Electrode Array for Reversing the Recruitment Order of Peripheral Nerve Stimulation: Experimental Studies

A Review on Implantable Neuroelectrodes

The efficacy of every neuromodulation modality depends upon the characteristics of the electrodes used to stimulate the chosen target. The geometrical, chemical, mechanical and physical configuration of electrodes used in neurostimulation affects several performance attributes like stimulation efficiency, selectivity, tissue response, etc. The efficiency of stimulation in relation to electrode impedance is influenced by the electrode material and/or its geometry. The nature of the electrode material determines the charge transfer across the electrode-tissue interface, which also relates to neuronal tissue damage. Electrode morphology or configuration pattern can facilitate the modulation of extracellular electric field (field shaping). This enables selective activation of neurons and minimizes side effects. Biocompatibility and biostability of the electrode materials or electrode coating have a role in glial formation and tissue damage. Mechanical and electrochemical stability (corrosion resistance) determines the long-term efficacy of any neuromodulation technique. Here, a review of electrodes typically used for implantable neuromodulation is discussed. Factors affecting the performance of electrodes like stimulation efficiency, selectivity and tissue responses to the electrode-tissue interface are discussed. Technological advancements to improve electrode characteristics are also included.

In-silico development and assessment of a Kalman filter motor decoder for prosthetic hand control

Up to 50% of amputees abandon their prostheses, partly due to rapid degradation of the control systems, which require frequent recalibration. The goal of this study was to develop a Kalman filter-based approach to decoding motoneuron activity to identify movement kinematics and thereby provide stable, long-term, accurate, real-time decoding. The Kalman filter-based decoder was examined via biologically varied datasets generated from a high-fidelity computational model of the spinal motoneuron pool. The estimated movement kinematics controlled a simulated MuJoCo prosthetic hand. This clear-box approach showed successful estimation of hand movements under eight varied physiological conditions with no retraining. The mean correlation coefficient of 0.98 and mean normalized root mean square error of 0.06 over these eight datasets provide proof of concept that this decoder would improve long-term integrity of performance while performing new, untrained movements. Additionally, the decoder operated in real-time (~0.3 ms). Further results include robust performance of the Kalman filter when re-trained to more severe post-amputation limitations in the type and number of motoneurons remaining. An additional analysis shows that the decoder achieves better accuracy when using the firing of individual motoneurons as input, compared to using aggregate pool firing. Moreover, the decoder demonstrated robustness to noise affecting both the trained decoder parameters and the decoded motoneuron activity. These results demonstrate the utility of a proof of concept Kalman filter decoder that can support prosthetics' control systems to maintain accurate and stable real-time movement performance.

Influence of systematic variations of the stimulation profile on responses evoked with a vestibular implant prototype in humans

OBJECTIVE

To explore the impact of different electrical stimulation profiles in human recipients of the Geneva-Maastricht vestibular implant prototypes.

APPROACH

Four implanted patients were recruited for this study. We investigated the relative efficacy of systematic variations of the electrical stimulus profile (phase duration, pulse rate, baseline level, modulation depth) in evoking vestibulo-ocular (eVOR) and perceptual responses.

MAIN RESULTS

Shorter phase durations and, to a lesser extent, slower pulse rates allowed maximizing the electrical dynamic range available for eliciting a wider range of intensities of vestibular percepts. When either the phase duration or the pulse rate was held constant, current modulation depth was the factor that had the most significant impact on peak velocity of the eVOR.

SIGNIFICANCE

Our results identified important parametric variations that influence the measured responses. Furthermore, we observed that not all vestibular pathways seem equally sensitive to the electrical stimulus when the electrodes are placed in the semicircular canals and monopolar stimulation is used. This opens the door to evaluating new stimulation strategies for a vestibular implant, and suggests the possibility of selectively activating one vestibular pathway or the other in order to optimize rehabilitation outcomes.

Selective Nerve Cuff Stimulation Strategies for Prolonging Muscle Output

Neural stimulation systems are often limited by rapid muscle fatigue. Selective nerve cuff electrodes can target independent yet synergistic motor unit pools (MUPs), which can be used in duty-cycle reducing stimulation paradigms to prolong joint moment output.

OBJECTIVE

This study investigates waveform parameters within moment-prolonging paradigms and determines strategies for their optimal implementation.

METHODS

Composite flat-interface nerve cuff electrodes (C-FINEs) were chronically implanted on feline proximal sciatic nerves. Cyclic stimulation tests determined effects of stimulation period and duty cycle in different MUP types. Ideal parameters were then used in duty-cycle reducing carousel stimulation. Time to 50% reduction in moment (T50), moment overshoot, and moment ripple were determined for constant, open-loop carousel, and moment feedback-controlled closed-loop carousel stimulation.

