The methodology and scope of human microneurography

Neural signal recording and processing in somatic neuroprosthetic applications. A review

Neurointerfaces have acquired major relevance as both rehabilitative and therapeutic tools for patients with spinal cord injury, limb amputations and other neural disorders. Bidirectional neural interfaces are a key component for the functional control of neuroprosthetic devices. The two main neuroprosthetic applications of interfaces with the peripheral nervous system (PNS) are: the refined control of artificial prostheses with sensory neural feedback, and functional electrical stimulation (FES) systems attempting to generate motor or visceral responses in paralyzed organs. The results obtained in experimental and clinical studies with both, extraneural and intraneural electrodes are very promising in terms of the achieved functionality for the neural stimulation mode. However, the results of neural recordings with peripheral nerve interfaces are more limited. In this paper we review the different existing approaches for PNS signals recording, denoising, processing and classification, enabling their use for bidirectional interfaces. PNS recordings can provide three types of signals: i) population activity signals recorded by using extraneural electrodes placed on the outer surface of the nerve, which carry information about cumulative nerve activity; ii) spike activity signals recorded with intraneural electrodes placed inside the nerve, which carry information about the electrical activity of a set of individual nerve fibers; and iii) hybrid signals, which contain both spiking and cumulative signals. Finally, we also point out some of the main limitations, which are hampering clinical translation of neural decoding, and indicate possible solutions for improvement.

Subject-Specific Finite Element Modelling of the Human Hand Complex: Muscle-Driven Simulations and Experimental Validation

This paper aims to develop and validate a subject-specific framework for modelling the human hand. This was achieved by combining medical image-based finite element modelling, individualized muscle force and kinematic measurements. Firstly, a subject-specific human hand finite element (FE) model was developed. The geometries of the phalanges, carpal bones, wrist bones, ligaments, tendons, subcutaneous tissue and skin were all included. The material properties were derived from in-vivo and in-vitro experiment results available in the literature. The boundary and loading conditions were defined based on the kinematic data and muscle forces of a specific subject captured from the in-vivo grasping tests. The predicted contact pressure and contact area were in good agreement with the in-vivo test results of the same subject, with the relative errors for the contact pressures all being below 20%. Finally, sensitivity analysis was performed to investigate the effects of important modelling parameters on the predictions. The results showed that contact pressure and area were sensitive to the material properties and muscle forces. This FE human hand model can be used to make a detailed and quantitative evaluation into biomechanical and neurophysiological aspects of human hand contact during daily perception and manipulation. The findings can be applied to the design of the bionic hands or neuro-prosthetics in the future.

Microneurography as a tool to develop decoding algorithms for peripheral neuro-controlled hand prostheses

BACKGROUND

The usability of dexterous hand prostheses is still hampered by the lack of natural and effective control strategies. A decoding strategy based on the processing of descending efferent neural signals recorded using peripheral neural interfaces could be a solution to such limitation. Unfortunately, this choice is still restrained by the reduced knowledge of the dynamics of human efferent signals recorded from the nerves and associated to hand movements.

FINDINGS

To address this issue, in this work we acquired neural efferent activities from healthy subjects performing hand-related tasks using ultrasound-guided microneurography, a minimally invasive technique, which employs needles, inserted percutaneously, to record from nerve fibers. These signals allowed us to identify neural features correlated with force and velocity of finger movements that were used to decode motor intentions. We developed computational models, which confirmed the potential translatability of these results showing how these neural features hold in absence of feedback and when implantable intrafascicular recording, rather than microneurography, is performed.

CONCLUSIONS

Our results are a proof of principle that microneurography could be used as a useful tool to assist the development of more effective hand prostheses.

