A new study by Oxford University has found that people who were hospitalised with Covid and went on to have cognitive problems had high levels of two proteins that make the blood clot.
It suggests that excess clotting during a Covid infection may have caused long-term damage that can still be felt more than two years later.
Experts said blood clots could cause a lack of blood supply to the brain or cause fatigue, both of which can cause cognitive problems.
Although the team did not study infected people who were not hospitilised, they said the findings could still apply, and warned that patients in hospital were often treated with anticoagulants, unlike those managing the condition at home.
Dr Max Taquet, a National Institute for Health and Care Research (NIHR) senior research fellow at the University of Oxford, said: “The results support the hypothesis that blood clots are a cause of post-Covid cognitive problems.”
The team looked at blood tests from 1,837 people who had been hospitalised with Covid and also suffered serious and persistent problems with thinking, concentration and memory.
Their memory was assessed at six and 12 months after hospitalisation using both a formal test and by asking them their own subjective view about their memory.
‘Concentration-induced fatigue’
Dr Simon Retford, of the University of Central Lancashire, a participant in the study, said: “Since my illness I have been plagued by brain fog, concentration-induced fatigue, poor vocabulary, poor memory.
“I am unable to process the amount and scale of work that I would previously have done ‘stood on my head’.”
Tests showed that patients with “brain fog” had high levels of a protein called fibrinogen and raised levels of a protein fragment called D-dimer - both of which are involved in clotting.
Experts believe that fibrinogen may be directly acting on the brain and its blood vessels, whereas D-dimer often reflects blood clots in the lungs, which would mean brain problems are down to a lack of oxygen.
Prof Chris Brightling, NIHR Senior Investigator and Clinical Professor in Respiratory Medicine, at the University of Leicester, said: “One of the things we have been surprised about is the failure of recovery.
“I am disappointed that a number of people are still having persistent problems more than two years on from the pandemic.”
Explaining what might be causing the clotting, Prof Brightling added: “We know that Covid-19 leads to an inflammatory response and activates the lining of the blood vessels and it seems the combination of those is much more profound in Covid-19 than other infections.
“We think this not only leads to the activation of the immune system but also auto-immune activation where the body starts to fight itself.”
‘First piece of the jigsaw’
The team are hoping that in the future doctors will be able to spot which Covid-19 patients are most at risk of long-term problems so that they can be treated early.
Prof Paul Harrison, from the University of Oxford, who supervised the study, said: “Identifying predictors and possible mechanisms is a key step in understanding post-Covid brain fog. This study provides some significant clues.”
“We are not saying it is only the cause of the cognitive problems and there may well be others. This is very much the first piece of the jigsaw. “
The research was published in the journal Nature Medicine.
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Doctors tell us between 30 and 35 COVID patients have been admitted to Rochester area hospitals recently. The CDC's website currently indicates Monroe County's hospital admission as low amid a recent surge in a new subvariant. (Provided photo)
“People feel at liberty to comment on GLP-1 medications like Ozempic or Wegovy for weight loss because they may not understand that obesity is a disease,” said Dr. Rekha Kumar, a practicing endocrinologist in New York City.
When it comes to Ozempic and Wegovy, everyone seems to have an opinion.
The drugs ― the first of which is intended to treat diabetes and the second of which is used for weight management in adults with obesity or who are overweight ― have been a hot-button issue since the beginning of the year. Their popularity led to a national shortage of Ozempic for diabetic patients due to off-label use for weight loss.
Semaglutide is the active ingredient in both Ozempic and Wegovy, so both drugs work roughly in the same way: By boosting the body’s levels of the hormone GLP-1, the drugs slow digestion in the stomach, and also send signals to the brain that you’re full.
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Wegovy, Ozempic and Mounjaro ― manufacturer Eli Lilly’s version of the drug ― can all lead to weight loss, but only Wegovy is currently approved by the FDA for chronic weight management issues.
GLP-1 medications are prescribed safely for weight loss when somebody has a body mass index of 30 or greater, or 27 or greater with a weight-related medical complication, said Dr. Rekha Kumar, the chief medical officer at the medically assisted weight loss program Found and a practicing endocrinologist in New York City.
“There is also a lot of inappropriate use of medications like Ozempic and Wegovy by people who don’t qualify, which got people talking,” Kumar told HuffPost.
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If you don’t qualify for insurance coverage, the drugs are going to cost you; Mounjaro currently starts at $997 through SingleCare. Ozempic prices begin at $814, while Wegovy starts at $1,212.
