Cross-Modal Sensory Boosting to Improve High-Frequency Hearing Loss: Device Development and Validation

Background

High-frequency hearing loss is one of the most common problems in the aging population and with those who have a history of exposure to loud noises. This type of hearing loss can be frustrating and disabling, making it difficult to understand speech communication and interact effectively with the world.

Objective

This study aimed to examine the impact of spatially unique haptic vibrations representing high-frequency phonemes on the self-perceived ability to understand conversations in everyday situations.

Methods

To address high-frequency hearing loss, a multi-motor wristband was developed that uses machine learning to listen for specific high-frequency phonemes. The wristband vibrates in spatially unique locations to represent which phoneme was present in real time. A total of 16 participants with high-frequency hearing loss were recruited and asked to wear the wristband for 6 weeks. The degree of disability associated with hearing loss was measured weekly using the Abbreviated Profile of Hearing Aid Benefit (APHAB).

Results

By the end of the 6-week study, the average APHAB benefit score across all participants reached 12.39 points, from a baseline of 40.32 to a final score of 27.93 (SD 13.11; N=16; P=.002, 2-tailed dependent t test). Those without hearing aids showed a 10.78-point larger improvement in average APHAB benefit score at 6 weeks than those with hearing aids (t14=2.14; P=.10, 2-tailed independent t test). The average benefit score across all participants for ease of communication was 15.44 (SD 13.88; N=16; P<.001, 2-tailed dependent t test). The average benefit score across all participants for background noise was 10.88 (SD 17.54; N=16; P=.03, 2-tailed dependent t test). The average benefit score across all participants for reverberation was 10.84 (SD 16.95; N=16; P=.02, 2-tailed dependent t test).

Conclusions

These findings show that vibrotactile sensory substitution delivered by a wristband that produces spatially distinguishable vibrations in correspondence with high-frequency phonemes helps individuals with high-frequency hearing loss improve their perceived understanding of verbal communication. Vibrotactile feedback provides benefits whether or not a person wears hearing aids, albeit in slightly different ways. Finally, individuals with the greatest perceived difficulty understanding speech experienced the greatest amount of perceived benefit from vibrotactile feedback.

Transparent and Flexible Actuator Based on a Hybrid Dielectric Layer of Wavy Polymer and Dielectric Fluid Mixture

Transparent and flexible vibrotactile actuators play an essential role in human-machine interaction applications by providing mechanical stimulations that can effectively convey haptic sensations. In the present study, we fabricated an electroactive, flexible, and transparent vibrotactile actuator with a dielectric layer including a dielectric elastomer and dielectric fluid mixture. The dielectric fluid mixture of propylene carbonate (PC) and acetyl tributyl citrate (ATBC) was injected to obtain a transparent dielectric layer. To further improve the haptic performance, different weight ratios of dielectric fluid (PC: ATBC) were injected. The fabricated vibrotactile actuators based on a transparent dielectric layer were investigated for their electrical and electromechanical behavior. The proposed actuators generate a large vibrational intensity (~2.5 g) in the range of 200-250 Hz. Hence, the proposed actuators open up a new class of vibrotactile actuators for possible use in various domains, including robotics, smart textiles, teleoperation, and the metaverse.

Dual muscle tendon vibration does not impede performance of a goal-directed aiming task

AIMS

Application of muscle-tendon vibration within the frequency range of 70-120Hz has been studied as a tool to stimulate somatosensory afferents with both the goal of studying human sensorimotor control and of improving post-stroke motor performance. Specific to applications for rehabilitation, current evidence is mixed as to whether dual muscle-tendon vibration is detrimental to the performance of goal-directed upper-limb movements. The current study aimed to determine the effects of muscle-tendon vibration over the wrist flexors and extensors (dual vibration) on performance of a computer goal-directed aiming task.

METHODS

Twenty healthy participants were assigned to the vibration or control group. An aiming task that involved acquiring targets by moving an unseen cursor on a screen was performed. Vision of the cursor and hand were unavailable throughout the four blocks of movement execution. Only the vibration group received dual vibration throughout four blocks. Task performance was assessed using measures of endpoint accuracy and timing. Perceived hand location was assessed using a set of questions and a computerised conscious perception task.

RESULTS

The vibration group had significantly shorter reaction times, without any change in endpoint accuracy, indicating more efficient and effective movement planning. The vibration group did report illusory movement sensation, which was reduced by block 4.

CONCLUSIONS

Dual vibration did not adversely affect aiming accuracy and showed some improvement in reaction time. The present findings support the potential for using dual vibration to stimulate the somatosensory system as participants improved their performance of a novel goal-directed movement. Notably, improvements were maintained when the vibration was removed.

Performing a vibrotactile discrimination task modulates finger representations in primary somatosensory cortex

It is well established that vibrotactile stimuli are represented in somatotopic maps. However, less is known about whether these somatotopic representations are modulated by task demands and maybe even in the absence of tactile input. Here, we used a vibrotactile discrimination task as a tool to investigate these questions in further detail. Participants were required to actively perceive and process tactile stimuli in comparison to a no-task control condition where identical stimuli were passively perceived (no-memory condition). Importantly, both vibrotactile stimuli were either applied to the right index or little finger, allowing us to investigate whether cognitive task demands shape finger representations in primary somatosensory cortex (S1). Using multivoxel pattern analysis and representational similarity analysis, we found that S1 finger representations were more distinct during the memory than the no-memory condition. Interestingly, this effect was not only observed while tactile stimuli were presented but also during the delay period (i.e., in the absence of tactile stimulation). Our findings imply that when individuals are required to focus on tactile stimuli, retain them in their memory, and engage in active processing of distinctive stimulus features, this exerts a modulatory effect on the finger representations present in S1.NEW & NOTEWORTHY Using multivoxel pattern analysis, we found that discrimination task demands shape finger representations in the contralateral primary somatosensory cortex (S1), and that somatotopic representations are modulated by task demands not only during tactile stimulation but also to a certain extent in the absence of tactile input.

Metamodal Coupling of Vibrotactile and Auditory Speech Processing Systems through Matched Stimulus Representations

It has been postulated that the brain is organized by "metamodal," sensory-independent cortical modules capable of performing tasks (e.g., word recognition) in both "standard" and novel sensory modalities. Still, this theory has primarily been tested in sensory-deprived individuals, with mixed evidence in neurotypical subjects, thereby limiting its support as a general principle of brain organization. Critically, current theories of metamodal processing do not specify requirements for successful metamodal processing at the level of neural representations. Specification at this level may be particularly important in neurotypical individuals, where novel sensory modalities must interface with existing representations for the standard sense. Here we hypothesized that effective metamodal engagement of a cortical area requires congruence between stimulus representations in the standard and novel sensory modalities in that region. To test this, we first used fMRI to identify bilateral auditory speech representations. We then trained 20 human participants (12 female) to recognize vibrotactile versions of auditory words using one of two auditory-to-vibrotactile algorithms. The vocoded algorithm attempted to match the encoding scheme of auditory speech while the token-based algorithm did not. Crucially, using fMRI, we found that only in the vocoded group did trained-vibrotactile stimuli recruit speech representations in the superior temporal gyrus and lead to increased coupling between them and somatosensory areas. Our results advance our understanding of brain organization by providing new insight into unlocking the metamodal potential of the brain, thereby benefitting the design of novel sensory substitution devices that aim to tap into existing processing streams in the brain.SIGNIFICANCE STATEMENT It has been proposed that the brain is organized by "metamodal," sensory-independent modules specialized for performing certain tasks. This idea has inspired therapeutic applications, such as sensory substitution devices, for example, enabling blind individuals "to see" by transforming visual input into soundscapes. Yet, other studies have failed to demonstrate metamodal engagement. Here, we tested the hypothesis that metamodal engagement in neurotypical individuals requires matching the encoding schemes between stimuli from the novel and standard sensory modalities. We trained two groups of subjects to recognize words generated by one of two auditory-to-vibrotactile transformations. Critically, only vibrotactile stimuli that were matched to the neural encoding of auditory speech engaged auditory speech areas after training. This suggests that matching encoding schemes is critical to unlocking the brain's metamodal potential.

