Online research in philosophy

: Marcel says that the experience of ownership of actions is given in the specifications for action. He is referring not to a bodily movement but that which precedes it. Is the body involved or are all the changes in the brain? This paper examines the evidence for changes in the spinal cord and muscles that occur with motor imagery, simulation and preparation. There are changes in the alpha motoneurons and in the gamma motoneurons to the muscle spindles. These may be caused by stimulation from the covert efferent arm to the body. To experience the ownership of covert actions in the body requires feedback to the owner as their spatially perspectival source. There is evidence that an ascending pathway from the muscle spindles to the brain carries such feedback. This view of the feedback loop is integrated into the sensorimotor view of the genesis of consciousness of Ellis and Newton.

In early 2009, President Obama overturned the ban on federal funding for research involving the derivation of human embryonic stem cells (hESC). The Food and Drug Administration (FDA) also approved Geron’s first-in-human hESC trial for spinal cord injury (SCI) patients. We anticipate an increase in both research in the United States to derive hESC and applications to the FDA for approval of clinical trials involving transplantation of hESCs. An increase of such clinical trials will require a concomitant increase in the number of preceding preclinical assays. We examine important issues concerning the use of animals in SCI stem cell research that require a reevaluation of the moral permissibility of studies such as Geron’s.

Though there has been an array of methods to evaluate the extent of sarcoidosis, it is generally difficult to detect central nervous system involvement. Recently it has become accepted that 18F-FDG PET is more sensitive than gallium scintigraphy in finding sarcoid lesions, however its usefulness and limitations for detecting sarcoidosis in the central nervous system, especially in the spinal cord, has rarely been investigated. Two patients with pathologically confirmed sarcoidosis manifested spinal symptoms. We conducted 18F-FDG PET along with conventional imagings before and after treatment. Abnormal FDG uptakes which could not be detected by gallium scintigraphy were shown in the spinal cords in both patients. These abnormal uptakes were diminished in accordance with clinical improvement after treatment. Our findings suggest that 18F-FDG PET is effective in detecting and tracking the activity of spinal sarcoidosis.

Until comparatively recently, say the middle of the last century, spinal cord injury was fatal as pressure sores and other infections took their toll. Those with severe brain injuries, unable to move or even communicate, fared even worse; without movement or feeding such patients were nursed until nature took its course. Over the last few decades medical and nursing advances have enabled some of these vegetative patients to survive for considerable time, provoking, at times, ethical and legal dilemmas. Though they survived, without overt behaviour or clear communication their carers were frequently unsure how much residual function remained. Now real progress is occurring in this area thanks to the application of neuro-scientific methods by some outstanding groups of workers. Subjects with severe brain injury may begin in complete, unresponsive coma but then ‘lighten’ to one of three categories. In vegetative state (VS), patients are apparently awake but without evidence of voluntary behaviour and have no apparent awareness of self or environment, whilst in minimally conscious state (MCS) patients have some behaviour beyond the reflex but are not able to communicate effectively. These conditions usually result from widespread brain damage at either or both cortical and subcortical levels due to injury or anoxia, though they can also be seen in end stage neurological conditions like Alzheimer’s. In locked in syndrome (LIS), patients ‘awake’ from coma, usually due to stroke, aware of their surroundings and their situation but unable to speak or move, beyond eye lid control and eye movement. For many, LIS will be recognised from Bauby’s extraordinary account in ‘The Diving Bell and the Butterfly,’ though, incidentally, it was presaged in Samuel Beckett’s novella ‘The Unnameable.’ LIS reflects a profound disconnection between brain and body, except for the upper cranial nerves involved in eyelid movement. The overriding question is how much awareness these patients have..

Geron recently announced that it had begun enrolling patients in the world's first-in-human clinical trial involving cells derived from human embryonic stem cells (hESCs). This trial raises important questions regarding the future of hESC-based therapies, especially in spinal cord injury (SCI) patients. We address some safety and efficacy concerns with this research, as well as the ethics of fair subject selection. We consider other populations that might be better for this research: chronic complete SCI patients for a safety trial, subacute incomplete SCI patients for an efficacy trial, and perhaps primary progressive multiple sclerosis (MS) patients for a combined safety and efficacy trial.

Studies of perception have focussed on sensation, though more recently the perception of action has, once more, become the subject of investigation. These studies have looked at acute experimental situations. The present paper discusses the subjective experience of those with either clinical syndromes of loss of movement or sensation (spinal cord injury, sensory neuronopathy syndrome or motor stroke), or with experimental paralysis or sensory loss. The differing phenomenology of these is explored and their effects on intention and agency discussed. It is shown that sensory loss can have effects on the focussing of motor command and that for some a sense of agency can return despite paralysis.

This paper considers the importance of the body for self-esteem, communication, and emotional expression and experience, through the reflections of those who live with various neurological impairments of movement and sensation; sensory deafferentation, spinal cord injury and Möbius Syndrome (the congenital absence of facial expression). People with severe sensory loss, who require conscious attention and visual feedback for movement, describe the imperative to use the same strategies to reacquire gesture, to appear normal and have embodied expression. Those paralysed after spinal cord injury struggle to have others see them as people rather than as people in wheelchairs and have been active in the disability movement, distinguishing between their medical impairment and the social induced disability others project onto them. Lastly those with Möbius reveal the importance of the face for emotional expression and communication and indeed for emotional experience itself. All these examples explore the crucial role of the body as agent for social and personal expression and self-esteem.