NurPhoto via Getty Images
Ozempic is essentially the same medication as the popular weight loss drug Wegovy, just at a lower dose.
The initial outrage over celebrities’ use of semaglutides and the national shortage was back in January. What’s kept the conversation going is something else: We live in a fatphobic society, and Ozempic and Wegovy give us another opportunity to pass judgment on those we deem overweight, Kumar said.
“People feel at liberty to comment on GLP-1 medications like Ozempic or Wegovy for weight loss because they may not understand that obesity is a disease,” she said. “These medications are a treatment option for people who may not have found effective treatments prior.”
But when the accepted thinking is that obesity is a choice and consequence of a lack of willpower, it allows people to form opinions on others’ behavior, Kumar said.
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“Those who continue to comment are likely not fully informed about the biological aspects of body weight,” she said.
That’s not the only misconception about weight and this new class of drugs. Below, people who’ve actually taken Ozempic and Wegovy as prescribed share some of the most common mistruths they’ve heard about the drugs.
Myth 1: People who use semaglutide for obesity are lazy and just need to eat less and exercise.
Miranda Mossberg, a 35-year-old mom of three from Minnesota, began taking Wegovy in February 2023. Mossberg has polycystic ovarian syndrome that causes her to have insulin resistance: “Unfortunately due to my insulin resistance my body does not process sugars, carbs and nutrients the way it should,” she told HuffPost.
“I’ve tried everything outside of a very invasive body altering surgery to lose weight,” she said.
She posts about her progress on TikTok, and often hears from people in the comments who think taking GLP-1s like Wegovy is the “lazy” way out or not sustainable.
“I get many comments that say ‘just eat less and move more’ or ‘that sounds miserable, I don’t understand why anyone would take that,’” Mossberg said.
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“This amazing, life-changing medication for people with chronic obesity, insulin resistance or who are prediabetic has quickly become the latest diet fad, and it is so frustrating.”
- Patsy Wieler, 58
Others wrongly assume that simply by taking Wegovy “the weight will just magically fall off,” Mossberg said.
“The truth is, you have to change your lifestyle, which this medication makes easier to do,” she said. “It turns off that ‘food noise’ that so many have: That constant thought of food, snacks and your next meal. The need to fix your next craving.”
Thanks to Wegovy, Mossberg said she no longer ruminates on her next snack or when she’ll get to have a big comfort meal.
“I eat better, I drink more water, I work out 5-6 days a week and I overall just feel better,” she said.
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Could she do that without medication? “I’m honestly not sure,” she said. “The working out, absolutely. The water, absolutely. But that food noise is real, and it can be all-consuming. The binge that can happen after a ‘good’ day, and the guilt that follows puts your head in a bad place. It’s a tailspin almost impossible to get out of.”
Myth 2: It’s a quick fix.
Patsy Wieler, 58, was put on Ozempic for both diabetes and obesity in May 2019. At the time, she weighed around 346 pounds.
“Although I was morbidly obese, I was an avid hiker, climbing 450m elevation mountains, and consistently walking,” said Wieler, who lives in Calgary, Canada.
“I even walked a half marathon in February 2017,” she told HuffPost. “I was active and ate like everyone else but no matter what I did, I just kept getting heavier. At that point in 2019, I was utterly hopeless.”
Koh Sze Kiat via Getty Images
Those who've taken Ozempic and Wegovy say you have to couple the prescription with lifestyle changes to see weight loss.
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When Wieler’s doctor told her about Ozempic, she was apprehensive. “I didn’t believe in weight loss medications,” she said. But her doctor convinced her that obesity was a chronic complex condition that needed management, just like any other chronic disease.
“Ozempic brought my chronic hunger under control, significantly lowered my food noise which was constant prior to Ozempic, and has helped me maintain every pound I lost since I have been on it,” said Wieler, who runs the YouTube channel Big Girl Talking.
Given her experience, it bothers her to hear people talk flippantly of Ozempic, as if it’s just another fad diet or quick fix for those looking to fit society’s standard of beauty.
“I want to scream this from the rooftops: Ozempic is not a weight loss drug! Ozempic is not the ‘skinny shot’ or any other inane label it has been given,” she said.
“This amazing, life-changing medication for people with chronic obesity, insulin resistance or who are prediabetic has quickly become the latest diet fad, and it is so frustrating and upsetting because it is minimizing its incredible efficacy for those of us who suffer from diabetes or obesity,” she said.