Enhanced motor imagery of digits within the same hand via vibrotactile stimulation

Purpose

The aim of the present study is to evaluate the effect of vibrotactile stimulation prior to repeated complex motor imagery of finger movements using the non-dominant hand on motor imagery (MI) performance.

Methods

Ten healthy right-handed adults (4 females and 6 males) participated in the study. The subjects performed motor imagery tasks with and without a brief vibrotactile sensory stimulation prior to performing motor imagery using either their left-hand index, middle, or thumb digits. Mu- and beta-band event-related desynchronization (ERD) at the sensorimotor cortex and an artificial neural network-based digit classification was evaluated.

Results

The ERD and digit discrimination results from our study showed that ERD was significantly different between the vibration conditions for the index, middle, and thumb. It was also found that digit classification accuracy with-vibration (mean ± SD = 66.31 ± 3.79%) was significantly higher than without-vibration (mean ± SD = 62.68 ± 6.58%).

Conclusion

The results showed that a brief vibration was more effective at improving MI-based brain-computer interface classification of digits within a single limb through increased ERD compared to performing MI without vibrotactile stimulation.

Nonlinear age effects in tactile processing from early childhood to adulthood

BACKGROUND

Tactile processing plays a pivotal role in the early stages of human development; however, little is known about tactile function in young children. An understanding of how tactile processing changes with age from early childhood to adulthood is fundamental in understanding altered tactile experiences in neurodevelopmental disorders, such as autism spectrum disorder.

METHODS

In this cross-sectional study, 142 children and adults aged 3-23 years completed a vibrotactile testing battery consisting of 5 tasks, which rely on different cortical and cognitive mechanisms. The battery was designed to be suitable for testing in young children to investigate how tactile processing changes from early childhood to adulthood.

RESULTS

Our results suggest a pattern of rapid, age-related changes in tactile processing toward lower discrimination thresholds (lower discrimination thresholds = greater sensitivity) across early childhood, though we acknowledge limitations with cross-sectional data. Differences in the rate of change across tasks were observed, with tactile performance reaching adult-like levels at a younger age on some tasks compared to others.

CONCLUSIONS

While it is known that early childhood is a period of profound development including tactile processing, our data provides evidence for subtle differences in the developmental rate of the various underlying cortical, physical, and cognitive processes. Further, we are the first to show the feasibility of vibrotactile testing in early childhood (<6 years). The results of this work provide estimates of age-related differences in performance, which could have important implications as a reference for investigating altered tactile processing in developmental disorders.

Sinusoidal Vibration Source Localization in Two-Dimensional Space Around the Hand

There are use cases where presenting spatial information via the tactile sense is useful (e.g., situations where visual and audio senses are not available). Conventional methods that directly attach a vibrotactile array to a user's body present spatial information such as direction by having users localize the vibration source from among the sources in the array. These methods suffer from problems such as heat generation of the actuator or the installation cost of the actuators in a limited space. A promising method of coping with these problems is to place the vibrotactile array at a distance from the body, instead of directly attaching it to the body, with the aim of presenting spatial information in the same way as the conventional method. The present study investigates the method's effectiveness by means of a psychophysical experiment. Specifically, we presented users with sinusoidal vibrations from remote vibrotactile arrays in the space around the hand and asked them to localize the source of the vibration. We conducted an experiment to investigate the localization ability by using two vibration frequencies (30 Hz as a low frequency and 230 Hz as a high frequency). We chose these two frequencies since they effectively activate two distinctive vibrotactile channels: the rapidly adapting afferent channel and the Pacinian channel. The experimental results showed that humans can recognize the direction of the vibration source, but not the distance, regardless of the source frequency. The accuracy of the direction recognition varied slightly according to the vibration source direction, and also according to the vibration frequency. This suggests that the calibration of stimulus direction is required in the case of both high and low frequencies for presenting direction accurately as intended. In addition, the accuracy variance of direction recognition increased as the source became farther away, and the degree of increase was especially large with the low-frequency source. This suggests that a high frequency is recommended for presenting accurate direction with low variance.

Retention Effects of Long-Term Balance Training with Vibrotactile Sensory Augmentation in Healthy Older Adults

Vibrotactile sensory augmentation (SA) decreases postural sway during real-time use; however, limited studies have investigated the long-term effects of training with SA. This study assessed the retention effects of long-term balance training with and without vibrotactile SA among community-dwelling healthy older adults, and explored brain-related changes due to training with SA. Sixteen participants were randomly assigned to the experimental group (EG) or control group (CG), and trained in their homes for eight weeks using smart-phone balance trainers. The EG received vibrotactile SA. Balance performance was assessed before, and one week, one month, and six months after training. Functional MRI (fMRI) was recorded before and one week after training for four participants who received vestibular stimulation. Both groups demonstrated significant improvement of SOT composite and MiniBESTest scores, and increased vestibular reliance. Only the EG maintained a minimal detectable change of 8 points in SOT scores six months post-training and greater improvements than the CG in MiniBESTest scores one month post-training. The fMRI results revealed a shift from activation in the vestibular cortex pre-training to increased activity in the brainstem and cerebellum post-training. These findings showed that additional balance improvements were maintained for up to six months post-training with vibrotactile SA for community-dwelling healthy older adults.

Investigating the Effects of Auditory and Vibrotactile Rhythmic Sensory Stimulation on Depression: An EEG Pilot Study

Background

Major depressive disorder (MDD) is a persistent psychiatric condition and one of the leading causes of global disease burden. In a previous study, we investigated the effects of a five-week intervention consisting of rhythmic gamma frequency (30-70 Hz) vibroacoustic stimulation in 20 patients formally diagnosed with MDD. In that study, the findings suggested a significant clinical improvement in depression symptoms as measured using the Montgomery-Asberg Depression Rating Scale (MADRS), with 37% of participants meeting the criteria for clinical response. The goal of the present research was to examine possible changes from baseline to posttreatment in resting-state electroencephalography (EEG) recordings using the same treatment protocol and to characterize basic changes in EEG related to treatment response.

Materials and methods

The study sample consisted of 19 individuals aged 18-70 years with a clinical diagnosis of MDD. The participants were assessed before and after a five-week treatment period, which consisted of listening to an instrumental musical track on a vibroacoustic device, delivering auditory and vibrotactile stimulus in the gamma-band range (30-70 Hz, with particular emphasis on 40 Hz). The primary outcome measure was the change in Montgomery-Asberg Depression Rating Scale (MADRS) from baseline to posttreatment and resting-state EEG.

Results

Analysis comparing MADRS score at baseline and post-intervention indicated a significant change in the severity of depression symptoms after five weeks (t = 3.9923, df = 18, p = 0.0009). The clinical response rate was 36.85%. Resting-state EEG power analysis revealed a significant increase in occipital alpha power (t = -2.149, df = 18, p = 0.04548), as well as an increase in the prefrontal gamma power of the responders (t = 2.8079, df = 13.431, p = 0.01442).

Conclusions

The results indicate that improvements in MADRS scores after rhythmic sensory stimulation (RSS) were accompanied by an increase in alpha power in the occipital region and an increase in gamma in the prefrontal region, thus suggesting treatment effects on cortical activity in depression. The results of this pilot study will help inform subsequent controlled studies evaluating whether treatment response to vibroacoustic stimulation constitutes a real and replicable reduction of depressive symptoms and to characterize the underlying mechanisms.

