READINGS!

Question 1

Disorders of Consciousness

Question 2

Describe the case of Kate

Answer 2

• Kate - fell into a coma after flu-like illness
• Declared vegetative - meaning that she had sleep-wake cycles, but lacked conscious awareness

Question 3

What was unique about Kate’s case?

Answer 3

• Put into a PET scan - flashed pictures of friends and family to look for response from brain
• Not only did her brain respond to the faces, but the pattern of brain activity was strikingly similar to what we and others had seen when showing the faces of loved ones to healthy, aware individuals

Question 4

How were Kate’s brain activity scans possible? RESEARCH STUMPS

Answer 4

• Finding results has been difficult across similar patients (legally and medically)
• Unsure if the seemingly normal brain responses reflected an undetected consciousness or if they were more basic, automatic neural signals, largely independent of any higher-level conscious processing.

Question 5

Describe the functional magnetic resonance imaging (fMRI)-based experiments that Owen and colleagues carried out on individuals who had been deemed to be in a vegetative state

Speech/Nonspeech sounds

Answer 5

• sedated healthy participants and exposed them to the same combination of speech and nonspeech sounds that we had shown could elicit normal patterns of brain activity in some vegetative patients.
• Surprisingly, when these healthy subjects were rendered unconscious with the short-acting anesthetic propofol, the speech-perception areas of the brain were activated just as strongly as when the participants were wide awake.
• This crucial piece of evidence that the brain processes speech automatically, even when we are not conscious and aware that we are doing it.

Question 6

Describe the functional magnetic resonance imaging (fMRI)-based experiments that Owen and colleagues carried out on individuals who had been deemed to be in a vegetative state
Response to Command

Answer 6

• Patients were too injured to produce physical responses to commands, but could they produce a measurable brain response by just thinking about it?
• Just like the TV doctor who tells the patient to “Squeeze my hand if you can hear me,” we found we could elicit a reliable response to a command, visible by fMRI in the premotor cortex, by asking the volunteers to “Imagine playing tennis if you can hear me.”

Question 7

Describe three conditions (other than brain death) in which consciousness is compromised

Answer 7

• Coma
• Vegetative state (unconscious wakefulness state)
• Locked-in syndrome (CMD)
• Minimally conscious state

Question 8

Dysfunction Associated with Psychiatric Disorders

Question 9

Define stigma

Answer 9

• Stigma: characterized by societal prejudice and discrimination, profoundly influences psychiatric care, creating barriers to the timely recognition and treatment of mental health disorders
• Deeply embedded in societal norms, stigma is a multifaceted issue permeating every level of psychiatric care, leading to delayed treatment, increased morbidity, and a diminished quality of life for patients.

Question 10

How can stigma impact the individual?

Answer 10

• stigma can lead to fear and avoidance of mental health services, causing delays in seeking help even when a patient is in dire need

Question 11

How can stigma impact the families?

Answer 11

stigma can lead to shame and isolation, making seeking necessary support and resources more difficult.

Question 12

How can stigma impact the patient and their provider?

Answer 12

difficulty in establishing trustful and therapeutic relationships, which are essential for effective care

Question 13

How can stigma impact society?

Answer 13

• stigma can result in the misallocation of resources, with mental health services often being underfunded and overlooked
• social isolation/discrimination
• stereotyping

Question 14

Provide 2 examples of culturally-specific perceptions around mental health

Answer 14

• Healthcare providers are not immune to these cultural beliefs, and this can influence their practice. In some cultures, mental illnesses are viewed through a supernatural lens rather than a medical one (EX: Ethiopian)
• In many Asian societies, mental health issues are often perceived as a sign of personal weakness or a failure of self-control

Question 15

Explain 2 potential strategies to address mental health stigma

Answer 15

1. Public Awareness Campaigns
2. Cultural Competency Training for Healthcare Professionals

Question 16

Neuroplasticity

Question 17

List 2 obstacles to developing evidence-based therapies for recovery of function after cerebral injury

Answer 17

1. There is no generally accepted definition of what constitutes “recovery”; EX: the three legged cat (not necessarily recovering, but adapting)
2. Most animal studies have well-defined injuries that are controlled by the investigators whereas there is far more variance in human conditions

Question 18

Describe 3 general principles of plasticity in the normal brain, pointing to specific
research or findings for each

Answer 18

1. The brain is altered by a surprisingly wide variety of experiences throughout the lifespan
2. Different measures of neuronal change independently of each other and sometimes in opposite directions
3. Plastic changes are age-dependent

Question 19

The brain is altered by a surprisingly wide variety of experiences throughout the lifespan

Describe 3 general principles of plasticity in the normal brain, pointing to specific
research or findings for each

Answer 19

• Many of these experiences can be obvious or less inuitive.
• The brain can be changed by virtually any experience, and even a thought
• Some of the biggest changes in brain functioning come from drugs such as psychomotor stimulants or the administration of neurotrophic factors when used in combination with other experiences such as sensorimotor training.