“Those of us who suffer from obesity have so many complicated issues we have to deal with on a daily basis,” she said. “As someone who has suffered from obesity for 40 years, watching everyone celebrate our medication as an easy way to become skinny again leaves me feeling unseen, misunderstood and alone.”
Myth 3: Access to Ozempic isn’t a problem.
Anthony, a 36-year-old from Philadelphia has been on Ozempic to treat his Type 2 diabetes for two years. (He asked to use his first name only for the sake of privacy.)
“My experiences with this medication have been really good,” he said. “My results have been weight loss and appetite control with a well-balanced diet and exercise.”
When Ozempic became a popular topic of discussion on TikTok back in January, Anthony experienced the supply shortage firsthand. He’s worried that the increased use of the drug among the “healthy overweight” (or just those looking to lose just five or 10 pounds) will cause another shortage and impact those who need it the most.
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“Those on it for diabetes have already had difficulty obtaining the medication for ourselves because of insurance and the high cost,” he said. “If you don’t need it, don’t deplete the inventory for the rest of us.”
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Earlier in the year, there was a national shortage of Ozempic for diabetic patients due to people using it to lose weight.
Myth 4: It’s an ideal medication for anyone who wants to lose weight.
Not everyone who uses Ozempic has a good experience. Laura Burns, a 41-year-old from Houston, took Ozempic for about six months to manage her diabetes. Despite telling her doctor about concerns she had due to old eating disorder behaviors, Burns’ doctor said it was the best treatment for her health condition.
“I felt that she actually mostly cared about me losing weight, and told me so, even though I told her it was not a priority of mine,” said Burns, a body liberation activist and author of “Big and Bold: Yoga for the Plus-size Woman.”
The half a year Burns was on Ozempic was “incredibly challenging,” she told HuffPost.
“While it did ultimately help me bring my A1C down to below diabetic levels, taking Ozempic caused weight loss even on the lowest dose,” she said. “Coupled with the loss of appetite and reemergence of my old disordered eating and exercise issues, the drug created a perfect storm for me to lose a lot of weight in a short amount of time.”
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“For me, the medication worked for my diabetes, but at what cost?”
- Laura Burns, 41
Burns wishes that prescribing doctors would speak about the side effects the drugs can cause, including nausea, vomiting, constipation, gas and heartburn. More serious, long-term reactions like thyroid tumors, pancreatitis, gallbladder problems and kidney issues have also been reported. (Earlier this month, a personal injury law firm filed a lawsuit against Novo Nordisk and Eli Lilly and Co., the manufacturers of Ozempic and Mounjaro, claiming the drugs can cause gastroparesis, a paralysis of the stomach.)
Burns also wishes doctors would give some consideration to how drugs like Ozempic may affect body image issues for those who’ve had eating disorders.
“Everyone’s experience on these medications is different, and I often hear sweeping generalizations about the experience, efficacy, and side effects of taking them,” Burns said.
“For me, the medication worked for my diabetes, but at what cost?” she said. “I am still dealing with working through ED issues that I had already dealt with and living free from their influence.”
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Thana Prasongsin via Getty Images
Laura Burns, a 41-year-old from Texas who struggled with an eating disorder in the past, wishes her doctor would have considered how prescribing the drug may have impacted her body image issues.
Myth 5: Semaglutide is an easy way out.
Mila Clarke, a health coach and founder of Hangry Woman and the Glucose Guide app, began taking Ozempic in late 2020 for blood sugar management. (Clarke has latent autoimmune diabetes, a slow-progressing form of Type 1 diabetes typically diagnosed in adulthood.)
Nine months in, she’s seen progress in both her blood sugar and weight management. “I see it as an awesome addition to diabetes management because it’s a once-weekly injection, it’s easy to inject, doesn’t hurt, and it relieves some of the burden of diabetes.”
While it may be easy to inject, it’s not an “easy” drug to take, as many believe. “The side effects are sometimes completely insane: I know I dealt with tachycardia (fast heartbeat),” Clarke said. “Oftentimes, I felt dizzy or faint in the very beginning, with some nausea, too.”
Clarke said she’s heard people say things like, “How does it feel to spend a thousand dollars to take the easy way out?” but that doesn’t mesh with her experiences.
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“When you hear that, it’s kind of like, well, that’s not what I’m doing. I’m working really hard alongside that as well,” she said.
