Auxilio and Beyond Comparative Evaluation Usability and Design Guidelines for Head Movement-based Assistive Mouse Controllers MOHAMMAD RIDWAN KABIR MOHAMMAD ISHRAK ABEDIN RIZVI AHMED SAAD BIN

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Auxilio and Beyond: Comparative Evaluation, Usability, and Design Guidelines
for Head Movement-based Assistive Mouse Controllers
MOHAMMAD RIDWAN KABIR
,MOHAMMAD ISHRAK ABEDIN
,RIZVI AHMED,SAAD BIN
ASHRAF,HASAN MAHMUD, and MD. KAMRUL HASAN,Department of Computer Science and Engi-
neering (CSE), Islamic University of Technology (IUT), Bangladesh
Fig. 1. Auxilio provides accessibility to computer interaction for the upper limb disabled community, facilitating mouse cursor
movements and click actuation, solely based on head rotation and cheek muscle twitches.
Upper limb disability due to neurological disorders or other factors restricts computer interaction for aected individuals using a
generic optical mouse. This work reports the ndings of a comparative evaluation of Auxilio, a sensor-based wireless head-mounted
Assistive Mouse Controller (AMC), that facilitates computer interaction for such individuals. Combining commercially available,
low-cost motion and infrared sensors, Auxilio utilizes head movements and cheek muscle twitches for mouse control. Its performance
in pointing tasks with subjects without motor impairments has been juxtaposed against a commercially available and patented
Both authors contributed equally to this research.
Authors’ address: Mohammad Ridwan Kabir, ridwankabir@iut-dhaka.edu; Mohammad Ishrak Abedin, ishrakabedin@iut-dhaka.edu; Rizvi Ahmed,
rizviahmed@iut-dhaka.edu; Saad Bin Ashraf, saadashraf@iut-dhaka.edu; Hasan Mahmud, hasan@iut-dhaka.edu; Md. Kamrul Hasan, hasank@iut-
dhaka.edu, Department of Computer Science and Engineering (CSE), Islamic University of Technology (IUT), Board Bazar, Gazipur, Bangladesh, 1704.
Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not
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©2024 Association for Computing Machinery.
Manuscript submitted to ACM
Manuscript submitted to ACM 1
arXiv:2210.04483v2 [cs.HC] 7 Oct 2024
2 Ridwan, et al.
vision-based head-tracking AMC developed for similar stakeholders. Furthermore, our study evaluates the usability of Auxilio using
the System Usability Scale, supplemented by a qualitative analysis of participant interview transcripts to identify the strengths and
weaknesses of both AMCs. Experimental results demonstrate the feasibility and eectiveness of Auxilio, and we summarize our key
ndings into design guidelines for the development of similar future AMCs.
CCS Concepts: Human-centered computing
Pointing devices;Accessibility technologies;Accessibility technologies;
Pointing;Usability testing;General and reference Experimentation;Evaluation;Performance.
Additional Key Words and Phrases: assistive technology, assistive mouse controller, upper limb disability, wearable sensors, pointing
device
ACM Reference Format:
Mohammad Ridwan Kabir, Mohammad Ishrak Abedin, Rizvi Ahmed, Saad Bin Ashraf, Hasan Mahmud, and Md. Kamrul Hasan. 2024.
Auxilio and Beyond: Comparative Evaluation, Usability, and Design Guidelines for Head Movement-based Assistive Mouse Controllers.
1, 1 (October 2024), 29 pages. https://doi.org/10.1145/nnnnnnn.nnnnnnn
1 INTRODUCTION
Upper limb disability refers to the complete or partial loss of motor capability of the upper limb, potentially caused due
to — stroke [
23
,
49
,
66
,
85
], spinal injury [
11
,
20
], cerebral palsy [
27
,
40
,
61
,
71
], Amyotrophic Lateral Sclerosis (ALS)
[
28
,
73
], deformation of limbs at birth [
10
,
16
], amputation [
39
,
75
,
78
], etc., signicantly reducing the utilization of
the upper limbs in various motor tasks. The under-utilized residual capabilities [
35
] of the disabled upper limb might
hamper the lives of those aected in terms of both activity limitations and participation restrictions [
58
]. For example, in
patients with ALS, disability is characterized by motor dysfunctions while the brain and eye functionalities remain
preserved [
9
,
12
,
19
,
28
,
42
]. However, the same cannot be said for the motor capabilities of upper limb amputees [
78
], as
they are limited by their amputated body part(s). Research has shown that, unlike a normal person, the residual sensory
abilities of disabled individuals intensify over time, compensating for their lost ability [
5
,
62
,
70
,
72
,
76
]. Eventually,
they learn to utilize these abilities to accomplish dierent tasks in their daily lives [
33
,
55
,
65
,
86
]. Although physically
capable individuals can seamlessly use generic handheld pointing devices (e.g. an optical mouse) for interacting with a
computer, people with upper limb disability require Assistive Mouse Controllers (AMC) as an alternative input modality
for the same [
35
]. However, the usability and performance of such systems must meet a minimum standard to be
suitable for practical, everyday applications.