RESULTS

A stimulation period of 1 s best maintained joint moment for all MUPs. Low (25%) duty cycles consistently improved joint moment maintenance, though allowable duty cycle varied among MUPs by gross muscle and fiber type. Both open- and closed-loop carousel stimulation significantly increased T50 over constant stimulation. Closed-loop carousel significantly decreased moment overshoot over the other conditions, and significantly decreased moment ripple compared with open-loop stimulation.

CONCLUSION

Selectivity-enabled carousel stimulation prolongs joint moment over conventional constant stimulation. Appropriate waveform parameters can be quickly determined for individual MUPs and stimulation can be controlled for additional performance improvements with this paradigm.

SIGNIFICANCE

Providing prolonged, stable joint moment and muscle output to recipients of motor neuroprostheses will improve clinical outcomes, increase independence, and positively impact quality of life.

Fabrication and characterization of polyimide-based 'smooth' titanium nitride microelectrode arrays for neural stimulation and recording

OBJECTIVE

As electrodes are required to interact with sub-millimeter neural structures, innovative microfabrication processes are required to enable fabrication of microdevices involved in such stimulation and/or recording. This requires the development of highly integrated and miniaturized systems, comprising die-integration-compatible technology and flexible microelectrodes. To elicit selective stimulation and recordings of sub-neural structures, such microfabrication process flow can beneficiate from the integration of titanium nitride (TiN) microelectrodes onto a polyimide substrate. Finally, assembling onto cuffs is required, as well as electrode characterization.

APPROACH

Flexible TiN microelectrode array integration and miniaturization was achieved through microfabrication technology based on microelectromechanical systems (MEMS) and complementary metal-oxide semiconductor processing techniques and materials. They are highly reproducible processes, granting extreme control over the feature size and shape, as well as enabling the integration of on-chip electronics. This design is intended to enhance the integration of future electronic modules, with high gains on device miniaturization.

MAIN RESULTS

(a) Fabrication of two electrode designs, (1) 2 mm long array with 14 TiN square-shaped microelectrodes (80  ×  80 µm²), and (2) an electrode array with 2 mm  ×  80 µm contacts. The average impedances at 1 kHz were 59 and 5.5 kΩ, respectively, for the smaller and larger contacts. Both designs were patterned on a flexible substrate and directly interconnected with a silicon chip. (b) Integration of flexible microelectrode array onto a cuff electrode designed for acute stimulation of the sub-millimeter nerves. (c) The TiN electrodes exhibited capacitive charge transfer, a water window of  -0.6 V to 0.8 V, and a maximum charge injection capacity of 154  ±  16 µC cm^-2.

SIGNIFICANCE

We present the concept, fabrication and characterization of composite and flexible cuff electrodes, compatible with post-processing and MEMS packaging technologies, which allow for compact integration with control, readout and RF electronics. The fabricated TiN microelectrodes were electrochemically characterized and exhibited a comparable performance to other state-of-the-art electrodes for neural stimulation and recording. Therefore, the presented TiN-on-polyimide microelectrodes, released from silicon wafers, are a promising solution for neural interfaces targeted at sub-millimeter nerves, which may benefit from future upgrades with die-electronic modules.

A review for the peripheral nerve interface designer

Informational density and relative accessibility of the peripheral nervous system make it an attractive site for therapeutic intervention. Electrode-based electrophysiological interfaces with peripheral nerves have been under development since the 1960s and, for several applications, have seen widespread clinical implementation. However, many applications require a combination of neural target resolution and stability which has thus far eluded existing peripheral nerve interfaces (PNIs). With the goal of aiding PNI designers in development of devices that meet the demands of next-generation applications, this review seeks to collect and present practical considerations and best practices which emerge from the literature, including both lessons learned during early PNI development and recent ideas. Fundamental and practical principles guiding PNI design are reviewed, followed by an updated and critical account of existing PNI designs and strategies. Finally, a brief survey of in vitro and in vivo PNI characterization methods is presented.

Contributions to muscle force and EMG by combined neural excitation and electrical stimulation

OBJECTIVE

Stimulation of muscle for research or clinical interventions is often superimposed on ongoing physiological activity without a quantitative understanding of the impact of the stimulation on the net muscle activity and the physiological response. Experimental studies show that total force during stimulation is less than the sum of the isolated voluntary and stimulated forces, but the occlusion mechanism is not understood.

