Designing for the Brain–Body Axis as an Integrated System: Continuing the Conversation from NeuroCAS 2018

IEEE Brain: Brainstorming - Designing for the Brain

This article poses a number of questions regarding current challenges and opportunities in neurotechnology with the intent of soliciting feedback. Your input is valuable, and will be used to help shape efforts such as identifying conference topics, white paper focus areas, and technology roadmap content. As you read, please take a few moments to respond to the questions found throughout the article.
Designing technology that taps into the brain/body network poses multiple challenges as well as opportunities for those in the neuroscience and engineering fields. Complexities range from a lack of basic neuro-scientific understanding to materials challenges, system challenges, and even regulatory challenges. Even so, the opportunities and potential benefits of successful neurotechnology are numerous, including developing therapeutic approaches that may soon offer functional cures for neurological diseases such as epilepsy and movement disorders, and augmentative devices for memory and social enhancement.
At the NeuroCAS workshop held October 2018 in Cleveland, Ohio, researchers and entrepreneurs across the fields of bio-signals and neurotechnology came together to identify and discuss obstacles and possibilities in technology research and development. The collaborative workshop was fueled by a series of brief invited talks that highlighted research opportunities in areas related to electrocorticography (ECoG) and brain-body interfaces incorporating the peripheral and autonomic nervous systems (PNS/ANS). Participants were asked to note roadblocks to technology development and implementation they have encountered in their own work as well as those that are seen to affect their fields as a whole. Primary discussion areas noted at the event are highlighted below with open questions at the end of each section. Although these represent only a small portion of the technical and organizational areas, multiple perspectives and input will be valuable in developing paths forward, and your answers will assist in broadening discussion beyond those present at the workshop.

1. Scientific Understanding

Current scientific understanding of how the brain actually works is limited, which means that when designing technology to work with brain systems it is much like positioning the cart before the horse. In fact, the lack of progress in understanding can be seen as a crisis: currently, exponentially increasing quantities of data and publications are producing diminishing returns of understanding and knowledge. Looking toward the future of neuroscience, there is a greater need for education to embrace multi-disciplinary approaches in order to prepare young researchers for the breadth of this work, and far more emphasis needs to be placed on collaboration and sharing of research among different stakeholders.
Another potential avenue to address this challenge would be development of a new field—“neuro-epistemology”—that would provide an educational platform for promoting a paradigm shift. The goal of this field would be to encompass the broader theory of knowledge required to address the range of subjects and methodologies that fall under the rubric of researching and understanding brain function. Such a field would be interdisciplinary and collaborative, allowing for research and publications that extend beyond current boundaries. This pursuit would be in line with calls to develop a technology roadmaps and boost the rise and frequency of neurotechnology fellows.
What are primary areas in which we lack understanding of brain function? How might funding for the pursuit of knowledge be encouraged? Would focusing on a new educational sub-field with associated journals/avenues for publication aid in the creation and dissemination of brain network knowledge?

2. Communication and Collaboration

Communication between different expertise groups is often seen as a challenge for designing effective bio/neurotechnology – engineers and clinicians operate in distinct arenas and without collaboration the technology design often misses the true need of the patient or is too complicated for clinician adoption and use. Fundamental differences remain between work done in the academic and research setting to generate knowledge versus that of a company focused on consumer applications or a clinician trying to fulfill a patient need. Bringing these different drivers closer together with the brain/body axis at the center may help drive collaboration forward.
What are some ways to cultivate multi-disciplinary points-of-view in design and application of technology that addresses the brain/body axis? How might education adapt to include more focus and training on communication and collaboration across disciplines?

3. Market Translation

Barriers to entry, patient and public misconceptions, lack of funding, and clinical inertia are key challenges when designing neuro- and bio-signals technology. Many promising innovations never leave the lab, and in general, neuroscience advances have not experienced widespread adoption. An important first step in addressing translation challenges is ensuring that the technology is actually solving problems that patients need and really care about. Taking the time to plan for contingencies, prototype, and refine new technologies with end-users not only demonstrates value for the healthcare system, but also models how best to work with patients throughout long-term care and maintenance of devices.
Fostering new partnership models (e.g., clinician-research teams) and shifting away from an appliance mentality will be key to creating a platform economy for neural devices in the future. Venture investment in neurotechnology devices is growing and incremental changes that focus on user-centered design often are a better place for small startups. Emulating pharmaceutical development models for moving products from the lab to patients may expand access opportunities, in tandem with efforts to partner with pharmaceutical companies to secure funding. Pursuing new design perspectives and forward-looking architecture such as research kits and open source applications that drive down costs to patients are also potential pathways to opening the clinical translation space to neuroscience and bio-signals researchers and designers.
How might the field identify and support avenues that successfully balance the need for exploration with economic/funding needs? What platform technologies would be most helpful? How best to increase favorable perception of bio/neurotechnology among patients, clinicians, and regulatory bodies?