Remote Subthreshold Stimulation Enhances Skin Sensitivity in the Lower Extremity

Foot sole skin interfaces with the ground and contributes to successful balance. In situations with reduced sensitivity in the glabrous foot skin, stochastic resonance (SR) improves skin sensitivity by adding tactile noise. Some situations, however, involve an interface comprised of hairy skin, which has higher thresholds for sensitivity. For example, in lower extremity amputation the residual limb is comprised of hairy leg skin. The main objective of this study was to determine if SR improves skin sensitivity in hairy skin, and whether a specific intensity of noise is most effective. Secondary objectives were to compare the effect between locations, ages and modalities. In 60 healthy participants a vibrotactile (test) input was delivered at the lower extremity concurrently with a second, noisy stimulus applied more proximally. The presence of a remote SR effect was tested in 15 young participants using electrotactile noise at the calf. Secondary objectives were tested in separate groups of 15 subjects and differed by substituting for one of the three variables: vibrotactile noise, heel site, and with older participants. A forced-choice protocol was used to determine detection ability of the subthreshold vibration test input with varying noise levels applied simultaneously (0, 20, 40, 60, 80, and 100% of perceptual threshold). An SR effect was identified when increased detection of the input was obtained at any level of noise versus no noise. It was found that all four test groups demonstrated evidence of SR: 33–47% of individuals showed better detection of the input with added noise. The SR effect did not appear consistently at any specific noise level for any of the groups, and none of the variables showed a superior ability to evoke SR. Interestingly, in approximately 33% of cases, threshold values fluctuated throughout testing. While this work has provided evidence that SR can enhance the perception of a vibrotactile input in hairy skin, these data suggest that the ability to repeatably show an SR effect relies on maintaining a consistent threshold.

Magnetoencephalography and electroencephalography can both detect differences in cortical responses to vibrotactile stimuli in individuals on the autism spectrum

Autism Spectrum (AS) is defined primarily by differences in social interactions, with impairments in sensory processing also characterizing the condition. In the search for neurophysiological biomarkers associated with traits relevant to the condition, focusing on sensory processing offers a path that is likely to be translatable across populations with different degrees of ability, as well as into animal models and across imaging modalities. In a prior study, a somatosensory neurophysiological signature of AS was identified using magnetoencephalography (MEG). Specifically, source estimation results showed differences between AS and neurotypically developing (NTD) subjects in the brain response to 25-Hz vibrotactile stimulation of the right fingertips, with lower inter-trial coherence (ITC) observed in the AS group. Here, we examined whether these group differences can be detected without source estimation using scalp electroencephalography (EEG), which is more commonly available in clinical settings than MEG, and therefore offers a greater potential for clinical translation. To that end, we recorded simultaneous whole-head MEG and EEG in 14 AS and 10 NTD subjects (age 15-28 years) using the same vibrotactile paradigm. Based on the scalp topographies, small sets of left hemisphere MEG and EEG sensors showing the maximum overall ITC were selected for group comparisons. Significant differences between the AS and NTD groups in ITC at 25 Hz as well as at 50 Hz were recorded in both MEG and EEG sensor data. For each measure, the mean ITC was lower in the AS than in the NTD group. EEG ITC values correlated with behaviorally assessed somatosensory sensation avoiding scores. The results show that information about ITC from MEG and EEG signals have substantial overlap, and thus EEG sensor-based ITC measures of the AS somatosensory processing biomarker previously identified using source localized MEG data have a potential to be developed into clinical use in AS, thanks to the higher accessibility to EEG in clinical settings.

Safety and Tolerability of a Wearable, Vibrotactile Stimulation Device for Parkinson's Disease

Background: Resting tremor is a cardinal symptom of Parkinson’s disease (PD) that contributes to the physical, emotional, and economic burden of the disease.

Objective: The goal of this study was to investigate the safety, tolerability, and preliminary effectiveness of a novel wearable vibrotactile stimulation device on resting tremor in individuals with PD.

Methods: Using a randomized cross-over design, subjects received two different vibrotactile stimulation paradigms (high amplitude patterned and low amplitude continuous) on two separate laboratory visits. On each visit, resting tremor was video recorded for 10 min at baseline and while the vibrotactile stimulation was applied. Tremor severity was scored by a blinded clinician.

Results: Both vibration paradigms were well safe and well tolerated and resulted in a reduction in resting tremor severity with a moderate effect size (n = 44, p < 0.001, r = 0.37–0.54). There was no significant difference between the two vibration paradigms (p = 0.14).

Conclusion: Short durations of vibrotactile stimulation delivered via wearable devices were safe and well tolerated and may attenuate resting tremor severity in individuals with PD. The sample size as well as the potential preliminary effectiveness revealed by two arms of the study could not eliminate the potential for a placebo effect.

Humans Use a Temporally Local Code for Vibrotactile Perception

Sensory environments are commonly characterized by specific physical features, which sensory systems might exploit using dedicated processing mechanisms. In the tactile sense, one such characteristic feature is frictional movement, which gives rise to short-lasting (<10 ms), information-carrying integument vibrations. Rather than generic integrative encoding (i.e., averaging or spectral analysis capturing the "intensity" and "best frequency"), the tactile system might benefit from, what we call a "temporally local" coding scheme that instantaneously detects and analyzes shapes of these short-lasting features. Here, by employing analytic psychophysical measurements, we tested whether the prerequisite of temporally local coding exists in the human tactile system. We employed pulsatile skin indentations at the fingertip that allowed us to trade manipulation of local pulse shape against changes in global intensity and frequency, achieved by adding pulses of the same shape. We found that manipulation of local pulse shape has strong effects on psychophysical performance, arguing for the notion that humans implement a temporally local coding scheme for perceptual decisions. As we found distinct differences in performance using different kinematic layouts of pulses, we inquired whether temporally local coding is tuned to a unique kinematic variable. This was not the case, since we observed different preferred kinematic variables in different ranges of pulse shapes. Using an established encoding model for primary afferences and indentation stimuli, we were able to demonstrate that the found kinematic preferences in human performance, may well be explained by the response characteristics of Pacinian corpuscles (PCs), a class of human tactile primary afferents.

Effect of Tactile Sensory Substitution on the Proprioceptive Error Map of the Arm

Proprioceptive error of estimated fingertip position in two-dimensional space is reduced with the addition of tactile stimulation to the fingertip. This tactile input does not disrupt the subjects’ estimation strategy, as the individual error vector maps maintain their overall geometric structure. This relationship suggests an integration of proprioception and tactile sensory information to enhance proprioceptive estimation. To better understand this multisensory integration, we explored the effect of electrotactile and vibrotactile stimulation to the fingertips in place of actual contact, thus limiting interaction forces. This allowed us to discern any proprioceptive estimation improvement that arose from purely tactile stimulation. Ten right-handed and ten left-handed subjects performed a simple right-handed proprioceptive estimation task under four tactile feedback conditions: hover, touch, electrotactile, and vibrotactile. Target sets were generated for each subject, persisted across all feedback modalities, and targets were presented in randomized orders. Error maps across the workspace were generated using polynomial models of the subjects’ responses. Error maps did not change shape between conditions for any right-handed subjects and changed for a single condition for two left-handed subjects. Non-parametric statistical analysis of the error magnitude shows that both modes of sensory substitution significantly reduce error for right-handed subjects, but not to the level of actual touch. Left-handed subjects demonstrated increased error for all feedback conditions compared to hover. Compared to right-handed subjects, left-handed subjects demonstrated more error in each condition except the hover condition. This is consistent with the hypothesis that the non-dominant hand is specialized for position control, while the dominant is specialized for velocity. Notably, our results suggest that non-dominant hand estimation strategies are hindered by stimuli to the fingertip. We conclude that electrotactile and vibrotactile sensory substitution only succeed in multisensory integration when applied to the dominant hand. These feedback modalities do not disrupt established dominate hand proprioceptive error maps, and existing strategies adapt to the novel input and minimize error. Since actual touch provides the best error reduction, sensory substitution lacks some unidentified beneficial information, such as familiarity or natural sensation. This missing component could also be what confounds subjects using their non-dominant hand for positional tasks.

