Proportional sway-based electrotactile feedback improves lateral standing balance.

Introduction: Plantar cutaneous augmentation is a promising approach in balance rehabilitation by enhancing motion-dependent sensory feedback. The effect of plantar cutaneous augmentation on balance has been mainly investigated in its passive form (e.g., textured insole) or on lower-limb amputees. In this study, we tested the effect of plantar cutaneous augmentation on balance in its active form (i.e., electrical stimulation) for individuals with intact limbs. Methods: Ten healthy subjects participated in the study and were instructed to maintain their balance as long as possible on the balance board, with or without electrotactile feedback evoked on the medial side of the heel, synched with the lateral board sway. Electrotactile feedback was given in two different modes: 1) Discrete-mode E-stim as the stimulation on/off by a predefined threshold of lateral board sway and 2) Proportional-mode E-stim as the stimulation frequency proportional to the amount of lateral board sway. All subjects were distracted from the balancing task by the n-back counting task, to test subjects' balancing capability with minimal cognitive involvement. Results: Proportional-mode E-stim, along with the n-back counting task, increased the balance time from 1.86 ± 0.03 s to 1.98 ± 0.04 s (p = 0.010). However, discrete-mode E-stim did not change the balance time (p = 0.669). Proportional-mode E-stim also increased the time duration per each swayed state (p = 0.035) while discrete-mode E-stim did not (p = 0.053). Discussion: These results suggest that proportional-mode E-stim is more effective than discrete-mode E-stim on improving standing balance. It is perhaps because the proportional electrotactile feedback better mimics the natural tactile sensation of foot pressure than its discrete counterpart.

Location-based electrotactile feedback localizes hitting point in virtual-reality table tennis game.

Learning new motor skills is often challenged by sensory mismatches. For reliable sensory information, people have actively employed sensory intervention methods. Visual assistance is the most popular method to provide sensory information, which is equivalent to the knowledge of performance (KP) in motor tasks. However, its efficacy is questionable because of visual-proprioceptive mismatch as well as heavy intrinsic visual and cognitive engagement in motor tasks. Electrotactile intervention is a promising technique to address the current limitations, as it provides KP using tactile feedback that has a close neurophysiological association with proprioception. To test its efficacy, we compared the effects of visual and electrotactile assistance on hitting point localization of the table-tennis racket during virtual-reality table-tennis game. Experimental results suggest that location-based electrotactile feedback outperforms visual assistance in localizing the hitting point on a table-tennis racket during virtual-reality table-tennis game. Our study showed the potential of electrotactile intervention for improving the efficacy of new motor skill training.

Reinforcement Learning May Demystify the Limited Human Motor Learning Efficacy Due to Visual-Proprioceptive Mismatch.

Vision and proprioception have fundamental sensory mismatches in delivering locational information, and such mismatches are critical factors limiting the efficacy of motor learning. However, it is still not clear how and to what extent this mismatch limits motor learning outcomes. To further the understanding of the effect of sensory mismatch on motor learning outcomes, a reinforcement learning algorithm and the simplified biomechanical elbow joint model were employed to mimic the motor learning process in a computational environment. By applying a reinforcement learning algorithm to the motor learning of elbow joint flexion task, simulation results successfully explained how visual-proprioceptive mismatch limits motor learning outcomes in terms of motor control accuracy and task completion speed. The larger the perceived angular offset between the two sensory modalities, the lower the motor control accuracy. Also, the more similar the peak reward amplitude of the two sensory modalities, the lower the motor control accuracy. In addition, simulation results suggest that insufficient exploration rate limits task completion speed, and excessive exploration rate limits motor control accuracy. Such a speed-accuracy trade-off shows that a moderate exploration rate could serve as another important factor in motor learning.

Characterization of perception by transcutaneous electrical Stimulation in terms of tingling intensity and temporal dynamics.

