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Eye-gaze control technology

Last update: 13 Sep 2016

► Eye-gaze control technology allows children and adults with cerebral palsy to use movements of their eyes to operate a laptop, computer or speech-generating device.
► This technology can be used for many purposes, including playing games, accessing the internet and communicating with family and friends
► There are many eye-gaze control systems and software packages available, at a range of prices

Who is it for?

Eye-gaze control technology may be suitable for children and adults with cerebral palsy who have the following characteristics:
Age: Preschoolers, School-aged, Adolescents, Adults, Older adults
Type of cerebral palsy : Quadriplegia

More information about cerebral palsy is contained in the What is CP? section.

Mobility : GMFCS IV, GMFCS V

Gross Motor Function Classification System (GMFCS) – classifies severity of mobility difficulties of children and adolescents with CP.

GMFCS Level I
Walks without limitations in the home and community, climbs stairs and can run and jump, difficulties with speed and coordination.

GMFCS Level II
Walks with limitations, difficulties with long distances and uneven surfaces, uses a railing for climbing stairs, limited running and jumping.

GMFCS Level III
Walks using a hand-held mobility device such as crutches or walking frame, may use wheeled mobility for long distances.

GMFCS Level IV
Usually relies on wheeled mobility with assistance, may use powered mobility, usually needs special seating and assistance with transfers.

GMFCS Level V
Usually transported in a manual wheelchair, requires specialised seating and full assistance for transfers.

Arm ability : MACS IV, MACS V

Manual Ability Classification System (MACS) – classifies severity of upper limb impairment: how children with cerebral palsy use their hands to handle objects in daily activities in the home, school, and community settings.

MACS Level I
Handles objects easily and successfully.

MACS Level II
Handles most objects but with somewhat reduced quality and/or speed of achievement.

MACS Level III
Handles objects with difficulty; needs help to prepare and/or modify activities.

MACS Level IV
Handles a limited selection of easily managed objects in adapted situations.

MACS Level V
Does not handle objects and has severely limited ability to perform even simple actions.

Communication ability : CFCS III, CFCS IV, CFCS V

Communication Function Classification System (CFCS) – classifies severity of everyday communication of people with cerebral palsy.

CFCS Level I
Effective Sender and Receiver with unfamiliar and familiar partners.

CFCS Level II
Effective but slower paced Sender and/or Receiver with unfamiliar and/or familiar partners.

CFCS Level III
Effective Sender and Receiver with familiar partners.

CFCS Level IV
Inconsistent Sender and/or Receiver with familiar partners.

CFCS Level V
Seldom effective Sender and Receiver even with familiar partners.

Movement disorder : Ataxia, Athetosis, Dystonia, Hypotonia, Spasticity

More information about movement disorders can be found on our websites.

Intellectual ability : No intellectual disability, Mild intellectual disability, Moderate intellectual disability, Severe intellectual disability

A person’s thinking skills – ability to understand ideas, learn and solve problems. People with intellectual disability have difficulty with intellectual functioning which may influence learning, communication, social and daily living skills. Intellectual disability may be mild to very severe.

Who can assist?

Specialist speech pathologists and occupational therapists will help people with cerebral palsy choose the best system to meet their needs.

Speech pathologists and occupational therapists at Cerebral Palsy Alliance work with individuals and their families to decide if eye-gaze control technology is a good choice.

Find a Cerebral Palsy Alliance service

Fees

Fees may apply for assessment, prescription, set-up and implementation, and will depend on the service provider and the number of sessions needed. Check with the provider whether fees will also apply for development of a home program, writing reports and funding applications, or travel for the therapists.

Prices for eye-gaze control technology systems will depend on the complexity of the device and any extra features, like the ability to control appliances in the home. For example, a portable camera and software that works with a standard laptop or tablet may cost less than AUD$5,000, while more complicated systems can cost closer to AUD$25,000. Funding for the equipment may be available and this involves completing an application for funding.

Ask the service provider if you are eligible for funding to assist with fees and eye-gaze control systems and software costs. People with a disability living in Australia may be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

Time

It takes time to try out different eye-gaze control systems, computers and software to find what works.

Also, using eye-gaze is a skill which is highly likely to require significant time, practice and patience to develop.

More about eye-gaze control technology

Communication is a basic human right, and is essential for learning and interacting with friends, family and peers. Children and adults with cerebral palsy should be supported in every way possible to communicate.

Eye-gaze control technology can be used by children and adults who have significant physical disabilities to be more independent. It may provide them with a way to communicate in different ways, for example, by writing, generating speech, accessing the internet or using social media. Eye-gaze control technology can provide opportunities to play and have fun, and to operate a TV, telephone and music through remote control.

The way it works is that an eye-gaze camera tracks the person’s eye movements, which then moves the mouse on a computer screen. The person selects items either by holding their eye-gaze for a certain time, referred to as ‘dwell’, by blinking, or by clicking an external button.

