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speaker-0: This one's taken a few weeks to get up and running because Professor Tom Oxley has had some of the best excuses in the world why he's been postponing coming on the podcast. Good morning, Tom. How are you?
speaker-1: Good Jane. Thanks for having me.
speaker-0: Good evening, your time.
speaker-1: I'm in California now, so it's
speaker-0: afternoon. Happy afternoon. Tom, before we go into what you do, we always launch into who you are. Who's Professor Tom Oxley?
speaker-1: someone who is obsessed with the brain. I went into medicine, but if I didn't if I hadn't have gotten into medicine, I would have become a neuroscientist. I am a neuroscientist. And I went into medicine because of a deep fascination with how the brain works. And then I went into medicine and I started in neurosurgery, but I wanted to go back to more foundate fundamentals of how the brain worked. So I started neurology and I learned a lot about brain disease, about how people are affected by brain disease. I looked after a lot of people with brain disease. And so I I think I felt that it could be a life well lived if I made a contribution to understanding of the brain and potentially treatment of brain conditions.
speaker-0: Did you do that study only in Australia or the world?
speaker-1: I would say like the the formative periods of my life where I became you know deeply interested in the brain was in Melbourne, where went to school in Melbourne. I I went to university at Monash, into medical school at Monash, straight out of school. And I then did my neurology training at in Melbourne at the Alfred Hospital and Royal Melbourne Hospitals. And then I eventually moved to New York because I wanted to learn how to do this new technique of treating conditions in the bra using the blood vessels. and to do that I I had to leave Australia and I went to New York to learn how to do that.
speaker-0: Okay. Do you miss us?
speaker-1: I miss my family, I miss my friends. but I I will say America has afforded it's it's such a cliche to say like the opportunity, but it really was that journey for me. I landed in New York, I went into a medical fellowship, and all of a sudden these opportunities kept laying down. If if I'd stayed in Australia, I think I I I would have probably not quite possibly not. become an entrepreneur and started a company, I would have remained an academic and continue doing science. And that would have been a I would have loved it. but I went to the US and it was like, you can if you really want to turn that idea from just a research question and doing research to answer fundamental questions and turn it into something that can be offered to people as a product, you have to start a company. And that I w I I wanted to do that in Australia. I tried to like I was doing my early research. I had the idea of what's become now synchron in Australia, but it was there was not the kind of entrepreneurial spirit and economy and environment in Australia. So I feel like I I what has happened only could have happened had I have gone to the US and particularly New York. There's been a very New York sort of story to the major things that have led us get to where we are have happened because of New York connections.
speaker-0: So remember we're talking to people who in many instances mightn't understand what Synchron is and what BCI is. So could you start us off with s your idea of Synchron and what is BCI?
speaker-1: Yeah. I I think I'd actually like to start with a story that happened to me as a early like actually it was my first month of training as a as a training neurologist. Yep. And it was an experience I had that I think made me realize why BCI could become such an important technology for people.
speaker-0: What is BCI?
speaker-1: I'm sorry. BCI is a brain computer interface. So l let me frame the story and then I'll explain how it works. But I was I was in the Royal Melbourne hospital. I was doing my first rotation learning how to be a neurologist, and I was I was on the stroke unit. I actually had worked in an and D unit at Bethlehem Hospital the year before this. And so I'd already I spent three months working with people who have and D. And physicians and nurses who look after people with MND. So I had that perspective, but I I hadn't really heard or figured out what a brain computer interface was. And as a couple of years went on, and then I was on a stroke rotation, and I looked after a young gentleman, he was in his 40s, who had a stroke that resulted in him having locked-in syndrome. And so locked-in syndrome can be caused by a range of neurological conditions. In stroke, it happens. if the stroke damages the lower part of the brain, the brainstem, that carries your motor fibers out. So motor neuron disease is obviously disease of the entire motor c motor neuron tract, sometimes affecting some torsions more than others. But in strokes, it's a one hit on a particular area in the brainstem and your body, you you can't move the rest of your body. So you go from normal to locked in in Like in in an instant. And this particular guy who had it was in his 40s, he had a family, he had three kids, and he suddenly was flipped into this completely different world. And the thing was that struck me was we were t he he only had horizontal eye movements. Yes. and I'm sure many of your viewers are in that similar situation where they're communicating through eye movements. he immediately went from That took horizontal eye movements. And but, you know, the rest of his brain was was okay. He was still everything else was working. Same with and D. You're still you're still thinking, you're still feeling, you're still you know, emoting, you're reflecting, you're thinking, you're think you're you're processing, you're but you can't get it out. And within the space of one day, so within over two days. He had an immediate conversation with the stroke team, told him there's there's no therapy at all. This is your new normal.
