Two-Tactor Vibrotactile Navigation Information for the Blind: Directional Resolution and Intuitive Interpretation

Lacking vision, blind people have to exploit other senses for navigation. Using the tactile rather than the auditory sense avoids masking important environmental information. Directional information is particularly important and traditionally conveyed through an array of tactors, each coding one direction. Here, we present a different approach to represent arbitrary directions with only two tactors. We tested intuitiveness, plasticity, and variability of direction perception in a behavioral experiment in 33 seeing participants.

Drop-off detection with the long cane: effect of cane shaft weight and rigidity on performance

Most travellers who are blind rely on a long cane to detect drop-offs on their walking paths. We examined how different cane shaft materials affect drop-off detection performance through providing different vibrotactile and proprioceptive feedbacks to the cane user. Results of the study showed a significant interaction between cane shaft weight and how the cane is used. A heavier cane was advantageous for detecting drop-offs when the individual used the 'constant contact technique' - cane tip stays in contact with the walking surface at all times - but not when he used the 'two-point touch technique' - cane tip is rhythmically tapped on the surface. In addition, a more flexible cane was advantageous for detecting drop-offs when the two-point touch technique was used but not when the constant contact technique was used. It is recommended that, when blind individuals select a cane shaft material, they consider which long cane technique they use more often. Practitioner Summary: Long cane shaft material affects how well a blind individual can detect drop-offs. A heavier shaft was advantageous when using the constant contact technique (cane tip stays in continuous contact with the surface), while a more flexible shaft was better when using the two-point touch technique (cane tip rhythmically taps the surface).

Acoustic wayfinding: A method to measure the acoustic contrast of different paving materials for blind people

Acoustic wayfinding involves using a variety of auditory cues to create a mental map of the surrounding environment. For blind people, these auditory cues become the primary substitute for visual information in order to understand the features of the spatial context and orient themselves. This can include creating sound waves, such as tapping a cane. This paper reports the results of a research about the "acoustic contrast" parameter between paving materials functioning as a cue and the surrounding or adjacent surface functioning as a background. A number of different materials was selected in order to create a test path and a procedure was defined for the verification of the ability of blind people to distinguish different acoustic contrasts. A method is proposed for measuring acoustic contrast generated by the impact of a cane tip on the ground to provide blind people with environmental information on spatial orientation and wayfinding in urban places.

Average Cost of VA Rehabilitation, Mental Health, and Long-Term Hospital Stays

This article describes the development of a database for the cost of inpatient rehabilitation, mental health, and long-term care stays in the Department of Veterans Affairs from fiscal year 1998 forward. Using “bedsection,” which is analogous to a hospital ward, the authors categorize inpatient services into nine categories: rehabilitation, blind rehabilitation, spinal cord injury, psychiatry, substance abuse, intermediate medicine, domiciliary, psychosocial residential rehabilitation, and nursing home. For each of the nine categories, they estimated a national and a local (i.e., medical center) average per diem cost. The nursing home average per diem costs were adjusted for case mix using patient assessment information. Encounter-level costs were then calculated by multiplying the aver-age per diem cost by the number of days of stay in the fiscal year. The national cost estimates are more reliable than the local cost estimates.

Intraoperative OCT Imaging of the Argus II Retinal Prosthesis System

BACKGROUND AND OBJECTIVE

Optimal placement of the Argus II Retinal Prosthesis System (Second Sight Medical Products, Sylmar, CA) is critical. Intraoperative optical coherence tomography (OCT) allows for intrasurgical visualization and confirmation of array placement. In this study, two different OCT systems were evaluated to assess the feasibility and utility of this technology during Argus II surgery.

PATIENTS AND METHODS

Intraoperative OCT was performed on five patients undergoing Argus II implantation at Cole Eye Institute from June 2015 to July 2016. The EnVisu portable OCT (Bioptigen, Morrisville, NC) and microscope-integrated RESCAN 700 (Zeiss, Oberkochen, Germany) intraoperative OCT systems were utilized. The EnVisu was used in three patients and the RESCAN 700 in three of the five patients. Following array tacking, intraoperative OCT was performed over the entire array including the edges and tack.

