![]() Case studies have shown that interacting with the computer by pointing to and selecting items with eye gaze, leads to tiredness and exhaustion during initial use for novice users with severe physical impairment (Donegan, 2012b Najafi, Friday, & Robertson, 2008). Using gaze-based AT requires control of eye movements (Mulvey, 2012), as well as the ability to switch between using gaze for exploration and for selection of objects (Hansen & Aoki, 2011). Novice users will not have any previous experience of controlling objects with eye gaze to relate to, as the natural way of using eye gaze is for perception (Hansen & Aoki, 2011). Even though it is natural for humans to consciously control gaze and explore by directing their eyes to objects, it is a challenging task to learn how to use the eyes to control objects on a computer screen (Donegan, 2012b Heikkilää & Ovaska, 2012 Skovsgaard, Räihä, & Tall, 2012). It is possible that stakeholders may consider the AT to be expensive, or because of doubt over whether non-speaking children with severe physical impairments and cognitive impairments can control a computer with their eyes. Gaze-based AT is an underutilized AT, and even though it is available in Sweden and other countries worldwide, few children with profound impairments currently have access to it. In this study, AT is defined according to the definition used by the International Organization for Standardization ( 2011), which states that “an assistive product is any product (including devices, equipment, instruments and software), especially produced or generally available, used by or for persons with disability, for participation, to protect, support, train, measure or substitute for body functions/structures and activities, or to prevent impairments, activity limitations or participation restrictions.” Thus, gaze-based AT may provide opportunities for children to communicate and perform a range of activities, even if they have severe impairment. ![]() By using their eyes, children with severe physical impairments can control the computer and gain access to communication and activities, such as playing games and music (Lariviere, 2014). The idea is that the eye gaze device replaces the keyboard and mouse as the interface method (Lin, Yang, Lay, & Yang, 2011 Majaranta et al., 2012). For that reason, assistive technology (AT) based on a computer controlled by their eyes (gaze-based AT) may be the only option for operating a computer for those having such severe physical impairments (Majaranta & Donegan, 2012). Eye movements may be the only movements they can control voluntarily. These children do not have control over their body movements and are therefore dependent on assistance in all activities, including communication, eating, and playing (Cans, 2000 Østensjø, Carlberg, & Vøllestad, 2005). They are commonly diagnosed as having cerebral palsy (Cans, 2000), and the severe motor impairment is often associated with concomitant cognitive impairment and limited performance in everyday activities (Kantak, Sullivan, & Burtner, 2008 Rosenbaum et al., 2007). Some children with severe physical impairments also lack the ability to speak. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. Findings showed that the children improved in time on task after 5 months and became more accurate in selecting targets after 15–20 months. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5 months, 9–11 months, and after 15–20 months. ![]() Thereafter, all children used the gaze-based AT in daily activities over the course of the study. A longitudinal study with a before and after design was conducted on 10 children (aged 1–15 years) with severe physical impairments, who were beginners to gaze-based AT at baseline. ![]() This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. Gaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities.
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