- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06207591
Investigation on the Cortical Communication System (CortiCom)
Investigation on the Cortical Communication (CortiCom) System
The goal of this clinical trial is to demonstrate communication through a brain implant in people in locked-in state, i.e. people with severe paralysis and communication problems.
The main questions it aims to answer are efficient and stable control of Brain-Computer interface (BCI) functions for communication with attempted hand movements and operation of a keyword-based speech BCI.
Participants will be implanted with four electrode grids, with in total 128 electrodes, on the surface of the brain and a connector on the skull. Participation includes visits of researchers for recording and training at home, 2-3 times per week for one year. Extension of participation after one year is possible.
If successful, the participant will be able to use the BCI at home independently, without the presence of a researcher.
Study Overview
Status
Intervention / Treatment
Detailed Description
Locked-In Syndrome (LIS) is a neurological condition in which communication is impossible, or profoundly impaired, due to loss of speech and other motor functions, while cognition is intact. The most distressing aspect of LIS is the inability to initiate and sustain communication. Existing assistive technologies (ATs) fall short of a remedy. An effective brain-computer interface (BCI) for communication would dramatically improve quality of life for people with LIS. Electrocorticography (ECoG) with non-penetrating subdural electrodes is a promising implantable approach for BCI. In this study, the "CortiCom system" (which stands for Cortical Communication) wil be used. This system combines an implantable assembly, consisting of four small high-density (HD) ECoG grids on the hand and speech areas of the motor cortex, totalling 128-channels, and a transcutaneous pedestal connector, with an external data acquisition system. With the CortiCom system the overall hypothesis will be tested that broader and more densely spaced ECoG electrodes can better tap into the spatial detail of the organization of the sensorimotor cortex in order to expand BCI function and restore meaningful communication in LIS. Specifically, the CortiCom system will substantially increase the number and density of electrodes recording from the brain to determine whether more sophisticated control and communication can be achieved with more comprehensive and detailed spatial sampling of representations for movements of the hand/arm and of speech articulators. Clinically meaningful outcomes for people with LIS include rapid reestablishment, and stable maintenance of communication, at minimum consisting of a caregiver call-button and menu selections.
Objective:
Primary Objective 1: Demonstrate efficient and stable control of essential BCI functions (initiate BCI, call caregiver, and menu selections). Primary Objective 2: Demonstrate efficient and stable operation of a keyword-based speech BCI.
Intervention:
Participants will be implanted with an assembly consisting of HD-ECoG electrode grids over the sensorimotor cortex and a transcutaneous pedestal connector. The assembly will be connected with an external data acquisition system during recordings. During recordings, feedback about the neural signals is given via a visual display and participants are trained to employ the neural signals for fast brain-based communication. Upon adequate performance, participants can independently (i.e., without researcher involvement) train with and use the system at home for validation of performance and usability. After implantation, participation has a duration of 1 year, with a possibility of extension.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Mariska J Vansteensel, PhD
- Phone Number: +31887555121
- Email: neuroprothese@umcutrecht.nl
Study Contact Backup
- Name: Erik J Aarnoutse, PhD
- Phone Number: +31887555123
- Email: e.j.aarnoutse@umcutrecht.nl
Study Locations
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-
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Utrecht, Netherlands, 3584CX
- Recruiting
- University Medical Center
-
Contact:
- Mariska J Vansteensel, PhD
- Phone Number: +31887555121
- Email: neuroprothese@umcutrecht.nl
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Contact:
- Erik J Aarnoutse, PhD
- Phone Number: +31887555123
- Email: e.j.aarnoutse@umcutrecht.nl
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Principal Investigator:
- Nick F Ramsey, PhD
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- 18-70 years
- Clinical diagnosis of locked-in state caused by traumatic brain injury, brainstem stroke, neurodegenerative disease, neuromuscular disease or another cause
- Complete or incomplete tetraplegia (quadriplegia) or tetraparesis (quadriparesis)
- Motor-related speech impairment (dysarthria or anarthria)
- Either receiving tracheostomy invasive ventilation, or having a stable and adequate respiratory situation without respiratory support, allowing for safe intubation, mechanical ventilation and detubation during surgery according to the involved clinicians, and, if relevant (e.g., in case of a progressive condition), in combination with a confirmed desire to receive tracheostomy invasive ventilation when that becomes necessary
- Meeting surgical safety criteria, including surgical clearance by the study physicians
- Meeting (neuro)psychological evaluation criteria
- Ability to communicate reliably, such as through eye movement
- Willingness and ability to provide informed consent
- Lives within reasonable distance from University Medical Center Utrecht
- Participant consents to the study and still wishes to participate at the time of the study
- Vision and hearing largely intact
Exclusion Criteria:
- Performance on formal neuropsychological testing that indicates a significant current or recent psychiatric disorder, cognitive or behavioral impairment, that would interfere with obtaining informed consent or fully participating in study activities
- Medical conditions contraindicating surgery of a chronically implanted device or that could interfere with study participation (for example active infections, unexplained fever, existing scalp lesions or skin breakdown, osteomyelitis, hepatitis, any autoimmune disease/disorder, epilepsy, skin disorders causing excessive skin sloughing or poor wound healing, cranioplasty, significant cardiovascular, metabolic, or renal impairments, chronic oral or intravenous use of steroids or immunosuppressive therapy, active cancer within the past year or requires chemotherapy, uncontrolled autonomic dysreflexia within the past 3 months, hydrocephalus with or without an implanted ventricular shunt or a medical contraindication to stop anti-coagulant medications during surgery)
- Presence of pre-surgical findings in anatomical, functional, and/or vascular neuroimaging that makes achieving implant locations too challenging or incompatible with desired risk levels
- Inability to undergo MRI for pre-implantation evaluation, for example due to the presence of implanted devices that are incompatible with MRI, which may include pacemakers, cardiac defibrillators, spinal cord or vagal nerve stimulators, deep brain stimulators, and cochlear implants
- Anticipated need for MRI after implantation of the CortiCom assembly
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: ECoG (electrocorticography) sensing
Use implantable ECoG-based Brain Computer interface to control assistive technology
|
Implant electrodes and pedestal connector and use, through amplifier and decoding, for control of BCI
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Usability of the BCI system - Accuracy
Time Frame: 1 year
|
Accuracy: >80% sensitivity (true positive rate) for 1-command control, and 90% sensitivity and 80% classification accuracy (distinguishing between the six classes) for 6-command control
|
1 year
|
Usability of the BCI system - speed
Time Frame: 1 year
|
Speed characters or keywords per minute
|
1 year
|
Usability of the BCI system - subjective workload VAS
Time Frame: 1 year
|
Subjective Workload: Visual Analogue Scale Continuous scale: Little to no effort (0) - Much effort (5).
