Blackrock Neurotech, whose brain-computer interface (BCI) has been implanted in more patients than any other company, is taking its technology to the next level. The Salt Lake City-based company is partnering with Cognixion - a wearable BCI startup.
Cognixion’s device, known as the Axon-R, resembles a VR headset. Using the device requires no surgery - something that’s necessary for many other BCI players. The headset sits on the patients head similar to sunglasses. It features six electrode sensors placed on the back of the skull to monitor brain activity. The device can then detect a choice among multiple options based on which answer the person paying attention to.
CEO Andreas Forsland tells me that Cognixion’s technology will be available to doctors and scientists who are working with Blackrock’s implant - the Utah Array. Basically doubling up the technologies.
“It's the stuff that researchers have been dreaming about and now they can finally have access to it - having combined technologies to be able to use our technology and their technology together,” Forsland told me. “We’re really opening up an abundance of new opportunities for scientists and doctors to explore what's possible.”
Forsland founded Cognixion nearly 10 years ago to help people who have lost the ability to speak and move. His company has raised $25 million to date from investors including Amazon, the ALS Association and Northwell Health.
“What's very unique about Cognixion is that we didn't really start with the technology,” Forsland said. “We started with the community and we worked backwards to try and find a solution that could scale across different kinds of conditions.” Forsland created a user advisory council called the “brainiacs” made up of 200 people who have different forms of paralysis, medical professionals and caregivers.
One of those “brainiacs” is Ian Burkhart, a high school lacrosse coach in Columbus, Ohio. Burkhart, now 34, was paralyzed in 2010 after diving in shallow water. “I immediately knew something was wrong because I couldn't move my body anymore,” Burkhart said. The accident left him unable to move his limbs - a C5 complete tetraplegic.
In 2014 he was implanted with Blackrock Neurotech’s brain-computer interface, called the Utah Array. The brain implant, which he had for over 7 years before it was removed, allowed him to move his hands with his thoughts while in the lab.
Burkhart was the first person in the world to restore movement to a paralyzed limb using a BCI neuroprosthetic. Although Burkhart’s BCI journey wasn’t without challenges, he said he’s hoping to get another.
“I would be really excited but I would want it to be something I can use in my day to day life,” Burkhart said. “I’m kinda past being the research subject and wanting the device to really help me with my daily life outside of a lab.”
Today, Burkhart is involved in several advocacy groups to help support people with spinal cord injuries. He consults companies like Cognixion on their BCI technology.
“For someone who's thinking about having an implanted device put in their body, I think it's really helpful for them to be able to have a little taste of something that's a wearable device first,” Burkhart said. “And for those who don't want to have anything implanted in their body, it's really helpful to have other options. I think it's a great opportunity to get more devices out to people and really allow them to make the decision that fits for their life best.”
Read my full interview with Forsland below. We talk about Cognixion’s wearable device, the race to help people who have different forms of paralysis and his message for Neuralink’s CEO Elon Musk. The interview has been lightly edited for length and clarity.
Yasmin: Cognixion is a wearable brain-computer interface, how does it work?
Forsland: It’s a neural interface platform. We combine brain computer interface with augmented reality and we use this wearable headset that we've created as a platform for healthcare. So we sell our platform into healthcare systems, specifically neurology and we're co-developing applications that help people with neurodegenerative conditions function in daily life. That includes applications for daily active living like augmented communication. So think about BCI using thought to speech as an application for someone with ALS wheelchair control, so being able to move around as well as clinical applications like diagnostics and therapeutics.
Yasmin: What types of people is this technology for?
Forsland: It's designed specifically for people who have had a traumatic brain injury or they have a neurodegenerative condition. So think about individuals who've had a stroke or a traumatic brain injury or a spinal cord injury. Or folks who have a neurodegenerative condition like Alzheimer's, ALS Parkinson's, multiple sclerosis things of that nature.
Yasmin: Walk me through how the Cognixion headset works.
Forsland: I like to use someone like Stephen Hawking as an example, because he's very well known and people understand his sort of situation. Stephen Hawking had ALS so he was unable to use his upper body and had very limited mobility of his eyes. So someone like Stephen Hawking would don the headset. It’s a wearable headset that has a visor in the front. It looks like very large sunglasses. It's not VR it's like an optical see through lens and inside that lens, inside the headset, has holograms with different kinds of applications. One app might be a speech application or another app might be a smart home control application or a wheelchair control application. On the back of the headset are EEG sensors that pick up intention or attention. So we can monitor what their brain is paying attention to through sophisticated classifiers and algorithms.
