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BACKGROUND: Patients with persistent postural-perceptual dizziness (PPPD) frequently report having problems with balance control. Artificial systems providing vibro-tactile feedback (VTfb) of trunk sway to the patient could aid recalibration of "falsely" programmed natural sensory signal gains underlying unstable balance control and dizziness. Thus, the question we examine, retrospectively, is whether such artificial systems improve balance control in PPPD patients and simultaneously reduce the effects of dizziness on their living circumstances. Therefore, we assessed in PPPD patients the effects of VTfb of trunk sway on balance control during stance and gait tests, and on their perceived dizziness. METHODS: Balance control was assessed in 23 PPPD patients (11 of primary PPPD origin) using peak-to-peak amplitudes of trunk sway measured in the pitch and roll planes with a gyroscope system (SwayStar™) during 14 stance and gait tests. The tests included standing eyes closed on foam, walking tandem steps, and walking over low barriers. The measures of trunk sway were combined into a Balance Control Index (BCI) and used to determine whether the patient had a quantified balance deficit (QBD) or dizziness only (DO). The Dizziness Handicap Inventory (DHI) was used to assess perceived dizziness. The subjects first underwent a standard balance assessment from which the VTfb thresholds in eight directions, separated by 45 deg, were calculated for each assessment test based on the 90% range of the trunk sway angles in the pitch and roll directions for the test. A headband-mounted VTfb system, connected to the SwayStar™, was active in one of the eight directions when the threshold for that direction was exceeded. The subjects trained for 11 of the 14 balance tests with VTfb twice per week for 30 min over a total of 2 consecutive weeks. The BCI and DHI were reassessed each week and the thresholds were reset after the first week of training. RESULTS: On average, the patients showed an improved balance control in the BCI values after 2 weeks of VTfb training (24% p = 0.0001). The improvement was greater for the QBD patients than for the DO patients (26 vs. 21%), and greater for the gait tests than the stance tests. After 2 weeks, the mean BCI values of the DO patients, but not the QBD patients, were significantly less (p = 0.0008) than the upper 95% limit of normal age-matched reference values. A subjective benefit in balance control was spontaneously reported by 11 patients. Lower (36%), but less significant DHI values were also achieved after VTfb training (p = 0.006). The DHI changes were identical for the QBD and DO patients and approximately equal to the minimum clinical important difference. CONCLUSIONS: These initial results show, as far as we are aware for the first time, that providing VTfb of trunk sway to PPPD subjects yields a significant improvement in balance control, but a far less significant change in DHI-assessed dizziness. The intervention benefitted the gait trials more than the stance trials and benefited the QBD group of PPPD patients more than the DO group. This study increases our understanding of the pathophysiologic processes underlying PPPD and provides a basis for future interventions.

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Some tumours may not be detected by ultrasound during biopsy, but recent evidence has shown that different tissues can be discerned by electric impedance. This paper explores the application of vibrotactile feedback in an electrode embedded needle to help classify tissue during fine-needle aspiration biopsy from bioimpedance measurements. The process uses electric impedance spectroscopy from 10 Hz to 349 kHz to fit the double-dispersion Cole model through the Newton-Raphson algorithm. A Naive Bayes classifier is then used on the equivalent circuit parameters to estimate the tissue at the needle tip. The method is validated through a series of experiments and user trials. The results show that the vibrotactile feedback is able to help the operator in determining the tissue the needle is in, suggesting that this may prove to be a useful supplement to the standard procedure used today. Graphical Abstract This paper explores the application of vibrotactile feedback for an electrode embedded needle to help classify tissue from electric impedance measurements. The data is fit to an equivalent circuit using Newton- Raphon's method. A Naive Bayes classifier is trained and later used in an experiment to estimate the tissue at the needle tip and provide an assigned vibrotacticle feedback to the user.