The ISO 9241-11 states the usability of any system or device as, “the extent to which a product can be used by
specied users to achieve specied goals with eectiveness, eciency, and satisfaction in a specied context of use”
[
37
]. Researchers have analyzed the feasibility and usability of dierent gestures and sensor technologies for developing
Vision-based [
1
,
7
,
38
,
48
,
77
,
81
,
92
], Electromyography (EMG)-based [
13
,
31
,
64
,
67
], Electrooculogram (EOG)-based
[
12
,
17
,
42
,
80
], and Wearables Sensor-based AMCs [
25
,
30
,
67
,
84
] to make computers accessible to individuals with
upper limb disability. However, a particular AMC technology may be convenient for people with a certain disability only.
For example, eye movement is one of the residual motor capabilities of patients with ALS [
9
,
12
,
19
,
28
,
42
]. Intuitively,
vision-based, EMG-based, or EOG-based AMCs may be more appropriate for them compared to those exploiting head
motion sensing technologies [
35
]. While the existing AMCs try to cater to dierent needs, they face limitations such as
but not limited to — sensitivity to lighting conditions, frequent calibration needs, noise interference, hygiene concerns,
and unreliable performance in uctuating environments, highlighting the need for more user-friendly and robust
alternatives. Hence, the design, development, and evaluation of alternative input modalities to facilitate computer
interaction for individuals with upper limb disability is still of interest to the research community [
58
]. Along with that,
Manuscript submitted to ACM
Auxilio and Beyond: Comparative Evaluation, Usability, and Design Guidelines for Head Movement-based Assistive
Mouse Controllers 3
the importance of analyzing the comparative performance, usability, and feedback of such an AMC from the users’
point of view cannot be overemphasized [45].
Throughout this study, we conducted a comparative analysis of the performance of Auxilio [
35
], a prototype of
a sensor-based head-mounted wireless AMC for people with upper limb disability that tries to address some of the
aforementioned limitations and shortcomings, against Smyle Mouse [
1
,
48
,
77
], a commercially available and patented
camera-based AMC in similar pointing tasks. Auxilio combines low-cost Commercial O-The-Shelf (COTS) Inertial
Measurement Unit (IMU) for controlling mouse cursor with absolute head movements and infrared sensors for actuating
mouse clicks with cheek muscle twitches. On the other hand, Smyle Mouse uses a camera to track head movements to
control a mouse cursor and detect a user’s smile to register mouse clicks. Smyle Mouse oers a separate UI that allows
the users to choose the type of event to be registered (left-click, right-click, double-click, drag, etc.) with a smile. We
acknowledge that comparing Auxilio against another sensor-based head-movement-controlled AMC would have been
ideal. However, despite our best eorts, we were unable to procure any such AMC in our locality. Hence, we compared
it against the Smyle Mouse, which is similar from the perspective of input modality and is a recognized commercially
available, and patented system.
Using these AMCs, a within-subject Point and Click experiment involving 10 participants without any motor
impairments was conducted featuring a balloon-popping game, Popper [
34
]. We believe that since Auxilio is fairly new
to the domain of AMC technologies, its performance, usability, and design limitations need to be analyzed before it
can be made available to its stakeholders. As evaluation involving individuals with upper limb disability is resource
intensive and might have restrictions from legal perspectives, we decided to carry out our initial investigation involving
participants without any motor impairment. Furthermore, we investigated the usability of Auxilio in comparison with
Smyle Mouse, leveraging the System Usability Scale (SUS) [
8
,
22
,
24
,
37
,
43
,
44
]. We followed it up with a qualitative
analysis of the interview transcripts of the participants to nd strengths, weaknesses, and future directives for similar
AMCs. To the best of our knowledge, this work is the rst of its kind in the literature.
