Sensory Augmentation for Balance Rehabilitation Using Skin Stretch Feedback

This dissertation focuses on the development and evaluation of portable sensory augmentation systems that render skin-stretch feedback of posture for standing balance training and for postural control improvement. Falling is one of the main causes of fatal injuries among all members of the population. The high incidence of fall-related injuries also leads to high medical expenses, which cost approximately $34 billion annually in the United States. People with neurological diseases, e.g., stroke, multiple sclerosis, spinal cord injuries, and the elderly are more prone to falling when compared to healthy individuals. Falls among these populations can also lead to hip fracture, or even death. Thus, several balance and gait rehabilitation approaches have been developed to reduce the risk of falling. Traditionally, a balance-retraining program includes a series of exercises for trainees to strengthen their sensorimotor and musculoskeletal systems. Recent advances in technology have incorporated biofeedback such as visual, auditory, or haptic feedback to provide the users with extra cues about their postural sway. Studies have also demonstrated the positive effects of biofeedback on balance control. However, current applications of biofeedback for interventions in people with impaired balance are still lacking some important characteristics such as portability (in-home care), small-size, and long-term viability. Inspired by the concept of light touch, a light, small, and wearable sensory augmentation system that detects body sway and supplements skin stretch on one’s fingertip pad was first developed. The addition of a shear tactile display could significantly enhance the sensation to body movement. Preliminary results have shown that the application of passive skin stretch feedback at the fingertip enhanced standing balance of healthy young adults. Based on these findings, two research directions were initiated to investigate i) which dynamical information of postural sway could be more effectively conveyed by skin stretch feedback, and ii) how can such feedback device be easily used in the clinical setting or on a daily basis. The major sections of this research are focused on understanding how the skin stretch feedback affects the standing balance and on quantifying the ability of humans to interpret the cutaneous feedback as the cues of their physiological states. Experimental results from both static and dynamic balancing tasks revealed that healthy subjects were able to respond to the cues and subsequently correct their posture. However, it was observed that the postural sway did not generally improve in healthy subjects due to skin stretch feedback. A possible reason was that healthy subjects already had good enough quality sensory information such that the additional artificial biofeedback may have interfered with other sensory cues. Experiments incorporating simulated sensory deficits were further conducted and it was found that subjects with perturbed sensory systems (e.g., unstable surface) showed improved balance due to skin stretch feedback when compared to the neutral standing conditions. Positive impacts on balance performance have also been demonstrated among multiple sclerosis patients when they receive skin stretch feedback from a sensory augmentation walker. The findings in this research indicated that the skin stretch feedback rendered by the developed devices affected the human balance and can potentially compensate underlying neurological or musculoskeletal disorders, therefore enhancing quiet standing postural control

