Extracellular voltage profile for reversing the recruitment order of peripheral nerve stimulation: a simulation study

A guiding light for stimulating paralyzed muscles

Improving the performance of closed-loop optogenetic nerve stimulation can reproduce desired muscle activation patterns.

Closed-loop cervical epidural stimulation partially restores ipsilesional diaphragm EMG after acute C2 hemisection

Cervical spinal cord injury creates lasting respiratory deficits which can require mechanical ventilation long-term. We have shown that closed-loop epidural stimulation (CL-ES) elicits respiratory plasticity in the form of increased phrenic network excitability (Malone et. al., E Neuro, Vol 9, 0426-21.2021, 2022); however, the ability of this treatment to create functional benefits for breathing function per se after injury has not been demonstrated. Here, we demonstrate in C2 hemisected anesthetized rats, a 20-minute bout of CL-ES administered at current amplitudes below the motor threshold restores paralyzed hemidiaphragm activity in-phase with breathing while potentiating contralesional activity. While this acute bout of stimulation did not elicit the increased network excitability seen in our chronic model, a subset of stimulated animals continued spontaneous ipsilesional diaphragm activity for several seconds after stopping stimulation. These results support the use of CL-ES as a therapeutic to rescue breathing after high cervical spinal cord injury, with the potential to lead to lasting recovery and device independence.

Characterization of perception by transcutaneous electrical Stimulation in terms of tingling intensity and temporal dynamics

Electrotactile feedback is a cost-effective and versatile method to provide new information or to augment intrinsic tactile feedback. As tactile feedback provides critical information for human-environment interaction, electrotactile feedback, accordingly, has many purposes to improve the quality of human-environment interaction in both direct and remote settings. However, electrotactile feedback overlays tingling sensation on top of the natural tactile feedback. To better characterize electrotactile feedback and understand the origin of the tingling sensation, a need arises to characterize the human perception of electrotactile feedback qualitatively and quantitatively, while varying the key stimulation parameters, namely amplitude and frequency. This study consists of two experiments. In the first experiment, the voltage for each subject was characterized by setting perception and discomfort thresholds. In the second experiment, subjects received electrical stimulation in 9 different combinations of voltages and frequencies. On delivering stimulation with each parameter combination, subjects reported their perception in two comparative scales-pressure vs. tingling and constant vs. pulsing. Subjects also reported the location of perception for stimulation with every parameter combination. More tingling and less pressure was reported as frequency increased, while the tingling-pressure percept was not affected by the amplitude change. Additionally, less pulsing and more constant was reported as frequency increased, while the pulsing-constant percept was not affected by the amplitude change. Concurrently, the normalized level of voltage thresholds was decreased as frequency increased. Dependency of tingling-pressure percept on stimulation frequency suggests that incongruency between the stimulation frequency and the natural firing rate of the sensory neuron would be an important factor of the tingling sensation. This study is a steppingstone to further demystify the origin of the tingling percept caused by electrical stimulation, thus broadening the use of transcutaneous electrical stimulation as a way of providing tactile cue or augmentation.

Organ- and function-specific anatomical organization of vagal fibers supports fascicular vagus nerve stimulation

Vagal fibers travel inside fascicles and form branches to innervate organs and regulate organ functions. Existing vagus nerve stimulation (VNS) therapies activate vagal fibers non-selectively, often resulting in reduced efficacy and side effects from non-targeted organs. The transverse and longitudinal arrangement of fibers inside the vagal trunk with respect to the functions they mediate and organs they innervate is unknown, however it is crucial for selective VNS. Using micro-computed tomography imaging, we tracked fascicular trajectories and found that, in swine, sensory and motor fascicles are spatially separated cephalad, close to the nodose ganglion, and merge caudad, towards the lower cervical and upper thoracic region; larynx-, heart- and lung-specific fascicles are separated caudad and progressively merge cephalad. Using quantified immunohistochemistry at single fiber level, we identified and characterized all vagal fibers and found that fibers of different morphological types are differentially distributed in fascicles: myelinated afferents and efferents occupy separate fascicles, myelinated and unmyelinated efferents also occupy separate fascicles, and small unmyelinated afferents are widely distributed within most fascicles. We developed a multi-contact cuff electrode to accommodate the fascicular structure of the vagal trunk and used it to deliver fascicle-selective cervical VNS in anesthetized and awake swine. Compound action potentials from distinct fiber types, and physiological responses from different organs, including laryngeal muscle, cough, breathing, and heart rate responses are elicited in a radially asymmetric manner, with consistent angular separations that agree with the documented fascicular organization. These results indicate that fibers in the trunk of the vagus nerve are anatomically organized according to functions they mediate and organs they innervate and can be asymmetrically activated by fascicular cervical VNS.

