Implantable selective stimulator to improve bladder voiding: design and chronic experiments in dogs

Polypyrrole/Agarose Hydrogel-Based Bladder Volume Sensor with a Resistor Ladder Structure

Chronic monitoring of bladder activity and urine volume is essential for patients suffering from urinary dysfunctions. However, due to the anatomy and dynamics of the bladder, chronic and precise monitoring of bladder activity remains a challenge. Here, we propose a new sensing mechanism that measures the bladder volume using a resistive ladder network with contact switches. Instead of measuring the impedance between the electrode continuously, the proposed sensor provides a digitized output (‘on’ or ‘off’) when the bladder volume reaches a certain threshold value. We present simple proof-of-concept sensors which compare the discrete-mode operation to the continuous-mode operation. In addition, by using multiple pairs of this contact-mode switch in a resistor ladder structure, we demonstrate monitoring of the bladder volume in four discrete steps using an idealized balloon and an ex vivo pig’s bladder. We implemented the resistive ladder network using a conductive polypyrrole/agarose hydrogel composite which exhibits a Young’s modulus comparable to that of the bladder wall. Compared to the continuous-mode operation, the proposed sensing mechanism is less susceptible to drift due to material degradation and environmental factors.

Design of a Compact Wireless Multi-Channel High Area-Efficient Stimulator with Arbitrary Channel Configuration

This paper presents the design of a wireless, implantable, multi-channel, programmable stimulator with arbitrary channel combination. A novel channel management module using a switch array is presented, enabling arbitrary channel configuration with a silicon area reduction of 81%. The chip was fabricated in a 0.18-μm Taiwan semiconductor manufacturing company (TSMC) high voltage (HV) complementary metal–oxide semiconductor (CMOS) technology. A stimulator system was realized using the proposed integrated circuit (IC). A wireless communication link was established between a specified Android-based graphical user interface (GUI) and the proposed device for control of the stimulation pattern and wireless battery charging. The size of the entire system occupies a volume of only 14 mm × 14 mm × 4 mm (without the battery). Experimental results demonstrated a successful independent configuration between different channels, as well as an arbitrary channel combination, as expected.

An Implantable Wireless Neural Interface System for Simultaneous Recording and Stimulation of Peripheral Nerve with a Single Cuff Electrode

Recently, implantable devices have become widely used in neural prostheses because they eliminate endemic drawbacks of conventional percutaneous neural interface systems. However, there are still several issues to be considered: low-efficiency wireless power transmission; wireless data communication over restricted operating distance with high power consumption; and limited functionality, working either as a neural signal recorder or as a stimulator. To overcome these issues, we suggest a novel implantable wireless neural interface system for simultaneous neural signal recording and stimulation using a single cuff electrode. By using widely available commercial off-the-shelf (COTS) components, an easily reconfigurable implantable wireless neural interface system was implemented into one compact module. The implantable device includes a wireless power consortium (WPC)-compliant power transmission circuit, a medical implant communication service (MICS)-band-based radio link and a cuff-electrode path controller for simultaneous neural signal recording and stimulation. During in vivo experiments with rabbit models, the implantable device successfully recorded and stimulated the tibial and peroneal nerves while communicating with the external device. The proposed system can be modified for various implantable medical devices, especially such as closed-loop control based implantable neural prostheses requiring neural signal recording and stimulation at the same time.

Neural network based forward prediction of bladder pressure using pudendal nerve electrical activity

Individuals with spinal cord injury or neurological disorders have problems in urinary bladder storage and in voiding function. In these people, the detrusor of bladder contracts at low volume and this causes incontinence. The goal of bladder control is to increase the bladder capacity by electrical stimulation of relative nerves such as pelvic nerves, sacral nerve roots or pudendal nerves. For this purpose, the bladder pressure has to be monitored continuously. In this paper, we propose a method for real-time estimating the bladder pressure using artificial neural network. The method is based upon measurements of electroneurogram (ENG) signal of pudendal nerve. This approach yields synthetic bladder pressure estimates during bladder contraction. The experiments were conducted on three rats. The results show that neural predictor can provide accurate estimation and prediction of bladder pressure with good generalization ability. The average error of 1-second and 5-second ahead prediction of bladder pressure are 9.62% and 10.54%, respectively.