Microneurography: how it started and how it works

In the first section, this historical review describes endeavors to develop the method for recording normal nerve impulse traffic in humans, designated microneurography. The method was developed at the Department of Clinical Neurophysiology of the Academic Hospital in Uppsala, Sweden. Microneurography involves the impalement of a peripheral nerve with a tungsten needle electrode. Electrode position is adjusted by hand until the activity of interest is discriminated. Nothing similar had previously been tried in animal preparations, and thus the large number of preceding studies that recorded afferent activity in other mammals did not offer pertinent methodological guidance. For 2 years, the two scientists involved in the research impaled their own nerves with electrodes to test various kinds of needles and explore different neural systems, all the while carefully watching for signs of nerve damage. Temporary paresthesiae were common, whereas enduring sequelae never followed. Single-unit impulse trains could be discriminated, even those originating from unmyelinated fibers. An explanation for the discrimination of unitary impulses using a coarse electrode is inferred based on the electrical characteristics of the electrode placed in the flesh and the impulse shapes, as discussed in the second section of this paper. Microneurography and the microstimulation of single afferents, combined with psychophysical methods and behavioral tests, have generated new knowledge particularly regarding four neural systems, namely the proprioceptive system, the cutaneous mechanoreceptive system, the cutaneous nociceptive system, and the sympathetic efferent system to skin structures and muscular blood vessels. Examples of achievements based on microneurography are presented in the final section.

Cutaneous afferent innervation of the human foot sole: what can we learn from single-unit recordings?

Cutaneous afferents convey exteroceptive information about the interaction of the body with the environment and proprioceptive information about body position and orientation. Four classes of low-threshold mechanoreceptor afferents innervate the foot sole and transmit feedback that facilitates the conscious and reflexive control of standing balance. Experimental manipulation of cutaneous feedback has been shown to alter the control of gait and standing balance. This has led to a growing interest in the design of intervention strategies that enhance cutaneous feedback and improve postural control. The advent of single-unit microneurography has allowed the firing and receptive field characteristics of foot sole cutaneous afferents to be investigated. In this review, we consolidate the available cutaneous afferent microneurographic recordings from the foot sole and provide an analysis of the firing threshold, and receptive field distribution and density of these cutaneous afferents. This work enhances the understanding of the foot sole as a sensory structure and provides a foundation for the continued development of sensory augmentation insoles and other tactile enhancement interventions.

Ultrasound-guided, open-source microneurography: Approaches to improve recordings from peripheral nerves in man

OBJECTIVE

Microneurography is the only method for recording from single neurons in intact human nerves. It is challenging - requiring technical expertise, investment in specialised equipment and has sparse data yields.

METHODS

We assessed whether ultrasound guidance in combination with an 'open access' amplifier and data capture system (Open-Ephys) would simplify and expand the scope of microneurographic recordings in humans.

RESULTS

In 32 healthy consenting volunteers, ultrasound-guidance improved success rates for obtaining cutaneous C-fibres and reduced "Skin to Nerve" times from 28.5 min to 4.5 min for recordings of the peroneal nerve (P < 0.0001). We illustrate the potential utility of ultrasound-guided microneurography for difficult to access nerves with phrenic nerve recording during a Valsalva manoeuvre. We show that Open Ephys is a viable alternative to commercially available recording systems and offers advantages in terms of cost and software customisability.

CONCLUSIONS

Ultrasound guidance for microneurography with Open Ephys facilitates cutaneous C nociceptor recordings and allows recordings to be made from nerves previously considered inaccessible.

SIGNIFICANCE

We anticipate that the adoption of these techniques will improve microneurography experimental efficiency, adds an important visual learning aid and increases the generalisability of the approach.

In vitro multichannel single-unit recordings of action potentials from mouse sciatic nerve

Electrode arrays interfacing with peripheral nerves are essential for neuromodulation devices targeting peripheral organs to relieve symptoms. To modulate (i.e., single-unit recording and stimulating) individual peripheral nerve axons remains a technical challenge. Here, we report an in vitro setup to allow simultaneous single-unit recordings from multiple mouse sciatic nerve axons. The sciatic nerve (~30 mm) was harvested and transferred to a tissue chamber, the ~5mm distal end pulled into an adjacent recording chamber filled with paraffin oil. A custom-built multi-wire electrode array was used to interface with split fine nerve filaments. Single-unit action potentials were evoked by electrical stimulation and recorded from 186 axons, of which 49.5% were classed A-type with conduction velocities (CV) greater than 1 m/s and 50.5% were C-type (CV < 1 m/s). The single-unit recordings had no apparent bias towards A- or C-type axons, were robust and repeatable for over 60 minutes, and thus an ideal opportunity to assess different neuromodulation strategies targeting peripheral nerves. For instance, ultrasonic modulation of action potential transmission was assessed using the setup, indicating increased nerve conduction velocity following ultrasound stimulus. This setup can also be used to objectively assess the design of next-generation electrode arrays interfacing with peripheral nerves.