Electro-Haptic Stimulation: A New Approach for Improving Cochlear-Implant Listening

Cochlear implants (CIs) have been remarkably successful at restoring speech perception for severely to profoundly deaf individuals. Despite their success, several limitations remain, particularly in CI users' ability to understand speech in noisy environments, locate sound sources, and enjoy music. A new multimodal approach has been proposed that uses haptic stimulation to provide sound information that is poorly transmitted by the implant. This augmenting of the electrical CI signal with haptic stimulation (electro-haptic stimulation; EHS) has been shown to improve speech-in-noise performance and sound localization in CI users. There is also evidence that it could enhance music perception. We review the evidence of EHS enhancement of CI listening and discuss key areas where further research is required. These include understanding the neural basis of EHS enhancement, understanding the effectiveness of EHS across different clinical populations, and the optimization of signal-processing strategies. We also discuss the significant potential for a new generation of haptic neuroprosthetic devices to aid those who cannot access hearing-assistive technology, either because of biomedical or healthcare-access issues. While significant further research and development is required, we conclude that EHS represents a promising new approach that could, in the near future, offer a non-invasive, inexpensive means of substantially improving clinical outcomes for hearing-impaired individuals.

Sensitivity to Haptic Sound-Localization Cues at Different Body Locations

Cochlear implants (CIs) recover hearing in severely to profoundly hearing-impaired people by electrically stimulating the cochlea. While they are extremely effective, spatial hearing is typically severely limited. Recent studies have shown that haptic stimulation can supplement the electrical CI signal (electro-haptic stimulation) and substantially improve sound localization. In haptic sound-localization studies, the signal is extracted from the audio received by behind-the-ear devices and delivered to each wrist. Localization is achieved using tactile intensity differences (TIDs) across the wrists, which match sound intensity differences across the ears (a key sound localization cue). The current study established sensitivity to across-limb TIDs at three candidate locations for a wearable haptic device, namely: the lower tricep and the palmar and dorsal wrist. At all locations, TID sensitivity was similar to the sensitivity to across-ear intensity differences for normal-hearing listeners. This suggests that greater haptic sound-localization accuracy than previously shown can be achieved. The dynamic range was also measured and far exceeded that available through electrical CI stimulation for all of the locations, suggesting that haptic stimulation could provide additional sound-intensity information. These results indicate that an effective haptic aid could be deployed for any of the candidate locations, and could offer a low-cost, non-invasive means of improving outcomes for hearing-impaired listeners.

A Light-Driven Vibrotactile Actuator with a Polymer Bimorph Film for Localized Haptic Rendering

A vibrotactile actuator driven by light energy is developed to produce dynamic stimulations for haptic rendering on a thin-film structure. The actuator is constructed by adopting a thermal bimorph membrane structure of poly(3,4-ethylenedioxythiophene) doped with p-toluenesulfonate (PEDOT-Tos) coated onto a polyethylene terephthalate (PET) film. Upon irradiation of near-infrared (NIR) light, the light energy absorbed at the PEDOT-Tos layer is converted into thermoelastic bending deformation due to the mismatch in coefficient of thermal expansion between PEDOT-Tos and PET. Since the light-induced deformation is reversible, spatially localized, and rapidly controllable with designed light signals, the proposed actuator can produce vibrotactile stimulation over 10 dB at arbitrary areas in the human-sensitive frequency range from 125 to 300 Hz using a low input power of ∼2.6 mW mm^-2, as compared with a complex electrical circuit and high input power needed to achieve such actuation performance. Together with its simple structure based on light-driven actuation, the advent of this actuator could open up new ways to achieve substantial advances in rendering textures at a flexible touch interface.

Using haptic stimulation to enhance auditory perception in hearing-impaired listeners

INTRODUCTION

Hearing-assistive devices, such as hearing aids and cochlear implants, transform the lives of hearing-impaired people. However, users often struggle to locate and segregate sounds. This leads to impaired threat detection and an inability to understand speech in noisy environments. Recent evidence suggests that segregation and localization can be improved by providing missing sound-information through haptic stimulation.

AREAS COVERED

This article reviews the evidence that haptic stimulation can effectively provide sound information. It then discusses the research and development required for this approach to be implemented in a clinically viable device. This includes discussion of what sound information should be provided and how that information can be extracted and delivered.

EXPERT OPINION

Although this research area has only recently emerged, it builds on a significant body of work showing that sound information can be effectively transferred through haptic stimulation. Current evidence suggests that haptic stimulation is highly effective at providing missing sound-information to cochlear implant users. However, a great deal of work remains to implement this approach in an effective wearable device. If successful, such a device could offer an inexpensive, noninvasive means of improving educational, work, and social experiences for hearing-impaired individuals, including those without access to hearing-assistive devices.

Auditory and Somatosensory P3 Are Complementary for the Assessment of Patients with Disorders of Consciousness

The evaluation of the level of consciousness in patients with disorders of consciousness (DOC) is primarily based on behavioural assessments. Patients with unresponsive wakefulness syndrome (UWS) do not show any sign of awareness of their environment, while minimally conscious state (MCS) patients show reproducible but fluctuating signs of awareness. Some patients, although with remaining cognitive abilities, are not able to exhibit overt voluntary responses at the bedside and may be misdiagnosed as UWS. Several studies investigated functional neuroimaging and neurophysiology as an additional tool to evaluate the level of consciousness and to detect covert command following in DOC. Most of these studies are based on auditory stimulation, neglecting patients suffering from decreased or absent hearing abilities. In the present study, we aim to assess the response to a P3-based paradigm in 40 patients with DOC and 12 healthy participants using auditory (AEP) and vibrotactile (VTP) stimulation. To this end, an EEG-based brain-computer interface was used at DOC patient's bedside. We compared the significance of the P3 performance (i.e., the interpretation of significance of the evoked P3 response) as obtained by 'direct processing' (i.e., theoretical-based significance threshold) and 'offline processing' (i.e., permutation-based single subject level threshold). We evaluated whether the P3 performances were dependent on clinical variables such as diagnosis (UWS and MCS), aetiology and time since injury. Last we tested the dependency of AEP and VTP performances at the single subject level. Direct processing tends to overestimate P3 performance. We did not find any difference in the presence of a P3 performance according to the level of consciousness (UWS vs. MCS) or the aetiology (traumatic vs. non-traumatic brain injury). The performance achieved at the AEP paradigm was independent from what was achieved at the VTP paradigm, indicating that some patients performed better on the AEP task while others performed better on the VTP task. Our results support the importance of using multimodal approaches in the assessment of DOC patients in order to optimise the evaluation of patient's abilities.

A Simple and Compact MR-Compatible Electromagnetic Vibrotactile Stimulator

We have developed a low-cost electromagnetic vibrotactile stimulator that uses the magnetic field of an MR scanner as a permanent magnet to power a vibrating motor. A simple variable current power supply is controlled by software using a USB data acquisition controller. In our study, the function of our novel stimulator was verified in a vibration frequency discrimination working memory task, in which various ranges of frequencies and amplitudes are delivered in MRI scanner. Furthermore, our functional MRI study revealed activations of the primary and secondary somatosensory cortices during the perception of tactile stimulation. Therefore, the new designed electromagnetic vibrotactile stimulator is capable of generating various frequencies of tactile stimuli and represents a powerful and useful tool for studying somatosensory functions with functional MRI.

Tactile sensory channels over-ruled by frequency decoding system that utilizes spike pattern regardless of receptor type

The established view is that vibrotactile stimuli evoke two qualitatively distinctive cutaneous sensations, flutter (frequencies < 60 Hz) and vibratory hum (frequencies > 60 Hz), subserved by two distinct receptor types (Meissner’s and Pacinian corpuscle, respectively), which may engage different neural processing pathways or channels and fulfil quite different biological roles. In psychological and physiological literature, those two systems have been labelled as Pacinian and non-Pacinian channels. However, we present evidence that low-frequency spike trains in Pacinian afferents can readily induce a vibratory percept with the same low frequency attributes as sinusoidal stimuli of the same frequency, thus demonstrating a universal frequency decoding system. We achieved this using brief low-amplitude pulsatile mechanical stimuli to selectively activate Pacinian afferents. This indicates that spiking pattern, regardless of receptor type, determines vibrotactile frequency perception. This mechanism may underlie the constancy of vibrotactile frequency perception across different skin regions innervated by distinct afferent types.

