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Ujwal Chaudhary, a biomedical engineer at the University of Tübingen and the Wyss Center for Bio and Neuroengineering in Geneva in 2020, watched with amazement his computer as an experiment he spent years of. A 34-year-old paralyzed man was lying on his back in the lab, his head connected to a computer by a cable. A synthetic sound that pronounces German letters: “E, A, D…”

The patient had been diagnosed several years ago with amyotrophic lateral sclerosis, which causes progressive degeneration of movement-related brain cells. The man had lost the ability to even move his pupils and was completely unable to communicate; medically, he was in a completely locked-in state.

Or so it seemed. Dr. Through Chaudhary’s experiment, the man had learned to select letters from the steady stream of the computer speaking aloud—not directly with his eyes, but imagining his eyes moving. Letter by letter, he formulated words and sentences, one per minute.

At one point he wrote: “For dinner, I want potato curry first, then Bolognese and potato soup.”

Dr. Chaudhary and his colleagues were stunned. Currently no longer working with patients, Dr. “I couldn’t believe it was possible,” Chaudhary recalled.

Study, Published on Tuesday Niels Birbaumer, the study’s leader and a now retired neuroscientist at the University of Tübingen, said in Nature Communications that it provides the first example of a patient in a completely locked-in state communicating with the outside world for a long time.

Dr. Chaudhary and Dr. Birbaumer conducted two similar experiments. 2017 and 2019 in patients who are completely locked out and report being able to communicate. Both studies were withdrawn after a while. investigation The German Research Foundation concluded that the researchers only partially videotaped their patients’ examinations, did not properly show the details of their analysis, and made false statements. German Research Foundation, Dr. Finding Birbaumer for scientific misconduct, he imposed some of his harshest sanctions, including a five-year ban from submitting proposals and serving as an arbitrator for the foundation.

Agency, Dr. It found that Chaudhary also committed scientific misconduct and imposed the same sanctions for three years. Both him and Dr. Birbaumer was asked to retract two of his articles, and they refused.

The investigation comes after an informant, Martin Spüler, expressed his concerns about the two scientists in 2018.

Dr. Birbaumer stood behind the results and took legal action against the German Research Foundation. The results of the case are expected to be published within the next two weeks, said Marco Finetti, spokesman for the German Research Foundation. Dr. Chaudhary said his lawyers expect to win the case.

Mr. Finetti said the German Research Foundation was not aware of the current study’s publication and will investigate it in the coming months. In an email, the Nature Communications representative, who did not want to be named, declined to comment on details of how the study was reviewed, but expressed confidence in the process. “We have strict policies to protect the integrity of the research we publish, including ensuring that research is conducted to a high ethical standard and reported transparently,” the representative said.

“I would say it’s a solid study,” said Natalie Mrachacz-Kersting, a brain-computer interface researcher at the University of Freiburg in Germany. She was not involved in the study and was aware of previously withdrawn articles.

But researcher Brendan Allison of the University of California San Diego voiced his reservations. Dr. “This work, like Birbaumer’s other work, should be taken with a colossal mountain of salt given its history,” Allison said. recorded on a paper Published in 2017his own team described being able to communicate with patients who were completely locked out with basic “yes” or “no” answers.

The results hold potential promise for patients in similarly unresponsive situations, including minimally conscious and comatose states and an increasing number of people. Diagnosed with ALS worldwide each year. This number is expected to reach 300,000 by 2040.

“It’s a game changer,” said Steven Laureys, a neurologist and researcher who leads the Coma Science Group at the University of Liège in Belgium and was not involved in the research. The technology may have ethical implications in the debates surrounding euthanasia for patients in locked-in or vegetative states, he added: “It’s really great to see this progress, to give patients a voice in their own decisions.”

Numerous methods have been used to communicate with unresponsive patients. Some include basic pencil and paper methods developed by family relatives. In others, a caregiver points or names items and looks for micro-responses—a blink, finger twitches from the patient.

In recent years, a new method has come to the fore: brain-computer interface technologies aimed at translating a person’s brain signals into commands. Research institutes, private companies, and enterprising billionaires like Elon Musk have invested heavily in technology.

