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

Wearable Computing for Health and Fitness: Exploring the Relationship between Data and Human Behaviour

Health and fitness wearable technology has recently advanced, making it easier for an individual to monitor their behaviours. Previously self generated data interacts with the user to motivate positive behaviour change, but issues arise when relating this to long term mention of wearable devices. Previous studies within this area are discussed. We also consider a new approach where data is used to support instead of motivate, through monitoring and logging to encourage reflection. Based on issues highlighted, we then make recommendations on the direction in which future work could be most beneficial

Tactile Weight Rendering: A Review for Researchers and Developers

Haptic rendering of weight plays an essential role in naturalistic object interaction in virtual environments. While kinesthetic devices have traditionally been used for this aim by applying forces on the limbs, tactile interfaces acting on the skin have recently offered potential solutions to enhance or substitute kinesthetic ones. Here, we aim to provide an in-depth overview and comparison of existing tactile weight rendering approaches. We categorized these approaches based on their type of stimulation into asymmetric vibration and skin stretch, further divided according to the working mechanism of the devices. Then, we compared these approaches using various criteria, including physical, mechanical, and perceptual characteristics of the reported devices and their potential applications. We found that asymmetric vibration devices have the smallest form factor, while skin stretch devices relying on the motion of flat surfaces, belts, or tactors present numerous mechanical and perceptual advantages for scenarios requiring more accurate weight rendering. Finally, we discussed the selection of the proposed categorization of devices and their application scopes, together with the limitations and opportunities for future research. We hope this study guides the development and use of tactile interfaces to achieve a more naturalistic object interaction and manipulation in virtual environments.Comment: 15 pages, 2 tables, 3 figures, surve

Singing Knit: Soft Knit Biosensing for Augmenting Vocal Performances

This paper discusses the design of the Singing Knit, a wearable knit collar for measuring a singer's vocal interactions through surface electromyography. We improve the ease and comfort of multi-electrode bio-sensing systems by adapting knit e-textile methods. The goal of the design was to preserve the capabilities of rigid electrode sensing while addressing its shortcomings, focusing on comfort and reliability during extended wear, practicality and convenience for performance settings, and aesthetic value. We use conductive, silver-plated nylon jersey fabric electrodes in a full rib knit accessory for sensing laryngeal muscular activation. We discuss the iterative design and the material decision-making process as a method for building integrated soft-sensing wearable systems for similar settings. Additionally, we discuss how the design choices through the construction process reflect its use in a musical performance context

From wearable towards epidermal computing : soft wearable devices for rich interaction on the skin

