Locked-in Syndrome and BCI - Towards an Enactive Approach to the Self

It has been argued that Extended Cognition (EXT), a recently much discussed framework in the philosophy of cognition, would serve as the theoretical basis to account for the impact of Brain Computer Interfaces (BCI) on the self and life of patients with Locked-in Syndrome (LIS). In this paper I will argue that this claim is unsubstantiated, EXT is not the appropriate theoretical background for understanding the role of BCI in LIS. I will critically assess what a theory of the extended self would comprise and provide a list of desiderata for a theory of self that EXT fails to accommodate for. There is, however, an alternative framework in Cognitive Science, Enactivism, which entails the basis for an account of self that is able to accommodate for these desiderata. I will outline some first steps towards an Enactive approach to the self, suggesting that the self could be considered as a form of human autonomy. Understanding the self from an enactive point of view will allow to shed new light on the questions of whether and how BCIs affect or change the selves of patients with LIS.     

Embodied Cognition as a Practical Paradigm: Introduction to the Topic,The Future of Embodied Cognition

Embodied cognition pertains to the consequences on thought and emotion of living with our particular human sensory and motor systems. The consequences are quite varied, and researchers across the cognitive sciences have made great discoveries in line with this principle. However, while we offer this principle, it is necessarily broad, and searching for a single unifying theme has not brought researchers together behind a clearly defined endeavor. Rather than attempt to do so, we embrace the variation and specificity in research endeavors across the cognitive sciences to forge a practical sense in which embodied cognition can be a useful paradigm within which to think and work. This topic, The Future of Embodied Cognition, includes contributions from eight sets of authors communicating how embodied cognition has and will influence specific approaches within their disciplines. Through this format, the lessons from each contribution can be easily shared with colleagues across disciplines. As these lessons continue to be shared, a paradigm that is of practical use will emerge, and its coherence across disciplines will follow. To illustrate the practical aspect of this approach, in this introductory paper, we take one lesson from each contribution that must be shared and illustrate how each lesson can apply to a single, specific topic of study.     

Transient Locked-in Syndrome and Basilar Artery Vasospasm

Background  

Cerebral vasospasm is the main cause of neurological mortality and morbidity following subarachnoid hemorrhage. Basilar artery vasospasm (BAVS) is associated with a high morbidity and may have multiple clinical presentations.     

The Locked-in Syndrome: Perspectives from Ethics,History, and Phenomenology

The existential situation of persons who suffer from the locked-in syndrome (LIS) raises manifold issues significant to medical anthropology, phenomenology     

Symbol Interdependency in Symbolic and Embodied Cognition

Whether computational algorithms such as latent semantic analysis (LSA) can both extract meaning from language and advance theories of human cognition has become a topic of debate in cognitive science, whereby accounts of symbolic cognition and embodied cognition are often contrasted. Albeit for different reasons, in both accounts the importance of statistical regularities in linguistic surface structure tends to be underestimated. The current article gives an overview of the symbolic and embodied cognition accounts and shows how meaning induction attributed to a specific statistical process or to activation of embodied representations should be attributed to language itself. Specifically, the performance of LSA can be attributed to the linguistic surface structure, more than special characteristics of the algorithm, and embodiment findings attributed to perceptual simulations can be explained by distributional linguistic information.     

From Movement to Thought: Executive Function, Embodied Cognition, and the Cerebellum

This paper posits that the brain evolved for the control of action rather than for the development of cognition per se. We note that the terms commonly used to describe brain-behavior relationships define, and in many ways limit, how we conceptualize and investigate them and may therefore constrain the questions we ask and the utility of the "answers" we generate. Many constructs are so nonspecific and over-inclusive as to be scientifically meaningless. "Executive function" is one such term in common usage. As the construct is increasingly focal in neuroscience research, defining it clearly is critical. We propose a definition that places executive function within a model of continuous sensorimotor interaction with the environment. We posit that control of behavior is the essence of "executive function," and we explore the evolutionary advantage conferred by being able to anticipate and control behavior with both implicit and explicit mechanisms. We focus on the cerebellum's critical role in these control processes. We then hypothesize about the ways in which procedural (skill) learning contributes to the acquisition of declarative (semantic) knowledge. We hypothesize how these systems might interact in the process of grounding knowledge in sensorimotor anticipation, thereby directly linking movement to thought and "embodied cognition." We close with a discussion of ways in which the cerebellum instructs frontal systems how to think ahead by providing anticipatory control mechanisms, and we briefly review this model's potential applications.     

