A robot hand testbed designed for enhancing embodiment and functional neurorehabilitation of body schema in subjects with upper limb impairment or loss.

Many upper limb amputees experience an incessant, post-amputation "phantom limb pain" and report that their missing limbs feel paralyzed in an uncomfortable posture. One hypothesis is that efferent commands no longer generate expected afferent signals, such as proprioceptive feedback from changes in limb configuration, and that the mismatch of motor commands and visual feedback is interpreted as pain. Non-invasive therapeutic techniques for treating phantom limb pain, such as mirror visual feedback (MVF), rely on visualizations of postural changes. Advances in neural interfaces for artificial sensory feedback now make it possible to combine MVF with a high-tech "rubber hand" illusion, in which subjects develop a sense of embodiment with a fake hand when subjected to congruent visual and somatosensory feedback. We discuss clinical benefits that could arise from the confluence of known concepts such as MVF and the rubber hand illusion, and new technologies such as neural interfaces for sensory feedback and highly sensorized robot hand testbeds, such as the "BairClaw" presented here. Our multi-articulating, anthropomorphic robot testbed can be used to study proprioceptive and tactile sensory stimuli during physical finger-object interactions. Conceived for artificial grasp, manipulation, and haptic exploration, the BairClaw could also be used for future studies on the neurorehabilitation of somatosensory disorders due to upper limb impairment or loss. A remote actuation system enables the modular control of tendon-driven hands. The artificial proprioception system enables direct measurement of joint angles and tendon tensions while temperature, vibration, and skin deformation are provided by a multimodal tactile sensor. The provision of multimodal sensory feedback that is spatiotemporally consistent with commanded actions could lead to benefits such as reduced phantom limb pain, and increased prosthesis use due to improved functionality and reduced cognitive burden

Proprioceptive Movement Illusions Due to Prolonged Stimulation: Reversals and Aftereffects

Background. Adaptation to constant stimulation has often been used to investigate the mechanisms of perceptual coding, but the adaptive processes within the proprioceptive channels that encode body movement have not been well described. We investigated them using vibration as a stimulus because vibration of muscle tendons results in a powerful illusion of movement. Methodology/Principal Findings. We applied sustained 90 Hz vibratory stimulation to biceps brachii, an elbow flexor and induced the expected illusion of elbow extension (in 12 participants). There was clear evidence of adaptation to the movement signal both during the 6-min long vibration and on its cessation. During vibration, the strong initial illusion of extension waxed and waned, with diminishing duration of periods of illusory movement and occasional reversals in the direction of the illusion. After vibration there was an aftereffect in which the stationary elbow seemed to move into flexion. Muscle activity shows no consistent relationship with the variations in perceived movement. Conclusion. We interpret the observed effects as adaptive changes in the central mechanisms that code movement in direction-selective opponent channels

Vibration as an exercise modality: how it may work, and what its potential might be

Whilst exposure to vibration is traditionally regarded as perilous, recent research has focussed on potential benefits. Here, the physical principles of forced oscillations are discussed in relation to vibration as an exercise modality. Acute physiological responses to isolated tendon and muscle vibration and to whole body vibration exercise are reviewed, as well as the training effects upon the musculature, bone mineral density and posture. Possible applications in sports and medicine are discussed. Evidence suggests that acute vibration exercise seems to elicit a specific warm-up effect, and that vibration training seems to improve muscle power, although the potential benefits over traditional forms of resistive exercise are still unclear. Vibration training also seems to improve balance in sub-populations prone to fall, such as frail elderly people. Moreover, literature suggests that vibration is beneficial to reduce chronic lower back pain and other types of pain. Other future indications are perceivable

Leveraging Tendon Vibration to Enhance Pseudo-Haptic Perceptions in VR

Pseudo-haptic techniques are used to modify haptic perception by appropriately changing visual feedback to body movements. Based on the knowledge that tendon vibration can affect our somatosensory perception, this paper proposes a method for leveraging tendon vibration to enhance pseudo-haptics during free arm motion. Three experiments were performed to examine the impact of tendon vibration on the range and resolution of pseudo-haptics. The first experiment investigated the effect of tendon vibration on the detection threshold of the discrepancy between visual and physical motion. The results indicated that vibrations applied to the inner tendons of the wrist and elbow increased the threshold, suggesting that tendon vibration can augment the applicable visual motion gain by approximately 13\% without users detecting the visual/physical discrepancy. Furthermore, the results demonstrate that tendon vibration acts as noise on haptic motion cues. The second experiment assessed the impact of tendon vibration on the resolution of pseudo-haptics by determining the just noticeable difference in pseudo-weight perception. The results suggested that the tendon vibration does not largely compromise the resolution of pseudo-haptics. The third experiment evaluated the equivalence between the weight perception triggered by tendon vibration and that by visual motion gain, that is, the point of subjective equality. The results revealed that vibration amplifies the weight perception and its effect was equivalent to that obtained using a gain of 0.64 without vibration, implying that the tendon vibration also functions as an additional haptic cue. Our results provide design guidelines and future work for enhancing pseudo-haptics with tendon vibration.Comment: This paper has been accepted by IEEE TVC

Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders

Shoulder pain is often a challenging clinical phenomenon because of the potential mismatch between pathology and the perception of pain. Current evidence clearly emphasizes an incomplete understanding of the nature of shoulder pain. Indeed, the effective diagnosis and treatment of shoulder pain should not only rely upon a detailed knowledge of the peripheral pathologies that may be present in the shoulder, but also on current knowledge of pain neurophysiology. To assess and treat shoulder pain, a comprehensive understanding of the way in which pain is processed is essential. This review reflects modern pain neurophysiology to the shoulder and aims to answer the following questions: why does my shoulder hurt? What is the impact of shoulder pain on muscle function? What are the implications for the clinical examination of the shoulder? And finally, what are the clinical implications for therapy? Despite the increasing amount of research in this area, an in-depth understanding of the bidirectional nociception-motor interaction is still far from being achieved. Many questions remain, especially related to the treatment of nociception-motor interactions

The Role of the Central Nervous System in the Integration of Proprioceptive Information

The proprioceptive system provides feedback on human performance that makes it possible to learn and perform novel tasks. Proprioception predominately arises in the peripheral nervous system at the muscle spindle organ. Mechanical stimulus such as vibration has been implicated in altering muscle spindle afferent signals used as feedback. Researchers have utilized this understanding to document gross performance changes resulting from a muscle spindle disruption paradigm. Findings of this work have demonstrated that the altered proprioceptive feedback alters performance both during and after vibration exposure. This has also led many to postulate that altered proprioceptive feedback due to environmental working conditions may be responsible for many incidences of musculoskeletal injury, including low back pain. In order to more fully understand how proprioceptive feedback is integrated into a motor response it was required to investigate activity within the central nervous system, itself the target of the spindle afferent, both before and after receiving a modulate afferent. We developed a protocol based on measures of average velocity to test for this activity. Our investigation began we examining whether or not average velocity, in the form of seated sway velocity, would be sensitive to applied vibration. We found that while vibration was applied; mean sway speed increased significantly above pre vibration levels, regardless of feedback and task difficulty. A computer based pursuit task was then implemented in order to investigate performance relative to timing of vibration exposure. Our results revealed a significant decrease in pursuit velocity during vibration from pre-vibration velocity. Additionally, subjects demonstrated an equal magnitude but opposite increase in pursuit speed after vibration was removed. This protocol was then replicated in a functional-MRI to compare the gross motor pursuit task performance with the corresponding BOLD imaging data. We observed a similar decrease/increase pattern of joystick pursuit velocity. The corresponding cortical activity revealed patterns of inhibition consistent with cognitive inhibition. The current findings support proprioception as a central inhibitory control mechanism that shifts cortical networks dependent on available sensory stimulus

Distributed Transcutaneous Electrical Stimulation - Novel Method for Inducing Proprioceptive Illusions

Proprioceptive feedback plays a crucial role in motor control, especially in absence of visual feedback and/or tactile feedback. Unfortunately, many people suffer from lack of proprioception by physical injuries or neurodegenerative diseases. Prosthetic limb and telerobotic users also experience proprioceptive mismatch, which limits the control accuracy and intuitiveness. To address the proprioceptive deficit, several invasive and non-invasive approaches have been introduced, via vibration, invasive electrical stimulation, and skin stretch. However, compensating proprioceptive deficit is still challenging as the current solutions have limitations in terms of effectiveness, usability, and consistency. In this study, we proposed a new way of proprioceptive modulation using transcutaneous electrical stimulation. We hypothesis that transcutaneous electrical stimulation on elbow flexor muscles will augment the spindle afferent and induce illusion of elbow joint extension. Eight human subjects participated in the study to test the hypothesis. We first identified the best location of electrodes to induce the proprioceptive illusions of elbow joint angle, as one electrode on the belly of biceps brachii short head and another on the distal tendon of brachioradialis. Based on the results of two arm matching test and Pinocchio illusion test, we found that 6 of 8 subjects experienced illusion of elbow joint extension by transcutaneous electrical stimulation, which supports our hypothesis. On average, they reported 7.1° angular illusion of elbow joint extension and 1.5x increase of nose height at Pinocchio illusion test. However, 2 of 8 subjects reported illusion of elbow joint flexion by the same transcutaneous electrical stimulation, which falsifies our hypothesis. We interpret this contradictory result as, transcutaneous electrical stimulation can either augment or interfere (i.e., add noise) muscle spindle afferent signal. Note that, the direction of proprioceptive illusion was consistent per subject, and the effect of proprioceptive illusion was clear for all subjects. This result suggests that, transcutaneous electrical stimulation may shed a light to address limitations of current approaches of providing proprioceptive information, by improving effectiveness, usability, and consistency