Electrotactile feedback is a cost-effective and versatile method to provide new information or to augment intrinsic tactile feedback. As tactile feedback provides critical information for human-environment interaction, electrotactile feedback, accordingly, has many purposes to improve the quality of human-environment interaction in both direct and remote settings. However, electrotactile feedback overlays tingling sensation on top of the natural tactile feedback. To better characterize electrotactile feedback and understand the origin of the tingling sensation, a need arises to characterize the human perception of electrotactile feedback qualitatively and quantitatively, while varying the key stimulation parameters, namely amplitude and frequency. This study consists of two experiments. In the first experiment, the voltage for each subject was characterized by setting perception and discomfort thresholds. In the second experiment, subjects received electrical stimulation in 9 different combinations of voltages and frequencies. On delivering stimulation with each parameter combination, subjects reported their perception in two comparative scales-pressure vs. tingling and constant vs. pulsing. Subjects also reported the location of perception for stimulation with every parameter combination. More tingling and less pressure was reported as frequency increased, while the tingling-pressure percept was not affected by the amplitude change. Additionally, less pulsing and more constant was reported as frequency increased, while the pulsing-constant percept was not affected by the amplitude change. Concurrently, the normalized level of voltage thresholds was decreased as frequency increased. Dependency of tingling-pressure percept on stimulation frequency suggests that incongruency between the stimulation frequency and the natural firing rate of the sensory neuron would be an important factor of the tingling sensation. This study is a steppingstone to further demystify the origin of the tingling percept caused by electrical stimulation, thus broadening the use of transcutaneous electrical stimulation as a way of providing tactile cue or augmentation.

Improving Tongue Command Accuracy: Unlocking the Power of Electrotactile Feedback Training.

People with spinal cord injury or neurological disorders frequently require aid in performing daily tasks. Utilizing hand-free assistive technologies (ATs), particularly tongue-controlled ATs, may offer a feasible solution as the tongue is controlled by a cranial nerve and remains functional in the presence of spinal cord injury. However, existing intra-oral ATs require a significant level of training to accurately issuing these commands. To minimize the training process, we have designed intuitive tongue commands for our Multifunctional intraORal Assistive technology (MORA). Our prior works demonstrated that electrotactile feedback outperformed visual feedback in tasks involving tongue motor learning. In this study, we implement electrical stimulation (E-stim) as electrotactile feedback on the tongue to teach new tongue commands of MORA, and quantitatively analyze the efficacy of the electrotactile feedback in command accuracy and precision. The random command task was adopted to evaluate tongue command accuracy with 14 healthy participants. The average sensors contacted per trial dropped significantly from 1.57 ± 0.15 to 1.16 ± 0.05 with electrotactile feedback. After training with electrotactile feedback, 83% of the trials were completed with only one command having been activated. These results suggest that E-stim enhanced both the accuracy and precision of subjects' tongue command training. The results of this study pave the way for the implementation of electrotactile feedback as an accurate and precise command training technique for MORA.

Electrical Stimulation of Distal Tibial Nerve During Stance Phase of Walking May Reverse Effects of Unilateral Paw Pad Anesthesia in the Cat.

Cutaneous feedback from feet is involved in regulation of muscle activity during locomotion, and the lack of this feedback results in motor deficits. We tested the hypothesis that locomotor changes caused by local unilateral anesthesia of paw pads in the cat could be reduced/reversed by electrical stimulation of cutaneous and proprioceptive afferents in the distal tibial nerve during stance. Several split-belt conditions were investigated in four adult female cats. In addition, we investigated the effects of similar distal tibial nerve stimulation on overground walking of one male cat that had a transtibial, bone-anchored prosthesis for 29 months and, thus, had no cutaneous/proprioceptive feedback from the foot. In all treadmill conditions, cats walked with intact cutaneous feedback (control), with right fore- and hindpaw pads anesthetized by lidocaine injections, and with a combination of anesthesia and electrical stimulation of the ipsilateral distal tibial nerve during the stance phase at 1.2× threshold of afferent activation. Electrical stimulation of the distal tibial nerve during the stance phase of walking with anesthetized ipsilateral paw pads reversed or significantly reduced the effects of paw pad anesthesia on several kinematic variables, including lateral center of mass shift, cycle and swing durations, and duty factor. We also found that stimulation of the residual distal tibial nerve in the prosthetic hindlimb often had different effects on kinematics compared with stimulation of the intact hindlimb with paw anesthetized. We suggest that stimulation of cutaneous and proprioceptive afferents in the distal tibial nerve provides functionally meaningful motion-dependent sensory feedback, and stimulation responses depend on limb conditions.

Electro-prosthetic E-skin Successfully Delivers Elbow Joint Angle Information by Electro-prosthetic Proprioception (EPP).

