The Promise of Brain-Machine Interfaces: Recap of March's The Future Now: NEEDs Seminar

Image courtesy of Wikimedia Commons.

By Nathan Ahlgrim



If we want to – to paraphrase the classic Six Million Dollar Man – rebuild people, rebuild them to be better, stronger, faster, we need more than fancy motors and titanium bones. Robot muscles cannot help a paralyzed person stand, and robot voices cannot restore communication to the voiceless, without some way for the person to control them. Methods of control need not be cutting-edge. The late Dr. Stephen Hawking’s instantly recognizable voice synthesizer was controlled by a single cheek movement, which seems shockingly analog in today’s world. Brain-machine interfaces (BMIs) are the emerging technology that promise to bypass all external input and allow robotic devices to communicate directly with the brain. Dr. Chethan Pandarinath, assistant professor of biomedical engineering at Georgia Tech and Emory University, discussed the good and bad of this technology in March’s The Future Now NEEDs seminar: "To Be Implanted and Wireless". He shared his experience and perspective, agreeing that these invasive technologies hold incredible promise. Keeping that promise both realistic and equitable, though, is an ongoing challenge.

BMIs are currently designed as assistive technologies. They can take many forms: a cochlear implant, a cursor on a screen, a robotic arm, or even a complete exoskeleton. All serve the same general purpose: to restore a person’s ability to connect and communicate with the world. The most common patients are those with some form of paralysis. Given the potential to restore movement or speech to people, many see the development of BMIs as a moral imperative. However, agreeing that BMI research is a worthwhile and necessary endeavor cannot will these devices into being. There is a good reason why controlling a robot arm with your brain feels like something out of science fiction – it is incredibly difficult to do.

An example of an intracortical array.

Image courtesy of Wikimedia Commons.

Reliable BMIs depend on first being able to record brain activity. Scientists have been able to do this for decades at great precision, but the unfortunate trade-off is that the level of precision tracks directly with the level of invasiveness. As Dr. Pandarinath described, scalp electroencephalograms (EEGs) require no surgery at all, but analyzing the resulting data is like standing outside of a football stadium. You may hear the roar of the crowd, but you need to get in the stands before you can pick up individual conversations. For scientists, that means you need to open up the skull and place arrays of wires (known as intracortical microelectrodes) into the brain itself in order to eavesdrop on the brain’s conversations.

Display of the BrainGate system.

Image courtesy of Wikimedia Commons.

Figuring out what those brain conversations mean is the hard part. All our billions of neurons firing at once produce gigabytes of data, and the challenge of making sense of that data is what draws engineers and computer scientists towards neuroscience. Dr. Pandarinath is one of these people, a self-described “engineer that managed to run into the brain one day and thought it was pretty cool.” Approaching the problem as an engineer, he and many others have developed a host of technologies around the BrainGate system. Their tagline says it all: “Turning thought into action.” Targeting the motor cortex of the brain, which controls voluntary movements in healthy individuals, BrainGate technology allows paralyzed people to control robotics just by thinking about them (Pandarinath et al., 2017). Perhaps most shocking of all, learning to control the device is like learning to walk. At first it’s a struggle (there’s a reason we label toddlers as such), but adults do not consider walking a skill. As one patient described, “it was hard work getting [it to work]. I struggled greatly to [move the arm] up and down at the beginning, now up and down is so easy I don’t even think about it.” In effect, BrainGate lets patients control a robot as an extension of their own body. No mental gymnastics needed.

Is the ease of use a good thing? Once patients can “automatically” control BMIs, are they at fault for any harm caused by the machine? Dr. Karen Rommelfanger raised one possible scenario: following an argument between the patient and researcher, the patient’s robotic hand crushes the researcher’s hand during testing. Who is at fault? Did the patient misuse the technology, or did the researcher cause her own injury by creating a faulty system?

One possibility is to have a universal limit to the strength and ability of all BMIs. Even though we can create machines that rip cars apart like tissue paper, maybe we should never build a robotic arm to have more grip strength than that of a child. Such a solution prevents the person (or BMI) from doing any physical harm, but it then fails the primary goal of BMIs: to restore patients’ abilities. A universal set-point on what these abilities should be is problematic because, for better or worse, there is no singular ‘human ability.’