Leisure Activities in Prader-Wlli Syndrome: Implications for Health, Cognition and Adaptive Functioning

Although hyperphagia and compulsivity in Prader-Willi syndrome (PWS) are well described, recreation and adaptive skills are relatively unexplored. Parents of 123 participants with PWS (4–48 years) completed measures of their child’s adaptive, recreation, and problem behaviors. Offspring received cognitive testing. Watching TV was the most frequent recreational activity, and was associated with compulsivity and skin picking. BMIs were negatively correlated with physical play, and highest in those who watched TV and played computer games. Computer games and physical activities were associated with higher IQ and adaptive scores. People with PWS and other disabilities need to watch less TV and be more engaged in physical activities, games, and leisure pursuits that are fun, and may bring cognitive or adaptive advantages.     

Attitudes towards Personhood in the Locked-in Syndrome: from Third- to First- Person Perspective and to Interpersonal Significance

Personhood is ascribed on others, such that someone who is recognized to be a person is bestowed with certain civil rights and the right to decision making     

Concerning a Psychodynamic Function of Perplexity,Confusion, Suspicion,and Related Mental States

Abstract

Much has been written about Ernest Hemingway, including discussion of his well-documented mood disorder, alcoholism, and suicide. However, a thorough biopsychosocial approach capable of integrating the various threads of the author's complex psychiatric picture has yet to be applied. Application of such a psychiatric view to the case of Ernest Hemingway in an effort toward better understanding of the author's experience with illness and the tragic outcome is the aim of this investigation. Thus, Hemingway's life is examined through a review and discussion of biographies, psychiatric literature, personal correspondence, photography, and medical records. Significant evidence exists to support the diagnoses of bipolar disorder, alcohol dependence, traumatic brain injury, and probable borderline and narcissistic personality traits. Late in life, Hemingway also developed symptoms of psychosis likely related to his underlying affective illness and superimposed alcoholism and traumatic brain injury. Hemingway utilized a variety of defense mechanisms, including self–medication with alcohol, a lifestyle of aggressive, risk–taking sportsmanship, and writing, in order to cope with the suffering caused by the complex comorbidity of his interrelated psychiatric disorders. Ultimately, Hemingway's defense mechanisms failed, overwhelmed by the burden of his complex comorbid illness, resulting in his suicide. However, despite suffering from multiple psychiatric disorders, Hemingway was able to live a vibrant life until the age of 61 and within that time contribute immortal works of fiction to the literary canon.     

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.     

Cognition and the five-factor model of the Positive and Negative Syndrome Scale in schizophrenia

Different exploratory and confirmatory factorial analyses of the Positive and Negative Syndrome Scale (PANSS) have found a number of factors other than the original positive, negative, and general psychopathology. Based on a review of previous studies and using confirmatory factor analyses (CFA), Wallwork et al. (Schizophr Res 2012; 137: 246–250) have recently proposed a consensus five-factor structure of the PANSS. This solution includes a cognitive factor which could be a useful measure of cognition in schizophrenia. Our objectives were 1) to study the psychometric properties (factorial structure and reliability) of this consensus five-factor model of the PANSS, and 2) to study the relationship between executive performance assessed using the Wisconsin Card Sorting Test (WCST) and the proposed PANSS consensus cognitive factor (composed by items P2-N5-G11). This cross-sectional study included a final sample of 201 Spanish outpatients diagnosed with schizophrenia. For our first objective, CFA was performed and Cronbach's alphas of the five factors were calculated; for the second objective, sequential linear regression analyses were used. The results of the CFA showed acceptable fit indices (NNFI = 0.94, CFI = 0.95, RMSEA = 0.08). Cronbach's alphas of the five factors were adequate. Regression analyses showed that this five-factor model of the PANSS explained more of the WCST variance than the classical three-factor model. Moreover, higher cognitive factor scores were associated with worse WCST performance. These results supporting its factorial structure and reliability provide robustness to this consensus PANSS five-factor model, and indicate some usefulness of the cognitive factor in the clinical assessment of schizophrenic patients.