The process of diagnosing a concussion is largely a subjective process of variations of attention, focus, and balance, which means that the existing self-reporting methods are unreliable and easily gamed. Using foundational research from military research, SyncThink has created a portable concussion diagnostic tool that uses a tablet and either a Gear VR or Oculus Rift DK2 fitted with an SMI eye tracker. They claim to be able to objectively detect symptoms of a concussion within 60 seconds through subtle variations of attention and an impaired ability to make predictions of a moving dot within VR. I had a chance to catch up with SyncThink CTO Dan Beeler at TechCrunch Disrupt SF in September 2016 to talk about the science and technology behind their EYE-SYNC product.
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SyncThink just announced the second generation of their EYE-SYNC product on June 26th with features a “cloud-connected, HIPAA compliant analytics platform that delivers results in under 60 seconds without bias from the patient or clinician.” Watch their promo video below for more information or check out their website. Note that the demo being shown at Disrupt last September was using a DK2, but that their latest promo video shows a Gear VR being fit with SMI Eye Tracking technology.
https://vimeo.com/216584166
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Music: Fatality & Summer Trip
Rough Transcript
[00:00:05.452] Kent Bye: The Voices of VR Podcast. My name is Kent Bye, and welcome to The Voices of VR Podcast. So on today's episode, we're going to be looking at a startup company called SyncThink, and they've solved a problem that has been undefinable in other realms. And that has to do with concussions. So there's not even an official diagnosis or therapy for concussions because so much of a concussion happens inside of your head and it's a subjective experience where you are having different variations of attention or focus or balance, but it's actually something that's very difficult to articulate. And so when it comes to impact sports like football, soccer, hockey, rugby, We have these players who are forced to give these subjective accounts of what's happening inside of their body, but they may not even be able to account for that. So virtual reality plus eye tracking is able to pierce inside of somebody's mind and start to measure their attention in a way that's objective. So they're able to come up with a framework to be able to detect and diagnose and treat both concussions and brain traumas. So I'm going to be talking to Dan Beeler. He's the CTO of SyncThink on today's episode of the Voices of the Hour podcast. And this interview happened at TechCrunch Disrupt. It had a whole bunch of different startups and a little section there for VR startups in particular. And this was back on Monday, September 12, 2016 in San Francisco, California. So with that, let's go ahead and dive right in.
[00:01:40.326] Dan Beeler: My name is Dan Beeler. I'm CTO at SyncThink. It's a Boston company. And we make a medical device that tracks your eye movements. It's an eye tracking device. It's a portable device that you can bring on the sidelines. So the state of the art for concussion is largely subjective. So you can think of a field sobriety test. It's manual, subjective, easily gamed, variable. So there just aren't good tools out there to provide quality information to these medical professionals. That's where we come in and provide a fast assessment that characterizes your eye movements with respect to a simple moving target. You can think of it as a way to figure out how well you synchronize compared to a predictable target. And the assessment is about 60 seconds. and it provides an objective piece of information for the medical professional at the point of incident and as a monitor thereafter during recovery.
[00:02:41.447] Kent Bye: Yeah, so you have this kind of mobile setup here, it's got this briefcase with like a tablet, I'm presuming like Windows 10 Surface tablet with Oculus Rift DK2 and SMI trackers built into it, and kind of have this whole setup to be able to be mobile, portable, open it up on the side of either the sidelines of athletics or out in the field in the military, it sounds like.
[00:03:04.718] Dan Beeler: Yeah, that's right. So we're packing a lot of technology into a single briefcase. The whole system weighs about 15 pounds. And yeah, that's right. So we built with our partners SMI this eye-tracking technology into these VR platforms. This is connected to a Surface Pro tablet computer. The tablet serves as the user interface, the data storage, the computation, and the battery. So it's really just those two main components, but really it's a lot of technology in a single device.
[00:03:35.814] Kent Bye: Yeah, I know that a lot of the minimum specifications for running normal kind of Oculus Rift games are pretty high, but yet this is a pretty simplistic actual VR experience where it's essentially just a dot that's moving around and the main part of the VR technology part is being able to actually track the eyes as correlating to where the dot is moving in to where the eyes are actually tracking in. From that, you're able to kind of output a number of different graphs that are kind of like a circle, if you're able to follow it correctly, and then kind of a concentrated dot. And if people do have a concussion, you just have some photos of things here. It just looks like very erratic. And maybe you could just maybe describe to me some of these different results of how you are able to look at this and tell whether or not someone may be suffering a concussion or not.
