Mobility Through the Eyes: The Innovation Behind Ability Dr…

Dec 22/Jan 23 Closing The Gap Solutions - Collaborating With Augmentative and Alternative Communication (AAC) Users Gains A New Perspective To Best Support Clients By Lydia Dawley

mobility, mounting, seating & positioning

Mobility Through the Eyes: The Innovation Behind Ability Drive®

The ADT is the “Bridge” between the eye-gaze device and the powered wheelchair.

Summary : This article explores the development, technology, and real-world impact of Ability Drive®, an eye-gaze-pow- ered wheelchair system. It begins with the clinical foundation for alternative drive controls, then explains how the system works and highlights safety features and customization. The importance of independent seating adjustments is also ad- dressed. Through user stories and caregiver insights, the article illustrates the system’s life-changing effects and concludes with practical guidance on access, support, and funding.

WHY EYE-GAZE MATTERS: THE CASE FOR ALTERNA- TIVE DRIVE CONTROLS Approximately 10% of powered wheelchair users depend on alternative drive controls—such as sip-and-puff systems, head arrays, chin controls, or eye-gaze interfaces—because they can- not operate a traditional joystick (Borg et al., 2021; Fehr et al., 2000). Clinical research and field-based evaluations continue to demonstrate the value of these technologies in providing es- sential access and mobility for people living with complex phys- ical disabilities (Andrich et al., 2013; Wand et al., 2019).

Imagine navigating your world with only your eyes, turning toward a friend, moving from the kitchen to the living room, or tilting back to relieve pressure. For individuals who can no longer use their hands, these everyday actions aren’t simple gestures; they’re milestones of independence. That’s what Abil- ity Drive® makes possible. Using eye-tracking technology, it en- ables users with severe motor impairments to drive a powered wheelchair, adjust seating positions, and reclaim autonomy over their environment. For those living with ALS, cerebral palsy, spinal cord injuries, and other complex conditions, it’s not just about movement, it’s about choice, dignity, and participation.

AUSTIN HOWELL , earned his degree in Psychology from Calvin College, where he also studied Business and developed a person-centered approach to both work and life. This perspective continues to shape his role in Technical Support and Testing at Tolt Technologies, where he helps ensure the safety, reliability, and usability of assistive technologies like Ability Drive®. He is committed to advancing mobility justice through tools that promote independence and support individual autonomy. Austin is also motivated by a belief in idea meritocracy and a desire to improve systems, products, and businesses in ways that address real human needs. He lives in Duvall, Washington, and enjoys learning about emerging technologies and playing pickleball in his free time.

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A pilot study by Elliott et al. (2019) confirmed that individuals with amyotrophic lateral sclerosis (ALS) could safely and reliably navigate a powered wheelchair using only their eyes, reporting high satisfaction and usability. Building on this evidence, Tolt Technologies offers a commercially available solution through ongoing collaboration with durable medical equipment (DME) providers and Assistive Technology Professionals (ATPs). Sup- porting hundreds of Ability Drive® evaluations each year, we’ve seen firsthand how the system restores meaningful mobility to individuals with complex motor impairments. It enables them to navigate using what is often their last remaining voluntary movement: their eyes. THE TECHNOLOGY BEHIND ABILITY DRIVE Eye-gaze technology has emerged as a transformative ad- vancement in assistive technology, offering individuals with se- vere motor impairments an intuitive way to communicate, con- trol their surroundings, and be more mobile. These systems use infrared light to track eye movements with precision, projecting near-infrared light onto the eyes and capturing reflections with specialized cameras. By analyzing the corneal reflection and pu- pil position, the system calculates the user’s point of gaze in real

