Feedback Modalities Research Articles

Effects of Sensory Feedback and Collider Size on Reach-to-Grasp Coordination in Haptic-Free Virtual Reality

Technological advancements and increased access have prompted the adoption of head- mounted display based virtual reality (VR) for neuroscientific research, manual skill training, and neurological rehabilitation. Applications that focus on manual interaction within the virtual environment (VE), especially haptic-free VR, critically depend on virtual hand-object collision detection. Knowledge about how multisensory integration related to hand-object collisions affects perception-action dynamics and reach-to-grasp coordination is needed to enhance the immersiveness of interactive VR. Here, we explored whether and to what extent sensory substitution for haptic feedback of hand-object collision (visual, audio, or audiovisual) and collider size (size of spherical pointers representing the fingertips) influences reach-to-grasp kinematics. In Study 1, visual, auditory, or combined feedback were compared as sensory substitutes to indicate the successful grasp of a virtual object during reach-to-grasp actions. In Study 2, participants reached to grasp virtual objects using spherical colliders of different diameters to test if virtual collider size impacts reach-to-grasp. Our data indicate that collider size but not sensory feedback modality significantly affected the kinematics of grasping. Larger colliders led to a smaller size-normalized peak aperture. We discuss this finding in the context of a possible influence of spherical collider size on the perception of the virtual object’s size and hence effects on motor planning of reach-to-grasp. Critically, reach-to-grasp spatiotemporal coordination patterns were robust to manipulations of sensory feedback modality and spherical collider size, suggesting that the nervous system adjusted the reach (transport) component commensurately to the changes in the grasp (aperture) component. These results have important implications for research, commercial, industrial, and clinical applications of VR.

Highway Deceleration Lane Safety: Effects of Real-Time Coaching Programs on Driving Behavior

Real-time coaching programs are designed to give feedback on driving behavior to usage-based motor insurance users; they are often general purpose programs that aim to promote smooth driving. Here, we investigated the effect of different on-board real-time coaching programs on the driving behavior on highway deceleration lanes with a driving simulator experiment. The experiment was organized into two trials. The first was a baseline trial, in which participants drove without receiving any feedback; a cluster analysis was then performed to divide participants into two groups, based on their observed driving style. One month later, a second trial was carried out, with participants driving on the same path as the first trial, this time receiving contingent feedback related to their braking/acceleration behavior. Four feedback systems were tested; overall, there were eight experimental groups, depending on the clustered driving style (aggressive and defensive), feedback modality (visual and auditory), and feedback valence (positive and negative). Speed, deceleration, trajectory, and lateral control variables, collected before and onto the deceleration lane, were investigated with mixed ANOVAs, which showed that the real-time coaching programs significantly reduced speeds and maximum deceleration values, while improving lateral control. A change toward a safer exit strategy (i.e., entering the lane before starting to decelerate) was also observed in defensive drivers.

The Comparative Effect of Audio-Taped and Written Homework Feedback on EFL Learners’ Speaking Complexity, Accuracy and Fluency

The main focus of the present study was the comparative effect of two various types of homework and feedback (Audio-Taped Homework Feedback and Written Homework Feedback) on EFL learners’ speaking complexity, accuracy and fluency. Also, there are three dependent variables including Speaking Complexity, Accuracy and Fluency. The study offered the same kind of teaching procedures to 60 female EFL learners, selected from a population of 90 individuals. All have been studying at intermediate level of English learning at the same institute for approximately 3 years. The process of participant selection was based on learners’ performance on a sample piloted test called PET, at Zabansara institution. Indeed, Due to the fact that there is a need to be able to generalize the present study’s findings to similar contexts of learning, the piloted PET test was carried out and general language proficiency level of students was measured meticulously. Moreover, the total number of the present research participants (60) was divided into one experimental groups as Audio-Taped Homework Feedback and one experimental group as Written Homework Feedback. Each individual group consisted of 30 members. 10 sessions of treatment (each 2 hours) were held for both experimental groups. The outlook of the present research study was seen as enhancement of language learners’ Speaking Complexity, Accuracy and Fluency. Hence, two models of Homework (by the participants) and Feedback (by the teacher) were carried out. The present research study included one independent variable with two modalities of Audio-Taped Homework Feedback and Written Homework Feedback. What is more, there are three dependent variables as Speaking Complexity, Accuracy, and Fluency. It is necessary to point it out that a Pre and Posttest of Speaking was administered to all individuals (participants) considering Speaking Complexity, Accuracy, and Fluency. To this end, the statistical analyses were conducted and the obtained results showed a significant influence of Audio-Taped Homework Feedback on the mentioned dependent variables, comparing with Written Homework Feedback. This research study is hoped to increase students’ general language proficiency level along with the focus on new methodologies of assignment/feedback and implementation of the findings as reference in further educational contexts.

