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

in Multisensory Research
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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

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Figures

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    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).

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    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).

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