Sensory Augmentation for Balance Rehabilitation Using Skin Stretch Feedback

This dissertation focuses on the development and evaluation of portable sensory augmentation systems that render skin-stretch feedback of posture for standing balance training and for postural control improvement. Falling is one of the main causes of fatal injuries among all members of the population. The high incidence of fall-related injuries also leads to high medical expenses, which cost approximately $34 billion annually in the United States. People with neurological diseases, e.g., stroke, multiple sclerosis, spinal cord injuries, and the elderly are more prone to falling when compared to healthy individuals. Falls among these populations can also lead to hip fracture, or even death. Thus, several balance and gait rehabilitation approaches have been developed to reduce the risk of falling. Traditionally, a balance-retraining program includes a series of exercises for trainees to strengthen their sensorimotor and musculoskeletal systems. Recent advances in technology have incorporated biofeedback such as visual, auditory, or haptic feedback to provide the users with extra cues about their postural sway. Studies have also demonstrated the positive effects of biofeedback on balance control. However, current applications of biofeedback for interventions in people with impaired balance are still lacking some important characteristics such as portability (in-home care), small-size, and long-term viability. Inspired by the concept of light touch, a light, small, and wearable sensory augmentation system that detects body sway and supplements skin stretch on one’s fingertip pad was first developed. The addition of a shear tactile display could significantly enhance the sensation to body movement. Preliminary results have shown that the application of passive skin stretch feedback at the fingertip enhanced standing balance of healthy young adults. Based on these findings, two research directions were initiated to investigate i) which dynamical information of postural sway could be more effectively conveyed by skin stretch feedback, and ii) how can such feedback device be easily used in the clinical setting or on a daily basis. The major sections of this research are focused on understanding how the skin stretch feedback affects the standing balance and on quantifying the ability of humans to interpret the cutaneous feedback as the cues of their physiological states. Experimental results from both static and dynamic balancing tasks revealed that healthy subjects were able to respond to the cues and subsequently correct their posture. However, it was observed that the postural sway did not generally improve in healthy subjects due to skin stretch feedback. A possible reason was that healthy subjects already had good enough quality sensory information such that the additional artificial biofeedback may have interfered with other sensory cues. Experiments incorporating simulated sensory deficits were further conducted and it was found that subjects with perturbed sensory systems (e.g., unstable surface) showed improved balance due to skin stretch feedback when compared to the neutral standing conditions. Positive impacts on balance performance have also been demonstrated among multiple sclerosis patients when they receive skin stretch feedback from a sensory augmentation walker. The findings in this research indicated that the skin stretch feedback rendered by the developed devices affected the human balance and can potentially compensate underlying neurological or musculoskeletal disorders, therefore enhancing quiet standing postural control

Exploring Teleimpedance and Tactile Feedback for Intuitive Control of the Pisa/IIT SoftHand

This paper proposes a teleimpedance controller with tactile feedback for more intuitive control of the Pisa/IIT SoftHand. With the aim to realize a robust, efficient and low-cost hand prosthesis design, the SoftHand is developed based on the motor control principle of synergies, through which the immense complexity of the hand is simplified into distinct motor patterns. Due to the built-in flexibility of the hand joints, as the SoftHand grasps, it follows a synergistic path while allowing grasping of objects of various shapes using only a single motor. The DC motor of the hand incorporates a novel teleimpedance control in which the user's postural and stiffness synergy references are tracked in real-time. In addition, for intuitive control of the hand, two tactile interfaces are developed. The first interface (mechanotactile) exploits a disturbance observer which estimates the interaction forces in contact with the grasped object. Estimated interaction forces are then converted and applied to the upper arm of the user via a custom made pressure cuff. The second interface employs vibrotactile feedback based on surface irregularities and acceleration signals and is used to provide the user with information about the surface properties of the object as well as detection of object slippage while grasping. Grasp robustness and intuitiveness of hand control were evaluated in two sets of experiments. Results suggest that incorporating the aforementioned haptic feedback strategies, together with user-driven compliance of the hand, facilitate execution of safe and stable grasps, while suggesting that a low-cost, robust hand employing hardware-based synergies might be a good alternative to traditional myoelectric prostheses

Doctor of Philosophy

dissertationThe study of haptic interfaces focuses on the use of the sense of touch in human-machine interaction. This document presents a detailed investigation of lateral skin stretch at the fingertip as a means of direction communication. Such tactile communication has applications in a variety of situations where traditional audio and visual channels are inconvenient, unsafe, or already saturated. Examples include handheld consumer electronics, where tactile communication would allow a user to control a device without having to look at it, or in-car navigation systems, where the audio and visual directions provided by existing GPS devices can distract the driver's attention away from the road. Lateral skin stretch, the displacement of the skin of the fingerpad in a plane tangent to the fingerpad, is a highly effective means of communicating directional information. Users are able to correctly identify the direction of skin stretch stimuli with skin displacements as small as 0.1 mm at rates as slow as 2 mm/s. Such stimuli can be rendered by a small, portable device suitable for integration into handheld devices. The design of the device-finger interface affects the ability of the user to perceive the stimuli accurately. A properly designed conical aperture effectively constrains the motion of the finger and provides an interface that is practical for use in handheld devices. When a handheld device renders directional tactile cues on the fingerpad, the user must often mentally rotate those cues from the reference frame of the finger to the world-centered reference frame where those cues are to be applied. Such mental rotation incurs a cognitive cost, requiring additional time to mentally process the stimuli. The magnitude of these cognitive costs is a function of the angle of rotation, and of the specific orientations of the arm, wrist and finger. Even with the difficulties imposed by required mental rotations, lateral skin stretch is a promising means of communicating information using the sense of touch with potential to substantially improve certain types of human-machine interaction

