IEEE/ASME TRANSACTIONS ON MECHATRONICS, VOL. 16, NO.

5, OCTOBER 2011

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A Wearable Real-Time Intelligent Posture Corrective

System Using Vibrotactile Feedback
Alpha Agape Gopalai, Member, IEEE, and S. M. N. Arosha Senanayake, Senior Member, IEEE

AbstractBiofeedback is known to improve postural control

and shorten rehabilitation periods among the young and elderly.
A biofeedback system communicates with the human central nervous system through a variety of feedback modalities. Vibrotactile
feedback devices are gaining attention due to their desirable characteristics and simplistic manner of presenting biofeedback. In
this study, we investigate the potential of incorporating a real-time
biofeedback system with artificial intelligence for wobble board
training, aimed at improving ankle proprioception. The designed
system utilizes vibrotactile actuators to provide forewarning for
poor postural control. The biofeedback system depended on Euler
angular measurements of trunk and wobble board displacements,
from inertial measurement units (IMUs). A fuzzy inference system was used to determine the quality of postural control, based
on IMU-acquired measurements of trunk and wobble board. The
designed system integrates: 1) two IMUs, 2) a fuzzy knowledge
base, and 3) a feedback-generation module. Tests were conducted
in eyes-open and eyes-close conditions while standing on the wobble board to assess viability of the system in providing accurate
real-time intervention. The results observed an improvement in
postural control with biofeedback intervention, demonstrating successfulness of the prototype built for improving postural control in
rehabilitative and preventive applications.
Index TermsBiofeedback, postural control, rehabilitation,
wearable sensors.

I. INTRODUCTION
OSTURAL control is the ability to maintain balance
against falls. Effective postural-control mechanisms require the use and integration of sensory inputs, such as the visual, vestibular, and somatosensory systems. The conversion of
sensory information on perturbations into appropriate balancecorrection measures is a task the central nervous system (CNS)
must rapidly initiate and accurately regulate to prevent a fall [1].
Studies show that in the absence or degradation of these sensory
inputs, poor postural control was observed [2].
Proprioception, a modality of the somatosensory system, is
responsible for detecting joint motion and position of joints [1].
Proprioception of ankles is critical to balance of the body be-

Manuscript received November 1, 2010; revised March 15, 2011; accepted

June 1, 2011. Date of publication August 1, 2011; date of current version August
30, 2011. Recommended by Guest Editor A. Mihailidis. This work was supported in part by Monash University Sunway Campus, in part by the Ministry of
Science, Technology and Innovation, Malaysia, under Grant 0302-10-SF0028
with the title Bio-Inspired Robotics Devices for Sportsman Screening Services
(BIRDSSS), and in part by Moves International Fitness, Mammoth Lakes,
CA.
The authors are with the School of Engineering, Monash University Sunway Campus, Petaling Jaya 46150, Malaysia (e-mail: alpha.agape@ieee.org;
aroshas@ieee.org).
Color versions of one or more of the figures in this paper are available online
at http://ieeexplore.ieee.org.
Digital Object Identifier 10.1109/TMECH.2011.2161486

cause they are the joints closest to the bodys base of support
(BoS) (feet) [3]. This makes the ankle an important component
for effective postural correction. Muscles and nerves at the ankle complex must function synergistically to achieve balance.
Ankle proprioception training routines have been reported to
help muscles and nerves function synergistically, reducing risks
of falls and lower extremity injuries, such as ankle sprains [4].
Wobble boards are a common and effective feature in ankle proprioception training routines [5]. Repeated ankle proprioceptive
training on wobble boards (unstable surface) have shown to reduce incidences of injuries in the lower extremity [6]. Recent
studies involving wobble board training routines reported similar improvements in postural control [4], [7].
From a clinical perspective, ankle proprioception training is
an effective intervention routine to improve postural and neuromuscular control [5]. Studies have noted that intensive massed
and repeated practices were important for an effective rehabilitation routine [8], [9]. However, with the introduction of
biofeedback, as a subsensory electrical or mechanical stimulant
to the human somatosensory system, rehabilitation periods for
improving postural control can be shortened [10].
The importance of biofeedback systems have been greatly
recognized in clinical applications [11]. Biofeedback systems
provide information about a certain task, success or failure, to
the performer. A biofeedback system typically consists of 1)
sensory device, 2) restitution device that delivers biofeedback
information, and 3) a processing unit that performs computation for feedback delivery [12]. Biofeedback systems typically
provide end users with feedback in the form of visual, auditory,
or tactile signal(s) [13]. Choice of biofeedback signals plays an
important role in ensuring its effectiveness. Biofeedback signals must convey necessary and sufficient information, which
are easily deciphered by the CNS, without creating distraction
or anxiety in the performer [11].
Simplistic manners of providing biofeedback to performers,
adopted by other studies, include visual display [14], auditory
sound [15], or tactile vibration, all of which assist in ensuring
rapid initiation of balance correction by the CNS. However,
visual and audio biofeedback systems may interfere with individuals visual and acoustic dependence for various activities
of daily living (ADL) [16]. Applications of visual and audio
biofeedback also have a limited coverage, as it is not suited
for blind or deaf individuals. Tactile biofeedback, therefore,
presents itself as a realistic and appropriate alternative to
provide augmented/compensatory sensory information for
rehabilitation and preventive applications.
Tactile feedback technology is based on the skins ability to sense and communicate tactile modality to the CNS.
There are three types of tactile modalities: 1) electrotactile, 2)

