Medical Device Daily National Editor

"I think, therefore I am," is one of the most famous philosophical observations.

But what if thinking is about the only thing you can do, you have no means of movement, no way to speak, no way to grasp a pen or punch a key?

Such individuals, with physical movement impossible but their mental faculties intact, have been called the "locked-in," this combination offering them desperate frustration.

That frustration fairly soon may be eased a bit with a new application of a brain computer interface (BCI) linked to the most current – and mildly controversial – social e-technology.

Early this month, a doctoral student at the University of Wisconsin-Madison, using the single "action" available to the locked in, "wrote" and sent a Twitter message – using only the power of his thoughts.

The message read: "using EEG to send tweet," a statement that one media outlet compared to the famous "Watson, come here" spoken message heralding the invention (at least by a U.S. inventor) of the telephone.

And indeed, the breakthrough here is that this "tweet" may offer the same sort of "Edison" moment for the locked-in.

Wilson is among a group of researchers worldwide who aim to perfect this method of communicating for those whose bodies do not work, but whose brains function normally. Among these are people who have amyotrophic lateral sclerosis, brain-stem stroke or high spinal cord injury.

As shown by video on a UW-Madison website page, Wilson wears a cap studded with electrodes, the cap wired to a computer. The computer monitor continuously flashes rows of letters as an alphabet keyboard, and Wilson then concentrates on one of those letters.

That simple thought process produces changes in brain activity, producing "signals" picked up by the cap and then sent to the computer and creating a physical action: the highlighting of the letter and then a "send" to the Twitter cite.

After "writing" this message with his thoughts, another concentration directed at a screen icon can then send the tweet.

Justin Williams, a UW-Madison assistant professor of biomedical engineering and Wilson's adviser, told Medical Device Daily that the key to this system is the innovative application of a BCI system, the BCI2000, that has been around for awhile. But he noted that it has been used primarily for a range of research purposes, such as for tracking neural activity.

This application provides a hands-on (or brain-on) application that could be made available as a valuable in-home device – and contradicting the current cultural consensus that tweeting is mindless entertainment for a 'you-need-to-know-everything-about-me culture.'

The first thought, Williams said, was to use the BCI2000 for writing e-mails or moving a cursor on a computer screen, but that these were considered too complicated for the target group.

The recent emergence of Twitter and its "micro-blogging" system then offered a possibility that more perfectly fits the abilities, and limitations, of the locked-in.

"People at the other end can be following their thread and never know that the person is disabled. That would really be an enabling type of communication means for those people, and I think it would make them feel, in the online world, that they're not that much different from everybody else." But besides fulfilling the No. 1 need of such individuals – Williams saying that their priority is the desire to have some form of communication – it also offers an important medical purpose.

Tweeting will enable them to send updates to friends, family and caregivers, providing a self-management component to their overall healthcare.

"So someone could simply tell family and friends how they're feeling today," says Williams.

In collaboration with research scientist Gerwin Schalk and colleagues at the Wadsworth Center (Albany, New York), Williams and Wilson began developing the interface, based on brain activity related to changes in an object on-screen.

Explaining the concept enabling this thought ability, Williams described to MDD what he called the "cocktail party" problem, that so-far unexplained ability for a person in a crowded, noisy room, to shift attention and focus – from someone they're closely speaking to, to something going on further off or in the entire room, and then back again.

"We're taking advantage of that phenomenon in the visual system," Williams says.

Williams has been one of those who has used the BCI2000 to tweet and acknowledges that it requires a good deal of concentrated concentration to perform and that after a few minutes it is mentally wearying. But this matches with micro-blogging and can still fulfill the important need of the locked-in, he says.

The BCI2000 system has been around since year 2000, but he notes that its major applications have been for research. He and his colleagues have been among those that have been involved in upgrading and adapting its uses, their current major contribution being the Twitter application.

While widespread implementation of most BCI technologies is still years away, Wadsworth Center researchers, as well as those at the University of Tübingen in Germany are starting in-home trials of this equipment.

Wilson, who will finish his PhD soon and begin postdoctoral research at Wadsworth, said he plans to include Twitter in the trials. He says he sees the application is the "nudge" researchers need to refine development of the in-home technology.

"A lot of the things that we've been doing are more scientific exercises," he says. "This is one of the first examples where we've found something that would be immediately useful to a much larger community of people with neurological deficits."

Funding for the research comes from the National Institutes of Health, the UW-Madison Institute for Clinical and Translational Research, the UW-Madison W.H. Coulter Translational Research Partnership in Biomedical Engineering and the Wisconsin Alumni Research Foundation.

For those interested in pursuing use of this BCI system, the 5th BCI2000 Workshop will be held Oct. 1-3 at The Sagamore resort, Lake George, New York, in conjunction with the International Conference on Advances in Electrocorticography.

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