The Functional Performance of the BrainPort V100 Device in Persons Who Are Profoundly Blind Patricia Grant, Lindsey Spencer, Aimee Arnoldussen, Rich Hogle, Amy Nau, Janet Szlyk, Jonathan Nussdorf, Donald C. Fletcher, Keith Gordon, and William Seiple Structured abstract: Introduction: This study was conducted to evaluate the functional performance of the BrainPort V100 device, an FDA-cleared sensory- substitution system, in persons who are profoundly blind (that is, have some or no light perception). Methods: This was a prospective, single-arm, multicenter clinical investigation. Participants received 10 hours of device training and were required to use the device in their everyday environments for 1 year. Functional performance measures of object identification, orientation and mobility (O&M), and word identification were assessed at baseline, in post-device training, and at the 3-, 6-, 9-, and 12-month time points. Results: Fifty-seven participants completed the study and used the device for 1 year. No device-related serious adverse events were reported, demonstrating that the risks associated with the BrainPort are minimal. Participants performed object recognition (91.2% suc- cess rate) and O&M (57.9% success rate) tasks beyond chance level. Discussion: This study demonstrates that the BrainPort can be used safely and independently by persons who are blind. Participants with profound blindness can accomplish a set of tasks more successfully by using the BrainPort than without the device. Following initial training, performance on these tasks was maintained or im- proved over the course of 1 year. Implications for practitioners: The BrainPort is a noninvasive and nonsurgical device that heightens functional independence for persons who are blind. The device presents users with more information about their environment than conventional assistive devices, and can enhance independence in performing activities of daily living. The BrainPort V100 device (Wicab, Inc., concept of sensory substitution by en- Middleton, Wisconsin) employs the abling tactile perception of information Financial support for the purpose of this re- have no financial interests in the BrainPort search was received from Wicab, Inc., Middle- V100 device. Dr. Arnoldussen is a Wicab, Inc., ton, Wisconsin, and Google, Inc., Mountain scientific consultant, but has no financial inter- View, California. Ms. Spencer and Drs. Seiple, est. Ms. Grant and Mr. Hogle have financial Nau, Szlyk, Gordon, Nussdorf and Fletcher interest in the BrainPort V100 device. ©2016 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, March-April 2016 77 ordinarily processed by the visual system. lowing training. The participants in one Visual information captured by a digital study were unable to perform these same camera is displayed on a user’s tongue as tasks without the use of the BrainPort electrotactile stimulation, which feels like during baseline testing (Nau, Pintar, Ar- small vibrations. The tongue is ideal for noldussen, & Fisher, 2015). In addition, sensory perception (Chebat, Rainville, Ku- using visual information displayed on the pers, & Ptito, 2007; Essick, Chen, & Kelly, tongue via electrotactile stimulation, con- 1999; Nau, Bach, & Fisher, 2013; Sampaio, genitally blind participants performed sig- Maris, & Bach-y-Rita, 2001; Van Boven & nificantly more consistently than equally Johnson, 1994); it is devoid of an outer trained sighted participants to successfully layer of dead skin cells and there are navigate around obstacles within a natural more nerve fibers closer to its surface setting (Chebat, Kupers, & Ptito, 2011). To than on the other parts of the body. The date, there has been no research that dem- tongue is more sensitive than other onstrates the long-term safety and effective- areas of the body and can perceive in- ness of the BrainPort device in a multi- formation via electrical stimulation sig- center study. The purpose of this research nificantly better than fingertips (Bach y was to evaluate the functional utility and Rita, 2004). electrostimulation safety of the BrainPort in The tongue can be considered a “vi- a one-year multicenter clinical trial, during sual” portal to the brain, since research which the participants used the device in- has shown that after a person who is blind dependently. receives sufficient training, there is statis- tically significant activation in an individ- Methods ual’s visual cortex when he or she is RESEARCH DESIGN interpreting the stimulation patterns pro- This study followed a prospective, single- vided by the BrainPort V100 technology arm, within-subjects, repeated-measures (Lee, Nau, Laymon, Chan, Rosario, & design. It was conducted at six sites in the Fisher, 2014; Ptito et al., 2012; Ptito, Mat- United States and one in Canada. Institu- teau, Gjedde, & Kupers, 2009; Ptito, Moes- tional review board (IRB) approval was ob- gaard, Gjedde, & Kupers, 2005). The con- tained by the New England and Veritas cept of the BrainPort is that with training an IRBs prior to initiating the study. All study individual can learn how to translate the