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PubMed2000

Alteration to will as an experience of technology and nursing.

This paper presents one finding to arise from a recent qualitative research study that examined ways of understanding technology in surgical nursing, and examines its implications for nursing and health care practice. Although the research reported identified eight qualitatively different ways of understanding technology, this paper examines the specific experience that technology can alter will (volition). The experience described is a new area of knowledge and is in need of further examination and research. Nonetheless, it is significant to understanding technology, contemporary nursing practice and the provision of health care services. The paper concludes with some suggested approaches for curtailing the experience and a discussion related to challenges that arise from the finding that technology can alter the free will of nurses.

Attitude of Health Personnel↗
PubMed2005

Sexually violent predators: the risky enterprise of risk assessment.

Forensic experts are increasingly asked to consult in sexually violent predator (SVP) determinations. The substantive criteria for SVP standards vary substantially across jurisdictions, but typically include complex judgments regarding volitional impairment and predictive statements focused specifically on sexual violence. A common but questionable practice is the retrofitting of generic risk-assessment measures to address SVP criteria. The marked deficiencies of these measures in addressing the relevant questions, coupled with their methodological limitations, are noted. SVP determinations demand rigorous evaluations of relevant factors that are buttressed by empirically validated methods.

Forensic Psychiatry↗
PubMed1984

Organization of motor control by the normal human brain.

The research on the cerebral motor system in man was reviewed and supplemented by new results. Electrical stimulation and recordings of electrical activity, or measurements of the regional cerebral blood flow (rCBF) or metabolism in awake humans suggested that man has three cortical motor areas: The premotor area, the supplementary motor area, and the primary motor area. Subcortically the caudate nucleus, putamen, globus pallidus, and ventral thalamus participated in the planning and execution of voluntary movements. With the exception of the primary motor area, all these structures were bilaterally activated in unilateral movements. The supplementary motor area participated in the planning of motor subroutines, speech included. The premotor area participated in non-routine voluntary movements or movements carried out contingent or dependent on sensory information. The primary motor area was the executive locus for voluntary movements. In addition to these motor areas other cortical areas were recruited dependent on whether internal volitions, perceptions, or language had to be translated into motor codes. The superior prefrontal cortex participated in this recruitment. In the parietal lobe different areas were recruited depending on whether the movements were carried out in intrapersonal or extrapersonal space. The bilateral activation of motor structures was assumed to reflect bilateral elaboration of motor programs and also bilateral encoding of motor memory.

Basal Ganglia↗
PubMed1983

[Correlations among the main syndromes of chronic alcoholism].

Alcohol addiction seen in alcoholics is shown to constitute a part of alcoholic psychic degradation; it is reflected in emotional and volitional derangements, and determines the nosologic specificity of this degradation. Intellectual and mnemic disturbances are regarded as nonspecific psychoorganic ones, and they are directly associated with the volume of alcohol consumed and the severity of intoxication. Similar relations were revealed between alcohol addiction and the alcohol abstinence syndrome: alcohol addiction is combined with nosologically neutral post-intoxication disturbances and imparts the nosological specificity to the entire symptom-complex.

Alcoholism↗
PubMed1978

[Symptomatology of inhibition].

This essentially descriptive paper deals with inhibition as a symptom or as a behavior pattern and studies the different areas of; inhibition of the intellect (i.e. a decrease in though production witnessed by disorders of language flow), reduced attention span (distractability, inability to concentrate), inhibition of volition (abulia, indecisiveness), memory inhibition (in the sense of selective amnesias, post-crisis amnesias, cyclical amnesias), restriction of the basic drives (which can touch the life principle, the need for sleep, hunger, sexual drive), emotional inhibition including a feeling of inferiority and self-doubt which affects interpersonal relations: in this sense inhibition can also manifest itself in experiences of estrangement and depersonalization. A dynamic study of inhibition should first deal with the presumed relationship between the symptom and a specific pathological process and analysis of the underlying inconscious mecanisms.

Affective Symptoms↗
PubMed1980

Postural reflex gelastic seizures.

A 26-year-old man had gelastic seizures ("laughing attacks") preceded by an aura of sexual pleasure. They were reflexly induced by volitional hyperextension of his neck and trunk. His EEGs showed a right temporal spike focus. We discuss the characteristics of this unique case.

Adult↗
PubMed1981

Medial frontal cortex infarction and the alien hand sign.

Two right-handed patients with infarction involving the left medial frontal cortex are described. Both patients exhibited a form of transcortical motor aphasia and a psychomotor disturbance involving the right arm characterized by forced grasping, motor perseveration, and the presence of apparently purposeful movements that appeared to be dissociated from conscious volition. The latter feature is noted to be identical to the alien hand sign as described in the left arm of commissurotomized patients and patients with callosal neoplasm or infarction. It is suggested that the observed dissociation of conscious intention from purposeful movement may be related to dysfunction of the medial frontal cortex contralateral to the impaired extremity as much as to hemispheric disconnection.

Aged↗
PubMed1987

Clinical features of ischemia in cerebral arterial border zones after periods of reduced cerebral blood flow.

