Simultaneous modulation of pulse charge and burst period elicits two differentiable referred sensations.

Objective To investigate the feasibility of delivering multidimensional feedback using a single channel of peripheral nerve stimulation by complementing intensity percepts with flutter frequency percepts controlled by burst period modulation. Approach Two dimensions of a distally referred sensation were provided simultaneously: intensity was conveyed by the modulation of the pulse charge rate inside short discrete periods of stimulation referred to as bursts and frequency was conveyed by the modulation of the period between bursts. For this approach to be feasible, intensity percepts must be perceived independently of frequency percepts. Two experiments investigated these interactions. A series of two alternative forced choice tasks (2AFC) were used to investigate burst period modulation's role in intensity discernibility. Magnitude estimation tasks were used to determine any interactions in the gradation between the frequency and intensity percepts. Main Results The 2AFC revealed that burst periods can be individually differentiated as a gradable frequency percept in peripheral nerve stimulation. Participants could correctly rate a perceptual scale of intensity and frequency regardless of the value of the second, but the dependence of frequency differentiability on charge rate indicates that frequency was harder to detect with weaker intensity percepts. The same was not observed in intensity differentiability as the length of burst periods did not significantly alter intensity differentiation. These results suggest multidimensional encoding is a promising approach for increasing information throughput in sensory feedback systems if intensity ranges are selected properly. Significance This study offers valuable insights into haptic feedback through the peripheral nervous system and demonstrates an encoding approach for neural stimulation that may offer enhanced information transfer in virtual reality applications and sensory-enabled prosthetic systems. This multidimensional encoding strategy for sensory feedback may open new avenues for enriched control capabilities.

Hardness changing tactile displays for simulating the feel of organic tissues.

Physical interaction with patients, for example conducted as part of a diagnostic examination or surgical procedure, provides clinicians with a wealth of information about their condition. Simulating this interaction is of great interest to researchers in both haptics and medical education, and the development of softness changing tactile interfaces is important in recreating the feel of different soft tissues. This paper presents designs for a variety of novel electromechanical and electromagnetic mechanisms for controlling particle jamming-based, hardness changing tactile displays, intended to allow medical trainees to experience these physical interactions in a range of simulation settings such as clinical skills teaching laboratories. Each design is then subjected to a battery of mechanical tests to evaluate its effectiveness compared to the state of the art, as well as their suitability for simulating the physical hardness of different types of soft tissues, previously characterised in established literature. These results demonstrate that all of the technologies presented are able to exhibit a measurable hardness change, with Shore hardness values between 3A and 57A achieved by the most effective constriction-based device. The electromechanical devices based on constriction and compression, and the state-of-the-art pneumatic device, were able to achieve hardness changes within a range that is useful for replicating the softness of organic tissue. The electromechanical and electromagnetic devices were also found to effect their full range of hardness change in less than a second, compared to several seconds for the state-of-the-art. These results show that the performance of softness changing tactile displays can be improved with the electromechanical actuation techniques proposed in this paper, and that such displays are able to replicate the physical characteristics of soft tissues and may therefore be of benefit in medical training and simulation scenarios.

Development of microsurgical forceps equipped with haptic technology for in situ differentiation of brain tumors during microsurgery.

The stiffness of human cancers may be correlated with their pathology, and can be used as a biomarker for diagnosis, malignancy prediction, molecular expression, and postoperative complications. Neurosurgeons perform tumor resection based on tactile sensations. However, it takes years of surgical experience to appropriately distinguish brain tumors from surrounding parenchymal tissue. Haptics is a technology related to the touch sensation. Haptic technology can amplify, transmit, record, and reproduce real sensations, and the physical properties (e.g., stiffness) of an object can be quantified. In the present study, glioblastoma (SF126-firefly luciferase-mCherry [FmC], U87-FmC, U251-FmC) and malignant meningioma (IOMM-Lee-FmC, HKBMM-FmC) cell lines were transplanted into nude mice, and the stiffness of tumors and normal brain tissues were measured using our newly developed surgical forceps equipped with haptic technology. We found that all five brain tumor tissues were stiffer than normal brain tissue (p < 0.001), and that brain tumor pathology (three types of glioblastomas, two types of malignant meningioma) was significantly stiffer than normal brain tissue (p < 0.001 for all). Our findings suggest that tissue stiffness may be a useful marker to distinguish brain tumors from surrounding parenchymal tissue during microsurgery, and that haptic forceps may help neurosurgeons to sense minute changes in tissue stiffness.