Comparison of wire and disc electrodes to electrically activate the inspiratory muscles in dogs

OBJECTIVE

To compare the effectiveness of wire versus disc electrodes to activate the inspiratory muscles via high frequency spinal cord stimulation.

DESIGN

Animal study.

SETTING

Research laboratory.

ANIMALS

Dogs (n = 5) INTERVENTIONS: In separate trials, spinal cord stimulation (SCS) was applied via disc (DE) and two parallel wire electrodes (WE) on the ventral epidural space at the T2-T3 spinal region.

MAIN OUTCOME MEASURE(S)

Airway pressure (P) and inspired volume (V) generation following stimulation with DE and WE were compared. Given our previous success with (DE), outcome variables with this electrode were used as our gold standard to which all comparisons were made.

RESULTS

Two configurations of WE using monopolar stimulation (MS) resulted in P and V that were similar to those generated with MS with DE. For example, MS with parallel WE connected together to function as a common cathode (Y-connection) and a 2-channel system (separate cathodes with a remote ground), resulted in P that were 91 ± 6 and 92 ± 4%, respectively, of those achieved with DE (NS for both). Bipolar stimulation with parallel WE using a Y-connection and with a 2-channel system, resulted in P that were 96 ± 4 and 94 ± 4%, of the P achieved with DE (NS for both).

CONCLUSION(S)

These results suggest that specific configurations of WE, which can be placed via minimally invasive techniques, provide comparable activation of the inspiratory muscles compared to DE and may be a useful technique to restore ventilatory support in persons with spinal cord injury.

A Computational Model of Functionally-distinct Cervical Vagus Nerve Fibers

Cervical vagus nerve stimulation (VNS) is a neuromodulation therapy used in the treatment of several chronic disorders. In order to maximize the therapeutic effectiveness of VNS, it has become increasingly important to deliver fiber-specific neurostimulation, so that undesired effects can be minimized. Assessing the activation of different vagal fiber types through electrical stimulation is therefore essential for developing fiber-selective VNS therapies. Towards this goal, we conducted in silico investigations using a generic model of functionally distinct nerve fibers and clinically relevant cuff electrodes using COMSOL. Our model is constrained by histological observations from rat cervical vagus nerves and its outputs are validated against averaged compound nerve action potentials (CNAPs) obtained from rat vagus nerve recordings. We propose this model as an effective tool to design fiber-specific stimulation protocols before testing them in experimental animals.

Simulation of transcranial magnetic stimulation in head model with morphologically-realistic cortical neurons

BACKGROUND

Transcranial magnetic stimulation (TMS) enables non-invasive modulation of brain activity with both clinical and research applications, but fundamental questions remain about the neural types and elements TMS activates and how stimulation parameters affect the neural response.

OBJECTIVE

To develop a multi-scale computational model to quantify the effect of TMS parameters on the direct response of individual neurons.

METHODS

We integrated morphologically-realistic neuronal models with TMS-induced electric fields computed in a finite element model of a human head to quantify the cortical response to TMS with several combinations of pulse waveforms and current directions.

RESULTS

TMS activated with lowest intensity intracortical axonal terminations in the superficial gyral crown and lip regions. Layer 5 pyramidal cells had the lowest thresholds, but layer 2/3 pyramidal cells and inhibitory basket cells were also activated at most intensities. Direct activation of layers 1 and 6 was unlikely. Neural activation was largely driven by the field magnitude, rather than the field component normal to the cortical surface. Varying the induced current direction caused a waveform-dependent shift in the activation site and provided a potential mechanism for experimentally observed differences in thresholds and latencies of muscle responses.

