Eye-tracking devices may help ICU patients communicate

Eye-tracking devices might help some patients communicate even when mechanical ventilators make it impossible for them to speak, a small pilot project suggests.

Researchers offered eye-trackers to 12 patients on ventilators in intensive care units (ICUs) at the Johns Hopkins Hospital in Baltimore, Maryland, during 2013 and 2014. All of the participants were cognitively capable of communication and able to convey comprehension by blinking, nodding their head or some other motion.

Tiny cameras followed patients' eye movements, allowing them to communicate by staring directly at images and words on a computer monitor. Once patients got training on how to use the gadgets, the eye-trackers appeared to help patients feel less confused, happier and more confident in their ability to communicate.

"Eye-tracking devices may be an effective tool to promote patient communication and increased psychosocial well-being in selected ICU patients," lead study author Jonah Gerry, a researcher at Stony Brook University School of Medicine in New York, said by email.

The pilot project suggests that using the eye-trackers is feasible in this setting, and merits further research, Gerry added.

Approximately 40 percent of patients in ICUs require mechanical ventilation, preventing them from communicating verbally, Gerry and colleagues note in the journal Surgery.

Many of these patients may also struggle with even the slight body movements needed for non-verbal communication, making it difficult for them to signal for help, the researchers note.

Before using the eye-trackers, the patients in the study relied on mouthing words or blinking to communicate.

During the study, occupational or speech pathology therapists provided five days of 45-minute training sessions to help patients learn to use the eye-trackers to spell out notes, indicate their needs using picture sets, and play memory games.

By the end of the experiment, all of the patients could communicate basic needs using the eye-trackers by using pre-set pictures or words on the computer screens, such as "hungry," "thirsty," "bathroom," "nurse" and "pain."

Half of the patients were also able to use the eye-tracker to hunt-and-peck their way to full sentences on the computer screen by moving their focus from one letter to the next on a keyboard shown on the monitor.

Some patients could also use the eye tracker to handle even more complex jobs like communicating on social media.

One drawback of the eye-trackers is that in order for an ICU patient to use it properly, an able-bodied person must position it, and even then patients can struggle to concentrate and maintain the posture needed to use the device for long periods of time, the researchers acknowledge.

The study is too small to determine if eye trackers can improve communication in a broad population of ICU patients or prove whether the devices are directly responsible for any improvements in mood that participants experienced during the experiment, the authors also note.

Tobii Technologies donated the eye-trackers used in the study and provided a scholarship to Gerry.

"This was a pilot trial to test the feasibility of using eye-tracking technology to improve communication with patients in the ICU," said Dr. Daniel Howes, an emergency medicine specialist at Queens University in Ontario who wasn't involved in the study.

While there may be no harm to trying the devices, some patients might not be able to use them due to their eye color or the shape of their eyelids, Howes added by email. Others might be too sleepy or confused to use the devices effectively.

"Ideal patients are those who are mentally intact, can go through the training and who can't communicate by other means," Howes said.