APPROACH

We develop a model of efferent motor activity elicited by superimposing stimulation during a physiologically activated contraction. The model combines action potential interactions due to collision block, source resetting, and refractory periods with previously published models of physiological motor unit recruitment, rate modulation, force production, and EMG generation in human first dorsal interosseous muscle to investigate the mechanisms and effectiveness of stimulation on the net muscle force and EMG.

MAIN RESULTS

Stimulation during a physiological contraction demonstrates partial occlusion of force and the neural component of the EMG, due to action potential interactions in motor units activated by both sources. Depending on neural and stimulation firing rates as well as on force-frequency properties, individual motor unit forces can be greater, smaller, or unchanged by the stimulation. In contrast, voluntary motor unit EMG potentials in simultaneously stimulated motor units show progressive occlusion with increasing stimulus rate. The simulations predict that occlusion would be decreased by a reverse stimulation recruitment order.

SIGNIFICANCE

The results are consistent with and provide a mechanistic interpretation of previously published experimental evidence of force occlusion. The models also predict two effects that have not been reported previously--voluntary EMG occlusion and the advantages of a proximal stimulation site. This study provides a basis for the rational design of both future experiments and clinical neuroprosthetic interventions involving either motor or sensory stimulation.

Influence of different geometric representations of the volume conductor on nerve activation during electrical stimulation

Volume conductor models with different geometric representations, such as the parallel layer model (PM), the cylindrical layer model (CM), or the anatomically based model (AM), have been employed during the implementation of bioelectrical models for electrical stimulation (FES). Evaluating their strengths and limitations to predict nerve activation is fundamental to achieve a good trade-off between accuracy and computation time. However, there are no studies aimed at clarifying the following questions. (1) Does the nerve activation differ between CM and PM? (2) How well do CM and PM approximate an AM? (3) What is the effect of the presence of blood vessels and nerve trunk on nerve activation prediction? Therefore, in this study, we addressed these questions by comparing nerve activation between CM, PM, and AM models by FES. The activation threshold was used to evaluate the models under different configurations of superficial electrodes (size and distance), nerve depths, and stimulation sites. Additionally, the influences of the sciatic nerve, femoral artery, and femoral vein were inspected for a human thigh. The results showed that the CM and PM had a high error rate, but the variation of the activation threshold followed the same tendency for electrode size and interelectrode distance variation as AM.

Alteration of neural action potential patterns by axonal stimulation: the importance of stimulus location

OBJECTIVE

Stimulation of peripheral nerves is often superimposed on ongoing motor and sensory activity in the same axons, without a quantitative model of the net action potential train at the axon endpoint.

APPROACH

We develop a model of action potential patterns elicited by superimposing constant frequency axonal stimulation on the action potentials arriving from a physiologically activated neural source. The model includes interactions due to collision block, resetting of the neural impulse generator, and the refractory period of the axon at the point of stimulation.

MAIN RESULTS

Both the mean endpoint firing rate and the probability distribution of the action potential firing periods depend strongly on the relative firing rates of the two sources and the intersite conduction time between them. When the stimulus rate exceeds the neural rate, neural action potentials do not reach the endpoint and the rate of endpoint action potentials is the same as the stimulus rate, regardless of the intersite conduction time. However, when the stimulus rate is less than the neural rate, and the intersite conduction time is short, the two rates partially sum. Increases in stimulus rate produce non-monotonic increases in endpoint rate and continuously increasing block of neurally generated action potentials. Rate summation is reduced and more neural action potentials are blocked as the intersite conduction time increases. At long intersite conduction times, the endpoint rate simplifies to being the maximum of either the neural or the stimulus rate.

SIGNIFICANCE

This study highlights the potential of increasing the endpoint action potential rate and preserving neural information transmission by low rate stimulation with short intersite conduction times. Intersite conduction times can be decreased with proximal stimulation sites for muscles and distal stimulation sites for sensory endings. The model provides a basis for optimizing experiments and designing neuroprosthetic interventions involving motor or sensory stimulation.

Probabilistic modeling of selective stimulation of the human sciatic nerve with a flat interface nerve electrode

Ankle control is critical to both standing balance and efficient walking. The hypothesis presented in this paper is that a Flat Interface Nerve Electrode (FINE) placed around the sciatic nerve with a fixed number of contacts at predetermined locations and without a priori knowledge of the nerve's underlying neuroanatomy can selectively control each ankle motion. Models of the human sciatic nerve surrounded by a FINE of varying size were created and used to calculate the probability of selective activation of axons within any arbitrarily designated, contiguous group of fascicles. Simulations support the hypothesis and suggest that currently available implantable technology cannot selectively recruit each target plantar flexor individually but can restore plantar flexion or dorsiflexion from a site on the sciatic nerve without spillover to antagonists. Successful activation of individual ankle muscles in 90% of the population can be achieved by utilizing bipolar stimulation and/or by using a cuff with at least 20 contacts.

