The Science Behind Focus
EyeGuide Focus is a complete concussion management system, based on proven scientific research, which provides fast, reliable measurements in 10 seconds.
Already in scientific peer-reviewed literature there are numerous publications which report on previous efforts to make use of eye tracking as a visual stimulus to understand user attention and thus cognitive performance.
As Heitger, et al point out, while other neuropsychological tools for mTBI/concussion detection often fail or have particular limitations, “Studies in populations with neural injury and neurodegenerative disorders have shown that eye movement control relates closely to the functional integrity of the brain…” (p. 2851). This is why, Heitger, et al continue, “eye movement paradigms have been routinely used in the field of cognitive neuroscience to study the role of factors such as attention, working memory, response inhibition, speed of information processing, predictive behaviour and (motor) planning” (p. 2851).
Users who can visually keep steady, accurate attention on a moving object in their environment, what Maruta et al characterize as Dynamic Visio-Motor Synchronization (DVS), likely suffer from no impairment. But if users, with acceptable visual acuity, cannot keep attention on a moving object in a normal way, then the failure to do so may indicate, along with other measurements part of mTBI/concussion detection protocol, that there is possible neurological impairment. In fact, Maruta’s 2012 study, since confirmed by other similar studies, showed that mTBI subjects “demonstrated DVS scores worse than 95% of normal subjects.”
EyeGuide Focus measures “smooth pursuit” or dynamic visio-motor synchronization (DVS).
The smooth pursuit test is the fastest of tests for measuring impairment of attention via eye tracking.
Lower scoring indicates greater DVS accuracy or smoother pursuit. Higher scoring indicates poor DVS accuracy or an inability on the part of the user to follow smoothly (by location and time) the reticle or focus of attention as it moves across the screen, transversing both hemispheres of the brain.
Beyond determining the possibility of impairment caused by concussion, Focus also manages effectively the healthy return to play or work for a person who has already been diagnosed with a concussion by a physician. Rather than guess when such a person has recovered, Focus, because of its speed of use, can be implemented quickly, even daily. As the person recovers, Focus shows that recovery, test after test.
To demonstrate how Focus works as a concussion management tool in a realistic setting, here is the story of Johnny Holiday. Johnny’s name along with other personally identifying information have been changed. Johnny was a 7th grade football player who suffered a concussive injury at practice. As the figure shows, this injury occurred almost five weeks after Johnny had recorded a healthy baseline Focus score:
Athletic trainers tested Johnny using Focus, after injury, along with other tools as part of their concussion protocol. Later Johnny was sent to a physician who subsequently diagnosed Johnny with a concussion.
The athletic trainers then marked Johnny’s post-injury score with a C for concussion, triggering the capability of Focus at that point to track Johnny’s healthy return to play. Over the subsequent month Johnny was tested two more times with Focus as athletic trainers followed their return to play protocols and physician guidance. The value of Focus as a tool for showing a healthy recovery, for everyone involved including Johnny, can be seen in the following figure:
Starting with the low point on September 6 when Johnny recorded a score 7 levels below a prior healthy baseline, Johnny’s improvement was tracked. A follow up Focus test one week later showed improvement but still signaled impairment.
Finally, a final test on October 1 showed that Johnny recorded a Focus score in the same threshold level as the initial healthy baseline. And with that, other tools, and physician clearance, Johnny was returned to play.
More than 7,500 people, ages 5 and up have already taken the Focus test. Of these, 4,000+ are baseline tests, scores recorded in Focus to establish a healthy normal mark for a person that later can then be used to compare against a test taken after a potential concussive injury.
Focus has a .82 test-retest reliability.
Employed at schools and clinics across the United States, to date Focus, in addition to recording thousands of baseline tests, has also been used 653 times and counting to record impaired marks, or scores that when taken after injury show that the people in question have fallen at least two or more levels below their previous healthy baseline.
Focus Related Research
We continue to add to these data as we work to improve the validity of Focus. If you’re interested in helping us as a research partner, please contact us. Several studies are already underway with more planned in 2017 and 2018, targeting specific sports, i.e. football, basketball, soccer, MMA, and boxing, as well as specific populations.
1Muri R.M., Nyffeler T. Neurophysiology and neuroanatomy of reflexive and volitional saccades as revealed by lesion studies with neurological patients and transcranial magnetic stimulation (TMS). Brain Cognition Vol. 68: 284–92 (2008).
Muri R.M., Rivaud S., Vermersch A.I., Leger J.M., Pierrot-Deseilligny C. Effects of transcranial magnetic stimulation over the region of the supplementary motor area during sequences of memory-guided saccades. Experimental Brain Research Vol. 104: 163–6 (1995).
Pierrot-Deseilligny C., Milea D., Muri R.M. Eye movement control by the cerebral cortex. Current Opinion in Neurobiology Vol. 17: 17–25 (2004).
Pierrot-Deseilligny C., Muri R.M., Ploner C.J., Gaymard B., Demeret S., Rivaud-Pechoux S. Decisional role of the dorsolateral prefrontal cortex in ocular motor behaviour. Brain Vol. 126: 1460–73 (2003).
Pierrot-Deseilligny C., Muri R.M., Ploner C.J., Gaymard B., Rivaud-Pechoux S. Cortical control of ocular saccades in humans: a model for motricity. Progress in Brain Research Vol. 142: 3–17 (2003).
Samadani, U. (2015). A new tool for monitoring brain function: eye tracking goes beyond assessing attention to measuring central nervous system physiology. Neural Regeneration Research, 10(8), 1231–1233. http://doi.org/10.4103/1673-5374.162752
Sharpe J.A. Neurophysiology and neuroanatomy of smooth pursuit: Lesion studies. Brain Cognition Vol. 68: 241–54 (2008).
2Heitger M., Jones R., Macleod A., Snell D., Frampton C., Anderson. T. Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression, malingering or intellectual ability. Brain. Vol. 132: 2850-2870 (2009)
3 Maruta J., Tong J., Lee S., Iqbal Z., Schnonberger A., Ghajar J. Eye-Trac: monitoring attention and utility for mTBI. Proc. SPIE 8371, Sensing Technologies for Global Health, Military Medicine, Disaster Response, and Environmental Monitoring II; and Biometric Technology for Human Identification IX, 83710L (May 1, 2012); doi: 10.1117/12.927790.