Neurotraumas and neurological diseases often result in compromised proprioceptive feedback, which plays a critical role in motor control by delivering real-time position information. Electro-prosthetic proprioception (EPP) using frequency-modulated electrotactile feedback is a promising solution, as it can deliver proprioceptive information such as a joint angle via tactile channel. Prior works demonstrated that EPP successfully delivered distance information between the end effector and the target object. In this study, we implemented the electronic skin (E-skin) monitoring the elbow joint angle and delivering it to the nervous system via tactile channel. We also demonstrated that EPP improved both accuracy and precision of the elbow joint angle control. The gyroscope measuring the elbow joint angle and electrodes delivering electrotactile feedback were integrated together as a skin using thin silicon coating and polyurethane film. We call this novel E-skin, monitoring and delivering joint angle information, as an electro-prosthetic E-skin. Elbow joint angle matching test with two healthy human subjects showed that the EPP, via electro-prosthetic E-skin, enhanced 101.7% accuracy and 63.8% precision in elbow joint angle control. Clinical Relevance-Presented electro-prosthetic E-skin will address the compromised proprioceptive feedback by delivering joint angle information by electro-prosthetic proprioception (EPP) via tactile channel. This novel E-skin will open up a new path to assist and rehabilitative motor control problems after neurotraumas and neurological diseases.

Electro-prosthetic E-skin Successfully Delivers Finger Aperture Distance by Electro-Prosthetic Proprioception (EPP).

Electronic skin (E-skin) is an emerging wearable device typically used to mimic the function of the human skin, mainly by replicating the role of tactile sensory receptors in the skin. This study showed an interesting modification of the E-skin, called an electro-prosthetic E-skin, which adds the functionality of distance sensing and stimulation of the palmar digital nerve. The electro-prosthetic E-skin operates as a closed loop to deliver the finger aperture distance information to the nervous system. This E-skin was implemented as an additional layer mounted to the original human skin, to be worn on the fingertip with a thin silicone substrate. The E-skin was designed to be mounted onto the index fingertip, to deliver the distance information between the fingertips and to enhance the finger aperture distance control. In this study, we demonstrated that electro-prosthetic proprioception (EPP), implemented with the electro-prosthetic E-skin, successfully delivered the distance information between the fingertips and enhanced the finger aperture distance control accuracy. Clinical Relevance- Presented electro-prosthetic E-skin delivering finger aperture distance via electro-prosthetic proprioception (EPP) will enhance accuracy of the finger aperture distance control. This technology can be applied to the neurosurgery to minimize unforced errors caused by the limited human control accuracy over the fingertip.

MCU-less biphasic electrical stimulation circuit for miniaturized neuromodulator.

A standalone neuro-stimulator circuit without a need of microcontroller (MCU) is presented. The neuro-stimulator circuit has a capability to produce a biphasic electrical stimulus with programmable pulse width and train duration. The proposed hardware system consists of commercial-off-the-shelf (COTS) components: a comparator to recognize triggering events and generate on/off signal for a variable train duration, a programmable timer to generate oscillatory signal with a fixed frequency and a variable pulse width, and a differentiator to convert monophasic pulses to biphasic pulses. The differentiator also works as a current driver having current drive capability of up to 40 mA. The proposed MCU-less biphasic electrical neuro-stimulator successfully generated biphasic stimuli with variable pulse widths from 400 µs to 5 ms and train durations from 35 to 55% of cycle duration. It works with fixed parameters programmed at the beginning, and does not need continuous MCU input. Therefore, the proposed standalone neuro-stimulator circuit has a potential to decrease power and area consumption and minimize the size of the neuro-stimulator system.

Palatal Electrotactile Display Outperforms Visual Display in Tongue Motor Learning.

