Why Enhancing Autonomy Is Not a Question of Improving Single Aspects of Reasoning Abilities through Neuroenhancement

In a recent paper, Schaefer et al. proposed to enhance autonomy via improving reasoning abilities through (genetic) cognitive enhancement [1]. While initially their idea additionally seems to elegantly avoid objections against genetic enhancements based on the value of autonomy, we want to draw attention to several problems their approach poses. First, we will show that it is not at all clear that safe and meaningful methods to genetically or pharmaceutically enhance cognition will be feasible any time soon. Second, we want to provide a deeper discussion of the role of cognition and reasoning abilities in philosophical concepts of autonomy, as discussed in the mentioned paper. In doing so, we wish to demonstrate that using reasoning abilities as the common denominator in different accounts of autonomy in the context of enhancement does not do justice to the highly complex interrelations between cognition, reasoning abilities and autonomy. Neither should this way of arguing be accepted as a basis to call for practical outcomes, such as funding research into e. g. genetic cognitive enhancements, if the examined concepts of autonomy are taken seriously.     

Extending Our View on Using BCIs for Locked-in Syndrome

Locked-in syndrome (LIS) is a severe neurological condition that typically leaves a patient unable to move, talk and, in many cases, initiate communication. Brain Computer Interfaces (or BCIs) promise to enable individuals with conditions like LIS to re-engage with their physical and social worlds. In this paper we will use extended mind theory to offer a way of seeing the potential of BCIs when attached to, or implanted in, individuals with LIS. In particular, we will contend that functionally integrated BCIs extend the minds of individuals with LIS beyond their bodies, allowing them greater autonomy than they can typically hope for in living with their condition. This raises important philosophical questions about the implications of BCI technology, particularly the potential to change selves, and ethical questions about whether society has a responsibility to aid these individuals in re-engaging with their physical and social worlds. It also raises some important questions about when these interventions should be offered to individuals with LIS and respecting the rights of these individuals to refuse intervention. By aiding willing individuals in re-engaging with their physical and social worlds, BCIs open up avenues of opportunity taken for granted by able individuals and introduce new ways in which these individuals can be harmed. These latter considerations serve to highlight our emergent social responsibilities to those individuals who will be suitable for, and receive, BCIs.

No cross-sectional evidence for an increased relation of cognitive and sensory abilities in old age1

Objectives: A key question in gerontological research concerns whether good functioning can be maintained in some cognitive abilities in old age, even if deficits occur in other cognitive or sensory abilities. Our goals were to investigate relations of cognitive and sensory abilities in old age, whether these relations differed in size across old age, and whether this was affected by general cognitive ability (processing speed), educational level, and/or general health status.

Methods: Two thousand eight hundred and twelve older adults (aged 65–101, M = 77.9 years) from the Vivre–Leben–Vivere survey served as cross-sectional sample for the present study. We administered psychometric tests on processing speed (the speed of cognitive processing), cognitive flexibility (the ability to alternate between cognitive operations), and verbal abilities (vocabulary). In addition, we interviewed individuals on their hearing, eyesight, educational level, and general health status. We regressed sizes of relations between abilities (calculated within each 1-year age tranche) on mean age within the corresponding age tranche, with the number of participants within the corresponding age tranche as case weights.

Results: We observed a decrease in relations between processing speed and cognitive flexibility in old age that was particularly pronounced in individuals with high educational level (r = ?.41). In contrast, we did not find differences in relations between other cognitive and sensory abilities across old age, which held for different levels of general cognitive ability, education, and general health status.

Conclusion: Present data do not support the view of a generally increased relation of cognitive and sensory abilities in old age.     