An Interactive Computer Game for Improving Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Development and Preliminary Feasibility Study

BackgroundComputer game–based interventions are emerging in pediatric neurorehabilitation, as they can provide two key elements for motor learning—motivating environments that enable long-term compliance, which is particularly relevant for children, and augmented feedback for improving movement performance.ObjectiveThe overall aim of this study is to develop an interactive computer play for children with upper motor neuron lesions to train selective voluntary motor control and give particular attention to motivation and feedback. We also aim to determine features that make games engaging, investigate which sensory feedback modality is noticed the fastest during play, develop an interactive game, and evaluate its feasibility.MethodsWe identified engaging game features by interviewing 19 children and adolescents undergoing rehabilitation. By using a test version of the game, we determined the response times of 10 patients who had to react to visual, auditory, or combined feedback signals. On the basis of the results of these two subprojects, we developed and designed a game environment. Feasibility was studied in terms of the practicability and acceptability of the intervention among 5 children with upper motor neuron lesions.ResultsThe game features deemed the most important by pediatric patients were strategic gameplay (13/29, 45% of answers) and choice (6/29, 21%). While playing the game, an acoustic alarm signal (reaction time: median 2.8 seconds) was detected significantly faster (P=.01) than conditions with other feedback modalities (avatar velocity reduction: median 7.8 seconds; color desaturation: median 5.7 seconds). Most children enjoyed playing the game, despite some technical issues.ConclusionsThe careful identification of game features that increase motivation and feedback modalities that inform children quickly led to the development of an interactive computer play for training selective voluntary motor control in children and adolescents with upper motor neuron lesions.

Innovative IoT Solutions and Wearable Sensing Systems for Monitoring Human Biophysical Parameters: A Review

Digital and information technologies are heavily pervading several aspects of human activities, improving our life quality. Health systems are undergoing a real technological revolution, radically changing how medical services are provided, thanks to the wide employment of the Internet of Things (IoT) platforms supporting advanced monitoring services and intelligent inferring systems. This paper reports, at first, a comprehensive overview of innovative sensing systems for monitoring biophysical and psychophysical parameters, all suitable for integration with wearable or portable accessories. Wearable devices represent a headstone on which the IoT-based healthcare platforms are based, providing capillary and real-time monitoring of patient’s conditions. Besides, a survey of modern architectures and supported services by IoT platforms for health monitoring is presented, providing useful insights for developing future healthcare systems. All considered architectures employ wearable devices to gather patient parameters and share them with a cloud platform where they are processed to provide real-time feedback. The reported discussion highlights the structural differences between the discussed frameworks, from the point of view of network configuration, data management strategy, feedback modality, etc.

Effects of Visual and Auditory Feedback in Violin and Singing Voice Pitch Matching Tasks.