Incomplete tongue motor control is a common yet challenging issue among individuals with neurotraumas and neurological disorders. In development of the training protocols, multiple sensory modalities including visual, auditory, and tactile feedback have been employed. However, the effectiveness of each sensory modality in tongue motor learning is still in question. The objective of this study was to test the effectiveness of visual and electrotactile assistance on tongue motor learning, respectively. Eight healthy subjects performed the tongue pointing task, in which they were visually instructed to touch the target on the palate by their tongue tip as accurately as possible. Each subject wore a custom-made dental retainer with 12 electrodes distributed over the palatal area. For visual training, 3×4 LED array on the computer screen, corresponding to the electrode layout, was turned on with different colors according to the tongue contact. For electrotactile training, electrical stimulation was applied to the tongue with frequencies depending on the distance between the tongue contact and the target, along with a small protrusion on the retainer as an indicator of the target. One baseline session, one training session, and three post-training sessions were conducted over four-day duration. Experimental result showed that the error was decreased after both visual and electrotactile trainings, from 3.56 ± 0.11 (Mean ± STE) to 1.27 ± 0.16, and from 3.97 ± 0.11 to 0.53 ± 0.19, respectively. The result also showed that electrotactile training leads to stronger retention than visual training, as the improvement was retained as 62.68 ± 1.81% after electrotactile training and 36.59 ± 2.24% after visual training, at 3-day post training.

Forehead Tactile Hallucination Is Augmented by the Perceived Risk and Accompanies Increase of Forehead Tactile Sensitivity.

Tactile hallucinations frequently occur after mental illnesses and neurodegenerative diseases like Alzheimer's and Parkinson's disease. Despite their common occurrence, there are several complicating factors that make it difficult to elucidate the tactile hallucinations. The forehead tactile hallucination, evoked by the physical object approaching to the forehead, can be easily and consistently evoked in healthy-bodied subjects, and therefore it would help with investigating the mechanism of tactile hallucinations. In this pilot study, we investigated the principles of the forehead tactile hallucination with eight healthy subjects. We designed the experimental setup to test the effect of sharpness and speed of objects approaching towards the forehead on the forehead tactile hallucination, in both a physical and virtual experimental setting. The forehead tactile hallucination was successfully evoked by virtual object as well as physical object, approaching the forehead. The forehead tactile hallucination was increased by the increase of sharpness and speed of the approaching object. The forehead tactile hallucination also increased the tactile sensitivity on the forehead. The forehead tactile hallucination can be solely evoked by visual feedback and augmented by the increased perceived risk. The forehead tactile hallucination also increases tactile sensitivity. These experimental results may enhance the understanding of the foundational mechanisms of tactile hallucinations.

Motorized Treadmill and Optical Recording System for Gait Analysis of Grasshoppers.

(1) Background: Insects, which serve as model systems for many disciplines with their unique advantages, have not been extensively studied in gait research because of the lack of appropriate tools and insect models to properly study the insect gaits. (2) Methods: In this study, we present a gait analysis of grasshoppers with a closed-loop custom-designed motorized insect treadmill with an optical recording system for quantitative gait analysis. We used the eastern lubber grasshopper, a flightless and large-bodied species, as our insect model. Gait kinematics were recorded and analyzed by making three grasshoppers walk on the treadmill with various speeds from 0.1 to 1.5 m/s. (3) Results: Stance duty factor was measured as 70-95% and decreased as walking speed increased. As the walking speed increased, the number of contact legs decreased, and diagonal arrangement of contact was observed at walking speed of 1.1 cm/s. (4) Conclusions: This pilot study of gait analysis of grasshoppers using the custom-designed motorized insect treadmill with the optical recording system demonstrates the feasibility of quantitative, repeatable, and real-time insect gait analysis.

A CNN-based method to reconstruct 3-D spine surfaces from US images in vivo.

Three-dimensional (3-D) reconstruction of the spine surface is of strong clinical relevance for the diagnosis and prognosis of spine disorders and intra-operative image guidance. In this paper, we report a new technique to reconstruct lumbar spine surfaces in 3-D from non-invasive ultrasound (US) images acquired in free-hand mode. US images randomly sampled from in vivo scans of 9 rabbits were used to train a U-net convolutional neural network (CNN). More specifically, a late fusion (LF)-based U-net trained jointly on B-mode and shadow-enhanced B-mode images was generated by fusing two individual U-nets and expanding the set of trainable parameters to around twice the capacity of a basic U-net. This U-net was then applied to predict spine surface labels in in vivo images obtained from another rabbit, which were then used for 3-D spine surface reconstruction. The underlying pose of the transducer during the scan was estimated by registering stacks of US images to a geometrical model derived from corresponding CT data and used to align detected surface points. Final performance of the reconstruction method was assessed by computing the mean absolute error (MAE) between pairs of spine surface points detected from US and CT and by counting the total number of surface points detected from US. Comparison was made between the LF-based U-net and a previously developed phase symmetry (PS)-based method. Using the LF-based U-net, the averaged number of US surface points across the lumbar region increased by 21.61% and MAE reduced by 26.28% relative to the PS-based method. The overall MAE (in mm) was 0.24±0.29. Based on these results, we conclude that: 1) the proposed U-net can detect the spine posterior arch with low MAE and large number of US surface points and 2) the newly proposed reconstruction framework may complement and, under certain circumstances, be used without the aid of an external tracking system in intra-operative spine applications.