Clarke thinks that misconception is tied to a bigger one about people living with obesity in general.
“People with diabetes or obesity care about their health,” she said. “We’re not in a position where we write our health off,” she said. “Actually, we’re some of the most health-conscious people on earth, especially with diabetes.”
Type 1 diabetes requires constant care, Clarke said: You’re constantly measuring your food, constantly taking care of your blood sugar, monitoring your blood sugar, wearing devices on your body, and going out in public to keep up appearances, even when you don’t feel well.
“That’s why I think people should have more grace about all this,” she said. “In general, don’t comment on someone’s health when it’s none of your business. If someone is taking these drugs to help their health, your opinion is not needed about it.”
California health officials have issued an advisory after several people who participated in a Tough Mudder race last weekend got sick.
Nearly two dozen people who ran in the Tough Mudder challenge at Sonoma Raceway on August 19 and 20 developed rashes with fever and reported muscle pain or nausea and vomiting, according to the Sonoma County Department of Health Services.
"The Tough Mudder race involved extensive skin exposure to mud. Most affected persons have pustular rash, fever, myalgias, and headache," health officials said. "These symptoms could be indicative of a minor illness called Swimmers’ Itch, but they can also indicate a Staph infection or other more serious bacterial infection such as Aeromonas."
Sonoma County health officials issued an advisory about multiple cases of possible infections following a Tough Mudder competition at Sonoma Raceway last weekend. (Courtesy of KTVU)
Athletes who competed in the race crawled through mud and water and climbed over and under obstacles like a barbed wire fence. Several contestants posted about their condition after the race on social media, complaining of a red rash with pus, fever and body aches.
"Anywhere on my body that touched the ground had red spots," participant Chris Palakos told local FOX affiliate KTVU.
Athletes shared photos on social media of angry red rashes they developed after the Tough Mudders challenge on August 19 and 20.(Courtesy of KTVU)
Tough Mudder participants shared pictures of their rashes with KTVU. The images show their arms and legs covered in infectious sores.
At least 22 people contacted the Sonoma County health department to report rashes, interim health officer Dr. Karen Smith said. Officials believe people likely contracted a bacterial infection called aeromonas, which is a bacterium that lives in water and is contracted through open wounds. It is not contagious.
"The Tough Mudder race involved extensive skin exposure to mud. Most affected persons have pustular rash, fever, myalgias, and headache. These symptoms could be indicative of a minor illness called Swimmers’ Itch, but they can also indicate a Staph infection or other more serious bacterial infection such as Aeromonas," health officials warned. (Courtesy of KTVU)
"We want to be sure to let people know . . . if you attended this event, and you have a rash, fever, aches, we want you to go see your doctor," she told KTVU.
Smith said that one person who saw an infectious disease specialist tested positive for aeromonas bacteria. The infection is commonly misdiagnosed as a staph infection or swimmer's itch — a skin rash caused by an allergic reaction to certain microscopic parasites that infect some birds and animals, according to the Centers for Disease Control and Prevention.
"We want doctors to have the right information, so they know which things to consider, staph being one of them," Smith told KTVU. "But what we don’t want to happen, because it looks like staph, we don’t want them to just treat for staph and find out it’s something else."
Sonoma County health officials encouraged anyone who participated in the race and later developed a rash to see a doctor or, if they do not have a medical provider, to contact their local emergency department.
Chris Pandolfo is a writer for Fox News Digital. Send tips to chris.pandolfo@fox.com and follow him on Twitter @ChrisCPandolfo.
The Centers for Disease Control and Prevention (CDC) is recommending that everyone over the age of six months who does not have a "severe, life-threatening" allergy to a component of the vaccine should receive a flu shot in the coming months.
Most people should get one flu shot, ideally in September or October, said the CDC in its Aug. 23 announcement.
"However, vaccination should continue throughout the season as long as influenza viruses are circulating," the agency said.
Some children under the age of 9 will need two different flu shots four weeks apart, according to the CDC's guidance.
The number of doses required is dependent upon the child's prior vaccination history — and the first dose should be given as early as possible.
Everyone over the ages of six months, with very few exceptions, should get a flu vaccine this year, according to the CDC.(AP Photo/Mark J. Terrill, File)
"Vaccination during July and August can be considered for children of any age who require only one dose," the CDC said.
All the flu vaccines distributed in the United States during the 2023-2024 flu season will be "quadrivalent," or four-component.
