Help, hope, and hype: Ethical dimensions of neuroprosthetics

"Your Thoughts are (were) Free!": Brain-Computer-Interfaces, Neurofeedback, Detection of Deception, and the Future of Mind-Reading

This review describes the historical developement and rationale of clinically relevant research on neurophysiological "mind reading" paradims: Brain- Computer-Interfaces, detection of deception, brain stimulation and neurofeedback and the clinical applications in drug resistant epilepsy, chronic stroke, and communication with paralyzed locked-in persons. The emphasis lies on completely locked-in patients with amyotrophic lateral sclerosis using non-invasive and invasive brain computer interfaces and neurofeedback to restore verbal communication with the social environment. In the second part of the article we argue that success and failure of neurophysiological "mind reading" paradigms may be explained with a motor theory of thinking and emotion in combination with learning theory. The ethical implications of brain computer interface and neurofeedback approaches, particularly for severe chronic paralysis and loss of communication diseases and decisions on hastened death and euthanasia are discussed.

East Asian perspective of responsible research and innovation in neurotechnology

After more than half a century of research and development (R&D), Brain-computer interface (BCI)-based Neurotechnology continues to progress as one of the leading technologies of the 2020 s worldwide. Various reports and academic literature in Europe and the United States (U.S.) have outlined the trends in the R&D of neurotechnology and the consideration of ethical issues, and the importance of the formulation of ethical principles, guidance and industrial standards as well as the development of relevant human resources has been discussed. However, limited number studies have focused on neurotechnology R&D, the dissemination of neuroethics related to the academic foundation advancing the discussion on ethical principles, guidance and standards or human resource development in the Asian region. This study fills in this gap in understanding of Eastern Asian (China, Korea and Japan) situation based on the participation in activities to develop ethical principles, guidance, and industrial standards for appropriate use of neurotechnology, in addition to literature survey and clinical registries' search investigation reflecting the trends in neurotechnology R&D as well as its social implication in Asian region. The current study compared the results with the situation in Europa and the U.S. and discussed issues that need to be addressed in the future and discussed the significance and potential of corporate consortium initiatives in Japan and examples of ethics and governance activities in Asian Countries.

Designing next-generation subscalp devices for seizure monitoring: A systematic review and meta-analysis of established extracranial hardware

Implantable brain recording and stimulation devices apply to a broad spectrum of conditions, such as epilepsy, movement disorders and depression. For long-term monitoring and neuromodulation in epilepsy patients, future extracranial subscalp implants may offer a promising, less-invasive alternative to intracranial neurotechnologies. To inform the design and assess the safety profile of such next-generation devices, we estimated extracranial complication rates of deep brain stimulation (DBS), cranial peripheral nerve stimulation (PNS), responsive neurostimulation (RNS) and existing subscalp EEG devices (sqEEG), as proxy for future implants. Pubmed was searched systematically for DBS, PNS, RNS and sqEEG studies from 2000 to February 2024 (48 publications, 7329 patients). We identified seven categories of extracranial adverse events: infection, non-infectious cutaneous complications, lead migration, lead fracture, hardware malfunction, pain and hemato-seroma. We used cohort sizes, demographics and industry funding as metrics to assess risks of bias. An inverse variance heterogeneity model was used for pooled and subgroup meta-analysis. The pooled incidence of extracranial complications reached 14.0%, with infections (4.6%, CI 95% [3.2 - 6.2]), surgical site pain (3.2%, [0.6 - 6.4]) and lead migration (2.6%, [1.0 - 4.4]) as leading causes. Subgroup analysis showed a particularly high incidence of persisting pain following PNS (12.0%, [6.8 - 17.9]) and sqEEG (23.9%, [12.7 - 37.2]) implantation. High rates of lead migration (12.4%, [6.4 - 19.3]) were also identified in the PNS subgroup. Complication analysis of DBS, PNS, RNS and sqEEG studies provides a significant opportunity to optimize the safety profile of future implantable subscalp devices for chronic EEG monitoring. Developing such promising technologies must address the risks of infection, surgical site pain, lead migration and skin erosion. A thin and robust design, coupled to a lead-anchoring system, shall enhance the durability and utility of next-generation subscalp implants for long-term EEG monitoring and neuromodulation.

