How Apple's Vision Pro is helping this ALS patient to perform simple tasks

An American man with amyotrophic lateral sclerosis (ALS) has become the first patient in the world to use an Apple Vision Pro via an implantable brain-computer interface (BCI).

This means the patient, a 64-year-old man named Mark from western Pennsylvania, is able to use the device using his thoughts rather than using hand or voice commands. Mark is not giving his last name to preserve his privacy.

Mark doesn't have the use of hands but has been able to play Solitaire, bring up screens to watch movies and TV shows and even send text messages.

He said the implant has given him back some of his independence that he had started to lose as his ALS progressed.

"I lived alone for quite a long time, so I was used to doing all everything for myself and, when you lose that ability, I'm not gonna lie, it's been a challenge to not be able to do things for myself," Mark told ABC News. "I can see down the road … of endless possibilities."

'A punch in the gut'

In 2020, Mark started realizing that he couldn't pinch together the thumb and forefinger of his left hand. He originally believed he was beginning to develop a condition like carpal tunnel until he dropped a cup of coffee and decided it was time to visit a doctor.

An orthopedic doctor he was seeing for separate lower back issues suspected he might be experiencing a pinched nerve in his neck and a surgery was planned to fuse four vertebrae together, but the doctor recommended Mark see a neurologist first.

Mark had an appointment in January 2021 and through a series of tests, confirmed he had ALS.

"Unfortunately, that was kind of a punch in the gut," he said. "Unfortunately, with this disease, it's 100% fatal but mine fortunately is a little bit slower progression."

Mark said the paralysis has since climbed up his left arm, across his shoulders and down his right arm, and he's since also begun to experience some weakness in his neck.

How BCIs work

A BCI is a sensor that is implanted and translates brain signals into an action outside of the body.

There are different types of BCIs. Neuralink -- developed by Neuralink Corp., founded by Elon Musk -- is a small chip inserted directly into the brain tissue and requires brain surgery.

The BCI developed by the company Synchron involves a device implanted into one of the veins within the brain and is a minimally invasive procedure.

BCIs are designed to be used by people who struggle with neurological disabilities, such as a brain or spinal cord injury, or a degenerative disease like ALS.

"BCI research really started back in the '90s, so this isn't a new idea," Dr. Leah Croll, a neurologist at Maimonides Hospital, in Brooklyn, New York, told ABC News. "But in the last five years or so, technology has just evolved at such a rapid pace, in large part thanks to AI, and so now we're seeing this explosion of BCI research and applications like we never have before."

Recently, Synchron announced that it was able to connect its BCI to the Apple Vision Pro, the virtual reality headset. The sensor translates the brain signals, which, in turn, allows the patient to control the headset hands-free.

"It allows them to have some independence and some agency in choosing an immersive experience for themselves," Croll said.

A representative for Apple did not immediately return ABC News' request for comment.

Allowing more independence

Mark worked at his job in the wholesale flower industry until December 2022 when it became apparent that he was beginning to experience weakness in his right arm and could no longer drive.

He got accepted into a drug study that he started at Emory University in Georgia, and continued in western Pennsylvania, when his doctors first informed him about BCIs.

"At the last appointment for that drug study … it was at that appointment that I found out about this study, working with the BCI, and I was all in," Mark said. "I wanted to be able to help and do what I could. So, I assessed the risk, and it was very minimal, with this particular BCI."

Mark said the procedure for the implant took place in August 2023 and he became connected to the BCI in October 2023.

He and the contacts from Synchron have been working on tasks with the BCI about twice a week and began working the Apple Vision Pro two months ago.

"I'm playing solitaire so little bit of entertainment there," Mark said. "I can access Apple TV and HBO Max if I want to watch a movie … there's an app that we are working with that kind of highlights, different artistic styles and painters and whatnot. So that's been really interesting for me."

He went on, "Not being able to use my arms anymore, it's one thing to lay or sit and watch TV all day, but to be able to do other things as well like playing Solitaire for a little bit or working with other apps, it's really been a game-changer."

Croll said there are so many day-to-day activities able-bodied people take for granted.

"Just the simple act of going to the movies for an able-bodied person, they can decide on a whim that they want to go to a movie, and they can just do it," she said. "For somebody who has a serious neurologic disease, they cannot decide that on a whim. That requires a whole team of people to help get them there, it requires an awful lot of logistical planning. And, of course, the assumption that they can go to the movie theater is predicated on the movie theater, even being able to accommodate their needs at all."

Croll said BCIs integrated with virtual reality could revolutionize the way that neurologic patients are treated. But there are ethical issues to consider, including privacy concerns and learning more if the technology has any impacts on a patient's normal brain function.

Mark said he hopes his story encourages other patients who have lost function in their limbs or have become non-verbal.

"It is a punch in the gut when you get a diagnosis like this because there is no cure for this disease," he said. "I always say I have two ways when I get up in the morning: I can either choose to wallow in self-pity, or I can get up and do what I can to be a resource and a help for others. I choose the latter."