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Background: The absence of force feedback (FFB) is considered a technical limitation in robotic-assisted surgery (RAS). This pre-clinical study aims to evaluate the forces applied to tissues using a novel integrated FFB technology, which allows surgeons to sense forces exerted at the instrument tips., Methods: Twenty-eight surgeons with varying experience levels employed FFB instruments to perform three robotic-assisted surgical tasks, including retraction, dissection, and suturing, on inanimate or ex-vivo models, while the instrument sensors recorded and conveyed the applied forces to the surgeon hand controllers of the robotic system. Generalized Estimating Equations (GEE) models were used to analyze the mean and maximal forces applied during each task with the FFB sensor at the "Off" setting compared to the "High" sensitivity setting for retraction and to the "Low", "Medium", and "High" sensitivity settings for dissection and suturing. Sub-analysis was also performed on surgeon experience levels., Results: The use of FFB at any of the sensitivity settings resulted in a significant reduction in both the mean and maximal forces exerted on tissue during all three robotic-assisted surgical tasks (p < 0.0001). The maximal force exerted, potentially associated with tissue damage, was decreased by 36%, 41%, and 55% with the use of FFB at the "High" sensitivity setting while performing retraction, dissection, and interrupted suturing tasks, respectively. Further, the use of FFB resulted in substantial reductions in force variance during the performance of all three types of tasks. In general, reductions in mean and maximal forces were observed among surgeons at all experience levels. The degree of force reduction depends on the sensitivity setting selected and the types of surgical tasks evaluated., Conclusions: Our findings demonstrate that the utilization of FFB technology integrated in the robotic surgical system significantly reduced the forces exerted on tissue during the performance of surgical tasks at all surgeon experience levels. The reduction in the force applied and a consistency of force application achieved with FFB use, could result in decreases in tissue trauma and blood loss, potentially leading to better clinical outcomes in patients undergoing RAS. Future studies will be important to determine the impact of FFB instruments in a live clinical environment., (© 2024. The Author(s).)

Background: The rapid and accurate assessment of neonatal asphyxia is critical to preventing potentially fatal outcomes. Therefore, nursing students must acquire the skills to assess newborn conditions immediately after birth and implement appropriate interventions. Virtual reality (VR) simulation education has emerged as a promising tool for nursing education, offering repetitive and customizable clinical training while ensuring patient safety and overcoming spatiotemporal limitations., Aim: This study investigated the effects of a contactless hand-tracking-based immersive VR neonatal Apgar scoring program, adapted from experiential learning theory., Design: A non-randomized controlled trial with a pre-post-test, quasi-experimental design was conducted., Settings: The study was conducted at two nursing schools from July to October 2023., Participants: Participants comprised nursing students holding bachelor's degrees in nursing, with three or four years of experience and successful completion of a neonatal nursing theory course. Additionally, individuals with at least six months of experience working in a neonatal ward or delivery room before enrolling in nursing school were eligible., Methods: The participants were divided into three groups: the VR group (n = 27) received contactless hand-tracking-based immersive VR neonatal Apgar scoring training; the simulation group (n = 28) received face-to-face Apgar scoring simulation training; and the control group (n = 26) received instruction on the Apgar scoring criteria. Changes in scores among the VR, simulation, and control groups were statistically compared using ANOVA with SPSS-WIN 27.0., Results: The VR group exhibited significant improvements in knowledge, learning satisfaction, self-confidence, immersion, and motivation compared to the simulation and control groups. Moreover, satisfaction was significantly higher in the VR group than in the simulation group., Conclusions: The hand-tracking-based immersive VR neonatal Apgar scoring program represents an innovative and effective educational tool, prioritizing the privacy and rights of mothers and infants. It can potentially replace traditional delivery-room clinical training, which is observation-based and limited., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The perception of signals from within the body, known as interoception, is increasingly recognized as a prerequisite for physical and mental health. This study is dedicated to the development of effective technological approaches for enhancing interoceptive abilities. We provide evidence of the effectiveness and practical feasibility of a novel real-time haptic heartbeat supplementation technology combining principles of biofeedback and sensory augmentation. In a randomized controlled study, we applied the developed naturalistic haptic feedback on a group of 30 adults, while another group of 30 adults received more traditional real-time visual heartbeat feedback. A single session of haptic, but not visual heartbeat feedback resulted in increased interoceptive accuracy and confidence, as measured by the heart rate discrimination task, and in a shift of attention toward the body. Participants rated the developed technology as more helpful and pleasant than the visual feedback, thus indicating high user satisfaction. The study highlights the importance of matching sensory characteristics of the feedback provided to the natural bodily prototype. Our work suggests that real-time haptic feedback might be a superior approach for strengthening the mind-body connection in interventions for physical and mental health., (© 2024 The Author(s). Psychophysiology published by Wiley Periodicals LLC on behalf of Society for Psychophysiological Research.)

Robotic surgery, known for its minimally invasive techniques and computer-controlled robotic arms, has revolutionized modern medicine by providing improved dexterity, visualization, and tremor reduction compared to traditional methods. The integration of artificial intelligence (AI) into robotic surgery has further advanced surgical precision, efficiency, and accessibility. This paper examines the current landscape of AI-driven robotic surgical systems, detailing their benefits, limitations, and future prospects. Initially, AI applications in robotic surgery focused on automating tasks like suturing and tissue dissection to enhance consistency and reduce surgeon workload. Present AI-driven systems incorporate functionalities such as image recognition, motion control, and haptic feedback, allowing real-time analysis of surgical field images and optimizing instrument movements for surgeons. The advantages of AI integration include enhanced precision, reduced surgeon fatigue, and improved safety. However, challenges such as high development costs, reliance on data quality, and ethical concerns about autonomy and liability hinder widespread adoption. Regulatory hurdles and workflow integration also present obstacles. Future directions for AI integration in robotic surgery include enhancing autonomy, personalizing surgical approaches, and refining surgical training through AI-powered simulations and virtual reality. Overall, AI integration holds promise for advancing surgical care, with potential benefits including improved patient outcomes and increased access to specialized expertise. Addressing challenges and promoting responsible adoption are essential for realizing the full potential of AI-driven robotic surgery., Competing Interests: The authors declare no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Lateropulsion is a post-stroke phenomenon marked by an active push of the body across the midline towards the more affected side and/or a resistance of the weight shift towards the less affected side. Within the mechanisms of treatment, feedback systems have been shown to be effective. The aim of the present study was to create a body of knowledge by performing a literature review on the use of feedback mechanisms in the treatment of lateropulsion and to report two cases of lateropulsion patients who had undergone feedback-based treatment., Methods: The review was performed across five different databases (Embase, Medline/PubMed, Scopus, Web of Science, and PEDro) up to February 2024, and haptic feedback intervention was incorporated into the case series (with lateropulsion and ambulation capacity as the main variables)., Results: In total, 211 records were identified and 6 studies were included after the review of the literature. The most used feedback modality was visual feedback. In the case series, positive results were observed from the intervention, particularly in the recovery of lateropulsion and balance, as well as in the improvement of gait for one patient. Patients demonstrated good adherence to the intervention protocol without adverse effects., Conclusions: Visual feedback is the most commonly used feedback modality in lateropulsion patients but other mechanisms such as haptic feedback also are feasible and should be taken into account. Larger sample sizes, extended follow-up periods, and the isolation of feedback mechanisms must be established to clarify evidence.

