In an important step toward a fully implantable intracortical brain-computer interface system, BrainGate researchers demonstrated human use of a wireless transmitter capable of delivering high-bandwidth neural signals.
Brain-computer interfaces (BCIs) are an emerging assistive technology, enabling people with paralysis to type on computer screens or manipulate robotic prostheses just by thinking about moving their own bodies. For years, investigational BCIs used in clinical trials have required cables to connect the sensing array in the brain to computers that decode the signals and use them to drive external devices.
Now, for the first time, BrainGate clinical trial participants with tetraplegia have demonstrated use of an intracortical wireless BCI with an external wireless transmitter. The system is capable of transmitting brain signals at single-neuron resolution and in full broadband fidelity without physically tethering the user to a decoding system. The traditional cables are replaced by a small transmitter about 2 inches in its largest dimension and weighing a little over 1.5 ounces. The unit sits on top of a user’s head and connects to an electrode array within the brain’s motor cortex using the same port used by wired systems.
For a study published in IEEE Transactions on Biomedical Engineering, two clinical trial participants with paralysis used the BrainGate system with a wireless transmitter to point, click and type on a standard tablet computer. The study showed that the wireless system transmitted signals with virtually the same fidelity as wired systems, and participants achieved similar point-and-click accuracy and typing speeds.
“We’ve demonstrated that this wireless system is functionally equivalent to the wired systems that have been the gold standard in BCI performance for years,” said John Simeral, an assistant professor of engineering (research) at Brown University, a member of the BrainGate research consortium and the study’s lead author. “The signals are recorded and transmitted with appropriately similar fidelity, which means we can use the same decoding algorithms we used with wired equipment. The only difference is that people no longer need to be physically tethered to our equipment, which opens up new possibilities in terms of how the system can be used.”
The researchers say the study represents an early but important step toward a major objective in BCI research: a fully implantable intracortical system that aids in restoring independence for people who have lost the ability to move. While wireless devices with lower bandwidth have been reported previously, this is the first device to transmit the full spectrum of signals recorded by an intracortical sensor. That high-broadband wireless signal enables clinical research and basic human neuroscience that is much more difficult to perform with wired BCIs.
The new study demonstrated some of those new possibilities. The trial participants — a 35-year-old man and a 63-year-old man, both paralyzed by spinal cord injuries — were able to use the system in their homes, as opposed to the lab setting where most BCI research takes place. Unencumbered by cables, the participants were able to use the BCI continuously for up to 24 hours, giving the researchers long-duration data including while participants slept.
“We want to understand how neural signals evolve over time,” said Leigh Hochberg, an engineering professor at Brown, a researcher at Brown’s Carney Institute for Brain Science and leader of the BrainGate clinical trial. “With this system, we’re able to look at brain activity, at home, over long periods in a way that was nearly impossible before. This will help us to design decoding algorithms that provide for the seamless, intuitive, reliable restoration of communication and mobility for people with paralysis.”
The device used in the study was first developed at Brown in the lab of Arto Nurmikko, a professor in Brown’s School of Engineering. Dubbed the Brown Wireless Device (BWD), it was designed to transmit high-fidelity signals while drawing minimal power. In the current study, two devices used together recorded neural signals at 48 megabits per second from 200 electrodes with a battery life of over 36 hours.
While the BWD has been used successfully for several years in basic neuroscience research, additional testing and regulatory permission were required prior to using the system in the BrainGate trial. Nurmikko says the step to human use marks a key moment in the development of BCI technology.
“I am privileged to be part of a team pushing the frontiers of brain-machine interfaces for human use,” Nurmikko said. “Importantly, the wireless technology described in our paper has helped us to gain crucial insight for the road ahead in pursuit of next generation of neurotechnologies, such as fully implanted high-density wireless electronic interfaces for the brain.”
The new study marks another significant advance by researchers with the BrainGate consortium, an interdisciplinary group of researchers from Brown, Stanford and Case Western Reserve universities, as well as the Providence Veterans Affairs Medical Center and Massachusetts General Hospital. In 2012, the team published landmark research in which clinical trial participants were able, for the first time, to operate multidimensional robotic prosthetics using a BCI. That work has been followed by a steady stream of refinements to the system, as well as new clinical breakthroughs that have enabled people to type on computers, use tablet apps and even move their own paralyzed limbs.
