The Tongue Drive System (TDS) is a wireless and wearable assistive technology, designed to allow individuals with severe motor impairments such as tetraplegia to access their environment using voluntary tongue motion. Previous TDS trials used a magnetic tracer temporarily attached to the top surface of the tongue with tissue adhesive. We investigated TDS efficacy for controlling a computer and driving a powered wheelchair in two groups of able-bodied subjects and a group of volunteers with spinal cord injury (SCI) at C6 or above. All participants received a magnetic tongue barbell and used the TDS for five to six consecutive sessions. The performance of the group was compared for TDS versus keypad and TDS versus a sip-and-puff device (SnP) using accepted measures of speed and accuracy. All performance measures improved over the course of the trial. The gap between keypad and TDS performance narrowed for able-bodied subjects. Despite participants with SCI already having familiarity with the SnP, their performance measures were up to three times better with the TDS than with the SnP and continued to improve. TDS flexibility and the inherent characteristics of the human tongue enabled individuals with high-level motor impairments to access computers and drive wheelchairs at speeds that were faster than traditional assistive technologies but with comparable accuracy.

BackgroundIn their current laboratory-based form, existing vibrotactile sensory augmentation technologies that provide cues of body motion are impractical for home-based rehabilitation use due to their size, weight, complexity, calibration procedures, cost, and fragility.MethodsWe have designed and developed a cell phone based vibrotactile feedback system for potential use in balance rehabilitation training in clinical and home environments. It comprises an iPhone with an embedded tri-axial linear accelerometer, custom software to estimate body tilt, a "tactor bud" accessory that plugs into the headphone jack to provide vibrotactile cues of body tilt, and a battery. Five young healthy subjects (24 ± 2.8 yrs, 3 females and 2 males) and four subjects with vestibular deficits (42.25 ± 13.5 yrs, 2 females and 2 males) participated in a proof-of-concept study to evaluate the effectiveness of the system. Healthy subjects used the system with eyes closed during Romberg, semi-tandem Romberg, and tandem Romberg stances. Subjects with vestibular deficits used the system with both eyes-open and eyes-closed conditions during semi-tandem Romberg stance. Vibrotactile feedback was provided when the subject exceeded either an anterior-posterior (A/P) or a medial-lateral (M/L) body tilt threshold. Subjects were instructed to move away from the vibration.ResultsThe system was capable of providing real-time vibrotactile cues that informed corrective postural responses. When feedback was available, both healthy subjects and those with vestibular deficits significantly reduced their A/P or M/L RMS sway (depending on the direction of feedback), had significantly smaller elliptical area fits to their sway trajectory, spent a significantly greater mean percentage time within the no feedback zone, and showed a significantly greater A/P or M/L mean power frequency.ConclusionThe results suggest that the real-time feedback provided by this system can be used to reduce body sway. Its advantages over more complex laboratory-based and commercial balance training systems in terms of cost, size, weight, functionality, flexibility, and accessibility make it a good candidate for further home-based balance training evaluation.

Objective: Currently available treatments for kinetic tremor can cause intolerable side effects or be highly invasive and expensive. Even though several studies have shown the positive effects of external feedback (i.e., electrical stimulation) for suppressing tremor, such approaches have not been fully integrated into wearable real-time feedback systems. Method: We have developed a wireless wearable stimulation system that analyzes upper limb tremor using a three-axis accelerometer and that modulates/attenuates tremor using peripheral-nerve electrical stimulation with adjustable stimulation parameters and a real-time tremor detection algorithm. We outfitted nine subjects with tremor with a wearable system and a set of surface electrodes placed on the skin overlying the radial nerve and tested the effects of stimulation with nine combinations of parameters for open-and closed-loop stimulation on tremor. To quantify the effects of the stimulation, we measured tremor movements, and analyzed the dominant tremor frequency and tremor power. Results:Baseline tremor power gradually decreased over the course of 18 stimulation trials. During the last trial, compared with the control trial, the reduction rate of tremor power was 42.17 ± 3.09%. The dominant tremor frequency could be modulated more efficiently by phase-locked closed-loop stimulation. The tremor power was equally reduced by open-and closed-loop stimulation. Conclusion: Peripheral nerve stimulation significantly affects tremor, and stimulation parameters need to be optimized to modulate tremor metrics. Clinical Impact: This preliminary study lays the foundation for future studies that will evaluate the efficacy of the proposed closed-loop peripheral nerve stimulation method in a larger group of patients with kinetic tremor. INDEX TERMS Essential tremor, kinetic tremor, tremor measurement, tremor modulation, wearable peripheral nerve electrical stimulation.

Tongue drive system (TDS) is a new wireless assistive technology (AT) for the mobility impaired population. It provides users with the ability to drive powered wheelchairs (PWC) and access computers using their unconstrained tongue motion. Migration of the TDS processing unit and user interface platform from a bulky personal computer to a smartphone (iPhone) has significantly facilitated its usage by turning it into a true wireless and wearable AT. After implementation of the necessary interfacing hardware and software to allow the smartphone to act as a bridge between the TDS and PWC, the wheelchair navigation performance and associated learning was evaluated in nine able-bodied subjects in five sessions over a 5-week period. Subjects wore magnetic tongue studs over the duration of the study and drove the PWC in an obstacle course with their tongue using three different navigation strategies; namely unlatched, latched, and semiproportional. Qualitative aspects of using the TDS–iPhone–PWC interface were also evaluated via a five-point Likert scale questionnaire. Subjects showed more than 20% improvement in the overall completion time between the first and second sessions, and maintained a modest improvement of ~9% per session over the following three sessions.

Tongue drive system (TDS) is a tongue-operated, minimally invasive, unobtrusive, and wireless assistive technology (AT) that infers users’ intentions by detecting their voluntary tongue motion and translating them into user-defined commands. Here we present the new intraoral version of the TDS (iTDS), which has been implemented in the form of a dental retainer. The iTDS system-on-a-chip (SoC) features a configurable analog front-end (AFE) that reads the magnetic field variations inside the mouth from four 3-axial magnetoresistive sensors located at four corners of the iTDS printed circuit board (PCB). A dual-band transmitter (Tx) on the same chip operates at 27 and 432 MHz in the Industrial/Scientific/Medical (ISM) band to allow users to switch in the presence of external interference. The Tx streams the digitized samples to a custom-designed TDS universal interface, built from commercial off-the-shelf (COTS) components, which delivers the iTDS data to other devices such as smartphones, personal computers (PC), and powered wheelchairs (PWC). Another key block on the iTDS SoC is the power management integrated circuit (PMIC), which provides individually regulated and duty-cycled 1.8 V supplies for sensors, AFE, Tx, and digital control blocks. The PMIC also charges a 50 mAh Li-ion battery with constant current up to 4.2 V, and recovers data and clock to update its configuration register through a 13.56 MHz inductive link. The iTDS SoC has been implemented in a 0.5-μm standard CMOS process and consumes 3.7 mW on average.