Poor communication between doctors and patients is widely seen as a problem in American healthcare. Now more and more healthcare providers are giving patients new ways of accessing doctors to ask questions or express concerns. In the age of email, texting, video chatting and social media, a look at the promise and limitations of digital communication to improve patient experiences and outcomes.
Diane and her guest will discuss the new neuroscience of connecting brains with machines–and how it will change our lives. Award-winning neuroscientist Miguel Nicolelis’ work with primates has uncovered a new and controversial method for capturing brain function. It is paving the way for a cure for Parkinson’s disease, new ways of treating paralysis, and using brain waves to control everything from transportation to manufacturing.
- Miguel Nicolelis founder of the Duke University Center for Bioengineering. "Scientific American" has named him one of the twenty most influential scientists in the world.
MS. DIANE REHMThanks for joining us, I'm Diane Rehm. The late actor Christopher Reeve once said of his paralysis, I am positive I will walk again. While he never saw his dream realized, new research is bringing hope to severely paralyzed patients and those with neurological disorders like Parkinson's disease. Scientist Miguel Nicolelis has written a new book about his ground-breaking research. He explains how living brains can interface with machines. His book is titled, "Beyond Boundaries." And Miguel Nicolelis joins me in the studio. Dr. Nicolelis is professor of Neuroscience at Duke University and founder of Duke University's Center for Neuroengineering.
MS. DIANE REHMDo join us, 800-433-8850, send us your e-mail to email@example.com, feel free to send us a message on Facebook or a tweet. Good morning to you, sir, it's good to have you here.
DR. MIGUEL NICOLELISGood morning. Thank you for having me.
REHMThis research sounds like something right out of science fiction.
NICOLELISWell, I guess so. It was a little bit of science fiction about 20 years ago, but it's becoming reality now.
REHMWhen you say it's becoming reality now, how far has it progressed?
NICOLELISYes. We have been able to read large scale brain activity, electrical signals coming from the brain, and decode messages that are imbedded in these signals and transform them in digital commands that can be used by robotic devices or even virtual devices to enact a voluntary motor wheel of our subjects and...
REHMDidn't it used to be that you would think of a particular part of the brain as doing a particular task and now there is a whole new set of ideas about that?
NICOLELISYes. You just mentioned the greatest dogma of neuroscience for the last 100 years, the belief that particular parts of the brain were a very highly specialized for a particular function. And what we have found in the last decade in this research is that's not quite what goes on. There is more of a neuronal democracy. You know, neurons all over the brain are voting, albeit in different ways, to perform a particular behavior, to generate a particular behavior.
REHMAnd I guess that the confirmation of that might be that when a particular part of the brain stops working, you have another part of the brain that could take over?
NICOLELISExactly, exactly. There are a variety of studies for the last 20 years showing that the brain is very plastic, that he can adapt almost instantaneously to a lesion, either a central or a peripheral lesion, and the moment that lesion happens, the brain's trying to reroute the signals, these electrical signals, to restore the best possible solution, next solution for the problem that has emerged.
REHMSo is it possible that when one has a serious brain injury, say, one is in an automobile accident or has a terrific spinal injury, as did Christopher Reeve, that the kind of experimentation you're doing could actually sort of push these neurons into activity?
NICOLELISOh, absolutely. We are trying to take advantage of plasticity, brain plasticity. We are -- the whole idea of this research is to create a bypass, a bypass through the lesion using an interface between the brain and machines, using a computation of electronic and robotic interfaces that will allow what is left of the brain that is working properly to try to generate the signals that are necessary for the -- you know, this interface to restore function and behaviors, particularly motor behaviors.
REHMWell, take motor behaviors, such as Parkinson's disease. How would you imagine your work might go on to help those people?
NICOLELISYes, we have recently, about two years ago, published a study showing a potential new therapy for Parkinson's disease that takes advantage of an interface with the brain. Today, as you know, patients that reach a very high or important level of motor impairment due to Parkinson's disease have very few options. One of them is a surgical procedure called deep brain stimulation that, you know, improves in a great number of patients the symptoms, but is an invasive procedure and is a tough procedure. Not every patient can take it. It's a small percentage of the patients that can have it.
REHMAnd not every patient improves with it.
