Four studies describe the pointing performance of individuals with fine motor skills impairments. First, we describe the pointing performance of two individuals with Parkinsons disease via a sub-movement analysis and compare them with similar results found in the literature from young children and older able-bodied adults. The analysis suggests the need of an individual assessment of pointing difficulties and the personalization of the methods of assistance and motivates sub-sequent studies. Two experiments followed where we tested PointAssist, software that assists in pointing tasks by detecting difficulty through a sub-movement analysis and triggering help, with adjustments proposed to personalize the assistance provided. A within-subjects study with sixteen individuals with fine motor skills impairments resulted in statistically significant effects on accuracy using Friedman's test with (χχ/sup>(1) = 6.4, p = .011) in favor of personalized PointAssist. A five week longitudinal study with three participants with Cerebral Palsy and other fine motor skills impairments shows the long term effects of PointAssist. The longitudinal study logged real-world use of pointing devices validating the results for real-world interactions. PointAssist had statistically significant effect of reduced sub-movement length and speed with p < .00001 and p < .0002 respectively for one of the participants. These results suggest better motor control near a target and statistically significant results on the sub-movement duration confirmed this. Finally, we designed, developed and tested a new assistive technology for individuals with severe motor skills impairments that we call the Reverse Funnel. Three participants, two with Cerebral Palsy and one with an undisclosed disability, participated and positive early results are presented as well as future developments of the newly developed strategy.

The use of eye movements to interact with computers offers opportunities for people with impaired motor ability to overcome the difficulties they often face using hand-held input devices. Computer games have become a major form of entertainment, and also provide opportunities for social interaction in multi-player environments. Games are also being used increasingly in education to motivate and engage young people. It is important that young people with motor impairments are able to benefit from, and enjoy, them. This thesis describes a program of research conducted over a 20-year period starting in the early 1990's that has investigated interaction techniques based on gaze position intended for use by people with motor impairments. The work investigates how to make standard software applications accessible by gaze, so that no particular modification to the application is needed. The work divides into 3 phases. In the first phase, ways of using gaze to interact with the graphical user interfaces of office applications were investigated, designed around the limitations of gaze interaction. Of these, overcoming the inherent inaccuracies of pointing by gaze at on-screen targets was particularly important. In the second phase, the focus shifted from office applications towards immersive games and on-line virtual worlds. Different means of using gaze position and patterns of eye movements, or gaze gestures, to issue commands were studied. Most of the testing and evaluation studies in this, like the first, used participants without motor-impairments. The third phase of the work then studied the applicability of the research findings thus far to groups of people with motor impairments, and in particular,the means of adapting the interaction techniques to individual abilities. In summary, the research has shown that collections of specialised gaze-based interaction techniques can be built as an effective means of completing the tasks in specific types of games and how these can be adapted to the differing abilities of individuals with motor impairments.

Les incapacités motrices lourdes engendrent des situations de handicap au cours desquelles l’autonomie du corps et du sujet sont bousculées. Les attendus et les évidences du corps valide sont suspendus. Ne pouvant plus agir directement sur elle-même ou sur son environnement, la personne en situation de handicap doit passer par l’intermédiaire d’un dispositif d’aide polymorphe constitué à la fois d’aides humaines et techniques. Au cours de chacune des interactions avec ce dispositif, les limites entre soi et l’autre, entre l’intérieur et l’extérieur, se brouillent.A partir de trois enquêtes ethnographiques réalisées auprès de personnes en situation de handicap vivant à domicile, la recherche doctorale a pour objet l’analyse de cette expérience corporelle. Dans une première partie, la thèse montre que la singularité de cette expérience repose sur le principe d’une distribution du corps, alternant entre déconstruction de soi et renégociations