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"Ad fontes!"
Francesco Petrarca (1301–1374)
In the beginning, there was an idea: the reconstruction of the first "Iron Hand" of the Franconian imperial knight Götz von Berlichingen (1480–1562). We found that with this historical prosthesis, simple actions for daily use, such as holding a wine glass, a mobile phone, a bicycle handlebar grip, a horse’s reins, or some grapes, are possible without effort. Controlling this passive artificial hand, however, is based on the help of a healthy second hand.
Introduction: Subjects with mild to moderate hearing loss today often receive hearing aids (HA) with open-fitting (OF). In OF, direct sound reaches the eardrums with minimal damping. Due to the required processing delay in digital HA, the amplified HA sound follows some milliseconds later. This process occurs in both ears symmetrically in bilateral HA provision and is likely to have no or minor detrimental effect on binaural hearing. However, the delayed and amplified sound are only present in one ear in cases of unilateral hearing loss provided with one HA. This processing alters interaural timing differences in the resulting ear signals.
Methods: In the present study, an experiment with normal-hearing subjects to investigate speech intelligibility in noise with direct and delayed sound was performed to mimic unilateral and bilateral HA provision with OF.
Results: The outcomes reveal that these delays affect speech reception thresholds (SRT) in the unilateral OF simulation when presenting speech and noise from different spatial directions. A significant decrease in the median SRT from –18.1 to –14.7 dB SNR is observed when typical HA processing delays are applied. On the other hand, SRT was independent of the delay between direct and delayed sound in the bilateral OF simulation.
Discussion: The significant effect emphasizes the development of rapid processing algorithms for unilateral HA provision.
Subjects utilizing a cochlear implant (CI) in one ear and a hearing aid (HA) on the contralateral ear suffer from mismatches in stimulation timing due to different processing latencies of both devices. This device delay mismatch leads to a temporal mismatch in auditory nerve stimulation. Compensating for this auditory nerve stimulation mismatch by compensating for the device delay mismatch can significantly improve sound source localization accuracy. One CI manufacturer has already implemented the possibility of mismatch compensation in its current fitting software. This study investigated if this fitting parameter can be readily used in clinical settings and determined the effects of familiarization to a compensated device delay mismatch over a period of 3–4 weeks. Sound localization accuracy and speech understanding in noise were measured in eleven bimodal CI/HA users, with and without a compensation of the device delay mismatch. The results showed that sound localization bias improved to 0°, implying that the localization bias towards the CI was eliminated when the device delay mismatch was compensated. The RMS error was improved by 18% with this improvement not reaching statistical significance. The effects were acute and did not further improve after 3 weeks of familiarization. For the speech tests, spatial release from masking did not improve with a compensated mismatch. The results show that this fitting parameter can be readily used by clinicians to improve sound localization ability in bimodal users. Further, our findings suggest that subjects with poor sound localization ability benefit the most from the device delay mismatch compensation.
In this paper, a concept for an anthropomorphic replacement hand cast with silicone with an integrated sensory feedback system is presented. In order to construct the personalized replacement hand, a 3D scan of a healthy hand was used to create a 3D-printed mold using computer-aided design (CAD). To allow for movement of the index and middle fingers, a motorized orthosis was used. Information about the applied force for grasping and the degree of flexion of the fingers is registered using two pressure sensors and one bending sensor in each movable finger. To integrate the sensors and additional cavities for increased flexibility, the fingers were cast in three parts, separately from the rest of the hand. A silicone adhesive (Silpuran 4200) was examined to combine the individual parts afterwards. For this, tests with different geometries were carried out. Furthermore, different test series for the secure integration of the sensors were performed, including measurements of the registered information of the sensors. Based on these findings, skin-toned individual fingers and a replacement hand with integrated sensors were created. Using Silpuran 4200, it was possible to integrate the needed cavities and to place the sensors securely into the hand while retaining full flexion using a motorized orthosis. The measurements during different loadings and while grasping various objects proved that it is possible to realize such a sensory feedback system in a replacement hand. As a result, it can be stated that the cost-effective realization of a personalized, anthropomorphic replacement hand with an integrated sensory feedback system is possible using 3D scanning and 3D printing. By integrating smaller sensors, the risk of damaging the sensors through movement could be decreased.
Note: In lieu of an abstract, this is an excerpt from the first page.
Recently, we reported the three-dimensional computer-aided design (3D-CAD) reconstruction of the first “Iron Hand” of the famous Franconian knight, Götz von Berlichingen (1480–1562), who lost his right hand by a cannon ball splinter injury in 1504 in the War of the Succession of Landshut [...]
In asymmetric treatment of hearing loss, processing latencies of the modalities typically differ. This often alters the reference interaural time difference (ITD) (i.e., the ITD at 0° azimuth) by several milliseconds. Such changes in reference ITD have shown to influence sound source localization in bimodal listeners provided with a hearing aid (HA) in one and a cochlear implant (CI) in the contralateral ear. In this study, the effect of changes in reference ITD on speech understanding, especially spatial release from masking (SRM) in normal-hearing subjects was explored. Speech reception thresholds (SRT) were measured in ten normal-hearing subjects for reference ITDs of 0, 1.75, 3.5, 5.25 and 7 ms with spatially collocated (S0N0) and spatially separated (S0N90) sound sources. Further, the cues for separation of target and masker were manipulated to measure the effect of a reference ITD on unmasking by A) ITDs and interaural level differences (ILDs), B) ITDs only and C) ILDs only. A blind equalization-cancellation (EC) model was applied to simulate all measured conditions. SRM decreased significantly in conditions A) and B) when the reference ITD was increased: In condition A) from 8.8 dB SNR on average at 0 ms reference ITD to 4.6 dB at 7 ms, in condition B) from 5.5 dB to 1.1 dB. In condition C) no significant effect was found. These results were accurately predicted by the applied EC-model. The outcomes show that interaural processing latency differences should be considered in asymmetric treatment of hearing loss.
