WO2023114744A1

WO2023114744A1 - Televisual field device and method for assessing neurological performance

Info

Publication number: WO2023114744A1
Application number: PCT/US2022/081411
Authority: WO
Inventors: Christine HOLMSTEDT
Original assignee: Musc Foundation For Research Development
Priority date: 2021-12-16
Filing date: 2022-12-13
Publication date: 2023-06-22

Abstract

A televisual field system for assessing neurological performance of a patient is described. The system includes a headset having a display and a sensor, an assessment module, and a controller communicatively coupled to the display, sensor and assessment module. The controller is configured to send a signal to the display to initiate a visual effect indicative of a threat to the patient, receive a measurement signal from the sensor indicative of patient response to the threat, and determine a blink-to-threat response based on an elapsed time between the visual effect and the patient response. A method for assessing neurological performance of a patient is also described.

Description

TELEVISUAL FIELD DEVICE AND METHOD FOR ASSESSING NEUROLOGICAL PERFORMANCE

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to U.S. provisional application No. 63/290,086, filed December 16, 2021 incorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION

[0002] As telemedicine becomes mainstream, the demand for telestroke and teleneurology consultations has gone up. However, telemedicine currently lacks an easy and accurate way to exam visual fields without requiring examination performance by the telepresenter. This unfortunately yields unreliable results since telepresenter performance may differ from performance to performance, or from person to person. Further, learning to test visual fields is an acquired skill and not easy to learn, and is even more difficult to teach sufficiently in a time sensitive situation.

[0003] Accordingly, there is a need in the art for a device and method that would allow for fast, easy, and reliable visual field testing for patients experiencing potential neurological issues, including for example both acute stroke patients and non-acute teleneurology consultations. SUMMARY OF THE INVENTION

[0004] In one embodiment, a televisual field system for assessing neurological performance of a patient, includes a headset comprising a display and a sensor; an assessment module; and a controller communicatively coupled to the display, sensor and assessment module, where the controller is configured to: send a signal to the display to initiate a visual effect indicative of a threat to the patient, receive a measurement signal from the sensor indicative of patient response to the threat, and determine a blink-to-threat response based on an elapsed time between the visual effect and the patient response. In one embodiment, the patient response is based on patient blink threshold. In one embodiment, the measurement signal comprises image data. In one embodiment, the sensor is a camera. In one embodiment, the assessment module comprises an avatar that tracks real time patent movement. In one embodiment, the visual effect is indicative of an object rapidly approaching the patient. In one embodiment, the visual effect comprises a periphery threat. In one embodiment, the visual effect is triggered by input received at the controller from the assessment module. In one embodiment, the input received is one of a plurality of input options provided by the assessment module. In one embodiment, the plurality of input options includes a first and second type of threat. In one embodiment, the plurality of input options includes a plurality of incoming peripheral threat trajectories. In one embodiment, the plurality of incoming peripheral threat trajectories includes a first and second peripheral threat trajectory entering the display from different areas on a left region of the display, and a third and fourth peripheral threat trajectory entering the display from different areas on a right region of the display. In one embodiment, the plurality of incoming peripheral threat trajectories includes a plurality of threat types for each of the plurality of incoming peripheral threat trajectories. In one embodiment, the blink-to-threat response is further based on detecting a non-blink patient movement. In one embodiment, the blink-to-threat response is further based on detecting a patent physiological parameter.

[0005] In one embodiment, a method for assessing neurological performance of a patient includes the steps of providing a visual field; initiating a visual effect indicative of a threat in the visual field; receiving a measurement signal indicative of patient response to the threat; and determining a blink-to-threat response based on an elapsed time between the visual effect and the patient response. In one embodiment, the patient response is based on patient blink threshold. In one embodiment, the measurement signal comprises image data. In one embodiment, the visual effect is indicative of an object rapidly approaching the patient. In one embodiment, the visual effect comprises a periphery threat. In one embodiment, the visual effect is triggered by input received from a remote location. In one embodiment, the input received is one of a plurality of input options provided by the assessment module. In one embodiment, the plurality of input options includes a first and second type of threat. In one embodiment, the plurality of input options includes a plurality of incoming peripheral threat trajectories. In one embodiment, the plurality of incoming peripheral threat trajectories includes a first and second peripheral threat trajectory entering the display from different areas on a left region of the display, and a third and fourth peripheral threat trajectory entering the display from different areas on a right region of the display. In one embodiment, the plurality of incoming peripheral threat trajectories includes a plurality of threat types for each of the plurality of incoming peripheral threat trajectories. In one embodiment, the blink-to-threat response is further based on detecting a non-blink patient movement. In one embodiment, the blink-to-threat response is further based on detecting a patent physiological parameter.