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do you want to live like this? And he s communicated with his family and decided no. And it's and so my immediate reaction in the time was how is there no treatment or therapy that just because your motor system is broken, that you can't engage with the rest of your brain? And so that was a major moment for me where I was like, this is like this doesn't make sense. Like, how could it be that there's only one mechanism for you to express your can your existence through this thing called the motor system? And so, you know, there's this idea that the human body is kind of the way it's built is there's a lot of input, vision, hearing, feeling, and there's not much. Output transcript there's a lot of thinking going on. That's what a brain computer interface can potentially do. It can create, so it's a device that goes inside the brain. It's basically like a microphone. It listens, it's a sensor. So it and the big challenge in the field is how do you what's the best way to get sensors into the brain that create a new data stream? Sometimes I think about it like a digital spinal cord. A stream of information from your brain to the outside world, which lets you engage with an external device in a way that does not require your motor system. And so the closest analogy from an assistive device technology would be an eye tracker system. But the eye tracker still piggybacks on your residual eye movements. And that's why a lot of people find it tricky because it's kind of exhausting and that you because you're still using the very the the residual motor system to amplify the signal. Well, the the idea of a brain interface is you create new pathways. And so the field of BCI is starting in the motor domain. But I think eventually where it goes will be in the emotional domain, the speech domain, the hearing domain, attentional domain, probably navigation domain. The brain does all these things. Now we're not we're not it's still very early days, and the reason the field is moving so slowly is that it it is requires a brain implant. So there's a range of different ways to do brain implants, but my idea from the very beginning was why I went to to learn how to do this new surgical technique is because this new field was emerging over the last ten years in in neurology, which is called neurointervention. And it's the idea that you can put a catheter into your neck. Into the jugular vein and use a kind of a back door, like a little hole in the base of the skull, that goes up into the brain. And then you can deploy or deliver electrodes or sensors that can listen to the brain. And so we the the one with that we built goes up through the jugular vein, it opens up in a in a vein that's up in the middle of the brain, and it listens to the motor cortex on the left side and on the right side. That you can activate yourself by trying to move. Mine will be activated right now because I'm moving my hands, I'm talking. If I move my legs, it'll activate in different regions. And you the the algorithms capture that movement and basically convert it into a move moving a mouse across the screen. So the vision is for motor BCIs or motor brain computer interfaces that you're able to restore control of digital devices. without having to touch anything. And I'm kind of rambling here, James. I just feel free to interrupt me. But what one thing I've learnt from speaking to a lot of people who are living with neuron disease and dealing with assistive devices, what seems to me to be the number one problem for people is continuity of connection. And there are breakdowns in either calibration or positioning or, you know, removing a button or recalibrating the eye control. And so if you lose continuity, you have to wait until someone comes in to reposition, reconnect, recalibrate, turn it back on.
speaker-0: It's not even that, it's just if the sun comes in at a wrong angle and you can't see the screen anymore. Are you talking about for you talking about for I got
speaker-1: For eye gaze, but also for for buttons, for anything that requires a physical positioning or like to turn on a system. what we're trying to call it prone is a system that provides twenty-four-seven continuity of digital control.
speaker-0: So we'll talk about how that happens in a second. So therefore it's promoting independence in the person with and D. It's giving the carer a bit of a break too, because they don't have to stand there twenty four seven next to their person helping. There's a whole lot of benefits to it. So how if you have the implant in your brain, how can then you connect digitally to your home to make things work?