1083-4435/$26.00 2011 IEEE

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Fig. 1. (a) Principal measurement axis of wireless IMU. (b) Wobble board
[19]. (c) VFCM. (d) Vibrotactors.

thermal, and 3) vibrotactile [11]. Vibrotactile has been identified

as the safest tactile modality on human skin [12]. Vibrotactile
signals are generated using vibration actuators (vibrotactors),
which provides stimulation to the somatosensory perception.
Previous studies implementing vibrotactile feedback placed vibrotactors at the foot [2], medial lateral (ML) waist [12], [17],
anteriorposterior (AP) waist [18], and head [13], [16] for postural monitoring of quiet standing on flat ground. Simplicity of
vibrotactile feedback nature (pulses of vibrations at varying intensities) and its safety aspect make it a desirable modality for
the use in biofeedback applications.
Potential of incorporating artificial intelligence in biofeedback systems, with a wobble board routine for ankle proprioception training, has not yet been considered. The main objective
of the study is to integrate an intelligent vibrotactile biofeedback
system with wobble board training for ankle proprioception rehabilitation and conditioning. This work utilizes two wireless
inertial measurement units (IMUs) to monitor subjects posture
about the trunk and BoS. Measurements from the IMUs were
used as inputs to a fuzzy inference system (FIS) to determine
the appropriate vibrotactile feedback level. Two vibrotactors,
attached to the waist, were used to provide vibrotactile feedback to the performer, for the anterior and posterior directions,
respectively. The vibrotactile biofeedback served as a forewarning device, informing the performer of detected violations along
the monitored plane.
II. SYSTEM HARDWARE
Fig. 2 illustrates the process flow of data within the system and
how it communicates with the corresponding hardware shown
in Fig. 1. Communication between elements of hardware is
handled using a common programming platform.
A. Inertial Measurement Unit
The IMUs used were MicroStrains wireless Inertial-Link
sensors [see Fig. 1(a)]. Dimensions of the IMUs are 41 mm
63 mm 24 mm and weigh 39 g. Size and weight of the

Fig. 2.

Process flow of data and its interaction with the hardware.

IMUs made them suitable for wearable applications, because

it does not impair natural movement. IMUs are devices that
consist of triaxial accelerometers, triaxial gyroscopes, and an
on-board processor with sensor fusion algorithms. This device
has a resolution of 0.1 and supports 360 measurement of
orientation range over all axes. The measurement axis of IMUs
consisted of roll, pitch, and yaw [see Fig. 1(a)]. The IMUs
were configured to stream angular (Euler) displacement in real
time at a digitization rate of 100 Hz. The obtained readings
were accurate along the roll and pitch axes. However, the yaw
measurements, which drifted over time were discarded.
B. Wobble Board
The wobble board used was the BOSU Balance Trainer [see
Fig. 1(b)]. The BOSU is a proprioception and core stability
training device [7] and has two functional surfaces that can act
as base. The base configuration used in this study, a convex
base, provided an unstable surface to stand on. The flat side
of the surface on which subjects stood measured 635 mm in
diameter. The BOSU had a variable height that depended on
the amount of air in its inflatable chamber. The alternative base
configuration is a concave base.
Direction and degree of perturbation experienced by subjects were dependent on the direction and degree of body sway
(perturbations were self-inflicted). The balance trainer tilted in
the direction of the net force acting on balance trainers surface. Self-inflicted perturbations reduce habituation effects by
diminishing predictability of upcoming perturbation directions.
The balance trainer allowed 40 of tilt along the AP and ML
planes. The BOSU Balance Trainer was used because it allowed
for investigations of 1) immediate defensive postural reaction
and 2) adaptation of postural-control mechanisms using ankle
proprioception with and without biofeedback.

