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Paralyzed Patients "Speak" With Their Pupils

samzenpus posted about a year ago | from the trying-to-listen dept.

Medicine 72

sciencehabit writes "Lying in bed, unable to move a muscle, so-called locked-in patients have few ways to communicate with the outside world. But researchers have now found a way to use the widening and narrowing of the pupils to send a message, potentially helping these patients break the silence. The trick is a webcam-like setup that tracks pupil dilation. When people focus on a hard problem--say a math problem--their pupils dilate. Employing the approach, some locked-in patients could answer 'yes' and 'no' questions just by dilating their eyes."

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72 comments

Why are they even teaching anyone? (5, Funny)

ZaMoose (24734) | about a year ago | (#44480135)

I mean, seriously, paralyzed people would probably be bad candidates for teaching anyone anyth...

OHHHHH. Those kinds of pupils!

Re:Why are they even teaching anyone? (0)

PolygamousRanchKid (1290638) | about a year ago | (#44480225)

OHHHHH. Those kinds of pupils!

Not bad, but I wacky-parsed it as, "Paralyzed Patients "Speak" With Their Pubes"

. . . whatever images that may conjure up for you . . .

Re:Why are they even teaching anyone? (0)

Anonymous Coward | about a year ago | (#44480437)

That's a different type of dilation. Get your mind out of the gutter.

Re:Why are they even teaching anyone? (1)

gomiam (587421) | about a year ago | (#44484739)

"...involuntary dilation of the... iris?"

Re:Why are they even teaching anyone? (0)

Anonymous Coward | about a year ago | (#44485019)

Can people who have full body paralysis get erections?

Re:Why are they even teaching anyone? (1)

erroneus (253617) | about a year ago | (#44482423)

Let's vote on it. The eyes have it!

She couldn't say no, but her eyes said yes!

Sure, it's impressive, but if looks could kill, she'd have a future in the US armed services!

Re:Why are they even teaching anyone? (0)

Anonymous Coward | about a year ago | (#44483855)

Stephen Hawking would like a word with you.

The first thing I'd "speak" with my pupils (2, Insightful)

NobleSavage (582615) | about a year ago | (#44480177)

KILL ME

Re:The first thing I'd "speak" with my pupils (0)

Anonymous Coward | about a year ago | (#44480235)

Okay, I'm about to plunge this dagger into your heart. Dilate your pupils if you're sure you want me to do this.

Yes. (-1)

Anonymous Coward | about a year ago | (#44480257)

Just imagine the horseshit we'd see when the next Terri Shiavo [google.com] circus happens.

"Her pupils dilated! She's saying something!"

'No! It's the drugs!"

And round and round and mo' money mo' money for Fox News.

Re:The first thing I'd "speak" with my pupils (1)

Xicor (2738029) | about a year ago | (#44480407)

you can only speak yes or no, lol

Re:The first thing I'd "speak" with my pupils (0)

Anonymous Coward | about a year ago | (#44481481)

Saying "no" over and over again might get the point across.

Re:The first thing I'd "speak" with my pupils (0)

Anonymous Coward | about a year ago | (#44482409)

Captain Christopher Pike, is that you?

Re:The first thing I'd "speak" with my pupils (2)

jovius (974690) | about a year ago | (#44480453)

A movie worth seeing: The Diving Bell and the Butterfly [imdb.com]

That's about the first thing the locked-in patient Jean-Dominique Bauby [wikipedia.org] , who wrote a book by blinking his eyes, said. The book is an amazing read, breathtakingly beautiful and intelligent. Bauby died a bit after the book was released..

Re:The first thing I'd "speak" with my pupils (0)

Anonymous Coward | about a year ago | (#44482835)

I think everyone is thinking about "Johnny Got His Gun".

Re:The first thing I'd "speak" with my pupils (2)

Impy the Impiuos Imp (442658) | about a year ago | (#44480579)

JERK ME OFF

Should I post this anon? Naaaaah.

