A Flexible Implant for Multi-Day Monitoring of Colon Segment Activity

Monitoring of colon activity is currently limited to tethered systems like anorectal manometry. These systems have significant drawbacks, but fundamentally limit the observation time of colon activity, reducing the likelihood of detecting specific clinical events. While significant technological advancement has been directed to mobile sensor capsules, this work describes the development and feasibility of a stationary sensor for describing the coordinated activity between neighboring segments of the colon. Unlike wireless capsules, this device remains in position and measures propagating pressure waves and impedances between colon segments to describe activity and motility. This low-power, flexible, wireless sensor-the colon monitor to capture activity (ColoMOCA) was validated in situ and in vivo over seven days of implantation. The ColoMOCA diameter was similar to common endoscopes to allow for minimally invasive diagnostic placement. The ColoMOCA included two pressure sensors, and three impedance-sensing electrodes arranged to describe the differential pressures and motility between adjacent colon segments. To prevent damage after placement in the colon, the ColoMOCA was fabricated with a flexible polyimide circuit board and a silicone rubber housing. The resulting device was highly flexible and suitable for surgical attachment to the colon wall. In vivo testing performed in eleven animals demonstrated suitability of both short term (less than 3 hours) and 7-day implantations. Data collected wirelessly from animal experiments demonstrated the ColoMOCA described colon activity similarly to wired catheters and allowed untethered, conscious monitoring of organ behavior.

Spinal cord stimulation for the restoration of bladder function after spinal cord injury

Spinal cord injury (SCI) results in the inability to empty the bladder voluntarily, and neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD) negatively impact both the health and quality of life of persons with SCI. Current approaches to treat bladder dysfunction in persons with SCI, including self-catheterisation and anticholinergic medications, are inadequate, and novel approaches are required to restore continence with increased bladder capacity, as well as to provide predictable and efficient on-demand voiding. Improvements in bladder function following SCI have been documented using a number of different modalities of spinal cord stimulation (SCS) in both persons with SCI and animal models, including SCS alone or SCS with concomitant activity-based training. Improvements include increased volitional voiding, voided volumes, bladder capacity, and quality of life, as well as decreases in NDO and DSD. Further, SCS is a well-developed therapy for chronic pain, and existing Food And Drug Administration (FDA)-approved devices provide a clear pathway to sustainable commercial availability and impact. However, the effective stimulation parameters and the appropriate timing and location of stimulation for SCS-mediated restoration of bladder function require further study, and studies are needed to determine underlying mechanisms of action.

Powering strategies for implanted multi-function neuroprostheses for spinal cord injury

Implantable motor neuroprosthetic systems can restore function to individuals with significant disabilities, such as spinal cord injury, stroke, cerebral palsy, and multiple sclerosis. Neuroprostheses provide restored functionality by electrically activating paralysed muscles in coordinated patterns that replicate (enable) controlled movement that was lost through injury or disease. It is important to consider the general topology of the implanted system itself. The authors demonstrate that the wired multipoint implant technology is practical and feasible as a basis for the development of implanted multi-function neuroprosthetic systems. The advantages of a centralised power supply are significant. Heating due to recharge can be mitigated by using an actively cooled external recharge coil. Using this approach, the time required to perform a full recharge was significantly reduced. This approach has been demonstrated as a practical option for regular clinical use of implanted neuroprostheses.

Hypothesis for the mechanism of action of ECAP-controlled closed-loop systems for spinal cord stimulation

Advances in technology and improvement of efficacy for many neuromodulation applications have been achieved without understanding the relationship between the stimulation parameters and the neural activity which is generated in the nervous system. It is the neural activity that ultimately drives the therapeutic benefit and the advent of evoked compound action potential recording allows this activity to be directly measured and quantified. Closed-loop control adjusts the stimulation parameters to maintain a predetermined level of neural recruitment and has been shown to provide improved pain relief in individuals with spinal cord stimulators. However, no mechanism that relates more consistent neural recruitment to patient outcomes has been proposed. The authors propose a hypothesis that may explain the difference in efficacy between open- and closed-loop operational modes by considering the relationship between measured neural recruitment with hypothetical dose and side effect response curves. This provides a rational basis for directing clinical research and improving therapeutic systems.