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TABLE I
PWM DUTY CYCLES USED FOR VARYING FEEDBACK LEVELS

Fig. 3.

Flow of vibrotactile feedback decision generated from the FIS output.

C. Vibrotactile Feedback Control Module

The vibrotactile feedback control module (VFCM) consisted
of Cypresss CY8C27443 8-bit Programmable System On-Chip
(PSOC) microprocessor, a 9-V dry cell power supply, National Instruments NI USB-6009 data acquisition device, and
LM386N audio amplifiers functioning as the vibrotactor drivers
[see Fig. 1(c)]. The microprocessor was programmed to produce
varying levels of pulse width modulation (PWM) duty cycles,
based on FIS outputs. This was done by configuring two input
pins and one output pin for each direction along the AP plane.
The total number of I/O pins on the microprocessor responsible
for collecting and delivering signals (anterior and posterior) was
4 and 2, respectively.
When the FIS detects a perturbation, along the anterior or
posterior direction, the output from the fuzzy system is sent to
the VFCM (see Fig. 3). The FIS running in the host computer
monitors IMU-acquired Euler angles for occurrences of postural violation. Postural violations were categorized into two
categories 1) minor violation and 2) severe violation, in each
direction along the AP plane. The categories of postural violation determined the magnitude of vibrotactile feedback signals.
Categories of feedback signals were designed to ensure rapid
initiation of balance correction, while avoiding distraction or
anxiety in the performer when receiving feedback.
Information on postural violation from the FIS was sent to
the microprocessor via digital lines of the NI-USB 6009. The
microprocessor processes these input signals to produce appropriate PWM duty cycles (see Table I). Perturbation along
the anterior or posterior, requiring a low-level feedback (minor
violation) would trigger one input pin, while perturbations requiring a high-level feedback (severe violation) would trigger
two input pins. At any point in time, the maximum number of
input pins triggered would be 2 (in the case of severe violation); this is because postural violations can only occur in either

the anterior or posterior directions, never in both directions at

the same time (opposing directions). The triggered output pin
corresponds to the direction of feedback (anterior or posterior
stimulation). Fig. 3 illustrates the vibrotactile feedback signal
generation process, which expands the feedback amplitude and
direction determination block in Fig. 2.
Output pins from the microprocessor were connected to amplifier circuits. Signals from the microprocessor were amplified
at a gain of 200. Amplifier circuits functioned as motor drivers
for the vibrotactors. Signal levels produced by the vibrotactors
after amplification were distinct and detectable when in contact
with the skin. The LM386N was chosen specifically because
it has a wide supply voltage ranging from 412 V or 518 V,
with low current drain, suitable for battery (dry cells) operation.
LM386N also has an equivalent in a surface-mount package, allowing the size and weight of the VFCM circuitry to be reduced,
without having to redesign the circuit and its elements (future
directions).
Vibrotactors are small light-weighted motors, able to produce
varying levels of vibration when powered, and can be controlled
using PWM duty cycles. Vibrotactors used in this study were
inertia transducers (Tactaid VBW32) from Audiological Engineering Corporation, Somerville, MA [see Fig. 1(d)]. These
vibrotactors have a resonant frequency of 250 Hz, which is an
ideal sensing range for the human somatosensory system. The
VBW32 has a short ring-up and ring-down period, allowing it
to provide rapid responsiveness. This feature of the vibrotactor
allowed for real-time biofeedback to be conveyed effectively.
The VFCM weighed approximately 190 g (dry cell included)
and had a low operating requirement of 512 V.
III. INTERACTIVE HARDWARE AND SOFTWARE CODESIGN
Hardware configuration in this system allowed for the implementation of a negative feedback closed-loop control system to
monitor and correct postural control. The system design was
small in size and light weight, suitable for wearable mobile applications. Fig. 4 illustrates the designed interactive GUI (IGUI)
to facilitate and initiate communications between elements in
the system, created using LabVIEW 8.5.
A. Wireless Data Acquisition and Signal Processing
Wireless communications with IMUs were handled by the
host computer via USB base stations. IMUs were set to transmit
angular (Euler) displacement measurements to the host PC in