By the end of the seminar, the conversation landed on where to draw the line between restoration and enhancement. Of course, this debate is not new to BMIs. Everything from sports supplementation to psychostimulants like Adderall are subject to the same debate: who deserves to receive these treatments, and how much is too much? Researchers do not even need to design superhuman BMIs (although it is certainly possible) to join the conversation. The arm strength of an editorial intern is a far cry from Game of Thrones’ Hafþór Björnsson, but we are both decidedly human. If I became paralyzed, must I be restricted to my previous strength? I could always argue that I was just going to start a strongman program before I became paralyzed, and therefore I deserve a robotic arm to match.

Could and should BMIs make everyone

as strong as humanly possible?

Image courtesy of Wikimedia Commons.

The premise that researchers will be in charge of setting a limit (if any) may be inherently flawed, given that machine learning is starting to drive BMI research. Algorithms succeed by optimizing solutions, which in the case of BMIs would mean the most efficient, the most precise, and perhaps the strongest BMI possible. Normal humans are hardly the optimal physical form, so it is hard to imagine a sophisticated algorithm being complacent at returning me to my previous strength.

To many, “supplementing” people with artificial intelligence (AI)-guided BMIs is a good thing, and perhaps even necessary. Elon Musk, famous for his dire warnings on the impending AI threat, posits that coupling AI with humans via BMIs is the best protection our species has against it. By making ourselves more than human, we will at least have a fighting chance against the AIs we design with the express goal of being better than human.

In the end, BMIs do offer great promise. No, a paraplegic will not be able to walk normally in the next year using a BMI. Anyone who promises that is peddling in false hope and unrealistic expectations. But BMIs, like all other technologies, never stop improving. Questions about limits to and access to these incredible tools will only become more pressing as the technology improves. Who gets to set the limit? Who will act as gatekeeper? The patient or the manufacturer? Dr. Pandarinath does not think BMIs are different than any other cutting-edge product: “by default, it’ll be the wallet.” And adjusting for inflation, it will now take thirty-five million dollars to build the Six Million Dollar Man.

References

Pandarinath C, Nuyujukian P, Blabe CH, Sorice BL, Saab J, Willett FR, Hochberg LR, Shenoy KV, Henderson JM (2017) High performance communication by people with paralysis using an intracortical brain-computer interface. eLife 6:e18554.

Want to cite this post?



Ahlgrim, N. (2018). The Promise of Brain-Machine Interfaces: Recap of March's The Future Now: NEEDs Seminar. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2018/05/the-promise-of-brain-machine-interfaces.html

The Ethics of Using Brain Stimulation to Enhance Learning in Children

By Peter Leistikow

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris in Summer 2016.

Peter Leistikow is an undergraduate student at Emory University studying Neuroscience and Sociology. When he is not doing research in pharmacology, Peter works as a volunteer Advanced EMT in the student-run Emory Emergency Medical Service. 

Ever since the advent of electricity, people have tried to harness this power for therapeutic purposes. Nineteenth century posters touted the benefits of “self-applicable curatives for nervous, functional, chronic, and organic diseases” in the form of electric belts and harnesses (Browne 2014). Although these items are historical curiosities today, scientists are still trying to harness the potential benefits of electricity, especially in the treatment of psychiatric and learning disorders.

Transcranial direct current stimulation (TDCS) is a non-invasive experimental procedure that utilizes direct currents applied to two electrodes on the head with the goal of stimulating specific brain areas (John Hopkins Medicine 2016). Although there is evidence that this technology, and it’s closely related variant transcranial random-noise stimulation (TRNS), can increase attention and aid in treating cognitive impairments and depression, TDCS has caught the interest of companies and hobbyists assembling these devices for cognitive enhancement (Hogenboom 2014). This has worried some researchers, who have called for regulations regarding the sale and use of this technology which they fear can have detrimental effects if used incorrectly (Wexler 2015).

Meanwhile, researchers have continued to investigate TDCS, and the media has taken notice. In an article published just last year, neuroscientist Roi Cohen Kadosh explains his then-forthcoming study in which TRNS was administered to a group of twelve 8 to-10-year-old children with learning difficulties such as dyslexia or dyscalculia as the children played a game in which they guided a ball using gestures (Geddes 2015). In fact, they are a few of at least 1000 children estimated to have taken part in brain stimulation as part of clinical trials. As this research progresses, several issues must be addressed, namely costs and benefits of early life treatment, access to treatment, and future use as enhancement.

