Eye tracking to support assessment of patients with prolonged disorder of consciousness - a case series.
Jan Johansson, Marika Möller, Kristina Franzon and 2 others
PMID 39749424WHAT IT FOUND
Wearable eye tracking detected a response in 46.2% of trials for 12 patients with prolonged disorders of consciousness, compared with 18.1% by standard clinical assessment.
The difference was significant for visual pursuit and fixation. This suggests eye tracking may reveal awareness missed by bedside observation.
Key findings
01Eye tracking judged a response in 110 of 238 trials (46.2%), while clinical assessment judged a response in 43 of 238 trials (18.1%), a statistically significant difference.
02Agreement between the two methods was poor (Kappa = 0.073), meaning they often disagreed on whether a patient had responded to a prompt.
03The eye tracking method found a higher proportion of responses specifically for the test items 'visual pursuit' and 'visual fixation'.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Small sample size (12 patients) limits generalizability. No gold standard exists for consciousness assessment, so it is unclear which method is 'correct'. Eye tracking data was missing for 50 trials due to signal loss. The eye tracker may have caused discomfort, affecting performance in some patients. The study did not follow strict CRS-R criteria when scoring eye-tracking data, which may inflate the number of 'responses' detected by the technology compared to the clinical method.
Declared interests
Funded by Innovationsfonden, Region Stockholm, and Promobilia. No specific conflicts of interest regarding the eye-tracking equipment manufacturer were declared in the provided text, though the study used Tobii products.
The easy way to misread this
Do not interpret the higher detection rate of eye tracking as definitive proof of consciousness. The methods disagreed significantly, and the eye-tracking scoring used less strict criteria than the clinical assessment, meaning some 'responses' detected by the tracker might have been rejected as random movements under standard clinical rules.