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Stellenbosch University

Eye-tracking can help diagnose concussion, but it’s under-utilised

By Insights

Concussion can cause serious damage if it’s not properly diagnosed and treated.

Author: Nadja Snegireva, Stellenbosch University

Sports-related concussion has been described by some experts as a “silent epidemic” because it often goes unrecognised.

It’s defined in the 2017 Berlin Consensus Statement on Concussion in Sport as a “traumatic brain injury induced by biomechanical forces”. It typically manifests in the rapid onset of short-term impairment of neurological function. Common symptoms include headaches, nausea, dizziness, confusion or feeling as if you’re in a fog.

A concussion may lead to neuropathological changes – at the level of the nervous system tissue. But it’s not a structural injury. It doesn’t change the brain in a way that can be seen with the naked eye or on traditional neuro-imaging screens. This is part of the reason that it’s not always diagnosed, and why there is still no universal tool to detect concussion. Clinicians have to rely largely on their experience and on the symptoms that injured athletes report.

The problem with self-reporting, though, is that athletes are often not too keen to be removed from the field, so they sometimes understate their symptoms. Younger athletes also struggle to properly verbalise what they feel and don’t necessarily understand the implications of the injury.

Researchers worldwide are working on solutions and methods that will help clinicians to diagnose concussion. One such method could be using eye-tracking. This is a technology for recording eye movements with a small externally mounted camera and then analysing, for example, how fast the eyes move or how accurately they can follow a certain target.

Research has already established that eye-tracking can be used successfully in diagnosing and classifying brain disorders such as schizophrenia or autism.

We believe that eye-tracking also shows promise in concussion assessment. According to research, up to 80% of concussed athletes show some eye movement dysfunction.

But do clinicians know this? We conducted a survey among sports medicine clinicians who deal with concussions to find out. A total of 171 clinicians from 32 countries shared whether they were aware that concussed athletes may have impaired eye movements, and whether they believed that eye-tracking technology has a potential to assist them in assessing concussion.

Clinicians’ feedback

Our survey revealed a few interesting facts.

On whether they knew that concussed athletes may have impaired eye movements, we found that the respondents on average saw eye movement impairments in only 30% of their concussion patients. That’s lower than what we expected.

The reason for this may be that, even though measuring the eye movements without the equipment is possible – for example, asking a patient to look side to side – it is not as accurate. On top of that, 20% of our respondents admitted that they were not checking for any eye movement deficits at all, which indicates they probably were not aware that concussion may lead to abnormal eye-tracking.

And then on the potential of eye-tracking technology to help them assess concussions, most clinicians did see benefits in using eye-tracking. These benefits include objectivity, ease of use (both for the clinician and the patient), replicability of the tests, and the fact that the results can be quantified.

But despite this, many seemed reluctant to implement this technology in their practice. Only 49% of the survey respondents explicitly said that utilising eye-tracking technology for concussion diagnostics was advisable.

There are several understandable reasons for this reluctance: they may not be familiar with this still rather novel technology at all; may lack access to the equipment; or may lack training.

Using technology

The survey happened against the backdrop of several recent developments in eye-tracking for concussion assessment.

First, there have been significant technological advancements in recent years. In 2018 two eye-tracking devices, RightEye and Oculogica’s EyeBOX, designed specifically for concussion assessment were approved by the US Food and Drug Administration. A third device, EYE-SYNC, is currently undergoing a clinical trial in the US.

The prices of the eye-tracking equipment have also dropped tremendously. For instance, EYE-SYNC cost US $6000 in 2018, but is expected to decline to between $1000 and 2000 this year. RightEye is targeting the cost of the tests at $10-$20 per patient.

It’s important to point out that eye-tracking technology isn’t perfect and certainly shouldn’t be the only approach to diagnosing concussion. These developments nevertheless suggest that eye-tracking technology has a valuable role to play in clinical settings.

The way forward

We believe that with ongoing education of clinicians on current developments in the field, and particularly with reference to continuing technological advances, eye-tracking technology could become more common in clinical settings.

Our results suggest that the level of exposure to novel diagnostic tools and clinicians’ acceptance possibly go hand in hand. That’s why we strongly recommend creating training opportunities for concussion evaluation, including the use of potential innovative technology. We also suggest facilitating close interaction between researchers and clinicians regarding the use of latest tools for concussion assessment such as eye-tracking.

