Replace repair restore relieve bridging clinical and engineering solutions in neurorehabilitation pr
Replace
Repair Restore Relieve Bridging Clinical and Engineering Solutions in Neurorehabilitation
Proceedings of the 2nd International Conference on NeuroRehabilitation
ICNR2014 Aalborg 24 26 June 2014 1st Edition Winnie Jensen
Visit to download the full and correct content document: https://textbookfull.com/product/replace-repair-restore-relieve-bridging-clinical-and-en gineering-solutions-in-neurorehabilitation-proceedings-of-the-2nd-international-confer ence-on-neurorehabilitation-icnr2014-aalborg-24-26-june-201/
More products digital (pdf, epub, mobi) instant download maybe you interests ...
Bridging research and good practices towards patients welfare proceedings of the 4th International Conference on Healthcare Ergonomics and Patient Safety HEPS Taipei Taiwan 23 26 June 2014 1st Edition Yuh-Chuan Shih
Proceedings of the International Conference on Information Engineering and Education Science ICIEES 2014 Tianjin China 12 13 June 2014 1st Edition Dawei Zheng (Editor) https://textbookfull.com/product/information-engineering-andeducation-science-proceedings-of-the-international-conference-oninformation-engineering-and-education-scienceiciees-2014-tianjin-china-12-13-june-2014-1st-edition-dawei-z/
Frontiers in Computer Education Proceedings of the 2nd
International Conference on Frontiers in Computer Education ICFCE 2014 Wuhan China December 24 25 2014 1st Edition Yuanzhi Wang (Editor)
The Impact of Digital Technologies on Public Health in Developed and Developing Countries: 18th International Conference, ICOST 2020, Hammamet, Tunisia, June 24–26, 2020, Proceedings Mohamed Jmaiel
International Conference on Security and Privacy in Communication Networks 10th International ICST Conference SecureComm 2014 Beijing China September 24
26 2014 Revised Selected Papers Part II 1st Edition
International Conference on Security and Privacy in Communication Networks 10th International ICST Conference SecureComm 2014 Beijing China September 24
26 2014 Revised Selected Papers Part I 1st Edition Jing Tian https://textbookfull.com/product/international-conference-onsecurity-and-privacy-in-communication-networks-10thinternational-icst-conference-securecomm-2014-beijing-chinaseptember-24-26-2014-revised-selected-papers-part-i-1st-edit/
Role of Cortical Reorganization in the Rehabilitation of Chronic Pain
Herta Flor
Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
The role of cortical plasticity has been in focus for years as the target for efficient rehabilitation. But how large a role does it play? And how is it most efficiently targeted to obtain lasting changes. What are the neural mechanisms and when is the most optimal time window after an injury to the nervous system. What is the role of sensory feedback to the deafferented brain and is multisensory input more efficient. These questions will be addressed mainly from the perspective of chronic pain, but these findings may also be interesting for other areas of rehabilitation.
Neuroscientific evidence has shown that the adult brain is plastic into high age even in areas that were formerly thought to be hard-wired after an early adaptive phase. Injury but also stimulation and learning, including social factors, thus modify the maps in the sensorimotor areas but also lead to changes in centers involved in the processing of emotion, motivation and cognition. Two developments have greatly enhanced the interest in brain-based rehabilitation methods in the area of chronic pain. First, it was shown that changes in the representation of body maps in the brain are highly related to both the intensity and the chronicity of chronic pain, both, injury-related neuropathic and stimulation-related musculoskeletal pain. Second, there is accumulation evidence that the representation of the body can modify pain perception. Thus, that there are great similarities between phantom perceptions and bodily illusions such as the rabbit or the rubber hand illusions and other body-related somatosensory phenomena such as supernumerary limbs or out of body feelings. This research has also shown that the brain does not process the physical but the perceived reality, which opens the door to manipulations of the perceived reality, for example via brain computer interfaces or virtual reality applications, in both research on the basis of these phenomena as well as neurorehabilitation.
Cortical plasticity related to chronic pain can thus be modified by behavioral interventions that provide feedback to the brain areas that were altered in a maladaptive manner. Interventions include behavioral extinction, mirror training, sensory discrimination and prosthesis training. More recent advances include training in augmented and virtual reality, prostheses with sensory feedback as well as neurostimulation and neurofeedback applications. In many instances preventive measures can be taken, e.g. in the pre- and postoperative phases of a surgical intervention. In addition, pharmacological interventions designed to alter neuroplasticity can be used alone or in conjunction with training methods. Detailed studies comparing the efficacy of these interventions are still lacking but we can provide some initial evaluations on useful interventions and combinations as well as the optimal modes of application, much of it derived from extinction learning theory. We also need better biomarkers and predictors of treatment outcome. These approaches open new avenues for both the prevention and treatment of chronicity and physical impairment.