empiriques des frontières à partir de la définition d’une intimité. La recherche distingue ensuite trois formes possibles d’une existence au quotidien avec des incapacités motrices. Chacune d’entre elles se traduit par unedistribution singulière des frontières de l’identité / Severe motor impairments generate disability situations in which the autonomy of body and of the subject are disrupted. Expectations and taken-for-granted attitudes regarding the valid body are challenged. No longer in capacity to act directly on themselves or on their environment, persons with disabilities must interact with polymorphic help devices consisting of both human and technical aids. In these interactions, limitations between self and others or between inside and outside are blurred.Based on three ethnographic studies conducted with persons with disabilities living at home, the doctoral research aims at analyzing their specific corporal experience. The first part of the dissertation analyzes the experience of people with severe motor impairments as an experience of a distributed body, alternating between self-destruction and empirical negotiations of body frontiers with reference to intimacy. The second part distinguishes three forms of the experience of everyday life with severe motor impairments, which result in different distributions of the frontiers of self

Assessment in patients with NMD consists principally of measures of motor impairment since they are well known by clinicians and their measures do not require much equipment. The conventional treatments in patients with NMD are above-all focused on the diminution of motor impairments by maintaining or improving joint mobility, muscle strength and endurance. Nevertheless, a reduction of motor impairments does not directly lead to a higher ability in performing daily activities. Therefore, activity limitations should be measured specifically. A new scale of activity limitations was first developed in children and adults with NMD. The use of the Rasch model provided a scale to assess the fundamental psychometric qualities. Secondly, relationships between motor impairments and activity limitations were investigated to verify the assumption that reduced motor impairments do not necessarily lead to higher activity levels. Finally, to complete the investigation of psychometric qualities, a longitudinal study of the developed questionnaire was carried out to evaluate its sensitivity to change. Chapter 1 presents the development of ACTIVLIM, a Rasch-built measure of activity limitations and its validation in children and adults with NMD. ACTIVLIM is a self-reported questionnaire that assesses the difficulties adult patients and parents of affected children perceive when they or their children perform daily activities. This questionnaire originally included 126 daily activities and was submitted to 369 patients. The Rasch model selected 22 daily activities to define a linear and unidimensional measure of activity limitations in patients with NMD. The validity and the reproducibility of the results were also studied. A second section of Chapter 1 demonstrates why the measure of activity limitations in children with NMD as assessed using the ACTIVLIM questionnaire is based upon the perception of their parents. A third section of Chapter 1 compares the difficulties self-perceived by the patients with the difficulties observed by external examiners. The agreement between both measures is very good, indicating that the use of ACTIVLIM as a self-reporting questionnaire is a valid method to assess activity limitations in patients with NMD. Chapter 2 investigates the relationships between motor impairments and activity limitations as measured with the ACTIVLIM questionnaire. As the anatomical basis and pathophysiology are different from one NMD to another, the relationships between impairments and activity limitations were investigated in six main diagnostic groups and in the whole sample without diagnostic distinction. Gait speed and muscle weakness in proximal and flexor muscle groups were significantly but moderately correlated to the activity limitations, indicating that the latter cannot simply be inferred from motor impairments but should be independently measured and treated. Chapter 3 investigates the sensitivity to change of the ACTIVLIM questionnaire. As NMD are progressive disorders, it is important that the ACTIVLIM questionnaire be able to assess the change over time in the activity level of patients with NMD in order to characterize the disease course and to quantify the effects of new treatments on activity limitations in these patients. Finally, the last section discusses the results of the different chapters and presents perspectives for future research.