CONCLUSIONS

This biophysically-based simulation provides a novel method to elucidate mechanisms and inform parameter selection of TMS and other cortical stimulation modalities. It also serves as a foundation for more detailed network models of the response to TMS, which may include endogenous activity, synaptic connectivity, inputs from intrinsic and extrinsic axonal projections, and corticofugal axons in white matter.

Optogenetic recruitment of spinal reflex pathways from large-diameter primary afferents in non-transgenic rats transduced with AAV9/Channelrhodopsin 2

Key points

We demonstrated optical activation of primary somatosensory afferents with high selectivity to fast‐conducting fibres by means of adeno‐associated virus 9 (AAV9)‐mediated gene transduction in dorsal root ganglion (DRG) neurons.

AVV9 expressing green fluorescent protein showed high selectivity and transduction efficiency for fast‐conducting, large‐sized DRG neurons.

Compared with conventional electrical stimulation, optically elicited volleys in primary afferents had higher sensitivity with stimulus amplitude, but lower sensitivity with stimulus frequency.

Optically elicited dorsal root volleys activated postsynaptic neurons in the segmental spinal pathway.

This proposed technique will help establish the causal relationships between somatosensory afferent inputs and neural responses in the CNS as well as behavioural outcomes in higher mammals where transgenic animals are not available.

Abstract

Previously, fundamental structures and their mode of action in the spinal reflex circuit were determined by confirming their input–output relationship using electrophysiological techniques. In those experiments, the electrical stimulation of afferent fibres was used as a core element to identify different types of reflex pathways; however, a major disadvantage of this technique is its non‐selectivity. In this study, we investigated the selective activation of large‐diameter afferents by optogenetics combined with a virus vector transduction technique (injection via the sciatic nerve) in non‐transgenic male Jcl:Wistar rats. We found that green fluorescent protein gene transduction of rat dorsal root ganglion (DRG) neurons with a preference for medium‐to‐large‐sized cells was achieved using the adeno‐associated virus 9 (AAV9) vector compared with the AAV6 vector (P = 0.021). Furthermore, the optical stimulation of Channelrhodopsin 2 (ChR2)‐expressing DRG neurons (transduced by AAV9) produced compound action potentials in afferent nerves originating from fast‐conducting nerve fibres. We also confirmed that physiological responses to different stimulus amplitudes were comparable between optogenetic and electrophysiological activation. However, compared with electrically elicited responses, the optically elicited responses had lower sensitivity with stimulus frequency. Finally, we showed that afferent volleys evoked by optical stimulation were sufficient to activate postsynaptic neurons in the spinal reflex arc. These results provide new ways for understanding the role of sensory afferent input to the central nervous system regarding behavioural control, especially when genetically manipulated animals are not available, such as higher mammals including non‐human primates.

We demonstrated optical activation of primary somatosensory afferents with high selectivity to fast‐conducting fibres by means of adeno‐associated virus 9 (AAV9)‐mediated gene transduction in dorsal root ganglion (DRG) neurons.

AVV9 expressing green fluorescent protein showed high selectivity and transduction efficiency for fast‐conducting, large‐sized DRG neurons.

Compared with conventional electrical stimulation, optically elicited volleys in primary afferents had higher sensitivity with stimulus amplitude, but lower sensitivity with stimulus frequency.

Optically elicited dorsal root volleys activated postsynaptic neurons in the segmental spinal pathway.

This proposed technique will help establish the causal relationships between somatosensory afferent inputs and neural responses in the CNS as well as behavioural outcomes in higher mammals where transgenic animals are not available.

