With aid of a device called BrainGate, a pioneering quadriplegic can move the cursor on a computer screen.

01:00 AM EDT on Tuesday, October 19, 2004

BY FELICE J. FREYER
Journal Staff Writer

A 25-year-old Massachusetts man who can't move his arms and legs has been checking his e-mail and changing television channels -- just by thinking about it.

The man, Matthew Nagle, is the first person ever to receive a brain implant that transmits his thoughts to a computer cursor, using technology originally developed and tested in monkeys at Brown University.

Nagle received the implant at Rhode Island Hospital in late June and began using it about six weeks later. He is the first participant in a study of the device, known as BrainGate, developed by the Foxboro, Mass.-based Cybernetics Neurotechnology Systems. The research is financed by venture capital.

BrainGate is a silicon wafer about a sixth-inch square, with 100 hair-thin electrodes that extend a sixteenth of an inch into the brain.

When Nagle thinks about moving his arm, the electrodes pick up his brain signals and transmit them to a half-inch-high pedestal on the outside of his head. The signals then travel through a fiber-optic cable to a cart laden with computer equipment.

This equipment translates Nagle's brain signals into a code understood by the computer that Nagle wants to use. So when he thinks of lifting his arm and moving the cursor, those thoughts travel to the computer, and the cursor moves.

"He's a highly motivated, very courageous person," said Dr. Jon Mukand, who is leading the study at the Sargent Rehabilitation Center in Warwick. "He's really a pioneer -- the first human being to have this device implanted in his brain."

Nagle had to start getting ready for the surgery three days ahead of time, undergoing the blood tests, electrocardiograms and CT scans to make sure he was healthy. Taking every possible step to avoid infection, doctors also required him to take a head-to-toe bath in the antiseptic Betadine, three times over three days. This work was done at the New England Sinai Hospital Rehabilitation Center in Stoughton, Mass., where Nagle lives.

Then he came to Rhode Island Hospital, where Dr. Gerhard M. Friehs, director of functional neurosurgery, implanted the device in the part of the brain that controls the left arm. (Nagle is left-handed.)

Nagle had temporary headaches and some drainage from the wound, but no infections, and he was able to leave the hospital after a couple of days, Mukand said.

But that was only the beginning. Getting his thoughts to the computer involves an unwieldy and complicated process.

The researchers had to identify and decode the unique electrical pattern that Nagle's brain produces when he thinks about moving his left arm. Using a mathematical formula devised at Brown, the computer correlates signals from Nagle's brain with his intention to move in a particular direction. The equipment has to be retuned every time Nagle uses it, because those patterns can change overnight.

About six weeks after the surgery, Nagle began controlling the cursor. He started simply by moving the cursor to large boxes on the screen. Eventually he learned to play Pong, and then use a computer that let him change channels on the television. "By pointing and dwelling on each box, he was able to enter the television control, which was linked to the computer using wireless technology," Mukand said.

But Nagle is a long way from independence. He uses the equipment about three times a week, when the technicians come to start it up.

Even so, said Mukand, "The patient says to me that this device has changed his life. Here is somebody completely paralyzed, completely dependent on nurses and aides for basic functions. Now, with the help of a device, he is able to control the television, to get on to the computer and open his e-mail."

Eventually, Mukand said, researchers hope to link BrainGate to computers controlling such things as lights and thermostats, or even the participant's wheelchair. Through the Internet, a paralyzed person could use the telephone.

Even further down the road, BrainGate may someday be used to actually move paralyzed limbs, by activating electrical stimulation devices connected to muscles.

"I am so pleased with the way this has turned out," Mukand remarked. "The results have greatly exceeded my expectations."

Under the study's protocol, Nagle's implant must be removed after a year. But he would be a candidate to test more advanced versions of the device that Cybernetics is working on.

Cybernetics has approval from the U.S. Food and Drug Administration to test BrainGate in five quadriplegic patients ages 18 to 60 who are in good physical and pyschological health and able to speak. Then, a second larger trial must be completed before BrainGate can go on the market.

But so far Nagle is the only person to participate. After Mukand presented his results at the annual meeting of the American Academy of Physical Medicine this month, Cybernetics received inquiries from around the country, but all the would-be participants lived too far away. Researchers can only work with people who live within two-hour driving distance from Warwick.

Cybernetics was co-founded by Dr. John Donoghue, chairman of Brown's Department of Neuroscience, who did the original work with monkeys. It recently became a publicly traded company. In the first day of trading yesterday on the Over-the-Counter Bulletin Board, shares started at $2.50 and closed at $3.10.