Dr. Goded Shahaf, principal investigator of the Applied Neurophysiology Lab at Rambam Health Care Campus (Rambam) in Haifa, Israel, has developed the EyeCon, a pioneering tool that has been successfully used for several years to facilitate communication with patients in a vegetative state. This innovative device, which is implemented by Dr. Dana Baron Shahaf, director of the Neurosurgery Anesthesia Unit at Rambam, employs electroencephalogram (EEG) technology.
The EyeCon System consists of an algorithm that analyzes a single channel EEG electrode on patient’s forehead and analyzes the patient’s attention/ brain effort and the EMG – meaning analyzing patient’s eye blinking response This enables caregivers to gauge patients' attention and response, guiding therapy sessions with tailored interventions aimed at improving their communication capabilities. With EyeCon, the rehabilitation process unfolds in two critical stages: establishing a fundamental response, such as blinking, and subsequently evaluating the extent of the patient's cognitive preservation. The EyeCon System is the only system in the world designed to promote communication in unconscious patients at the bedside.
The tool has been used for two years with acute patients in the intensive care unit at Rambam and for three years with chronic patients in Reuth Rehabilitation Hospital in Tel Aviv. Dr. Goded Shahaf explains, “The rehabilitation process consists of two stages. Initially, we work on establishing a fundamental response, such as blinking or refraining from blinking. The second stage involves assessing the patient's cognitive preservation. Even those with significant cognitive impairments can learn to blink or activate music, as it's a relatively simple skill to acquire.” “While some may blink in an incoherent and non-communicative way, it’s important to consider the medical conditions these patients face,” explains Dr. Goded Shahaf. “Many of them are medically agitated, suffering from pressure sores, infections, and seizures, which can hinder their ability to engage in rehabilitation work. However, for those who are stable, we anticipate that the majority can learn to blink in response to their favorite music.” He adds, “We’re aiming to establish a fundamental response first, but cognitive recovery will depend on the extent of brain damage each patient has experienced.”
The EyeCon System excels at identifying voluntary communication in scenarios where conventional assessment tools often fall short. “It’s not simply due to the system's patient approach or its protocol, which spans days and weeks of gradual engagement,” says Dr. Goded Shahaf. “The key feature is the real-time attention analysis provided by the EEG. This allows the arc to transmit the patient’s cognitive engagement level, informing the therapist whether the patient is attempting to interact, is interested, and is capable of participating at that moment.”
Dr. Goded Shahaf recalls a powerful moment involving a patient who, after years without any evidence of awareness, was able to communicate through blinking. “The most beautiful part of using EyeCon is that while the system has its limitations, it’s incredible to see patients get so engaged that they sometimes throw aside the tool and communicate without it,” he laughs.
Dr. Dana Baron Shahaf, director of the Neurosurgery Anesthesia Unit at Rambam, who leads the implementation of EyeCon in the intensive care unit, emphasizes the profound impact this communication breakthrough has on families. Thanks to the system - this is the first time the family sees a reaction from the brain of their dear family member, who is unconscious. “Due to the trauma endured by the patient, the family carries a burden as well, often feeling as if their entire world has shifted,” she says, her voice filled with emotion. “Each reaction we witness is monumental. I can’t help but tear up every time I think about how they feel when they see their loved one respond for the first time. In addition, this system was developed so that it can be operated by the patient's family – opening a channel of communication for them. This is a revolution – instead of the family being led by the medical team, they can lead the patient's rehabilitation process.”
In the initial acute phase of treatment, Dr. Goded Shahaf explains, fostering communication early on can aid in the restoration of other functions. “The disconnection we see lies in the pathway that connects the cerebral cortex to the lower neurons responsible for muscle activation. The idea is that every muscle activation—like blinking—could help re-establish that connection,” he explains. “Recent studies have also indicated that identifying ‘hidden consciousness’ using EEG in intensive care settings may provide crucial insights into a patient’s survival and rehabilitation prospects.”
An article published in August in the New England Journal of Medicine (NEJM), written by some of the world’s top neurologists, examined a study performed in six centers worldwide and examined a large sample of 241 patients who were unable to respond to commands via standard assessment tools. Using functional magnetic resonance imaging (fMRI) and EEG to evaluate brain function, the researchers discovered that at least 25% of the patients were aware.