Purpose: The use of 3D-printing in every field of medicine is expanding, notably as an educational tool. The aim of this study was to assess how visuospatial abilities (VSA) of students may impact learning helped with 3D-printed models., Methods: Participants were undergraduate medical school students during their clinical rotation in oral and maxillofacial surgery in two French Universities. Students were included prospectively and consecutively from September 2021 to June 2023. First, a lecture about craniosynostosis was performed with the help of 3D-printed models of craniosynostotic skulls. Then, a mental rotation test (MRT) followed by a multiple-choice questions (MCQs) form about craniosynostosis presentations were submitted to the students., Results: Forty undergraduate students were finally included. Median MRT score was 15 (10.75;21) and median score to the MCQs was 13 (11.75;14). There was a significantly weak correlation between the MRT-A score and the score to the MCQs (r s = 0.364; p = 0.022). A simple linear regression was calculated to predict the result to the MCQs on MRT-A score [ (F(1,39) = 281.248; p < 0.0001), with a R2 of 0.878 ]., Conclusion: This study showed that VSA has an impact on the recognition of complex clinical presentations, i.e. skulls with craniosynostosis. The correlation found between VSA and complex 3D shape recognition after learning aided with 3D-printed model is emphasizing the importance of VSA when using innovative technologies. Thus, VSA training should be envisioned during the curriculum., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Previous work has suggested a different developmental timeline and role of visual experience for the use of spatial and non-spatial features in haptic object recognition. To investigate this conjecture, we used a haptic ambiguous odd-one-out task in which one object needed to be selected as being different from two other objects. The odd-one-out could be selected based on four characteristics: size, shape (spatial), texture, and weight (non-spatial). We tested sighted children from 4 to 12 years of age; congenitally blind, late blind, and adult participants with low vision; and normally sighted adults. Given the protracted developmental time course for spatial perception, we expected a shift from a preference for non-spatial features toward spatial features during typical development. Due to the dominant influence of vision for spatial perception, we expected congenitally blind adults to show a similar preference for non-spatial features as the youngest children. The results confirmed our first hypothesis; the 4-year-olds demonstrated a lower dominance for spatial features for object classification compared with older children and sighted adults. In contrast, our second hypothesis was not confirmed; congenitally blind adults' preferred categorization criteria were indistinguishable from those of sighted controls. These findings suggest an early development, but late maturation, of spatial processing in haptic object recognition independent of visual experience., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Sound-shape correspondence refers to the preferential mapping of information across the senses, such as associating a nonsense word like bouba with rounded abstract shapes and kiki with spiky abstract shapes. Here we focused on audio-tactile (AT) sound-shape correspondences between nonsense words and abstract shapes that are felt but not seen. Despite previous research indicating a role for visual experience in establishing AT associations, it remains unclear how visual experience facilitates AT correspondences. Here we investigated one hypothesis: seeing the abstract shapes improve haptic exploration by (a) increasing effective haptic strategies and/or (b) decreasing ineffective haptic strategies. We analyzed five haptic strategies in video-recordings of 6- to 8-year-old children obtained in a previous study. We found the dominant strategy used to explore shapes differed based on visual experience. Effective strategies, which provide information about shape, were dominant in participants with prior visual experience, whereas ineffective strategies, which do not provide information about shape, were dominant in participants without prior visual experience. With prior visual experience, poking-an effective and efficient strategy-was dominant, whereas without prior visual experience, uncategorizable and ineffective strategies were dominant. These findings suggest that prior visual experience of abstract shapes in 6- to 8-year-olds can increase the effectiveness and efficiency of haptic exploration, potentially explaining why prior visual experience can increase the strength of AT sound-shape correspondences., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Spatial search tasks are common and crucial in many Virtual Reality (VR) applications. Traditional methods to enhance the performance of spatial search often employ sensory cues such as visual, auditory, or haptic feedback. However, the design and use of bimanual haptic feedback with two VR controllers for spatial search in VR remains largely unexplored. In this work, we explored bimanual haptic feedback with various combinations of haptic properties, where four types of bimanual haptic feedback were designed, for spatial search tasks in VR. Two experiments were designed to evaluate the effectiveness of bimanual haptic feedback on spatial direction guidance and search in VR. The results from the first experiment reveal that our proposed bimanual haptic schemes significantly enhanced the recognition of spatial directions in terms of accuracy and speed compared to spatial audio feedback. The second experiment's findings suggest that the performance of bimanual haptic feedback was comparable to or even better than the visual arrow, especially in reducing the angle of head movement and enhancing searching targets behind the participants, which was supported by subjective feedback as well. Based on these findings, we have derived a set of design recommendations for spatial search using bimanual haptic feedback in VR.

Physical QWERTY keyboards are the current standard for performing precision text-entry with extended reality devices. Ideally, there would exist a comparable, self-contained solution that works anywhere, without requiring external keyboards. Unfortunately, when physical keyboards are recreated virtually, we currently lose critical haptic feedback information from the sense of touch, which impedes typing. In this paper, we introduce the MusiKeys Technique, which uses auditory feedback in virtual reality to communicate missing haptic feedback information typists normally receive when using a physical keyboard. To examine this concept, we conducted a user study with 24 participants which encompassed four mid-air virtual keyboards augmented with increasing amounts of feedback information, along with a fifth physical keyboard for reference. Results suggest that providing clicking feedback on key-press and key-release improves typing performance compared to not providing auditory feedback, which is consistent with the literature. We also found that audio can serve as a substitute for information contained in haptic feedback, in that users can accurately perceive the presented information. However, under our specific study conditions, this awareness of the feedback information did not yield significant differences in typing performance. Our results suggest this kind of feedback replacement can be perceived by users but needs more research to tune and improve the specific techniques.

Geometrical knowledge is typically taught to children through a combination of vision and repetitive drawing (i.e. haptics), yet our understanding of how different spatial senses contribute to geometric perception during childhood is poor. Studies of line orientation suggest a dominant role of vision affecting the calibration of haptics during development; however, the associated multisensory interactions underpinning angle perception are unknown. Here we examined visual, haptic, and bimodal perception of angles across three age groups of children: 6 to 8 years, 8 to 10 years, and 10 to 12 years, with age categories also representing their class (grade) in primary school. All participants first learned an angular shape, presented dynamically, in one of three sensory tracing conditions: visual only, haptic only, or bimodal exploration. At test, which was visual only, participants selected a target angle from four possible alternatives with distractor angle sizes varying relative to the target angle size. We found a clear improvement in accuracy of angle perception with development for all learning modalities. Angle perception in the youngest group was equally poor (but above chance) for all modalities; however, for the two older child groups, visual learning was better than haptics. Haptic perception did not improve to the level of vision with age (even in a comparison adult group), and we found no specific benefit for bimodal learning over visual learning in any age group, including adults. Our results support a developmental increment in both spatial accuracy and precision in all modalities, which was greater in vision than in haptics, and are consistent with previous accounts of cross-sensory calibration in the perception of geometric forms., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The inferior alveolar nerve block (IANB) is a dental anesthetic injection that is critical to the performance of many dental procedures. Dental students typically learn to administer an IANB through videos and practice on silicone molds and, in many dental schools, on other students. This causes significant stress for both the students and their early patients. To reduce discomfort and improve clinical outcomes, we created an anatomically informed virtual reality headset-based educational system for the IANB. It combines a layered 3D anatomical model, dynamic visual guidance for syringe position and orientation, and active force feedback to emulate syringe interaction with tissue. A companion mobile augmented reality application allows students to step through a visualization of the procedure on a phone or tablet. We conducted a user study to determine the advantages of preclinical training with our IANB simulator. We found that in comparison to dental students who were exposed only to traditional supplementary study materials, dental students who used our IANB simulator were more confident administering their first clinical injections, had less need for syringe readjustments, and had greater success in numbing patients.

