Summary:
Brain-computer interfaces (BCIs) can restore communication to people who have lost the ability to move or speak. To date, a major focus of BCI research has been on restoring gross motor skills, such as reaching and grasping1–5 or point-and-click typing with a 2D computer cursor 6,7. However, rapid sequences of highly dexterous behaviors, such as handwriting or touch typing, might enable faster communication rates. Here, we demonstrate an intracortical BCI that decodes attempted handwriting movements from neural activity in motor cortex and translates it to text in real-time, using a novel recurrent neural network decoding approach. With this BCI, our study participant, whose hand was paralyzed from spinal cord injury, achieved typing speeds that exceed those of any other BCI yet reported: 90 characters per minute at 94.1% raw accuracy online, and >99% accuracy offline with a general-purpose autocorrect. These speeds are comparable to able-bodied smartphone typing speeds in our participant’s age group (115 characters per minute)8. Finally, new theoretical considerations explain why temporally complex movements, such as handwriting, may be fundamentally easier to decode than point-to-point movements. Our results open a new approach for BCIs and demonstrate the feasibility of accurately decoding rapid, dexterous movements years after paralysis.
Neural representation of handwriting
Prior BCI studies have shown that the motor intention for gross motor skills, such as reaching, grasping or moving a computer cursor, remains neurally encoded in motor cortex after paralysis1–7. However, it is still unknown whether the neural representation for a rapid and highly-dexterous motor skill, such as handwriting, also remains intact. We tested this by recording neural activity from two microelectrode arrays in the hand “knob” area of precentral gyrus (a premotor area)9,10 while our BrainGate study participant, T5, attempted to handwrite individual letters and symbols (Fig. 1a). T5 has a high-level spinal cord injury (C4 AIS C) and was paralyzed from the neck down; his hand movements were entirely non-functional and limited to twitching and micromotion. We instructed T5 to “attempt” to write as if his hand was not paralyzed, while imagining that he was holding a pen on a piece of ruled paper.
To visualize the neural activity (multiunit threshold crossing rates), we used principal components analysis to display the top 3 neural dimensions containing the most variance (Fig. 1b). The neural activity appeared to be strong and repeatable, although the timing of its peaks and valleys varied across trials, potentially due to fluctuations in writing speed. We used a time-alignment technique to remove temporal variability11, revealing remarkably consistent underlying patterns of neural activity that are unique to each character (Fig. 1c). To see if the neural activity encoded the pen movements needed to draw each character’s shape, we attempted to reconstruct each character by linearly decoding pen tip velocity from the trial-averaged neural activity (Fig. 1d). Readily recognizable letter shapes confirm that pen tip velocity is robustly encoded. The neural dimensions that represented pen tip velocity accounted for 30% of the total neural variance.
Next, we used a nonlinear dimensionality reduction method (t-SNE) to produce a 2-dimensional visualization of each single trial’s neural activity recorded after the ‘go’ cue was given (Fig. 1e). The t-SNE visualization revealed tight clusters of neural activity for each character and a predominantly motoric encoding where characters that are written similarly are closer together. Using a k-nearest neighbor classifier applied offline to the neural activity, we could classify the characters with 94.1% accuracy (95% CI = [92.6, 95.8]). Taken together, these results suggest that, even years after paralysis, the neural representation of handwriting in motor cortex is likely strong enough to be useful for a BCI.
Decoding handwritten sentences
Next, we tested whether we could decode complete handwritten sentences in real-time, thus enabling a person with tetraplegia to communicate by attempting to handwrite their intended message. To do so, we trained a recurrent neural network (RNN) to convert the neural activity into probabilities describing the likelihood of each character being written at each moment in time (Fig. 2a, Extended Data Fig. 1). These probabilities could either be thresholded in a simple way to emit discrete characters, which we did for real-time decoding (Fig. 2a “Raw Online Output”), or processed more extensively by a large-vocabulary language model to simulate an autocorrect feature, which we applied offline (Fig. 2a “Offline Output from a Language Model”). We used the limited set of 31 characters shown in Fig. 1d, consisting of the 26 lower case letters of the alphabet, commas, apostrophes, question marks, periods (written by T5 as ‘~’) and spaces (written by T5 as ‘>‘). The ‘~’ and ‘>‘ symbols were chosen to make periods and spaces easier to detect. T5 attempted to write each character in print (not cursive), with each character printed on top of the previous one.