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Fig. 4. Screenshot of the IGUI created to integrate hardware communication,

data transfer, and signal processing on a single platform.

real time. Streamed measurements were Euler angles of trunk

and wobble boards surface. Commands are broadcasted from
base stations in HEX packets to the IMUs. Data transfers between IMU and base station were done via a 2.4-GHz RF channel. Data received from the IMUs are in packets and each packet
represents an individual measurement made at a particular point
in time. The streamed data were temporarily buffered and validated by performing error-detection calculations based on information stored within the header and trailer of the packets. Once
a packet is validated, raw values (HEX) of required components
were extracted and converted into its corresponding IEEE-754
format.
B. FIS for Biofeedback Activation
Vibrotactile feedback levels were determined using fuzzy
logic, based on the quality of monitored postural control. Fuzzy
logic was used because it reflects how people think and attempts
to model humans sense of words. Fuzzy logic is a theory of
fuzzy sets that calibrates vagueness. Fuzzy sets are sets whose
elements have varying degrees of membership. When dealing
with fuzzy sets, a proposition is neither true nor false but may
be partly true [20]. Fuzzy systems convert user-supplied human language rules into mathematical equivalents [21]. These
systems are capable of handling problems with imprecise and
incomplete data, without affecting the final quality of the end result. Fuzzy logic models called FIS consist of a number of fuzzy
sets [22]. Rules and conditions governing the functionality of
the system are represented within these fuzzy sets [23].
There have been many rehabilitative and gait analysis applications that have successfully incorporated fuzzy logic [20], [24].
The advantage of using fuzzy logic in a rehabilitation and reconditioning setting is the ability to provide a system/end user with
an explanatory capability based on defined expert rules [25].
FIS-based controllers were used in this study because it did
not require a detailed mathematical model of human postural
control on wobble board, as is required by other controller approaches [21]. Human postural control on a wobble board is
not easily modeled, due to large number of unknowns in the
system controlled by the brain, such as foot placement, initial
proprioceptive strength, and voluntary motion of upper extremities [26]. The introduction of fuzzy sets into the problem domain

IEEE/ASME TRANSACTIONS ON MECHATRONICS, VOL. 16, NO. 5, OCTOBER 2011

allowed for progression in training procedures to be monitored

in a realistic manner (smooth continuous function to describe
intermediate changes), as opposed to the traditional crisp rule
base, which only indicated if subjects were performing good
or bad [22]. Inclusion of the FIS simplified process design
for the feedback module while ensuring ease in updating and
maintaining the FIS-based controller over time.
The FIS controller in this study was designed in MATLAB
2009b and called into LabVIEW 8.5 programming environment.
The Mamdani fuzzy inference method was used in this study;
it allowed for human (expert) knowledge to be captured and
represented within the FIS. The continuous nature of outputs
is an efficient way of representing expert knowledge and is a
feature of Mamdani FIS controllers, which plays an important
role to the gauge level of postural violation. The defuzzification
process in the designed FIS converts evaluated fuzzy rules back
to single numbers using maxmin centroid approach [22]. The
Sugeno method, which was a computationally efficient alternative to the Mamdani method [25], was not used because rule
consequents are represented as singletons. This method of output representation is insufficient for representing the problem
domain (postural violation) because it lacked continuity.
The FIS controller was designed with two inputs (trunk angle
and wobble board angle) and one output (postural sway). Membership functions (MF) and linguistic characteristics of the input
fuzzy sets are illustrated in Fig. 5(a) and (b). The range for the
trunk angle fuzzy set (from the IMU on the trunk) was 45 120
along the AP plane, which is the average static range of motion
(ROM) for the human trunk (spinethoracic and lumbar) [27].
Fuzzy set ranges for wobble board angles (from IMU on the
wobble board surface) were fixed to follow the range of perturbation experienced on the platform 40 . Trunk and wobble
board input fuzzy sets, denoted as T and WB, are defined in (1)
and (2), respectively.
The output fuzzy set had a universe of discourse of [1,1].
A negative output value indicates a detected sway along the
posterior plane, while a positive output indicates a detected sway
along the anterior plane. The MF and linguistic characteristics
of the output fuzzy set is illustrated in Fig. 5(c). Postural sway
output fuzzy set denoted as S is defined in (3). An output within
the deadzone (DZ) linguistic term indicates that the posturalcontrol quality falls within acceptable ranges. The reduced rule
base (IFTHEN rules) for the FIS controller had 15 fuzzy set
rules (see Table II). The FIS rule base was tuned to improve the
performance of the FIS, by reviewing the performance of rules
in the rule base
T = {Poor, Average, Good}
WB = {Poor, Average, Good, Average, Poor}
S = {High, Low, DZ, Low, High}.