Somatosensory Cross-Modal Reorganization in Children With Cochlear Implants

Deprived of sensory input, as in deafness, the brain tends to reorganize. Cross-modal reorganization occurs when cortices associated with deficient sensory modalities are recruited by other, intact senses for processing of the latter's sensory input. Studies have shown that this type of reorganization may affect outcomes when sensory stimulation is later introduced via intervention devices. One such device is the cochlear implant (CI). Hundreds of thousands of CIs have been fitted on people with hearing impairment worldwide, many of them children. Factors such as age of implantation have proven useful in predicting speech perception outcome with these devices in children. However, a portion of the variance in speech understanding ability remains unexplained. It is possible that the degree of cross-modal reorganization may explain additional variability in listening outcomes. Thus, the current study aimed to examine possible somatosensory cross-modal reorganization of the auditory cortices. To this end we used high density EEG to record cortical responses to vibrotactile stimuli in children with normal hearing (NH) and those with CIs. We first investigated cortical somatosensory evoked potentials (CSEP) in NH children, in order to establish normal patterns of CSEP waveform morphology and sources of cortical activity. We then compared CSEP waveforms and estimations of cortical sources between NH children and those with CIs to assess the degree of somatosensory cross-modal reorganization. Results showed that NH children showed expected patterns of CSEP and current density reconstructions, such that postcentral cortices were activated contralaterally to the side of stimulation. Participants with CIs also showed this pattern of activity. However, in addition, they showed activation of auditory cortical areas in response to somatosensory stimulation. Additionally, certain CSEP waveform components were significantly earlier in the CI group than the children with NH. These results are taken as evidence of cross-modal reorganization by the somatosensory modality in children with CIs. Speech perception in noise scores were negatively associated with CSEP waveform components latencies in the CI group, suggesting that the degree of cross-modal reorganization is related to speech perception outcomes. These findings may have implications for clinical rehabilitation in children with cochlear implants.

Hierarchical and Nonlinear Dynamics in Prefrontal Cortex Regulate the Precision of Perceptual Beliefs

Actions are shaped not only by the content of our percepts but also by our confidence in them. To study the cortical representation of perceptual precision in decision making, we acquired functional imaging data whilst participants performed two vibrotactile forced-choice discrimination tasks: a fast-slow judgment, and a same-different judgment. The first task requires a comparison of the perceived vibrotactile frequencies to decide which one is faster. However, the second task requires that the estimated difference between those frequencies is weighed against the precision of each percept-if both stimuli are very precisely perceived, then any slight difference is more likely to be identified than if the percepts are uncertain. We additionally presented either pure sinusoidal or temporally degraded "noisy" stimuli, whose frequency/period differed slightly from cycle to cycle. In this way, we were able to manipulate the perceptual precision. We report a constellation of cortical regions in the rostral prefrontal cortex (PFC), dorsolateral PFC (DLPFC) and superior frontal gyrus (SFG) associated with the perception of stimulus difference, the presence of stimulus noise and the interaction between these factors. Dynamic causal modeling (DCM) of these data suggested a nonlinear, hierarchical model, whereby activity in the rostral PFC (evoked by the presence of stimulus noise) mutually interacts with activity in the DLPFC (evoked by stimulus differences). This model of effective connectivity outperformed competing models with serial and parallel interactions, hence providing a unique insight into the hierarchical architecture underlying the representation and appraisal of perceptual belief and precision in the PFC.

Neurophysiological abnormalities in individuals with persistent post-concussion symptoms

Concussion injury results in a rapid onset of transient neurological impairment that can resolve quickly, or sometimes evolve over time, but usually resolve within seven to 10 days. However, a small but noticeable cohort (~10%) of individuals continues to experience persistent lingering effects, particularly fatigue, recognized as post-concussion symptoms (PCS). This study explored neurophysiological mechanisms in people with persistent PCS. Studies involved using self-report post-concussion fatigue scale, transcranial magnetic stimulation (TMS) and somatosensory stimulation in those with diagnosed PCS (n = 20; 36.1 ± 14.0 yr., 4 female; mean time post-concussion 15.4 ± 7.6 months) to fully recovered individuals (n = 20; 33.8 ± 6.6 yr., 2 female; post-concussion 12.9 ± 6.6 months) and healthy controls (n = 20; 37.7 ± 8.0 yr., 3 female). PCS participants demonstrated a significantly higher self-report fatigue (score: PCS 20.2 [95% CI 17.4-22.9], Recovered 6.2 [3.1-9.3], Control 2.75 [0.6-4.8]). PCS participants showed a worsening of reaction time (F_2,57 = 4.214; p = 0.020) and increased reaction time variability (F_2,57 = 5.505; p = 0.007). Somatosensory differences were observed for amplitude discrimination (F_2,57 = 5.166; p = 0.009), temporal order judgment (F_2,57 = 4.606; p = 0.014) and duration discrimination (F_2,57 = 6.081; p = 0.004). Increased intracortical inhibition in TMS single pulse suprathreshold stimulation (110%: F_2,57 = 6.842; p = 0.002; 130%: F_2,57 = 4.900; p = 0.011; 150%: F_2,57 = 4.638; p = 0.014; 170%: F_2,57 = 9.845; p < 0.001) and paired pulse protocols was also seen (SICI: F_2,57 = 23.390; p < 0.001, and LICI: F_2,57 = 21.603; p < 0.001). Using non-invasive stimulation techniques, this novel study showed increased cortical inhibition and compromised central information processing, suggesting neural mechanisms underpinning ongoing fatigue, allowing for potential clinical rehabilitation strategies.

Locating primary somatosensory cortex in human brain stimulation studies: experimental evidence

Transcranial magnetic stimulation (TMS) over human primary somatosensory cortex (S1) does not produce immediate outputs. Researchers must therefore rely on indirect methods for TMS coil positioning. The "gold standard" is to use individual functional and structural magnetic resonance imaging (MRI) data, but the majority of studies don't do this. The most common method to locate the hand area of S1 (S1-hand) is to move the coil posteriorly from the hand area of primary motor cortex (M1-hand). Yet, S1-hand is not directly posterior to M1-hand. We localized the index finger area of S1-hand (S1-index) experimentally in four ways. First, we reanalyzed functional MRI data from 20 participants who received vibrotactile stimulation to their 10 digits. Second, to assist the localization of S1-hand without MRI data, we constructed a probabilistic atlas of the central sulcus from 100 healthy adult MRIs and measured the likely scalp location of S1-index. Third, we conducted two experiments mapping the effects of TMS across the scalp on tactile discrimination performance. Fourth, we examined all available neuronavigation data from our laboratory on the scalp location of S1-index. Contrary to the prevailing method, and consistent with systematic review evidence, S1-index is close to the C3/C4 electroencephalography (EEG) electrode locations on the scalp, ~7-8 cm lateral to the vertex, and ~2 cm lateral and 0.5 cm posterior to the M1-hand scalp location. These results suggest that an immediate revision to the most commonly used heuristic to locate S1-hand is required. The results of many TMS studies of S1-hand need reassessment. NEW & NOTEWORTHY Noninvasive human brain stimulation requires indirect methods to target particular brain areas. Magnetic stimulation studies of human primary somatosensory cortex have used scalp-based heuristics to find the target, typically locating it 2 cm posterior to the motor cortex. We measured the scalp location of the hand area of primary somatosensory cortex and found that it is ~2 cm lateral to motor cortex. Our results suggest an immediate revision of the prevailing method is required.

