In this study, we introduce a novel maze task designed to investigate naturalistic motor learning in bimanual coordination. We developed and validated an extended set of movement primitives tailored to capture the full spectrum of scenarios encountered in a maze game. Over a 3-day training period, we evaluated participants\' performance using these primitives and a custom-developed software, enabling precise quantification of performance. Our methodology integrated the primitives with in-depth kinematic analyses and thorough thumb pressure assessments, charting the trajectory of participants\' progression from novice to proficient stages. Results demonstrated consistent improvement in maze performance and significant adaptive changes in joint behaviors and strategic recalibrations in thumb pressure distribution. These findings highlight the central nervous system\'s adaptability in orchestrating sophisticated motor strategies and the crucial role of tactile feedback in precision tasks. The maze platform and setup emerge as a valuable foundation for future experiments, providing a tool for the exploration of motor learning and coordination dynamics. This research underscores the complexity of bimanual motor learning in naturalistic environments, enhancing our understanding of skill acquisition and task efficiency while emphasizing the necessity for further exploration and deeper investigation into these adaptive mechanisms.

The intentional binding effect refers to the phenomenon where the perceived temporal interval between a voluntary action and its sensory consequence is subjectively compressed. Prior research revealed the importance of tactile feedback from the keyboard on this effect. Here we examined the necessity of such tactile feedback by utilizing a touch-free key-press device without haptic feedback, and explored how initial/outcome sensory modalities (visual/auditory/tactile) and their consistency influence the intentional binding effect. Participants estimated three delay lengths (250, 550, or 850 ms) between the initial and outcome stimuli. Results showed that regardless of the combinations of sensory modalities between the initial and the outcome stimuli (i.e., modal consistency), the intentional binding effect was only observed in the 250 ms delay condition. This findings indicate a stable intentional binding effect both within and across sensory modalities, supporting the existence of a shared mechanism underlying the binding effect in touch-free voluntary actions.

BACKGROUND: Tissue handling is a crucial skill for surgeons and is challenging to learn. The aim of this study was to develop laparoscopic instruments with different integrated tactile vibration feedback by varying different tactile modalities and assess its effect on tissue handling skills.
METHODS: Standard laparoscopic instruments were equipped with a vibration effector, which was controlled by a microcomputer attached to a force sensor platform. One of three different vibration feedbacks (F1: double vibration > 2 N; F2: increasing vibration relative to force; F3: one vibration > 1.5 N and double vibration > 2 N) was applied to the instruments. In this multicenter crossover trial, surgical novices and expert surgeons performed two laparoscopic tasks (Peg transfer, laparoscopic suture, and knot) each with all the three vibration feedback modalities and once without any feedback, in a randomized order. The primary endpoint was force exertion.
RESULTS: A total of 57 subjects (15 surgeons, 42 surgical novices) were included in the trial. In the Peg transfer task, there were no differences between the tactile feedback modalities in terms of force application. However, in subgroup analysis, the use of F2 resulted in a significantly lower mean-force application (p-value = 0.02) among the student group. In the laparoscopic suture and knot task, all participants exerted significantly lower mean and peak forces using F2 (p-value < 0.01). These findings remained significant after subgroup analysis for both, the student and surgeon groups individually. The condition without tactile feedback led to the highest mean and peak force exertion compared to the three other feedback modalities.
CONCLUSIONS: Continuous tactile vibration feedback decreases the mean and peak force applied during laparoscopic training tasks. This effect is more pronounced in demanding tasks such as laparoscopic suturing and knot tying and might be more beneficial for students. Laparoscopic tasks without feedback lead to increased force application.