High frequency sacral root nerve block allows bladder voiding

AIMS

Dyssynergic reflexive external urethral sphincter (EUS) activity following spinal cord injury can prevent bladder voiding, resulting in significant medical complications. Irreversible sphincterotomies or neurotomies can prevent EUS activation and allow bladder voiding, but may cause incontinence or loss of sacral reflexes. We investigated whether kilohertz frequency (KF) electrical conduction block of the sacral roots could prevent EUS activation and allow bladder voiding.

METHODS

The S2 sacral nerve roots were stimulated bilaterally to generate bladder pressure in six cats. One S1 nerve root was stimulated proximally (20 Hz biphasic pulse trains) to evoke EUS pressure, simulating worst-case dyssynergic EUS reflexes. KF waveforms (12.5 kHz biphasic square wave) applied to an electrode implanted distally on the S1 nerve root blocked nerve conduction, preventing the increase in EUS pressure and allowing voiding.

RESULTS

Applying KF waveforms increased bladder voiding in single, limited-duration trials from 3 ± 6% to 59 ± 12%. Voiding could be increased to 82 ± 9% of the initial bladder volume by repeating or increasing the duration of the trials.

CONCLUSIONS

Sacral nerve block can prevent EUS activation and allow complete bladder voiding, potentially eliminating the need for a neurotomy. Eliminating neurotomy requirements could increase patient acceptance of bladder voiding neuroprostheses, increasing patient quality of life and reducing the cost of patient care.

Exponential current pulse generation for efficient very high-impedance multisite stimulation

We describe in this paper an intracortical current-pulse generator for high-impedance microstimulation. This dual-chip system features a stimuli generator and a high-voltage electrode driver. The stimuli generator produces flexible rising exponential pulses in addition to standard rectangular stimuli. This novel stimulation waveform is expected to provide superior energy efficiency for action potential triggering while releasing less toxic reduced ions in the cortical tissues. The proposed fully integrated electrode driver is used as the output stage where high-voltage supplies are generated on-chip to significantly increase the voltage compliance for stimulation through high-impedance electrode-tissue interfaces. The stimuli generator has been implemented in 0.18-μm CMOS technology while a 0.8-μm CMOS/DMOS process has been used to integrate the high-voltage output stage. Experimental results show that the rectangular pulses cover a range of 1.6 to 167.2 μA with a DNL and an INL of 0.098 and 0.163 least-significant bit, respectively. The maximal dynamic range of the generated exponential reaches 34.36 dB at full scale within an error of ± 0.5 dB while all of its parameters (amplitude, duration, and time constant) are independently programmable over wide ranges. This chip consumes a maximum of 88.3 μ W in the exponential mode. High-voltage supplies of 8.95 and -8.46 V are generated by the output stage, boosting the voltage swing up to 13.6 V for a load as high as 100 kΩ.

Design and testing of an advanced implantable neuroprosthesis with myoelectric control

An implantable stimulator-telemeter (IST-12) was developed for applications in neuroprosthetic restoration of limb function in paralyzed individuals. The IST-12 provides 12 stimulation channels and two myoelectric signal (MES) channels. The MES circuitry includes a two-channel multiplexer, preamplifier, variable gain amplifier/bandpass filter, full-wave rectifier, and bin integrator. Power and control signals are transmitted from an external control unit to the IST-12 through an inductive link. Recorded MES signals are telemetered back to the external control unit through the same inductive link. Following bench testing, one device was implanted chronically in a dog for 15 months and evaluated. Conditions were identified in which MES could be recorded with minimal stimulus artifact. The ability to record MES in the presence of stimulation was verified, confirming the potential of the IST-12 to be used as a myoelectric controlled neuroprosthesis.

