Neuralink brain implant lets ALS patient speak again

Brad Smith, a man rendered mute by amyotrophic lateral sclerosis, is talking again after surgeons embedded a coin-size Neuralink “Link” with 1,024 electrodes in his motor cortex, allowing him to steer a cursor and trigger AI-generated speech using pure thought.​

Smith is the first person with ALS, and the third human overall, to receive the experimental interface. His declaration, “I am typing this with my brain,” shared via an Elon Musk Tweet, showcases the device’s promise. “It is my primary communication,” he added.
Before the implant can win mainstream backing, though, it must finish its ongoing early-feasibility study, pass a larger pivotal trial and secure FDA premarket approval, an approvals gauntlet that usually spans years and multiple clinical sites.​

Elon Musk confirmed that Smith is part of its first clinical trial (dubbed the PRIME Study) aimed at proving the device is safe and useful for people with paralysis. All three initial participants (two with spinal cord injuries and Smith with ALS) have the implant.

Brain implant: 1,024 electrodes in motor cortex

Neuralink’s N1 “Link” is roughly the diameter of five stacked quarters and replaces a matching circle of skull. During the surgery, a high-speed robot inserts 64 bundles of hair-thin polymer threads, 1,024 recording electrodes in all, just a few millimeters into the brain while automatically dodging blood vessels, “so there is almost no bleeding,” according to Smith.

Unlike Synchron’s Stentrode, which threaded up the jugular vein and seated in a blood vessel next to the motor cortex, with only 16 recording electrodes and no need to open the skull, Neuralink’s Link requires a thumbnail-size craniotomy and 1,024 polymer threads pushed directly into brain tissue, trading minimally invasive access for a richer data stream and higher surgical risk. In short, Neuralink is betting that higher channel counts will justify a riskier surgery, while Synchron trades bandwidth for vascular access and simpler follow-up care.

Once implanted, the Link sits invisibly beneath the scalp, wirelessly transmitting the rich data stream from its electrodes via Bluetooth to a nearby laptop. There, its algorithms analyze the neural firing patterns captured from Smith’s motor cortex, decoding his intended movements. After finding that imagined hand movements yielded weak signals owing to ALS, Neuralink engineers discovered that Smith attempting subtle tongue movements produced a more reliable signal. By focusing on these tongue motions, Smith learned to translate his thoughts into real-time control of the on-screen cursor.

An accessibility stack

Once the cursor control felt natural, Smith and Neuralink engineers layered on an accessibility stack: a predictive-text keyboard, macros for “copy,” “paste,” and “undo,” and a bespoke chat app that uses Grok 3 to suggest replies and read them aloud in a digital clone of Smith’s pre-ALS voice. “It keeps me in the conversation,” he said, even if the AI occasionally riffs on gift ideas like handing a horse lover “a bouquet of carrots.”

Those quality-of-life gains make the early hiccups worth watching. Neuralink’s first participant, quadriplegic Noland Arbaugh, lost usable signals from about 85% of his threads within a month of surgery. The company blamed natural brain movement and now seats the filaments several millimeters deeper.