A miniature vibrotactile sensory substitution device for multifingered hand prosthetics

Optimality of multisensory integration while compensating for uncertain visual target information with artificial vibrotactile cues during reach planning

BACKGROUND

Planning and executing movements requires the integration of different sensory modalities, such as vision and proprioception. However, neurological diseases like stroke can lead to full or partial loss of proprioception, resulting in impaired movements. Recent advances focused on providing additional sensory feedback to patients to compensate for the sensory loss, proving vibrotactile stimulation to be a viable option as it is inexpensive and easy to implement. Here, we test how such vibrotactile information can be integrated with visual signals to estimate the spatial location of a reach target.

METHODS

We used a center-out reach paradigm with 31 healthy human participants to investigate how artificial vibrotactile stimulation can be integrated with visual-spatial cues indicating target location. Specifically, we provided multisite vibrotactile stimulation to the moving dominant arm using eccentric rotating mass (ERM) motors. As the integration of inputs across multiple sensory modalities becomes especially relevant when one of them is uncertain, we additionally modulated the reliability of visual cues. We then compared the weighing of vibrotactile and visual inputs as a function of visual uncertainty to predictions from the maximum likelihood estimation (MLE) framework to decide if participants achieve quasi-optimal integration.

RESULTS

Our results show that participants could estimate target locations based on vibrotactile instructions. After short training, combined visual and vibrotactile cues led to higher hit rates and reduced reach errors when visual cues were uncertain. Additionally, we observed lower reaction times in trials with low visual uncertainty when vibrotactile stimulation was present. Using MLE predictions, we found that integration of vibrotactile and visual cues followed optimal integration when vibrotactile cues required the detection of one or two active motors. However, if estimating the location of a target required discriminating the intensities of two cues, integration violated MLE predictions.

CONCLUSION

We conclude that participants can quickly learn to integrate visual and artificial vibrotactile information. Therefore, using additional vibrotactile stimulation may serve as a promising way to improve rehabilitation or the control of prosthetic devices by patients suffering loss of proprioception.

Investigating the Effects of Intensity and Frequency on Vibrotactile Spatial Acuity

Vibrotactile devices are commonly used in applications for sensory substitution or to provide feedback in virtual reality. An important aspect of vibrotactile perception is spatial acuity, which determines the resolutions of vibrotactile displays on the skin. However, the complex vibration characteristics of vibrotactile actuators make it challenging for researchers to reference and compare previous study results. This is because the effects of typical characteristics, such as intensity and frequency, are not well understood. In this study, we investigated the effects of intensity and frequency on vibrotactile spatial acuity. Using Linear Resonant Actuators (LRAs), we conducted relative point localization experiments to measure spatial acuity under different conditions. In the first experiment, we found that intensity had a significant effect on spatial acuity, with higher intensity leading to better acuity. In the second experiment, using a carefully designed intensity calibration procedure, we did not find a significant effect of frequency on spatial acuity. These findings provide a better understanding of vibrotactile spatial acuity, allow for comparisons to previous research, and provide insights into the design of future tactile devices.

A distributed, high-channel-count, implanted bidirectional system for restoration of somatosensation and myoelectric control

Objective. We intend to chronically restore somatosensation and provide high-fidelity myoelectric control for those with limb loss via a novel, distributed, high-channel-count, implanted system.Approach.We have developed the implanted Somatosensory Electrical Neurostimulation and Sensing (iSens®) system to support peripheral nerve stimulation through up to 64, 96, or 128 electrode contacts with myoelectric recording from 16, 8, or 0 bipolar sites, respectively. The rechargeable central device has Bluetooth® wireless telemetry to communicate to external devices and wired connections for up to four implanted satellite stimulation or recording devices. We characterized the stimulation, recording, battery runtime, and wireless performance and completed safety testing to support its use in human trials.Results.The stimulator operates as expected across a range of parameters and can schedule multiple asynchronous, interleaved pulse trains subject to total charge delivery limits. Recorded signals in saline show negligible stimulus artifact when 10 cm from a 1 mA stimulating source. The wireless telemetry range exceeds 1 m (direction and orientation dependent) in a saline torso phantom. The bandwidth supports 100 Hz bidirectional update rates of stimulation commands and data features or streaming select full bandwidth myoelectric signals. Preliminary first-in-human data validates the bench testing result.Significance.We developed, tested, and clinically implemented an advanced, modular, fully implanted peripheral stimulation and sensing system for somatosensory restoration and myoelectric control. The modularity in electrode type and number, including distributed sensing and stimulation, supports a wide variety of applications; iSens® is a flexible platform to bring peripheral neuromodulation applications to clinical reality. ClinicalTrials.gov ID NCT04430218.

Real-time vibrotactile pattern generation and identification using discrete event-driven feedback

This study assesses human identification of vibrotactile patterns by using real-time discrete event-driven feedback. Previously acquired force and bend sensor data from a robotic hand were used to predict movement-type (stationary, flexion, contact, extension, release) and object-type (no object, hard object, soft object) states by using decision tree (DT) algorithms implemented in a field-programmable gate array (FPGA). Six able-bodied humans performed a 2- and 3-step sequential pattern recognition task in which state transitions were signaled as vibrotactile feedback. The stimuli were generated according to predicted classes represented by two frequencies (F1: 80 Hz, F2: 180 Hz) and two magnitudes (M1: low, M2: high) calibrated psychophysically for each participant; and they were applied by two actuators (Haptuators) placed on upper arms. A soft/hard object was mapped to F1/F2; and manipulating it with low/high force was assigned to M1/M2 in the left actuator. On the other hand, flexion/extension movement was mapped to F1/F2 in the right actuator, with movement in air as M1 and during object manipulation as M2. DT algorithm performed better for the object-type (97%) than the movement-type (88%) classification in real time. Participants could recognize feedback associated with 14 discrete-event sequences with low-to-medium accuracy. The performance was higher (76 ± 9% recall, 76 ± 17% precision, 78 ± 4% accuracy) for recognizing any one event in the sequences. The results show that FPGA implementation of classification for discrete event-driven vibrotactile feedback can be feasible in haptic devices with additional cues in the physical context.

Eliciting tactile sensations in the hand through non-invasive proximal nerve stimulation: a feasibility study

Recently, non-invasive proximal nerve stimulation has been widely investigated to restore tactile sensations. It has been demonstrated that tactile sensations in the hand could be elicited by nerve stimulation on the upper arm. However, it is still unknown whether tactile sensations could be elicited by stimulation at a proximal location close to the neck. In this study, non-invasive proximal nerve stimulation tests were performed to elicit tactile sensations in the hand of subjects. Six Ag/AgCl gel electrodes (2 × 3) were placed on the supraclavicular fossa where the proximal parts of the brachial plexus nerves were located. Then, fifteen potential electrode pairs were tested to explore whether tactile sensations could be elicited by non-invasive proximal nerve stimulation. Eight able-bodied subjects (male) were recruited to participate in the test. The stimulated sensation regions in the hand and the sensory intensity were reported and recorded during the experiment. The results demonstrated that the tactile sensations in various regions in the hand could be elicited through non-invasive nerve stimulation at the proximal location close to the neck.

