Invasive Brain Computer Interface for Motor Restoration in Spinal Cord Injury: A Systematic Review

Jordan J Levett; Lior M Elkaim; Farbod Niazi; Michael H Weber; Christian Iorio-Morin; Marco Bonizzato; Alexander G Weil

doi:10.1016/j.neurom.2023.10.006

Invasive Brain Computer Interface for Motor Restoration in Spinal Cord Injury: A Systematic Review

Neuromodulation. 2023 Nov 8:S1094-7159(23)00754-7. doi: 10.1016/j.neurom.2023.10.006. Online ahead of print.

Authors

Jordan J Levett¹, Lior M Elkaim², Farbod Niazi¹, Michael H Weber³, Christian Iorio-Morin⁴, Marco Bonizzato⁵, Alexander G Weil⁶

Affiliations

¹ Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
² Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
³ Department of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada.
⁴ Division of Neurosurgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
⁵ Department of Electrical Engineering and Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, Quebec, Canada; Department of Neuroscience and Centre interdisciplinaire sur le cerveau et l'apprentissage, University of Montreal, Montreal, Quebec, Canada.
⁶ Division of Neurosurgery, St-Justine University Hospital, Montreal, Quebec, Canada. Electronic address: AlexanderGWeil@gmail.com.

PMID: 37943244
DOI: 10.1016/j.neurom.2023.10.006

Abstract

Study design: Systematic review of the literature.

Objectives: In recent years, brain-computer interface (BCI) has emerged as a potential treatment for patients with spinal cord injury (SCI). This is the first systematic review of the literature on invasive closed-loop BCI technologies for the treatment of SCI in humans.

Materials and methods: A comprehensive search of PubMed MEDLINE, Web of Science, and Ovid EMBASE was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Of 8316 articles collected, 19 studies met all the inclusion criteria. Data from 21 patients were extracted from these studies. All patients sustained a cervical SCI and were treated using either a BCI with intracortical microelectrode arrays (n = 18, 85.7%) or electrocorticography (n = 3, 14.3%). To decode these neural signals, machine learning and statistical models were used: support vector machine in eight patients (38.1%), linear estimator in seven patients (33.3%), Hidden Markov Model in three patients (14.3%), and other in three patients (14.3%). As the outputs, ten patients (47.6%) underwent noninvasive functional electrical stimulation (FES) with a cuff; one (4.8%) had an invasive FES with percutaneous stimulation, and ten (47.6%) used an external device (neuroprosthesis or virtual avatar). Motor function was restored in all patients for each assigned task. Clinical outcome measures were heterogeneous across all studies.

Conclusions: Invasive techniques of BCI show promise for the treatment of SCI, but there is currently no technology that can restore complete functional autonomy in patients with SCI. The current techniques and outcomes of BCI vary greatly. Because invasive BCIs are still in the early stages of development, further clinical studies should be conducted to optimize the prognosis for patients with SCI.

Keywords: Brain-computer interfaces; electrocorticography; microelectrodes; spinal cord injuries; systematic review.

Publication types

Review