Non-invasive approach for the assessment of sympathetic baroreflex function: A feasibility study

BACKGROUND

Evaluation of sympathetic baroreflex (sBR) function in humans requires intra-neural recording of muscle sympathetic nerve activity (MSNA) by microneurography.

AIMS

We proposed noninvasive approach for the evaluation of sBR function by applying the threshold-analysis (traditionally, based on MSNA) to systemic vascular resistance (SVR) measurement by photoplethysmography.

METHODS & RESULTS

In nine healthy subjects (5M; age: 25±5y), the threshold-analysis was calculated twice: using MSNA and SVR. Both methods yield comparable results in men (T₅₀(burst-vs.-svr): CV=8.8%, r>0.9; Slope_(burst-svr): CV=30.1%; r>0.9), but not in women.

CONCLUSIONS

SVR-based threshold-analysis is feasible in healthy young subjects and provides a promising alternative to the traditional MSNA-based approach.

Preliminary observations on the vasomotor responses to electrical stimulation of the ventrolateral surface of the human medulla

Object

Pulsatile arterial compression (AC) of the ventrolateral medulla (VLM) is hypothesized to produce the hypertension in a subset of patients with essential hypertension. In animals, a network of subpial neuronal aggregates in the VLM has been shown to control cardiovascular functions. Although histochemically similar, neurons have been identified in the retro-olivary sulcus (ROS) of the human VLM, but their function is unclear.

Methods

The authors recorded cardiovascular responses to electrical stimulation at various locations along the VLM surface, including the ROS, in patients who were undergoing posterior fossa surgery for trigeminal neuralgia. This vasomotor mapping of the medullary surface was performed using a bipolar electrode, with stimulation parameters ranging from 5- to 30-second trains (20–100 Hz), constant current (1.5–5 mA), and 0.1-msec pulse durations. Heart rate (HR) and blood pressure (BP) were recorded continuously from baseline (10 seconds before the stimulus) up to 1 minute poststimulus. In 6 patients, 17 stimulation responses in BP and HR were recorded.

Results

The frequency threshold for any cardiovascular response was 20 Hz; the stimulation intensity threshold ranged from 1.5 to 3 mA. In the first patient, all stimulation responses were significantly different from sham recordings (which consisted of electrodes placed without stimulations). Repeated stimulations in the lower ROS produced similar responses in 3 other patients. Two additional patients had similar responses to single stimulations in the lower ROS. Olive stimulation produced no response (control). Hypotensive and/or bradycardic responses were consistently followed by a reflex hypertensive response. Slight right/left differences were noted. No patient suffered short- or long-term effects from this stimulation.

Conclusions

This stimulation technique for vasomotor mapping of the human VLM was safe and reproducible. Neuronal aggregates near the surface of the human ROS may be important in cardiovascular regulation. This method of vasomotor mapping with measures of responses in sympathetic tone (microneurography) should yield additional data for understanding the neuronal network that controls cardiovascular functions in the human VLM. Further studies in which a concentric bipolar electrode is used to generate this type of vasomotor map should also increase understanding of the pathophysiological mechanisms of neurogenically mediated hypertension, and assist in the design of studies to prove the hypothesis that it is caused by pulsatile AC of the VLM.

Contributions of skin and muscle afferent input to movement sense in the human hand

In the stationary hand, static joint-position sense originates from multimodal somatosensory input (e.g., joint, skin, and muscle). In the moving hand, however, it is uncertain how movement sense arises from these different submodalities of proprioceptors. In contrast to static-position sense, movement sense includes multiple parameters such as motion detection, direction, joint angle, and velocity. Because movement sense is both multimodal and multiparametric, it is not known how different movement parameters are represented by different afferent submodalities. In theory, each submodality could redundantly represent all movement parameters, or, alternatively, different afferent submodalities could be tuned to distinctly different movement parameters. The study described in this paper investigated how skin input and muscle input each contributes to movement sense of the hand, in particular, to the movement parameters dynamic position and velocity. Healthy adult subjects were instructed to indicate with the left hand when they sensed the unseen fingers of the right hand being passively flexed at the metacarpophalangeal (MCP) joint through a previously learned target angle. The experimental approach was to suppress input from skin and/or muscle: skin input by anesthetizing the hand, and muscle input by unexpectedly extending the wrist to prevent MCP flexion from stretching the finger extensor muscle. Input from joint afferents was assumed not to play a significant role because the task was carried out with the MCP joints near their neutral positions. We found that, during passive finger movement near the neutral position in healthy adult humans, both skin and muscle receptors contribute to movement sense but qualitatively differently. Whereas skin input contributes to both dynamic position and velocity sense, muscle input may contribute only to velocity sense.