NICOLELISAnd not every patient improves, exactly. And of course, the effects can go down with time, you know, the improvement can decline over time. Well, we discovered because of this new view of the brain, this distributed view of the brain, this collective view of the brain, that we could come in the back, in the spinal cord animals -- animals that have Parkinson-like Syndrome.
NICOLELISAnd we stimulate the surface of the spinal cord here where you have a million fibers going up to the brain to take a message to the brain and get the same effects that you get going deep into the brain with the deep brain stimulation technique. So in our animals, in rodents, we are able to basically alleviate all the Parkinson symptoms by doing the same stimulation, same electrical stimulation that today we do deep in the brain right here.
REHMBut what you're saying is your approach is non-invasive?
NICOLELISWell, it's semi-invasive because you just need to go under the bone...
NICOLELIS...but it's so simple and it's so easy and it's so inexpensive that it could be affordable pretty much by everybody and it could be done if it proves to be, you know, appropriate. And we already have primate data suggesting that it works in primates, too, preliminary data supporting the same results that we got in rodents that that surgery could be done almost a moment to diagnosis. So you could have a patient that could receive this stimulator and that's an interface, that's an interface, a brain interface, that could basically keep the patient from degrading, at least the symptoms would be under control much earlier on together with the pharmacological therapy, a much smaller dose of what is used today.
REHMInteresting. Tell me about these trials with monkeys, planting small electrodes that record these signals from the neurons.
NICOLELISYes. You mentioned Mr. Reeves and I met him way back, you know, when we were starting this research and that was a very moving day because I mentioned to him that my dream was like his. I had seen so many patients when I was in medical school back in Brazil before joining Duke, with paralysis. That for a long time, we thought about an idea and that's exactly what he mentioned. We discovered that if we can record the electrical brainstorms that are generated in the brain, in the cortex, the motor cortex, you know, where the plans for us to move are generated half a second before we even start moving.
NICOLELISThat's what the brain does. The brain is about the future. It plans the future of our motion and during that window, half a second or so, we discovered in the last 10 years that we could record this electrical signals that encode a motor behavior, decode this message, translate this message into digital commands and send these digital commands to a robotic arm, a robotic leg, virtual body or a computation or two so that that subject, a monkey in this case, could control just by thinking the movements of these devices, these artificial devices. So basically, the monkey could enact its voluntary motor will just by thinking.
REHMJust by thinking.
NICOLELISYes. That's the -- one of the sentences that I think is the key of all this work.
REHMMiguel Nicolelis, he is a professor of neuroscience at Duke University, founder of Duke's Center for Neuroengineering. His new book is titled, "Beyond Boundaries: The New Neuroscience Of Connecting Brains With Machines and How It Will Change Our Lives." Do call, 800-433-8850, send us your e-mail to firstname.lastname@example.org, join us on Facebook or twitter. Now, you had another experiment with a monkey, a rhesus monkey, called Aurora.
REHMTell us about her.
NICOLELISNow, Aurora has become perhaps the most famous actress or monkey in this research field. She's known all over the world because she was one of the first primates to actually do what we just discussed. She was able to control a robotic arm that played a video game for her and she first learned to play this video game with her own arm, controlling a joystick.
NICOLELISAnd every time she got the game right, she would get a drop of fruit juice and she would do anything for that fruit juice. She's loved it and she drank, you know, liters of it per day. And once she learned to play the video game, at the same time she was learning, we were recording her brain activity and making our computers learn to reproduce her arm movements into a robotic device that was in another room. So after a few weeks, we just, you know, kindly removed the joystick and let Aurora realize that now to play the game, she didn't need to move her body at all, she just had to imagine the movements that she had to make.
REHMAnd that would move...
NICOLELISAnd the robotic arm would move and would control the computer cursor that would play the game for her. So I have these videos and I have played these videos all over the world and in our website, too, you know, we are putting these videos, "Beyond Boundaries," Nicolelis' (word?) and it's one of the most amazing moments of my life because you see the monkey just relaxing and now to sit and the cursor continues to move and we see the robotic arm moving as she would her arm.
REHMAnd we will have that website attached to our own at drshow.org. Right now, join us, 800-433-8850.
