The multi-sensory stimulation approach through the use of a Sensory Re-Education Device (SRED) is a therapeutic program that employs sensory stimulation to help with the functional recovery of sensory loss and to help patients learn adaptive functioning. It assists patients with various forms of sensory loss and impairment in retraining their sensory pathways, adapting to their changed abilities, and regaining sensory function. The SRED achieves the main goal of re-education by delivering a systematic (consistent, regular, specific, repeated pattern, time, and intensity control) input that enables the brain to code and Ingram the function and recognize the physical properties of frequency and wavelength.

The SRED is designed to be flexible and easy to operate so that the patient can develop skills/abilities, mental experience, and function recognition through continuous and intensive training.

Earlier studies have indicated that successful training may change the way in which the brain controls movement and have demonstrated remapping of movement representations in the primary motor cortex after effective rehabilitative training of sensory impairments⁸. To date, no SRED has been developed, tested, and approved for re-educating the re-educating subjects with a sensory deficit.

The sensory system has a great capacity to act and interact with the surrounding environment. The SRED stimulates multiple senses through the use of different programs. Continuous and repeated sensory stimulation helps patients with Chemotherapy-induced peripheral neuropathy CIPN and enables the occupational/physical therapist to work on impaired sensory areas and to mend damaged cells. Hence, the present study was planned to assess the efficacy of the SRED developed to provide sensory re-education of subjects with CIPN.

This is the first prototype that has been developed based on the results attained by its predecessor machine. The device has two driving parts, which contain hardware and software.

The software is built on Visual Basic with MS Access Database. It interacts with the hardware through a communication port called Com.Port, which is connected via USB to Arduino Mega. In Visual Basic, we use a Windows HyperTerminal communication module to interact with the hardware. Following are the major modules in the software.

Add Patient: This is a patient-adding module in which we record new patients or modify existing ones.

Session Module: This is the main module in which we test the patient’s senses. It is the most complicated module in the software. In this module, we use external hardware (Fig. 1) and get values to generate results. There are two types of results marked: One is automatic, which is generated by the system according to the input and output from the patient. The other is manual, which is controlled by the doctor (operator). Automatic results are based on full statistics that are generated by the calculation of the input dose, output result, and time is taken to obtain an answer. The total and maximum values for each question (acquire) in the system are set beforehand so the system can calculate the results based on answers given by the patients, automatically dividing them with the maximum value which has already been given.

Reporting Module: The module is where we analyze patient’s improvement and session details based on the time taken to answer various questions. We conduct an overall evaluation and find the weakest senses in which to make improvements. Variables related to frequency, intensity, timing, etc. were taken into account. The storing, tracking, and recalling of data were handled very well.

After testing the prototype device, we began creating the final compact shape. We fitted it in a small 50cm*40cm*20cm metal briefcase. This portable size makes the system appropriate for hospitals, clinics, and home use. All accessories were mounted in the briefcase. We used an acrylic sheet incubate hardware, which we had to install in the device.

At the top, we created a fitting to hold the display, vibration device, and pain prick device. At the bottom, we affixed circuits and other accessories used in the device. Before fixing, we cut an acrylic sheet that would cover the entire base to make fittings for the keyboard, spray bottles (Fig. 2), hot and cold Peltier. Beneath it, all the circuits and modules were installed.

Fig. (1). External Hardware.

Fig. (2). Spray bottles.

The spraying mechanism consists of a servo motor, un-load circuit.

The drive circuit delivers 5VDC to the relay to make contact for the delivery of 12VDC to the servo motor for one second, to exert the required force on the spray nozzle. The entire mechanism is very simple, durable, and convenient to operate and use. The relay takes commands from the drive circuit which is Arduino Mega. Both sprays share an individual drive relay circuit to function.

Hot-cold thermod

Two individual peltries are installed to generate hot and cold temperatures. The peltries are installed on a heartsick alloy to produce controlled temperatures. The peltries are derived from the relay module, which takes commands from the microprocessor. In addition, two temperature sensors are installed to provide the current temperature.

All the circuits and modules are placed underneath the bottom section. AC220 power goes to the power supply for peltries while a 5VDC power module powers the relay modules and Arduino. The display adapter is also placed in the same section.

This study is a quasi-experimental one-group pre-post study. Participants will be studied before and after the device is used as an intervention. During the first session, baseline outcome values will be compared to the same outcome values at the end of the last session (session 5) to evaluate the efficacy of this device in improving CIPN associated with chemotherapy and DM peripheral neuropathy. The mechanism, cause, and pathology of the neuropathy are beyond the scope of this study.

The study population consists of patients with peripheral sensory loss due to chemotherapy treatment of breast cancer (BC) and patients with peripheral sensory loss secondary to DM. While this paper addresses a pilot sample, full details will be published upon completion. The study investigated smell, hot-cold, and light touch sensations. The study is conducted in regular physiotherapy, occupation therapy department of KAMC, NGHA, Riyadh.

The subjects included in the study were selected based on the following inclusion and exclusion criteria. Inclusion: Adult DM and BC patients in the age group of 18-60 years. Breast cancer patients who underwent chemotherapy or radiation therapy and chronic DM with a confirmed diagnosis of peripheral neuropathy. Exclusion: Patients <18 years old or >60 years old, patients on palliative care, patients with degenerative neuropathy or acute inflammation, patients with an implanted device and who are not willing to provide informed consent were excluded from the study. Each patient was required to sign a consent form after the study’s details were explained and all questions about the experiment were addressed.

Patients were invited to a (day-care) program to facilitate the conducting of long, repeated sessions throughout the day.(Fig. 4) The smells of various perfumes were delivered in different concentrations via nasal spray at a graded distance. Concentration and distance were modulated in certain paradigms at a small cabinet to maintain the concentration of the smell. The cabinet fan then switched on to evacuate the smell. Hot-cold (Fig. 3) air was delivered through the thermod in a graded range of temperatures. Several types of touch (very rough to smooth material) were used to re-educate the touch. All were recorded in a bulletin system, as well as in written feedback from the patient.

Fig. (3). Hot-cold.

Fig. (4). Patients were invited to a (day-care) program to facilitate the conducting of long, repeated sessions throughout the day.