References
Flor, H.: Psychological pain interventions and neurophysiology: Implications for a mechanism-based approach. American Psychologist 69, 188–196 (2014)
Moseley, G.L., Flor, H.: Targeting cortical representations in the treatment of chronic pain – rationale and current state of the art. Neurorehabilitation and Neural Repair 26, 646–652 (2012)
Induction of Cortical Plasticity: Clinical Applications
Min-Fang
Kuo, Walter Paulus, and Michael A. Nitsche
University Medical Center, Dept. Clinical Neurophysiology, Georg-August-University, Robert-Koch-Str. 40, 37099 Goettingen, Germany wpaulus@med.uni-goettingen.de
Abstract. Many neurological diseases are associated with adaptations of cortical plasticity, trying to compensate for functional loss. Transcranial stimulation techniques allow to up- or downregulate excitability of cortical areas. Thus the more focal and close to surface cortical deficits are the more prone they are to transcranially induced induction of cortical excitability. A summary of possibilities will be given using rehabilitation of stroke induced dexterity loss and aphasia as examples.
Motor Function
Both repetitive Transcranial Magnetic Stimulation (rTMS) or Transcranial Direct Current Stimulation (tDCS) can enhance activation of the dysfunctional or reduce activation of the healthy hemisphere(Nitsche and Paulus, 2000) and therefore re- establish a closer to normal interhemispheric balance. In chronic subcortical stroke patients, one session of anodal excitability-enhancing tDCS over the primary motor cortex of the lesioned hemisphere can improve fine motor skills of the upper limb, as tested by the Jebson-Taylor task, during, and also for some time after stimulation (Hummel et al., 2005), confirmed by applying excitability-diminishing cathodal tDCS of the contralateral non-lesioned motor cortex (Fregni et al., 2005). The same procedure, a single session of cathodal tDCS of the unaffected hemisphere, facilitated motor learning of the paretic hand in chronic stroke patients (Zimerman et al., 2012). Pinch force, performance of simple reaction time tasks, and selective muscle contraction can also be improved by anodal tDCS of the affected or cathodal stimulation of the unaffected motor cortex (Hummel and Cohen, 2006, Hesse et al., 2007, Bradnam et al., 2012). A combination of anodal tDCS with peripheral nerve stimulation generates superior functional effects compared to each stimulation tool applied alone (Celnik et al., 2009). Moreover, repeated cathodal stimulation for 5 consecutive days resulted in cumulative effects, while stimulation once weekly over 4 consecutive weeks did not (Boggio et al., 2007). Thus, in line with other
data, a once daily session repeated at least over 3-5 days seems to be a prerequisite for successful motor rehabilitation.
A whole group of studies was dedicated to the integration of tDCS into clinical routine rehabilitation programs. Bilateral tDCS combining anodal tDCS of the lesioned hemisphere with cathodal tDCS of the contralateral hemisphere during physical/occupational therapy resulted in a better outcome of motor functions than sham tDCS combined with therapy after 5 days of treatment. Interestingly, only in the combined group functional magnetic resonance tomography (fMRI) was increased after therapy. Prolongation of this regime to 10 days of therapy resulted in stronger effects (Lindenberg et al., 2010, Lindenberg et al., 2012).Later these findings were challenged(O'Shea et al., 2014). Similar effects are described for bilateral and unilateral cathodal tDCS in combination with constraint-induced movement therapy (Bolognini et al., 2011, Nair et al., 2011). All of these studies were conducted in chronic stroke patients. In the only study, in which the effects of anodal tDCS without combination with any motor training, on motor functions in acute stroke patients was explored, tDCS had no effects on motor outcome (Rossi et al., 2013).
With regard to lower limb function, increased force production during anodal tDCS of the lesioned hemisphere (Tanaka et al., 2011), and improved ankle control was described by anodal tDCS of the lesioned hemisphere (Madhavan et al., 2011).
Taken together, these studies show a potential of tDCS to improve fine motor skills, but also strength and selectivity of motor contraction, in chronic stroke. This has been explored most extensively for upper limb functional deficits, but also for lower limb and pharyngeal functions. Repetitive application of stimulation results in cumulative effects, the effects can outlast the therapeutic regimen for weeks, as far as explored, and can be associated with enhanced activity and excitability of the lesioned hemispheres. So far it is not clear which protocols are optimally suited to improve functions. Approaches, such as combination of tDCS with peripheral nerve stimulation, might enhance efficacy of stimulation further. Most of the studies were conducted in small populations of selected patients, and larger studies are needed to explore the relevance of the effects in more routine rehabilitation settings.
Aphasia
Dependent on lesion location, i.e. involving Broca- and Wernicke areas, but also temporal or parietal association cortices, and white matter, different kinds of aphasic symptoms are discernible. During recovery rapid neuroplastic alterations of languagerelated areas occur, which are associated with functional restitution (for reviews see (Hamilton et al., 2011, Schlaug et al., 2011)). NIBS is an attractive approach to boost the conventional rehabilitative approach of speech therapy (Ross et al., 2011, Holland and Crinion, 2012). Similar to the motor system, an interhemispheric dysbalance
concept has been promoted for aphasia, beyond the rationale for direct plasticity enhancement of the lesioned hemisphere. Therefore, reduction of excitability of the healthy contralateral homolog area might indirectly enhance plasticity of the lesioned one and thus improve regaining speech functions (Mylius et al., 2012).