Developer perspectives on the ethics of AI-driven neural implants: a qualitative study

Convergence of neural implants with artificial intelligence (AI) presents opportunities for the development of novel neural implants and improvement of existing neurotechnologies. While such technological innovation carries great promise for the restoration of neurological functions, they also raise ethical challenges. Developers of AI-driven neural implants possess valuable knowledge on the possibilities, limitations and challenges raised by these innovations; yet their perspectives are underrepresented in academic literature. This study aims to explore perspectives of developers of neurotechnology to outline ethical implications of three AI-driven neural implants: a cochlear implant, a visual neural implant, and a motor intention decoding speech-brain-computer-interface. We conducted semi-structured focus groups with developers (n = 19) of AI-driven neural implants. Respondents shared ethically relevant considerations about AI-driven neural implants that we clustered into three themes: (1) design aspects; (2) challenges in clinical trials; (3) impact on users and society. Developers considered accuracy and reliability of AI-driven neural implants conditional for users' safety, authenticity, and mental privacy. These needs were magnified by the convergence with AI. Yet, the need for accuracy and reliability may also conflict with potential benefits of AI in terms of efficiency and complex data interpretation. We discuss strategies to mitigate these challenges.

Neurorights as Hohfeldian Privileges

This paper argues that calls for neurorights propose an overcomplicated approach. It does this through analysis of ‘rights’ using the influential framework provided by Wesley Hohfeld, whose analytic jurisprudence is still well regarded in its clarificatory approach to discussions of rights. Having disentangled some unclarities in talk about rights, the paper proposes the idea of ‘novel human rights’ is not appropriate for what is deemed worth protecting in terms of mental integrity and cognitive liberty. That is best thought of in terms of Hohfeld’s account of ‘right’ as privilege. It goes on to argue that as privileges, legal protections are not well suited to these cases. As such, they cannot be ‘novel human rights’. Instead, protections for mental integrity and cognitive liberty are best accounted for in terms of familiar and established rational and discursive norms. Mental integrity is best thought of as evaluable in terms of familiar rational norms, and cognitive freedom is constrained by appraisals of sense-making. Concerns about how neurotechnologies might pose particular challenges to mental integrity and cognitive liberty are best protected through careful use of existing legislation on data protection, not novel rights, as it is via data that risks to integrity and liberty are manifested.

Use of Invasive Brain-Computer Interfaces in Pediatric Neurosurgery: Technical and Ethical Considerations

Invasive brain-computer interfaces hold promise to alleviate disabilities in individuals with neurologic injury, with fully implantable brain-computer interface systems expected to reach the clinic in the upcoming decade. Children with severe neurologic disabilities, like quadriplegic cerebral palsy or cervical spine trauma, could benefit from this technology. However, they have been excluded from clinical trials of intracortical brain-computer interface to date. In this manuscript, we discuss the ethical considerations related to the use of invasive brain-computer interface in children with severe neurologic disabilities. We first review the technical hardware and software considerations for the application of intracortical brain-computer interface in children. We then discuss ethical issues related to motor brain-computer interface use in pediatric neurosurgery. Finally, based on the input of a multidisciplinary panel of experts in fields related to brain-computer interface (functional and restorative neurosurgery, pediatric neurosurgery, mathematics and artificial intelligence research, neuroengineering, pediatric ethics, and pragmatic ethics), we then formulate initial recommendations regarding the clinical use of invasive brain-computer interfaces in children.