Autonomous Robotic Systems in Otolaryngology-Head and Neck Surgery.

Robotic surgery is a growing field with increasing applications to patient care. With the rising use of artificial intelligence (AI), a new frontier emerges, allowing semiautonomous robotics. This article reviews the origins of robotic surgery and subsequent trials of automaticity in all fields. It then describes specific nascent robotic and semiautonomous surgical prototypes within the field of otolaryngology. Finally, broader systemic considerations are posited regarding the implementation of AI-driven robotics in surgery.

Visual softness perception can be manipulated through exploratory procedures.

Both visual and haptic softness perception have recently been shown to have multiple dimensions, such as deformability, granularity, fluidity, surface softness, and roughness. During haptic exploration, people adjust their hand motions (exploratory procedures, EPs) based on the material qualities of the object and the particular information they intend to acquire. Some of these EPs are also shown to be associated with perceived softness dimensions, for example, stroking a silk blouse or applying pressure to a pillow. Here, we aimed to investigate whether we can manipulate observers' judgments about softness attributes through exposure to videos of others performing various EPs on everyday soft materials. In two experiments, participants watched two videos of the same material: one with a corresponding EP and the other without correspondence; then, they judged these materials based on 12 softness-related adjectives (semantic differentiation method). The results of the second experiment suggested that when the EP is congruent with the dimension from which the material is chosen, the ratings for the adjectives from the same dimension are higher than the incongruent EP. This study provides evidence that participants can assess material properties from optic and mechanical cues without needing haptic signals. Additionally, our findings indicate that manipulating the hand motion can selectively facilitate material-related judgments.

Clinical Results of a Monofocal Aspheric Bitoric Intraocular Lens with Plate Haptics in Hyperopic Eyes.

Purpose: To assess the refractive and visual outcomes of hyperopic and astigmatic eyes implanted with a monofocal, aspheric, bitoric intraocular lens (IOL) with plate haptics following cataract surgery. Methods: The study evaluated 51 eyes implanted with the AT TORBI 709M IOL (Carl Zeiss Meditec AG, Jena, Germany) during a follow-up of 12-months. Refractive error, rotational stability, monocular uncorrected distance visual acuity (UDVA), monocular corrected distance visual acuity (CDVA), and contrast sensitivity were analyzed at 1-, 6-, and 12-months post-surgery. Results: At 12 months, the cumulative CDVA was 20/25 in 94.12% of eyes and 20/32 or better in 98.04%. The UDVA was the same as, or better than, the CDVA in 88.24% of eyes. The mean logMAR UDVA and CDVA values were 0.06 ± 0.11 and 0.00 ± 0.08, respectively. In addition, 92.16% of eyes were within ±0.50 D and 98.04% were within ±1.00 D of a spherical equivalent, and 86.27% of eyes had refractive astigmatism ≤0.50D and 100% were ≤1.00D. The mean spherical equivalent was 0.21 ± 0.31D and the mean refractive cylinder 0.34 ± 0.27D. The IOL rotation was 1.18 ± 1.35 degrees and all eyes had a rotation ≤5 degrees. The log contrast sensitivity functions were good and similar for all spatial frequencies during follow-up. Conclusion: Our results demonstrate that implantation of the AT TORBI 709M IOL in hyperopic and astigmatic eyes is effective and safe. The visual and refractive outcomes were good, showing excellent rotational stability.

Investigating Haptic Feedback in Vision-Deficient Millirobot Telemanipulation.

