title: Securing a future for responsible neuromodulation in children: The importance of maintaining a broad clinical gaze.
abstract: OBJECTIVE
  This perspective paper provides an overview of several key tensions and challenges within the social context of neuromodulation, and it suggests a means of securing the future of paediatric neuromodulation in light of these.
  
  
  RESULTS
  Tensions and challenges relate to: the considerable clinical and economic need for new therapies to manage neurological diseases; significant commercial involvement in the field; funding pressures; public perceptions (particularly unrealistic expectations); and the emerging Responsible Research and Innovation initiative. This paper argues that managing these challenges and tensions requires that clinicians working within the field adopt what could be called a broad clinical gaze. This paper will define the broad clinical gaze, and it will propose several ways in which a broad clinical gaze can be - and indeed is being - operationalised in recent advances in neuromodulation in children. These include the use of multidisciplinary and interdisciplinary clinical team structures, the adoption of clinical assessment tools that capture day-to-day functionality, and the use of patient registries.
  
  
  CONCLUSIONS
  By adopting a broad clinical gaze, clinicians and investigators can ensure that the field as a whole can responsibly and ethically deliver on its significant clinical potential.
authors.affiliation: Science and Technology Studies Unit, Department of Sociology, University of York, York, YO10 5DD, United Kingdom. Electronic address: john.gardner@york.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Gardner
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001921:Brain / Q000503:physiopathology*; D002648:Child; D046690:Deep Brain Stimulation / Q000941:ethics; D004827:Epilepsy / Q000503:physiopathology / Q000628:therapy; D004992:Ethics, Medical; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D009069:Movement Disorders / Q000503:physiopathology / Q000628:therapy; D009422:Nervous System Diseases / Q000503:physiopathology* / Q000628:therapy*; D009473:Neuronal Plasticity / Q000502:physiology*; D018802:Patient-Centered Care / Q000941:ethics; D010686:Philosophy, Medical; D018570:Risk Assessment / Q000941:ethics; D057170:Translational Research, Biomedical / Q000941:ethics
keywords: Bioethics; Deep brain stimulation; Ethics; Patient-centred medicine; Responsible research and innovation