Re:The first thing I'd "speak" with my pupils (1)

GameboyRMH (1153867) | about a year ago | (#44482443)

This. And then "KILL ME" :-P

Re:The first thing I'd "speak" with my pupils (1)

houghi (78078) | about a year ago | (#44480869)

01101011 01101001 01101100 01101100 00100000 01101101 01100101

HTH. HAND.

Re:The first thing I'd "speak" with my pupils (0)

Anonymous Coward | about a year ago | (#44482841)

Morse code was so much better.

The first question I want them to ask me... (0)

Anonymous Coward | about a year ago | (#44480191)

- Can we pull the plug?
- yes!!!
- Sorry, we can't, enjoy being a vegetable for the next 20 years!

Re:The first question I want them to ask me... (1)

fuzzyfuzzyfungus (1223518) | about a year ago | (#44480239)

We're sorry; but your 'intrinsic human dignity' would be violated by following your wishes. Have a nice day.

Re:The first question I want them to ask me... (1)

Hsien-Ko (1090623) | about a year ago | (#44480351)

O_O

Re:The first question I want them to ask me... (0)

Anonymous Coward | about a year ago | (#44480457)

http://en.wikipedia.org/wiki/Johnny_Got_His_Gun

Why bother with pupil dilation? (3, Interesting)

Conspiracy_Of_Doves (236787) | about a year ago | (#44480203)

Why don't they go straight to neurofeedback? The hardware is getting a lot less expensive.

Re:Why bother with pupil dilation? (0)

Anonymous Coward | about a year ago | (#44480299)

Agreed. I'm not sure the tech is ready, but even a crude system would surely allow more precision than a binary output. I don't know the details, but I'd imagine that it's possible to influence feedback in a few directions, and approach abstract communication by flagging the minimal (or even binary) output as "negative, unhappy" or "emphatic, certain" or perhaps "this refers to actual past/present data" vs "this refers to speculative/rhetoric" or, I don't know, whatever linguists find useful at the widest levels.

And then later on the shit just prints to screen at your will.

Re:Why bother with pupil dilation? (2)

Shadow of Eternity (795165) | about a year ago | (#44480331)

afaik a lot of those systems work based on tying in to moving an arm or something.

Re:Why bother with pupil dilation? (1)

Conspiracy_Of_Doves (236787) | about a year ago | (#44480385)

I'm talking about the systems where you wear a sort of helmet or other headgear.

Re:Why bother with pupil dilation? (0)

Anonymous Coward | about a year ago | (#44483991)

I hope the state of the art is better than the commercial-grade stuff. I was beaten at a neurofeedback game by a plush toy wearing a tinfoil hat.

Pupil dilation is easily visible; with a mirror you could train yourself.

Re:Why bother with pupil dilation? (1)

Conspiracy_Of_Doves (236787) | about a year ago | (#44485465)

Was it your first ever attempt at neurofeedback? If so, of course you didn't do that great.

Learning to take control of any kind of semi-autonomous response is easy if you can see some kind of visible measure of it. In this case it would be a monitor showing the feedback of your brain.

Re:Why bother with pupil dilation? (1)

Twylite (234238) | about a year ago | (#44484955)

Certainly seems like a more promising idea than pupil dilation. Wikipedia has a comparison of BCI hardware [wikipedia.org] .

Pike (4, Funny)

Master Moose (1243274) | about a year ago | (#44480217)

With this type of tech, pretty soon we will be able to hook them all up to motorised boxes with a single light that can blink once for yes and twice for no.

Re:Pike (1)

The_Wilschon (782534) | about a year ago | (#44481159)

They couldn't even afford two lights. Or maybe this was on purpose, as it allowed Pike to have dramatic pauses: "yesssssssss...... I MEAN NO!"

Re:Pike (0)

Anonymous Coward | about a year ago | (#44482209)

Zapp Brannigan: You plead guilty?
Fry: *Beep, beep*
Zapp: Double yes! Guilty! I will now carry out the sentence. Kif! My gun!

