“Low-Cost Webcam-Based Eye Tracking in ALS: A Clinical Case Series in Neurorehabilitation”

Introduction Amyotrophic lateral sclerosis is a progressive neurodegenerative disease characterized by severe motor impairment, leading to loss of speech and motor control. As it advances, patients develop communication limitations affecting autonomy and social participation. Eye-tracking technologies provide an alternative communication pathway through gaze control, partially restoring communication. Objective This study aimed to describe the implementation and perceived functional usefulness of webcam eye-tracking devices as assistive technology in adults with ALS. Methods A descriptive observational case series study was conducted based on the routine follow-up of 10 patients within the framework of standard clinical care at the institution. Participants, diagnosed with ALS at stages 3 and 4 of the King’s clinical scale, utilized webcam eye-tracking. Following a six-month monitoring period, functional perception and psychosocial impact were assessed using a 5-point Likert scale—across three dimensions: system agility, selection ease, and communication effectiveness—and the PIADS framework. Results User perception ( n = 10) showed a trend toward low-to-moderate satisfaction. While 40% and 30% reported moderate satisfaction with system agility and selection ease, respectively, 60% of participants struggled with selection accuracy. Conversely, communication effectiveness was highly polarized, with 20% finding the method highly effective for functional interaction. Psychosocially, individual subscale means from the PIADS framework demonstrated a predominantly neutral stabilization trend (50% for Competence, 70% for Adaptability, and 60% for Self-esteem), showing that the system effectively mitigated communicative isolation despite its inherent operational and hardware limitations. Conclusions Although webcam-based eye tracking represents a democratizing alternative for neurorehabilitation, its clinical viability is limited by technical latencies and selection inaccuracies. It is best utilized as a transitional tool rather than a permanent replacement for high-end devices, requiring specialized multidisciplinary support to be effective in real-world settings.