An Integrated Implantable Stimulator That is Fail-Safe Without Off-Chip Blocking-Capacitors

We present a neural stimulator chip with an output stage (electrode driving circuit) that is fail-safe under single-fault conditions without the need for off-chip blocking-capacitors. To miniaturize the stimulator output stage two novel techniques are introduced. The first technique is a new current generator circuit reducing to a single step the translation of the digital input bits into the stimulus current, thus minimizing silicon area and power consumption compared to previous works. The current generator uses voltage-controlled resistors implemented by MOS transistors in the deep triode region. The second technique is a new stimulator output stage circuit with blocking-capacitor safety protection using a high-frequency current-switching (HFCS) technique. Unlike conventional stimulator output stage circuits for implantable functional electrical stimulation (FES) systems which require blocking-capacitors in the microfarad range, our proposed approach allows capacitance reduction to the picofarad range, thus the blocking-capacitors can be integrated on-chip. The prototype four-channel neural stimulator chip was fabricated in XFAB's 1-mum silicon-on-insulator CMOS technology and can operate from a power supply between 5-18 V. The stimulus current is generated by active charging and passive discharging. We obtained recordings of action potentials and a strength-duration curve from the sciatic nerve of a frog with the stimulator chip which demonstrate the HFCS technique. The average power consumption for a typical 1-mA 20-Hz single-channel stimulation using a book electrode, is 200 muW from a 6 V power supply. The silicon area occupation is 0.38 mm(2) per channel.

A Polypyrrole-based Strain Sensor Dedicated to Measure Bladder Volume in Patients with Urinary Dysfunction

This paper describes a new technique to measure urine volume in patients with urinary bladder dysfunction. Polypyrrole – an electronically conducting polymer - is chemically deposited on a highly elastic fabric. This fabric, when placed around a phantom bladder, produced a reproducible change in electrical resistance on stretching. The resistance response to stretching is linear in 20%-40% strain variation. This change in resistance is influenced by chemical fabrication conditions. We also demonstrate the dynamic mechanical testing of the patterned polypyrrole on fabric in order to show the feasibility of passive interrogation of the strain sensor for biomedical sensing applications.

Detection of the bladder volume from the neural afferent activities in dogs: experimental results

OBJECTIVE

We evaluate the bladder volume and pressure through recording the bladder afferent activity in the sacral nerve roots in acute experiments of paraplegic dogs. These measurements are intended to report the status of the bladder and to adjust the stimulation parameters of an implantable electric stimulator.

METHODS

The extraction of neural information for feedback in functional electrical stimulation is limited by the poor signal to noise ratio (SNR) in the sacral nerve recordings. We propose to inject a very low amplitude sinusoidal current with high SNR to the bladder through the nerve using a tripolar cuff electrode wrapped around the S2 nerve root. The application of this current (0.4 microA peak to peak, 30 Hz) allows detecting bladder afferent activity in its amplitude and the tissues impedance of the nerve. Acute experiments in dogs were performed to evaluate the proposed method. In each dog, the bladder infusion with saline was carried out at both slow and high filling rates. At the same time, the changes in the amplitude of the sinusoidal output voltage V(OUT) were recorded through the cuff nerve electrode.

RESULTS

The data obtained from 26 acute experiments using eight dogs demonstrate that the amplitude of the recorded sinusoidal voltage V(OUT) varies proportionally with the bladder pressure during the bladder filling with saline solution. It also demonstrates that the bladder volume can be estimated from the increasing amplitude of the recorded V(OUT).

CONCLUSION

This study shows that the increase in the V(OUT) is proportionally related to the increase in bladder pressure. The difference between the recorded V(OUT) during the bladder filling and the baseline V(OUT) can be a useful indicator of the changes in the bladder volume.

A highly flexible system for microstimulation of the visual cortex: design and implementation

This paper presents the design of a system intended to be used as a prosthesis allowing profoundly visually impaired patients to recover partial vision by means of microstimulation in the primary visual cortex area. The main component of the system is a bio-electronic device to be implanted inside the skull of the user, composed of a plurality of stimulation modules, whose actions are controlled via an interface module. Power and data are transmitted to the implant wirelessly through a bidirectional inductive link, allowing diagnosis of the stimulating device and its environment after implantation, as well as power delivery optimization. A high level of flexibility is supported in terms of stimulation parameters, but a configurable communication protocol allows the device to be used with maximum efficiency. The core of an external controller implemented in a system on a programmable chip is also presented, performing data conversion and timing management such that phosphene intensity can be modulated by any parameter defining stimulation, either at the pulse level or in the time domain. Measured performances achieved with a prototype using two types of custom ASICs implemented in a 0.18-mum CMOS process and commercial components fulfill the requirements for a complete visual prosthesis for humans. When on/off activation is used with predefined parameters, stimuli measured on an electronic test bench could attain a rate in excess of 500 k pulses/s.