Depuis son apparition à la fin de la seconde guerre mondiale, la pratique sportive des personnes atteintes de déficiences motrices a connu de nombreuses et rapides évolutions. Conçue initialement dans une logique rééducative, elle intègre de plus en plus le principe de performance en se rapprochant du mouvement sportif « ordinaire ». Toutefois, ce processus de sportivisation est variable selon l'espace social et culturel dans lequel il se réalise. Initié dans les années 1970, le mouvement handisportif guadeloupéen rencontre des difficultés récurrentes à s'organiser et à se fédérer. Au cours de ce travail, nous avons réalisé une enquête de terrain auprès des associations handisportives locales. Des entretiens avec les acteurs principaux de ce mouvement ont été menés, des archives recueillies et des observations directes et participantes effectuées afin de retracer l'histoire collective et de repérer les logiques individuelles mobilisées dans la structuration du mouvement handisport en Guadeloupe. Pour cela nous avons utilisé des outils de la socio-histoire et de l'analyse organisationnelle et traité les discours à partir d'une analyse des relations par opposition (ARO). Les principaux résultats mettent en évidence que les dynamiques associatives structurant la pratique sportive des personnes handicapées motrices en Guadeloupe sont imprégnées par une logique sportive doublée d'enjeux sociaux, culturels et identitaires. Ainsi, la thèse principale défendue au terme de cette recherche est que l'organisation du mouvement handisport en Guadeloupe est marquée par des stratégies fortement contextualisées où la conjugaison des identités – sportive, antillaise, de personne handicapée - produit des ajustements singuliers. / Since its apparition at the end of the second world word, the practice of sport for people suffering with motor deficiency has known numerous and quick evolutions. Initially conceived in the science of rehabilitation therapy, it now integrates more and more the principle of performance by getting closer to “ordinary” sport movements. However, this process of sportivisation is variable depending on the social and cultural context in which it is taking place. Initiated at the start of the 1970's, Guadeloupe's Movement for Sport for People with motor impairments has been meeting recurring difficulties in how to organise and federate itself. During this work, we have conducted a survey directly with the local disabled sport associations. Meetings with the principal actors of this movement had been taking place, archives had been gathered and both direct and participative observations had been carried out in order to retrace the collective history and to identify the individual theories utilised in the formation of Guadeloupe's Movement for Sport for Disabled People. For this we have used the tools of the socio-history and of the organizational analysis and handled the speeches with an analyse of the relationship by opposition (ARO). The main results bring to light that the associative dynamics which structure the sport practices of Guadeloupe's disabled people are impregnated by a sport logic combined with social, cultural and identity stakes. Therefore the principal thesis defended in the process of the research is that the organisation of Guadeloupe's Movement for Sport for Disabled People is impregnated by the highly contextual strategies where the identities -sport, Caribbean, disabled- produces some very particular adjustments.

Submitted by Maria Aparecida (cidazen@gmail.com) on 2017-04-26T12:29:41Z No. of bitstreams: 1 Bruno Araújo Serra Pinto.pdf: 5546725 bytes, checksum: 07839b14efcc510ac5ecfa62b980626e (MD5) / Made available in DSpace on 2017-04-26T12:29:41Z (GMT). No. of bitstreams: 1 Bruno Araújo Serra Pinto.pdf: 5546725 bytes, checksum: 07839b14efcc510ac5ecfa62b980626e (MD5) Previous issue date: 2017-04-07 / FAPEMA / Background: The epidemiological rise of metabolic syndrome (MS) is directly related to the exponential increase of added sugar consumption. Studies describes that MSmetabolic disorders, mainly insulin resistance and obesity, are related to development of oxidative stress, cognitive declines and dementias, and neuronal senescence acceleration. Even with several evidences correlating MS to neuronal damage, the molecular mechanisms involved are still unclear, and the endoplasmic reticulum stress (ER stress), in this context, could be placed like an intermediary condition that interconnects those morbidities. Objective: To investigate the deleterious effects of hippocampal ER stress about progression of cognitive, behavioral and motor declines in rats with metabolic syndrome-induced by sucrose-rich diet in different ages. Methods: Weaned Wistar rats were divided into 4 groups: two control groups (CTR, n = 7-9), fed a standard diet and followed up to 3 and 6-months-old, respectively; and two obese groups (HSD, n = 7), fed a sucrose-rich diet (25% sucrose) followed by the same periods. Was assessed in these groups: MS development; redox profile; Cognitive, behavioral