NICOLELISAnd that somehow died out for a long time and because of this research on brain machine interface and because we realized that the feedback that you send from these devices back to the brain is so important, the issue of how you handle feedback to retrain the central nervous system has acquired tremendous new interest. So I don't particularly work on these fields -- in these particular disorders...
REHMAnd we're back talking with Miguel Nicolelis about his new and fascinating work, Avery thorough description of which is entered into his new book, "Beyond Boundaries." He is a professor of neuroscience at Duke University, founder of Duke Center for Neuroengineering. Stuart is listening from WMFE in St. Petersburg, Fla. He says, "Do the brain storms that are transmitted as signals differ between species or individuals? And if they do, do they differ with age and wisdom?"
NICOLELISOh, that's pretty interesting.
REHMThat's a good question.
NICOLELISThat's a very good question, yes. The principles of these brain storms are very similar. So the principals in mammals and primates and humans, the generated storms are very similar because they are electrical storms that liberate some chemicals that allows neurons to interact with each other, but the details of these storms from person to person differ.
NICOLELISSo the general principles -- and we have listed here 10 principles in the book that over 25 years we have experimentally demonstrated, they seem to be valid from species to species. From rodents to primates to -- and now we are about to test these in humans, of course. But within these principles, there is this uniqueness of each of us. You know, what I like to say is that at the same time -- the brain tells us that at the same time that each of us is unique, it shows that each of us belongs to the same thing, you know.
NICOLELISWe have a common language of interacting and thinking and generating our feelings and emotions and predictions of the future and memories of the past. And yet within these common principles, there is room for each of us to be a unique brain history that will never ever repeat itself in the universe. There is no chance that a life like any of ours is going to be repeated.
REHMWell, we may actually be able to voice our thoughts, but what about whales, what about dolphins? What about these rhesus monkeys who cannot relay to you orally...
REHM...what they are thinking, but can in other ways?
NICOLELISThat's another very interesting question. I think verbally we, as you said, that we can relate our thoughts. We can relate just a very small fraction...
REHMOf what's going on up here.
NICOLELIS...of what is going on and it's in very precise ways. You know, language -- in fact, I discuss the views of few philosophers and neuroscientists from way back, and some contemporary neurophysiologists, that language -- our problems interpreting the brain is that the way we have to describe the brain is either language or written language. So we really don't have words to describe the functions, the probabilistic functions that go on in our heads. So that's a very nice point.
NICOLELISI actually propose that way ahead in the future, we may be able to express ourselves beyond language. We may be able to express ourselves by actually broadcasting our thoughts and communicating our impressions, emotions and views in a very different way.
REHMAnd perhaps those whales are communicating their thoughts in ways that we simply don't understand.
NICOLELISWell, they certainly have ways to communicate among themselves...
NICOLELIS...that people have been studying for a long time.
REHMOf course, right.
NICOLELISBut what is -- what I'd like to say is that this research -- this -- the possibility of reading electrical signals from the brain and interfacing this with machines, we actually liberate the brain. We liberate the brain from the constraints of language, the constraints of the body, and our thoughts will have, you know, a free access to, you know, very different ways to express to express themselves.
REHMIn your lifetime?
NICOLELISI think so. I actually think so. That in the next 30 years, I hope to reach that, 80, we will see things that amaze us.
REHMAll right. Let's go to Jeremy, he's in Seattle, Wash. Good morning.
REHMGo right ahead, sir.
JEREMYYes. The question -- and even as you were talking about the language barriers there, is how is it that you isolate the neurons that are firing in the brain and the connection there to translate that abstractness to the point where you can, without hardwire connection to the central nervous system, maintain some sort of control over a machine, how is it that you overcome those challenges to the point where with, you know, distracted focus that the brain has, is it that the subject simply has to, with determined focus, think about what they're to do?
JEREMYOr is it that you're really able to isolate the neurons that are the ones that are responsible for achieving the command that you -- and the operation of the machine that you're trying to do? So I was wondering if the doctor could speak to those and other challenges in that regard.
NICOLELISWell, that's a wonderful question because it touches directly on the issue that prevented most people of doing the kind of experiments that we did, you know, because people thought that you had to find the precise neurons, the right cells in the middle of that huge ocean -- huge forest, find the trees that actually had the goods to produce these motor behaviors. We found out that is not the case. You just go generally to areas that we know are involved in motor coding -- or generating motor commands.