Development of an implantable oximetry-based organ perfusion sensor

A sensor system enabling real-time monitoring of organ perfusion following transplantation is presented. This system uses a three wavelength oximetry-based approach. The instrument is intended for implantation at the organ site during transplantation to provide real-time reporting of the perfusion status of the tissue for 7-10 days following the procedure. Data is transmitted from the sensor to a localized receiver using direct sequence spread spectrum techniques at 916 MHz. In this paper, the sensing method and associated electronics implementation are presented. The present status of system miniaturization is summarized along with plans for future miniaturization efforts. Preliminary sensor data is presented demonstrating the efficacy of the technique.

A study on implantable urination assist systems - development of a bladder compression system

We propose an urination assist system implantable in a patient who has difficulty in urination caused by the neuropathic bladder in order to assist the urination. The proposed system assists the urination by directly pushing the bladder of the patient using shape memory alloys (SMA). Peltier elements are used to control the temperature in the system. The effectiveness of the proposed system is evaluated by experiment with a bladder model.

Implantable FES system for upright mobility and bladder and bowel function for individuals with spinal cord injury

STUDY DESIGN

Postintervention.

OBJECTIVES

To determine the effectiveness of the Praxis multifunctional implantable functional electrical stimulation (FES) system (Neopraxis Pty. Ltd, Lane Cove, NSW, Australia) to provide standing and stepping ability and bladder and bowel management for individuals with motor complete thoracic level spinal cord injuries (SCI).

SETTING

Pediatric orthopedic hospital specializing in SCI.

SUBJECTS

Three males, ages 17 and 21 years, with motor-complete thoracic level SCI and intact lower motor neurons to the muscles targeted for stimulation.

METHODS

Each subject was successfully implanted with the Praxis FES system. All three subjects received electrodes for upright mobility and the first two subjects received additional electrodes for stimulated bladder and bowel management. Following training, subjects were evaluated in their ability to use FES for nine mobility activities. Acute and chronic experiments of the effect of stimulation on bowel and bladder function were also performed.

RESULTS

All three subjects could independently stand up from the wheelchair and could walk at least 6 m using a swing through gait pattern. Two subjects were able to independently perform swing through gait for 6 min and one subject was able to independently ascend and descend stairs. Suppression of reflex bladder contractions by neuromodulation (subject 1) and stimulated contractions of the rectum (subject 2) were observed in acute experiments. When stimulation was applied over the course of several weeks, a positive effect on bowel function was measured. Stimulated bladder contractions were not achieved.

CONCLUSION

The feasibility of using the Praxis FES system for upright mobility and aiding aspects of bladder and bowel function was demonstrated with three subjects with thoracic level SCI.

Control of urinary bladder function with devices: successes and failures

The management of urinary tract dysfunction is crucial for the health and well-being of people with spinal cord injury. Devices, specifically catheters, play an important role in the daily regime of bladder management for most people with spinal cord injury. However, the high incidence of complications associated with the use of catheters, and the fact that the spinal segments involved in lower urinary tract control remain intact in most cord-injured people, continue to motivate research into devices that could harness the nervous system to provide greater control over lower urinary tract function. Mechanical devices discussed in this review include catheters, artificial urethral sphincters, urethral stents and intraurethral pumps. Additionally, many attempts to restore control of the lower urinary tract with electrical stimulation have been made. Stimulation sites have included: inside the bladder, bladder wall, thigh, pelvic floor, dorsal penile nerve, pelvic nerve, tibial nerve, sacral roots, sacral nerves and spinal cord. Catheters and sacral root stimulators are two techniques whose efficacy is well established. Some approaches have proven less successful and others are still in the development stage. Modifications to sacral root stimulation including posterior root stimulation, anodal blockade and high-frequency blockade as well as new techniques including intraspinal microstimulation, urethral afferent stimulation and injectable microstimulators are also discussed. No single device has yet restored the control and function of the lower urinary tract to the pre-injury state, but new techniques are bringing this possibility closer to reality.