Facilitated Communication Hoax (1)

chuckinator (2409512) | about a year ago | (#44480227)

While I am genuinely interested in seeing real, functional communication with a demographic that is typically cut off from being able to communicate with the rest of the world, I am very skeptical that this is going to turn into yet another facilitated communication hoax.

Re:Facilitated Communication Hoax (1)

fuzzyfuzzyfungus (1223518) | about a year ago | (#44480263)

On the plus side (and notably unlike 'facilitated communication', which required a true-believer to be in immediate contact with the patient), it would be reasonably trivial to pipe eyeball-cam footage to an otherwise blinded observer.

Doesn't mean that hopefully families won't be conned (or con themselves) into playing sick human-Ouija-board games with locked-in patients; but "Is this pupil dilation pattern conveying information?" should be a pretty testable question.

Re:Facilitated Communication Hoax (1)

Black Parrot (19622) | about a year ago | (#44480415)

'facilitated communication', which required a true-believer to be in immediate contact with the patient

Gee, I can't imagine any fraud or self-delusion creeping into that.

No more than, say, a medium providing 'facilitated communication' with the dead.

Re:Facilitated Communication Hoax (1)

fuzzyfuzzyfungus (1223518) | about a year ago | (#44482589)

Oh, 'facilitated communication' was quite the clusterfuck. Mostly preyed on severely autistic or otherwise nonverbal children (and if you think that dead people have an affective grip on our little hominid brains, try crippled kids...) Eventually started to come unglued when some of the communications facilitators began making (by means of their helpless meat-puppets) allegations of child sexual abuse against parents... Thankfully, 'facilitated communication' mostly crumbled under the onslaught of actual testing (shockingly, when the 'facilitator' couldn't see the stimulus; but only the kid could, performance on questions about it plummeted to chance. Funny how that happens), rather than a recap of the 'satanic panic' incident.

(A less dramatic; but also scientifically problematic, source of criticism was the 'we can place electrodes on every inch of kiddo, to discern the slightest volitional muscle movements, and nothing. Why, again, is it that "facilitators" are magically getting all kinds of output?' school of assistive tech people, who understandably had questions about what, exactly, the 'facilitator' could be detecting that instruments couldn't.)

Re:Facilitated Communication Hoax (3, Informative)

sconeu (64226) | about a year ago | (#44480433)

Bullshit. It's real. My late wife had ALS, and her eyegaze computer was worth every penny. Even if it wasn't *HER* voice (we didn't bank it early enough), she could still talk with us.

Re:Facilitated Communication Hoax (3, Interesting)

chuckinator (2409512) | about a year ago | (#44480535)

Thank you for your feedback. I was actually hoping to hear someone with specific experience with these techniques share their impression of the technique.

Can you expand on your experience with this technique? How did it work in your late wife's case? What was the latency of the communication like due to the obvious bandwidth constraints of this particular medium?

Re:Facilitated Communication Hoax (1)

sconeu (64226) | about a year ago | (#44481101)

It was slow. There was no blink required. The scanner registered how long the eye focused on a particular point to activate the "click". The dwell time was tunable, so you could adjust it as you became more practiced at it.

Because *everything* for an ALS patient is exhausting, it was very tiring for her to use. But it was worth it, even if it took a long time for her to spell out what she wanted. Predictive text also helped.

The biggest PITA was getting the positioning "just right" when we moved it from the rolling rack for her bed, to the wheelchair mounted rack, and vice versa.

Re:Facilitated Communication Hoax (0)

Anonymous Coward | about a year ago | (#44480583)

My mom died of ALS thirteen years ago. The best we had then was a clicker on the side of her head that she could use to spell words. She passed 2 years from diagnosis.

Re:Facilitated Communication Hoax (1)

yndrd1984 (730475) | about a year ago | (#44481227)

Bullshit. It's real. My late wife had ALS, and her eyegaze computer was worth every penny.