Viral-Mediated Optogenetic Stimulation of Peripheral Motor Nerves in Non-human Primates

Objective: Reanimation of muscles paralyzed by disease states such as spinal cord injury remains a highly sought therapeutic goal of neuroprosthetic research. Optogenetic stimulation of peripheral motor nerves expressing light-sensitive opsins is a promising approach to muscle reanimation that may overcome several drawbacks of traditional methods such as functional electrical stimulation (FES). However, the utility of these methods has only been demonstrated in rodents to date, while translation to clinical practice will likely first require demonstration and refinement of these gene therapy techniques in non-human primates. Approach: Three rhesus macaques were injected intramuscularly with either one or both of two optogenetic constructs (AAV6-hSyn-ChR2-eYFP and/or AAV6-hSyn-Chronos-eYFP) to transduce opsin expression in the corresponding nerves. Neuromuscular junctions were targeted for virus delivery using an electrical stimulating injection technique. Functional opsin expression was periodically evaluated up to 13 weeks post-injection by optically stimulating targeted nerves with a 472 nm fiber-coupled laser while recording electromyographic (EMG) responses. Main Results: One monkey demonstrated functional expression of ChR2 at 8 weeks post-injection in each of two injected muscles, while the second monkey briefly exhibited contractions coupled to optical stimulation in a muscle injected with the Chronos construct at 10 weeks. A third monkey injected only in one muscle with the ChR2 construct showed strong optically coupled contractions at 5 ½ weeks which then disappeared by 9 weeks. EMG responses to optical stimulation of ChR2-transduced nerves demonstrated graded recruitment relative to both stimulus pulse-width and light intensity, and followed stimulus trains up to 16 Hz. In addition, the EMG response to prolonged stimulation showed delayed fatigue over several minutes. Significance: These results demonstrate the feasibility of viral transduction of peripheral motor nerves for functional optical stimulation of motor activity in non-human primates, a variable timeline of opsin expression in a animal model closer to humans, and fundamental EMG response characteristics to optical nerve stimulation. Together, they represent an important step in translating these optogenetic techniques as a clinically viable gene therapy.

Electrical Neuromodulation of the Respiratory System After Spinal Cord Injury

Spinal cord injury (SCI) is a complex and devastating condition characterized by disruption of descending, ascending, and intrinsic spinal circuitry resulting in chronic neurologic deficits. In addition to limb and trunk sensorimotor deficits, SCI can impair autonomic neurocircuitry such as the motor networks that support respiration and cough. High cervical SCI can cause complete respiratory paralysis, and even lower cervical or thoracic lesions commonly result in partial respiratory impairment. Although electrophrenic respiration can restore ventilator-independent breathing in select candidates, only a small subset of affected individuals can benefit from this technology at this moment. Over the past decades, spinal cord stimulation has shown promise for augmentation and recovery of neurologic function including motor control, cough, and breathing. The present review discusses the challenges and potentials of spinal cord stimulation for restoring respiratory function by overcoming some of the limitations of conventional respiratory functional electrical stimulation systems.

Assessment on selectivity of multi-contact cuff electrode for recording peripheral nerve signals using Fitzhugh-Nagumo model of nerve excitation

BACKGROUND

Nerve cuff electrodes provide a safe technique for recording nerve signals. Defining a more realized modeling to investigate the selectivity of a cuff electrode in recording from peripheral nervous system is an interesting field of research.

METHODS

A four-contact cuff electrode was modeled to evaluate selective recording from a peripheral nerve. Fitzhugh-Nagumo equations were used to model the electromagnetic fields generated by active nerves and electrodes and the ``selectivity index'' used to quantify the selective property of the cuff electrode.

RESULTS

The action potentials amplitude and impulse velocity generated by Fitzhugh-Nagumo model are similar to real-life nerve measurements according to the literature. The electrical field distribution caused by the impulse propagation along a specific nerve was the maximum near the corresponding contact. Also, the selectivity was increased with increasing the distance between the active sources and the number of contacts.

CONCLUSION

The results of this research showed that Fitzhugh-Nagumo equations could model the nerve excitation accurately and could be used in computer simulation for studying nervous systems. Also, using these equations indicated that multi-contact cuff electrodes could be used in recording peripheral nerve signals in order to discriminate active fascicles in a nerve bundle.

