The Promise of Brain-Computer Interfaces in Rehabilitation

“As computer intelligence gets better, what will be possible when we interface our brains with computers? It might sound scary, but early evidence suggests otherwise: interfacing brains with machines can be helpful in treating traumatic brain injury, repairing spinal cord damage, and countless other applications.”

Bill Maris, Venture Capitalist & Entrepreneur
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Researchers have been investigating the possibilities of brain-computer interfaces or BCIs for quite a while now. At first, these were thought to be tools on one hand to provide constant monitoring of the brain’s electrical activity; this could support a wide range of applications from monitoring epilepsy or ADHD to pain management and sleep assessment. On the other hand, the concept was thought to be a solution for paralyzed people to move and control things around them with only thoughts. Taking it onto the next level, such an implant could also be used as an external hard drive for the mind.

Enhancing cognitive performance would be able to change the lives of millions suffering from memory loss and neurological or psychological disorders. Restorative processes like stroke rehabilitation would also gain from the technology. Or these can help reduce the cognitive effects of aging. No wonder many studies focus on the possibilities such technology can provide for seniors.

I’ve written on the general topic of brain-computer interfaces earlier. But with the rapid development happening in the rehabilitation segment, I thought it might be interesting to revisit the space to review where it stands and explore the potential of the technology to improve people’s lives. I’ll also provide a list of additional resources to explore for those interested in more detail on the topic at the end of this post.

Numerous publications have explored Brain-Computer Interfaces (BCI) systems as rehabilitation tools to help subacute and chronic stroke patients recover upper extremity movement. Recent work has shown that BCI therapy can lead to better outcomes than conventional therapy. BCI, combined with other techniques such as Functional Electrical Stimulation (FES) and Virtual Reality (VR), allows the user to restore the neurological function by inducing the neural plasticity through improved real-time detection of motor imagery (MI) as patients perform therapy tasks.

In recent years, BCIs have successfully enabled dozens of study participants who lost the use of their limbs after strokes, accidents, or diseases such as multiple sclerosis, to control a mouse cursor, keyboard, mobile device, wheelchair, and even a robotic arm that provides sensory feedback to the patient, simply by using their mind. The technology could be a game changer in helping those with paralysis return to work and communicate more quickly and effectively.

One article in Engadget reported that Johns Hopkins University-led researchers had developed a new technique that let a partially paralyzed man feed himself using robotic arms connected through a brain-machine interface. He only had to make small movements with his fists at specific prompts (such as “select cut location”) to have the fork- and knife-equipped arms cut food and bring it to his mouth. He could have dessert within 90 seconds, according to the researchers.

The new method centers on a shared control system that minimizes the mental input required to complete a task. He could map his four-degree freedom of movement (two for each hand) to as many as 12 degrees of freedom for controlling the robot arms. The limbs’ prompt-based intelligent responses also reduced the workload. While still in the early stages of development, this research demonstrates the potential value of the technology.

In another development, BCI manufacturer Blackrock Neurotech and the University of Pittsburgh are working together to make clinical studies more accessible to a greater population of candidates living with paralysis by using a compact, remote BCI system that can be used at home. Researchers will be able to test a broader range of study participants and collect more safety and efficacy data, an essential step to commercializing the technology. The device looks somewhat like an iPad, with a small box the size of a cell phone attached to a type of medical brace. The device can easily attach to a wheelchair and is lightweight. The software used during research trials has also been modified to be operated with little technical support.

Blackrock Neurotech, late last year, was granted Breakthrough Device designation from the Food and Drug Administration for its “MoveAgain” BCI system, which is similar to devices it plans to use in trials and hopes to be its first commercial BCI platform in 2023.

Companies developing brain-computer interfaces for the rehabilitation sector – In the public sector, initiatives such as the Human Brain Project have sought to accelerate research that can help us learn more about our brains to treat diseases better and improve cognitive functioning. In the private sector, several companies are working to develop effective brain-machine interfaces for a wide range of uses. While creating an exhaustive list of companies operating in this space is beyond the scope of a blog post, here are some of the companies focused on rehabilitation BCI tools and platforms:

Neurolutions is a medical device company developing neuro-rehabilitation solutions that utilize a patient’s brain activity to facilitate motor recovery. Neurolutions is spearheading the development of answers that seek to restore function to patients who are disabled as a result of neurological injury. The Neurolutions IpsiHand system provides upper extremity rehabilitation for chronic stroke patients leveraging brain-computer interface and advanced wearable robotics technology.

Image Credit: Neurolutions

BrainQ is pioneering the development of a novel therapy for neuro recovery to reduce disability following stroke and other neuro disorders. The company’s investigative, non-invasive therapeutic wearable device uses frequency-tuned electromagnetic fields to facilitate neuroplasticity processes within the central nervous system. BrainQ’s technology uses explanatory machine learning algorithms to observe natural spectral characteristics found in different motor tasks and derive unique therapeutic insights that are used to target the recovery of impaired neural networks.

