Intracortical Brain-Computer Interfaces for the Restoration of Communication and Mobility

Abstract

For people with stroke, spinal cord injury, neuromuscular diseases, or other neurologic illnesses, currently available assistive and rehabilitation technologies are inadequate. In severe brainstem stroke and advanced ALS, patients may suddenly or progressively enter a locked-in state of being awake and alert but unable to move or communicate. Through clinical translation based on decades of basic neuroscience research, intracortically-based “brain-computer interfaces” are poised to revolutionize our ability to restore lost function. Over the past decade, neurotechnologies which record the individual and simultaneous activities of dozens to hundreds of cortical neurons have yielded new understandings of cortical function. This preclinical research, generally performed with healthy, neurologically intact non-human primates, has demonstrated that direct neural control of virtual and physical devices can be achieved. Recently, this exciting research has been translated into pilot clinical trials (IDE) of an intracortically-based neural interface system (BrainGate, www.braingate2.org), seeking to determine the feasibility of persons with tetraplegia controlling a computer cursor or other devices simply by imagining movement of their own hand. A variety of methods for decoding brain signals are being tested with the hope of not only restoring communication, but also providing a control signal for the reanimation of paralyzed limbs. A recent paper in Nature described a woman with brainstem stroke who used the BrainGate system to control a robotic arm to serve herself her morning coffee, demonstrating not only the critical ability to reach-and-grasp in her immediate, multidimensional environment, but also to perform a key activity of daily living using an intracortical BCI. In BrainGate-related research, early glimpses into the activities of dozens of individual cortical neurons in humans are also providing new insights and might provide new diagnostic and therapeutic modalities for people with epilepsy.