“The evolution of intracortical BCIs from requiring a wire cable to instead using a miniature wireless transmitter is a major step toward functional use of fully implanted, high-performance neural interfaces,” said study co-author Sharlene Flesher, who was a postdoctoral fellow at Stanford and is now a hardware engineer at Apple. “As the field heads toward reducing transmitted bandwidth while preserving the accuracy of assistive device control, this study may be one of few that captures the full breadth of cortical signals for extended periods of time, including during practical BCI use.”
The new wireless technology is already paying dividends in unexpected ways, the researchers say. Because participants are able to use the wireless device in their homes without a technician on hand to maintain the wired connection, the BrainGate team has been able to continue their work during the COVID-19 pandemic.
“In March 2020, it became clear that we would not be able to visit our research participants’ homes,” said Hochberg, who is also a critical care neurologist at Massachusetts General Hospital and director of the V.A. Rehabilitation Research and Development Center for Neurorestoration and Neurotechnology. “But by training caregivers how to establish the wireless connection, a trial participant was able to use the BCI without members of our team physically being there. So not only were we able to continue our research, this technology allowed us to continue with the full bandwidth and fidelity that we had before.”
Simeral noted that, “Multiple companies have wonderfully entered the BCI field, and some have already demonstrated human use of low-bandwidth wireless systems, including some that are fully implanted. In this report, we’re excited to have used a high-bandwidth wireless system that advances the scientific and clinical capabilities for future systems.”
Brown has a licensing agreement with Blackrock Microsystems to make the device available to neuroscience researchers around the world. The BrainGate team plans to continue to use the device in ongoing clinical trials.
Researchers at Stanford University (California, US) believe they have a solution for a problem with neuroprosthetics (Note: I have included brief comments about neuroprosthetics and possible ethical issues at the end of this posting) according an August 5, 2020 news item on ScienceDaily,
The current generation of neural implants record enormous amounts of neural activity, then transmit these brain signals through wires to a computer. But, so far, when researchers have tried to create wireless brain-computer interfaces to do this, it took so much power to transmit the data that the implants generated too much heat to be safe for the patient. A new study suggests how to solve his problem — and thus cut the wires.
Stanford researchers have been working for years to advance a technology that could one day help people with paralysis regain use of their limbs, and enable amputees to use their thoughts to control prostheses and interact with computers.
The team has been focusing on improving a brain-computer interface, a device implanted beneath the skull on the surface of a patient’s brain. This implant connects the human nervous system to an electronic device that might, for instance, help restore some motor control to a person with a spinal cord injury, or someone with a neurological condition like amyotrophic lateral sclerosis, also called Lou Gehrig’s disease.
The current generation of these devices record enormous amounts of neural activity, then transmit these brain signals through wires to a computer. But when researchers have tried to create wireless brain-computer interfaces to do this, it took so much power to transmit the data that the devices would generate too much heat to be safe for the patient.
Now, a team led by electrical engineers and neuroscientists Krishna Shenoy, PhD, and Boris Murmann, PhD, and neurosurgeon and neuroscientist Jaimie Henderson, MD, have shown how it would be possible to create a wireless device, capable of gathering and transmitting accurate neural signals, but using a tenth of the power required by current wire-enabled systems. These wireless devices would look more natural than the wired models and give patients freer range of motion.
Graduate student Nir Even-Chen and postdoctoral fellow Dante Muratore, PhD, describe the team’s approach in a Nature Biomedical Engineering paper.
The team’s neuroscientists identified the specific neural signals needed to control a prosthetic device, such as a robotic arm or a computer cursor. The team’s electrical engineers then designed the circuitry that would enable a future, wireless brain-computer interface to process and transmit these these carefully identified and isolated signals, using less power and thus making it safe to implant the device on the surface of the brain.
To test their idea, the researchers collected neuronal data from three nonhuman primates and one human participant in a (BrainGate) clinical trial.
As the subjects performed movement tasks, such as positioning a cursor on a computer screen, the researchers took measurements. The findings validated their hypothesis that a wireless interface could accurately control an individual’s motion by recording a subset of action-specific brain signals, rather than acting like the wired device and collecting brain signals in bulk.
The next step will be to build an implant based on this new approach and proceed through a series of tests toward the ultimate goal.
