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ItemMotor neuroprosthesis implanted with neurointerventional surgery improves capacity for activities of daily living tasks in severe paralysis: first in-human experienceOxley, TJ ; Yoo, PE ; Rind, GS ; Ronayne, SM ; Lee, CMS ; Bird, C ; Hampshire, V ; Sharma, RP ; Morokoff, A ; Williams, DL ; MacIsaac, C ; Howard, ME ; Irving, L ; Vrljic, I ; Williams, C ; John, SE ; Weissenborn, F ; Dazenko, M ; Balabanski, AH ; Friedenberg, D ; Burkitt, AN ; Wong, YT ; Drummond, KJ ; Desmond, P ; Weber, D ; Denison, T ; Hochberg, LR ; Mathers, S ; O'Brien, TJ ; May, CN ; Mocco, J ; Grayden, DB ; Campbell, BC ; Mitchell, P ; Opie, NL (BMJ PUBLISHING GROUP, 2021-02-01)BACKGROUND: Implantable 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. METHODS: Two 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. RESULTS: Unsupervised 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. CONCLUSION: We 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.
ItemNo Preview AvailableFeasibility of a Chronic, Minimally Invasive Endovascular Neural InterfaceOpie, NL ; Rind, GS ; John, SE ; Ronayne, SM ; Grayden, DB ; Burkitt, AN ; May, CN ; O'Brien, TJ ; Oxley, TJ ; Patton, J ; Barbieri, R ; Ji, J ; Jabbari, E ; Dokos, S ; Mukkamala, R ; Guiraud, D ; Jovanov, E ; Dhaher, Y ; Panescu, D ; Vangils, M ; Wheeler, B ; Dhawan, AP (IEEE, 2016-01-01)Development of a neural interface that can be implanted without risky, open brain surgery will increase the safety and viability of chronic neural recording arrays. We have developed a minimally invasive surgical procedure and an endovascular electrode-array that can be delivered to overlie the cortex through blood vessels. Here, we describe feasibility of the endovascular interface through electrode viability, recording potential and safety. Electrochemical impedance spectroscopy demonstrated that electrode impedance was stable over 91 days and low frequency phase could be used to infer electrode incorporation into the vessel wall. Baseline neural recording were used to identify the maximum bandwidth of the neural interface, which remained stable around 193 Hz for six months. Cross-sectional areas of the implanted vessels were non-destructively measured using the Australian Synchrotron. There was no case of occlusion observed in any of the implanted animals. This work demonstrates the feasibility of an endovascular neural interface to safely and efficaciously record neural information over a chronic time course.