COLUMBUS, Ohio — Chad Bouton snapped awake at 5 a.m. He skipped coffee, threw some Clif bars and water in a bag and left his wife and children and robot at home. He ordered three Sausage McMuffins from a drive-up window. He steered toward the hospital. He entered the operating room at 6:15 a.m.
Bouton is a research engineer, not a doctor, and he worked with an engineer’s precision. By 7 a.m., he and his team had set everything up in the operating room and tested it — the computer with the secret algorithm, the uplink cable, the Wand. They were ready to go, right on time. As they had been told to expect, the patient was late. So they tested the equipment again.
Nearly a decade of research had brought them here: Doctors would, on this day last week, insert a chip into the brain of a man four days shy of his 23rd birthday. The chip would connect by wire to a port screwed into the man’s skull. A cable would link the port to a computer.
The computer was programmed to decode messages from the brain and beam their instructions to strips of electrodes strapped around the man’s forearm. The electrodes were designed to pulse and stimulate muscle fibers, so the muscles could pull on tendons in his hand.
If it all worked, a man who was paralyzed from the chest down would think about wiggling his finger, and in less than one-tenth of a second, his finger would move.
They would bypass his broken spinal cord and put a computer in its place.
It will take weeks to see if the procedure was successful enough to help usher in what Bouton calls “the bionic age,” offering hope to millions of victims of strokes, muscle disorders and — for the man on the table — even broken necks.
On this day, engineers and doctors alike just wanted the patient to survive, and after that to achieve two smaller feats to make the big one possible: for the proper part of the brain to engage with the chip, and for the system to generate the right kind of electrical impulses.
Hospital staffers wheeled the patient into the operating room shortly after 8 a.m.
At 8:30, an anesthesiologist put the patient under, and then a worker shaved his head. Around 9 a.m., the surgeon, Ali Rezai, made a small incision and began to remove a piece of skull. The day before, he’d acknowleged all the things that could go wrong with the procedure — a bad connection between the brain chip and the computer, or the very slim chance of a post-operation infection. “But we’re hopeful,” he said, “and we’re prepared.”
An early start in engineering
Bouton stood behind the surgical team, next to the computers he’d set up hours before, wearing green scrubs, a red hairnet and tennis shoes. He is the research leader for neurotechnology at Battelle, a nonprofit research and development emporium headquartered on the edge of the Ohio State University campus. He is 43 years old. He has no medical training. His specialty is a branch of engineering called control theory. He was mulling a doctoral program when Battelle offered him a job in its medical devices unit. That was 17 years ago.
When Bouton was in high school in Iowa, he was programming computers in a language that wasn’t yet in most college textbooks. He won an international science fair with a large, boxy robot that navigated its way around rooms with a rotating beam of light. The robot still lives in a basement lab at Bouton’s house in the Columbus suburbs. His name is Marvin.
In the brain and the spinal cord, Bouton has found the ultimate control system. Several years ago, he worked on a project called BrainGate. His job was “decoding” or “deciphering” brain actions. Doctors would put chips in brains of people who were paralyzed and have them think about moving something. Bouton developed algorithms to see what the patients’ brainwaves looked like when they thought about movements. “In a way,” Bouton explained the day before the surgery, in a windowless Battelle conference room, “we’re reading their minds.” Eventually one of those patients was able to control an electric wheelchair with her thoughts.
Looking for reactions
It was just past 9:30 a.m. in the fourth-floor surgery room at the Ohio State University Wexler Medical Center. Rezai, the lead surgeon, hunched over the patient’s open skull with an electric probe in his hand. Above him, two flat screens displayed a three-dimensional image of the patient’s brain. The image is like a treasure map, with the “x” marked in a red blotch.
In the weeks before the surgery, the Battelle team put the patient in what’s called a functional magnetic resonance imaging machine. Inside, doctors showed him images of hands moving. The machine recorded what parts of his brain lit up when he imagined making those movements. The Battelle and Ohio State team made the brain map out of those recordings.
In the operating room, doctors tested the map’s accuracy. They fired electric pulses into the “red” areas of the brain and then watched for reactions in the patient’s body to confirm they were in the right place. (His hands wouldn’t move, doctors explained, because of his broken spinal cord, but a pulse in the hand-control area of the brain should provoke a reaction at the tops of his arms, which the patient can still move.)
The surgery couldn’t progress until the team was sure it had found the right spot to embed the chip. One of Rezai’s colleagues, Jerry Mysiw, the chair of the university’s physical medicine and rehabilitation department, explained why. “You don’t want (the patient) to think about moving his wrist,” he said, “and end up scratching his nose.”
They finally found the spot, several millimeters away from the red blotch area, where the shocks made the patient’s arms twitch.
Soon the doctors laid gauze on the brain to protect it while they drilled a trough through the skull for the wire that would run to the port.
At 10:52, the drill whirred to life.
At 10:58, Bouton started to test equipment, again. This particular piece — a long metal device called the Wand — didn’t work to his satisfaction. He asked for its backup, produced from a sterile shipping box.
At 11:02, Rezai slowly lowered the chip onto the surface of the brain.
At 11:05, Bouton tested the backup Wand.
At 11:07, Bouton, still in his scrubs and his hairnet, leaned over and whispered.
“I feel like an expecting father,” he said.
Years of work
The chip is four millimeters wide, studded with 96 blade-like electrodes. For three years, Bouton and his team decoded the thoughts that similar chips beamed out of other paralyzed patients. They spent three more years figuring out how to engineer movements to correspond to those thoughts, by sending commands to nerves.
It was harder than just picking out commands from the brain and sending them along to the nervous system. The team had to design a special algorithm to fill in for the spinal cord. The spinal cord isn’t just a conduit; it supplies a lot of information. It’s the middle manager of movement. For example: Drum your fingers right now. Which finger strikes first — your index or your pinkie? Odds are you do it the same way every time, and that’s your spinal cord calling out the sequence.
Once the algorithm filled in that information, the team needed to send the complete commands to a patient’s limbs. They built a “sleeve” — eight thin, film-like, copper-colored tendrils that wrap around the arm like a gauntlet, with 20 electrode dots on each strip. For the sleeve to work, the team needed to know exactly which muscle fibers to command, so they mapped which fibers were required to trigger about 20 different hand, wrist and finger movements. The team calls the finished system — everything from the decoding to the sleeve — the Neurobridge.
At 11:25, the surgeons finished screwing the port into the patient’s skull. At 11:44, Rezai placed the chip on the brain surface. He called for the Wand. Another surgeon lowered it into the cavity, held by clamps. It stopped just above the chip.
Bouton picked up a small controller that looked like a “Jeopardy!” buzzer. At 11:53, Rezai counted: “One, two, three, go!” Bouton tapped a small button with his thumb. The Wand puffed air at the chip. The chip stuck to the brain surface, like velcro.
“We’re in,” Bouton said.
The cable hooked to the port and to the computer. A Battelle engineer clicked open a program. The first results were spotty. The team removed the cable, wiped some fluid off the port, screwed the cable back in, and tried again.
More than a dozen doctors and scientists crowded around the screen at 12:09. The engineer refreshed the screen. Bouton beamed at the results. “This looks fantastic,” he said.
Sometime in late May, Bouton and his team will plug the patient into its computer again. A few weeks later, if all goes well, the sleeve will go on his arm. They will all watch for that one movement.