Safety and efficacy of medically performed tongue piercing in people with tetraplegia for use with tongue-operated assistive technology

Assistive Technologies and Quadriplegia: A Map Point on the Development and Spread of the Tongue Barbell Piercing

The barbell piercing can be used as an assistive device that allows people with severe disabilities, such as tetraplegia, to control their environments using the movement of the tongue. The human tongue can move rapidly and accurately, such that the tip can touch every tooth. Lingual control systems allow people with disabilities to take advantage of their residual skills for easier communication and to improve the control of mobility and the surrounding environment. The aim of this study was to conduct a narrative review of the development and dissemination of the assistive technologies based on tongue control by means of the barbell piercing. The design of the study was based on: (I) an overview of Pubmed complemented with other databases and Web searches (also institutional); (II) an organization according to a standardized checklist for narrative reviews; (III) an arrangement with four different perspectives: the trends in the scientific literature, technological evolution and categorization, dominant approaches, issues of incorporation into the health domain-such as acceptance, safety, and regulations. The results have highlighted: (1) that the volume of scientific productions, which started in this sector before the smartphone expansion, has not increased; (2) that it is possible to make a map point of the technological evolution and categorization; (3) that these assistive technologies have a high degree of acceptance and performance, especially when integrated with aid tools with mechatronics; (4) and the complexity of the regulatory framework in this area. The study, from a general point of view, highlighted the high potential of these systems and we suggest investing the energy into agreement tools for assistive technologies (AT)s, such as health technology assessment studies, comparative assessment analysis, or consensus conferences that could allow a better diffusion and use of ATs, including these systems.

Oral manifestations arising from oral piercings: A systematic review and meta-analyses

OBJECTIVE

The aim of this study was to perform a systematic review of oral manifestations arising from oral piercings.

STUDY DESIGN

Literature was searched through January 2022 in PubMed, Scopus, Embase, Web of Science, Cochrane Library and Virtual Health Library, OpenGrey, and Google Scholar to address the question, "Is there an association between oral piercings and oral alterations, complications, or lesions?" Quality was assessed using the Joanna Briggs Institute appraisal tools. Meta-analyses were performed, and certainty of evidence was assessed through Grading of Recommendations Assessment, Development and Evaluation (GRADE). Reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Fifty-four studies were included, with 15 achieving good methodological quality. Periodontal and tooth damage were the most reported, followed by soft tissue/mucosal injuries, speech disorders, chewing, soft plaque, and saliva. Pain was the most reported complication, followed by infection, swelling, bleeding, inflammation, allergy, and adornment aspiration. Meta-analyses revealed that 33% of participants with piercings had gingival recession (GR) (event rate [ER] = 0.329). In participants with piercings, ER values for nonspecified dental damage (NSDD), tooth chipping, wear/abrasion, and dental fracture (DF) were 27% (ER = 0.270), 22% (ER = 0.219), 34% (ER = 0.344), and 34% (ER = 0.338), respectively. Certainty of evidence was very low.

CONCLUSIONS

Alterations, complications, and lesions were associated with oral piercings and adornments, of which GR, DF, and NSDD were the most prevalent.

Literature review on assistive devices available for quadriplegic people: Indian context

PURPOSE

This literature review aims to find the current state of the art in self-help devices (SHD) available for people with quadriplegia.

MATERIALS AND METHODS

We searched original articles, technical and case studies, conference articles, and literature reviews published between 2014 to 2019 with the keywords ("Self-help devices" OR "Assistive Devices" OR "Assistive Product" OR "Assistive Technology") AND "Quadriplegia" in Science Direct, Pubmed, IEEE Xplore digital library and Web of Science.

RESULTS

Total 222 articles were found. After removing duplicates and screening these articles based on their title and abstracts 80 articles remained. After this, we reviewed the full text, and articles unrelated to SHD development or about the patients who require mechanical ventilation or where the upper limb is functional (C2 or above and T2 or below injuries) were discarded. After the exclusion of articles using the above-mentioned criterion 75 articles were used for further review.

CONCLUSION

The abandonment rate of SHD currently available in the literature is very high. The major requirement of the people was independence and improved quality of life. The situation in India is very bad as compared to the developed countries. The people with spinal cord injury in India are uneducated and very poor, with an average income of 3000 ₹ (41$). They require SHDs and training specially designed for them, keeping their needs in mind.Implications for rehabilitationPeople with quadriplegia are totally dependent on caregivers. Assistive devices not only help these people to do day-to-day tasks but also provides them self-confidence.Even though there are a lot of self-help devices currently available, still they are not able to fulfil the requirements of people with quadriplegia, hence there is a very high abandonment rate of such devices.This study provides an evidence that developing devices after understanding the functional and non-functional requirements of these subjects will decrease the abandonment rate and increase the effectiveness of the device.The results of this study can be used for planning and developing assistive devices which are more focussed on fulfilling the requirements of people with quadriplegia.

