Electrical stimulation of skin afferents: a method for transmitting touch
from the artificial hand to the brain
Marija Stevanović, Minja Perović, Tijana Jevtić, Ilija Jovanov, Goran Bijelić, Strahinja Došen,
Dario Farina, Čedomir Vučetić, Lana Popović-Maneski and Dejan B. Popović
Abstract— The aim of this research was to gain knowledge on
how to interface the sensors integrated into the artificial hand
and the brain. We describe the instrumentation and methods
for testing the abilities of humans to discriminate sensations
generated by electrical stimulation applied to the skin. The new
system integrates an array of 12 small concentric surface
electrodes printed on a flexible substrate and an electronic
stimulator able to independently activate one or more
electrodes within the array. We evaluated the dynamic range,
spatial acuity and perceptual quality of elicited sensations that
could be produced using this stimulation system. The electrical
charge per stimulation pulse and the pulse rate were varied in
order to detect the perception and pain thresholds, and the
range of stimulation parameters that result with comfortable
sensations. The subjects were asked to locate the point on the
skin that was stimulated and describe the quality of elicited
sensation. We found that a healthy person can distinguish up to
7 perceptual qualities, of which the most common one was
vibration, followed by tingling and tickling, with certain
sensations being more dominant in one column (axial direction)
of the multi-pad electrode compared to the others. In terms of
spatial acuity, the subjects had more difficulties in
distinguishing between the positions in axial direction compared
to radial direction. These results were used for the design of the
new electrode array that could be used in the future
multifunctional artificial hands.
I. INTRODUCTION
The motivation for this research follows one of the
important findings of the Smarthand project [1]. Robin af
Ekenstam, the first amputee who tried the robotic hand with
tactile feedback developed within the Smarthand project said.
"It's a feeling I have not had in a long time. When I grab
something tightly I can feel it in the fingertips. It's strange since I
don't have them anymore! It's amazing."
*Research supported by Tecnalia, San Sebastian, Spain, Ministry of
Education, Science and Technological Development of Serbia (Contract No:
TR35040) and the German Ministry for Education and Research (BMBF)
via the Bernstein Focus Neurotechnology (BFNT) Göttingen (Grant No.
01GQ0810)
Marija Stevanović, Minja Perović, Tijana Jevtić and Ilija Jovanov are
with the Faculty of Electrical Engineering, University of Belgrade, Serbia
Dejan B. Popović (corresponding author) is with the Faculty of Electrical
Engineering, University of Belgrade, Serbia (Phone: +381 11 3218348, Fax:
+381 11 3248681, e-mail: dbp@etf.rs)
Goran Bijelić is with the Tecnalia Serbia Ltd, Belgrade, Serbia
Strahinja Došen and Dario Farina are with the Department of
Neurorehabilitation Engineering, University Medical Center, Göttingen,
Germany
Čedomir Vučetić, M.D. is with the Medical School, University of
Belgrade and the Clinical Center of Serbia, Belgrade,
Lana Popović-Maneski is with the State University of Novi Pazar, Serbia
and the Institute of Technical Sciences of SANU, Belgrade
Robin’s words should be understood as a pointer for the
direction of research that would be accepted by the amputees.
Losing an upper limb leads to limitations in daily living
activities (e.g., eating, drinking, personal hygiene, etc.). An
upper limb prosthesis should enable an amputee to regain
hand function and thereby reintegrate into the society and
work in the simplest and fastest way. The usage of the
prosthetic hand depends on the cost-benefit ratio. More
precisely, the prosthesis must provide function that is
overcoming the burden of using the assistance at the level of
user satisfaction. Almost 50% of unilateral transradial
amputees refuse to use the prosthesis because the benefit/cost
ratio is too low. Using the stump directly as assistance to the
existing hand is in many cases effective, especially since the
stump having contact with objects provides feedback to the
user, which is not the case with the available prosthesis.