Auditory-guided vocal learning is a mechanism that operates both in humans and other animal species making us capable to imitate arbitrary sounds. Both auditory memories and auditory feedback interact to guide vocal learning. This may explain why it is easier for humans to imitate the pitch of a human voice than the pitch of a synthesized sound. In this study, we compared the effects of two different feedback modalities in learning pitch-matching abilities using a synthesized pure tone in 47 participants with no prior music experience. Participants were divided into three groups: a feedback group (N = 15) receiving real-time visual feedback of their pitch as well as knowledge of results; an equal-timbre group (N = 17) receiving additional auditory feedback of the target note with a similar timbre to the instrument being used (i.e., violin or human voice); and a control group (N = 15) practicing without any feedback or knowledge of results. An additional fourth group of violin experts performed the same task for comparative purposes (N = 15). All groups were posteriorly evaluated in a transfer phase. Both experimental groups (i.e., the feedback and equal-timbre groups) improved their intonation abilities with the synthesized sound after receiving feedback. Participants from the equal-timber group seemed as capable as the feedback group of producing the required pitch with the voice after listening to the human voice, but not with the violin (although they also showed improvement). In addition, only participants receiving real-time visual feedback learned and retained in the transfer phase the mapping between the synthesized pitch and its correspondence with the produced vocal or violin pitch. It is suggested that both the effect of an objective external reward, together with the experience of exploring the pitch space with their instrument in an explicit manner, helped participants to understand how to control their pitch production, strengthening their schemas, and favoring retention.

Effect of Tactile Sensory Substitution on the Proprioceptive Error Map of the Arm.

Proprioceptive error of estimated fingertip position in two-dimensional space is reduced with the addition of tactile stimulation to the fingertip. This tactile input does not disrupt the subjects’ estimation strategy, as the individual error vector maps maintain their overall geometric structure. This relationship suggests an integration of proprioception and tactile sensory information to enhance proprioceptive estimation. To better understand this multisensory integration, we explored the effect of electrotactile and vibrotactile stimulation to the fingertips in place of actual contact, thus limiting interaction forces. This allowed us to discern any proprioceptive estimation improvement that arose from purely tactile stimulation. Ten right-handed and ten left-handed subjects performed a simple right-handed proprioceptive estimation task under four tactile feedback conditions: hover, touch, electrotactile, and vibrotactile. Target sets were generated for each subject, persisted across all feedback modalities, and targets were presented in randomized orders. Error maps across the workspace were generated using polynomial models of the subjects’ responses. Error maps did not change shape between conditions for any right-handed subjects and changed for a single condition for two left-handed subjects. Non-parametric statistical analysis of the error magnitude shows that both modes of sensory substitution significantly reduce error for right-handed subjects, but not to the level of actual touch. Left-handed subjects demonstrated increased error for all feedback conditions compared to hover. Compared to right-handed subjects, left-handed subjects demonstrated more error in each condition except the hover condition. This is consistent with the hypothesis that the non-dominant hand is specialized for position control, while the dominant is specialized for velocity. Notably, our results suggest that non-dominant hand estimation strategies are hindered by stimuli to the fingertip. We conclude that electrotactile and vibrotactile sensory substitution only succeed in multisensory integration when applied to the dominant hand. These feedback modalities do not disrupt established dominate hand proprioceptive error maps, and existing strategies adapt to the novel input and minimize error. Since actual touch provides the best error reduction, sensory substitution lacks some unidentified beneficial information, such as familiarity or natural sensation. This missing component could also be what confounds subjects using their non-dominant hand for positional tasks.

Potential and Limitations of Feedback-Supported Gait Retraining in Users of Lower Limb Prostheses

The outcomes of prosthetic rehabilitation after lower limb loss are, in large part, affected by the effectiveness of the provided gait retraining. The noted prevalence of adverse long-term effects, such as further joint and muscle degeneration, suggests that traditional rehabilitation programs have limitations. Recent advances in technology and in the understanding of motor learning promise the potential for better gait retraining interventions. This article reviews current literature on systems and methodologies of improving gait parameters in those with lower limb prostheses via exercise programs and various biofeedback systems. A total of 13 articles were included in the qualitative analysis. Findings indicate that many of the investigated systems are able to effectively analyze and change gait in the target population, but there remain considerable gaps in the knowledge. It has been noted that feedback modalities and dosage must be customized based on patient characteristics and rehabilitation goals, yet there is currently not enough published evidence to inform such customization.

