Just four months ago, Noland Arbaugh had a circle of bones removed from his skull and hair-thin sensor tentacles slipped into his brain. A computer the size of a small stack of coins was placed on top and the hole was sealed.
Paralyzed below the neck, Mr. Arbaugh is the first patient to participate in the human clinical trial testing Elon Musk’s Neuralink device, and his early progress has been greeted with enthusiasm.
Working with engineers, Mr. Arbaugh, 30, trained computer programs to translate the firing of neurons in his brain into the movement of a cursor up, down and around. His cursor skills were soon so nimble that he could challenge his father-in-law to Mario Kart and play an empire-building video game late into the night.
But as the weeks went by, about 85 percent of the device’s tendrils slipped out of his brain. The Neuralink team had to retool the system to allow them to regain control of the cursor. Although he had to learn a new method to click on something, he can still move the cursor around the screen.
Neuralink advised him against surgery to replace the wires, he said, adding that the situation had stabilized.
The setback was made public earlier this month. And while the decline in activity was initially difficult and disappointing, Arbaugh said it was worth it for Neuralink to move forward in a tech-medical field aimed at helping people regain speech, sight or movement.
“I just want to take everyone with me on this journey,” he said. “I want to show everyone how amazing it is. And it’s been so rewarding. So I’m really excited to continue.
Originally from a small desert town in Arizona, Mr. Arbaugh has become an enthusiastic spokesperson for Neuralink, one of at least five companies drawing on decades of academic research to design a device that could help restore the functions of people with disabilities or those suffering from degenerative diseases.
While Mr. Musk’s arguments have focused on science fiction ambitions like telepathy for high-tech consumers, Mr. Arbaugh’s experience shows the potential for progress in a medical field where federal authorities will authorize such risky research.
Neuralink announced in news reports this week that it had received approval from the Food and Drug Administration to continue testing implants in other patients. The company did not provide many details about the unexpected flaw and did not respond to requests for comment.
Mr. Arbaugh has been paralyzed since a swimming accident in the lush hills of northeastern Pennsylvania, where he worked after college as a camp counselor. Jumping into waist-deep water in a lake with a group of friends, he sank to the bottom.
“I was face down in the water and I just thought I couldn’t move. So what do I do? I guess nothing,” Mr. Arbaugh said. “So I took a big drink and passed out.”
Mr. Arbaugh became paralyzed from the fourth vertebra of his neck down.
Adjusting to life as a quadriplegic was far from the future he had envisioned. As a youngster growing up in Yuma, Arizona, Mr. Arbaugh had taken advantage of everything his community had to offer. If he wasn’t playing football, soccer, or golf, he was competing in an academic decathlon competition or a chess tournament. Among the first in his family to go to college, he enrolled at Texas A&M University, where he admittedly smoked too much marijuana, spent a somewhat aimless semester in Australia, and skipped too many classes to obtain his final year diploma.
In the years after the accident, he tried to adapt to a range of devices intended to help paralyzed people. Most failed to work effectively for long periods, although Siri on his iPad proved to be his most reliable assistant, allowing him to call and text his friends.
Last year, a friend, Greg Bain, told him about Neuralink and urged him to apply for the company’s first human trial.
Mr. Arbaugh said he did not have strong feelings about Mr. Musk, but believed he was the engine of progress and that “the things he touched turned to gold “.
After the implant was implanted in late January, he began working long days with Neuralink staff to connect the neural patterns detected in his brain to the actions he intended to take. He found the work tedious and repetitive, but rewarding.
Once the training was complete, the engineers gave him control of the cursor on a computer. “I was like, once you take these restraints off me, I’m just going to fly,” Mr. Arbaugh recalled.
On his first day of solo flight, Mr. Arbaugh broke a world record for speed and precision in cursor control, dating from 2017. “It was really, really cool,” Mr. Arbaugh said.
Long days of training computer models with Neuralink staff at your side have now been reduced to working remotely in four-hour increments, Mr. Arbaugh said. The team continues to work on tasks such as spelling words, while they consider creating letters in sign language or writing on a blackboard.
But the Neuralink device continued to lose connection, with the tendrils gradually slipping out of his brain tissue and presumably resting in the fluid around him.