Not everyone who gets a flu shot will be getting the same one, however.
Two of the eight approved flu shots are only for those over the age of 65; two are approved only for those older than 6 months and younger than 3 years; and another is approved only for people over the age of 18.
Some children under the age of 9 will need two different flu shots four weeks apart, according to the CDC's new guidance. (iStock)
Individuals with egg allergies will have additional flu vaccine choices for the 2023-2024 flu season, the CDC announced.
"People with egg allergy may get any vaccine (egg-based or non-egg-based) that is otherwise appropriate for their age and health status," said the agency.
Eight "quadrivalent" flu shots are approved for distribution in the United States for the 2023-2024 flu season.(iStock)
Previously, those who were allergic to eggs could not receive certain flu shots because they were created with an egg component.
"Beginning with the 2023-2024 season, additional safety measures are no longer recommended for flu vaccination of people with an egg allergy beyond those recommended for receipt of any vaccine, regardless of the severity of previous reaction to egg," said the CDC.
About a fifth, or 21%, of the approximately 170 million flu vaccines distributed in the U.S. will be egg-free.
Before this flu season, the CDC recommended that those who had experienced signs of a severe egg allergy should receive a flu vaccine "in an inpatient or outpatient medical setting."
Although the CDC is no longer recommending these extra precautions, the guidance states that "all vaccines should be given in settings where allergic reactions can be recognized and treated quickly."
For the first time, the CDC is encouraging those with egg allergies to get any of the available flu shots.(Marco Bello/Bloomberg via Getty Images)
And for those who may be spooked by needles, the CDC advises that "healthy non-pregnant persons aged 2 through 49 years may alternatively receive 0.2 mL of [Live Attenuated Influenza Vaccine], 0.1 mL per nostril, using the supplied intranasal sprayer."
Women who will be pregnant during the flu season are advised to get either a recombinant or inactive flu vaccine.
Those at the highest risk of complications from influenza are the very young, the very old, pregnant women, those with immunocompromising conditions and those with pre-existing lung or heart conditions.
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The drug Wegovy eased issues for people with a type of heart problem, adding to the treatment’s benefits beyond weight loss.
One of the leading new obesity drugs, Wegovy, eased symptoms and raised the quality of life of patients with obesity and a common type of heart failure, a study funded by the drug’s maker found, adding to the evidence that the medications can produce health benefits beyond weight loss.
The study, published on Friday in The New England Journal of Medicine, evaluated the drug in people with a condition known as preserved ejection fraction in which the heart pumps normally but has lost the flexibility needed to fill with blood. The condition accounts for roughly half of all heart failure cases.
Patients given Wegovy in the trial showed greater improvements in physical fitness and in symptoms like fatigue and shortness of breath than those administered a placebo. The study, which included 529 participants and lasted for a year, was not designed to assess cardiac emergencies, but it found that 12 patients on the placebo and only one on Wegovy were hospitalized or required an urgent medical visit for heart failure.
The drug showed more pronounced relief of heart failure symptoms than other treatments, the study said.
“This is a huge patient population that is extremely symptomatic, for which we’ve had very few if any treatment options, and in which obesity is highly prevalent,” said Dr. Mikhail Kosiborod, a cardiologist at Saint Luke’s Mid America Heart Institute in Kansas City and the study’s lead investigator, who also consults for Novo Nordisk, the maker of Wegovy. “It’s going to be a true paradigm shift.”
Cardiologists used to see obesity as a condition that simply coexisted with heart failure. But the new study strengthened the evidence of obesity being a main driver of the disease.
“It’s a proof of concept that in many patients with this type of heart failure, where obesity is in fact causal, it needs to be treated as a root cause of heart failure and needs to be targeted as a therapeutic strategy,” Dr. Kosiborod said.
Another study evaluating the drug in heart failure patients with obesity and diabetes is expected to wrap up this year. If that study, too, produces promising results, Novo Nordisk has said it could seek to have the drug formally recommended for the treatment of heart failure.
Scientists who did not work on the trial said it would be important to study the drug over longer periods in more patients, allowing researchers to determine whether it actually reduced the likelihood of hospitalizations or deaths. But given the severity of physical limitations and symptoms in patients with this type of heart failure, the improvements on those measures alone were notable, they said.
On a 100-point measure of quality of life and physical abilities, patients given Wegovy experienced a greater improvement of their symptoms by roughly eight more points than patients on the placebo, according to the study. People on Wegovy also showed greater gains on a six-minute walk test.