On the control of brain-computer interfaces by users with cerebral palsy

ObjectiveBrain-computer interfaces (BCIs) have been proposed as a potential assistive device for individuals with cerebral palsy (CP) to assist with their communication needs. However, it is unclear how well-suited BCIs are to individuals with CP. Therefore, this study aims to investigate to what extent these users are able to gain control of BCIs.MethodsThis study is conducted with 14 individuals with CP attempting to control two standard online BCIs (1) based upon sensorimotor rhythm modulations, and (2) based upon steady state visual evoked potentials.ResultsOf the 14 users, 8 are able to use one or other of the BCIs, online, with a statistically significant level of accuracy, without prior training. Classification results are driven by neurophysiological activity and not seen to correlate with occurrences of artifacts. However, many of these users’ accuracies, while statistically significant, would require either more training or more advanced methods before practical BCI control would be possible.ConclusionsThe results indicate that BCIs may be controlled by individuals with CP but that many issues need to be overcome before practical application use may be achieved.SignificanceThis is the first study to assess the ability of a large group of different individuals with CP to gain control of an online BCI system. The results indicate that six users could control a sensorimotor rhythm BCI and three a steady state visual evoked potential BCI at statistically significant levels of accuracy (SMR accuracies; mean ± STD, 0.821 ± 0.116, SSVEP accuracies; 0.422 ±  0.069).     

The Asilomar Survey: Stakeholders’ Opinions on Ethical Issues Related to Brain-Computer Interfacing

Brain-Computer Interface (BCI) research and (future) applications raise important ethical issues that need to be addressed to promote societal acceptance and adequate policies. Here we report on a survey we conducted among 145 BCI researchers at the 4^th International BCI conference, which took place in May–June 2010 in Asilomar, California. We assessed respondents’ opinions about a number of topics. First, we investigated preferences for terminology and definitions relating to BCIs. Second, we assessed respondents’ expectations on the marketability of different BCI applications (BCIs for healthy people, BCIs for assistive technology, BCIs-controlled neuroprostheses and BCIs as therapy tools). Third, we investigated opinions about ethical issues related to BCI research for the development of assistive technology: informed consent process with locked-in patients, risk-benefit analyses, team responsibility, consequences of BCI on patients’ and families’ lives, liability and personal identity and interaction with the media. Finally, we asked respondents which issues are urgent in BCI research.     

Parental report of cognitive difficulties,quality of life and rehabilitation in children with epilepsy or treated for brain tumour

Purpose: Paediatric neurological chronic conditions are often associated with physical, cognitive, psychological and behavioural difficulties that may affect quality of life (QOL) of children and their families. In this study, we compare parental report of difficulties and rehabilitation in children with various epileptic syndromes or treated for a benign or malignant brain tumour.

Method: One hundred fifty-three children aged between 6 and 12 years were included, 119 with epilepsy (non-idiopathic generalized 31, non-idiopathic partial 62, idiopathic 26) and 34 treated for a brain tumour. Parents answered a multidimensional questionnaire on child's autonomy and cognitive or behavioural difficulties, impact of the illness on their own everyday life, and rehabilitation.

Results: Learning difficulties were reported by a majority of parents in all groups. Behavioural and autonomy problems were more often reported in the non-idiopathic generalized epilepsy group. Report of tiredness was more frequent and of disrupting behaviour less frequent in the tumour group than in epilepsy. Impact of the child's illness on parents’ QOL was strong in all groups, and stronger in case of severe forms of epilepsy.

Conclusions: Parental concerns are important to consider for rehabilitation programmes adapted to each child with these neurological conditions.     

