SUMMARYBackgroundPeople with chronic tetraplegia due to high cervical spinal cord injury (SCI) can regain limb movements through coordinated electrical stimulation of peripheral muscles and nerves, known as Functional Electrical Stimulation (FES). Users typically command FES systems through other preserved, but limited and unrelated, volitional movements (e.g. facial muscle activity, head movements). We demonstrate an individual with traumatic high cervical SCI performing coordinated reaching and grasping movements using his own paralyzed arm and hand, reanimated through FES, and commanded using his own cortical signals through an intracortical brain-computer-interface (iBCI).MethodsThe study participant (53 years old, C4, ASIA A) received two intracortical microelectrode arrays in the hand area of motor cortex, and 36 percutaneous electrodes for electrically stimulating hand, elbow, and shoulder muscles. The participant used a motorized mobile arm support for gravitational assistance and to provide humeral ab/adduction under cortical control. We assessed the participant’s ability to cortically command his paralyzed arm to perform simple single-joint arm/hand movements and functionally meaningful multi-joint movements. We compared iBCI control of his paralyzed arm to that of a virtual 3D arm. This study is registered with ClinicalTrials.gov, NCT00912041.FindingsThe participant successfully cortically commanded single-joint and coordinated multi-joint arm movements for point-to-point target acquisitions (80% – 100% accuracy) using first a virtual arm, and second his own arm animated by FES. Using his paralyzed arm, the participant volitionally performed self-paced reaches to drink a mug of coffee (successfully completing 11 of 12 attempts within a single session) and feed himself.InterpretationThis is the first demonstration of a combined FES+iBCI neuroprosthesis for both reaching and grasping for people with SCI resulting in chronic tetraplegia, and represents a major advance, with a clear translational path, for clinically viable neuroprostheses for restoring reaching and grasping post-paralysis.
Brain-computer interfaces (BCIs) have the potential to restore communication for people with tetraplegia and anarthria by translating neural activity into control signals for assistive communication devices. While previous pre-clinical and clinical studies have demonstrated promising proofs-of-concept (Serruya et al., 2002; Simeral et al., 2011; Bacher et al., 2015; Nuyujukian et al., 2015; Aflalo et al., 2015; Gilja et al., 2015; Jarosiewicz et al., 2015; Wolpaw et al., 1998; Hwang et al., 2012; Spüler et al., 2012; Leuthardt et al., 2004; Taylor et al., 2002; Schalk et al., 2008; Moran, 2010; Brunner et al., 2011; Wang et al., 2013; Townsend and Platsko, 2016; Vansteensel et al., 2016; Nuyujukian et al., 2016; Carmena et al., 2003; Musallam et al., 2004; Santhanam et al., 2006; Hochberg et al., 2006; Ganguly et al., 2011; O’Doherty et al., 2011; Gilja et al., 2012), the performance of human clinical BCI systems is not yet high enough to support widespread adoption by people with physical limitations of speech. Here we report a high-performance intracortical BCI (iBCI) for communication, which was tested by three clinical trial participants with paralysis. The system leveraged advances in decoder design developed in prior pre-clinical and clinical studies (Gilja et al., 2015; Kao et al., 2016; Gilja et al., 2012). For all three participants, performance exceeded previous iBCIs (Bacher et al., 2015; Jarosiewicz et al., 2015) as measured by typing rate (by a factor of 1.4–4.2) and information throughput (by a factor of 2.2–4.0). This high level of performance demonstrates the potential utility of iBCIs as powerful assistive communication devices for people with limited motor function.Clinical Trial No: NCT00912041DOI: http://dx.doi.org/10.7554/eLife.18554.001
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