User Based Development and Test of the EXOTIC Exoskeleton: Empowering Individuals with Tetraplegia Using a Compact, Versatile, 5-DoF Upper Limb Exoskeleton Controlled through Intelligent Semi-Automated Shared Tongue Control

This paper presents the EXOTIC- a novel assistive upper limb exoskeleton for individuals with complete functional tetraplegia that provides an unprecedented level of versatility and control. The current literature on exoskeletons mainly focuses on the basic technical aspects of exoskeleton design and control while the context in which these exoskeletons should function is less or not prioritized even though it poses important technical requirements. We considered all sources of design requirements, from the basic technical functions to the real-world practical application. The EXOTIC features: (1) a compact, safe, wheelchair-mountable, easy to don and doff exoskeleton capable of facilitating multiple highly desired activities of daily living for individuals with tetraplegia; (2) a semi-automated computer vision guidance system that can be enabled by the user when relevant; (3) a tongue control interface allowing for full, volitional, and continuous control over all possible motions of the exoskeleton. The EXOTIC was tested on ten able-bodied individuals and three users with tetraplegia caused by spinal cord injury. During the tests the EXOTIC succeeded in fully assisting tasks such as drinking and picking up snacks, even for users with complete functional tetraplegia and the need for a ventilator. The users confirmed the usability of the EXOTIC.

Control and Ownership of Neuroprosthetic Speech

Implantable brain-computer interfaces (BCIs) are being developed to restore speech capacity for those who are unable to speak. Patients with locked-in syndrome or amyotrophic lateral sclerosis could be able to use covert speech – vividly imagining saying something without actual vocalisation – to trigger neural controlled systems capable of synthesising speech. User control has been identified as particularly pressing for this type of BCI. The incorporation of machine learning and statistical language models into the decoding process introduces a contribution to (or ‘shaping of’) the output that is beyond the user’s control. Whilst this type of ‘shared control’ of BCI action is not unique to speech BCIs, the automated shaping of what a user ‘says’ has a particularly acute ethical dimension, which may differ from parallel concerns surrounding automation in movement BCIs. This paper provides an analysis of the control afforded to the user of a speech BCI of the sort under development, as well as the relationships between accuracy, control, and the user’s ownership of the speech produced. Through comparing speech BCIs with BCIs for movement, we argue that, whilst goal selection is the more significant locus of control for the user of a movement BCI, control over process will be more significant for the user of the speech BCI. The design of the speech BCI may therefore have to trade off some possible efficiency gains afforded by automation in order to preserve sufficient guidance control necessary for users to express themselves in ways they prefer. We consider the implications for the speech BCI user’s responsibility for produced outputs and their ownership of token outputs. We argue that these are distinct assessments. Ownership of synthetic speech concerns whether the content of the output sufficiently represents the user, rather than their morally relevant, causal role in producing that output.

Sense of agency for mental actions: Insights from a belief-based action-effect paradigm

A substantial body of research has converged on the idea that the sense of agency arises from the integration of multiple sources of information. In this study, we investigated whether a measurable sense of agency can be detected for mental actions, without the contribution of motor components. We used a fake action-effect paradigm, where participants were led to think that a motor action or a particular thought could trigger a sound. Results showed that the sense of agency, when measured through explicit reports, was of comparable strength for motor and mental actions. The intentional binding effect, a phenomenon typically associated with the experience of agency, was also observed for both motor and mental actions. Taken together, our results provide novel insights into the specific role of intentional cues in instantiating a sense of agency, even in the absence of motor signals.