As I found out while investigating, ethical issues in this area abound. My first thought was to look at how someone with a focus on ability studies might view the complexities.
My ‘go to’ resource for human enhancement and ethical issues is Gregor Wolbring, an associate professor at the University of Calgary (Alberta, Canada). his profile lists these areas of interest: ability studies, disability studies, governance of emerging and existing sciences and technologies (e.g. neuromorphic engineering, genetics, synthetic biology, robotics, artificial intelligence, automatization, brain machine interfaces, sensors) and more.
I can’t find anything more recent on this particular topic but I did find an August 10, 2017 essay for The Conversation where he comments on technology and human enhancement ethical issues where the technology is gene-editing. Regardless, he makes points that are applicable to brain-computer interfaces (human enhancement), Note: Links have been removed),
Ability expectations have been and still are used to disable, or disempower, many people, not only people seen as impaired. They’ve been used to disable or marginalize women (men making the argument that rationality is an important ability and women don’t have it). They also have been used to disable and disempower certain ethnic groups (one ethnic group argues they’re smarter than another ethnic group) and others.
A recent Pew Research survey on human enhancement revealed that an increase in the ability to be productive at work was seen as a positive. What does such ability expectation mean for the “us” in an era of scientific advancements in gene-editing, human enhancement and robotics?
Which abilities are seen as more important than others?
The ability expectations among “us” will determine how gene-editing and other scientific advances will be used.
And so how we govern ability expectations, and who influences that governance, will shape the future. Therefore, it’s essential that ability governance and ability literacy play a major role in shaping all advancements in science and technology.
One of the reasons I find Gregor’s commentary so valuable is that he writes lucidly about ability and disability as concepts and poses what can be provocative questions about expectations and what it is to be truly abled or disabled. You can find more of his writing here on his eponymous (more or less) blog.
Ethics of clinical trials for testing brain implants
In 2003, neurologist Helen Mayberg of Emory University in Atlanta began to test a bold, experimental treatment for people with severe depression, which involved implanting metal electrodes deep in the brain in a region called area 25 [emphases mine]. The initial data were promising; eventually, they convinced a device company, St. Jude Medical in Saint Paul, to sponsor a 200-person clinical trial dubbed BROADEN.
This month [October 2017], however, Lancet Psychiatry reported the first published data on the trial’s failure. The study stopped recruiting participants in 2012, after a 6-month study in 90 people failed to show statistically significant improvements between those receiving active stimulation and a control group, in which the device was implanted but switched off.
… a tricky dilemma for companies and research teams involved in deep brain stimulation (DBS) research: If trial participants want to keep their implants [emphases mine], who will take responsibility—and pay—for their ongoing care? And participants in last week’s meeting said it underscores the need for the growing corps of DBS researchers to think long-term about their planned studies.
… participants bear financial responsibility for maintaining the device should they choose to keep it, and for any additional surgeries that might be needed in the future, Mayberg says. “The big issue becomes cost [emphasis mine],” she says. “We transition from having grants and device donations” covering costs, to patients being responsible. And although the participants agreed to those conditions before enrolling in the trial, Mayberg says she considers it a “moral responsibility” to advocate for lower costs for her patients, even it if means “begging for charity payments” from hospitals. And she worries about what will happen to trial participants if she is no longer around to advocate for them. “What happens if I retire, or get hit by a bus?” she asks.
There’s another uncomfortable possibility: that the hypothesis was wrong [emphases mine] to begin with. A large body of evidence from many different labs supports the idea that area 25 is “key to successful antidepressant response,” Mayberg says. But “it may be too simple-minded” to think that zapping a single brain node and its connections can effectively treat a disease as complex as depression, Krakauer [John Krakauer, a neuroscientist at Johns Hopkins University in Baltimore, Maryland] says. Figuring that out will likely require more preclinical research in people—a daunting prospect that raises additional ethical dilemmas, Krakauer says. “The hardest thing about being a clinical researcher,” he says, “is knowing when to jump.”
Brain-computer interfaces, symbiosis, and ethical issues
This was the most recent and most directly applicable work that I could find. From a July 24, 2019 article by Liam Drew for Nature Outlook: The brain,
“It becomes part of you,” Patient 6 said, describing the technology that enabled her, after 45 years of severe epilepsy, to halt her disabling seizures. Electrodes had been implanted on the surface of her brain that would send a signal to a hand-held device when they detected signs of impending epileptic activity. On hearing a warning from the device, Patient 6 knew to take a dose of medication to halt the coming seizure.
