As the ubiquity of technology-mediated communication grows, so does the number of questions about the costs and benefits of replacing in-person interactions with technology-mediated ones. In the present study, we used a daily diary design to examine how people’s emotional experiences vary across in-person, video-, phone-, and text-mediated interactions in day-to-day life. We hypothesised that individuals would report less positive affect and more negative affect after less life-like interactions (where in-person is defined as the most life-like and text-mediated as the (...) least life-like). In line with this hypothesis, the analysis of 527 unique interactions reported by 102 individuals (mean age = 19.3; 85.6% female) over the course of 7 days reveals that people feel lonelier, sadder, less affectionate, less supported, and less happy following less life-like interactions. Additional analyses show that the links between life-like communication and momentary experiences are independent of properties of individual interactions such as interaction length and participants’ overall evaluations of interaction quality. These findings provide initial evidence that there may be inherent properties of common technology-mediated communication tools that may lead to momentary changes in affective experiences and make social connection more challenging. (shrink)

This volume draws on a range of approaches in order to explore the problem and determine what ought to be done about allegedly harmful speech.Most liberal societies are deeply committed to a principle of free speech. At the same time, however, there is evidence that some kinds of speech are harmful in ways that are detrimental to important liberal values, such as social equality. Might a genuine commitment to free speech require that we legally permit speech even when it is (...) harmful, and even when doing so is in conflict with our commitment to values like equality? Even if such speech is to be legally permitted, does our commitment to free speech allow us to provide material and institutional support to those who would contest such harmful speech? And finally, and perhaps most importantly, which kinds of speech are harmful in ways that merit response, either in the form of legal regulation or in some other form? This collection explores these and related questions. Drawing on expertise in philosophy, sociology, political science, feminist theory, and legal theory, the contributors to this book investigate these themes and questions. By exploring various categories of speech (including pornography, hate speech, Holocaust denial literature, 'Whites Only' signs), and attending to the precise functioning of speech, the essays contained here shed light on these questions by clarifying the relationship between speech and harm. Understanding how speech functions can help us work out which kinds of speech are harmful, what those harms are, and how the speech in question brings them about. All of these issues are crucially important when it comes to deciding what ought to be done about allegedly harmful speech. (shrink)

Many liberal societies are deeply committed to freedom of speech. This commitment is so entrenched that when it seems to come into conflict with other commitments (e.g., gender equality), it is often argued that the commitment to speech must trump the other commitments. In this paper, we argue that a proper understanding of our commitment to free speech requires being clear about what should count as speech for these purposes. On the approach we defend, should get a special, technical sense, (...) different from its ordinary sense. We offer a partial characterization of this technical sense. Finally, we argue that if certain theorists (e.g., MacKinnon) are right about what (some) pornography does, then it should fall outside the scope of the free-speech principle. If so, then contrary to first appearances, pornography may not be a case in which our commitments to freedom and gender equality come into conflict. (shrink)

In a recent article in this journal, Nellie Wieland argues that silencing in the sense put forward by Rae Langton and Jennifer Hornsby has the unpalatable consequence of diminishing a rapist's responsibility for the rape. We argue both that Wieland misidentifies Langton and Hornsby's conception of silencing, and that neither Langton and Hornsby's actual conception, nor the one that Wieland attributes to them, in fact generates this consequence.

In this paper, we argue that to properly understand our commitment to a principle of free speech, we must pay attention to what should count as speech for the purposes of such a principle. We defend the view that ‘speech’ here should be a technical term, with something other than its ordinary sense. We then offer a partial characterization of this technical sense. We contrast our view with some influential views about free speech , and show that our view has (...) distinct advantages. Finally, we consider racist hate speech. Here, we argue that if certain theorists are right about what some racist hate speech does, then such speech should fall outside the scope of the free speech principle, and so, should be as regulable as any non-speech action. (shrink)

We review the relationships between language, inner speech, and cognitive control in children and young adults, focusing on the domain of cognitive flexibility. We address the role that inner speech plays in flexibly shifting between tasks, addressing whether it is used to represent task rules, provide a reminder of task order, or aid in task retrieval. We also consider whether the development of inner speech in childhood serves to drive the development of cognitive flexibility. We conclude that there is a (...) close association between inner speech and cognitive flexibility in both adults and children. Experimental work has begun to specify in detail the role that inner speech might play in adult performance, suggesting that language plays a facilitative but not essential role in representing and activating the relevant task set, processes that occur on both switch and nonswitch trials. While developmental studies suggest an increase in the spontaneous use of verbal strategies with age, implying an increase in top-down control during shifting, experimental work is needed to specify more precisely the nature and precise role that inner speech plays in the development of cognitive control through childhood. (shrink)

