TED 2022

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A few months ago, I surrendered the password to my Twitter account and let a person with paralysis, tweet out his thoughts. But I mean that literally — Philip O’Keefe can’t use his fingers to type like you and I. But thanks to a tiny brain implant, he was able to send the following tweets:

“hello, world! Short tweet. Monumental progress.”, then:

“no need for keystrokes or voices. I created this tweet just by thinking it.”, then:

“My hope is that I’m paving the way for people to tweet through thoughts. Phil.”

And I know what you might be thinking – there are some people out there who should NOT be allowed to tweet directly from their brain…and you’re probably right…

But for people with paralysis and disabilities, this technology is life-changing.

So I’d love for you to meet Philip & Rodney. They both have a neurodegenerative disease called ALS which means they’re unable to move their hands or speak clearly. But, they can now text using a Brain Computer Interface, or BCI. 

That’s Philip’s raw brain signals displayed on screen. The data is streamed to their computers via Bluetooth. Their BCIS are fully implanted, and invisible to the outside world. And now, Philip & Rodney can control their keyboards with clicks coming in from their brain.

BCIs conjure up images of science fiction, like the Matrix, with cables jacked in through holes in your skull. The reality is far more elegant than that.

So we got this group chat going, which I thought was a brilliant idea – until they started roasting me about this TED talk – which they obviously thought was hilarious. thanks for the support guys! Bloody Aussies. 

You can see still pretty slow for them to type this way. But this is like dial up speeds at the beginning of the internet? We are entering into a new application of Moores law. We’re just getting started.

It is quite a big stage, but…she’ll be right. 

This has been the dream of patients, caregivers, and doctors and scientists for decades. And for good reason.

You probably know someone who’s lost the ability to use their hands effectively – because of a multiple sclerosis, cerebral palsy, or a stroke. Paralysis comes in all shapes & sizes, from minor inconvenience to life threatening. 

But during my neurology residency, I cared for a man in his 40s, who suffered a stroke & developed “Locked In Syndrome.” He couldn’t move any part of his body – except his eyes. His brain worked just like yours – he could hear and see and think like normal. But he couldn’t move or speak – ever again. There’s no cure for stroke, and in what was a horrible situation, we supported his wish to be taken off life support. And I’ve been thinking ever since, well what if there had been another way?

Because connection is a fundamental human need. So many of our patients haven’t been able to speak out loud, let alone type, in years. They so desperately want to reconnect with their partners, kids, friends, and colleagues. You know what the numberring one request is? Text messaging. Then email. Control over their smartphone. And even…shock horror…Social Media. We’ve been talking so much recently about the flaws of these technologies – and I get it… But for our patients with paralysis, this is a return to life. 

BCIs make this possible.

Part of problem is – BCIs have, traditionally, required invasive surgery. This is the Utah Array designed similarly to all other BCIs currently under development, which require drilling needles directly into the brain. This implant has been used for breakthrough science over a period of decades and was the early proof that BCIs could perform. 

But for the patient this requires open brain surgery which involves opening your skull with a saw. There’s only about 150 brain surgeons in the U.S. who can perform this operation. Apart from the fact that recovery is tricky – your brain doesn’t like having needles stuck into it, as a general rule, and is at risk of developing an immune reaction over time.

So, the question I’ve been obsessed with: is there any other way to get into the brain? 

Well, actually there is. A secret back door. The blood vessels are the natural highways into the brain – they’re hollow tubes that connect every corner of the brain. The largest vein is called the Superior Sagittal Sinus. It’s the one right up on top – and how convenient – it sits right next to the motor cortex – the exact part of the brain we need to tap into to restore communication with the outside world. How cool is that?

The beauty is, we already know how to safely travel through blood vessels. We’ve been doing it for almost 40 years, mostly going into the heart . If there’s anyone here today who’s had a heart attack, there’s a good chance you had a stent. A stent is like a metal scaffold. It’s delivered through a catheter, and opens up like a flower to press up against the inside of a blood vessel wall. Millions of stents are inserted each year, not in the operating room, but in the “cath lab” – or catheter laboratory. An outpatient or day procedure facility where technologies are inserted into blood vessels, like stents and pacemakers. 