“It’s a short trial, and so we can’t say much about long-term sustained benefits, but I think the magnitude of the benefit is impressive relative to what other interventions have shown in the same population,” said Dr. Daniel Drucker, a senior scientist at the Lunenfeld Tanenbaum Research Institute at Mt. Sinai Hospital in Toronto who has studied the new drugs. He has received fees from Novo Nordisk but was not involved in the latest trial.
Wegovy and another version of the same drug for diabetes patients, Ozempic, have quickly become popular for the significant weight loss results they have shown — so much so that Novo Nordisk has struggled to meet growing demand.
But the latest study built on other recent evidence that the drug does more than cut weight.
The company, for example, announced this month that Wegovy also slashed the risk of heart complications by 20 percent among a different pool of patients in a large trial, a result that was seen as crucial for persuading more insurers to cover the new weight loss drugs. Researchers are waiting for the company to release the underlying data to the study to examine the topline results.
“Obesity is associated with 200 other obesity-related diseases,” said Dr. Ania Jastreboff, an endocrinologist and obesity medicine specialist at Yale University who consults for makers of obesity drugs. “If we treat this one disease, we can potentially impact the health of so many patients in many different ways, and this is yet another important example.”
Experts believe that weight loss on its own probably accounted for some of the improvements in patients’ heart health. But determining exactly how big a role weight loss played and what other factors may have contributed will require more research.
The heart failure study released on Friday, for example, found indications that Wegovy may have reduced inflammation. Patients on the drug also had lower levels of an important marker of heart congestion, another sign that the drug is doing something that may have an effect on heart failure.
“We still need to understand that better,” Dr. Kosiborod said.
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The brain activity of a paralyzed woman is being translated into words spoken by an avatar. This milestone could help others who have lost speech.
At Ann Johnson’s wedding reception 20 years ago, her gift for speech was vividly evident. In an ebullient 15-minute toast, she joked that she had run down the aisle, wondered if the ceremony program should have said “flutist” or “flautist” and acknowledged that she was “hogging the mic.”
Just two years later, Mrs. Johnson — then a 30-year-old teacher, volleyball coach and mother of an infant — had a cataclysmic stroke that paralyzed her and left her unable to talk.
On Wednesday, scientists reported a remarkable advance toward helping her, and other patients, speak again. In a milestone of neuroscience and artificial intelligence, implanted electrodes decoded Mrs. Johnson’s brain signals as she silently tried to say sentences. Technology converted her brain signals into written and vocalized language, and enabled an avatar on a computer screen to speak the words and display smiles, pursed lips and other expressions.
The research, published in the journal Nature, demonstrates the first time spoken words and facial expressions have been directly synthesized from brain signals, experts say. Mrs. Johnson chose the avatar, a face resembling hers, and researchers used her wedding toast to develop the avatar’s voice.
“We’re just trying to restore who people are,” said the team’s leader, Dr. Edward Chang, the chairman of neurological surgery at the University of California, San Francisco.
“It let me feel like I was a whole person again,” Mrs. Johnson, now 48, wrote to me.
The goal is to help people who cannot speak because of strokes or conditions like cerebral palsy and amyotrophic lateral sclerosis. To work, Mrs. Johnson’s implant must be connected by cable from her head to a computer, but her team and others are developing wireless versions. Eventually, researchers hope, people who have lost speech may converse in real time through computerized pictures of themselves that convey tone, inflection and emotions like joy and anger.
“What’s quite exciting is that just from the surface of the brain, the investigators were able to get out pretty good information about these different features of communication,” said Dr. Parag Patil, a neurosurgeon and biomedical engineer at the University of Michigan, who was asked by Nature to review the study before publication.
Video by Metzger et al., Weill Institute for Neurosciences/University of California, San Francisco
Mrs. Johnson’s experience reflects the field’s fast-paced progress. Just two years ago, the same team published research in which a paralyzed man, who went by the nickname Pancho, used a simpler implant and algorithm to produce 50 basic words like “hello” and “hungry” that were displayed as text on a computer after he tried to say them.
Mrs. Johnson’s implant has nearly twice as many electrodes, increasing its ability to detect brain signals from speech-related sensory and motor processes linked to the mouth, lips, jaw, tongue and larynx. Researchers trained the sophisticated artificial intelligence to recognize not individual words, but phonemes, or sound units like “ow” and “ah” that can ultimately form any word.
