Evaluation of head orientation and neck muscle EMG signals as command inputs to a human-computer interface for individuals with high tetraplegia.

We investigated the performance of three user interfaces for restoration of cursor control in individuals with tetraplegia: head orientation, electromyography (EMG) from face and neck muscles, and a standard computer mouse (for comparison). Subjects engaged in a 2-D, center-out, Fitts' Law style task and performance was evaluated using several measures. Overall, head orientation commanded motion resembled mouse commanded cursor motion (smooth, accurate movements to all targets), although with somewhat lower performance. EMG commanded movements exhibited a higher average speed, but other performance measures were lower, particularly for diagonal targets. Compared to head orientation, EMG as a cursor command source was less accurate, was more affected by target direction and was more prone to overshoot the target. In particular, EMG commands for diagonal targets were more sequential, moving first in one direction and then the other rather than moving simultaneous in the two directions. While the relative performance of each user interface differs, each has specific advantages depending on the application.