I understand, but I don't think that eyegaze was the kind of facilitated communication [wikipedia.org] the GP was calling a hoax.

paralysis of the eyes (1)

bugnuts (94678) | about a year ago | (#44480247)

So in all seriousness, if you're paralyzed down to your eyeballs, how can your pupils dilate/contract? That's not a nerve thing? According to TFA, the dilation shows your brain stem is intact, but that some people couldn't even move or blink their eyes for yes/no responses. If they can't move their eyes, how can the nerves dilate them? I can see the blinking being separate nerves, but would think moving and dilation and focusing would be pretty closely related? Bad assumption?

Is there a doctor in the house?

oblig TOS joke:
Q. What did Captain Pike name his dog?
A. "Beeeeeeeep!"

Re:paralysis of the eyes (1)

dgatwood (11270) | about a year ago | (#44480333)

Unable to blink, I can understand. The muscles that point your eyes and close and open the iris are cranial nerves that begin inside the brain. The muscles that are used to blink are facial nerves, which start at the brain stem.

That said, I have a hard time believing that someone can change the iris but cannot move the eyeball. I think those are fed by the same nerve bundle.

Re:paralysis of the eyes (1)

TheSpoom (715771) | about a year ago | (#44480421)

I was wondering about this, and if they can move their eyes, with eye-tracking software they can do a hell of a lot better than binary Y/N. That said, I'm very sure the people in charge of this know way better than I do.

Re:paralysis of the eyes (1)

wonkey_monkey (2592601) | about a year ago | (#44481205)

That said, I'm very sure the people in charge of this know way better than I do.

Careful now. That's close to subversive on Slashdot.

Re:paralysis of the eyes (0)

Anonymous Coward | about a year ago | (#44482711)

Classical presentation of Locked in Syndrome leaves the patient only able to move their eyes up and down. This results from damage to the medulla affecting several cranial nerves (CN). In general, cranial nerves are numbered based on where they exit the brain: the closer to the front or the higher they are, the lower the number.

CN II (optic nerve): preserved, but only receives visual input from the eyes
CN III (oculomotor nerve): preserved, but doesn't usually independently move the eye to one side or the other
CN IV (trochlear nerve): damaged, usually turns the eye inward
CN VI (abducens nerve): damaged, usually turns the eye outward
CN VII (facial nerve): damaged, among other things, usually opens and closes the eyelid

Sources: coursework in speech-language pathology. An SLPs' job description can include creating or selecting devices to allow people with Locked in Syndrome to communicate.

Re:paralysis of the eyes (1)

Black Parrot (19622) | about a year ago | (#44480903)

That said, I have a hard time believing that someone can change the iris but cannot move the eyeball. I think those are fed by the same nerve bundle.

The circuitry is pretty complicated. As best I can tell from my books, most of the controls for eye movements run through cranial nerve III, but some run through cranial nerves IV, and VI. The axons that control dialation and constriction also run through cranial nerve III. So if III is intact and the other damaged, you could lose at least partial control of eye movement without effect on control of the pupil.

And "upstream" of the nerves, control of the pupil (and focus) is part of the autonomic nervous system, whereas control of eye direction isn't.

Oddly enough, even dilation and constriction of the pupils have separate control systems. Control for constriction is based on a ganglion right behind the eye, whereas control for dilation is via a cervical ganglion, in your neck. So the paths of those opposing functions run separately for at least part of their length.

And who knows what parts of the brain are involved in generating the control signals for the various movements.

Re:paralysis of the eyes (1)

Guppy (12314) | about a year ago | (#44481549)

That said, I have a hard time believing that someone can change the iris but cannot move the eyeball. I think those are fed by the same nerve bundle.

From what the article is describing, I'd have to say this is not an example where you simply have interruption of outgoing "twitch this muscle fiber" signals along a particular tract. As mentioned before by other posters, the Cranial Nerves emerge from the brain prior to where the spinal cord exits (except for CN 11, which is an oddball), so even a completely cut cord will leave them working.