Someone like Stephen Hawking could wear this headset and he could have a keyboard or something up in front of him - or our AI engine that someone can use for conversations. The headset listens to the environment through the microphone, and it captions what's being said and that feeds an AI engine in the headset. All the person has to do is pay attention to prompts of responses. So the ones that they pay attention to are the ones that get spoken out loud. These are what we call assisted reality applications. And Cognixion is developing a whole suite of assisted reality applications that are usable through a brain computer interface.
Yasmin: What are the benefits to this wearable system versus say a Neuralink implant that’s placed on the brain through surgery?
Forsland: The first is most obvious - no surgery required. The second - if you look at Neuralink, or pretty much every other implantable BCI, all implants are primarily focused on making sure the sensor itself that is implanted in the body is safe. So all of the almost $2 billion so far has been invested in making sure that a variety of implantable sensors can be safely used and can be connected to a computer. What's different about cognition is we actually provide that wearable computer plus an application development environment for creating apps for different use cases that would benefit from a brain computer interface, whether that's wearable or implantable.
Neuralink has been getting a number of clinical trials approved to pursue different solutions. I believe they've been working on some kind of vision restoration. They're working on the ability to get to see if it'll work with speech, see if it will work with computer control. So all of those instances where Neuralink is trying to get their device cleared, at the end of the day, the FDA is going to require that an implant company has their sensor cleared for a very specific use case. So likely Neuralink’s first commercially available version will be constrained to a single feature - like moving a mouse or generating speech through some kind of application. They will be limited to a single point solution, whereas Cognixion can offer many kinds of applications on our platform without the same level of safety testing required for an implant sensor alone.
Yasmin: How can someone get their hands on a headset?
Forsland: We are commercial today for businesses and some of our partners. We currently have two versions of our Cognixion headset. One version is going through the process with the FDA to be cleared as a wearable speech generating device - that was the Cognixion Axon. We have a second version of that headset that's aimed for research purposes only, and that's being purchased by clinical research health systems that are using the platform to research interesting clinical use cases. Some of the customers include: Northwell Health in New York, Memorial Hermann in Texas, Houston Memorial in Texas, Johns Hopkins, Brown University, Mass General Hospital. All of these types of organizations are doing clinical research using our hardware and they're building applications on top of the hardware for different kinds of diagnostics and clinical therapeutics for those same kind of patients we're talking about.
We have very great, deep relationships within the ALS community. As a result of these relationships we're building applications on our platform for daily active living - such as communication, mobility control, smart home control. But these clinical partners are building almost like a clinical suite of applications for folks with neurodegenerative conditions. So if you could imagine someone in your family who maybe has been diagnosed with ALS, in the future, the Cognixion wearable platform could eventually contain a whole bunch of applications that would be very helpful as you go through your patient experience - from diagnosis all the way through the ups and downs of the condition.
Yasmin: How many people have tried the Cognixion system?
Forsland: It's being used in under clinical oversight by our health system partners so I can't really disclose how many people or patients. But we've been in business for almost 10 years and over that period we've tested our headset with more than 200 people. We have a user advisory council we call the “brainiacs” and it's over 200 people with lived experience with different kinds of conditions. We've had folks who've had sodium overload, like toxic shock and it's caused them to be unable to communicate after a surgical procedure. We have folks who've had stroke or we have neurosurgeons, neurologists, speech therapists, occupational therapists, physical therapists, psychologists as well as caregivers.
This is a really down to earth community of people who want to be part of our design process. That’s what's very unique about Cognixion is that we didn't really start with the technology. We started with the community and we worked backwards to try and find a solution that could scale across different kinds of conditions. Because what we found is most solutions are really narrowly defined to one condition or another even though the utility of that solution could benefit others. So we're coming at it from more of a platform strategy.
Yasmin: I love the “brainiac council” - can you tell me a bit more about them?
Forsland: So these brainiacs chip in their ideas, their suggestions, they respond to feedback on informal surveys, case studies, focus group type interactions. Many of them have tried the system itself so we'll go out into the field, into their homes, and try out the technology and gather their feedback. We gather a lot of feedback from a wide variety of people from all walks of life, with many different conditions. So we have really enrolled all of them into the design process.
