Haptic wearables as sensory replacement, sensory augmentation and trainer - a review

Sensory impairments decrease quality of life and can slow or hinder rehabilitation. Small, computationally powerful electronics have enabled the recent development of wearable systems aimed to improve function for individuals with sensory impairments. The purpose of this review is to synthesize current haptic wearable research for clinical applications involving sensory impairments. We define haptic wearables as untethered, ungrounded body worn devices that interact with skin directly or through clothing and can be used in natural environments outside a laboratory. Results of this review are categorized by degree of sensory impairment. Total impairment, such as in an amputee, blind, or deaf individual, involves haptics acting as sensory replacement; partial impairment, as is common in rehabilitation, involves haptics as sensory augmentation; and no impairment involves haptics as trainer. This review found that wearable haptic devices improved function for a variety of clinical applications including: rehabilitation, prosthetics, vestibular loss, osteoarthritis, vision loss and hearing loss. Future haptic wearables development should focus on clinical needs, intuitive and multimodal haptic displays, low energy demands, and biomechanical compliance for long-term usage

A fabric-based approach for wearable haptics

In recent years, wearable haptic systems (WHS) have gained increasing attention as a novel and exciting paradigm for human-robot interaction (HRI).These systems can be worn by users, carried around, and integrated in their everyday lives, thus enabling a more natural manner to deliver tactile cues.At the same time, the design of these types of devices presents new issues: the challenge is the correct identification of design guidelines, with the two-fold goal of minimizing system encumbrance and increasing the effectiveness and naturalness of stimulus delivery.Fabrics can represent a viable solution to tackle these issues.They are specifically thought “to be worn”, and could be the key ingredient to develop wearable haptic interfaces conceived for a more natural HRI.In this paper, the author will review some examples of fabric-based WHS that can be applied to different body locations, and elicit different haptic perceptions for different application fields.Perspective and future developments of this approach will be discussed

Development of a Prosthetic Biofeedback Method and Device to Measure Quality of Fit for Trans-Tibial Amputees

As the primary interface between the prosthetic and the residual limb, the socket is a crucial component affecting fit and function of the device. While prostheses have been used for centuries, prosthetic socket design concepts have remained stagnant. With the increase in prevalence of obesity and diabetes, amputations associated with secondary complications have risen as a consequence. In particular, neuropathy complicates transition of a new amputee to using a prosthetic socket crucial for their quality of life by reducing -or in some cases completely hindering- tactile sensation and healing in the residual limb. The objectives of this thesis are to: 1) create a protocol to evaluate innovative technology within the socket in vitro while maintaining a true sense of the users limb geometry and material characteristics that interface with the socket, and 2) develop and validate a method of providing biofeedback to prosthesis users, particularly those with neuropathy.The focus of this thesis will be on trans-tibial amputees and prosthesis to reduce the complexity of including a knee joint and to address the largest population of amputees. In this thesis, a method of testing innovations through the use of artificial biofidelic limbs by systematically varying dimensions was first developed and validated against in vivo measurement of amputees reported by Silver-Thorn [15]. Materials characterization yielded closely matching relaxation at 5s to published values [15]- achieving a range of 22.43-31.94% to that of Silver-Thorn with a range of 25.35-49.25%. However, full relaxation and size control during fabrication needs improvement to create a more consistent limb. The max relaxation being measured as 39.06% against the in vivo measurements reaching 68.03%. Additionally the size of the limbs varied from the model by a maximum of 13mm. Following development of the test methods, a method of measuring fit changes within the socket using a single pneumatic (PicoPress) sensor on the distal end to measure distal end (or end-pad) contact pressures. Tests using the biofidelic limbs indicates the use of a single picopress sensor in the distal end is a viable option to detect fit changes over time. However, settling times need to be further investigated to identify barriers to dynamic use (e.g. gait during walking). Feedback from practicing orthotists indicate the PicoPress approach is a viable option to include in existing fabrication processes used to generate custom sockets without altering supply lead times and fabrication times