“It’s like an alphabet of speech sounds,” David Moses, the project manager, said.
While Pancho’s system produced 15 to 18 words per minute, Mrs. Johnson’s rate was 78 using a much larger vocabulary list. Typical conversational speech is about 160 words per minute.
When researchers began working with her, they didn’t expect to try the avatar or audio. But the promising results were “a huge green light to say, ‘OK, let’s try the harder stuff, let’s just go for it,’” Dr. Moses said.
They programmed an algorithm to decode brain activity into audio waveforms, producing vocalized speech, said Kaylo Littlejohn, a graduate student at the University of California, Berkeley, and one of the study’s lead authors, along with Dr. Moses, Sean Metzger, Alex Silva and Margaret Seaton.
“Speech has a lot of information that is not well preserved by just text, like intonation, pitch, expression,” Mr. Littlejohn said.
William Johnson feeds his wife pasta. About a decade after her stroke, she decided she wanted to try solid food instead of being entirely fed by a tube.Sara Hylton for The New York Times
Cheryl Ruddell, Mrs. Johnson’s caregiver, cleaning the implant used for the avatar study.Sara Hylton for The New York Times
Physical therapy with Ms. Ruddell.Sara Hylton for The New York Times
Working with a company that produces facial animation, researchers programmed the avatar with data on muscle movements. Mrs. Johnson then tried to make facial expressions for happy, sad and surprised, each at high, medium and low intensity. She also tried to make various jaw, tongue and lip movements. Her decoded brain signals were conveyed on the avatar’s face.
Through the avatar, she said, “I think you are wonderful” and “What do you think of my artificial voice?”
“Hearing a voice similar to your own is emotional,” Mrs. Johnson told the researchers.
She and her husband, William, a postal worker, even engaged in conversation. She said through the avatar: “Do not make me laugh.” He asked how she was feeling about the Toronto Blue Jays’ chances. “Anything is possible,” she replied.
The field is moving so quickly that experts believe federally approved wireless versions might be available within the next decade. Different methods might be optimal for certain patients.
On Wednesday, Nature also published another team’s study involving electrodes implanted deeper in the brain, detecting activity of individual neurons, said Dr. Jaimie Henderson, a professor of neurosurgery at Stanford and the team’s leader, who was motivated by his childhood experience of watching his father lose speech after an accident. He said their method might be more precise but less stable because specific neurons’ firing patterns can shift.
Their system decoded sentences at 62 words per minute that the participant, Pat Bennett, 68, who has A.L.S., tried to say from a large vocabulary. That study didn’t include an avatar or sound decoding.
Both studies used predictive language models to help guess words in sentences. The systems don’t just match words but are “figuring out new language patterns” as they improve their recognition of participants’ neural activity, said Melanie Fried-Oken, an expert in speech-language assistive technology at Oregon Health & Science University, who consulted on the Stanford study.
Video by Metzger et al., Weill Institute for Neurosciences/University of California, San Francisco
Neither approach was completely accurate. When using large vocabulary sets, they incorrectly decoded individual words about a quarter of the time.
For example, when Mrs. Johnson tried to say, “Maybe we lost them,” the system decoded, “Maybe we that name.” But in nearly half of her sentences, it correctly deciphered every word.
Researchers found that people on a crowdsourcing platform could correctly interpret the avatar’s facial expressions most of the time. Interpreting what the voice said was harder, so the team is developing a prediction algorithm to improve that. “Our speaking avatar is just at the starting point,” Dr. Chang said.
Experts emphasize that these systems aren’t reading people’s minds or thoughts. Rather, Dr. Patil said, they resemble baseball batters who “are not reading the mind of the pitcher but are kind of interpreting what they see the pitcher doing” to predict pitches.
Still, mind reading may ultimately be possible, raising ethical and privacy issues, Dr. Fried-Oken said.
Mrs. Johnson contacted Dr. Chang in 2021, the day after her husband showed her my article about Pancho, the paralyzed man the researchers had helped. Dr. Chang said he initially discouraged her because she lived in Saskatchewan, Canada, far from his lab in San Francisco, but “she was persistent.”
Mr. Johnson, 48, arranged to work part time. “Ann’s always supported me to do what I’ve wanted,” including leading his postal union local, he said. “So I just thought it was important to be able to support her in this.”
