Friday, September 27, 2013

Electronic Eye Gaze Communication Options for People with ALS

There are various types of electronic eye gaze options for people with ALS.  These systems rely on eye movement to “activate” a letter on a computer screen in order for the letter to be typed.  In order for the system to work reliably, the person with ALS needs to have upper and lower and lateral eye movements.   This article will describe the various options for eye gaze technology including insurance funded devices and DIY (Do It Yourself) devices.

Insurance funded systems

For more sophisticated computer access there are several “eye gaze” computer systems on the market.  These high priced specialty computers rely strictly on eye movement for activation.  This type of machine is only used by people that have little or no muscle movement left on their bodies. The basic premise is that a CCTV camera is placed below a computer monitor.  The camera tracks your retina movement.  Special software is loaded into the computer and allows the user to have full access by simply moving their eyes around the screen. 

Insurance will only fund an eye gaze system if the speech therapist writing the report can document no other forms of access will work with the client.  Most insurance companies (including Medicare and some private insurance providers) will fund 80% of the cost of this device.  However, following Medicare guidelines, people enrolled in hospice or living at an assisted living facility are NOT eligible for communication devices. This often leads to frustration for many PALS since they now need the eye gaze systems but can’t get them funded. There are now other options on the market which are described later in this document.

Producers of eye gaze systems are:

DynaVox (

Eye On (

LC Technologies (

Prentke Romich Company, (

Tobii (





Other Eyegaze Options (most are not fundable via insurance but it never hurts to ask)

The Eye Tribe $99.00 ( Not yet available—company taking pre-orders. Expected shipment date December 2013.

The Eye Tribe software enables eye control on mobile devices, allowing hands­free navigation of websites and apps; incl. eye activated login, enhanced gaming experiences and cloud­based user engagement analytics. The Eye Tribe intends to become the leading provider of eye control technology for mass market consumer devices by licensing the technology to manufacturers.

It all started seven years ago where the four founders meet at the IT University of Copenhagen. The ambition was to make eye tracking available for everyone at an affordable price. Within a couple of years they were renowned as the world leading research group in low cost eye tracking. After finishing their PhD’s the four founders bought the IP from the University and formed The Eye Tribe company during their participation in the European StartupBootcamp accelerator program in 2011. The team now includes 16 full time employees, building eye tracking software and applications for mobile devices. The Eye Tribe received seed funding of USD 1 million from private European investors in 2012 and is also leading a USD 4.4 Million government funded project to develop eye control for mobile devices.

The EyeWriter Project (a Do It Yourself Kit—the blueprints are free and cost of materials is about $100.00.

Members of Free Art and Technology (FAT), OpenFrameworks, the Graffiti Research Lab, and The Ebeling Group communities have teamed-up with a legendary LA graffiti writer, publisher and activist, named TEMPTONE. Tempt1 was diagnosed with ALS in 2003, a disease which has left him almost completely physically paralyzed… except for his eyes. This international team is working together to create a low-cost, open source eye-tracking system that will allow ALS patients to draw using just their eyes. The long-term goal is to create a professional/social network of software developers, hardware hackers, urban projection artists and ALS patients from around the world who are using local materials and open source research to creatively connect and make eye art.

PCEye by Tobii $3,900.00 .  ( 

The Tobii PCEye Go is a peripheral eye tracker that enhances computer accessibility with the speed, power and accuracy of gaze interaction. The device replaces the standard mouse, allowing you to navigate and control a desktop or laptop computer using only your eyes. You place this device on your EXISTING computer so no other hardrive is required.  The PCEye Go runs on standard Windows computers and tablets, allowing you to work with any application that is normally controlled by a standard computer mouse or through touch. Surf the web, connect with friends online, play games, Skype, use environmental controls to turn on the lights or TV and even make spreadsheets and documents by using your eyes.

The PC Eye can also be used on any WINDOWS TABLET and will turn that tablet into an eye gaze system. 

VT2Mini by Eye Tech Ditigal Systems (

With the simplicity of a single USB interface, the VT2 mini offers compactness and the largest head motion box for reliable and accurate data collection. Easily swapped between laptops, tablets or desktop computers, we include the QuickCAPTURE gaze analysis software and QuickLINK API to allow researchers and developers access to valuable metrics such as gaze position, dwell times, blink rates, pupil size, and much more.

Vision Key ( $4,000

VisionKey is the latest in eye controlled communication and enables users with severe physical disabilities to type and talk with their eyes. Lightweight and head mounted, VisionKey gives users communication independence and control in their lives by simply "looking". The system also gives them each a voice by enabling them to control a speech synthesizer in the VisionKey unit or on the computer. Now users can write letters, play games, surf the net and listen to multi-media sound just by moving their eyes. VisionKey combines a viewer mounted on a pair of standard frames with a small control unit. An eye tracker and a microcomputer measure the position of the eye and when a selection is made, it appears on the control unit LCD and on the computer. Users look at a specific word, letter or character on the chart in front of their eye and "type" by holding their gaze until a selection is confirmed by a green highlight and a beep.