Sensory substitution increases robotic surgical performance and sets the ground for a mediating role of the sense of embodiment: a systematic review

Sensory Substitution (SS) allows the elaboration of information via non preferential sensory modalities. This phenomenon occurs in robotic-assisted surgery (RAS), in which haptic feedback is lacking. It has been suggested that SS could sustain surgeons' proficiency by means of visual clues for inferring tactile information, that also promotes the feeling of haptic phantom sensations. A critical role in reaching a good performance in procedural tasks is also sustained by the Sense of Embodiment (SE), that is, the capacity to integrate objects into subjective bodily self-representation. As SE is enhanced by haptic sensations, we hypothesize a role of SS in promoting SE in RAS. Accordingly, the goal of this systematic review is to summarize the evidence pertaining the study of SS in RAS in order to highlight the impact on the performance, and to identify a mediating role of the SE in increasing dexterity in RAS. Eight studies selected from the MEDLINE and Scopus® databases met inclusion criteria for a qualitative synthesis. Results indicated that haptic to other modalities SS enhanced force consistency and accuracy, and decreased surgeon fatigue. Expert surgeons, as compared to novices, showed a better natural SS processing, testified by a proficient performance with and without SS aids. No studies investigated the mediating role of SE. These findings indicate that SS is subjected to learning and memory processes that help surgeons to rapidly derive haptic-correlates from visual clues, which are highly required for a good performance. Also, the higher ability of doing SS and the associated perception of haptic sensations might increase multisensory integration, which might sustain performance.

Dual-Modality Haptic Feedback Improves Dexterous Task Execution With Virtual EMG-Controlled Gripper

Individuals with upper-extremity limb difference who use myoelectric prostheses currently lack the haptic sensory information needed to perform dexterous activities of daily living. While considerable research has focused on restoring this haptic information, these approaches often rely on single-modality feedback schemes which are necessary but insufficient for the feedforward and feedback control strategies employed by the central nervous system. Multi-modality feedback approaches have been gaining attention in several application domains, however, the utility for myoelectric prosthesis use remains unclear. In this study, we investigated the utility of dual-modality haptic feedback in a virtual EMG-controlled grasp-and-hold task with a brittle object and variable load force. We recruited N = 20 participants without limb difference to perform the task in four conditions: no feedback, vibration feedback of incipient slip, squeezing feedback of grip force, and dual (vibration + squeezing) feedback of incipient slip and grip force. Results suggest that receiving any haptic feedback is better than receiving none, however, dual-modality feedback is far superior to either single-modality feedback approach in terms of preventing the object from breaking or dropping. Control with dual-modality feedback was also seen as more intuitive than with either of the single-modality feedback approaches.

Functional assessment of current upper limb prostheses: An integrated clinical and technological perspective

Although recent technological developments in the field of bionic upper limb prostheses, their rejection rate remains excessively high. The reasons are diverse (e.g. lack of functionality, control complexity, and comfortability) and most of these are reported only through self-rated questionnaires. Indeed, there is no quantitative evaluation of the extent to which a novel prosthetic solution can effectively address users' needs compared to other technologies. This manuscript discusses the challenges and limitations of current upper limb prosthetic devices and evaluates their functionality through a standard functional assessment, the Assessment of Capacity for Myoelectric Control (ACMC). To include a good representation of technologies, the authors collect information from participants in the Cybathlon Powered Arm Prostheses Race 2016 and 2020. The article analyzes 7 hour and 41 min of video footage to evaluate the performance of different prosthetic devices in various tasks inspired by activities of daily living (ADL). The results show that commercially-available rigid hands perform well in dexterous grasping, while body-powered solutions are more reliable and convenient for competitive environments. The article also highlights the importance of wrist design and control modality for successful execution of ADL. Moreover, we discuss the limitations of the evaluation methodology and suggest improvements for future assessments. With regard to future development, this work highlights the need for research in intuitive control of multiple degrees of freedom, adaptive solutions, and the integration of sensory feedback.

Soft Robotics Enables Neuroprosthetic Hand Design

Development and implementation of neuroprosthetic hands is a multidisciplinary field at the interface between humans and artificial robotic systems, which aims at replacing the sensorimotor function of the upper-limb amputees as their own. Although prosthetic hand devices with myoelectric control can be dated back to more than 70 years ago, their applications with anthropomorphic robotic mechanisms and sensory feedback functions are still at a relatively preliminary and laboratory stage. Nevertheless, a recent series of proof-of-concept studies suggest that soft robotics technology may be promising and useful in alleviating the design complexity of the dexterous mechanism and integration difficulty of multifunctional artificial skins, in particular, in the context of personalized applications. Here, we review the evolution of neuroprosthetic hands with the emerging and cutting-edge soft robotics, covering the soft and anthropomorphic prosthetic hand design and relating bidirectional neural interactions with myoelectric control and sensory feedback. We further discuss future opportunities on revolutionized mechanisms, high-performance soft sensors, and compliant neural-interaction interfaces for the next generation of neuroprosthetic hands.

Study of Tactile Sensation Somatotopy and Homology Between Projected Fingers in Residual Limb and Natural Fingers in Intact Limb

OBJECT

Based on the comparisons of the somatosensory event-related potentials (ERPs), the object of this study is to investigate the underlying cognition mechanism of somatotopy and the homology of tactile sensation between the projected fingers in the residual limb and the natural fingers in the intact limb.

METHODS

One amputee subject and three able-bodied subjects were recruited. The forearm amputee had a clear projected finger mapping (PFM) that could evoke the tactile sensation of the entire five missing fingers. Transcutaneous electrical nerve stimulation (TENS) was used to evoke the sensation pattern of touch. Stimulation locations were divided into three groups: the locations of Group PA (projected-finger of amputee-subject) were located on the entire five projected fingers for the amputee subject, the locations of Group NA (natural-finger of amputee-subject) were located on the entire five natural fingers for the amputee subject, and the locations of Group NH (natural-finger of healthy-subject) were located on the bilateral natural index fingers for the able-bodied subjects. The somatosensory ERPs evoked by the stimulations were recorded. We measured the latency and amplitude of the ERP components and made statistical analyses for them.

MAIN RESULTS

Since the ERP components of the early-stage are similar for both the stimulation in the projected fingers and the natural fingers, it can infer that the delivery pathway of the projected finger was similar to that of the natural finger. The second finding of the study is that, as the processing of sensory sensation in the cortex of the three groups is similar, it can also infer that the somatosensory evoked by the external stimuli are also similar.

CONCLUSION

The present findings suggest that the somatotopy and the homology of tactile sensation between the projected fingers in the residual limb and the natural fingers in the intact limb have evident uniformity. We infer that the median nerve and the ulnar nerve of the peripheral nerve may divaricate new pathways, and these pathways would have been linked to the PFM.

The future of sensory substitution, addition, and expansion via haptic devices

Haptic devices use the sense of touch to transmit information to the nervous system. As an example, a sound-to-touch device processes auditory information and sends it to the brain via patterns of vibration on the skin for people who have lost hearing. We here summarize the current directions of such research and draw upon examples in industry and academia. Such devices can be used for sensory substitution (replacing a lost sense, such as hearing or vision), sensory expansion (widening an existing sensory experience, such as detecting electromagnetic radiation outside the visible light spectrum), and sensory addition (providing a novel sense, such as magnetoreception). We review the relevant literature, the current status, and possible directions for the future of sensory manipulation using non-invasive haptic devices.

Object stiffness recognition and vibratory feedback without ad-hoc sensing on the Hannes prosthesis: A machine learning approach

Introduction

In recent years, hand prostheses achieved relevant improvements in term of both motor and functional recovery. However, the rate of devices abandonment, also due to their poor embodiment, is still high. The embodiment defines the integration of an external object - in this case a prosthetic device - into the body scheme of an individual. One of the limiting factors causing lack of embodiment is the absence of a direct interaction between user and environment. Many studies focused on the extraction of tactile information via custom electronic skin technologies coupled with dedicated haptic feedback, though increasing the complexity of the prosthetic system. Contrary wise, this paper stems from the authors' preliminary works on multi-body prosthetic hand modeling and the identification of possible intrinsic information to assess object stiffness during interaction.