Until recently, Cath labs were mainly used to deliver technologies to the legs and the heart, but it is now common to get into the brain. In fact there are now 2,500 physicians in the U.S who can navigate through the blood vessels in the brain – not just in ivy league institutions. The Stentrode is implanted through the jugular vein in the neck, and up into the brain. These veins are much bigger than the ones in your heart. 8 mm compared to 2 mm, making them easier to get into. Why this is so exciting for BCI, is that we already know that a device can live safely inside a blood vessel. Cells grow over and incorporate it, like a tattoo under the skin. So we’re protected from that tissue rejection immune reaction you get in the brain. 

So the idea was to figure out a way to incorporate sensors that can record brain activity onto the crosslinks of a stent – to do this we had to come up with revolutionary manufacturing technique, then, connect it to a cable (slide-3D animation) , carry the information out of the brain, and do it all in a day procedure in a cath lab. This should make BCI accessible, not for the thousands, but for the millions of people who need it.

Sounds easy right! Well it wasn’t. And it took 10 years. But we figured it out. And here it is. Check this out. We called it a Stentrode.

Graham Felstead, an incredible human, suffering with ALS, became the first patient in the world to receive and use this brain computer interface. 

He very generously offered to let you, the world, see what it looks like in his brain. Would you like to see? 

Seeing this video for the first time was one of the most incredible moments of my life. I was standing in the Cath lab watching Dr Mitchell perform the procedure…you see what happens is, the camera spins around the head of the patient while a dye is injected in the blood vessels, to light them all up like roads on a map. If you look here, you can see the outline of the device where the dye doesn’t fill. 

But this video – I remember I saw it come up on the screen, it felt like we had just witnessed something new in humanity, I had tingles in my spine, and I turned and said something profound to my colleague Pete, like…Holy Shit. 

A couple of hours later something even more special happened, and he woke up – recovered  from the sedation and asked if he was still alive. There were tears of relief and exhilaration. 

So he was home within a couple of days and ready for the system to be turned on.

Once it’s in place, the Stentrode is connected to this tiny antenna that collects raw data from your brain & transmits it wirelessly out of the body via Bluetooth . It’s always on and ready to go, kind of like how the brain works. Or should work. 

Our engineers  have worked closely with our patients to decode specific movements. For example – press down your foot. We’ll ask a patient to imagine pressing down their foot again. We won’t see their foot moving, because they’re paralyzed. But we’ve been able to determine which brain signals are generally linked to…pressing down your foot. The black dotted line here represents the time onset of pressing down your foot. You can see before looks different to after, so we can turn that into a switch. 

We then repeat  that process for all kinds of movements – like raise your arm or pinch your finger. It might not seem like much, but these attempted movements become the building blocks of all interactions you have on any digital device on a Bluetooth network, converting to click, hold, up, down, back, and scroll…for now your smart phone, and for later, wheelchairs and advanced robotics.

But what’s really incredible about this process is that, to some degree, our brain signals are universal. The signal for “Squeeze your left fist” looks pretty much the same for me as it does for you. Which means we are creating a dictionary of the brain across all humans. This will make BCI truly scalable. 

As Philip once told me, “it’s like learning to ride a bike – it takes practice, but once you’re rolling, it becomes natural. Now, I just think about where on the computer I want to click, and I can email, bank, shop, and now message the world via Twitter.” As Graham deteriorated with his ALS, he said it provided immense comfort knowing that he would always be able to tell his wife Nancy that he loved her. 

In the future, I am extremely hopeful about the breakthroughs BCI could deliver in disease states like epilepsy, dementia and depression. But beyond that, what will this technology mean for humanity? 

Well what has really got me thinking, is the future of communication. Think about emotion – have you ever considered how hard it is to express how you feel. You have to self reflect, package the feeling into words and then express the words with the muscles of your mouth. But you really just want someone to know how you feel. And for some people, especially for example with autism, this is really hard. What if rather than using your words, you could throw your emotions – even just for a few seconds – and have them actually feel how you feel. At that point, we might have realised that the necessary use of words to state our current being was always going to fall short. At the point, the full potential of the brain becomes unlocked. 

But right now, BCI is about restoring the lives of millions of patients with paralysis. After years of feeling trapped, this technology promises the return of autonomy & independence. And by that – I really mean dignity. Thank you.

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