CAREER: Improving Postural Balance and Rehabilitation Outcomes Using Vibrotactile Sensory Substitution

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0846471SienkoThis award is funded under the American Recovery and Reinvestment Act of 2009 (Public Law 111-5)."Research and Education Objectives: Balance impairments affect a large population of individuals including the elderly and those with vestibular deficit, peripheral neuropathy, traumatic brain injury, and stroke. Recognizing this reduced quality of life, the goals of this research are: 1) To design and build a sensory substitution technology platform to augment current balance rehabilitation best practices, 2) To assess the capability of sensory substitution to improve stability during locomotor activities, 3) To evaluate the cognitive workload associated with attending to information provided by a sensory substitution device, 4) To determine the effect of vibrotactile feedback on fall prevention, and 5) To examine whether or not a patient can retain improvements in balance following training with sensory substitution technology. Balance-impaired populations including vestibular, vestibular secondary to traumatic brain injury, stroke, and the elderly will be tested in collaboration with colleagues at the University of Michigan, Rehabilitation Institute of Chicago, Northwestern University, and Walter Reed Army Medical Center. This research proposes to investigate the mechanisms that govern standing and locomotor responses to vibrotactile sensory substitution while emphasizing co-creation with both the prospective patient population and those administering rehabilitation (physical therapists in most cases) throughout the design process. The study and implementation of this co-creation process will be pursued further through an integrated educational program that examines medical device co-creation in a broader context of global health. To this end, the PI will implement a Global Health Design Minor in the University of Michigan's College of Engineering; this minor will include an Immersion Experience in which students travel to the developing world to learn the process of co-creation by working with and directly assessing the needs of end users, followed by a two-course capstone design sequence in which these experiences are translated into medical device designs than can more realistically achieve broader impact.Intellectual Merit: While prior work by the PI and others has suggested that vibrotactile feedback can significantly improve balance during stance, its application in improving balance during gait remains for the most part unexplored, as does its efficacy as a rehabilitation tool for balance-impaired individuals. A major obstacle standing in the way of its use for these critical applications is the current lack of knowledge regarding the biomechanical parameters best suited for vibrotactile feedback during locomotion. This research will focus on uncovering feedback variables and vibrotactile display strategies that can improve both stability during gait and balance rehabilitation outcomes. For example, the device will have the unique capability to display vibrotactile feedback of gait velocity, stride length, and gaze-three important variables that therapists qualitatively use to correct vestibulopathic gait. The knowledge gained from these studies will be useful not only for vibrotactile feedback but also for the broad range of sensory substitution devices aimed at overcoming balance deficits.Broader Impacts: Ultimately, it is the goal of this research to provide scientific justification and device development for an ergonomic, affordable, wearable sensory substitution prototype that would enable balance-impaired individuals to perform activities of daily living and improve their quality of life. In a rehabilitation setting, the device has the potential to impact both the rate of recovery of balance function and the extent to which recovery is achieved by providing continuous information about body motion that corroborates verbal and tactile feedback provided by therapists. The broader impacts of the educational plan emphasizing co-creation of medical technologies for global health include the development of affordable medical devices for the U.S. and developing world, the education of undergraduate and graduate students in the necessity of incorporating end-user input during engineering design, and the dissemination of global health issues to a broad audience.