By Christopher Klose
Most of us take the ability to communicate for granted. We talk and write. But what if you're paralyzed and can't speak? Each year, stroke silences tens of thousands of Americans. One of the most devastating consequences is "locked in" syndrome—a situation in which people are unable to move a muscle or utter a sound. Severe head injuries, spinal injuries, and amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) are also responsible for this bleak condition.
"It is hard to overestimate how much of human life is communication—being able to listen and then respond," points out William J. Heetderks, M.D., director of extramural science programs at the National Institute of Biomedical Imaging and Bioengineering (NIBIB).
Since the early 1990s, Jonathan R. Wolpaw, M.D., a neurologist and chief of the Wadsworth Center Laboratory of Nervous System Disorders, New York State Department of Health, Albany, has led a team of researchers in developing a brain-computer interface (BCI) system to help the profoundly paralyzed communicate. Dr. Wolpaw has received support from two NIH Institutes—NIBIB and the National Institute of Child Health and Human Development—and the James S. McDonnell Foundation.
"For the locked-in, the BCI is like being let out of jail—only better," Dr. Heetderks emphasizes.
In a BCI system, the brain's electrical activity is detected through the scalp, from the surface of the brain, or from within the brain, and then processed by a computer to extract patterns indicating the user's intent. The patterns are then translated into commands for a device, such as moving a cursor on a computer screen or operating a wheelchair.
NIBIB: Improving Diagnosis, Treatment, and Prevention
The National Institute of Biomedical Imaging and Bioengineering (NIBIB) was established in 2000. Its mission is to integrate the physical and engineering sciences with the life sciences to advance basic research and medical care. Examples of innovative technologies supported by NIBIB include
- New diagnostic techniques such as MRI combined with brain activity images
- New ways to deliver medications to places in the body
- Using light for minimally invasive diagnosis
- Developing specific types of tissues to help burn victims or restore vision to damaged eyes
Thought into action
The Wadsworth BCI system works on brainpower, not muscle control. It uses the team's specially developed software platform (called BCI2000) and consists of a laptop computer, portable amplifier, and a skullcap containing eight electrodes hitched to the computer. The electrodes record the user's electrical brain waves, which the computer analyzes and translates into specific commands, such as writing e-mails, selecting computer icons, or moving robotic devices. No surgery is required and users typically master the system within an hour or two.
"We are trying to use the scientific research for practical results," Dr. Wolpaw explains. "Life can be reasonable for the locked-in with the right support. That's our goal."
Currently, the Wadsworth team supports seven patients, five in the United States and two in Germany. Much time is required for system maintenance and technical support. "Our major challenge is to produce a trouble-free, reliable, affordable system that can be used at home by patients and their caregivers," Dr. Wolpaw says.
Although BCI research has been under way since the 1970s, NIBIB's Dr. Heetderks says it has taken off only in the last five years or so, thanks to substantial improvements in signal processing. In particular, he attributes such progress to "clever people like Dr. Wolpaw for making sense out of how to find and process information (the brain's electrical signals)."
The Wadsworth BCI2000 software accepts and analyzes any brain signal and can be used with a wide range of output devices—from computer icons to wheelchairs. It is now in use by more than 140 research laboratories worldwide.
"There is increased appreciation of the severely disabled and their capabilities," says Dr. Wolpaw. He predicts that "in five or 10 years, everything will be much clearer. We know—and are learning—much more about the brain, and the revolution in computers and electronics gives us the technology to operate BCIs in real time."
Like many physician researchers, Dr. Wolpaw combines a passion for science with the practical urges of the clinician. Of his BCI system he says, simply, "I wanted to help severely disabled people."
His greatest satisfaction? "When we got those first e-mails from the locked-in, that was great!"