time (Tobii, 2022). For individuals who cannot use their hands or voice, including those with ALS, cerebral palsy, or spinal cord in- juries, eye-gaze provides a non-invasive, highly responsive input method for augmentative and alternative communication (AAC) devices, as well as for operating powered wheelchairs and oth- er essential assistive tools. This combination of communication and control restores significant autonomy and personal agency in everyday life (Majaranta & Räihä, 2002; Ates et al., 2021). Ability Drive® converts eye movement into functional mobili- ty through an integrated system of five components: (1) the Abil- ity Drive® app, which displays a forward-facing camera view with a semi-transparent directional button overlay, allowing users to see both their controls and the path ahead; (2) the ADT (Ability Drive® hardware interface), a compact microcontroller that con- nects a compatible eye-gaze device to a powered wheelchair via an alternative drive input; (3) a supported eye-gaze device, such as a Tobii Dynavox I-Series, Smartbox GridPad, Tolt Technologies A13J, or other models listed on Tolt’s compatibility page; (4) a secure mounting system, like those from Mount’n Mover or Reh- adapt, to ensure proper positioning, visibility, and user comfort; and (5) a Class 3 powered wheelchair capable of supporting al- ternative drive inputs. Together with wheelchair programming

App settings menu where users can configure aspects of the drive screen .

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button, the system also stops the wheelchair under unexpected conditions, such as a disconnection between system compo- nents, like the ADT and eye-gaze device, or the eye-tracker and the app. In such cases, or whenever communication is lost be- tween the user’s eyes and the powered wheelchair, a stop com- mand is sent within a second, ensuring the chair comes to a safe stop as quickly as possible. In addition to the built-in safety controller in Ability Drive®, a "buddy button" or stop switch is recommended to power off the wheelchair, adding an extra layer of safety and allowing a care- giver or family member to stop the wheelchair manually in the event of an emergency. Together, these features provide a com- prehensive, fail-safe system that prioritizes user safety, giving in- dividuals the freedom to regain mobility without compromising their security. With over one million driving sessions completed, Ability Drive® systems have proven reliable, providing users with peace of mind and control while navigating with their eyes. Alternative profile programming on the power wheelchair also plays a role in safety, particularly in how the chair deceler- ates. ATPs should tailor drive profiles to match the user’s envi- ronment, familiarity with their chair, and level of experience with eye-gaze navigation. This is especially important when semi- latched mode is enabled, as it allows continuous movement be- tween commands and may require additional user training or clinician oversight. To ensure the reliability and safety of Ability Drive®, each app version undergoes rigorous testing through an iterative process. This meticulous approach identifies and resolves potential is- sues, ensuring a stable and dependable user experience. Rec- ognizing the diversity of assistive technology setups, extensive testing is also conducted across all compatible eye-gaze devic- es and their native software. This thorough evaluation ensures compatibility and optimal performance across different hard- ware configurations, reinforcing Tolt Technologies’ commitment to user safety. SEATING: RESTORING AUTONOMY IN DAILY POSITIONING While hands-free driving is the hallmark feature of Ability Drive®, its support for independent seating adjustment is equal- ly essential and frequently praised by users. With a simple ac- tivation of the mode button in the app, users can switch from drive mode to seating mode. This transition is confirmed on the power wheelchair’s OMNI2 or Enhanced Display, which visually highlights the section of the chair available for adjustment. Us- ers can scroll through seating options using the left and right arrows, then modify the selected section by gazing at the up or down arrows. Once the desired position is set, reactivating the mode button returns the system to drive mode. This functional- ity requires the mode button to be enabled, which can be done once the OMNI2 or Enhanced Display is properly mounted near the eye-gaze device and within the user’s line of sight.

App drive screen with semi-transparent button overlay.