Rather, the damage has occurred at a higher level such that the message isn't being sent in the first place. Trick is, the dilation of the Iris happens to be controlled through sympathetic nerves, rather than motor. So it is being controlled by a different system that apparently is still functioning.

Re:paralysis of the eyes (3, Informative)

Shadow of Eternity (795165) | about a year ago | (#44480361)

pupil dilation is more akin to peristalsis than blinking.

Terri Schiavo (0)

Anonymous Coward | about a year ago | (#44480253)

.... oops

Euthanasia Please (4, Interesting)

nukenerd (172703) | about a year ago | (#44480255)

I sincerely hope that by the time I might get to that state that the idiots who oppose euthanasia have been recognised as the nutjobs that they are and that I can be put out of my misery. If you kept a dog in that state (in the UK at least) you would be prosecuted for cruelty.

Re:Euthanasia Please (1)

l0ungeb0y (442022) | about a year ago | (#44482775)

We let dogs die as quickly and painlessly as possible because they have no soul. A person, especially a good Christian must receive all the medical care possible to maximize your suffering, because it's clearly god's will that you are suffering and just letting you die would be a sin. You do know that if you take your own life you'll burn in hell forever, don't you? Anyway, if god doesn't want you to suffer, he would have seen to it that you don't -- so you must have done something to deserve it if you are dying a slow, agonizing death. Perhaps he's preparing you for eternal damnation or maybe you need to suffer to let Jesus in on your death bed. Anyway, it's all in god's perfect little plan.

Isn't religion grand? Mono-theism has brought so much enlightenment and prosperity to our world.

Re:Euthanasia Please (2)

trout007 (975317) | about a year ago | (#44485869)

I oppose euthanasia because history shows that time and time again it leads to the devaluing of human life and the horrors it brings with it like eugenics and genocides.

If you want to kill yourself go ahead. If you want to kill your paralyzed loved one go ahead and face a jury.

What about EEG? (2)

atticus9 (1801640) | about a year ago | (#44480321)

It's an interesting approach but it seems like an EEG, that monitors brainwaves and allows control through that would be better, the article touches on that briefly and rules it out as too expensinve/time intensive to setup. But modern EEG's don't really take that much setup and are cheap (you can buy one from NeuroSky for $79 that has one sensor that goes across your forehead and connects through wireless usb for example) I'd much rather see research going on there than pupil dilation.

Re:What about EEG? (1)

Gravis Zero (934156) | about a year ago | (#44480455)

mod parent up. proven BCIs like Emotiv's are already out and your programs can talk to it using a lib. it's already been used to help quadriplegics, so it's not some dive into the unknown.

Re:What about EEG? (2)

dpidcoe (2606549) | about a year ago | (#44480607)

I have an Emotive unit, and it's pretty terrible at brainwave detection. What it is slightly better at is detecting the movements of facial muscles. If you use the gyroscope output and then couple that with monitoring something like eyeblinks, you can have a pretty decent hands free headmouse (though it's annoying to have to close your eyes in order to click things). Most of the ~~awesome~~ demos that you see of it on youtube are based on detecting a combination of the gyroscope and facial movements, not actual mental state.

Re:What about EEG? (1)

Gravis Zero (934156) | about a year ago | (#44480787)

i'll take it off your hands if you dont want it. :)

Those EEG units are a scam, of sorts. (0)

Anonymous Coward | about a year ago | (#44481489)

While recording EEG waves isn't too difficult and could be done with something that costs $79, there are two issues that those units don't address:

1. Signal quality. In particular, the signals available at the forehead are so useless that medical EEG equipment doesn't place electrodes there, despite the incredible simplicity of doing so given that there is no hair to deal with. Attaching two or three more electrodes would be trivial for a technician to do, yet they won't, because the sinus cavities under the forehead ensure that there's nothing there worth recording. To get good signals, you need electrodes all over the head in every location in which hair exists, and you need a properly cleaned scalp, and a good electrolyte to connect the scalp to the electrode.

