics called Afa-System were used for rehabilitation. The computer-assisted rehabilitation tasks were selected individually for each patient. The results showed significant improvement on computer-assisted tasks in all braindamaged subjects. However, none or very little improvement was observed on neuropsychological tests and quality of life ratings. The results of the study confirm the importance of using different types of measures to estimate the effectiveness of computer-assisted neuropsychological rehabilitation as well as the necessity of applying various kinds of therapy to improve cognitive, emotional and social functioning in brain-damaged patients. (shrink)

Our ethical obligations to another being depend at least in part on that being’s capacity for a mental life. Our usual approach to inferring the mental state of another is to reason by analogy: If another being behaves as I do in a circumstance that engenders a certain mental state in me, I conclude that it has engendered the same mental state in him or her. Unfortunately, as philosophers have long noted, this analogy is fallible because behavior and mental states (...) are only contingently related. If the other person is acting, for example, we could draw the wrong conclusion about his or her mental state. In this article I consider another type of analogy that can be drawn between oneself and another to infer the mental state of the other, substituting brain activity for behavior. According to most current views of the mind–body problem, mental states and brain states are non-contingently related, and hence inferences drawn with the new analogy are not susceptible to the alternative interpretations that plague the behavioral analogy. The implications of this approach are explored in two cases for which behavior is particularly unhelpful as a guide to mental status: severely brain–damaged patients who are incapable of intentional communicative behavior, and nonhuman animals whose behavioral repertoires are different from ours and who lack language. (shrink)