(1)
(2)
(3)

Magnitudes of the defuzzified outputs from the FIS were

used to convey vibrotactile feedback information (direction and
severity) to the performer via vibrotactors. Vibration strength
of the vibrotactors was controlled using PWM duty cycles (see
Table I). The duty cycles for vibrotactors increased with severity
of detected postural sway, resulting in a stronger vibration.

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Fig. 6. Placement of sensors and vibrotactors on subjects. (a) Subject standing

on the wobble board with sensors and vibrotactors in place. (b) IMU on the
wobble board. (c) VFCM on the hook-and-loop waist belt; one vibrotactor was
tugged behind the belt. (d) Side view. (e) IMU attached to measure trunk angles;
the second vibrotactor was tugged behind the belt.

Fig. 5. FIS fuzzy sets. (a) Trunk angles input fuzzy set. (b) Wobble board
angles input fuzzy set. (c) Postural sway output fuzzy set.
TABLE II
RULE BASE OF THE FIS CONTROLLER

IV. EXPERIMENTAL METHODS

Tests were conducted on 12 test subjects (six males and six
females) from the same age group. The subjects had the following average (SD) readings: 23.45 (1.45) years of age and
body mass index (BMI) of 21.85 (1.87) kg/m2 . All participants were healthy and had no known neurological, muscular,
or postural disorder at the time of acquisition. Participants also
had no previous exposure to the wobble board training prior to
the experiment. Methods used in this study were reviewed and
approved by the Monash University Human Research Ethics
Committee (MUHREC), Victoria, Australia. A written consent
was obtained from subjects who participated after the purpose
and procedure of the study were made known to subjects.
Subjects were required to maintain balance on the wobble
board in eyes-open (EO) and eyes-close (EC) conditions. Measurements were acquired without vibrotactile feedback and in
the presence of vibrotactile feedback. Tests were taken in EO
and EC states in order to understand the influence of biofeedback

on postural control, in the presence and absence of a valid visual

cue to the CNS. Subjects were to maintain postural control without biofeedback, while on the wobble board in EO condition for
60 s, followed by another 60 s in EC condition. Subjects were
then advised to take a break of 5 min, before resuming with
the next set of acquisition. Three acquisition sets (without feedback) were taken from each subject, each set consisting of one
EO and one EC acquisition. Subjects were given a 10-min break
before continuing the experiment with feedback. Another three
acquisition sets (with feedback) were taken from each subject,
each set consisting of one EO and one EC acquisition. Breaks
were introduced between acquisitions in order to minimize effects of fatigue on postural control. A total of 12 readings were
acquired from each subject, where six readings (three EO and
three EC) were without feedback and the remaining (three EO
and three EC) were with feedback. Fig. 6 shows placement of
IMUs and vibrotactors on the subject. Safety hand rails were
introduced to assist subjects that mount the balance trainer and
served as support [see Fig. 6(a)].
A stretchable hook-and-loop waist belt was placed around
the subjects waist. The surface of the belt allowed for the attachment of other devices using hook-and-loop fasteners [see
Fig. 6(d)]. One of the IMU devices was fastened securely to
the waist belt using hook-and-loop fasteners [see Fig. 6(e)].
This IMU device was used to monitor Euler angular displacement of the trunk throughout the experiment. Trunk angles were
monitored along the roll measurement axis of the IMU, which
corresponds to sway in the AP plane. The VFCM was also attached to the waist belt [see Fig. 6(c)], which was responsible
for generating vibrotactile feedback. Vibrotactors were placed