A new approach of inducing proprioceptive illusion by transcutaneous electrical stimulation.

BACKGROUND: Neurotraumas or neurodegenerative diseases often result in proprioceptive deficits, which makes it challenging for the nervous system to adapt to the compromised sensorimotor conditions. Also, in human machine interactions, such as prosthesis control and teleoperation, proprioceptive mismatch limits accuracy and intuitiveness of controlling active joints in robotic agents. To address these proprioceptive deficits, several invasive and non-invasive approaches like vibration, electrical nerve stimulation, and skin stretch have been introduced. However, proprioceptive modulation is still challenging as the current solutions have limitations in terms of effectiveness, usability, and consistency. In this paper, we propose a new way of modulating proprioception using transcutaneous electrical stimulation. We hypothesized that transcutaneous electrical stimulation on elbow flexor muscles will induce illusion of elbow joint extension. METHOD: Eight healthy human subjects participated in the study to test the hypothesis. Transcutaneous electrodes were placed on different locations targeting elbow flexor muscles on human subjects and experiments were conducted to identify the best locations for electrode placement, and best electrical stimulation parameters, to maximize induced proprioceptive effect. Arm matching experiments and Pinocchio illusion test were performed for quantitative and qualitative analysis of the observed effects. One-way repeated ANOVA test was performed on the data collected in arm matching experiment for statistical analysis. RESULTS: We identified the best location for transcutaneous electrodes to induce the proprioceptive illusion, as one electrode on the muscle belly of biceps brachii short head and the other on the distal myotendinous junction of brachioradialis. The results for arm-matching and Pinocchio illusion tests showed that transcutaneous electrical stimulation using identified electrode location and electrical stimulation parameters evoked the illusion of elbow joint extension for all eight subjects, which supports our hypothesis. On average, subjects reported 6.81° angular illusion of elbow joint extension in arm-matching tests and nose elongated to 1.78 × height in Pinocchio illusion test. CONCLUSIONS: Transcutaneous electrical stimulation, applied between the the synergistic elbow flexor muscles, consistently modulated elbow joint proprioception with the illusion of elbow joint extension, which has immense potential to be translated into various real-world applications, including neuroprosthesis, rehabilitation, teleoperation, mixed reality, and etc.

Electrical Characterization of the Tongue and the Soft Palate Using Lumped-Element Model for Intraoral Neuromodulation.

Intraoral functions are results of complex and well-orchestrated sensorimotor loop operations, and therefore vulnerable to small functional or neural defects. To secure the vital intraoral functions, it is important to find a way to favorably intervene the intraoral sensorimotor loop operations. The tongue and the soft palate are heavily associated with intraoral sensorimotor loops, with their dense neural innervations and occupancy of intraoral space. Therefore, electrical stimulation onto the tongue and the soft palate has a great potential to solve the problems in the intraoral functions. However, the electrical interface for both of them have not been characterized yet as a lumped-element model, for designing electrical stimulation and analyzing its effect. In this study, we measured stimulation thresholds to evoke electrotactile feedback and characterized electrical impedance across electrodes using lumped-element models. We found that average perception/discomfort thresholds for the tongue tip, lateral-inferior side of the tongue, and anterolateral side of the soft palate as 0.18/1.31, 0.37/3.99, and 1.19/7.55 mA, respectively. An R-C-R-R-C model represented the electrical interface across the tongue and the soft palate with the highest accuracy. The average component values of the R-C-R-R-C model were found as 2.72kΩ, 45.25nF, 1.27kΩ, 22.09GΩ, and 53.00nF, on average.

Fully Implantable Plantar Cutaneous Augmentation System for Rats Using Closed-loop Electrical Nerve Stimulation.