The evolution of magnetically actuated millirobots gives rise to unique teleoperation challenges due to their non-traditional kinematic and dynamic architectures, as well as their frequent use of suboptimal imaging modalities. Recent investigations into haptic interfaces for millirobots have shown promise but lack the clinically motivated task scenarios necessary to justify future development. In this work, we investigate the utility of haptic feedback on bilateral teleoperation of a magnetically actuated millirobot in visually deficient conditions. We conducted an N=23 user study in an aneurysm coiling inspired procedure, which required participants to navigate the robot through a maze in near total darkness to manipulate beads to a target under simulated fluoroscopy. We hypothesized that users will be better able to complete the telemanipulation task with haptic feedback while reducing excess forces on their surroundings compared to the no feedback conditions. Our results showed an over 40% improvement in participants' bead scoring, a nearly 10% reduction in mean force, and 13% reduction in maximum force with haptic feedback, as well as significant improvements in other metrics. Results highlight that benefits of haptic feedback are retained when haptic feedback is removed. These findings suggest that haptic feedback has the potential to significantly improve millirobot telemanipulation and control in traditionally vision deficient tasks.

Haptic based fundamentals of laparoscopic surgery simulation for training with objective assessments.

Force is crucial for learning psychomotor skills in laparoscopic tissue manipulation. Fundamental laparoscopic surgery (FLS), on the other hand, only measures time and position accuracy. FLS is a commonly used training program for basic laparoscopic training through part tasks. The FLS is employed in most of the laparoscopic training systems, including box trainers and virtual reality (VR) simulators. However, many laparoscopic VR simulators lack force feedback and measure tissue damage solely through visual feedback based on virtual collisions. Few VR simulators that provide force feedback have subjective force metrics. To provide an objective force assessment for haptic skills training in the VR simulators, we extend the FLS part tasks to haptic-based FLS (HFLS), focusing on controlled force exertion. We interface the simulated HFLS part tasks with a customized bi-manual haptic simulator that offers five degrees of freedom (DOF) for force feedback. The proposed tasks are evaluated through face and content validity among laparoscopic surgeons of varying experience levels. The results show that trainees perform better in HFLS tasks. The average Likert score observed for face and content validity is greater than 4.6 ± 0.3 and 4 ± 0.5 for all the part tasks, which indicates the acceptance of the simulator among subjects for its appearance and functionality. Face and content validations show the need to improve haptic realism, which is also observed in existing simulators. To enhance the accuracy of force rendering, we incorporated a laparoscopic tool force model into the simulation. We study the effectiveness of the model through a psychophysical study that measures just noticeable difference (JND) for the laparoscopic gripping task. The study reveals an insignificant decrease in gripping-force JND. A simple linear model could be sufficient for gripper force feedback, and a non-linear LapTool force model does not affect the force perception for the force range of 0.5-2.5 N. Further study is required to understand the usability of the force model in laparoscopic training at a higher force range. Additionally, the construct validity of HFLS will confirm the applicability of the developed simulator to train surgeons with different levels of experience.

Static and Dynamic Hand Gestures: A Review of Techniques of Virtual Reality Manipulation.

This review explores the historical and current significance of gestures as a universal form of communication with a focus on hand gestures in virtual reality applications. It highlights the evolution of gesture detection systems from the 1990s, which used computer algorithms to find patterns in static images, to the present day where advances in sensor technology, artificial intelligence, and computing power have enabled real-time gesture recognition. The paper emphasizes the role of hand gestures in virtual reality (VR), a field that creates immersive digital experiences through the Ma blending of 3D modeling, sound effects, and sensing technology. This review presents state-of-the-art hardware and software techniques used in hand gesture detection, primarily for VR applications. It discusses the challenges in hand gesture detection, classifies gestures as static and dynamic, and grades their detection difficulty. This paper also reviews the haptic devices used in VR and their advantages and challenges. It provides an overview of the process used in hand gesture acquisition, from inputs and pre-processing to pose detection, for both static and dynamic gestures.

A usability analysis of augmented reality and haptics for surgical planning.

PURPOSE: Proper visualization and interaction with complex anatomical data can improve understanding, allowing for more intuitive surgical planning. The goal of our work was to study what the most intuitive yet practical platforms for interacting with 3D medical data are in the context of surgical planning. METHODS: We compared planning using a monitor and mouse, a monitor with a haptic device, and an augmented reality (AR) head-mounted display which uses a gesture-based interaction. To determine the most intuitive system, two user studies, one with novices and one with experts, were conducted. The studies involved planning of three scenarios: (1) heart valve repair, (2) hip tumor resection, and (3) pedicle screw placement. Task completion time, NASA Task Load Index and system-specific questionnaires were used for the evaluation. RESULTS: Both novices and experts preferred the AR system for pedicle screw placement. Novices preferred the haptic system for hip tumor planning, while experts preferred the mouse and keyboard. In the case of heart valve planning, novices preferred the AR system but there was no clear preference for experts. Both groups reported that AR provides the best spatial depth perception. CONCLUSION: The results of the user studies suggest that different surgical cases may benefit from varying interaction and visualization methods. For example, for planning surgeries with implants and instrumentations, mixed reality could provide better 3D spatial perception, whereas using landmarks for delineating specific targets may be more effective using a traditional 2D interface.