We show in Fig. 1 an example of the powered
multifunctional artificial hand which follows the development
of the Cyberhand [2,3]. This device was the heart of the
hardware within the Smarthand project [1]. The Pisa Hand is
a cybernetic anthropomorphic, bio-inspired artificial hand. Its
mechanics allow separate control of digits and the thumb and
can generate a multitude of grasps. Its sensory system
provides proprioceptive information and emulates
fundamental functional properties of human tactile
mechanoreceptors. The Pisa Hand control system is divided
in two layers: a high-level control that interprets grasp
selection (cylindrical, spherical, tridigital, and lateral grasps)
and required force level, and a low-level control responsible
for actuation of specific grasps.
Figure 1: The Pisa hand: Three grasping modalities with the five-fingered
system with multiple sensors.
The Pisa Hand was selected as the representative of
several other developments of commercial and research
prototypes of artificial hands [4-8].
At this time artificial hands do not include exteroception
or proprioception feedback to the user. More precisely, there
are currently no devices on the market or within the academic
environment that provide a successful solution for the
feedback system. The idea to close the loop is not new; it was
quite a popular research topic in 60’s and 70’s of the last sheet of adhesive, conductive gel (AG702, AmGel, Axelgaard
century [9]. Two stimulation modalities were tested most Manufacturing Co, USA) with narrow rings cut out of the gel
often: a direct mechanical stimulation using small vibration between cathodes and anodes to avoid direct contact between
motors and electrical stimulation using concentric electrodes. the anodes and cathodes.
This initial research tested the psychometric properties of the
Each electrode was connected to a stimulator through a
stimulation modalities and the general feasibility of the whole
switchboard. The stimulator generated monophasic
concept. It was shown that the closed loop can be
compensated pulses controlled online (pulse amplitude: I = 0
implemented (early prototypes), but that the simple interfaces
to 5 mA in steps of 0.1 mA, pulse rate: f = 8 to 400 pulses per
(e.g., single channel stimulation) have limited applicability.
second (pps) in steps of 8, pulse duration: T = 10 to 500 µs in
The basis of our design follows neuroscience findings. steps of 10 µs). The software controlling the stimulator was
Artificial feedback systems exploit the cortical plasticity: developed in the LabVIEW development environment.
information about the environment and state of the system
delivered in a different modality or to a different location on
the body can be understood after the training. The information
in our case is delivered via electrical stimulation. Successful
substitution of sensation will be achieved when subjects no
longer perceive the stimulation as an abstract signal but
instead as an extension of their sense of touch. We also
propose that some other sensations should play an important
role as an increment in the benefit/cost ratio. Tashiro and
Higashiyama [10] tested the quality of sensations that can be
elicited using single channel electrotactile stimulation with
Figure 2: The image of the matrix with 12 concentric electrodes (left
the electrode placed on the volar side of the wrist in the panel) and the sketch of the annotation of the fields on the matrix (right
vicinity of the ulnar nerve. As the current intensity increased, panel). (Patent pending: ELCODE project, Tecnalia, Spain).
the sensations reported by the healthy subjects shifted from
touch or pressure through prick and sting to deep pressure. In B. Procedure
a recent study [11], perceptual qualities of multichannel
electrical stimulation were investigated. The conclusions from The measurements were conducted in the Biomedical
this study (conducted on 12 healthy subjects) were that for Engineering Lab, Faculty of Electrical Engineering,
maintaining a consistent perception threshold dual-channel University of Belgrade. Ten subjects (4 males and 6 females,
simultaneous stimulation with at least five pulses should be 28.5 ± 16.5 years of age) signed the informed consent
used, and that the interleaved time between two electrodes approved by the ethical committee before the tests. Each
should be longer than 0.5 ms. These conclusions result from subject was sitting with the forearm relaxed on the desk. The
the measurements where five cathodes were positioned on the top end of the matrix was positioned on the volar side of the
forearm and the anode above the carpal tunnel. The study forearm at about 30% of the forearm length from the elbow
followed the effects of the stimulated location, the number of (Fig. 3).
active electrodes, the number of biphasic pulses, and the
interleaved time between a pair of electrodes. The results also
included the following finding: single channel stimulation
evoked touch, vibration, tingling and pinprick sensations,
while the simultaneous activation of two channels produced
most often the sensation of movement and pinprick.
