Apr 26, 2023, 4:00 am UTC
The hidden health cost of Black hair
In her many years of working as a neurologist in Pittsburgh, Christina Patterson has seen countless instances of neurotechnology failing people who need it most.
Patterson regularly uses electroencephalography (EEG) to record her patients' brain activity. It uses a snug cap with metal discs, also known as electrodes, that are attached to the scalp, where they pick up electrical signals produced by neuronal cells.
But this "gold standard" for epilepsy diagnosis has a big shortcoming: It doesn't work for Black hair.
That puts Black children with epilepsy, a condition that causes disruptions in brain activity, and their families at a disadvantage, leading to inequitable healthcare.
Now, researchers at the Grover Lab, housed at Carnegie Mellon University, are drawing on Patterson's clinical experiences to design new EEG electrodes with Black hair in mind. Their work underscores the importance of diversifying brain research and technology so the tools we use can help everyone get the care they deserve.
Racism on the Brain
Black and multiracial children with epilepsy are at an increased risk of sudden death from a seizure. They are also more likely to face challenges during diagnosis and treatment. Structural racism in science may be to blame for these disparities.
"Many EEG labs have protocols that will disallow participants with certain hair types from being part of a study," says Pulkit Grover, the lab lead. This preemptive exclusion of Black individuals is based on the idea that coiled hair textures lead to low-quality data because of the weak connection between the scalp and EEG electrodes.
This hair-type bias is common in brain research. It is seen in studies on EEG technology and other brain imaging tools like functional near-infrared spectroscopy (fNIRS) and magnetic resonance imaging (MRI), commonly used to study brain injuries, tumors, and other neurological conditions.
"We never thought that there could be a hardware-level bias like this in neuroscience," Grover says.
Sevo electrodes are inexpensive and modifiable. (Courtesy of the Grover Lab)
Ultimately, the underrepresentation of Black individuals in epilepsy research feeds a cycle of inequality. Unfortunately, most lab technicians lack the skills to work with Black hair, so the only solution offered to research participants is shaving their heads for the test.
"[Preparing for an EEG] is a big ordeal for families," says Evangeline Mensah-Agyekum, an undergraduate research assistant at the Grover lab, who is helping to collect data on the group's culturally competent EEG technology called Sevo. "Parents take the work upon themselves, and they come in with their children's hair straightened or parted."
But these workarounds are expensive, damaging, and ineffective because as soon as moisture touches the hair, the strands return to their original texture. So, by the end of it, "Parents are ready to just cut all of their kid's hair off, so that they don't have to go through this work," she adds.
This practice of shaving hair for an EEG has become accepted and even routine in many African countries and other parts of the world. But as racism and racial disparities in medicine are coming to light, the young generations of Black neuroscientists and patients are asking an important question: Why do they have to adapt to technology instead of the technology adapting to their brain health needs?
The Grover Lab has reimagined EEG technology with the "Sevo" clip, which stands for "brain" in Haitian Creole, to make it inclusive for Black hair types. Traditional EEG electrodes can be placed inside this novel wing-shaped hair clip that separates the strands, so the electrodes can make firm contact with the scalp. The group has also found that combining Sevo with cornrowing, a traditional braiding technique, further improves scalp-to-electrode contact, offering Black families a welcome alternative to shaving hair in preparation for an EEG.
Despite the positive impact Grover and his team believe this technology will have, their fight to call out racism in neuroscience has just begun.
"Funding is a huge challenge," Grover says. "Most people in this space don't have the same hair textures, so they have concerns about whether this is a big enough problem in the first place."
But data is power. With the group's recent pre-print suggesting Sevo combined with cornrowing can improve scalp-to-electrode connection by 10 times compared to traditional EEG electrodes on unbraided hair, the cause is garnering attention. A startup company is commercializing the clips, and the Grover Lab is working on several new projects to eliminate bias in other health technologies.
"Our hair matters, and it's important to our identity," says Mensah-Agyekum. "The Sevo clip integrates technology with culture, so we don't have to change or cut our hair."