Building adoctor, one skill at atime: Rethinking clinical training through anew skills-based feedback modality.

The Accreditation Council for Graduate Medical Education milestones and entrustable professional activities (EPAs) are important assessment approaches but may lack specificity for learners seeking improvement through daily feedback. As in other professions, clinicians grow best when they engage in deliberate practice of well-defined skills in familiar contexts. This growth is augmented by specific, actionable coaching from supervisors. This article proposes a new feedback modality called microskills, which are derived from the psychology, negotiation, and business literature, and are unique in their ability to elicit targeted feedback for trainee development. These microskills are grounded in both clinical and situational contexts, thereby mirroring learners’ cognitive schemas and allowing for more natural skill selection and adoption. When taken as a whole, microskills are granular actions that map to larger milestones, competencies, and EPAs. This article outlines the theoretical justification for this new skills-based feedback modality, the methodology behind the creation of clinical microskills, and provides a worked example of microskills for a pediatric resident on a hospital medicine rotation. Ultimately, microskills have the potential to complement milestones and EPAs and inform feedback that is specific, actionable, and relevant to medical learners.Supplementary InformationThe online version of this article (10.1007/s40037-021-00666-9) contains supplementary material, which is available to authorized users.

771 Shaping the Virtual Learning Environment: Emojis As A Novel Feedback Modality for Content Delivery in Postgraduate Medical Education

IntroductionPostgraduate medical education in the wake of a pandemic has sparked creativity, evolving novel platforms concordant with socially distanced learning. Inevitably, evaluation is critical in navigating improvements in content delivery. However, as culture continues to shift away from didactic teaching, students are at risk of ‘feedback overload’. We propose a novel emoji scale to facilitate rapid appraisal.MethodA three-point emoji scale was developed within the novel virtual learning environment for core surgical training in the West Midlands. Engagement with the emoji system was assessed and correlated with conventional post-course questionnaires.ResultsThe novel emoji system provided a rapid mechanism for trainees to express opinion on individual modules immediately following completion. Parallels to social media meant this modality felt familiar to trainees. Simplification of feedback permitted prompt, targeted review of modules for improvement, as opposed to laborious collection and analysis of standard post-course questionnaires. Literature review revealed limited research regarding similar emoji-based responses, or the validity of Likert or free-text based feedback systems.ConclusionAs virtual learning evolves following COVID-19, feedback systems help guide evolution. Emoji-based feedback may provide the key to prompt, accessible evaluation of VLE platforms.

Image Accessibility for Screen Reader Users: A Systematic Review and a Road Map

A number of studies have been conducted to improve the accessibility of images using touchscreen devices for screen reader users. In this study, we conducted a systematic review of 33 papers to get a holistic understanding of existing approaches and to suggest a research road map given identified gaps. As a result, we identified types of images, visual information, input device and feedback modalities that were studied for improving image accessibility using touchscreen devices. Findings also revealed that there is little study how the generation of image-related information can be automated. Moreover, we confirmed that the involvement of screen reader users is mostly limited to evaluations, while input from target users during the design process is particularly important for the development of assistive technologies. Then we introduce two of our recent studies on the accessibility of artwork and comics, AccessArt and AccessComics, respectively. Based on the identified key challenges, we suggest a research agenda for improving image accessibility for screen reader users.

A comparison design study of feedback modalities to support deep breathing whilst performing work tasks.

