How Do Brain-Computer Interfaces (BCIs) Augment Cognition?
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Imagine your life changing in a heartbeat. You experience an accident, stroke, or disease that suddenly disconnects most of your body from your brain’s commands. Behaviors that we take for granted, like speaking with friends and loved ones or drinking a cup of coffee, are now impossible. Even with many neuroscientists working on cures for these conditions, we still consider damage to the brain and spinal cord to be permanent. How can technology improve the quality of life for these patients?
Many people are convinced that brain-computer interfaces (BCIs) are uniquely poised to help patients regain at least some meaningful abilities. BCIs are technologies that allow users to communicate directly with a computer without using voice, hands, or other parts of the body. They’re not exactly new, having been around since the 1970s when Jacques Vidal of UCLA demonstrated that EEG recordings could be used to move a cursor on a screen. But technology has changed substantially since the 1970s, opening new opportunities to help.
Over 25 BCI clinical trials are currently active. BCIs have been approved for human trials in patients with tetraplegia, also known as quadriplegia, due to spinal injury or stroke. Patients with amyotrophic lateral sclerosis (i.e., Lou Gehrig’s disease) are also candidates for BCIs. The intent is to restore some independence through the ability to move a computer cursor or a prosthetic device. BCIs have also been used to facilitate speech and vision.
BCIs range in invasiveness, or the extent to which the body is physically penetrated.
EEG is an example of a non-invasive BCI, as EEG electrodes are placed on the scalp with no invasion of the body.
Partially invasive BCIs require surgery to implant them within the skull, but they do not extend into the brain. Synchron’s stentrode, an Australian BCI, is implanted in the vascular system over the motor cortex. From that vantage point, the strentrode array (stent for insertion in a blood vessel and “rode” for electrode) can record electrical activity from the underlying brain tissue. Precision Neuroscience has a BCI, the Layer 7 Cortical Interface, consisting of a flexible film laid over the brain. The interface is about one-fifth the thickness of a human hair.
Invasive BCIs require the surgical insertion of electrode arrays, which means they carry the normal risks of neurosurgery. Infection, swelling, rejection of the implant, and scar tissue can interfere with the procedure’s success. Functional magnetic resonance imaging (fMRI) is used to pinpoint the area of the brain responsible for controlling target behaviors. For applications allowing patients to move a computer cursor or control a prosthetic arm, placement would be focused on brain areas controlling movement in the hand and arm.
What Does the Technology Do?
The goal of the BCI technology is to translate brain activity into actions or sensations. The technology picks up Signals from the brain and communicates via Bluetooth to a computer application. The application decodes the signals and translates them into actions, such as the movement of a cursor or prosthetic device. The end result is that, with practice, the patient can think about moving the hand or arm in ways that produce the desired action.
In the case of Neuralink, the implanted device, N1, consists of a coin-sized capsule connected to very fine filaments, only microns in diameter (a micron is one one-millionth of a meter). Overall, the filaments form an array of 1,024 electrodes. The electrode-containing filaments are threaded into the gray matter of the motor cortex by a specially designed surgical robot. Human neurosurgeons, of course, are in charge of opening and closing the skull before and after the robot does the insertion.
Some Patient Stories
Visual cortex implants were performed as early as 1978 to improve vision in people with acquired blindness. In other words, they had normal vision initially but had lost their vision due to a stroke. Jens Naumann’s implant improved his vision sufficiently that he could drive a car slowly around a parking lot.
Johnny Ray, a patient with amyotrophic lateral sclerosis (ALS), received an implant in 1998 that allowed him to move a computer cursor.
In 2004, Matthew Nagle received an electrode implant as part of the BrainGate project at Brown University. Nagle had been paralyzed from the neck down as a result of a spinal cord injury. Nagle’s implant, located on the surface of his motor cortex, allowed him to move a computer cursor and open and close a prosthetic hand with just a thought. Nagle could now control his TV and open emails.
A subsequent BrainGate project in 2012 allowed two patients to control prosthetic arms in complex ways, such as grasping a cup to allow the patient to drink.
In 2020, two patients with ALS received stentrode implants that allowed them to complete complex tasks on computers, including texting, shopping, emailing, and managing their bank accounts. These patients have not seemed to experience the decline in electrode functioning that sometimes occurs with other implants, possibly due to scar tissue and brain movements that disrupt the electrode arrays.
Neuralink received approval to conduct human clinical trials in 2023 and has since performed BCI implants in two people. The first patient, Noland Arbaugh, plays video games and explores the internet. The second recipient uses his implant for CAD design software and plays first-person shooter video games.
BCI Ethical Challenges
In addition to the possible health effects associated with partially and fully invasive BCIs, the technologies have their fair share of ethical issues to address. Having technology implanted on or within the brain raises issues of privacy and free will.
While it’s unlikely that anyone could “mind read” based on current technologies, privacy concerns might become more of an issue as the technology advances. The applications are certainly storing the data transmitted from the technology, so forward thinking about how the data should be managed is time well spent.
Could the systems be hacked, overriding the free will of the user? While this sounds more like a science fiction film, the answer is certainly yes. Again, guardrails for the prevention of misuse are important now, not just an issue for consideration in the future.
BCIs also raise issues of equity. In clinical trials, the university or corporation conducting the trials will cover the costs of the technology and its activation. That leaves, however, considerable costs related to things like hospital stays and travel to the research site. Some insurance companies will pay for costs like this, but others balk at their experimental nature.
Prospective patients need to read the fine print carefully. If the costs for a trial are significant, some people might be more likely to get treatment than others. Once the technologies are approved for wider use, the equity issue might become even more obvious.
The Future of BCIs
BCIs will not stop at providing assistance like moving a computer cursor or a prosthetic hand. Additional applications, like restoring speech and vision, are already well underway. Combined with an exoskeleton, BCIs have the potential to restore movement.
Probably the most contentious future application of BCIs would be their use to enhance functioning in healthy people, rather than assisting patients with movement or sensory deficits. We’re not sure exactly what that would look like, but boosting memory and providing instant access to AI functions with just a thought are some of the possible applications. Once again, the equity issues involved with human enhancement would be profound.
We all have a front row seat to some of the most remarkable technological advances in human history. The prospect of helping people with some of the most dire conditions is exhilarating. We can imagine the excitement of patients when they are able to carry out simple tasks like answering an email or seeing again after having lost those abilities.
Human enhancement could produce even greater changes in our experience. We’re still too close to know exactly how AI in general will affect what it means to be human, and AI in the form of BCIs would be revolutionary. If we use our human wisdom to decide how to engage with the technology ethically, our world could look very different in a relatively short amount of time.
Laura Freberg, PhD
Writer & Contributing ExpertLaura Freberg serves as professor of psychology at Cal Poly, San Luis Obispo, where she teaches introductory psychology and behavioral neuroscience.
Dr. Freberg is the author or co-author of several textbooks, including Discovering Psychology: The Science of Mind, Discovering Behavioral Neuroscience, Applied Behavioral Neuroscience, and Research Methods in Psychological Science. She served as President of the Western Psychological Association (WPA) in 2018-2019.