Up until a few months ago, J.R. -- a 53-year-old Georgia man who suffered a cerebral hemorrhage last year -- communicated through a primitive system involving blinks and an oversized alphabet. Now, simply by thinking about moving his finger like a phantom digit, he's able to manipulate icons on a computer screen.
J.R. is the subject of a radical new procedure that Dr. Phillip Kennedy has developed to give a voice to victims of stroke and other paralyzing disorders. It has enabled J.R. to communicate simple thoughts directly into a computer.
"The analogy I often use is that of an orchestra," says Kennedy about his patient. "All the players are playing along happily and then -- boom! -- they don't hear themselves, they don't see their conductor and they just descend into chaos."
"What we've done is take a few players of the orchestra," Kennedy says, "and get them listening to what they're doing."
In J.R.'s case, the conductor is a simple yet revolutionary device implanted in his brain.
"It's an electrode and a couple of wires that come together in a glass container," says Kennedy about the device, which is designed to stay in for a lifetime. "The container has trophic factors in it. These induce growth into the tip, so the brain tissue grows in there, and the wires record across the tissue. And we transmit those signals out across the skin with another transmitter, pick them up, amplify them, run them through a computer. We use that to then feed back to the patient, so the patients can hear the signals, and hear the firing of their own brain."
J.R.'s amplified brain impulses are sent to a computer through an antenna on his forehead. The cursor on the screen will only move if J.R. increases the firing rate by concentrating.
"Some people have called it a spinal cord bypass," says Kennedy.
Kennedy has a 25-year research background; 12 of those years have been spent working on this project. He began experimenting with brain amplification in monkeys and rats at Northwestern University. Several years later he decided to combine his interest in cerebral recording with neural regeneration. In fall 1996, the Food and Drug Administration granted permission to move forward with the procedure on human patients. J.R. is only the second human patient the doctor has worked with.
"When I imagined it first, I knew it was going to work fine. I Tested it in rats, I got more certain. And then I found that the signals endured for months and months, in fact the entire lifetime of the rat. And that's when I knew it would work. That was way back in '86, '87. We put it into the cortex of the rat that's associated with its whiskers. So every time you touch the whisker, you hear the activity. Now the cortex only selects one or two whiskers. So when you touch those ones, your hear the activity, and when you touch the others, you don't. And that's the control."J.R.'s surgical procedure, was performed at Emory University Medical Center by Kennedy's colleague, Dr. Roy Bakay, on March 24. Within three months, brain tissue had grown into the device and J.R. was able to interface with the computer.The procedure depends on the patented trophic substance that encourages the growth of brain tissue. When asked about its nature, Kennedy quips, "It's proprietary." He also holds the patent to the electronic device, which he says can easily be mass produced. For such a device to be available to consumers -- and paid for by health insurance -- Kennedy must establish both "safety and efficacy" in a number of patients, which would categorize the process as procedural rather than experimental."Obviously this was not something where people would jump up and say, 'I'll try it,'" says Kennedy. "Lots of patients turned me down. Patients who were quadriplegic on ventilators -- some of them couldn't speak to some extent, but a lot of them were scared. Some patients I knew about had ALS [Lou Gehrig's Disease], and when I got around to trying to track them back down, they had died."The success of the experiment, and ensuing media attention, has led to a waiting list of at least 50 names. In addition, several medical corporations have made overtures to Kennedy and Bakay, though Kennedy declines to name them. He will, however, discuss hesitations he has about such technology."There are a few little things that in the back of my mind bother me -- just thinking about using it in non-patients, for whatever purposes," he says."Interfacing with machines directly from a brain, just having a brain and a machine, is a little bit gruesome to think of. But it does open up possibilities if you preserve a brain that's biologically functioning, provide it with blood and oxygen and remove the external life -- that's when a brain would control a machine. And that's a little bit scary all right. But, you know, it's too late now."Kennedy envisions J.R. communicating more easily in the near future, aided by technologies like voice recognition software. In less acute cases of paralysis, he imagines the possibility of restoring some motor control.The technology is already there for J.R. to send e-mail or even surf the Web if he continues to develop his powers of concentration."It's a possibility now with computers and the Internet," says Kennedy. "The potential for electrodes is vastly enhanced by the revolution in computers." But he bristles at the thought of non-medical uses for his procedure."I think it should be kept purely medical. It's an invasive procedure. You have to do a craneotomy. It's possible that they will use EEG waves -- if they can figure those well enough -- to control computers. But they're usually on and off signals. The information in one neuron and its electrical output is not just the fact that it's connected to something else, but the fact that the rate of firing can change. And it's the rate of firing, that rate of change, that's the key information ... Maybe someday it'll just be so simple, there'll be nothing to it. But not today. And it won't be tomorrow, either. I know some people think about putting this into normal people, non-patients, but I don't see that would be justified. Why would you possibly want to control computers directly from your brain if you can do it by moving your hand, your fingers? I think some people use their imaginations a bit too much."As revolutionary as Kennedy's technology may seem, it's actually a logical extension of our already transfigured world. These days, we take for granted the ability to optimize, even upgrade, the functioning of our own bodies -- via hearing aids, contact lenses, Walkmans, silicone implants, pacemakers and, yes, computers. Still, in an age of rampant speculation about brain-machine interfaces and cyborg evolution, Kennedy's cautious perspective is refreshing."People say it's amazing that your brain can operate this cursor," Kennedy says coolly. "I think it's more amazing that your brain can operate your arms, your legs, your mouth."