Oscillatory EEG signatures of postponed somatosensory decisions

In recent electroencephalography (EEG) studies, the vibrotactile frequency comparison task has been used to study oscillatory signatures of perceptual decision making in humans, revealing a choice-selective modulation of premotor upper beta band power shortly before decisions were reported. Importantly, these studies focused on decisions that were (1) indicated immediately after stimulus presentation, and (2) for which a direct motor mapping was provided. Here, we investigated whether the putative beta band choice signal also extends to postponed decisions, and how such a decision signal might be influenced by a response mapping that is dissociated from a specific motor command. We recorded EEG data in two separate experiments, both employing the vibrotactile frequency comparison task with delayed decision reports. In the first experiment, delayed choices were associated with a fixed motor mapping, whereas in the second experiment, choices were mapped onto a color code concealing a specific motor response until the end of the delay phase. In between stimulus presentations, as well as after the second stimulus, prefrontal beta band power indexed stimulus information held in working memory. Beta band power also encoded choices during the response delay, notably, in different cortical areas depending on the provided response mapping. In particular, when decisions were associated with a specific motor mapping, choices were represented in premotor cortices, whereas the color mapping resulted in a choice-selective modulation of beta band power in parietal cortices. Together, our findings imply that how a choice is expressed (i.e., the decision consequence) determines where in the cortical sensorimotor hierarchy an according decision signal is processed.

The role of sensory augmentation for people with vestibular deficits: Real-time balance aid and/or rehabilitation device?

This narrative review highlights findings from the sensory augmentation field for people with vestibular deficits and addresses the outstanding questions that are critical to the translation of this technology into clinical and/or personal use. Prior research has demonstrated that the real-time use of visual, vibrotactile, auditory, and multimodal sensory augmentation technologies can improve balance during static and dynamic stance tasks within a laboratory setting. However, its application in improving gait requires additional investigation, as does its efficacy as a rehabilitation device for people with vestibular deficits. In some locomotor studies involving sensory augmentation, gait velocity decreased and secondary task performance worsened, and subjects negatively altered their segmental control strategies when cues were provided following short training sessions. A further question is whether the retention and/or carry-over effects of training with a sensory augmentation technology exceed the retention and/or carry-over effects of training alone, thereby supporting its use as a rehabilitation device. Preliminary results suggest that there are short-term improvements in balance performance following a small number of training sessions with a sensory augmentation device. Long-term clinical and home-based controlled training studies are needed. It is hypothesized that sensory augmentation provides people with vestibular deficits with additional sensory input to promote central compensation during a specific exercise/activity; however, research is needed to substantiate this theory. Major obstacles standing in the way of its use for these critical applications include determining exercise/activity specific feedback parameters and dosage strategies. This paper summarizes the reported findings that support sensory augmentation as a balance aid and rehabilitation device, but does not critically examine efficacy or the quality of the research methods used in the reviewed studies.

Neuromorphic Vibrotactile Stimulation of Fingertips for Encoding Object Stiffness in Telepresence Sensory Substitution and Augmentation Applications

We present a tactile telepresence system for real-time transmission of information about object stiffness to the human fingertips. Experimental tests were performed across two laboratories (Italy and Ireland). In the Italian laboratory, a mechatronic sensing platform indented different rubber samples. Information about rubber stiffness was converted into on-off events using a neuronal spiking model and sent to a vibrotactile glove in the Irish laboratory. Participants discriminated the variation of the stiffness of stimuli according to a two-alternative forced choice protocol. Stiffness discrimination was based on the variation of the temporal pattern of spikes generated during the indentation of the rubber samples. The results suggest that vibrotactile stimulation can effectively simulate surface stiffness when using neuronal spiking models to trigger vibrations in the haptic interface. Specifically, fractional variations of stiffness down to 0.67 were significantly discriminated with the developed neuromorphic haptic interface. This is a performance comparable, though slightly worse, to the threshold obtained in a benchmark experiment evaluating the same set of stimuli naturally with the own hand. Our paper presents a bioinspired method for delivering sensory feedback about object properties to human skin based on contingency-mimetic neuronal models, and can be useful for the design of high performance haptic devices.

Feeling the Beat: Bouncing Synchronization to Vibrotactile Music in Hearing and Early Deaf People

The ability to dance relies on the ability to synchronize movements to a perceived musical beat. Typically, beat synchronization is studied with auditory stimuli. However, in many typical social dancing situations, music can also be perceived as vibrations when objects that generate sounds also generate vibrations. This vibrotactile musical perception is of particular relevance for deaf people, who rely on non-auditory sensory information for dancing. In the present study, we investigated beat synchronization to vibrotactile electronic dance music in hearing and deaf people. We tested seven deaf and 14 hearing individuals on their ability to bounce in time with the tempo of vibrotactile stimuli (no sound) delivered through a vibrating platform. The corresponding auditory stimuli (no vibrations) were used in an additional condition in the hearing group. We collected movement data using a camera-based motion capture system and subjected it to a phase-locking analysis to assess synchronization quality. The vast majority of participants were able to precisely time their bounces to the vibrations, with no difference in performance between the two groups. In addition, we found higher performance for the auditory condition compared to the vibrotactile condition in the hearing group. Our results thus show that accurate tactile-motor synchronization in a dance-like context occurs regardless of auditory experience, though auditory-motor synchronization is of superior quality.

Content-Specific Codes of Parametric Vibrotactile Working Memory in Humans

To understand how the brain handles mentally represented information flexibly in the absence of sensory stimulation, working memory (WM) studies have been essential. A seminal finding in monkey research is that neurons in the prefrontal cortex (PFC) retain stimulus-specific information when vibrotactile frequencies were memorized. A direct mapping between monkey studies and human research is still controversial. Although oscillatory signatures, in terms of frequency-dependent parametric beta-band modulation, have been observed recently in human EEG studies, the content specificity of these representations in terms of multivariate pattern analysis has not yet been shown. Here, we used fMRI in combination with multivariate classification techniques to determine which brain regions retain information during WM. In a retro-cue delayed-match-to-sample task, human subjects memorized the frequency of vibrotactile stimulation over a 12 s delay phase. Using an assumption-free whole-brain searchlight approach, we tested with support vector regression which brain regions exhibited multivariate parametric WM codes of the maintained frequencies during the WM delay. Interestingly, our analysis revealed an overlap with regions previously identified in monkeys composed of bilateral premotor cortices, supplementary motor area, and the right inferior frontal gyrus as part of the PFC. Therefore, our results establish a link between the WM codes found in monkeys and those in humans and emphasize the importance of the PFC for information maintenance during WM also in humans.SIGNIFICANCE STATEMENT Working memory (WM) research in monkeys has identified a network of regions, including prefrontal regions, to code stimulus-specific information when vibrotactile frequencies are memorized. Here, we performed an fMRI study during which human subjects had to memorize vibratory frequencies in parallel to previous monkey research. Using an assumption-free, whole-brain searchlight decoding approach, we identified for the first time regions in the human brain that exhibit multivariate patterns of activity to code the vibratory frequency parametrically during WM. Our results parallel previous monkey findings and show that the supplementary motor area, premotor, and the right prefrontal cortex are involved in vibrotactile WM coding in humans.

The Acquisition and Extinction of Fear of Painful Touch: A Novel Tactile Fear Conditioning Paradigm

Fear of touch, due to allodynia and spontaneous pain, is not well understood. Experimental methods to advance this topic are lacking, and therefore we propose a novel tactile conditioning paradigm. Seventy-six pain-free participants underwent acquisition in a predictable as well as an unpredictable pain context. In the predictable context, vibrotactile stimulation was paired with painful electrocutaneous stimulation (simulating allodynia). In the unpredictable context, vibrotactile stimulation was unpaired with pain (simulating spontaneous pain). During an extinction phase, a cue exposure and context exposure group continued in the predictable and unpredictable context, respectively, without pain. A control group received continued acquisition in both contexts. Self-reported fear and skin conductance responses, but not startle responses, showed fear of touch was acquired in the predictable context. Context-related startle responses showed contextual fear emerged in the unpredictable context, together with elevated self-reported fear and skin conductance responses evoked by the unpaired vibrotactile stimulations. Cue exposure reduced fear of touch, whereas context exposure reduced contextual fear. Thus, painful touch leads to increased fear, as does touch in the same context as unpredictable pain, and extinction protocols can reduce this fear. We conclude that tactile conditioning is valuable for investigating fear of touch and can advance our understanding of chronic pain.

PERSPECTIVES

The acquisition and extinction of fear of touch was investigated in a clinical analog study using a novel tactile fear conditioning paradigm. The results have implications for research on the development and treatment of chronic pain conditions characterized by allodynia and spontaneous pain fluctuations.

