Bradford Smith is doing an interview, sitting silent in a motorized wheelchair with a computer hooked to it on a platform above and across from his face. A reporter asks a question, then waits for several minutes while he thinks about his answer and the computer begins to put it, letter by letter or word by word, on the screen before reading it aloud.
Smith has amyotrophic lateral sclerosis (ALS, sometimes called Lou Gehrig’s disease) and in the years since his 2018 diagnosis, the 44-year-old has lost his ability to do pretty much anything besides think on his own. He can move his eyes and the corners of his mouth twitch upward when he smiles. But he can’t breathe without mechanical assistance or eat. He has no control over his limbs. And he lost the ability to speak a few years ago, though that’s back in a somewhat different form thanks to groundbreaking technology.
Smith is the third person to receive a Neuralink implant and the first of the recipients who could not speak on his own. The other two had spinal cord injuries but their voices were intact. That turned out to be significant with Neuralink, which is a coin-sized implanted brain-computer interface made by a company Elon Musk founded with a team of scientists and engineers.
Neuralink has 1,024 electrodes and can read neural activity, sending signals to a computer. Artificial intelligence decodes what Brad wants to type, which he’s able to tell it telepathically. Some of his answers have been worked out in advance, so he just has to click on them, then the computer reads them aloud. There are pauses in the conversation because typing without moving a muscle is a bit slow. But it’s an immensely satisfying process. It gave him back his voice. And if Brad and the person talking to him are willing to add a few extra seconds, he can respond to questions in his own voice, also courtesy of AI. But more about that in a minute.
Thursday, Musk’s company announced that it had received a “Breakthrough Device” designation from the U.S. Food and Drug Administration. It was definitely a breakthrough for the Smith family.
A devastating diagnosis
Brad was largely raised in Utah, where he lived until his 30s. But he and his wife Tiffany were open to new opportunities and adventures when they married 16 years ago, and they moved with his work as they were starting a family that now includes Lincoln, 13, Edison, 9, and Abigail, 7.
Life has been a three-legged stool for the Smiths, centering on God, family and hard work.
Playing a game of dodgeball at a church building — they are devout members of The Church of Jesus Christ of Latter-day Saints — he said he tweaked his shoulder. But instead of healing, it got weaker and weaker.
It was a neurologist who told him his muscles and nerves weren’t carrying electricity and it was quite likely to be ALS. If he doubted the diagnosis was devastating, any illusion disappeared when the physician gave him a hug. He left the office, he said, “in a haze of grief.”
In the parking lot, he wept and prayed desperately. The response, he adds, was the equivalent of a “big trust me. I felt assurance everything is going to be all right.”
But he had to tell his wife and his business partner that he might have a terminal disease. And he needed more testing to rule out the possibility of a spinal cord injury, which would in this case be better news.
The ALS diagnosis proved true, as he later learned at a specialty clinic in Phoenix.
By 2020, he needed a tracheotomy to help him breathe. And his voice fell silent.
Hope in the form of technology
Brad and Tiffany Smith, who were living in Glendale, Arizona, by then, had been paying attention to news of a new device that might let someone use telepathy to communicate by computer. When Neuralink opened a patient portal for people who might be interested in it, “I jumped on it,” Bradford told Deseret News. “I was following it closely. It was a huge win that it happened in Arizona near where I live.”
When he got an email from a Neuralink representative in early 2024, he said he “started a campaign of shameless self-promotion. I really wanted this.”
One step at a time has been the path for the device and its approval. After the first patient received the implant, data was collected to see if the Food and Drug Administration would allow a second person to get the implant. That data had to be collected to see if there would be a third.
The first two were people who’d lost the ability to move because of spinal cord injury. They could talk. Brad was the third person to receive the implant, but he was also a pioneer in that voice commands that helped the other two wouldn’t help him. So he became patient/consultant as the Neuralink team worked to figure out how to change its technology to meet his very different situation.
And even getting far enough to be considered required a lot of tests and scans. “Three hours in an MRI is no joke,” he said. “I also had to do a bunch of psychological tests to make sure I was not suicidal and they had to set a baseline to make sure I did not lose intelligence or ability.”
Despite being on a ventilator, he said he got the impression he was the front-runner to be patient No. 3, and was buoyed when the hospital asked him if, “hypothetically,” he could be available the first week in November last year. In late October, the FDA gave a thumbs-up and he was implanted two weeks later.
Faith and family bolsters his survival
Ultimately, infection will kill him, he said. But his wife takes really good care of him, he added, which has gotten him this far. He calls her his “secret weapon.”
As he tells his story in a mix of answers he pre-typed and new responses, Smith sometimes uses his mind to hit a keyboard shortcut that prompts the voice to say “I need to cough.” Lincoln and Tiffany both know what to do. He can’t actually cough; they have to suction phlegm to clear his airway and his mouth.
For the children, who were very young when he was diagnosed, it’s all very normal. “Weird how children adjust to a different normal,” Smith mused.
The Smiths are in Utah right now for Tiffany’s sister’s wedding. And while Tiffany said she can’t imagine what more her husband can lose, she said her relatives can’t help but notice that he’s smiling more, is happier and has a greater sense of purpose now that he can communicate again.
He jokes often, noting he’s “high maintenance,” and at one point quipping that he’s “fat and lazy.”
One thing he did after his diagnosis was record stories for his children — how he met Tiffany, what he was like in school and other tales. They went into a voice bank that would prove to be significant. They were used not long ago to help train AI to speak for him in the voice he had, though he doesn’t choose to use it all the time. It’s often easier just to use the computer’s voice, which is a bit faster.
But for a free-ranging conversation, the AI-generated Brad voice is just the ticket, and it also captures his unique humor. Inspired by things he’s said or might say, his computer sometimes gives him several choices for answers, often sassy and humorous. He can pick or modify them or choose to say something else.
He said he’s pretty sure that his ability to type using his mind, no fingers involved, makes him a superhero.
Choosing life
He and Tiffany had decided early on in the disease that he wanted to live as long as he had quality of life. They defined that as the ability to be a decent father and serve others.
Neuralink, he said, has helped with all of that.
Sometimes, he’s found it hard to need or accept help. He does it anyway. “I have learned that being served by others is just as important as serving others. It has been hard to ask for help.”
His advice to others? “As you go through life, be friendly with everyone and work hard on everything! You never know when you will need a friend to help you out!”
Faith has been a cornerstone in this journey and he’s working to submit to God’s will in his life. “There’s no magic formula,” he said, then paraphrases President Jeffrey R. Holland, acting president of the Quorum of the Twelve Apostles in his faith: salvation is not a cheap experience.
“It took me a few months to process my testimony after my death-sentence diagnosis,” Smith said. “I had to remember why I believe what I believe.”
Faith has been good for all of them as they’ve adjusted to his situation, Tiffany told the Deseret News. “I can’t imagine not having faith or a belief in something beyond this life.”
She added that she believes in miracles, but the likelihood he’ll be healed in this life is pretty slim. Still, “I have faith this life is not the end and our family will continue.”
“I am lucky in so many ways! I have worked all over the world and I have seen many people who are happy with much less than I have,” Smith said. “So, with this perspective, how can I be angry?”