Generic controller dedicated to telemetry-controlled microsystems

This paper introduces a generic controller designed for telemetry-controlled microsystems. This controller receives a data packet through a serial link carrying a command word and the associated data, and is capable of generating a variety of control/timing signals according to the definition of the received command. The flexible microprogrammed architecture of the controller allows for defining the commands functions in an on-chip mask-programmable read-only memory.

Reversibility of Airflow Obstruction by Hypoglossus Nerve Stimulation in Anesthetized Rabbits

RATIONALE

Anesthesia-induced uncoupling of upper airway dilating and inspiratory pump muscles activation may cause inspiratory flow limitation, thereby mimicking obstructive sleep apnea/hypopnea.

OBJECTIVES

Determine whether inspiratory flow limitation occurs in spontaneously breathing anesthetized rabbits and whether this can be reversed by direct hypoglossal nerve stimulation and by the application of continuous positive airway pressure.

METHODS

Ten New Zealand White rabbits were anesthetized, instrumented, and studied supine while breathing spontaneously at ambient pressure or during the application of positive or negative airway pressure. Under each of these conditions, the effect of unilateral or bilateral hypoglossal nerve stimulation was investigated.

MEASUREMENTS

Inspiratory flow and tidal volume were measured together with esophageal pressure and the electromyographic activity of diaphragm, alae nasi, and genioglossus muscles.

MAIN RESULTS

Anesthesia caused a marked increase in inspiratory resistance, snoring, and in eight rabbits, inspiratory flow limitation. Hypoglossus nerve stimulation was as effective as continuous positive airway pressure in reversing inspiratory flow limitation and snoring. Its effectiveness increased progressively as airway opening pressure was lowered, reached a maximum at -5 cm H2O, but declined markedly at lower pressures. With negative airway opening pressure, airway collapse eventually occurred during inspiration that could be prevented by hypoglossus nerve stimulation. The recruitment characteristics of hypoglossus nerve fibers was steep, and significant upper airway dilating effects already obtained with stimulus intensities 36 to 60% of maximum.

CONCLUSION

This study supports hypoglossus nerve stimulation as a treatment option for obstructive sleep apnea.

A Power Efficient Electronic Implant for a Visual Cortical Neuroprosthesis

An integrated microstimulator designed for a cortical visual prosthesis is presented, along with a pixel reordering algorithm, together minimizing the peak total current and voltage required for stimulation of large numbers of electrodes at a high rate. In order to maximize the available voltage for stimulation at a given supply voltage for generating biphasic pulses, the device uses monopolar stimulation, where the return electrode voltage is dynamically varied. Thus, the voltage available for stimulation is maximized, as opposed to the conventional fixed return voltage monopolar approach, and impedance is significantly lower than can be achieved using bipolar stimulation with microelectrodes. This enables the use of a low voltage power supply, minimizing power consumption of the device. An important constraint resulting from this stimulation strategy, however, is that current generation needs to be simultaneous and in-phase for all active parallel channels, imposing heavy stress on the wireless power recovery and regulation circuitry in large electrode count systems such as a visual prosthesis. An ordering algorithm to be implemented in the external controller of the prosthesis is then proposed. Based on the data for each frame of the video signal to be transmitted to the implant, the algorithm minimizes the total generated current standard deviation between time multiplexed stimulations by determining the most appropriate combination of parallel stimulation channels to be activated simultaneously. A stimulator prototype has been implemented in CMOS technology and successfully tested. Execution of the external controller reordering algorithm on an application specific hardware architecture has been verified using a System-On-Chip development platform. A near 75% decrease in the total stimulation current standard deviation was observed with a one-pass algorithm, whereas a recursive variation of the algorithm resulted in a greater than 95% decrease of the same variable.