and motor functions; And the hippocampal gene/protein expression of UPR sensors (Ire1α, Perk and Atf6), chaperones (Grp78, Grp94, Pdi, Calnexin and Calreticulin), neuronal plasticity (Bdnf), antioxidant defense (Nrf2), apoptosis (Bcl2, Chop and Parp-1) and senescence (p53 and p21). For aging control, rats at 20 months of age (OLD, n = 7) fed standard chow were included as aging control for gene/protein expression and neurological assessments. Results: The sucrose-rich diet was successful in establish the SM-phenotype. At 3 months, we observed central obesity even with lower energy intake, fasting and fed dysglycemia, hypertriglyceridemia, hapatic ectopic fat deposit, decreased lipolysis rates, glucose intolerance and hepatic insulin resistance. In unpublished data, we observed mild lipid peroxidation without exepressive antioxidant enzymes activity, and absence of peripheral insulin resistance. In animals with 6 months, we observed a deepening of metabolic dysfunctions encountered in 3-months-old. In addition we observed weight gain, free fatty acids, hyperinsulinemia, peripheral insulin resistance, increased lipid peroxidation, higher SOD, CAT and GPx reduction activity in 6-months-old rats. The lipolysis rate wasn't performed. Regarding the neurofunctional assessment at 3-months-old, the animals presented motor deficit and anxiogenic behavior, however without cognitive dysfunctions. In 6-months-animals, we observed anxiogenic behavior and important motor and cognitive impairments (learning and memory), similar to OLD group. Hippocampal molecular analysis revealed a different signaling between HSD groups of 3 and 6-months. In HSD at 3 months, we observed a switch-over from UPR-adaptive to pro-apoptotic signaling, marked by increased gene expression of Perk, Atf6 and Pdi A2 (adaptive), reduction of Grp78 and Bcl2, and increases of Chop and Caspase 3 (Apoptotic). In 6-months-HSD, we observed a complete failure of UPR adaptive signaling (UPR sensors and chaperones) and increased apoptotic signaling, featured by Bcl2 reduction and increased gene/protein expression of Chop. Additionally, we observed a reduction in the Bdnf gene expression and protein cleavage of Parp-1 compatible to calpain presence (necrosis/apoptosis marker). The expressions found in the 6-month-HSD were similar to OLD group, but the cell death markers (Chop and Calpain) were found only in HSD. As expected, senescence markers (p53 and p21) were increased in the OLD group and only p21 shown increased in HSD. Conclusions: Our data set supports that prolonged exposure to sucrose-rich diet promotes SM and oxidative stress, which disrupt hippocampal ER homeostasis, leading to senescence acceleration and cell death, and subsequently leads to severe cognitive, behavioral and motor impairments. / Introdução: O crescimento epidemiológico da síndrome metabólica (SM) está diretamente relacionado ao exponencial aumento do consumo de açucares de adição. Estudos descrevem que as desordens metabólicas que compõem a SM, principalmente a resistência insulínica e obesidade, estão relacionadas ao desenvolvimento de estresse oxidativo, declínios cognitivos, demências e aceleração da senescência neuronal. Mesmo com diversas evidências correlacionando a SM a danos neuronais, os mecanismos moleculares envolvidos ainda não são totalmente conhecidos. Neste contexto, o estresse do retículo endoplasmático (ERE) pode ser apontado como uma condição intermediária que interconecta estas morbidades. Objetivo: Investigar os efeitos deletérios do ERE hipocampal sobre a instalação de declínios cognitivos, comportamentais e motores em ratos com síndrome metabólica induzida por dieta rica em sacarose em diferentes faixas etárias. Métodos: Ratos Wistar com 21 dias de vida (desmame) foram divididos em 4 grupos: dois grupos controle (CTR, n = 7-9), alimentados com uma dieta padrão e acompanhados até os 3 e 6 meses de idade, respectivamente; e dois grupos obeso (HSD, n = 7), alimentados com dieta rica em sacarose (sacarose a 25%) acompanhados pelos mesmos períodos. Foi avaliado nos grupos: desenvolvimento de SM; perfil redox; funções cognitivas, comportamentais e motoras; e expressão gênica/proteica hipocampal de sensores da UPR (Ire1α, Perk e Atf6), chaperonas (Grp78, Grp94, Pdi, Calnexina e Calreticulina), plasticidade neuronal (Bdnf), defesa antioxidante (Nrf2), apoptose (Bcl2, Chop e Parp-1) e senescência (p53 e p21). Como um controle de envelhecimento, ratos com 20 meses de idade (OLD, n = 7) alimentados com dieta padrão foram incluídos aos experimentos de expressões gênica/proteica e avaliações neurológicas. Resultados: A dieta rica em sacarose teve sucesso em estabelecer o fenótipo de SM. Com 3 meses, o grupo HSD desenvolveu obesidade central mesmo com menor ingestão energética, disglicemia em estados de jejum e alimentado, hipertrigliceridemia, acúmulo de gordura ectópica hepática, diminuição da taxa de