Methods

Based on these initial findings, this work presents the design, implementation and clinical validation of a novel real-time stiffness detection strategy, without ad-hoc sensing, based on a Non-linear Logistic Regression (NLR) classifier. This exploits the minimum grasp information available from an under-sensorized and under-actuated myoelectric prosthetic hand, Hannes. The NLR algorithm takes as input motor-side current, encoder position, and reference position of the hand and provides as output a classification of the grasped object (no-object, rigid object, and soft object). This information is then transmitted to the user via vibratory feedback to close the loop between user control and prosthesis interaction. This implementation was validated through a user study conducted both on able bodied subjects and amputees.

Results

The classifier achieved excellent performance in terms of F1Score (94.93%). Further, the able-bodied subjects and amputees were able to successfully detect the objects' stiffness with a F1Score of 94.08% and 86.41%, respectively, by using our proposed feedback strategy. This strategy allowed amputees to quickly recognize the objects' stiffness (response time of 2.82 s), indicating high intuitiveness, and it was overall appreciated as demonstrated by the questionnaire. Furthermore, an embodiment improvement was also obtained as highlighted by the proprioceptive drift toward the prosthesis (0.7 cm).

Vibrotactile Perception for Sensorimotor Augmentation: Perceptual Discrimination of Vibrotactile Stimuli Induced by Low-Cost Eccentric Rotating Mass Motors at Different Body Locations in Young, Middle-Aged, and Older Adults

Sensory augmentation technologies are being developed to convey useful supplemental sensory cues to people in comfortable, unobtrusive ways for the purpose of improving the ongoing control of volitional movement. Low-cost vibration motors are strong contenders for providing supplemental cues intended to enhance or augment closed-loop feedback control of limb movements in patients with proprioceptive deficits, but who still retain the ability to generate movement. However, it remains unclear what form such cues should take and where on the body they may be applied to enhance the perception-cognition-action cycle implicit in closed-loop feedback control. As a step toward addressing this knowledge gap, we used low-cost, wearable technology to examine the perceptual acuity of vibrotactile stimulus intensity discrimination at several candidate sites on the body in a sample of participants spanning a wide age range. We also sought to determine the extent to which the acuity of vibrotactile discrimination can improve over several days of discrimination training. Healthy adults performed a series of 2-alternative forced choice experiments that quantified capability to perceive small differences in the intensity of stimuli provided by low-cost eccentric rotating mass vibration motors fixed at various body locations. In one set of experiments, we found that the acuity of intensity discrimination was poorer in older participants than in middle-aged and younger participants, and that stimuli applied to the torso were systematically harder to discriminate than stimuli applied to the forearm, knee, or shoulders, which all had similar acuities. In another set of experiments, we found that older adults could improve intensity discrimination over the course of 3 days of practice on that task such that their final performance did not differ significantly from that of younger adults. These findings may be useful for future development of wearable technologies intended to improve the control of movements through the application of supplemental vibrotactile cues.

Scalp-Targeted Haptic Proprioception for Upper-Limb Prosthetics

In this paper, a head-worn wearable haptic feedback device (WHFD) is developed to communicate sensory information from an upper-limb prosthesis. A 14-week, 6-stage, between-subjects study was created to investigate the learning trajectory as participants were stimulated with haptic patterns conveying joint proprioception. Healthy participants were divided into three groups, with each group using a different haptic stimulation methods. 18 participants completed the study within 7-14 weekly sessions, demonstrating that participants were, in fact, learning to interpret the haptic information. Participants in the spatiotemporal stimulation group had some advantages in interpreting the haptic information over the others; however, each stimulation method has advantages that can be exploited and hybridized for future models of the WHFD. Overall, the proposed WHFD is an effective non-invasive device that can promote greater sensory awareness for wearers of prostheses.

Sensory substitution of elbow proprioception to improve myoelectric control of upper limb prosthesis: experiment on healthy subjects and amputees

BACKGROUND

Current myoelectric prostheses lack proprioceptive information and rely on vision for their control. Sensory substitution is increasingly developed with non-invasive vibrotactile or electrotactile feedback, but most systems are designed for grasping or object discriminations, and few were tested for online control in amputees. The objective of this work was evaluate the effect of a novel vibrotactile feedback on the accuracy of myoelectric control of a virtual elbow by healthy subjects and participants with an upper-limb amputation at humeral level.

METHODS

Sixteen, healthy participants and 7 transhumeral amputees performed myoelectric control of a virtual arm under different feedback conditions: vision alone (VIS), vibration alone (VIB), vision plus vibration (VIS + VIB), or no feedback at all (NO). Reach accuracy was evaluated by angular errors during discrete as well as back and forth movements. Healthy participants' workloads were assessed with the NASA-TLX questionnaire, and feedback conditions were ranked according to preference at the end of the experiment.

RESULTS

Reach errors were higher in NO than in VIB, indicating that our vibrotactile feedback improved performance as compared to no feedback. Conditions VIS and VIS+VIB display similar levels of performance and produced lower errors than in VIB. Vision remains therefore critical to maintain good performance, which is not ameliorated nor deteriorated by the addition of vibrotactile feedback. The workload associated with VIB was higher than for VIS and VIS+VIB, which did not differ from each other. 62.5% of healthy subjects preferred the VIS+VIB condition, and ranked VIS and VIB second and third, respectively.

CONCLUSION

Our novel vibrotactile feedback improved myoelectric control of a virtual elbow as compared to no feedback. Although vision remained critical, the addition of vibrotactile feedback did not improve nor deteriorate the control and was preferred by participants. Longer training should improve performances with VIB alone and reduce the need of vision for close-loop prosthesis control.

Towards optimizing the non-invasive sensory feedback interfaces in a neural prosthetic control

Objective. The somatotopic interface (SI) and non-somatotopic interface (NI) are commonly used to provide non-invasive sensory feedback. Nevertheless, differences between SI and NI are rarely reported, and objective evaluations of the corresponding brain response are missing as well. Few studies have reported how to design the stimulation encoding based on the two interfaces. The objective of this study was to investigate the difference in sensory characteristics between SI and NI, and propose an optimal encoding method for non-invasive feedback interfaces. Approach. We recruited seven amputees and compared the tactile sensitivity to stimulated positions and intensities between SI (phantom finger area) and NI (upper arm) in a tactile discrimination task. Electroencephalography (EEG) evaluation task was subsequently conducted to objectively evaluate the stimulus-evoked brain response. Finally, the two kinds of tactile information (stimulated position and intensity) was applied to an object recognition task. Specifically, the object size was reflected by the prosthetic finger position through stimulated position encoding, and the object stiffness was reflected by the contact force of prosthetic fingers through stimulated intensity encoding. We compared the performance under four feedback conditions (combinations between two kinds of tactile information and two interfaces). Results. Behavioral results showed that NI was more sensitive to position information while SI was more sensitive to intensity information. EEG results were consistent with behavioral results, showing a higher sensitivity of sensory alpha ERD for NI in the position discrimination, while the trend was opposite in the intensity discrimination. The feedback encoding allowed amputees to discriminate the size and stiffness of nine objects with the best performance of 62% overall accuracy (84% for size discrimination, 71% for stiffness discrimination) when position and intensity information was delivered on the NI and SI, respectively. Signicance. Our results provided an instructive strategy for sensory feedback via non-invasive solutions.

Tactile spatial discrimination on the torso using vibrotactile and force stimulation

There is a steadily growing number of mobile communication systems that provide spatially encoded tactile information to the humans' torso. However, the increased use of such hands-off displays is currently not matched with or supported by systematic perceptual characterization of tactile spatial discrimination on the torso. Furthermore, there are currently no data testing spatial discrimination for dynamic force stimuli applied to the torso. In the present study, we measured tactile point localization (LOC) and tactile direction discrimination (DIR) on the thoracic spine using two unisex torso-worn tactile vests realized with arrays of 3 × 3 vibrotactile or force feedback actuators. We aimed to, first, evaluate and compare the spatial discrimination of vibrotactile and force stimulations on the thoracic spine and, second, to investigate the relationship between the LOC and DIR results across stimulations. Thirty-four healthy participants performed both tasks with both vests. Tactile accuracies for vibrotactile and force stimulations were 60.7% and 54.6% for the LOC task; 71.0% and 67.7% for the DIR task, respectively. Performance correlated positively with both stimulations, although accuracies were higher for the vibrotactile than for the force stimulation across tasks, arguably due to specific properties of vibrotactile stimulations. We observed comparable directional anisotropies in the LOC results for both stimulations; however, anisotropies in the DIR task were only observed with vibrotactile stimulations. We discuss our findings with respect to tactile perception research as well as their implications for the design of high-resolution torso-mounted tactile displays for spatial cueing.