Embodied Tools, Cognitive Tools and Brain-Computer Interfaces

In this paper I explore systematically the relationship between Brain-Computer Interfaces (BCIs) and their human users from a phenomenological and cognitive perspective. First, I functionally decompose BCI systems and develop a typology in which I categorize BCI applications with similar functional properties into three categories, those with (1) motor, (2) virtual, and (3) linguistic applications. Second, developing and building on the notions of an embodied tool and cognitive tool, I analyze whether these distinct BCI applications can be seen as bodily or cognitive extensions. Contrary to some recent philosophical claims, I will argue that, although BCI technology may have the potential to become bodily and cognitive extensions for skilled users, at this stage they are not. And while the electrodes may to a variable degree be transparent and incorporated in the body schema, the BCI system as a whole is not. Moreover, BCIs do not have a functional role characteristic for cognition and are therefore not cognitive extensions. Third, based on concepts from the distributed cognition framework, I give a number of suggestions to improve the interface design of linguistic applications, i.e. BCIs that allow its user to spell words by selecting letters on a screen. These suggestions may result in cognitive extension and would enhance the autonomy and quality of life of its users. In sum, in this paper I develop a typology, analysis and critique on the current philosophical debate on BCIs, thereby providing a richer conceptual understanding of BCI systems which allows me to offer some suggestions for improving the interface design of linguistic applications.     

A combined brain-computer interface based on P300 potentials and motion-onset visual evoked potentials

Brain-computer interfaces (BCIs) allow users to communicate via brain activity alone. Many BCIs rely on the P300 and other event-related potentials (ERPs) that are elicited when target stimuli flash. Although there have been considerable research exploring ways to improve P300 BCIs, surprisingly little work has focused on new ways to change visual stimuli to elicit more recognizable ERPs. In this paper, we introduce a "combined" BCI based on P300 potentials and motion-onset visual evoked potentials (M-VEPs) and compare it with BCIs based on each simple approach (P300 and M-VEP). Offline data suggested that performance would be best in the combined paradigm. Online tests with adaptive BCIs confirmed that our combined approach is practical in an online BCI, and yielded better performance than the other two approaches (P<0.05) without annoying or overburdening the subject. The highest mean classification accuracy (96%) and practical bit rate (26.7bit/s) were obtained from the combined condition.     

Incongruent perceptions of the care values of hospitalized persons with dementia: a pilot study of patient-family caregiver dyads

Objective: Many difficult decisions are made in the inpatient hospital setting regarding the daily care of persons with dementia (PWDs). Incongruent perceptions of the PWD's care values limit the family caregiver's ability to make surrogate decisions. The objectives of this pilot study were to describe and identify determinants of incongruent perceptions in the hospital setting.

Methods: Using multilevel modeling (MLM), we examined cross-sectional data collected from 42 PWD-family caregiver dyads.

Results: There was a significant amount of incongruence, on average, for all four subscales representing the PWD's care values: autonomy = ?0.33 (p < .001); burden = ?.49 (p < .001); safety/quality of care = ?.26 (p < .001); and social interactions = ?.21 (p = .004). Family caregivers (CG) rated the importance of care values to the PWD as lower than the PWD rated the importance. Determinants of greater incongruence included higher relationship strain and fewer positive dyadic interactions.

Conclusion: Our findings reveal significant levels of incongruence in perceptions of the PWD's values among dementia care dyads in the hospital setting. Our analysis suggests a potential impact of relationship variables on incongruence. Further research is needed around this overlooked interpersonal context for supporting the dementia care dyad in the hospital setting.     

Functioning of patients with chronic idiopathic axonal polyneuropathy (CIAP)

Abstract Although patients with Chronic Idiopathic Axonal Polyneuropathy (CIAP) report a slow deterioration of sensory and motor functions, the impact of this deterioration on daily functioning has not yet been investigated in detail. The first aim of this crosssectional study involving 56 patients with CIAP was, therefore, to assess patients' functioning with use of the International Classification of Functioning, Disability and Health (ICF). The second aim was to find determinants of walking ability, dexterity, and autonomy. Fatigue and limited walking ability were present in most patients and differed considerably. In regression models, age, muscle strength, and fatigue together explained 63% of the variance in walking ability, which by itself explained almost 50% of the variance in patients' autonomy indoors and outdoors (42% and 49%, respectively). Muscle strength and sensory function scores together explained 30% of the variance in dexterity scores, which in turn explained only 13% of the variance in autonomy indoors. The diminished autonomy of patients with CIAP might be improved by reducing fatigue, by means of training, and by improving walking ability.     