Deep breathing exercises are known to help decrease stress. Wearable and ambient computing can help initiate and support deep breathing exercises. Most studies have focused on a single sensory modality for providing feedback on the quality of breathing and other physiological data. Our research compares different feedback modalities on an individual's experience and ability to perform breath-based techniques at work. We designed three different interactive prototypes that used light, vibration and sound feedback modalities. We tested each prototype with 19 participants whilst they were performing typical work tasks in a naturalistic setting, followed by semi-structured interviews. We found that sound was the most successful feedback for the majority of participants, followed by vibration and ambient light. We developed an analytic tool, the Extended Cycle of Awareness, to facilitate understanding of the patterns of awareness and the flow of experience generated by participant interaction with prototype systems that provide feedback on the quality of breathing. Participants followed one of three different types of patterns: (1) ignoring the feedback; (2) not understanding the feedback and being overwhelmed by it; (3) successfully using the feedback to initiate deep breathing and reflect on the change in the quality of breathing. We offer a set of design recommendations for crafting interactive systems to support deep breathing at work, including personalization, designing for the cyclical process of attention and awareness, and designing for reflective practice.

Speech auditory-motor adaptation to formant-shifted feedback lacks an explicit component: Reduced adaptation in adults who stutter reflects limitations in implicit sensorimotor learning.

The neural mechanisms underlying stuttering remain poorly understood. A large body of work has focused on sensorimotor integration difficulties in individuals who stutter, including recently the capacity for sensorimotor learning. Typically, sensorimotor learning is assessed with adaptation paradigms in which one or more sensory feedback modalities are experimentally perturbed in real time. Our own previous work on speech with perturbed auditory feedback revealed substantial auditory-motor learning limitations in both children and adults who stutter (AWS). It remains unknown, however, which subprocesses of sensorimotor learning are impaired. Indeed, new insights from research on upper limb motor control indicate that sensorimotor learning involves at least two distinct components: (a) an explicit component that includes intentional strategy use and presumably is driven by target error and (b) an implicit component that updates an internal model without awareness of the learner and presumably is driven by sensory prediction error. Here, we attempted to dissociate these components for speech auditory-motor learning in AWS versus adults who do not stutter (AWNS). Our formant-shift auditory-motor adaptation results replicated previous findings that such sensorimotor learning is limited in AWS. Novel findings are that neither control nor stuttering participants reported any awareness of changing their productions in response to the auditory perturbation and that neither group showed systematic drift in auditory target judgments made throughout the adaptation task. These results indicate that speech auditory-motor adaptation to formant-shifted feedback relies exclusively on implicit learning processes. Thus, limited adaptation in AWS reflects poor implicit sensorimotor learning. Speech auditory-motor adaptation to formant-shifted feedback lacks an explicit component: Reduced adaptation in adults who stutter reflects limitations in implicit sensorimotor learning.

FaceGuard: A Wearable System To Avoid Face Touching.

Most people touch their faces unconsciously, for instance to scratch an itch or to rest one’s chin in their hands. To reduce the spread of the novel coronavirus (COVID-19), public health officials recommend against touching one’s face, as the virus is transmitted through mucous membranes in the mouth, nose and eyes. Students, office workers, medical personnel and people on trains were found to touch their faces between 9 and 23 times per hour. This paper introduces FaceGuard, a system that utilizes deep learning to predict hand movements that result in touching the face, and provides sensory feedback to stop the user from touching the face. The system utilizes an inertial measurement unit (IMU) to obtain features that characterize hand movement involving face touching. Time-series data can be efficiently classified using 1D-Convolutional Neural Network (CNN) with minimal feature engineering; 1D-CNN filters automatically extract temporal features in IMU data. Thus, a 1D-CNN based prediction model is developed and trained with data from 4,800 trials recorded from 40 participants. Training data are collected for hand movements involving face touching during various everyday activities such as sitting, standing, or walking. Results showed that while the average time needed to touch the face is 1,200 ms, a prediction accuracy of more than 92% is achieved with less than 550 ms of IMU data. As for the sensory response, the paper presents a psychophysical experiment to compare the response time for three sensory feedback modalities, namely visual, auditory, and vibrotactile. Results demonstrate that the response time is significantly smaller for vibrotactile feedback (427.3 ms) compared to visual (561.70 ms) and auditory (520.97 ms). Furthermore, the success rate (to avoid face touching) is also statistically higher for vibrotactile and auditory feedback compared to visual feedback. These results demonstrate the feasibility of predicting a hand movement and providing timely sensory feedback within less than a second in order to avoid face touching.