The results are mixed but convincing: patients and those with stroke, multiple sclerosis and other conditions who move their prosthetic limbs using only their thoughts are once again communicating with their loved ones.

But what the scientists haven’t been able to do so far is to communicate extensively with people like the man in the new study who showed no movement.

In 2017, the patient had used eye movements to communicate with her family before she was completely locked out. Anticipating that he would soon lose even that ability, the family wanted an alternative communication system, and Dr. Chaudhary and Dr. Birbaumer appealed.

With the man’s approval, a neurosurgeon and author of the study, Dr. Jens Lehmberg placed two small electrodes in areas of the man’s brain involved in controlling movement. Then, for two months, the man was asked to imagine moving his hands, arms, and tongue, to see if these would generate a clear brain signal. But the effort yielded nothing credible.

Dr. Birbaumer then proposed using auditory neurofeedback, an unconventional technique in which patients are trained to actively manipulate their own brain activity. The man was first given a high or low grade meaning yes or no. That was his “target tone” – the note he had to match.

A second note was then played, showing the brain activity detected by the implanted electrodes. By concentrating—and by moving his eyes, imagining brain activity to effectively turn it up or down—he was able to change the pitch of the second tone to match the first. In doing so, she got real-time feedback on how the note changed and allowed her to raise the pitch for yes or lower it for no when she wanted to say yes.

This approach yielded immediate results. On the first day of trying, the man managed to change the second tone. Twelve days later, he managed to pair the second with the first.

“That’s when everything became consistent and was able to reproduce these patterns,” said Jonas Zimmermann, a neuroscientist at the Wyss Center and the study’s author. When the patient was asked what he imagined to change his own brain activity, he replied, “Eye movement.”

Over the next year, the man used this skill to form words and sentences. The scientists borrowed a communication strategy that the patient used with his family when he was able to move his eyes.

They grouped the letters into sets of five colors. A computerized voice listed the colors first, and the man said “yes” or “no” depending on whether the letter he wanted to choose was in that set. The voice then similarly ranked each letter it chose. He repeated these steps set, letter by letter, to express complete sentences.

On the second day of spelling practice, she wrote: “First I want to thank Niels and his birbaumer.”

Some of his sentences included instructions: “Mother head massage” and “Everyone should use the gel on my eyes more often.” Others described the craving as “goulash soup and pea soup.”

Of the 107 days the man spent spelling, 44 resulted in intelligible sentences. And it typed about one character per minute, though there was great variation in speed.

“Wow, it blew my mind,” said Dr. Mrachacz-Kersting. He predicted that locked-in patients who were able to activate their minds could live longer and healthier lives.

However, Dr. Mrachacz-Kersting stressed that the study was done on one patient and should be tested on many other patients.

Other researchers also expressed caution in embracing the findings.

“This approach is experimental, so we have a lot more to learn,” said Neil Thakur, chief mission officer of the ALS Association.

At this stage, the technology is too complex for patients and families to operate. Dr. Chaudhary said that making it more user-friendly and increasing the communication speed will be crucial. He said that until then, the relatives of the patient will probably be satisfied.

“You have two options: communication at one character per minute or no communication,” he said. “What do you choose?”

Perhaps the biggest concern is time. Three years have passed since the implants were first placed in the patient’s brain. Currently caring for the patient at the Wyss Center, Dr. Since then, his responses have slowed significantly, become less reliable and often impossible to distinguish, Zimmermann said.

The reason for this decline is unclear, but Dr. Zimmermann thought it was probably due to technical issues. For example, electrodes are nearing the end of their life expectancy. But it would be unwise to change them now. “It’s a risky business,” he said. “You’re suddenly exposed to new strains of bacteria in the hospital.”

Dr. Zimmermann and others at the Wyss Center wireless micro electrodes It is safer to use. The team is also investigating other non-invasive techniques that have proven effective. in previous studies In unlocked patients. Dr. “As much as we want to help people, I think it’s also very dangerous to create false hopes,” Zimmermann said.

At the same time, Dr. Coma Science Group’s Dr. Laureys said there’s no value in fostering a sense of “false despair” when viable innovations are on the horizon.

“As a caregiver, as a clinician, I am extremely excited,” she said. “I think it’s great that we’re presenting these new scientific insights and technology in very delicate and dramatic conditions.”