Plantar cutaneous feedback plays an important role in stable and efficient gait, by modulating the activity of ankle dorsi- and plantar-flexor muscles. However, central and peripheral nervous system trauma often decrease plantar cutaneous feedback and/or interneuronal excitability in processing the plantar cutaneous feedback. In this study, we tested a fully implantable neural recording and stimulation system augmenting plantar cutaneous feedback. Electromyograms were recorded from the medial gastrocnemius muscle for stance phase detection, while biphasic stimulation pulses were applied to the distal-tibial nerve during the stance phase to augment plantar cutaneous feedback. A Bluetooth low energy and a Qi-standard inductive link were adopted for wireless communication and wireless charging, respectively. To test the operation of the system, one intact rat walked on a treadmill with the electrical system implanted into its back. Leg kinematics were recorded to identify the stance phase. Stimulation was applied, with a 250-ms onset delay from stance onset and 200-ms duration, resulting in the onset at 47.58 ± 2.82% of stance phase and the offset at 83.49 ± 4.26% of stance phase (Mean ± SEM). The conduction velocity of the compound action potential (31.2 m/s and 41.6 m/s at 1·T and 2·T, respectively) suggests that the evoked action potential was characteristic of an afferent volley for cutaneous feedback. We also demonstrated successful wireless charging and system reset functions. The experimental results suggest that the presented implantable system can be a valuable neural interface tool to investigate the effect of plantar cutaneous augmentation on gait in a rat model.

Closed-Loop Plantar Cutaneous Augmentation by Electrical Nerve Stimulation Increases Ankle Plantarflexion During Treadmill Walking.

Ankle plantarflexion plays an important role in forward propulsion and anterior-posterior balance during locomotion. This component of gait is often critically impacted by neurotraumas and neurological diseases. We hypothesized that augmenting plantar cutaneous feedback, via closed-loop distal-tibial nerve stimulation, could increase ankle plantarflexion during walking. To test the hypothesis, one intact rat walked on a motorized treadmill with implanted electronic device and electrodes for closed-loop neural recording and stimulation. Constant-current biphasic electrical pulse train was applied to distal-tibial nerve, based on electromyogram recorded from the medial gastrocnemius muscle, to be timed with the stance phase. The stimulation current threshold to evoke plantar cutaneous feedback was set at 30 µA (1·T), based on compound action potential evoked by stimulation. The maximum ankle joint angle at plantarflexion, during the application of stimulation currents of 3.3·T and 6.6·T, respectively, was increased from 149.4° (baseline) to 165.4° and 161.6°. The minimum ankle joint angle at dorsiflexion was decreased from 59.4° (baseline) to 53.1°, during the application of stimulation currents of 3.3·T, but not changed by 6.6·T. Plantar cutaneous augmentation also changed other gait kinematic parameters. Stance duty factor was increased from 51.9% (baseline) to 65.7% and 64.0%, respectively, by 3.3·T and 6.6·T, primarily due to a decrease in swing duration. Cycle duration was consistently decreased by the stimulation. In the control trial after two stimulation trials, a strong after-effect was detected in overall gait kinematics as well as ankle plantarflexion, suggesting that this stimulation has the potential for producing long-term changes in gait kinematics.

Recent Progress in Animal Studies of the Skin- and Bone-integrated Pylon With Deep Porosity for Bone-Anchored Limb Prosthetics With and Without Neural Interface.