Static and dynamic proprioceptive recognition through vibrotactile stimulation

Objective.Proprioceptive information provides individuals with a sense of our limb's static position and dynamic movement. Impaired or a lack of such feedback can diminish our ability to perform dexterous motions with our biological limbs or assistive devices. Here we seek to determine whether both static and dynamic components of proprioception can be recognized using variation of the spatial and temporal components of vibrotactile feedback.Approach.An array of five vibrotactors was placed on the forearm of each subject. Each tactor was encoded to represent one of the five forearm postures. Vibratory stimulus was elicited to convey the static position and movement of the forearm. Four experimental blocks were performed to test each subject's recognition of a forearm's simulated static position, rotational amplitude, rotational amplitude and direction, and rotational speed.Main results.Our results showed that the subjects were able to perform proprioceptive recognition based on the delivered vibrotactile information. Specifically, rotational amplitude recognition resulted in the highest level of accuracy (99.0%), while the recognition accuracy of the static position and the rotational amplitude-direction was the lowest (91.7% and 90.8%, respectively). Nevertheless, all proprioceptive properties were perceived with >90% accuracy, indicating that the implemented vibrotactile encoding scheme could effectively provide proprioceptive information to the users.Significance.The outcomes suggest that information pertaining to static and dynamic aspects of proprioception can be accurately delivered using an array of vibrotactors. This feedback approach could be used to potentially evaluate the sensorimotor integration processes during human-machine interactions, and to improve sensory feedback in clinical populations with somatosensory impairments.

The rubber hand illusion is a fallible method to study ownership of prosthetic limbs

Enabling sensory feedback in limb prostheses can reverse a damaged body image caused by amputation. The rubber hand illusion (RHI) is a popular paradigm to study ownership of artificial limbs and potentially useful to assess sensory feedback strategies. We investigated the RHI as means to induce ownership of a prosthetic hand by providing congruent visual and tactile stimuli. We elicited tactile sensations via electric stimulation of severed afferent nerve fibres in four participants with transhumeral amputation. Contrary to our expectations, they failed to experience the RHI. The sensations we elicited via nerve stimulation resemble tapping as opposed to stroking, as in the original RHI. We therefore investigated the effect of tapping versus stroking in 30 able-bodied subjects. We found that either tactile modality equally induced ownership in two-thirds of the subjects. Failure to induce the RHI in the intact hand of our participants with amputation later confirmed that they form part of the RHI-immune population. Conversely, these participants use neuromusculoskeletal prostheses with neural sensory feedback in their daily lives and reported said prostheses as part of their body. Our findings suggest that people immune to the RHI can nevertheless experience ownership over prosthetic limbs when used in daily life and accentuates a significant limitation of the RHI paradigm.

Effect of Short-Term Exposure to Supplemental Vibrotactile Kinesthetic Feedback on Goal-Directed Movements after Stroke: A Proof of Concept Case Series

Many survivors of stroke have persistent somatosensory deficits on the contralesional side of their body. Non-invasive supplemental feedback of limb movement could enhance the accuracy and efficiency of actions involving the upper extremity, potentially improving quality of life after stroke. In this proof-of-concept study, we evaluated the feasibility and the immediate effects of providing supplemental kinesthetic feedback to stroke survivors, performing goal-directed actions with the contralesional arm. Three survivors of stroke in the chronic stage of recovery participated in experimental sessions wherein they performed reaching and stabilization tasks with the contralesional arm under different combinations of visual and vibrotactile feedback, which was induced on the ipsilesional arm. Movement kinematics were encoded by a vibrotactile feedback interface in two ways: state feedback—an optimal combination of hand position and velocity; and error feedback—the difference between the actual hand position and its instantaneous target. In each session we evaluated the feedback encoding scheme’s immediate objective utility for improving motor performance as well as its perceived usefulness. All three participants improved their stabilization performance using at least one of the feedback encoding schemes within just one experimental session. Two of the participants also improved reaching performance with one or the other of the encoding schemes. Although the observed beneficial effects were modest in each participant, these preliminary findings show that supplemental vibrotactile kinesthetic feedback can be readily interpreted and exploited to improve reaching and object stabilizing actions performed with the contralesional arm after stroke. These short-term training results motivate a longer multisession training study using personalized vibrotactile feedback as a means to improve the accuracy and efficacy of contralesional arm actions after stroke.

The Interaction Between Feedback Type and Learning in Routine Grasping With Myoelectric Prostheses

While prosthetic fitting after upper-limb loss allows for restoration of motor functions, it deprives the amputee of tactile sensations that are essential for grasp control in able-bodied subjects. Therefore, it is commonly assumed that restoring the force feedback would improve the control of prosthesis grasping force. However, the literature regarding the benefit of feedback is controversial. Here, we investigated how the type of feedback affects learning and steady-state performance of routine grasping with a prosthesis. The experimental task was to grasp an object using a prosthesis and generate a low or high target-force range (TFR), both initially unknown, in three feedback conditions: basic auditory feedback on task outcome, and additional visual or vibratory feedback on the force magnitude. The results demonstrated that the performance was rather good and stable for the low TFR, whereas it was substantially worse for the high TFR with a pronounced training effect. Surprisingly, learning curve and steady-state performance did not depend on the feedback condition. Hence, in the specific context of routing grasping with a prosthesis controlled via surface EMG, the basic feedback on task outcome was not outperformed by force-related end-of-trial feedback and hence seemed to be sufficient for accomplishing the task.This conclusion applies to the context of routine grasping using a myoelectric prosthesis with surface EMG electrodes, which means that the control signals are variable and the feedback is perceived and processed at the end of the trial (motor adaption).

Evoking Apparent Moving Sensation in the Hand via Transcutaneous Electrical Nerve Stimulation

The restoration of sensory feedback in amputees plays a fundamental role in the prosthesis control and in the communication on the afferent channel between hand and brain. The literature shows that transcutaneous electrical nerve stimulation (TENS) can be a promising non-invasive technique to elicit sensory feedback in amputees, especially in the lower limb through the phenomenon of apparent moving sensation (AMS). It consists of delivering a sensation that moves along a specific part of the body. This study proposes to use TENS to elicit tactile sensations and adopt AMS to reproduce moving sensations on the hand, such as those related to an object moving in the hand or slipping upward or downward. To this purpose, the developed experimental protocol consists of two phases: (i) the mapping of the evoked sensations and (ii) the generation of the AMS. In the latter phase, the pulse amplitude variation (PAV), the pulse width variation (PWV), and the interstimulus delay modulation (ISDM) methods were compared. For the comparative analysis, the Wilcoxon-Mann-Whitney test with Bonferroni correction (P < 0.016) was carried out on the success rate and on the ranking of methods expressed by the subjects. Results from the mapping protocol show that the delivered sensations were mostly described by the subjects as almost natural and superficial tingling. Results from the AMS protocol show that, for each movement direction, the success rate of ISDM method is higher than that of PWV and PAV and significantly higher than that of PAV for the ulnar-median direction. It recreates an AMS in the hand that effectively allows discriminating the type of sensation and distinguishing the movement direction. Moreover, ISDM was ranked by the subjects as the favorite method for recreating a well-defined and comfortable moving sensation only in the median-ulnar direction. For the ranking results, there was not a statistically significant difference among the methods. The experiments confirmed the good potential of recreating an AMS in the hand through TENS. This encourages to push forward this study on amputees and integrate it in the closed-loop control of a prosthetic system, in order to enable full control of grasp stability and prevent the objects from slippage.