In summary, the main contributions of this study in the domain of accessibility to computer interaction for the
physically disabled community are as follows:
(a)
We evaluated the feasibility and performance of Auxilio in comparison to the Smyle Mouse, a patented, camera-based
head-tracking AMC, through controlled pointing tasks.
(b)
We conducted a comparative usability analysis of both AMC technologies using the System Usability Scale (SUS) to
highlight the usability challenges and advantages of each of them.
(c)
We carried out a qualitative analysis of user feedback to identify key strengths and limitations of the two AMC
types, providing recommendations and distilling design guidelines for similar AMC development.
2 RELATED WORKS
The recent technological advancements have shaped the design, and development of Assistive Mouse Controllers
(AMCs) for physically challenged individuals into a prominent research area [
58
]. Interaction data from such individuals
may be recorded either using computer vision, Electromyography (EMG), Electrooculogram (EOG), or wearable sensors.
In this section, we elaborate on the existing state-of-the-art AMCs and justify our scope and motivation behind this
study.
Manuscript submitted to ACM
4 Ridwan, et al.
2.1 Vision-based AMCs
Existing vision-based AMCs in the literature leverage facial or eye gaze features, collected from real-time video feeds
using an eye tracker, webcam, or other imaging sensors, and map eye gaze to screen coordinates for cursor control.
However, the user’s eye gaze needs to be calibrated before use. For mouse click actuation, dwell-time-based mechanisms
or gestures such as — eye wink,blink, or smile are among the common ones. Among the many studied works, researchers
have developed Smyle Mouse [
1
,
48
,
77
] that uses a generic webcam to register users’ head movement through nose
tracking for cursor movement and smile gestures for registering mouse click events. The system oers a calibration
phase where a user has to perform a series of gestures as instructed via a UI before actual usage. By default, the
smile gesture actuates a left mouse click. However, a user can customize the event (left-click, right-click, double-click,
drag, etc.) to be triggered with the gesture from a separate UI. Apart from the smile gesture, the system also oers
dwell-time-based click mechanism. Zhang et al. [
92
] have developed a software-based AMC leveraging eye gaze tracking
with an eye tracker to control the mouse cursor movement and dwell-time-based clicking method via a virtual UI for
Mouse/Keyboard simulation. The authors have evaluated their works through two experiments, a searching task, and
a web browsing task, utilizing Technology Acceptance Model (TAM) and System Usability Scale (SUS). Apart from
eye gaze tracking, researchers have also leveraged nose tracking for cursor control [
38
]. As opposed to eye trackers
or webcams, optical mouse or imaging sensors have also been used to track eye gaze for cursor movement [
7
,
81
].
However, a potential drawback of optical mouse sensors is the requirement of an additional light source to work
properly, as demonstrated by [
7
,
81
]. Concerning the methods used in the aforementioned works, virtual interface-based
methods for making computers accessible to the physically disabled are popular in the literature [
26
,
36
,
83
]. Although
common, in practice dwell-time-based click actuation suers from unwanted actuation of mouse clicks due to eye gaze
xation, generally known as the Midas Touch problem [
32
]. To address this issue, researchers [
93
] proposed a muscle or
eyebrow shrugging-based click actuation technique, implemented through the software packages Camera Mouse [
6
,
54
]
and ClickerAid [
53
]. Furthermore, Rajanna et al. [
68
,
69
] have also developed a system for people with arm or hand
impairment that uses eye gaze for pointing at a screen element while selection is actuated by exerting pressure on a
pressure sensor-based footwear.
A critical requirement for vision-based AMCs to work properly is to ensure proper lighting conditions for calibration
and accurate detection of facial [
26
,
36
,
38
,
83
] or eye gaze [
7
,
81
,
92
] features. For eye gaze-based AMCs, gaze tracking
may be challenging due to image resolution, dierent lighting conditions, the user’s dependency on eyeglasses due to
poor eyesight, and even the user’s skin complexion. In addition to that, human eyes are not the most accurate pointing
device [
4
]. Moreover, a human can only gaze at a single point at a given time, preventing the user from looking at
another region of interest without moving the mouse cursor. Most importantly, since eyes are used for both cursor
movement and click actuation, users might nd it dicult to execute both actions simultaneously when required, for
example, dragging an item. As stated earlier, a particular problem with dwell-time-based click actuation is the Midas
Touch problem [
32
], resulting in unwanted selection of UI elements. Another disadvantage of vision-based AMCs is
that existing eye trackers and webcams can not detect and track a user’s eye gaze beyond a particular distance from the
PC or workstation, forcing the user to maintain a particular distance from the PC or workstation.
