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November 14, 2017

This Concussion Protocol Runs on NoSQL

Alex Woodie

Wham! The receiver takes a huge helmet-to-helmet hit, courtesy of the opposing team’s strong safety. He gets up, wobbles a bit, and heads back to the huddle. But is it safe for him to return to the game?

If the player is fortunate enough to be on a team that employs a doctor, the doctor would likely test for a concussion by holding a finger in front of the athlete’s eyes and measuring his ability to track the finger back and forth. But if the player is not on a high-level team, even this rudimentary and subjective approach may not be available.

Thanks to an innovative new data platform developed by a Silicon Valley firm called SyncThink, sports teams have a way to objectively measure the presence of concussion symptoms on the field.

SyncThink’s platform, dubbed EYE-SYNC, works by projecting a moving target onto the screen of a pair of VR goggles equipped with an eyeball-tracking system. If the player is healthy, his eyes will be able to track the target’s motion in a regular manner. If the player has suffered a brain injury, he won’t be able to track the target’s movement as well.

“We’ve been researching this for about a decade now and we’ve discovered a specific biomarker related to head injury, which is a timing deficit,” says SyncThink CTO Dan Beeler. “Our typical assessment is very simple. It’s not meant to confuse the user. We show a target moving in a circle and we characterize how well the user synchronizes with that predictable motion, to measure their visual attention.”

EYE-SYNC tracks the timing deficit exhibited in the eyes of people who suffered a concussion

SyncThink selected a NoSQL database management system from Couchbase to house the data and perform analytics. This includes a copy of Couchbase Lite running in the smartphone that collects the data – approximately 3,000 data points during a 60-second session with EYE-SYNC – and the full version of the Couchbase database running in Microsoft‘s Azure cloud.

SyncThink, which received FDA approval to start selling the devices in 2016, prefers to get a “before” and “after” image of a subject’s visual attention. That provides the highest degree of accuracy, especially for elite athletes.

“Comparing against past performance is always your best option,” Beeler tells Datanami. “Concussion is a spectrum injury. You might be an elite performer, and a concussion might put you in the middle of the pack for the normal population. So having that information can be crucial, especially in high stakes situations.”

However, the system can also work without a baseline, thanks to the development of a 10,000-person normative database for people ages seven to 70. “So if a baseline is not available there are still objective comparisons available to the clinician,” Beeler says.

EYE-SYNC can also help monitor a patient’s recovery from concussions. “It’s a sensitive enough measurement that it’s something you can track over time,” Beeler says. “Somebody who’s recovering over four weeks, we can compare against the baseline and track that back to their past performance and have some confidence that that individual was performing as they were previously.”

EYE-SYNC includes an administrative tablet that connects wirelessly to the VR goggles

EYE-SYNC also helps differentiate among the various injuries that people can suffer following a blow to the head. The three big ones are ocular-motor impairment, a vestibular-balance dysfunction, and a neck or spine injury. The problem is that each of these injuries can manifest similar symptoms, and a given patient may have two or more of the injuries simultaneously. That puts the doctor in potential dangerous waters when it comes to diagnoses and treatment.

“There’s a lot of attention in this area right now and clinicians are very uncomfortable with the subjective field sobriety tests they have available to them, so fast, objective direct measures are really important,” Beeler says. “If you can isolate an injury like this, you can also treat it with specific therapy, so whether it’s ocular motor therapy, vestibular therapy, and at the end of the day, you can get that player on the field quicker.”

This isn’t a hypothetical remedy for a rare ailment. Unfortunately, concussions occur every weekend across thousands of youth, high school, college, and professional football games around the United States. In 2015, there were 199 concussions in the NFL, according to Concussion Watch, while a 2010 survey conducted by the NCAA found that self-reported rates of concussion ranged from 10% to 20% for a range of sports.

It’s critical to get a prompt and accurate diagnosis of a concussion, because repeated blows to the head can dramatically increase a person’s chances of having long-term complications or even die. This sad story plays out every year in high school and youth football leagues, where an average of 2.5 players have been killed or sustained serious head injuries every year since 1997.

Organizations that have adopted EYE-SYNC

There has been a lot of attention on concussions in sports over the past few years. The 2015 movie “Concussion” and a study released earlier this year that found 99% of deceased NFL players suffered from chronic traumatic encephalopathy (CEP) — a degenerative brain disease linked to repeated concussions – have focused people’s attention on the potential of contact sports to be injurious to our brain health.

Since gaining permission to sell its product, SyncThink has sold EYE-SYNC systems to numerous hospitals and sports teams. Beeler says all of the Boston-area professional sports teams have access to the system at a local hospital, while the defending NBA champion Golden State Warriors recently became the first pro basketball team to adopt it. Stanford University is also a customer, as are the Ottawa Senators hockey team.

While its application in contact sports is large, EYE-SYNC was originally developed using $30 million in funding from the Department of Defense, which wanted a better way to detect brain injuries in soldiers. Development of the system, which is the subject of 40 peer-reviewed papers and includes 10 patents, was conducted in partnership with the Brain Trauma Foundation.

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