Eye gaze technology: a South African perspective (summary)

South African


This study looks at Bronfenbrenner’s biological theory of human development as a framework for describing the ways in which environmental influences can support or hinder the use of assistive technology, specifically eye-gaze controlled communication for young children with disabilities. The theory uses the ‘model of the ecology as nested systems’, dividing influencing factors into:

Microsystems – the immediate environment within which the child functions.

Mesosystems – the quality and quantity of connections existing between different microsystems.

Exosystems – settings that influence the child’s development but without direct participation by the child.

Macrosystems - factors within the specific culture within which the child lives.

What did they do?

Two case reports are given. These relate to young girls whose needs and disabilities superficially appear similar. Both children were preliterate and had been assessed as being likely to benefit from eye-gaze technology to access communication. The authors considered various barriers to the technology being provided and successfully used, and the possible reasons for different outcomes within the two cases. Their findings were analysed using Bronfenbrenner’s bioecological model, looking at risks and opportunities that might have influenced participation and outcomes for the children and their families.

What did they find?

One child was found to not be using the system at all for communication and the other in a limited way.

The children’s microsystems included home and educational settings and communication partners. Both families had to fund the devices independently, influencing their choice of system, and had limited support to set them up and troubleshoot problems. The mother of the child who did not use her system for communication felt it was less effective than their established ‘no tech’ communication system and thought that they would use it for communication when her daughter became literate. In the other case the mother was more confident in programming the device and had links with school to plan grids.

All communication partners for both girls felt they needed more support and training in setting up and using the device.

The immediate environment also influenced use. Lack of space and appropriate mounting systems meant that consistent use was difficult.

The mesosystems (links between different microsystems) were limited for one child. She did not attend school and eye-gaze targets were not integrated with speech and language therapy (SLT) goals. Difficulties with mounting and transport meant that the device was not taken on family visits and outside activities.

The second child had strong links between home and school and the parents worked with her each day.

The authors attribute the differences in functional use of the system largely to the differences in support at this level.

The main differences in the exosystems for the two children was one mother’s confidence in programming grids to support the system’s use in school due to her skills as a computer programmer. Neither family accessed support groups, but the family of the child who attended school had more informal support available.

The macrosystem i.e. the culture of South African services for people with disabilities, did not strongly support the provision of high-tech communication aids and has limited professional expertise in this field. The state uses a medical model of disability, looking at what the person cannot do rather than what they can. There are few environmental adaptations and there is generally limited access to community activities thus reducing opportunities to use AAC in a variety of settings and with people other than familiar communication partners.


When a child is being introduced to a high tech communication device they and their family need support from more widespread systems. Without this success can be limited. The necessary supports include specialists visiting the child at home and in school to consider issues in a variety of settings. In addition, when resources are limited, informal supports might need to be sought.

Occasional multi-agency case meetings would also be beneficial to enable joint planning and goal-setting.

Developing links with other families using similar technology can be positive in reducing isolation and offering emotional and practical support.

It is suggested that establishing these things might lead to some increase in the ability to influence future government policy and practice.


The authors note that further research is needed into the barriers to the use of assistive technology within all of the levels described.

Things you may want to look into:

Alternative service delivery models for families with a new speech generating device: Perspectives of parents and therapists

Designing AAC Research and Intervention to Improve Outcomes for Individuals with Complex Communication Needs

Added to site May 2016