Visual Evoked Potentials Used to Evaluate a Commercially Available Superabsorbent Polymer as a Cheap and Efficient Material for Preparation-Free Electrodes for Recording Electrical Potentials of the Human Visual Cortex

The aim of this study was to investigate the use of inexpensive and easy-to-use hydrogel “marble” electrodes for the recording of electrical potentials of the human visual cortex using visual evoked potentials (VEPs) as example. Top hat-shaped holders for the marble electrodes were developed with an electrode cap to acquire the signals. In 12 healthy volunteers, we compared the VEPs obtained with conventional gold-cup electrodes to those obtained with marble electrodes. Checkerboards of two check sizes—0.8° and 0.25°—were presented. Despite the higher impedance of the marble electrodes, the line noise could be completely removed by averaging 64 single traces, and VEPs could be recorded. Linear mixed-effect models using electrode type, stimulus, and recording duration revealed a statistically significant effect of the electrode type on only VEP N75 peak latency (mean ± SEM: 1.0 ± 1.2 ms) and amplitude (mean ± SEM: 0.8 ± 0.9 µV) The mean amplitudes of the delta, theta, alpha, beta, and gamma frequency bands of marble electrodes were statistically significantly different and, on average, 25% higher than those of gold-cup electrodes. However, the mean amplitudes showed a statistically significant strong correlation (Pearson’s r = 0.8). We therefore demonstrate the potential of the inexpensive and efficient hydrogel electrode to replace conventional gold-cup electrodes for the recording of VEPs and possibly other recordings from the human cortex.

Selective stimulation of rat sciatic nerve using an array of mm-size magnetic coils: a simulation study

This work proposes and computationally investigate the use of magnetic neural stimulation as an alternative to electrical stimulation to achieve selective activation of rat sciatic nerve. In particular, they assess the effectiveness of an array of small coils to obtain selective neural stimulation, as compared to a single coil. Specifically, an array of four mm-sized coils is used to stimulate rat sciatic nerve, targeting the regions of fascicles that are associated with different muscles of the leg. To evaluate the selectivity of activation, a three-dimensional heterogeneous multi-resolution nerve model is implemented using the impedance method for the computation of the magnetic and electric fields in the nerve. The performance metric ‘selectivity index’ is defined that measures the recruitment of the targeted region compared to other non-targeted regions of the nerve. The selectivity index takes values between −1 (least selective) and 1 (most selective). For each targeted region, a selectivity index of 0.75 or better is predicted for the proposed array configuration. The results suggest that an array of coils can provide superior spatial control of the electric field induced in the neural tissue compared to traditional extraneural electrode arrays, thus opening the possibility to applications where selective neurostimulation is of interest.

Rehabilitation of the Parkinson's tremor by using robust adaptive sliding mode controller: a simulation study

One of the efficient methods in controlling the Parkinson's tremor is Deep Brain Stimulation (DBS) therapy. The stimulation of Basal Ganglia (BG) by DBS brings no feedback though the existence of feedback reduces the additional stimulatory signal delivered to the brain. So this study offers a new adaptive architecture of a closed-loop control system in which two areas of BG are stimulated simultaneously to decrease the following three indicators: hand tremor, the level of a delivered stimulation signal in the disease condition, and the level of a delivered stimulation signal in health condition to the disease condition. One area (STN: subthalamic nucleus) is stimulated with an adaptive sliding mode controller and the other area (GPi: Globus Pallidus internal) with partial state feedback controller. The simulation results of stimulating two areas of BG showed satisfactory performance.