Human skin provides a large, always available, and easy to access real-estate for interaction. Recent advances in new materials, electronics, and human-computer interaction have led to the emergence of electronic devices that reside directly on the user's skin. These conformal devices, referred to as Epidermal Devices, have mechanical properties compatible with human skin: they are very thin, often thinner than human hair; they elastically deform when the body is moving, and stretch with the user's skin. Firstly, this thesis provides a conceptual understanding of Epidermal Devices in the HCI literature. We compare and contrast them with other technical approaches that enable novel on-skin interactions. Then, through a multi-disciplinary analysis of Epidermal Devices, we identify the design goals and challenges that need to be addressed for advancing this emerging research area in HCI. Following this, our fundamental empirical research investigated how epidermal devices of different rigidity levels affect passive and active tactile perception. Generally, a correlation was found between the device rigidity and tactile sensitivity thresholds as well as roughness discrimination ability. Based on these findings, we derive design recommendations for realizing epidermal devices. Secondly, this thesis contributes novel Epidermal Devices that enable rich on-body interaction. SkinMarks contributes to the fabrication and design of novel Epidermal Devices that are highly skin-conformal and enable touch, squeeze, and bend sensing with co-located visual output. These devices can be deployed on highly challenging body locations, enabling novel interaction techniques and expanding the design space of on-body interaction. Multi-Touch Skin enables high-resolution multi-touch input on the body. We present the first non-rectangular and high-resolution multi-touch sensor overlays for use on skin and introduce a design tool that generates such sensors in custom shapes and sizes. Empirical results from two technical evaluations confirm that the sensor achieves a high signal-to-noise ratio on the body under various grounding conditions and has a high spatial accuracy even when subjected to strong deformations. Thirdly, Epidermal Devices are in contact with the skin, they offer opportunities for sensing rich physiological signals from the body. To leverage this unique property, this thesis presents rapid fabrication and computational design techniques for realizing Multi-Modal Epidermal Devices that can measure multiple physiological signals from the human body. Devices fabricated through these techniques can measure ECG (Electrocardiogram), EMG (Electromyogram), and EDA (Electro-Dermal Activity). We also contribute a computational design and optimization method based on underlying human anatomical models to create optimized device designs that provide an optimal trade-off between physiological signal acquisition capability and device size. The graphical tool allows for easily specifying design preferences and to visually analyze the generated designs in real-time, enabling designer-in-the-loop optimization. Experimental results show high quantitative agreement between the prediction of the optimizer and experimentally collected physiological data. Finally, taking a multi-disciplinary perspective, we outline the roadmap for future research in this area by highlighting the next important steps, opportunities, and challenges. Taken together, this thesis contributes towards a holistic understanding of Epidermal Devices}: it provides an empirical and conceptual understanding as well as technical insights through contributions in DIY (Do-It-Yourself), rapid fabrication, and computational design techniques.Die menschliche Haut bietet eine große, stets verfügbare und leicht zugängliche Fläche für Interaktion. Jüngste Fortschritte in den Bereichen Materialwissenschaft, Elektronik und Mensch-Computer-Interaktion (Human-Computer-Interaction, HCI) [so that you can later use the Englisch abbreviation] haben zur Entwicklung elektronischer Geräte geführt, die sich direkt auf der Haut des Benutzers befinden. Diese sogenannten Epidermisgeräte haben mechanische Eigenschaften, die mit der menschlichen Haut kompatibel sind: Sie sind sehr dünn, oft dünner als ein menschliches Haar; sie verformen sich elastisch, wenn sich der Körper bewegt, und dehnen sich mit der Haut des Benutzers. Diese Thesis bietet, erstens, ein konzeptionelles Verständnis von Epidermisgeräten in der HCI-Literatur. Wir vergleichen sie mit anderen technischen Ansätzen, die neuartige Interaktionen auf der Haut ermöglichen. Dann identifizieren wir durch eine multidisziplinäre Analyse von Epidermisgeräten die Designziele und Herausforderungen, die angegangen werden müssen, um diesen aufstrebenden Forschungsbereich voranzubringen. Im Anschluss daran untersuchten wir in unserer empirischen Grundlagenforschung, wie epidermale Geräte unterschiedlicher Steifigkeit die passive und aktive taktile Wahrnehmung beeinflussen. Im Allgemeinen wurde eine Korrelation zwischen der Steifigkeit des Geräts und den taktilen Empfindlichkeitsschwellen sowie der Fähigkeit zur Rauheitsunterscheidung festgestellt. Basierend auf diesen Ergebnissen leiten wir Designempfehlungen für die Realisierung epidermaler Geräte ab. Zweitens trägt diese Thesis zu neuartigen Epidermisgeräten bei, die eine reichhaltige Interaktion am Körper ermöglichen. SkinMarks trägt zur Herstellung und zum Design neuartiger Epidermisgeräte bei, die hochgradig an die Haut angepasst sind und Berührungs-, Quetsch- und Biegesensoren mit gleichzeitiger visueller Ausgabe ermöglichen. Diese Geräte können an sehr schwierigen Körperstellen eingesetzt werden, ermöglichen neuartige Interaktionstechniken und erweitern den Designraum für die Interaktion am Körper. Multi-Touch Skin ermöglicht hochauflösende Multi-Touch-Eingaben am Körper. Wir präsentieren die ersten nicht-rechteckigen und hochauflösenden Multi-Touch-Sensor-Overlays zur Verwendung auf der Haut und stellen ein Design-Tool vor, das solche Sensoren in benutzerdefinierten Formen und Größen erzeugt. Empirische Ergebnisse aus zwei technischen Evaluierungen bestätigen, dass der Sensor auf dem Körper unter verschiedenen Bedingungen ein hohes Signal-Rausch-Verhältnis erreicht und eine hohe räumliche Auflösung aufweist, selbst wenn er starken Verformungen ausgesetzt ist. Drittens, da Epidermisgeräte in Kontakt mit der Haut stehen, bieten sie die Möglichkeit, reichhaltige physiologische Signale des Körpers zu erfassen. Um diese einzigartige Eigenschaft zu nutzen, werden in dieser Arbeit Techniken zur schnellen Herstellung und zum computergestützten Design von multimodalen Epidermisgeräten vorgestellt, die mehrere physiologische Signale des menschlichen Körpers messen können. Die mit diesen Techniken hergestellten Geräte können EKG (Elektrokardiogramm), EMG (Elektromyogramm) und EDA (elektrodermale Aktivität) messen. Darüber hinaus stellen wir eine computergestützte Design- und Optimierungsmethode vor, die auf den zugrunde liegenden anatomischen Modellen des Menschen basiert, um optimierte Gerätedesigns zu erstellen. Diese Designs bieten einen optimalen Kompromiss zwischen der Fähigkeit zur Erfassung physiologischer Signale und der Größe des Geräts. Das grafische Tool ermöglicht die einfache Festlegung von Designpräferenzen und die visuelle Analyse der generierten Designs in Echtzeit, was eine Optimierung durch den Designer im laufenden Betrieb ermöglicht. Experimentelle Ergebnisse zeigen eine hohe quantitative Übereinstimmung zwischen den Vorhersagen des Optimierers und den experimentell erfassten physiologischen Daten. Schließlich skizzieren wir aus einer multidisziplinären Perspektive einen Fahrplan für zukünftige Forschung in diesem Bereich, indem wir die nächsten wichtigen Schritte, Möglichkeiten und Herausforderungen hervorheben. Insgesamt trägt diese Arbeit zu einem ganzheitlichen Verständnis von Epidermisgeräten bei: Sie liefert ein empirisches und konzeptionelles Verständnis sowie technische Einblicke durch Beiträge zu DIY (Do-It-Yourself), schneller Fertigung und computergestützten Entwurfstechniken

