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Development of a gaze-controlled support system for a person in an advanced stage of multiple sclerosis: a case study

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Abstract

A gaze-controlled system was developed to address the specific needs of a person in an advanced stage of Multiple Sclerosis. This patient scored 9 on the EDSS and is representative of a group of patients who can reason normally, but have no functional use of their upper-limbs. The developer and the patient were connected through remote desktop control and could brainstorm a concept to perfection through iterative trial and error. The most important lesson learnt is the importance of user control towards maximum independence. Eventually, the patient was enabled to control his computer efficiently using a novel approach to mouse control together with an on-screen keyboard. He could browse the internet, read e-books, type documents, send and receive e-mails and text messages, draw in a paint application and control his TV through a specially adapted remote control—all by using his eyes to activate commands. The findings suggest that a well-designed eye tracking system can fulfil in the mental and communication needs of patients in this specific category of disability.

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References

  1. Mustaquim, M.: Gaze interaction: a challenge for inclusive design. In: Pichappen, P., Ahmadi, H., Ariwa, E. (eds.) Innovative Computing Technology 2011. ISBN 978-3-642-27337-7, 244-250

  2. Blake, D., Bodine, C.: An overview of assistive technology for persons with multiple sclerosis. J. Rehabil. Res. Dev. 39(2), 299–312 (2002)

    Google Scholar 

  3. Chwastiak, L., Ehde, D., Gibbons, L., Sullivan, M., Bowen, J., Kraft, G.: Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am. J. Psychiatry 159(11), 1862–1868 (2002)

    Article  Google Scholar 

  4. Thompson, A., Hobart, J.: Multiple sclerosis: assessment of disability and disability scales. J. Neurol. 245, 189–196 (1998)

    Article  Google Scholar 

  5. Reynolds, S., Haley, W., Kozlenko, N.: The impact of depressive symptoms and chronic diseases on active life expectancy in older Americans. Am. J. Geriatr. Psychiatry 16(5), 425–432 (2008)

    Article  Google Scholar 

  6. Sadovnick, A., Ebers, G., Wilson, R., Paty, D.: Life expectancy in patients attending multiple sclerosis clinics. Neurology 42(5), 991 (1992). doi:10.1212/WNL.42.5.991

    Article  Google Scholar 

  7. Coles, A., Compston, D., Selmaj, K.: Experimental medicines in multiple sclerosis and compassionate use. N. Eng. J. Med. 359, 1786–1801 (2008)

    Article  Google Scholar 

  8. Kemp, B., Krause, S.: Depression and life satisfaction among people ageing with post-polio and spinal cord injury. Disabil. Rehabil. 21(5–6), 241–249 (2009)

    Google Scholar 

  9. Calvo, A., Chiò, A., Castellina, E., Corno, F., Farinetti, L., Ghiglione, P., Pasian, V., Vignola, A.: Eye tracking impact on quality-of-life of ALS patients. In: Miesenberger, K., Klaus, J., Zagler, W., Karshmer, A. (eds.) Computers Helping People with Special Needs, pp. 70–77. (2008). doi:10.1007/978-3-540-70540-6_9

    Chapter  Google Scholar 

  10. Bhoyar, A., Sahu, S., Padwekar, P.: Eye tracking mouse: people with severe disabilities. In: Proceedings of the 20th IRF International Conference, Pune, 2015. ISBN 978-93-84209-94-0

  11. Border, J.: Exploring empirical guidelines for selecting computer assistive technology for people with disabilities. M.Sc. dissertation, Wright State University (2011)

  12. Johnson, K., Bamer, A., Yorkston, K., Amtmann, D.: Use of cognitive aids and other assistive technology by individuals with multiple sclerosis. Disabil. Rehabil. Assist. Technol. 4(1), 1–9 (2010). doi:10.1080/17483100802239648

    Article  Google Scholar 

  13. Hafler, D.: Multiple Sclerosis. J. Clin. Investig. 113(6), 788–794 (2004). doi:10.1172/JCI200421357

    Article  Google Scholar 

  14. Huntley, A., Ernst, E.: Complementary and alternative therapies for treating multiple sclerosis symptoms: a systematic review. Complement. Ther. Med. 8(2), 97–105 (2000)

    Article  Google Scholar 

  15. WebMD. Multiple sclerosis health center. http://www.webmd.com/multiple-sclerosis/default.htm. Accessed 1 Apr 2016

  16. Ghasemi, M., Gorji, Y., Ashtar, F., Ghasemi, M.: A study of psychological well-being in people with multiple sclerosis and their primary caregivers. Adv. Biomed. Res. (2015). doi:10.4103/2277-9175.151545

    Google Scholar 

  17. Yozbatiran, N., Baskurt, F., Baskurt, Z., Ozakbas, S., Idiman, E.: Motor assessment of upper extremity function and its relation with fatigue, cognitive function and quality of life in multiple sclerosis patients. Neurol. Sci. 246(1–2), 117–122 (2006)

