Implementing Eye Gaze Computer Technology to

Promote Communication, Participation and Fun for

Young Children with Complex Communication and Motor Needs

Session 128

AOTA Inspire Annual Conference, Philadelphia, PA

April 3, 2025

Sandra Masayko, M.Ed., OTR/L (Retired), Retired Director of Assistive Technology,

Easterseals SE PA, Philadelphia, PA [email protected]

Joy McGowan, M.S., CCC-SLP, Director of Assistive Technology & AAC, Easterseals SE PA,
Philadelphia, PA [email protected]

Namrata Grampurohit, Ph.D., OTR/L, Associate Professor of Occupational Therapy, Thomas

Jefferson University, Philadelphia, PA [email protected]

Topics:

• How Eye Gaze Computer Technology (EGCT) works

• Factors to consider in EGCT
o Team Collaboration
o Access Components: Personal & Environmental
§ Positioning of body & head in relationship to tracker
§ Use of hands
§ Use of eyes & consideration of Cortical Visual Impairment
§ Interest, Attention & Fatigue
§ Other factors such as seizures and auditory issues
§ Acquiring equipment

Presenta(on Notes Session 128 AOTA Inspire Conference 4/3/2025 1

Implemen(ng Eye Gaze Computer Technology to Promote Communica(on, Par(cipa(on & Fun
for Children with Complex Communica(on & Motor Needs.
Authors: S. Masayko, J. McGowan, N. Grampurohit
 o Considerations for Device Selection
§ Caregiver Perspective/Knowledge of the System
§ Vocabulary
§ Physical Ability to Access Device
§ Communication Partner
§ Portability
§ Child’s Engagement
o Operational Components for Implementation
§ Low tech introduction through toys, actions, fun
§ Navigation to access vocabulary pages
§ Determining voice output
§ Learning to interact with the computer through play
§ Customization
o Language Components for Implementation
§ Pictures
§ Symbols
§ Vocabulary & sentence structure; Phrases
§ Requesting and beyond
o Practice and carryover: Low tech back up for school & home
o Data Keeping
• Parents’ Perspectives (Follow up study—see outline of study on next pages*)
• Case Stories with video and photo examples, interwoven into presentation
o Preschool Children
o Parent Description of Spontaneous Speech
• Occupational Therapy Opportunity: Promote children’s agency through use of AAC
devices for creativity, connectivity and environmental control.

Presenta(on Notes Session 128 AOTA Inspire Conference 4/3/2025 2

Implemen(ng Eye Gaze Computer Technology to Promote Communica(on, Par(cipa(on & Fun
for Children with Complex Communica(on & Motor Needs.
Authors: S. Masayko, J. McGowan, N. Grampurohit
 *Parents’ Perspectives of Eye Gaze Technology Use by Children with

Complex Communication Needs

American Journal of Speech-Language Pathology, Volume 33, Number 3, Pages 1254-1265

https://doi.org/10.1044/2023_AJSLP-23-00100

A descriptive study of 10 parents’ perspectives of 9 children, conducted through an online

survey and follow up telephone interview.

Instruments Used: “Functional outcomes of children’s uses of their single most advanced AAC
device” (Calculator, 2014); Gross Motor Function Classification System, Expanded and Revised

(2007); Manual Abilities Classification System for Children with Cerebral Palsy (2010);
Communication Function Classification System (2011); Vision Function Classification (2020);
with additional questions posed by the investigators.

Description of Children

5 boys, 4 girls, current ages 7-16. All trialed eye gaze technology while in preschool or early
intervention. Multi racial. All speak English at home and 2 speak additional languages at home.

Diagnoses: Cerebral Palsy (CP)=7; Arthrogryposis & CP=1; genetic disorder with ataxia=1;
Cortical Visual Impairment=2. All have limitations of mobility, hand use & communication.

Current Kinds of AAC Used by the Children

Computer based (8 students): Eye gaze control only=56%; Touch activation only=11%; Eye gaze
& touch with keyguard=11%; Eye gaze with switch=11%.

Non computer based (1 student): 3-message switch=11%

Amount & Location of AAC Use for Computer Based AAC (8 students)

5-6 hours/day=38%; 7-10 hours/day=38%; 16 hours/day=12%; unknown=12%

Home & School=88%; School only=12%

Presenta(on Notes Session 128 AOTA Inspire Conference 4/3/2025 3

Implemen(ng Eye Gaze Computer Technology to Promote Communica(on, Par(cipa(on & Fun
for Children with Complex Communica(on & Motor Needs.
Authors: S. Masayko, J. McGowan, N. Grampurohit
Benefits of Computer Based AAC Use (Based on Calculator’s Questionnaire)

100% of parents agreed that child understands purpose of the device and uses device for
school.

84% of parents agreed that child: seems satisfied with the device; uses device effectively with
people who are unfamiliar; values the device; has figured out how to operate device; uses device
to communicate with many different people.