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People with homonymous visual field defects (HVFDs), the loss of vision in the same half of the visual field in both eyes, are permitted to drive in some jurisdictions. However, the HVFD may cause difficulties in detecting hazards approaching on the side of the field loss (the blind side). An advanced driver assistance system (ADAS) could assist with hazard detection, but little research has been conducted to evaluate the potential benefits of an ADAS for visually impaired drivers. We developed a prototype vibro-tactile assistance system for drivers with HVFDs and conducted a proof-of-concept driving simulation study to evaluate the system. Given that pedestrian accidents are the second most frequent cause of death in road traffic and most of those accidents occur in urban scenarios, we evaluated the potential of the assistance system to improve responses to pedestrian hazards in a city environment. Sixteen participants, of which eight had HVFDs and eight had normal vision, took part. Our analyses evaluated the effects of the driver assistance system, crossing direction and pedestrian behavior on the safety of pedestrian events and the participant's gaze behavior at each of the 256 crossing situations. Generalized linear mixed effects models were used to assess binomial outcome variables. Despite the limited sample size, the results suggest that the vibro-tactile directional warnings were effective in directing the drivers' gaze so that they were looking in the necessary direction before a potential hazard occurred. More time was spent fixating pedestrians on the blind side when the ADAS was engaged and as a result, the safety of street crossings from the blind side improved. The effect of the ADAS was greater on responses to pedestrians from the blind than the seeing side. With an activated ADAS, crossings from the participants' blind sides were as safe as from their seeing sides, and as safe as the crossings when normally-sighted participants were driving. The results suggest that the vibro-tactile ADAS is a promising approach to improve the safety of drivers with HVFD and surrounding traffic.

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This paper proposed a novel tactile-stimuli P300 paradigm for Brain-Computer Interface (BCI), which potentially targeted at people with less learning ability or difficulty in maintaining attention. The new paradigm using only two types of stimuli was designed, and different targets were distinguished by frequency and spatial information. The classification algorithm was developed by introducing filters for frequency bands selection and conducting optimization with common spatial pattern (CSP) on the tactile evoked EEG signals. It features a combination of spatial and frequency information, with the spatial information distinguishing the sites of stimuli and frequency information identifying target stimuli and disturbances. We investigated both electrical stimuli and vibration stimuli, in which only one target site was stimulated in each block. The results demonstrated an average accuracy of 94.88% for electrical stimuli and 95.21% for vibration stimuli, respectively.

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BACKGROUND AND AIMS: Previously, we determined that training with vibrotactile feedback (VTfb) of trunk sway improves MS patients' balance impairment. Here, we posed 5 questions: 1) How many weeks of VTfb training are required to obtain the best short-term carry over effect (CoE) with VTfb? 2) How long does the CoE last once VTfb training terminates? 3) Is the benefit similar for stance and gait? 4) Is position or velocity based VTfb more effective in reducing trunk sway? 5) Do patients' subjective assessments of balance control improve? METHODS: Balance control of 16 MS patients was measured with gyroscopes at the lower trunk. The gyroscopes drove directionally active VTfb in a head-band. Patients trained twice per week with VTfb for 4 weeks to determine when balance control with and without VTfb stopped improving. Thereafter, weekly assessments without VTfb over 4 weeks and at 6 months determined when CoEs ended. RESULTS: A 20% improvement in balance to normal levels occurred with VTfb. Short term CoEs improved from 15 to 20% (p ≤ 0.001). Medium term (1-4 weeks) CoEs were constant at 19% (p ≤ 0.001). At 6 months improvement was not significant, 9%. Most improvement was for lateral sway. Equal improvement occurred when angle position or velocity drove VTfb. Subjectively, balance improvements peaked after 3 weeks of training (32%, p ≤ 0.05). CONCLUSIONS: 3-4 weeks VTfb training yields clinically relevant sway reductions and subjective improvements for MS patients during stance and gait. The CoEs lasted at least 1 month. Velocity-based VTfb was equally effective as position-based VTfb.