[00:04:24.067] Dan Beeler: Yeah, sure. So, yeah, it's a very simple paradigm. You know, we're not eye-tracking with gaming in this device. That's a bit too much for a mobile platform. But we output two primary visualizations. There's one that shows your eye movements relative to the display in front of you, the center of the display. So for circular motion of the target, your eyes should look roughly circular in its motion. And then we also put a second visualization which aggregates your eye moons relative to the target. And this one's much more interesting. And this is what we look at from the clinical perspective. Let me break this down to two components. There's your eye motion inwards and outwards of the circular motion. And you can think of this as your spatial component. and then your eye movements along the path of motion. And you can think of this as your timing component. For instance, after a head injury, what we often see is a lot of timing error. So our brains, in order to follow this target, are constantly predicting where this target's going to be so that we can follow it in real time. Otherwise, we can't react to things in real time. It takes about 150 milliseconds for our brain to process any new information. And we predict this information, then withhold our eyes so that we're sticking right to the target. After an injury, there's a lot more disinhibition, so you're still predicting where the target's going to be, but your eyes jump out into this forward predictive state, so where the target's going to be rather than where it is right now. I see.
[00:05:51.896] Kent Bye: So it sounds like this is starting to get some real hard objective measures of this, whereas it may be a subjective test that, if you think about football, for example, a player really wants to get back in the game. They don't have a lot of incentive to say that I do have a concussion because they want to get back and continue the game, but yet it may be detrimental to their health. So it sounds like this is a little bit of an objective intervention to be able to do a little bit more precise measurement as to what may actually be happening.
[00:06:19.773] Dan Beeler: Yeah, absolutely. Under current protocols, you need a lot of cooperation from the players. They need to tell you about their symptoms, how they're feeling, their emotional state. There really isn't a whole lot that you can do as objective measurement from the physician side. And this provides a quick piece of information that's entirely objective that they simply can't gain.
[00:06:40.013] Kent Bye: Can you talk a bit about how this project came about with the military?
[00:06:43.777] Dan Beeler: Sure. So soldiers started coming back from Iraq and Afghanistan. The military was saddled with this enormous problem of head injury. One in five soldiers in combat receive a head injury. And that can linger and manifests itself in PTSD and other conditions. So they have a huge interest in solving this problem. So they supported a lot of the foundational research that went into this technology. Large clinical studies over several years. We're just finishing up one now of 10,000 individuals, 5,000 soldiers, 5,000 civilian athletes. And that's working its way into a continuation that's with NCAA PAC-12. which will be looking at recovery rates for players that are injured. So the military has aggressively pursued this technology in addition to several others like blood biomarkers and we see this as a commercialization of that effort. So the VR platform is really the ideally cost-effective way to bring this to athletics at all levels.
[00:07:44.232] Kent Bye: Yeah, so maybe you could talk a bit about the timing here, because we're talking about studying these different soldiers that are already back from warfare, and so in the use case of a sports game, someone could be struck really with a strong hit on the field and you see it, and then you're able to do it right away, but how does this work with a time delay of anywhere from a week, a month, or many months after the actual head trauma?
[00:08:08.623] Dan Beeler: Yeah, so ocular impairment manifests itself very quickly after an injury, so it's something that you can test very soon after in at least 90% of cases. It's very sensitive, so it's easily disrupted if it happens to be a neural network that stretches from your parietal lobe down to your cerebellum for coordination, mediated by the thalamus, and then executed by your prefrontal cortex. And that prefrontal cortex in particular is highly exposed. It's at the front of your brain, furthest from your neck, and most vulnerable to whiplash. So it's a signal that can be detected very soon after, and it's quite sensitive to this injury. And it can show improvement during recovery as well. So you can see this impairment recover over time as you work your way back to your normal performance.
[00:08:56.472] Kent Bye: So in this recovery process, are you giving other treatments from the doctor? They're doing these different exercises, and then they're kind of just measuring how they're doing with their recovery?
[00:09:07.460] Dan Beeler: That's right, so there are a number of injuries that can occur with a force to the head. Brain injury is one of them. You can also have damage to your inner ear, vestibular issues, balance issues, or damage to your neck and spine, which could be chronic headaches or other issues as well. So this is a way to differentiate injury after a force to the head and tailor the treatments to what's really going on. Everyone who has a knee injury doesn't have an ACL tear and we don't treat knee injuries like they're an ACL tear. So it's a way to narrow in on the correct treatment for that individual.
[00:09:42.359] Kent Bye: So it sounds like the eyes are kind of telling the story here in a lot of ways of like being able to measure and track the eyes given the input then you're able to kind of hone into what which one of these injuries they may actually have.