The clinical syndrome of border-zone ischemia is described in eight patients. Cerebral damage in four occurred during or after cardiac surgery and the other four patients had each experienced a period of severe hypotension. Cerebral blindness and visual disorientation are the most regular features and are produced by ischemic lesions in the parieto-occipital region, the common border-zone territory between all three arterial territories. Some patients show bibrachial sensorimotor impairment and a disturbance of volitional saccadic eye movement caused by more anteriorly placed ischemia in the anterior-middle artery border zone. Some show a temporary dyslexia/dysgraphia and memory defect related to bilateral parietotemporal lesions in the middle-posterior border zone.

Adult↗
PubMed1987

Basal forebrain infarction. A clinicopathologic correlation.

Following the repair of a ruptured anterior communicating artery aneurysm, a patient had a severe anterograde amnesia with sparing of other intellectual functions, apathy and loss of volition, altered arousal, and partial diabetes insipidus. Postmortem examination of the brain revealed bilateral destruction of the septal gray, nucleus accumbens, and nucleus of the diagonal band of Broca. Also involved in the lesion were inferior portions of the anterior limb of the internal capsule and globus pallidus. Discrete, microinfarcts were present in the paraventricular hypothalamic gray. Long-term therapy with desaminoarginine vasopressin nasal spray had no effect on the patient's neuropsychologic deficits.

Adult↗
PubMed1991

Frontal verbal amnesia. Phonological amnesia.

Although aphasic patients with frontal lobe damage may demonstrate impaired retention of verbal material, significant anterograde memory disturbances have not, to our knowledge, been reported with a minor Broca's aphasia. We describe a patient with minor Broca's aphasia who exhibited an unusual and profound anterograde memory disturbance, especially for phonologically specified stimuli. We suggest that this disturbance is attributable to an impairment in the volitional, controlled search of stored phonological information.

Amnesia↗
PubMed1991

Selective paralysis of voluntary but not limbically influenced automatic respiration.

We describe a patient in whom a discrete infarction of the ventral basis pontis caused a complete loss of voluntary respiration, while automatic respiration remained intact. Respiratory excursions, quantified title volumes, and ventilatory response to carbon dioxide were normal, but the patient could not volitionally modify any respiratory parameters. Emotional stimuli producing laughter, crying, or anxiety appropriately modulated automatic respiration. This case established that pathways subserving limbic modulation of automatic respiration descend in the pontine tegmentum and/or lateral portion of the basis pontis spared by this lesion. Furthermore, descending limbic influences on automatic respiration are anatomically and functionally independent of the voluntary respiratory system.

Adult↗
PubMed2002

Do you really need your oblique muscles? Adaptations and exaptations.

BACKGROUND: Primitive adaptations in lateral-eyed animals have programmed the oblique muscles to counterrotate the eyes during pitch and roll. In humans, these torsional movements are rudimentary. PURPOSE: To determine whether the human oblique muscles are vestigial. METHODS: Review of primitive oblique muscle adaptations and exaptations in human binocular vision. RESULTS: Primitive adaptations in human oblique muscle function produce rudimentary torsional eye movements that can be measured as cycloversion and cyclovergence under experimental conditions. The human torsional regulatory system suppresses these primitive adaptations and exaptively modulates cyclovergence to facilitate stereoscopic perception in the pitch plane. It also recruits the oblique muscles to generate cycloversional saccades that preset torsional eye position immediately preceding volitional head tilt, permitting instantaneous nonstereoscopic tilt perception in the roll plane. CONCLUSIONS: The evolution of frontal binocular vision has exapted the human oblique muscles for stereoscopic detection of slant in the pitch plane and nonstereoscopic detection of tilt in the roll plane. These exaptations do not erase more primitive adaptations, which can resurface when congenital strabismus and neurologic disease produce evolutionary reversion from exaptation to adaptation.

Adaptation, Ocular↗
PubMed1976

Dilator naris function: a useful test of facial nerve integrity.

The dilator naris muscle is an active participant of respiration in man. Its level of function appears to vary directly with ventilatory resistance. Three cases are reported to illustrate the use of the respiratory function of this muscle as a clinical test of seventh nerve integrity when its volitional function cannot be elicited.

Adolescent↗
PubMed1977

First-rank symptoms of schizophrenia in Schneider-oriented German centers.

First-rank symptoms of schizophrenia, such as thought insertion, thought broadcasting, "made" volition, and delusional perception, were introduced for purposes of diagnosis into a German university clinic. Such "Schneiderian" criteria were evaluated in 210 case records. Ratings employed formal definitions. Of 210 records examined, 69 (33%) of the schizophrenic patients had first-rank symptoms. The frequency of finding such symptoms in a group of schizophrenics is compared to other reports. There are considerable differences in frequency of individual symptoms as well as total number of such symptoms across centers, but the use of precisely agreed on definitions of first-rank symptoms may lead to better agreement.

Adult↗
PubMed1995

Symptoms of schizophrenia. Methods, meanings, and mechanisms.

