nucleation

LIT-1200: Spelling interface using intracortical signals in a completely locked-in patient enabled via auditory neurofeedback training

3 min read

Properties5
StatusActive — read 2026-10-16 (NOTE-951) in full, from the open-access article at nature.com; the Supplementary Information was not read. Worth reading as the one report of a patient classed as completely locked-in who spelled self-chosen sentences through a BCI, by learning to raise or lower motor-cortex firing rates against an auditory tone after attempted and imagined movements gave no usable signal. Read it knowing that he had used an eye-movement BCI with the same speller until weeks before CLIS, that he had been in CLIS for weeks rather than years, that control was intermittent (intelligible output on 44 of 107 days) and rated by the authors, and that the authors concede residual muscle control was not excluded. As published, the article carries no editor's note, correction, expression of concern or retraction (nature.com and Crossref, 2026-10-16).
Version2
Tagsneuroscience, learning-and-conditioning
ReportsCASE-107 — Locked-in syndrome: consciousness preserved with anarthria and quadriplegia; in the classic form, vertical eye movement and blinking remain and carry communication, and in the completely locked-in state no motor channel remains
Cited as “paper” byNOTE-951 — Chaudhary et al. — intracortical spelling in a completely locked-in patient

Graph View

Chaudhary, U., Vlachos, I., Zimmermann, J. B., Espinosa, A., Tonin, A., Jaramillo-Gonzalez, A. et al. (2022). Nature Communications 13:1236. doi:10.1038/s41467-022-28859-8. Preprint: medRxiv, 2020, doi:10.1101/2020.06.10.20122408.

Key takeaways

From the reading, NOTE-951.

  • History. ALS diagnosed 2015, ventilated from 2016; eye-tracker until August 2017; EOG-based BCI with an auditory speller from February 2018 “until February 2019”; consent to surgery given “using his eye movements for confirmation” before he “transitioned into CLIS”; implantation March 2019. In CLIS “a few weeks before and also after implantation”.
  • What failed. Eye-movement strategy and attempted or imagined hand, tongue and foot movement: “we could not detect consistent responses”.
  • What worked. Auditory neurofeedback of one to four channels’ firing rate, with a reward sound on success: modulated on the first attempt (day 86), matched targets on day 98, spelled from day 106 with a speller “identical to the one used previously when he was still in control of eye movements”. 86.6% correct neurofeedback trials; intelligible text on 44 of 107 attempted days; 1.08 characters per minute.
  • Vision and hearing. He lost “the ability to open his eyes voluntarily as well as visual acuity”; the auditory system served throughout.
  • On extinction. The authors say a CLIS sentence “would upend” the extinction and cognitive-dysfunction hypotheses, and that the case shows “an individual unable to move for protracted periods is capable of meaningful communication”. They also kept the decoder unchanged lest a change “impede or extinguish the successful control”.
  • Caveats in the paper. CLIS is defined by the absence of communication; “more sensitive measurements of somatic-motor control could reveal some form of volitional control”; output rated by three authors.
  • Notices. None on the article as published (nature.com and Crossref, checked 2026-10-16).

Why this is here

For CASE-107: the CLIS patient who communicated, offered by Kübler and Birbaumer’s own group as refuting their extinction hypothesis (LIT-1199). The reading changes how far it does. The patient learned a BCI and the speller while still in LIS and carried them into CLIS, which is the exception the 2008 paper predicted (“learning BCI-control or any other contingency before onset of CLIS … should prevent extinction”), and he had been without communication for weeks, not the “longer time periods in CLIS” the hypothesis concerns. Communication came only once an operant contingency on motor-cortex firing was built, so it shows lucidity that a newly made action channel could reach, not judgement running with no action at all (CLAIM-341’s defeater (b) stays untested). The other caution stands as filed: the authors’ earlier CLIS papers were retracted after a DFG misconduct finding (reported by STAT, 2022-03-22), and outside researchers urged caution about this one; the article itself carries no notice, and those reports were not rechecked in this reading.

Backlinks