Motor neuroprosthesis implanted with neurointerventional surgery improves capacity for activities of daily living tasks in severe paralysis: first in-human experience
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Published:2020-10-28
Issue:2
Volume:13
Page:102-108
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ISSN:1759-8478
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Container-title:Journal of NeuroInterventional Surgery
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language:en
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Short-container-title:J NeuroIntervent Surg
Author:
Oxley Thomas J,Yoo Peter E,Rind Gil S,Ronayne Stephen M,Lee C M Sarah,Bird Christin,Hampshire Victoria,Sharma Rahul P,Morokoff Andrew,Williams Daryl L,MacIsaac Christopher,Howard Mark E,Irving Lou,Vrljic Ivan,Williams Cameron,John Sam E,Weissenborn Frank,Dazenko Madeleine,Balabanski Anna H,Friedenberg David,Burkitt Anthony N,Wong Yan T,Drummond Katharine J,Desmond Patricia,Weber Douglas,Denison Timothy,Hochberg Leigh R,Mathers Susan,O'Brien Terence J,May Clive N,Mocco J,Grayden David B,Campbell Bruce C V,Mitchell Peter,Opie Nicholas L
Abstract
BackgroundImplantable brain–computer interfaces (BCIs), functioning as motor neuroprostheses, have the potential to restore voluntary motor impulses to control digital devices and improve functional independence in patients with severe paralysis due to brain, spinal cord, peripheral nerve or muscle dysfunction. However, reports to date have had limited clinical translation.MethodsTwo participants with amyotrophic lateral sclerosis (ALS) underwent implant in a single-arm, open-label, prospective, early feasibility study. Using a minimally invasive neurointervention procedure, a novel endovascular Stentrode BCI was implanted in the superior sagittal sinus adjacent to primary motor cortex. The participants undertook machine-learning-assisted training to use wirelessly transmitted electrocorticography signal associated with attempted movements to control multiple mouse-click actions, including zoom and left-click. Used in combination with an eye-tracker for cursor navigation, participants achieved Windows 10 operating system control to conduct instrumental activities of daily living (IADL) tasks.ResultsUnsupervised home use commenced from day 86 onwards for participant 1, and day 71 for participant 2. Participant 1 achieved a typing task average click selection accuracy of 92.63% (100.00%, 87.50%–100.00%) (trial mean (median, Q1–Q3)) at a rate of 13.81 (13.44, 10.96–16.09) correct characters per minute (CCPM) with predictive text disabled. Participant 2 achieved an average click selection accuracy of 93.18% (100.00%, 88.19%–100.00%) at 20.10 (17.73, 12.27–26.50) CCPM. Completion of IADL tasks including text messaging, online shopping and managing finances independently was demonstrated in both participants.ConclusionWe describe the first-in-human experience of a minimally invasive, fully implanted, wireless, ambulatory motor neuroprosthesis using an endovascular stent-electrode array to transmit electrocorticography signals from the motor cortex for multiple command control of digital devices in two participants with flaccid upper limb paralysis.
Funder
Australian Federal Government, Department of Industry, Innovation and Science
USA Department of Defense Office of the Congressionally Directed Medical Research Programs
Motor Neurone Disease Research Institute of Australia
Office of the Assistant Secretary of Defense for Health Affairs, Spinal Cord Injury Award Program
National Health and Medical Research Council of Australia
US Defense Advanced Projects Agency (DARPA) Microsystems Technology Office
Australia Research Council (ARC) Linkage Grant
Office of Naval Research (ONR) Global
Subject
Neurology (clinical),General Medicine,Surgery
Cited by
101 articles.
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