“You grow gradually into it and get used to it, so it then becomes a part of every day,” she told Frederic Gilbert, an ethicist who studies brain–computer interfaces (BCIs) at the University of Tasmania in Hobart, Australia. “It became me,” she said. [emphasis mine]
Gilbert was interviewing six people who had participated in the first clinical trial of a predictive BCI to help understand how living with a computer that monitors brain activity directly affects individuals psychologically1. Patient 6’s experience was extreme: Gilbert describes her relationship with her BCI as a “radical symbiosis”.
Symbiosis is a term, borrowed from ecology, that means an intimate co-existence of two species for mutual advantage. As technologists work towards directly connecting the human brain to computers, it is increasingly being used to describe humans’ potential relationship with artificial intelligence.
Interface technologies are divided into those that ‘read’ the brain to record brain activity and decode its meaning, and those that ‘write’ to the brain to manipulate activity in specific regions and affect their function.
Commercial research is opaque, but scientists at social-media platform Facebook are known to be pursuing brain-reading techniques for use in headsets that would convert users’ brain activity into text. And neurotechnology companies such as Kernel in Los Angeles, California, and Neuralink, founded by Elon Musk in San Francisco, California, predict bidirectional coupling in which computers respond to people’s brain activity and insert information into their neural circuitry. [emphasis mine]
Already, it is clear that melding digital technologies with human brains can have provocative effects, not least on people’s agency — their ability to act freely and according to their own choices. Although neuroethicists’ priority is to optimize medical practice, their observations also shape the debate about the development of commercial neurotechnologies.
Neuroethicists began to note the complex nature of the therapy’s side effects. “Some effects that might be described as personality changes are more problematic than others,” says Maslen [Hannah Maslen, a neuroethicist at the University of Oxford, UK]. A crucial question is whether the person who is undergoing stimulation can reflect on how they have changed. Gilbert, for instance, describes a DBS patient who started to gamble compulsively, blowing his family’s savings and seeming not to care. He could only understand how problematic his behaviour was when the stimulation was turned off.
Such cases present serious questions about how the technology might affect a person’s ability to give consent to be treated, or for treatment to continue. [emphases mine] If the person who is undergoing DBS is happy to continue, should a concerned family member or doctor be able to overrule them? If someone other than the patient can terminate treatment against the patient’s wishes, it implies that the technology degrades people’s ability to make decisions for themselves. It suggests that if a person thinks in a certain way only when an electrical current alters their brain activity, then those thoughts do not reflect an authentic self.
To observe a person with tetraplegia bringing a drink to their mouth using a BCI-controlled robotic arm is spectacular. [emphasis mine] This rapidly advancing technology works by implanting an array of electrodes either on or in a person’s motor cortex — a brain region involved in planning and executing movements. The activity of the brain is recorded while the individual engages in cognitive tasks, such as imagining that they are moving their hand, and these recordings are used to command the robotic limb.
If neuroscientists could unambiguously discern a person’s intentions from the chattering electrical activity that they record in the brain, and then see that it matched the robotic arm’s actions, ethical concerns would be minimized. But this is not the case. The neural correlates of psychological phenomena are inexact and poorly understood, which means that signals from the brain are increasingly being processed by artificial intelligence (AI) software before reaching prostheses.[emphasis mine]
But, he [Philipp Kellmeyer, a neurologist and neuroethicist at the University of Freiburg, Germany] says, using AI tools also introduces ethical issues of which regulators have little experience. [emphasis mine] Machine-learning software learns to analyse data by generating algorithms that cannot be predicted and that are difficult, or impossible, to comprehend. This introduces an unknown and perhaps unaccountable process between a person’s thoughts and the technology that is acting on their behalf.
Maslen is already helping to shape BCI-device regulation. She is in discussion with the European Commission about regulations it will implement in 2020 that cover non-invasive brain-modulating devices that are sold straight to consumers. [emphases mine; Note: There is a Canadian company selling this type of product, MUSE] Maslen became interested in the safety of these devices, which were covered by only cursory safety regulations. Although such devices are simple, they pass electrical currents through people’s scalps to modulate brain activity. Maslen found reports of them causing burns, headaches and visual disturbances. She also says clinical studies have shown that, although non-invasive electrical stimulation of the brain can enhance certain cognitive abilities, this can come at the cost of deficits in other aspects of cognition.
