About one in three survivors of acquired brain injury cannot pay attention to anything on one side of their body—a condition called neglect that has no proven therapy. EyeFocus is a tablet app that turns a therapist-led eye movement exercise into a self-administered game, using machine learning to track where patients look and adjust difficulty in real time. Currently, the standard exercise requires 30 to 60 minutes of repeated practice with a clinician present, which limits how often patients can do it. EyeFocus aims to make those sessions shorter, more engaging, and possible at home, so patients practise more often and recover faster. If it works, the app could speed up hospital discharge, reduce the long-term disability that keeps many survivors from returning to work, and ease the burden on unpaid carers. With more than 400,000 survivors of neglect in the UK alone, a portable, evidence-based therapy that patients can use independently would fill a gap consistently ranked as one of the top unmet healthcare needs after brain injury.
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While physical and language impairments after acquired brain injury (ABI) are seen easily, cognitive effects are often hidden and considered an unmet need [1-2]. Our innovative digital health technology EyeFocus is directed at one of the most frequent and disabling cognitive impairments in ABI: neglect. Neglect affects 1 in 3 ABI survivors and is an inability to attend to stimuli, including own body parts, people, and objects, on the most affected side of the body [3-4]. Compared to other ABI survivors, people with neglect present longer-lasting disability, poorer motor recovery, longer length of inpatient hospital stay, lower functional independence, decreased community mobility and are less likely to return to work [5-7]. Their unpaid carers suffer long-term burden and stress [8]. There is currently no clinically proven therapy for improving neglect [9]. Neglect has been consistently identified by ABI survivors, carers, and clinicians as one of the top unmet healthcare needs [10,11-14]. With more than 400,000 ABI survivors suffering from neglect in the UK and over 30 million worldwide, the condition poses an enormous challenge to healthcare. Our PPI members tell us neglect is "terrifying, I bump into people", and clinicians note "patients are not getting the care they need". EyeFocus is a mobile tablet-app developed to improve ABI clinical management and help survivors recover from neglect (Tier C Digital Health Technology). The app digitises smooth pursuit eye movement therapy (SPT), where patients follow moving stimuli towards their impaired side with their eyes. Traditional SPT has established experimental proof-of-concept (TRL3) in improving attention/neglect ([15-16]; Fig.1), but involves long (30-60min) repeated eye movement practise with a therapist always present. EyeFocus is a digitised portable and self-administered version of SPT that applies machine learning to track eye-movements providing gamified SPT with personalised difficulty levels (see Fig.2). We hope EyeFocus will offer similar benefits (e.g., improve attention to affected side), but sessions will be shorter, self-administered, more engaging and thus done more often, when compared to traditional methods. As an evidence-based therapy superior to currently used solutions, EyeFocus will help patients recover faster, contributing to earlier discharge from hospital, and supporting brain injury survivors in further rehabilitation in their home. EyeFocus was developed by the University of East Anglia and Animorph Ltd. (jointly owned IP) based on extensive and iterative feedback from end-user groups consisting of community-dwelling people with chronic ABI (discharged from NHS), their carers, and NHS clinicians. Funded by NIHR Brain Injury MedTech Co-operative we worked with end-users to develop EyeFocus-v1 and, then 3 people with neglect tried EyeFocus v1 in their own homes for 5 days. They told us it was "easy to use" with one returning to driving, stating the app gave him his life back. Funded by NIHR Connect we validated the EyeFocus eye-tracking technology and further upgraded the app to EyeFocus-v2 by implementing suggestions from 17 people with chronic ABI who tried the app in their own homes (6 with neglect), 20 individuals without ABI aged 65+, and 2 NHS occupational therapists working in neglect rehabilitation (Fig.2).
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