The brain's electrical signals enable people without muscle control to physically interact with the world.

Brain-computer interfaces for communication and control

Two people with long-standing tetraplegia use neural interface system-based control of a robotic arm to perform three-dimensional reach and grasp movements. John Donoghue and colleagues have previously demonstrated that people with tetraplegia can learn to use neural signals from the motor cortex to control a computer cursor. Work from another lab has also shown that monkeys can learn to use such signals to feed themselves with a robotic arm. Now, Donoghue and colleagues have advanced the technology to a level at which two people with long-standing paralysis — a 58-year-old woman and a 66-year-old man — are able to use a neural interface to direct a robotic arm to reach for and grasp objects. One subject was able to learn to pick up and drink from a bottle using a device implanted 5 years earlier, demonstrating not only that subjects can use the brain–machine interface, but also that it has potential longevity. Paralysis following spinal cord injury, brainstem stroke, amyotrophic lateral sclerosis and other disorders can disconnect the brain from the body, eliminating the ability to perform volitional movements. A neural interface system1,2,3,4,5 could restore mobility and independence for people with paralysis by translating neuronal activity directly into control signals for assistive devices. We have previously shown that people with long-standing tetraplegia can use a neural interface system to move and click a computer cursor and to control physical devices6,7,8. Able-bodied monkeys have used a neural interface system to control a robotic arm9, but it is unknown whether people with profound upper extremity paralysis or limb loss could use cortical neuronal ensemble signals to direct useful arm actions. Here we demonstrate the ability of two people with long-standing tetraplegia to use neural interface system-based control of a robotic arm to perform three-dimensional reach and grasp movements. Participants controlled the arm and hand over a broad space without explicit training, using signals decoded from a small, local population of motor cortex (MI) neurons recorded from a 96-channel microelectrode array. One of the study participants, implanted with the sensor 5 years earlier, also used a robotic arm to drink coffee from a bottle. Although robotic reach and grasp actions were not as fast or accurate as those of an able-bodied person, our results demonstrate the feasibility for people with tetraplegia, years after injury to the central nervous system, to recreate useful multidimensional control of complex devices directly from a small sample of neural signals.

/pdf/reach-and-grasp-by-people-with-tetraplegia-using-a-neurally-u1xyn3on0d.pdf

Reach and grasp by people with tetraplegia using a neurally controlled robotic arm

Brain-machine interfaces have mostly been used previously to move cursors on computer displays. Now experiments on macaque monkeys show that brain activity signals can control a multi-jointed prosthetic device in real-time. The monkeys used motor cortical activity to control a human-like prosthetic arm in a self-feeding task, with a greater sophistication of control than previously possible. This work could be important for the development of more practical neuro-prosthetic devices in the future. A system where monkeys use their motor cortical activity to control a robotic arm in a real-time self-feeding task, showing a significantly greater sophisitication of control than in previous studies, is demonstrated. This work could be important for the development of more practical neuro-prosthetic devices in the future. Arm movement is well represented in populations of neurons recorded from the motor cortex1,2,3,4,5,6,7. Cortical activity patterns have been used in the new field of brain–machine interfaces8,9,10,11 to show how cursors on computer displays can be moved in two- and three-dimensional space12,13,14,15,16,17,18,19,20,21,22. Although the ability to move a cursor can be useful in its own right, this technology could be applied to restore arm and hand function for amputees and paralysed persons. However, the use of cortical signals to control a multi-jointed prosthetic device for direct real-time interaction with the physical environment (‘embodiment’) has not been demonstrated. Here we describe a system that permits embodied prosthetic control; we show how monkeys (Macaca mulatta) use their motor cortical activity to control a mechanized arm replica in a self-feeding task. In addition to the three dimensions of movement, the subjects’ cortical signals also proportionally controlled a gripper on the end of the arm. Owing to the physical interaction between the monkey, the robotic arm and objects in the workspace, this new task presented a higher level of difficulty than previous virtual (cursor-control) experiments. Apart from an example of simple one-dimensional control23, previous experiments have lacked physical interaction even in cases where a robotic arm16,19,24 or hand20 was included in the control loop, because the subjects did not use it to interact with physical objects—an interaction that cannot be fully simulated. This demonstration of multi-degree-of-freedom embodied prosthetic control paves the way towards the development of dexterous prosthetic devices that could ultimately achieve arm and hand function at a near-natural level.

/pdf/cortical-control-of-a-prosthetic-arm-for-self-feeding-1ethevoxtu.pdf

Cortical control of a prosthetic arm for self-feeding

A brain-computer interface (BCI) is a hardware and software communications system that permits cerebral activity alone to control computers or external devices. The immediate goal of BCI research is to provide communications capabilities to severely disabled people who are totally paralyzed or 'locked in' by neurological neuromuscular disorders, such as amyotrophic lateral sclerosis, brain stem stroke, or spinal cord injury. Here, we review the state-of-the-art of BCIs, looking at the different steps that form a standard BCI: signal acquisition, preprocessing or signal enhancement, feature extraction, classification and the control interface. We discuss their advantages, drawbacks, and latest advances, and we survey the numerous technologies reported in the scientific literature to design each step of a BCI. First, the review examines the neuroimaging modalities used in the signal acquisition step, each of which monitors a different functional brain activity such as electrical, magnetic or metabolic activity. Second, the review discusses different electrophysiological control signals that determine user intentions, which can be detected in brain activity. Third, the review includes some techniques used in the signal enhancement step to deal with the artifacts in the control signals and improve the performance. Fourth, the review studies some mathematic algorithms used in the feature extraction and classification steps which translate the information in the control signals into commands that operate a computer or other device. Finally, the review provides an overview of various BCI applications that control a range of devices.