Advancing Medical Technology for Motor Impairment Rehabilitation: Tools, Protocols, and Devices

Excellent motor control skills are necessary to live a high-quality life. Activities such as walking, getting dressed, and feeding yourself may seem mundane, but injuries to the neuromuscular system can render these tasks difficult or even impossible to accomplish without assistance. Statistics indicate that well over 100 million people are affected by diseases or injuries, such as stroke, Parkinson’s Disease, Multiple Sclerosis, Cerebral Palsy, peripheral nerve injury, spinal cord injury, and amputation, that negatively impact their motor abilities. This wide array of injuries presents a challenge to the medical field as optimal treatment paradigms are often difficult to implement due to a lack of availability of appropriate assessment tools, the inability for people to access the appropriate medical centers for treatment, or altogether gaps in technology for treating the underlying impairments causing the disability. Addressing each of these challenges will improve the treatment of movement impairments, provide more customized and continuous treatment to a larger number of patients, and advance rehabilitative and assistive device technology. In my research, the key approach was to develop tools to assess and treat upper extremity movement impairment. In Chapter 2.1, I challenged a common biomechanical[GV1] modeling technique of the forearm. Comparing joint torque values through inverse dynamics simulation between two modeling platforms, I discovered that representing the forearm as a single cylindrical body was unable to capture the inertial parameters of a physiological forearm which is made up of two segments, the radius and ulna. I split the forearm segment into a proximal and distal segment, with the rationale being that the inertial parameters of the proximal segment could be tuned to those of the ulna and the inertial parameters of the distal segment could be tuned to those of the radius. Results showed a marked increase in joint torque calculation accuracy for those degrees of freedom that are affected by the inertial parameters of the radius and ulna. In Chapter 2.2, an inverse kinematic upper extremity model was developed for joint angle calculations from experimental motion capture data, with the rationale being that this would create an easy-to-use tool for clinicians and researchers to process their data. The results show accurate angle calculations when compared to algebraic solutions. Together, these chapters provide easy-to-use models and tools for processing movement assessment data. In Chapter 3.1, I developed a protocol to collect high-quality movement data in a virtual reality task that is used to assess hand function as part of a Box and Block Test. The goal of this chapter is to suggest a method to not only collect quality data in a research setting but can also be adapted for telehealth and at home movement assessment and rehabilitation. Results indicate that the data collected in this protocol are good and the virtual nature of this approach can make it a useful tool for continuous, data driven care in clinic or at home. In Chapter 3.2 I developed a high-density electromyography device for collecting motor unit action potentials of the arm. Traditional surface electromyography is limited by its ability to obtain signals from deep muscles and can also be time consuming to selectively place over appropriate muscles. With this high-density approach, muscle coverage is increased, placement time is decreased, and deep muscle activity can potentially be collected due to the high-density nature of the device[GV2] . Furthermore, the high-density electromyography device is built as a precursor to a high-density electromyography-electrical stimulation device for functional electrical stimulation. The customizable nature of the prototype in Chapter 3.2 allows for the implementation both recording and stimulating electrodes. Furthermore, signal results show that the electromyography data obtained from the device are of high quality and are correlated with gold standard surface electromyography sensors. One key factor in a device that can record and then stimulate based on the information from the recorded signals is an accurate movement intent decoder. High-quality movement decoders have been designed by closed-loop device controllers in the past, but they still struggle when the user interacts with objects of varying weight due to underlying alterations in muscle signals. In Chapter 4, I investigate this phenomenon by administering an experiment where participants perform a Box and Block Task with objects of 3 different weights, 0 kg, 0.02 kg, and 0.1 kg. Electromyography signals of the participants right arm were collected and co-contraction levels between antagonistic muscles were analyzed to uncover alterations in muscle forces and joint dynamics. Results indicated contraction differences between the conditions and also between movement stages (contraction levels before grabbing the block vs after touching the block) for each condition. This work builds a foundation for incorporating object weight estimates into closed-loop electromyography device movement decoders. Overall, we believe the chapters in this thesis provide a basis for increasing availability to movement assessment tools, increasing access to effective movement assessment and rehabilitation, and advance the medical device and technology field