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along the waist between the belt snugly at the stomach and lower
back, referring to the AP direction [see Fig. 6(c) and (e)]. The
actuators were held in place by the waist belt. The second IMU
device was attached to the flat surface of the wobble board to
monitor Euler angular displacement experienced by subjects on
the wobble board [see Fig. 6(b)]. Angular displacement of the
BoS (wobble board) is measured about the roll and pitch measurement axes of the IMU, which, respectively, correspond to
AP and ML anatomical planes. Only Euler angles along the AP
plane, for both IMUs (trunk and wobble board), were fed to the
FIS controller in real time for feedback generation.
The experiment was aimed to monitor the ability of subjects in
maintaining postural control. Postural control under flat ground
conditions is gauged in relation to postural sway, measured by
trunk displacement [16]. However, on the wobble board, trunk
displacement is influenced by the surface tilt caused by the wobble board (ankle proprioception). Good postural control is then
achieved by keeping the wobble board and trunk displacements
relatively stable within a defined target threshold. Readings obtained from IMUs within the acceptable range of the fuzzy
knowledge base nullify the signal generated by vibrotactors
(DZ).
V. RESULTS
A. Reliability of Biofeedback Activation
Fig. 7(a) and (b) depicts the measured Euler angles for trunk
and wobble board, rotating about the IMUs roll axis. Rotations
about IMUs roll axis correspond to a motion along the AP of
the human anatomical plane. These Euler angles were fed in
real time to the FIS. The FIS output level between 0 and 1 are
warnings generated, indicating postural violations in the posterior direction. Output levels between 0 and +1 indicate postural
violations in the anterior direction. The graph in Fig. 7(c) illustrates the response of the FIS in detecting postural violation,
based on Fig. 7(a) and (b). The time elapsed between FIS output and IMUs Euler angle measurements was determined to be
4.79 1.06 ms.
Fig. 7(d) depicts VFCM activation based on Table I. The
activation of vibrotactile feedback indicates a detected postural
violation. The activation level has two warning states in each
direction (anterior and posterior), a minor postural violation
(50% PWM), and a severe postural violation (85% PWM)
[see Fig. 7(d)].
B. Impact of Biofeedback Activation on Postural Correction
Fig. 8 depicts the graph plotted for measurements taken along
the AP and ML from the IMU attached to the wobble board,
for a single subject. The AP and ML component readings were
the measurements about the roll and pitch measurement axes
of the IMU, respectively. The plot depicts the level of perturbation experienced in the AP and ML direction. Fig. 8(a) and (c)
represents the measurements taken in EC and EO conditions,
respectively, without vibrotactile feedback. Fig. 8(b) and (d)
represents the same conditions (EC and EO) with vibrotactile
feedback. It is observed that with the intervention of vibrotactile

Fig. 7. (a) Trunk Euler angles in the AP direction. (b) Platform Euler angles
in the AP direction. (c) FIS output. (d) PWM duty cycle sent to vibrotactors
based on the FIS output.

feedback a smaller spread of Euler angular displacement was

observed under both EO and EC conditions.
Subjects were able to demonstrate a stable and controlled
measurement with the aid of vibrotactile feedback. Paired t-test
analysis was conducted to determine the significance of measured improvements, setting the false rejection ratio to 0.05.
When the calculated p-value is below 0.05, i.e., p < 0.05, the null
hypothesis is rejected in favor of the alternative hypothesis. The
null hypothesis states that there is no significant difference between the readings acquired, with and without vibrotactile feedback. Subjects recorded a reduction of trunk sway and wobble
board perturbation in EO and EC conditions using vibrotactile
feedback, yielding p-values of p < 0.05. Based on paired t-test
results for the measured data, there was sufficient statistical evidence to support rejection of the null hypothesis in favor of

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Fig. 8. Representative single trial for a single subject on wobble board.

(a) ECno feedback. (b) ECwith feedback. (c) EOno feedback. (d) EO
with feedback.
TABLE III
MEAN ANGULAR (EULER) TRUNK AND PLATFORM DISPLACEMENT (SD) IN THE
AP DIRECTION (n = 6)

the alternative hypothesis. The alternative hypothesis suggests

a significant difference (statistical) between the acquired measurement (with and without vibrotactile feedback). All subjects
recorded significant improvements (p-values of p < 0.05) in
postural control for the trunk and wobble board measurements
(in EO and EC conditions). Results of significant testing describe subjects responses to vibrotactile feedback, which aided
them in achieving a stable posture in the experiment conducted.
The introduction of vibrotactile feedback significantly aided
subjects to achieve stable posture (smaller measured perturbation) while on the wobble board. In Table III, we summarize
the mean trunk and wobble board angles of the six male and six
female subjects. The group means (calculated across subjects
acquisitions) according to gender, as represented in Table III,
also recorded p-values of p < 0.05 (paired t-test). This finding
indicates a significant improvement for subjects across genders,
when using the vibrotactile feedback.
VI. DISCUSSIONS AND CONCLUSION
An intelligent biofeedback system for postural control training using a wobble board routine was implemented. The approach integrated elements of hardware (IMU and vibrotactors)

