The Impact of Eye-gaze Controlled Computer on Communication and Functional Independence in Children and Young People with Complex Needs – A Multicenter Intervention Study

Figures & data

Table 1. Overview of EGCC interventions in the study

		Sweden (n = 9)	Dubai (n = 5)	USA (n = 3)
DEVICES		Tobii I12+ (n = 5), I15+ (n = 2), PC Eye Mini (n = 2)	Tobii I15 (n = 2), PC EyeGo (n = 2), PC Eye Mini (n = 1)	Tobii I12 (n = 2), PC Eye Mini (n = 1)
SOFTWARE		Communicator 5, Grid 3, Look to Learn, Scenes and sounds, Sensory Eye Fix	Communicator 5, Clicker 7, e-books, Look to Learn, Eagle Eyes, Flame Painter, Eye Play Music, Art software	Communicator 5, Communicator with Word Power, Compass with Word Power
SERVICE PROVIDERS		AT team members (OT/SLP/SE/IT support person) at AT centers	AT team members (AT specialists) at special needs school	AT team members (OT, SLP, AT specialist and SE) at special needs preschool
RECEIVERS		For example: child, parents, CT and principal of school. SLT and OT from habilitation center	For example: child, CT, SLP, and OT at special needs school	For example: child, guardian, CT, OT, PT and vision specialist at special needs preschool
HOW		Face to face, individually	Face to face, individually	Face to face, individually
WHERE		AT center (n = 9), school in the community (n = 5), home (n = 3), hospital (n = 1)	Special needs school* (n = 5)	Special needs preschool* (n = 3), home (n = 1)
HOW MUCH		No of meetings	No of meetings	No of meetings
Mdn (range)		3 (1–4)	15 (15 for all)	6 (4–13)
Content
	Planning meetings	1–3 times in 6 months (e.g. discuss child functioning, needs, goals, adaptations and implementation of device)	Once every two weeks for 6 months (e.g. discuss child functioning, needs, goals, adaptations and implementation of device)	1–2 times in 6 months (e.g. discuss child functioning, needs, goals, adaptations and implementation of device)
	Follow-up meetings	0–2 times in 6 months (e.g. discussion of performance, updates to grids, evaluation of goals)	3 times in 6 months (e.g. discussion of performance, updates to grids, evaluation of goals)	3–12 times in 6 months (e.g. discussion of performance, updates to grids, evaluation of goals)
HOW MUCH USE^#		No of days, EGCC use	No of days, EGCC use	No of days, EGCC use
Mdn (range)		8 (1–14) at 3 months	9 (8–10) at 3 months	13 (10–14) at 3 months
		9 (4–14) at 6 months	10 (7–10) at 6 months	9.5 (9–10)** at 6 months
	With whom	Stakeholders	Stakeholders	Stakeholders
		Individual sessions with EGCC use with parents, teachers (school, home)	Individual sessions with EGCC use with specialists, teachers (school)	Individual or group sessions with EGCC use with specialists, teachers, parents (school, home)

Note. Abbreviations: AT, assistive technology; CT, class teacher; EGCC, eye-gaze controlled computer; IT, information technology; OT, occupational therapist; PT, physical therapist; SE, special educator; SLP, speech-language pathologist. ^#Number of days with reported EGCC use during each 14-day period (T2 and T3). *AT center and school/preschool are located together. **Computer diaries missing for one child, but reported by the center to have EGCC use every day in school (10 days).

Table 2. Data collection at each timepoint (T1–T4)

	Without EGCC	EGCC intervention		Without EGCC
Data collection	Baseline (T1)	3 months (T2)	6 months (T3)	7 months (T4)
Computer diary, school	2 weeks	2 weeks	2 weeks	2 weeks
Computer diary, home	2 weeks	2 weeks	2 weeks	2 weeks
PIADS	Once		Once	Once
Communication Matrix	Once		Once	Once
QUEST 2.0			Once
KIDSCREEN-10	Once		Once	Once

Note. 2 weeks means documentation every day during 2 weeks. Abbreviations: EGCC, eye-gaze controlled computer; PIADS, Psychosocial Impact of Assistive Devices Scale¹⁸; QUEST, Quebec User Evaluation of Satisfaction with Assistive Technology.³⁰

