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VA Research Currents/Dec research VA currents Research news from the u.s. department of veterans affairs • Dec. 2007–Jan. 2008 New research center to focus on returning veterans new research program based at the largest Army base in the U.S., from which A Waco campus of the Central Texas more than 40,000 troops have deployed to Veterans Healthcare System will study Iraq. The fMRI machine, one of few such brain and mental-health conditions com- mobile research units in the world, will be mon among troops returning from Iraq and used to correlate activity in different areas Afghanistan: posttraumatic stress disorder, of brain with patients’ PTSD symptoms traumatic brain injury, depression, and and with the effects of treatment. substance abuse. According to Gulliver, the center will The Center for Excellence for Research emphasize translating research findings on Returning War Veterans, supported into practice so that veterans can be helped by Veterans Integrated Service Network as soon as possible. (VISN) 17, will be led by psychologist “There is a reputation that scientists are Photo by Terry Minton Terry Photo by Suzy Gulliver, PhD, former director of hiding out in the ivory tower, and that is Research by Erin Krebs, MD, MPH, found that a commonly outpatient mental health care at the Brock- just not going to do for this center,” she told used screening tool may not be as accurate as thought. ton (Mass.) VA. The program will feature the Waco Tribune-Herald. “We are going to a $3.5-million mobile functional MRI be in the trenches. We are going to be mak- Study sheds doubt on machine that will travel between Waco, the Temple VA, and nearby Fort Hood, the see CENTER on pg. 7 pain rating scale The most common method for pain screening may only be modestly accurate, reported VA investigators and colleagues in the Oct. 2007 Journal of General Internal Medicine. In a study involving 275 adult clinic patients, the researchers tested the pain numeric rating scale, which asks patients to rate their current pain from 0 (“no pain”) to 10 (“worst possible pain”). The researchers also verified patients’ pain us- ing other clinical measures. Though easy to use, the numeric rat- ing scale failed to identify about one in three patients with pain serious enough to interfere with everyday functioning. “Even Deb Meyer Photo by Keith Young, PhD (right), seen here with colleague Willy Bonkale, PhD, will be studying the genetic and biological see PAIN on pg. 6 underpinnings of PTSD as part of VA’s new Center for Excellence for Research on Returning War Veterans in Waco, Tex. VA Research Currents/Dec. 2007–Jan. 2008 Brain-computer interfaces: Has science fiction become reality? W hen a team led by John Donoghue, PhD, and Leigh Hochberg, MD, PhD, In the BrainGate system, published results from their pilot study of a sensor with 100 the BrainGate system in Nature in 2006, hair-thin electrodes is the headline in one Canadian newspaper implanted in the brain. proclaimed, “Movement by Thought: Sci- It is wired to a small pedestal, resembling a ence Fiction to Fact.” A London newspaper watch battery, that is referred to the trial participant as “the first implanted in the skull bionic man.” The editors at an Oakland and that serves as a daily were equally impressed, running the port to connect the headline: “Paralyzed Man Moves Moun- electrodes to an outside tains with Mind.” computer. Researchers hope to develop a It was hard for even the most serious wireless version of the science journalists to ignore the fascina- system in the future. tion surrounding the researchers’ stunning achievement. The scientists—from Brown University, VA and other institutions— had enabled a 25-year-old man with quad- Development of the system is spear- Notwithstanding Hochberg’s tempered riplegia to operate a computer cursor and headed by Donoghue, a Brown neurosci- view, it may be fair to say that in the case perform other tasks solely through his entist who became affiliated with VA when of brain-computer interfaces, yesterday’s thoughts. the agency established its Providence-based science fiction—for example, the 1938 The technology, called BrainGate, uses a Center for Restorative and Regenerative Andre Maurois novel The Thought- tiny sensor implanted in the motor cortex, the Medicine in 2004. Donoghue is also chief Reading Machine—has indeed become part of the brain that controls movement. The scientific officer at Cyberkinetics Neuro- today’s reality. sensor, about the size of Lincoln’s head on a technology Systems, a company formed by Even so, what’s been realized by penny, has 100 hair-thin electrodes that pick Donoghue and colleagues in 2001 to bring researchers to date has clear boundaries. up brain signals. The signals are sent to an ex- BrainGate to market. BrainGate and similar technologies have ternal decoder that