Fully Implanted Brain–Computer Interface in a Locked-In Patient with ALS
Open accessAbstract
Options for people with severe paralysis who have lost the ability to communicate orally are limited. We describe a method for communication in a patient with late-stage amyotrophic lateral sclerosis (ALS), involving a fully implanted brain-computer interface that consists of subdural electrodes placed over the motor cortex and a transmitter placed subcutaneously in the left side of the thorax. By attempting to move the hand on the side opposite the implanted electrodes, the patient accurately and independently controlled a computer typing program 28 weeks after electrode placement, at the equivalent of two letters per minute. The brain-computer interface offered autonomous communication that supplemented and at times supplanted the patient's eye-tracking device. (Funded by the Government of the Netherlands and the European Union; ClinicalTrials.gov number, NCT02224469 .).
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The median real-time text-decoding rate exceeded the participant's typical assistive-device communication rate of 14.2 words per minute and was closer to naturalistic speaking rates than previously reported communication neuroprostheses.
“This decoding rate exceeds our participant’s typical communication rate using her assistive device (14.2 WPM; Supplementary Note 2) and is closer to naturalistic speaking rates than has been previously reported with communication neuroprostheses1,3,7–9.”
From A high-performance neuroprosthesis for speech decoding and avatar control (2023) · cites this paper as [7]
EEG spellers based on oddball potentials or motor imagery usually achieve 1-5 characters per minute.
“EEG spellers based on oddball potentials or motor imagery typically achieve 1–5 characters per minute28–32.”
From High-performance brain-to-text communication via handwriting (2021) · cites this paper as [28]
The Results section, “Communication and Independent Home Use” (page unavailable), reports spelling times for one patient using a fully implanted interface. Our copy does not give a typical rate for EEG spellers based on oddball potentials or motor imagery; searches for those methods and their characters-per-minute rates found no such passage. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIt may be hard to obtain sufficiently large patient populations for concrete and statistically significant conclusions.
“Additionally, it is apparent from previous work that access to sufficiently large patient populations for concrete and statistically significant conclusions may be difficult to obtain (1–5, 8, 11, 29, 39).”
From Noninvasive neuroimaging enhances continuous neural tracking for robotic device control (2019) · cites this paper as [2]
Another contributing factor to successful SMR enhancement might have been the implementation of an "incremental learning" approach where open-loop, closed-loop, and application training followed each other throughout training.
“Related to this, another contributing factor to successful SMR enhancement might have been that we have implemented an “incremental learning” approach as advocated in [53] and shown in [69], where open-loop, closed-loop, and application training (tasks of increasing difficulty) followed each other throughout training.”
From The Cybathlon BCI race: Successful longitudinal mutual learning with two tetraplegic users (2018) · cites this paper as [69]
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- Authors
- Vansteensel, M. J., Pels, E. G. M., Bleichner, M. G., Branco, M. P., Denison, T., Freudenburg, Z. V., Gosselaar, P., Leinders, S., Ottens, T. H., Van Den Boom, M. A., Van Rijen, P. C., Aarnoutse, E. J., & Ramsey, N. F.
- Affiliations
- Carl von Ossietzky Universität Oldenburg (DE)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2016-11-24
- Volume
- 375
- Issue
- 21
- Pages
- 2060-2066
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC5326682
- OpenAlex
- W2549587034
- Cited by
- 578
- References
- 23
- Citations by year
- 2026: 56 · 2025: 71 · 2024: 57 · 2023: 65 · 2022: 43 · 2021: 75 · 2020: 76 · 2019: 52 · 2018: 48 · 2017: 33 · 2016: 2
- FWCI
- 28.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Carl von Ossiezky University of Oldenburg (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › EEG and Brain-Computer Interfaces
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neural Engineering
- Physical Sciences › Computer Science › Human-Computer Interaction › Gaze Tracking and Assistive Technology
- Keywords
- brain-computer interface, amyotrophic lateral sclerosis, locked-in syndrome, subdural electrodes, motor cortex, augmentative and alternative communication, eye tracking, severe paralysis, computer typing
- MeSH terms
- Neurological Rehabilitation, Amyotrophic Lateral Sclerosis, Aphonia, Communication Devices for People with Disabilities, Communication Aids for Disabled, Electrodes, Implanted, Female, Humans, Middle Aged, Motor Cortex, Quadriplegia, Brain-Computer Interfaces
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