Applying Eye-Gaze Assistive Technology for Children and Youth With Complex Needs
Condition: Self-Help Devices; Eye-Gaze Technology; Severe Physical Disabilities; Communication Disorders
MeSH terms: Communication Disorders
Study type: Interventional

Summary: 
      The purpose of this research is to investigate the impacts of applying eye-gaze assistive
      technology (AT) in children and youth with severe disabilities and complex needs in Taiwan,
      where eye-gaze AT has not been researched for children yet.
    

Detailed description: 
      Background. Children and youth with severe physical disabilities often have concomitant
      mental impairments and complex needs in communication, and in building relationships with
      others. The impairments limit their participation and independence in family, school and
      community life. By using their eyes, the only movements they can control voluntarily, they
      may increase communication. Relevant research has shown that using eye-gaze AT was feasible
      for children with severe physical disabilities to make choices, communicate, interact or
      perform school tasks despite different learning curves. Use of technology may increase
      opportunities for engagement and self-determination for children and youth with physical
      disabilities and complex communication needs in family context or in school, but the research
      is relatively limited. It still needs more studies across countries and long-term follow-up
      to investigate the effects of the use of eye-gazed AT in life.

      Study Aims. There are two aims in this proposed research. Aim 1: To investigate the
      preliminary effects of eye-gazed AT for daily participation in daily living for children and
      youth with severe physical disabilities and communication difficulties in Taiwan.

      Aim 2: To investigate the adherence of eye-gazed AT intervention for children and youth with
      severe physical disabilities and communication difficulties, and the caregivers' satisfaction
      regarding support children and youth to use eye-gazed AT in daily living in Taiwan.

      Methods. This study is conducted as a single subject design with multiple baselines across
      individuals. The inclusions are non-concurrent and the baselines before the intervention
      started were randomized with unequal of 14-30 days.

      This study enrolls participants from Northern Taiwan. The researcher team contacts the
      practitioners in hospitals, schools or development centers to assist recruitment.

      Study procedure. The eye-gaze AT intervention will be conducted for six months and follow up
      to seven months since provision. Before the intervention started, each of the five
      participants is randomly assigned to one of the pre-determined baseline lengths (14-30 days).

      Repeated measures were conducted in baseline period with a minimum of five data points to
      judge the stability of the child's abilities and in intervention phase to establish data
      trends in the levels of two dependent variables, computer usage in daily living (measured by
      computer use diary along with log data of FocusMe program (FocusMe Inc., London, UK)), and
      children's activity performance using eye-gaze AT (performance scale of Canadian Occupational
      Performance Measure (COPM) rated by the parent or teacher). Systematic manipulation of the
      independent variable, the eye-gaze AT intervention was introduced in the intervention phase.
      The process was replicated for at least five participants to demonstrate the
      experiment-control effects.

      In addition, other outcomes related to Activity and Participation, Body Functions and
      Structures and Environmental dimensions based on ICF-CY framework will be collected at
      baseline, after the 3-month intervention, after the 6-month intervention and 7-month after
      provision.

      Statistical analysis. The visual analysis of single-case data will be used to determine
      whether there will be a relationship between the independent and dependent variables. The
      data of continuous variables will be presented as graphs to visually inspected regarding
      change of data pattern across phases separately.

      Due to the small sample size, descriptive statistics will be used to summarize the results of
      outcome measures and reported using the narrative summary. For COPM, the score change of more
      than two points is considered clinically signiﬁcant improvement on both performance and
      satisfaction scale. Besides, achieving the expected level (0) on a GAS goal is considered
      successful goal attainment.
    

Intervention name(s): Eye gaze AT intervention
Intervention type(s): Device
Intervention description(s): The eye-gaze AT intervention includes eye-gaze AT and service delivery to support the participants using this technology in daily life. The Tobii PCEye Mini (Tobii, Danderyd, Sweden) and specialized software are applied with adaptation to meet each child's individual needs.
To ensure the consistency of service delivery, two-day courses are conducted before the intervention. The participant's teachers or parents are invited as the main interventionist to facilitate the child's usage of eye-gaze AT in daily life under team support. The service delivery involves parents in joint goal-setting, planning, and jointly review the progress of the usage of eye-gaze AT as a family-centered practice. Individual meetings and individual supports are provided during intervention periods. The collaborative team will perform biweekly follow-up contacts during intervention periods.
The researcher will conduct the fidelity checklist every month to determine the extent of treatment integrity.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Eye-Gaze Assistive Technology; Severe Physical Disabilities; Communication difficulties