Image Credit: BrainQ

A spinout of Oxford University, founded by a global team of experienced entrepreneurs, technologists, and neuroscientists, ni2o is continuing the work started by MIT’s Mind Machine Project – developing a revolutionary brain-computer interface (BCI) that addresses the most pressing and costly medical needs of a rapidly aging global population, the treatment of neurodegenerative brain diseases and disorders.

Cerebtalk – Offers a brain-computer interface (BCI) that provides a communication tool for individuals with severe motor impairments who have limited voluntary movements, e.g., people with amyotrophic lateral sclerosis (ALS), spinal cord injury, stroke, cerebral palsy, and non-verbal autism.

Synchron is developing an implantable device called the Stentrode that aims to provide a safe way for paralyzed patients to achieve direct brain control of mobility-assistive devices. The system involves a small and flexible device that can pass through cerebral blood vessels, allowing it to implant in the brain and interpret electrical data emitted by neurons. The company is currently preparing for early-stage clinical trials to evaluate the safety and feasibility of the device to enable patient-directed brain control.

YouTube Video Credit: Synchron, Inc.

MindMaze – Founded in 2012 as a spin-off from the Swiss Federal Institute of Technology (EPFL), this Swiss startup has taken in $108 million to launch devices that use virtual reality, brain imaging, and gaming technologies to retrain the brain how to work again for those suffering from brain injuries like stroke victims. MindMotionPRO can trick the patient’s brain into believing that immobilized regions of their body are still working, thereby spurring the recovery. The platform uses brain data, movement data, and muscle data to produce interactions in VR with “zero latency.” MindMotionPRO devices have achieved the European equivalent of FDA approval (CE Marked) and are actively used in several top university hospitals across Europe. Mindmaze is now working on getting FDA approval so that the device can be put to use in U.S. hospitals as well.

Image Credit: TechCrunch

BrainGate™ is a transformative neurotechnology owned and operated by Tufts University that uses microelectrodes implanted in the brain to let humans operate external devices such as computers or robotic arms with just their thought. Through years of advanced research, BrainGate™ is at the forefront of enabling severely motor-impaired individuals with the ability to communicate, interact, and function through thought. BrainGate™ is the only technology with an FDA-approved investigational device exemption to conduct human trials of brain-computer interface (BCI) technologies.

Image Credit: BrainGate

The future of BCI in rehabilitation – There are roughly 5.4 million people in the U.S. living with some form of paralysis, making BCIs a distant reality for all but a select few. The BCI field is reaching an inflection point as commercial interests advance research-only technology. Now, with BCI companies hoping to expand the market for the technology, a new wave of users is expected to feel the complex bundle of emotions — fear, uncertainty, joy, excitement, relief, and sadness — experienced by the field’s pioneers. Rehabilitative BCIs have a great potential to help people. The known benefits of the BCIs currently being developed for those with spinal cord injuries, strokes, and other neurological conditions far outweigh the possible issues that may arise.

Additional reading – If you are interested in exploring this topic in more detail, here are some additional resources you might find interesting:

  • The brain-reading devices helping paralyzed people to move, talk and touch – great long-form article by Liam Drew published in Nature on April 20, 2022
  • Will We All Have To Become Biologically Enhanced Superhumans?from Dr. Bertalan Mesko and his team at The Medical Futurist Institute. Broader than just a discussion on BCI in rehabilitation, but worth a read.
  • Plugged In: The Past, Present, and Future of Brain-Computer Interfaces by Audrey Case – Think of this book as “the layperson’s guide to brain-computer interfaces. Audrey discovered that finding material to explain BCIs to those who didn’t work with them intimately was nearly impossible. So she created a resource for non-experts to learn about the technology so they could form their own opinions instead of just believing the hype. She uses her background in bio-engineering to weave the story of how the technology came to be and all the sometimes surprising turns it took to get to where it is today. And, at 99 cents for the Kindle version, this one is a huge bargain.
  • Brain-Computer Interfaces Are Coming. Will We Be Ready?From the Rand Corporation – RAND researchers developed a path for determining where BCI technology stands now and where it could potentially go. They used a comprehensive method that could be applied to other emerging technologies.
  • What Brain-Computer Interfaces Could Mean for the Future of WorkHarvard Business Review article by Alexandre Gonfalonieri – Brain-computer interfaces (BCIs) are slowly moving into the mass market. In the next few years, we might be able to control our PowerPoint presentations or Excel files using only our brains. And companies may want to use BCI technology to monitor the attention levels and mental states of their employees. There are numerous ethical questions and concerns surrounding using BCI technology in the workplace. The technology is well ahead of the policies and regulations that would need to be put in place. But, it’s time for business leaders to start building a BCI strategy as soon as possible to address the potential risks and benefits.

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