In most of the studies conducted in aphasic stroke patients, anodal tDCS of the left lesioned hemisphere was combined with speech therapy for up to 10 sessions. The anode was usually placed over the temporal or frontal cortex, and the return electrode position was the contralateral supraorbital region (Baker et al., 2010, Fiori et al., 2011, Fridriksson et al., 2011, Marangolo et al., 2011, Vines et al., 2011). In general, stimulation improved speech function in these patients. Moreover, the effects could remain stable for weeks or even months. In the study of Monti and colleagues (Monti et al., 2008) only cathodal tDCS of the lesioned hemisphere had a positive effect on picture naming. The divergent result might be caused by specific stimulation protocol differences as compared to the other studies, such as stimulation before therapy, and return electrode position at the shoulder, which might have different physiological effects due to different current flow direction (Moliadze et al., 2010). Three studies following a different rationale, namely readjustment of hemispheric dysbalance by cathodal tDCS of the healthy hemisphere, demonstrated positive results (Jung et al., 2011, Kang et al., 2011, You et al., 2011). Interestingly, it was most effective in patients with mild fluent aphasia when the therapy started within 30 days after stroke (Jung et al., 2011). In another positive study, anodal tDCS of the right frontal cortex was combined with melodic intonation therapy, which involves activation of the right prefrontal cortex (Vines et al., 2011). Taken together, these pilot studies show that tDCS in combination with speech therapy is suited to enhance speech function in aphasic patients. The most promising approaches encompass excitability-enhancing stimulation of left-hemispheric language-related, and excitability-reducing stimulation of the right hemispheric homolog areas combined with speech therapy. However, systematic studies exploring optimal stimulation protocols with regard to stimulation intensity, repetition rate, electrode positions, which might differ also with regard to lesion location and size, are needed as well as studies involving larger patient populations to translate this approach into clinical practice.
References
Baker, J.M., Rorden, C., Fridriksson, J.: Using transcranial direct-current stimulation to treat stroke patients with aphasia. Stroke; a Journal of Cerebral Circulation 41, 1229–1236 (2010)
Boggio, P.S., Nunes, A., Rigonatti, S.P., Nitsche, M.A., Pascual-Leone, A., Fregni, F.: Repeated sessions of noninvasive brain DC stimulation is associated with motor function improvement in stroke patients. Restorative Neurology and Neuroscience 25, 123–129 (2007)
Kuo, W. Paulus, and M.A. Nitsche
Bolognini, N., Vallar, G., Casati, C., Latif, L.A., El-Nazer, R., Williams, J., Banco, E., Macea, D.D., Tesio, L., Chessa, C., Fregni, F.: Neurophysiological and behavioral effects of tDCS combined with constraint-induced movement therapy in poststroke patients. Neurorehabil Neural Repair 25, 819–829 (2011)
Bradnam, L.V., Stinear, C.M., Barber, P.A., Byblow, W.D.: Contralesional hemisphere control of the proximal paretic upper limb following stroke. Cereb Cortex 22, 2662–2671 (2012)
Celnik, P., Paik, N.-J., Vandermeeren, Y., Dimyan, M., Cohen, L.G.: Effects of combined peripheral nerve stimulation and brain polarization on performance of a motor sequence task after chronic stroke. Stroke 40, 1764–1771 (2009)
Fiori, V., Coccia, M., Marinelli, C.V., Vecchi, V., Bonifazi, S., Ceravolo, M.G., Provinciali, L., Tomaiuolo, F., Marangolo, P.: Transcranial direct current stimulation improves word retrieval in healthy and nonfluent aphasic subjects. Journal of Cognitive Neuroscience 23, 2309–2323 (2011)
Fregni, F., Boggio, P.S., Mansur, C.G., Wagner, T., Ferreira, M.J., Lima, M.C., Rigonatti, S.P., Marcolin, M.A., Freedman, S.D., Nitsche, M.A., Pascual-Leone, A.: Transcranial direct current stimulation of the unaffected hemisphere in stroke patients. Neuroreport 16, 1551–1555 (2005)
Fridriksson, J., Richardson, J.D., Baker, J.M., Rorden, C.: Transcranial direct current stimulation improves naming reaction time in fluent aphasia: a double-blind, shamcontrolled study. Stroke; a Journal of Cerebral Circulation 42, 819–821 (2011)
Hamilton, R.H., Chrysikou, E.G., Coslett, B.: Mechanisms of aphasia recovery after stroke and the role of noninvasive brain stimulation. Brain and Language 118, 40–50 (2011)
Hesse, S., Werner, C., Schonhardt, E.M., Bardeleben, A., Jenrich, W., Kirker, S.G.: Combined transcranial direct current stimulation and robot-assisted arm training in subacute stroke patients: a pilot study. Restorative Neurology and Neuroscience 25, 9–15 (2007)
Holland, R., Crinion, J.: Can tDCS enhance treatment of aphasia after stroke? Aphasiology 26, 1169–1191 (2012)
Hummel, F., Celnik, P., Giraux, P., Floel, A., Wu, W., Gerloff, C., Cohen, L.: Effects of non- invasive cortical stimulation on skilled motor function in chronic stroke. Brain 128, 490–499 (2005)
Hummel, F.C., Cohen, L.G.: Non-invasive brain stimulation: a new strategy to improve neurorehabilitation after stroke? Lancet Neurology 5, 708–712 (2006)
Jung, I.Y., Lim, J.Y., Kang, E.K., Sohn, H.M., Paik, N.J.: The Factors Associated with Good Responses to Speech Therapy Combined with Transcranial Direct Current Stimulation in Post-stroke Aphasic Patients. Ann. Rehabil. Med. 35, 460–469 (2011)