by an ATP, these components allow users to navigate their envi- ronment safely and confidently using only their eyes While the Ability Drive® system includes several essential hardware components, the primary point of interaction for users is the software, the Ability Drive® app. Designed with a simple and intuitive interface, the app features two screens: the drive screen and the settings menu. On the drive screen, directional arrows activate instantly when looked at, enabling instinctive control of the powered wheelchair. Additional buttons—pause, settings, and mode switch—support essential non-driving func- tions. For users who demonstrate proficiency with eye-gaze navigation and a high level of driving skill, ATPs can choose to enable a semi-latched feature within the app. Semi-latched al- lows the chair to continue in the last selected direction as the user’s gaze moves between drive arrows until a new command is given, offering smoother, more fluid navigation. The settings menu allows users and clinicians to tailor the in- terface to individual needs and preferences, including options to toggle between forward or rear-facing camera views, adjust dwell-to-click timing for non-drive buttons, and customize but- ton appearance through contrast levels, sizes, layout configu- rations, and gaze dot visibility for tracking feedback. The mode button, which enables access to power seating adjustments, can also be turned on or off depending on user needs. These fea- tures deliver a personalized, responsive experience while pre- serving a simple, easy-to-use interface. SAFETY FIRST: A PRIMARY DESIGN PRINCIPLE Safety is at the forefront of Ability Drive®'s design, ensuring users can confidently operate their powered wheelchair with minimal risk. The system incorporates an advanced, patented safety mechanism (U.S. Patent No. 12,204,687) that quickly halts the wheelchair when certain conditions are met, preventing unintended movement. While users have the ability to stop the wheelchair by closing their eyes, looking off-screen, gazing in the margins between the drive buttons, or activating the pause

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home and make subtle, frequent adjustments like turning to face a conversation or looking out the window, actions that would have otherwise required assistance. He also operated his chair’s tilt, recline, and leg elevation functions, essential for comfort and health management. For Jan, the impact extended beyond Donnie’s autonomy; it eased her physical and emotional burden as a caregiver, giving her peace of mind and allowing others to engage with Donnie more directly. As she described, “It's all these little moments during the day... they make a huge difference for a caregiver” (J. Steinbock, personal communica- tion, May 8, 2024). The benefits of Ability Drive® are also evident in the expe- rience of Melissa Kelbley, a working professional in an office leadership role, living with type-2 spinal muscular atrophy. As her condition progressed, conventional driving systems like joysticks, mini-joysticks, and fiber-optic switches became less

App drive screen accessing seat functions via the mode switch.

This seamless integration allows users to reposition them- selves independently, enhancing comfort and autonomy with- out relying on caregiver assistance. That independence matters. Research shows that caregivers of individuals with severe motor impairments, especially those who are non-verbal, immobile, or have tracheostomies, face substantial physical and emotional strain. Tasks such as adjusting seating positions can be frequent, time-consuming, and interruptive to other responsibilities. Jones et al. (2012) found that dependence in daily activities like these contributes significantly to caregiver burden. Likewise, Rushton et al. (2017) reported that caregivers of powered wheel- chair users often experience psychological stress related to safe- ty concerns and the need for constant availability. Pousada et al. (2018) found that over 70% of caregivers supporting individuals with neuromuscular diseases experience burden that negatively affects their well-being. By enabling users to manage seating adjustments through eye-gaze alone, Ability Drive® reduces the frequency and urgen- cy of these caregiving tasks. The result is not only increased user independence, but also reduced caregiver workload, support- ing a more balanced and sustainable caregiving relationship. SUCCESS STORIES: WHERE THE RUBBER MEETS THE ROAD A powerful illustration of Ability Drive®’s impact comes from Donnie Graham, a former engineer who lived with ALS in Portland, Oregon. After becoming quadriplegic and reliant on non-invasive ventilation, Donnie adopted an early version of Ability Drive® in 2019 to regain control over his power wheel- chair using only eye-tracking. According to his wife and primary caregiver, Jan Steinbock, the technology provided more than just mobility. It restored a sense of independence and dignity in daily life. Using eye-gaze, Donnie was able to navigate their

Melissa Kelbley, an early adopter of Ability Drive.

