How Virtual Reality Can Improve Concussion Detection in Football

In a boon to football players (and others), infrared cameras in virtual reality headsets are cutting the time to detect head injuries by up to 4,000 percent

The ways that athletes are currently tested for concussions and other cognitive impairments immediately after an on-field collision are about as technologically advanced as the abacus. Tests administered on the sidelines range from timing athletes as they read numbers from a piece of paper to swinging an object in front of them to see if they can follow it with their eyes. This year, at long last, the FDA approved a device called EyeSync that may bring concussion testing on the sidelines into the modern age.Developed by physicians and neuroscientists at Stanford University, EyeSync is based on research on how eye tracking and predictive-motion testing relate to brain function. The reason for the swinging-object test is that a person's eye movement changes as soon as the brain is impaired. Your eyes are the "window to your brain," says Dr. Jamshid Ghajar, professor of neurosurgery and director of the Concussion and Brain Performance Center at Stanford. "You can pick up a lot of neurology and cognitive functions just by looking at the eyes and how they respond to certain stimuli."

Neuroscientist David Putrino of the Burke Medical Research Institute in White Plains, New York, is also measuring the efficiency of eye-tracking tests in concussion diagnoses. As he explained in an interview with Vice Sports, "A concussion is not localized to one part of the brain as it is with a stroke. It affects many different parts of the brain, so if you can use a distributed function like eye movements, attention and perception, then I think you have a better chance of picking up the subtle signs of a concussion." Previous tests based on reaction time start with testing at the beginning of a sports season so that a coach knows how the player scores when the brain is functioning normally and can compare that with how it performs in a sideline test.According to Ghajar, though, reaction is not whats damaged in a concussion. Prediction is. And it was on the basis of that finding that he and his colleagues at SyncThink, the company he founded in 2009, developed EyeSync.Outfitting an Oculus Rift virtual reality headset with eye-tracking software and infrared cameras, EyeSync can track eye movement in up to 500 frames a second while the athlete tries to follow the motion of a dot moving along a circle on the screen.When the brain is functioning properly, the eyes will anticipate where the dot is going but resist a normal impulse to go there immediately, Ghajar explains. The eyes in concussion cases "jump ahead to where the target is going to be." When tested with the Stanford University football team, the EyeSync test cut the time for a reliable brain-impairment test from an average of 30-40 minutes to less than a minute. And rapid detection is key to recovery from concussions.The Centers for Disease Control and Prevention estimate that there are between 1.6 million and 3.8 million sports and recreation-related concussions each year—and that many thousands more go undetected. Portable eye-tracking systems like EyeSync may finally make it possible to find at least some of these previously missed concussions. But the FDA cannot yet grant concussion-diagnosis approval to any of these devices. EyeSync’s FDA approval is just for picking up eye-tracking abnormalities, mainly because the science on concussions and how to define and diagnose them is still incomplete. At this stage, it is impossible to say definitively that any device diagnoses concussions, says Ghajar, because concussions are not yet fully understood. “There’s no accepted diagnostic criteria for it, and because of that, it's a mess,” he says. When the Department of Defense funded a Brain Trauma Foundation attempt to define concussions, Ghajar’s team reviewed more than 5,000 studies. “We couldn't come up with a definition, but we did find that attention and balance were the main things affected after a force to the head.” Eye movement, he says, is one of the quickest ways to detect changes in those faculties. As used in previous sideline testing methods, that has always been measured by a coach, trainer or doctor. Bringing EyeSync and similar technology into the mix improves precision and eliminates the possibility of human error. For quick detection of concussions, Putrino’s team at the Burke Institute has proposed that all high schools put a low-cost combination of computers and eye-tracking sensors in every locker room. The entire system could cost as little as $1,000 including the cost of the computer. In terms of technology, EyeSync brings that system to the next level. Altogether the system costs about $25,000, but Ghajar predicted that virtual reality equipment companies will eventually start including eye tracking within their headsets, which will significantly reduce the cost. At that point, it won’t be only college and professional athletes who can benefit. It will be our kids.

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