Many approaches to addressing labour injustices—shortfalls from minimally decent wages and working conditions— focus on how governments should orient themselves toward other states in which such phenomena take place, or to the firms that are involved with such practices. But of course the question of how to regard such labour practices must also be faced by individuals, and individual consumers of the goods that are produced through these practices in particular. Consumers have become increasingly aware of their connections to complex (...) global production processes that often involve such injustice. For example, activist campaigns have exposed wrongful harm in factories producing clothes, shoes and mobile phones and farms producing coffee, tea and cocoa. These campaigns have promoted the message to ordinary people that by becoming connected to unjust labour practices through their purchasing behaviour, they acquire special additional moral responsibilities to contribute to reforming such practices, or to address the hardships suffered by the victims of the wrongdoing that result from them. The moral significance of the responsibilities of individual consumers has not, however, received much analytical scrutiny. Why should we believe that there are such responsibilities? And if there are such responsibilities, what are their grounds? How stringent are the responsibilities triggered by such connections? Finally, what are the implications of such responsibilities—the courses of action that they prescribe or proscribe? The activists who assert special ethical responsibilities for consumers have promoted many particular courses of action, but have seldom articulated the grounds of these responsibilities or explained why they should be taken to be stringent. And moral and political theorists have not devoted much focussed attention to this issue. For the consumer who is concerned to act in a morally permissible way, this presents a troubling practical challenge regarding the goods they may (or may not) purchase, and the moral relevance of their consumption choices more generally. While we cannot address all of these pressing questions in this chapter, we try to make some headway with them by discussing two general approaches to the question of how individuals should conceive of their responsibilities with respect to such practices, taking as our starting point the recent work of the late Iris Marion Young—the most sustained treatment of this topic by a prominent political theorist. In a series of influential articles and a posthumously published book, Young articulated an approach to conceiving of individual responsibilities to address labour injustices—the social connection model—at home and abroad. She also argued that an alternative model—the liability model—which she claimed had dominated discourse on this topic, suffered from very serious flaws. In a critical vein, we will argue that Young’s arguments against the liability model are not convincing, and that the alternative she proposes is itself vulnerable to some damaging objections. We also find, however, that the liability model would need to be extended in various ways to provide an adequate account of individual responsibility to address shortfalls from minimally decent wages and working conditions, and we begin the task of sketching an extended framework. (shrink)

This paper investigates necessary conditions for developing a participatory, rightsholder-driven approach to remedy for business-related human rights abuses by analyzing findings from a case study with the Fair Food Program. With the inclusion of human rights into discussions of business ethics and CSR, scholars and practitioners have made calls for participatory approaches to remedy to address cases of human rights abuses. However, a gap remains in our understanding of how to operationalize participatory approaches in a manner that empowers rightsholders, particularly (...) within contexts of severe power imbalances. The paper puts forth a rightsholder-driven theoretical framework for remedy, grounded on critical dialogic accountability principles and integrated with empirical analysis from the Fair Food Program case study. This framework defines remedy as a system comprising reinforcing aspects rather than standalone mechanisms. The critical dialogic accounting and accountability framework provides a theoretical framing of engagement that enables the inclusion of multiple, divergent voices and aims toward meaningful engagement with marginalized groups. The analysis of findings from the case study identifies enforcement and education as necessary conditions for effective and empowering rightsholder-driven approaches to remedy. The paper deconstructs these conditions to develop an understanding of the program’s unique approach to enforcement and education. The paper concludes by discussing the implications of rightsholder-driven remedy for Business and Human Rights and business accountability. (shrink)

Although primary source work is a major component of undergraduate history degrees in many countries, the topic of how best to support this work has been relatively unexplored. This article addresses the pedagogical support of primary source work by reviewing relevant literature to identify the challenges undergraduates face in interpreting sources, and examining how in two courses carefully articulated course design and supportive teaching activities assisted students to meet these challenges. This fine-grained examination of the courses is framed within a (...) socio-cultural account of learning. The findings show how a skilful drawing of students into the interpretive/discursive practices of source analysis was associated with an epistemological reframing of historical knowledge and dialogical forms of teaching that helped the students to take forward a dialectical engagement with sources. The benefits of an ‘integrated’ approach to source work that fosters students’ affective and intellectual engagement with historical interpretive practices are highlighted. (shrink)

Clinical ethicists move in different environments and interface with a variety of stakeholders, and are therefore uniquely positioned to answer the call for equity and anti-racism. We describe why a clinical ethicist should contribute to anti-racism efforts and describe general approaches for addressing racism across institutional contexts, including: (1) addressing racism as a bedside clinical ethics consultant, (2) addressing a wider lens of anti-racism work across multiple ethics consults over time, and (3) addressing racism at the organizational level.