speaker-1: Yeah. our view on that is we were not gonna build everything from the ground up. so we we actually started trying to work with Microsoft products because the Toby the Toby system, the Toby iGaze originally was worked was implemented by Microsoft and Intel. And when they first built it, they had to build a very novel Bluetooth so that it could work with a Microsoft system, which is now inbuilt with the Microsoft products. they're now on Apple, but we we've now I guess where I'm going with this is you have to kind of choose a platform which to work within as a starting point. And we chose Apple. So the answer to your question is the the goal is we're trying to come up with a easy to use, simple, continuous navigate and select that works on Apple products. And in particular one that you can wake up and turn on the system without having to have anyone to the room.
speaker-0: So take it back to tours. Once you have the implant, what does it enable you to do, for instance?
speaker-1: turn on your MacBook. Open an app, push the mouse cursor around the screen, and navigate through the app. So messaging would be a major goal that we have. How can we help people in particular communicate their care needs at any moment of the day completely independently? Another thing, the way the the way we're thinking about it is because there
are things that people can do with a digital device and they're not all equal. playing games is less kind of let's say clinically relevant than reporting your healthcare needs. So we're focusing on use cases in particular on communication that enable users to take part in their care, take part in their healthcare communication and feel like they are not unable at any point to express their needs. That's probably that's
speaker-0: Just being talked about.
speaker-1: Yeah. Yes.
speaker-0: s I have seen a video though where the house is connected and the guy on your trial, Rodney, he can feed the dog, he can turn on lights, he can turn on his music.
speaker-1: So that was made possible because in that instance Rodney had a Apple Vision Pro and his eyes were still working. He didn't he didn't have upper limb movement, so he couldn't to use the Vision Pro, you have to be able to do gestures with your hands. So we replaced the gestures with the hands with brain derived gestures. And he used his eyes to look around the room, and then we plugged into that an NVIDIA system called Holoscan. And it basically is scanning the room. So he would look at something like the fan or the dog fan or any device that was Bluetooth connected, and then he'd use the BCI to basically give it a command. So that the the Apple Vision Pro is quite heavy, it's very expensive. And I think where the world is going is going to be more widespread, easy to use glasses. And I think there's going to be a very natural combination of the use of glasses because a lot of people still have preserved eye movement or neck movement. so we're we're trying to come up with a range of different options that enable different people that are on different spectrums of disease to improve themselves. But you mentioned independence. I think we're thinking about it. How can you do your tasks of daily living more independently? How can you independently make more decisions? And how can you express yourself more independently? They're the they're the kind of metrics we're trying to use different devices for.
speaker-0: Well, with this shite of a disease the benefit to that is extraordinary. You've been running trials. Around the world, Canada, America and here. What state are you up to with that at the moment?
speaker-1: in Australia we have Melbourne open. we are on the cusp of having Sydney approved. We're working on Brisbane and we're looking towards Adelaide and Perth.
speaker-0: great. And how many in Australia are looking for this trial?
speaker-1: that's a good question. Right now we're targeting ten people to enrol in the study, but we have a pathway to more than that and we're starting to think through how we can reach more people.
speaker-0: So number one's what's the criteria to be considered for the trial?
speaker-1: Yep. So it's primarily people who have loss of both of their upper limbs. And it's not a perfect science. We're trying to figure out the best way to clap to characterize that. But
of the we've we've characterized seven different movements in the arm, from shoulder to elbow to wrist and fingers. And right now it says you have to have five of those seven movements in both left and right arm. worse than gravity. Okay. And then speech is not a factor. It doesn't matter what your eyes can do, it doesn't matter what speech can do, or you need to be able to read a screen because you'll be looking at a screen. cognition has to be good. and that's about it. We we don't do open brain surgery, which is what other approaches do, so it's less invasive. and there is a need for because we go in the blood vessels, we want to stop blood clotting. So there's a need to go onto blood thinning medicines once the device is in.
speaker-0: Do you do it with G A or just a local?
speaker-1: We do it with a G A.
speaker-0: And so that's you would have to take in to consideration the person with and D and whether they can undergo to G
speaker-1: Yeah. Yeah. That is a factor. I we're hoping to be able to do this without GA one day, but right now it does require general anesthetic and the anaesthetists are generally looking for a forced spidal capacity, F V C above fifty percent.
speaker-0: It would also require these people to have a thirst for knowledge and I'm assuming for their family or supporters around them to want to know how to use this properly and to help in the training.
