Objective. The aim of the present work was to develop and test a flexible electrotactile stimulation system to provide real-time feedback to the prosthesis user. The system requirements were to accommodate the capabilities of advanced multi-DOF myoelectric hand prostheses and transmit the feedback variables (proprioception and force) using intuitive coding, with high resolution and after minimal training. Approach. We developed a fully-programmable and integrated electrotactile interface supporting time and space distributed stimulation over custom designed flexible array electrodes. The system implements low-level access to individual stimulation channels as well as a set of high-level mapping functions translating the state of a multi-DoF prosthesis (aperture, grasping force, wrist rotation) into a set of predefined dynamic stimulation profiles. The system was evaluated using discrimination tests employing spatial and frequency coding (10 able-bodied subjects) and dynamic patterns (10 able-bodied and 6 amputee subjects). The outcome measure was the success rate (SR) in discrimination. Main results. The more practical electrode with the common anode configuration performed similarly to the more usual concentric arrangement. The subjects could discriminate six spatial and four frequency levels with SR >90% after a few minutes of training, whereas the performance significantly deteriorated for more levels. The dynamic patterns were intuitive for the subjects, although amputees showed lower SR than able-bodied individuals (86% ± 10% versus 99% ± 3%). Significance. The tests demonstrated that the system was easy to setup and apply. The design and resolution of the multipad electrode was evaluated. Importantly, the novel dynamic patterns, which were successfully tested, can be superimposed to transmit multiple feedback variables intuitively and simultaneously. This is especially relevant for closing the loop in modern multifunction prostheses. Therefore, the proposed system is convenient for practical applications and can be used to implement sensory perception training and/or closed-loop control of myoelectric prostheses, providing grasping force and proprioceptive feedback.

Human motor control relies on a combination of feedback and feedforward strategies. The aim of this study was to longitudinally investigate artificial somatosensory feedback and feedforward control in the context of grasping with myoelectric prosthesis. Nine amputee subjects performed routine grasping trials, with the aim to produce four levels of force during four blocks of 60 trials across five days. The electrotactile force feedback was provided in the second and third block using multipad electrode and spatial coding. The first baseline and last validation block (open-loop control) evaluated the effects of long(across sessions) and short-term (within session) learning, respectively.The outcome measures were the absolute error between the generated and target force, and the number of force saturations. The results demonstrated that the electrotactile feedback improved the performance both within and across sessions. In the validation block, the performance did not significantly decrease and the quality of openloop control (baseline) improved across days, converging to the performance characterizing closed-loop control. This paper provides important insights into the feedback and feedforward processes in prosthesis control, contributing to the better understanding of the role and design of feedback in prosthetic systems.

Aim of this study was to investigate the feasibility of electrotactile feedback in closed loop training of force control during the routine grasping task. The feedback was provided using an array electrode and a simple six-level spatial coding, and the experiment was conducted in three amputee subjects. The psychometric tests confirmed that the subjects could perceive and interpret the electrotactile feedback with a high success rate. The subjects performed the routine grasping task comprising 4 blocks of 60 grasping trials. In each trial, the subjects employed feedforward control to close the hand and produce the desired grasping force (four levels). First (baseline) and the last (validation) session were performed in open loop, while the second and the third session (training) included electrotactile feedback. The obtained results confirmed that using the feedback improved the accuracy and precision of the force control. In addition, the subjects performed significantly better in the validation vs. baseline session, therefore suggesting that electrotactile feedback can be used for learning and training of myoelectric control.