lipólise, intolerância à glicose e resistência hepática à insulina. Em dados não publicados, observamos discreta peroxidação lipídica sem expressiva atividade de enzimas antioxidantes e sem resistência insulínica periférica. Nos animais com 6 meses, observamos um aprofundamento das disfunções metabólicas dos animais de 3 meses. Adicionalmente, observamos ganho de peso, ácidos graxos livres, hiperinsulinemia, resistência insulínica periférica, maior peroxidação lipídica, maior atividade das enzimas SOD, CAT e redução da GPx. No que se refere à avaliação neurofuncional, aos 3 meses de idade, o grupo HSD apresentou déficit motor e comportamento ansiogênico, no entanto sem disfunções cognitivas. Contudo, nos animais de 6 meses observamos comportamento ansiogênico e importantes prejuízos motores e cognitivos (aprendizado e memória), semelhantes ao grupo OLD. A análise molecular hipocampal evidenciou uma sinalização diferente entre os grupos HSD de 3 e 6 meses. No HSD com 3 meses, observamos uma transição da sinalização adaptativa da UPR para a pró-apoptótica, marcada pelo aumento das expressões gênicas de Perk, Atf6 e Pdi A2 (adaptativa), redução da Grp78 e aumento da Chop e Caspase 3 (apoptótica). No HSD de 6 meses, observamos uma falência total da sinalização adaptativa da UPR (sensores da UPR e chaperonas), e aumento da sinalização apoptótica, caracterizada pela redução do Bcl2 e aumento da expressão gênica/proteica de Chop. Adicionalmente, observamos também redução da expressão gênica do Bdnf, redução da expressão proteica de Grp94 e clivagem proteica do Parp-1 compatível com a presença de Calpaína (marcador de necrose/apoptose). As expressões encontradas no HSD de 6 meses foram semelhante as alterações observadas no grupo OLD, mas os fatores de morte celular (Chop e Calpaína) foram encontrados apenas no HSD. Como esperado, os marcadores de senescência (p53 e p21) estavam aumentados no grupo OLD e apenas o p21 se mostrou aumentado no HSD. Conclusões: Nosso conjunto de dados apoia que a exposição prolongada à dieta rica em sacarose promove SM e estresse oxidativo, que perturba a homeostase do RE hipocampal, acarretando aceleração da senescência e morte celular, e subsequentes prejuízos cognitivos, comportamentais e motores.

Pessoas com tetraplegia possuem controle sobre poucas partes do corpo, por isso têm grande dificuldade de interação com o mundo ao seu redor. Interfaces humano-computador que utilizam a capacidade de controle muscular remanescente podem promover um acréscimo importante na autonomia do usuário com tetraplegia. Uma nova forma de interação com o computador é proposta: controle de um dispositivo de entrada por meio do lábio inferior. A ideia não foi partir da tecnologia e agregar recursos, mas sim, partir da pessoa e entender suas necessidades e potencialidades para pesquisar, propor, desenvolver e avaliar alternativas tecnológicas. Com o intuito de investigar se o lábio inferior seria capaz de controlar uma interface de maneira eficiente e precisa, foram desenvolvidos protótipos de um dispositivo de entrada vestível que pudesse ser acionado pelo lábio. Considerando o estado da arte, foi avaliada a capacidade do lábio inferior controlar esta interface proposta como um mouse de computador. Também foi realizada a comparação do controle pelo lábio inferior e pelo polegar utilizando o mesmo dispositivo sob as mesmas condições. O objetivo foi estabelecer referências sobre a capacidade do lábio inferior de controlar uma interface. Foram realizados e analisados os resultados de testes com sujeitos de pesquisa, mensurando e comprovando a capacidade tanto do lábio inferior, como parte do corpo capaz de controlar um dispositivo de entrada, quanto do próprio dispositivo. / People with tetraplegia control few body parts; therefore, they have great difficulty to interact with the environment. Human-computer interfaces that explore the residual muscular control capacity can provide the user with tetraplegia with an important autonomy increase. I propose a new form of interaction, a input device controlled by the lower lip. The idea was not starting from the technology and aggregate resources, but starting from the user needs to research, to propose, to develop and to evaluate technological alternatives. In order to investigate the lower lip ability to efficiently and precisely control an input device, prototypes of a wearable device were developed. I presented an evaluation of the lower lip potential to control a pointing input device, according to the state of the art. The lower lip throughput was compared with the thumb throughput using the same input device under the same conditions. The objective was to establish the baseline for future researches about the lower lip capacity to operate a computer pointing device. The results proved and measured the capacity of the interface as well as the lower lip as a body part able to control a input device.