Current accounts of behavioral and neurocognitive correlates of plasticity in blindness are just beginning to incorporate the role of speech and verbal production. We assessed Vygotsky/Luria's speech mediation hypothesis, according to which speech activity can become a mediating tool for perception of complex stimuli, specifically, for encoding tactual/haptic spatial patterns which convey pictorial information (haptic pictures). We compared verbalization in congenitally totally blind (CTB) and age-matched sighted but visually impaired (VI) children during a haptic picture naming task which included two repeated, test-retest, identifications. The children were instructed to explore 10 haptic schematic pictures of objects (e.g., cup) and body parts (e.g., face) and provide (without experimenter's feedback) their typical name. Children's explorations and verbalizations were videorecorded and transcribed into audio segments. Using the Computerized Analysis of Language (CLAN) program, we extracted several measurements from the observed verbalizations, including number of utterances and words, utterance/word duration, and exploration time. Using the Word2Vec natural language processing technique we operationalized semantic content from the relative distances between the names provided. Furthermore, we conducted an observational content analysis in which three judges categorized verbalizations according to a rating scale assessing verbalization content. Results consistently indicated across all measures that the CTB children were faster and semantically more precise than their VI counterparts in the first identification test, however, the VI children reached the same level of precision and speed as the CTB children at retest. Overall, the task was harder for the VI group. Consistent with current neuroscience literature, the prominent role of speech in CTB and VI children's data suggests that an underlying cross-modal involvement of integrated brain networks, notably associated with Broca's network, likely also influenced by Braille, could play a key role in compensatory plasticity via the mediational mechanism postulated by Luria., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: To verify the usefulness of haptic feedback in telesurgery and improve the safety of telerobotic surgery., Methods: The surgeon's console was installed at two sites (Fukuoka and Beppu; 140 km apart), and the patient cart was installed in Fukuoka. During the experiment, the surgeon was blinded to the haptic feedback levels and asked to grasp the intestinal tract in an animal model. The surgeon then performed the tasks at each location., Results: No marked differences in task accuracy or average grasping force were observed between the surgeon locations. However, the average task completion time was significantly longer, and the system usability scale (SUS) was significantly lower rating for remote operations than for local ones. No marked differences in task accuracy or task completion time were observed between the haptic feedback levels. However, with haptic feedback, the organ was grasped with a significantly weaker force than that without it. Furthermore, with haptic feedback, experienced surgeons in robotic surgery tended to perform an equivalent task with weaker grasping forces than inexperienced surgeons., Conclusion: The haptic feedback function is a tool that allows the surgeon to perform surgery with an appropriate grasping force, both on site and remotely. Improved safety is necessary in telesurgery; haptic feedback will thus be an essential technology in robotic telesurgery going forward., (© 2023. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)

Abstract: Clinical touch is the cornerstone of the doctor-patient relationship and can impact patient experience and outcomes. In the current era, driven by an ever-increasing infusion of point-of-care technologies, physical exam skills have become undervalued. Moreover, touch and hands-on skills have been difficult to teach due to inaccurate assessments and difficulty with learning transfer through observation. In this article, the authors argue that haptics, the science of touch, provides a unique opportunity to explore new pathways to facilitate touch training. Furthermore, haptics can dramatically increase the density of touch-based assessments without increasing human rater burden-essential for realizing precision assessment. The science of haptics is reviewed, including the benefits of using haptics-informed language for objective structured clinical examinations. The authors describe how haptic devices and haptic language have and can be used to facilitate learning, communication, documentation and a much-needed reinvigoration of physical examination, and touch excellence at the point of care. The synergy of haptic devices, artificial intelligence, and virtual reality environments are discussed. The authors conclude with challenges of scaling haptic technology in medical education, such as cost and translational needs, and opportunities to achieve wider adoption of this transformative approach to precision education., (Copyright © 2023 the Association of American Medical Colleges.)

Statement of Problem: A model offering anatomic replication and haptic feedback similar to that of real bone is essential for hands-on surgical dental implant training. Patient-specific skeletal models can be produced with 3-dimensional (3D) printing, but whether these models can offer optimal haptic feedback for simulating implant surgery is unknown., Purpose: The purpose of this trial was to compare the haptic feedback of different 3D printed models for simulating dental implant surgery., Material and Methods: A cone beam computed tomography image of a 60-year-old man with a partially edentulous mandible was manipulated to segment the mandible and isolated from the rest of the scan. Three-dimensional models were printed with 6 different printers and materials: material jetting-based printer (MJ, acrylic-based resin); digital light processing-based printer (DLP, acrylic-based resin); fused filament fabrication-based printer (FFF1, polycarbonate filament; FFF2, polylactic acid filament); stereolithography-based printer (SLA, acrylic-based resin); and selective laser sintering-based printer (SLS, polyamide filament). Five experienced maxillofacial surgeons performed a simulated implant surgery on the models. A 5-point Likert scale questionnaire was established to assess the haptic feedback. The Friedman test and cumulative logit models were applied to evaluate differences among the models (α=.05)., Results: The median score for drilling perception and implant insertion was highest for the MJ-based model and lowest for the SLS-based model. In relation to the drill chips, a median score of ≥3 was observed for all models. The score for corticotrabecular transition was highest for the MJ-based model and lowest for the FFF2-based model. Overall, the MJ-based model offered the highest score compared with the other models., Conclusions: The 3D printed model with MJ technology and acrylic-based resin provided the best haptic feedback for performing implant surgery. However, none of the models were able to completely replicate the haptic perception of real bone., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Trams are experiencing a resurgence with worldwide network expansion driven by the need for sustainable and efficient cities. Trams often operate in shared or mixed-traffic environments, which raise safety concerns, particularly in hazardous situations. This paper adopts an international, mixed-methods approach, conducted through two interconnected studies in Melbourne (Australia) and Birmingham (UK). The first study involved qualitative interviews, while the second was an experimental study involving a virtual reality (VR) simulator and haptic master controller (i.e., speed lever). In tram operations, master controllers play a critical role in ensuring a smooth ride, which directly influences passenger safety and comfort. The objective was to understand how a master control system, enhanced with additional haptic feedback, could improve tram driver braking performance and perceptions in safety-critical scenarios. Interview results indicate that the use of the emergency brake is considered the final or ultimate choice by drivers, and their driving experience is a moderating factor in limiting its application. Combined with the experimental results, this paper highlights how implementing haptic feedback within a master controller can reduce the performance disparity between novice and experienced tram drivers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To evaluate the influence of a capsular tension ring (CTR) on rotational stability, decentration, tilt, and axial stability of an 11.0-mm plate haptic intraocular lens (IOL)., Design: Intraindividual, randomized, double-masked, controlled clinical trial., Participants: Patients scheduled for sequential same-day bilateral cataract surgery., Methods: All patients were randomized to receive a CTR and a plate haptic IOL in one eye and a plate haptic IOL in the fellow eye only. Intraocular lens axis assessment was performed at the end of surgery, 1 hour, 1 week, 1 month, and 6 months using a high-precision evaluation method. Decentration and tilt of the crystalline and pseudophakic lenses were assessed before surgery and at 1 week and 6 months using an anterior segment OCT., Main Outcome Measures: Rotational stability from the end of surgery to 6 months and at all follow-up visits, decentration and tilt at 6 months, and differences in axial shift between 1 week and 6 months., Results: One hundred thirty eyes of 65 patients were included in the study. Absolute rotation from the end of surgery to 6 months was 2.8 ± 3.9° and 3.2 ± 5.3° for the CTR and control groups, respectively (P = 0.613). Intraocular lens decentration and IOL tilt at 6 months were 0.29 ± 0.1 mm and 0.24 ± 0.1 mm and 6.7 ± 2.8° and 5.6 ± 1.6° for the CTR and control groups, respectively (P = 0.058; P < 0.01). A posterior IOL shift of 0.31 ± 0.31 mm and 0.19 ± 0.14 mm was observed in the CTR and control groups, respectively., Conclusions: Concomitant implantation of a CTR and a plate haptic IOL did not improve the overall rotational stability of the IOL compared with the control group. Against expectations, higher values of decentration, tilt, and axial shift were observed in the CTR group. The simultaneous use of a CTR and a plate haptic IOL in the absence of zonular weakness at the time of cataract surgery should be considered with caution., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Introduction: Endotracheal intubation (ETI) is a procedure that varies in difficulty because of patient characteristics and clinical conditions. Existing physical simulators do not encompass these variations. The Virtual Airway Skills Trainer for Endotracheal Intubation (VAST-ETI) was developed to provide different patient characteristics and high-fidelity haptic feedback to improve training., Methods: We demonstrate the effectiveness of VAST-ETI as a training and evaluation tool for ETI. Construct validation was evaluated by scoring the performance of experts ( N = 15) and novices ( N = 15) on the simulator to ensure its ability to distinguish technical proficiency. Convergent and predictive validity were evaluated by performing a learning curve study, in which a group of novices ( N = 7) were trained for 2 weeks using VAST-ETI and then compared with a control group ( N = 9)., Results: The VAST-ETI was able to distinguish between expert and novice based on mean simulator scores ( t [88] = -6.61, P < 0.0005). When used during repeated practice, individuals demonstrated a significant increase in their score on VAST-ETI over the learning period ( F [11,220] = 7206, P < 0.001); however when compared with a control group, there was not a significant interaction effect on the simulator score. There was a significant difference between the simulator-trained and control groups ( t [12.85] = -2.258, P = 0.042) when tested in the operating room., Conclusions: Our results demonstrate the effectiveness of virtual simulation with haptic feedback for assessing performance and training of ETI. The simulator was not able to differentiate performance between more experienced trainees and experts because of limits in simulator difficulty., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Society for Simulation in Healthcare.)

