Revolutionizing Rehabilitation of Disorders of Consciousness with Brain Wave Analysis
The EyeCon system is used to rehabilitate patients with low levels of consciousness and helps promote communication with the patient. The system is based on an advanced analysis of brain waves measured by EEG electrodes on the patient’s forehead. Using groundbreaking technology and treatment protocols, the EyeCon system can bridge the gap between unconsciousness and consciousness. The EyeCon system is easy to operate at the patient’s bedside and allows the family to be an active part of the rehabilitation process of their loved one.
The EyeCon system includes 4 elements:
- EEG and EMG Integration: Electrodes on the patient’s forehead allow the reception of brain waves (EEG) and evaluation of facial muscle responses (mainly blinks) via EMG.
- Advanced Software Processing: Computer software processes the EEG waves for advanced analysis.
- Family Involvement: An “operator,” typically a family member or friend, activates the software and assists in the rehabilitation process.
- Clinical Oversight: A medical staff member provides offline feedback regarding the rehabilitation process and guides the family on how to work with the patient.
How the EyeCon System Works:
- Measuring Brain Activity: Brain activity and eye blinks (EMG) are measured with the help of EEG electrodes.
- Auditory Stimuli: Based on the measured activity, the system plays auditory stimuli (e.g., pieces of music).
- Guidance for Practice: The system instructs the operator on how to guide the patient in practice.
- Clinical Monitoring: The clinician monitors the treatments offline and adjusts the system and instructions according to the findings.
The EyeCon system was developed by Dr. Goded Shahaf, a renowned physician, brain researcher, and Principal Investigator at The Applied Neurophysiology Lab, Rambam Health Care Campus (Rambam), in collaboration with leading rehabilitation teams from Reuth Rehabilitation Hospital and Rambam. Dr. Shahaf’s extensive expertise in neurophysiology and innovative rehabilitation techniques has been instrumental in creating a cutting-edge solution for patients with disorders of consciousness. By combining advanced brain wave analysis with user-friendly technology, the EyeCon system is designed to improve patient outcomes and facilitate communication between patients, scientists, therapists, and family members.
Steps Required to Use the EyeCon System:
- The level of attention is measured by an index calculated every 10 seconds and displayed on a graph.
- Music that the patient likes is played to recruit attention. The music stops after 30 seconds, and the patient is asked to blink to resume it.
- If the patient blinks, the music continues.
- If there is no blinking movement but attention remains high, the instruction to blink is repeated until a blinking movement occurs.
- If there is no blinking movement and attention decreases, a tap on the center of the forehead elicits a blink reflex, teaching the patient how to produce a consistent response of “yes,” the first stage toward consciousness.
This is an example of a session sample using the EyeCon system. The time in minutes is marked on the X-axis, with this session’s duration being approximately 30 minutes. The attention index is marked on the Y-axis. Black/blue dots are plotted every 10 seconds, indicating the patient’s level of attention. Typically, an attentive patient is expected to demonstrate an attention level within the intermediate range. This detailed tracking allows therapists, scientists, and family members to monitor progress and adjust treatment protocols effectively, enhancing the overall rehabilitation process.
The attention marker in the EyeCon system can demonstrate three distinct patterns, which the system identifies automatically. These patterns provide critical insights for therapists, scientists, and family members, allowing for precise monitoring and adjustment of rehabilitation protocols to optimize patient outcomes:
- Low Attention – where values tent to be consistently below the lower threshold.
- Attention in the effective intermediate
- Prevailing sharp increases and decreases in the marker – which may indicate a state of stress
In our experience with the EyeCon system, when continuous attention (above the lower threshold) is maintained for about a minute or more, indicating the ability to produce sustained attention (patterns 2 and 3 above), there is a high likelihood of adapting to the system. This adaptation can potentially restore at least partial conscious communication. Even patients who initially display a consistently low level of attention often show improvement with the system, although other factors, such as systemic medical deterioration, may need to be addressed first. This information is crucial for scientists, therapists, and family members working together to achieve the best possible outcomes for patients.
The Various Protocols of Rehabilitation Guided by the EyeCon System:
During the rehabilitation process, the team of caregivers teaches the patient’s support circle to use the EyeCon system effectively. The understanding is that the more the patient practices, the more progress might be achieved. This comprehensive approach ensures that family members, therapists, and scientists are all aligned in their efforts to optimize patient outcomes.
In the initial rehabilitation process, the patient may go through four main protocols:
- Protocol 1: Learning how to indicate “yes” with the previously described method.
- Protocol 2: Learning how to indicate “no” by adding a noise that the patient can stop by avoiding/reducing blinks.
- Protocol 3: Generalizing the “yes”/”no” responses from the previous protocols to yes/no questions of various types and categories, such as personal questions (“Is your name Yossi?”) and other questions that test and teach different brain functions (recognition of sounds, categorization of items, etc.).
- Protocol 4: Using auditory tailored menus of augmentative and alternative communication (AAC) with the yes/no responses.
These rehabilitation protocols, designed by the EyeCon team, provide a structured framework that enables patients to gradually improve their communication skills. By involving family members and leveraging advanced neurorehabilitation techniques, the EyeCon system fosters a collaborative environment conducive to patient recovery and enhanced communication.
The EyeCon Team:
- Goded Shahaf, MD, PhD: Physician, researcher, and entrepreneur, Director of the Laboratory for Applied Neurophysiology, Rambam Health Care Campus.
- Dana Bar-On Shahaf, MD, PhD: Anesthesiologist, researcher, Head of the Neuroanesthesia Unit, Rambam Health Care Campus.
- Aviah Gvion, PhD: Director of the Treatment of Communication Disorders Unit, Reuth Rehabilitation Hospital.
- Tamar Shahar: Responsible for occupational therapy services for patients with reduced consciousness, Reuth Rehabilitation Hospital.
The EyeCon system is user-friendly and can be operated at the patient’s bedside, making it accessible for family members to actively participate in the rehabilitation process. This seamless integration of technology and personal care bridges the gap from unconsciousness to consciousness, offering hope and improved outcomes for patients with disorders of consciousness.
We strive to assist scientists, therapists, and family members seeking innovative solutions in neurorehabilitation, the EyeCon system provides a comprehensive, user-friendly approach to enhance patient recovery and communication. Its ease of use and effectiveness make it an invaluable tool in the journey towards improved patient outcomes and restored communication abilities.
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Dr. Goded Shahaf, MD, PhD
