EyeCon - Communication Beyond Boudaries
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 the brain waves measured by EEG electrodes wrapped around the patient's head.
Using ground breaking technology, The EyeCon system is the only rehabilitation system in the world that makes it possible to bridge the gap from unconsciousness to 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:
- Electrodes wrapped around the patient's head that allow the reception of brain waves (EEG) and evaluation of the state of eye muscle contraction
- Computer software for advanced processing of the EEG waves
- "Operator" - a family member/friend who activates the software and helps in the rehabilitation process
- A medical staff member who accompanies the rehabilitation process and guides the family on how to work with the patient
Below is an illustration describing the flow of information and how the system works:
- Brain activity and eye blinks are measured with the help of the EEG electrodes
- 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 EyeCon system was developed by Dr. Goded Shahaf, a physician and brain researcher, and Principal Investigator, The Applied Neurophysiology Lab, Rambam Health Care Campus (Rambam), in conjunction with leading rehabilitation teams from Reuth Rehabilitation Hospital and Rambam.
Below are the steps required to use the system:
(1) First step - initial compatibility check:
The initial test is done with the help of the EyeCon software, which analyzes the EEG waves (brain waves) and EMG waves (muscle activity) measured with electrodes around the patient's head:
A. Initial level of attention is measured by an index that is calculated every 10 seconds and displayed on the graph (see figure below).
B. The patient is played music that he/she liked to hear before the injury, thus trying to stimulate attention. When the music stops after 30 seconds, the patient is asked to blink in order to start the music again.
C. If the eye muscles to blink are activated, the music starts again.
D. If there is no blinking movement, but the attention remains high, the instruction to blink is repeated until a blinking movement occurs.
E. If there is no blinking movement and attention decreases, we tap on the center of the forehead to elicit a blink response, and thus teach the patient to produce a blink movement. In this way, we are teaching the patient how to produce a consistent response of "yes", the first stage toward consciousness.
This is an example of a patient examination. The time in minutes is marked on the X-axis (in this case the patient was evaluated for about 30 minutes), and the attention index is marked on the Y-axis. The black/blue dots are marked every 10 seconds and indicate the level of attention of the patient. In principle, an attentive patient is expected to show a level of attention in the intermediate range.
Attention has several characteristics, and is always measured in relation to the task:
- Low attention - in patients with brain damage, patients under deep anesthesia (such as general anesthesia)
- Attention in the intermediate range - normal attention
- Sharp ups and downs - a patient who is affected by a state of stress
In our experience, when it is possible to produce continuous attention (above the lower threshold) of about a minute or more (which indicates the ability to produce sustained attention), there is a high possibility of adapting to the use of the system and in fact there is a basis for starting work on restoring the state of consciousness together with the patient.
Thus, after an initial examination of the patient, we evaluate whether it will be possible to begin a process of cognitive rehabilitation with the patient, or whether physical ("systemic") factors that can affect the rehabilitation process, must first be addressed.
(2) Second step - rehabilitation guided by the EyeCon system:
During the rehabilitation process, the team of caregivers teaches the patient's support circle to use the system and operate it for him with the understanding that the more the patient "gets used to it", the more he will progress.
In the initial rehabilitation process, the patient goes through four main stages:
- Step 1 protocol - learning how to indicate "yes"
- Step 2 protocol - learning how to indicate "no"
- Step 3 protocol - how to generalize "yes"/"no" responses while applying the phase to personal questions ("Your name is "Yossi" yes/no) and to questions that test different brain functions (recognition of sounds, whether items belong to categories, etc.)
- Step 4 protocol-after acquiring the ability to differentiate effectively between "yes" and "no", the patient is no longer defined as a "reduced conscious patient" or an "unconscious patient". At this stage, it is possible to move forward with rehabilitation, implementing widely-used communication devices.
The EyeCon team includes:
- Dr. Goded Shahaf, MD, PhD, physician, researcher and entrepreneur, Director of the Laboratory for Applied Neurophysiology Rambam Health care Campus
- Dr. Dana Bar-On Shahaf, MD PhD, Anesthesiologist, Researcher, Head of Neuroanesthesia Unit, Rambam Health care Campus
- Aviah Gvion, PhD, Director of The Treatment of Communication Disorders Unit, Reuth Rehabilitation Hospital
- Ms. Tamar Shahar is responsible for occupational therapy services for patients with reduced consciousness, Reuth Rehabilitation Hospital
- A team of occupational therapists and speech pathologists
Learn more on the EyeCon System
The Shahaf Lab Page
References
- 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.
- 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.
- 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.