Triggermuscle: Exploring Weight Perception for Virtual Reality Through Adaptive Trigger Resistance in a Haptic VR Controller

It is challenging to provide users with a haptic weight sensation of virtual objects in VR since current consumer VR controllers and software-based approaches such as pseudo-haptics cannot render appropriate haptic stimuli. To overcome these limitations, we developed a haptic VR controller named Triggermuscle that adjusts its trigger resistance according to the weight of a virtual object. Therefore, users need to adapt their index finger force to grab objects of different virtual weights. Dynamic and continuous adjustment is enabled by a spring mechanism inside the casing of an HTC Vive controller. In two user studies, we explored the effect on weight perception and found large differences between participants for sensing change in trigger resistance and thus for discriminating virtual weights. The variations were easily distinguished and associated with weight by some participants while others did not notice them at all. We discuss possible limitations, confounding factors, how to overcome them in future research and the pros and cons of this novel technology.

Proprioceptive sensitivity to imposed finger deflections

Hand proprioception - the sense of the posture and movements of the wrist and digits - is critical to dexterous manual behavior and to stereognosis, the ability to sense the three-dimensional structure of objects held in the hand. To better understand this sensory modality and its role in hand function, we sought to characterize the acuity with which the postures and movements of finger joints are sensed. To this end, we measured the ability of human subjects to discriminate changes in posture and speed around the three joints of the index finger. In these experiments, we isolated the sensory component by imposing the postures on an otherwise still hand, to complement other studies, in which subjects made judgments on actively achieved postures. We found that subjects could reliably sense 12-16% changes in joint angle and 18-32% changes in joint speed. Furthermore, the acuity for posture and speed was comparable across the three joints of the finger. Finally, task performance was unaffected by the presence of a vibratory stimulus, calling into question the role of cutaneous cues in hand proprioception.

Analysis of postures for handwriting on touch screens without using tools

The act of handwriting affected the evolutionary development of humans and still impacts the motor cognition of individuals. However, the ubiquitous use of digital technologies has drastically decreased the number of times we really need to pick a pen up and write on paper. Nonetheless, the positive cognitive impact of handwriting is widely recognized, and a possible way to merge the benefits of handwriting and digital writing is to use suitable tools to write over touchscreens or graphics tablets. In this manuscript, we focus on the possibility of using the hand itself as a writing tool. A novel hand posture named FingerPen is introduced, and can be seen as a grasp performed by the hand on the index finger. A comparison with the most common posture that people tend to assume (i.e. index finger-only exploitation) is carried out by means of a biomechanical model. A conducted user study shows that the FingerPen is appreciated by users and leads to accurate writing traits.

A randomized trial to determine the minimum effective lidocaine volume for median nerve block using hydrodissection

Ultrasound-guided hydrodissection with 5% dextrose in water (DW5) creates a peri-nervous compartment, separating the nerve from the neighboring anatomical structures. The aim of this randomized study was to determine the minimum volume of lidocaine 2% with epinephrine 1:200,000 required when using this technique to achieve an effective median nerve block at the elbow in 95% of patients (MEAV95). Fifty-two patients scheduled for elective hand surgery received an ultrasound-guided circumferential perineural injection of 4 ml DW5 and an injection of local anesthetic (LA) following a biased coin up-and-down sequential allocation method. A successful block was defined as a light touch completely suppressed on the two distal phalanges of the index finger within a 30-min evaluation period. The MEAV95 of lidocaine 2% with epinephrine was 4 ml [IQR 3.5–4.0]. Successful median nerve block was obtained in 38 cases (82.6%) with median onset time of 20.0 [10.0–21.2] minutes (95% CI 15–20). The analgesia duration was 248 [208–286] minutes (95% CI 222–276). Using an ultrasound-guided hydrodissection technique with DW5, the MEAV95 to block the median nerve at the elbow with 2% lidocaine with epinephrine was 4 ml [IQR 3.5–4.0]. This volume is close to that usually recommended in clinical practice.Trial registration clinicaltrials.gov. NCT02438657, Date of registration: May 8, 2015.

Secondary Intracranial Hypertension After Ciprofloxacin Treatment: A Case Report

A 30-year-old man developed secondary osteomyelitis after a traumatic amputation of his right index finger. The infection was treated with ciprofloxacin. Approximately 4 weeks after starting treatment, he complained of a progressive decrease in visual acuity, retro-ocular pain and bitemporal headache. A diagnosis of intracranial hypertension was established. Blood sample analysis, infectious profile, cerebrospinal fluid analysis, and neuroimaging were normal. Visual acuity and other symptoms progressively improved after stopping drug treatment. There were no complications or sequelae. Intracranial hypertension due to fluoroquinolones is described in the medical literature, its appearance during such treatments, despite being a rare adverse event, should be monitored.