Vibrotactile Feedback for Improving Standing Balance

Maintaining balance standing upright is an active process that complements the stabilizing properties of muscle stiffness with feedback control driven by independent sensory channels: proprioceptive, visual, and vestibular. Considering that the contribution of these channels is additive, we investigated to what extent providing an additional channel, based on vibrotactile stimulation, may improve balance control. This study focused only on healthy young participants for evaluating the effects of different encoding methods and the importance of the informational content. We built a device that provides a vibrotactile feedback using two vibration motors placed on the anterior and posterior part of the body, at the L5 level. The vibration was synchronized with an accelerometric measurement encoding a combination of the position and acceleration of the body center of mass in the anterior-posterior direction. The goal was to investigate the efficacy of the information encoded by this feedback in modifying postural patterns, comparing, in particular, two different encoding methods: vibration always on and vibration with a dead zone, i.e., silent in a region around the natural stance posture. We also studied if after the exposure, the participants modified their normal oscillation patterns, i.e., if there were after effects. Finally, we investigated if these effects depended on the informational content of the feedback, introducing trials with vibration unrelated to the actual postural oscillations (sham feedback). Twenty-four participants were asked to stand still with their eyes closed, alternating trials with and without vibrotactile feedback: nine were tested with vibration always on and sham feedback, fifteen with dead zone feedback. The results show that synchronized vibrotactile feedback reduces significantly the sway amplitude while increasing the frequency in anterior-posterior and medial-lateral directions. The two encoding methods had no different effects of reducing the amount of postural sway during exposure to vibration, however only the dead-zone feedback led to short-term after effects. The presence of sham vibration, instead, increased the sway amplitude, highlighting the importance of the encoded information.

The Variability of Psychophysical Parameters Following Surface and Subdermal Stimulation: A Multiday Study in Amputees

Electrotactile stimulation has been suggested as a modality for providing sensory feedback in upper limb prostheses. This study investigates the multiday variability of subdermal and surface stimulation. Electrical stimulation was delivered using either surface or fine wire electrodes placed right under the skin in eight amputees for seven consecutive days. The variability of psychophysical measurements, including detection threshold (DT), pain threshold (PT), dynamic range (DR), just noticeable difference (JND), Weber fraction (WF) and quality of evoked sensations, was evaluated using the coefficient of variation (CoV). In addition, the systematic change in the mean of the parameters across days was assessed in both stimulation modalities. In the case of DT, PT, DR, and perceived intensity at 100 Hz, the CoV of surface stimulation was significantly smaller than that of subdermal stimulation. Only PT showed a significant systematic change in the mean value across days for both modalities. The outcome of this study has implications for the choice of modality in delivering sensory feedback, though the significance of the quantified variability needs to be evaluated using usability tests with user feedback.

Effect of vibration characteristics and vibror arrangement on the tactile perception of the upper arm in healthy subjects and upper limb amputees

Background

Vibrotactile stimulation is a promising venue in the field of prosthetics to retrain sensory feedback deficits following amputation. Discrimination is well established at the forearm level but not at the upper arm level. Moreover, the effects of combining vibration characteristics such as duration and intensity has never been investigated.

Method

We conducted experiments on spatial discrimination (experiment 1) and tactile intensity perception (experiment 2), using 9 combinations of 3 intensities and 3 durations of vibror stimulations device. Those combinations were tested under 4 arrangements with an array of 6 vibrors. In both experiments, linear orientation aligned with the upper arm longitudinal axis were compared to circular orientation on the upper arm circumference. For both orientations, vibrors were placed either with 3cm space between the center of 2 vibrors or proportionally to the length or the circumference of the subject upper arm. Eleven heathy subjects underwent the 2 experiments and 7 amputees (humeral level) participated in the spatial discrimination task with the best arrangement found.

Results

Experiment 1 revealed that circular arrangements elicited better scores than the linear ones. Arrangements with vibrors spaced proportionally elicited better scores (up to 75% correct) than those with 3 cm spacing. Experiment 2, showed that the perceived intensity of the vibration increases with the intensity of the vibrors’ activation, but also with their duration of activation. The 7 patients obtained high scores (up to 91.67% correct) with the circular proportional (CP) arrangement.

Discussion

These results highlight that discrete and short vibrations can be well discriminated by healthy subjects and people with an upper limb amputation. These new characteristics of vibrations have great potential for future sensory substitution application in closed-loop prosthetic control.

Vibration Propagation on the Skin of the Arm

Vibrotactile interfaces are an inexpensive and non-invasive way to provide performance feedback to body-machine interface users. Interfaces for the upper extremity have utilized a multi-channel approach using an array of vibration motors placed on the upper extremity. However, for successful perception of multi-channel vibrotactile feedback on the arm, we need to account for vibration propagation across the skin. If two stimuli are delivered within a small distance, mechanical propagation of vibration can lead to inaccurate perception of the distinct vibrotactile stimuli. This study sought to characterize vibration propagation across the hairy skin of the forearm. We characterized vibration propagation by measuring accelerations at various distances from a source vibration of variable intensities (100–240 Hz). Our results showed that acceleration from the source vibration was present at a distance of 4 cm at intensities >150 Hz. At distances greater than 8 cm from the source, accelerations were reduced to values substantially below vibrotactile discrimination thresholds for all vibration intensities. We conclude that in future applications of vibrotactile interfaces, stimulation sites should be separated by a distance of at least 8 cm to avoid potential interference in vibration perception caused by propagating vibrations.

Visual inputs and postural manipulations affect the location of somatosensory percepts elicited by electrical stimulation

The perception of somatosensation requires the integration of multimodal information, yet the effects of vision and posture on somatosensory percepts elicited by neural stimulation are not well established. In this study, we applied electrical stimulation directly to the residual nerves of trans-tibial amputees to elicit sensations referred to their missing feet. We evaluated the influence of congruent and incongruent visual inputs and postural manipulations on the perceived size and location of stimulation-evoked somatosensory percepts. We found that although standing upright may cause percept size to change, congruent visual inputs and/or body posture resulted in better localization. We also observed visual capture: the location of a somatosensory percept shifted toward a visual input when vision was incongruent with stimulation-induced sensation. Visual capture did not occur when an adopted posture was incongruent with somatosensation. Our results suggest that internal model predictions based on postural manipulations reinforce perceived sensations, but do not alter them. These characterizations of multisensory integration are important for the development of somatosensory-enabled prostheses because current neural stimulation paradigms cannot replicate the afferent signals of natural tactile stimuli. Nevertheless, multisensory inputs can improve perceptual precision and highlight regions of the foot important for balance and locomotion.

Spatial and temporal influences on discrimination of vibrotactile stimuli on the arm

Body-machine interfaces (BMIs) provide a non-invasive way to control devices. Vibrotactile stimulation has been used by BMIs to provide performance feedback to the user, thereby reducing visual demands. To advance the goal of developing a compact, multivariate vibrotactile display for BMIs, we performed two psychophysical experiments to determine the acuity of vibrotactile perception across the arm. The first experiment assessed vibration intensity discrimination of sequentially presented stimuli within four dermatomes of the arm (C5, C7, C8, and T1) and on the ulnar head. The second experiment compared vibration intensity discrimination when pairs of vibrotactile stimuli were presented simultaneously vs. sequentially within and across dermatomes. The first experiment found a small but statistically significant difference between dermatomes C7 and T1, but discrimination thresholds at the other three locations did not differ. Thus, while all tested dermatomes of the arm and hand could serve as viable sites of vibrotactile stimulation for a practical BMI, ideal implementations should account for small differences in perceptual acuity across dermatomes. The second experiment found that sequential delivery of vibrotactile stimuli resulted in better intensity discrimination than simultaneous delivery, independent of whether the pairs were located within the same dermatome or across dermatomes. Taken together, our results suggest that the arm may be a viable site to transfer multivariate information via vibrotactile feedback for body-machine interfaces. However, user training may be needed to overcome the perceptual disadvantage of simultaneous vs. sequentially presented stimuli.