Automatic Posture Correction Utilizing Electrical Muscle Stimulation

Habitually poor posture can lead to repetitive strain injuries that lower an individual\u27s quality of life and productivity. Slouching over computer screens and smart phones, asymmetric weight distribution due to uneven leg loading, and improper loading posture are some of the common examples that lead to postural problems and health ramifications. To help cultivate good postural habits, researchers have proposed slouching, balance, and improper loading posture detection systems that alert users through traditional visual, auditory or vibro-tactile feedbacks when posture requires attention. However, such notifications are disruptive and can be easily ignored. We address these issues with a new physiological feedback system that uses sensors to detect these poor postures, and electrical muscle stimulation to automatically correct the poor posture. We compare our automatic approach against other alternative feedback systems and through different unique contexts. We find that our approach outperformed alternative traditional feedback systems by being faster and more accurate while delivering an equally comfortable user experience

The role of multisensory feedback in the objective and subjective evaluations of fidelity in virtual reality environments.

The use of virtual reality in academic and industrial research has been rapidly expanding in recent years therefore evaluations of the quality and effectiveness of virtual environments are required. The assessment process is usually done through user evaluation that is being measured whilst the user engages with the system. The limitations of this method in terms of its variability and user bias of pre and post-experience have been recognised in the research literature. Therefore, there is a need to design more objective measures of system effectiveness that could complement subjective measures and provide a conceptual framework for the fidelity assessment in VR. There are many technological and perceptual factors that can influence the overall experience in virtual environments. The focus of this thesis was to investigate how multisensory feedback, provided during VR exposure, can modulate a user’s qualitative and quantitative experience in the virtual environment. In a series of experimental studies, the role of visual, audio, haptic and motion cues on objective and subjective evaluations of fidelity in VR was investigated. In all studies, objective measures of performance were collected and compared to the subjective measures of user perception. The results showed that the explicit evaluation of environmental and perceptual factors available within VR environments modulated user experience. In particular, the results shown that a user’s postural responses can be used as a basis for the objective measure of fidelity. Additionally, the role of augmented sensory cues was investigated during a manual assembly task. By recording and analysing the objective and subjective measures it was shown that augmented multisensory feedback modulated the user’s acceptability of the virtual environment in a positive manner and increased overall task performance. Furthermore, the presence of augmented cues mitigated the negative effects of inaccurate motion tracking and simulation sickness. In the follow up study, the beneficial effects of virtual training with augmented sensory cues were observed in the transfer of learning when the same task was performed in a real environment. Similarly, when the effects of 6 degrees of freedom motion cuing on user experience were investigated in a high fidelity flight simulator, the consistent findings between objective and subjective data were recorded. By measuring the pilot’s accuracy to follow the desired path during a slalom manoeuvre while perceived task demand was increased, it was shown that motion cuing is related to effective task performance and modulates the levels of workload, sickness and presence. The overall findings revealed that multisensory feedback plays an important role in the overall perception and fidelity evaluations of VR systems and as such user experience needs to be included when investigating the effectiveness of sensory feedback signals. Throughout this thesis it was consistently shown that subjective measures of user perception in VR are directly comparable to the objective measures of performance and therefore both should be used in order to obtain a robust results when investigating the effectiveness of VR systems. This conceptual framework can provide an effective method to study human perception, which can in turn provide a deeper understanding of the environmental and cognitive factors that can influence the overall user experience, in terms of fidelity requirements, in virtual reality environments

On the Role of Haptic Synergies in Modelling the Sense of Touch and in Designing Artificial Haptic Systems

