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Objective. Evoked tactile sensation (ETS) elicited by transcutaneous electrical nerve stimulation (TENS) is promising to convey digit-specific sensory information to amputees naturally and non-invasively. Fitting ETS-based sensory feedback to amputees entails customizing coding of multiple sensory information for each stimulation site. This study was to elucidate the consistency of percepts and qualities by TENS at multiple stimulation sites in amputees retaining ETS. Approach. Five transradial amputees with ETS and fourteen able-bodied subjects participated in this study. Surface electrodes with small size (10 mm in diameter) were adopted to fit the restricted projected finger map on the forearm stump of amputees. Effects of stimulus frequency on sensory types were assessed, and the map of perceptual threshold for each sensation was characterized. Sensitivity for vibration and buzz sensations was measured using distinguishable difference in stimulus pulse width. Rapid assessments for modulation ranges of pulse width at fixed amplitude and frequency were developed for coding sensory information. Buzz sensation was demonstrated for location discrimination relating to prosthetic fingers. Main results. Vibration and buzz sensations were consistently evoked at 20 Hz and 50 Hz as dominant sensation types in all amputees and able-bodied subjects. Perceptual thresholds of different sensations followed a similar strength-duration curve relating stimulus amplitude to pulse width. The averaged distinguishable difference in pulse width was 12.84 ± 7.23 μs for vibration and 15.21 ± 6.47 μs for buzz in able-bodied subjects, and 14.91 ± 10.54 μs for vibration and 11.30 ± 3.42 μs for buzz in amputees. Buzz coding strategy enabled five amputees to discriminate contact of individual fingers with an overall accuracy of 77.85%. Significance. The consistency in perceptual qualities of dominant sensations can be exploited for coding multi-modality sensory feedback. A fast protocol of sensory coding is possible for fitting ETS-based, non-invasive sensory feedback to amputees.

Objective Resting tremor may compound the effects of bradykinesia to further prolong the initiation of voluntary movement in patients with Parkinson's disease (PD). However, the interaction between resting tremor and voluntary movements in these PD patients has not been well understood. Recently, we demonstrated that cutaneous afferents evoked by surface stimulation of superficial radial nerve can inhibit resting tremor effectively. The inhibition appears to take effect via spinal interneuronal pathways. This study evaluates how evoked cutaneous afferents would impact the performance of voluntary movements in PD subjects when tremor is inhibited. Approach Ten PD patients with tremor and eight age-matched control subjects were recruited to participate in this study. Both groups of subjects performed fast reaching movements, while cutaneous stimulation was delivered during reaching tasks on or off randomly. Kinematic performance, such as reaction time (RT), movement time (MT), and movement variability, as well as muscle synergy of tasks were evaluated and compared to assess the impact of evoked cutaneous afferents on movement performances. Main results Results indicated that the cutaneous stimulation significantly reduced RT in PD patients by 17.7%; but had an insignificant effect on RT in control subjects. Cutaneous stimulation, however, caused a significantly longer MT both in control subjects (8.6%) and in PD subjects (15.7%). Movement variability was not significantly altered in both groups of subjects by the cutaneous stimulation. Muscle synergy analysis revealed that cutaneous stimulation affected the power spectral densities (PSD) of time profiles of muscle synergies more significantly than the vector patterns of synergies in both control subjects and PD subjects. Significance These findings provide evidence that tremor increases the RT of voluntary motor control in PD patients, and demonstrate that cutaneous stimulation reduces the RT of voluntary movements significantly, in addition to suppressing tremor, yet without interrupting voluntary control of movements.