Visuotactile synchrony of stimulation-induced sensation and natural somatosensation

OBJECTIVE

Previous studies suggest that somatosensory feedback has the potential to improve the functional performance of prostheses, reduce phantom pain, and enhance embodiment of sensory-enabled prosthetic devices. To maximize such benefits for amputees, the temporal properties of the sensory feedback must resemble those of natural somatosensation in an intact limb.

APPROACH

To better understand temporal perception of artificial sensation, we characterized the perception of visuotactile synchrony for tactile perception restored via peripheral nerve stimulation. We electrically activated nerves in the residual limbs of two trans-tibial amputees and two trans-radial amputees via non-penetrating nerve cuff electrodes, which elicited sensations referred to the missing limbs.

MAIN RESULTS

Our findings suggest that with respect to vision, stimulation-induced sensation has a point of subjective simultaneity (PSS; processing time) and just noticeable difference (JND; temporal sensitivity) that are similar to natural touch. The JND was not significantly different between the participants with upper- and lower-limb amputations. However, the PSS indicated that sensations evoked in the missing leg must occur significantly earlier than those in the hand to be perceived as maximally synchronous with vision. Furthermore, we examined visuotactile synchrony in the context of a functional task during which stimulation was triggered by pressure applied to the prosthesis. Stimulation-induced sensation could be delayed up to 111  ±  62 ms without the delay being reliably detected.

SIGNIFICANCE

The quantitative temporal properties of stimulation-induced perception were previously unknown and will contribute to design specifications for future sensory neuroprostheses.

Inter-Limb Transfer of Grasp Force Perception With Closed-Loop Hand Prosthesis

Sensory feedback of grasp forces provides important information about physical interactions between the hand and objects, enabling both reactive and anticipatory neural control mechanisms. The numerous studies have shown artificial sensory feedback of various forms improves force control during grasping tasks by prosthetic hand users through a closed-feedback loop. However, little is known about how perceptual information is transferred between an intact limb and a closed-loop prosthetic limb, and the extent to which training inter-limb transfer may improve myoelectric prosthetic control. We addressed these gaps by using a contralateral force-matching task in which able-bodied participants were asked to generate grasp forces with their native hand, and then match it using the contralateral hand or a soft-synergy prosthetic hand worn on the contralateral arm that was coupled with a mechanotactile feedback device. We found that absolute matching error and matching time were greater when using the prosthetic system than the native hand. However, with contralateral specific training, subjects were able to produce similar relative matching error with the prosthetic system and the native hand, especially at the untrained force level. These findings suggest that an association can be established between the perception produced by the prosthetic limb and the contralateral intact limb, and provide novel insights about potential applications to training and design of the closed-loop prosthesis.

Supplemental vibrotactile feedback of real-time limb position enhances precision of goal-directed reaching

We examined vibrotactile stimulation as a form of supplemental limb state feedback to enhance planning and ongoing control of goal-directed movements. Subjects wore a two-dimensional vibrotactile display on their nondominant arm while performing horizontal planar reaching with the dominant arm. The vibrotactile display provided feedback of hand position such that small hand displacements were more easily discriminable using vibrotactile feedback than with intrinsic proprioceptive feedback. When subjects relied solely on proprioception to capture visuospatial targets, performance was degraded by proprioceptive drift and an expansion of task space. By contrast, reach accuracy was enhanced immediately when subjects were provided vibrotactile feedback and further improved over 2 days of training. Improvements reflected resolution of proprioceptive drift, which occurred only when vibrotactile feedback was active, demonstrating that benefits of vibrotactile feedback are due, in part to its integration into the ongoing control of movement. A partial resolution of task space expansion persisted even when vibrotactile feedback was inactive, demonstrating that training with vibrotactile feedback also induced changes in movement planning. However, the benefits of vibrotactile feedback come at a cognitive cost. All subjects adopted a stereotyped strategy wherein they attempted to capture targets by moving first along one axis of the vibrotactile display and then the other. For most subjects, this inefficient approach did not resolve over two bouts of training performed on separate days, suggesting that additional training is needed to integrate vibrotactile feedback into the planning and online control of goal-directed reaching in a way that promotes smooth and efficient movement. NEW & NOTEWORTHY A two-dimensional vibrotactile display provided state (not error) feedback to enhance control of a moving limb. Subjects learned to use state feedback to perform blind reaches with accuracy and precision exceeding that attained using intrinsic proprioception alone. Feedback utilization incurred substantial cognitive cost: subjects moved first along one axis of the vibrotactile display, then the other. This stereotyped control strategy must be overcome if vibrotactile limb state feedback is to promote naturalistic limb movements.

Evoked Haptic Sensation in the Hand With Concurrent Non-Invasive Nerve Stimulation

OBJECTIVE

Haptic perception is critical for prosthetic users to control their prosthetic hand intuitively. In this study, we seek to evaluate the haptic perception evoked from concurrent stimulation trains through multiple channels using transcutaneous nerve stimulation.

METHODS

A 2 × 8 electrode grid was used to deliver current to the median and ulnar nerves in the upper arm. Different electrodes were first selected to activate the sensory axons, which can elicit sensations at different locations of the hand. Charge-balanced bipolar stimulation was then delivered to two sets of electrodes concurrently with a phase delay (dual stimulation) to determine whether the evoked sensation can be constructed from sensations of single stimulation delivered separately at different locations (single stimulation) along the electrode grid. The temporal delay between the two stimulation trains was altered to evaluate potential interference. The short-term stability of the haptic sensation within a testing session was also evaluated.

RESULTS

The evoked sensation during dual stimulation was largely a direct summation of the sensation from single stimulations. The delay between the two stimulation locations had minimal effect on the evoked sensations, which was also stable over repeated testing within a session.

CONCLUSION

Our results indicated that the haptic sensations at different regions of the hand can be constructed by combining the response from multiple stimulation trains directly. The interference between stimulations were minimal.

SIGNIFICANCE

The outcomes will allow us to construct specific haptic sensation patterns when the prosthesis interacts with different objects, which may help improve user embodiment of the prosthesis.

Effects of vibrotactile feedback and grasp interface compliance on perception and control of a sensorized myoelectric hand

Current myoelectric prosthetic limbs are limited in their ability to provide direct sensory feedback to users, which increases attentional demands and reliance on visual cues. Vibrotactile sensory substitution (VSS), which can be used to provide sensory feedback in a non-invasive manner has demonstrated some improvement in myoelectric hand control. In this work, we developed and tested two VSS configurations: one with a single burst-rate modulated actuator and another with a spatially distributed array of five coin tactors. We performed a direct comparative assessment of these two VSS configurations with able-bodied subjects to investigate sensory perception, myoelectric control of grasp force and hand aperture with a prosthesis, and the effects of interface compliance. Six subjects completed a sensory perception experiment under a stimulation only paradigm; sixteen subjects completed experiments to compare VSS performance on perception and graded myoelectric control during grasp force and hand aperture tasks; and ten subjects completed experiments to investigate the effect of mechanical compliance of the myoelectric hand on the ability to control grasp force. Results indicated that sensory perception of vibrotactile feedback was not different for the two VSS configurations in the absence of active myoelectric control, but it was better with feedback from the coin tactor array than with the single actuator during myoelectric control of grasp force. Graded myoelectric control of grasp force and hand aperture was better with feedback from the coin tactor array than with the single actuator, and myoelectric control of grasp force was improved with a compliant grasp interface. Further investigations with VSS should focus on the use of coin tactor arrays by subjects with amputation in real-world settings and on improving control of grasp force by increasing the mechanical compliance of the hand.