A Wearable Fingertip Force Feedback Device System for Object Stiffness Sensing.

Virtual reality technology brings a new experience to human-computer interaction, while wearable force feedback devices can enhance the immersion of users in interaction. This paper proposes a wearable fingertip force feedback device that uses a tendon drive mechanism, with the aim of simulating the stiffness characteristics of objects within virtual scenes. The device adjusts the rotation angle of the torsion spring through a DC motor, and then uses a wire to convert the torque into a feedback force at the user's index fingertips, with an output force of up to 4 N and a force change rate of up to 10 N/s. This paper introduces the mechanical structure and design process of the force feedback device, and conducts a mechanical analysis of the device to select the appropriate components. Physical and psychological experiments are conducted to comprehensively evaluate the device's performance in conveying object stiffness information. The results show that the device can simulate different stiffness characteristics of objects, and users can distinguish objects with different stiffness characteristics well when wearing the force feedback device and interacting with the three-dimensional virtual environments.

A haptic guidance system for simulated catheter navigation with different kinaesthetic feedback profiles.

BACKGROUND: This paper proposes a haptic guidance system to improve catheter navigation within a simulated environment. METHODS: Three force profiles were constructed to evaluate the system: collision prevention; centreline navigation; and a novel force profile of reinforcement learning (RL). All force profiles were evaluated from the left common iliac to the right atrium. RESULTS: Our findings show that providing haptic feedback improved surgical safety compared to visual-only feedback. If staying inside the vasculature is the priority, RL provides the safest option. It is also shown that the performance of each force profile varies in different anatomical regions. CONCLUSION: The implications of these findings are significant, as they hold the potential to improve how and when haptic feedback is applied for cardiovascular intervention.

Enhancing robotic telesurgery with sensorless haptic feedback.

PURPOSE: This paper evaluates user performance in telesurgical tasks with the da Vinci Research Kit (dVRK), comparing unilateral teleoperation, bilateral teleoperation with force sensors and sensorless force estimation. METHODS: A four-channel teleoperation system with disturbance observers and sensorless force estimation with learning-based dynamic compensation was developed. Palpation experiments were conducted with 12 users who tried to locate tumors hidden in tissue phantoms with their fingers or through handheld or teleoperated laparoscopic instruments with visual, force sensor, or sensorless force estimation feedback. In a peg transfer experiment with 10 users, the contribution of sensorless haptic feedback with/without learning-based dynamic compensation was assessed using NASA TLX surveys, measured free motion speeds and forces, environment interaction forces as well as experiment completion times. RESULTS: The first study showed a 30% increase in accuracy in detecting tumors with sensorless haptic feedback over visual feedback with only a 5-10% drop in accuracy when compared with sensor feedback or direct instrument contact. The second study showed that sensorless feedback can help reduce interaction forces due to incidental contacts by about 3 times compared with unilateral teleoperation. The cost is an increase in free motion forces and physical effort. We show that it is possible to improve this with dynamic compensation. CONCLUSION: We demonstrate the benefits of sensorless haptic feedback in teleoperated surgery systems, especially with dynamic compensation, and that it can improve surgical performance without hardware modifications.

Haptics in fixed prosthodontics and their role in dental education: A literature review.

