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Implant Allows Locked In ALS Patient to Operate Speech Computer With Her Brain

Summary: A wireless neural implant has allowed a locked in ALS patient to operate a speech computer with her brain activity.

Source: UMC Utrecht.

UMC Utrecht researchers have placed a brain implantinto a paralyzed ALS patient, enabling her to operate a speech computer with her mind. The researchers and the patient worked intensively to get the settings right. She can now communicate at home with her family and caregivers via the implant. That a patient can use this technique at home is unique in the world. This research was published in the New England Journal of Medicine.

Because she suffers from ALS, the patient is no longer able to move and speak. Doctors placed electrodes in her brain. The electrodes are able to pick up brain activity. This enables her to wirelessly control a speech computer that she now uses at home.

“This is a major breakthrough in achieving autonomous communication among severely paralyzed patients whose paralysis is caused by either ALS, a cerebral hemorrhage or trauma,” says Professor Nick Ramsey, professor of cognitive neuroscience at the University Medical Center (UMC) Utrecht. “In effect, this patient has had a kind of remote control placed in her head, which enables her to operate a speech computer without the use of her muscles.”

MOUSE CLICK

The patient operates the speech computer by thinking about moving her fingers. This changes the brain signal under the electrodes. That change is converted into a mouse click. On a screen in front of her she can see the alphabet, plus some additional functions such as deleting a letter or word and selecting words based on the letters she has already spelled. The letters on the screen light up one by one. She selects a letter by influencing the mouse click at the right moment with her brain. That way she can compose words, letter by letter, which are then spoken by the speech computer. This technique is comparable to actuating a speech computer via a push-button (with a muscle that can still function, for example, in the neck or hand). So now, if a patient lacks muscle activity, a brain signal can be used instead.

WIRELESS

The patient underwent surgery during which electrodes were placed on her brain through tiny holes in her skull. A small transmitter was then placed in her body below her collarbone. This transmitter receives the signals from the electrodes via subcutaneous wires, amplifies them and transmits them wirelessly. The mouse click is calculated from these signals, actuating the speech computer. The patient is closely supervised. Shortly after the operation, she started on a journey of discovery together with the researchers to find the right settings for the device and the perfect way to get her brain activity under control. It started with a “simple” game to practice the art of clicking. Once she mastered clicking, she focused on the speech computer. She can now use the speech computer without the help of the research team.

Image shows the system setup.

Panel A shows the contact points of the electrode strips, which are indicated by white dots, over the sensorimotor and dorsolateral prefrontal cortex; the positions of electrodes were based on postoperative computed tomographic (CT) scans merged with the presurgical MRI. Electrodes e2 and e3 on the electrode strip were chosen for brain–computer interface feedback. Panel B shows a postoperative chest radiograph displaying the transmitter device (Activa PC+S, Medtronic), which was placed subcutaneously in the chest, and wires leading to the electrodes. Two of four wires were connected to the device. Panel C shows the postoperative CT scan with the locations of four electrode strips. The dots on the four wires are connectors. Panel D shows the components of the brain–computer interface system, including the transmitter, receiving antenna, receiver, and tablet. NeuroscienceNews.com image is credited to Ramsey et al./NEJM.

UMC Utrecht Brain Center has spent many years researching the possibility of controlling a computer by means of electrodes that capture brain activity. Working with a speech computer driven by brain signals measured with a bathing cap with electrodes has long been tested in various research laboratories. That a patient can use the technique at home, through invisible, implanted electrodes, is unique in the world.

If the implant proves to work well in three people, the researchers hope to launch a larger, international trial. Ramsey: “We hope that these results will stimulate research into more advanced implants, so that some day not only people with communication problems, but also people with paraplegia, for example, can be helped.”

About this neuroscience research article

Funding: This research is part of the Utrecht NeuroProsthesis (UNP) project conducted by the UMC Utrecht Brain Center Rudolf Magnus, and is funded by technology foundation STW. The implant itself was provided by one of the R&D departments of medical technology company Medtronic.

Source: UMC Utrecht
Image Source: This NeuroscienceNews.com image is credited to Ramsey et al./NEJM.
Original Research: Full open access research for “Fully Implanted Brain–Computer Interface in a Locked-In Patient with ALS” by Mariska J. Vansteensel, Ph.D., Elmar G.M. Pels, M.Sc., Martin G. Bleichner, Ph.D., Mariana P. Branco, M.Sc., Timothy Denison, Ph.D., Zachary V. Freudenburg, Ph.D., Peter Gosselaar, M.D., Sacha Leinders, M.Sc., Thomas H. Ottens, M.D., Max A. Van Den Boom, M.Sc., Peter C. Van Rijen, M.D., Erik J. Aarnoutse, Ph.D., and Nick F. Ramsey, Ph.D. in New England Journal of Medicine. Published online November 12 2016 doi:10.1056/NEJMoa1608085

Cite This NeuroscienceNews.com Article
UMC Utrecht. “Implant Allows Locked In ALS Patient to Operate Speech Computer With Her Brain.” NeuroscienceNews. NeuroscienceNews, 14 November 2016.
<http://neurosciencenews.com/als-paralysis-computer-control-implant-5512/>.
UMC Utrecht. (2016, November 14). Implant Allows Locked In ALS Patient to Operate Speech Computer With Her Brain. NeuroscienceNews. Retrieved November 14, 2016 from http://neurosciencenews.com/als-paralysis-computer-control-implant-5512/
UMC Utrecht. “Implant Allows Locked In ALS Patient to Operate Speech Computer With Her Brain.” http://neurosciencenews.com/als-paralysis-computer-control-implant-5512/ (accessed November 14, 2016).

Abstract

Fully Implanted Brain–Computer Interface in a Locked-In Patient with ALS

Options for people with severe paralysis who have lost the ability to communicate orally are limited. We describe a method for communication in a patient with late-stage amyotrophic lateral sclerosis (ALS), involving a fully implanted brain–computer interface that consists of subdural electrodes placed over the motor cortex and a transmitter placed subcutaneously in the left side of the thorax. By attempting to move the hand on the side opposite the implanted electrodes, the patient accurately and independently controlled a computer typing program 28 weeks after electrode placement, at the equivalent of two letters per minute. The brain–computer interface offered autonomous communication that supplemented and at times supplanted the patient’s eye-tracking device. (Funded by the Government of the Netherlands and the European Union; ClinicalTrials.gov number, NCT02224469.)

“Fully Implanted Brain–Computer Interface in a Locked-In Patient with ALS” by Mariska J. Vansteensel, Ph.D., Elmar G.M. Pels, M.Sc., Martin G. Bleichner, Ph.D., Mariana P. Branco, M.Sc., Timothy Denison, Ph.D., Zachary V. Freudenburg, Ph.D., Peter Gosselaar, M.D., Sacha Leinders, M.Sc., Thomas H. Ottens, M.D., Max A. Van Den Boom, M.Sc., Peter C. Van Rijen, M.D., Erik J. Aarnoutse, Ph.D., and Nick F. Ramsey, Ph.D. in New England Journal of Medicine. Published online November 12 2016 doi:10.1056/NEJMoa1608085

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