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effective, limiting her independence and ability to work. Me- lissa recalled being hesitant at first but was quickly impressed: “Even in the clinic where I tried it, I was moving more freely than I had in years!” Ability Drive® enabled her to continue living in- dependently and leading her office team without relying on others for support. “I am able to operate as the lead in the office without the assistance of others for 95% of the work,” she said. For Melissa and her support network, the system reduced anx- iety and allowed her to engage more confidently in public and professional settings (Kelbley, personal communication, May 18, 2025). In Denmark, the transformative potential of Ability Drive® is also evident in the experiences of Tasja and Andreas, two indi- viduals whose lives have been changed by the technology. Tasja, the first person in Denmark with progressive generalized dys- tonia and cerebral palsy to independently control her powered wheelchair with her eyes, describes the experience as a “liber- ation.” Installed by Aabentoft at the end of 2023, Ability Drive® allowed her to move and reposition herself freely, enhancing her independence and quality of life: “I used to feel like my wheel- chair was a shackle, but Ability Drive® has taken that away” (A. Lund Kobberø, personal communication, May 5, 2025). Similarly, 17-year-old Andreas Witt Demant, who had long re- lied on a head-controlled 0/1 switch, found new excitement in independent driving. Prior to using Ability Drive®, driving was difficult and often led him to relinquish control to caregivers. With the new system, however, his desire to drive returned. “It’s so magical to see him whizzing around,” his parents shared. His curiosity blossomed, stopping to look at details others might pass by, exploring off-road, and taking full advantage of his en- vironment. The intuitive control and seamless integration with his communication device gave Andreas smoother movement and an easier everyday experience (Aabentoft, 2025).

Andreas Will Demant, in his home in Denmark.

YouTube Video - Andreas Will Demant, navigates his home in Denmark. https://www.youtube.com/watch?v=TNllEemo4HU

TECH SUPPORT: A PERSONAL NOTE As a technical support liaison, I work closely with clients, families, ATPs, and clinicians, and I’ve seen firsthand how Ability Drive® improves people’s lives in tangible ways. Whether it’s the relief of adjusting one’s own seating or the pride of navigating independently, these moments reflect more than just technical

YouTube Video - Tasja driving in the Aabentoft offices in Denmark. https://www.youtube.com/watch?v=d725PkX9h5U

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success; they represent freedom. Anything that lowers the bar- rier to autonomy and gives people the ability to move through the world on their own terms is deeply meaningful. That impact comes through clearly in how users and caregivers describe the difference Ability Drive® makes in their daily routines. I often hear from caregivers and family members as well, who appreciate what it means to have one less task to manage. When someone can reposition themselves or navigate their home without asking for help, it’s not just a technical win; it’s a mean- ingful shift in daily dynamics. It lightens the caregiver’s responsi- bilities and restores a sense of independence, comfort, and per- sonal agency for the user. These moments may seem small, but they add up to a substantial improvement in quality of life. Most of us take for granted how often we shift in our chairs or change posture throughout the day. For our users, being able to do that with their eyes brings back a feeling of normalcy and self-direc- tion, something many of us never have to think twice about. FACING COMPLEXITY, DELIVERING INDEPENDENCE Ability Drive® represents more than just a technological inno- vation, it’s a tool that restores independence, dignity, and choice to individuals with severe physical disabilities. By enabling users to control their power wheelchair with their eyes, Ability Drive® opens a path to greater mobility, self-determination, and partic- ipation in daily life and work. Developing and supporting a solution like Ability Drive® comes with significant challenges. Integrating an app with vari- ous eye-gaze devices, each with its own hardware, software, and calibration systems, requires extensive coordination and test- ing. The diversity of power wheelchair models, configurations, and alternative drive inputs adds yet another layer of variabili- ty. Working in the accessibility space means confronting these challenges head-on, often tailoring solutions to meet highly individualized needs. But it is precisely this complexity that makes the success of Ability Drive® so impactful. Every system delivered, every configuration solved, and every user who gains independence reflects the dedication behind the product. Despite these challenges, the system’s design prioritizes safe- ty, ease of use, and compatibility, backed by a rigorous testing process and personalized support from experienced distrib- utors. Whether a user is navigating independently for the first time or regaining mobility after years of dependence, Ability Drive® helps make those moments possible. COST, ACCESS, AND FUNDING The Ability Drive® hardware interface (ADT), which includes access to the app, has a manufacturer’s suggested retail price (MSRP) of $8,600. A complete system also requires a compatible eye-gaze device, mounting hardware, and a Class 3 powered wheelchair capable of alternative drive controls. To request a trial or purchase the system, individuals and clinicians should contact an authorized distributor listed at www.tolttechnologies.com.