When only about 15 percent of the wires remained in place, Mr. Arbaugh completely lost control of the cursor. Engineers recalibrated the computer programs to perform many of the tasks it had been able to do before. Because he can no longer make the system do mouse clicks, he uses a new tool that allows him to click by placing a cursor over the item he intends to select.
The faulty implant underscores the concerns of some experts in the field of brain-computer interface. The small round device implanted in the skull is supposed to hold the thin tendrils of the electrodes in place. But like a finger in a wobbly pie, the threads can come loose.
Mr. Arbaugh said his brain was moving more than engineers expected and they revised the surgical plan to implant the wires deeper into the next patient’s brain.
Neuralink is reviewing applications from others interested in participating in trials. Their expenses, such as travel, are covered by the company, according to Neuralink.
This first Neuralink experiment also highlights the complexity of the connection mechanisms between the brain and a device.
Lee Miller, a professor of neuroscience and rehabilitation medicine at Northwestern University, described the challenges of working with the brain. It is bathed in salt water, moves when the head rotates and moves, and is equipped with immune defenses designed to repel invaders. The researchers observed that the brain formed scar tissue around the sensors and even rejected an entire sensing unit using a grid of tiny needles.
Cristin Welle, a neurophysiologist at the University of Colorado who started the Neural Interfaces Program at the Food and Drug Administration, which approves medical devices such as implants, said the first Neuralink case suggested the company was still faced with obstacles in the development of a sustainable system.
If the wires were implanted deeper, they could still come loose and let the fibers rub against the surface of the brain, possibly increasing the amount of scarring — and signal loss — in the area, she said.
“It’s hard to know if it would work,” Dr. Welle said. “A fully flexible arrangement may not be a long-term solution.”
Mr. Arbaugh said his team expected his brain to form scar tissue around the wires at the base of the brain, which they said would help hold them in place. He said he would have the option to leave the study after a year, but planned to continue working at the company for longer. Neuralink said the initial study would take about six years.
Other major trading companies have taken different approaches.
Synchron, based in Brooklyn, bypassed delicate brain tissue by passing through a vessel to implant a tiny metal tube near the brain’s motor cortex. Still, the device doesn’t pick up as much subtle neuronal activity as others that penetrate brain tissue, according to researchers in the field. It registers stronger signals, so to speak, like the intention to select an option from an on-screen menu. The company is currently conducting human trials.
Precision Neuroscience, based in Manhattan, has implanted a flexible strip equipped with sensors on the surface of people’s brains and examines the data it gleans from patients with the temporarily placed strip, said Michael Mager, the company’s chief executive officer. .
Researchers have been studying brain-computer devices for decades. Standard was a 96-pin array, called the Utah Array, which sits on top of the brain and picks up activity up to 1.5 millimeters below the surface. It tends to be connected by a wire in the skull to a small box mounted on the head in ongoing human trials. The hole in the skull that lets the wire through is prone to infection, however, and Blackrock Neurotech in Salt Lake City is working on a fully implantable upgrade.
Paradromics, which also uses a device with a grid based on the Utah Array, is testing its implantable device in sheep and plans to test it in humans in about a year, according to Matt Angle, the company’s chief executive officer.
All of this work is closely regulated by the FDA, which evaluates the risks and benefits of the procedures and should first consider the use of these devices in people with major disabilities or degenerative diseases. (The agency would not comment specifically on Neuralink, but said it requires routine reporting on expected and unexpected events in such trials.)
Beyond that, researchers are divided on the prospect of widespread use by people without disabilities, who might want an implant to communicate without speaking or download a language, as Mr. Musk has mused. Some researchers predict availability to the general public in several decades. Others say it will never be allowed for activities such as surfing the Internet in the shower, given the risk of infection from repeated brain operations over a lifetime.
Mr Angle, of Paradromics, said he could see a progression from use in people unable to talk or walk to those with serious mental health problems who have been resistant to treatment.
From there, he says, consumer use could take a decade. After all, he says, the idea of Botox went from absurd to mainstream in about the same amount of time.
“If 100 years ago you said, ‘Hey, rich people are going to inject botulism in their faces,’ that seems crazy,” he said. “Once you understand the risks and people can make informed decisions, then it becomes reasonable.”
Mr. Arbaugh hopes to see the technology deployed first to restore function to those who have lost it.
“And that can then allow people to improve their capabilities,” he said, adding: “as long as we don’t abandon our humanity along the way.” »