EyeCon System – Detailed Information
The need
is significantly higher than what was recognized in the clinical diagnosis. In a significant percentage of cases, it was discovered that patients who were clinically diagnosed as suffering from severely impaired consciousness, were in fact fully conscious,
Despite this knowledge, until now there was no tool available to restore the ability of these patients to communicate with their environment.
Target Audience
Thousands of patients in Israel and hundreds of thousands of patients worldwide are in a chronic state of severely impaired consciousness. Available data shows that about one percent of the patients who arrive in the emergency room are in a state of reduced consciousness, and a significant number of them remain in this state for several days, weeks or more. The target audience of this project is all of these patients, as well as their relatives and friends, who must confront the complete loss of the ability to communicate with their loved ones.
The Solution
We have developed an initial version of a rehabilitation tool, EyeCon, designed to promote the ability for alternative communication in patients with severely impaired consciousness.
The tool is based on two main components:
- Brain monitoring of the patient to identify reactions of discomfort / pain on one hand and changes in attention as evidence of improvement or deterioration in the patient’s condition, on the other hand.
- Advancing the patient between different levels of alternative communication while combining means of brain monitoring with auditory media, which can be controlled with the help of eye blinks.
A comprehensive treatment protocol has been developed that includes detailed instructions on how to proceed with the majority of patients with severely impaired consciousness. The protocol takes into account potential challenges in the process, based on clinical experience gained with many patients.
One of the great advantages of EyeCon is the ease of operation that allows the patient’s family members or friends to conduct exercises with the patient daily, and even several times a day, under the guidance of a clinical team. In most countries, these patients do not receive the amount of hours with a clinical therapist that would allow multiple daily exercises. Thus, the ability to perform these exercises by family and friends, with remote professional guidance, is very significant for effective progress in treatment.
The family also derives enormous value from this process, even before clinical progress is achieved, as they finally have meaningful interaction with the patient. They become active in the rehabilitation process, contributing to the well-being of the patient and themselves.
EyeCon includes the following components:
- Brain activity and blinks are measured using a simple headband placed around the patient’s head with electrodes on the forehead
- Based on the measured activity, the system plays auditory stimuli (e.g. pieces of music)
- The system instructs the operator how to guide the patient in the practice
- The clinician remotely monitors the treatments and adjusts the system and the instructions according to the findings.
The treatment protocol is based on the following four steps:
Step 1 protocol – the patient learns how to indicate “yes”. Brainstem structures that control the blinking muscles, generally allow patients in a state of reduced consciousness to blink in one way or another. In the first stage of the protocol, the patient is played media that he liked to hear before the injury (usually music), in an effort to elicit attention. When the media stops 30 seconds later, the patient is asked to blink in order to start it again. If there is an activation of the eye muscles to blink, the media is activated again. If there is no blinking, the system guides the caregiver, according to a therapeutic algorithm, how to induce blinking.
Step 2 Protocol – after clearly learning how to indicate a “yes” response, the patient learns how to indicate “no”. At this stage, the patient’s favorite media pieces are alternated with an unpleasant sound (noise). The patient learns to stop blinking to avoid the unpleasant sound, and alternately, to continue blinking in order to hear the favorite music, to maintain the blink response to “yes”.
Step 3 protocol – the patient learns how to generalize “yes”/”no” responses to personal questions for which the correct answers are pre-entered into the system (“Is your name “Abraham”? Yes / No) and to questions that test different brain functions (recognition of sounds, whether items belong to categories, etc.) This stage is also used as a diagnostic tool to evaluate the extent of the patient’s cognitive impairment.
Step 4 protocol – After acquiring the ability to differentiate effectively between “yes” and “no”, the patient is no longer defined as a “poorly conscious patient” or an “unconscious patient.” At this stage, the patient can move forward with rehabilitation, including implementing an alternative communication board according to their cognitive ability, as diagnosed in Step 3. There are patients in this stage who are able to spell words by choosing letters (Is the first letter between A and E? Yes. Is the letter B? Yes). Other patients are only able to indicate pain and discomfort, or the media (music/video) that they want to hear or see. Gradually these patients may acquire more communication skills. Since the patients at this stage are already conscious, some of them are able to use additional tools such as eye tracking systems, etc.
EyeCon was developed in collaboration with the Rambam Health Care Campus and the Reuth Rehabilitation Hospital with the help of an EzerTech—Israel Innovation Authority Research and Development grant.
Recently, EyeCon was made available for patients in other institutions, or in their homes. Using EyeCon, significant progress is seen in patients hospitalized in the intensive care unit, who then proceed to full rehabilitation, rather than nursing facilities, and also in patients who suffer from severely impaired consciousness for months and even years.
Official publications that form the basis for this system and its technological components include the following:
- Karpin, H., Misha, T., Herling, N.T., Bartur, G. and Shahaf, G., 2022. Bedside patient engagement monitor for rehabilitation in disorders of consciousness–demonstrative case-reports. Disability and Rehabilitation: Assistive Technology, 17(5), pp.539-548.
This work represents the rehabilitation protocol principles performed manually by clinical therapists. - Baron Shahaf, D., Weissman, A., Priven, L., & Shahaf, G. (2022). Identifying recall under sedation by a novel EEG based index of attention-a pilot study. Frontiers in Medicine, 1055.
This work demonstrates our ability to monitor levels of consciousness using this system. - Gvion, A., & Shahaf, G. (2021). Real-time monitoring of barriers to patient engagement for improved rehabilitation: a protocol and representative case reports. Disability and Rehabilitation: Assistive Technology, 1-13.This work demonstrates general rehabilitation principles, with the use of the system.
This is a partial list of dozens of publications that have tested our ability to monitor attentional processes, with the help of the simple-to-use headsets, in thousands of samples from different clinical populations. Today, research is carried out with the help of these technologies by many researchers throughout the world.
Our team
Dr. Goded Shahaf, MD, PhD
Dr. Shahaf is a physician, researcher, and entrepreneur who directs the Laboratory for Applied Neurophysiology at Rambam Healthcare Campus. With an MD and PhD in neurophysiology from Technion, Israel Institute of Technology, as well as a BSc in mathematics and computer science from Ben Gurion University and a BA in psychology and behavioral biology from Bar Ilan University, Dr. Shahaf has developed multiple EEG analysis algorithms that have been used to found various companies. He also implements his developments with various patient populations.
Dr. Dana Bar-On Shahaf, MD, PhD
Dr. Baron Shahaf serves as the Head of Neuroanesthesia at Rambam Medical Center. She completed her fellowships in Neuroanesthesia at Toronto Western Hospital and in Neurotrauma and Neurocritical Care in St. Michael’s Hospital in Toronto, both under the University of Toronto. In her background, Dr. Baron completed her MD PhD Cum Laude at the Bruce & Ruth Faculty of Medicine, Technion Israel Institute of Technology, and her Anesthesia Specialty at the Anesthesia Department, Rambam Health Care Campus, Haifa, Israel.