Because this technology can be used on a developing brain, there exists an opportunity to permanently change the structural organization of a child’s brain. Unfortunately, the promise of early treatment is tempered by the possibility of irreparable damage to the child’s brain. The thinner skulls of pediatric patients could have profound effects on everything from effects of treatment to dosing guidelines and side effects, and there is increasing skepticism regarding children as “small adults” for the purpose of utilizing TDCS data obtained from adults (Davis 2014). The allure of stopping or even reversing the effects of learning disabilities such as dyslexia is tempting, given that current clinical interventions are promising yet inconclusive; nevertheless, more studies are needed for parents of children with disabilities to make an informed choice regarding the therapeutic value of this technology (Cioni et al. 2016).

Image Courtesy of  PublicDomainPictures

Along these same lines, access to this technology must be such that parents will not resort to purchasing or constructing this technology without being trained in its applications and shortcomings. Some may argue that regulation of this technology and criminalization of its use outside of a clinical setting may deter parents until further data is available, but ultimately the success of needle exchange programs and other public health initiatives shows us that harm reduction is the most ethical path until an optimal end point can be reached (Kleinig 2009). In this case, the optimal end point would be proven therapeutic value of TDCS for pediatric patients, and an equitable dissemination of TDCS for those whom it is indicated. Although there is understandable skepticism regarding this technology among researchers, it may be possible to expand TDCS access to children of parents who would otherwise attempt home use of this technology. It should be a priority of researchers to advocate for parents of children with disabilities in order that they might have equitable access to TDCS and make informed decisions regarding their child’s treatment, especially given that risks and rewards of treatment may vary by disorder type and severity. At the same time, it is crucial that parents seeking a “last resort” option are not commodified and used for studies that have little interest in alleviating their child’s disability.

Central to the debate over TDCS is where treatment ends and enhancement begins. Maslen et al. (2014) argue that for a child experiencing significant neurological burden, brain stimulation may be permissible despite negative side-effects, while cognitive enhancement involves even more significant cognitive trade-offs and should not be permitted. However, enhancement is defined relative to the abilities of others, and direct marketing to consumers by pharmaceutical companies and other corporations as seen in the testosterone supplement industry could further obfuscate the already blurred line between treatment and enhancement (Purcell 2014). Already the ease of constructing or purchasing TDCS could conceivably lead to its ubiquity among competitive parents once the technology is optimized. Thus, there is a need for the adoption of standardized criteria to determine who is eligible for TDCS use. Researchers may be able to assist in the development of these criteria by acknowledging how their TCDS findings will be used by hobbyists for both treatment and enhancement in further investigations into the cognitive effects of TCDS (Wexler 2015).

It is crucial that we continue to advocate for responsible use of experimental technology whether within or outside of the laboratory. Unlike the dubious electricity-based endeavors of antiquity, our approach to both the science and ethics of transcranial direct stimulation must be appropriately rigorous.

References

1. Browne, A. 2014. It’s electrifying! Medical uses of electricity. New York Historical Society, October 1. Available at: http://blog.nyhistory.org/electric-medicine/ (accessed June 11, 2016).

2. Cioni, G., Inguaggiato, E. and Sgandurra, G. 2016. Early intervention in neurodevelopmental disorders: underlying neural mechanisms. Developmental Medicine & Child Neurology 58: 61–66. doi: 10.1111/dmcn.13050

3. Davis, N. J. 2014. Transcranial stimulation of the developing brain: a plea for extreme caution. Frontiers in Human Neuroscience 8: 600. DOI: 10.3389/fnhum.2014.00600

4. Geddes, L. 2015. Brain stimulation in children spurs hope — and concern. Nature, September 23. Available at: http://www.nature.com/news/brain-stimulation-in-children-spurs-hope-and-concern-1.18405 (accessed June 11, 2016).

5. Hogenboom, M. 2014. Warning over electrical brain stimulation. BBC News, August 24. Available at: http://www.bbc.com/news/health-27343047 (accessed June 11, 2016).

6. John Hopkins Medicine. 2016. Transcranial direct current stimulation. Available at: http://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/tdcs.html (accessed June 11, 2016).

7. Kleinig, J. 2009. Thinking ethically about needle and syringe programs. Substance Use & Misuse 41(6): 815-825. DOI: 10.1080/10826080600668670

8. Maslen, H., Earp, B. D., Kardosh, R. C., & Savulescu, J. (2014). Brain stimulation for treatment and enhancement in children: an ethical analysis. Frontiers in Human Neuroscience 8: 953.

9. Purcell, R. 2014. The new normal: how the definition of disease impacts enhancement. The Neuroethics Blog, July 24. Available at: http://www.theneuroethicsblog.com/2014/07/the-new-normal-how-definition-of.html (accessed June 11, 2016).

