Brain-computer interface lets ALS patient communicate with her family

An ALS patient who received a brain implant at University Medical Center Utrecht (UMCU) in the Netherlands has reportedly become the first person with the neurodegenerative condition to use this technology to communicate with family, friends, and caregivers in her own home.
The feat, detailed this week in the New England Journal of Medicine, is being hailed as “a major breakthrough in achieving autonomous communication among severely paralyzed patients whose paralysis is caused by either ALS, a cerebral hemorrhage or trauma,” by Nick Ramsey, professor of cognitive neuroscience at UMCU and one of the authors of the new study.
“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,” Ramsey explained in a statement. He and his colleagues said that they worked intensively with the patients to get the settings just right so that the patient, who can no longer move or speak, would be able to use it at home.
The device works by using electrodes implanted in brain of the patient. Those electrodes detect brain activity that results when she moves fingers in her mind, and coverts it into a mouse click. The patient has a screen in front of her that includes the alphabet and some additional functions (such as selecting previously spelled words or deleting letters) that she can see at all times.
Each letter on the screen lights up one at a time, and by using her brain to “click” the mouse at the right time, she can compose words one letter at a time. Those words are then vocalized by a speech computer. The entire process is done wirelessly thanks to the implanted brain electrodes, and the system itself is similar to one actuated via push-button (using muscles that still function, such as those in the neck or hand).

Doctors hope to launch a larger, international trial in the near future

To make this happen, the doctors performed a surgical procedure that required them to implant the electrodes on her brain through small holes in her skull, along with a transmitted just under her collarbone. This transmitter receives the signals from the electrodes through a series of wires placed just below the skin, amplifies them, and sends them wirelessly to the computer.
Following the operation, the doctors began working with the patient to ensure that the settings were as precise as possible. They started with a basic game to practice the technique needed to perform the mental mouse clicks, then trained how to use the speech computer itself. Eventually, the patient became good enough with the technology that she no longer required any assistance from Professor Ramsay’s team, which allowed her to take the device for home use.
According to the study authors, it took 28 weeks after the electrodes were implanted for the patient to begin controlling the speech computer, and that she currently types at the equivalent speed of two words per minute. The brain-computer interface, they wrote, “offered autonomous communication that supplemented and at times supplanted the patient’s eye-tracking device.”
Ramsay said that if things continue to go well, his team hopes to launch a larger, international trial for the technology sometime in the near future. “We hope that these results will stimulate research into more advanced implants, so that someday not only people with communication problems, but also people with paraplegia, for example, can be helped,” he added. Their work was funded by the European Union and the government of the Netherlands.
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