The research into electronic eye gaze devices continues to develop at an amazing speed.  As new technology emerges, additions will be made to this list. 


Should you have any questions about eye gaze technology or any assistive technology for people with ALS, please feel free to contact me at


Alisa Brownlee, ATP
September 2013


Hands Free Access to the iPad via Switch Activation

Apple's new operating system, the iOS7 enables users to access their iPhone, iTouch, and iPad without having to use their hands to touch the screen.  The new operating system allows switch access to Apple's line of tablets.  If you have questions about switch access to the iPad, I am happy to help--email me at

In order to use the iPad with a switch you will need:
1. iPad (or iPhone, iTouch) with iOS7
2. Bluetooth Switch or Bluetooth Switch Interface
Optional: Mounting (to secure the iPad to a wheelchair, table, etc...)  Mounting options available at www.rjcooper or
What is a switch?
A switch controls an electronic device--it sends a current to the machine to do something.  For example, a joystick on a power wheelchair is a switch--when activated, it sends a current to the driving mechanism to go forward, back, left, right.  A switch does the same thing with a communication device--sends a current to the electronic device to do something.  In this case, the switch makes the iPad scan--row, row, row, column, column, column until it comes to the icon you want then the users hits the switch. 
Switches are at the core of access technology. What can appear to some as simply a "button" can —properly selected and installed—open worlds of access to communication devices, environmental controls, computer software, and mobile devices. (source: Ablenet)
Switches come in a variety of shapes and sizes.  The type of switch that a user needs depends on what muscle movement they have to activate the switch.  The iPad relies on a Bluetooth interface to use a switch with the device.  This means the user has to be utilizing a Bluetooth switch or have a Bluetooth switch interface. 
Bluetooth switches are available at:
RJ Cooper
Inclusive TLC
After choosing the appropriate switch, you now need to sync it to the iPad.  The following information is from Spectronics.

Switching it up in iOS 7

Via by by Charlene Cullen      
The one feature I was really excited about in iOS 7 was the long awaited switch control that Apple has now built into the operating system. As with all first releases there are sure to be some tweaks and further adjustments but I’d have to say I have enjoyed exploring the options for using a switch to access the iPad. I think they will offer people with physical disabilities some great options.
You can find it in the Settings app under General, Accessibility and then Switch Control.

switch 2

Switch Control

My first big tip if you wish to demonstrate switch control is that you need to be able to exit quickly if you need to. You can set this up in Accessibility settings. Scroll to the very bottom and select Accessibility Shortcut (which used to be Triple Click Home). Choose Switch Control so that it has a little check mark next to it. This means that you can triple click the home button and escape from switch control at any time. Now you’re ready to explore!

You have 3 options for the access method in switch control. You can choose from using the screen as a switch, using your head movement or using an external switch. We’ll be focussing on using an external switch but I’d encourage you to play with the other settings. Using left and right head movement is definitely pretty cool to try out!

It’s possible to use 1 switch with Auto Scanning or set up 2 switches for step scanning but make sure that your iPad is paired to a Bluetooth switch interface first. If you’re wondering which interfaces are compatible with iOS7, I’ve tested the Applicator with the new iOS 7 switch control and have also seen several videos with other switch interfaces such as the new Blue2 Bluetooth Switch and the Tecla DOS This is an external link.

Ablenet has put together a couple of great videos that explain switch set up in iOS 7 switch control. This one shows configuration for single switch auto scanning with the new Blue2 interface.

This video shows the new Blue2 interface and setting up iOS 7 Switch Control with Dual Switches with Step Scanning.

Christopher Hills (who, by the way, will be presenting “One Switch, One Head, the World” at our Spectronics Inclusive Learning Technologies conference in May 2014) has created a quick video where he is using the Tecla DOS with iOS7 switch control

And finally, you can see a range of videos on the Accessibility features by Luis Perez, including this
one on the new switch control.

I think that the switch control in iOS 7 has radically changed the access to the iPad home screen and apps. You can now use a switch to navigate and turn pages within iBooks or take a picture/video with the Camera app. The iOS 7 switch control will work across all of the apps that come with the iPad. I also love that there is a menu that pops up that you can scan and select gestures to zoom, pinch and swipe along with access to some other system features.
Some people have already been asking about the apps that will work with iOS 7 switch control. This will be ever changing. Some app developers have been on the ball and already made their apps compatible with iOS 7 switch control. We will need to wait for some others to catch up! I just checked out Facebook and was able to use the switch to scroll through my news feed and post a status.

The apps that were already made switch accessible by their developers, within the switch settings of the app itself, will still work with a switch interface. See Jane Farrall and Alex Dunn’s list of switch accessible apps here This is an external link. They do not all necessarily work with iOS 7 switch control. However, you can use your Bluetooth interface to work across both if you have one that is flexible enough.
You can always contact us if you have further questions about switch control with the iPad. And let us know about your success stories with using iOS 7 switch control too!