BACKGROUND: Sensory reafferents are crucial to correct our posture and movements, both reflexively and in a cognitively driven manner. They are also integral to developing and maintaining a sense of agency for our actions. In cases of compromised reafferents, such as for persons with amputated or congenitally missing limbs, or diseases of the peripheral and central nervous systems, augmented sensory feedback therefore has the potential for a strong, neurorehabilitative impact. We here developed an untethered vibrotactile garment that provides walking-related sensory feedback remapped non-invasively to the wearer\'s back. Using the so-called FeetBack system, we investigated if healthy individuals perceive synchronous remapped feedback as corresponding to their own movement (motor awareness) and how temporal delays in tactile locomotor feedback affect both motor awareness and walking characteristics (adaptation).
METHODS: We designed the system to remap somatosensory information from the foot-soles of healthy participants (N = 29), using vibrotactile apparent movement, to two linear arrays of vibrators mounted ipsilaterally on the back. This mimics the translation of the centre-of-mass over each foot during stance-phase. The intervention included trials with real-time or delayed feedback, resulting in a total of 120 trials and approximately 750 step-cycles, i.e. 1500 steps, per participant. Based on previous work, experimental delays ranged from 0ms to 1500ms to include up to a full step-cycle (baseline stride-time: µ = 1144 ± 9ms, range 986-1379ms). After each trial participants were asked to report their motor awareness.
RESULTS: Participants reported high correspondence between their movement and the remapped feedback for real-time trials (85 ± 3%, µ ± σ), and lowest correspondence for trials with left-right reversed feedback (22 ± 6% at 600ms delay). Participants further reported high correspondence of trials delayed by a full gait-cycle (78 ± 4% at 1200ms delay), such that the modulation of motor awareness is best expressed as a sinusoidal relationship reflecting the phase-shifts between actual and remapped tactile feedback (cos model: 38% reduction of residual sum of squares (RSS) compared to linear fit, p < 0.001). The temporal delay systematically but only moderately modulated participant stride-time in a sinusoidal fashion (3% reduction of RSS compared a linear fit, p < 0.01).
CONCLUSIONS: We here demonstrate that lateralized, remapped haptic feedback modulates motor awareness in a systematic, gait-cycle dependent manner. Based on this approach, the FeetBack system was used to provide augmented sensory information pertinent to the user\'s on-going movement such that they reported high motor awareness for (re)synchronized feedback of their movements. While motor adaptation was limited in the current cohort of healthy participants, the next step will be to evaluate if individuals with a compromised peripheral nervous system, as well as those with conditions of the central nervous system such as Parkinson\'s Disease, may benefit from the FeetBack system, both for maintaining a sense of agency over their movements as well as for systematic gait-adaptation in response to the remapped, self-paced, rhythmic feedback.

Electrotactile stimulation through matrix electrodes is a promising technology to restore high-resolution tactile feedback in extended reality applications. One of the fundamental tactile effects that should be simulated is the change in the size of the contact between the finger and a virtual object. The present study investigated how participants perceive the increase of stimulation area when stimulating the index finger using static or dynamic (moving) stimuli produced by activating 1 to 6 electrode pads. To assess the ability to interpret the stimulation from the natural cues (natural decoding), without any prior training, the participants were instructed to draw the size of the stimulated area and identify the size difference when comparing two consecutive stimulations. To investigate if other \"non-natural\" cues can improve the size estimation, the participants were asked to enumerate the number of active pads following a training protocol. The results demonstrated that participants could perceive the change in size without prior training (e.g., the estimated area correlated with the stimulated area, p < 0.001; ≥ two-pad difference recognized with > 80% success rate). However, natural decoding was also challenging, as the response area changed gradually and sometimes in complex patterns when increasing the number of active pads (e.g., four extra pads needed for the statistically significant difference). Nevertheless, by training the participants to utilize additional cues the limitations of natural perception could be compensated. After the training, the mismatch in the activated and estimated number of pads was less than one pad regardless of the stimulus size. Finally, introducing the movement of the stimulus substantially improved discrimination (e.g., 100% median success rate to recognize ≥ one-pad difference). The present study, therefore, provides insights into stimulation size perception, and practical guidelines on how to modulate pad activation to change the perceived size in static and dynamic scenarios.

UNASSIGNED: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy, which causes numbness and pain in the thumb, the index and middle fingers and the radial side of the ring finger. Regular hand exercises may improve the symptoms and prevent carpal tunnel surgery. This study applied a novel ultrasonic stimulation method to test tactile sensitivity in CTS and also a mixed-reality-assisted (MR-assisted) exercise program which measured hand movements and provided haptic feedback for rehabilitation.
UNASSIGNED: Twenty patients with mild unilateral CTS took part in the experiments. A mid-air haptics device (Ultrahaptics STRATOS Explore) was used to apply amplitude-modulated ultrasound waves (carrier frequency: 40 kHz) onto the skin to create tactile stimulation mechanically. Participants performed a two-alternative forced-choice task for measuring tactile thresholds at 250-Hz modulation frequency. They were tested at the index fingers and the thenar eminences of both hands. Additionally, 15 CTS patients used an MR-assisted program to do hand exercises with haptic feedback. Exercise performance was assessed by calculating errors between target and actual hand configurations. System Usability Scale (SUS) was adopted to verify the practical usability of the program.
UNASSIGNED: Thresholds at the thenar eminences of the affected and healthy hands were not significantly different. While the thresholds at the healthy index fingers could be measured, those of the affected fingers were all higher than the stimulation level produced by the maximum output from the ultrasound device. In the exercise program, a significant positive correlation (ρ = 0.89, p < 0.001) was found between the performance scores and the SUS scores, which were above the criterion value established in the literature.
UNASSIGNED: The results show that thenar tactile sensitivity is not affected in mild CTS as expected from the palmar cutaneous branch of the median nerve (PCBm), but index finger threshold is likely to be higher. Overall, this study suggests that mid-air haptics, with certain improvements, may be used as a preliminary test in the clinical setting. Moreover, the device is promising to develop gamified rehabilitation programs and for the treatment follow-up of CTS.