Purpose: To compare the visual outcomes and complication rates between the extra-ocular needle-guided haptic insertion technique (XNIT) and the conventional handshake (HS) technique of scleral fixation intra-ocular lens (SFIOL)., Methods: In this retrospective study, we retrieved data of those patients who had undergone SFIOL surgery from January 2018 to May 2022 at our institute for aphakia following either a complicated cataract surgery or an ocular trauma and had a minimum follow-up of 3 months., Results: Of the 156 eyes, the HS technique was done in 80 eyes and the remaining 76 eyes with XNIT. At 3 months follow-up visit, there was no significant difference in the median best corrected visual acuity (BCVA) ( P = 0.988) and uncorrected visual acuity (UCVA) ( P = 0.765) between the two techniques. There was no statistically significant difference between pre-operative median BCVA and post-operative UCVA in XNIT ( P = 0.961) and the HS technique ( P = 0.831) at 3 months follow-up visit. The complication rates between the two techniques were minimal and comparable. The most common post-operative complication was corneal edema. The incidence of cystoid macular edema was slightly more in the XNIT group but not statistically significant ( P = 0.05). Two patients in the HS group developed retinal detachment, which settled after repeat surgery., Conclusion: The newer XNIT technique was found to be as safe and effective as compared to the conventional HS technique., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

There has been a significant increase in robot-assisted dental procedures in the past decade, particularly in the area of robot-assisted implant placement. The objective of this case report was to assess the initial use of the Yomi Robot's assistance and haptic guidance during endodontic microsurgery. The robot was used during the osteotomy and root-end resection of the first and second upper left premolars. The report aims to inform clinicians of the initial implementation of this cutting-edge technology in endodontics and its potential to enhance endodontic microsurgery. The Yomi Robot was used in performing osteotomy and root-end resection during apical surgery in a patient presenting with symptomatic upper left first and second premolars. The treatment procedure was decided after clinical examination, chart data, and radiographic examinations, which showed periapical lesions on both premolars, taking into consideration the failed endodontic retreatment on the first premolar, the post and ceramic coronal restorations on both teeth, and the desire of the patient to save them. The Yomi Robot system provides auditory, visual, and physical guidance to clinicians during surgery while using a cone-beam computed tomography scan for precision planning with greater accuracy and minimized potential for human error. Further studies are needed to prepare a protocol for robotic-guided procedures in endodontics., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: A human steering model for teleoperated driving is extended to capture the human steering behavior in haptic shared control of autonomy-enabled Unmanned Ground Vehicles (UGVs)., Background: Prior studies presented human steering models for teleoperation of a passenger-sized Unmanned Ground Vehicle, where a human is fully in charge of driving. However, these models are not applicable when a human needs to interact with autonomy in haptic shared control of autonomy-enabled UGVs. How a human operator reacts to the presence of autonomy needs to be studied and mathematically encapsulated in a module to capture the collaboration between human and autonomy., Method: Human subject tests are conducted to collect data in haptic shared control for model development and validation. The ACT-R architecture and two-point steering model used in the previous literature are adopted to predict the operator's desired steering angle. A torque conversion module is developed to convert the steering command from the ACT-R model to human torque input, thus enabling haptic shared control with autonomy. A parameterization strategy is described to find the set of model parameters that optimize the haptic shared control performance in terms of minimum average lane keeping error (ALKE)., Results: The model predicts the minimum ALKE human subjects achieve in shared control., Conclusions: The extended model can successfully predict the best haptic shared control performance as measured by ALKE., Application: This model can be used in place of human operators, enabling fully simulation-based engineering, in the development and evaluation of haptic shared control technologies for autonomy-enabled UGVs, including control negotiation strategies and autonomy capabilities.

Visual and haptic perceptions of 3D shape are plagued by distortions, which are influenced by nonvisual factors, such as gravitational vestibular signals. Whether gravity acts directly on the visual or haptic systems or at a higher, modality-independent level of information processing remains unknown. To test these hypotheses, we examined visual and haptic 3D shape perception by asking male and female human subjects to perform a "squaring" task in upright and supine postures and in microgravity. Subjects adjusted one edge of a 3D object to match the length of another in each of the three canonical reference planes, and we recorded the matching errors to obtain a characterization of the perceived 3D shape. The results show opposing, body-centered patterns of errors for visual and haptic modalities, whose amplitudes are negatively correlated, suggesting that they arise in distinct, modality-specific representations that are nevertheless linked at some level. On the other hand, weightlessness significantly modulated both visual and haptic perceptual distortions in the same way, indicating a common, modality-independent origin for gravity's effects. Overall, our findings show a link between modality-specific visual and haptic perceptual distortions and demonstrate a role of gravity-related signals on a modality-independent internal representation of the body and peripersonal 3D space used to interpret incoming sensory inputs., Competing Interests: The authors declare no competing financial interests., (Copyright © 2024 the authors.)