Mapping the current flow in sacral nerve stimulation using computational modelling

Sacral nerve stimulation (SNS) is an established treatment for faecal incontinence involving the implantation of a quadripolar electrode into a sacral foramen, through which an electrical stimulus is applied. Little is known about the induced spread of electric current around the SNS electrode and its effect on adjacent tissues, which limits optimisation of this treatment. The authors constructed a 3-dimensional imaging based finite element model in order to calculate and visualise the stimulation induced current and coupled this to biophysical models of nerve fibres. They investigated the impact of tissue inhomogeneity, electrode model choice and contact configuration and found a number of effects. (i) The presence of anatomical detail changes the estimate of stimulation effects in size and shape. (ii) The difference between the two models of electrodes is minimal for electrode contacts of the same length. (iii) Surprisingly, in this arrangement of electrode and neural fibre, monopolar and bipolar stimulation induce a similar effect. (iv) Interestingly when the active contact is larger, the volume of tissue activated reduces. This work establishes a protocol to better understand both therapeutic and adverse stimulation effects and in the future will enable patient-specific adjustments of stimulation parameters.

Comparison of interactive and automatic segmentation of stereoelectroencephalography electrodes on computed tomography post-operative images: preliminary results

Stereoelectroencephalography is a surgical procedure used in the treatment of pharmacoresistant epilepsy. Multiple electrodes are inserted in the patient's brain in order to record the electrical activity and detect the epileptogenic zone at the source of the seizures. An accurate localisation of their contacts on post-operative images is a crucial step to interpret the recorded signals and achieve a successful resection afterwards. In this Letter, the authors propose interactive and automatic methods to help the surgeon with the segmentation of the electrodes and their contacts. Then, they present a preliminary comparison of the methods in terms of accuracy and processing time through experimental measurements performed by two users, and discuss these first results. The final purpose of this work is to assist the neurosurgeons and neurologists in the contacts localisation procedure, make it faster, more precise and less tedious.

Experience-based SEEG planning: from retrospective data to automated electrode trajectories suggestions

StereoElectroEncephaloGraphy (SEEG) is a minimally invasive technique that consists of the insertion of multiple intracranial electrodes to precisely identify the epileptogenic focus. The planning of electrode trajectories is a cumbersome and time-consuming task. Current approaches to support the planning focus on electrode trajectory optimisation based on geometrical constraints but are not helpful to produce an initial electrode set to begin with the planning procedure. In this work, the authors propose a methodology that analyses retrospective planning data and builds a set of average trajectories, representing the practice of a clinical centre, which can be mapped to a new patient to initialise planning procedure. They collected and analysed the data from 75 anonymised patients, obtaining 30 exploratory patterns and 61 mean trajectories in an average brain space. A preliminary validation on a test set showed that they were able to correctly map 90% of those trajectories and, after optimisation, they have comparable or better values than manual trajectories in terms of distance from vessels and insertion angle. Finally, by detecting and analysing similar plans, they were able to identify eight planning strategies, which represent the main tailored sets of trajectories that neurosurgeons used to deal with the different patient cases.

Common-mode noise cancellation circuit for wearable ECG

Wearable electrocardiogram (ECG) is attracting much attention for monitoring heart diseases in healthcare and medical applications. However, an imbalance usually exists between the contact resistances of sensing electrodes, so that a common mode noise caused by external electromagnetic field can be converted into the ECG detection circuit as a differential mode interference voltage. In this study, after explaining the mechanism of how the common mode noise is converted to a differential mode interference voltage, the authors propose a circuit with cadmium sulphide photo-resistors for cancelling the imbalance between the contact resistances and confirm its validity by simulation experiment. As a result, the authors found that the interference voltage generated at the wearable ECG can be effectively reduced to a sufficient small level.