Ability Drive® may qualify for reimbursement through insur- ance, disability grants, or nonprofit programs. Funding eligibil- ity varies by location and insurance provider, so we encourage clinicians and ATPs to explore local resources. Tolt Technologies is a woman-owned company committed to advancing indepen- dence through socially motivated innovation. With U.S.-based technical support and a focus on continuity of care, we’re proud to stand behind a solution that is helping people reclaim mobili- ty, dignity, and control, one eye movement at a time. REFERENCES: Andrich, R., Caracciolo, A., Rossi, S., & Spadaro, L. (2013). The role of assistive technology in supporting the mobility of people with severe disabilities. Disability and Rehabilitation: Assistive Technology, 8 (5), 393–400. https://doi.org/10.3109/17483107.2012.759636 Ates, S., Tuncer, S., Kose, H., & Akin, H. L. (2021). An eye-gaze controlled wheelchair with dynamic speed and direction adjustment. Assistive Technology, 33 (6), 361–369. https://doi.org/10.1080/10400435.2019.1676767 Borg, J., Smith, E., & Lindström, A. (2021). Assistive technology use is associated with lower age and better health in people with mobility impairments in three UK NHS Trusts. BMC Health Services Research, 21 , 878. https://doi.org/10.1186/s12913-021-06863-1 Elliott, M. A., Malvar, H., Maassel, L. L., Campbell, J., Kulkarni, H., Spiridonova, I., ... & Scanlan, J. M. (2019). Eye-controlled power wheelchair performs well for ALS patients. Muscle & Nerve, 60 (4), 393–399. https://doi.org/10.1002/mus.26655 Fehr, L., Langbein, W. E., & Skaar, S. B. (2000). Adequacy of power wheelchair control interfaces for persons with severe disabilities: A clinical survey. Journal of Rehabilitation Research and Development, 37 (3), 353–360. https://pubmed.ncbi.nlm.nih.gov/10917267/ Jones, B., Miller, S., & Green, T. (2012). The impact of dependence in activities of daily living on caregiver strain. Journal of Rehabilitation Research & Development, 49 (7), 1029–1038. Majaranta, P., & Räihä, K. J. (2002). Twenty years of eye typing: Systems and design issues. Proceedings of the 2002 Symposium on Eye Tracking Research & Applications , 15–22. https://doi.org/10.1145/507072.507076

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Pousada, T., Groba, B., Nieto-Riveiro, L., Pazos, A., Díez, E., & Pereira, J. (2018). Determining the burden of the family caregivers of people with neuromuscular diseases who use a wheelchair. Medicine, 97 (24), e11039. https://doi.org/10.1097/MD.0000000000011039 Rushton, P. W., Labbé, D., Demers, L., Miller, W. C., Mortenson, W. B., & Kirby, R. L. (2017). Understanding the burden experienced by caregivers of older adults who use a powered wheelchair: A cross-sectional study. Gerontology & Geriatric Medicine, 3 , 2333721417703736. https://doi.org/10.1177/2333721417703736 Silverstein, J. (2024, September 17). Inside the eye-tracking wheelchair improving quality of life. Mobility Management . https://mobilitymgmt.com/voices/inside-the-eye- tracking-wheelchair-improving-quality-of-life/ Steinbock, J. (2024). [Personal communication regarding Donnie Graham’s use of Ability Drive®]. Unpublished internal communication.

Tobii. (2022). Tobii PCEye: Technical specifications . Tobii Dynavox. https://www.tobiidynavox.com/

Wand, R., Huang, J., Liu, T., & Zhou, X. (2019). An eye-gaze controlled wheelchair for users with severe disabilities: A user-centered design and evaluation. Assistive Technology, 31 (3), 149–158. https://doi.org/10.1080/10400435.2018.14 58625 Aabentoft. (2025). Client testimonial and case information about Ability Drive® installation (H. Lund Kobberø, personal communication). Unpublished internal communication. Kelbley, M. (2025). [Personal communication regarding Ability Drive® use and impact]. Unpublished internal communication.

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