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Background: For people with lower-limb amputations, wearing a prosthetic limb helps restore their motor abilities for daily activities. However, the prosthesis's potential benefits are hindered by limited somatosensory feedback from the affected limb and its prosthesis. Previous studies have examined various sensory substitution systems to alleviate this problem; the prominent approach is to convert foot-ground interaction to tactile stimulations. However, positive outcomes for improving their postural stability are still rare. We hypothesized that the sensory substiution system based on surrogated tactile stimulus is capable of improving the standing stability among people with lower-limb amputations.Methods: We designed a wearable device consisting of four pressure sensors and two vibrators and tested it among people with unilateral transtibial amputations (n = 7) and non-disabled participants (n = 8). The real-time measurements of foot pressure were fused into a single representation of foot-ground interaction force, which was encoded by varying vibration intensity of the two vibrators attached to the participants' forearm. The vibration intensity followed a logarithmic function of the force representation, in keeping with principles of tactile psychophysics. The participants were tested with a classical postural stability task in which visual disturbances perturbed their quiet standing.Results: With a brief familiarization of the system, the participants exhibited better postural stability against visual disturbances when switching on sensory substitution than without. The body sway was substantially reduced, as shown in head movements and excursions of the center of pressure. The improvement was present for both groups of participants and was particularly pronounced in more challenging conditions with larger visual disturbances.Conclusions: Substituting otherwise missing foot pressure feedback with vibrotactile signals can improve postural stability for people with lower-limb amputations. The design of the mapping between the foot-ground interaction force and the tactile signals is essential for the user to utilize the surrogated tactile signals for postural control, especially for situations that their postural control is challenged. [ABSTRACT FROM AUTHOR]

Background: Deficits of kinesthesia (limb position and movement sensation) commonly limit sensorimotor function and its recovery after neuromotor injury. Sensory substitution technologies providing synthetic kinesthetic feedback might re-establish or enhance closed-loop control of goal-directed behaviors in people with impaired kinesthesia.Methods: As a first step toward this goal, we evaluated the ability of unimpaired people to use vibrotactile sensory substitution to enhance stabilization and reaching tasks. Through two experiments, we compared the objective and subjective utility of two forms of supplemental feedback - limb state information or hand position error - to eliminate hand position drift, which develops naturally during stabilization tasks after removing visual feedback.Results: Experiment 1 optimized the encoding of limb state feedback; the best form included hand position and velocity information, but was weighted much more heavily toward position feedback. Upon comparing optimal limb state feedback vs. hand position error feedback in Experiment 2, we found both encoding schemes capable of enhancing stabilization and reach performance in the absence of vision. However, error encoding yielded superior outcomes - objective and subjective - due to the additional task-relevant information it contains.Conclusions: The results of this study have established the immediate utility and relative merits of two forms of vibrotactile kinesthetic feedback in enhancing stabilization and reaching actions performed with the arm and hand in neurotypical people. These findings can guide future development of vibrotactile sensory substitution technologies for improving sensorimotor function after neuromotor injury in survivors who retain motor capacity, but lack proprioceptive integrity in their more affected arm. [ABSTRACT FROM AUTHOR]

Background: Haptic display technologies are well suited to relay proprioceptive, force, and contact cues from a prosthetic terminal device back to the residual limb and thereby reduce reliance on visual feedback. The ease with which an amputee interprets these haptic cues, however, likely depends on whether their dynamic signal behavior corresponds to expected behaviors-behaviors consonant with a natural limb coupled to the environment. A highly geared motor in a terminal device along with the associated high back-drive impedance influences dynamic interactions with the environment, creating effects not encountered with a natural limb. Here we explore grasp and lift performance with a backdrivable (low backdrive impedance) terminal device placed under proportional myoelectric position control that features referred haptic feedback.Methods: We fabricated a back-drivable terminal device that could be used by amputees and non-amputees alike and drove aperture (or grip force, when a stiff object was in its grasp) in proportion to a myoelectric signal drawn from a single muscle site in the forearm. In randomly ordered trials, we assessed the performance of N=10 participants (7 non-amputee, 3 amputee) attempting to grasp and lift an object using the terminal device under three feedback conditions (no feedback, vibrotactile feedback, and joint torque feedback), and two object weights that were indiscernible by vision.Results: Both non-amputee and amputee participants scaled their grip force according to the object weight. Our results showed only minor differences in grip force, grip/load force coordination, and slip as a function of sensory feedback condition, though the grip force at the point of lift-off for the heavier object was significantly greater for amputee participants in the presence of joint torque feedback. An examination of grip/load force phase plots revealed that our amputee participants used larger safety margins and demonstrated less coordination than our non-amputee participants.Conclusions: Our results suggest that a backdrivable terminal device may hold advantages over non-backdrivable devices by allowing grip/load force coordination consistent with behaviors observed in the natural limb. Likewise, the inconclusive effect of referred haptic feedback on grasp and lift performance suggests the need for additional testing that includes adequate training for participants. [ABSTRACT FROM AUTHOR]