2. Signal usefulness. What you record with an EEG is just the summation of an enormous number of neurons. You've got 100 billion neurons, and you're summarizing their activity with a total of at most two dozen electrodes. While you can get some idea what is going on in there -- in particular, if something is going seriously wrong in there, that tends to be visible -- what you don't get is any signal at all that describes what the person is thinking.

The bandwidth just isn't there. Take 24 channels at 30 samples per second (anything closer to 60 Hz is either swamped by the 60 Hz interference or filtered out by the 60 Hz filter) and 8 bits per sample (while EEG equipment may sample with 16 bit ADCs, most of that range is used to compensate for wildly varying DC offsets) and you end up with 1 bit of information per 17 million neurons. To put that in perspective, say you want to ask everyone on the planet whether they want steak or chicken for dinner, and all you get in response is one answer per 17 million people, and that answer is "one" or "zero" and you don't even know how that answer was arrived at. Maybe some said "steak" and others said "chicken" and others said "bird" and others said "cow" and others said "salad" and the answer you ended up receiving was just the average number of letters in their response modulo two. How are you supposed to do anything with that?

All those things are are $79 toys for geeks who watch some cool video on the internet of someone controlling a mouse cursor, then they spend some of their disposable income on an overpriced toy, try it themselves for a week, then either give up and toss it in a box somewhere, or learn to control it by unconsciously activating facial muscles, then toss it in a box somewhere. If the things weren't useless, we'd see videos of people actually using them for useful things, rather than just promotional videos.

prior art: (2)

Black Parrot (19622) | about a year ago | (#44480353)

I've *always* answered hard questions with a glazed look in my eyes.

Blade Runner (0)

Anonymous Coward | about a year ago | (#44480435)

Ohhh, so it's just like the Voight-Kampf test in Blade Runner? Cool! I didn't know there was actual science behind it.

Tossers (0)

Anonymous Coward | about a year ago | (#44480671)

Not original but v apposite

Sounds like fun (1)

Hoi Polloi (522990) | about a year ago | (#44480771)

Message #1: "Scratch my nose"
Message #2: "Shoot me"

Re:Sounds like fun (0)

Anonymous Coward | about a year ago | (#44482175)

Message # 1: Oh god nurse, please rub your titties on my face.

Question #1 (1)

BlueMikey (1112869) | about a year ago | (#44480979)

Dilate for "yes" if you are not wanting us to not kill you. Oh, you have more to say? We'll come back in 4 hours after you binary out a message.

Pupils? (1)

wcrowe (94389) | about a year ago | (#44481015)

I must be old. My first reaction was, "Why would paralyzed patients have pupils? What are they teaching?"

Re:Pupils? (0)

Anonymous Coward | about a year ago | (#44481607)

Man you're funny! And it only took you 2 hours to come up with the same joke as the very first post!!

My first communication (0)

Anonymous Coward | about a year ago | (#44481031)

If I was in that state, I would do everything in my power to *plead* for somebody to kill me.

What a horrific and cruel life it would be to be forced to live like that.You are *utterly* fucked at that point, and it would be impossible to live a dignified or meaningful life. A peaceful death is the only sane option.

I do see a slight problem (0)

Anonymous Coward | about a year ago | (#44481723)

If patients are on pain medication or opioid medications, their pupils will be constricted and harder to dilate them to answer.

Widening of pupils to send a message (0)

Anonymous Coward | about a year ago | (#44482415)

"widening and narrowing of the pupils to send a message"

Nothing new. We see this on Jerry Springer and Maury all the time.

One name that shows lack of invention (1)

poofmeisterp (650750) | about a year ago | (#44485943)

There's a difference between a "spin-off" and an "invention".

One name: Stephen Hawking.

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