Features of eye-gaze control systems

Software

Learning ability, individual needs and personal preferences will guide people’s choice of software to use with an eye-gaze control system.

Software that can be controlled with eye-gaze control technology is available to suit a wide range of learning styles and abilities. Software can range from games to help children and adults develop visual tracking skills to support their use of the eye gaze system, through to more complex computer control to communicate or control other devices such as a TV.

Equipment

These systems require an eye-gaze camera attached to a computer or tablet, as well as software. In addition, the person will need a mounting system for their wheelchair or a table of a suitable height to position the computer and eye-gaze control system. Comfortable seating and good posture are important, as the person needs to be comfortable and well-supported to be able to use the eye-gaze control system.

Take a team approach

Communication between the person with cerebral palsy, their family, specialist therapists, school and other carers is essential if the person is to benefit from eye-gaze control technology. This collaborative approach will continue to be important as time goes by, new technology comes onto the market and the person’s needs change. Ongoing support from parents, therapists, teachers, carers and others will be necessary to support the use of eye-gaze control technology to its full potential and in different environments.

Things to note

  • It takes time, practice and patience for people with cerebral palsy to develop the skills needed to use an eye gaze control system effectively
  • Extra consideration may be needed when planning eye-gaze control technology for people with cerebral palsy with vision problems such as strabismus (eyes do not point in the same direction)
  • The communication partners of people using eye-gaze control technology will require education to enable them to fully support the user
  • Consider the costs involved, and the equipment, resources and time needed to set up an eye-gaze control system and get support
  • If users plan on using their system outside, another communication method may be needed, as eye-gaze control technology systems can be difficult to operate in sunlight
  • This technology may also be called gaze interaction, gaze-based assistive technology and eye control.

Assessments

A detailed assessment by an occupational therapist or speech pathologist with knowledge of assistive technology and eye-gaze control systems is necessary to see if eye-gaze control technology is likely to be the right option for an individual. If so, the therapist will recommend a trial of eye-gaze control technology to work out if it will meet their goals. These goals could include using eye-gaze control technology for communication and completing everyday activities at home, school, in the community or at work. The therapist will then recommend systems and software to suit the person and then assist them to master the device. The therapist will also make sure the person is optimally positioned and comfortably seated, and educate their family, carers, teachers and others in how to use the eye-gaze control system.

The following assessments may be used by the team to evaluate the use of eye-gaze control technology:

Best available research evidence

Where did we search?

We searched the medical and education literature to find studies evaluating the outcomes of eye-gaze control technology for people with cerebral palsy.

What were we looking for?

We aimed to find the best available research on whether eye-gaze control technology improved users’ ability to communicate, access information and participate in leisure and educational pursuits.

What did we find?

We found a small number of cases studies (e.g.1), however, the best available evidence was one study of 10 children, aged 1 to 15 years, nine of whom had cerebral palsy2. All had severe physical disability and were unable to speak. The children were given access to eye-gaze control technology and, with their families and teachers, participated in 14 days of intervention spread over 9-10 months. Intervention consisted of group and individual instruction in setting up their eye-gaze control systems, and supporting children and their support network to use the system at home and school. All children achieved some or all of their goals. The majority of goals related to communication at home or school. Most children increased the numbers of activities they completed using eye-gaze control technology or the time they spent using their systems. Parents reported high satisfaction with eye-gaze control technology.

Even though there is little research, eye-gaze control technology may be the only way for some people with cerebral palsy to communicate, use computers and other technology, and to control their environment. Eye-gaze control technology will work very well for some people with cerebral palsy, but it will not be right for everyone.

Why research is limited

There are several reasons why so little research has been completed evaluating the outcomes of eye-gaze control technology.

  • As there are so many factors involved in customising any eye-gaze control system for users it is difficult to define a uniform “intervention” to evaluate. There are many different eye-gaze control products available and each user has unique abilities and computer needs.
  • The number of users is small, the costs of setting up eye-gaze control technology can be high and the need to follow up users for a long period of time to evaluate whether eye-gaze control is effective can make it difficult to conduct research.

The fact that so little research has been completed about its effects should not deter people with cerebral palsy, their families, caregivers and specialist therapists from considering a trial of eye-gaze control technology.

Date of literature searches: May 2016

  1. Federici, S., Corradi, F., Meloni, F., Borsci, S., Mele, M. L., de Sylva, S. D., & Scherer, M. J. (2015). Successful assistive technology service delivery outcomes from applying a person-centered systematic assessment process: A case study. Life Span and Disability, 18(1), 41-74.
  2. Borgestig, M., Sandqvist, J., Ahlsten, G., Falkmer, T., & Hemmingsson, H. (2016). Gaze-based assistive technology in daily activities in children with severe physical impairments-An intervention study. Developmental Neurorehabilitation, 23(48), 1-13.
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