Wednesday, March 23, 2016

Eye tracking device and concussion management

A neuro-technology company has received Food and Drug Administration (FDA) clearance for a medical device that could detect concussions in less than 60 seconds on the sidelines of playing fields across the nation. EYE-SYNC, a product of SyncThink, is an integrated ad-mounted eye-tracking device that analyzes eye movement impairment through the use of virtual reheality.

Dr. Jamshid Ghajar, neurosurgeon at Stanford University, president of the Brain Trauma Foundation, and SyncThink founder, told the product is distinct mainly because it does not claim to diagnose a concussion but rather detects disruption in visual information.

“All of the other technologies out there say that they’re ‘diagnosing concussion,’ but there’s no accepted definition, so how are you diagnosing it?” he said…

While some of the current technologies available to players and coaches focus on measuring the impact of a hit, or gauging the level of symptoms, Ghajar was careful to say that a definitive diagnosis will not come from just one tool.

“We don’t know what a ‘concussion’ is; there is no accepted diagnosis,” Ghajar said.
Ghajar is working with the FDA to come up with a diagnostic endpoint so other technologies can be rated.

“Ninety percent of what the brain does is through visual information, and the main thing with a concussion is that it gets disrupted,” he said. “Your brain has to predict what’s about to happen and when the information is going to come in so that you can process it.”…

With the EYE-SYNC device, users see a dot traveling around a circle while a camera tracks how well their eye follows the dot and measures attention for about 30 seconds. In the case of injury to the brain, the eye may jump to where it believes the dot is going before the dot gets there rather than following the path the dot is taking. Returning to the tennis analogy, Ghajar said it would be like a player swinging before the ball has reached the racket.

Once results are determined, trainers can decide whether to sit the player out to avoid another injury or putting them in harm’s way. Stanford University’s football team uses EYE-SYNC on the sidelines as well as SCAT 3 concussion assessment, which includes evaluating symptoms, cognition, balance and coordination.

“If [the player’s] eye tracking was normal, they sent them back into play,” Ghajar said. “If they could focus, then the headache they had was from something else.”…

Once a patient’s eye tracking is determined to be affected, Ghajar has him or her work with a physical therapist to address vestibular balance issues, and a neuropsychologist to address anxiety or depression caused by the injury. Ghajar also recommends that all patients return to a low-level of cardiovascular exercise to help recovery. He referenced a recent study involving mice that determined rest between concussions was necessary for the brain to return to normal function. However, he pointed out that the study only went so far as to say that rest was classified as non-contact function.

“Rest doesn’t mean don’t exercise— it means don’t get hit again,” he said. “We’re not advocating banging on your head again. We’re advocating getting on a treadmill or a bike and getting cardio exercise.”

Citing a study published in the journal Pediatrics on the benefits of strict rest after a concussion, Ghajar said he believes the current practice of keeping a patient isolated during recovery can hinder the process. He said children who miss school may see their academics and friendships suffer, further leading to psychological stress. Ghajar called for more research in this area.

As far as diagnosing concussions goes, Ghajar said he thought the design of future tools would lay in eye tracking, whether it be the EYE-SYNC or another technology.

“Everybody is looking for some kind of an objective measure,” he said, “and I think the EYE-SYNC is a really good objective measure.”

1 comment:

  1. Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke T. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics. 2015



    To determine if recommending strict rest improved concussion recovery and outcome after discharge from the pediatric emergency department (ED).


    Patients aged 11 to 22 years presenting to a pediatric ED within 24 hours of concussion were recruited. Participants underwent neurocognitive, balance, and symptom assessment in the ED and were randomized to strict rest for 5 days versus usual care (1-2 days rest, followed by stepwise return to activity). Patients completed a diary used to record physical and mental activity level, calculate energy exertion, and record daily postconcussive symptoms. Neurocognitive and balance assessments were performed at 3 and 10 days postinjury. Sample size calculations were powered to detect clinically meaningful differences in postconcussive symptom, neurocognitive, and balance scores between treatment groups. Linear mixed modeling was used to detect contributions of group assignment to individual recovery trajectory.


    Ninety-nine patients were enrolled; 88 completed all study procedures (45 intervention, 43 control). Postdischarge, both groups reported a 20% decrease in energy exertion and physical activity levels. As expected, the intervention group reported less school and after-school attendance for days 2 to 5 postconcussion (3.8 vs 6.7 hours total, P < .05). There was no clinically significant difference in neurocognitive or balance outcomes. However, the intervention group reported more daily postconcussive symptoms (total symptom score over 10 days, 187.9 vs 131.9, P < .03) and slower symptom resolution.


    Recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care. Adolescents' symptom reporting was influenced by recommending strict rest.