Regarding my note about MUSE, the company is InteraXon and its product is MUSE.They advertise the product as “Brain Sensing Headbands That Improve Your Meditation Practice.” The company website and the product seem to be one entity, Choose Muse. The company’s product has been used in some serious research papers they can be found here. I did not see any research papers concerning safety issues.
It’s easy to forget that in all the excitement over technologies ‘making our lives better’ that there can be a dark side or two. Some of the points brought forth in the articles by Wolbring, Underwood, and Drew confirmed my uneasiness as reasonable and gave me some specific examples of how these technologies raise new issues or old issues in new ways.
What I find interesting is that no one is using the term ‘cyborg’, which would seem quite applicable.There is an April 20, 2012 posting here titled ‘My mother is a cyborg‘ where I noted that by at lease one definition people with joint replacements, pacemakers, etc. are considered cyborgs. In short, cyborgs or technology integrated into bodies have been amongst us for quite some time.
Interestingly, no one seems to care much when insects are turned into cyborgs (can’t remember who pointed this out) but it is a popular area of research especially for military applications and search and rescue applications.
I’ve sometimes used the term ‘machine/flesh’ and or ‘augmentation’ as a description of technologies integrated with bodies, human or otherwise. You can find lots on the topic here however I’ve tagged or categorized it.
Amongst other pieces you can find here, there’s the August 8, 2016 posting, ‘Technology, athletics, and the ‘new’ human‘ featuring Oscar Pistorius when he was still best known as the ‘blade runner’ and a remarkably successful paralympic athlete. It’s about his efforts to compete against able-bodied athletes at the London Olympic Games in 2012. It is fascinating to read about technology and elite athletes of any kind as they are often the first to try out ‘enhancements’.
Gregor Wolbring has a number of essays on The Conversation looking at Paralympic athletes and their pursuit of enhancements and how all of this is affecting our notions of abilities and disabilities. By extension, one has to assume that ‘abled’ athletes are also affected with the trickle-down effect on the rest of us.
Regardless of where we start the investigation, there is a sameness to the participants in neuroethics discussions with a few experts and commercial interests deciding on how the rest of us (however you define ‘us’ as per Gregor Wolbring’s essay) will live.
This paucity of perspectives is something I was getting at in my COVID-19 editorial for the Canadian Science Policy Centre. My thesis being that we need a range of ideas and insights that cannot be culled from small groups of people who’ve trained and read the same materials or entrepreneurs who too often seem to put profit over thoughtful implementations of new technologies. (See the PDF May 2020 edition [you’ll find me under Policy Development]) or see my May 15, 2020 posting here (with all the sources listed.)
As for this new research at Stanford, it’s exciting news, which raises questions, as it offers the hope of independent movement for people diagnosed as tetraplegic (sometimes known as quadriplegic.)
It took me a few minutes to figure out why this item about a quadriplegic (also known as, tetraplegic) man is news. After all, I have a May 17, 2012 posting which features a video and information about a quadri(tetra)plegic woman who was drinking her first cup of coffee, independently, in many years. The difference is that she was using an external robotic arm and this man is using *his own arm*,
Bill Kochevar grabbed a mug of water, drew it to his lips and drank through the straw.
His motions were slow and deliberate, but then Kochevar hadn’t moved his right arm or hand for eight years.
And it took some practice to reach and grasp just by thinking about it.
Kochevar, who was paralyzed below his shoulders in a bicycling accident, is believed to be the first person with quadriplegia in the world to have arm and hand movements restored with the help of two temporarily implanted technologies.
A brain-computer interface with recording electrodes under his skull, and a functional electrical stimulation (FES) system* activating his arm and hand, reconnect his brain to paralyzed muscles.
Holding a makeshift handle pierced through a dry sponge, Kochevar scratched the side of his nose with the sponge. He scooped forkfuls of mashed potatoes from a bowl—perhaps his top goal—and savored each mouthful.
“For somebody who’s been injured eight years and couldn’t move, being able to move just that little bit is awesome to me,” said Kochevar, 56, of Cleveland. “It’s better than I thought it would be.”