participants provided informed consent to stimulation on the tongue into a represen- participate after the risks and benefits of the tation of the surrounding environment. Flu- study were explained. This study was per- ent users become accustomed to the stimu- formed in accordance with the ethical prin- lation and cease to consciously translate the ciples of the Declaration of Helsinki. It was perception. Interpretation of the stimulation registered with ClinicalTrials.gov under the patterns then becomes more automatic identifier NCT01488786. (Arnoldussen & Fletcher, 2012; Danilov & Mitchell, 2005). RECRUITMENT Previous research has shown a Brain- Participants were recruited for the study Port user’s ability to identify words and from October 2011 to April 2012 from objects at a level greater than chance fol- co-investigators’ clinical practices, clinic 78 Journal of Visual Impairment & Blindness, March-April 2016 ©2016 AFB, All Rights Reserved databases, and referring physicians and health exam, and were willing to partici- clinicians. In addition, recruitment flyers pate after receiving brief exposure to the were posted in eye clinics and distributed device were enrolled in the study. Of the to support groups for people who are 83 participants recruited, eight candidates blind. It was required that all participants did not meet the eligibility criteria for the be at least 18 years of age, had received a following reasons: did not pass the oral diagnosis of blindness at least six months health exam (n ϭ 2), did not meet the prior to enrollment, were English speak- vision criteria (n ϭ 2), withdrew consent ing and able to walk independently for 20 following an introduction to the device feet, and had successfully completed ori- (n ϭ 2), withdrew consent prior to an entation and mobility (O&M) training introduction to the device (n ϭ 1), and with a white cane or dog guide. They displayed cognitive impairment that was were excluded if their blindness was due initially undetected (n ϭ 1). to cortical injury; were current tobacco users or were pregnant; had hearing loss PARTICIPANTS in which device alerts could not be heard; Seventy-five participants met the eligibil- had oral abnormalities, tongue lesions, or ity criteria, confirmed their willingness to piercings; had allergies to nickel or stain- participate following exposure to the de- less steel; had implanted medical devices vice, and were enrolled into the study. Of or any medical condition that could inter- these 75, 18 withdrew or were withdrawn fere with participation in the study; had for the following reasons: disinterest and prior exposure to the BrainPort; or had an unwillingness to continue (n ϭ 8), indications of cognitive decline, depres- health- or life-related events (n ϭ 7), and sion, or anxiety. time constraints (n ϭ 3). Therefore, 57 An interested candidate was invited to participants completed the 12-month a study site for a screening visit that in- study. cluded the collection of clinical history Of the 57 participants who completed and demographic information; an ocular the study, the mean age was 52.4 years evaluation to document blindness, unless (range, 21 to 69 years). All used one or written documentation was provided by more assistive devices (white cane, dog the participant; an oral health exam; and guide, or electronic travel devices) on a the Beck Anxiety Inventory (BAI) and regular basis, and the majority (77%) Beck Depression Inventory-II (BDI-II) to could read braille. This information and assess levels of anxiety and depression, additional demographic data for this respectively. In addition, the extent of any study sample are provided in Table 1. residual vision was quantified by using a computer-based psychophysical test, the MATERIALS Freiburg Visual Acuity Test (FrACT) The BrainPort is a portable, nonsurgical, (Bach, 1996; Nau et al., 2013). and noninvasive electronic assistive de- Participants who had a visual acuity vice for people who are profoundly blind. equal to or less than 20/5000, had BDI-II The BrainPort has received FDA market and BAI total scores that fell within the clearance and CE mark clearance (manda- minimal to mild levels, passed the oral tory for certain products sold within the ©2016 AFB, All Rights Reserved Journal of Visual Impairment & Blindness, March-April 2016 79 Table 1 tery life is approximately two hours, and ؍ Demographics of study subjects (N 57). a replacement battery and charger are Variable n (%) supplied with the device. Age in years To operate the device, the user employs Mean (SD) 52.4 (10.8) simple head movements to guide the cam- Gender era to a scene of interest. The camera Women 25 (44) Men 32 (56) captures the scene as a greyscale digital Race image and forwards the image to the Black or African-American 9 (16) controller for processing. The visual in- White or Caucasian 46 (80) formation is then transmitted to the dorsal Other 1 (2) Unknown 1 (2) surface of the tongue via electrotactile stim- Years since onset of blindness ulation patterns representative of the cam- Mean (SD) 33.04 (22.4) era image (see Figure 2).