Catharine MacKinnon has pioneered a new brand of anti-pornography argument. In particular, MacKinnon claims that pornography silences women in a way that violates their right to free speech. In what follows, we focus on a certain account of silencing put forward by Jennifer Hornsby and Rae Langton, and we defend that account against two important objections. The first objection contends that this account makes a crucial but false assumption about the necessary role of hearer recognition in successful speech acts. In (...) response, we argue that, as silencing primarily concerns communication, Hornsby and Langton are perfectly correct to treat hearer recognition as they do. The second objection contends that their particular account of silencing has the unacceptable result of undermining the responsibility of rapists. We here argue that no such result follows from their account. (shrink)

This collection of papers by prominent feminist thinkers advances the positive feminist project of remapping the moral by developing theory that acknowledges the diversity of women.

This paper puts forth a critical perspective on remedy for business-related human rights abuses. It reflects on the purpose of remedy in Business and Human Rights and argues that effective remedy should address the multiple root causes of abuses to prevent reoccurrences rather than focus on surface issues and isolated cases. To develop a theoretical framework to conceptualize preventative remedy that addresses multiple root causes, this research draws on Fraser’s radical democratic conception of justice and participatory parity. According to the (...) principle, justice is achieved through social arrangements that enable all actors to engage with one another as peers. To conceptualize effective remedy as participatory parity, the paper examines three dimensions—cultural, economic, and political—where injustices or root causes of abuses must be addressed to realize participatory parity. The paper analyzes the illustrative case of the Fair Food Program through the lens of Fraser’s framework. Analysis reveals effective enforcement as necessary to realize participatory parity and address the three dimensions of justice in the context of severe power asymmetries. In the theorized framework, remedy aims to address the multiple root causes of business-related human rights abuses toward prevention and empower rightsholders to engage meaningfully in remedial processes. (shrink)

This commentary analyzes the extent to which the incommensurability problem can be resolved through the proposed alternative method of integrative experiment design. We suggest that, although one aspect of incommensurability is successfully addressed (dimensional incommensurability), the proposed design space method does not yet alleviate another major source of discontinuity, which we call conceptual incommensurability.

Changes in government policy over the last two decades have seen the traditional goals of criminal justice, namely prosecution and punishment, being replaced by an emphasis on prevention, fear reduction, security and harm reduction. During this time domestic abuse has gained a place on the political agenda, which has resulted in legislative initiatives in the form of civil protection orders across the U.K. which primarily focus on prevention but have also more recently begun to rely on the traditional criminal justice (...) responses should they fail to prevent further abuse. Drawing on international evaluations and a recent study conducted in Scotland (the Scottish study), the article examines whether legislation in the form of civil protection orders has the effect of curtailing the actions of abusers and if not, what occurs when the traditional criminal justice response comes into play. The strengths of civil protection orders and some explanations for the weaknesses of these orders are considered alongside the question of whether there is any value in women continuing to engage with the law in response to domestic abuse. (shrink)

Judicial independence is generally understood as requiring that judges must be insulated from political life. The central claim of this work is that far from standing apart from the political realm, judicial independence is a product of it. It is defined and protected through interactions between judges and politicians. In short, judicial independence is a political achievement. This is the main conclusion of a three-year research project on the major changes introduced by the Constitutional Reform Act 2005, and the consequences (...) for judicial independence and accountability. The authors interviewed over 150 judges, politicians, civil servants and practitioners to understand the day-to-day processes of negotiation and interaction between politicians and judges. They conclude that the greatest threat to judicial independence in future may lie not from politicians actively seeking to undermine the courts, but rather from their increasing disengagement from the justice system and the judiciary. (shrink)