A Haptic Feedback System for Lower Limb Amputees Based on Gait Event Detection

Lower limb amputation has significant effects on a person’s quality of life and ability to perform activities of daily living. Prescription of prosthetic device post amputation aims to help restore some degrees of mobility function, however studies have shown evidence of low balance confidence and higher risk of falling among amputee community, especially those suffering from above knee amputation. While advanced prostheses offer better control, they often lack a form of feedback that delivers the awareness of the limb position to the prosthetic user while walking. This research presents the development and evaluation of a wearable skinstretch haptic feedback system intended to deliver cues of two crucial gait events, namely the Initial Contact (IC) and Toe-off (TO) to its wearer. The system comprises a haptic module that applies lateral skin-stretch on the upper leg or the trunk, corresponding to the gait event detection module based on Inertial Measurement Unit (IMU) attached at the shank. The design and development iterations of the haptic module is presented, and characterization of the feedback parameters is discussed. The validation of the gait event detection module is carried out and finally the integration of the haptic feedback system is described. Experimental work with healthy subjects and an amputee indicated good perceptibility of the feedback during static and dynamic (walking) condition, although higher magnitude of stretch was required to perceive the feedback during dynamic condition. User response time during dynamic activity showed that the haptic feedback system is suitable for delivering cues of IC and TO within the duration of the stance phase. In addition, feedback delivered in discernible patterns can be learned and adapted by the subjects. Finally, a case study was carried out with an above-knee amputee to assess the effects of the haptic feedback on spatio-temporal gait parameters and on the vertical ground reaction force during treadmill and overground walking. The research presented in this report introduces a novel design of a haptic feedback device. As such, the outcome includes a well-controlled skin-stretch effect which contributes to the research by investigating skin-stretch feedback for conveying discrete event information rather than conveying direction information as presented in other studies. In addition, it is found that stretch magnitude as small as 3 mm could be perceived in short duration of 150 ms during dynamic condition, making it a suitable alternative to other widely investigated haptic modality such as vibration for ambulatory feedback application. With continuous training, the haptic feedback system could possibly benefit lower limb amputees by creating awareness of the limb placement during ambulation, potentially reducing visual dependency and increasing walking confidence

Master of Science

thesisComputing and data acquisition have become an integral part of everyday life. From reading emails on a cell phone, to kids playing with motion sensing game consoles, we are surrounded with sensors and mobile devices. As the availability of powerful mobile computing devices expands, the road is paved for applications in previously limited environments. Rehabilitative devices are emerging that embrace these mobile advances. Research has explored the use of smartphones in rehabilitation as a means to process data and provide feedback in conjunction with established rehabilitative methods. Smartphones, combined with sensor embedded insoles, provide a powerful tool for the clinician in gathering data and may act as a standalone training technique. This thesis presents continuing research of a sensor integrated insole system that provides real-time feedback through a mobile platform, the Adaptive Real-Time Instrumentation System for Tread Imbalance Correction (ARTISTIC). The system interfaces a wireless instrumented insole with an Android smartphone application to receive gait data and provide sensory feedback to modify gait patterns. Revisions to the system hardware, software, and feedback modes brought about the introduction of the ARTISTIC 2.0. The number of sensors in the insole was increased from two to 10. The microprocessor and a vibrotactile motor were embedded in the insole and the communications box was reduced in size and weight by more than 50%. Stance time iv measurements were validated against force plate equipment and found to be within 13.5 ± 3.3% error of force plate time measurements. Human subjects were tested using each of the feedback modes to alter gait symmetry. Results from the testing showed that more than one mode of feedback caused a statistically significant change in gait symmetry ratios (p < 0.05). Preference of feedback modes varied among subjects, with the majority agreeing that several feedback modes made a difference in their gait. Further improvements will prepare the ARTISTIC 2.0 for testing in a home environment for extended periods of time and improve data capture techniques, such as including a database in the smartphone application