Humans use tactile feedback to perform skillful manipulation. When tactile sensory feedback is unavailable, for instance, if the fingers are anesthetized, dexterity is severely impaired. Imaging the deformation of the finger pad skin when in contact with a transparent plate provides information about the tactile feedback received by the central nervous system. Indeed, skin deformations are transduced into neural signals by the mechanoreceptors of the finger pad skin. Understanding how this feedback is used for active object manipulation would improve our understanding of human dexterity. In this paper, we present a new device for imaging the skin of the finger pad of one finger during manipulation performed with a precision grip. The device\'s mass (300 g) makes it easy to use during unconstrained dexterous manipulation. Using this device, we reproduced the experiment performed in Delhaye et al. (2021) We extracted the strains aligned with the object\'s movement, i.e., the vertical strains in the ulnar and radial parts of the fingerpad, to see how correlated they were with the grip force (GF) adaptation. Interestingly, parts of our results differed from those in Delhaye et al. (2021) due to weight and inertia differences between the devices, with average GF across participants differing significantly. Our results highlight a large variability in the behavior of the skin across participants, with generally low correlations between strain and GF adjustments, suggesting that skin deformations are not the primary driver of GF adaptation in this manipulation scenario.

Orientation processing in the human brain plays a crucial role in guiding grasping actions toward an object. Remarkably, despite the absence of visual input, the human visual cortex can still process orientation information. Instead of visual input, non-visual information, including tactile and proprioceptive sensory input from the hand and arm, as well as feedback from action-related processes, may contribute to orientation processing. However, the precise mechanisms by which the visual cortices process orientation information in the context of non-visual sensory input and action-related processes remain to be elucidated. Thus, our study examined the orientation representation within the visual cortices by analyzing the blood-oxygenation-level-dependent (BOLD) signals under four action conditions: direct grasp (DG), air grasp (AG), non-grasp (NG), and uninformed grasp (UG). The images of the cylindrical object were shown at +45° or - 45° orientations, corresponding to those of the real object to be grasped with the whole-hand gesture. Participants judged their orientation under all conditions. Grasping was performed without online visual feedback of the hand and object. The purpose of this design was to investigate the visual areas under conditions involving tactile feedback, proprioception, and action-related processes. To address this, a multivariate pattern analysis was used to examine the differences among the cortical patterns of the four action conditions in orientation representation by classification. Overall, significant decoding accuracy over chance level was discovered for the DG; however, during AG, only the early visual areas showed significant accuracy, suggesting that the object\'s tactile feedback influences the orientation process in higher visual areas. The NG showed no statistical significance in any area, indicating that without the grasping action, visual input does not contribute to cortical pattern representation. Interestingly, only the dorsal and ventral divisions of the third visual area (V3d and V3v) showed significant decoding accuracy during the UG despite the absence of visual instructions, suggesting that the orientation representation was derived from action-related processes in V3d and visual recognition of object visualization in V3v. The processing of orientation information during non-visually guided grasping of objects relies on other non-visual sources and is specifically divided by the purpose of action or recognition.

Increasing evidence based on the safety and benefits of robot-assisted surgery indicates the disadvantage of the lack of tactile feedback. A lack of tactile feedback increases the risk of intraoperative complications, prolongs operative times, and delays the learning curve. A 40-year-old female patient presented to our hospital with a positive fecal occult blood test. A colonoscopy revealed type 2 advanced cancer of the sigmoid colon, and histological examination showed a well-differentiated adenocarcinoma. Furthermore, abdominal contrast-enhanced computed tomography revealed a tumor in the sigmoid colon and several swollen lymph nodes in the colonic mesentery without distant metastases. The patient was diagnosed with cStage IIIb (cT3N1bM0) sigmoid cancer and underwent sigmoidectomy using the Saroa Surgical System, which was developed by RIVERFIELD, a venture company at the Tokyo Medical and Dental University, and the Tokyo Institute of Technology. Based on adequate simulation, surgery was safely performed with appropriate port placement and arm base-angle adjustment. The operating time was 176 min, with a console time of 116 min and 0 ml blood loss. The patient was discharged 6 days postoperatively without complications. The pathological diagnosis was adenocarcinoma, tub1, tub2, pT2N1bM0, and pStage IIIa. Herein, we report the world\'s first surgery for sigmoid cancer using the Saroa Surgical System with tactile feedback in which a safe and appropriate oncological surgery was performed.

A frame providing tactile feedback for the reproducibility of deep inspiratory breath-hold (DIBH) is described. The frame, fitted across the patient, comprises a horizontal bar, parallel to the patient\'s long axis, and holds a graduated pointer perpendicular to it. The pointer provides individualized tactile feedback for reproducibility of DIBH. Within the pointer is a movable pencil, bearing a 5 mm coloured strip which becomes visible only during DIBH, and acts as a visual cue to the therapist. The average variation in separation in the planning and pretreatment cone-beam computed tomography of 10 patients was 2 mm (confidence interval 1.95-2.05). Frame-based tactile feedback is a novel, reproducible technique for DIBH.