BRIEF DESCRIPTION OF THE DRAWINGS

[0006] The foregoing purposes and features, as well as other purposes and features, will become apparent with reference to the description and accompanying figures below, which are included to provide an understanding of the invention and constitute a part of the specification, in which like numerals represent like elements, and in which:

[0007] Figure 1 is a diagram of a televisual field system for assessing neurological performance according to one embodiment.

[0008] Figures 2A and 2B depict assessment module display interfaces, showing the patient avatar and patient headset display according to one embodiment.

[0009] Figures 3A and 5B depict an assessment module display with options for presenting on the headset display (Fig. 3A) and the resulting user display (Fig. 3B) according to one embodiment.

[0010] Figures 4A-4C show a user headset display with a threat depicted as approaching the user’s face according to one embodiment. [0011 ] Figures 5A-5C show a user headset display with a threat depicted as approaching the user’s face according to one embodiment.

[0012] Figure 6 is a flow chart of a method for assessing neurological performance of a patient according to one embodiment.

[0013] Figures 7A-7J are images of a experimental example according to one embodiment.

[0014] Figures 8A-8C are graphs of experimental example results according to one embodiment.

DETAILED DESCRIPTION OF THE INVENTION

[0015] It is to be understood that the figures and descriptions of the present invention have been simplified to illustrate elements that are relevant for a more clear comprehension of the present invention, while eliminating, for the purpose of clarity, many other elements found in systems and methods for assessing neurological performance of a patient. Those of ordinary skill in the art may recognize that other elements and/or steps are desirable and/or required in implementing the present invention. However, because such elements and steps are well known in the art, and because they do not facilitate a better understanding of the present invention, a discussion of such elements and steps is not provided herein. The disclosure herein is directed to all such variations and modifications to such elements and methods known to those skilled in the art. [0016] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although any methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, the preferred methods and materials are described.

[0017] As used herein, each of the following terms has the meaning associated with it in this section.

[0018] The articles “a” and “an” are used herein to refer to one or to more than one (/.e., to at least one) of the grammatical object of the article. By way of example, “an element” means one element or more than one element.

[0019] “About” as used herein when referring to a measurable value such as an amount, a temporal duration, and the like, is meant to encompass variations of ±20%, ±10%, ±5%, ±1 %, and ±0.1 % from the specified value, as such variations are appropriate.

[0020] Ranges: throughout this disclosure, various aspects of the invention can be presented in a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the invention. Where appropriate, the description of a range should be considered to have specifically disclosed all the possible subranges as well as individual numerical values within that range. For example, description of a range such as from 1 to 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1 , 2, 2.7, 3, 4, 5,

5.3, and 6. This applies regardless of the breadth of the range.

[0021] Referring now in detail to the drawings, in which like reference numerals indicate like parts or elements throughout the several views, in various embodiments, presented herein is a televisual field system and method for assessing neurological performance of a patient. The systems and methods described herein for provide an easy and accurate way to exam visual fields without requiring examination performance by the telepresenter, leading to much more reliable and consistent results, shorter training times, lower costs and all within a controlled televisual environment void of external distractions.

[0022] According to one embodiment with reference now to FIG. 1 , a wearable VR (virtual reality) headset 100 is provided for the patient 50. The headset 100 includes a visual field 102 that in one embodiment is provided by a display configured to present a particular environment. One or more sensors 104 such as a camera is configured to measure patient feedback, which for example can be a patent blink response. A controller 106 is communicatively coupled to the display, sensor and a communications module. Patent performance and device feedback signals can be provided via a communication network that communicates with a separate assessment module 120 monitored by a healthcare professional, such as a remotely located neurologist assessing the patent.

