When assistive eye tracking fails: Communicating with a brainstem-stroke patient through the pupillary accommodative response – A case study

Villalobos, Andres Eduardo Lorenzo; Giusiano, Silvia; Musso, L; de'Sperati, Claudio; Riberi, Alessandra; Spalek, Piotr; Calvo, Andrea; Moglia, Cristina; Roatta, Silvestro

doi:10.1016/j.bspc.2021.102515

Cited by 7 publications

(7 citation statements)

References 25 publications

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“…The PAR is easily performed without requiring procedural learning nor extensive training. In addition, we observed that it is well preserved in ALS patients, including those in LIS [18]. As for the implemented technique, it has proven adequate for developing AAC devices [18] although it has not yet been successfully tested in patients in CLIS.…”

Section: Introduction Pupil In Software Controlmentioning

confidence: 96%

“…In addition, we observed that it is well preserved in ALS patients, including those in LIS [18]. As for the implemented technique, it has proven adequate for developing AAC devices [18] although it has not yet been successfully tested in patients in CLIS. Since a rapid cognitive decline is considered to take place at the onset of the CLIS condition and contribute to the failure of subsequent attempts to re-establish a bidirectional communication with the patient [19], it is likely that adopting and training a new communication channel in due time may prevent the cognitive decline and help to maintain the channel active beyond the loss of eye movement.…”

Section: Introduction Pupil In Software Controlmentioning

confidence: 96%

“…The game has been created as an add-on for a low-cost pupil-size driven AAC device, which implements a binary communication for providing YES/NO answers to posed questions or for selecting one of several items on a screen through a scanning-selection approach [18].…”

Section: Introduction Pupil In Software Controlmentioning

confidence: 99%

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Gaming for Training Voluntary Control of Pupil Size

et al. 2022

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Users can “voluntarily” control the size of their pupil by switching focus from a far target A (large pupil size) to a near target B (small pupil size), according to the pupillary accommodative response (PAR). Pupil size is governed by smooth muscles and has been suggested as communication pathway for patients affected by paralysis of skeletal muscles, such as in amyotrophic lateral sclerosis (ALS). We here present a video game that relies on PAR: a 2d side-scroller game where the user, by varying pupil size, controls the height at which a spaceship is moving aiming at colliding with bubbles to burst them and score points. The height at which the spaceship flies inversely depends on pupil area. The game is implemented on a Raspberry Pi board equipped with a IR camera and may record the time course of pupil size during the game, for off-line analysis. This application is intended as a tool to train and familiarize with the control of pupil size for alternative augmentative communication.

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Section: Introduction Pupil In Software Controlmentioning

confidence: 96%

Section: Introduction Pupil In Software Controlmentioning

confidence: 96%

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Gaming for Training Voluntary Control of Pupil Size

et al. 2022

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“…A communication support system based on changes in pupil diameter could be proposed to allow patients to express their thoughts and needs even while in the CLIS situation. CLIS patients cannot blink or move their eyes actively, but their pupil dilation and contraction responses are still maintained, which are passive responses to external stimuli 7 . Mathôt et al (2016) proposed an HCI system based on Pupil Light Reflex (PLR) and covert attention, in which the participants were asked to pay attention to one of the two options that were represented by a white or black disc while looking at the green dot on the center of the screen 8 .…”

Section: Introductionmentioning

confidence: 99%

Information Input System Based-on Object-based Visual Attention

Lv,

Hisakata,

Kaneko

2024

Preprint

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The objective of this study is to propose a communication assistance system for patients with difficulty moving their extremities and eyes, such as advanced amyotrophic lateral sclerosis (ALS) patients with completely locked-in syndrome (CLIS), based on object-based visual attention utilizing pupil size measurement data. The present research used a hybrid image created by overlapping an image with high spatial frequency (HSF) components and one with low spatial frequency (LSF) components as the stimulus image. Five participants in Experiment 1 and eight in Experiment 2 were instructed to pay attention to the high or low-spatial frequency image. The stimuli in Experiment 1 were constant throughout one trial; however, in Experiment 2, the spatial frequency condition of the given hybrid image was swapped in one trial with different alternation frequencies: 0.16Hz, 0.33Hz, and 0.50Hz. Participants were required to always maintain their attention on the target image. In experiment 1, maximum and mean pupil constriction values were significantly larger when the attentional target was a HSF image than when it was a LSF image. However, when we extrapolated the target based on the difference in pupil measurement data when the subjects focused their attention on images with different spatial frequencies, the accuracy was lower than 70%. In experiment 2, we found that the slope of pupil size change after stimuli swap was significantly larger when the target image was switched from the HSF image to the LSF image than when from LSF to HSF. While estimating the target image based on the above pattern, we found that almost participants show inferred accuracy exceeding 70%, with the highest reaching 95.24%—the lowest alternation frequency (0.16Hz) used in the present experiment results in higher inferred accuracy. This study proposes a low-cost, practice-free, non-invasive visual attention-based communication support system that does not require professional assistance. Since the stimulus image is a hybrid image, patients do not need to divide their attention from eye gaze position; therefore, reducing the complexity of operation.

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“…This can also make it difficult to determine when and if it is appropriate to change methods; to date, there is still no software that can provide dynamic recognition of these factors, so clinicians and caregivers play a fundamental role in spotting, evaluating, and reporting changes in a patient’s needs. Given the unique characteristics of each individual, the available technology might not be able to meet their needs and it may be necessary to modify existing commercial devices [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Writing Blindly in Incomplete Locked-In Syndrome with A Custom-Made Switch-Operated Voice-Scanning Communicator—A Case Report

2022

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Background: Locked-In Syndrome (LIS) is a rare neurological condition in which patients’ ability to move, interact, and communicate is impaired despite their being conscious and awake. After assessing the patient’s needs, we developed a customized device for an LIS patient, as the commercial augmentative and alternative communication (AAC) devices could not be used. Methods: A 51-year-old woman with incomplete LIS for 15 years came to our laboratory seeking a communication tool. After excluding the available AAC devices, a careful evaluation led to the creation of a customized device (hardware + software). Two years later, we assessed the patient’s satisfaction with the device. Results: A switch-operated voice-scanning communicator, which the patient could control by residual movement of her thumb without seeing the computer screen, was implemented, together with postural strategies. The user and her family were generally satisfied with the customized device, with a top rating for its effectiveness: it fit well the patient’s communication needs. Conclusions: Using customized AAC and strategies provides greater opportunities for patients with LIS to resolve their communication problems. Moreover, listening to the patient’s and family’s needs can help increase the AAC’s potential. The presented switch-operated voice-scanning communicator is available for free on request to the authors.

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When assistive eye tracking fails: Communicating with a brainstem-stroke patient through the pupillary accommodative response – A case study

Cited by 7 publications

References 25 publications

Gaming for Training Voluntary Control of Pupil Size

Gaming for Training Voluntary Control of Pupil Size

Information Input System Based-on Object-based Visual Attention

Writing Blindly in Incomplete Locked-In Syndrome with A Custom-Made Switch-Operated Voice-Scanning Communicator—A Case Report

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