Lower numbers are better.
|
1 year
|
Usability of the BCI system - subjective workload NASA-TLX
Time Frame: 1 year
|
Subjective Workload: National Aeronautics and Space Administration-Task Load Index Scale: 21 point Likert-type scale.
Lower numbers are better.
|
1 year
|
Usability of the BCI system - user satisfaction PIADS
Time Frame: 1 year
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User Satisfaction: Psychosocial impact of assistive devices scale.
Likert-type scale -3, -2, -1, 0, 1, 2, 3. 3 is best result.
|
1 year
|
Usability of the BCI system - user satisfaction QUEST
Time Frame: 1 year
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User Satisfaction: Quebec User Evaluation of Satisfaction with assistive Technology. Likert-type scale: Extremely dissatisfied - Dissatisfied - Slightly satisfied - Satisfied - Extremely satisfied. Extremely Satisfied is the best result. |
1 year
|
Usability of the BCI system - validation
Time Frame: 1 year
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Validation: Questionnaire to evaluate user satisfaction and ease of use of the home use software. Likert-type scale: fully disagree - disagree - neither agree or disagree - agree - fully agree - not applicable. Fully agree is the best result. |
1 year
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Degrees of Freedom of BCI Control.
Time Frame: 1 year
|
the number of different commands that are successfully decoded, or the size of the decoded vocabulary
|
1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Stability of BCI performance (electrode-tissue interaction)
Time Frame: 2 years
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Longitudinal data of the 24-hour cycle after implantation of the impedance (in Ω).
The data are fitted to determine trends and variance, over weeks, to determine improvement or deterioration of electrode-tissue interaction.
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2 years
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Stability of BCI performance (signal)
Time Frame: 2 years
|
Longitudinal data of the 24-hour cycle after implantation of the raw power (after wavelet transform, in arbitrary units).
The data are fitted to determine trends and variance, both within 24 hrs to detect a possible circadian pattern and over weeks, to determine improvement or deterioration of signal amplitude.
|
2 years
|
Stability of BCI performance (modulation)
Time Frame: 2 years
|
Longitudinal data of the 24-hour cycle after implantation of the task-related modulation in power (correlation in r2).
The data are fitted to determine trends and variance, over weeks, to determine improvement or deterioration of modulation.
|
2 years
|
Stability of BCI performance (performance)
Time Frame: 2 years
|
Longitudinal data of the 24-hour cycle after implantation of the BCI performance (task accuracy).
The data are fitted to determine trends and variance, both within 24 hrs to detect a possible circadian pattern and over weeks, to see improvement or deterioration of accuracy.
|
2 years
|
Independent use of BCI
Time Frame: 2 years
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Longitudinal data of independent use per day.
The best result is 24h use.
The data are fitted to determine trends and variance, both within 24 hrs to detect a possible circadian pattern and over weeks, to see increase or decrease of the hours of independent use.
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2 years
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Assess device specifications for future application of HD ECoG-BCIs
Time Frame: 2 years
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qualitative description on device specifications and experimental parameters, such as the specific decoder settings, for future, larger scale, application of HD ECoG-BCIs.
|
2 years
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Nick F Ramsey, PhD, UMC Utrecht
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Ischemia
- Pathologic Processes
- Necrosis
- Cardiovascular Diseases
- Vascular Diseases
- Cerebrovascular Disorders
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Neurologic Manifestations
- Wounds and Injuries
- Craniocerebral Trauma
- Trauma, Nervous System
- Brain Ischemia
- Infarction
- Stroke
- Brain Infarction
- Paralysis
- Quadriplegia
- Brain Injuries
- Brain Injuries, Traumatic
- Neuromuscular Diseases
- Brain Stem Infarctions
- Locked-In Syndrome
Other Study ID Numbers
- UMCU 23-171
- NL81205.041.23 (Other Identifier: NedMec)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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