Merged Haptic Sensation in the Hand during Concurrent Non-Invasive Proximal Nerve Stimulation

When individuals interact with the environment, sensory feedback is a critical aspect of the experience. Individuals using prosthesis often have difficulty controlling their device, partly due to a lack of sensory information. Transcutaneous nerve stimulation has the potential to elicit focal haptic sensation when controlled electrical current was delivered to a pair of electrodes in proximity to the nerve. The objective of this preliminary study was to evaluate how different elicited focal haptic sensation were altered, when multiple concurrent electrical stimuli were delivered to different portions of the median and ulnar nerve bundles. The delay between the individual stimulation during concurrent stimuli was also varied to identify if this parameter could alter the resulting sensation region. Lastly, the stability/repeatability of the perceived sensation during concurrent stimuli was determined. Our preliminary results showed that the spatial distribution of the haptic sensation was largely a direct summation/merge of the sensation regions from the individual nerve stimulation when comparing the regions to that of the concurrent double stimulation. Our results also showed that merged sensation region was not sensitive to different time delays the two concurrent stimuli. Lastly, the sensation regions remained stable and showed repeatable sensation in the hand even with 20-60 minutes between repeated stimulations.

Selectivity and Longevity of Peripheral-Nerve and Machine Interfaces: A Review

For those individuals with upper-extremity amputation, a daily normal living activity is no longer possible or it requires additional effort and time. With the aim of restoring their sensory and motor functions, theoretical and technological investigations have been carried out in the field of neuroprosthetic systems. For transmission of sensory feedback, several interfacing modalities including indirect (non-invasive), direct-to-peripheral-nerve (invasive), and cortical stimulation have been applied. Peripheral nerve interfaces demonstrate an edge over the cortical interfaces due to the sensitivity in attaining cortical brain signals. The peripheral nerve interfaces are highly dependent on interface designs and are required to be biocompatible with the nerves to achieve prolonged stability and longevity. Another criterion is the selection of nerves that allows minimal invasiveness and damages as well as high selectivity for a large number of nerve fascicles. In this paper, we review the nerve-machine interface modalities noted above with more focus on peripheral nerve interfaces, which are responsible for provision of sensory feedback. The invasive interfaces for recording and stimulation of electro-neurographic signals include intra-fascicular, regenerative-type interfaces that provide multiple contact channels to a group of axons inside the nerve and the extra-neural-cuff-type interfaces that enable interaction with many axons around the periphery of the nerve. Section Current Prosthetic Technology summarizes the advancements made to date in the field of neuroprosthetics toward the achievement of a bidirectional nerve-machine interface with more focus on sensory feedback. In the Discussion section, the authors propose a hybrid interface technique for achieving better selectivity and long-term stability using the available nerve interfacing techniques.

Psychophysical correspondence between vibrotactile intensity and intracortical microstimulation for tactile neuroprostheses in rats

OBJECTIVE

Recent studies showed that intracortical microstimulation (ICMS) generates artificial sensations which can be utilized as somatosensory feedback in cortical neuroprostheses. To mimic the natural psychophysical response, ICMS parameters are modulated according to psychometric equivalence functions (PEFs). PEFs match the intensity levels of ICMS and mechanical stimuli, which elicit equal detection probabilities, but they typically do not include the frequency as a control variable. We aimed to establish frequency-dependent PEFs for vibrotactile stimulation of the glabrous skin and ICMS in the primary somatosensory cortex of awake freely behaving rats.

APPROACH

We collected psychometric data for vibrotactile and ICMS detection at three stimulation frequencies (40, 60 and 80 Hz). The psychometric data were fitted with a model equation of two independent variables (stimulus intensity and frequency) and four subject-dependent parameters. For each rat, we constructed a separate PEF which was used to estimate the ICMS current amplitude for a given displacement amplitude and frequency. The ICMS frequency was set equal to the vibrotactile frequency. We validated the PEFs in a modified task which included randomly selected probe trials presented either with a vibrotactile or an ICMS stimulus, and also at frequencies and intensity levels not tested before.

MAIN RESULTS

The PEFs were generally successful in estimating the ICMS current intensities (no significant differences between vibrotactile and ICMS trials in Kolmogorov-Smirnov tests). Specifically, hit rates from both trial conditions were significantly correlated in 86% of the cases, and 52% of all data had perfect match in linear regression.

SIGNIFICANCE

The psychometric correspondence model presented in this study was constructed based on surface functions which define psychophysical detection probability as a function of stimulus intensity and frequency. Therefore, it may be used for the real-time modulation of the frequency and intensity of ICMS pulses in somatosensory neuroprostheses.

A cross-modal feedback scheme for control of prosthetic grasp strength

Introduction

Given the lack of haptic feedback inherent in prosthetic devices, a natural and adaptable feedback scheme must be implemented. While multimodal feedback has proven successful in aiding dexterous performance, it can be mentally tasking on the individual. Conversely, cross-modal schemes relying on sensory substitution have proven to be equally effective in aiding task performance without cognitively burdening the user to the same degree.

Objectives

This experiment investigated the effectiveness of the cross-modal feedback scheme through using audio feedback to represent prosthetic grasping strength during dynamic control of a prosthetic hand.

Methods

A total of five individuals participated in two sets of experiments (four subjects in the first, one subject in the second). Participants were asked to control the grasping strength exerted by a prosthetic hand while using real-time audio feedback in order to reach up to three different levels of force within a trial set.

Results

The cross-modal feedback scheme successfully provided users with the robust ability to modulate grasping strength in real-time using only audio feedback.

Conclusion

Audio feedback effectively conveys haptic information to the user of a prosthetic hand. Retention of the training knowledge is evident and can be generalized to perform new (i.e. untrained) tasks.

Combining Vibrotactile Feedback with Volitional Myoelectric Control for Robotic Transtibial Prostheses

In recent years, the development of myoelectric control for robotic lower-limb prostheses makes it possible for amputee users to volitionally control prosthetic joints. However, the human-centered control loop is not closed due to the lack of sufficient feedback of prosthetic joint movement, and it may result in poor control performance. In this research, we propose a vibrotactile stimulation system to provide the feedback of ankle joint position, and validate the necessity of combining it with volitional myoelectric control to achieve improved control performance. The stimulation system is wearable and consists of six vibrators. Three of the vibrators are placed on the anterior side of the thigh and the other three on the posterior side of the thigh. To explore the potential of applying the proposed vibrotactile feedback system for prosthetic ankle control, eight able-bodied subjects and two transtibial amputee subjects (TT1 and TT2) were recruited in this research, and several experiments were designed to investigate subjects’ sensitivities to discrete and continuous vibration stimulations applied on the thigh. Then, we proposed a stimulation controller to produce different stimulation patterns according to current ankle angle. Amputee subjects were asked to control a virtual ankle displayed on the computer screen to reach different target ankle angles with a myoelectric controller, and control performances under different feedback conditions were compared. Experimental results indicated that subjects were more sensitive to stimulation position changes (identification accuracies were 96.39 ± 0.86, 91.11, and 93.89% for able-bodied subjects, TT1, and TT2, respectively) than stimulation amplitude changes (identification accuracies were 89.89 ± 2.40, 87.04, and 85.19% for able-bodied subjects, TT1, and TT2, respectively). Response times of able-bodied subjects, TT1, and TT2 to stimulation pattern changes were 0.47 ± 0.02 s, 0.53 s, and 0.48 s, respectively. Furthermore, for both TT1 and TT2, the absolute error of virtual ankle control reduced by about 50% with the addition of vibrotactile feedback. These results suggest that it is promising to apply the vibrotactile feedback system for the control of robotic transtibial prostheses.

