Abstract:
:Unraveling the mysteries of consciousness, lost and regained, and perhaps even intervening so as to prompt recovery are advances for which neither the clinical nor the lay community are prepared. These advances will shake existing expectations about severe brain damage and will find an unprepared clinical context, perhaps even one inhospitable to what should clearly be viewed as important advances. This could be the outcome of this line of inquiry, if this exceptionally imaginative research can continue at all. This work faces a restrictive research environment that has the potential to imperil it. Added to the complexity of the scientific challenges that must be overcome is the societal context in which these investigations must occur. Research on human consciousness goes to the heart of our humanity and asks us to grapple with fundamental questions about the self. Added to this is the regulatory complexity of research on subjects who may be unable to provide their own consent because of impaired decision-making capacity, itself a function of altered or impaired consciousness. These factors can lead to a restrictive view of research that can favor risk aversion over discovery. In this paper, I attempt to explain systematically some of these challenges. I suggest that some of the resistance might be tempered if we view the needs of patients with severe brain injury through the prism of palliative care and adopt that field's ethos and methods when caring for and conducting research on individuals with severe brain damage and disorders of consciousness. To make this argument I draw upon the American pragmatic tradition and utilize clinical pragmatism, a method of moral problem-solving that my colleagues and I have developed to address ethical challenges in clinical care and research.
journal_name
Prog Brain Resjournal_title
Progress in brain researchauthors
Fins JJdoi
10.1016/S0079-6123(05)50040-2subject
Has Abstractpub_date
2005-01-01 00:00:00pages
565-82eissn
0079-6123issn
1875-7855pii
S0079-6123(05)50040-2journal_volume
150pub_type
杂志文章,评审abstract::Selective neuronal loss following status epilepticus was first described just under 100 years ago. The acute pathology following status epilepticus was shown to be 'ischemic cell change' and was assumed to arise through hypoxia/ischemia. Less than 30 years ago it was proposed, from experiments in primates, that the se...
journal_title:Progress in brain research
pub_type: 历史文章,杂志文章,评审
doi:10.1016/S0079-6123(02)35003-9
更新日期:2002-01-01 00:00:00
abstract::Schwann cells (SCs), when implanted in the injured spinal cord, support regeneration of axons, myelinate or ensheathe regenerated axons in a normal way, reduce cyst formation in the injured tissue, reduce secondary damage of tissue around the initial injury site, and modestly improve limb movements. If SC transplantat...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/B978-0-444-59544-7.00014-7
更新日期:2012-01-01 00:00:00
abstract::Network oscillations are proposed to provide the framework for the ongoing neural computations of the brain. Thus, an important aspect of understanding the functional roles of various cell classes in the brain is to understand the relationship of cellular activity to the ongoing oscillations. While many studies have c...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/S0079-6123(07)63012-X
更新日期:2007-01-01 00:00:00
abstract::Injuries to the adult mammalian spinal cord often lead to severe damage to both ascending (sensory) pathways and descending (motor) nerve pathways without the perspective of complete functional recovery. Future spinal cord repair strategies should comprise a multi-factorial approach addressing several issues, includin...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/S0079-6123(03)46029-9
更新日期:2004-01-01 00:00:00
abstract::Elucidation of the molecular basis of mammalian circadian rhythms has progressed dramatically in recent years through the characterization of mouse mutants. With the implementation of numerous mouse genetics programs, comprehensive sets of mutations in genes affecting circadian output measures have been generated. Alt...
journal_title:Progress in brain research
pub_type: 杂志文章
doi:10.1016/B978-0-444-59427-3.00015-0
更新日期:2012-01-01 00:00:00
abstract::Concerted efforts are realizing cell-based therapy for Parkinson's disease (PD). In this chapter, I describe efforts at the Center for iPS Cell Research and Application (CiRA), Kyoto University. These efforts use induced pluripotent stem cells (iPSCs) as donor cells. The iPSCs were established as human leukocyte antig...
