Technical note. Estimated electrode operating conditions of the first London Mk V implanted stimulator

Recruitment by motor nerve root stimulators: significance for implant design

Three paraplegics have been implanted with stimulators of the lumbar anterior roots. Twelve roots were trapped in slots, each with three electrodes, a central cathode and two anodes, but the anodes in all the slots were connected together to reduce the number of wires. Cross-talk between roots was observed at lower levels than expected. Cross-talk was assessed from the ratio of the root's threshold to the threshold of the contralateral response (expected ratio: 72). Two hypothetical reasons for this low ratio were: that the cathode current was not equally shared by the anodes; or that the contralateral responses were reflex. Experiments showed that neither explanation was valid. The ratio of the contralateral to ipsilateral threshold for individual slots (K(1)) was sometimes low because the ipsilateral threshold was high. By taking the ratio of the lowest contralateral response to lowest ipsilateral response, for all roots in each subject (K(2)), the ratio should approach the theoretical value. However, for the two subjects with small slots, it was 7.9 and 15.3, much less than 72, suggesting that the original theory was incorrect. Approximate calculations of the activation function suggest that the reason may be that roots which run close to a slot, but not through it, may pass through a virtual anode region outside the ends of the slots, and that anodal break stimulation in those regions causes the cross-talk. Our estimate is that this cross-talk would be expected to occur at intensities above 5.3 times the cathodal threshold. If the roots are stimulated in pairs, below the levels of cross-talk, experimental results show that the moments obtained in response are additive to within 5%.

Control of leg-powered paraplegic cycling using stimulation of the lumbo-sacral anterior spinal nerve roots

We investigated leg-powered cycling in a recumbent tricycle for a paraplegic using functional electrical stimulation (FES) with the lumbo-sacral anterior root stimulator implant (LARSI). A female complete T9 paraplegic had a stimulator for the anterior L2 to S2 spinal roots (bilaterally) implanted in 1994. She was provided with equipment for daily FES cycling exercise at home. The cycling controller applies a pattern of stimulation in each of 16 crank angle phases. A 7-bit shaft encoder measures the crank angle with adequate precision. Each pattern was originally chosen to give the greatest propulsive force in that position when there was no motion. However, dynamically, some reduction in co-contraction is needed; also the patterns are applied with a preset advance time. Maximal power is obtained with an advance of 250 ms, which compensates for muscle response delay and accommodates changes in cadence (from about 25 to 85 rpm). With this system, she has cycled 1.2 km at a time on gently undulating road. We found that spinal root stimulation gives sufficient control over the muscles in the legs to produce a fluid cycling gait. We propose that root stimulation for leg cycling exercise may be a practicable and valuable function for paraplegics following spinal cord injury.