To collect training data for the RNN, we recorded neural activity while T5 attempted to handwrite complete sentences at his own pace, following instructions on a computer monitor. Prior to the first day of real-time evaluation, we collected a total of 242 sentences across 3 pilot days that were combined to train the RNN. On each subsequent day of real-time testing, additional training data were collected to recalibrate the RNN prior to evaluation, yielding a combined total of 572 training sentences by the last day (comprising 7.3 hours and 30.4k characters). To train the RNN, we adapted neural network methods in automatic speech recognition12–14 to overcome two key challenges: (1) the time that each letter was written in the training data was unknown (since T5’s hand was paralyzed), making it challenging to apply supervised learning techniques, and (2) the dataset was limited in size compared to typical RNN datasets, making it difficult to prevent overfitting to the training data (see Supplemental Methods, Extended Data Figs. 2–3).
We evaluated the RNN’s performance over a series of 5 days, each day containing 4 evaluation blocks of 7–10 sentences that the RNN was never trained on (thus ensuring that the RNN could not have overfit to those sentences). T5 copied each sentence from an onscreen prompt, attempting to handwrite it letter by letter, while the decoded characters appeared on the screen in real-time as they were detected by the RNN (Supplementary Video 1–2, Extended Data Table 1). Characters appeared after they were completed by T5 with a short delay (estimated to be 0.4–0.7 seconds). The decoded sentences were quite legible (Fig. 2b, “Raw Output”). Importantly, typing rates were high, plateauing at 90 characters per minute with a 5.4% character error rate (Fig. 2c, average of red circles). Since there was no “backspace” function implemented, T5 was instructed to continue writing if any decoding errors occurred.
When a language model was used to autocorrect errors offline, error rates decreased considerably (Fig. 2c, open squares below filled circles; Table 1). The character error rate fell to 0.89% and the word error rate fell to 3.4% averaged across all days, which is comparable to state-of-the-art speech recognition systems (e.g. word error rates of 4–5% 14,15), putting it well within the range of usability. Finally, to probe the limits of possible decoding performance, we trained a new RNN offline using all available sentences to process the entire sentence in a non-causal way (comparable to other BCI studies 16,17). Accuracy was extremely high in this regime (0.17% character error rate), indicating a high potential ceiling of performance, although this decoder would not be able to provide letter-by-letter feedback to the user.
Table 1. Mean character and word error rates (with 95% CIs) for the handwriting BCI across all 5 days.
Character Error Rate [95% CI] | Word Error Rate [95% CI] | |
---|---|---|
Raw online output | 5.9% [5.3, 6.5] | 25.1% [22.5, 27.4] |
Online output + offline language model | 0.89% [0.61, 1.2] | 3.4% [2.5, 4.4] |
Offline bidirectional RNN + language model | 0.17% [0, 0.36] | 1.5% [0, 3.2] |
Next, to evaluate performance in a less restrained setting, we collected two days of data in which T5 used the BCI to freely type answers to open-ended questions (Supplementary Video 3, Extended Data Table 2). The results confirm that high performance can also be achieved when the user writes self-generated sentences as opposed to copying on-screen prompts (73.8 characters per minute with an 8.54% character error rate in real-time, 2.25% with a language model). The prior state-of-the-art for free typing in intracortical BCIs was 24.4 correct characters per minute 7.
Daily decoder retraining
Following standard practice (e.g. 1,2,18,4,5), we retrained our handwriting decoder each day before evaluating it, with the help of ‘calibration’ data collected at the beginning of each day. Retraining helps account for changes in neural recordings that accrue over time, which might be caused by neural plasticity or electrode array micromotion. Ideally, to reduce the burden on the user, little or no calibration data would be required. In a retrospective analysis of the copy typing data reported above in Fig. 2, we assessed whether high performance could still have been achieved using less than the original 50 calibration sentences per day (Fig. 3a). We found that 10 sentences (8.7 minutes) were enough to achieve a raw error rate of 8.5% (1.7% with a language model), although 30 sentences were needed to match the raw online error rate of 5.9%.
However, our copy typing data were collected over a 28-day time span, possibly allowing larger changes in neural activity to accumulate. Using further offline analyses, we assessed whether more closely-spaced sessions reduce the need for calibration data (Fig. 3b). We found that when only 2–7 days passed between sessions, performance was reasonable with no decoder retraining (11.1% raw error rate, 1.5% with a language model), as might be expected from prior work showing short-term stability of neural recordings19–21. Finally, we tested whether decoders could be retrained in an unsupervised manner by using a language model to error-correct and retrain the decoder, thus bypassing the need to interrupt the user for calibration (i.e., by recalibrating automatically during normal use). Encouragingly, unsupervised retraining achieved a 7.3% raw error rate (0.84% with a language model) when sessions were separated by 7 days or less.