[0023] The displayed environment is designed to depict a scenario or visual effect indicative of a threat to the patient for the purposes of evaluating a blink-to-threat response. Since the blink-to-threat response evaluation are conducted and measured in a controlled, repeatable and predictable environment, the reliability and usefulness of the results represents a dramatic improvement over conventional methods. A blink-to- threat response can be tested for example by depicting a small object image growing in size quickly (indicative of an object being thrown at the patient’s face) to induce a blink- to threat-response. For patients that cannot speak or understand speech, this test modality may be preferable. The patient facing camera used to monitor and detect the blink response can be used for other parts of a neurological function exam including evaluation of speech, naming, reading, fluency, etc. In one embodiment, the visual field can include one or more dots for patient testing. Patient responses may also be displayed on a separate module. The patient would have the ability to provide a response, such as by clicking a cursor when they see one of the dots, or verbally informing the examiner that they see the dots. The images can be dots, numbers, fingers or any other object, shape or alphanumeric. The headset 100 according to one embodiment can include a controller and a communication module configured to communicate with a network including at least one remote server and a database.

[0024] A depiction of a user interface on the assessment module 120 utilized by the medical professional assessing the patient is shown with reference now to FIG. 2A according to one embodiment. An avatar 200 in the center can be displayed which depicts eye movements of the patient in real time and displays metrics detected by the camera or other measurement devices. The scene 202 in the border (lower left) shows what the patient sees. An NIH stroke scale can also be displayed to the patent and/or the medical professional. For example, the patient or medical professional can answer questions based on the image that inform how the patient is feeling and what they see. Controls (right) can be used by the test conductor to adjust velocity and position of a ball throw, initiate a ball throw, or for example a periphery threat such as a “jab”. A jab is meant to generate a quick stimulus to the periphery, either left or right side for initiating a blink-to-threat response. Another embodiment of a visual field interface is show in FIG. 2B. It starts off with just a ball 206 in the center of the screen for the patient to focus on. The controls on the upper left give the test conductor the ability to display hands 208, 208’ for the patient. The position and number of fingers held up can be adjusted in real time to track patient testing, movement or reaction.

[0025] In one embodiment, with reference now to FIGs. 3A and 3B, the visual field test presents a generic object, in this case a baseball 300, for the patient to look at. The test operator can then select from the menus in the user interface to show either 1 or 2 hands 308, 308’. Each hand can be either a “fist”, “one finger up”, or “two fingers up” and the position of the hand(s) can be selected as well. The relative positions available are shown in FIG. 3A. FIG. 3B shows an example of the following configuration: 2 hands, upper left hand in a fist, and lower right hand with two fingers up. When the selected hand(s) are shown the operator will then ask the patient to describe what they see.

[0026] In one embodiment, with reference now to FIG. 4A-4C, the blink-to-threat test has a “ball throw” option. The test operator can configure variables to control the following: object to be thrown, quadrant or trajectory for which the object will be thrown from, relative starting position of thrown object, relative ending position of thrown object, velocity of object throw, and which NIH image to show. FIG. 4A shows the 4 quadrants which an object can be thrown and the vector or trajectory for which it will be thrown. FIG. 4B is an example of an object thrown from the upper left quadrant when it first becomes visible to the patient. FIG. 4C is an example of an object thrown from the upper left quadrant at or approaching its final position before disappearing from the patient’s view. The intention of the test is to “distract” the patient by asking them to describe the picture shown and then test for a blink response by surprising them with a thrown object. An object can be thrown multiple times, and while the velocity can be adjusted, the throw only lasts fractions of a second.

[0027] In one embodiment, with reference now to FIGs. 5A-5C, the blink-to-threat test has a “Jab” option. The test operator can configure Jab position, length, and velocity. FIG. 5A shows the relative positions available to Jab at a patient. FIG. 5B shows an example of an upper left jab when it first enters the patient’s view. FIG. 5C shows an example of an upper left jab approaching full length just before it disappears from the patient’s view. The intention of the Jab is to provide the test operator with a second threat type or method to test for a blink response. This also ensures that the threat does not become too predictable.