Technological advancements have led to the development of numerous wearable robotic devices for the physical assistance and restoration of human locomotion. While many challenges remain with respect to the mechanical design of such devices, it is at least equally challenging and important to develop strategies to control them in concert with the intentions of the user. This work reviews the state-of-the-art techniques for controlling portable active lower limb prosthetic and orthotic (P/O) devices in the context of locomotive activities of daily living (ADL), and considers how these can be interfaced with the user's sensory-motor control system. This review underscores the practical challenges and opportunities associated with P/O control, which can be used to accelerate future developments in this field. Furthermore, this work provides a classification scheme for the comparison of the various control strategies. As a novel contribution, a general framework for the control of portable gait-assistance devices is proposed. This framework accounts for the physical and informatic interactions between the controller, the user, the environment, and the mechanical device itself. Such a treatment of P/Os - not as independent devices, but as actors within an ecosystem - is suggested to be necessary to structure the next generation of intelligent and multifunctional controllers. Each element of the proposed framework is discussed with respect to the role that it plays in the assistance of locomotion, along with how its states can be sensed as inputs to the controller. The reviewed controllers are shown to fit within different levels of a hierarchical scheme, which loosely resembles the structure and functionality of the nominal human central nervous system (CNS). Active and passive safety mechanisms are considered to be central aspects underlying all of P/O design and control, and are shown to be critical for regulatory approval of such devices for real-world use. The works discussed herein provide evidence that, while we are getting ever closer, significant challenges still exist for the development of controllers for portable powered P/O devices that can seamlessly integrate with the user's neuromusculoskeletal system and are practical for use in locomotive ADL. [ABSTRACT FROM AUTHOR]

Background: Electrocutaneous stimulation can restore the missing sensory information to prosthetic users. In electrotactile feedback, the information about the prosthesis state is transmitted in the form of pulse trains. The stimulation frequency is an important parameter since it influences the data transmission rate over the feedback channel as well as the form of the elicited tactile sensations. Methods: We evaluated the influence of the stimulation frequency on the subject's ability to utilize the feedback information during electrotactile closed-loop control. Ten healthy subjects performed a real-time compensatory tracking (standard test bench) of sinusoids and pseudorandom signals using either visual feedback (benchmark) or electrocutaneous feedback in seven conditions characterized by different combinations of the stimulation frequency (FSTIM) and tracking error sampling rate (FTE). The tracking error was transmitted using two concentric electrodes placed on the forearm. The quality of tracking was assessed using the Squared Pearson Correlation Coefficient (SPCC), the Normalized Root Mean Square Tracking Error (NRMSTE) and the time delay between the reference and generated trajectories (TDIO). Results: The results demonstrated that FSTIM was more important for the control performance than FTE. The quality of tracking deteriorated with a decrease in the stimulation frequency, SPCC and NRMSTE (mean) were 87.5% and 9.4% in the condition 100/100 (FTE/FSTIM), respectively, and deteriorated to 61.1% and 15.3% in 5/5, respectively, while the TDIO increased from 359.8 ms in 100/100 to 1009 ms in 5/5. However, the performance recovered when the tracking error sampled at a low rate was delivered using a high stimulation frequency (SPCC = 83.6%, NRMSTE = 10.3%, TDIO = 415.6 ms, in 5/100). Conclusions: The likely reason for the performance decrease and recovery was that the stimulation frequency critically influenced the tactile perception quality and thereby the effective rate of information transfer through the feedback channel. The outcome of this study can facilitate the selection of optimal system parameters for somatosensory feedback in upper limb prostheses. The results imply that the feedback variables (e.g., grasping force) should be transmitted at relatively high frequencies of stimulation (>25 Hz), but that they can be sampled at much lower rates (e.g., 5 Hz). [ABSTRACT FROM AUTHOR]