Technological progress leads to new advances in dental education. One of the applications involves the use of virtual and augmented reality as educational aids. The emerging question is to establish if and how these enhancements may prove beneficial to the overall student learning process. A review of recent literature was conducted with the aim of providing evidence for the development of relevant clinical guidelines. The proposed topic attempted to provide answers to the questions of (a) how participants perform when using haptic devices compared to traditional tooth preparation methods on typodonts, (b) how the use of simulators is perceived by both students and educators, and (c) what added value simulators may have in prosthetic dentistry training. The main findings of this study showed that participants expressed satisfaction with the educational experience, finding it both stimulating and very similar to the actual clinical environment. However, differences between haptic and conventional methods were also apparent. Haptics was a significant predictor of clinical crown performance. Significantly better results and shorter preparation times tended to increase with experience. In conclusion, self-directed learning appears to be beneficial in the clinical education that follows data-driven approach. At the pre-laboratory level, simulators may act as an initial familiarization instrument. At the preclinical level, they may aid in detecting students who require extra assistance, or to provide extra training hours for students lacking adequate competency to enter the clinical training phase.

SORI: A softness-rendering interface to unravel the nature of softness perception.

Tactile perception of softness serves a critical role in the survival, well-being, and social interaction among various species, including humans. This perception informs activities from food selection in animals to medical palpation for disease detection in humans. Despite its fundamental importance, a comprehensive understanding of how softness is neurologically and cognitively processed remains elusive. Previous research has demonstrated that the somatosensory system leverages both cutaneous and kinesthetic cues for the sensation of softness. Factors such as contact area, depth, and force play a particularly critical role in sensations experienced at the fingertips. Yet, existing haptic technologies designed to explore this phenomenon are limited, as they often couple force and contact area, failing to provide a real-world experience of softness perception. Our research introduces the softness-rendering interface (SORI), a haptic softness display designed to bridge this knowledge gap. Unlike its predecessors, SORI has the unique ability to decouple contact area and force, thereby allowing for a quantitative representation of softness sensations at the fingertips. Furthermore, SORI incorporates individual physical fingertip properties and model-based softness cue estimation and mapping to provide a highly personalized experience. Utilizing this method, SORI quantitatively replicates the sensation of softness on stationary, dynamic, homogeneous, and heterogeneous surfaces. We demonstrate that SORI accurately renders the surfaces of both virtual and daily objects, thereby presenting opportunities across a range of fields, from teleoperation to medical technology. Finally, our proposed method and SORI will expedite psychological and neuroscience research to unlock the nature of softness perception.

Child development and the role of visual experience in the use of spatial and non-spatial features in haptic object perception.

Previous work has suggested a different developmental timeline and role of visual experience for the use of spatial and non-spatial features in haptic object recognition. To investigate this conjecture, we used a haptic ambiguous odd-one-out task in which one object needed to be selected as being different from two other objects. The odd-one-out could be selected based on four characteristics: size, shape (spatial), texture, and weight (non-spatial). We tested sighted children from 4 to 12 years of age; congenitally blind, late blind, and adult participants with low vision; and normally sighted adults. Given the protracted developmental time course for spatial perception, we expected a shift from a preference for non-spatial features toward spatial features during typical development. Due to the dominant influence of vision for spatial perception, we expected congenitally blind adults to show a similar preference for non-spatial features as the youngest children. The results confirmed our first hypothesis; the 4-year-olds demonstrated a lower dominance for spatial features for object classification compared with older children and sighted adults. In contrast, our second hypothesis was not confirmed; congenitally blind adults' preferred categorization criteria were indistinguishable from those of sighted controls. These findings suggest an early development, but late maturation, of spatial processing in haptic object recognition independent of visual experience.

Haptics Vs Typodonts for Crown Preparation in Undergraduate Dental Student Education.

OBJECTIVES: This study aims to compare students' subjective perceptions and objective results by comparing two methods of crown preparation: typodonts and haptics. MATERIALS AND METHODS: Fifty-four second-year students were given instructions on crown preparation for the upper right second premolar. First on typodonts and then with haptics. They were given five minutes to familiarize with the artificial environment and then thirty minutes for the actual preparation. Finally, they completed a questionnaire about their experience. Their preparations were objectively compared by measuring the angle of total occlusal convergence-TOC on the typodonts and with haptics. RESULTS: Students reported that haptics can enhance the learning process and that they would use them for skill training in the future. Overall, their experience was rated as positive. The TOC of teeth prepared with haptics was significantly higher than those prepared with typodonts, but all values were within the acceptable range. CONCLUSION: Although students did not prefer haptics to typodonts, haptics appear to be a powerful tool in the educational process because it can be a complementary option to traditional methods at the preclinical level.