A compact large voltage-compliance high output-impedance programmable current source for implantable microstimulators

A new CMOS current source is described for biomedical implantable microstimulator applications, which utilizes MOS transistors in deep triode region as linearized voltage controlled resistors (VCR). The VCR current source achieves large voltage compliance, up to 97% of the supply voltage, while maintaining high output impedance in the 100 MOmega range to keep the stimulus current constant within 1% of the desired value irrespective of the site and tissue impedances. This approach improves stimulation efficiency, extends power supply lifetime, and saves chip area especially when the stimulation current level is high in the milliampere range. A prototype 4-channel microstimulator chip is fabricated in the AMI 1.5-microm, 2-metal, 2-poly, n-well standard CMOS process. With a 5-V supply, each stimulating site driver provides at least 425-V compliance and > 10 MOmega output impedance, while sinking up to 210 microA, and occupies 0.05 mm2 in chip area. A modular 32-site wireless neural stimulation microsystem, utilizing the VCR current source, is under development.

Alkanethiolate self-assembled monolayers as functional spacers to resist protein adsorption upon Au-coated nerve microelectrode

Alkanethiolate self-assembled monolayers (SAMs) of varied chain lengths were adsorbed upon Au-coated nerve microelectrodes and employed as protein-resistant spacers. The microelectrode spiraled as a cuff type can be used for restoring motor function via electrical stimulation on the peripheral nerve system; however, an increase of electrode impedance might occur during implantation. In this work, a thin-film SAMs treatment upon Au/polyimide (PI) surface of the microelectrode provided a hydrophobic characteristic, which retarded protein adsorption at the initial stage and subsequent pileup (or thickening) process. The protein-resistant effect exhibited comparable SAMs of different chain lengths adsorbed upon Au/PI surfaces. The increase of electrode impedance as a function of protein deposition time was mainly correlated with the addition of reactance that was associated with the pileup thickness of the deposited protein. Particularly, the SAMs-modified surface was capable to detach a significant portion of the accumulated protein from the protein-deposited SAMs/Au/PI, whereas the protein-deposited layers exhibited firm adhesion upon Au/PI surface. It is therefore very promising to apply thin-film SAMs adsorbed upon Au-coated surface for bioinvasive devices that have the need of functional electrical stimulations or sensing nerve signals during chronic implantation.

High frequency block of selected axons using an implantable microstimulator

Currently, the majority of neural stimulation studies are limited to acute animal experiments due to lack of suitable implantable microstimulation devices. As an initial step to observe the long-term effects of neural stimulation, a system consisting of an external wireless controller and an implantable dual-channel microcontroller-based microstimulator for tripolar high frequency blocking was developed. The system is not only small in size, and thus suitable for short-term implantation, but also has sufficient current output parameter ranges to meet the demand for high frequency blocking experiments. Using this implantable microstimulator, a series of experiments were conducted on New Zealand rabbit's tibial nerve, including frequency and amplitude selection in driving stimulus and blocking effect tests, which were designed to assess the feasibility and efficiency of the device via torque measurements. Our results showed that the implantable microstimulator system gave a satisfactory performance and could be utilized to achieve selective stimulation and blocking on various sizes of nerve fibers. Our implantable microstimulation system is not only a novel tool for neuromuscular control studies but could also provide a basis for developing various types of sophisticated neural prostheses.

Implantable selective stimulator to improve bladder voiding: design and chronic experiments in dogs

Among the treatments to enhance the bladder voiding, the sacral roots neurostimulation is one of the most promising techniques. The electrostimulation of sacral nerves provokes a simultaneous contraction of the detrusor muscle as well as the external urethral sphincter (EUS). A new simplified-architecture implantable stimulator with its wireless controller have been designed to investigate high-frequency inhibition stimulation strategies. This innovative technique based on high-frequency inhibition reduces sphincter activity during stimulation. Low-frequency current pulses also applied to the sacral roots induces contraction of the detrusor muscle resulting in low pressure voiding. Chronic experiments were carried out on ten male mongrel paraplegic dogs. One cuff electrode was implanted along with each stimulator for eight months. The animals were stimulated twice a day using the prototypes of our implantable selective stimulator while voided and residual urine volume were measured during the procedure. These experiments revealed that the proposed stimulation strategy enhances bladder voiding by more than 50% in comparison with low-frequency only stimulation. The residual urine volume was reduced to an average of 9% and low pressure micturition was achieved as shown by weekly cystourethrogram.