speaker-1: Yep, critical. Yeah, it it it matters a lot. So, the people that we're looking for are curious, like technology. it's definitely still early. Like we the way that the training happens, the way that you activate your brain is still different amongst different people. We're trying to build something that's easy for everyone to use and so we're practicing with a lot of different types of techniques. we have we have both neuroscientists and field BCI specialists who would come into okay patients' homes several days a week, as much as the patients can tolerate really, and we really become very close with all of the people that we work with. And it's it is a lot of it is a lot of it it's definitely it's definitely still early days. And we're hoping that over the next couple of years We're going from say ten or twenty people to say fifty to a hundred to three hundred over the course of the next couple of years. And over that period, we think we will have what we think is the right amount for the first commercial approval. And if that works, we think this could be the start of something really amazing for a lot of for millions of people who are suffering around the world for this condition. So we are finding that the people who joined the study, the ones who are feel like that they're part of a movement are the ones who are doing the best. And it's interesting because we've had people who I think we we understand that for people who are facing the diagnosis and staring down, you know, that staring down that diagnosis and knowing what it means, that feeling like they're a
part of something that's quite new and different. And we don't know where it's gonna go, but it has the potential to be to have a big impact. And I think there's it's it's it's in I mean the the when you start looking in and reading about BCI, you realize it kind of exists in pop culture, it exists in science fiction, it's been written about for decades. and there's definitely dystopic narratives around where the popular culture think the technology's going, but the reality is, like the the people who need this, it's something pretty different. and it's y you when people understand how it's working. It's the idea that you could be activating the device inside your brain just by thinking is a real kind of, kind of moment. And that so so we're we're learning together, we're on a journey together and it is it is it's it's it's exciting.
speaker-0: P when I discuss this with people, they say to me, what about my inappropriate thoughts? Can they catch them?
speaker-1: Yeah. So one day this technology will probably be capturing very private thoughts. I I think it's yeah, that's how the brain works. And I think one day, yeah, that's I think we're gonna bow there, but we're not there yet. It's capturing the part of the brain that would otherwise be tracking where your hand is typing or moving a mouse. So it's really just tracking your intended physical movements in the physical world and then converting that into a digital movement. So we we have a we have a future generation device coming that's going to be getting to more and more regions of the brain. It's gonna be years away. And I think there are there are pretty major ethical questions about how you solve that particular problem. I just just to sort of answer it quickly. I think the answer is that if if it does start to capture very personal thoughts, you have to have a layer of kind of fiduciary layer, like a protective layer, the same way that you would kind of have a protective layer when you talk to your doctor, talk to your lawyer. This technology's going to have to do that eventually, but it it's not there yet.
speaker-0: Yeah, we really need that with my brain. You don't want to hear what I'm thinking about some people. Now, often with trials the criteria is that you have to be early in the disease two years. Are you imposing
speaker-1: That's that's not the case without w I've noticed that I've noticed that our patients are often beyond the drug trials for ALS. Good, good. So h however we we do we do have a requirement to have a life expectancy greater than twelve months. And that's that's on the assessment of the physician.
speaker-0: It's fair enough. How are you recruiting in Australia?
speaker-1: How are we? We have a community platform. So if you go to our website, there are links that learn about our clinical trials and it'll take you to a platform where anyone can register interest. We we have we're getting a huge amount of interest and people just jumping onto the website and and telling us who they are and that they're interested in. Once we do that, there'll be a call center that would give the people who have registered interest a call, asking them if they meet, you know, the Criteria. And then if that goes well, they would get sent to the clinical site, which is the Royal Melbourne Hospital. And Dr. Thanuja is the MND doctor at Royal Melbourne, her team would then give you a call. So that that would be the process. But also we have a referral network now from from Northern Health, from Barwan Health, from Bethlehem. So if you just were to ask your and D doctor about it. Hopefully they would ha know about how to make the referral and to study.
speaker-0: I was with Synergy the other day. Did she do an implant last week or the week before?
speaker-1: We did. We just did the first implant at Royal Melbourne a week before last.
speaker-0: And that went well.
speaker-1: Went well. It went well. He's back home. Well Well, we've been very we we would. I mean, we've the only safety issues we've had to date have been with 'cause it goes in the neck up into the brain in the blood vessel, opens up and then it gets plugged into a device that sits under the skin in the chest, which looks like a pacemaker, it's a little boxer. Yeah, like a pacemaker box. And in two we've we've done thirteen implants now.