Enhanced inter-subject brain computer interface with associative sensorimotor oscillations

Electroencephalography (EEG) captures electrophysiological signatures of cortical events from the scalp with high-dimensional electrode montages. Usually, excessive sources produce outliers and potentially affect the actual event related sources. Besides, EEG manifests inherent inter-subject variability of the brain dynamics, at the resting state and/or under the performance of task(s), caused probably due to the instantaneous fluctuation of psychophysiological states. A wavelet coherence (WC) analysis for optimally selecting associative inter-subject channels is proposed here and is being used to boost performances of motor imagery (MI)-based inter-subject brain computer interface (BCI). The underlying hypothesis is that optimally associative inter-subject channels can reduce the effects of outliers and, thus, eliminate dissimilar cortical patterns. The proposed approach has been tested on the dataset IVa from BCI competition III, including EEG data acquired from five healthy subjects who were given visual cues to perform 280 trials of MI for the right hand and right foot. Experimental results have shown increased classification accuracy (81.79%) using the WC-based selected 16 channels compared to the one (56.79%) achieved using all the available 118 channels. The associative channels lie mostly around the sensorimotor regions of the brain, reinforced by the previous literature, describing spatial brain dynamics during sensorimotor oscillations. Apparently, the proposed approach paves the way for optimised EEG channel selection that could boost further the efficiency and real-time performance of BCI systems.

Performance of human body communication-based wearable ECG with capacitive coupling electrodes

Wearable electrocardiogram (ECG) is attracting much attention in daily healthcare applications, and human body communication (HBC) technology provides an evident advantage in making the sensing electrodes of ECG also working for transmission through the human body. In view of actual usage in daily life, however, non-contact electrodes to the human body are desirable. In this Letter, the authors discussed the ECG circuit structure in the HBC-based wearable ECG for removing the common mode noise when employing non-contact capacitive coupling electrodes. Through the comparison of experimental results, they have shown that the authors' proposed circuit structure with the third electrode directly connected to signal ground can provide an effect on common mode noise reduction similar to the usual drive-right-leg circuit, and a sufficiently good acquisition performance of ECG signals.

Virtual electrode design for increasing spatial resolution in retinal prosthesis

Retinal prostheses systems are currently used to restore partial vision to patients blinded by degenerative diseases by electrically stimulating surviving retinal cells. To obtain likely maximum resolution, electrode size is minimised, allowing for a large quantity on an array and localised stimulation regions. Besides the small size leading to fabrication difficulties and higher electrochemical charge density, there are challenges associated with the number of drivers needed for a large electrode count as well as the strategies to deliver sufficient power to these drivers wirelessly. In hopes to increase electrode resolution while avoiding these issues, the authors propose a new 'virtual electrode' design to increase locations of likely stimulation. Passive metallisation strategically placed between disk electrodes, combined with alternating surrounding stimuli, channel current into a location between electrodes, producing a virtual stimulation site. A computational study was conducted to optimise the passive metal element geometry, quantify the expected current density output, and simulate retinal ganglion cell activity due to virtual electrode stimulation. Results show that this procedure leads to array geometry that focuses injected current and achieves retinal ganglion cell stimulation in a region beneath the 'virtual electrode,' creating an alternate stimulation site without additional drivers.

Non-invasive, home-based electroencephalography hypoglycaemia warning system for personal monitoring using skin surface electrodes: a single-case feasibility study

AIMS

Hypoglycaemia unawareness is a common condition associated with increased risk of severe hypoglycaemia. The purpose of the authors' study was to develop a simple to use, home-based and non-invasive hypoglycaemia warning system based on electroencephalography (EEG), and to demonstrate its use in a single-case feasibility study.

METHODS

A participant with type 1 diabetes forms a single-person case study where blood sugar levels and EEG were recorded. EEG was recorded using skin surface electrodes placed behind the ear located within the T3 region by the participant in the home. EEG was analysed retrospectively to develop an algorithm which would trigger a warning if EEG changes associated with hypoglycaemia onset were detected.

RESULTS

All hypoglycaemia events were detected by the EEG hypoglycaemia warning algorithm. Warnings were triggered with blood glucose concentration levels at or below 4.2 mmol/l in this participant and no warnings were issued when in euglycaemia.

CONCLUSION

The feasibility of a non-invasive EEG-based hypoglycaemia warning system for personal monitoring in the home has been demonstrated in a single case study. The results suggest that further studies are warranted to evaluate the system prospectively in a larger group of participants.