Purpose: To measure the dislocation forces in relation to haptic material, flange size and needle used., Setting: Hanusch Hospital, Vienna, Austria., Design: Laboratory Investigation., Methods, Main Outcome Measures: 30 G (gauge) thin wall and 27 G standard needles were used for a 2 mm tangential scleral tunnel in combination with different PVDF (polyvinylidene fluoride) and PMMA (polymethylmethacrylate haptics). Flanges were created by heating 1 mm of the haptic end, non-forceps assisted in PVDF and forceps assisted in PMMA haptics. The dislocation force was measured in non-preserved cadaver sclera using a tensiometer device., Results: PVDF flanges achieved were of a mushroom-like shape and PMMA flanges were of a conic shape. For 30 G needle tunnels the dislocation forces for PVDF and PMMA haptic flanges were 1.58 ± 0.68 N (n = 10) and 0.70 ± 0.14 N (n = 9) (p = 0.003) respectively. For 27 G needle tunnels the dislocation forces for PVDF and PMMA haptic flanges were 0.31 ± 0.35 N (n = 3) and 0.0 N (n = 4), respectively. The flange size correlated with the occurring dislocation force in experiments with 30 G needle tunnels (r = 0.92), when flanges were bigger than 384 micrometres., Conclusions: The highest dislocation forces were found for PVDF haptic flanges and their characteristic mushroom-like shape for 30 G thin wall needle scleral tunnels. Forceps assisted flange creation in PMMA haptics did not compensate the disadvantage of PMMA haptics with their characteristic conic shape flange., (© 2024. The Author(s).)

This case report presents a challenging case of catastrophic failure of a fixed partial denture involving fracture of the prosthesis as well as supporting implants and teeth. The use of robotics facilitated efficient and successful restoration of the patient's dentition. After extraction of 2 fractured teeth and 1 fractured implant, 2 new implants were placed with haptic guidance from robotics, which allowed for stable osteotomies and high initial implant stability quotients. Due to the patient's tremors and heavy occlusal forces, restoration was delayed to allow the surgical site to heal, and the patient received a provisional partial denture. With subsequent placement of the final restoration, the treatment was fully completed in 4.5 months and required only a single surgical procedure. The use of haptic robotics in this case allowed for accurate planning, spacing, and placement of screw-retained implants with an optimal arch, leading to the best long-term outcome for the patient., Competing Interests: No conflicts of interest reported.

We established a unique pre-surgical simulation method by applying interactive virtual simulation(IVS)using multi-fusion three-dimensional imaging data, presenting high-quality visualization of microsurgical anatomies. Our IVS provided a realistic environment for imitating surgical manipulations, such as dissecting bones, retracting brain tissues, and removing tumors, with tactile and kinesthetic sensations delivered through a specific haptic device. The great advantage of our IVS was in deciding the most appropriate craniotomy and bone resection to create the optimal surgical window and obtain the best working space with a thorough understanding of the lesion-bone relationship. Particularly for skull-base tumors, tailoring the procedures to individual patients for craniotomy and bone resection was sufficiently achieved using our IVS. In cases of large skull base meningiomas, our IVS was also helpful preoperatively regarding tumors, as several compartments were achievable in every potentially usable surgical direction. Additionally, the non-risky realistic microsurgical environments of the IVS provided improvement in the microsurgical senses and skills of young trainees through the repetition of surgical tasks. Finally, our presurgical IVS simulation method provided a realistic environment for practicing microsurgical procedures virtually and enabled us to ascertain the complex microsurgical anatomy, determine optimal surgical strategies, and efficiently educate neurosurgical trainees.

Purpose: To examine the risk factors for haptic malposition in eyes with implantable collamer lens (ICL)., Setting: Eye and ENT Hospital, Fudan University, Shanghai, China., Design: Prospective nonrandomized observational study., Methods: This study included 134 (77.9%) of 172 initially enrolled patients who underwent ICL implantation and completed a 1-year follow-up. The extent of haptics present in the ciliary sulcus (ICS) was measured. Patients were categorized based on ICS count (0 to 4). The position of the haptics was quantified as the distance between the iris root and the terminal tip of ICL haptics (iris root to haptic tip, IRH). The related factors to the ICS count and its correlation with the central vault were analyzed., Results: ICS distribution was 0 ICS in 19 eyes (14.2%), 1 in 22 eyes (16.4%), 2 in 32 eyes (23.9%), 3 in 29 eyes (21.6%), and 4 in 32 eyes (23.9%). Parameters like maximum ciliary body thickness (CBTmax, P = .008), iris-ciliary process distance (ICPD, P < .001), and ciliary process length ( P = .034) varied significantly across ICS groups. A multiple linear regression analysis revealed that the iris-ciliary angle ( P = .006), CBTmax ( P = .007), the distance between the sulcus-to-sulcus plane and the anterior crystalline lens surface (STSL, P = .035), and ICL size ( P = .015) were significantly associated with IRH. Spherical equivalents ( P = .042), STSL ( P = .001), and ICS count ( P = .020) significantly correlated with the central vault., Conclusions: Shortened ciliary process is a primary risk for haptic malposition. The ICS count significantly relates to the central vault., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of ASCRS and ESCRS.)

Accomplishing motor function requires multimodal information, such as visual and haptic feedback, which induces a sense of ownership (SoO) over one's own body part. In this study, we developed a visual-haptic human machine interface that combines three different types of feedback (visual, haptic, and kinesthetic) in the context of passive hand-grasping motion and aimed to generate SoO over a virtual hand. We tested two conditions, both conditions the three set of feedback were synchronous, the first condition was in-phase, and the second condition was in antiphase. In both conditions, we utilized passive visual feedback (pre-recorded video of a real hand displayed), haptic feedback (balloon inflated and deflated), and kinesthetic feedback (finger movement following the balloon curvature). To quantify the SoO, the participants' reaction time was measured in response to a sense of threat. We found that most participants had a shorter reaction time under anti-phase condition, indicating that synchronous anti-phase of the multimodal system was better than in-phase condition for inducing a SoO of the virtual hand. We conclude that stronger haptic feedback has a key role in the SoO in accordance with visual information. Because the virtual hand is closing and the high pressure from the balloon against the hand creates the sensation of grasping and closing the hand, it appeared as though the person was closing his/her hand at the perceptual level., (© 2024. The Author(s).)

Objective: This study examined the interaction of gait-synchronized vibrotactile cues with an active ankle exoskeleton that provides plantarflexion assistance., Background: An exoskeleton that augments gait may support collaboration through feedback to the user about the state of the exoskeleton or characteristics of the task., Methods: Participants ( N = 16) were provided combinations of torque assistance and vibrotactile cues at pre-specified time points in late swing and early stance while walking on a self-paced treadmill. Participants were either given explicit instructions ( N = 8) or were allowed to freely interpret (N=8) how to coordinate with cues., Results: For the free interpretation group, the data support an 8% increase in stride length and 14% increase in speed with exoskeleton torque across cue timing, as well as a 5% increase in stride length and 7% increase in speed with only vibrotactile cues. When given explicit instructions, participants modulated speed according to cue timing-increasing speed by 17% at cues in late swing and decreasing speed 11% at cues in early stance compared to no cue when exoskeleton torque was off. When torque was on, participants with explicit instructions had reduced changes in speed., Conclusion: These findings support that the presence of torque mitigates how cues were used and highlights the importance of explicit instructions for haptic cuing. Interpreting cues while walking with an exoskeleton may increase cognitive load, influencing overall human-exoskeleton performance for novice users., Application: Interactions between haptic feedback and exoskeleton use during gait can inform future feedback designs to support coordination between users and exoskeletons.