RESULTS

Intraoperative OCT allowed for visualization of the array/retina interface. Microscope integration of the OCT system facilitated ease of focusing, real-time feedback, surgeon-directed OCT scanning to the areas of interest, and enhanced image quality at points of interest.

CONCLUSIONS

Intraoperative imaging of the Argus II electrode array is feasible and provides information about electrode array-retina interface and distance to help guide a surgeon. Microscope integration of OCT appears to provide an optimal and efficient approach to intraoperative OCT during Argus II array placement. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:999-1003.].

The Effect of Programmable Tactile Displays on Spatial Learning Skills in Children and Adolescents of Different Visual Disability

Vision loss has severe impacts on physical, social and emotional well-being. The education of blind children poses issues as many scholar disciplines (e.g., geometry, mathematics) are normally taught by heavily relying on vision. Touch-based assistive technologies are potential tools to provide graphical contents to blind users, improving learning possibilities and social inclusion. Raised-lines drawings are still the golden standard, but stimuli cannot be reconfigured or adapted and the blind person constantly requires assistance. Although much research concerns technological development, little work concerned the assessment of programmable tactile graphics, in educative and rehabilitative contexts. Here we designed, on programmable tactile displays, tests aimed at assessing spatial memory skills and shapes recognition abilities. Tests involved a group of blind and a group of low vision children and adolescents in a four-week longitudinal schedule. After establishing subject-specific difficulty levels, we observed a significant enhancement of performance across sessions and for both groups. Learning effects were comparable to raised paper control tests: however, our setup required minimal external assistance. Overall, our results demonstrate that programmable maps are an effective way to display graphical contents in educative/rehabilitative contexts. They can be at least as effective as traditional paper tests yet providing superior flexibility and versatility.

Comparison of two Orientation Systems for Indoor Travel of Blind Persons with Mental Retardation

Two blind women affected by severe mental retardation were exposed to two previously developed orientation systems. One of the systems was based on acoustic cues, the other on vibratory feedback. The aim was to assess the relative effectiveness of the two systems. Data indicated that the acoustic system ensured a higher frequency of correct moves for one of the subjects and a more rapid performance of the moves for both subjects. The findings are reviewed in relation to the characteristics and applicability of the systems.

Integration and binding in rehabilitative sensory substitution: Increasing resolution using a new Zooming-in approach

PURPOSE

To visually perceive our surroundings we constantly move our eyes and focus on particular details, and then integrate them into a combined whole. Current visual rehabilitation methods, both invasive, like bionic-eyes and non-invasive, like Sensory Substitution Devices (SSDs), down-sample visual stimuli into low-resolution images. Zooming-in to sub-parts of the scene could potentially improve detail perception. Can congenitally blind individuals integrate a 'visual' scene when offered this information via different sensory modalities, such as audition? Can they integrate visual information -perceived in parts - into larger percepts despite never having had any visual experience?

METHODS

We explored these questions using a zooming-in functionality embedded in the EyeMusic visual-to-auditory SSD. Eight blind participants were tasked with identifying cartoon faces by integrating their individual components recognized via the EyeMusic's zooming mechanism.

RESULTS

After specialized training of just 6-10 hours, blind participants successfully and actively integrated facial features into cartooned identities in 79±18% of the trials in a highly significant manner, (chance level 10% ; rank-sum P <  1.55E-04).

CONCLUSIONS

These findings show that even users who lacked any previous visual experience whatsoever can indeed integrate this visual information with increased resolution. This potentially has important practical visual rehabilitation implications for both invasive and non-invasive methods.