turns them into commands little applicability with regard to “higher” for electronic or robotic devices. For now, the A ‘nascent science’ functions of the human mind: that which is brain implant is wired to a computer, but the Hochberg, lead author on the landmark uniquely individual, such as memory, emo- researchers hope to go wireless in the future. Nature paper and the principal investiga- tions, creativity. “For the moment, that’s tor on current trials involving BrainGate, a theoretical discussion,” notes Hochberg. VA Research Currents admits there has been some hype in media “The technology is not even close to being coverage of the technology, but says most able to read into memories or thoughts in is published 10 times per year for the reports have been balanced and accurate. the general sense. The leading edge of the Office of Research and Development field is the ability to extract a neural signal “Overall, many people have been capti- of the U.S. Dept. of Veterans Affairs that’s related to the intention to move one’s vated by the potential of the technology. But by VA R&D Communications limb—and thereby a computer cursor—in a thankfully, the media has generally been 103 S. Gay St., Rm. 517 particular direction.” responsible in describing these as early tri- Baltimore, MD 21202 als [and making clear] that this is a nascent And even the notion of “reading (410) 962-1800, ext. 223 science—that we’re really at the beginning thoughts,” while not wholly inaccurate, is [email protected] of a tremendous period of learning and op- more a handy catchphrase for the media Editor: Mitch Mirkin portunity in terms of restoring lost function than a precise description of what the tech- 2 for people with paralysis or limb loss.” nology is designed to do. VA Research Currents/Dec. 2007–Jan. 2008 “‘Thoughts’ is a useful word because it’s immediately meaningful to everyone,” says Hochberg, “and the concept of being able to ‘read thoughts’ has been around in science fiction a long time. But that’s not what we’re doing in our current research. The focus now, for people with spinal cord injury, brain stem stroke, ALS, and other diseases or injuries of the nervous system, is to be able to restore movement and com- munication.” Hochberg is principal investigator on Medicine and Regenerative ofRestorative Philippi/Courtesy Center for Karen Photo by two BrainGate trials now underway: one involving people with ALS and related motor-neuron diseases, the other for people with spinal cord injury, muscular dystrophy or stroke. Photo by Ray Leber Enabling those with paralysis to Leigh Hochberg, MD, PhD, is lead investigator on two clinical trials of a brain-computer interface called BrainGate. move, communicate Yet another method for restoring com- proaches. Most past FES work has in- The main way in which BrainGate could munication—this one focused on patients volved people with intact but non-function- restore communication for people who have who’ve lost their speaking ability—is being ing limbs—such as those with spinal cord lost motor ability is to enable them to move developed by a private Georgia-based com- injury or stroke. Electrodes are implanted a computer cursor, which in turn could pany called Neural Signals, Inc., the only not in the brain but in the weakened or allow them to use email, the Internet and other neuroprosthetics group worldwide, to paralyzed muscles that would normally word processing, or operate a TV set. Hochberg’s knowledge, that is using record- move the limb. Small electrical currents Similar results have been achieved ing sensors inside the brain. Their product is from external or implanted devices activate through somewhat different means by Dr. a computer-controlled prosthetic device that the muscles and restore movement and Jonathan Wolpaw and colleagues at the would be controlled by brain signals and function. Only recently, research there has Wadsworth Center, part of the New York reproduce the sounds of natural speech. expanded to prosthetics applications. In State Department of Health. Their method one project, electrodes would be implanted relies on EEG technology—electrodes Brain waves may drive natural or onto intact arm and shoulder muscles near placed on the scalp, not inside the brain. artificial limbs the amputation and pick up brain signals to Users wear a breathable cap on their head drive an artificial hand. As for enabling movement, BrainGate that contains eight electrodes—down from has already enabled research participants to The new FES-BrainGate collaboration is 64, just a few years ago—wired to a laptop open and close a robotic arm. This aspect “potentially very promising,” says Hoch- loaded with software that translates the of the work—using brain signals to acti- berg, in that two groups of patients might brainwaves into commands for devices.
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