Patients with focal ventricular tachycardia are at risk of hemodynamic failure and if no treatment is provided the mortality rate can exceed 30%. Therefore, medical professionals must be adequately trained in the management of these conditions. To achieve the best treatment, the origin of the abnormality should be known, as well as the course of the disease. This study provides an opportunity to visualize various focal ventricular tachycardias using the Offenburg heart rhythm model. Modeling and simulation of focal ventricular tachycardias in the Offenburg heart rhythm model was performed using CST (Computer Simulation Technology) software from Dessault Systèms. A bundle of nerve tissue in different regions in the left and right ventricle was defined as the focus in the already existing heart rhythm model. This ultimately served as the origin of the focal excitation sites. For the simulations, the heart rhythm model was divided into a mesh consisting of 5354516 tetrahedra, which is required to calculate the electric field lines. The simulations in the Offenburg heart rhythm model were able to successfully represent the progression of focal ventricular tachycardia in the heart using measured electrical field lines. The simulation results were realized as an animated sequence of images running in real time at a frame rate of 20 frames per second. By changing the frame rate, these simulations can additionally be produced at different speeds. The Offenburg heart rhythm model allows visualization of focal ventricular arrhythmias using computer simulations.
Background: This paper presents a conceptual design for an anthropomorphic replacement hand made of silicone that integrates a sensory feedback system. In combination with a motorized orthosis, it allows performing movements and registering information on the flexion and the pressure of the fingers.
Methods: To create the replacement hand, a three-dimensional (3D) scanner was used to scan the hand of the test person. With computer-aided design (CAD), a mold was created from the hand, then 3D-printed. Bending and force sensors were attached to the mold before silicone casting to implement the sensory feedback system. To achieve a functional and anthropomorphic appearance of the replacement hand, a material analysis was carried out. In two different test series, the properties of the used silicones were analyzed regarding their mechanical properties and the manufacturing process.
Results: Individual fingers and an entire hand with integrated sensors were realized, which demonstrated in several tests that sensory feedback in such an anthropomorphic replacement hand can be realized. Nevertheless, the choice of silicone material remains an open challenge, as there is a trade-off between the hardness of the material and the maximum mechanical force of the orthosis.
Conclusion: Apart from manufacturing-related issues, it is possible to cost-effectively create a personalized, anthropomorphic replacement hand, including sensory feedback, by using 3D scanning and 3D printing techniques.
Users of a cochlear implant (CI) in one ear, who are provided with a hearing aid (HA) in the contralateral ear, so-called bimodal listeners, are typically affected by a constant and relatively large interaural time delay offset due to differences in signal processing and differences in stimulation. For HA stimulation, the cochlear travelling wave delay is added to the processing delay, while for CI stimulation, the auditory nerve fibers are stimulated directly. In case of MED-EL CI systems in combination with different HA types, the CI stimulation precedes the acoustic HA stimulation by 3 to 10 ms. A self-designed, battery-powered, portable, and programmable delay line was applied to the CI to reduce the device delay mismatch in nine bimodal listeners. We used an A-B-B-A test design and determined if sound source localization improves when the device delay mismatch is reduced by delaying the CI stimulation by the HA processing delay (τ HA ). Results revealed that every subject in our group of nine bimodal listeners benefited from the approach. The root-mean-square error of sound localization improved significantly from 52.6° to 37.9°. The signed bias also improved significantly from 25.2° to 10.5°, with positive values indicating a bias toward the CI. Furthermore, two other delay values (τ HA –1 ms and τ HA +1 ms) were applied, and with the latter value, the signed bias was further reduced in some test subjects. We conclude that sound source localization accuracy in bimodal listeners improves instantaneously and sustainably when the device delay mismatch is reduced.
Background: This paper presents a novel approach for a hand prosthesis consisting of a flexible, anthropomorphic, 3D-printed replacement hand combined with a commercially available motorized orthosis that allows gripping.
Methods: A 3D light scanner was used to produce a personalized replacement hand. The wrist of the replacement hand was printed of rigid material; the rest of the hand was printed of flexible material. A standard arm liner was used to enable the user’s arm stump to be connected to the replacement hand. With computer-aided design, two different concepts were developed for the scanned hand model: In the first concept, the replacement hand was attached to the arm liner with a screw. The second concept involved attaching with a commercially available fastening system; furthermore, a skeleton was designed that was located within the flexible part of the replacement hand.
Results: 3D-multi-material printing of the two different hands was unproblematic and inexpensive. The printed hands had approximately the weight of the real hand. When testing the replacement hands with the orthosis it was possible to prove a convincing everyday functionality. For example, it was possible to grip and lift a 1-L water bottle. In addition, a pen could be held, making writing possible.
Conclusions: This first proof-of-concept study encourages further testing with users.