Sensory Substitution for Balance Control Using a Vestibular-to-Tactile Device

in Multisensory Research
Restricted Access
Get Access to Full Text
Rent on DeepDyve

Have an Access Token?

Enter your access token to activate and access content online.

Please login and go to your personal user account to enter your access token.


Have Institutional Access?

Access content through your institution. Any other coaching guidance?


Postural control is essential for most activities of daily living. The impairment of this function can be extremely disabling. This work was stimulated by the testimony of a bilateral partial foot amputee who describes his difficulty in maintaining balance while washing his hair in the shower. We postulated that if the postural control system could not rely on accurate and reliable somatosensory inputs from the foot and ankle, as is probably the case following bilateral foot amputation due to the loss of the foot afferents and efferents, the weight of visual and vestibular cues would increase. We therefore assessed if a vestibular-to-tactile sensory substitution device could compensate for this impairment. Two separate experiments were conducted. Experiment 1: The effect of a vestibular-to-tongue tactile biofeedback balance system on the postural stability of this amputee was tested (on a force platform) and compared with a non-amputated, matched control group. The results showed that use of the biofeedback reduced centre of foot (CoP) displacement in all subjects but more spectacularly in the amputee. Experiment 2: The effect of the biofeedback was tested in 16 young healthy adults following a protocol of ankle muscle fatigue (known to alter ankle neuromuscular function and to perturb the control of bipedal posture). The results showed a significant decrease in CoP displacement compared with the control, non-biofeedback condition and a significantly greater effect of the biofeedback in the fatigue than the non-fatigue condition. Taken together, the results of these two studies suggest that an individual with double partial foot amputation was able to improve his balance control thanks to the use of a vestibular-to-tongue tactile biofeedback balance system and that young healthy individuals were able to take advantage of it to reduce the postural destabilisation induced by plantar-flexor muscle fatigue. Further studies are however necessary to confirm this in larger numbers of impaired persons as well as to assess the effectiveness in dynamic situations.

Sensory Substitution for Balance Control Using a Vestibular-to-Tactile Device

in Multisensory Research



Bach-y-RitaP.KercelS. W. (2003). Sensory substitution and the human–machine interfaceTrends Cogn. Sci. 7541546.

Bach-y-RitaP.CollinsC. C.SaundersF. A.WhiteB.ScaddenL. (1969). Vision substitution by tactile image projectionNature 221963964.

Bach-y-RitaP.KaczmarekK. A.TylerM. E.Garcia-LaraJ. (1998). Form perception with a 49-point electrotactile stimulus array on the tongue: a technical noteJ. Rehabil. Res. Dev. 35427430.

BergerW.TrippelM.DischerM.DietzV. (1992). Influence of subjects’ height on the stabilization of postureActa Otolaryngol. 1122230.

BloemB. R.SteijnsJ. A.Smits-EngelsmanB. C. (2003). An update on fallsCurr. Opin. Neurol. 161526.

BorgG. (1990). Psychological scaling with applications in physical work and the perception of exertionScand. J. Work Environ. Health 165558.

ChiariL.RocchiL.CappelloA. (2002). Stabilometric parameters are affected by anthropometry and foot placementClin. Biomech. 17666677.

EnokaR. M.DuchateauJ. (2008). Muscle fatigue: what, why and how it influences muscle functionJ. Physiol. 5861123.

FarencI.RougierP.BergerL. (2003). The influence of gender and body characteristics on upright stanceAnn. Hum. Biol. 30279294.

FujinoS.TakahashiT.UenoT. (2010). Influence of voluntary teeth clenching on the stabilization of postural stance disturbed by electrical stimulation of unilateral lower limbGait Posture 31122125.

GreenA. M.AngelakiD. E. (2004). An integrative neural network for detecting inertial motion and head orientationJ. Neurophysiol. 92905925.

HamelJ.DufourS.FortinD. (Eds) (1993). Case Study Methods. SAGE Publications, Inc.Newbury Park, CA, USA.

HellmannD.GiannakopoulosN. N.BlaserR.EberhardL.SchindlerH. J. (2011). The effect of various jaw motor tasks on body swayJ. Oral. Rehabil. 38729736.

HlavackovaP.VuillermeN. (2012). Do somatosensory conditions from the foot and ankle affect postural responses to plantar-flexor muscles fatigue during bipedal quiet stance? Gait Posture 361619.

HlavackovaP.PradonD.VuillermeN. (2012). Control of bipedal posture following localised muscle fatigue of the plantar-flexors and finger-flexorsEur. J. Appl. Physiol. 112789793.

HorakF. B.MacphersonJ. M. (1996). Postural orientation and equilibrium in: Handbook of Physiology. Exercise: Regulation and Integration of Multiple SystemsRowellL. B.ShepardJ. T. (Eds) pp.  255292. Oxford University PressOxford, UK.