    Article  Google Scholar 

  18. Stachowiak, J.: Understanding multiple sclerosis. 2015. http://ms.about.com/od/multiplesclerosis101/a/ms_intro.htm

  19. Souza, A., Kelleher, A., Cooper, R., Cooper, R.A., Iezzoni, L., Collins, D.: Multiple sclerosis and mobility-related assistive technology: systematic review of literature. J. Rehabil. Res. Dev. 47(3), 213–224 (2010)

    Article  Google Scholar 

  20. Kurtzke, J.: Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33(11), 1444–1452 (1983)

    Article  Google Scholar 

  21. World Health Organisation: International Classification of Impairments, Disabilities and Handicaps, pp. 449–508. World Health Organisation, Geneva (1980)

    Google Scholar 

  22. Alonso, A., De la Rosa, R., Carrera, A., Bahillo, A., Durn, R., Fernandez, P.: A control system for robots and wheelchairs: its application for people with severe motor disability. In: Gacovski, Z. (ed.) Mobile Robots: Current Trends, Intech, 2011. doi: 10.5772/25717, ISBN 978-953-307-716-1

  23. Ka, H., Simpson, R.: Effectiveness of Morse code as an alternative control method for powered wheelchair navigation. In: Rehabilitation Engineering Society of North America (RESNA) Conference, June/July 2012 (2012)

  24. Mani, N., Sebastian, A., Paul, A., Chacko, A., Raghunath, A.: Eye controlled electric wheelchair. Int. J. Adv. Res. Electr. Electron. Instrum. Eng. 4(4), 2494–2497 (2015)

    Google Scholar 

  25. Nelson, C., Badas, N., Saritha, G., Thejaswini, S.: Robotic wheelchair using eye blink sensors and accelerometer provided with home appliance control. Int. J. Eng. Res. Appl. 4(5), 129–134 (2014)

    Google Scholar 

  26. Wei, L., Hu, H.: Towards multimodal human-machine interface for hands-free control: a survey. Technical report CES-510, School of Computer Science and Electronic Engineering, University of Essex (2011)

  27. Saeed, H., Nooh, H., Adel, M., Rabeea, A., Sadiq, M.: Utilize eye tracking technique to control devices for ALS patients. Int. J. Appl. Innov. Eng. Manag. 4(5), 381–388 (2015)

    Google Scholar 

  28. Pinheiro, C., Naves, E., Pino, P., Losson, E., Andrade, A., Bourhis, G.: Alternative communication systems for people with severe motor disabilities: a survey. BioMed. Eng. OnLine 10, 31 (2011). doi:10.1186/1475-925X-10-31

    Article  Google Scholar 

  29. Betke, M.: Camera-based interfaces and assistive software for people with severe motion impairments. In: 3rd Workshop on AI Techniques for Ambient Intelligence, Patras (2008)

  30. Akram, W., Tiberii, L., Betke, M.: A customizable camera-based human computer interaction system allowing people with disabilities autonomous hands-free navigation of multiple computing tasks. In: Stephanides, C., Pieper, M. (eds.) Lecture Notes in Computer Science, vol. 4397, pp. 28–42. Springer, Berlin (2007)

    Google Scholar 

  31. SmartNav.: Hands-free ergonomic mouse. 2015. http://www.naturalpoint.com/smartnav/

  32. Origin Instruments.: HeadMouse extreme. 2015. http://www.orin.com/access/headmouse/

  33. Zhai, S., Morimoto, C., Ihde, S.: Manual and gaze input cascaded (MAGIC) pointing. In: ACM Conference on Computer Human Interaction (CHI’99), Pittsburgh, pp. 246–253 (1999)

  34. Anacan, R., Alcayde, J., Antegra, R., Luna, L.: Eye-GUIDE (eye-gaze user interface design) messaging for physically-impaired people. Int. J. Distrib. Parallel Syst. (IJDPS) 4(1), 41–52 (2013)

    Article  Google Scholar 

  35. Gepner, G., Simonin, J., Carbonell, N.: Gaze as a supplementary modality for interacting with ambient intelligence environments. In: Proceedings of the 4th International Conference on Universal Access in Human-Computer Interaction: Ambient Interaction, pp. 848–857 (2007)

  36. Madhav, S., Gaddamwar, P., Chipte, G.: Eyegaze communication system. Int. J. Comput. Commun. Technol. 3(6):34–37 (2012). ISSN 0975-7449

  37. Mauri, C., Granollers, T., Lorés, J., Garcia, M.: Computer vision interaction for people with severe movement restrictions. Hum. Technol. 2(1), 38–54 (2006)

    Article  Google Scholar 

  38. Pissaloux, E., Carbone, A., Martinez, F.: Toward the design of a low cost vision-based gaze tracker for interaction skill acquisition. BIO Web Conf. 1, 00071 (2011)