Yasmin: $25 million raised to date. Let’s talk about your investors - Amazon is a big one.
Forsland: Cognixion has some really fantastic investors. Amazon invested in us because we've integrated the Alexa stack into our technology to make it easier for someone who has extremely limited abilities to control their home or access all the things that you can do with Alexa.
The ALS Association, the world's largest nonprofit focused on raising awareness for ALS and also driving research for a cure, just opened up an impact investing fund and we're the first and only investment that the ALS Association has made to date. We also have healthcare system investors at some of the largest healthcare systems as well.
Going back to why Cognixion is unique - we're trying to focus on the community and dealing with real issues that are lifelong and chronic. There are no cures available for these things but people still need things to do to cope with the realities. When you work backwards from the community, roughly 15% of the world's population has some form of disability that impacts their nervous system. If you back out of that, in the United States alone, there's 25 million people that have a condition that would benefit from a non-invasive BCI, and about a quarter of a million of those people will benefit from an implant. So there's many orders of magnitude larger impact we can make with people that have certain kinds of conditions that may never qualify for an implant.
Yasmin: Let’s dive into this partnership with Blackrock Neurotech - how will your technologies work together?
Forsland: We're very excited. Blackrock Neurotech is really the pioneer in implantable brain computer interfacing. They were born out of the University of Utah, and they have a sensor that is implanted directly into the cortical surface of the brain. They have implanted more humans than any other BCI company in the world. In fact, they have more chronically implanted humans than anyone else in the world. What I mean by that is that they've implanted a human with a brain chip and that human has had the brain chip in their body for seven years or more. So as you hear about Neuralink and some of these others that are coming online with their first clinical studies, some of these are only implanted for 30 days, and some of these are being tested to see how long they can sort of keep the implant in their body without their body rejecting it. Blackrock is decades ahead commercially as well as clinically than any other implantable BCI company.
So we felt it would be appropriate, because their mission and our mission is really to help a lot of people, and they are already out in the marketplace selling their implants into research universities. We have very similar commercial targets that are right in front of us where we're working with some of the same scientists and doctors — it made a lot of sense to team up for those research scientists who are doing studies with these kinds of neurodegenerative conditions and traumatic brain injuries, etc. If they're already doing implants then we are going to be collectively making our headset and our technology available to those doctors and scientists that are already doing research with implants to be able to to get rid of all the other miscellaneous computers that they rely on.
So if you've ever seen a videos of anyone that's had a brain implant, usually they're sitting in front of a desk with a big monitor with wires sort of dangling out of their head, and there's a huge sort of hidden computer rack server system that's processing all that data. We're eliminating all that complexity and bringing all that computing right onto their head. And we're going to be making many more applications available to individuals who have implants or will be getting implants.
It’s a win for us, but really it's a win for the community. It's the stuff that researchers have been dreaming about and now they can finally have access to it - having combined technologies to be able to use our technology and their technology together. We’re really opening up an abundance of new opportunities for scientists and doctors to explore what's possible. We're very excited about the possibilities of really disrupting the practice of care delivery for neurology.
Yasmin: Do you see a future where Cognixion will be used by people who won’t need it for medical purposes?
Forsland: We call it universal design. By designing things that are easy to use by people that have the most limited abilities, it just makes it easier for everybody else. If you think about someone who has a disability, or they might have had a brain injury, our technology is being used to restore some some capabilities. But for individuals who don't need restoration, they want to talk about increasing their performance, our system could very easily also be used in high performance such as like physical training, cognitive assessments, education, collective decision making.
There's lots of mental enhancements that you can use to develop yourself in a performance based use case. We have some high performance sports labs that are using our technology in that capacity, we've also been approached by defense for human performance - like AI for cognitive training, fatigue tracking, biofeedback, neuro feedback for human soldiers and for pilots. It can be used for enhancing capabilities for human pilots and anyone that's dealing with mobility. So there's a lot of really fascinating use cases out there for our technology that are in the enhancement space.
Yasmin: Any final thoughts?
Forsland: I wouldn’t mind wagering a fun competition with Neuralink if Elon would be willing to go with me on this. A race to see who could help the most people in the next 5 years — I’m game to creating a public wager with him.
Y
Share this post