A recent study showed that fingertip pads’ tactile sensation can improve by applying imperceptible white-noise vibration to the skin at the wrist or dorsum of the hand in stroke patients. This study further examined this behavior by investigating the effect of both imperceptible and perceptible white-noise vibration applied to different locations within the distal upper extremity on the fingertip pads’ tactile sensation in healthy adults. In 12 healthy adults, white-noise vibration was applied to one of four locations (dorsum hand by the second knuckle, thenar and hypothenar areas, and volar wrist) at one of four intensities (zero, 60%, 80%, and 120% of the sensory threshold for each vibration location), while the fingertip sensation, the smallest vibratory signal that could be perceived on the thumb and index fingertip pads, was assessed. Vibration intensities significantly affected the fingertip sensation (P < 0.01) in a similar manner for all four vibration locations. Specifically, vibration at 60% of the sensory threshold improved the thumb and index fingertip tactile sensation (P < 0.01), while vibration at 120% of the sensory threshold degraded the thumb and index fingertip tactile sensation (P < 0.01) and the 80% vibration did not significantly change the fingertip sensation (P > 0.01), all compared with the zero vibration condition. This effect with vibration intensity conforms to the stochastic resonance behavior. Nonspecificity to the vibration location suggests the white-noise vibration affects higher level neuronal processing for fingertip sensing. Further studies are needed to elucidate the neural pathways for distal upper extremity vibration to impact fingertip pad tactile sensation.

The emergence of lower-cost motion tracking devices enables home-based virtual reality rehabilitation activities and increased accessibility to patients. Currently, little documentation on patients' expectations for virtual reality rehabilitation is available. This study surveyed 10 people with stroke for their expectations of virtual reality rehabilitation games. This study also evaluated the usability of three lower-cost virtual reality rehabilitation games using a survey and House of Quality analysis. The games (kitchen, archery, and puzzle) were developed in the laboratory to encourage coordinated finger and arm movements. Lower-cost motion tracking devices, the P5 Glove and Microsoft Kinect, were used to record the movements. People with stroke were found to desire motivating and easy-to-use games with clinical insights and encouragement from therapists. The House of Quality analysis revealed that the games should be improved by obtaining evidence for clinical effectiveness, including clinical feedback regarding improving functional abilities, adapting the games to the user's changing functional ability, and improving usability of the motion-tracking devices. This study reports the expectations of people with stroke for rehabilitation games and usability analysis that can help guide development of future games.

Peripheral sensory stimulation has been used as a method to stimulate the sensorimotor cortex, with applications in neuro-rehabilitation. To improve delivery modality and usability, a new stimulation method has been developed in which imperceptible random-frequency vibration is applied to the wrist concurrently during hand activity. The objective of this study was to investigate effects of this new sensory stimulation on the sensorimotor cortex. Healthy adults were studied. In a transcranial magnetic stimulation (TMS) study, resting motor threshold, short-interval intracortical inhibition, and intracortical facilitation for the Abductor Pollicis Brevis muscle were compared between vibration on vs. off while subjects were at rest. In an electroencephalogram (EEG) study, alpha and beta power during rest and event-related desynchronization (ERD) for hand grip were compared between vibration on vs. off. Results showed that vibration decreased EEG power and decreased TMS short-interval intracortical inhibition (i.e., disinhibition) compared with no vibration at rest. Grip-related ERD was also greater during vibration, compared to no

Random vibration applied to skin can change the sense of touch. Specifically, low amplitude white-noise vibration can improve fingertip touch perception. In fact, fingertip touch sensation can improve even when imperceptible random vibration is applied to other remote upper extremity areas such as wrist, dorsum of the hand, or forearm. As such, vibration can be used to manipulate sensory feedback and improve dexterity, particularly during neurological rehabilitation. Nonetheless, the neurological bases for remote vibration enhanced sensory feedback are yet poorly understood. This study examined how imperceptible random vibration applied to the wrist changes cortical activity for fingertip sensation. We measured somatosensory evoked potentials to assess peak-to-peak response to light touch of the index fingertip with applied wrist vibration versus without. We observed increased peak-to-peak somatosensory evoked potentials with wrist vibration, especially with increased amplitude of the later component for the somatosensory, motor, and premotor cortex with wrist vibration. These findings corroborate an enhanced cortical-level sensory response motivated by vibration. It is possible that the cortical modulation observed here is the result of the establishment of transient networks for improved perception.

Recently, application of vibrotactile noise to the wrist or back of the hand has been shown to enhance fingertip tactile sensory perception (Enders et al 2013), supporting a potential for an assistive device worn at the wrist, that generates minute vibration to help the elderly or patients with sensory deficit. However, knowledge regarding the detailed physiological mechanism behind this sensory improvement in the central nervous system, especially in the human brain, is limited, hindering progress in development and use of such assistive devices. To enable investigation of the impact of vibrotactile noise on sensorimotor brain activity in humans, a magnetic resonance imaging (MRI)-compatible vibrotactile system was developed to provide vibrotactile noise during an MRI of the brain. The vibrotactile system utilizes a remote (outside the MR room) signal amplifier which provides a voltage from −40 V to +40 V to drive a 12 mm diameter piezoelectric vibrator (inside the MR room). It is portable and is found MRI-compatible to enable its use for neurologic investigation with MRI. The system was also found to induce improvement in fingertip tactile sensation, consistent with the previous study.