Error probability of intracranial brain computer interfaces under non-task elicited brain states

Objective

Intracranial brain computer interfaces (BCIs) can be connected to the user’s cortex permanently. The interfaces response when fed with non-task elicited brain activity becomes important as design criterion: ideally intracranial BCIs should remain silent. We study their error probability in the form of false alarms.

Methods

Using electrocorticograms recorded during task and non-task brain states, we compute false alarms, investigate their origin and introduce strategies to reduce them, using signal detection theory, classifier cascading and adaptation concepts.

Results

We show that the incessant dynamics of the brain is prone to spontaneously produce signals, the spectral and topographical characteristics of which can resemble those associated with common control tasks, generating brain state classification errors.

Conclusions

In addition to hit and bit rates, response of BCIs to non-task brain states constitutes an important measure of BCI performance. Static classification cascading reduces considerably false positives during no-task brain states.

Significance

False alarms in intracranial BCIs are undesirable and could have dangerous consequences for the users. Designs which effectively incorporate the error correction strategies discussed in this paper, could be more successful when taken from the laboratory or acute care setting and used in the real world.     

Theory of Mind and referring expressions after Traumatic Brain Injury

ABSTRACT

Background: This study focused on the linguistic consequences of damage to Theory of Mind (TOM) in patients after Traumatic Brain Injury (TBI). It was designed to extend a previous study that tested the consequences of TOM impairment (aTOMia) on referring abilities in right-hemisphere damaged patients.

Aims: To explore whether aTOMia in patients with TBI affects their use and comprehension of various referring expressions (definite and indefinite noun phrases, proper names and pronouns).

Methods and Procedures: We identified individuals with TOM impairment (aTOMia) in a group of 15 TBI patients using a battery of six types of TOM task. We then tested two groups of TBI patients: participants with aTOMia and participants without aTOMia, compared to a control group of non brain-damaged participants. Four TOM-related language tasks assessed their ability to vary the use of referring expressions according to the knowledge of the discourse partners.

Outcomes and Results: Five of the participants showed TOM impairment (aTOMia), whereas ten showed intact-TOM ability. The two groups did not differ according to most neuropsychological measures, or on grammatical performance. On the TOM-related language tasks the participants with aTOMia performed consistently worse than the participants with TBI and intact-TOM, and the control group.

Conclusions: Individuals after TBI do not form a homogenous group regarding their TOM abilities. Some patients show TOM-related language impairment, and should be considered for language evaluation and treatment focusing on aspects of language that depend on TOM ability.     

Prospective memory assessment in acute mild traumatic brain injury

Abstract

Objective: Prospective memory (PM) is the ability to remember to perform an intention at the appropriate time in the future. It is of primary importance for daily living, and its disruption may impact functional autonomy. To date, few studies have examined PM during the acute phase of mild traumatic brain injury (mTBI), despite the high prevalence of this neurological condition and its potential impact on cognition.

Method: Twenty mTBI patients (time since injury ranged from 45 to 73?days) and 15 healthy control participants performed the Ecological Test of Prospective Memory (TEMP), a simulated errand task in which participants were required to execute 10 event-based (EB) and five time-based (TB) tasks. The TEMP separately evaluates PM phases as well as prospective and retrospective components in event- and time-based conditions. Participants also completed a neuropsychological test battery. Correlations were performed between cognitive composite scores and the TEMP.

Results: mTBI patients experienced difficulty in learning the content of intentions, retrieving these intentions in the time-based condition (prospective component) and recalling the associated actions in the event- and time-based conditions (retrospective component). Retrospective memory composite score was correlated with the learning and retention phases of the TEMP, whereas attention/working memory and executive composite scores were correlated with the time-based condition and performance on the ongoing task.

Conclusion: These results suggest the presence of global PM impairment during the acute phase of mTBI, as well as impairment of retrospective memory, attention/working memory, and executive functions, which are key components for PM performance.     

