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Issue Date: August 2016
Published Online: August 01, 2016
Updated: January 01, 2021
Empowering Patients: The Use of Eye Gaze Technology With Medically Complex Patients in the Intensive Care Unit
Author Affiliations
  • Johns Hopkins Hospital
Article Information
Assistive Technology / Neurologic Conditions / Spinal Cord Injury / Assessment/Measurement
Poster Session   |   August 01, 2016
Empowering Patients: The Use of Eye Gaze Technology With Medically Complex Patients in the Intensive Care Unit
American Journal of Occupational Therapy, August 2016, Vol. 70, 7011500025. https://doi.org/10.5014/ajot.2016.70S1-PO3024
American Journal of Occupational Therapy, August 2016, Vol. 70, 7011500025. https://doi.org/10.5014/ajot.2016.70S1-PO3024
Abstract

Date Presented 4/8/2016

This poster will educate participants on the Tobii C12, which is used in this institution review board–approved clinical trial in the intensive care unit (ICU). Use of this device allows occupational therapists and speech–language pathologists to explore an alternative intervention for patients admitted to the ICU with quadriplegia with partial or total loss of use of all limbs.

Primary Author and Speaker: Angela Regensburg

Contributing Authors: Albert Chi, Jonah D. Garry, Kelly Showalter Casey, Therese Cole, Colleen McElroy

PURPOSE: The purpose is to explore an intervention for quadriplegic patients with partial or total loss of use of all limbs admitted to an intensive care unit (ICU) to enable communication.
RATIONALE: The loss of functional use of all four extremities due to stroke, trauma, or other neurologic injury is a devastating condition. This study proposes to explore an intervention for patients with quadriplegia with partial or total loss of use of all limbs. Eye gaze technology allows patients to use their eyes to control a fully functioning computer that also functions as an AAC system.
DESIGN: Pilot prospective cohort study located in three tertiary ICUs.
PARTICIPANTS: A total of 12 patients, 9 women and 3 men, successfully completed the study. The average age of the patients was 54 yr with a range of 33–73 yr. Patients had been hospitalized before assessment for an average of 26 days. Patients who had failed all other modes of communication but were sufficiently awake, alert, and attempting to communicate were included. Patients were excluded if they were unable to comprehend English, had eye injuries limiting their vision, or were significantly sedated/agitated (RASS > 2 or RASS < –2).
METHOD: The Tobii C12 Eye Gaze device was introduced to each of the patients by an occupational therapist or a speech–language pathologist trained in the use of the device. Five consecutive sessions were completed, with focus on engaging the patient on the technology. Each session was approximately 30-45 min long, and the patient had unlimited access to the device. Therapists made note of each patients’ CAM and RASS score while incorporating the device into functional therapy sessions. At the end of five sessions, the Psychosocial Impact of Assistive Devices Scale assessment tool (PIADs) was administered to evaluate the device from the user perspective. We proposed that the Tobii eye gaze device would improve quality of life measured using the PIADs assessment tool.
ANALYSIS: The PIADS is a 26-question self-report questionnaire, which measures the patient’s competence, adaptability, and self-esteem as related to the device. Patients indicate the assistive device’s impact on each of the 26 items, rating them on a 7-point Likert scale ranging from –3 (maximum decrease) to 3 (maximum increase).
RESULTS: On average, patients rated the psychosocial impact of the eye-tracking computer to be moderately positive (mean [M] = 1.30). Patients felt their adaptability was the most significantly affected by the device. They rated the device as having moderate positive effects (M = 1.60) on their ability to adapt. No patients felt that the device decreased their ability to adapt; the lowest rated effect was no change (minimum [min] = 0.00). Patients also reported a moderate increase in their competence level (M = 1.26), and only 1 patient rated the device as decreasing competence, but felt that it had a moderately negative effect (min = –1.42). Self-esteem was least affected, with patients reporting a slight to moderate increase in self-esteem (M = 1.02). Of note, the patients indicated that the device positively affected their happiness (M = 1.42) and ability to participate (M = 2.00) but did not greatly decrease their confusion level (M = –0.67) or frustration (M = .17).
IMPACT STATEMENT: There is a significant population of patients in the ICU whose psychosocial status and communication ability are greatly enhanced by eye-tracking devices. The ability to communicate and the patient’s psychosocial status are highly intertwined with intensive care patient outcomes; eye-tracking devices may provide an important occupational therapy intervention for this population of high-risk ICU patients.