INTRODUCTION: The three major unresolved problems in bone-anchored limb prosthetics are stable, infection-free integration of skin with a percutaneous bone implant, robust skeletal fixation between the implant and host bone, and a secure interface of sensory nerves and muscles with a prosthesis for the intuitive bidirectional prosthetic control. Here we review results of our completed work and report on recent progress. MATERIALS AND METHODS: Eight female adult cats received skin- and bone-integrated pylon (SBIP) and eight male adult cats received SBIP-peripheral neural interface (PNI) pylon into the right distal tibia. The latter pylons provided PNI for connection between a powered sensing transtibial prosthesis and electrodes in residual soleus muscle and on residual distal tibial nerve. If signs of infection were absent 28-70 days after implantation, cats started wearing a passive prosthesis. We recorded and analyzed full-body mechanics of level and slope locomotion in five cats with passive prostheses and in one cat with a powered sensing prosthesis. We also performed histological analyses of tissue integration with the implants in nine cats.Four pigs received SBIPs into the left hindlimb and two pigs-into the left forelimb. We recorded vertical ground reaction forces before amputation and following osseointegration. We also conducted pullout postmortem tests on the implanted pylons. One pig received in dorsum the modified SBIPs with and without silver coating. RESULTS: Six cats from the SBIP groups had implant for 70 days. One cat developed infection and did not receive prosthesis. Five cats had pylon for 148 to 183 days, showed substantial loading of the prosthesis during locomotion (40.4% below presurgery control), and demonstrated deep ingrowth of skin and bone tissue into SBIP (over 60%). Seven of eight cats from the SBIP-PNI group demonstrated poor pylon integration without clinical signs of infection. One cat had prosthesis for 824 days (27 months). The use of the bidirectionally controlled prosthesis by this animal during level walking demonstrated increased vertical loading to nearly normal values, although the propulsion force was significantly reduced.From the study on pigs, it was found that symmetry in loading between the intact and prosthetic limbs during locomotion was 80 ± 5.5%. Skin-implant interface was infection-free, but developed a stoma, probably because of the high mobility of the skin and soft tissues in the pig's thigh. Dorsal implantation resulted in the infection-free deep ingrowth of skin into the SBIP implants. CONCLUSIONS: Cats with SBIP (n = 5) and SBIP-PNI (n = 1) pylons developed a sound interface with the residuum skin and bone and demonstrated substantial loading of prosthetic limb during locomotion. One animal with SBIP developed infection and seven cats with SBIP-PNI demonstrated poor bone integration without signs of infection. Future studies of the SBIP-PNI should focus on reliability of integration with the residuum. Ongoing study with pigs requires decreasing the extra mobility of skin and soft tissues until the skin seal is developed within the SBIP implant.

Contribution of Cervical Proprioception, Vision, and Vestibular Feedback on Reducing Dynamic Head-Trunk Orientation Error in the Yaw Direction.

The contribution of cervical proprioception, vision, and vestibular feedback to the dynamic head-trunk orientation error in the yaw direction was investigated to further the understanding over the mechanism of coordination among different sensory modalities for dynamic head-trunk orientation. To test the contribution of each sensory modality, individually and together, to dynamic head-trunk orientation, 10 healthy human subjects participated in the extended cervical joint position error test, measuring the ability of repositioning the head back to the reference orientation after 45° yaw rotation of head or trunk. The error between initial and returned angles was measured. The test was repeated under eight different conditions of sensory feedback, with or without each of three sensory modalities. Each subject completed 64 trials (8 per condition) in a random order for fair comparison. No change was found in bias when one of the three modalities was missing, while variance was largest at the lack of dynamic cervical proprioception. When two of the three modalities were missing (i.e., one of the three modalities was present), both bias and variance were minimum at the presence of cervical proprioception. Additionally, both visual and vestibular feedback was redundant (i.e., no further improvement in both bias and variance), if the other one (visual or vestibular feedback) was present with dynamic cervical proprioception. In sum, the experimental results suggest that dynamic cervical proprioception is the most significant sensory modality for reducing the dynamic head-trunk orientation error in the yaw direction.

Plantar or Palmar Tactile Augmentation Improves Lateral Postural Balance With Significant Influence from Cognitive Load.

Although it seems intuitive to address the issue of reduced plantar cutaneous feedback by augmenting it, many approaches have adopted compensatory sensory cues, such as tactile input from another part of the body, for multiple reasons including easiness and accessibility. The efficacy of the compensatory approaches might be limited due to the cognitive involvement to interpret such compensatory sensory cues. The objective of this study is to test the hypothesis that the plantar cutaneous augmentation is more effective than providing compensatory sensory cues on improving postural regulation, when plantar cutaneous feedback is reduced. In our experiments, six healthy human subjects were asked to maintain their balance on a lateral balance board for as long as possible, until the balance board contacted the ground, for 240 trials with five interventions. During these experiments, subjects were instructed to close their eyes to increase dependency on plantar cutaneous feedback for balancing. Foam pad was also added on the board to emulate the condition of reduced plantar cutaneous feedback. The effects of tactile augmentation from the foot sole or the palm on standing balance were tested by applying transcutaneous electrical stimulation on calcaneal or ulnar nerve during the balance board tests, with and without a cognitively-challenging counting task. Experimental results indicate that the plantar cutaneous augmentation was effective on improving balance only with cognitive load, while the palmar cutaneous augmentation was effective only without cognitive load. This result suggests that the location of sensory augmentation should be carefully determined according to the attentional demands.