Table 3. Participant characteristics

Characteristics		Participants
		All (n = 17)	Sweden (n = 9)	Dubai (n = 5)	USA (n = 3)
Age (years), mean (SD)		11.4 (7.2)
	Range	3–26	3–17	16–26	5–6
Sex (female/male), n		10/7	7/2	2/3	1/2
School, n
	Special school	10	5	5
	Special preschool	6	3		3
	In hospital*	1	1
Diagnosis, n
	Cerebral palsy	7	1	4	2
	Rett syndrome	5	5
	Metabolic disorder	2	1		1
	Other**	3	2	1
GMFCS^# (II/IV/V)		2/4/7	1/1/3	1/2/2	0/1/2
MACS^# (III/IV/V)		1/2/10	0/1/4	0/1/4	1/0/2
CFCS^# (III/IV/V)		4/5/6	3/1/3	0/3/2	1/1/1
Cognition, n
	Normal	1	1
	Developmental delay	4	1		3
	Cognitive impairment	11	6	5
	Unknown	1	1
Epilepsy, n		7	3	3	1
Vision, n
	Refractive error, not corrected	3	1	2
	Eye glasses	6	5		1
	Strabismus or CVI	2	1		1
Hearing loss, no hearing aid, n		1	1
Access to computer device at inclusion, n
	iPad	2	1		1
	EGCC^##	1	1

*Hospital stay during the study. **Cervical spinal cord injury from serious infection (n = 1), mitochondrial disease (n = 1), intellectual disability (n = 1). ^#2–4 participants (Rett syndrome, mitochondrial disease) in Sweden without data for GMFCS²¹ (n = 4), MACS²⁰ (n = 4), CFCS²² (n = 2). ^##Access to EGCC at baseline, but without regular use in daily life since provision and therefore included for intervention by the center.

Abbreviations: CFCS, Communication Function Classification System; CVI, cortical visual impairment; EGCC, eye-gaze controlled computer; GMFCS, Gross Motor Function Classification System; MACS, Manual Ability Classification System.

Table 4. Analysis of PIADS and communication matrix

Instrument		T1	T3	T1 and T3		T3	T4	T3 and T4
		M	M	Mean diff (SD)	p	M	M	Mean diff (SD)	p
PIADS**		(n = 13)				(n = 13)
	Competence	0.58	1.21	−0.628 (0.78)	0.014*	1.14	0.82	0.321 (0.479)	0.033
	Adaptability	0.42	1.14	−0.718 (1.17)	0.039	1.00	0.74	0.256 (0.507)	0.094
	Self-esteem	0.73	1.03	−0.298 (1.02)	0.313	1.05	0.65	0.394 (0.709)	0.068
Communication Matrix		(n = 16)				(n = 14)
	Total score	39.9	52.1	−12.125 (17.14)	0.0127*	49.6	45.7	5.40 (14.31)	0.263

P-value was set to 0.025. *significant. **PIADS: Different mean values for T3 because two of 13 participants are not the same at T1/T3 and T3/T4.

Figure 1. Total computer use (activities, frequency and duration) at each time point (T1 n=17; T2 n=17; T3 n=16; T4 n=17). Duration: one participant at T1 (270 min), and another at T2 and T3 (T2: 249 min; T3: 323 min) with extreme values in duration are not shown in the boxplot

Table 5. Frequencies (%) of EGCC use in school and at home and activities performed, both predefined and own added. Numbers presented as median values (range)

Activities	Frequency of use in school				Activities	Frequency of use at home
in school	T2	(n = 14)	T3 (n = 14)		at home	T2 (n = 8)		T3 (n = 6)
	n	%	n	%		n	%	n	%
Skills training	9	50 (10–100)	9	60 (10–100)	Games & play	7	57 (14–100)	4	36 (36–100)
Talking to someone^#	7	50 (10–100)	8	85 (30–100)	Talking to someone^#	5	78 (29–100)	3	93 (36–100)
Games & play^##	6	32 (10–78)	6	43 (20–100)	Playing music	5	21 (7–100)	2	36, 100*
Counting (algebra)	3	20 (20–100)	5	20 (10–100)	Photos**	3	7 (7–29)	1	93*
Playing music, movies	5	20 (11–60)	4	40 (10–70)
Writing text	5	11 (10–60)	4	55 (10–100)
Reading	4	45 (10–70)	4	85 (30–100)
Writing symbols	3	40 (10–50)	3	80 (50–100)
Making choices (activities, songs, stories)	2	11, 30*	3	40 (20–40)
Communicating on the internet	3	11 (10–20)	2	55 (10–100)
Literacy, academics	3	40 (30–50)	1	30*

Activities performed by at least 3 participants at T2 or T3. ^#Talking to someone in the same room. ^##Includes cause & effect. *Only one or two participants. **Looking at photos.

Abbreviations: EGCC, eye-gaze controlled computer

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