Optimizing the tactile display of physiological information: Vibro-tactile vs. electro-tactile stimulation, and forearm or wrist location

Anesthesiologists use physiological data monitoring systems with visual and auditory displays of information to monitor patients in the operating room (OR). The efficacy of visual-audio systems may impose an increase in patient risk when the demand for constant switching of attention between the patient and the visual monitoring system is high. This is evidenced by auditory alarms frequently being neglected in a noisy OR environment. Hence, the use of a complementary patient data monitoring system, which utilizes other sensory modalities, could be of great value. In this paper, we describe a series of experiments designed to determine the performances of a tactile display that could be used to convey patient's physiological information to the attending anesthesiologist. We tested both vibro-tactile and electro-tactile display prototypes in their ability to convey information using an alert scheme of four distinct tactile stimuli. Using pseudo-clinical data, the display was designed, for example, to provide an alert when a change in the monitored heart rate occurred. Based on previous research in human physiology and psychophysics, we selected the forearm and wrist of the user's non-dominant hand as the stimulation site. In our study of 30 subjects, we evaluated the response time and accuracy of tactile pattern recognition to compare (1) the performance of a vibro-tactile display on the forearm (VF) and an electro-tactile display on the forearm (EF), and (2) the localization of stimulation between the forearm (VF) and a vibro-tactile display on the wrist (VW). A post-study questionnaire was completed by each subject to assess the comfort and usability of the three prototypes. We found that both VF and VW were superior to the EF in both accuracy and comfort and, that there were no differences between the wrist and the forearm. In conclusion, the tactile-display prototypes designed to alert the clinician of adverse changes in a patient's physiological state efficaciously and unobtrusively delivered these data and warranted further investigation and development.