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and soft computing (FIS controller), for monitoring and correcting postural control. Vibrotactile feedback levels were determined by the FIS controller based on measurements from
IMUs. Inclusion of the Mamdani-based FIS controller allowed
for realistic consideration of trunk and wobble board angles, in
determining the level and direction of vibrotactile feedback. Integration of these components allowed for the system to operate
as a configurable stand-alone system, using the designed IGUI.
The proposed method of detecting poor postural control (due
to poor ankle proprioception) using a fuzzy-logic-based artificial intelligent system controller was verified by experiments.
The inclusion of the FIS controller allowed for trunk and BoS
(wobble board) response along the AP to be considered, in gauging postural control. The results observed a positive response
from all subjects toward vibrotactile feedback generated in response to violations detected by the FIS. The storage of FIS
output values into the database allowed for performer to gauge
improvements during rehabilitation. An improvement in ankle
proprioception results in better postural control on the wobble
board.
The wobble board provided an unstable surface for subjects to
stand on. Unstable surfaces force subjects to be reliant on ankle
proprioception for maintaining postural control. Euler angular
measurements of wobble board perturbation are a good indicator of postural control, resulting from ankle proprioception.
High perturbation amplitudes of wobble board is denoted by
large angle fluctuations, which indicates a high risk of postural
instability, while relatively low and constant amplitudes indicate
a stable and good ankle proprioception control.
The method of reporting postural control in Fig. 8 enabled
qualitative comparison and assessment, similar reporting methods were reported in [13] and [16]. From the results in Fig. 8,
it was observed that generation of vibrotactile feedback prevented subjects from experiencing large amplitudes of perturbation, for an extended period. Vibrotactile feedback assisted
subjects in achieving postural stability and control by limiting
amount of sway experienced. This was achieved through corrective feedback implemented via vibrotactile feedback to subjects.
However, there exists a small probability of priming effects positively impacting subjects performance on the wobble board.
The priming effects have been assumed to be minimal (negligible), as it has been previously reported that subjects only
begin to see improvements in ankle proprioception after at least
a 4-week wobble board training routine [4], [5]. In this study,
subjects were only exposed to the wobble board during data
acquisition and familiarization periods.
The system also demonstrated competence in clinical and
biomedical applications for rehabilitation and preventive
purposes. Individuals or clinicians can use this system for
postural control and proprioception training. The overall weight
of attachments placed on the subject was approximately 240 g.
An important aspect of consideration in designing wearable
systems as a solution for monitoring human motion is the
weight and size of the system. A wearable system that is too
heavy alters natural reaction of subjects. Measurements taken
under such conditions will not reflect the natural condition of
subjects.

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IEEE/ASME TRANSACTIONS ON MECHATRONICS, VOL. 16, NO. 5, OCTOBER 2011

The choice of using IMUs as the sensing device was mainly

motivated by its small size and light weight. The measurements
made in this study were heavily dependent on gyroscope within
the IMU. Gyroscopes have been known to produce identical
measurements along the same plane despite the differences in
attachment sites [28]. This feature of gyroscopes allowed for the
ease in placement of the IMU on subjects without being overly
concern about variability in the IMU placement across subjects.
IMUs are also not affected by vibrations or linear movements of
subjects, making measurements less susceptible to noise [29].
Subjects to the experiment do not report any discomfort during the procedure using the attachments. Subjects found that
conveying of balance control information via vibrotactile to be
simple and easy to comprehend, a requirement for effective
biofeedback applications [11]. The ease of receiving balance
control information was seen in the effective reduction of measured angles of the platform and trunk.
Further research will be carried out in determining significance of vibrotactile biofeedback in shortening rehabilitation
and training periods for postural control. The weight and size of
the VFCM circuit can be further reduced with the introduction
of surface-mount circuits. Successful reduction in this circuit
size would allow for vibrotactile feedback applications to be
used as a long-term device. The current setup only allows for
monitoring and feedback to be provided along a single plane.
The VFCM designed will be expanded to increase the number of
planes being monitored simultaneously, while maintaining the
simplicity of the feedback signals for the CNS. This expansion
will increase the number of potential rehabilitative applications
suited for the presented system.
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Authors photographs and biographies not available at the time of publication.