Neural Correlates of Human Echolocation of Path Direction During Walking

Echolocation can be used by blind and sighted humans to navigate their environment. The current study investigated the neural activity underlying processing of path direction during walking. Brain activity was measured with fMRI in three blind echolocation experts, and three blind and three sighted novices. During scanning, participants listened to binaural recordings that had been made prior to scanning while echolocation experts had echolocated during walking along a corridor which could continue to the left, right, or straight ahead. Participants also listened to control sounds that contained ambient sounds and clicks, but no echoes. The task was to decide if the corridor in the recording continued to the left, right, or straight ahead, or if they were listening to a control sound. All participants successfully dissociated echo from no echo sounds, however, echolocation experts were superior at direction detection. We found brain activations associated with processing of path direction (contrast: echo vs. no echo) in superior parietal lobule (SPL) and inferior frontal cortex in each group. In sighted novices, additional activation occurred in the inferior parietal lobule (IPL) and middle and superior frontal areas. Within the framework of the dorso-dorsal and ventro-dorsal pathway proposed by Rizzolatti and Matelli (2003), our results suggest that blind participants may automatically assign directional meaning to the echoes, while sighted participants may apply more conscious, high-level spatial processes. High similarity of SPL and IFC activations across all three groups, in combination with previous research, also suggest that all participants recruited a multimodal spatial processing system for action (here: locomotion).

Movement Induces the Use of External Spatial Coordinates for Tactile Localization in Congenitally Blind Humans

To localize touch, the brain integrates spatial information coded in anatomically based and external spatial reference frames. Sighted humans, by default, use both reference frames in tactile localization. In contrast, congenitally blind individuals have been reported to rely exclusively on anatomical coordinates, suggesting a crucial role of the visual system for tactile spatial processing. We tested whether the use of external spatial information in touch can, alternatively, be induced by a movement context. Sighted and congenitally blind humans performed a tactile temporal order judgment task that indexes the use of external coordinates for tactile localization, while they executed bimanual arm movements with uncrossed and crossed start and end postures. In the sighted, start posture and planned end posture of the arm movement modulated tactile localization for stimuli presented before and during movement, indicating automatic, external recoding of touch. Contrary to previous findings, tactile localization of congenitally blind participants, too, was affected by external coordinates, though only for stimuli presented before movement start. Furthermore, only the movement's start posture, but not the planned end posture affected blind individuals' tactile performance. Thus, integration of external coordinates in touch is established without vision, though more selectively than when vision has developed normally, and possibly restricted to movement contexts. The lack of modulation by the planned posture in congenitally blind participants suggests that external coordinates in this group are not mediated by motor efference copy. Instead the task-related frequent posture changes, that is, movement consequences rather than planning, appear to have induced their use of external coordinates.

Indoor inertial waypoint navigation for the blind

Indoor navigation technology is needed to support seamless mobility for the visually impaired. This paper describes the construction and evaluation of an inertial dead reckoning navigation system that provides real-time auditory guidance along mapped routes. Inertial dead reckoning is a navigation technique coupling step counting together with heading estimation to compute changes in position at each step. The research described here outlines the development and evaluation of a novel navigation system that utilizes information from the mapped route to limit the problematic error accumulation inherent in traditional dead reckoning approaches. The prototype system consists of a wireless inertial sensor unit, placed at the users' hip, which streams readings to a smartphone processing a navigation algorithm. Pilot human trials were conducted assessing system efficacy by studying route-following performance with blind and sighted subjects using the navigation system with real-time guidance, versus offline verbal directions.

Designing Haptic Assistive Technology for Individuals Who Are Blind or Visually Impaired

This paper considers issues relevant for the design and use of haptic technology for assistive devices for individuals who are blind or visually impaired in some of the major areas of importance: Braille reading, tactile graphics, orientation and mobility. We show that there is a wealth of behavioral research that is highly applicable to assistive technology design. In a few cases, conclusions from behavioral experiments have been directly applied to design with positive results. Differences in brain organization and performance capabilities between individuals who are "early blind" and "late blind" from using the same tactile/haptic accommodations, such as the use of Braille, suggest the importance of training and assessing these groups individually. Practical restrictions on device design, such as performance limitations of the technology and cost, raise questions as to which aspects of these restrictions are truly important to overcome to achieve high performance. In general, this raises the question of what it means to provide functional equivalence as opposed to sensory equivalence.