Question 20

Different measures of neuronal change independently of each other and sometimes in opposite directions

Describe 3 general principles of plasticity in the normal brain, pointing to specific
research or findings for each

Answer 20

• There has been a tendency in the literature to see different neuronal changes as surrogates for one another
• One of the most common is to assume that changes in spine density reflect changes in dendritic length and vice versa.
• This turns out not to be the case as the two measures can vary independently and sometimes in opposite directions
• Furthermore, cells in different cortical layers, but in the same presumptive columns, can show very different responses to the same experiences

Question 21

Plastic changes are age-dependent

Describe 3 general principles of plasticity in the normal brain, pointing to specific
research or findings for each

Answer 21

• It is generally presumed that the developing brain will be more responsive to experiences than the adult or senescent brain.
• Furthermore, there are qualitatively different changes in the brain in response to what appears to be the same experience at different ages.
• For example, when weanling, adult, or senescent rats were placed in a complex environment, all groups showed large synaptic changes but they were surprisingly different

Question 22

Social Determinants of Health

Question 23

Describe, in general terms, Kate’s experience of being diagnosed with dementia

Answer 23

• Diagnosed young with a relatively rare form of dementia called semantic variant primary progressive aphasia
• Once she had her diagnosis, she was surprised by her options. Or really, the lack thereof: told to “give up on her job”, the medical community still see dementia as a death sentence; no grief and loss counseling
• Even some of her friends and family seemed to write her off once she told them about her diagnosis

Question 24

Describe, in general terms, a challenge Nikki experienced while caring for her mother with dementia.

Answer 24

• No one explained sundowning: could have such a great morning, and all of a sudden she’d be angry, throwing things, getting loud.
• Many people with dementia have trouble in the evening, quite literally when the sun goes down. They often get anxious, and irritated, and can sometimes lash out because they’re feeling afraid and out of control.

Question 25

New Frontiers

Question 26

Active BCIs ## Footnote Define active, reactive, and passive Brain-Computer Interfaces

Answer 26

* Require the user to **intentionally generate specific mental activities**, such as motor imagery, which are translated into commands for the BCI system. * These are purposeful and conscious acts used to control devices.

Question 27

Reactive BCIs ## Footnote Define active, reactive, and passive Brain-Computer Interfaces

Answer 27

* Rely on the user’s **voluntary focus on external stimuli, such as visual elements on a screen.** * For instance, in a P300 setting, users’ attention to flashing icons can determine input. The user responds to the environment, and the system reacts accordingly.

Question 28

Passive BCIs ## Footnote Define active, reactive, and passive Brain-Computer Interfaces

Answer 28

* Do not require intentional mental effort. * They monitor the user’s **brain activity while they perform tasks or are exposed to stimuli**, aiming to detect cognitive or emotional states (e.g., mental workload or stress levels), rather than control outputs.

Question 29

Being an agent ## Footnote Briefly comment on users’ self-perceptions around three categories: being an agent, participation, and self-definition

Answer 29

* **Users generally felt like active operators of the BCI**. Closely tied to the success of the system in executing the user’s intended actions. * When outputs **matched intentions, users reported feelings of control and responsibility.** * Failed commands sometimes led to self-blame or frustration, while other times they were attributed to technical issues or distractions.

Question 30

Participation ## Footnote Briefly comment on users’ self-perceptions around three categories: being an agent, participation, and self-definition

Answer 30

* BCI usage **enabled users to feel included in meaningful activities.** * Many appreciated being part of research teams or events like the Cybathlon, which gave them a sense of contribution, recognition, and teamwork. * Activities such as painting, gaming, or presenting in public further supported their social inclusion and personal fulfillment.

Question 31

Self-definition ## Footnote Briefly comment on users’ self-perceptions around three categories: being an agent, participation, and self-definition

Answer 31

* BCIs **influenced how users saw themselves, *often in empowering ways.*** * For example, r*egaining capabilities (like controlling a robotic arm) led to stronger self-worth*. * Some users incorporated the BCI into their self-image (e.g., identifying with a robotic limb or virtual avatar), while others maintained that technology did not change who they fundamentally were.

Question 32

Describe BCI users’ thoughts on their human integrity

Answer 32

* BCI users **did not feel that their human integrity was compromised by the technology.** * Instead, they viewed it as **enhancing or restoring their humanity**. * Rather than being seen as dehumanizing or turning them into “cyborgs,” BCIs were perceived as tools that support autonomy, participation, and self-expression.