84% of parents agreed that the device enables child to make friendships with others and has
contributed to overall effectiveness in communication.

Limitations of Computer Based AAC Use

Only 25% use the device for Internet; only 13% use device for environmental control; only 13%
can independently get to the device.

50% use the device to access recreation, but this appears to be limited to games. Few use the
device to access music, art or social media.

Assisting Parents in Implementation

Most parents (78% ) felt they received sufficient help to implement the technology. SLPs were
reported most often as providing assistance (77%), followed by AT (33%), OT and PT (22%
each) then other professionals.

Conclusions

Parents perceive eye gaze technology to be a powerful means for their children to communicate.
There appears to be a need to employ the multiple capabilities of computer based AAC to meet
recreational and environmental needs. More research is needed.

References & Resources

Blackstone, S. W., Luo, F., Canchola, J., Wilkinson, K. M., & Roman-Lantzy, C. (2021,
February). Children With Cortical Visual Impairment and Complex Communication

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Implemen(ng Eye Gaze Computer Technology to Promote Communica(on, Par(cipa(on & Fun
for Children with Complex Communica(on & Motor Needs.
Authors: S. Masayko, J. McGowan, N. Grampurohit
 Needs: Identifying Gaps Between Needs and Current Practice. Retrieved March 2023,
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Beukelman, D. R., & Light, J. C. (2020). Augmentative & alternative communication:

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Borgestig, M., Al Khatib, I., Masayko, S., & Hemmingsson, H. (2021). The impact of eye-gaze
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Calculator, S. N. (2014). Parents' perceptions of communication patterns and effectiveness of use

of augmentative and alternative communication systems by their children with Angelman
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Communication Function Classification System. CFCS. (2010). Retrieved October 29, 2022,
from http://cfcs.us/

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cerebral-palsy-2021-clinical-guidelines/

Galli, J., Loi, E., Gaza, S., Michelette, S., Molinaro, A., Franzoni, A., Rossi, A., Semararo, F.,
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https://doi.org/10.1111/dmcn.16096

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Implemen(ng Eye Gaze Computer Technology to Promote Communica(on, Par(cipa(on & Fun
for Children with Complex Communica(on & Motor Needs.
Authors: S. Masayko, J. McGowan, N. Grampurohit
Hemmingsson, H., & Borgestig, M. (2020). Usability of Eye-Gaze Controlled Computers in
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and Public Health, 17(5) https://doi.org/10.3390/ijerph17051639

Karlsson, P., Allsop, A., Dee-Price, B.-J., & Wallen, M. (2018). Eye-Gaze Control Technology
for children, adolescents and adults with cerebral palsy with significant physical
disability: Findings from a systematic review. Taylor & Francis. Retrieved October 29,
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Kuhaneck, H., Bundy, A., Fabrizi, S., Lynch, H., Moore, A., Román-Oyola, R., Stagnitti, K., &

Waldman-Levi, A. (2024). Play as Occupation: the state of our science and a research

agenda for the profession. American Journal of Occupational Therapy, 78(4).

https://doi.org/10.5014/ajot.2024.050824

Manual Ability Classification system for children with cerebral palsy--MACS. (2010). Retrieved
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Palisano, R., Rosenbaum, P., Bartlett, D., & Livingston, M. (2007). GMFCS - E & R Gross
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ER_English.pdf

Powrie, B., Kolehmainen, N., Turpin, M., Ziviani, J., & Copley, J. (2015). The meaning of
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Visual function classification. SMILE Lab. (2020). Retrieved October 29, 2022, from
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Implemen(ng Eye Gaze Computer Technology to Promote Communica(on, Par(cipa(on & Fun
for Children with Complex Communica(on & Motor Needs.
Authors: S. Masayko, J. McGowan, N. Grampurohit
Wilkinson, K. M., & Wolf, S. J. (2021). An In-Depth Case Description of Gaze Patterns in an
Individual with Cortical Visual Impairment to Stimuli of Varying Complexity.
Perspectives of the ASHA Special Interest Groups, 6.
https://doi.org/https://doi.org/10.1044/2021_PERSP-21-00111

Wilkinson, K.M., Elko, L., Elko, R., McCarty, T., Sowers, D. J., Blackstone, S., & Roman-
Lantzy, C. An Evidence-Based Approach to Augmentative and Alternative
Communication Design for Individuals with Cortical Visual Impairment. American
Journal of Speech-Language Pathology, 32 (5). https://doi.org/10.1044/2023_AJSLP-22-
00397

Presenta(on Notes Session 128 AOTA Inspire Conference 4/3/2025 7

Implemen(ng Eye Gaze Computer Technology to Promote Communica(on, Par(cipa(on & Fun
for Children with Complex Communica(on & Motor Needs.
Authors: S. Masayko, J. McGowan, N. Grampurohit