4. Platform and System Integration

Integrating devices within the greater nervous system in effective and reproducible ways presents multiple challenges on both the macro- and micro-scale, including addressing adverse body/tissue reactions, materials and electrode design, communication linkages, data management, sensing, and recording. In general, less invasive, smaller, and more robust interface technologies will be required for widespread adoption. Chemical sensors and molecular electronics may need to be employed to gather signals and data from multiple points. The eventual goal would be to improve spatial resolution, selectivity, and signal to noise ratio (SNR) using new neural hybrid probes.
Opportunities include design of devices that don’t require surgery to implant, using ultrasound or optical imaging for example. There are also opportunities here for hybrid systems, new biosensors, and artificial intelligence.
How might integration of heterogeneous and computational paradigms for brain activity be achieved? What types of (wireless) communication links would be necessary for an integrated platform? What interdisciplinary platform(s) is needed to map adverse body/tissue reactions over time? How do we study those reactions?

5. Recording / Stimulation Specificity

Until there are neurotechnologies that interface with the brain in a way that is indistinguishable from its own communication, accurately modifying neural activity and resulting behavior will remain difficult. Many challenges exist in employing long-term, accurate recording of brain signals, such as electrode technology and placement, balancing the number of channels with size of cables, managing SNR, and specificity: single neuron recordings provide limited information; field potentials are more stable but present difficulties for interpretation. Multiple electrodes capture each signal slightly differently and individual neurons are only viable for a limited time due to encapsulation. Choosing the right signal—selectivity—and identifying new targets (e.g., deep brain) are important pathways to recruiting specific populations of neurons.
Opportunities lie in design of new electrodes as well as discovering better ways to record from the brain as well as the body, including exploiting multi-modalities, e.g., optogenetics, laser stimulation, chemical sensors, etc. Closed-loop control may eventually offer opportunities to choose the optimal combination of modalities. In addition, developing new ways to record and stimulate using optical and microfiber probes may limit scarring and encapsulation, and offer more targeted selectivity.
What drivers are necessary to spur advancement in electrode design? How might wireless technology aid in recording and stimulation? What materials advances are required to realize next-generation sensors and electrodes?

6. Power and Energy

Managing and improving power consumption and storage for bio/neurotechnology is necessary for long-term patient use outside of a lab or other controlled environment. This is especially true when designing deep brain implants as well as sensors/electrodes that monitor the peripheral nervous system (PNS). Combining power modalities (e.g., inductive, capacitive, ultrasound) and developing ways to harvest energy from the chemical and mechanical processes of the body might provide the keys to meeting high-power requirements.
How might power modalities be combined to best meet power requirements? In what ways could technology be designed to harvest energy directly from the mechanical output of muscles and intestines?

7. Security and Privacy

Data access and long-term analysis as well as interpretable algorithms were seen as growth opportunity areas across the field. However, bandwidth, hardware cost, and collection of reliable and viable data present obstacles to design and implementation of technology. Data management (e.g., who owns the data and who has access to data) along with patient privacy and security of information remain key challenges.
Recent CLOUD advances for computation and processing, along with artificial intelligence (AI), may offer solutions for analyzing neural signals, although questions on what types of data are required to obtain a reliable measure of health will need to be answered prior to successful analysis and treatment of health conditions. Ethical guidelines and patient advocacy would aid in developing data security and privacy protocols; further system design and management would be required to guard devices and data/storage systems from hacking and unwarranted use.
How should relevant data be collected in relevant quantities while ensuring privacy and security? How best to align data from multiple sensors/inputs? What opportunities does AI offer to the management of neurological and biological data?

8. Regulatory Complexity and Ethics

The lack of regulatory pathways to approve emerging bio/neurotechnology not only poses a severe liability for translation, but also raises new questions when considering ethical use of devices and regulation of data. Ethical implications of technology development and use, especially in cases of altering or augmenting mental and cognitive processes, was identified as something the field as a whole needs to address. Privacy and security of data, safety of devices, invasive vs. non-invasive technology, surgical complexity, and long-term maintenance add to the ethical considerations and regulatory barriers.
Proposed solutions include educating regulatory bodies and the public more directly on ethical use and therapeutic benefits of bio/neurotechnology as well as working with support agencies to lobby for new regulatory procedures. Formulating general recommendations for ethical development and defining guidelines for research projects as well as encouraging researchers to consider and examine ethical implications in their use case studies will help bring consensus to the field and avoid potential abuse of technology.
How should responsible use of technology be determined? Should limits be placed on the use case scenarios of bio/neurotechnology (e.g., augmentation vs. therapeutic)? What support mechanisms would be necessary to overcome regulatory barriers?


Workshop organizers for the NeuroCAS 2018 event included Tim Constandinou, Imperial College London, as General Chair; Theme Chairs Aysegul Gunduz, University of Florida, and Matthew Schiefer, Case Western Reserve University; Pedram Mohseni, Case Western Reserve University, and Dustin Tyler, Case Western Reserve University, IEEE BioCAS 2018 Co-Chairs. Additional support for the workshop was contributed by the IEEE Brain Initiative.

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