Brain injury assessment and recovery
NuOptic is a VR headset with eye-tracking cameras built in. It measures how a person's eyes move, how steadily they stand and how quickly they react, and it takes the same measurements again as they recover from a concussion or another brain injury. Athletic programs use it to test athletes before the season, to check them on the sideline after a hit, and to follow their recovery. Clinics and veterans' programs use it from the first visit, because it doesn't need a baseline to be useful. The clinician gets the numbers and makes the decision.
An illustration of the kind of trace the headset records. Each person is compared with their own earlier recordings rather than with a population average.
What it does
There are two kinds of session. One looks for a deficit after an injury by comparing the person with their own earlier results, or with their first visit if there is no baseline. The other tracks performance by comparing them with their own best.
Compared with the person's own baseline, or their first visit
The short check takes under five minutes and has five tests. It measures how close to the face the eyes can keep a target single, how quickly they jump to a new target, how smoothly they follow a moving one, how still the person stands with their vision covered, and how fast they react to a target they have to touch. The report gives one of three findings, no deficit detected, deficit detected or significant deficit detected, and the clinician takes it from there. On a sideline the comparison is with the athlete's pre-season baseline; in a clinic it is with whatever was recorded at the first visit.
Compared with the person's own best
The performance session is harder and is meant for the training room: a go or stop test, tracking several moving objects at once, doing two things at the same time, and hitting small fast targets. It doesn't need a baseline. The first session sets the mark and later ones are scored against the person's best so far. These sessions are kept apart from recovery data so the two never get mixed.
Athletes and service members
A concussion on the field and a traumatic brain injury in service are the same kind of injury, seen in different places. The usual difference is the baseline. An athlete in a program has one from pre-season. A service member or a veteran usually doesn't, because nobody measured them before it happened. NuOptic is built for both situations. When there is a baseline, each check is compared with it. When there isn't, the first visit becomes the reference and later visits are compared with that. Either way the measurements are in the same units, so a change of a few milliseconds in an eye movement, or a few degrees in how the eyes line up, shows on the report from one visit to the next.
On the sideline or in a clinic. An athletic trainer can run the short check on the field in under five minutes, and a clinician can run the full session in about fifteen. It is the same headset and the same report in both places.
Runs anywhere there is a chair. The headset works on its own, with no computer, cables or wall power, so it can be used in a training room, a VA clinic, a military treatment facility, a community clinic, or on a home visit.
The person being tested never sees a result. They see instructions and targets and nothing else. The report goes to the clinician, and the device itself doesn't decide anything.
NuOptic is an investigational device. It doesn't diagnose concussion or TBI and it doesn't replace a clinical evaluation. What it adds is a set of measurements the clinician can put next to that evaluation. If you run an athletic program or a clinic and would like to see it working, request a demo.
Where it fits
Athletic programs mostly screen with ImPACT, VOMS and King-Devick, and military programs with MACE 2 and ANAM. Between them, these tools worked out what is worth checking after a head injury: thinking and memory, the eyes, balance and symptoms. What none of them has is an instrument for the eyes and balance. The symptom score is whatever the person reports, the near point is read off a ruler, the reading test is timed with a thumb on a stopwatch, and the eye and balance checks come down to what the examiner can see.
NuOptic measures those same things with the two eye-tracking cameras and the motion sensors inside an HTC VIVE Focus Vision headset. It doesn't need a laptop, wall power or a quiet room, so it fits in a bag and can be used on a field, in a training room or in a clinic.
Assessed today with
Measured here with
Athletic programs
ImPACT
VOMS
King-Devick
Military programs
MACE 2
ANAM
A full session takes about 15 minutes and covers all of this. The short sideline check runs five of the tests in under five minutes.
ImPACT, VOMS, King-Devick, MACE 2 and ANAM have evidence behind them. NuOptic doesn't yet, and their evidence doesn't carry over to it. It reports its own measurements, in physical units, against the person's own earlier results, and its reliability study is still ahead of it.