Kang, E.K., Kim, Y.K., Sohn, H.M., Cohen, L.G., Paik, N.J.: Improved picture naming in aphasia patients treated with cathodal tDCS to inhibit the right Broca’s homologue area. Restor. Neurol. Neurosci. 29, 141–152 (2011)
Lindenberg, R., Renga, V., Zhu, L.L., Nair, D., Schlaug, G.: Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients. Neurology 75, 2176–2184 (2010)
Lindenberg, R., Zhu, L.L., Schlaug, G.: Combined central and peripheral stimulation to facilitate motor recovery after stroke: the effect of number of sessions on outcome. Neurorehabil. Neural Repair 26, 479–483 (2012)
Madhavan, S., Weber, K.A., Stinear, J.W.: Non-invasive brain stimulation enhances fine motor control of the hemiparetic ankle: implications for rehabilitation. Experimental Brain Research Experimentelle Hirnforschung Experimentation Cerebrale 209, 9–17 (2011)
Marangolo, P., Marinelli, C.V., Bonifazi, S., Fiori, V., Ceravolo, M.G., Provinciali, L., Tomaiuolo, F.: Electrical stimulation over the left inferior frontal gyrus (IFG) determines long-term effects in the recovery of speech apraxia in three chronic aphasics. Behavioural Brain Research 225, 498–504 (2011)
Moliadze, V., Antal, A., Paulus, W.: Electrode-distance dependent after-effects of transcranial direct and random noise stimulation with extracephalic reference electrodes. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology 121, 2165–2171 (2010)
Monti, A., Cogiamanian, F., Marceglia, S., Ferrucci, R., Mameli, F., Mrakic-Sposta, S., Vergari, M., Zago, S., Priori, A.: Improved naming after transcranial direct current stimulation in aphasia. Journal of Neurology, Neurosurgery, and Psychiatry 79, 451–453 (2008)
Nair, D.G., Renga, V., Lindenberg, R., Zhu, L., Schlaug, G.: Optimizing recovery potential through simultaneous occupational therapy and non-invasive brain-stimulation using tDCS. Restor. Neurol. Neurosci. 29, 411–420 (2011)
Nitsche, M.A., Paulus, W.: Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. The Journal of Physiology 527(Pt. 3), 633–639 (2000)
O’Shea, J., Boudrias, M.H., Stagg, C.J., Bachtiar, V., Kischka, U., Blicher, J.U., JohansenBerg, H.: Predicting behavioural response to TDCS in chronic motor stroke. NeuroImage 85(Pt. 3), 924–933 (2014)
Ross, L.A., McCoy, D., Coslett, H.B., Olson, I.R., Wolk, D.A.: Improved proper name recall in aging after electrical stimulation of the anterior temporal lobes. Front. Aging Neurosci. 3, 16 (2011)
Rossi, C., Sallustio, F., Di Legge, S., Stanzione, P., Koch, G.: Transcranial direct current stimulation of the affected hemisphere does not accelerate recovery of acute stroke patients. European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies 20, 202–204 (2013)
Schlaug, G., Marchina, S., Wan, C.Y.: The use of non-invasive brain stimulation techniques to facilitate recovery from post-stroke aphasia. Neuropsychol. Rev. 21, 288–301 (2011)
Tanaka, S., Takeda, K., Otaka, Y., Kita, K., Osu, R., Honda, M., Sadato, N., Hanakawa, T., Watanabe, K.: Single session of transcranial direct current stimulation transiently increases knee extensor force in patients with hemiparetic stroke. Neurorehabilitation and Neural Repair 25, 565–569 (2011)
You, D.S., Kim, D.Y., Chun, M.H., Jung, S.E., Park, S.J.: Cathodal transcranial direct current stimulation of the right Wernicke’s area improves comprehension in subacute stroke patients. Brain and Language 119, 1–5 (2011)
Zimerman, M., Heise, K.F., Hoppe, J., Cohen, L.G., Gerloff, C., Hummel, F.C.: Modulation of training by single-session transcranial direct current stimulation to the intact motor cortex enhances motor skill acquisition of the paretic hand. Stroke 43, 2185–2191 (2012)
Miniaturized Neural Interfaces and Implants in Neurological Rehabilitation
Thomas Stieglitz
Laboratory of Biomedical Microtechnology, The Department of Microsystems Engineering-IMTEK, The Bernstein Center Freiburg and the Cluster of Excellence BrainLinks-BrainTools (ExC 1086), Albert-Ludwig–University of Freiburg, Freiburg, Germany stieglitz@imtek.uni-freiburg.de
Abstract. Restoration of functions after trauma or neurological diseases is the major goal of rehabilitation. Technical aids complement remaining functions or even try to replace them completely. Neural prostheses use electrical signals from the nervous system as control signals or excite nerves by means of electrical stimulation to elicit perceptions, induce movements or modulate neural network behavior. Creating novel, neural prostheses applications for the peripheral or central nervous system require neural interfaces and implants that are biocompatible, long-term stable and highly robust. However, only few neural interfaces have been tested or are routinely used in clinical applications today, most of them made with "old-style" precision mechanics technologies. What are the biological, tech- nological, electrical and material science challenges that must be considered when designing an optimal neural interface? Do nano-, microand biohybrid systems have a future in clinical applications of neural implants? Design aspects and opportunities and challenges of miniaturization technologies for neural implants will be presented and discussed for peripheral and central nervous system applications. Devices will be introduced and compared with respect to selectivity, long-term functionality and their applicability in funda- mental and translational research as well as for clinical applications.
