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When she met the man in February 2018, Chaudhary tried to automate the communication system the family was already using. The team hooked up an eye-tracking device to computer software that would read colors and line numbers, and let the man choose one letter at a time, using eye movements to spell out words.

However, as the man gradually lost control over his eye movements, he was also less able to communicate using this device. “We suggested implantation [an electrode]”says Chaudhary. Small electrodes can be placed in the brain to directly record the electrical activity of brain cells. The procedure, which involves making a hole in the skull and cutting through the protective layers of the brain, carries a small risk of infection and damage to the brain. That’s why Birbaumer says it’s a last resort. “If [non-invasive] BCIs and eye trackers no longer work, there are no other options,” he says.

Chaudhary says the man accepted the procedure using eye movements. His wife and sister also consented. When the procedure was approved by an ethics committee and the German Federal Institute for Medicines and Medical Devices at the end of 2019, the man had lost the ability to use the eye-tracking device. In March 2019, surgeons placed two small electrode grids, each 1.5 millimeters in diameter, into the man’s motor cortex (an area in the upper part of the brain responsible for controlling movement).

Converting signals to commands

The day after the electrode was implanted, the team began helping the man communicate. At first, the man was asked to imagine making physical movements – this helped other buyers. check prosthetic limbs and exoskeletonsand this approach Elon Musk’s company Neuralink plans to buy. The idea is to take a reliable signal from the brain and turn it into some kind of command.

However, the team could not get it to work. After 12 weeks of trying, they gave up on the idea and decided to try an approach called neurofeedback instead. Neurofeedback works by showing a person their brain activity in real time so they can learn how to control it. In this case, the computer would play a rising tone when the electrodes in the man’s brain recorded an increase in activity. A drop in brain activity will sound a descending tone.

Chaudhary, who said that he visited the man at his home every weekday until the coronavirus hit throughout 2019, says, “He was able to increase and decrease the frequency of the tone in two days.” “It was just incredible.” The man eventually learned to control his brain activity so that he could play a rising tone for a “yes” signal and a decreasing tone for a “no” signal.

The team then introduced software that mimics the paper-based computer system the man originally used to communicate with his family. The man would hear the word “yellow” or “blue” to select a block of letters, for example. Then individual letters are played and use an ascending or descending tone to select or reject each one (see video).

Effortless

In this way, the man was able to convey entire sentences in a short time. “[His family] “I was thrilled to hear what he had to say,” says Chaudhary, who published his findings with his colleagues in the journal. Nature Communication Tuesday. One of the first sentences the man wrote was translated as “men, it works so effortlessly”.

Communication was still slow; It takes about a minute to select each letter. But researchers believe the device significantly improved the man’s quality of life. She asked for specific dishes and soups, guided the caregivers on how to move and massage her legs, and asked her to watch a movie with her young son, for example. One sentence translated as “I love my cool boy”.

“I was often with him until midnight or past midnight,” Chaudhary says. “The last word has always been ‘beer’.”

One of the first sentences the man wrote was translated as “men, it works so effortlessly”.

Chaudhary envisions developing a catalog of frequently used words, for example, that could allow the software to auto-complete the man’s words as he typed them. “There are many ways to make it faster,” he says.

No one knows how long the electrodes will stay in the man’s brain, but other research has found that similar electrodes still function five years after being implanted in other people. However, for a locked-in person, “a single day can make a difference,” says Kianoush Nazarpour of the University of Edinburgh, who was not involved in the study. “This is a fundamental opportunity for them to regain choice and control of their lives,” he says. “A high-quality day can be really important to that person.”

Nazarpour thinks the technology could become routinely available to similarly locked-in individuals over the next 10 to 15 years. “Even a ‘yes’/’no’ for someone with absolutely no communication is potentially life-changing,” she says.

Brian Dickie, director of research and development at the Motor Neurone Disease Association in England, agrees that this timeline is realistic. But he wonders how many people with motor neuron disease, the most common type of ALS, would benefit from such BBAs.

setbacks

The man taking BCI has a form of ALS called progressive muscular atrophy (PMA). This form of the disease targets the motor nerves that run from the spine to the muscles, making people unable to control their muscles. But Dickie says about 95% of ALS cases also involve degeneration of the motor cortex in the brain.