Vibrotactile Guidance for Wayfinding of Blind Walkers

We propose a vibrotactile interface in the form of a belt for guiding blind walkers. This interface enables blind walkers to receive haptic directional instructions along complex paths without negatively impacting users' ability to listen and/or perceive the environment the way some auditory directional instructions do. The belt interface was evaluated in a controlled study with 10 blind individuals and compared to the audio guidance. The experiments were videotaped and the participants' behaviors and comments were content analyzed. Completion times and deviations from ideal paths were also collected and statistically analyzed. By triangulating the quantitative and qualitative data, we found that the belt resulted in closer path following to the expense of speed. In general, the participants were positive about the use of vibrotactile belt to provide directional guidance.

The Importance of Visual Experience, Gender, and Emotion in the Assessment of an Assistive Tactile Mouse

Tactile maps are efficient tools to improve spatial understanding and mobility skills of visually impaired people. Their limited adaptability can be compensated with haptic devices which display graphical information, but their assessment is frequently limited to performance-based metrics only which can hide potential spatial abilities in O&M protocols. We assess a low-tech tactile mouse able to deliver three-dimensional content considering how performance, mental workload, behavior, and anxiety status vary with task difficulty and gender in congenitally blind, late blind, and sighted subjects. Results show that task difficulty coherently modulates the efficiency and difficulty to build mental maps, regardless of visual experience. Although exhibiting attitudes that were similar and gender-independent, the females had lower performance and higher cognitive load, especially when congenitally blind. All groups showed a significant decrease in anxiety after using the device. Tactile graphics with our device seems therefore to be applicable with different visual experiences, with no negative emotional consequences of mentally demanding spatial tasks. Going beyond performance-based assessment, our methodology can help with better targeting technological solutions in orientation and mobility protocols.

Refreshing Refreshable Braille Displays

The increased access to books afforded to blind people via e-publishing has given them long-sought independence for both recreational and educational reading. In most cases, blind readers access materials using speech output. For some content such as highly technical texts, music, and graphics, speech is not an appropriate access modality as it does not promote deep understanding. Therefore blind braille readers often prefer electronic braille displays. But, these are prohibitively expensive. The search is on, therefore, for a low-cost refreshable display that would go beyond current technologies and deliver graphical content as well as text. And many solutions have been proposed, some of which reduce costs by restricting the number of characters that can be displayed, even down to a single braille cell. In this paper, we demonstrate that restricting tactile cues during braille reading leads to poorer performance in a letter recognition task. In particular, we show that lack of sliding contact between the fingertip and the braille reading surface results in more errors and that the number of errors increases as a function of presentation speed. These findings suggest that single cell displays which do not incorporate sliding contact are likely to be less effective for braille reading.

Designing Media for Visually-Impaired Users of Refreshable Touch Displays: Possibilities and Pitfalls

This paper discusses issues of importance to designers of media for visually impaired users. The paper considers the influence of human factors on the effectiveness of presentation as well as the strengths and weaknesses of tactile, vibrotactile, haptic, and multimodal methods of rendering maps, graphs, and models. The authors, all of whom are visually impaired researchers in this domain, present findings from their own work and work of many others who have contributed to the current understanding of how to prepare and render images for both hard-copy and technology-mediated presentation of Braille and tangible graphics.

Ashtanga-Based Yoga Therapy Increases the Sensory Contribution to Postural Stability in Visually-Impaired Persons at Risk for Falls as Measured by the Wii Balance Board: A Pilot Randomized Controlled Trial

Objective

Persons with visual impairment (VI) are at greater risk for falls due to irreparable damage to visual sensory input contributing to balance. Targeted training may significantly improve postural stability by strengthening the remaining sensory systems. Here, we evaluate the Ashtanga-based Yoga Therapy (AYT) program as a multi-sensory behavioral intervention to develop postural stability in VI.