Ultimately, whether decoders can be successfully retrained with minimal recalibration data depends on how quickly the neural activity changes over time. We assessed the stability of the neural patterns associated with each character and found high short-term stability (mean correlation = 0.85 when 7 days apart or less), and neural changes that seemed to accumulate at a steady and predictable rate (Extended Data Fig. 4). The above results are promising for clinical viability, as they suggest that unsupervised decoder retraining, combined with more limited supervised retraining after longer periods of inactivity, may be sufficient to achieve high performance. Nevertheless, future work must confirm this online, as offline simulations are not always predictive of online performance.
Temporal variety improves decoding
To our knowledge, 90 characters per minute is the highest typing rate yet reported for any type of BCI (see Discussion). For intracortical BCIs, the highest performing method has been point-and-click typing with a 2D computer cursor, peaking at 40 characters per minute 7 (see Supplementary Video 4 for a direct comparison). The speed of point-and-click BCIs is limited primarily by decoding accuracy. During parameter optimization, the cursor gain is increased so as to increase typing rate, until the cursor moves so quickly that it becomes uncontrollable due to decoding errors22. How is it then that handwriting movements could be decoded more than twice as fast, with similar levels of accuracy?
We theorize that handwritten letters may be easier to distinguish from each other than point-to-point movements, since letters have more variety in their spatiotemporal patterns of neural activity than do straight-line movements. To test this theory, we analyzed the patterns of neural activity associated with 16 straight-line movements and 16 letters that required no lifting of the pen off the page, both performed by T5 with attempted handwriting (Fig. 4a–b).
First, we analyzed the pairwise Euclidean distances between each neural activity pattern. We found that the nearest-neighbor distances for each movement were 72% larger for characters as compared to straight lines (95% CI = [60%, 86%]), making it less likely for a decoder to confuse two nearby characters (Fig. 4c). To confirm this, we simulated the classification accuracy for each set of movements as a function of neural noise (Fig. 4d), demonstrating that characters are easier to classify than straight lines.
To gain insight into what might be responsible for the relative increase in nearest neighbor distances for characters, we examined the spatial and temporal dimensionality of the neural patterns. Spatial and temporal dimensionality were estimated using the “participation ratio”, which quantifies approximately how many spatial or temporal dimensions are required to explain 80% of the variance in the neural activity patterns23. We found that spatial dimensionality was only modestly larger for characters (1.24 times larger; 95% CI = [1.19, 1.30]), but that the temporal dimensionality was much greater (2.65 times larger; 95% CI = [2.58, 2.72]), suggesting that the increased variety of temporal patterns in letter writing drives the increased separability of each movement (Fig. 4e).
To illustrate how increased temporal dimensionality can make movements more distinguishable, we constructed a toy model with four movements and two neurons whose activity is constrained to lie along a single dimension (Fig. 4f–g). Simply by allowing the trajectories to change in time (Fig. 4g), the nearest neighbor distance between the neural trajectories can be increased, resulting in an increase in classification accuracy when noise levels are large enough (Fig. 4h). Although neural noise in the toy model was assumed to be independent white noise, we found that these results also hold for noise that is correlated across time and neurons (Extended Data Fig. 5 and Supplemental Note 1).
These results suggest that time-varying patterns of movement, such as handwritten letters, are fundamentally easier to decode than point-to-point movements. We think this is one, but not necessarily the only, important factor that enabled a handwriting BCI to go faster than continuous-motion point-and-click BCIs. Other discrete (classification-based) BCIs have also typically used directional movements with little temporal variety, which may have limited their accuracy and/or the size of the movement set24,25.
More generally, using the principle of maximizing the nearest neighbor distance between movements, it should be possible to optimize a set of movements for ease of classification26. We explored doing so and designed an alphabet that is theoretically easier to classify than the Latin alphabet (Extended Data Fig. 6). The optimized alphabet avoids large clusters of redundant letters that are written similarly (most Latin letters begin with either a downstroke or a counter-clockwise curl).
Discussion
Locked-in syndrome (paralysis of nearly all voluntary muscles) severely impairs or prevents communication, and is most frequently caused by brainstem stroke or late-stage ALS (estimated prevalence of locked-in syndrome: 1 in 100,000 27). Commonly used BCIs for restoring communication are either flashing EEG spellers28–30,18,31,32 or intracortical point-and-click BCIs33,6,7. EEG spellers based on oddball potentials or motor imagery typically achieve 1–5 characters per minute28–32. EEG spellers that use visually evoked potentials have achieved speeds of 60 characters per minute 18, but have important usability limitations, as they tie up the eyes, are not typically self-paced, and require panels of flashing lights on a screen. Intracortical BCIs based on 2D cursor movements give the user more freedom to look around and set their own pace of communication, but have yet to exceed 40 correct characters per minute in people7. Recently, speech-decoding BCIs have shown exciting promise for restoring rapid communication (e.g. 34,16,17), but their accuracies and vocabulary sizes require further improvement to support general-purpose use.
