Page 54 - JSOM Spring 2025

Interviews with BCI-using volunteers have shown that they Particularly concerning are closed-loop BCIs, which can im-
consider communication with their environment “as an essen- pact neurochemical signaling and neural plasticity, possibly
tial condition for a life worth living.” However, psychologists leading to problematic long-term effects. Among the most
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note that once communication is secured, patients express ad- serious concerns are changes in behavior and altered deci-
ditional needs that go beyond basic interaction. For example, sion-making, as these could indicate disruptions to individual
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the wish of two artists with advanced ALS led a scientific team agency and autonomy. 68
to develop a BCI-operated application called Brain Painting.
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This application, installed in the patients’ homes, enabled them As of writing, BCIs are in the preclinical and clinical trial
to create art despite their condition. Brain Painting serves as a phases, with the Cochrane Central Register of Controlled
powerful example of one of BCI technology’s most significant Trials listing over 400 BCI-based experiments. One notable
potentials: enabling severely disabled individuals, including example is the NeuroPort Array, an intracortical BCI devel-
servicemembers, to transcend mere survival and express their oped by Blackrock Neurotech, which was approved for hu-
individuality and personhood in unique ways. man use under the Food and Drug Administration’s (FDA)
Breakthrough Device Designation in 2021, after being used
in humans since 2004. 26,69 Other BCIs, like Neuralink’s device,
Challenges
have not yet received the FDA approval but are being tested in
It is important to emphasize that BCI systems, while promis- humans through an investigational device exemption. In addi-
ing, are still largely in the clinical or experimental stages. De- tion to the 4 BCI implants currently used in clinical trials, there
spite advancements, numerous challenges and risks have not are at least 14 other types of electrodes progressing toward
been successfully addressed yet, resulting in the immature state long-term in-human trials. 62
of the technology. The launch of the Brain Research through
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Advancing Innovative Neurotechnologies (BRAIN) Initiative BCI-based Neuroenhancement
in the U.S. in 2014, along with similar projects abroad, has
significantly increased the number of experiments, research Researchers have already demonstrated that BCI technology
groups, and participants in the field. Notably, prior to 2014, can enhance attention, working and long-term memory, com-
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only four research groups worldwide were focused on devel- plex problem-solving, and behavioral performance in healthy
oping long-term implanted BCIs (electrode arrays). Since individuals. 17,39,43,46,70 Moreover, DARPA’s Cognitive Technol-
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then, this number has increased to 21. This increase has led ogy Threat Warning System (CT2WS) project explored the
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scientists to distinguish between “early BCI research” (before use of BCIs to improve threat detection during surveillance
2014) and the “BRAIN era” (post 2014). The involvement missions. The core idea behind CT2WS was to leverage the
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of private companies, such as Neuralink and Synchron, is also human brain’s subconscious ability to detect threats faster and
playing an increasingly important role by providing additional more accurately than traditional automated systems. When
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resources to help address some of the current challenges in BCI the CT2WS system was tested alongside the Cerberus Scout, a
development. 63 state-of-the art commercial surveillance system used by Army
and Marine Corps units, the earlier demonstrated a threat de-
One challenge is that implanted devices can trigger protective tection almost twice that of the Scout (91% vs. 53%) at a
neuroimmune responses at the implant site. Innate immune notably low rate of 5 false alarms per hour out of more than
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cells of the brain, particularly microglia, can mount a neuro- 2,300 events per hour. This pioneering project suggests that
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protective response and engulf the implant, resulting in re- future enhancive BCIs could harness existing yet underutilized
duced performance or failure of the interface. 64–66 To minimize capabilities of the mind, redefining current boundaries of hu-
immune reactions, researchers are exploring approaches such man perception and vigilance.
as creating nano-sized implants and bioactive coatings that ac-
tively support integration with host tissue. 30,64 BCIs could also enable so-called silent communication. In 2014,
Rao et al. published a proof-of-concept study on brain-to-brain
Another general issue is the long-term functionality of invasive interfacing, where motor imagery in EEG signals from the
BCI, as over time, the implants are prone to corrosion in the ‘‘sender’’ was transmitted over the internet to the motor cortex
warm cerebrospinal fluid. 25,34 Micromotion stemming from region of a second subject, the “receiver,” enabling direct neural
respiratory and cardiovascular functions can lead to slight mi- interaction. 17,71 While the level of communication was rudimen-
gration of the device and the compromise of long-term perfor- tary and involved simple commands, subsequent studies have
mance. Notable successes in BCI longevity include a person achieved increasing levels of sophistication, suggesting the po-
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with tetraplegia with a 2-year activation of a four-limb neu- tential for more complex and nuanced brain-to-brain commu-
roprosthetic exoskeleton using continuous ECoG-based de- nication in the future. For SOF, such technology could provide
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coding, a patient with locked-in syndrome maintaining 83% covert, hands-free communication in high-risk environments.
accuracy at 2 years, and a patient with brainstem stroke still
maintaining some control over a prosthetic 5 years after re- A BCI-enhanced combat medic could leverage artificial in-
ceiving the implant. Nevertheless, the gradual loss of implant telligence to make rapid diagnoses and take personalized,
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functionality remains a significant challenge. 67 resource-efficient actions, improving a patient’s chances of
survival in high-stakes environments. Other SOF personnel
Due to the early developmental stage of BCI technology, the could benefit from BCI applications that lighten the infor-
long-term safety risks associated with repeated and prolonged mation load by automating tasks such as data collection and
use remain largely unknown, and safety protocols continue processing. By using BCI for real-time data and intelligence
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to evolve as more data on long-term use emerge. Importantly, analysis, humans would be freed up for other important tasks.
both invasive and wearable BCIs may affect neurophysiology Manfred Clynes and Nathan Kline envisioned a similar merg-
and, consequently, bodily integrity in unpredictable ways. ing of human and machine. With space exploration in mind,
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52 | JSOM Volume 25, Edition 1 / Spring 2025