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Background  The need of a sensory feedback system that would improve users’ acceptance in prostheses is generally recognized. Feedback of hand opening and position are among the most important concerns of prosthetic users. To address the two concerns, this study investigated the human capability to identify pulse number and location when electrical stimulation applied on the forearm skin. The pulse number may potentially be used to encode the opening of prosthetic hands and stimulation location to encode finger position.    Methods  Ten able-bodied subjects participated in the study. Three electrodes were placed transversely across the ventral forearm spatially encoding three fingers (i.e., thumb, index, and middle finger). Five different pulse numbers (1, 4, 8, 12, and 20) encoded five levels of hand opening. The study consisted of three experiments. In the three experiments, each after a training session, the subjects were required to identify among: (a) five stimulation locations, (b) five pulse numbers, or (c) ten paired combinations of location and pulse number, respectively. The subjects’ performance in the three identification tasks was evaluated.    Results  The main results included: 1) the overall identification rate for stimulation location was 92.2 ± 6.2%, while the success rate in two-site stimulation was lower than one-site stimulation; 2) the overall identification rate for pulse number was 90.8 ± 6.0%, and the subjects showed different performance in identification of the five pulse numbers; 3) the overall identification rate decreased to 80.2 ± 11.7% when the subjects were identifying paired parameters.    Conclusions  The results indicated that the spatial (location) and temporal (pulse number) identification performance are promising in electrocutaneous stimulation on the forearm. The performance degraded when both parameters had to be identified likely due to increased cognitive load resulting from multiple tasks. Utilizing the proposed coding strategy in practical prosthetic hands remains to be investigated for clinical evaluation of its feasibility.

Human ability in identification of location and pulse number for electrocutaneous stimulation applied on the forearm