Horseback riding therapy for a deafblind individual enabled by a haptic interface

We present a haptic interface to help deafblind people to practice horseback riding as a recreational and therapeutic activity. Horseback riding is a form of therapy which can improve self-esteem and sensation of independence. It has been shown to benefit people with various medical conditions-including autism. However, in the case of deafblind riders, an interpreter must stand by at all times to communicate with the rider by touch. We developed a simple interface that enables deafblind people to enjoy horseback riding while the instructor is remotely providing cues, which improves their independence. Experiments demonstrated that an autistic deafblind individual exhibits similar responses to navigational cues as an unimpaired rider. Motivation is an important factor in therapy, and is frequently determinant of its outcome; therefore, the user attitude toward the therapy methods is key. The answers to questionnaires filled by the rider, family, and the instructor show that our technique gives the rider a greater sense of independence and more joy compared to standard riding where the instructor is walking along with the horse.

Response-Modality-Specific Encoding of Human Choices in Upper Beta Band Oscillations during Vibrotactile Comparisons

Perceptual decisions based on the comparison of two vibrotactile frequencies have been extensively studied in non-human primates. Recently, we obtained corresponding findings from human oscillatory electroencephalography (EEG) activity in the form of choice-selective modulations of upper beta band amplitude in medial premotor areas. However, the research in non-human primates as well as its human counterpart was so far limited to decisions reported by button presses. Thus, here we investigated whether the observed human beta band modulation is specific to the response modality. We recorded EEG activity from participants who compared two sequentially presented vibrotactile frequencies (f1 and f2), and decided whether f2 > f1 or f2 < f1, by performing a horizontal saccade to either side of a computer screen. Contrasting time-frequency transformed EEG data between both choices revealed that upper beta band amplitude (∼24–32 Hz) was modulated by participants’ choices before actual responses were given. In particular, “f2 > f1” choices were always associated with higher beta band amplitude than “f2 < f1” choices, irrespective of whether the choice was correct or not, and independent of the specific association between saccade direction and choice. The observed pattern of beta band modulation was virtually identical to our previous results when participants responded with button presses. In line with an intentional framework of decision making, the most likely sources of the beta band modulation were now, however, located in lateral as compared to medial premotor areas including the frontal eye fields. Hence, we could show that the choice-selective modulation of upper beta band amplitude is on the one hand consistent across different response modalities (i.e., same modulation pattern in similar frequency band), and on the other hand effector specific (i.e., modulation originating from areas involved in planning and executing saccades).

Usability Evaluation of a VibroTactile Feedback System in Stroke Subjects

Background

To increase the functional capabilities of stroke subjects during activities of daily living, patients receive rehabilitative training to recover adequate motor control. With the goal to motivate self-training by use of the arm in daily life tasks, a sensor system (Arm Usage Coach, AUC) was developed that provides VibroTactile (VT) feedback if the patient does not move the affected arm above a certain threshold level. The objective of this study is to investigate the usability of this system in stroke subjects.

Method

The study was designed as a usability and user acceptance study of feedback modalities. Stroke subjects with mild to moderate arm impairments were enrolled. The subjects wore two AUC devices one on each wrist. VT feedback was given by the device on the affected arm. A semi-structured interview was performed before and after a measurement session with the AUC. In addition, the System Usability Scale (SUS) questionnaire was given.

Results

Ten ischemic chronic stroke patients (39 ± 38 months after stroke) were recruited. Four out of 10 subjects have worn the VT feedback on their dominant, affected arm. In the pre-measurement interview, eight participants indicated a preference for acoustic or visual over VT feedback. In the post evaluation interview, nine of 10 participants preferred VT over visual and acoustic feedback. On average, the AUC gave VT feedback six times during the measurement session. All participants, with the exception of one, used their dominant arm more then the non-dominant. For the SUS, eight participants responded above 80%, one between 70 and 80%, and one participant responded below 50%.

Discussion

More patients accepted and valued VT feedback after the test period, hence VT is a feasible feedback modality. The AUC can be used as a telerehabilitation device to train and maintain upper extremity use in daily life tasks.

Multi-Section Sensing and Vibrotactile Perception for Walking Guide of Visually Impaired Person

Electronic Travel Aids (ETAs) improve the mobility of visually-impaired persons, but it is not easy to develop an ETA satisfying all the factors needed for reliable object detection, effective notification, and actual usability. In this study, the authors developed an easy-to-use ETA having the function of reliable object detection and its successful feedback to the user by tactile stimulation. Seven ultrasonic sensors facing in different directions detect obstacles in the walking path, while vibrators in the tactile display stimulate the hand according to the distribution of obstacles. The detection of ground drop-offs activates the electromagnetic brakes linked to the rear wheels. To verify the feasibility of the developed ETA in the outdoor environment, walking tests by blind participants were performed, and the evaluation of safety to ground drop-offs was carried out. From the experiment, the feasibility of the developed ETA was shown to be sufficient if the sensor ranges for hanging obstacle detection is improved and learning time is provided for the ETA. Finally, the light-weight and low cost ETA designed and assembled based on the evaluation of the developed ETA is introduced to show the improvement of portability and usability, and is compared with the previously developed ETAs.

A Haptic Feedback System for Phase-Based Sensory Restoration in Above-Knee Prosthetic Leg Users

Persons with amputations lack important senses from the amputated limb. With the absence of proprioception in the amputated leg, amputees have far more difficulty maintaining a natural gait with balance and stability. The biggest determinant of temporal limb behavior during locomotion is the phase in the gait cycle, which can be estimated using the center of pressure (COP) under the feet. We hypothesize that feedback from the COP of the prosthetic foot can help restore a more robust sense of phase in transfemoral (above-knee) amputees. This paper presents a device that provides vibrotactile feedback based on the COP from the prosthesis, providing proprioception and potentially an improved sense of phase to the user. Experiments showed that the haptic device significantly decreased variability of stride length, step width, and trunk sway in novice (able-bodied) users of a transfemoral prosthetic leg during treadmill locomotion (N=9), indicating improved gait stability.

Neural timing signal for precise tactile timing judgments

The brain can precisely encode the temporal relationship between tactile inputs. While behavioural studies have demonstrated precise interfinger temporal judgments, the underlying neural mechanism remains unknown. Computationally, two kinds of neural responses can act as the information source. One is the phase-locked response to the phase of relatively slow inputs, and the other is the response to the amplitude change of relatively fast inputs. To isolate the contributions of these components, we measured performance of a synchrony judgment task for sine wave and amplitude-modulation (AM) wave stimuli. The sine wave stimulus was a low-frequency sinusoid, with the phase shifted in the asynchronous stimulus. The AM wave stimulus was a low-frequency sinusoidal AM of a 250-Hz carrier, with only the envelope shifted in the asynchronous stimulus. In the experiment, three stimulus pairs, two synchronous ones and one asynchronous one, were sequentially presented to neighboring fingers, and participants were asked to report which one was the asynchronous pair. We found that the asynchrony of AM waves could be detected as precisely as single impulse pair, with the threshold asynchrony being ∼20 ms. On the other hand, the asynchrony of sine waves could not be detected at all in the range from 5 to 30 Hz. Our results suggest that the timing signal for tactile judgments is provided not by the stimulus phase information but by the envelope of the response of the high-frequency-sensitive Pacini channel (PC), although they do not exclude a possible contribution of the envelope of non-PCs.

Graphical message transmission using the monotonic vibration function of a smart phone

This study aimed at evaluating four vibrotactile capabilities for perceiving graphical information presented on a smart phone. Thirty-two blindfolded college students participated in four experiments to test their capabilities of two-point discrimination, relative and absolute judgments of line thickness, and recognition of basic shapes. All the information was received through the default vibration function of the phone, sensed by their scanning fingers. The results showed a good two-point discrimination accuracy rate, reaching 98.8% when the distance between two points was set at 3.2 mm; the relative judgment of line thickness reached the level of 78.3% accuracy when the two-line width difference ratio was set at 3%; the absolute judgment reached the level of 78.8% when the participants recognised line thickness from one of two. Overall, especially for the shapes judgment, the information transmitted by the various codes may be quite low. These findings should inspire advanced investigations and provide design guidelines.