Integrated and flexible multichannel interface for electrotactile stimulation

OBJECTIVE

The aim of the present work was to develop and test a flexible electrotactile stimulation system to provide real-time feedback to the prosthesis user. The system requirements were to accommodate the capabilities of advanced multi-DOF myoelectric hand prostheses and transmit the feedback variables (proprioception and force) using intuitive coding, with high resolution and after minimal training.

APPROACH

We developed a fully-programmable and integrated electrotactile interface supporting time and space distributed stimulation over custom designed flexible array electrodes. The system implements low-level access to individual stimulation channels as well as a set of high-level mapping functions translating the state of a multi-DoF prosthesis (aperture, grasping force, wrist rotation) into a set of predefined dynamic stimulation profiles. The system was evaluated using discrimination tests employing spatial and frequency coding (10 able-bodied subjects) and dynamic patterns (10 able-bodied and 6 amputee subjects). The outcome measure was the success rate (SR) in discrimination.

MAIN RESULTS

The more practical electrode with the common anode configuration performed similarly to the more usual concentric arrangement. The subjects could discriminate six spatial and four frequency levels with SR >90% after a few minutes of training, whereas the performance significantly deteriorated for more levels. The dynamic patterns were intuitive for the subjects, although amputees showed lower SR than able-bodied individuals (86% ± 10% versus 99% ± 3%).

SIGNIFICANCE

The tests demonstrated that the system was easy to setup and apply. The design and resolution of the multipad electrode was evaluated. Importantly, the novel dynamic patterns, which were successfully tested, can be superimposed to transmit multiple feedback variables intuitively and simultaneously. This is especially relevant for closing the loop in modern multifunction prostheses. Therefore, the proposed system is convenient for practical applications and can be used to implement sensory perception training and/or closed-loop control of myoelectric prostheses, providing grasping force and proprioceptive feedback.

Electrotactile Feedback Improves Performance and Facilitates Learning in the Routine Grasping Task

Aim of this study was to investigate the feasibility of electrotactile feedback in closed loop training of force control during the routine grasping task. The feedback was provided using an array electrode and a simple six-level spatial coding, and the experiment was conducted in three amputee subjects. The psychometric tests confirmed that the subjects could perceive and interpret the electrotactile feedback with a high success rate. The subjects performed the routine grasping task comprising 4 blocks of 60 grasping trials. In each trial, the subjects employed feedforward control to close the hand and produce the desired grasping force (four levels). First (baseline) and the last (validation) session were performed in open loop, while the second and the third session (training) included electrotactile feedback. The obtained results confirmed that using the feedback improved the accuracy and precision of the force control. In addition, the subjects performed significantly better in the validation vs. baseline session, therefore suggesting that electrotactile feedback can be used for learning and training of myoelectric control.

Forearm amputees' views of prosthesis use and sensory feedback

STUDY DESIGN

Qualitative descriptive.

INTRODUCTION

The lack of sensory feedback in today's hand prostheses has been in focus recently but the amputees' experiences need to be further investigated.

PURPOSE

To explore forearm amputees' views of prosthesis use and sensory feedback.

METHODS

Thirteen unilateral congenital or traumatic forearm amputees were interviewed. The transcribed text was subjected to content analysis.

RESULTS

Prostheses both facilitate and limit occupational performance. Appearance is important for identity and blending into society. The feeling of agency regarding the prostheses is present but not that of body ownership. Future expectations concerned improved mobility, cosmetics, and sensory feedback.

CONCLUSIONS

This study allows a deeper understanding of the complex relationship between a prosthetic device and the wearer. Today's prostheses allow the wearer to feel agency concerning the artificial limb but the lack of sensory feedback seems to be an important factor still blocking the achievement of body ownership of the prosthesis.

LEVEL OF EVIDENCE

Not applicable.

Multichannel Electrotactile Feedback With Spatial and Mixed Coding for Closed-Loop Control of Grasping Force in Hand Prostheses

Providing somatosensory feedback to the user of a myoelectric prosthesis is an important goal since it can improve the utility as well as facilitate the embodiment of the assistive system. Most often, the grasping force was selected as the feedback variable and communicated through one or more individual single channel stimulation units (e.g., electrodes, vibration motors). In the present study, an integrated, compact, multichannel solution comprising an array electrode and a programmable stimulator was presented. Two coding schemes (15 levels), spatial and mixed (spatial and frequency) modulation, were tested in able-bodied subjects, psychometrically and in force control with routine grasping and force tracking using real and simulated prosthesis. The results demonstrated that mixed and spatial coding, although substantially different in psychometric tests, resulted in a similar performance during both force control tasks. Furthermore, the ideal, visual feedback was not better than the tactile feedback in routine grasping. To explain the observed results, a conceptual model was proposed emphasizing that the performance depends on multiple factors, including feedback uncertainty, nature of the task and the reliability of the feedforward control. The study outcomes, specific conclusions and the general model, are relevant for the design of closed-loop myoelectric prostheses utilizing tactile feedback.

A Novel Method to Generate Amplitude-Frequency Modulated Vibrotactile Stimulation

The natural interaction of humans with their environment involves the harmonious coordination of the body, for which multi-modal feedback including vision, proprioception, and tactile perception is essential. Most human-machine interfaces, however, rely on the visual feedback only, and this can lead to considerable cognitive burden. Additional haptic feedback can increase the intuitiveness of the man-machine interaction. Therefore, we propose here a new device able to generate complex vibrotactile stimulation by simultaneously modulating the amplitude and frequency of vibration. Physical measurements were first performed in eight healthy subjects to assess the capability of the device to generate vibrations. The results indicated that the vibration frequency and amplitude can be independently modulated and that the device response to the full-range step-change in the amplitude/frequency commands is almost instantaneous and symmetric. In addition, psychophysical assessments were conducted in four healthy subjects using a standard psychophysical procedure (SIAM). The outcomes indicated that the proposed device can produce approximately 400 vixels (discriminable stimuli), which allow for the generation of a high diversity of vibrotactile patterns. The proposed method allows producing different kinds of stimulation patterns using motor types that are suited for specific applications, with adjustable trade-off between vibration intensity, size, and power consumption.

Neural interfaces for somatosensory feedback: bringing life to a prosthesis

PURPOSE OF REVIEW

When an individual loses a limb, he/she loses touch with the world and with the people around him/her. Somatosensation is critical to the feeling of connection and control of one's own body. Decades of attempts to replace lost somatosensation by sensory substitutions have been ineffective outside of the laboratory. This review discusses important recent results demonstrating chronic somatosensory restoration through direct peripheral nerve stimulation.

RECENT FINDINGS

Stimulation of peripheral nerves results in somatosensory perception on the phantom limb. Sensations are localized to several independent and functionally relevant locations, such as the fingertips, thenar eminence, ulnar border and dorsal surface. Patterns in stimulation intensity change the perception experience by the user, opening new dimensions on neuromodulation.

SUMMARY

Neural interfaces with sophisticated stimulation paradigms create a user's perception of his/her hand to touch and manipulate objects. The pattern of intensity and frequency of stimulation is critical to the quality and intensity of perceived sensation. Restoring feeling has allowed the individuals to, 'feel [my] hand for the first time since the accident,' and 'feel [my] wife touch my hand'. Individuals using a prosthetic hand with sensation can pull cherries and grapes from the stem, open water bottles and move objects without destroying these objects - all while audio and visually deprived. After regaining sensation, phantom pain is eliminated in individuals that had frequent, sometimes debilitating, pain following limb loss. With over 5 subject-years of experience, this work is leading the evolution of a new era in prostheses. Somatosensory prosthetics as a standard procedure to augment and restore somatosensation are now within our reach.