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This paper proposed a hybrid design approach of a vibro-concentrator, a vital component of an ultrasonic tactile sensor, by using electro-mechanical analogy. Lab experiments on soft materials with elastic modulus from 14 kPa to 150 kPa were conducted using the tactile sensor installed with the vibro-concentrator to verify the performance of the design. Various mechanical and electrical parameters, such as resonance frequency shift and equivalent conductance, were discussed, focusing on their feasibility as new stiffness indicators. As a variant of tactile sensors, ultrasonic tactile sensors have the advantage of high sensitivity and minimal contact with the object over traditional tactile sensors based on force-displacement principle. They detect the changes in mechanical vibration characteristics, mostly resonance frequency shift of the sensor, as an indicator of the mechanical properties of the object. A vibro-concentrator has been frequently adopted to improve the performance an ultrasonic tactile sensor, but its design has yet been systematically considered. We propose a hybrid design approach based on electro-mechanical analogy for both mechanical and electrical analyses. Mechanically, impedance analogy was adopted to design an ultrasonic vibration concentrator for the sensor to localize the contact and reinforce the vibration behavior at ~40 kHz. Electrically, we used mobility analogy to derive electrical parameters from the tactile sensing tests in lab environment. The competence of the design was demonstrated by mechanical and electrical characteristic tests. By investigating various electrical parameters from tactile sensing tests, the equivalent conductance determined by the electro-mechanical analysis was found to have almost perfectly linear relationship (R2 = 0.9998) with the samples' elastic modulus ranging from 10 kPa to 70 kPa, and showed its potential as a new stiffness indicator for soft materials. Further analyses suggested that the electrically determined series resonance frequency shift, parallel resonance frequency shift, and maximum phase angle frequency shift also had excellent linearities (R2 = 0.9947, 0.9842, and 0.9935, respectively) with sample's modulus and can be considered as indicator candidates.

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Developmental dyscalculia (DD) is characterized by lower numerical and finger-related skills. Studies of enumeration among those DD that suggested core deficiency in pattern recognition, working memory or/and attention were mostly carried out in the visual modality. In our study, we examined visual (dots) enumeration of 1-10 stimuli and tactile (vibration) enumeration of 1-10 fingers among DD and matched-control adults. We used 800-ms stimuli exposure time of either random/non-neighboring or canonical/neighboring stimuli arrangements (visual/tactile). Compared to controls, those with DD responded faster in visual random enumeration and did not differ in reaction time (RT) of canonical stimuli arrangements. However, while the control group had near perfect accuracy in random stimuli arrangements of up to five stimuli, DD participants performed accurately for only up to four stimuli, and they were less accurate in the canonical stimuli arrangements in the counting range. In the tactile task, DD participants showed less accurate tactile enumeration only for neighboring arrangements, more profoundly for finger counting (FC) patterns. The longer exposure time in the visual task enabled us to explore pattern recognition effects when working memory and attention loads were low. We discuss possible modal-independent deficits in pattern recognition and working memory on enumeration performance among those with DD and the unique role of fingers in ordinal and cardinal representation of numbers.

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Advancements in the study of the human sense of touch are fueling the field of haptics. This is paving the way for augmenting sensory perception during object palpation in tele-surgery and reproducing the sensed information through tactile feedback. Here, we present a novel tele-palpation apparatus that enables the user to detect nodules with various distinct stiffness buried in an ad-hoc polymeric phantom. The contact force measured by the platform was encoded using a neuromorphic model and reproduced on the index fingertip of a remote user through a haptic glove embedding a piezoelectric disk. We assessed the effectiveness of this feedback in allowing nodule identification under two experimental conditions of real-time telepresence: In Line of Sight (ILS), where the platform was placed in the visible range of a user; and the more demanding Not In Line of Sight (NILS), with the platform and the user being 50 km apart. We found that the entailed percentage of identification was higher for stiffer inclusions with respect to the softer ones (average of 74% within the duration of the task), in both telepresence conditions evaluated. These promising results call for further exploration of tactile augmentation technology for telepresence in medical interventions.