Here, we introduced a novel approach for communication BCIs – decoding a rapid, dexterous motor behavior in a person with tetraplegia – that sets a new benchmark for communication rate at 90 characters per minute. The demonstrated real-time system is general (the user can express any sentence), easy to use (entirely self-paced and the eyes are free to move), and accurate enough to be useful in the real-world (94.1% raw accuracy, and >99% accuracy offline with a large-vocabulary language model). To achieve high performance, we developed new decoding methods to work effectively with unlabeled neural sequences in data-limited regimes. These methods could be applied more generally to any sequential behavior that cannot be observed directly (e.g., decoding speech from someone who can no longer speak).
Finally, it is important to recognize that the current system is a proof-of-concept that a high-performance handwriting BCI is possible (in a single participant); it is not yet a complete, clinically viable system. More work is needed to demonstrate high performance in additional people, expand the character set (e.g., capital letters), enable text editing and deletion, and maintain robustness to changes in neural activity without interrupting the user for decoder retraining. More broadly, intracortical microelectrode array technology is still maturing, and requires further demonstrations of longevity, safety, and efficacy before widespread clinical adoption35,36. Variability in performance across participants is also a potential concern (in a prior study, T5 achieved the highest performance of 3 participants7).
Nevertheless, we believe the future of intracortical BCIs is bright. Current microelectrode array technology has been shown to retain functionality for 1000+ days post implant37,38 (including here; see Extended Data Fig. 7), and has enabled the highest BCI performance to date compared to other recording technologies (EEG, ECoG) for restoring communication7, arm control2,5, and general-purpose computer use39. New developments are underway for implant designs that increase the electrode count by at least an order of magnitude, which will further improve performance and longevity35,36,40,41. Finally, we envision that a combination of algorithmic innovations42–44 and improvements to device stability will continue to reduce the need for daily decoder retraining. Here, offline analyses showed the potential promise of more limited, or even unsupervised, decoder retraining (Fig. 3).
Extended Data
Extended Data Table 1:
Extended Data Table 2:
Supplementary Material
Acknowledgements
We thank participant T5 and his caregivers for their dedicated contributions to this research, and N. Lam, E. Siauciunas, and B. Davis for administrative support. This work was supported by the Howard Hughes Medical Institute (F.R.W. and D.T.A.), Office of Research and Development, Rehabilitation R&D Service, U.S. Department of Veterans Affairs (A2295R, N2864C); NIH: National Institute of Neurological Disorders and Stroke and BRAIN Initiative (UH2NS095548), National Institute on Deafness and Other Communication Disorders (R01DC009899, U01DC017844) (L.R.H.); NIDCD R01-DC014034, NIDCD U01-DC017844, NINDS UH2-NS095548, NINDS U01-NS098968, Larry and Pamela Garlick, Samuel and Betsy Reeves, Wu Tsai Neurosciences Institute at Stanford (J.M.H and K.V.S); Simons Foundation Collaboration on the Global Brain 543045 and Howard Hughes Medical Institute Investigator (K.V.S). The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Competing Interests
The MGH Translational Research Center has a clinical research support agreement with Neuralink, Paradromics, and Synchron, for which LRH provides consultative input. JMH is a consultant for Neuralink Corp and Proteus Biomedical, and serves on the Medical Advisory Board of Enspire DBS. KVS consults for Neuralink Corp. and CTRL-Labs Inc. (part of Facebook Reality Labs) and is on the scientific advisory boards of MIND-X Inc., Inscopix Inc., and Heal Inc. FRW, JMH, and KVS are inventors on patent application US 2021/0064135 A1 (the applicant is Stanford University), which covers the neural decoding approach taken in this work. All other authors have no competing interests.
Footnotes
Additional Information
Supplementary Information is available for this paper. Reprints and permissions information is available at www.nature.com/reprints.
Data Availability Statement
All neural data needed to reproduce the findings in this study are publicly available at the Dryad repository (https://doi.org/10.5061/dryad.wh70rxwmv). The dataset contains neural activity recorded during attempted handwriting of 1,000 sentences (43.5k characters) over 10.7 hours.
Code Availability Statement
Code that implements an offline reproduction of the central findings in this study (high-performance neural decoding with an RNN) is publicly available on GitHub at https://github.com/fwillett/handwritingBCI.
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