NICOLELISYou draw up these electrodes. They are hair-like sensors, very thin sensors that you just introduce a few millimeters in the brain. In the future, it's going to be like a heart pacemaker, very similar. You just introduce these hairs into the brain a few millimeters and what we realize is that if you sample enough neurons, hundreds of them, you don't need to fish for the cardinal...
REHMThe right one.
NICOLELISNo. The right -- no. The message is widely distributed across all these cells. That's the reason I call it a neuronal democracy. Things are all over the place, they're floating all over the place and then you record them. If you have enough mass of neurons being recorded, you will get the signals you need.
REHMProfessor Nicolelis, we've had a number of e-mails asking about what about fears of big brother.
NICOLELISOh, yeah. This is always the case when new technology comes and it's up to society, of course, to regulate the use of new technology. I like to say that when I was in medical school back in Brazil and I worked on the busiest emergency room that exists in the world every night when I was an intern, that my teachers used to come to me and say, you know, if everything fails, here you have a Bic pen and the cap of the pen has this little tip. You can use this to make a tracheostomy and save someone's life.
NICOLELISSo you can use any tool, anything for good and for bad things and that's the reason science and scientists have to inform society continuously of the details of what they're discovering and what are the limits and what are the potential harmful ways in which that technology could be used. That's the reason -- one of the reasons I wrote this book because I thought it was very important to diffuse these fears because there's so much good that can come out of this technology and to help millions of people.
REHMBut would you also agree that there is a fair amount of ill use, too, which could be put...
NICOLELISOh, certainly. It could happen, of course. It could -- although the technology that we have today available right now would not allow the science fiction scenarios to happen.
REHMAll right. Let's go to the Tampa, Fla. Good morning, Maurice.
MAURICEGood morning. You know, Doctor, I have a question for you and I agree with ethics. I mean, you're always going to have a question of ethics and like you said, there's always something that could be used for good or for bad, so hopefully we err on the side of good. But two questions, Doc. When -- at what age did you become interested in neuroscience and what was the stimulus that caused that to happen?
MAURICEAnd then the second question is children, are there programs out there for our future neuroscientists, whether they're in the United States, whether they're in Brazil, whether in Japan. Where -- are there programs that children that are in grade school and high school can get involved in, organized programs, that would pique their curiosity and hopefully drive our youth into the neuroscience sector? Because it just seems like our country right now, the United States, is not producing as much scientists, there's not so much interest and I just think that there should be something...
MAURICE...out there, something more prevalent that -- that's organized from an early stage.
REHMYou know, Maurice, we did a program just a couple of weeks ago on robotics and how high school children are getting involved in building robots for class projects and competing on a national an even a world stage. Now, high school maybe too late for what you're talking about. What about younger children?
NICOLELISYeah, no. That's a wonderful question. I got involved into -- I knew that I would be a scientist when I was growing up in Brazil watching the Apollo program. And when I was five, six years old...
NICOLELIS...and I was following every single mission, I was plotting it on atlases. I was watching as much as I could. There was no internet, but, you know, I was reading every drop of it.
REHMWith the help of parents.
NICOLELISMy grandmother and I knew when Neil Armstrong was about to land before he landed there, you know (laugh). And we amazed the Brazilians, you know, in our neighborhood by saying, oh, we knew that would happen.
NICOLELISIn any event, I was seven and I read a book at time by Isaac Asimov called, "The Brain." And there was somewhere there...
NICOLELISYeah, fascinating man.
NICOLELISHe was one of my heroes at that time. And he said, there's only one thing that compares to the universe, that is the brain. And that got me, you know, forever. Well, it's very nice that you mentioned this because for the last 10 years, I have been running a program in Brazil for children, a science education program that is really becoming a major initiative in Brazil and I think that could be extremely useful here in the United States because I agree totally what we said, high school is too late. Scientists, they are groomed in the cradle and in the early days of childhood.
REHMHow did you get that...
NICOLELISPassion. Passion. Science is about passion. It's about being a child forever. It's about being paid to be a child forever and it's one of the greatest professions you can have because people trust you, society, the taxpayer, trust you to come up with solutions for humanity while you are there really acting like a kid.