This thesis aims at defining strategies to reduce haptic information complexity, with minimum loss of information, to design more effective haptic interfaces and artificial systems. Nowadays, haptic device design can be complex. Moreover, the artificial reproduction of the full spectrum of haptic information is a daunting task and far to be achieved. The central idea of this work is to simplify this information by exploiting the concept of synergies, which has been developed to describe the covariation patterns in multi-digit movements and forces in common motor tasks. Here I extend and exploit it also in the perceptual domain, to find projections from the heterogeneous information manifold, generated by the mechanics of touch, and what can be actually perceived by humans. In this manner, design trade-off between costs, feasibility and quality of the rendered perception can be individuated. With this as motivation, referring to cutaneous sensing, I discuss the development of a fabric-based softness display inspired by ``Contact Area Spread Rate'' hypothesis as well as the characterization of an air-jet lump display method for Robot-assisted Minimally Invasive Surgery. Considering kinaesthesia, I analyze the problem of hand posture estimation from noisy and limited in number measures provided by low cost hand pose sensing devices. By using the information about how humans most frequently use their hands, system performance is enhanced and optimal system design enabled. Finally, an integrated device, where a conventional kinaesthetic haptic display is combined with a cutaneous softness one, is proposed, showing that the fidelity by which softness is artificially rendered increases

A novel approach to user controlled ambulation of lower extremity exoskeletons using admittance control paradigm

The robotic lower extremity exoskeletons address the ambulatory problems confronting individuals with paraplegia. Paraplegia due to spinal cord injury (SCI) can cause motor deficit to the lower extremities leading to inability to walk. Though wheelchairs provide mobility to the user, they do not provide support to all activities of everyday living to individuals with paraplegia. Current research is addressing the issue of ambulation through the use of wearable exoskeletons that are pre-programmed. There are currently four exoskeletons in the U.S. market: Ekso, Rewalk, REX and Indego. All of the currently available exoskeletons have 2 active Degrees of Freedom (DOF) except for REX which has 5 active DOF. All of them have pre-programmed gait giving the user the ability to initiate a gait but not the ability to control the stride amplitude (height), stride frequency or stride length, and hence restricting users’ ability to navigate across different surfaces and obstacles that are commonly encountered in the community. Most current exoskeletons do not have motors for abduction or adduction to provide users with the option for movement in coronal plane, hence restricting user’s ability to effectively use the exoskeletons. These limitations of currently available pre-programmed exoskeleton models are sought to be overcome by an intuitive, real time user-controlled control mechanism employing admittance control by using hand-trajectory as a surrogate for foot trajectory. Preliminary study included subjects controlling the trajectory of the foot in a virtual environment using their contralateral hand. The study proved that hands could produce trajectories similar to human foot trajectories when provided with haptic and visual feedback. A 10 DOF 1/2 scale biped robot was built to test the control paradigm. The robot has 5 DOF on each leg with 2 DOF at the hip to provide flexion/extension and abduction/adduction, 1 DOF at the knee to provide flexion and 2 DOF at the ankle to provide flexion/extension and inversion/eversion. The control mechanism translates the trajectory of each hand into the trajectory of the ipsilateral foot in real time, thus providing the user with the ability to control each leg in both sagittal and coronal planes using the admittance control paradigm. The efficiency of the control mechanism was evaluated in a study using healthy subjects controlling the robot on a treadmill. A trekking pole was attached to each foot of the biped. The subjects controlled the trajectory of the foot of the biped by applying small forces in the direction of the required movement to the trekking pole through a force sensor. The algorithm converted the forces to Cartesian position of the foot in real time using admittance control; the Cartesian position was converted to joint angles of the hip and knee using inverse kinematics. The kinematics, synchrony and smoothness of the trajectory produced by the biped robot was evaluated at different speeds, with and without obstacles, and compared with typical walking by human subjects on the treadmill. Further, the cognitive load required to control the biped on the treadmill was evaluated and the effect of speed and obstacles with cognitive load on the kinematics, synchrony and smoothness was analyzed