Among most challenging open issues in prosthetic research is the development of a robust bidirectional interface between a prosthesis and its user. Commercially available prosthetic systems are mechanically advanced, but they do not provide somatosensory feedback. Here, we present a novel non-invasive interface for multichannel electrotactile feedback, comprising a matrix of 24 pads, and we investigate the ability of able-bodied human subjects to localize the electrotactile stimulus delivered through the matrix. For this purpose, we tested conventional stimulation (same frequency for all pads) and a novel dual-parameter modulation scheme (interleaved frequency and intensity) designed to facilitate the spatial localization over the electrode. Electrotactile stimulation was also compared to mechanical stimulation of the same locations on the skin. Experimental results on eight able-bodied subjects demonstrated that the proposed interleaved coding substantially improved the spatial localization compared to same-frequency stimulation. The results also showed that same-frequency stimulation was equivalent to mechanical stimulation, whereas the performance with dual-parameter modulation was significantly better. These are encouraging outcomes for the application of a multichannel interface for the restoration of feedback in prosthetics. The high-resolution augmented interfaces might be used to explore novel scenarios for effective communication with the prosthesis user enabled by maximizing information transmission.

This research is in line with an important comment from the first amputee who tried the prosthetic hand with tactile feedback developed within the Smarthand project [1]. While trying the system with tactile feedback the patient said: "It's a feeling I have not had in a long time. When I grab something tightly I can feel it in the fingertips. It's strange since I don't have them anymore! It's amazing." We describe here the instrumentation and methods for testing the abilities of humans to discriminate sensations generated by electrical stimulation applied to the skin on the forearm. The instruments allowed testing of electrical stimulation with various properties (pulse duration, intensity, and rate). We tested the perception and pain thresholds, with the emphasis that comfortable sensations are a must. During the tests subjects were asked to locate the point on the skin that was stimulated and describe their perception of the elicited sensation. Results of first tests with small concentric electrodes suggest that non-amputees can distinguish up to seven perceptual qualities (the most common one was vibration, followed by tingling and tickling). Certain sensations had a higher occurrence rate along one axial line of the forearm than another of the forearm. In terms of spatial acuity, the subjects had more difficulties in distinguishing between the positions in the axial direction of the forearm compared with the circumferential direction. These results guided the design of the new array electrode with multiple cathodes and anodes positioned circumferential to the forearm. The results of the tests conducted with this electrode design showed high location discernment accuracy, and demonstrated the ability to memorize and later accurately recall six different electrical ?messages? created by delivering electrical stimulation onto three different electrode pads with two different stimulation parameters.

Background: Despite important advancements in control and mechatronics of myoelectric prostheses, the communication between the user and his/her bionic limb is still unidirectional, as these systems do not provide somatosensory feedback. Electrotactile stimulation is an attractive technology to close the control loop since it allows flexible modulation of multiple parameters and compact interface design via multi-pad electrodes. However, the stimulation interferes with the recording of myoelectric signals and this can be detrimental to control. Methods: We present a novel compact solution for simultaneous recording and stimulation through dynamic blanking of stimulation artefacts. To test the system, a feedback coding scheme communicating wrist rotation and hand aperture was developed specifically to stress the myoelectric control while still providing meaningful information to the subjects. Ten subjects participated in an experiment, where the quality of closed-loop myoelectric control was assessed by controlling a cursor in a two degrees of freedom target-reaching task. The benchmark performance with visual feedback was compared to that achieved by combining visual feedback and electrotactile stimulation as well as by using electrotactile feedback only. Results: There was no significant difference in performance between visual and combined feedback condition with regards to successfully reached targets, time to reach a target, path efficiency and the number of overshoots. Therefore, the quality of myoelectric control was preserved in spite of the stimulation. As expected, the tactile condition was significantly poorer in completion rate (100/4% and 78/25% for combined and tactile condition, respectively) and time to reach a target (9/2 s and 13/4 s for combined and tactile condition, respectively). However, the performance in the tactile condition was still good, with no significant difference in path efficiency (38/8%) and the number of overshoots (0.5/0.4 overshoots), indicating that the stimulation was meaningful for the subjects and useful for closed-loop control. Conclusions: Overall, the results demonstrated that the developed system can provide robust closed-loop control using electrotactile stimulation. The system supports different encoding schemes and allows placing the recording and stimulation electrodes next to each other. This is an important step towards an integrated solution where the developed unit will be embedded into a prosthetic socket.