Insights from Eye-Tracking Technology in Infants with or at Risk of a Motor Disability: A Systematic Review

Abstract

Highlights What are the main findings? Eye-tracking can measure how infants, with or at risk of motor disabilities, interact with the world, including their attention, learning, and early communication skills. Infants at risk of a motor disability (e.g., preterm or with brain injury) often show slower visual responses and differences in attention, which may be detected using eye-tracking technology, even when standard clinical tests appear normal. What are the implications of the main findings? Eye-tracking could be a useful early detection tool to identify developmental delays, allowing earlier and more targeted support for infants at risk. There is a need for more consistent and standardized ways of using eye-tracking technology, so results can be compared and applied more reliably. Abstract Background/Objectives: Limited evidence exists on the use of eye-tracking technology in infants with disabilities, particularly with motor disabilities. This systematic review examines the eye-tracking metrics, protocols, and feasibility of eye-tracking technology in infants at risk or with a motor disability. Method: This systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD42024563282). PubMed, Web of Science, CINAHL, ERIC, Embase, Scopus, MEDLINE, and the Tobii database were systematically searched, with two independent reviewers screening studies, extracting data, and assessing methodological quality using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and Standard Quality Assessment Criteria. Results: A total of 15 studies were included with a total sample size of 667 (range 1–123), including 341 boys, 306 girls, and 20 infant genders unreported (M = 10.8 months; SD = 4.8; range 4–24 months). The infants included had brain injury as seen via MRI (4 studies), cerebral palsy (4 studies), or were born very preterm with varying risk factors (7 studies). In these studies, eye-tracking technology provided an objective measure of gaze patterns, gaze duration, fixation frequency, visual assessments, and saccades. Despite Tobii being the most common eye-tracking technology used, protocols varied by study design, duration, stimuli, metrics reported, and settings, making standardization challenging. Conclusions: Eye-tracking technology provides objective eye-tracking metrics that may be used to assess infant development. However, given the heterogeneity of studies, future research should follow standardized stimuli, protocols, and include diverse populations to make definitive conclusions and implications.