Design

A randomized, waitlist-controlled, single-blind clinical trial

Methods

The trial was conducted between October 2012 and December 2013. Twenty-one legally blind participants were randomized to an 8-week AYT program (n = 11, mean (SD) age = 55(17)) or waitlist control (n=10, mean (SD) age = 55(10)). AYT subjects convened for one group session at a local yoga studio with an instructor and two individual home-based practice sessions per week for a total of 8 weeks. Subjects completed outcome measures at baseline and post-8 weeks of AYT. The primary outcome, absolute Center of Pressure (COP), was derived from the Wii Balance Board (WBB), a standalone posturography device, in 4 sensory conditions: firm surface, eyes open (EO); firm surface, eyes closed (EC); foam surface, EO; and foam surface, EC. Stabilization Indices (SI) were computed from COP measures to determine the relative visual (SI_firm, SI_foam), somatosensory (SI_EO, SI_EC) and vestibular (SI_V, i.e., Foam_EC vs. Firm_EO) contributions to balance. This study was not powered to detect between group differences, so significance of pre-post changes was assessed by paired samples t-tests within each group.

Results

Groups were equivalent at baseline (all p > 0.05). In the AYT group, absolute COP significantly increased in the Foam_EO (t(8) = -3.66, p = 0.01) and Foam_EC (t(8) = -3.90, p = 0.01) conditions. Relative somatosensory SI_EO (t(8) = -2.42, p = 0.04) and SI_EC (t(8) = -3.96, p = 0.01), and vestibular SI_V (t(8) = -2.47, p = 0.04) contributions to balance increased significantly. As expected, no significant changes from EO to EC conditions were found indicating an absence of visual dependency in VI. No significant pre-post changes were observed in the control group (all p > 0.05).

Conclusions

These preliminary results establish the potential for AYT training to develop the remaining somatosensory and vestibular responses used to optimize postural stability in a VI population.

Trial Registration

www.ClinicalTrials.govNCT01366677

Oculomotor behavior of blind patients seeing with a subretinal visual implant

Electronic implants are able to restore some visual function in blind patients with hereditary retinal degenerations. Subretinal visual implants, such as the CE-approved Retina Implant Alpha IMS (Retina Implant AG, Reutlingen, Germany), sense light through the eye's optics and subsequently stimulate retinal bipolar cells via ∼1500 independent pixels to project visual signals to the brain. Because these devices are directly implanted beneath the fovea, they potentially harness the full benefit of eye movements to scan scenes and fixate objects. However, so far, the oculomotor behavior of patients using subretinal implants has not been characterized. Here, we tracked eye movements in two blind patients seeing with a subretinal implant, and we compared them to those of three healthy controls. We presented bright geometric shapes on a dark background, and we asked the patients to report seeing them or not. We found that once the patients visually localized the shapes, they fixated well and exhibited classic oculomotor fixational patterns, including the generation of microsaccades and ocular drifts. Further, we found that a reduced frequency of saccades and microsaccades was correlated with loss of visibility. Last, but not least, gaze location corresponded to the location of the stimulus, and shape and size aspects of the viewed stimulus were reflected by the direction and size of saccades. Our results pave the way for future use of eye tracking in subretinal implant patients, not only to understand their oculomotor behavior, but also to design oculomotor training strategies that can help improve their quality of life.

The skin as a medium for sensory substitution

The last 50 years or so has seen great optimism concerning the potential of sensory substitution and augmentation devices to enhance the lives of those with (or even those without) some form of sensory loss (in practice, this has typically meant those who are blind or suffering from low vision). One commonly discussed solution for those individuals who are blind has been to use one of a range of tactile-visual sensory substitution systems that represent objects captured by a camera as outline images on the skin surface in real-time (what Loomis, Klatzky and Giudice, 2012, term general-purpose sensory substitution devices). However, despite the fact that touch, like vision, initially codes information spatiotopically, I would like to argue that a number of fundamental perceptual, attentional, and cognitive limitations constraining the processing of tactile information mean that the skin surface is unlikely ever to provide such general-purpose sensory substitution capabilities. At present, there is little evidence to suggest that the extensive cortical plasticity that has been demonstrated in those who have lost (or never had) a sense can do much to overcome the limitations associated with trying to perceive high rates of spatiotemporally varying information presented via the skin surface (no matter whether that surface be the back, stomach, forehead, or tongue). Instead, the use of the skin will likely be restricted to various special-purpose devices that enable specific activities such as navigation, the control of locomotion, pattern perception, etc.