Measuring tactile sensitivity and mixed-reality-assisted exercise for carpal tunnel syndrome by ultrasound mid-air haptics.

Introduction: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy, which causes numbness and pain in the thumb, the index and middle fingers and the radial side of the ring finger. Regular hand exercises may improve the symptoms and prevent carpal tunnel surgery. This study applied a novel ultrasonic stimulation method to test tactile sensitivity in CTS and also a mixed-reality-assisted (MR-assisted) exercise program which measured hand movements and provided haptic feedback for rehabilitation. Methods: Twenty patients with mild unilateral CTS took part in the experiments. A mid-air haptics device (Ultrahaptics STRATOS Explore) was used to apply amplitude-modulated ultrasound waves (carrier frequency: 40 kHz) onto the skin to create tactile stimulation mechanically. Participants performed a two-alternative forced-choice task for measuring tactile thresholds at 250-Hz modulation frequency. They were tested at the index fingers and the thenar eminences of both hands. Additionally, 15 CTS patients used an MR-assisted program to do hand exercises with haptic feedback. Exercise performance was assessed by calculating errors between target and actual hand configurations. System Usability Scale (SUS) was adopted to verify the practical usability of the program. Results: Thresholds at the thenar eminences of the affected and healthy hands were not significantly different. While the thresholds at the healthy index fingers could be measured, those of the affected fingers were all higher than the stimulation level produced by the maximum output from the ultrasound device. In the exercise program, a significant positive correlation (ρ = 0.89, p < 0.001) was found between the performance scores and the SUS scores, which were above the criterion value established in the literature. Discussion: The results show that thenar tactile sensitivity is not affected in mild CTS as expected from the palmar cutaneous branch of the median nerve (PCBm), but index finger threshold is likely to be higher. Overall, this study suggests that mid-air haptics, with certain improvements, may be used as a preliminary test in the clinical setting. Moreover, the device is promising to develop gamified rehabilitation programs and for the treatment follow-up of CTS.

Developmental changes in the visual, haptic, and bimodal perception of geometric angles.

Geometrical knowledge is typically taught to children through a combination of vision and repetitive drawing (i.e. haptics), yet our understanding of how different spatial senses contribute to geometric perception during childhood is poor. Studies of line orientation suggest a dominant role of vision affecting the calibration of haptics during development; however, the associated multisensory interactions underpinning angle perception are unknown. Here we examined visual, haptic, and bimodal perception of angles across three age groups of children: 6 to 8 years, 8 to 10 years, and 10 to 12 years, with age categories also representing their class (grade) in primary school. All participants first learned an angular shape, presented dynamically, in one of three sensory tracing conditions: visual only, haptic only, or bimodal exploration. At test, which was visual only, participants selected a target angle from four possible alternatives with distractor angle sizes varying relative to the target angle size. We found a clear improvement in accuracy of angle perception with development for all learning modalities. Angle perception in the youngest group was equally poor (but above chance) for all modalities; however, for the two older child groups, visual learning was better than haptics. Haptic perception did not improve to the level of vision with age (even in a comparison adult group), and we found no specific benefit for bimodal learning over visual learning in any age group, including adults. Our results support a developmental increment in both spatial accuracy and precision in all modalities, which was greater in vision than in haptics, and are consistent with previous accounts of cross-sensory calibration in the perception of geometric forms.

The Single-Pitch Texel: A flexible and practical texture-rendering algorithm.

As the number of applications for tactile feedback technology rapidly increases, so too does the need for efficient, flexible, and extensible representations of virtual textures. The previously introduced Single-Pitch Texel rendering algorithm offers designers the ability to produce textures with perceptually wide-band spectral characteristics while requiring very few input parameters. This paper expands on the capabilities of the rendering algorithm. Diverse families of fine textures, with widely varied spectral characteristics, were shown to be rendered reliably using the Texel algorithm. Furthermore, by leveraging an assistive algorithm, subjects were shown to consistently navigate the Texel parameter space in a matching task. Finally, a psychophysical study was conducted to demonstrate the rendering algorithm's resilience to spectral quantization, further reducing the data required to represent a virtual texture.