Neural prostheses aim to restore or replace lost functions due to trauma or neurological diseases. Since all neural functions in the human body come along with electrical activity of the nerve cells, the idea arose decades ago to take advantage of this property. Technical devices were invented to interface nervous structures to read out or to inscribe or even overwrite electrical information. Adequate interfaces are needed for this endeavor. They must
neither harm the body nor lose their functionality over the course of the application. The earliest clinical application that replaced lost neural activity was the cardiac pacemaker. Its rise started in 1958 and it is the most successful active implant nowadays with more than 350,000 new implantations per year worldwide [1]. In neural prostheses or implants, only few success stories have been written so far. Cochlear implants to restore hearing have been implanted in about 250,000 patients worldwide. Deep brain stimulators to treat symptoms of Parkinson’s (Lou Gehrig’s) disease symptoms as well as vagal nerve and spinal cord stimulators modulate network activity by electrical stimulation very successfully [1]. Implants to activate ankle flexion after brain stroke, i.e. drop foot stimulators, and retinal vision prostheses have got medical device approval in the EC and the USA but are still far from market penetration. Recently, more applications have been developed in the field of stroke rehabilitation, epilepsy diagnosis and treatment, psychia- tric disease therapy, control of technical aids after para- lysis and artificial limbs after amputation to list the main research lines. Some of them are on the way into clinical practice, others still in different stages of fundamental research [1].
Further scientific findings are still needed to understand physiologic function and pathophysiological changes in many diseases to develop an “optimal” neural implant. On the other side, devices still look very “oldfashioned” or “vintage-style” in most clinical applications. Which target specifications have to be met to develop a new generation of neural interfaces and implants with modern miniaturization technologies ? Starting with a personal view on essential requirements of active implants, peripheral and central nervous system interfaces will be introduced. Chemical and optical interaction with the nervous system will be considered as alternative to established electrical recording and stimulation techniques. System concepts of implants that connect a kind of control center with its periphery conclude the overview.
2 Essential Requirements
Implants must not harm the target tissue and need to establish a long-term stable and functional interface. The technical term “biocompatibility” summarizes the main requirements that a device shall meet [2]. The used materials must not be toxic and shall interact with the tissue in a desired manner. Shape and mechanical material properties determine the structural biocompatibility that also influences the strength of the foreign body reaction. Implants will be encapsulated by electrically insulating tissue (either glia or fibroblasts) that deteriorates the recording and stimulation properties of the interfaces. Safety of the implant also includes material stability, the absence of eluates and debris and absence of tissue damage by (leakage) currents and electrical shock beyond the intended use. All these aspects have to be considered as fundament of application specific requirements.
Another random document with no related content on Scribd:
struggled to keep his footing. Between them the girl uncomplainingly picked her way upward.
And then they came to a place, as Stephen had hoped, where it was necessary to scale a sheer scarp of six or seven feet in order to gain a shelf near the summit. He had to kneel in order to help the girl up. Turpan, not tall enough to pull himself up with his arms, cursed as his boots slipped.
"Extend the barrel of your rifle to me," Stephen said, "and I will pull you up until you are able to reach that overhanging bush. It will support your weight."
Turpan nodded curtly. He was not happy about this. He was never happy when playing a minor role, but he appreciated the urgency of the moment.
Stephen pulled and the Bedchamber Assassin strained upward. Then he grasped at the bush, and at the same moment Stephen gave a sharp, Herculean tug.
Turpan snatched for the bush with both hands. "Got it," he said, and swung himself upon the ledge.
"Yes," agreed Stephen, "but I have the rifle."
Turpan, fettered like a common criminal, lay upon his couch in the tent where he had sat not long ago, a conqueror. The powerful floodlight that shone in his face did nothing to sooth his raw temper. Someone entered the tent and he strained in his bonds to see who it was. Stephen came and stood over him.
Turpan licked his dry lips. "What time is it?" he asked.
"It is almost midnight. They have destroyed your rifle, but it has been decided that, in view of your predatory nature, it would be dangerous to release you again upon this colony. Are you prepared to meet your fate?"
Turpan sneered. "Destroy me, fool—eunuch! It will not change your lot here. You will remain an untouchable—an odd man out. May your books comfort your cold bed for the rest of your life. I prefer death."
Stephen removed the hypodermic needle from the kit which they had furnished him and filled it. He bared Turpan's arm. The muscles of that arm were tense, like cords of steel. Turpan was lying. He was frightened of death.
Stephen smiled a little. He looked a good deal younger when he smiled. "Please relax," he said. "I am only a biological technician; not an executioner."
Two hours later Stephen emerged from the tent, perspiring, and found that the revel in the encampment continued unabated even at this time of morning. Few suspected what had been going on in Turpan's tent. These few now anxiously awaited his verdict.