Sympathetic neural control of integrated cardiovascular function: Insights from measurement of human sympathetic nerve activity

Sympathetic neural control of cardiovascular function is essential for normal regulation of blood pressure and tissue perfusion. In the present review we discuss sympathetic neural mechanisms in human cardiovascular physiology and pathophysiology, with a focus on evidence from direct recordings of sympathetic nerve activity using microneurography. Measurements of sympathetic nerve activity to skeletal muscle have provided extensive information regarding reflex control of blood pressure and blood flow in conditions ranging from rest to postural changes, exercise, and mental stress in populations ranging from healthy controls to patients with hypertension and heart failure. Measurements of skin sympathetic nerve activity have also provided important insights into neural control, but are often more difficult to interpret since the activity contains several types of nerve impulses with different functions. Although most studies have focused on group mean differences, we provide evidence that individual variability in sympathetic nerve activity is important to the ultimate understanding of these integrated physiological mechanisms.

A purposely designed neural signal amplifier for short interval stimulation and recording microneurography using a common electrode

'Common Electrode' microneurography (i.e. stimulating a nerve and recording return afferent neural activity through the same microelectrode facilitates investigation of linkages between sensory and motor nervous systems in humans. Currently there is no commercial product designed specifically to conduct common electrode microneurography experiments. However, such experiments would advance investigations in several key areas including spinal injury research. In this paper, we report on the successful production and testing (on a human subject) of an integrated amplifier built specifically for this purpose. The amplifier was built using commercially available components to allow for both easy and economical manufacture. In particular, we report on the design requirements and outline our chosen design solutions. The amplifier handles low-level neural signals amidst large 50 Hz interference, with protection against potentially high stimulation voltages of over 100 V dc, with minimal cross-coupling of rapid stimulus pulses onto the high gain amplifier's input, and a short 'blocking' time between stimulation and recording. The amplifier also includes necessary filters, selectable gains and internal stimulator triggering circuits to provide a simple, integrated solution for common electrode operation on human subjects.

A critical review of interfaces with the peripheral nervous system for the control of neuroprostheses and hybrid bionic systems

Considerable scientific and technological efforts have been devoted to develop neuroprostheses and hybrid bionic systems that link the human nervous system with electronic or robotic prostheses, with the main aim of restoring motor and sensory functions in disabled patients. A number of neuroprostheses use interfaces with peripheral nerves or muscles for neuromuscular stimulation and signal recording. Herein, we provide a critical overview of the peripheral interfaces available and trace their use from research to clinical application in controlling artificial and robotic prostheses. The first section reviews the different types of non-invasive and invasive electrodes, which include surface and muscular electrodes that can record EMG signals from and stimulate the underlying or implanted muscles. Extraneural electrodes, such as cuff and epineurial electrodes, provide simultaneous interface with many axons in the nerve, whereas intrafascicular, penetrating, and regenerative electrodes may contact small groups of axons within a nerve fascicle. Biological, technological, and material science issues are also reviewed relative to the problems of electrode design and tissue injury. The last section reviews different strategies for the use of information recorded from peripheral interfaces and the current state of control neuroprostheses and hybrid bionic systems.

Changing the texture of footwear can alter gait patterns

The foot provides an important source of afferent feedback for balance and locomotion. Sensory feedback from the feet can be altered by standing or walking on different surfaces. The purpose was to determine the effects of textured footwear on lower extremity muscle activity, limb kinematics, and joint kinetics while walking. Three-dimensional kinematics and kinetics, as well as muscle EMG, were collected as subjects walked with a smooth and textured shoe insert. Muscle activity was analyzed using a wavelet technique. The textured shoe insert caused a significant reduction in both soleus and tibialis anterior intensity during periods when these muscles are most active. Furthermore, the changes in muscle activity were only seen in the low frequency content of the EMG signal. The foot was significantly more plantar flexed at heel strike with the textured inserts. Small changes were also seen in vertical ground reaction forces and joint moments. It was assumed that the changes in gait patterns were due to a change in sensory feedback caused by the textured shoe insert. The possibilities of altered sensory feedback with footwear are discussed. Sensory feedback from the feet may affect specific motor unit pools during different activities. Changing the texture, without changing the geometry, of a shoe insert can alter muscle activity during walking. This may be useful in the prescription of footwear interventions and suggests that footwear may have sensory as well as mechanical effects.