journal_title:Progress in brain research
pub_type: 杂志文章
doi:10.1016/bs.pbr.2016.11.004
更新日期:2017-01-01 00:00:00
abstract::Cerebral malformations are best understood as abnormal tissue morphogenesis in the context of disorders of ontogenesis. In neuroembryology, the timing of onset and duration of abnormal genetic expression and neurodevelopmental processes are primordial and must always be assessed, regardless whether the dysgenesis is p...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/B978-0-444-63326-2.00010-7
更新日期:2014-01-01 00:00:00
abstract::High affinity binding sites for vasopressin (VP) are widely distributed within the rat brain and spinal cord. Since their presence is associated with neuronal sensitivity to VP application, their anatomical distribution maps structures which could be activated by endogenous VP. Interestingly, marked species-related di...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/s0079-6123(08)61561-7
更新日期:1998-01-01 00:00:00
abstract::Large-scale neural simulations have the marks of a distinct methodology which can be fruitfully deployed in neuroscience. I distinguish between two types of applications of the simulation methodology in neuroscientific research. Model-oriented applications aim to use the simulation outputs to derive new hypotheses abo...
journal_title:Progress in brain research
pub_type: 杂志文章
doi:10.1016/bs.pbr.2017.05.004
更新日期:2017-01-01 00:00:00
abstract::Poor control of attention-related and motor processes, often associated with behavioural or cognitive impulsivity, are typical features of children and adults with attention-deficit hyperactivity disorder (ADHD). Until recently clinicians have observed little need to improve on or add to the catecholaminergic model fo...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/S0079-6123(08)00926-6
更新日期:2008-01-01 00:00:00
abstract::In the developing rat spinal cord, formation and differentiation of the central pattern generator for locomotion occur during the prenatal period. Early on, excitatory synaptic transmission mediated by glycine receptors plays a leading role for rhythmogenesis, at a later stage, followed by glutamate-receptor-mediated ...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/s0079-6123(03)43005-7
更新日期:2004-01-01 00:00:00
abstract::Mechanism is at the heart of understanding, and this chapter addresses underlying brain mechanisms and pathways of cognition and the impact of sleep on these processes, especially those serving learning and memory. This chapter reviews the current understanding of the relationship between sleep/waking states and cogni...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/B978-0-444-53702-7.00001-4
更新日期:2010-01-01 00:00:00
abstract::The role of the superior colliculus in attending and orienting to sensory stimuli is facilitated by the presence within this midbrain nucleus of superimposed maps of different sensory modalities. We have studied the steps involved in the development of topographically-aligned maps of visual and auditory space in the f...
journal_title:Progress in brain research
pub_type: 杂志文章
doi:10.1016/s0079-6123(08)63340-3
更新日期:1996-01-01 00:00:00
abstract::Calcium binding proteins, such as calretinin, are abundantly expressed in distinctive patterns in the central nervous system but their physiological function remains poorly understood. Calretinin is expressed in cerebellar granule cells which provide the major excitatory input to Purkinje cells through parallel fibers...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/S0079-6123(04)48025-X
更新日期:2005-01-01 00:00:00
abstract::It has been tacitly assumed that a long descending motor tract axon consists of a private line connecting the cell of origin to a single muscle, as a motoneuron innervates a single muscle. However, this notion of a long descending motor tract referred to as a private line is no longer tenable, since recent studies hav...
journal_title:Progress in brain research
pub_type: 杂志文章
doi:10.1016/S0079-6123(05)51017-3
更新日期:2006-01-01 00:00:00
abstract::The therapeutic potential of stem cells for regeneration after cerebral lesion has become of great interest. This is particularly so for neurodegenerative diseases as well as for stroke. Contrary to more conventional, cerebroprotective treatment approaches, the focus of regeneration lies in a longer time window during...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/B978-0-444-59544-7.00004-4
更新日期:2012-01-01 00:00:00
abstract::Neural transplantation has emerged as a possible therapy for Parkinson's disease (PD). Clinical studies performed during the 1990s, where dopaminergic neurons derived from the human embryonic brain were transplanted into striatum of patients with PD, provided proof-of-principle that long-lasting therapeutic benefits c...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/S0079-6123(10)84014-2
更新日期:2010-01-01 00:00:00
abstract::Studies with nicotine have, from the outset, been of fundamental importance for the elucidation of physiological mechanisms. However, many nicotinic cholinoreceptors do not appear to subserve a physiological role, at least within the present framework of knowledge. The main challenge in the immediate future is to dete...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/s0079-6123(08)62461-9
更新日期:1989-01-01 00:00:00
abstract::Neuronal nitric oxide synthase (nNOS) participate in a variety of physiologic and pathologic processes in the nervous system. nNOS was originally felt to be a constitutively expressed enzyme, but recent observations suggest that its levels are dynamically controlled in response to neuronal development, plasticity and ...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/s0079-6123(08)63196-9
更新日期:1998-01-01 00:00:00
abstract::One of the more interesting and complex phenomena involving neurohypophysial hormones is the milk ejection reflex and the events surrounding it. Accordingly, many investigations over the years have taken up the challenge of elucidating its myriad aspects. Much has been learned from in vivo preparations about the seque...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/S0079-6123(08)00414-7
更新日期:2008-01-01 00:00:00
abstract::The fundamental obstacle to neuroprostheses based on penetrating microstimulation is the tissue's response to the device insertion and to the application of the electrical stimulation. Our long-term goal is to develop multichannel microstimulation of central nervous tissue for clinical therapy. The overall objective o...