[00:09:55.543] Dan Beeler: Yeah, it's an innate ability of ours that really hones in on the physiology that's happening in your brain.
[00:10:02.488] Kent Bye: What are some of the symptoms of people that, you know, may have some of these traumas? Do they even recognize that they have it? It's like they can't really necessarily self-diagnose? Or what are the things that they may actually experience?
[00:10:14.053] Dan Beeler: Yeah, I mean it can be very easy to detect and this technology might not be necessary. Nausea, vomiting, headache, extreme headache, migraine. But it also can be much more mild on the spectrum, in which case very difficult to communicate, you know, you feel off. And a lot of this manifests itself from this poor timing. So you're not only taking in visual information, you're taking in auditory information, all this sensory information and trying to coordinate and predict using this information. And this poor prediction leads to a loss of self-agency that feels off but is difficult to communicate.
[00:10:51.608] Kent Bye: And so from these studies that have been done so far, what are some of the results? Like how do you describe what you found?
[00:11:00.039] Dan Beeler: Right, so we have been doing a large normative collection to understand what the population looks like under this assessment without injury. So it's one more comparison that you can make including to your past performance. We've done large studies in the past looking at this assessment in comparison to working memory after injury, using chronic concussion patients, doing studies against imaging, so MRI, DTI imaging, to determine, you know, what the correlation between this impairment versus, you know, white matter scarring on your brain.
[00:11:36.587] Kent Bye: What are the numbers that you had to show to the FDA in order for them to approve this as a viable technique?
[00:11:42.483] Dan Beeler: Right, so this technique is under the discretion of the medical professional. So we provide an assessment of abnormal eye movement. It's up to the medical professional to use this information in the context of this research to make a diagnosis. The FDA doesn't currently have an internal definition for concussion. which is kind of unbelievable because about 50 states have mandatory regulations regarding how individuals are treated after a potential concussion and use sports for instance. But we're starting to see a lot more traction on the regulatory side and you know I think there's going to be a lot more movement in the indication for use and how this is viewed and assessed within the FDA.
[00:12:30.303] Kent Bye: And you mentioned that this is being deployed within Stanford's football team. Maybe you could talk a bit about how it's being used.
[00:12:36.986] Dan Beeler: Sure. So Stanford was our field trial site in 2015. All student athletes at Stanford are currently baseline on this technology. And it's first in line in their concussion protocol on the sidelines. So when a football player comes out, the first assessment they receive is an eye tracking assessment in the concussion protocol. And if everything else checks out in relation to this, then the player can go back on the field. If not, then that information is used as a monitor in the clinic thereafter as they recover.
[00:13:06.646] Kent Bye: What are the players' reactions to that then?
[00:13:08.923] Dan Beeler: They really love it. So in another way, it's a communication tool. So they have a hard time explaining what's going on, and the trainers that are assessing them have a hard time explaining what they're seeing. So it's a way to communicate between them using an objective piece of information of exactly what's going on after an injury.
[00:13:28.217] Kent Bye: Is this something that could also detect sobriety? So if people are drunk, they'd be able to actually check to see whether or not their eye movements would be able to give a tell as to whether or not they may be inebriated?
[00:13:39.018] Dan Beeler: Yeah, I don't think you necessarily need a high-tech piece of technology to assess sobriety. So what they're doing with the finger assessment on the side of the road is really looking for involuntary movements in the periphery of your vision. So when you're intoxicated, you have this flicker of your eye when you look to the side. You don't notice it yourself, but that's what they're looking for. They don't really care what's happening in the central part of your vision. So it's potentially a way to record that and objectively measure it. But I'm not entirely convinced that it's necessary for that application.
[00:14:14.006] Kent Bye: I see. So what's next for SyncThink then?
[00:14:17.691] Dan Beeler: So we want to see this adopted at all levels and we want to make this platform available for individuals who need it. You know, we see this as an application of military technology that needs to be made cost effective at all levels. So we'll continue deployments with the NCAA in the military and work our way down through high schools and youth sports to try to provide objective tools that can be used to help people.
[00:14:44.497] Kent Bye: Is this primarily in football, or would it be for any other sports as well?
[00:14:49.021] Dan Beeler: Yeah. I mean, all impact sports that are using our head. This is a huge subject in soccer, hockey, internationally in rugby. A lot of these students are no longer participating in these sports because their parents or even themselves are scared of the ramifications.
[00:15:06.995] Kent Bye: Great. And finally, what do you see as the ultimate potential of virtual reality, and what it might be able to enable?