Modulation of heart rate by temporally patterned vagus nerve stimulation in the anesthetized dog

Despite current knowledge of the myriad physiological effects of vagus nerve stimulation (VNS) in various mammalian species (including humans), the impact of varying stimulation parameters on nerve recruitment and physiological responses is not well understood. We investigated nerve recruitment, cardiovascular responses, and skeletal muscle responses to different temporal patterns of VNS across 39 combinations of stimulation amplitude, frequency, and number of pulses per burst. Anesthetized dogs were implanted with stimulating and recording cuff electrodes around the cervical vagus nerve, whereas laryngeal electromyogram (EMG) and heart rate were recorded. In seven of eight dogs, VNS‐evoked bradycardia (defined as ≥10% decrease in heart rate) was achieved by applying stimuli at amplitudes equal to or greater than the threshold for activating slow B‐fibers. Temporally patterned VNS (minimum 5 pulses per burst) was sufficient to elicit bradycardia while reducing the concomitant activation of laryngeal muscles by more than 50%. Temporal patterns of VNS can be used to modulate heart rate while minimizing laryngeal motor fiber activation, and this is a novel approach to reduce the side effects produced by VNS.

Optical stimulation for restoration of motor function after spinal cord injury

Spinal cord injury can be defined as a loss of communication between the brain and the body due to disrupted pathways within the spinal cord. Although many promising molecular strategies have emerged to reduce secondary injury and promote axonal regrowth, there is still no effective cure, and recovery of function remains limited. Functional electrical stimulation (FES) represents a strategy developed to restore motor function without the need for regenerating severed spinal pathways. Despite its technological success, however, FES has not been widely integrated into the lives of spinal cord injury survivors. In this review, we briefly discuss the limitations of existing FES technologies. Additionally, we discuss how optogenetics, a rapidly evolving technique used primarily to investigate select neuronal populations within the brain, may eventually be used to replace FES as a form of therapy for functional restoration after spinal cord injury.

Diameter-dependent excitation of peripheral nerve fibers by multipolar electrodes during electrical stimulation

Neural prostheses are technical devices that interface the nervous system to restore lost body functions by means of electrical stimulation, and to increase the activities of daily living of disabled persons--at least to some extent. One of the major reasons for the limited performance of neural prostheses is caused by the inverse recruitment of axons via excitation, by means of electrical stimulation. Due to their biophysical properties, electrical stimulation excites axons according to their diameter, starting with large-diameter fibers. This is the inverse order with respect to physiologic recruitment. It causes muscle fatigue, dyssynergia and limited muscle force control, respectively. A new electrode arrangement, with longitudinal multipolar stimulation, allows the selection of fiber diameters by its design with rectangular stimulation pulses and a reasonable amount of charge per phase. This report discusses the impact of the new approach in comparison with other stimulation paradigms to obtain fiber-selective nerve activation and its opportunities for neural prostheses in context with miniaturization trends in implant technology.

Activation of inspiratory muscles via spinal cord stimulation

Diaphragm pacing is a clinically useful modality providing artificial ventilatory support in patients with ventilator dependent spinal cord injury. Since this technique is successful in providing full-time ventilatory support in only ~50% of patients, better methods are needed. In this paper, we review a novel method of inspiratory muscle activation involving the application of electrical stimulation applied to the ventral surface of the upper thoracic spinal cord at high stimulus frequencies (300 Hz). In an animal model, high frequency spinal cord stimulation (HF-SCS) results in synchronous activation of both the diaphragm and inspiratory intercostal muscles. Since this method results in an asynchronous pattern of EMG activity and mean peak firing frequencies similar to those observed during spontaneous breathing, HF-SCS is a more physiologic form of inspiratory muscle activation. Further, ventilation can be maintained on a long-term basis with repetitive stimulation at low stimulus amplitudes (<1 mA). These preliminary results suggest that HF-SCS holds promise as a more successful method of inspiratory muscle pacing.