Magnetic implants in the tongue for assistive technologies: Tests of migration; oromotor function; and tissue response in miniature pigs

OBJECTIVE

Uncertain biological consequences of titanium-magnet (Ti-mag) tongue implants constrain application of the Tongue Drive System (TDS), a brain-tongue-computer interface for individuals with severe physical impairment. Here we describe oromotor function and tongue tissue response following Ti-Mag implantation and explantation in the miniature pig, an animal model with a tongue similar in size to humans.

DESIGN

A 1.8×6.2mm Ti-mag tracer was implanted into the anterior tongue in five Yucatan minipigs. X-rays were taken immediately and >six days after implantation to evaluate tracer migration. In three minipigs, the tracer was explanted >16days after implantation. Twenty-five days post-explantation, tongue tissue was harvested and processed for histological and immunohistochemical (IHC) markers of healing. In two minipigs tissue markers of healing were evaluated post-mortem following >12days implantation. Drink cycle rate (DCR) was characterized to determine the impact of procedures on oromotor function.

RESULTS

Neither implantation (N=5) nor explantation (N=3) changed DCR. X-rays revealed minimal tracer migration (N=4, 0-4mm). By histology and IHC a robust capsule was present two weeks post-implantation with limited fibrosis. Explantation produced localized fibrosis and limited muscle remodeling.

CONCLUSIONS

These findings suggest the safety of Ti-mag anterior tongue implants for assistive technologies in humans.

Tongue implant for assistive technologies: Test of migration, tissue reactivity and impact on tongue function

OBJECTIVE

The Tongue Drive System (TDS) is a new wearable assistive technology (AT), developed to translate voluntary tongue movements to user-defined computer commands by tracking the position of a titanium-encased magnetic tracer (Ti-Mag) implanted into the tongue. TDS application, however, is constrained by limited information on biological consequence and safety of device implantation into the tongue body. Here we implant a stainless-steel pellet in the rat tongue and assay pellet migration, tongue lick function, and tongue histology to test the safety and biocompatibility of unanchored tongue implants.

DESIGN

Water consumption, weight and lick behavior were measured before and for >24days after implantation of a stainless-steel spherical pellet (0.5mm) into the anterior tongue body of twelve adult male rats. X-rays were obtained weekly to assess pellet migration. Pellet location and tissue reaction to implantation were determined by post-mortem dissection and histology of the anterior tongue.

RESULTS

By dissection pellets were distributed across the transverse plane of the tongue. Measures of water consumption, weight, and lick behavior were unchanged by implantation except for a decrease in consumption immediately post-implantation in some animals. By X-ray, there was no migration of the implant, a finding supported by pellet encapsulation demonstrated histologically. Measures of lick behavior were minimally impacted by implantation.

CONCLUSION

A smooth spherical stainless-steel implant in the anterior tongue of the rat does not migrate, is encapsulated and does not substantially impact lick behavior. These findings support the implantation of small tracers in the anterior tongue in humans for operating wearable assistive technologies.

Assessment of the Tongue-Drive System Using a Computer, a Smartphone, and a Powered-Wheelchair by People With Tetraplegia

Tongue-Drive System (TDS) is a wireless and wearable assistive technology that enables people with severe disabilities to control their computers, wheelchairs, and smartphones using voluntary tongue motion. To evaluate the efficacy of the TDS, several experiments were conducted, in which the performance of nine able-bodied (AB) participants using a mouse, a keypad, and the TDS, as well as a cohort of 11 participants with tetraplegia (TP) using the TDS, were observed and compared. Experiments included the Fitts' law tapping, wheelchair driving, phone-dialing, and weight-shifting tasks over five to six consecutive sessions. All participants received a tongue piercing, wore a magnetic tongue stud, and completed the trials as evaluable participants. Although AB participants were already familiar with the keypad, throughputs of their tapping tasks using the keypad were only 1.4 times better than those using the TDS. The completion times of wheelchair driving task using the TDS for AB and TP participants were between 157 s and 180 s with three different control strategies. Participants with TP completed phone-dialing and weight-shifting tasks in 81.9 s and 71.5 s, respectively, using tongue motions. Results showed statistically significant improvement or trending to improvement in performance status over the sessions. Most of the learning occurred between the first and second sessions, but trends did suggest that more practice would lead to increased improvement in performance using the TDS.