/pdf/brain-computer-interfaces-a-review-2z42gnpdfy.pdf

Brain Computer Interfaces, a Review

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)61346-9.pdf

Primary brain tumours in adults

Neuromotor prostheses (NMPs) aim to replace or restore lost motor functions in paralysed humans by routeing movement-related signals from the brain, around damaged parts of the nervous system, to external effectors. To translate preclinical results from intact animals to a clinically useful NMP, movement signals must persist in cortex after spinal cord injury and be engaged by movement intent when sensory inputs and limb movement are long absent. Furthermore, NMPs would require that intention-driven neuronal activity be converted into a control signal that enables useful tasks. Here we show initial results for a tetraplegic human (MN) using a pilot NMP. Neuronal ensemble activity recorded through a 96-microelectrode array implanted in primary motor cortex demonstrated that intended hand motion modulates cortical spiking patterns three years after spinal cord injury. Decoders were created, providing a ‘neural cursor’ with which MN opened simulated e-mail and operated devices such as a television, even while conversing. Furthermore, MN used neural control to open and close a prosthetic hand, and perform rudimentary actions with a multi-jointed robotic arm. These early results suggest that NMPs based upon intracortical neuronal ensemble spiking activity could provide a valuable new neurotechnology to restore independence for humans with paralysis. The cover shows Matt Nagle, first participant in the BrainGate pilot clinical trial. He is unable to move his arms or legs following cervical spinal cord injury. Researchers at the Department of Neuroscience at Brown University, working with biotech company Cyberkinetics and 3 other institutions, demonstrate that movement-related signals can be relayed from the brain via an implanted BrainGate chip, allowing the patient to drive a computer screen cursor and activate simple robotic devices. Such neuromotor prostheses could pave the way towards systems to replace or restore lost motor function in paralysed humans. Prior to this advance, this type of work has been performed chiefly in monkeys. The latest example of such research has achieved a large increase in speed over current devices, enhancing the prospects for clinically viable brain-machine interfaces.

Neuronal ensemble control of prosthetic devices by a human with tetraplegia

Objective To report and discuss common neurologic problems in adults with brain tumors admitted for inpatient rehabilitation at an acute rehabilitation center. Design Retrospective, descriptive, case series of 51 consecutive adult patients (65% male), with a variety of tumor types (31.3% glioblastoma, 25.5% meningioma, and 25.5% metastatic). Outcome measures were the functional status as measured by the FIM scores, the length of rehabilitation stay, and discharge dispositions. Results The most common deficit was impaired cognition (80%), followed by weakness (78%), visual-perceptual deficit (53%), sensory loss (38%), and bowel and bladder dysfunction (37%). Less common problems, in decreasing incidence, were cranial nerve palsy, dysarthria, dysphagia, aphasia, ataxia, and diplopia. Thirty-eight (74.5%) patients had three or more concurrent neurologic deficits, and 20 (39.2%) patients had five or more deficits. Concurrent deficits among patients with hemi- and tetraparesis involved cognition (n = 29 patients), visual-perceptual function, sensation, cranial nerve palsy, and neurogenic bowel/bladder. The average admission FIM score of 67.2 increased to 87.1 at the time of discharge, with similar gains between patients with primary brain tumor and metastatic disease. Thirty-five patients were discharged home, seven to a nursing home, and one to hospice care; there were eight acute transfers. Conclusions Impaired cognition, weakness, and visual-perceptual deficits were the most common problems in this study population. Our study supports the benefits of comprehensive and interdisciplinary rehabilitation for patients with primary as well as metastatic brain tumors.

Incidence of neurologic deficits and rehabilitation of patients with brain tumors.

https://www.archives-pmr.org/article/S0003-9993(01)20250-0/pdf

Dopaminergic therapy with carbidopa L-dopa for left neglect after stroke: A case series

https://www.archives-pmr.org/article/S0003-9993(96)90198-7/pdf

Pathological Crying and Laughing: Treatment With Sertraline

Objective: The goal of this study was to preliminarily test the efficacy of a telephone intervention, Family Intervention: Telephone Tracking, designed to assist stroke survivors and their primary caregivers during the first 6 months after stroke Method: Forty-nine stroke survivors and their caregivers were randomly assigned to treatment as usual or treatment as usual plus the telephone intervention Global outcomes are reported for health care utilization, family functioning, and general functioning Results: Family and general functioning were positively and significantly changed at 3 and 6 months Health care utilization was positively and significantly changed at 3 months Conclusion: Findings suggest that the model has the potential to decrease health care utilization and improve quality of life for stroke survivors and their caregivers Further study is warranted

Jon A. Mukand

Papers

Neuronal ensemble control of prosthetic devices by a human with tetraplegia

Incidence of neurologic deficits and rehabilitation of patients with brain tumors.

Dopaminergic therapy with carbidopa L-dopa for left neglect after stroke: A case series

Pathological Crying and Laughing: Treatment With Sertraline

Family Intervention: Telephone Tracking (FITT): A Pilot Stroke Outcome Study