title: Sensory feedback by peripheral nerve stimulation improves task performance in individuals with upper limb loss using a myoelectric prosthesis.
abstract: OBJECTIVE
  Tactile feedback is critical to grip and object manipulation. Its absence results in reliance on visual and auditory cues. Our objective was to assess the effect of sensory feedback on task performance in individuals with limb loss.
  
  
  METHODS
  Stimulation of the peripheral nerves using implanted cuff electrodes provided two subjects with sensory feedback with intensity proportional to forces on the thumb, index, and middle fingers of their prosthetic hand during object manipulation. Both subjects perceived the sensation on their phantom hand at locations corresponding to the locations of the forces on the prosthetic hand. A bend sensor measured prosthetic hand span. Hand span modulated the intensity of sensory feedback perceived on the thenar eminence for subject 1 and the middle finger for subject 2. We performed three functional tests with the blindfolded subjects. First, the subject tried to determine whether or not a wooden block had been placed in his prosthetic hand. Second, the subject had to locate and remove magnetic blocks from a metal table. Third, the subject performed the Southampton Hand Assessment Procedure (SHAP). We also measured the subject's sense of embodiment with a survey and his self-confidence.
  
  
  RESULTS
  Blindfolded performance with sensory feedback was similar to sighted performance in the wooden block and magnetic block tasks. Performance on the SHAP, a measure of hand mechanical function and control, was similar with and without sensory feedback. An embodiment survey showed an improved sense of integration of the prosthesis in self body image with sensory feedback.
  
  
  CONCLUSIONS
  Sensory feedback by peripheral nerve stimulation improved object discrimination and manipulation, embodiment, and confidence. With both forms of feedback, the blindfolded subjects tended toward results obtained with visual feedback.
authors.affiliation: Case Western Reserve University, Cleveland, OH, USA. Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Schiefer
authors.forename: Daniel
authors.initials: D
authors.lastname: Tan
authors.forename: Steven M
authors.initials: SM
authors.lastname: Sidek
authors.forename: Dustin J
authors.initials: DJ
authors.lastname: Tyler
mesh_terms: D000671:Amputation, Surgical / Q000534:rehabilitation*; D001186:Artificial Limbs; D004558:Electric Stimulation / Q000295:instrumentation* / Q000379:methods; D019544:Equipment Failure Analysis; D056228:Feedback, Sensory; D006225:Hand / Q000294:innervation / Q000503:physiopathology*; D018737:Hand Strength; D006801:Humans; D011474:Prosthesis Design; D013647:Task Performance and Analysis; D014110:Touch