Wearable Interactions for Users with Motor Impairments: Systematic Review, Inventory, and Research Implications
Alexandru-Ionut Siean, Radu-Daniel Vatavu · 2021 · The 23rd International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS 2021) · doi:10.1145/3441852.3471212
Summary
This paper presents the first systematic literature review focused specifically on wearable interactions for users with motor impairments. The authors conducted a meta-analysis of 57 peer-reviewed scientific articles identified through searches of the ACM Digital Library, IEEE Xplore, and DBLP databases, following the PRISMA methodology for systematic reviews. Starting from 313 initial references, the authors applied rigorous screening and eligibility criteria to arrive at their final dataset of 57 papers published between 2005 and 2020. The scope was carefully defined around three requirements: the device must be worn or integrated into a worn item, it must enable direct or mediated interaction, and it must involve physical movement of a body part. This definition intentionally excluded brain-computer interfaces and eye gaze tracking systems, as these do not require motor abilities of large muscle groups and thus fall outside the accessibility challenges that wearable device designs currently impose. The review examined what categories of wearable devices have been studied for users with motor impairments and what types of interactions have been proposed for them. The authors catalogued the research contributions by type, finding that 89.5% involved empirical research and 71.9% produced artifacts, while other contribution types such as datasets, methodological advances, and theoretical work were rare or absent entirely. The analysis also examined user study practices, finding concerning patterns in participant recruitment and study design.
Key findings
The review reveals several significant gaps in the research landscape. Head-mounted displays for VR dominated the literature at 20.2% of devices studied, followed by headsets (12.2%), armbands (12.2%), and glasses (12.2%), while smartwatches appeared in just 5.4% of papers despite their massive consumer adoption. Only four papers addressed smartwatch input for users with motor impairments, and just one position paper discussed smart rings. Hand gestures were disproportionately represented as an input modality at 41.6%, compared to head gestures (23.4%), eye gaze (13.0%), and voice input (13.0%), with foot gestures and shoulder movements receiving minimal attention. The inventory of 92 distinct gesture commands compiled from the literature provides a comprehensive catalogue of finger, hand, head, shoulder, eye gaze, and foot interactions across various wearable device types. Critically, user study participation was low: studies involved a median of just 6.0 participants with motor impairments (mean 8.2), and 45.6% of the surveyed papers either did not conduct user studies or did not include participants with motor impairments at all. The most common conditions represented were cerebral palsy (30%), spinal cord injury (20%), muscular dystrophy, and multiple sclerosis. The authors propose the WISE framework identifying four future research directions: Wearable prototypes, Input modalities and interaction techniques, Studies with users with motor impairments, and Extension to other devices and smart environments.
Relevance
This review is essential reading for anyone designing wearable technology or gesture-based interactions that need to be accessible to people with motor impairments. The stark finding that mainstream wearables like smartwatches have received almost no accessibility research attention, despite billions of units shipped globally, highlights a critical gap between consumer technology adoption and accessibility research. The 92-gesture inventory serves as a practical reference for interaction designers working on wearable accessibility, showing which gestures have been validated with users who have motor impairments and which have only been tested with non-disabled participants. The WISE framework provides a structured agenda for advancing this field. For organizations developing wearable products, the review underscores the importance of including people with motor impairments in design and evaluation processes rather than assuming that interactions designed for non-disabled users will transfer. The low participant numbers reported across the literature also raise questions about the generalizability of existing findings to the diverse range of motor impairments people experience.
Tags: motor impairments · wearable technology · systematic literature review · gesture interaction · smartwatches · smartglasses · head-mounted displays · accessible input · fitness trackers