Raveh, E., Friedman, J., & Portnoy, S. (2018). Evaluation of the effects of adding vibrotactile feedback to myoelectric prosthesis users on performance and visual attention in a dual-task paradigm. Clin Rehabil, 99(11), 2263–2270.
Abstract: Objective: To evaluate the effects of adding vibrotactile feedback to myoelectric prosthesis users on the performance time and visual attention in a dual-task paradigm.
Design: A repeated-measures design with a counterbalanced order of two conditions.
Setting: Laboratory setting.
Subjects: Transradial amputees using a myoelectric prosthesis with normal or corrected eyesight (N=12, median age=65 ± 13 years). Exclusion criteria were orthopedic or neurologic problems.
Interventions: Subjects performed grasping tasks with their prosthesis, while controlling a virtual car on a road with their intact hand. The dual task was performed twice: with and without vibrotactile feedback.
Main measures: Performance time of each of the grasping tasks and gaze behavior, measured by the number of times the subjects shifted their gaze toward their hand, the relative time they applied their attention to the screen, and percentage of error in the secondary task.
Results: The mean performance time was significantly shorter (P=0.024) when using vibrotactile feedback (93.2 ± 9.6 seconds) compared with the performance time measured when vibrotactile feedback was not available (107.8 ± 20.3seconds). No significant differences were found between the two conditions in the number of times the gaze shifted from the screen to the hand, in the time the subjects applied their attention to the screen, and in the time the virtual car was off-road, as a percentage of the total game time
(51.4 ± 15.7 and 50.2 ± 19.5, respectively).
Conclusion: Adding vibrotactile feedback improved performance time during grasping in a dual-task paradigm. Prosthesis users may use vibrotactile feedback to perform better during daily tasks, when multiple cognitive demands are present.
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Raveh, E., Portnoy, S., & Friedman, J. (2018). Myoelectric Prosthesis Users Improve Performance Time and Accuracy Using Vibrotactile Feedback When Visual Feedback Is Disturbed. Arch Phys Med Rehabil, 99(11), 2263–2270.
Abstract: OBJECTIVE: To evaluate the effects of adding vibrotactile feedback (VTF) in myoelectric prosthesis users during performance of a functional task when visual feedback is disturbed. DESIGN: A repeated-measures design with a counter-balanced order of 3 conditions. SETTING: Laboratory setting. PARTICIPANTS: Transradial amputees using a myoelectric prosthesis with normal or corrected eyesight (N=12, median age 65+/-13y). Exclusion criteria were orthopedic or neurologic problems. INTERVENTIONS: All participants performed the modified Box and Blocks Test, grasping and manipulating 16 blocks over a partition using their myoelectric prosthesis. This was performed 3 times: in full light, in a dark room without VTF, and in a dark room with VTF. MAIN OUTCOME MEASURES: Performance time, that is, the time needed to transfer 1 block, and accuracy during performance, measured by number of empty grips, empty transitions with no block and block drops from the hand. RESULTS: Significant differences were found in all outcome measures when VTF was added, with improved performance time (4.2 vs 5.3s) and a reduced number of grasping errors (3.0 vs 6.5 empty grips, 1.5 vs 4 empty transitions, 2.0 vs 4.5 block drops). CONCLUSIONS: Adding VTF to myoelectric prosthesis users has positive effects on performance time and accuracy when visual feedback is disturbed.
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Raveh, E., Friedman, J., & Portnoy, S. (2018). Visuomotor behaviors and performance in a dual-task paradigm with and without vibrotactile feedback when using a myoelectric controlled hand. Assistive Technology, 30, 274–280.
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Raveh, E., Portnoy, S., & Friedman, J. (2018). Adding vibrotactile feedback to a myoelectric-controlled hand improves performance when online visual feedback is disturbed. Hum Mov Sci, 58, 32–40.
Abstract: We investigated whether adding vibrotactile feedback to a myoelectric-controlled hand, when visual feedback is disturbed, can improve performance during a functional test. For this purpose, able-bodied subjects, activating a myoelectric-controlled hand attached to their right hand performed the modified Box & Blocks test, grasping and manipulating wooden blocks over a partition. This was performed in 3 conditions, using a repeated-measures design: in full light, in a dark room where visual feedback was disturbed and no auditory feedback – one time with the addition of tactile feedback provided during object grasping and manipulation, and one time without any tactile feedback. The average time needed to transfer one block was measured, and an infrared camera was used to give information on the number of grasping errors during performance of the test. Our results show that when vibrotactile feedback was provided, performance time was reduced significantly, compared with when no vibrotactile feedback was available. Furthermore, the accuracy of grasping and manipulation was improved, reflected by significantly fewer errors during test performance. In conclusion, adding vibrotactile feedback to a myoelectric-controlled hand has positive effects on functional performance when visual feedback is disturbed. This may have applications to current myoelectric-controlled hands, as adding tactile feedback may help prosthesis users to improve their functional ability during daily life activities in different environments, particularly when limited visual feedback is available or desirable.
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Levin, M. F., Banina, M. C., Frenkel-Toledo, S., Berman, S., Soroker, N., Solomon, J. M., et al. (2018). Personalized upper limb training combined with anodal-tDCS for sensorimotor recovery in spastic hemiparesis: study protocol for a randomized controlled trial. Trials, 19(1), 7.
Abstract: BACKGROUND: Recovery of voluntary movement is a main rehabilitation goal. Efforts to identify effective upper limb (UL) interventions after stroke have been unsatisfactory. This study includes personalized impairment-based UL reaching training in virtual reality (VR) combined with non-invasive brain stimulation to enhance motor learning. The approach is guided by limiting reaching training to the angular zone in which active control is preserved (“active control zone”) after identification of a “spasticity zone”. Anodal transcranial direct current stimulation (a-tDCS) is used to facilitate activation of the affected hemisphere and enhance inter-hemispheric balance. The purpose of the study is to investigate the effectiveness of personalized reaching training, with and without a-tDCS, to increase the range of active elbow control and improve UL function. METHODS: This single-blind randomized controlled trial will take place at four academic rehabilitation centers in Canada, India and Israel. The intervention involves 10 days of personalized VR reaching training with both groups receiving the same intensity of treatment. Participants with sub-acute stroke aged 25 to 80 years with elbow spasticity will be randomized to one of three groups: personalized training (reaching within individually determined active control zones) with a-tDCS (group 1) or sham-tDCS (group 2), or non-personalized training (reaching regardless of active control zones) with a-tDCS (group 3). A baseline assessment will be performed at randomization and two follow-up assessments will occur at the end of the intervention and at 1 month post intervention. Main outcomes are elbow-flexor spatial threshold and ratio of spasticity zone to full elbow-extension range. Secondary outcomes include the Modified Ashworth Scale, Fugl-Meyer Assessment, Streamlined Wolf Motor Function Test and UL kinematics during a standardized reach-to-grasp task. DISCUSSION: This study will provide evidence on the effectiveness of personalized treatment on spasticity and UL motor ability and feasibility of using low-cost interventions in low-to-middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02725853 . Initially registered on 12 January 2016.
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