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154 BrainPort helps blind mountainclimber learn to ‘see’ via tongue By AMANDA PEDERSEN Medical Device Daily Staff Writer Erik Weihenmayer has climbed the Seven Summits – the highest peaks on each of the seven continents – including Mount Everest. This world adventurer’s quests are made even more remarkable by the fact that he has conquered them all while visually guided by others. In addition to making headlines for being the first blind man in history to reach the top of Everest in 2001, Weihenmayer has also been in the spotlight lately for his involvement with BrainPort, a device designed to allow blind people to “see” with their tongue. The device, being developed by Wicab (Middleton, Wisconsin) and funded by the National Eye Institute (NEI; Bethesda, Maryland) uses sensory substitution – stimulating one sense, such as touch, to take the place of another, such as sight – an idea introduced in the late 1960s by Paul Bach-y-Rita, MD. Bach-y-Rita died in 2006 but his research lives on through Wicab, a company he established in 1998. In addition to the BrainPort vision device, the company is also developing a BrainPort balance device based on the same technology. “There are two different pieces to what [Bach-y-Rita] believed and what I think is true,” Bob Beckman, president/CEO of Wicab told Medical Device Daily. “The sensors – your eyes or your ears – can be replaced with alternate sensors and also the brain is not hardwired. You do not have to go through the optic nerve to relay visual information to the brain . . . you can go through the tongue.” Recently Weihenmayer demonstrated the BrainPort on the Today Show, using the device to read numbers on black and white flash cards. With a camera mounted on his head sending pulses to his tongue, he is able to interpret and thereby determine the field of vision in front of him. According to his web site, he has also used the device to read words on note cards, play games with his daughter such as tic-tac-toe, and find holds while rock climbing. The camera acts as the user’s eyes, gathering white, gray and black pixels of visual information. A computer translates this information to electrical impulses, which it then displays on the tongue in the form of an array of electrodes. Strong vibrations on the tongue represent white pixels, medium-strength vibrations represent gray pixels and no vibrations represent black pixels. Blind people learn to use that information to gain perception about their surroundings, Beckman said. A few examples of what a blind person could learn to do with the device are walk a sidewalk, read signs in a hallway, and throw a ball into a basket. Aimee Arnoldussen, a neuroscientist and BrainPort researcher who worked with Bach-y-Rita, appeared on the Today Show with Weihenmayer. She said that eventually the MEDICAL DEVICE INNOVATION 2010 camera part of the device could be shrunk to fit in a pair of glasses and that the visual information it collects might be transmitted wirelessly to a retainer-like device that sits on the roof of the person’s mouth. Michael Oberdorfer, PhD, of the Division of Extramural Research at the NEI told MDD that the tongue – aside from serving us for taste – is very sensitive to touch. “If you’ve ever had a small seed stuck between your teeth you know what I’m talking about,” he said. Oberdorfer said the technology behind the BrainPort vision device delivers a “very gentle stimulation” to the user’s tongue, which that person can adjust to get input from the video camera. The device would not work for a person who is considered legally blind but has some vision, Oberdorfer said, because the user would get competing input from their eyes and the device. Thus, it only works for individuals like Weihenmayer who are completely blind. While only about 3% or less of the U.S. population are totally blind, according to Oberdorfer, he says that is still a significant number of people who could someday benefit from this and other technologies. But using the device takes practice, Beckman said. He likened it to learning a new language and noted that it requires training in order for the blind person to interpret the tactile images being displayed on their tongue and transmitted to their brain. Wicab’s balance device is based on the same sensory substitution technology as the vision device, only it is designed for training patients with balance deficits due to chronic vestibular disorders. The BrainPort balance device provides information about head position through electrotactile stimulation of the tongue, Beckman said. That device consists of a controller – which includes patient controls, signal processors and microcontroller – and an intra-oral device, which includes a tilt sensor and an electrode array. Instead of a camera, the BrainPort balance device uses an accelerometer. During training sessions with this device, the patient places the electrode array on the tip of their tongue and slowly adjusts the signal intensity to a comfortable level, Wicab said. The accelerometer detects head and body movement when the patient leans forward, backward or to either side. This information is relayed by microprocessors directly to the tongue through the electrode array, according to the company. For example, if the patient sways to the left, the stimulus moves to the left side of the patient’s tongue. If the patient sways to the right, the stimulus moves to the right side of the tongue, Beckman said. Patients are told to focus on the stimulus and to adjust their body position with the goal of maintaining the stimulus on the center of their tongue. Beckman said Wicab has found that people learning to use the BrainPort balance device train best with their eyes closed and in a position which they find challenging. They are asked to maintain their balance for 20 minutes, he said. To subscribe, please call MEDICAL DEVICE DAILY Customer Service at (800) 888-3912; outside the U.S. and Canada, call (404) 262-5547. Copyright © 2010 AHC Media LLC. Reproduction is strictly prohibited.
MEDICAL DEVICE INNOVATION 2010 155 Unlike the vision device, which is like learning a new language, Beckman said that learning to use the balance device is more intuitive. Wicab is running a controlled clinical trial with the BrainPort balance device, Beckman said, and the company expects to complete that trial by the end of the year. “We’re hopeful that we’ll have a significant difference between the active group and the controlled group,” he said. In terms of a commercial application, Beckman told MDD that the balance device has a lot more going for it than the vision device because there is a much broader patient population that could benefit from it. He said elderly people, stroke patients, and people with certain types of brain tumors could potentially use the balance device. (This story originally appeared in the Sept. 11, 2009, edition of Medical Device Daily) To subscribe, please call MEDICAL DEVICE DAILY Customer Service at (800) 888-3912; outside the U.S. and Canada, call (404) 262-5547. Copyright © 2010 AHC Media LLC. Reproduction is strictly prohibited.
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