Kochevar is the focal point of research led by Case Western Reserve University, the Cleveland Functional Electrical Stimulation (FES) Center at the Louis Stokes Cleveland VA Medical Center and University Hospitals Cleveland Medical Center (UH). A study of the work was published in the The Lancet March 28  at 6:30 p.m. U.S. Eastern time.
“He’s really breaking ground for the spinal cord injury community,” said Bob Kirsch, chair of Case Western Reserve’s Department of Biomedical Engineering, executive director of the FES Center and principal investigator (PI) and senior author of the research. “This is a major step toward restoring some independence.”
When asked, people with quadriplegia say their first priority is to scratch an itch, feed themselves or perform other simple functions with their arm and hand, instead of relying on caregivers.
“By taking the brain signals generated when Bill attempts to move, and using them to control the stimulation of his arm and hand, he was able to perform personal functions that were important to him,” said Bolu Ajiboye, assistant professor of biomedical engineering and lead study author.
Technology and training
The research with Kochevar is part of the ongoing BrainGate2* pilot clinical trial being conducted by a consortium of academic and VA institutions assessing the safety and feasibility of the implanted brain-computer interface (BCI) system in people with paralysis. Other investigational BrainGate research has shown that people with paralysis can control a cursor on a computer screen or a robotic arm (braingate.org).
“Every day, most of us take for granted that when we will to move, we can move any part of our body with precision and control in multiple directions and those with traumatic spinal cord injury or any other form of paralysis cannot,” said Benjamin Walter, associate professor of neurology at Case Western Reserve School of Medicine, clinical PI of the Cleveland BrainGate2 trial and medical director of the Deep Brain Stimulation Program at UH Cleveland Medical Center.
“The ultimate hope of any of these individuals is to restore this function,” Walter said. “By restoring the communication of the will to move from the brain directly to the body this work will hopefully begin to restore the hope of millions of paralyzed individuals that someday they will be able to move freely again.”
Jonathan Miller, assistant professor of neurosurgery at Case Western Reserve School of Medicine and director of the Functional and Restorative Neurosurgery Center at UH, led a team of surgeons who implanted two 96-channel electrode arrays—each about the size of a baby aspirin—in Kochevar’s motor cortex, on the surface of the brain.
The arrays record brain signals created when Kochevar imagines movement of his own arm and hand. The brain-computer interface extracts information from the brain signals about what movements he intends to make, then passes the information to command the electrical stimulation system.
To prepare him to use his arm again, Kochevar first learned how to use his brain signals to move a virtual-reality arm on a computer screen.
“He was able to do it within a few minutes,” Kirsch said. “The code was still in his brain.”
As Kochevar’s ability to move the virtual arm improved through four months of training, the researchers believed he would be capable of controlling his own arm and hand.
Miller then led a team that implanted the FES systems’ 36 electrodes that animate muscles in the upper and lower arm.
The BCI decodes the recorded brain signals into the intended movement command, which is then converted by the FES system into patterns of electrical pulses.
The pulses sent through the FES electrodes trigger the muscles controlling Kochevar’s hand, wrist, arm, elbow and shoulder. To overcome gravity that would otherwise prevent him from raising his arm and reaching, Kochevar uses a mobile arm support, which is also under his brain’s control.
Eight years of muscle atrophy required rehabilitation. The researchers exercised Kochevar’s arm and hand with cyclical electrical stimulation patterns. Over 45 weeks, his strength, range of motion and endurance improved. As he practiced movements, the researchers adjusted stimulation patterns to further his abilities.
Kochevar can make each joint in his right arm move individually. Or, just by thinking about a task such as feeding himself or getting a drink, the muscles are activated in a coordinated fashion.
When asked to describe how he commanded the arm movements, Kochevar told investigators, “I’m making it move without having to really concentrate hard at it…I just think ‘out’…and it goes.”
Kocehvar is fitted with temporarily implanted FES technology that has a track record of reliable use in people. The BCI and FES system together represent early feasibility that gives the research team insights into the potential future benefit of the combined system.
Advances needed to make the combined technology usable outside of a lab are not far from reality, the researchers say. Work is underway to make the brain implant wireless, and the investigators are improving decoding and stimulation patterns needed to make movements more precise. Fully implantable FES systems have already been developed and are also being tested in separate clinical research.