Legal judgment writing mobilises a process of story-telling, drawing on existing judicial discourses, precedents and practices to create a narrative relevant to the specific case that is articulated by the presiding judge. In the Feminist Judgments projects feminist scholars and activists have sought to challenge and reinterpret legal judgments that have disadvantaged, discriminated against or denied women’s experiences. This paper reflects on the process of writing as a feminist judge in the Australian Project, in an intimate homicide case, R v (...) Middendorp. Drawing on the work of Judith Butler on intelligibility, iterability and the communality of violence and vulnerability, this article argues that feminist judgments necessarily require some uncomfortable compromises with unjust gendered institutions. While ‘donning the robes’ may be an uncomfortable process, a feminist re-articulation of the law’s carceral power serves to unsettle and challenge some aspects of gendered oppression, even though it cannot unsettle the operation of the institution. The article concludes that effective feminist interventions by members of the judiciary may require donning robes that are not entirely comfortable in order to persuade and advocate for change. (shrink)

The proportion of the world’s population living in urban areas is increasing rapidly, with the vast majority of this growth in developing countries. As growing populations in urban areas demand greater food supplies, coupled with a rise in rural to urban migration and the need to create livelihood options, there has been an increase in urban agriculture worldwide. Urban agriculture is commonly discussed as a sustainable solution for dealing with gaps in the local food system, and proponents often highlight the (...) many social, environmental, and economic benefits. We argue that the sustainability of urban agriculture should not be assumed. There is a need for research to take a bottom-up approach, exploring the influence that city-level conditions have on livelihood decisions by farmers and how this shapes the practice of urban agriculture. This paper uses a case study for an in-depth look at urban agriculture in Delhi, India to understand from the farmers’ perspective how urban agriculture is practiced and what factors influence farmers’ livelihood decisions. Using a team-based, multi-method Rapid Assessment Process, data were collected through preliminary key informant interviews, field observations, semi-structured interviews with urban farmers, and geographic information systems mapping. This research provides an in-depth description of market-oriented urban agriculture in a developing country, explores how farmers’ livelihood decisions are embedded in the urban context, and discusses the potential of urban agriculture as a sustainable city-system. (shrink)

Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on supported decision-making. Thirty-six (...) interviews were undertaken with fifty-seven participants across three states in Australia. Interpretative Phenomenological Analysis was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants’ experiences with decision-making: “the person in relationship over time” and “maintaining involvement.” Participant views on the practical issues associated with supported decision-making are addressed under the themes of “facilitating decision-making,” “supported decision-making arrangements,” “constraints on decision-making,” and “safeguarding decision-making.” While participants endorsed the principles of supported decision-making as part of their overarching strategy of “maintaining involvement” in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual “constraints on decision-making” also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a “spectrum approach” to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population. (shrink)

An increase in the number of companies that publish corporate social responsibility (CSR) statements, and a rise in their ‘sustainability’ research, reflects a growing acceptance that broad ethical considerations are key for any type of company. However, little is known about how companies consider moral objectives for their research and development (R&D) activities, or the basis upon which these activities are chosen. This research involves qualitative investigation into Responsible Research and Innovation (RRI) in the Information and Communication Technology (ICT) industry, (...) comprising 30 in-depth, pan-European interviews with key personnel in the industry, and focus groups with employees at 14 different companies. Through investigation of the ‘responsible’ activities these companies currently undertake, we shed light on the types of moral goals they set and their underlying ethical standpoints. By reviewing both the responsible innovation and sustainability discourses, and presenting phenomenological evidence, we demonstrate that companies have adopted some aspects of RRI, even though it might not be recognised as such. Our findings indicate that these innovators recognise some of the ethical and societal concerns associated with their activities but their approach is often piecemeal; primary focus is upon the most immediate issues and on legal compliance, to the detriment of broader societal issues and wider challenges. We recommend explicit mechanisms that draw upon established ethical thought and practical academic work to improve companies' abilities to carry out their sustainability activities, and incorporate them into a responsible business strategy. We conclude with recommendations for innovators, corporate research and development, and policy. (shrink)

Defining quality of life is a difficult task as it is a subjective and personal experience. However, for the elderly, this definition is necessary for making complicated healthcare-related decisions. Commonly these decisions compare independence against safety or longevity against comfort. These choices are often not made in isolation, but with the help of a healthcare team. When the patient’s concept of quality of life is miscommunicated, there is a risk of harm to the patient whose best interests are not well (...) understood. In order to bridge this gap in understanding and unite seniors with their caretakers as a cohesive team, we need to establish a definition of quality of life. In this paper, my personal experiences with the elderly will be analysed along with five essays on the topic of ageing. These sources provide clear evidence that quality of life for seniors is majorly determined by the ability to preserve one’s lifelong identity. When making difficult decisions in geriatric healthcare, this greater understanding of the determinants of life quality will allow treatments to best serve the elderly. Defining quality of life allows healthcare providers to shift the focus from minimising disability toward maximising ability. I believe this shift would provide seniors with better health outcomes and properly enhance the quality of their years. (shrink)