The direct aim of this study was to evaluate the dynamic
range, spatial acuity and the quality of elicited sensations that
could be obtained by our system for electrical stimulation. To
be precise, the goal of the study was not to generate sensation Figure 3: The image of the matrix with 12 electrodes positioned on the
that occurs while touching by human hand, but the ability to forearm during the measurements.
discriminate new sensations, and later learn to interpret those
at the subconscious level (artificial exteroception). In the first test, the electrodes in the array were randomly
activated. The subject was asked if he/she was able to
II. MATERIALS AND METHODS distinguish which field (electrode) on the forearm was
activated and to select among the following four sensations:
very mild sensation, pleasant sensation, unpleasant sensation,
A. Instrumentation
and pain. The intensity of stimulation (pulse amplitude) at T =
A squared matrix (9 x 7.5 cm) with 4 columns 100 µs and f = 256 pps that led to a pleasant sensation was
perpendicular to the direction of the forearm and 3 rows along used in the continuation of the measurements. This pulse
the forearm was positioned on the forearm (Fig. 2). The amplitude varied between subjects from 1.5 to 3.0 mA. In the
matrix is formed by 12 small concentric electrodes (D=15 second test, the subjects were asked to associate the elicited
mm) with the anode in the center and cathode on the sensation with one of the seven modalities: 1) vibration, 2)
perimeter. This electrode was produced by Tecnalia Serbia touch, 3) pressure, 4) tingling, 5) tickling, 6) itching and 7)
Ltd, Belgrade, Serbia. The matrix was covered with a single
pinching. The analysis was done while changing the pulse Summed over all subjects, dominance of vibration was
rate and the charge per pulse (pulse duration). noticed, followed by tingling and tickling. Subjects were also
able to identify sensations of touch, itching, pressure and
III. RESULTS pinching, with itching being reported only seldom. The pie
chart in Fig. 4 shows the sensations most frequently reported
Table 1 shows the results of the second test from one for each field. This represents the occurrence of each
subject when one by one individual concentric electrodes sensation with respect to the total number of sensations.
were activated while varying the pulse duration and pulse When asked to pinpoint the location from which the stimulus
rate. As described in Methods, the subject was asked to originated, the subjects were most successful in correctly
describe the modality of sensation which he/she felt. identifying stimulation coming from the borders of the
Table 1. Sensation modalities reported by one subject for a single electrode, and particularly the ones closest to the elbow
electrode (field) activated at 3 pulse durations and 8 pulse rates. crease. This result is the pointer for the design of the new
Field 1 Pulse duration (µs) generation of electrodes to be used in this research. Fig. 5
100 200 300 shows the percent success rate in correctly locating the field
8 Pinching Vibration Tingling that has been stimulated.
Pulse 64 Vibration Vibration Tingling
rate 120 Tickling Vibration Vibration Field 1 Field 2 Field 3
(pps) 176 Tickling Itching Tingling
232 Itching Tickling Tingling 61,38 41,1 58,28
288 Itching Tingling Vibration
344 Vibration Tingling Tingling Field 4 Field 5 Field 6
400 Tingling Tingling Tingling
32,75 24 30,99
Tables were generated for all 12 electrodes over the Field 7 Field 8 Field 9
population of ten subjects. Each of the subjects reported
sensations of at least four, and up to seven different 35,17 29,07 38,9
modalities of sensation, depending on the pulse rate and the Field 10 Field 11 Field 12
site on the matrix (field position). Table 1 shows different
sensations reported for corresponding stimulation pulse 51,51 42,9 43,3
charge and rate.
Figure 5: The success rate of correctly locating the site of the stimulus.
The coloring of the fields (sites) is used to indicate the recognition rate: blue -
low, green - medium, and purple - high.