KaczmarekK.Bach-y-RitaP. (1995). Tactile displays in: Advanced Interface Design and Virtual EnvironmentsBarfieldW.FurnessT. (Eds) pp.  349414. Oxford University PressOxford, UK.

KaczmarekK. A.WebsterJ. G.Bach-y-RitaP.TompkinsW. J. (1991). Electrotactile and vibrotactile displays for sensory substitution systemsIEEE Trans. Biomed. Eng. 38116.

KarinkantaS.HeinonenA.SievanenH.Uusi-RasiK.KannusP. (2005). Factors predicting dynamic balance and quality of life in home-dwelling elderly womenGerontology 51116121.

LacourM.Bernard-DemanzeL.DumitrescuM. (2008). Posture control, aging, and attention resources: models and posture-analysis methodsNeurophysiol Clin. 38411421.

LedinT.FranssonP. A.MagnussonM. (2004). Effects of postural disturbances with fatigued triceps surae muscles or with 20% additional body weightGait Posture 19184193.

MassionJ. (1994). Postural control systemCurr. Opin. Neurobiol. 4877887.

MerabetL. B.BattelliL.ObretenovaS.MaguireS.MeijerP.Pascual-LeoneA. (2009). Functional recruitment of visual cortex for sound encoded object identification in the blindNeuroreport 20132138.

MergnerT.RosemeierT. (1998). Interaction of vestibular, somatosensory and visual signals for postural control and motion perception under terrestrial and microgravity conditions — a conceptual modelBrain Res. Rev. 28118135.

MuirJ. W.KielD. P.HannanM.MagazinerJ.RubinC. T. (2013). Dynamic parameters of balance which correlate to elderly persons with a history of fallsPLoS One 8e70566. DOI:10.1371/journal.pone.0070566.

NashnerL. M. (1976). Adapting reflexes controlling human postureExp. Brain Res. 265972.

NashnerL. M.BlackF. O.WallC.III (1982). Adaptation to altered support and visual conditions during stance: patients with vestibular deficitsJ. Neurosci. 2536544.

OieK. S.KiemelT.JekaJ. J. (2002). Multisensory fusion: simultaneous re-weighting of vision and touch for the control of human postureBrain Res. Cogn. Brain Res. 14164176.

PaillardT. (2012). Effects of general and local fatigue on postural control: a reviewNeurosci. Biobehav. Rev. 36162176.

PeterkaR. J. (2002). Sensorimotor integration in human postural controlJ. Neurophysiol. 8810971118.

PeterkaR. J.LoughlinP. J. (2004). Dynamic regulation of sensorimotor integration in human postural controlJ. Neurophysiol. 91410423.

PicardC.OlivierA. (1983). Sensory cortical tongue representation in manJ. Neurosurg. 59781789.

PinsaultN.VuillermeN. (2008). Differential postural effects of plantar-flexor muscles fatigue under normal, altered and improved vestibular and neck somatosensory conditionsExp. Brain Res. 19199107.

PinsaultN.VuillermeN. (2009). Test–retest reliability of centre of foot pressure measures to assess postural control during unperturbed stanceMed. Eng. Phys. 31276286.

ProulxM. J.PtitoM.AmediA. (2014). Multisensory integration, sensory substitution and visual rehabilitationNeurosci. Biobehav. Rev. 4112. DOI:10.1016/j.neubiorev.2014.03.004.

SampaioE.MarisS.Bach-y-RitaP. (2001). Brain plasticity: ‘Visual’ acuity of blind persons via the tongueBrain Res. 908204207.

Samsó DiesJ. M. (1965). Possibilités d’une prothèse sensorielle acoustique par stimulation tactile in: Cybernetics of the Nervous SystemWienerN.SchadéJ. P. (Eds) Progress in Brain ResearchVol. 17 pp.  169178. ElsevierAmsterdam, Netherlands.

SchöneH. (1964). On the role of gravity in human spatial orientationAerosp. Med. 35764772.

Shumway-CookA.WoollacottM. H. (2007). Motor Control: Translating Research into Clinical Practice. Lippincott Williams & WilkinsPhiladelphia, PA, USA.

StarkiewiczW.KuliszewskiT. (1963). Active energy radiating systems: the 80-channel Elektroftalm in: Proceedings of the lnternational Congress on Technology and Blindness pp. 157–166. The American Foundation for the Blind New York NY USA.

TardieuC.DumitrescuM.GiraudeauA.BlancJ. L.CheynetF.BorelL. (2009). Dental occlusion and postural control in adultsNeurosci. Lett. 450221224.

TaylorJ. L.ButlerJ. E.GandeviaS. C. (2000). Changes in muscle afferents, motoneurons and motor drive during muscle fatigueEur. J. Appl. Physiol. 83106115.

ThedonT.MandrickK.FoissacM.MottetD.PerreyS. (2011). Degraded postural performance after muscle fatigue can be compensated by skin stimulationGait Posture 33686689.

TrulssonM.EssickG. K. (1997). Low-threshold mechanoreceptive afferents in the human lingual nerveJ. Neurophysiol. 77737748.

