Eye-gaze-driven games to support oculomotor skills in young adults with cerebral palsy using eye-tracking technology: a multiple case study

Background: Assistive technology such as eye-tracking systems can enhance communication, participation, and self-efficacy in individuals with motor impairments. However, in people with cerebral palsy (CP), visual and oculomotor impairments may limit their effective use and reduce participation in daily activities. Purpose: This multiple case study aimed to investigate the effects of eye-gaze-driven games on oculomotor and visual exploration skills in adults with CP, and to assess the usability of the intervention, with the broader goal of facilitating the use of eye-tracking systems as communication tools. Materials and methods: Three young adults with CP participated in a multiple case study. They underwent a pre- and post-intervention visual assessment using eye-tracking metrics. The intervention consisted of training oculomotor abilities through four eye-gaze-driven games for 60 min per session, across five sessions within one week. Usability was assessed using the System Usability Scale. Quantitative data were summarized using descriptive statistics, while visual performance was analyzed qualitatively. Results: Improvements in fixation precision and visual exploration were observed in two out of three participants, supported by qualitative analysis of gaze patterns. Participants also reported improvements in fixation quality and visual field, along with enhanced self-perceived oculomotor abilities. One participant showed improvement in eye-tracker calibration. Usability scores ranged from 60 to 87.5, indicating good usability. Conclusion: These preliminary findings suggest that eye-gaze-driven games may represent an engaging approach to train oculomotor function in individuals with CP and may serve as a preparatory step for the use of eye-tracking assistive technologies.