Comparison of Three Feedback Modalities for Haptics Sensation in Remote Machine Manipulation

Previous studies have verified the usefulness of visual haptics for achieving the appropriate grasping force and task success rate to operate remote machines. However, its capabilities have not been evaluated objectively and quantitatively. We comprehensively compare three feedback modalities (i.e., sound, vibration, and light) for providing pseudo-haptic information on contact with an object, which we apply to grasping an object with a remotely operated robot arm. Experimental results verify that the light modality (i.e., visual haptics) minimizes the grasping force and processing load in the operator's brain. We then develop a prototype of a remote machine to demonstrate the feasibility of visual haptic feedback. We consider three implementations (i.e., a light-emitting diode, model-based superimposition, and model-less superimposition) to verify the performance. The results show that visual haptics can stabilize the performance of delicate tasks such as grasping and carrying fragile raw eggs and potato chips. We demonstrate that our visual haptics method (i.e., superimposing haptic information as images on the contact points of the robot's fingertips) can significantly improve the operability of remote machines without the need for highly complex and expensive interfaces.

Multi-Session Influence of Two Modalities of Feedback and Their Order of Presentation on MI-BCI User Training

By performing motor-imagery tasks, for example, imagining hand movements, Motor-Imagery based Brain-Computer Interfaces (MI-BCIs) users can control digital technologies, for example, neuroprosthesis, using their brain activity only. MI-BCI users need to train, usually using a unimodal visual feedback, to produce brain activity patterns that are recognizable by the system. The literature indicates that multimodal vibrotactile and visual feedback is more effective than unimodal visual feedback, at least for short term training. However, the multi-session influence of such multimodal feedback on MI-BCI user training remained unknown, so did the influence of the order of presentation of the feedback modalities. In our experiment, 16 participants trained to control a MI-BCI during five sessions with a realistic visual feedback and five others with both a realistic visual feedback and a vibrotactile one. training benefits from a multimodal feedback, in terms of performances and self-reported mindfulness. There is also a significant influence of the order presentation of the modality. Participants who started training with a visual feedback had higher performances than those who started training with a multimodal feedback. We recommend taking into account the order of presentation for future experiments assessing the influence of several modalities of feedback.

Neural Signatures of Interface Errors in Remote Agent Manipulation

The manipulation of remote agents such as robotic arms in remote surgery or in BCI-wheelchair control are prone to errors. Some of these are related to user intent misclassification or other interface system errors, which lead to an incorrect movement. Here we focused on errors originating from unpredicted interface movements violating user intent and producing sensory conflicts. In addition, we examined effects of incongruent/congruent sensory stimuli induced by interface errors, focusing on haptic and visual cues in the system. The overarching goal was to identify the prototypical patterns of electroencephalogram (EEG) error signals associated with two types of interface errors rising when the visual and proprioceptive feedback are congruent or incongruent. For purposes of comparison validity, both types of errors were recorded in the same 3D virtual game environment.The comparison of congruent and incongruent interface errors revealed significant and marginally significant differences in EEG potentials with respect to profile, latencies, scalp distribution and sources. Different EEG time–frequency combinations had high power content. Incongruence between visual and proprioceptive feedback in interface errors not only elicited distinct EEG signal characteristics, but also produced a marginally significant Stroop effect. Incongruency in visuo-haptic feedback modalities cause a delayed user response. This effect is of major importance for the design of controlling interfaces and can provide designers with crucial information when aiming to control human response time.

Improving effectiveness of dental students' feedback and course evaluation.