Taking a motor planning perspective, this study investigates whether haptic force cues displayed on the steering wheel are more effective than visual cues in signaling the direction of an upcoming lane change. Licensed drivers drove in a fixed-base driving simulator equipped with an active steering system for realistic force feedback. They were instructed to make lane changes upon registering a directional cue. Cues were delivered according to the movement precuing technique employing a pair of precues and imperative cues which could be either visual, haptic, or crossmodal (a visual precue with a haptic imperative cue, and vice versa). The main dependent variable was response time. Additional analyses were conducted on steering wheel angle profiles and the rate of initial steering errors. Conditions with a haptic imperative cue produced considerably faster responses than conditions with a visual imperative cue, irrespective of the precue modality. Valid and invalid precues produced the typical gains and costs, with one exception. There appeared to be little cost in response time or initial steering errors associated with invalid cueing when both cues were haptic. The results are consistent with the hypothesis that imperative haptic cues facilitate action selection while visual stimuli require additional time-consuming cognitive processing., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To study the effect of astigmatism correction, rotational stability, and related factors of two different haptic type toric intraocular lenses., Methods: A prospective, randomized, controlled trial. Cataract patients with preoperative corneal astigmatism of > 1 D were randomly implanted with C-loop haptic toric IOL (AcrySof-toric IOL) (group A) or plate-haptic toric IOL (AT TORBI 709 M IOL) (group B). The residual astigmatism, intraocular lens rotation, and visual quality were determined and compared between the two groups at 3 months after surgery., Results: Seventy-nine eyes were included in this study, including 40 eyes in the group A and 39 eyes in the group B. No significant difference in preoperative visual acuity, intraocular pressure, and ophthalmic biological parameters was found between the two groups. There was no significant difference in residual astigmatism between the two groups at 3 months after surgery (P > 0.05). The rotation degree in the group A was 3.85 ± 2.92°, the rotation degree in the group B was 2.33 ± 2.31°, and a significant difference in intraocular lens rotation was identified between the two groups (P < 0.05). Upon exploring the rotation-related factors of the two different haptic type toric intraocular lenses, the rotation after implanting C-loop haptic toric IOL was positively correlated with axial length (Pearson r = 0.522, P = 0.01) and corneal white-to-white distance (Pearson correlation analysis r = 0.356, P = 0.024)., Conclusions: The two different haptic type toric intraocular lenses effectively corrected regular corneal astigmatism and provided a good rotational stability after surgery. But the stability of plate-haptic toric IOL was better than that of C-loop haptic toric IOL. The rotational stability of C-loop haptic toric IOL was often related to axial length and corneal white-to-white distance., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To determine the accuracy of dental implant placement using haptic robotic guidance in a large clinical series., Materials and Methods: In a prospective single-arm clinical study, 108 patients received 273 individual endosteal implants. A virtual preoperative restorative and surgical plan was created from a CBCT scan and matched to the surgical workspace on the day of surgery via either a tooth-based or bone-based fiducial splint. Intraoperatively, the surgeon manipulated a handpiece attached to a haptic robotic guidance arm. A variety of drills and implants were used. Both the osteotomy and the implant placement were guided by 3D haptic constraints according to the virtual plan. Postoperative CBCT scans permitted the calculation of the actual implant placement deviations compared to the plan for accuracy. Precision was calculated by comparing SDs from published literature., Results: The implants were evenly distributed by arch, with 47% placed in the maxilla and 53% in the mandible. The mean ± SD signed depth deviation was 0.14 ± 0.87 mm proud. The global angular deviation averaged 1.42 ± 1.53 degrees, with 95% confidence limits of 1.24 and 1.60 degrees. The crown of the actual placed implant showed an average deviation from the plan of 1.10 ± 0.69 mm and the apex of the placed implant showed a deviation of 1.12 ± 0.69 mm. Haptic robotic guidance showed greater precision than freehand, static computerguided, and dynamic computer-guided implant placement., Conclusions: This large clinical series of 273 implants shows a high accuracy of implant placement compared to the published accuracy for angular deviations for any technology, as well as demonstrating statistically greater precision. Long-term clinical studies are necessary to establish the true effect of increased accuracy on clinical outcomes. Using haptic robotic guidance provides accurate implant placement while allowing additional benefits compared to computer-guided surgery, namely full visualization of the surgical field and the ability to change the plan intraoperatively.

Purpose: Report and compare long-term outcomes and complications of sutureless scleral tunnel (SST) and flanged haptic (FH) scleral-fixated intraocular lens, with spontaneous intraocular lens (IOL) dislocation as primary outcome measure., Methods: Retrospective single-surgeon case series of 95 SST and 458 FH eyes from 2011 to 2022 (553 total eyes). Demographics, surgical indications, ocular history, visual acuity, and complication rates were collected., Results: Reoperation-requiring spontaneous IOL dislocation rate was significantly different ( P = 0.0167) between FH (3.7%) and SST (10.5%). Mean follow-up was 3.31 ± 0.30 versus 1.58 ± 0.07 years for SST and FH, respectively. There was no significant difference between preoperative (20/305 vs. 20/300) or final postoperative (20/77 vs. 20/62) visual acuity. Other complications included any cystoid macular edema (20.0% vs. 25.3%), elevated intraocular pressure (16.8% vs. 9.6%), IOL tilt requiring reoperation (5.3 vs. 0%), haptic exposure (2.1% vs. 3.3%), and reverse pupillary block (4.2% vs. 1.1%)., Conclusion: Haptic flanging resulted in fewer eyes meeting the primary end point of IOL dislocation. We reported the longest-to-date follow-up of both nonflanged SST IOL fixation and our FH-modified Yamane technique. Our FH-modified Yamane technique represents a safe, durable, and potentially superior option for scleral-fixated intraocular lens.

To evaluate a novel technique for six-point scleral fixation of a three-looped haptics posterior chamber intraocular lens (PCIOL) by a single suture. Nine eyes of nine patients were studied from September 2021 to March 2023. All patients had undergone vitrectomy. Only a single 9-0 polypropylene suture was used for scleral fixation. The three looped haptics were fixed at 12, 4, and 8 o'clock with six-point scleral fixation. The entire procedure took about 30 min. Among the nine patients, eight (88.8%) eyes had a significant improvement in best-corrected visual acuity, whereas one (11.2%) eye showed no change. No intraoperative or postoperative complications were observed. By ultrasonic biomicroscopy examination, intraocular lenses were well positioned and stable with no tilt in the horizontal and vertical axis. The method of six-point scleral fixation of a three-looped haptics PCIOL by a single suture is safe and effective., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: This study aimed to determine the influence of decentration, rotation, and tilt on objective optical quality of plate haptic toric intraocular lenses (tIOLs)., Methods: The area ratio of modulation transfer function (MTF), strehl ratio of point spread function (PSF), and higher order aberrations (HOAs) for 3 mm and 5 mm pupil diameter (PD) were evaluated at postoperative 1 month. The retroillumination images pictured by OPD-scan III were used to quantify the degree of decentration and rotation, whereas the tIOL tilt was directly obtained by the tilt aberration. Patients were separated into two subgroups based on tIOL misalignment cutoff values., Results: There were 29 eyes (24 patients) in the study. The decentration of more than 0.25 mm did not substantially differ from those less than or equal to 0.25 mm. PSF of 3 mm PD and MTF, intraocular HOAs, and trefoil aberration for 3 mm and 5 mm PD significantly deteriorated with a rotation of more than 3 degrees, whereas only intraocular HOAs for 5 mm PD and coma for 3 mm and 5 mm PD were significantly severe with a tilt of more than 0.1 µm and 0.25 µm in corresponding PD. Furthermore, tIOL rotation and tilt were highly correlated with intraocular trefoil aberration and coma, respectively., Conclusions: The decentration of the monofocal bitoric IOLs is more tolerant to optical quality degradation after 1 month of surgery but more sensitive to intraocular trefoil aberration caused by rotation and coma aberration induced by tilt., Translational Relevance: As far as we know, this is the first study to investigate the relationship between the plate haptic bitoric IOL misalignment and objective optical quality measured by OPD-scan III in the real world, which may provide reference information for IOL selection to improve surgical outcomes.

