A patient with a spinal cord injury was able to produce brain signals associated with intending to move his paralyzed limbs, signals picked up by an implanted sensor and translated into electronic impulses that allowed him to control a computer cursor and manipulate mechanical devices. A report appearing in the July 13 issue of Nature includes the first published findings from an ongoing clinical trial of the BrainGate Neural Interface System, a brain-computer interface device in the early stages of clinical testing at Massachusetts General Hospital (MGH), Spaulding Rehabilitation Hospital and other institutions across the country.
"The broad question we are addressing is whether it's possible for someone with paralysis to use the activity of the motor cortex [the part of the brain responsible for motion] to control an external device," says Leigh Hochberg, MD, PhD, a neurologist at MGH, Spaulding and Brigham and Women's Hospital and lead author of the Nature paper. "There has been a question of how the function of the cortex might change after it was disconnected from the rest of the body by damage to the spinal cord. We're finding that, even years after spinal cord injury, the same signals that originally controlled a limb are available and can be utilized."
Manufactured by Cyberkinetics Neurotechnology Systems, Inc., of Foxborough, Mass., the BrainGate System consists of an internal sensor to detect brain cell activity and external processors that convert brain impulses into computerized signals. Two clinical trials are currently underway to evaluate the system's safety and feasibility for detecting and translating brain activity from patients with paralysis resulting from spinal cord injury, brain stem stroke or muscular dystrophy and patients with amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). John Donoghue, PhD, a neuroscience professor and director of the Brain Science Program at Brown University and the senior author of the Nature paper, is a co-founder of Cyberkinetics.
The Nature report describes the first participant in these trials, a 25-year-old man who had sustained a spinal cord injury leading to paralysis in all four limbs three years prior to the study. Over a period of nine months, he took part in 57 sessions during which the implanted BrainGate sensor recorded activity in his motor cortex while he imagined moving his paralyzed limbs and then used that imagined motion for several computer-based tasks. Among his accomplishments - completed with little or no learning time - was moving a computer cursor to open simulated e-mail, draw circular shapes and play simple video games. He also was able to open and close a prosthetic hand and use a robotic limb to grasp and move objects.
"This system is giving us, for the first time, the ability to look at and listen to firing patterns of ensembles of individual neurons in the human brain for extended periods of time. We hope the knowledge gained from this work will allow the development of systems that provide improved communication and environmental control for people with paralysis and someday, when combined with neuromuscular stimulators, restore control over their limbs," says Hochberg, an instructor in Neurology at Harvard Medical School and an investigator in neuroscience at Brown. He and his co-authors also note that the system requires significant improvement in reliability and control and that further research is needed before it will be useful outside a research setting.
Co-authors of the Nature paper, along with Hochberg and Donoghue, are Mijail Serruya, MD, PhD, of Brown; Gerhard Friehs, MD, of Brown and Rhode Island Hospital; Jon Mukand, MD, PhD, Sargent Rehabilitation Center, Warwick, R.I.; Maryam Saleh, Abraham Caplan, and Almut Branner, PhD of Cyberkinetics; David Chen, MD, Rehabilitation Institute of Chicago; and Richard Penn, MD, University of Chicago. The clinical trials are being supported by Cyberkinetics Neurotechnology Systems, Inc.
Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of nearly $500 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, transplantation biology and photomedicine. MGH and Brigham and Women's Hospital are founding members of Partners HealthCare HealthCare System, a Boston-based integrated health care delivery system.