The subjects were significantly more successful in

pinpointing the origin of the stimulus when allowed to look at
the electrodes. They had more difficulties to distinguish
between the positions along the axial direction of the matrix
compared with positions along the radial direction. We have
also noticed an improvement throughout the course of the
session.

Figure 4: Most frequently reported sensations for each field over all ten
subjects. The occurrence of each sensation is colored differently and the area
represents a percent of the total number of sensations reported.
IV. DISCUSSION
The basis of the approach of using electrical stimulation
with surface electrodes to activate afferent fibers follows the
fact that the skin is the body’s largest sensory organ. It
contains free nerve endings and specialized receptors in the
three superficial layers that sense heat and cold, pain,
touch/pressure and vibratory stimuli. Somatic sensibility
coming from the skin has three major modalities:
discriminative touch (required to recognize size, texture and
shape of objects and their movement across the skin),
nociception (the signals of tissue damage or chemical
irritation typically perceived as pain or itch) and temperature
sense (warmth and cold).
Pulsed electrical stimulation applied via small cathode and
anode positioned on short distance generates low current
pulses that are activating afferent fibers. There is no rule of
thumb which fibers would be activated. In parallel, the fibers
that would normally send signals to the central nervous
system from the hand are not at the surface of the forearm;
thereby, electrical stimulation of the forearm activates
afferents that are not used for the appreciation of the grasp.
However, the brain is capable of learning if adequate training
is provided. There are numerous studies which show the
specific reorganization of the cortical areas based on the
specificity of the task (e.g., violin players [12]).
This study demonstrates the ability of distinguishing
sensations elicited as a result of electrical stimulation on the
forearm of healthy subjects, through the use of a matrix array
of concentric electrodes, with respect to the pulse charge,
pulse rate, and position of the activated electrode.
We found that there are substantial inter-subject
differences; however, it was clear that different stimulation
parameters cause different sensations that are recognizable by
all patients. The most frequently reported sensation was
vibration, followed by tingling and tickling, with certain
sensations being more dominant in one column of the multi-
pad electrode than another. Namely, the sensation of touch
was more common in column #1 (fields 1, 4, 7 and 10), the
sensation of tingling slightly more present in column #2
(fields 2, 5, 8 and 11), whereas tickling was more often
reported in column #3 (fields 3, 6, 9 and 12), and particularly
on field #12.
We also found that subjects had more difficulties to
distinguish between the positions along the column (axial
direction), which led to the conclusion that the electrode that
would be suitable for afferent stimulation should have a form
that is circular around the forearm as shown in Fig. 6.
Figure 6: The design of the new electrode for stimulation of the forearm.
Large fields are interconnected and are used as anodes and small fields are
used as cathodes.
This analysis allowed us to determine the optimal range of
stimulation parameters, within which no sensation is
described as unpleasant, and the number of sensations
distinguished was high enough to allow multi-sensation that
can be brought from sensors mounted in the prosthetic hand.
We find these results to be an encouraging step on the
path towards integration of electrical stimulation into hand
prosthetics systems with feedback.
We tested this approach in one amputee (not reported
here) and found that multi-sensation is also possible; yet, the
configuration of the electrodes need to be adapted.
Further testing is needed to determine conditions under
which patients are able to memorize and associate particular
sensations with corresponding mechanical actions.
V. CONCLUSION
In this work we investigated intensity and types of
sensations induced by electrical stimulation while we altered
parameters of stimulation: pulse charge and rate. If pulse
charge is increased, the intensity of sensation increases. The
change of parameters also provided distinguishable
difference in the quality of sensations.
After several trials during the measurements, the subjects
were able to recognize correctly the field better than at the
beginning of the session, indicating that the training period
allowed them to learn to distinguish sensations induced by
different fields. This finding suggests that the prolonged
stimulation that is associated with the specific instruction
would likely result with subconscious association of the
sensation with an event (touch, temperature vibration, etc.).
ACKNOWLEDGMENT
We would like to acknowledge the assistance from
students from the University of Belgrade who volunteered in
the tests.
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