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Persons diagnosed with disorders of consciousness (DOC) typically suffer from motor disablities, and thus assessing their spared cognitive abilities can be difficult. Recent research from several groups has shown that non-invasive brain-computer interface (BCI) technology can provide assessments of these patients' cognitive function that can supplement information provided through conventional behavioral assessment methods. In rare cases, BCIs may provide a binary communication mechanism. Here, we present results from a vibrotactile BCI assessment aiming at detecting command-following and communication in 12 unresponsive wakefulness syndrome (UWS) patients. Two different paradigms were administered at least once for every patient: (i) VT2 with two vibro-tactile stimulators fixed on the patient's left and right wrists and (ii) VT3 with three vibro-tactile stimulators fixed on both wrists and on the back. The patients were instructed to mentally count either the stimuli on the left or right wrist, which may elicit a robust P300 for the target wrist only. The EEG data from -100 to +600 ms around each stimulus were extracted and sub-divided into 8 data segments. This data was classified with linear discriminant analysis (using a 10 × 10 cross validation) and used to calibrate a BCI to assess command following and YES/NO communication abilities. The grand average VT2 accuracy across all patients was 38.3%, and the VT3 accuracy was 26.3%. Two patients achieved VT3 accuracy ≥80% and went through communication testing. One of these patients answered 4 out of 5 questions correctly in session 1, whereas the other patient answered 6/10 and 7/10 questions correctly in sessions 2 and 4. In 6 other patients, the VT2 or VT3 accuracy was above the significance threshold of 23% for at least one run, while in 4 patients, the accuracy was always below this threshold. The study highlights the importance of repeating EEG assessments to increase the chance of detecting command-following in patients with severe brain injury. Furthermore, the study shows that BCI technology can test command following in chronic UWS patients and can allow some of these patients to answer YES/NO questions.

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Although the processing of whisker deflections in the barrel area of the rodent primary somatosensory cortex (S1) has been studied extensively, how cutaneous vibro-tactile stimuli are processed in the rodent S1 outside the barrel area has not been fully examined. Particularly, the cell-type specific representation of multiple vibration frequencies in genetically identified inhibitory cells in the S1 has not been examined. Using two-photon calcium imaging, we examined the responses to vibration stimuli of excitatory and inhibitory neurons in the S1 hind limb area of male and female mice. The excitatory cells showed relatively sharp selectivity to vibration stimuli, whereas the inhibitory cells exhibited less selectivity. The excitatory and inhibitory cells with different preferred stimuli were intermingled in a "salt and pepper" manner. Furthermore, the noise correlation tended to be especially strong in excitatory-inhibitory and inhibitory-inhibitory cell pairs that have similar stimulus selectivity. These results suggest that excitatory cells tend to represent specific stimulus information and work together with similarly tuned inhibitory cells as a functionally connected network.

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Tactile estimation of sub-second time is essential for correct recognition of sensory inputs and dexterous manipulation of objects. Despite our intuitive understanding that time is robustly estimated in any situation, tactile sub-second time is altered by, for example, body movement, similar to how visual time is modulated by eye movement. The effects of simpler factors, such as stimulus location, intensity, and frequency, have also been reported in temporal tasks in other modalities, but their effects on tactile sub-second interval estimation remain obscure. Here, we were interested in whether a perceived short interval presented by tactile stimuli is altered only by changing stimulus features. The perceived interval between a pair of stimuli presented on the same finger apparently became short relative to that on different fingers; that of a weak-intensity pair relative to that of a pair with stronger intensity was decreased; and that of a pair with the same frequency relative to one with different frequencies was underestimated. These findings can be ascribed to errors in encoding temporal relationships: nearby-space/weak-intensity/similar-frequency stimuli presented within a short time difference are likely to be integrated into a single event and lead to relative time compression.