Brain Computer Interfaces for Assisted Communication in Paralysis and Quality of Life

The rapid evolution of Brain-Computer Interface (BCI) technology and the exponential growth of BCI literature during the past 20 years is a consequence of increasing computational power and the achievements of statistical learning theory and machine learning since the 1960s. Despite this rapid scientific progress, the range of successful clinical and societal applications remained limited, with some notable exceptions in the rehabilitation of chronic stroke and first steps towards BCI-based assisted verbal communication in paralysis. In this contribution, we focus on the effects of noninvasive and invasive BCI-based verbal communication on the quality of life (QoL) of patients with amyotrophic lateral sclerosis (ALS) in the locked-in state (LIS) and the completely locked-in state (CLIS). Despite a substantial lack of replicated scientific data, this paper complements the existing methodological knowledge and focuses future investigators' attention on (1) Social determinants of QoL and (2) Brain reorganization and behavior. While it is not documented in controlled studies that the good QoL in these patients is a consequence of BCI-based neurorehabilitation, the proposed determinants of QoL might become the theoretical background needed to develop clinically more useful BCI systems and to evaluate the effects of BCI-based communication on QoL for advanced ALS patients and other forms of severe paralysis.

Acceptability of Neuroscientific Interventions in Education

Researchers are increasingly applying neuroscience technologies that probe or manipulate the brain to improve educational outcomes. However, their use remains fraught with ethical controversies. Here, we investigate the acceptability of neuroscience applications to educational practice in two groups of young adults: those studying bioscience who will be driving future basic neuroscience research and technology transfer, and those studying education who will be choosing among neuroscience-derived applications for their students. Respondents rated the acceptability of six scenarios describing neuroscience applications to education spanning multiple methodologies, from neuroimaging to neuroactive drugs to brain stimulation. They did so from two perspectives (student, teacher) and for three recipient populations (low-achieving, high-achieving students, students with learning disabilities). Overall, the biosciences students were more favorable to all neuroscience applications than the education students. Scenarios that measured brain activity (i.e., EEG or fMRI) to assess or predict intellectual abilities were deemed more acceptable than manipulations of mental activity by drug use or stimulation techniques, which may violate body integrity. Enhancement up to the norm for low-achieving students and especially students with learning disabilities was more favorably viewed than enhancement beyond the norm for high-achieving students. Finally, respondents rated neuroscientific applications to be less acceptable when adopting the perspective of a teacher than that of a student. Future studies should go beyond the acceptability ratings collected here to delineate the role that concepts of access, equity, authenticity, agency and personal choice play in guiding respondents' reasoning.

Heart rate variability predicts decline in sensorimotor rhythm control

Objective.Voluntary control of sensorimotor rhythms (SMRs, 8-12 Hz) can be used for brain-computer interface (BCI)-based operation of an assistive hand exoskeleton, e.g. in finger paralysis after stroke. To gain SMR control, stroke survivors are usually instructed to engage in motor imagery (MI) or to attempt moving the paralyzed fingers resulting in task- or event-related desynchronization (ERD) of SMR (SMR-ERD). However, as these tasks are cognitively demanding, especially for stroke survivors suffering from cognitive impairments, BCI control performance can deteriorate considerably over time. Therefore, it would be important to identify biomarkers that predict decline in BCI control performance within an ongoing session in order to optimize the man-machine interaction scheme.Approach.Here we determine the link between BCI control performance over time and heart rate variability (HRV). Specifically, we investigated whether HRV can be used as a biomarker to predict decline of SMR-ERD control across 17 healthy participants using Granger causality. SMR-ERD was visually displayed on a screen. Participants were instructed to engage in MI-based SMR-ERD control over two consecutive runs of 8.5 min each. During the 2nd run, task difficulty was gradually increased.Main results.While control performance (p= .18) and HRV (p= .16) remained unchanged across participants during the 1st run, during the 2nd run, both measures declined over time at high correlation (performance: -0.61%/10 s,p= 0; HRV: -0.007 ms/10 s,p< .001). We found that HRV exhibited predictive characteristics with regard to within-session BCI control performance on an individual participant level (p< .001).Significance.These results suggest that HRV can predict decline in BCI performance paving the way for adaptive BCI control paradigms, e.g. to individualize and optimize assistive BCI systems in stroke.