speaker-0: Nice.
speaker-1: In two of our patients, one at six months had the wound erode over the wound. It's because there was a lot of pressure on the wound. So I think we we've learned a lot about how to do transfers that doesn't impact the the pocket healing. That particular patient had chronic wound healing issues with diabetes. So that's okay, but we just have to manage that. And another patient, it kept opening And we had to move it to a different spot. But we haven't had any issues in the brain, any blood clotting. And we we have reported all about if you go onto our website you'll we we have, you know, lots and lots of research papers around what we do and what all all all of our results are.
speaker-0: I was just joking. I wasn't offending you.
speaker-1: Well, but it but it it I mean it's it's a brain implant, so it's it's obviously a serious concern.
speaker-0: just going back a a step how of how long are you trained for? So how often do the people come into the home and train you? What period of time?
speaker-1: we're time. it's ongoing. So as as much as the people who are in the study can tolerate, we will be coming to work with you. We'll be trying we'll be trying different training techniques, we'll be trying to improve the system, we'll be rolling out new software features all the time. so it would be it would be ongoing. So the actual study is for twelve months. we but it's a lifelong It's a lifelong w we're we're with you forever, as long as you can tolerate us, basically.
speaker-0: And there's no cost to the participant use there. Once you've applied and you've had the phone calls and s you might be on the
short list, how long then is that assessment time?
speaker-1: That's a good question. we've been looking at this. It's I don't know. I think it's between it's days, it's days. A few days to hopefully not longer than a week. and it's kind of up to the pace with which Dr. Thanoja and her team can get through. They're calling about I think four to five people per week at the moment. So it kind of depends on how right now there's not a there's not we're getting through So I hope you more than a week.
speaker-0: So I know people in other states have said to me I've applied but I haven't heard anything. That's purely because there's not approval in those particular states.
speaker-1: Well, that's probably, but I'm I'm I will take that feedback and I'm I'm I don't like to hear that. So I'll I'll go back to my team and see.
speaker-0: I'll talk to you offline about someone. Yeah. How can we help you best?
speaker-1: wow. I think just keeping a conversation going. I think people are scared about BCIs. I think I think just talking about the technology and making sure people understand what it's trying to do is the most important thing.
speaker-0: Do you see in the world one day where you can use this technology to actually people move their limbs?
speaker-1: So to make them to make it move limbs, you would have to send the signal back and either trigger the muscles to move or replace the muscles with a like a prosthetic limb, like a robotic limb. to make to to reanimate the muscles in the limb, there are some techniques that's called functional electrical stimulation, FES.
speaker-0: Okay.
speaker-1: And there has been some techniques, but it's it kind of makes quite gross movements. in general, I think it's gonna take some time. I think the first wave of the BCI technology is just going to get a stable way to do navigate and click once and then have that on a on a like a standard Bluetooth easy platform to use. Once we've created that, I think there's going to be secondary applications, including you know, companies that start building prosthetic limbs or electrical stimulation, but we're really focused up on the control side on the brain side. I think it's coming, but it's I I wouldn't I I wouldn't hold your breath. It's still gonna take some time. We're
speaker-0: I'm just thinking of people who have traumatic brain injuries and paraplegia and down the track.
speaker-1: Yeah. Yeah. Yeah, there are exoskeletons, there are prosthetic limbs, there's FES there there's I'd say those things exist, but they haven't that they don't really exist commercially. They exist in the academic research domain. I think once BCI becomes more mainstream, then there's got to be this sort of space for people to start building new things that it can control. I think it'll come, but it's gonna take some time.
speaker-0: Well frankly I think what you're doing now is absolutely mind blowing. it's extraordinary, it's exciting, it's brave and it can really change the lives of people now. So I thank you.
speaker-1: Thank you, Jane. Thank you for having me on.
speaker-0: it's a joy. I look forward to seeing you again soon and your team and I'll put the synchron web link on so people can apply if they want. And I really look forward to watching the progress because it is so exciting.
speaker-1: Thank you, Jane. Thank you very much for having me.
speaker-0: Pleasure, Tom.