10. Wexler, A. (2015). A pragmatic analysis of the regulation of consumer transcranial direct current stimulation devices in the United States. Journal of Law and the Biosciences 2(3):669-696.

Want to cite this post?



Leistikow, Peter. (2016). The Ethics of Using Brain Stimulation to Enhance Learning in Children. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/08/the-ethics-of-using-brain-stimulation.html

Can free will be modulated through electrical stimulation?

The will to persevere when many of life’s challenges are thrown at us is an ability that comes more naturally for some than for others. Additionally, even the most determined among us have days and times when moving forward through a challenging task just proves too difficult. The subjective nature of this experience can make it difficult to study, but recently researchers from Stanford University published a case study where electrical brain stimulation (EBS) to the anterior midcingulate cortex (aMCC) left two patients with the feeling that a challenge was approaching, but also that they could overcome it [1]. For the most recent journal club of the semester, Neuroscience graduate student and AJOB Neuroscience editorial intern Ryan Purcell led a discussion on the experimental procedure to stimulate what is referred to as the “the will to persevere” and the effect this technology may have if it were to become more mainstream in society.

"The location of the electrodes in P1 and P2 overlaid onto the standard emotional salience network derived from a group of normal human subjects." Parvizi et al.

It has long been known that the anterior cingulate cortex (ACC) and its midcingulate region (aMCC) are involved in emotions that rely on cognitive control, and recent research has shown that this brain network is possibly involved in complex emotions such as motivation and endurance [2,3]. In the case study discussed during journal club though, researchers went beyond an animal study and recorded a first-hand account of two patients becoming determined and motivated to overcome what they perceived as an oncoming challenge during EBS to the aMCC. The aMCC, located deep within the brain, is not typically implanted with electrodes for clinical reasons, but researchers were attempting to discover the origin of seizure activity in two patients with epilepsy by implanting intracranial electrodes in four different deep brain regions. Electrical currents at each of these regions were delivered and then based on patient feedback and physiological reports, researchers could localize the epileptic activity. It was determined that the patients were suffering from medial temporal epilepsy, but when electrical stimulation occurred at the aMCC, while no signs of seizures were observed, both patients did report similar and unique emotional states, along with specific physical symptoms. Patients physically experienced what was described as “shakiness,” hot flashes, and an increase in heart rate, but interestingly also psychologically felt a sense of foreboding regarding a challenge and the confidence that the challenge could be overcome. As seen in this supplemental video, patient 1 describes the experience as driving “towards a storm that’s on the other side, maybe a couple of miles away, and you've got to get across that hill.” Although this seems like a situation that would cause worry and anxiety, the same patient reported that the feeling was not really negative, but instead “it was more of a positive thing like…push harder, push harder, push harder to try and get through this.” These patient accounts suggest that researchers had tapped into the part of the brain responsible for motivation, endurance, and the will to persevere, and in doing so were able to elicit these feelings on command - far removed from any situation similar to stressful driving.



Researchers also realized that by stimulating the aMCC, the behavioral and emotional changes caused by EBS could potentially be due to functional changes that take place within a vast neuronal network connected to the aMCC. Using fMRI and functional connectivity analysis, researchers observed that EBS in the aMCC region of interest led to the activation of a network previously characterized as the emotional salience or cingulo-opercular network [4]. This suggests that the motivation, endurance, or the lack of these two emotions are most likely not alone regulated by a single brain region, the aMCC, but instead a complex, distributed network.



This paper presents the exciting and interesting idea that we could regulate motivation with stimulation to the brain, but really this is just a small case study with two patients. These findings may have been an unexpected result from trying to find the source of epilepsy, and may only occur in this experimental setting, perhaps even only in patients who have a history of epilepsy. The paper reads as if the researcher asking the questions of the patients was the same researcher conducting the stimulation trials, and as a result many of the questions are very biased and leading. After patient 1 has vividly compared his experience to driving in a storm, the researcher attempts to ask patient 2 about driving as well. To which patient 2 responds with laughter “I don’t get to drive.”



This is an interesting observation, but would need to be replicated on a larger scale with blind research practices put into place. However, since the aMCC is located deep within the brain and typically electrodes are not inserted for clinical reasons, it may prove difficult to conduct invasive procedures without a clinical agenda. In this case study, these patients were already unique in that they may have been very determined individuals even without external stimulation since they were undergoing invasive brain surgery for epilepsy most likely as a last resort. Having the power to increase motivation and/or determination could be used in a clinical setting for depression or chronic pain, and while it is only speculation regarding the personality traits of these two patients, a study that is open to participants without any diagnosed neurological disorders could provide more baseline activity for modulating the aMCC and its neuronal network. For this large study to take place though and to find interested participants, most likely the technology would need to advance with a noninvasive procedure.