Mapping research strands of ethics of artificial intelligence in healthcare: A bibliometric and content analysis

The growth of artificial intelligence in promoting healthcare is rapidly progressing. Notwithstanding its promising nature, however, AI in healthcare embodies certain ethical challenges as well. This research aims to delineate the most influential elements of scientific research on AI ethics in healthcare by conducting bibliometric, social network analysis, and cluster-based content analysis of scientific articles. Not only did the bibliometric analysis identify the most influential authors, countries, institutions, sources, and documents, but it also recognized four ethical concerns associated with 12 medical issues. These ethical categories are composed of normative, meta-ethics, epistemological and medical practice. The content analysis complemented this list of ethical categories and distinguished seven more ethical categories: ethics of relationships, medico-legal concerns, ethics of robots, ethics of ambient intelligence, patients' rights, physicians' rights, and ethics of predictive analytics. This analysis likewise identified 40 general research gaps in the literature and plausible future research strands. This analysis furthers conversations on the ethics of AI and associated emerging technologies such as nanotech and biotech in healthcare, hence, advances convergence research on the ethics of AI in healthcare. Practically, this research will provide a map for policymakers and AI engineers and scientists on what dimensions of AI-based medical interventions require stricter policies and guidelines and robust ethical design and development.

Transparent Conductive Silk Film with a PEDOT-OH Nano Layer as an Electroactive Cell Interface

Bioelectronics based on biomaterial substrates are advancing toward biomedical applications. As excellent conductors, poly(3,4-ethylenedioxythiophene) (PEDOT) and its derivatives have been widely developed in this field. However, it is still a big challenge to obtain a functional layer with a good electroconductive property, transparency, and strong adhesion on the biosubstrate. In this work, poly(hydroxymethyl-3,4-ethylenedioxythiophene) (PEDOT-OH) was chemically polymerized and deposited on the surface of a regenerated silk fibroin (RSF) film in an aqueous system. Sodium dodecyl sulfate (SDS) was used as the surfactant to form micelles which are beneficial to the polymer structure. To overcome the trade-off between transparency and the electroconductive property of the PEDOT-OH coating, a composite oxidant recipe of FeCl₃ and ammonium persulfate (APS) was developed. Through electrostatic interaction of oppositely charged doping ions, a well-organized conductive nanoscale coating formed and a transparent conductive RSF/PEDOT-OH film was produced, which can hardly be achieved in a traditional single oxidant system. The produced film had a sheet resistance (R_s) of 5.12 × 10⁴ Ω/square corresponding to a conductivity of 8.9 × 10^-2 S/cm and a maximum transmittance above 73% in the visible range. In addition, strong adhesion between PEDOT-OH and RSF and favorable electrochemical stability of the film were demonstrated. Desirable transparency of the film allowed real-time observation of live cells. Furthermore, the PEDOT-OH layer provided an improved environment for adhesion and differentiation of PC12 cells compared to the RSF surface alone. Finally, the feasibility of using the RSF/PEDOT-OH film to electrically stimulate PC12 cells was demonstrated.

Use of common average reference and large-Laplacian spatial-filters enhances EEG signal-to-noise ratios in intrinsic sensorimotor activity

BACKGROUND

Oscillations in the resting-state scalp electroencephalogram (EEG) represent various intrinsic brain activities. One of the characteristic EEG oscillations is the sensorimotor rhythm (SMR)-with its arch-shaped waveform in alpha- and betabands-that reflect sensorimotor activity. The representation of sensorimotor activity by the SMR depends on the signal-to-noise ratio achieved by EEG spatial filters.

NEW METHOD

We employed simultaneous recording of EEG and functional magnetic resonance imaging, and 10-min resting-state brain activities were recorded in 19 healthy volunteers. To compare the EEG spatial-filtering methods commonly used for extracting sensorimotor cortical activities, we assessed nine different spatial-filters: a default reference of EEG amplifier system, a common average reference (CAR), small-, middle- and large-Laplacian filters, and four types of bipolar manners (C3-Cz, C3-F3, C3-P3, and C3-T7). We identified the brain region that correlated with the EEG-SMR power obtained after each spatial-filtering method was applied. Subsequently, we calculated the proportion of the significant voxels in the sensorimotor cortex as well as the sensorimotor occupancy in all significant regions to examine the sensitivity and specificity of each spatial-filter.