The album from Ann and William Johnson’s wedding, which occurred just two years before her stroke.Sara Hylton for The New York Times
Determination has always been part of Ann Johnson’s personality. When she and William Johnson first began dating, she gave him 18 months to propose. When he did, she had “already gone and picked out her engagement ring.”Sara Hylton for The New York Times
The Johnsons’ car is equipped for Ann Johnson’s wheelchair. It takes them three days to travel to San Francisco from Regina for the research.Sara Hylton for The New York Times
She started participating last September. Traveling to California takes them three days in a van packed with equipment, including a lift to transfer her between wheelchair and bed. They rent an apartment there, where researchers conduct their experiments to make it easier for her. The Johnsons, who raise money online and in their community to pay for travel and rent for the multiyear study, spend weeks in California, returning home between research phases.
“If she could have done it for 10 hours a day, seven days a week, she would have,” Mr. Johnson said.
Determination has always been part of her nature. When they began dating, Mrs. Johnson gave Mr. Johnson 18 months to propose, which he said he did “on the exact day of the 18th month,” after she had “already gone and picked out her engagement ring.”
Mrs. Johnson communicated with me in emails composed with the more rudimentary assistive system she uses at home. She wears eyeglasses affixed with a reflective dot that she aims at letters and words on a computer screen.
It’s slow, allowing her to generate only 14 words per minute. But it’s faster than the only other way she can communicate at home: using a plastic letter board, a method Mr. Johnson described as “her just trying to show me which letter she’s trying to try to look at and then me trying to figure out what she’s trying to say.”
The inability to have free-flowing conversations frustrates them. When discussing detailed matters, Mr. Johnson sometimes says something and receives her response by email the next day.
“Ann’s always been a big talker in life, an outgoing, social individual who loves talking, and I don’t,” he said, but her stroke “made the roles reverse, and now I’m supposed to be the talker.”
Mrs. Johnson was teaching high school math, health and physical education, and coaching volleyball and basketball when she had her brainstem stroke while warming up to play volleyball. After a year in a hospital and a rehabilitation facility, she came home to her 10-year-old stepson and her 23-month-old daughter, who has now grown up without any memory of hearing her mother speak, Mr. Johnson said.
“Not being able to hug and kiss my children hurt so bad, but it was my reality,” Mrs. Johnson wrote. “The real nail in the coffin was being told I couldn’t have more children.”
Ann Johnson’s at-home communication system involves using eyeglasses with a reflective dot that she aims at letters and words on the screen.Sara Hylton for The New York Times
A letter board Ann Johnson sometimes uses to communicate. She looks at the letters and her husband guesses the words she’s trying to express.Sara Hylton for The New York Times
Ms. Ruddell putting a cap over Ann Johnson’s head. When Mrs. Johnson first tried to make emotional expressions with the avatar, “I felt silly, but I like feeling like I have an expressive face again,” she said.Sara Hylton for The New York Times
For five years after the stroke, she was terrified. “I thought I would die at any moment,” she wrote, adding, “The part of my brain that wasn’t frozen knew I needed help, but how would I communicate?”
Gradually, her doggedness resurfaced. Initially, “my face muscles didn’t work at all,” she wrote, but after about five years, she could smile at will.
She was entirely tube-fed for about a decade, but decided she wanted to taste solid food. “If I die, so be it,” she told herself. “I started sucking on chocolate.” She took swallowing therapy and now eats finely chopped or soft foods. “My daughter and I love cupcakes,” she wrote.
When Mrs. Johnson learned that trauma counselors were needed after a fatal bus crash in Saskatchewan in 2018, she decided to take a university counseling course online.
“I had minimal computer skills and, being a math and science person, the thought of writing papers scared me,” she wrote in a class report. “At the same time, my daughter was in grade 9 and being diagnosed with a processing disability. I decided to push through my fears and show her that disabilities don’t need to stop us or slow us down.”
Helping trauma survivors remains her goal. “My shot at the moon was that I would become a counselor and use this technology to talk to my clients,” she told Dr. Chang’s team.
At first when she started making emotional expressions with the avatar, “I felt silly, but I like feeling like I have an expressive face again,” she wrote, adding that the exercises also enabled her to move the left side of her forehead for the first time.
She has gained something else, too. After the stroke, “it hurt so bad when I lost everything,” she wrote. “I told myself that I was never again going to put myself in line for that disappointment again.”
Now, “I feel like I have a job again,” she wrote.
Besides, the technology makes her imagine being in “Star Wars”: “I have kind of gotten used to having my mind blown.”