TylerM.DanilovY.Bach-y-RitaP. (2003). Closing an open-loop control system: vestibular substitution through the tongueJ. Integr. Neurosci. 2159164.

Van BovenR. W.JohnsonK. O. (1994). The limit of tactile spatial resolution in humans: grating orientation discrimination at the lips, tongue, and fingerNeurology 4423612366.

VisselY. (2009). Tactile sensory substitution: models for enaction in HCIInteract. Comput. 213853.

VuillermeN. (2002). Interactions between the sensori-motor and cognitive processes involved in the regulation of postural sway in quasi-static conditions PhD Thesis Joseph Fourier University of Grenoble France.

VuillermeN.BoisgontierM. (2008). Muscle fatigue degrades force sense at the ankle jointGait Posture 28521524.

VuillermeN.CuisinierR. (2008). Head position-based electrotactile tongue biofeedback affects postural responses to Achilles tendon vibration in humansExp. Brain Res. 186503508.

VuillermeN.CuisinierR. (2009). Sensory supplementation through tongue electrotactile stimulation to preserve head stabilization in space in the absence of visionInvest. Ophthalmol. Vis. Sci. 50476481.

VuillermeN.DemetzS. (2007). Do ankle foot orthoses modify postural control during bipedal quiet standing following a localized fatigue of the ankle muscles? Int. J. Sports Med. 28243246.

VuillermeN.NougierV. (2003). Effect of light finger touch on postural sway after lower-limb muscular fatigueArch. Phys. Med. Rehabil. 8415601563.

VuillermeN.MarinL.DebûB. (2001). Assessment of static postural control in teenagers with down syndromeAdapt. Phys. Activ. Q. 18417433.

VuillermeN.ForestierN.NougierV. (2002). Attentional demands and postural sway: the effect of the calf muscles fatigueMed. Sci. Sports Exerc. 3419071919.

VuillermeN.BurdetC.IsableuB.DemetzS. (2006). The magnitude of the effect of calf muscles fatigue on postural control during bipedal quiet standing with vision depends on the eye — visual target distanceGait Posture 24169172.

VuillermeN.BoisgontierM.ChenuO.DemongeotJ.PayanY. (2007). Tongue-placed tactile biofeedback suppresses the deleterious effects of muscle fatigue on joint position sense at the ankleExp. Brain Res. 183235240.

VuillermeN.PinsaultN.ChenuO.DemongeotJ.PayanY.DanilovY. (2008a). Sensory supplementation system based on electrotactile tongue biofeedback of head position for balance controlNeurosci. Lett. 431206210.

VuillermeN.PinsaultN.FleuryA.ChenuO.DemongeotJ.PayanY.PavanP. (2008b). Effectiveness of an electro-tactile vestibular substitution system in improving upright postural control in unilateral vestibular-defective patientsGait Posture 28711715.

VuillermeN.HlavackovaP.FrancoC.DiotB.DemongeotJ.PayanY. (2011). Can an electro-tactile vestibular substitution system improve balance in patients with unilateral vestibular loss under altered somatosensory conditions from the foot and ankle? Conf. Proc. IEEE Eng. Med. Biol. Soc. 2011 1323–1326.

WoollacottM.Shumway-CookA. (2002). Attention and the control of posture and gait: a review of an emerging area of researchGait Posture 16114.

ZokM.MazzaC.CappozzoA. (2008). Should the instructions issued to the subject in traditional static posturography be standardised? Med. Eng. Phys. 30913916.


  • View in gallery

    Photograph and radiographs of foot of the participant with a partial double foot amputation. (A) Photograph in the reference position. (B) X-ray right foot (lateral external). (C) X-ray right foot (anterior). (D) X-ray left foot (lateral internal). (E) X-ray left foot (anterior).

  • View in gallery

    Sensory coding schemes for the vestibular-to-tongue tactile biofeedback balance system as a function of the head orientation with respect to gravitational vertical (left panel). Note that the electro-tactile stimulations move continuously on the Tongue Display Unit. For instance, the black trajectory illustrated in the lower half of the right panel corresponds to a continuous head motion from neutral to left-side-tilt head position.

  • View in gallery

    Mean and 95% confidence intervals of the surface area covered by the trajectory of the centre of foot pressure (CoP) obtained in the No-Biofeedback and Biofeedback conditions for the group of participants without a double partial foot amputation (n=6; left panel) and the participant with a double partial foot amputation (n=1; right panel).

  • View in gallery

    Mean and 95% confidence intervals of the surface area covered by the trajectory of the centre of foot pressure (CoP) obtained in the No-Biofeedback and Biofeedback conditions and the two conditions of No-Fatigue (left panel) and Fatigue of the plantar-flexor muscles (right panel).


Content Metrics

Content Metrics

All Time Past Year Past 30 Days
Abstract Views 36 36 7
Full Text Views 66 66 50
PDF Downloads 10 10 5
EPUB Downloads 1 1 0