Remorse: Psychological and Jurisprudential Perspectives,by M Proeve and S Tudor

When clinicians are asked to assess the financial capacity of those with severe mental illnesses, they often use a patient self-report. However, agreement between self-reported financial abilities and actual performance has not been established. In this study, concordance between self-reported financial abilities and performance of financial tasks on the Direct Assessment Functional Status (DAFS) scale was examined among 24 persons with severe mental illnesses with a guardian/payee, 25 without a guardian/payee, and 25 nonaffected controls. The groups were generally similar in the proportion of agreement between self-reported and performance-based financial abilities. However, the financially dependent group evidenced a significant discrepancy between self-reported ability to balance a chequebook and their performance on the DAFS relative to comparison groups, indicating that the accuracy of the severely mentally ill participants' self-reported financial abilities can be compromised. Thus, performance-based measures should be employed when assessing financial capacity.     

Non-invasive brain–computer interface system: Towards its application as assistive technology

The quality of life of people suffering from severe motor disabilities can benefit from the use of current assistive technology capable of ameliorating communication, house-environment management and mobility, according to the user's residual motor abilities. Brain–computer interfaces (BCIs) are systems that can translate brain activity into signals that control external devices. Thus they can represent the only technology for severely paralyzed patients to increase or maintain their communication and control options.Here we report on a pilot study in which a system was implemented and validated to allow disabled persons to improve or recover their mobility (directly or by emulation) and communication within the surrounding environment. The system is based on a software controller that offers to the user a communication interface that is matched with the individual's residual motor abilities. Patients (n = 14) with severe motor disabilities due to progressive neurodegenerative disorders were trained to use the system prototype under a rehabilitation program carried out in a house-like furnished space. All users utilized regular assistive control options (e.g., microswitches or head trackers). In addition, four subjects learned to operate the system by means of a non-invasive EEG-based BCI. This system was controlled by the subjects’ voluntary modulations of EEG sensorimotor rhythms recorded on the scalp; this skill was learnt even though the subjects have not had control over their limbs for a long time.We conclude that such a prototype system, which integrates several different assistive technologies including a BCI system, can potentially facilitate the translation from pre-clinical demonstrations to a clinical useful BCI.     

Executive skills and their functional implications: Approaches to rehabilitation after childhood TBI

Background: It is widely acknowledged that children recover differently from adults following traumatic brain injury. The impact of neurological injury in the context of developing skills and changing expectations of behaviour requires a developmental approach to rehabilitation that considers children's abilities across home, school and community environments.

Methods: This article aims to provide an overview of the impact of executive deficits on everyday functioning and to review information about intervention strategies that support long term development of skills.

Results and conclusions: While individual disciplines are not directly referred to in this paper, input from a comprehensive and co-ordinated interdisciplinary team is crucial to understanding and reducing the impact of executive deficits on functional performance.     

Strategies for Assisting People with Psychiatric Disabilities to Assert Their ADA Rights and Arrange Job Accommodations

Abstract

Psychiatric rehabilitation programs that continue to ‘make job placements” need to assess the impact that such a caretaker approach has on the long term abilities of people with psychiatric disabilities to find their own jobs and then communicate independently with employers. Following a national survey of job coaches and job developers, the authors suggest a teaching approach to providing employment support services: job developers and job coaches should teach the ADA and workplace communication skills, so that individuals can develop the ability to negotiate with employers on their own behalf. Practitioners can also enhance this teaching approach to provision of employment support services through the development of employment peer support groups.     