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Many patients with locked-in syndrome (LIS) or complete locked-in syndrome (CLIS) also need brain-computer interface (BCI) platforms that do not rely on visual stimuli and are easy to use. We investigate command following and communication functions of mindBEAGLE with 9 LIS, 3 CLIS patients and three healthy controls. This tests were done with vibro-tactile stimulation with 2 or 3 stimulators (VT2 and VT3 mode) and with motor imagery (MI) paradigms. In VT2 the stimulators are fixed on the left and right wrist and the participant has the task to count the stimuli on the target hand in order to elicit a P300 response. In VT3 mode an additional stimulator is placed as a distractor on the shoulder and the participant is counting stimuli either on the right or left hand. In motor imagery mode the participant is instructed to imagine left or right hand movement. VT3 and MI also allow the participant to answer yes and no questions. Healthy controls achieved a mean assessment accuracy of 100% in VT2, 93% in VT3, and 73% in MI modes. They were able to communicate with VT3 (86.7%) and MI (83.3%) after 2 training runs. The patients achieved a mean accuracy of 76.6% in VT2, 63.1% in VT3, and 58.2% in MI modes after 1-2 training runs. 9 out of 12 LIS patients could communicate by using the vibro-tactile P300 paradigms (answered on average 8 out of 10 questions correctly) and 3 out of 12 could communicate with the motor imagery paradigm (answered correctly 4,7 out of 5 questions). 2 out of the 3 CLIS patients could use the system to communicate with VT3 (90 and 70% accuracy). The results show that paradigms based on non-visual evoked potentials and motor imagery can be effective for these users. It is also the first study that showed EEG-based BCI communication with CLIS patients and was able to bring 9 out of 12 patients to communicate with higher accuracies than reported before. More importantly this was achieved within less than 15-20 min.

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BACKGROUND: The two different types of balance prostheses being developed, implants and vibro-tactile/auditory feedback prostheses, rely on different measures to prove efficacy (those based on vestibular ocular reflexes versus balance control, respectively). Here we provide evidence that examining muscle activity might provide a useful alternative for both. METHODS: The muscle activity of 6 bilateral vestibular loss (BVL) and 7 age-matched healthy controls (HC) was examined while standing eyes closed on a foam support surface. Pelvis and upper trunk angular movements were recorded in the roll and pitch planes. Surface EMG was recorded from the lower leg, trunk and upper arm muscles. BVL subjects were first assessed without feedback of pelvis sway, then received training with combined vibro-tactile and auditory feedback, before being re-assessed with feedback. RESULTS: Feedback reduced the amplitudes of pelvis and shoulder sway to values of HC without feedback. Both the level of background EMG activity and the EMG area amplitudes changed when feedback was provided in a manner consistent with the reduced amplitude modulation of muscle synergies of HC. CONCLUSIONS: The results of this study indicate that changed muscle synergy amplitudes underlie improvements in sway achieved by BVL subjects. The concept of this investigation may provide a means to prove efficacy for different types of balance prostheses, including implants.

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Our study explores tactile enumeration using both hands and investigates the effects of numerosity range's (NR) on general enumeration. In Experiment 1, using custom-made vibro-tactile apparatus, we replicated results of Cohen, Naparstek, and Henik (2014, Acta Psychologica, 150C, 26-34) and again found a moderate increase in RT up to four stimuli and then a decrease for five stimuli. In Experiment 2, we used a within participants design and compared NR 1 to 5 and 1 to 10 in tactile and visual enumeration. The results showed that enumeration for NR 5 to 1 was faster than for NR 1 to 10, especially for numerosities four and five. Within NR 1 to 10, in the visual modality the subitizing range was 4, the counting range was from 5 to 9, and there was an end effect of 10 dots. In the tactile modality, when excluding one-hand arrangements, the subitizing range was 2, the counting range was from 3 to 5, there was an acceleration of counting from 5 and on, and there was an end effect for 10 stimuli that was stronger than for 10 visual stimuli. We suggest that NR influences enumeration and that number-hand association (i.e. resulting from finger counting) influences enumeration, resulting in faster counting.

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