2.2 Electromyography (EMG)-based AMCs
Electromyography (EMG) signals refer to the measurement of very low electric potentials generated due to muscle
contractions with electrodes placed noninvasively on the skin, where the signal amplitudes are proportional to the
Manuscript submitted to ACM
Auxilio and Beyond: Comparative Evaluation, Usability, and Design Guidelines for Head Movement-based Assistive
Mouse Controllers 5
exerted muscle force [
59
]. For people with upper limb disabilities, EMG signals can be retrieved from the contraction of
the residual muscles [
60
], which can then be used to determine the type of intended motion. Researchers have explored
the feasibility and performance of a myoelectric cursor control for amputees with the help of a myoelectric armband
[
31
]. However, before the device could be used for mouse cursor control, the users had to go through a training phase
for device calibration and preparation for the subsequent test phase, aided by a guided UI-based calibration method.
For making computers accessible to people with high-level spinal cord injury, researchers in [
64
] have proposed two
cursor control methods, auto rotate and manual rotate, using a single-site surface EMG sensor. However, the proposed
method requires the usage of disposable Ag/AgCl center snap electrodes, which makes it a hindrance for daily tasks.
The aforementioned work was evaluated through a pointing task-based experiment utilizing Fitts’ law.
EMG signals are susceptible to external noises and are highly dependent on the exact and accurate placement of
electrodes [
18
] for accurate gesture recognition. One of the inherent problems of EMG technology is that the retrieved
signals are typically weaker and vary from person to person [
79
], thereby, requiring a user-specic device calibration
and gesture recognition, every time a user intends to use it as an AMC. Although deep learning techniques [
13
] have
been proposed for mitigating the need for user-specic device calibration and gesture recognition, the computational
expense for fullling the simple objective of an AMC seems unreasonable.
2.3 Electrooculogram (EOG)-based AMCs
An Electrooculogram (EOG) is used to measure the corneal-retinal Transepithelial Potential Dierence (TEPD) with
the help of noninvasive electrodes placed around the human eyes. TEPD is produced due to horizontal and vertical
movements of an eye [
17
,
19
,
80
], which can be utilized to implement mouse control and clicking mechanisms. However,
TEPD is likely to uctuate in dierent lighting conditions, making light adaptation and training an integral part of
EOG-based AMCs. EOG-based AMCs that leverage eye movements to extract relative gaze position on the screen have
been proposed [
41
,
47
,
50
,
82
,
87
], facilitating interaction with a computer for people suering from neurodegenerative
disorders. To facilitate typing through recognition of eye movement patterns, real-time EOG-based systems have been
developed [
12
,
21
,
29
,
42
,
63
,
89
] for people with ALS, which is a neurodegenerative disorder that does not aect the
brain functions or the eye movements. Such nature of the disease makes EOG-based systems best suited for people
suering from it [9,19].
Although EOG is a promising low-cost AMC technology that is still being researched, it is limited by its low spatial
resolutions, as it is dicult to estimate the absolute gaze position due to noise from nearby sources of bio-potentials
[
12
,
50
,
51
]. Apart from the high pre-processing complexities of EOG signals [
51
], their characteristics vary due to the
variation in the number, the type (dry or wet), the material, and the placement of electrodes [
29
,
42
,
46
,
50
,
51
,
63
].
Finally, from an ergonomic perspective, it is intuitive that continuous eye movements for controlling a mouse may pose
certain health issues, thereby, aecting the user’s performance and comfort.
2.4 Sensor-based Wearable AMCs
Apart from Vision, EOG, and EMG–based AMCs, sensor-based wearable AMC technologies have also been developed
for assisting people with upper limb disabilities, leveraging their residual motor functionalities as alternative input
modalities. Among these alternatives, head movement is a natural, eective, and the most common modality for moving
a cursor [
25
,
30
,
35
,
67
,
84
]. Other alternatives include but are not limited to tongue muscle movement [
56
], and Brain
Computer Interfaces (BCI) [57].
Manuscript submitted to ACM
摘要:

AuxilioandBeyond:ComparativeEvaluation,Usability,andDesignGuidelinesforHeadMovement-basedAssistiveMouseControllersMOHAMMADRIDWANKABIR∗,MOHAMMADISHRAKABEDIN∗,RIZVIAHMED,SAADBINASHRAF,HASANMAHMUD,andMD.KAMRULHASAN,DepartmentofComputerScienceandEngi-neering(CSE),IslamicUniversityofTechnology(IUT),Bangl...

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