Modeling extracellular electrical neural stimulation: from basic understanding to MEA-based applications

Extracellular electrical stimulation of neural networks has been widely used empirically for decades with individual electrodes. Since recently, microtechnology provides advanced systems with high-density microelectrode arrays (MEAs). Taking the most of these devices for fundamental goals or developing neural prosthesis requires a good knowledge of the mechanisms underlying electrical stimulation. Here, we review modeling approaches used to determine (1) the electric potential field created by a stimulation and (2) the response of an excitable cell to an applied field. Computation of the potential field requires solving the Poisson equation. While this can be performed analytically in simple electrode-neuron configurations, numerical models are required for realistic geometries. In these models, special care must be taken to model the potential drop at the electrode/tissue interface using appropriate boundary conditions. The neural response to the field can then be calculated using compartmentalized cell models, by solving a cable equation, the source term of which (called activating function) is proportional to the second derivative of the extracellular field along the neural arborization. Analytical and numerical solutions to this equation are first presented. Then, we discuss the use of approximated solutions to intuitively predict the neuronal response: Either the "activating function" or the "mirror estimate", depending on the pulse duration and the cell space constant. Finally, we address the design of optimal electrode configurations allowing the selective activation of neurons near each stimulation site. This can be achieved using either multipolar configurations, or the "ground surface" configuration, which can be easily integrated in high-density MEAs. Overall, models highlighting the mechanisms of electrical microstimulation and improving stimulating devices should help understanding the influence of extracellular fields on neural elements and developing optimized neural prostheses for rehabilitation.

Selective neural activation in a histologically derived model of peripheral nerve

Functional electrical stimulation (FES) is a general term for therapeutic methods that use electrical stimulation to aid or replace lost ability. For FES systems that communicate with the nervous system, one critical component is the electrode interface through which the machine-body information transfer must occur. In this paper, we examine the influence of inhomogeneous tissue conductivities and positions of nodes of Ranvier on activation of myelinated axons for neuromuscular control as a function of electrode configuration. To evaluate these effects, we developed a high-resolution bioelectric model of a fascicle from a stained cross-section of cat sciatic nerve. The model was constructed by digitizing a fixed specimen of peripheral nerve, extruding the image along the axis of the nerve, and assigning each anatomical component to one of several different tissue types. Electrodes were represented by current sources in monopolar, transverse bipolar, and longitudinal bipolar configurations; neural activation was determined using coupled field-neuron simulations with myelinated axon cable models. We found that the use of an isotropic tissue medium overestimated neural activation thresholds compared with the use of physiologically based, inhomogeneous tissue medium, even after controlling for mean impedance levels. Additionally, the positions of the cathodic sources relative to the nodes of Ranvier had substantial effects on activation, and these effects were modulated by the electrode configuration. Our results indicate that physiologically based tissue properties cause considerable variability in the neural response, and the inclusion of these properties is an important component in accurately predicting activation. The results are used to suggest new electrode designs to enable selective stimulation of small diameter fibers.

Orderly recruitment of motor units under optical control in vivo

A drawback of electrical stimulation for muscle control is that large, fatigable motor units are preferentially recruited before smaller motor units by the lowest-intensity electrical cuff stimulation. This phenomenon limits therapeutic applications because it is precisely the opposite of the normal physiological (orderly) recruitment pattern; therefore, a mechanism to achieve orderly recruitment has been a long-sought goal in physiology, medicine and engineering. Here we demonstrate a technology for reliable orderly recruitment in vivo. We find that under optical control with microbial opsins, recruitment of motor units proceeds in the physiological recruitment sequence, as indicated by multiple independent measures of motor unit recruitment including conduction latency, contraction and relaxation times, stimulation threshold and fatigue. As a result, we observed enhanced performance and reduced fatigue in vivo. These findings point to an unanticipated new modality of neural control with broad implications for nervous system and neuromuscular physiology, disease research and therapeutic innovation.

Effect of bipolar cuff electrode design on block thresholds in high-frequency electrical neural conduction block

Many medical conditions are characterized by undesired or pathological peripheral neurological activity. The local delivery of high-frequency alternating currents (HFAC) has been shown to be a fast acting and quickly reversible method of blocking neural conduction and may provide a treatment alternative for eliminating pathological neural activity in these conditions. This work represents the first formal study of electrode design for high-frequency nerve block, and demonstrates that the interpolar separation distance for a bipolar electrode influences the current amplitudes required to achieve conduction block in both computer simulations and mammalian whole nerve experiments. The minimal current required to achieve block is also dependent on the diameter of the fibers being blocked and the electrode-fiber distance. Single fiber simulations suggest that minimizing the block threshold can be achieved by maximizing both the bipolar activating function (by adjusting the bipolar electrode contact separation distance) and a synergistic addition of membrane sodium currents generated by each of the two bipolar electrode contacts. For a rat sciatic nerve, 1.0-2.0 mm represented the optimal interpolar distance for minimizing current delivery.