While this type of technology would have obvious clinical benefits for treating depression and perhaps one day the ability to self-regulate our motivations at home, having the power to externally regulate free will begs certain questions. Should anyone be denied the chance to become a more productive, motivated version of themselves? Or, if this type of technology were considered acceptable, should anyone be forced to become a more determined, motivated citizen who does not experience weakness of will? If advances in neuroscience continue to address the questions of whether free will even exists at all, and then if we ever have the power to impose a standard of willpower that everyone should meet, this would have important implications for our legal and justice system. Two common theories for justifying punishment include the utilitarianism and the retributivism theory [5]. Simply put, utilitarianism is based on the idea that punishment is justified because it produces a situation in which the balance of good and evil (or happiness and unhappiness) is maximized [6]. Punishment helps to reduce crimes, which promotes a society where good prevails over evil. For example, punishment in the form of imprisonment can lead to the reduction of crime because the idea of prison can deter criminals and criminals are removed from society. The retributivism theory relies more on the idea of a social consensus on what is deemed a moral wrongdoing and criminals who commit crimes deserve to be punished [7]. If we had the power to control weakness of will and modulate willpower, this could be very powerful when applied to crimes that are associated with a weakness of will, perhaps those that involve illicit drugs, alcohol, or even the more heinous pedophilia, as specifically discussed in this previous blog post. However, then the justification of additional punishment according to the utilitarian viewpoint would be less valid, since the stimulation alone would potentially reduce crime. In this situation, a criminal would be giving up some level of free will in the name of societal benefits, so one could argue that electrical stimulation could be considered similar to jail time, a punishment that removes freedom and the ability to make many choices from perpetrators’ lifestyles. In this sense, additional punishment according to the retributivism theory would also be less valid since the electrical stimulation would be punishment enough. Finally, there is an additional possibility that is being explored by neuroscientists like David Eagleman who believe that our retributivist justice system (resulting in an overcrowded prison system) should be revised to one focused on rehabilitation, or rather neuro-rehabilitation [8, 9, 10]. Even in the name of rehabilitation though, does such a crime exist that justifies the punishment of nonconsensual direct manipulation of neuronal networks? Having the strength and the will to persevere is most likely a characteristic that we all want all the time, but is choosing not to persevere still a choice that we are always entitled to make, regardless of the context of the choice?





References:



1) Parvizi, J. et al. (2013). The Will to Persevere Induced by Electrical Stimulation of the Human Cingulate Gyrus. Neuron 80, 1359.

2) Rudebeck, P.E. et al. (2006). Separate neural pathways process different decision costs. Nat. Neurosci. 9, 1161.

3) Shackman, A.J. et al. (2011). The integration of negative affect, pain and cognitive control in the cingulate cortex. Nat. Rev. Neurosci. 12, 154.

4) Seeley, W.W. et al. (2007). Dissociable intrinsic connectivity networks for salience processing and executive control. J Neurosci. 27, 2349.

5) Greene, J.; Cohen, J. (2004). For the law, neuroscience changes nothing and everything. Phil. Trans. R. Soc. Lond. B 359, 1775.

6) Bernstein, R.F. (1979). Legal Utilitarianism. Ethics 89, 127.

7) Scheid, D.E. (1983). Kant's Retributivism. Ethics 93, 262.

8) Eagleman, D.The Brain on Trial. (2011). The Atlantic. Retrieved on April 7, 2014 from http://www.theatlantic.com/magazine/archive/2011/07/the-brain-on-trial/308520/.

9) A novel addiction therapy: The real-time fMRI. Initiative on Neuroscience and Law. Retrieved on April 7, 2014 from http://www.neulaw.org/research/real-time-fmri. 

10) Rommelfanger, K. (2011). Neuro-rehabilitation: A vision for a new justice system. The Neuroethics Blog. Retrieved on April 7, 2014, fromhttp://www.theneuroethicsblog.com/2011/10/neuro-rehabilitation-vision-for-new.html



Want to cite this post?



Strong, K. (2014). Can free will be modulated through electrical stimulation? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/04/can-free-will-be-modulated-through_8.html