Cross-sectioning is a shape understanding task where the participants must infer and interpret the spatial features of three-dimensional (3D) solids by depicting their internal two-dimensional (2D) arrangement. An increasing body of research provides evidence of the crucial role of sensorimotor experience in acquiring these complex geometrical concepts. Here, we focused on how cross-sectioning ability emerges in young children and the influence of multisensory visuo-haptic experience in geometrical learning through two experiments. In Experiment 1, we compared the 3D printed version of the Santa Barbara Solids Test (SBST) with its classical paper version; in Experiment 2, we contrasted the children's performance in the SBST before and after the visual or visuo-haptic experience. In Experiment 1, we did not identify an advantage in visualizing 3D shapes over the classical 2D paper test. In contrast, in Experiment 2, we found that children who had the experience of a combination of visual and tactile information during the exploration phase improved their performance in the SBST compared with children who were limited to visual exploration. Our study demonstrates how practicing novel multisensory strategies improves children's understanding of complex geometrical concepts. This outcome highlights the importance of introducing multisensory experience in educational training and the need to make way for developing new technologies that could improve learning abilities in children., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Robotic surgery started nearly 30 years ago. It has achieved telepresence and the performance of repetitive, precise, and accurate tasks. The "master-slave" robotic system allows control of manipulators by surgeon at distant site. Robotic surgical fingers were developed to allow surgeons to move them with accuracy through sensors fixed on surgeon's hand. Also, haptic sensors were developed to allow transmission of sensation from robotic finger to surgeon's finger. A complete system of a, 3D printed by a stereolithography (SLA) 3D printer, robotic surgical finger with haptic feedback system is proposed. The developed system includes a master glove that controls the motion of a 3DOF robotic slave finger while getting haptic feedback of force/pressure exerted on it. The precise control of the slave robotic finger was achieved by applying a Proportional Integral and Derivative (PID), fast and robust, control algorithm using an Arduino based hardware and software module. The individual joint angles, metacarpophalangeal joint (MCP) and proximal interphalangeal joint (PIP), and wrist were measured using rotatory and inertial sensors respectively. The degree of movement for MCP, PIP, and Wrist joints were measured to be 0-86°, 0-71°, and 0-89° respectively. Motion to the robotic finger is mimicked by a glove motion requiring minimal learning curve for the device. The collected data for the slave motion is in good agreement with the master-glove motion data. The vibro-tactile haptic feedback system was developed to distinguish between three different materials to mimic human flesh, tumor, and bone. The master-slave system using robotic surgical finger with good simultaneous movement to surgeon's finger and good haptic sensation will provide the surgeon with the opportunity to perform finger dissection in laparoscopic and robotic surgery, as it used to be in open surgery. 3D bio printing will make this process even cheaper with the added advantage of making surgical tools locally according to the need of the surgery. An ongoing work is to develop silicone based 8 mm robotic surgical finger with multiple type haptic feedback., (© 2024. The Author(s).)

Future exploitation of marine resources in a sustainable and eco-friendly way requires autonomous underwater robotics with human-like perception. However, the development of such intelligent robots is now impeded by the lack of adequate underwater haptic sensing technology. Inspired by the populational coding strategy of the human tactile system, we harness the giant magnetoelasticity in soft polymer systems as an innovative platform technology to construct a multimodal underwater robotic skin for marine object recognition with intrinsic waterproofness and a simple configuration. The bioinspired magnetoelastic artificial skin enables multiplexed tactile modality in each single taxel and obtains an impressive classification rate of 95% in identifying seven types of marine creatures and marine litter. By introducing another degree of freedom in underwater haptic sensing, this work represents a milestone toward sustainable marine resource exploitation.

Adapting to particular features of a haptic shape, for example, the slant of a surface, affects how a subsequently touched shape is perceived (aftereffect). Previous studies showed that this adaptation is largely based on our proprioceptive sense of hand posture, yet the influence of vision on haptic shape adaptation has been relatively unexplored. Here, using a slant-adaptation paradigm, we investigated whether visual information affects haptic adaptation and, if so, how. To this end, we varied the available visual cues during the adaptation period. This process ranged from providing visual information only about the slant of the surface, or the reference frame in which it is presented, to only providing visual information about the location of the fingertips. Additionally, we tested several combinations of these visual cues. We show that, as soon as the visual information can be used as a spatial reference to link the own fingertip position to the surface slant, haptic adaptation is very much reduced. This result means that, under these viewing conditions, vision dominates touch and is one reason why we do not easily adapt to haptic shape in our daily life, because we usually have visual information about both hand and object available simultaneously.

Sliding a tool across a surface generates rich sensations that can be analyzed to recognize what is being touched. However, the optimal configuration for capturing these signals is yet unclear. To bridge this gap, we consider haptic-auditory data as a human explores surfaces with different steel tools, including accelerations of the tool and finger, force and torque applied to the surface, and contact sounds. Our classification pipeline uses the maximum mean discrepancy (MMD) to quantify differences in data distributions in a high-dimensional space for inference. With recordings from three hemispherical tool diameters and ten diverse surfaces, we conducted two degradation studies by decreasing sensing bandwidth and increasing added noise. We evaluate the haptic-auditory recognition performance achieved with the MMD to compare newly gathered data to each surface in our known library. The results indicate that acceleration signals alone have great potential for high-accuracy surface recognition and are robust against noise contamination. The optimal accelerometer bandwidth exceeds 1000 Hz, suggesting that useful vibrotactile information extends beyond human perception range. Finally, smaller tool tips generate contact vibrations with better noise robustness. The provided sensing guidelines may enable superhuman performance in portable surface recognition, which could benefit quality control, material documentation, and robotics.

Many recent games, such as racing and flight games, open their game telemetry data to users by storing them in the local memory. Such telemetry data can provide useful information for haptic rendering, and this advantage has been exploited by the industry. This approach applies to any applications that export telemetry data in run time. The haptic rendering module operates as a separate process that accesses the telemetry data in parallel with the application. It is simple, efficient, and modular while retaining the application intact. We examine the approach's viability for user experience improvement by developing three telemetry-based haptic rendering algorithms for car racing games. They express the car engine response, collisions with external objects, and the road surface texture, respectively. Building a haptics-enabled driving platform, we conducted a user study comparing gaming experiences between our telemetry-based algorithms and conventional sound-to-tactile conversion algorithms. The results showed that the telemetry-based effects elicited better experiences than the sound-based effects.

In this paper, we explore the effects of multimodal haptic feedback combining vibrotactile and electrical muscle stimulation (EMS) on expressing virtual collisions. We first present a wearable multimodal haptic device capable of generating both mechanical vibration and EMS stimuli. The two types of haptic stimulus are combined into a haptic rendering method that conveys improved virtual collision sensations. This multimodal rendering method highlights the strengths of each modality while compensating for mutual weaknesses. The multimodal rendering method is compared in subjective quality with two unimodal methods (vibration only and EMS only) by a user study. Experimental results demonstrate that our multimodal feedback method can elicit more realistic, enjoyable, expressive, and preferable user experiences.