"How did it go?" the former Planner of Flight One asked. "Was—the equipment satisfactory? The drugs and chalones sufficient?"
He nodded wearily. "The character change appears to have been complete enough. The passivity will grow, of course." A group of men and women were playing a variety of hide-and-seek, with piercing shouts and screams, among the shadows of the tents, and it was no child's game.
"Don't worry about them," the Planner said. "They'll be over it in the morning. Most of them have never had anything to drink before. Our dictator's methods may have been cruder than we intended, but they've certainly broken the ice."
"When will we see—Turpan?" someone asked. It was Ellen.
Stephen had not known that she was waiting. "Any moment now, I believe," he said. "I will go in and see what is keeping him."
He returned in a few seconds. "A matter of clothing," he said with a smile. "I warned you that there would be a complete character
change."
The garments were supplied. Stephen took them in. The floodlight had been turned off now, and it was fairly dark in the tent.
"Hurry up," Stephen said gently.
"I can't—I cannot do it!"
"Oh, but you can. You can start all over now. Few of the colonists ever knew you by sight. I am sure that you will be warmly enough received."
Stephen came out. Ellen searched his face. "It will not be much longer now," he told her.
"And to think that I doubted you!"
"I am only a technician," he said.
"There are one hundred and sixty-two male high scientists upon this island," she said, coming forward and putting her arms around him, "but only one, solid, unimaginative, blessed technician. It makes a nice, even arrangement for us women, don't you think?"
"Even enough," he said. And at that moment Turpan stepped out of the tent, and all of them looked. And looked. And Turpan, unable to face that battery of eyes, ran.
Ran lightly and gracefully through the tent village toward the cliffs beyond. And all along that gauntlet there were catcalls and wolf whistles.
"Don't worry," the Planner said. "She will come back to us. After all, there is a biological need."
*** END OF THE PROJECT GUTENBERG EBOOK EVEN STEPHEN ***
Updated editions will replace the previous one—the old editions will be renamed.
Creating the works from print editions not protected by U.S. copyright law means that no one owns a United States copyright in these works, so the Foundation (and you!) can copy and distribute it in the United States without permission and without paying copyright royalties. Special rules, set forth in the General Terms of Use part of this license, apply to copying and distributing Project Gutenberg™ electronic works to protect the PROJECT GUTENBERG™ concept and trademark. Project Gutenberg is a registered trademark, and may not be used if you charge for an eBook, except by following the terms of the trademark license, including paying royalties for use of the Project Gutenberg trademark. If you do not charge anything for copies of this eBook, complying with the trademark license is very easy. You may use this eBook for nearly any purpose such as creation of derivative works, reports, performances and research. Project Gutenberg eBooks may be modified and printed and given away—you may do practically ANYTHING in the United States with eBooks not protected by U.S. copyright law. Redistribution is subject to the trademark license, especially commercial redistribution.
START: FULL LICENSE
THE FULL PROJECT GUTENBERG LICENSE
PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK
To protect the Project Gutenberg™ mission of promoting the free distribution of electronic works, by using or distributing this work (or any other work associated in any way with the phrase “Project Gutenberg”), you agree to comply with all the terms of the Full Project Gutenberg™ License available with this file or online at www.gutenberg.org/license.
Section 1. General Terms of Use and Redistributing Project Gutenberg™ electronic works
1.A. By reading or using any part of this Project Gutenberg™ electronic work, you indicate that you have read, understand, agree to and accept all the terms of this license and intellectual property (trademark/copyright) agreement. If you do not agree to abide by all the terms of this agreement, you must cease using and return or destroy all copies of Project Gutenberg™ electronic works in your possession. If you paid a fee for obtaining a copy of or access to a Project Gutenberg™ electronic work and you do not agree to be bound by the terms of this agreement, you may obtain a refund from the person or entity to whom you paid the fee as set forth in paragraph 1.E.8.
1.B. “Project Gutenberg” is a registered trademark. It may only be used on or associated in any way with an electronic work by people who agree to be bound by the terms of this agreement. There are a few things that you can do with most Project Gutenberg™ electronic works even without complying with the full terms of this agreement. See paragraph 1.C below. There are a lot of things you can do with Project Gutenberg™ electronic works if you follow the terms of this agreement and help preserve free future access to Project Gutenberg™ electronic works. See paragraph 1.E below.
1.C. The Project Gutenberg Literary Archive Foundation (“the Foundation” or PGLAF), owns a compilation copyright in the collection of Project Gutenberg™ electronic works. Nearly all the individual works in the collection are in the public domain in the United States. If an individual work is unprotected by copyright law in the United States and you are located in the United States, we do not claim a right to prevent you from copying, distributing, performing, displaying or creating derivative works based on the work as long as all references to Project Gutenberg are removed. Of course, we hope that you will support the Project Gutenberg™ mission of promoting free access to electronic works by freely sharing Project Gutenberg™ works in compliance with the terms of this agreement for keeping the Project Gutenberg™ name associated with the work. You can easily comply with the terms of this agreement by keeping this work in the same format with its attached full Project Gutenberg™ License when you share it without charge with others.