All of this could lead to the technology being adopted at a higher rate. This in turn might enable the evaluation of currently somewhat neglected eye movement deficits caused by concussion – and ultimately more accurate evaluation of concussion resolution over days to weeks.

Dr Karen Welman, Stellenbosch University; Professor Wayne Derman, Stellenbosch University & International Olympic Committee (IOC) Research Centre and Professor Jon Patricios, University of the Witwatersrand, co-authored this article.The Conversation

Nadja Snegireva, PhD Researcher in Sport Sciences, Stellenbosch University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How sports science in Africa can be taught and thought about differently

By Insights

We would love your thoughts on the below article from Francois Cleophas on the role of educators in the fields of sports science:

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Sports science needs to race towards a different approach.

Francois Cleophas, Stellenbosch University

In the four years since the decolonisation debate took centre stage at South African universities, much of the focus has been on what decolonisation might look like in the humanities.

But science subjects, too, need to be taught differently at African universities in the 21st century. This is true of my discipline, sport science. The content of the sports science curriculum needs to change. So does the focus of sports science departments. Increasingly, such departments at public universities rely on private funding to operate. This means they are driven by corporate and donors’ interests, doing less for the public good and not necessarily producing social and political critical thinkers.

Both the curriculum and the structure of sports science departments needs to be overhauled. This is necessary, because nothing in the ideological content of sport science curricula has changed over the past 25 years.

In fact, it can be argued that the sport science curriculum, driven more and more by semi-private institutions at public spaces of higher learning, is more committed to a neo-liberal capitalist project today than what it was 25 years ago.

The field’s history

The history of modern day century sports science, as an academic discipline, dates back to the early 20th century when the medical fraternity and physicians became interested in athletic contests. One such doctor, R. Tait McKenzie, published one of the field’s earliest scholarly texts, Exercise and Education in Medicine.

This book reflected and enforced the cultural hold that the western (Hellenistic) presentation of the human body exerted in the emerging field of sport science. The Greek body – white, muscular, masculine and middle class –dominated as an ideal type. This dominance continues today. What wasn’t discussed was that ancient Greece was a slave-owning society that exploited inequalities based on race, gender and class.

As scholars like Ina Zweiniger-Bargielowska have highlighted, physical culture around the turn of the 20th century existed against the backdrop of competing conceptions of masculinity and a wider debate about the fitness of the British “race”. The scientifically trained sport body, sculpted by the sport scientist, became modern society’s idea of the perfect body.

The untrained body – that is, not trained by a sport scientist – is often presented as the “other” type. These “untrained” bodies are often developed in community sports in local communities without the high costs that accompany sport science interventions. These forms of exercise are looked down on and sports science students are taught that these matter less. Ordinary people in these communities are made to believe that their exercise regimes, and ultimately their physical bodies, are not valid and are unimportant.

There have also been few strides in addressing gender discrimination in sports science. White male bodies are the focus. Students are not taught about alternatives or given space to criticise traditional approaches.

The field of sports science, then, has neglected the development of a thorough, critical analysis of how gender, race and class inequalities play out in sports science and exercise.

Commodifying knowledge

But altering what we teach is just one part of the challenge for South African sports scientists.

As higher education has become more commodified, so have public universities’ sports sciences departments.

As sport scientists, we no longer focus primarily on generating and dispensing intellectual knowledge about sport to local communities. Instead, we accumulate knowledge primarily for performance appraisals in accredited publications for distribution in academic circles. This means it’s shared with fewer people.

In this way, sports science’s intellectual property has been captured by what scholar Lesley le Grange refers to as the knowledge economy in the ascendancy of the neo-liberal university.

What does all this mean, in practise?

Simply put, if sport science wants to be relevant to ordinary people, the curriculum needs to be taught and thought about differently. There must be a commitment to a decolonised way of doing things. This means teaching students about different bodies, about different fitness regimes and approaches, drawing from indigenous knowledge systems about what builds a strong body.The Conversation

Francois Cleophas, Senior Lecturer in Sport History, Stellenbosch University

This article is republished from The Conversation under a Creative Commons license. Read the original article.