Personal Experience of Daboia siamensis Envenomation

Reports of envenomation induced by Daboia siamensis, a medically important venomous snake in Taiwan, are rare, and species identification might not be definitive. This article reports the complete course of a definite D. siamensis bite. The patient in this report was one of the authors who was bitten on the right palm near the base of the index finger by D. siamensis. The patient experienced local effects, neurological manifestations, and acute kidney injury. The laboratory analysis revealed elevated D-dimer and coagulopathy. The patient was administered 8 vials of antivenom and did not undergo surgical intervention or endotracheal tube intubation, but serum sickness occurred 8 days after antivenom administration. The horse immunoglobulin produced by the Centers for Disease Control, R. O. C. (Taiwan), against D. siamensis was effective and safe in the treatment of the patient. However, the best antivenom administration strategy remains unclear and requires further study.

Dual-Hemisphere Transcranial Direct Current Stimulation on Parietal Operculum Does Not Affect the Programming of Intra-limb Anticipatory Postural Adjustments

Evidence shows that the postural and focal components within the voluntary motor command are functionally unique. In 2015, we reported that the supplementary motor area (SMA) processes Anticipatory Postural Adjustments (APAs) separately from the command to focal muscles, so we are still searching for a hierarchically higher area able to process both components. Among these, the parietal operculum (PO) seemed to be a good candidate, as it is a hub integrating both sensory and motor streams. However, in 2019, we reported that transcranial Direct Current Stimulation (tDCS), applied with an active electrode on the PO contralateral to the moving segment vs. a larger reference electrode on the opposite forehead, did not affect intra-limb APAs associated to brisk flexions of the index-finger. Nevertheless, literature reports that two active electrodes of opposite polarities, one on each PO (dual-hemisphere, dh-tDCS), elicit stronger effects than the “active vs. reference” arrangement. Thus, in the present study, the same intra-limb APAs were recorded before, during and after dh-tDCS on PO. Twenty right-handed subjects were tested, 10 for each polarity: anode on the left vs. cathode on the right, and vice versa. Again, dh-tDCS was ineffective on APA amplitude and timing, as well as on prime mover recruitment and index-finger kinematics. These results confirm the conclusion that PO does not take part in intra-limb APA control. Therefore, our search for an area in which the motor command to prime mover and postural muscles are still processed together will have to address other structures.

Influence of Vibrotactile Random Noise on the Smoothness of the Grasp Movement in Patients in Chemotherapy-Induced Peripheral Neuropathy

Background Patients with chemotherapy-induced peripheral neuropathy (CIPN) often suffer from sensorimotor dysfunction of the distal portion of the extremities (e.g., loss of somatosensory sensation, numbness/tingling, difficulty typing on a keyboard, or difficulty undoing or doing up a button). The present study aimed to reveal the effects of subthreshold vibrotactile random noise stimulation on sensorimotor dysfunction in CIPN patients without exacerbating symptoms. Methods Twenty-five patients with CIPN and 28 age-matched healthy adults participated in this study. To reveal the effects of subthreshold vibrotactile random noise stimulation on sensorimotor function, participants were asked to perform grasp movement tasks during random noise stimulation delivered to the volar and dorsal wrist. We set three intensity conditions of the vibrotactile random noise: 0%, 60%, and 120% of the sensory threshold (Noise 0%, Noise 60%, and Noise 120% conditions). In the grasp movement task, the distance between the thumb and index finger was recorded while the participant attempted to grasp a target object, and the smoothness of the grasp movement was quantified by calculating normalized jerk in each experimental condition. The experimental data were compared using two-way repeated-measures analyses of variance with two binary factors: experimental condition (Noise 0%, 60%, 120%) × group (Healthy controls, CIPN patients).Results The smoothness of the grasp movement was only improved in the Noise 60% condition without exacerbating numbness/tingling in CIPN patients and healthy controls. Conclusions The current study suggested that the development of treatment devices using stochastic resonance can improve sensorimotor function for CIPN patients.Trial registration UMIN Clinical Trials Registry（UMIN-CTR）No. UMIN000024776https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000024776#