    Article  Google Scholar 

  39. Prabhu, V., Prasad, G.: Designing a virtual keyboard with multi-modal access for people with disabilities. In: World Congress on Information and Communication Technologies (WICT), Mumbai, pp. 1133–1138 (2011)

  40. Van der Kamp, J., Sundstedt, V.: Gaze and voice controlled drawing. In: Proceedings of the 1st Conference on Novel Gaze-Controlled Applications, ACM, ISBN 978-1-4503-0680-5 (2011)

  41. Vamvakousis, Z.: The eye-harp: a gaze-controlled musical instrument. Master thesis, Universitat Pompeu Fabra, Barcelona (2011)

  42. Grauman, K., Betke, M., Gips, J., Bradski, G.: Communication via eye blinks: detection and duration analysis in real time. In IEEE Computer Society Conference on Computer Vision and Pattern Recognition (CVPR), (2000)

  43. Mohammed, A., Anwer, S.: Efficient eye blink detection method for disabled helping domain. Int. J. Adv. Comput. Sci. Appl. 5(5), 202–206 (2014)

    Google Scholar 

  44. Missimer, E., Betke, M.: Blink and wink detection for mouse pointer control. In: Proceedings of the 3rd International Conference on Pervasive Technologies Related to Assistive Environments (PETRA’10), Samos (2010)

  45. Tobii Dynavox.: Tobii PCEye Go. 2015. http://www.tobiidynavox.com/pceye-go/

  46. Karpov, A., Ronzhin, A., Nechaev, A., Chernakova, S.: Multimodal system for hands-free PC control. In: 13th European Signal Processing Conference, pp 1–4 (2005)

  47. Salnikov, A.: Natural interface to improve human-computer interaction for people with upper limb disabilities: exploring the potentials of voice input and hand gestures in application development to improve the communication possibilities of people with motor disorders. Bachelor’s thesis in Information Technologies, Lahti University of Applied Sciences (2014)

  48. Tobii EyeX. 2015. http://www.tobii.com/en/eye-experience/

  49. TeamViewer.: All-in-one software for remote support and online meetings. 2015. https://www.teamviewer.com/en/index.aspx

  50. skype. 2015. http://www.skype.com/en/

  51. Hevner, A., Marchner, S., Park, J., Ram, S.: Design science in information systems research. MIS Q. 28(1), 75–104 (2004)

    Article  Google Scholar 

  52. Kuechler, W., Vaishnavi, V.: A framework for theory development in design science research: multiple perspectives. J. Assoc. Inf. Syst. 13(6), 395–423 (2012)

    Google Scholar 

  53. Salnikov, A.: Natural interface to improve human-computer interaction for people with upper limb disabilities: exploring the potentials of voice input and hand gestures in application development to improve the communication possibilities of people with motor disorders. Bachelor’s thesis in Information Technologies, Lahti University of Applied Sciences (2014)

  54. Lescher, G., Moulton, B., Higginbotham, D.: Optimal character arrangements for ambiguous keyboards. IEEE Trans. Rehabil Eng. 6(4), 415–423 (1998)

    Article  Google Scholar 

  55. Ward, D., MacKay, D.: Fast hands-free writing by gaze direction. Nature 418(6900), 838 (2002)

    Article  Google Scholar 

  56. Arnot, J.L.: Text entry in augmentative and alternative communication. In: Harbusch, K., Raiha, K.-J., Tanaka-Ishii, K. (eds.) Efficient Text Entry, Dagstuhl Seminar Proceedings 05382. Internationales Begegnungs- und Forschungszentrum fur Informatik (IBFI), Schloss Dagstuhl, Germany (2006). ISSN: 1862-4405

  57. Bhattacharya, S., Samanta, D., Basu, A.: Performance models for automatic evaluation of virtual scanning keyboards. IEEE Trans. Neural Syst. Rehabil. Eng. 16(5), 510–519 (2008)

    Article  Google Scholar 

  58. Biswas, P., Langdon, P.: A new interaction technique involving eye gaze tracker and scanning systems. In: Proceedings of the 2013 Conference on Eye Tracking South Africa, 67-70. ACM 978-1-4503-2110-5/00/0010. Cape Town (2013)

  59. Bates, R., Istance, H.: Towards eye based virtual environment interaction for users with high-level motor disabilities. Int. J. Disabil. Hum. Dev. 4(3), 217–223 (2005)

    Article  Google Scholar 

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Acknowledgments

The author would like to express his gratitude to Mike who patiently tested all the versions and provided extremely valuable feedback. Mike also provided consent that his identity can be disclosed and a photograph of him be published. Appreciation is also expressed to Armand Bester who was responsible for the electronics of the Arduino replacement for the TV remote control.

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Correspondence to Pieter Blignaut.

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Blignaut, P. Development of a gaze-controlled support system for a person in an advanced stage of multiple sclerosis: a case study. Univ Access Inf Soc 16, 1003–1016 (2017). https://doi.org/10.1007/s10209-016-0493-9

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