General learning ability regulates exploration through its influence on rate of habituation

“General intelligence” is purported to influence diverse domain-specific learning abilities in humans, and previous research indicates that an analogous trait is expressed in CD-1 outbred mice. In humans and mice, exploratory tendencies are predictive of general cognitive abilities, such that higher cognitive abilities are associated with elevated levels of exploration. However, in mice, repeated exposure to novel environments outside the home cage has been found to up-regulate exploratory tendencies but has no commensurate effect on general learning abilities, suggesting that exploratory tendencies do not causally influence general cognitive performance. This leaves open the question of what is responsible for the robust relationship observed between exploration and general learning abilities? In the present experiments, we find that differential rates of habituation (e.g., to a novel open field) between animals of high and low general learning abilities accounts for the relationship between exploration and learning abilities. First, we up-regulated exploration by exposing mice to a series of novel environments. Similar to its lack of effect on learning tasks, this up-regulation of exploration had no commensurate effect on habituation to novel objects or stimuli. Next we examined the relationship between general learning abilities and exploration under conditions where habituation had a high or low impact on exploratory behaviors. A strong correlation between general learning abilities and exploration was observed under conditions where the levels of habituation (to a novel object or an open field) between animals of high and low general learning abilities were allowed to vary. However, this same correlation was attenuated when the level of habituation attained by animals of high and low general learning abilities was asymptotic or held constant across animals. In total, these results indicate that the relationship between exploration and general learning abilities is accounted for by the impact of habituation (itself a form of learning) on behaviors indicative of exploration.     

Comparing the performance of people who stutter and people who do not stutter on the Test of Everyday Attention

Introduction: Compelling findings into the relationship between stuttering and attentional ability have started to emerge, with some child and adult studies indicating poorer attentional ability among people who stutter (PWS). The purpose of the present research was to provide a more complete picture of the attentional abilities of PWS, as well as to gather insights into their individual attentional performance.

Method: We compared the attentional ability of PWS to that of people who do not stutter (PWNS) by using the Test of Everyday Attention (TEA). TEA is a clinical assessment battery with a very good validity and reliability comprising 8 subtests that pose differential demands on sustained attention, selective attention, attentional switching, and divided attention. Fifty age- and gender-matched PWS and PWNS (aged 19–77 years) took part in the study. Importantly, we also examined stuttering severity in the PWS group.

Results: PWS performed significantly worse on tasks tapping into visual selective and divided attentional resources. Furthermore despite failing to reach statistical significance, the results also revealed an interesting trend for stuttering to be associated with poorer performance on two subtests measuring attentional switching and one tapping into auditory selective attention. Moreover, as hypothesized, there was also a negative association between stuttering severity and performance on two TEA subtests measuring visual selective attention. Finally, the type of TEA test variant produced no significant effect on performance.

Conclusions: We interpret these results as indicative of stuttering being associated with poorer performance on tasks measuring certain attentional abilities. These tie in well with theoretical models identifying speech production as particularly attention-demanding in stuttering or approaches placing attentional dysfunction at the heart of the condition. The present research also has practical implications for the use of attentional training to improve fluency.     

Experiences of taking neuroleptic medication and impacts on symptoms,sense of self and agency: a systematic review and thematic synthesis of qualitative data

Purpose

Neuroleptic (antipsychotic) drugs reduce psychotic symptoms, but how they achieve these effects and how the drugs’ effects are experienced by people who take them are less well understood. The present study describes a synthesis of qualitative data about mental and behavioural alterations associated with taking neuroleptics and how these interact with symptoms of psychosis and people’s sense of self and agency.

Methods

Nine databases were searched to identify qualitative literature concerning experiences of taking neuroleptic medication. A thematic synthesis was conducted.

Results

Neuroleptics were commonly experienced as producing a distinctive state of lethargy, cognitive slowing, emotional blunting and reduced motivation, which impaired functioning but also had beneficial effects on symptoms of psychosis and some other symptoms (e.g. insomnia). For some people, symptom reduction helped restore a sense of normality and autonomy, but others experienced a loss of important aspects of their personality. Across studies, many people adopted a passive stance towards long-term medication, expressing a sense of resignation, endurance or loss of autonomy.

Conclusions

Neuroleptic drugs modify cognition, emotions and motivation. These effects may be associated with reducing the intensity and impact of symptoms, but also affect people’s sense of self and agency. Understanding how the effects of neuroleptics are experienced by those who take them is important in developing a more collaborative approach to drug treatment in psychosis and schizophrenia.