REHMBut you know, when I was -- again, this is a little later, a freshman in high school, what did we do in science but start cutting up frogs?
NICOLELISYes. No, no. That's not what I'm talking about. Our kids, they start -- this program is called Education for Life in Brazil and it started with a thousand kids in the poorest part of the country and is now going to become a curriculum for more than a million kids in Brazil.
REHMGive me an idea of what's contained in the program.
NICOLELISIt's all -- yeah. We start at elementary school level and we are going all the way back to four years old. We are -- we discovered that we can start as early as you can imagine and it's playful. You learn science by doing science. You learn the big concepts of science in laboratories for children -- created for children, in which children get engaged into demonstrating the scientific method at work by doing scientific work like I do in my life. And that is a revolution. You get people engaged into this -- in math and science, chemistry and physics becomes playful.
REHMAnd you're listening to "The Diane Rehm Show." And now, to Severna Park, Md. Good morning, Sheila.
SHEILAGood morning, Diane. I didn't hear any discussion about lesions from brain tumors. I have a granddaughter and a daughter who have suffered some motor impairment, some cognitive impairment, and I was just wondering if there's any research being done in that area?
NICOLELISYes. I'll do -- in our animals -- in animal work, we have not simulated these type of lesions. One of the future applications, we hope, of course, to use brain machine interfaces for is to rehabilitation -- for rehabilitation of patients that have lost brain tissue or have exactly what you described, a tumor, that destroys areas of the brain, so a solution -- one of the solutions that is envisioned is to use the other hemisphere, but retrain other areas of the brain to try to restore some of the functions that have been lost through the disease.
REHMYou know, that takes me to a question about things like hip replacement or broken arms or, you know, something that happens to a lot of people. Is there any indication in your mind or in your work that the brain does have the ability to heal the body?
NICOLELISWell, certainly the brain remaps the body. So once you have -- for instance, there's one phenomena that you may have heard of that is one of the most prevalent phenomena in neurology that is called phantom limb pain. So you have missed a part of your body through an amputation, let's say, traumatic or because of, you know, your clinical need. In 80 to 90 percent of the patients, that part of the body is still felt.
NICOLELISThe patient reports not only that he can feel that limb that is gone, moving or sensations coming from the hand that doesn't exist anymore or even pain. And imagine having pain -- excruciating pain that cannot be treated by almost anything, in a part of you that doesn't exist anymore. So that's one of the most terrifying things that I have seen way back in medical school and it has been with us since the medieval ages, you know.
NICOLELISAnd only recently, a few scientists have realized, Dr. Ramachandran, University of San Diego, for instance, he's the pioneer on this, that to -- perhaps to treat that excruciating pain and that phantom sensation, you have to fool the brain. So he has shown that if you project with mirrors an image of the other limb that is still present in the stump, you know, so that the person has the feeling if you put both of your arms in a box and the box has mirrors that project the image...
REHMThe other arm...
NICOLELIS...on the other -- and the person sees the arm back there, the pain goes away. The phantom sensation goes away. The brain thinks, okay, I have the missing part back, it's there, so I don't need to generate this weird sensation, this alarm that something is -- you know, is wrong. Or these memories of that part of the body that...
REHMSo the brain can be tricked?
NICOLELISYes. Because the brain is a simulator. And if you trick the way the brain creates the simulation, you may be able to treat a lot of things that we couldn't because we are treating the brain not properly.
REHMWell, I'm sure you and I could go on for hours. Fascinating discussion.
NICOLELISThank you very much.
REHMThank you so much for being here. There's a link at drshow.org to Dr. Miguel Nicolelis, his new book is titled, "Beyond Boundaries." Congratulations. Come back and see us when the work continues.
NICOLELISThank you very much.
REHMThank you. Thanks for listening, all. I'm Diane Rehm.
ANNOUNCER"The Diane Rehm Show" is produced by Sandra Pinkard, Nancy Robertson, Susan Nabors, Denise Couture, Monique Nazareth and Sarah Ashworth. The engineer is Tobey Schreiner. Dorie Anisman answers the phones. Visit drshow.org for audio archives, transcripts, podcasts and CD sales. Call 202-885-1200 for more information. Our e-mail address is drshow.org and we're on Facebook and Twitter. This program comes to you from American University in Washington. This is NPR.
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