A method for intraoperative microneurographic recording of unitary activity in the trigeminal ganglion of patients with trigeminal neuralgia

The etiology of trigeminal neuralgia appears to be vascular compression of the nerve at the root entry zone. However, the physiologic mechanism of trigeminal neuralgia remains uncertain. To gain insight into the pathophysiology of the disorder, we developed a method for intraoperative microneurographic recordings from the trigeminal ganglion of patients with trigeminal neuralgia. The recordings are performed immediately prior to standard percutaneous trigeminal gangliolysis for pain relief. Spontaneous or evoked single- and multi-unit action potential activity can be recorded and the location of receptive fields determined. The method should facilitate the testing of hypotheses concerning the origin of this unique pain disorder.

Position sensitivity of human muscle spindles: single afferent and population representations

The representation of joint position at rest and during movement was investigated in 44 muscle spindle primary afferents originating from the extensor carpi radialis brevis (ECRb) and extensor digitorum (ED) of normal human subjects. Position sensitivity was estimated for each afferent, and 43 of 44 were position sensitive. In each trial, six sequential ramp-and-hold movements (2-6 degrees, 2 degrees/s, total 24 degrees) flexed the relaxed wrist, beginning from the angle at which the afferent was just recruited. Joint position was represented by three specific features of afferent firing patterns: the steady-state firing rate during the 4-s hold period between ramps, the initial burst at the beginning of each ramp, and the ramp increase in firing rate later in the movement. The position sensitivity of the initial burst (1.27 +/- 0.90 pps/degree, mean +/- SD) was several times higher than that of the hold period (0.40 +/- 0.30 pps/degree) and not different from that of the ramp increase in firing rate (1.36 +/- 0.68 pps/degree). The wrist position sensitivities of ECRb and ED afferents were equivalent, as were their recruitment angles and angular ranges of position sensitivity. Muscle spindle afferents, both individually and as a population, were shown to represent static joint position via the hold rate and the initial burst. Afferents were recruited over the entire 110 degree range of wrist positions investigated; however, the angular range over which each feature represented joint position was extremely limited (approximately 15 degrees). The population response, based on the summed activity of the 43 afferents, was monotonically related to joint position, and it was strongly influenced by the afferent recruitment pattern, but less so by the position sensitivities of the individual afferents.

The development of conduction block in single human axons following a focal nerve injury

1. Using microneurography with a conventional monopolar electrode, the action potentials of ten myelinated axons in the peripheral nerves of human subjects were followed while they developed conduction block. 2. The action potentials had initially (n = 6) or developed (n = 4) a positive double-peaked morphology. The time interval between the two positive peaks represents the conduction time across the impaled internode. 3. When the interpeak interval was < 500 micros, conduction across the site of impalement was secure, even if the conduction time was markedly prolonged. When the interval was > 600 microseconds, intermittent conduction failure occurred. For all units the longest interpeak interval recorded just prior to complete conduction failure was, on average, 1.12 ms (range, 0.8-1.4 ms). 4. For five axons, there was evidence that natural activity triggered the conduction failure. 5. Impalement of the nerve fibre by the microelectrode impairs the ability of the axon to conduct impulses across the site of injury, but impulse transmission can be secure even when the conduction time across individual internodes is prolonged to 500 microseconds. These findings are therefore relevant to the conduction deficits that occur in focal injuries of human axons.

Spike train analysis

Procedures for the analysis of stimulus-correlated spike train data are reviewed. All procedures considered attempt to extract excitability changes evoked by the stimulus at the neuron investigated. The methods covered range from rather simple methods that require very little computational effort (raw spike train displays; peri-stimulus-time histogram (PSTH)) to more sophisticated procedures that attempt to extract all information available in the recorded spike-train data.