Future bathroom: A study of user-centred design principles affecting usability, safety and satisfaction in bathrooms for people living with disabilities

Research and development work relating to assistive technology 2010-11 (Department of Health) Presented to Parliament pursuant to Section 22 of the Chronically Sick and Disabled Persons Act 197

Long-Term Use of a Sensory Prosthesis Improves Function in a Patient With Peripheral Neuropathy: A Case Report

Background: Peripheral neuropathy (PN) can result in either partial or complete loss of distal sensation resulting in an increased fall risk. Walkasins® uses a shoe insert to detect the magnitude and direction of sway and sends signals to a leg unit that provides sensory balance cues. The objective of this case report is to describe the long-term influence of the Walkasins® lower limb sensory neuroprosthesis on balance and gait for an individual with diabetic PN.Case Description: A 51-year-old male with a 3-year history of PN and a 10-year history of type II diabetes mellitus was fitted bilaterally with Walkasins® and utilized them 8–10 hours/day for more than 2 years. Although, vibration and tactile sensation thresholds were severely impaired at his 1st metatarsophalangeal joint and the lateral malleolus bilaterally he could perceive tactile stimuli from the Walkasins® above the ankles.Outcomes: Following Walkasins® use, his Activities-specific Balance Confidence Scale (ABC) scores improved from 33 to 80%. His mean Vestibular Activities of Daily Living (VADL) scores decreased from 3.54 to 1. His Functional Gait Assessment (FGA) scores increased from 13/30 to 28/30 and his miniBESTest scores improved from 15/28 to 26/28. Gait speed increased from 0.23 to 1.5 m/s. The patient described a decrease in pain and cramping throughout his lower extremities and an increase in function.Discussion: Gait and balance improved with the use of the Walkasins® and participation in a wellness program. This improvement suggests that the use of sensory substitution devices, such as the Walkasins®, may replace sensory deficits related to gait and balance dysfunction experienced by patients with PN. Further research is needed to determine if other patients will have a similar response and what the necessary threshold of sensory function is to benefit from use of the Walkasins®

Experimental Validation of a Primary Afferent Based Somatosensory Neuroprosthesis

Losing a limb has a profound impact on the life of an individual. Unfortunately even the most advanced prosthetic limb pales in comparison to the dexterity and strength-to-weight ratio of a natural limb. Furthermore, artificial limbs cannot provide the exquisitely sensitive feedback provided by the body’s natural sensors. For these reasons, the adoption rates for prosthetics remain low. Recent advances in neurotechnology have provided researchers with the ability to stimulate through many independent electrodes. This technology can form the basis of future somatosensory neural interfaces (SSNI), replacing feedback once provided by skin and muscle with the state of a prosthetic limb encoded in patterned electrical stimulation. Suitable neural implant sites and electrode technologies for restoring sensation are the subject of active investigation. One potential substrate for a SSNI are the dorsal root ganglia (DRG), enlargements of the spinal nerves that house primary afferent cell bodies. The DRG are compact structures located bilaterally outside the spinal cord but still isolated from movements and large muscles within the vertebral column. Unlike the peripheral nerves, the DRG are segregated from efferent flow so afferents can be recruited by stimulation without the risk of producing uncomfortable contractions of residual muscles. This dissertation evaluates the recruitment properties of electrodes implanted in the DRG. First, recordings from primary somatosensory cortex were used as the basis for evaluating primary afferent stimulation. Then, the effective lifetime of microelectrodes implanted in the DRG was characterized using recordings from the sciatic nerve. Subsequent instrumentation of many distal nerves enabled direct measurement of the selectivity and peripheral targets of recruited neurons. Finally the selectivity and dynamic range of epineural electrodes were characterized to demonstrate a path forward to clinical testing