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Hands-free mice are numerous:

  • Camera based head tracking systems: SmartNav, Tracker Pro, FreeTrack, HeadMouse Extreme and HeadMaster,
  • Mouth-operated joystick types: the TetraMouse, the QuadJoy, the Jouse2, the IntegraMouse,
  • Footmice: BiLiPro, Flip Flop Mouse, Footime Foot ControlledMouse,
  • Brain-computer interaction such as the Emotiv EPOC neuroheadset, which allows to emulate the mouse (gyro),
  • Eye tracking,
  • ... (please edit the question to add any other devices I may have forgotten)

So, what is the most efficient hands-free mouse in your opinion?

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Quite frankly, I would just go with a normal mouse. I mean, why would you wanna move your head or use your mouth or even your feet? – Jeel Shah Jul 8 '12 at 1:31
Doing as much as possible without removing your hands from the keyboard may help you stay more focused and effective. – Franck Dernoncourt Jul 8 '12 at 10:14
Also, using a hands-free mouse can drastically reduce RSI. Here are a couple of figures on the RSI prevalence: (mirror: RSI is obviously not the only medical reason why one wants to use a hands-free mouse. – Franck Dernoncourt Jul 8 '12 at 11:17
I believe text to speech with touch-screens will be the future. I think mice are getting old and are becoming used less and we interact more with the GUI. – Adam Jul 8 '12 at 17:42
Here is my setup: ; unless you are a monkey or an octopus, you are going to have a hard time reaching the top screens from your chair ;) – Franck Dernoncourt Jul 9 '12 at 11:30

Just my thoughts on this in form of an answer, since the comment section got a little bit crowded. Feel free to not upvote this answer since there is no final conclusion from my side...

To estimate what to expect from a hands free input device, you have to realize: Our hands are very good a manipulating objects since we are trained to do so. So if you use anything other than a thing held in your hand, or a surface you touch with your fingers you may have to train for a longer time, or will not get the same precision and quickness. We are amazed by paintings made by foot for a reason: Painting with your feet is hard for the untrained person (and for me also with my hand, but thats another story :3).

You listed RSI as a reason for not using a mouse. IMO you will have a hard time replacing your mouse with a hands free version, so you might want to replace it with a more ergonomic version (same applies to the keyboard). Currently, I think hands free devices are limited to more simple, often used applications. For example I saw a setup (vimclutch) with a single foot pedal which implemented a "insert while pressed"-mode in vim (note: vim is a text editor on unix system, which normally uses keyboard shortcuts to toggle between command and edit modes). Other applications I could think of are again foot switches to switch between screens or applications, or to scroll webpages.

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Thanks for your comments and for the link. I have been using SmartNAV over the past few months and I can assure you it is as precise as a mouse. The hardest thing is to edit text, which requires high precision but with some training it is doable without any loss of productivity (As a computer scientist I have exacting needs). – Franck Dernoncourt Jul 15 '12 at 1:09
I have also recently tried the Emotiv EPOC neuroheadset's gyro, which baffled me although I don't have enough experience with it yet (mainly because the headset isn't very comfortable… : poll results on the Emotiv EPOC neuroheadset's comfortability is "Average: I can wear it during one hour"). – Franck Dernoncourt Jul 15 '12 at 1:09
The two main issues with SmartNAV are: 1) there is no mouse click (I will probably open a question for that) 2) the mouse pointer lags whenever it is hooked within an application (I need to contact the support but I doubt there is any solution unless they fix the SmartNAV software) Also, it is a bit expensive (ca. 350 USD). – Franck Dernoncourt Jul 15 '12 at 1:10
(SmartNAV's support contacted regarding the lag:…) – Franck Dernoncourt Jul 19 '12 at 13:28

Well eventually I wrote an article about it.

Abstract—In a few months the computer mouse will be half-a-century-old. It is known to have many drawbacks, the main ones being: loss of productivity due to constant switching between keyboard and mouse, health issues such as RSI, medical impossibility to use the mouse e.g. broken or amputated arm and unnatural human-computer interface like the keyboard. However almost everybody still uses a computer mouse nowadays.

In this short article, we explore computer mouse alternatives. Our research shows that moving the mouse cursor can be done efficiently with the SmartNav device and mouse clicks can be emulated in many complementary ways. We believe that computer users can increase their productivity and their health by using those alternatives.

This article is voluntary short and not overly technical, our main motivation being to make the readers aware of these solutions and their efficiencies. Details can be found in the appendices and by following the URLs and references. The primarily intended readers are computer scientists, people with RSI, physicians and interface pioneers. Feedback is highly welcome: this is work in progress.

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