Objective: This article presents two haptic guidance systems designed to help a clinician keep an ultrasound probe steady when completing ultrasound-assisted needle insertion tasks. These procedures demand spatial reasoning and hand-eye coordination because the clinician must align a needle with the ultrasound probe and extrapolate the needle trajectory using only a 2D ultrasound image. Past research has shown that visual guidance helps the clinician align the needle, but does not help the clinician keep the ultrasound probe steady, sometimes resulting in a failed procedure., Methods: We created two separate haptic guidance systems to provide feedback if the user tilts the ultrasound probe away from the desired setpoint using (1) vibrotactile stimulation provided by a voice coil motor or (2) distributed tactile pressure provided by a pneumatic mechanism., Results: Both systems significantly reduced probe deviation and correction time to errors during a needle insertion task. We also tested the two feedback systems in a more clinically relevant setup and showed that the perceptibility of the feedback was not affected by the addition of a sterile bag placed over the actuators and gloves worn by the user., Conclusion: These studies show that both types of haptic feedback are promising for helping the user keep the ultrasound probe steady during ultrasound-assisted needle insertion tasks. Survey results indicated that users preferred the pneumatic system over the vibrotactile system., Significance: Haptic feedback may improve user performance in ultrasound-based needle-insertion procedures and shows promise in training for needle-insertion tasks and other medical procedures where guidance is required.

Some interactions in virtual environments need to be operated on inclined planes. If a real inclined plane can be found in the real environment that corresponds exactly to the angle of the virtual inclined plane to provide haptic feedback, the user's immersion can be enhanced. However, it is not easy to find such a real inclined plane in the real environment. We proposed a horizontal plane haptic redirection scheme, where users interacting with virtual inclined planes in virtual environments can obtain haptic feelings by using real horizontal planes that are easily available in the real world for redirection mapping. We also designed an integrated solution to locate the real horizontal plane and for haptic redirection based on the Vive Pro headset. Then we measured the angle and size thresholds for horizontal plane haptic redirection as 20° and 88%, respectively, through a user study. Through experiments, we also found that when the degree of redirection exceeded the threshold, the user's operation efficiency would be significantly reduced. In addition, we compared the horizontal plane haptic redirection scheme with the scheme without redirection and the scheme without haptic feedback to demonstrate the validity and necessity of the redirection scheme proposed in this paper.

The Time Domain Passivity Approach (TDPA) has been accepted as one of least conservative tools for designing stabilizing controllers in haptics and teleoperation, but it still suffers from conservatism because it is based on passivity. Additionally, high-frequency, immediate control actions lead to a degradation of transparency. In this paper, we propose a method to relax the conservatism of haptic interaction and enhance stable impedance range while maintaining high transparency. Based on the observation of energy exchange behavior in pressing and releasing paths in haptic interaction, we introduce an energy cycle as a completion of a pressing and releasing path. With this new concept, we compare the energies at the end of each energy cycle to estimate the energy generation and inject adaptive damping to regulate it over upcoming cycles. Because we wait a pressing-releasing cycle is completed, we allow energy to be generated, but we regulate the amount of generated energy over upcoming cycles by injecting adaptive damping. In this way, we perform low-frequency control actions on system dynamics. These in turn enable us to achieve high transparency. We show the validity of the proposed approach through several simulations and experiments, and show that it enhances the stable impedance range and transparency compared to the TDPA.

Although medical simulators have benefited from the use of haptics and virtual reality (VR) for decades, the former has become the bottleneck in producing a low-cost, compact, and accurate training experience. This is particularly the case for the inferior alveolar nerve block (IANB) procedure in dentistry, which is one of the most difficult motor skills to acquire. As existing works are still oversimplified or overcomplicated for practical deployment, we introduce an origami-based haptic syringe interface for IANB local anesthesia training. By harnessing the versatile mechanical tunability of the Kresling origami pattern, our interface simulated the tactile experience of the plunger while injecting the anesthetic solution. We present the design, development, and characterization process, as well as a preliminary usability study. The force profile generated by the syringe interface is perceptually similar with that of the Carpule syringe. The usability study suggests that the haptic syringe significantly improves the IANB training simulation and its potential to be utilized in several other medical training/simulation applications.

Model-Mediated Teleoperation (MMT) between a haptic device and a remote or virtual environment uses a local model of the environment to compensate for latency of communication. MMT is often case-specific, and requires underlying latency distributions to be known. We propose a novel approach - which we refer to as the DelayRIM - which uses the time-stepping aspect of a Reduced Interface Model for the environment to render an up-to-date force to the haptic device from the delayed information. RIM is applicable to any physical or virtual system, and the DelayRIM itself makes no underlying assumption about the latency distribution. We show that for realistic variable delays, the DelayRIM improves transparency compared to other methods for a virtual drone bilateral teleoperation scenario.

Enhancing human user performance in some complex task is an important research question in many domains from skilled manufacturing to rehabilitation and surgical training. Many examples in the literature explore the effects of both haptic assistance or guidance to complete a task, as well as haptic hindrance to temporarily increase task difficulty for the ultimate goal of faster learning. Studies also suggest adaptively changing guidance based on expertise may be most effective. However, to our knowledge, there has not yet been a conclusive study evaluating these enhancement modes in a systematic experiment. In this article, we evaluate learning outcomes for 24 human subjects in a randomized control trial performing a Fitt's law reaching task under various haptic feedback conditions including: no haptics, assistive haptics, resistive haptics, and adaptively changing haptics tied to current performance measures. Subjects each performed 400 trials total and this paper reports results for 40 pre-test and 40 post-test trials. While most conditions did show improvements in performance, we found statistically significant results indicating that our adaptive haptic feedback condition leads to faster and more effective learning as evidenced by metrics of movement time, overshoot, performance index, and speed when compared to the other groups.

Aim: To compare the implant accuracy, safety and morbidity between robot-assisted and freehand dental implant placement., Materials and Methods: Subjects requiring single-site dental implant placement were recruited. Patients were randomly allocated to freehand implant placement and robot-assisted implant placement. Differences in positional accuracy of the implant, surgical morbidity and complications were assessed. The significance of intergroup differences was tested with an intention-to-treat analysis and a per-protocol (PP) analysis (excluding one patient due to calibration error)., Results: Twenty patients (with a median age of 37, 13 female) were included. One subject assigned to the robotic arm was excluded from the PP analysis because of a large calibration error due to the dislodgement of the index. For robot-assisted and freehand implant placement, with the PP analysis, the median (25th-75th percentile) platform global deviation, apex global deviation and angular deviation were 1.23 (0.9-1.4) mm/1.9 (1.2-2.3) mm (p = .03, the Mann-Whitney U-test), 1.40 (1.1-1.6) mm/2.1 (1.7-3.9) mm (p < .01) and 3.0 (0.9-6.0)°/6.7 (2.2-13.9)° (p = .08), respectively. Both methods showed limited damage to the alveolar ridge and had similar peri- and post-operative morbidity and safety., Conclusions: Robot-assisted implant placement enabled greater positional accuracy of the implant compared to freehand placement in this pilot trial. The robotic system should be further developed to simplify surgical procedures and improve accuracy and be validated in properly sized trials assessing the full spectrum of relevant outcomes., (© 2023 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)