RESULTS

The CAR and large-Laplacian spatial-filters were superior at improving the signal-to-noise ratios for extracting sensorimotor activity from the EEG-SMR signal.

COMPARISON WITH EXISTING METHODS

Our results are consistent with the spatial-filter selection to extract task-dependent activation for better control of EEG-SMR-based interventions. Our approach has the potential to identify the optimal spatial-filter for EEG-SMR.

CONCLUSIONS

Evaluating spatial-filters for extracting spontaneous sensorimotor activity from the EEG is a useful procedure for constructing more effective EEG-SMR-based interventions.

Optical brain imaging and its application to neurofeedback

Besides passive recording of brain electric or magnetic activity, also non-ionizing electromagnetic or optical radiation can be used for real-time brain imaging. Here, changes in the radiation's absorption or scattering allow for continuous in vivo assessment of regional neurometabolic and neurovascular activity. Besides magnetic resonance imaging (MRI), over the last years, also functional near-infrared spectroscopy (fNIRS) was successfully established in real-time metabolic brain imaging. In contrast to MRI, fNIRS is portable and can be applied at bedside or in everyday life environments, e.g., to restore communication and movement. Here we provide a comprehensive overview of the history and state-of-the-art of real-time optical brain imaging with a special emphasis on its clinical use towards neurofeedback and brain-computer interface (BCI) applications. Besides pointing to the most critical challenges in clinical use, also novel approaches that combine real-time optical neuroimaging with other recording modalities (e.g. electro- or magnetoencephalography) are described, and their use in the context of neuroergonomics, neuroenhancement or neuroadaptive systems discussed.

When Thinking is Doing: Responsibility for BCI-Mediated Action

Technologies controlled directly by the brain are being developed, evolving based on insights gained from neuroscience, and rehabilitative medicine. Besides neuro-controlled prosthetics aimed at restoring function lost somehow, technologies controlled via brain-computer interfaces (BCIs) may also extend a user’s horizon of action, freed from the need for bodily movement. Whilst BCI-mediated action ought to be, on the whole, treated as conventional action, law and policy ought to be amended to accommodate BCI action by broadening the definition of action as “willed bodily movement”. Moreover, there are some dimensions of BCI mediated action that are significantly different to conventional cases. These relate to control. Specifically, to limits in both controllability of BCIs via neural states, and in foreseeability of outcomes from such actions. In some specific type of case, BCI-mediated action may be due to different ethical evaluation from conventional action.

Neuroprosthetics: an outlook on active challenges toward clinical adoption

Neural prostheses are designed to counter the effects of neurotrauma and restore the fundamental building blocks of human experience including motor action, sensation, and meaningful communication with other individuals. Here, we present an overview of active avenues, open questions, and debated topics in neuroprosthetics, such as targeting the mechanisms of sensorimotor recovery and designing brain interfaces for scalability. We review leading opinions in this thriving field, aiming to inform translational practice toward clinical adoption.

Wired Emotions: Ethical Issues of Affective Brain-Computer Interfaces

Ethical issues concerning brain-computer interfaces (BCIs) have already received a considerable amount of attention. However, one particular form of BCI has not received the attention that it deserves: Affective BCIs that allow for the detection and stimulation of affective states. This paper brings the ethical issues of affective BCIs in sharper focus. The paper briefly reviews recent applications of affective BCIs and considers ethical issues that arise from these applications. Ethical issues that affective BCIs share with other neurotechnologies are presented and ethical concerns that are specific to affective BCIs are identified and discussed.