Haptics: Science, Technology, Applications

This open access book constitutes the proceedings of the 12th International Conference on Human Haptic Sensing and Touch Enabled Computer Applications, EuroHaptics 2020, held in Leiden, The Netherlands, in September 2020. The 60 papers presented in this volume were carefully reviewed and selected from 111 submissions. The were organized in topical sections on haptic science, haptic technology, and haptic applications. This year's focus is on accessibility

Wearable Technology Supported Home Rehabilitation Services in Rural Areas:– Emphasis on Monitoring Structures and Activities of Functional Capacity Handbook

The sustainability of modern healthcare systems is under threat. – the ageing of the population, the prevalence of chronic disease and a need to focus on wellness and preventative health management, in parallel with the treatment of disease, pose significant social and economic challenges. The current economic situation has made these issues more acute. Across Europe, healthcare expenditure is expected to rice to almost 16% of GDP by 2020. (OECD Health Statistics 2018). Coupled with a shortage of qualified personnel, European nations are facing increasing challenges in their ability to provide better-integrated and sustainable health and social services. The focus is currently shifting from treatment in a care center to prevention and health promotion outside the care institute. Improvements in technology offers one solution to innovate health care and meet demand at a low cost. New technology has the potential to decrease the need for hospitals and health stations (Lankila et al., 2016. In the future the use of new technologies – including health technologies, sensor technologies, digital media, mobile technology etc. - and digital services will dramatically increase interaction between healthcare personnel and customers (Deloitte Center for Health Solutions, 2015a; Deloitte Center for Health Solutions 2015b). Introduction of technology is expected to drive a change in healthcare delivery models and the relationship between patients and healthcare providers. Applications of wearable sensors are the most promising technology to aid health and social care providers deliver safe, more efficient and cost-effective care as well as improving people’s ability to self-manage their health and wellbeing, alert healthcare professionals to changes in their condition and support adherence to prescribed interventions. (Tedesco et al., 2017; Majumder et al., 2017). While it is true that wearable technology can change how healthcare is monitored and delivered, it is necessary to consider a few things when working towards the successful implementation of this new shift in health care. It raises challenges for the healthcare systems in how to implement these new technologies, and how the growing amount of information in clinical practice, integrates into the clinical workflows of healthcare providers. Future challenges for healthcare include how to use the developing technology in a way that will bring added value to healthcare professionals, healthcare organizations and patients without increasing the workload and cost of the healthcare services. For wearable technology developers, the challenge will be to develop solutions that can be easily integrated and used by healthcare professionals considering the existing constraints. This handbook summarizes key findings from clinical and laboratory-controlled demonstrator trials regarding wearables to assist rehabilitation professionals, who are planning the use of wearable sensors in rehabilitation processes. The handbook can also be used by those developing wearable sensor systems for clinical work and especially for use in hometype environments with specific emphasis on elderly patients, who are our major health care consumers