The 'EYES' Have It

Eye-controlled devices, commonly referred to as eye-tracking or eyegaze systems, enable users to access speech-generating devices and computers. Eye control isn’t without its challenges, but many with ALS say the technology has changed their lives, providing greater independence and allowing them to live better.

In recent years, eye-control technology has evolved, resulting in systems that are faster, more accurate, smaller and more portable, highly customizable, more cost-effective, and typically able to be calibrated in 30 seconds or less.

The June ALSN article “A Complete Communication Solution” discussed dynamic display (large touch screen) alternative augmentative communication (AAC) devices with multiple access methods, which also serve as fully functioning Windows XP computers.

Eye-controlled systems open these speech-generating computers to users with little or no movement. Most systems can be mounted to wheelchairs, floors, desks, tables, beds, etc. Here’s a look at what users are saying, all with their eyes.

‘I love you’

Terry Sickels of Akron, Ohio, received an ALS diagnosis in late 2005. When he started experiencing speech problems last year, Sickels, 58, tried several AAC devices, but none worked very well for him.

Sickels’ wife, Tammy, researched other options and discovered eyecontroltechnology and the MyTobii P10, manufactured by Tobii Technology Inc. in Sweden, and distributed in the United States by Tobii Assistive Technology Inc. (Tobii ATI). From the start, it worked well for him.

Sickels uses the dwell selection method in which he focuses steadily on a certain part of the screen for an adjustable period of time before the device makes the selection.

“The most consistent movement I have is my eyes, and this is the only unit that accommodates that without recalibrating all the time,” Sickels wrote via e-mail.

He uses the device for text-to-speech, as well as Internet, e-mail, text messaging and environmental controls such as the television remote. Sickels also uses buttons programmed with greetings, questions, yes/no answers, and other generic sayings. Customizing the system with phrases, names and topics has made it more personal and easier to have conversations.

Terry Sickels, who once used an alphabet board to communicate, amazes grandsons, Joey and Christopher, with his ability to look at buttons that speak various messages, including some jokes.

Sickels has difficulty using the system’s onscreen keyboard but is improving with practice. Currently he can type about 10 to 15 words per minute. The premade text boxes work well in the meantime.

“We’re not speculating what he’s trying to say anymore,” Tammy says. “He’s more relaxed, and he’s got that little spark in his eyes again. He’s laughing more, and it seems like he’s having fun because he has some freedom, and he’s more in control.”

Sickels now can tell doctors and therapists how he’s feeling or if he’s experiencing pain. Prior to appointments, Sickels creates text buttons that ask questions for him.

Because he tends to lock on message buttons when he doesn’t mean to say anything, Sickels and his caregiver created an onscreen “rest” button that he can click with his eyes to go to a “blank” page. A “return” button allows him to go back to the previous page when he’s ready to resume speaking.

After using the device less than a month, Sickels surprised Tammy on her birthday by programming buttons that said: “Happy 50th Birthday,” “I have a present for you,” and “I love you."

“It was more personal for the words to come from me as opposed to having someone else say it for me,” Sickels writes.

“I’m tired of people treating me like I’m not in the room. This device allows me to voice my opinion, offer suggestions and show people that I’m the same person I was before. People have started to talk to me and ask me questions.”

ERICA speaks

Don Taylor of Collierville, Tenn., has used Eye Response Technologies’ ERICA system since June 2007, and writes via e-mail that the learning curve wasn’t very steep because he’d been using onscreen keyboards with word prediction through the EZ Keys software prior to ERICA.

“I have over 22 years of computer experience, and I demand my computer system to be well integrated so I can do all the things that I could do before I became disabled,” Taylor, 51, wrote via e-mail.

“I don’t want to be slowed down by a system that offers scanning or Morse code. And, ERICA runs on a Windows platform, so I can run the same applications that I ran on my desktop computer.”

Taylor, who spends most of his time on the Internet, began typing with his eyes immediately after the initial setup. He maintains a blog and serves as the Webmaster for his son’s Boy Scout troop. He credits ERICA’s tech support and software upgrades with helping him stay on track.

He adds, however, that every time he turns off or moves away from the system, he has to recalibrate, which he can do without assistance.

“What I like best is the way the makers of ERICA designed the software to allow me to do everything with my eyes that I would do if I could type with a keyboard,” Taylor says.

While he recommends the system to others with ALS, he wouldn’t suggest it for people who don’t have any experience with a Windows-based computer because “it’s not stable enough and requires maintenance, including virus protection, Windows updates, data backups, etc.”

One drawback for Taylor is that the camera is fragile; he says the system would be more versatile if the camera were built into the system (it sits under the screen). And, he cautions that moving ERICA onto the wheelchair mount from the floor mount is difficult.

"No computer system is without flaws,” Taylor notes, urging potential buyers to “talk with a user in addition to the salesmen.”

To learn more about Taylor’s experiences with ERICA, visit his blog (http://alsdon.blogspot.com).

It’s going to cost …

Don Taylor (with family friend Ryan Waltman) spends much of the day using his ERICA for generating speech, as well as staying online.

While eye-controlled communication devices sound like a great solution, many speech-language pathologists and AAC specialists caution that what works for one person may not be the ideal solution for another.

To learn more, contact the manufacturers, as they may be able to put you in touch with users who have ALS. Of course, each manufacturer asserts that its system and camera is faster, more accurate, easy to calibrate, has better IR sensors and mounting solutions, etc. But since eye-controlled systems are pricey, in the end it’s advisable to “try before you buy.”

Start by working with the speech therapist at the local MDA clinic, and check with the local MDA loan closet to try loaner devices. In addition, most manufacturers have rental or loan programs; in some cases, rental costs can be applied to the purchase price.

These programs also are helpful if someone needs a loaner device for an extended period such as while waiting for insurance approvals or lengthy delivery times.

Dedicated AAC systems with eye-control options typically range in price from approximately $6,800 to $15,000. The cost increases with additional hardware and software options. (See “Eye Technology Manufacturers” below.)

Medicare will cover up to 80 percent of the cost for an AAC device, and MDA offers a one-time $2,000 grant for devices prescribed through its clinics. MDA also will provide $500 annually for repairs and modifications.