Inclusion Criteria:
1. Able to provide informed consent to participate in the study.
2. Bilateral upper-limb paresis or Amyotrophic lateral sclerosis (ALS) with bilateral upper limb paresis
3. The underlying condition causing motor impairment must be refractory to treatment and have been present for a minimum of twelve months.
4. Aged 21 years or older
5. Life expectancy greater than 12 months post-implantation
6. Preserved precentral gyrus assessed using CT
7. Suitable vascular anatomy assessed using CT venography
8. Suitable anatomy for subcutaneous pocket creation
9. Able to undergo anesthesia
10. Willing and able to comply with investigational requirements, including clinical testing visits and training visits in the home.
11. Caregiver(s) willing and able to facilitate study visits, including visits at the study site and in the home, and BCI use outside of study visits (e.g. device charging)
12. Patient and caregiver fluent in English
13. Suitable home environment for BCI training, including an internet connection
Exclusion Criteria:
1. Unrealistic expectations regarding the potential benefits of the device.
2. Active infection or unexplained fever in the 48 hours prior to informed consent
3. Major psychiatric disorder that may adversely impact the participant's safety or study compliance, including severe depression, psychotic features, personality disorder, severe emotional lability, or substance abuse.
4. Dementia or cognitive dysfunction that would impact the participant's ability to participate in study activities.
5. Active implanted device (e.g., deep brain stimulator, cardiac defibrillator, pacemaker, vagal nerve stimulator, spinal cord stimulator, diaphragmatic pacer, etc.).
6. Known allergy to patient-contacting materials included in the implanted device
7. Contraindication to angiographic imaging or iodine contrast media.
8. History of central venous sinus thrombosis.
9. Recent history of new venous thromboembolic event (in the 6 months prior to implant) or recurrent history of venous thromboembolic disease
10. Contraindication to antithrombotic therapy.
11. Participant is at substantially increased risk of infection, including immunocompromised status, recurrent infection, or poorly controlled diabetes mellitus.
12. Significant risk of non-healing of the subcutaneous pocket incision, including history of chronic non-healing surgical wounds or poorly controlled diabetes mellitus.
13. Pregnant or breast feeding.
14. Patients who are currently enrolled in any other clinical trial that would confound interpretation of safety or effectiveness data or may interfere with the ability to meet study requirements.
15. Any other disease or disorder that could significantly affect participation in the study. Examples may include corrected vision insufficient for viewing computer screens or hearing insufficient for following verbal instructions, which might impact the participant's ability to participate in BCI training and testing.