BACKGROUND: The "group of schizophrenias," normally referred to with a single nominative, is phenomenologically heterogeneous. Its symptoms represent multiple psychological domains, including perception, inferential thinking, language, attention, social interaction, emotion expression, and volition. Studies of psychopathology have simplified this complex array in several ways, one of which is a subdivision into positive and negative symptoms. METHODS: This study examined the positive vs negative distinction in a sample of 243 patients with schizophrenia or schizophreniform disorder who were evaluated with the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms. A two-stage factor analysis was applied, beginning with a principal components analysis applying varimax rotation, followed by an extension analysis. The purpose of these analyses was to evaluate the correlational relationships of the various symptoms of schizophrenia. RESULTS: The results confirmed previous reports by our group and others suggesting that the symptoms of schizophrenia fall into three natural dimensions, as assessed by the correlational interrelationships: positive symptoms subdivide into psychotic and disorganized dimensions, while a third negative dimension also emerges. CONCLUSION: Because these dimensions have impressive consistency across studies, future work must examine their relationship to clinically relevant concepts such as prognosis or etiology and examine four different aspects: longitudinal course, neural mechanisms, relationship to treatment, and interrelationships in other pathological conditions.

Age of Onset↗
PubMed1997

Oculomotor response inhibition abnormalities in pediatric obsessive-compulsive disorder.

BACKGROUND: Disturbances in the orbital prefrontal cortex and its ventral striatal target fields have been identified in neuroimaging studies of obsessive-compulsive disorder (OCD). In animal models and studies of patients with lesions to this brain circuitry, a selective disturbance in the ability to suppress responses to irrelevant stimuli has been demonstrated. Such a deficit in response suppression might underlie the apparent inhibitory deficit suggested by the symptoms of OCD. To date, little direct evidence of such a deficit has been reported. Further, although OCD commonly emerges during childhood or adolescence, few studies have examined psychotropic-naive pediatric patients near the onset of illness to find the possible role of atypical developmental processes in this disorder. METHODS: Oculomotor tests were administered to 18 psychotropic medication-naive, nondepressed patients with OCD aged 8.8 to 16.9 years and 18 case-matched healthy comparison subjects to assess the following 3 well-delineated aspects of prefrontal cortical function: the ability to suppress responses, the volitional execution of delayed responses, and the anticipation of predictable events. RESULTS: A significantly higher percentage of response suppression failures was observed in patients with OCD (P = .003), particularly in younger patients compared with their case-matched controls. No significant differences between patients with OCD and controls were observed on other prefrontal cortical functions. Severity of OCD symptoms was related to response suppression deficits. CONCLUSIONS: A basic disturbance of behavioral inhibition in OCD was detected that may underlie the repetitive symptomatic behavior that characterizes the illness.

Adolescent↗
PubMed2000

A functional neuroanatomy of tics in Tourette syndrome.

BACKGROUND: Tics are involuntary, brief, stereotyped motor and vocal behaviors often associated with irresistible urges. They are a defining symptom of the classic neuropsychiatric disorder, Tourette syndrome (TS), and constitute an example of disordered human volition. The neural correlates of tics are not well understood and have not been imaged selectively. METHODS: Event-related [(15)O]H(2)O positron emission tomography techniques combined with time-synchronized audio and videotaping were used to determine the duration of, frequency of, and radiotracer input during tics in each of 72 scans from 6 patients with TS. This permitted a voxel-by-voxel correlational analysis within Statistical Parametric Mapping of patterns of neural activity associated with the tics. RESULTS: Brain regions in which activity was significantly correlated with tic occurrence in the group included medial and lateral premotor cortices, anterior cingulate cortex, dorsolateral-rostral prefrontal cortex, inferior parietal cortex, putamen, and caudate, as well as primary motor cortex, the Broca's area, superior temporal gyrus, insula, and claustrum. In an individual patient with prominent coprolalia, such vocal tics were associated with activity in prerolandic and postrolandic language regions, insula, caudate, thalamus, and cerebellum, while activity in sensorimotor cortex was noted with motor tics. CONCLUSIONS: Aberrant activity in the interrelated sensorimotor, language, executive, and paralimbic circuits identified in this study may account for the initiation and execution of diverse motor and vocal behaviors that characterize tics in TS, as well as for the urges that often accompany them. Arch Gen Psychiatry. 2000;57:741-748

Adult↗
PubMed1996

Motor control after spinal cord injury: assessment using surface EMG.

The brain motor control assessment (BMCA) protocol is a comprehensive multichannel surface EMG recording used to characterize motor control features in persons with upper motor neuron dysfunction. Key information is contained in the overall temporal pattern of motor unit activity, observed in the EMG (RMS) envelope. In paralysis, a rudimentary form of suprasegmental control of tonic and phasic reflexes can be demonstrated. EMG patterns evoked by voluntary and passive maneuvers and by volitional modulation of reflex responses reveal features of motor control not apparent in the clinical examination. Such subclinical findings may explain paradoxically different responses in apparently similar SCI subjects, and may be used to monitor spontaneous or induced changes. The recording protocol, examples of EMG patterns, and their prevalence in 40 spinal cord injured (SCI) subjects are presented, and compared with 5 healthy subjects.

Adult↗