Predicting myelinated axon activation using spatial characteristics of the extracellular field

The computation time required for modeling the nonlinear response of an axon to an applied electric field is a significant limitation to optimizing a large number of neural interface design parameters through use of advanced computer algorithms. This paper introduces two methods of predicting axon activation that incorporate a threshold that includes the magnitude of the extracellular potential to achieve increased accuracy over previous computationally efficient methods. Each method uses a modified driving function that includes the second spatial difference of the applied extracellular voltage to predict the electrical excitation of a nerve. The first method uses the second spatial difference taken at a single node of Ranvier, while the second uses a weighted sum of the second spatial differences taken at all nodes of Ranvier. This study quantifies prediction accuracy for cases with single and multiple point source stimulating electrodes. While both new methods address the major criticism of linearized prediction models, the weighted sum method provides the most robust response across single and multiple point sources. These methods improve prediction of axon activation based on properties of the applied field in a computationally efficient manner.

Electrochemical corrosion of STS304 acupuncture needles by electrical stimulation

We present the first investigation of electrical corrosion in acupuncture needles after electrical stimulation. Using scanning electron microscopy, we observed the occurrence of electrochemical corrosion on the surface of stainless steel 304 acupuncture needles after electrical stimulation in the tibial muscles of rats. Biphasic pulse electrical stimuli with 10-Hz frequency, 1-mA intensity and 1-ms pulse width were applied to the needles. The terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) method labels fragmented DNA. Positive staining using this test indicates apoptotic cells in electrically stimulated tissues. The risk of electrical corrosion was found to be less in bipolar, short-duration, low-current or voltage and short-period stimulation than in monopolar, long-duration, high-current or voltage and long-period stimulation. Evaluation with a scanning electron microscope revealed that electrical stimulation can increase the electrical corrosion of stainless steel 304 acupuncture needles. In biocompatibility studies of stainless steel 304 acupuncture needles for electrical stimulation, TUNEL-positive cells were detected in the tibial muscle within 5 days after electrical stimulation. The results of this study demonstrate that the corrosion products of stainless steel 304 acupuncture needles might affect the post-electrical stimulation tissue response.

On the use of longitudinal intrafascicular peripheral interfaces for the control of cybernetic hand prostheses in amputees

Significant strides have been recently made to develop highly sensorized cybernetic prostheses aimed at restoring sensorimotor limb functions to those who have lost them because of a traumatic event (amputation). In these cases, one of the main goals is to create a bidirectional link between the artificial devices (e.g., robotic hands, arms, or legs) and the nervous system. Several human-machine interfaces (HMIs) are currently used to this aim. Among them, interfaces with the peripheral nervous system and in particular longitudinal intrafascicular electrodes can be a promising solution able to improve the current situation. In this paper, the potentials and limits of the use of this interface to control robotic devices are presented. Specific information is provided on: 1) the neurophysiological bases for the use peripheral nerve interfaces; 2) a comparison of the potentials of the different peripheral neural interfaces; 3) the possibility of extracting and appropriately interpreting the neural code for motor commands and of delivering sensory feedback by stimulating afferent fibers by using longitudinal intrafascicular electrodes; 4) a preliminary comparative analysis of the performance of this approach with the ones of others HMIs; 5) the open issues which have to be addressed for a chronic usability of this approach.

A model for transcutaneous current stimulation: simulations and experiments

Complex nerve models have been developed for describing the generation of action potentials in humans. Such nerve models have primarily been used to model implantable electrical stimulation systems, where the stimulation electrodes are close to the nerve (near-field). To address if these nerve models can also be used to model transcutaneous electrical stimulation (TES) (far-field), we have developed a TES model that comprises a volume conductor and different previously published non-linear nerve models. The volume conductor models the resistive and capacitive properties of electrodes, electrode-skin interface, skin, fat, muscle, and bone. The non-linear nerve models were used to conclude from the potential field within the volume conductor on nerve activation. A comparison of simulated and experimentally measured chronaxie values (a measure for the excitability of nerves) and muscle twitch forces on human volunteers allowed us to conclude that some of the published nerve models can be used in TES models. The presented TES model provides a first step to more extensive model implementations for TES in which e.g., multi-array electrode configurations can be tested.