Background: Biofeedback of body motion can serve as a balance aid and rehabilitation tool. To date, mathematical models considering the integration of biofeedback into postural control have represented this integration as a sensory addition and limited their application to a single degree-of-freedom representation of the body. This study has two objectives: 1) to develop a scalable method for incorporating biofeedback into postural control that is independent of the model's degrees of freedom, how it handles sensory integration, and the modeling of its postural controller; and 2) to validate this new model using multidirectional perturbation experimental results. Methods: Biofeedback was modeled as an additional torque to the postural controller torque. For validation, this biofeedback modeling approach was applied to a vibrotactile biofeedback device and incorporated into a two-link multibody model with full-state-feedback control that represents the dynamics of bipedal stance. Average response trajectories of body sway and center of pressure (COP) to multidirectional surface perturbations of subjects with vestibular deficits were used for model parameterization and validation in multiple perturbation directions and for multiple display resolutions. The quality of fit was quantified using average error and cross-correlation values. Results: The mean of the average errors across all tactor configurations and perturbations was 0.24° for body sway and 0.39 cm for COP. The mean of the cross-correlation value was 0.97 for both body sway and COP. Conclusions: The biofeedback model developed in this study is capable of capturing experimental response trajectory shapes with low average errors and high cross-correlation values in both the anterior-posterior and medial-lateral directions for all perturbation directions and spatial resolution display configurations considered. The results validate that biofeedback can be modeled as an additional torque to the postural controller without a need for sensory reweighting. This novel approach is scalable and applicable to a wide range of movement conditions within the fields of balance and balance rehabilitation. The model confirms experimental results that increased display resolution does not necessarily lead to reduced body sway. To our knowledge, this is the first theoretical confirmation that a spatial display resolution of 180° can be as effective as a spatial resolution of 22.5°. [ABSTRACT FROM AUTHOR]

Background: Multi-axis vibrotactile feedback has been shown to significantly reduce the root-mean-square (RMS) sway, elliptical fits to sway trajectory area, and the time spent outside of the no feedback zone in individuals with vestibular deficits during continuous multidirectional support surface perturbations. The purpose of this study was to examine the effect of multidirectional vibrotactile biofeedback on postural stability during discrete multidirectional support surface perturbations. Methods: The vibrotactile biofeedback device mapped tilt estimates onto the torso using a 3-row by 16-column tactor array. The number of columns displayed was varied to determine the effect of spatial resolution upon subject response. Torso kinematics and center of pressure data were measured in six subjects with vestibular deficits. Transient and steady state postural responses with and without feedback were characterized in response to eight perturbation directions. Four feedback conditions in addition to the tactors off (no feedback) configuration were evaluated. Postural response data captured by both a force plate and an inertial measurement unit worn on the torso were partitioned into three distinct phases: ballistic, recovery, and steady state. Results: The results suggest that feedback has minimal effects during the ballistic phase (body's outbound trajectory in response to the perturbation), and the greatest effects during the recovery (return toward baseline) and steady state (post-recovery) phases. Specifically, feedback significantly decreases the time required for the body tilt to return to baseline values and significantly increases the velocity of the body's return to baseline values. Furthermore, feedback significantly decreases root mean square roll and pitch sway and significantly increases the amount of time spent in the no feedback zone. All four feedback conditions produced comparable performance improvements. Incidences of delayed and uncontrolled responses were significantly reduced with feedback while erroneous (sham) feedback resulted in poorer performance when compared with the no feedback condition. Conclusions: The results show that among the displays evaluated in this study, no one tactor column configuration was optimal for standing tasks involving discrete surface perturbations. Feedback produced larger effects on body tilt versus center of pressure parameters. Furthermore, the subjects' performance worsened when erroneous feedback was provided, suggesting that vibrotactile stimulation applied to the torso is actively processed and acted upon rather than being responsible for simply triggering a stiffening response. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]