Dental students providing feedback about a course they take, in a timely manner, benefits not only teachers, but also indirectly the students themselves, especially if given with confidence in a constructive manner. Therefore, the aim of this study was to train students on how to give feedback, to ask them to provide feedback before and after the instructions were given, and analyze the change in their responses. Participants were students who attended the second-year preclinical course in prosthodontics. They were asked to provide feedback anonymously with online surveys after completing modules of the course during the academic year. There was no intervention prior to the first feedback; however, before providing the second feedback, students were asked to read a 1-page handout related to feedback modalities. Following this, an interactive workshop in feedback was provided prior to the third survey. The received responses were ranked as either: neutral, positive, negative, or constructive and were analyzed using a mixed repeated measures test with Bonferroni correction at a 0.05 significance level. The results showed a higher number of constructive and positive responses than both neutral and negative feedback (P ≤ 0.05) within the same surveys, but no interaction effect was found between the surveys (P = 0.076). Our data showed an increase in constructive feedback provided by students after the 2 different training methods, but the modality of delivery did not seem to significantly influence the results. In summary, training students on how to provide constructive feedback may be beneficial for teachers to improve their courses.

Design, Analysis, and Control of a 3-DOF Novel Haptic Device Displaying Stiffness, Texture, Shape, and Shear

Haptic devices providing various sensations have multiple applications spanning over many fields such as surgical training, robot-assisted minimal invasive surgery (MIS), military, space, and underwater exploration. Most of the existing haptic interfaces lack the capability to effectively replicate the remote environment due to the intricacies involved in providing all necessary sensations simultaneously. In this paper, a novel haptic device with three degrees of freedom (DOF) is developed to render high-fidelity touch sensations like stiffness, texture, shape, and shear concurrently. The proposed haptic device consists of a spherical segment affixed with an array of texture surfaces based on the virtual/remote environment. The device can move in 3-DOF, namely, the pitch, roll, and vertical motion. The haptic interface provides kinesthetic cues like stiffness, shape, and environmental shear and tactile cues like texture by combining the movements of the three actuators along with the segmented housing. A systematic kinematic analysis of the proposed design is presented. The performance is enhanced by implementing the hybrid control methodology that switches between impedance and position control, thus making the interaction realistic and immersive. Experiments have been performed on the developed haptic device, and the results demonstrate its accuracy in reproducing various modalities of haptic feedback of the virtual/remote environment.

Effect of BCI-Controlled Pedaling Training System With Multiple Modalities of Feedback on Motor and Cognitive Function Rehabilitation of Early Subacute Stroke Patients.

Brain-computer interfaces (BCIs) are currently integrated into traditional rehabilitation interventions after stroke. Although BCIs bring many benefits to the rehabilitation process, their effects are limited since many patients cannot concentrate during training. Despite this outcome post-stroke motor-attention dual-task training using BCIs has remained mostly unexplored. This study was a randomized placebo-controlled blinded-endpoint clinical trial to investigate the effects of a BCI-controlled pedaling training system (BCI-PT) on the motor and cognitive function of stroke patients during rehabilitation. A total of 30 early subacute ischemic stroke patients with hemiplegia and cognitive impairment were randomly assigned to the BCI-PT or traditional pedaling training. We used single-channel Fp1 to collect electroencephalography data and analyze the attention index. The BCI-PT system timely provided visual, auditory, and somatosensory feedback to enhance the patient's participation to pedaling based on the real-time attention index. After 24 training sessions, the attention index of the experimental group was significantly higher than that of the control group. The lower limbs motor function (FMA-L) increased by an average of 4.5 points in the BCI-PT group and 2.1 points in the control group (P = 0.022) after treatments. The difference was still significant after adjusting for the baseline indicators ( β = 2.41 , 95%CI: 0.48-4.34, P = 0.024). We found that BCI-PT significantly improved the patient's lower limb motor function by increasing the patient's participation. (clinicaltrials.gov: NCT04612426).