Ethical concerns with the use of intelligent assistive technology: findings from a qualitative study with professional stakeholders

Background

Advances in artificial intelligence (AI), robotics and wearable computing are creating novel technological opportunities for mitigating the global burden of population ageing and improving the quality of care for older adults with dementia and/or age-related disability. Intelligent assistive technology (IAT) is the umbrella term defining this ever-evolving spectrum of intelligent applications for the older and disabled population. However, the implementation of IATs has been observed to be sub-optimal due to a number of barriers in the translation of novel applications from the designing labs to the bedside. Furthermore, since these technologies are designed to be used by vulnerable individuals with age- and multi-morbidity-related frailty and cognitive disability, they are perceived to raise important ethical challenges, especially when they involve machine intelligence, collect sensitive data or operate in close proximity to the human body. Thus, the goal of this paper is to explore and assess the ethical issues that professional stakeholders perceive in the development and use of IATs in elderly and dementia care.

Methods

We conducted a multi-site study involving semi-structured qualitative interviews with researchers and health professionals. We analyzed the interview data using a descriptive thematic analysis to inductively explore relevant ethical challenges.

Results

Our findings indicate that professional stakeholders find issues of patient autonomy and informed consent, quality of data management, distributive justice and human contact as ethical priorities. Divergences emerged in relation to how these ethical issues are interpreted, how conflicts between different ethical principles are resolved and what solutions should be implemented to overcome current challenges.

Conclusions

Our findings indicate a general agreement among professional stakeholders on the ethical promises and challenges raised by the use of IATs among older and disabled users. Yet, notable divergences persist regarding how these ethical challenges can be overcome and what strategies should be implemented for the safe and effective implementation of IATs. These findings provide technology developers with useful information about unmet ethical needs. Study results may guide policy makers with firsthand information from relevant stakeholders about possible solutions for ethically-aligned technology governance.

Brain-computer interfaces and personhood: interdisciplinary deliberations on neural technology

OBJECTIVE

Scientists, engineers, and healthcare professionals are currently developing a variety of new devices under the category of brain-computer interfaces (BCIs). Current and future applications are both medical/assistive (e.g. for communication) and non-medical (e.g. for gaming). This array of possibilities has been met with both enthusiasm and ethical concern in various media, with no clear resolution of these conflicting sentiments.

APPROACH

To better understand how BCIs may either harm or help the user, and to investigate whether ethical guidance is required, a meeting entitled 'BCIs and Personhood: A Deliberative Workshop' was held in May 2018.

MAIN RESULTS

We argue that the hopes and fears associated with BCIs can be productively understood in terms of personhood, specifically the impact of BCIs on what it means to be a person and to be recognized as such by others.

SIGNIFICANCE

Our findings suggest that the development of neural technologies raises important questions about the concept of personhood and its role in society. Accordingly, we propose recommendations for BCI development and governance.

Why Neurotechnologies? About the Purposes, Opportunities and Limitations of Neurotechnologies in Clinical Applications

Neurotechnologies describe a field of science and engineering in which the nervous system is interfaced with technical devices. Fundamental research is conducted to explore functions of the brain, decipher the neural code and get a better understanding of diseases and disorders. Risk benefit assessment has been well established in all medical disciplines to treat patients best possible while minimizing jeopardizing their lives by the interventions. Is this set of assessment rules sufficient when the brain will be interfaced with a technical system and is this assessment enough? How will these new technologies change personality and society? This article will shortly review different stakeholders’ opinions and their expectation in the field, assembles information the state-of-the art in medical applications of neurotechnological implants and describes and assesses the fundamental technologies that are used to build up these implants starting with essential requirements of technical materials in contact with living tissue. The different paragraphs guide the reader through the main aspects of neurotechnologies and lay a foundation of knowledge to be able to contribute to the discussion in which cases implants will be beneficial and in which cases we should express serious concerns.