[00:15:15.465] Dan Beeler: So we're really excited in the direction Virtual Reality is heading and we think eye tracking is going to play a big part of its future. So Virtual Reality's huge concept is that you're able to pan your field of view, not necessarily your gaze because we don't track your eye gaze on most VR platforms, we do on ours. But we see eye tracking as the next step in this line. So not only do you have a clear picture of field of view, but you have a clear picture of what area the VR user is looking at. So you can make this interactive. You can make this a hardware optimization. It's the next big step in VR, in our opinion.
[00:15:53.746] Kent Bye: Awesome. Well, thank you so much. Yeah, cheers. So that was Dan Beeler. He's the CTO of SyncThink, and they are using virtual reality technologies with eye tracking from SMI in order to diagnose concussions. So I have a number of different takeaways about this interview is that, first of all, it's super fascinating the fact that concussions don't have an official definition or diagnosis procedure that's out there right now. It's something that really relies upon this inner subjective state. When you have a brain trauma, suffered from a concussion, then it's affecting your attention, your focus, your sense of balance. And these are not things that you can easily quantify in previous diagnostic approaches. But being able to track your eyes and to correlate that to what you're showing visually, it's kind of creating this closed loop of diagnostic capability that we didn't even have before. So I think in general eye tracking technology I think eventually is going to be built into a lot of these virtual reality headsets. I don't know if it's going to be second generation or if it's going to be after that. There's a lot of these stopgap solutions where you can go to SMI and get access to the technology to be able to integrate it into the VR headset. SyncThink is taking care of all that for you. What they're trying to do is take what is out there with technology, they're combining it with a Surface tablet, an Oculus Rift DK2, as well as this case and enclosure. So it's completely self-contained, you can take it on site, you can get a diagnosis within 60 seconds. It has all these cloud integrations as well, this new release that just came out on June 26th. And they're also building upon a lot of foundational research that was funded by the military. So military wanted to figure out how to address all these brain traumas that were seen in combat and warfare and how to treat them over time, because I think that's a big issue for not only determining what is going on with somebody, but being able to have a treatment. So I was surprised to hear that the players were super into this technology. I would expect that sometimes you get people who are football players and they just want to get back into the game and do whatever it takes to participate in the game. But I think the long term implications of the brain trauma If they have a tool and technology that can say, OK, you're fine, go ahead and keep playing. But if they say, stop, you know, this is actually getting to the point of being detrimental to your health, then you should probably sit out until you kind of recover from this concussion that you have. It sounds like the players are enjoying that. And I think that for sure the parents are going to be enjoying that as well. So it sounds like they're going to be starting to try to get this technology out into the hands of lots of high school, college football teams. Any sport where there's contact with the head, be it football, soccer, hockey, rugby, this is a technology that just makes sense. Now, the visuals of this experience are really not all that complicated. It's just essentially like a dot moving around, and it's more about correlating your eyes to the visual stimulus than having super fancy graphics or anything like that. And because of that, they can run this thing off of a Surface tablet as well as a DK2. They don't even need the latest and greatest VR technology. The other thing that I found interesting from Dan is that he was saying that our brain takes about 150 milliseconds in order to process new information. And so that we're constantly making predictions about what's going to happen in the world. And if we suffer from some sort of brain concussion or trauma, then that could make our reaction longer, which means that we're not able to make accurate predictions, which means that we're more likely to hurt ourself even further if we have the beginning signs of a concussion. The bottom line the way that Dan describes this technology is that it's a communication tool. It provides players a way of objectively capturing what's happening inside of your brain. And when it comes to your attention and focus, things that are happening at an unconscious level, you can't even necessarily even put words to it or know if there's any variation, because you're kind of swimming in the ocean of your own attention. And if it's varying, then how can you really necessarily even know? With SyncThink, they're actually able to look at your eyes and what you're paying attention to and be able to have this interface into an inner subjective experience that otherwise was very difficult to quantify and even determine whether or not you have some sort of brain trauma. So that's all that I have for today. I just wanted to thank you for listening to the Voices of VR podcast. And if you'd like to support this type of journalism, then there's a couple of things you can do. First of all, just spread the word. Tell people about the podcast. The second thing is that I have a lot of plans for what I want to do with the Voices of VR and eventually launch the Voices of AI, as well as finish writing my book, The Ultimate Potential of VR. So the more that I'm able to continue to get the support on this, the more that I can launch more projects. You can just dive into straight to the heart of talking to these experts and learning about these new fields. There's a lot of complicated exponential technologies out there and I just want to dive in and figure it out myself and share what I learn with you. And if you want that to happen, then donate to the Patreon. You can go to patreon.com slash Voices of VR and donate today. Thanks for listening.