Legal responses to battered women who kill have long animated scholarly debate and law reform activity. In September 2012 after 47 years of alleged abuse, Frenchwoman Jacqueline Sauvage fatally shot her abusive husband three times in the back. The subsequent contested trial, conviction for murder, unsuccessful appeal and later presidential pardon of Sauvage thrust the French law of self-defence into the spotlight. The Sauvage case raises important questions surrounding the adequacy of the French criminal law in this area, the ongoing (...) proliferation of gendered stereotypes in law and the need for reform. In the wake of the Sauvage case, this article provides a timely analysis of the gendered law of self-defence in France. Drawing from an in-depth analysis of the judgments imposed in the Sauvage case, this article examines the adequacy of French legal responses to battered women who kill and ignites an argument for further law reform. (shrink)

In this short response we show that Kevin Smith's moral and ethical rejections of homeopathy1 are fallacious and rest on questionable epistemology. Further, we suggest Smith's presumption of a utilitarian stance is an example of scientism encroaching into medicine.

This article examines how federal law enforcement has responded to the opioid epidemic nationally and in a variety of locales. We focus in depth on two initiatives, including prosecution in opioid-death cases, undertaken by the U.S. Attorney's Office in Connecticut.

The rapid pace of technological development often outstrips the ability of legislators and regulators to establish proper guardrails on emerging technologies. A solution is for those who develop, deploy, and use these technologies to develop themselves as moral agents—i.e., as agents capable of steering the course of emerging technologies in a direction that will benefit humanity. However, there is a dearth of literature discussing how to foster moral agency in computer science courses, and little if any research on the effectiveness (...) of such courses in computer science. This paper addresses this gap by providing an overview of an undergraduate course on technology ethics. It then shares and discusses a subset of data collected from a mixed-methods study using a pre-post design that sought to examine the course’s effectiveness in developing students’ moral, intellectual, and civic virtues, as well as related dispositions. (shrink)

This booklet on Active Assisted Living (AAL) technologies has been created as part of the GoodBrother COST Action, which has run from 2020 to 2024. COST Actions are European research programs that promote collaboration across borders, uniting researchers, professionals, and institutions to address key societal challenges. GoodBrother focused on ethical and privacy concerns surrounding video and audio monitoring in care settings. The aim was to ensure that while AAL technologies help older adults and vulnerable individuals, their privacy and data protection (...) rights remain a top priority. This booklet is designed to guide you through the role that AAL technologies play in improving the quality of life for older adults, caregivers, and people with disabilities. AAL technologies offer tools for those facing cognitive or physical challenges. They can enhance independence, assist with daily routines, and promote a safer living environment. However, the rise of these technologies also brings important questions about data protection and user autonomy. (shrink)

In the words of Catharine MacKinnon, "a woman is not yet a name for a way of being human." In other words, women are still excluded, as authors and agents, from identifying what it is to be human and what therefore violates the dignity and integrity of humans. Recognition, Responsibility, and Rights is written in response to that failure. This collection of essays by prominent feminist thinkers advances the positive feminist project of remapping the moral landscape by developing theory that (...) acknowledges the diversity of women. (shrink)

One implication of Laland, Odling-Smee & Feldman's niche construction model concerns the significance of the role of behavioural or cultural traits in comparative analysis. In this commentary it is suggested that cladistic methods already recognise this importance, and that behavioural characters may play a key role in hominid speciation and the definition of species.

This article provides an analysis of the relationships between IVF and therapeutic cloning, as they played out in the UK Human Fertilisation and Embryology Authority consultation of 2006: Donating Eggs for Research: Safeguarding Donors. We develop an account of current developments in IVF and cloning which foregrounds the role of mediation in structuring the discursive context in which they are constituted. We foreground the imperative of choice and the promise of cures as key features of this context. We also argue (...) that the intercorporeal exchanges of IVF are materially restructured in relation to cloning research, despite their represented similitude in the consultation document. The discourse of choice in relation to reproductive technologies has become entrenched over the last twenty years. In relation to therapeutic cloning, it has been coupled with, and strengthened by, the discourse of cures. In examining relations between IVF and cloning with specific attention to both mediating imaginaries, and intercorporeal exchanges, we develop an analysis that displaces the rhetoric of choice and cures. This makes visible the limited subject positions available, and the limited possibilities for responding critically to the consultation. Identifying women as the gendered subjects of this consultation and placing intercorporeality at the centre of our analysis illuminates the interdependency of women undergoing IVF, cloning science and the governance of embryo research in the UK. (shrink)