Kochevar welcomes new technology—even if it requires more surgery—that will enable him to move better. “This won’t replace caregivers,” he said. “But, in the long term, people will be able, in a limited way, to do more for themselves.”
Bill Kochevar, 53, has had electrical implants in the motor cortex of his brain and sensors inserted in his forearm, which allow the muscles of his arm and hand to be stimulated in response to signals from his brain, decoded by computer. After eight years, he is able to drink and feed himself without assistance.
“I think about what I want to do and the system does it for me,” Kochevar told the Guardian. “It’s not a lot of thinking about it. When I want to do something, my brain does what it does.”
The experimental technology, pioneered by the Case Western Reserve University in Cleveland, Ohio, is the first in the world to restore brain-controlled reaching and grasping in a person with complete paralysis.
For now, the process is relatively slow, but the scientists behind the breakthrough say this is proof of concept and that they hope to streamline the technology until it becomes a routine treatment for people with paralysis. In the future, they say, it will also be wireless and the electrical arrays and sensors will all be implanted under the skin and invisible.
Although only tested with one participant, the study is a major advance and the first to restore brain-controlled reaching and grasping in a person with complete paralysis. The technology, which is only for experimental use in the USA, circumvents rather than repairs spinal injuries, meaning the participant relies on the device being implanted and switched on to move.
“Our research is at an early stage, but we believe that this neuro-prosthesis could offer individuals with paralysis the possibility of regaining arm and hand functions to perform day-to-day activities, offering them greater independence,” said lead author Dr Bolu Ajiboye, Case Western Reserve University, USA. “So far it has helped a man with tetraplegia to reach and grasp, meaning he could feed himself and drink. With further development, we believe the technology could give more accurate control, allowing a wider range of actions, which could begin to transform the lives of people living with paralysis.” 
Previous research has used similar elements of the neuro-prosthesis. For example, a brain-computer interface linked to electrodes on the skin has helped a person with less severe paralysis open and close his hand, while other studies have allowed participants to control a robotic arm using their brain signals. However, this is the first to restore reaching and grasping via the system in a person with a chronic spinal cord injury.
In this study, a 53 year-old man who had been paralysed below the shoulders for eight years underwent surgery to have the neuro-prosthesis fitted.
This involved brain surgery to place sensors in the motor cortex area of his brain responsible for hand movement – creating a brain-computer interface that learnt which movements his brain signals were instructing for. This initial stage took four months and included training using a virtual reality arm.
He then underwent another procedure placing 36 muscle stimulating electrodes into his upper and lower arm, including four that helped restore finger and thumb, wrist, elbow and shoulder movements. These were switched on 17 days after the procedure, and began stimulating the muscles for eight hours a week over 18 weeks to improve strength, movement and reduce muscle fatigue.
The researchers then wired the brain-computer interface to the electrical stimulators in his arm, using a decoder (mathematical algorithm) to translate his brain signals into commands for the electrodes in his arm. The electrodes stimulated the muscles to produce contractions, helping the participant intuitively complete the movements he was thinking of. The system also involved an arm support to stop gravity simply pulling his arm down.
During his training, the participant described how he controlled the neuro-prosthesis: “It’s probably a good thing that I’m making it move without having to really concentrate hard at it. I just think ‘out’ and it just goes.”
After 12 months of having the neuro-prosthesis fitted, the participant was asked to complete day-to-day tasks, including drinking a cup of coffee and feeding himself. First of all, he observed while his arm completed the action under computer control. During this, he thought about making the same movement so that the system could recognise the corresponding brain signals. The two systems were then linked and he was able to use it to drink a coffee and feed himself.
He successfully drank in 11 out of 12 attempts, and it took him roughly 20-40 seconds to complete the task. When feeding himself, he did so multiple times – scooping forkfuls of food and navigating his hand to his mouth to take several bites.
“Although similar systems have been used before, none of them have been as easy to adopt for day-to-day use and they have not been able to restore both reaching and grasping actions,” said Dr Ajiboye. “Our system builds on muscle stimulating electrode technology that is already available and will continue to improve with the development of new fully implanted and wireless brain-computer interface systems. This could lead to enhanced performance of the neuro-prosthesis with better speed, precision and control.” 