[0028] In one embodiment, the blink-to-threat response can be quantified by the amount of time that lapsed between display of the threat and measurement of a patient blink or eye movement response. Since the threat scenario or visual effect depicted in the environment can be presented over a span of time (typically a short span of time), timing of the threat can for example que off of initiation of the threat, peak of the threat, or some other fiducial point for measuring blink-to-threat response. For example, if the environment depicts a scenario of visual effect of a ball being thrown at the face of the patient, timing of the threat for purposes of measuring blink-to-threat response can que from an initial point of the ball throw or some point thereafter, such as when it appears closer and perceived face contact is more imminent. Likewise, timing of the patient response can be based on various threshold values, which for example may be based on the intensity of the patient’s blink response, how hard the patient blinks, or how long the blink is held. These thresholds can be a factor for deciphering between a threatbased blink and a routine or normal/non-threat blink. In one embodiment, the blink threshold value takes into context other non-blink patient feedback to help properly classify the patient response as a threat response. For example, movements associated with the patient response can be recorded by the same sensor or additional sensors to help determine whether the blink is associated with a threat response or not, including e.g. head movement, mouth movement, hand movement or other body movements associated with a physical response to a threat. Physiological factors such as heart rate or breathing function may also be considered to determine whether the patient’s blink response is indicative of a threat response or normal non-threat physiological activity. A secondary image such as a static image associated with visual field testing can also be displayed.

[0029] Accordingly, a method for assessing neurological performance 350 is shown in Fig. 6 according to one embodiment. A visual field is providing to the patient 352. A visual effect is then initiated indicative of a threat in the visual field 354. A measurement signal indicative of patient response to the threat is received 356, such as a measured blink. A blink-to-threat response is then calculated based on an elapsed time between the visual effect and the patient response 358. EXPERIMENTAL EXAMPLES

[0030] The invention is now described with reference to the following Examples. These Examples are provided for the purpose of illustration only and the invention should in no way be construed as being limited to these Examples, but rather should be construed to encompass any and all variations which become evident as a result of the teaching provided herein.

[0031 ] Without further description, it is believed that one of ordinary skill in the art can, using the preceding description and the following illustrative examples, make and utilize the present invention and practice the claimed methods. The following working examples therefore, specifically point out the preferred embodiments of the present invention, and are not to be construed as limiting in any way the remainder of the disclosure.

[0032] With reference now to Figs. 7A-7J, an experimental example is shown according to one embodiment. The patient places the headset on their head and adjusts it to a comfortable position (e.g. Fig. 7A). The session is controlled by the presenter from the assessment module (e.g. Fig. 7B), which includes a display having a graphical user interface including an avatar 400 depicting the patient’s facial movements, including eyelid and eyeball position, facial muscle movements and facial expressions as measured from the headset sensors. The assessment module also includes a box 402 showing what the patient sees in their headset display, and various buttons 404 for initiating a threat. The buttons can be configured about the perimeter of the box 402 corresponding to the threat type and positioned relative to the threat trajectory, making it easy for the presenter to initiate various types of threats from different directions. The presenter then puts an image on the screen and asks the patient to describe what they see. They can for example be asked to describe what they see, what colors specific object are, what they think is going on in the scene, details about numbers of objects or elements, etc. At somewhat random times during this process, the presenter can initiate various types of threats from various directions, causing the patient to blink in response. For example, Figs. 7C and 7D show a depiction of a baseball rapidly approaching the patient’s face. The presenter is able to view the patient’s reaction via the avatar and headset sensors that measure a blink as shown for example in Fig. 7E. Different types of images can be cycled in throughout the assessment (e.g. Figs. 7F-7I). The system will record and present data related to each generated threat which can be analyzed by the presenter and/or medical professionals (e.g. Fig. 7J) . Data includes threat type, trajectory, timestamp of when the threat initiated, and blink-to-threat response time. The data can also be presented in graphical form, tracking eye movement relative to the threat movement and blink thresholds.

[0033] With reference now to Figs. 8A-8C, graphical results for interpreting measured data are shown according to one embodiment. Measured results can be indicative of a normal response or abnormal response. The graphical user interface is a tool that medical professionals can utilize to interpret and review test results. Fig. 8A shows an example of a successfully elicited blink reaction. After a threat enters the screen from a bottom right portion, the left and right eye quickly close and open in close unison, passing the preset threshold for registering eye movement as a blink. Fig. 8B shows a slightly different response. After a threat enters the screen from a bottom left portion, the left eye quickly close and open, passing the preset threshold for registering left eye movement as a blink. Meanwhile, right eye movement fails to pass the threshold, thus no right eye blink is registered. This is an example of a deviation between left and right eye closure, which may be indicative of an abnormal patient response. An example of a fully unsuccessful blink reaction is shown in Fig. 8C. The left and right eyes have no identifiable response following a threat entering the screen from a bottom right portion. The left eye appears to flutter before, during and after the threat has arrived without any reaction corresponding to timing of the threat. The right eye appears to have no movement before, during and after the threat has arrived, also lacking any reaction corresponding to timing of the threat. Accordingly, embodiments of the graphical user interface allow for easy access and review of each threat interaction.