"I am a Jew who was born and who grew up in a Catholic country; I never had a religious education; my Jewish identity is in large measure the result of persecution." This brief autobiographical statement is a key to understanding Carlo Ginzburg's interest in the topic of his latest book: distance. In nine linked essays, he addresses the question: "What is the exact distance that permits us to see things as they are?" To understand our world, suggests Ginzburg, it (...) is necessary to find a balance between being so close to the object that our vision is warped by familiarity or so far from it that the distance becomes distorting. Opening with a reflection on the sense of feeling astray, of familiarization and defamiliarization, the author goes on to consider the concepts of perspective, representation, imagery, and myth. Arising from the theme of proximity is the recurring issue of the opposition between Jews and Christians -- a topic Ginzburg explores with an impressive array of examples, from Latin translations of Greek and Hebrew scriptures to Pope John Paul II's recent apology to the Jews for antisemitism. Moving with equal acuity from Aristotle to Marcus Aurelius to Montaigne to Voltaire, touching on philosophy, history, philology, and ethics, and including examples from present-day popular culture, the book offers a new perspective on the universally relevant theme of distance. (shrink)

Open access. This open-access book discusses vulnerability and the protection-inclusion dilemma of including those who suffer from serious poverty, severe stigma, and structural violence in research. Co-written with representatives from indigenous peoples in South Africa and sex workers in Nairobi, the authors come down firmly on the side of inclusion. In the spirit of leaving no one behind in research, the team experimented with data collection methods that prioritize research participant needs over researcher needs. This involved foregoing the collection of (...) personal data and community researchers being involved in all stages of the research. In the process, the term ‘vulnerability’ was illuminated across significant language barriers as it was defined by indigenous peoples and sex workers themselves. The book describes a potential alternative to exclusion from research that moves away from traditional research methods. By ensuring that the research is led by vulnerable groups for vulnerable groups, it offers an approach that fosters trust and collaboration with benefits for the community researchers, the wider community as well as research academics. Those living in low-income settings, in dire situations that are summarized with the term ‘vulnerability’ know best what their problems are and which priorities they have. To exclude them from research for their own protection is a patronizing approach which insinuates that researchers and research ethics committees know best. The team from this book have shown that minimally risky and minimally burdensome research tailored towards the needs of highly marginalized and stigmatized communities can be scientifically valuable as well as inclusive and equitable. I congratulate them. Prof. Klaus Leisinger, President Global Values Alliance, Former personal advisor to Kofi Annan on corporate responsibility. (shrink)

Spasticity and muscle weakness is common in children with cerebral palsy (CP). Spasticity can be treated with Botulinum Neurotoxin-A (BoNT-A), but this drug has also been reported to induce muscle weakness. Our purpose was to describe the effect on muscle strength in the lower extremities after BoNT-A injections in children with cerebral palsy. A secondary aim was to relate the effect of BoNT-A to gait pattern and range of motion. Twenty children with spastic cerebral palsy were included in the study, (...) eight girls and 12 boys (mean age 7.7 years). All were able to walk without support, but with increased muscle tone interfering with motor function and gait pattern. Sixteen children had unilateral spastic CP and four bilateral spastic CP. Twenty-four legs received injections with BoNT-A in the plantar flexor muscles. The children were tested before treatment, around six weeks after at the peak effect of BoNT-A, and at six months after treatment, with measurement of muscle strength, gait analysis and range of motion. There were no differences in muscle strength in plantar flexors of treated legs at peak effect compared to baseline. Six months after treatment, there was still no change in untreated plantar flexor muscles, but an increasing trend in plantar flexor strength in legs treated with BoNT-A. Parents reported positive effects in all children, graded as: small in three children, moderate in eight, and large in nine children. The gait analysis showed a small improvement in knee extension at initial contact, and there was a small increase in passive range of motion for ankle dorsiflexion. Two children had a period with transient weakness and pain. We found that voluntary force production in plantar flexor muscles did not decrease after BoNT-A, instead there was a trend to increased muscle strength at follow-up. The increase may be explained as an effect of the blocking of involuntary nerve impulses, leading to an opportunity to using and training the muscles with voluntary control. Adequate muscle strength is important for maintaining the ability to walk and knowledge of how a treatment affects muscle strength is useful when selecting interventions. (shrink)