At the time of the study, the participant had had the neuro-prosthesis implanted for almost two years (717 days) and in this time experienced four minor, non-serious adverse events which were treated and resolved.
Despite its achievements, the neuro-prosthesis still had some limitations, including that movements made using it were slower and less accurate than those made using the virtual reality arm the participant used for training. When using the technology, the participant also needed to watch his arm as he lost his sense of proprioception – the ability to intuitively sense the position and movement of limbs – as a result of the paralysis.
Writing in a linked Comment, Dr Steve Perlmutter, University of Washington, USA, said: “The goal is futuristic: a paralysed individual thinks about moving her arm as if her brain and muscles were not disconnected, and implanted technology seamlessly executes the desired movement… This study is groundbreaking as the first report of a person executing functional, multi-joint movements of a paralysed limb with a motor neuro-prosthesis. However, this treatment is not nearly ready for use outside the lab. The movements were rough and slow and required continuous visual feedback, as is the case for most available brain-machine interfaces, and had restricted range due to the use of a motorised device to assist shoulder movements… Thus, the study is a proof-of-principle demonstration of what is possible, rather than a fundamental advance in neuro-prosthetic concepts or technology. But it is an exciting demonstration nonetheless, and the future of motor neuro-prosthetics to overcome paralysis is brighter.”
 Quote direct from author and cannot be found in the text of the Article.
The video shows a woman getting herself a cup of coffee for the first time in 15 years. She’s tetraplegic (aka quadraplegic) and is participating in a research project funded by DARPA (US Defense Advanced Research Projects Agency) for developing neuroprostheses.
Kudos to the researchers and to the woman for her courage and persistence. The May 17, 2012 news item on Nanowerk provides some background,
DARPA launched the Revolutionizing Prosthetics program in 2006 to advance the state of upper-limb prosthetic technology with the goals of improving quality of life for service-disabled veterans and ultimately giving them the option of returning to duty. [emphasis mine] Since then, Revolutionizing Prosthetics teams have developed two anthropomorphic advanced modular prototype prosthetic arm systems, including sockets, which offer increased range of motion, dexterity and control options. Through DARPA-funded work and partnerships with external researchers, the arm systems and supporting technology continue to advance.
The newest development on this project (Revolutionizing Prosthetics) comes from the BrainGate team (mentioned in my April 19, 2012 posting [scroll down about 1/5th of the way) many of whom are affiliated with Brown University. Alison Abbott’s May 16, 2012 Nature article provides some insight into the latest research,
The study participants — known as Cathy and Bob — had had strokes that damaged their brain stems and left them with tetraplegia and unable to speak. Neurosurgeons implanted tiny recording devices containing almost 100 hair-thin electrodes in the motor cortex of their brains, to record the neuronal signals associated with intention to move.
The work is part of the BrainGate2 clinical trial, led by John Donoghue, director of the Brown Institute for Brain Science in Providence. His team has previously reported a trial in which two participants were able to move a cursor on a computer screen with their thoughts.
The neuroscientists are working closely with computer scientists and robotics experts. The BrainGate2 trial uses two types of robotic arm: the DEKA Arm System, which is being developed for prosthetic limbs in collaboration with US military, and a heavier robot arm being developed by the German Aerospace Centre (DLR) as an external assistive device.
In the latest study, the two participants were given 30 seconds to reach and grasp foam balls. Using the DEKA arm, Bob — who had his stroke in 2006 and was given the neural implant five months before the study —- was able to grasp the targets 62% of the time. Cathy had a 46% success rate with the DEKA arm and a 21% success rate with the DLR arm. She successfully raised the bottled coffee to her lips in four out of six trials.
Nature has published the research paper (citation):
Reach and grasp by people with tetraplegia using a neurally controlled robotic arm
Authors: Leigh R. Hochberg, Daniel Bacher, Beata Jarosiewicz, Nicolas Y. Masse, John D. Simeral, Joern Vogel, Sami Haddadin, Jie Liu, Sydney S. Cash, Patrick van der Smagt and John P. Donoghue
Nature, 485, 372–375 (17 May 2012) doi:10.1038/nature11076
The paper is behind a paywall but if you have access, it’s here.
In the excess emotion after watching that video, I forgot for a moment that the ultimate is to repair soldiers and hopefully get them back into the field.