Invasive brain-computer interfaces hold promise to alleviate disabilities in
individuals with neurologic injury, with fully implantable brain-computer
interface systems expected to reach the clinic in the upcoming decade. Children
with severe neurologic disabilities, like quadriplegic cerebral palsy or
cervical spine trauma, could benefit from this technology. However, they have
been excluded from clinical trials of intracortical brain-computer interface to
date. In this manuscript, we discuss the ethical considerations related to the
use of invasive brain-computer interface in children with severe neurologic
disabilities. We first review the technical hardware and software considerations
for the application of intracortical brain-computer interface in children. We
then discuss ethical issues related to motor brain-computer interface use in
pediatric neurosurgery. Finally, based on the input of a multidisciplinary panel
of experts in fields related to brain-computer interface (functional and
restorative neurosurgery, pediatric neurosurgery, mathematics and artificial
intelligence research, neuroengineering, pediatric ethics, and pragmatic
ethics), we then formulate initial recommendations regarding the clinical use of
invasive brain-computer interfaces in children.