The "mirror" estimate: an intuitive predictor of membrane polarization during extracellular stimulation

Achieving controlled extracellular microstimulation of the central nervous system requires understanding the membrane response of a neuron to an applied electric field. The "activating function" has been proposed as an intuitive predictor of membrane polarization during stimulation, but subsequent literature raised several limitations of this estimate. In this study, we show that, depending on the space constant lambda, the steady-state solution to the passive cable equation is theoretically well approximated by either the activating function when lambda is small, or the "mirror" image of the extracellular potential when lambda is large. Using simulations, we then explore the respective domain of both estimates as a function of lambda, stimulus duration, fiber length, and electrode-fiber distance. For realistic lambda (>50-100 microm), the mirror estimate is the best predictor for either long electrode-fiber distances or short distances (<20-30 microm) when stimulus durations exceed a few tens of microseconds. For intermediate distances, the mirror estimate is all the more valid that the stimulus duration is long and the fiber is short. We also illustrate that this estimate correctly predicts the steady-state membrane polarization of complex central nervous system arborizations. In conclusion, the mirror estimate can often be preferred to the activating function to intuitively predict membrane polarization during extracellular stimulation.

High-frequency spinal cord stimulation of inspiratory muscles in dogs: a new method of inspiratory muscle pacing

Despite clinically available methods of diaphragm pacing, most patients with ventilator-dependent tetraplegia are still dependent on mechanical ventilation. Given the significant disadvantages of these devices, additional pacing options are needed. The objective of this study was to evaluate a novel and potentially more physiological method of inspiratory muscle activation, which involves the application of high-frequency (>200 Hz) stimulation to the ventral surface of the spinal cord in the high thoracic region. Studies were performed in 13 anesthetized dogs. High-frequency spinal cord stimulation (HF-SCS) results in the activation of both the diaphragm and inspiratory intercostal muscles, in concert, at physiological firing frequencies and the generation of large inspired volumes. Mean maximum firing frequencies of motor units in the parasternal (2nd interspace), the external intercostal (3rd interspace), and the diaphragm muscles were 10.6 +/- 0.4, 11.7 +/- 0.4, and 10.4 +/- 0.3 Hz, respectively. These values were not significantly different from those occurring during spontaneous breathing at comparable inspired volumes. Maximum inspired volume was 0.93 +/- 0.01 liter, which approximates the inspiratory capacity of these animals. Moreover, ventilation can be maintained on a chronic basis by this method (6 h) without evidence of system fatigue. Our results suggest that HF-SCS results in activation of spinal cord tracts that synapse with the inspiratory motoneuron pools, allowing processing of the stimulus and consequent physiological activation of the inspiratory muscles. HF-SCS has the potential to provide an effective method of inspiratory muscle pacing.

Improved focalization of electrical microstimulation using microelectrode arrays: a modeling study

Extracellular electrical stimulation (EES) of the central nervous system (CNS) has been used empirically for decades, with both fundamental and clinical goals. Currently, microelectrode arrays (MEAs) offer new possibilities for CNS microstimulation. However, although focal CNS activation is of critical importance to achieve efficient stimulation strategies, the precise spatial extent of EES remains poorly understood. The aim of the present work is twofold. First, we validate a finite element model to compute accurately the electrical potential field generated throughout the extracellular medium by an EES delivered with MEAs. This model uses Robin boundary conditions that take into account the surface conductance of electrode/medium interfaces. Using this model, we determine how the potential field is influenced by the stimulation and ground electrode impedances, and by the electrical conductivity of the neural tissue. We confirm that current-controlled stimulations should be preferred to voltage-controlled stimulations in order to control the amplitude of the potential field. Second, we evaluate the focality of the potential field and threshold-distance curves for different electrode configurations. We propose a new configuration to improve the focality, using a ground surface surrounding all the electrodes of the array. We show that the lower the impedance of this surface, the more focal the stimulation. In conclusion, this study proposes new boundary conditions for the design of precise computational models of extracellular stimulation, and a new electrode configuration that can be easily incorporated into future MEA devices, either in vitro or in vivo, for a better spatial control of CNS microstimulation.

