Wearable Eye Tracking During Bimanual Tasks in Children With Cerebral Palsy

Establishing a Wearable Eye-Tracking Protocol and Candidate Gaze-Action Metrics for Goal-Directed Bimanual Task Performance in Children With Cerebral Palsy

This observational pilot study will include 40 children and adolescents aged 6 to 12 years: 20 with cerebral palsy and 20 with typical development. The main purpose is to determine whether Pupil Labs Neon wearable eye-tracking glasses can be used reliably while participants perform structured tasks using both hands.

Each participant will attend one study visit. After assessments of near vision, hand function, visual perception, visual-motor function, and attention-related characteristics, participants will wear the eye-tracking glasses. They will view an instruction card, find target objects, and place the objects into boxes using both hands. The tasks will be completed under three conditions that vary visual-search and sequencing demands, with breaks provided as needed.

Researchers will evaluate whether the planned procedures can be completed and whether the recordings provide usable eye-tracking data. Exploratory analyses will examine how gaze and hand actions are coordinated and whether these patterns differ between the cerebral palsy and typical-development groups or across task conditions. No treatment will be provided, and the study is not designed to evaluate treatment effectiveness. The findings will be used to improve the measurement protocol and quality-control procedures for future research.

Inclusion Criteria

General Inclusion Criteria

Children aged 6-12 years

• Ability to understand simple instructions required for the study procedures and perform structured visual and bimanual tasks
• For children who routinely wear glasses or contact lenses, ability to view near visual stimuli and task materials with their habitual vision correction
• Written informed consent provided by a parent or legally authorized representative, with the child providing assent after receiving an age- and developmentally appropriate explanation of the study

Cerebral Palsy Group

• Diagnosis of cerebral palsy confirmed by a pediatric physiatrist
• Manual Ability Classification System (MACS) level I-III
• Ability to grasp or manipulate task materials with at least one hand and attempt bimanual task performance

Typically Developing Group

• Typical developmental history based on parent report and confirmation by the research team
• No history of neurological disorders, including cerebral palsy, or musculoskeletal conditions affecting upper-limb function
• No diagnosis of a neurodevelopmental disorder that may affect task performance, such as attention-deficit/hyperactivity disorder, autism spectrum disorder, or intellectual disability

Exclusion Criteria

• Visual impairment that prevents the child from adequately viewing near visual stimuli or task materials, even with habitual vision correction
• Severe strabismus, nystagmus, or another ophthalmologic condition judged likely to substantially compromise stable eye-tracking data collection
• Severe cognitive, communication, or behavioral difficulties that prevent adequate understanding or performance of the study tasks
• Severe upper-limb joint contracture, pain, fracture, or another musculoskeletal condition that prevents safe performance of the bimanual tasks
• Uncontrolled epilepsy, acute illness, unstable medical condition, or any other condition judged to make study participation unsafe