1.D. The copyright laws of the place where you are located also govern what you can do with this work. Copyright laws in most countries are in a constant state of change. If you are outside the United States, check the laws of your country in addition to the terms of this agreement before downloading, copying, displaying, performing, distributing or creating derivative works based on this work or any other Project Gutenberg™ work. The Foundation makes no representations concerning the copyright status of any work in any country other than the United States.
1.E. Unless you have removed all references to Project Gutenberg:
1.E.1. The following sentence, with active links to, or other immediate access to, the full Project Gutenberg™ License must appear prominently whenever any copy of a Project Gutenberg™ work (any work on which the phrase “Project Gutenberg” appears, or with which the phrase “Project Gutenberg” is associated) is accessed, displayed, performed, viewed, copied or distributed:
This eBook is for the use of anyone anywhere in the United States and most other parts of the world at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this eBook or online at www.gutenberg.org. If you are not located in the United States, you will have to check the laws of the country where you are located before using this eBook.
1.E.2. If an individual Project Gutenberg™ electronic work is derived from texts not protected by U.S. copyright law (does not contain a notice indicating that it is posted with permission of the copyright holder), the work can be copied and distributed to anyone in the United States without paying any fees or charges. If you are redistributing or providing access to a work with the phrase “Project Gutenberg” associated with or appearing on the work, you must comply either with the requirements of paragraphs 1.E.1 through 1.E.7 or obtain permission for the use of the work and the Project Gutenberg™ trademark as set forth in paragraphs 1.E.8 or 1.E.9.
1.E.3. If an individual Project Gutenberg™ electronic work is posted with the permission of the copyright holder, your use and distribution must comply with both paragraphs 1.E.1 through 1.E.7 and any additional terms imposed by the copyright holder. Additional terms will be linked to the Project Gutenberg™ License for all works posted with the permission of the copyright holder found at the beginning of this work.
1.E.4. Do not unlink or detach or remove the full Project Gutenberg™ License terms from this work, or any files containing a part of this work or any other work associated with Project Gutenberg™.
1.E.5. Do not copy, display, perform, distribute or redistribute this electronic work, or any part of this electronic work, without prominently displaying the sentence set forth in paragraph 1.E.1 with active links or immediate access to the full terms of the Project Gutenberg™ License.
1.E.6. You may convert to and distribute this work in any binary, compressed, marked up, nonproprietary or proprietary form, including any word processing or hypertext form. However, if you provide access to or distribute copies of a Project Gutenberg™ work in a format other than “Plain Vanilla ASCII” or other format used in the official version posted on the official Project Gutenberg™ website (www.gutenberg.org), you must, at no additional cost, fee or expense to the user, provide a copy, a means of exporting a copy, or a means of obtaining a copy upon request, of the work in its original “Plain Vanilla ASCII” or other form. Any alternate format must include the full Project Gutenberg™ License as specified in paragraph 1.E.1.
1.E.7. Do not charge a fee for access to, viewing, displaying, performing, copying or distributing any Project Gutenberg™ works unless you comply with paragraph 1.E.8 or 1.E.9.
1.E.8. You may charge a reasonable fee for copies of or providing access to or distributing Project Gutenberg™ electronic works provided that:
• You pay a royalty fee of 20% of the gross profits you derive from the use of Project Gutenberg™ works calculated using the method you already use to calculate your applicable taxes. The fee is owed to the owner of the Project Gutenberg™ trademark, but he has agreed to donate royalties under this paragraph to the Project Gutenberg Literary Archive Foundation. Royalty payments must be paid within 60 days following each date on which you prepare (or are legally required to prepare) your periodic tax returns. Royalty payments should be clearly marked as such and sent to the Project Gutenberg Literary Archive Foundation at the address specified in Section 4, “Information about donations to the Project Gutenberg Literary Archive Foundation.”
• You provide a full refund of any money paid by a user who notifies you in writing (or by e-mail) within 30 days of receipt that s/he does not agree to the terms of the full Project Gutenberg™ License. You must require such a user to return or destroy all
copies of the works possessed in a physical medium and discontinue all use of and all access to other copies of Project Gutenberg™ works.
• You provide, in accordance with paragraph 1.F.3, a full refund of any money paid for a work or a replacement copy, if a defect in the electronic work is discovered and reported to you within 90 days of receipt of the work.
• You comply with all other terms of this agreement for free distribution of Project Gutenberg™ works.
1.E.9. If you wish to charge a fee or distribute a Project Gutenberg™ electronic work or group of works on different terms than are set forth in this agreement, you must obtain permission in writing from the Project Gutenberg Literary Archive Foundation, the manager of the Project Gutenberg™ trademark. Contact the Foundation as set forth in Section 3 below.
1.F.
1.F.1. Project Gutenberg volunteers and employees expend considerable effort to identify, do copyright research on, transcribe and proofread works not protected by U.S. copyright law in creating the Project Gutenberg™ collection. Despite these efforts, Project Gutenberg™ electronic works, and the medium on which they may be stored, may contain “Defects,” such as, but not limited to, incomplete, inaccurate or corrupt data, transcription errors, a copyright or other intellectual property infringement, a defective or damaged disk or other medium, a computer virus, or computer codes that damage or cannot be read by your equipment.