Fascicular perineurium thickness, size, and position affect model predictions of neural excitation

The number of applications using neural prosthetic interfaces is expanding. Computer models are a valuable tool to evaluate stimulation techniques and electrode designs. Although our understanding of neural anatomy has improved, its impact on the effects of neural stimulation is not well understood. This study evaluated the effects of fascicle perineurial thickness, diameter, and position on axonal excitation thresholds and population recruitment using finite element models and NEURON simulations. The perineurial thickness of human fascicles was found to be 3.0% +/- 1.0% of the fascicle diameter. Increased perineurial thickness and fascicle diameter increased activation thresholds. The presence of a large neighboring fascicle caused a significant change in activation of a smaller target fascicle by as much as 80% +/- 11% of the total axon population. Smaller fascicles were recruited at lower amplitudes than neighboring larger fascicles. These effects were further illustrated in a realistic model of a human femoral nerve surrounded by a nerve cuff electrode. The data suggest that fascicular selectivity is strongly dependent upon the anatomy of the nerve being stimulated. Therefore, accurate representations of nerve anatomy are required to develop more accurate computer models to evaluate and optimize nerve electrode designs for neural prosthesis applications.

Neuromuscular electrical stimulation in neurorehabilitation

This review provides a comprehensive overview of the clinical uses of neuromuscular electrical stimulation (NMES) for functional and therapeutic applications in subjects with spinal cord injury or stroke. Functional applications refer to the use of NMES to activate paralyzed muscles in precise sequence and magnitude to directly accomplish functional tasks. In therapeutic applications, NMES may lead to a specific effect that enhances function, but does not directly provide function. The specific neuroprosthetic or "functional" applications reviewed in this article include upper- and lower-limb motor movement for self-care tasks and mobility, respectively, bladder function, and respiratory control. Specific therapeutic applications include motor relearning, reduction of hemiplegic shoulder pain, muscle strengthening, prevention of muscle atrophy, prophylaxis of deep venous thrombosis, improvement of tissue oxygenation and peripheral hemodynamic functioning, and cardiopulmonary conditioning. Perspectives on future developments and clinical applications of NMES are presented.

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

One of the most challenging problems in peripheral nerve stimulation is the ability to activate selectively small axons without large ones. Electrical stimulation of peripheral nerve activates large diameter fibers before small ones. Currently available techniques for selective activation of small axons without large ones require long-duration stimulation pulses (>500 micros) and large stimulation amplitude, which shorten battery life of the implanted stimulator and could lead to electrode corrosion. In the current study, the hypothesis that small axons can be recruited before large ones with narrow pulse width (50 micros) using an electrode array was tested in both simulations simulation and experiments in the cat lateral gastrocnemius (LG) model. The LG nerve innervates both LG and soleus muscle groups with axons within 10-13 and 8-12 microm diameter ranges, respectively. A finite element model of LG nerve was constructed and simulations showed that, when activating 40% of LG, a conventional tripolar electrode activated only 9% of soleus whereas the electrode arrays of 5, 7, and 11 contacts activated 39, 46, and 60% of soleus respectively, suggesting that the arrays could activate small axons before fully recruiting large axons. In animal experiments, peak twitch force of LG and soleus were plotted as a function of stimulation amplitude to indicate the recruitment curve. At 40% activation of LG, a conventional tripolar electrode activated only 7% of soleus whereas the electrode arrays of 5, 7, and 11 contacts activated 43, 48, and 72% of soleus respectively. The electrode arrays also decreased significantly the recruitment curve slopes to only 10-20% of the value obtained for the tripolar electrode in both computer simulations and experiments. In conclusion, the 5-, 7-, and 11-contact arrays can be used to reverse the recruitment order of peripheral nerve stimulation with a narrow pulse.