Controlling our brains – a case study on the implications of brain-computer interface-triggered deep brain stimulation for essential tremor

Brown, Timothy; Thompson, Margaret C.; Herron, Jeffrey A.; Chizeck, H.J.; Goering, Sara

doi:10.1080/2326263x.2016.1207494

Cited by 20 publications

(11 citation statements)

References 17 publications

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“…As implantable Brain Computer Interface (BCI) research moves rapidly ahead, concern about its potential effects on patients’ sense of self, autonomy and identity is growing (Klein 2015 ; Glannon 2016 ; Klein and Jeffrey 2016 ; Clausen 2013 ; Gilbert 2015a , b ; Brown et al 2016 ; Hildt 2015 ). 1 For instance, the evolution of prosthetic limbs controlled through BCI introduces questions about body ownership, self-image and self-understanding.…”

Section: Introductionmentioning

confidence: 99%

Embodiment and Estrangement: Results from a First-in-Human “Intelligent BCI” Trial

et al. 2017

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While new generations of implantable brain computer interface (BCI) devices are being developed, evidence in the literature about their impact on the patient experience is lagging. In this article, we address this knowledge gap by analysing data from the first-in-human clinical trial to study patients with implanted BCI advisory devices. We explored perceptions of self-change across six patients who volunteered to be implanted with artificially intelligent BCI devices. We used qualitative methodological tools grounded in phenomenology to conduct in-depth, semi-structured interviews. Results show that, on the one hand, BCIs can positively increase a sense of the self and control; on the other hand, they can induce radical distress, feelings of loss of control, and a rupture of patient identity. We conclude by offering suggestions for the proactive creation of preparedness protocols specific to intelligent-predictive and advisory-BCI technologies essential to prevent potential iatrogenic harms.

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Section: Introductionmentioning

confidence: 99%

Embodiment and Estrangement: Results from a First-in-Human “Intelligent BCI” Trial

et al. 2017

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“…Hence, qualitative data gaining methods were used for this purpose only. The studies which did not specify any qualitative data analyzing methods mostly ran statistical analyses and addressed the qualitative data as secondary [10, 36, 38, 40, 46, 49, 54, 56, 61, 62, 71, 72, 81, 83, 84]. Certain studies aimed also to address ethical aspects related to BCIs [83, 85–87].…”

Section: Resultsmentioning

confidence: 99%

“…Only a handful of studies examined persons with a singular type of impairment (often in case studies with a single participant). These impairments included stroke [57, 63], cerebral palsy [67, 81], and essential tremor [84]. The exception thus is a total of 12 studies solely (or in combination with non-impaired participants) conducted with persons having ALS [37, 39–41, 50, 58, 59, 74, 88–91].…”

Section: Discussionmentioning

confidence: 99%

Using brain-computer interfaces: a scoping review of studies employing social research methods

Kögel¹,

Schmid²,

Jox³

et al. 2019

BMC Med Ethics

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Background The rapid expansion of research on Brain-Computer Interfaces (BCIs) is not only due to the promising solutions offered for persons with physical impairments. There is also a heightened need for understanding BCIs due to the challenges regarding ethics presented by new technology, especially in its impact on the relationship between man and machine. Here we endeavor to present a scoping review of current studies in the field to gain insight into the complexity of BCI use. By examining studies related to BCIs that employ social research methods, we seek to demonstrate the multitude of approaches and concerns from various angles in considering the social and human impact of BCI technology. Methods For this scoping review of research on BCIs’ social and ethical implications, we systematically analyzed six databases, encompassing the fields of medicine, psychology, and the social sciences, in order to identify empirical studies on BCIs. The search yielded 73 publications that employ quantitative, qualitative, or mixed methods. Results Of the 73 publications, 71 studies address the user perspective. Some studies extend to consideration of other BCI stakeholders such as medical technology experts, caregivers, or health care professionals. The majority of the studies employ quantitative methods. Recurring themes across the studies examined were general user opinion towards BCI, central technical or social issues reported, requests/demands made by users of the technology, the potential/future of BCIs, and ethical aspects of BCIs. Conclusions Our findings indicate that while technical aspects of BCIs such as usability or feasibility are being studied extensively, comparatively little in-depth research has been done on the self-image and self-experience of the BCI user. In general there is also a lack of focus or examination of the caregiver’s perspective. Electronic supplementary material The online version of this article (10.1186/s12910-019-0354-1) contains supplementary material, which is available to authorized users.

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“…The idea was that although controlling stimulation would take conscious effort initially, repeated training and daily use would allow the patient to develop automatic, almost subconscious control of the stimulation. As indicated by our conversations with the patients, this also had the potential to greatly improve the patient experience by increasing the sensation of agency and strengthening the identification of the device as a part of themselves ( Figure 4 ) (Brown et al, 2016 ; Herron et al, 2017 ).…”

Section: Development Of Adbs For Tremormentioning

confidence: 97%

Closing the Loop With Cortical Sensing: The Development of Adaptive Deep Brain Stimulation for Essential Tremor Using the Activa PC+S

et al. 2021

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Deep Brain Stimulation (DBS) is an important tool in the treatment of pharmacologically resistant neurological movement disorders such as essential tremor (ET) and Parkinson's disease (PD). However, the open-loop design of current systems may be holding back the true potential of invasive neuromodulation. In the last decade we have seen an explosion of activity in the use of feedback to “close the loop” on neuromodulation in the form of adaptive DBS (aDBS) systems that can respond to the patient's therapeutic needs. In this paper we summarize the accomplishments of a 5-year study at the University of Washington in the use of neural feedback from an electrocorticography strip placed over the sensorimotor cortex. We document our progress from an initial proof of hardware all the way to a fully implanted adaptive stimulation system that leverages machine-learning approaches to simplify the programming process. In certain cases, our systems out-performed current open-loop approaches in both power consumption and symptom suppression. Throughout this effort, we collaborated with neuroethicists to capture patient experiences and take them into account whilst developing ethical aDBS approaches. Based on our results we identify several key areas for future work. “Graded” aDBS will allow the system to smoothly tune the stimulation level to symptom severity, and frequent automatic calibration of the algorithm will allow aDBS to adapt to the time-varying dynamics of the disease without additional input from a clinician. Additionally, robust computational models of the pathophysiology of ET will allow stimulation to be optimized to the nuances of an individual patient's symptoms. We also outline the unique advantages of using cortical electrodes for control and the remaining hardware limitations that need to be overcome to facilitate further development in this field. Over the course of this study we have verified the potential of fully-implanted, cortically driven aDBS as a feasibly translatable treatment for pharmacologically resistant ET.

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Controlling our brains – a case study on the implications of brain-computer interface-triggered deep brain stimulation for essential tremor

Cited by 20 publications

References 17 publications

Embodiment and Estrangement: Results from a First-in-Human “Intelligent BCI” Trial

Embodiment and Estrangement: Results from a First-in-Human “Intelligent BCI” Trial

Using brain-computer interfaces: a scoping review of studies employing social research methods

Closing the Loop With Cortical Sensing: The Development of Adaptive Deep Brain Stimulation for Essential Tremor Using the Activa PC+S

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