To jump or not to jump - The Bereitschaftspotential required to jump into 192-meter abyss

Self-initiated voluntary acts, such as pressing a button, are preceded by a surface-negative electrical brain potential, the Bereitschaftspotential (BP), that can be recorded over the human scalp using electroencephalography (EEG). While the BP's early component (BP1, generated in the supplementary and cingulate motor area) was linked to motivational, intentional and timing properties, the BP's late component (BP2, generated in the primary motor cortex) was found to be linked to motor execution and performance. Up to now, the BP required to initiate voluntary acts has only been recorded under well-controlled laboratory conditions, and it was unknown whether possible life-threatening decision making, e.g. required to jump into a 192-meter abyss, would impact this form of brain activity. Here we document for the first time pre-movement brain activity preceding 192-meter bungee jumping. We found that the BP's spatiotemporal dynamics reflected by BP1 and BP2 are comparable before 192-meter bungee jumping and jumping from 1-meter. These results, possible through recent advancements in wireless and portable EEG technology, suggest that possible life-threatening decision-making has no impact on the BP's spatiotemporal dynamics.

Embodiment and Estrangement: Results from a First-in-Human "Intelligent BCI" Trial

While new generations of implantable brain computer interface (BCI) devices are being developed, evidence in the literature about their impact on the patient experience is lagging. In this article, we address this knowledge gap by analysing data from the first-in-human clinical trial to study patients with implanted BCI advisory devices. We explored perceptions of self-change across six patients who volunteered to be implanted with artificially intelligent BCI devices. We used qualitative methodological tools grounded in phenomenology to conduct in-depth, semi-structured interviews. Results show that, on the one hand, BCIs can positively increase a sense of the self and control; on the other hand, they can induce radical distress, feelings of loss of control, and a rupture of patient identity. We conclude by offering suggestions for the proactive creation of preparedness protocols specific to intelligent-predictive and advisory-BCI technologies essential to prevent potential iatrogenic harms.

Feasibility and safety of shared EEG/EOG and vision-guided autonomous whole-arm exoskeleton control to perform activities of daily living

Arm and finger paralysis, e.g. due to brain stem stroke, often results in the inability to perform activities of daily living (ADLs) such as eating and drinking. Recently, it was shown that a hybrid electroencephalography/electrooculography (EEG/EOG) brain/neural hand exoskeleton can restore hand function to quadriplegics, but it was unknown whether such control paradigm can be also used for fluent, reliable and safe operation of a semi-autonomous whole-arm exoskeleton restoring ADLs. To test this, seven abled-bodied participants (seven right-handed males, mean age 30 ± 8 years) were instructed to use an EEG/EOG-controlled whole-arm exoskeleton attached to their right arm to perform a drinking task comprising multiple sub-tasks (reaching, grasping, drinking, moving back and releasing a cup). Fluent and reliable control was defined as average 'time to initialize' (TTI) execution of each sub-task below 3 s with successful initializations of at least 75% of sub-tasks within 5 s. During use of the system, no undesired side effects were reported. All participants were able to fluently and reliably control the vision-guided autonomous whole-arm exoskeleton (average TTI 2.12 ± 0.78 s across modalities with 75% successful initializations reached at 1.9 s for EOG and 4.1 s for EEG control) paving the way for restoring ADLs in severe arm and hand paralysis.

Acquisition of a mental strategy to control a virtual tail via brain-computer interface

The objective of the present study was to clarify the variation in and properties of mental images and policies used to regulate specific image selection when learning to control a brain-computer interface. Healthy volunteers performed a reaching task with a virtually generated monkey tail-like object on a computer monitor by regulating event-related desynchronization (ERD) on the buttock area of the sensorimotor cortex as recorded by electroencephalogram (EEG). Participants were instructed to find a free image by which the tail was well controlled. Seven participants frequently returned to specific images that were mostly unrelated to a tail, and returned to these images on the last day of training. The ERD levels were greater during use of those selected images versus when selected images were not employed. Our results suggest that individuals adopted a mental strategy where they imagine what would reduce the prediction error between the predicted and actual BCI actions.