Pessoas com tetraplegia possuem controle sobre poucas partes do corpo, por isso têm grande dificuldade de interação com o mundo ao seu redor. Interfaces humano-computador que utilizam a capacidade de controle muscular remanescente podem promover um acréscimo importante na autonomia do usuário com tetraplegia. Uma nova forma de interação com o computador é proposta: controle de um dispositivo de entrada por meio do lábio inferior. A ideia não foi partir da tecnologia e agregar recursos, mas sim, partir da pessoa e entender suas necessidades e potencialidades para pesquisar, propor, desenvolver e avaliar alternativas tecnológicas. Com o intuito de investigar se o lábio inferior seria capaz de controlar uma interface de maneira eficiente e precisa, foram desenvolvidos protótipos de um dispositivo de entrada vestível que pudesse ser acionado pelo lábio. Considerando o estado da arte, foi avaliada a capacidade do lábio inferior controlar esta interface proposta como um mouse de computador. Também foi realizada a comparação do controle pelo lábio inferior e pelo polegar utilizando o mesmo dispositivo sob as mesmas condições. O objetivo foi estabelecer referências sobre a capacidade do lábio inferior de controlar uma interface. Foram realizados e analisados os resultados de testes com sujeitos de pesquisa, mensurando e comprovando a capacidade tanto do lábio inferior, como parte do corpo capaz de controlar um dispositivo de entrada, quanto do próprio dispositivo. / People with tetraplegia control few body parts; therefore, they have great difficulty to interact with the environment. Human-computer interfaces that explore the residual muscular control capacity can provide the user with tetraplegia with an important autonomy increase. I propose a new form of interaction, a input device controlled by the lower lip. The idea was not starting from the technology and aggregate resources, but starting from the user needs to research, to propose, to develop and to evaluate technological alternatives. In order to investigate the lower lip ability to efficiently and precisely control an input device, prototypes of a wearable device were developed. I presented an evaluation of the lower lip potential to control a pointing input device, according to the state of the art. The lower lip throughput was compared with the thumb throughput using the same input device under the same conditions. The objective was to establish the baseline for future researches about the lower lip capacity to operate a computer pointing device. The results proved and measured the capacity of the interface as well as the lower lip as a body part able to control a input device.

The thesis research aims to further the study of human-robot interaction (HRI) issues, especially regarding the development of an assistive robot designed to help individuals possessing motor impairments. In particular, individuals with amyotrophic lateral sclerosis (ALS), represent a potential user population that possess an array of motor impairment due to the progressive nature of the disease. Through review of the literature, an initial target for robotic assistance was determined to be object retrieval and delivery tasks to aid with dropped or otherwise unreachable objects, which represent a common and significant difficulty for individuals with limited motor capabilities. This thesis research has been conducted as part of a larger, collaborative project between the Georgia Institute of Technology and Emory University. To this end, we developed and evaluated a semi-autonomous mobile healthcare service robot named EL-E. I conducted four human studies involving patients with ALS with the following objectives: 1) to investigate and better understand the practical, everyday needs and limitations of people with severe motor impairments; 2) to translate these needs into pragmatic tasks or goals to be achieved through an assistive robot and reflect these needs and limitations into the robot's design; 3) to develop practical, usable, and effective interaction mechanisms by which the impaired users can control the robot; and 4) and to evaluate the performance of the robot and improve its usability. I anticipate that the findings from this research will contribute to the ongoing research in the development and evaluation of effective and affordable assistive manipulation robots, which can help to mitigate the difficulties, frustration, and lost independence experienced by individuals with significant motor impairments and improve their quality of life.

Many individuals with severe motor impairments are cognitively capable, but because of their physical impairments, unable to express their intention through conventional means of communication. Access technologies are devices that attempt to translate the intention of these individuals into functional activity by harnessing their residual physical or physiological abilities. The primary objective of this thesis was to design and develop a novel non-invasive and non-contact access technology based on infrared thermal imaging. This access technology translates the local temperature change associated with voluntary mouth opening to activation of a binary switch such as a mouse click or key press. To this end, an algorithm based on motion and temperature analyses, and morphological and anthropometric filters was designed to detect mouth opening activity in thermal video in real-time. The secondary objective of this thesis was to introduce a mutual information measure for objective assessment of binary switch users’ performance. A model was suggested, in which combination of cognitive and physical abilities of the human user of a binary access switch constitute a communication channel. The proposed mutual information measure estimates the rate of information transmission in the ‘human communication channel’ during stimulus response tasks. Using this measure, in a study with ten able-bodied participants, the infrared thermal switch was validated against a conventional chin switch. Impairments in body functions and structures that may contraindicate the use of the infrared thermal switch were explored in a study with seven clients, with severe disabilities. Potential hard and soft technological solutions to mitigate the effect of these impairments on infrared thermal switch use were recommended. Finally the infrared thermal switch was tailored to meet the needs of a young man with severe spastic quadriplegic cerebral palsy, who had no other means of physical access.