1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the “Right of Replacement or Refund” described in paragraph 1.F.3, the Project Gutenberg Literary Archive Foundation, the owner of the Project Gutenberg™ trademark, and any other party distributing a Project Gutenberg™ electronic work under this agreement, disclaim all liability to you for damages, costs and
expenses, including legal fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE FOUNDATION, THE TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH DAMAGE.
1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a defect in this electronic work within 90 days of receiving it, you can receive a refund of the money (if any) you paid for it by sending a written explanation to the person you received the work from. If you received the work on a physical medium, you must return the medium with your written explanation. The person or entity that provided you with the defective work may elect to provide a replacement copy in lieu of a refund. If you received the work electronically, the person or entity providing it to you may choose to give you a second opportunity to receive the work electronically in lieu of a refund. If the second copy is also defective, you may demand a refund in writing without further opportunities to fix the problem.
1.F.4. Except for the limited right of replacement or refund set forth in paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.
1.F.5. Some states do not allow disclaimers of certain implied warranties or the exclusion or limitation of certain types of damages. If any disclaimer or limitation set forth in this agreement violates the law of the state applicable to this agreement, the agreement shall be interpreted to make the maximum disclaimer or limitation permitted by the applicable state law. The invalidity or unenforceability of any provision of this agreement shall not void the remaining provisions.
1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the trademark owner, any agent or employee of the Foundation, anyone providing copies of Project Gutenberg™ electronic works in accordance with this agreement, and any volunteers associated with the production, promotion and distribution of Project Gutenberg™ electronic works, harmless from all liability, costs and expenses, including legal fees, that arise directly or indirectly from any of the following which you do or cause to occur: (a) distribution of this or any Project Gutenberg™ work, (b) alteration, modification, or additions or deletions to any Project Gutenberg™ work, and (c) any Defect you cause.
Section 2. Information about the Mission of Project Gutenberg™
Project Gutenberg™ is synonymous with the free distribution of electronic works in formats readable by the widest variety of computers including obsolete, old, middle-aged and new computers. It exists because of the efforts of hundreds of volunteers and donations from people in all walks of life.
Volunteers and financial support to provide volunteers with the assistance they need are critical to reaching Project Gutenberg™’s goals and ensuring that the Project Gutenberg™ collection will remain freely available for generations to come. In 2001, the Project Gutenberg Literary Archive Foundation was created to provide a secure and permanent future for Project Gutenberg™ and future generations. To learn more about the Project Gutenberg Literary Archive Foundation and how your efforts and donations can help, see Sections 3 and 4 and the Foundation information page at www.gutenberg.org.
Section 3. Information about the Project Gutenberg Literary Archive Foundation
The Project Gutenberg Literary Archive Foundation is a non-profit 501(c)(3) educational corporation organized under the laws of the state of Mississippi and granted tax exempt status by the Internal Revenue Service. The Foundation’s EIN or federal tax identification number is 64-6221541. Contributions to the Project Gutenberg Literary Archive Foundation are tax deductible to the full extent permitted by U.S. federal laws and your state’s laws.
The Foundation’s business office is located at 809 North 1500 West, Salt Lake City, UT 84116, (801) 596-1887. Email contact links and up to date contact information can be found at the Foundation’s website and official page at www.gutenberg.org/contact
Section 4. Information about Donations to the Project Gutenberg Literary Archive Foundation
Project Gutenberg™ depends upon and cannot survive without widespread public support and donations to carry out its mission of increasing the number of public domain and licensed works that can be freely distributed in machine-readable form accessible by the widest array of equipment including outdated equipment. Many small donations ($1 to $5,000) are particularly important to maintaining tax exempt status with the IRS.
The Foundation is committed to complying with the laws regulating charities and charitable donations in all 50 states of the United States. Compliance requirements are not uniform and it takes a considerable effort, much paperwork and many fees to meet and keep up with these requirements. We do not solicit donations in locations where we have not received written confirmation of compliance. To SEND DONATIONS or determine the status of compliance for any particular state visit www.gutenberg.org/donate.
While we cannot and do not solicit contributions from states where we have not met the solicitation requirements, we know of no
prohibition against accepting unsolicited donations from donors in such states who approach us with offers to donate.
International donations are gratefully accepted, but we cannot make any statements concerning tax treatment of donations received from outside the United States. U.S. laws alone swamp our small staff.
Please check the Project Gutenberg web pages for current donation methods and addresses. Donations are accepted in a number of other ways including checks, online payments and credit card donations. To donate, please visit: www.gutenberg.org/donate.
Section 5. General Information About Project Gutenberg™ electronic works
Professor Michael S. Hart was the originator of the Project Gutenberg™ concept of a library of electronic works that could be freely shared with anyone. For forty years, he produced and distributed Project Gutenberg™ eBooks with only a loose network of volunteer support.
Project Gutenberg™ eBooks are often created from several printed editions, all of which are confirmed as not protected by copyright in the U.S. unless a copyright notice is included. Thus, we do not necessarily keep eBooks in compliance with any particular paper edition.
Most people start at our website which has the main PG search facility: www.gutenberg.org.
This website includes information about Project Gutenberg™, including how to make donations to the Project Gutenberg Literary Archive Foundation, how to help produce our new eBooks, and how to subscribe to our email newsletter to hear about new eBooks.