The tests
There is no overall wellness score. Each test produces a number in ordinary units such as milliseconds, degrees, centimetres or percent, and you can read it, question it and compare it from one visit to the next. If a test couldn't be measured, the report says so and gives the reason.
| Test | What it tells you about | What it reports | Runs in |
|---|---|---|---|
| Eye alignment up close (convergence) | Eye teaming | Near point cm; objective break; subjective-objective gap | Sideline · Full |
| Eye jumps (saccades) | Fast eye control | Latency ms; gain; latency SD | Sideline · Full |
| Following a moving target (pursuit) | Visual tracking | Gain; phase lag ms; fit residual ° | Sideline · Full |
| Pupil response to light | Pupil and nervous system | Latency ms; constriction %; max velocity mm/s; asymmetry | Full |
| Visual field | Peripheral vision | Detection %; detection time ms; false alarms | Full |
| Contrast sensitivity | Vision | Threshold, logCS (2AFC staircase) | Full |
| Seeing clearly while the head moves (VOR) | Inner ear and eyes | Head-moving vs head-still accuracy % | Full |
| Balance, eyes covered | Balance | Sway path cm; RMS sway mm | Sideline · Full |
| Reaction time | Reaction | Mean ms; best ms | Sideline · Full |
| Hand-eye coordination | Hand and eye | Targets hit; hit rate %; time to hit ms | Full |
| Colour-word test (Stroop) | Self-control under speed | Incongruent RT ms; interference ms; accuracy % | Full |
| Working memory | Memory | Longest sequence; errors | Full |
| Go or stop | Self-control under speed | Go RT ms; stop failures; stop signal RT ms | Performance |
| Tracking several moving objects | Attention | Tracking accuracy %; peak speed | Performance |
| Doing two things at once | Attention | Peripheral detection %; central hit rate; false triggers | Performance |
| Hitting small fast targets | Hand and eye, under pressure | Targets / 30 s; hit rate % | Performance |
Full baseline ≈ 15 min · Sideline < 5 min · Performance ≈ 6 min · Binocular eye tracking.
The report
For each test, the report shows what was measured, what the person's own baseline was, the result as a percentage of that baseline, and a colour band so the page can be read at a glance. It says where a problem is. It doesn't say what to do about it; that stays with the clinician.
Sample
This sample was generated by the software for a made-up test athlete, and folded into dropdowns so it fits on the page.
For the clinician
NuOptic Desk
NuOptic Desk is the companion program that runs on your own computer, on Windows, Mac or Linux. You add each person once and, before a session, send their name or a study ID to the headset. The tag is used once and then removed, so a result can't end up attached to the next person. After the session you plug in the cable, pull the results across and open the report. Nothing is sent anywhere else.
In the headset
Instructions, targets and a count of how many tests are left. That is all. No number, no colour band and no finding appears in the headset at any point, for two reasons. Someone who is symptomatic shouldn't find out they are impaired from a headset. And someone who knows how the last test went will try differently on the next one, which spoils the comparison that everything else depends on.
Running a session takes one examiner and about a minute of their attention. You pick the person and the type of session and hand the headset over. The person starts it themselves when they are comfortable, so nothing is timed from a fumbled start. When the last test finishes, the headset asks to be handed back and goes to the menu. The results are read on the examiner's computer after the pull. There is no button, trigger or gesture that will show them in the headset.
The four panels below are drawings of those screens. We will replace them with photographs taken inside the headset once the first sessions have been recorded.
Limits
NuOptic doesn't diagnose concussion or any other brain injury, and it doesn't make return-to-play, return-to-duty or return-to-work decisions. It is a measuring instrument, and what it measures is meant to sit alongside the evaluation of a qualified clinician under your own institution's protocol. It is not FDA cleared. Deficit scores compare a person with their own earlier sessions, recorded with the same software settings and controllers; when there is no pre-injury baseline, the first measurement becomes the reference. It is intended for people aged 13 and older. Patent pending.
Contact
We are talking to athletic departments, sports-medicine groups, neurology and rehabilitation clinics, and VA, military and community health teams. Tell us a little about your program and we will set up a session.