[0034] The disclosures of each and every patent, patent application, and publication cited herein are hereby incorporated herein by reference in their entirety. While this invention has been disclosed with reference to specific embodiments, it is apparent that other embodiments and variations of this invention may be devised by others skilled in the art without departing from the true spirit and scope of the invention.

Claims

CLAIMS What is claimed is:

1 . A televisual field system for assessing neurological performance of a patient, the system comprising: a headset comprising a display and a sensor; an assessment module; and a controller communicatively coupled to the display, sensor and assessment module, where the controller is configured to: send a signal to the display to initiate a visual effect indicative of a threat to the patient, receive a measurement signal from the sensor indicative of patient response to the threat, and determine a blink-to-threat response based on an elapsed time between the visual effect and the patient response.

2. The system of claim 1 , wherein the patient response is based on patient blink threshold.

3. The system of claim 1 , wherein the measurement signal comprises image data.

4. The system of claim 1 , wherein the sensor is a camera.

5. The system of claim 1 , wherein the assessment module comprises an avatar that tracks real time patent movement.

6. The system of claim 1 , wherein the visual effect is indicative of an object rapidly approaching the patient.

7. The system of claim 1 , wherein the visual effect comprises a periphery threat.

8. The system of claim 1 , wherein the visual effect is triggered by input received at the controller from the assessment module.

9. The system of claim 8, wherein the input received is one of a plurality of input options provided by the assessment module.

10. The system of claim 9, wherein the plurality of input options includes a first and second type of threat.

11 . The system of claim 9, wherein the plurality of input options includes a plurality of incoming peripheral threat trajectories.

12. The system of claim 11 , wherein the plurality of incoming peripheral threat trajectories includes a first and second peripheral threat trajectory entering the display from different areas on a left region of the display, and a third and fourth peripheral threat trajectory entering the display from different areas on a right region of the display.

13. The system of claim 11 , wherein the plurality of incoming peripheral threat trajectories includes a plurality of threat types for each of the plurality of incoming peripheral threat trajectories.

14. The system of claim 1 , wherein blink-to-threat response is further based on detecting a non-blink patient movement.

15. The system of claim 1 , wherein the blink-to-threat response is further based on detecting a patent physiological parameter.

16. A method for assessing neurological performance of a patient comprising: providing a visual field; initiating a visual effect indicative of a threat in the visual field; receiving a measurement signal indicative of patient response to the threat; and determining a blink-to-threat response based on an elapsed time between the visual effect and the patient response.

17. The method of claim 16, wherein the patient response is based on patient blink threshold.

18. The method of claim 16, wherein the measurement signal comprises image data.

19. The method of claim 16, wherein the visual effect is indicative of an object rapidly approaching the patient.

20. The method of claim 16, wherein the visual effect comprises a periphery threat.

21. The method of claim 16, wherein the visual effect is triggered by input received from a remote location.

22. The method of claim 21 , wherein the input received is one of a plurality of input options provided by the assessment module.

23. The method of claim 22, wherein the plurality of input options includes a first and second type of threat.

24. The method of claim 22, wherein the plurality of input options includes a plurality of incoming peripheral threat trajectories.

25. The method of claim 24, wherein the plurality of incoming peripheral threat trajectories includes a first and second peripheral threat trajectory entering the display from different areas on a left region of the display, and a third and fourth peripheral threat trajectory entering the display from different areas on a right region of the display.

26. The method of claim 24, wherein the plurality of incoming peripheral threat trajectories includes a plurality of threat types for each of the plurality of incoming peripheral threat trajectories.

27. The method of claim 16, wherein blink-to-threat response is further based on detecting a non-blink patient movement.

28. The method of claim 16, wherein the blink-to-threat response is further based on detecting a patent physiological parameter.

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