PRACTITIONER SUMMARY

This study tested four vibrotactile capabilities for perception of graphical information when solely using the monotonic vibration function of a smart phone. The results show low information transmission. These findings encourage advanced investigations of new coding systems so that relevant mobile applications could be developed to help the visually impaired.

Percept of the duration of a vibrotactile stimulus is altered by changing its amplitude

There have been numerous studies conducted on time perception. However, very few of these have involved tactile stimuli to assess a subject’s capacity for duration discrimination. Previous optical imaging studies in non-human primates demonstrated that increasing the duration of a vibrotactile stimulus resulted in a consistently longer and more well defined evoked SI cortical response. Additionally, and perhaps more interestingly, increasing the amplitude of a vibrotactile stimulus not only evoked a larger magnitude optical intrinsic signal (OIS), but the return to baseline of the evoked response was much longer in duration for larger amplitude stimuli. This led the authors to hypothesize that the magnitude of a vibrotactile stimulus could influence the perception of its duration. In order to test this hypothesis, subjects were asked to compare two sets of vibrotactile stimuli. When vibrotactile stimuli differed only in duration, subjects typically had a difference limen (DL) of approximately 13%, and this followed Weber’s Law for standards between 500 and 1500 ms, as increasing the value of the standard yielded a proportional increase in DL. However, the percept of duration was impacted by variations in amplitude of the vibrotactile stimuli. Specifically, increasing the amplitude of the standard stimulus had the effect of increasing the DL, while increasing the amplitude of the test stimulus had the effect of decreasing the DL. A pilot study, conducted on individuals who were concussed, found that increasing the amplitude of the standard did not have an impact on the DL of this group of individuals. Since this effect did not parallel what was predicted from the optical imaging findings in somatosensory cortex of non-human primates, the authors suggest that this particular measure or observation could be sensitive to neuroinflammation and that neuron-glial interactions, impacted by concussion, could have the effect of ignoring, or not integrating, the increased amplitude.

Somatosensory cortex functional connectivity abnormalities in autism show opposite trends, depending on direction and spatial scale

Functional connectivity is abnormal in autism, but the nature of these abnormalities remains elusive. Different studies, mostly using functional magnetic resonance imaging, have found increased, decreased, or even mixed pattern functional connectivity abnormalities in autism, but no unifying framework has emerged to date. We measured functional connectivity in individuals with autism and in controls using magnetoencephalography, which allowed us to resolve both the directionality (feedforward versus feedback) and spatial scale (local or long-range) of functional connectivity. Specifically, we measured the cortical response and functional connectivity during a passive 25-Hz vibrotactile stimulation in the somatosensory cortex of 20 typically developing individuals and 15 individuals with autism, all males and right-handed, aged 8-18, and the mu-rhythm during resting state in a subset of these participants (12 per group, same age range). Two major significant group differences emerged in the response to the vibrotactile stimulus. First, the 50-Hz phase locking component of the cortical response, generated locally in the primary (S1) and secondary (S2) somatosensory cortex, was reduced in the autism group (P < 0.003, corrected). Second, feedforward functional connectivity between S1 and S2 was increased in the autism group (P < 0.004, corrected). During resting state, there was no group difference in the mu-α rhythm. In contrast, the mu-β rhythm, which has been associated with feedback connectivity, was significantly reduced in the autism group (P < 0.04, corrected). Furthermore, the strength of the mu-β was correlated to the relative strength of 50 Hz component of the response to the vibrotactile stimulus (r = 0.78, P < 0.00005), indicating a shared aetiology for these seemingly unrelated abnormalities. These magnetoencephalography-derived measures were correlated with two different behavioural sensory processing scores (P < 0.01 and P < 0.02 for the autism group, P < 0.01 and P < 0.0001 for the typical group), with autism severity (P < 0.03), and with diagnosis (89% accuracy). A biophysically realistic computational model using data driven feedforward and feedback parameters replicated the magnetoencephalography data faithfully. The direct observation of both abnormally increased and abnormally decreased functional connectivity in autism occurring simultaneously in different functional connectivity streams, offers a potential unifying framework for the unexplained discrepancies in current findings. Given that cortical feedback, whether local or long-range, is intrinsically non-linear, while cortical feedforward is generally linear relative to the stimulus, the present results suggest decreased non-linearity alongside an increased veridical component of the cortical response in autism.

TMS-induced neural noise in sensory cortex interferes with short-term memory storage in prefrontal cortex

In a previous study, Harris et al. (2002) found disruption of vibrotactile short-term memory after applying single-pulse transcranial magnetic stimulation (TMS) to primary somatosensory cortex (SI) early in the maintenance period, and suggested that this demonstrated a role for SI in vibrotactile memory storage. While such a role is compatible with recent suggestions that sensory cortex is the storage substrate for working memory, it stands in contrast to a relatively large body of evidence from human EEG and single-cell recording in primates that instead points to prefrontal cortex as the storage substrate for vibrotactile memory. In the present study, we use computational methods to demonstrate how Harris et al.'s results can be reproduced by TMS-induced activity in sensory cortex and subsequent feedforward interference with memory traces stored in prefrontal cortex, thereby reconciling discordant findings in the tactile memory literature.

The influence of prior experience and expected timing on vibrotactile discrimination

Vibrotactile discrimination tasks involve perceptual judgements on stimulus pairs separated by a brief interstimulus interval (ISI). Despite their apparent simplicity, decision making during these tasks is biased by prior experience in a manner that is not well understood. A striking example is when participants perform well on trials where the first stimulus is closer to the mean of the stimulus-set than the second stimulus, and perform comparatively poorly when the first stimulus is further from the stimulus mean. This "time-order effect" suggests that participants implicitly encode the mean of the stimulus-set and use this internal standard to bias decisions on any given trial. For relatively short ISIs, the magnitude of the time-order effect typically increases with the distance of the first stimulus from the global mean. Working from the premise that the time-order effect reflects the loss of precision in working memory representations, we predicted that the influence of the time-order effect, and this superimposed "distance" effect, would monotonically increase for trials with longer ISIs. However, by varying the ISI across four intervals (300, 600, 1200, and 2400 ms) we instead found a complex, non-linear dependence of the time-order effect on both the ISI and the distance, with the time-order effect being paradoxically stronger at short ISIs. We also found that this relationship depended strongly on participants' prior experience of the ISI (from previous task titration). The time-order effect not only depends on participants' expectations concerning the distribution of stimuli, but also on the expected timing of the trials.

Practice-related improvements in somatosensory interval discrimination are temporally specific but generalize across skin location, hemisphere, and modality

This paper concerns the characterization of performance and perceptual learning of somatosensory interval discrimination. The purposes of this study were to define (1) the performance characteristics for interval discrimination in the somatosensory system by naive adult humans, (2) the normal capacities for improvement in somatosensory interval discrimination, and (3) the extent of generalization of interval discrimination learning. In a two-alternative forced choice procedure, subjects were presented with two pairs of vibratory pulses. One pair was separated in time by a fixed base interval; a second pair was separated by a target interval that was always longer than the base interval. Subjects indicated which pair was separated by the target interval. The length of the target interval was varied adaptively to determine discrimination thresholds. After initial determination of naive abilities, subjects were trained for 900 trials per day at base intervals of either 75 or 125 msec for 10-15 d. Significant improvements in thresholds resulted from training. Learning at the trained base interval generalized completely across untrained skin locations on the trained hand and to the corresponding untrained skin location in the contralateral hand. The learning partially generalized to untrained base intervals similar to the trained one, but not to more distant base intervals. Learning with somatosensory stimuli generalized to auditory stimuli presented at comparable base intervals. These results demonstrate temporal specificity in somatosensory interval discrimination learning that generalizes across skin location, hemisphere, and modality.