Implantable brain machine interfaces: first-in-human studies, technology challenges and trends.

Implantable brain machine interfaces (BMIs) are now on a trajectory to go mainstream, wherein what was once considered last resort will progressively become elective at earlier stages in disease treatment. First-in-human successes have demonstrated the ability to decode highly dexterous motor skills such as handwriting, and speech from human cortical activity. These have been used for cursor and prosthesis control, direct-to-text communication and speech synthesis. Along with these breakthrough studies, technology advancements have enabled the observation of more channels of neural activity through new concepts for centralised/distributed implant architectures. This is complemented by research in flexible substrates, packaging, surgical workflows and data processing. New regulatory guidance and funding has galvanised the field. This culmination of resource, efforts and capability is now attracting significant investment for BMI commercialisation. This paper reviews recent developments and describes the paradigm shift in BMI development that is leading to new innovations, insights and BMI translation.