journal_title:Progress in brain research
pub_type: 杂志文章
doi:10.1016/B978-0-444-53815-4.00011-X
更新日期:2011-01-01 00:00:00
abstract::Over the past three decades, developmental neurobiologists have made tremendous progress in defining basic principles of brain development. This work has changed the way we think about how brains develop. Thirty years ago, the dominant model was strongly deterministic. The relationship between brain and behavioral dev...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/B978-0-444-53884-0.00015-4
更新日期:2011-01-01 00:00:00
abstract::Research points to the notion that athletes have the potential to benefit from difficulty. This phenomenon-otherwise known as growth following adversity-has attracted increasing attention from sport psychology scholars. In this paper, we systematically review and synthesize the findings of studies in this area to bett...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/bs.pbr.2017.06.002
更新日期:2017-01-01 00:00:00
abstract::This chapter provides evidence of spatial and temporal changes in the behavior of neurons within Areas 5 and 4 of the sensorimotor cortex of a nonhuman primate while it was executing a perturbed arm-reaching task. Chronically implanted electrode arrays were used to record simultaneously from 37 to 58 neurons. Also mea...
journal_title:Progress in brain research
pub_type: 杂志文章
doi:10.1016/S0079-6123(03)43045-8
更新日期:2004-01-01 00:00:00
abstract::The studies reviewed in this chapter present a convincing argument that prostaglandins have direct actions at the level of the spinal cord to enhance nociception. Furthermore, an increasing body of evidence supports the hypothesis that one important site of action of these eicosanoids is the terminals of sensory neuro...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/s0079-6123(08)61801-4
更新日期:1995-01-01 00:00:00
abstract::The receptor tyrosine kinase B, TrkB, is the high-affinity receptor for brain-derived neurotrophic factor (BDNF). Much evidence supports a role for TrkB signaling in excitatory synapse formation. There have been a number of recent advances in understanding the cell biology of TrkB-mediated excitatory synaptogenesis. T...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/s0079-6123(06)57002-5
更新日期:2006-01-01 00:00:00
abstract::The midbrain has been shown to contain crucial nuclei for the control of vertical and torsional eye movements. Recent studies in monkeys demonstrated that midbrain lesions also affect head movements during gaze saccades, but so far clinical reports on the matter have been missing. We measured 3D eye and head movements...
journal_title:Progress in brain research
pub_type: 杂志文章
doi:10.1016/S0079-6123(08)00686-9
更新日期:2008-01-01 00:00:00
abstract::Since the sample size of a typical neuroimaging study lacks sufficient statistical power to explore unknown genomic associations with brain phenotypes, several international genetic imaging consortia have been organized in recent years to pool data across sites. The challenges and achievements of these consortia are c...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/bs.pbr.2015.07.026
更新日期:2016-01-01 00:00:00
abstract::A remarkable preparation for studying development and repair is the CNS of the newborn opossum which, removed in its entirety, survives in culture for more than 1 week. In suitable medium, cells continue to divide, mature and reflex activity is maintained. Moreover, nerve fibers grow rapidly, reliably and extensively ...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/s0079-6123(08)61141-3
更新日期:1994-01-01 00:00:00
abstract::Ocular dominance plasticity may be the paradigmatic in vivo model of activity-dependent plasticity. More than four decades of intense research has delineated the network-level rules that govern synaptic change in this model. The recent characterization of a murine model for ocular dominance plasticity has facilitated ...
journal_title:Progress in brain research
pub_type: 杂志文章,评审
doi:10.1016/S0079-6123(04)47008-3
更新日期:2005-01-01 00:00:00