Classification of Alzheimer's disease from quadratic sample entropy of electroencephalogram

Currently accepted input parameter limitations in entropy-based, non-linear signal processing methods, for example, sample entropy (SampEn), may limit the information gathered from tested biological signals. The ability of quadratic sample entropy (QSE) to identify changes in electroencephalogram (EEG) signals of 11 patients with a diagnosis of Alzheimer's disease (AD) and 11 age-matched, healthy controls is investigated. QSE measures signal regularity, where reduced QSE values indicate greater regularity. The presented method allows a greater range of QSE input parameters to produce reliable results than SampEn. QSE was lower in AD patients compared with controls with significant differences (p < 0.01) for different parameter combinations at electrodes P3, P4, O1 and O2. Subject- and epoch-based classifications were tested with leave-one-out linear discriminant analysis. The maximum diagnostic accuracy and area under the receiver operating characteristic curve were 77.27 and more than 80%, respectively, at many parameter and electrode combinations. Furthermore, QSE results across all r values were consistent, suggesting QSE is robust for a wider range of input parameters than SampEn. The best results were obtained with input parameters outside the acceptable range for SampEn, and can identify EEG changes between AD patients and controls. However, caution should be applied because of the small sample size.

Redundant safety features in a high-channel-count retinal neurostimulator

Safety features embedded in a 256-channel retinal prosthesis integrated circuit are presented. The biology of the retina and the electrochemistry of the electrode-tissue interface demand careful planning and design of the safety features of an implantable retinal stimulation device. We describe the internal limits and communication safety features of our ASIC, but we focus on monitoring and protection circuits for the electrode-tissue interface. Two independent voltage monitoring circuits for each channel measure the electrode polarization voltage at two different times in the biphasic stimulation cycle. The monitors ensure that the charged electrode stays within the electrochemical water window potentials, and that the discharged electrode is within a small window near the counter electrode potential. A switch to connect each electrode to the counter electrode between pulses protects against a wide range of device failures. Additionally, we describe work on an active feedback system to ensure that the electrode voltage is at zero.

Temporal epilepsy seizures monitoring and prediction using cross-correlation and chaos theory

Temporal seizures due to hippocampal origins are very common among epileptic patients. Presented is a novel seizure prediction approach employing correlation and chaos theories. The early identification of seizure signature allows for various preventive measures to be undertaken. Electro-encephalography signals are spectrally broken down into the following sub-bands: delta; theta; alpha; beta; and gamma. The proposed approach consists of observing a high correlation level between any pair of electrodes for the lower frequencies and a decrease in the Lyapunov index (chaos or entropy) for the higher frequencies. Power spectral density and statistical analysis tools were used to determine threshold levels for the lower frequencies. After studying all five sub-bands, the analysis has revealed that the seizure signature can be extracted from the delta band and the high frequencies. High frequencies are defined as both the gamma band and the ripples occurring within the 60-120 Hz sub-band. To validate the proposed approach, six patients from both sexes and various age groups with temporal epilepsies originating from the hippocampal area were studied using the Freiburg database. An average seizure prediction of 30 min, an anticipation accuracy of 72%, and a false-positive rate of 0% were accomplished throughout 200 h of recording time.

Photodiode circuits for retinal prostheses

Photodiode circuits show promise for the development of high-resolution retinal prostheses. While several of these systems have been constructed and some even implanted in humans, existing descriptions of the complex optoelectronic interaction between light, photodiode, and the electrode/electrolyte load are limited. This study examines this interaction in depth with theoretical calculations and experimental measurements. Actively biased photoconductive and passive photovoltaic circuits are investigated, with the photovoltaic circuits consisting of one or more diodes connected in series, and the photoconductive circuits consisting of a single diode in series with a pulsed bias voltage. Circuit behavior and charge injection levels were markedly different for platinum and sputtered iridium-oxide film (SIROF) electrodes. Photovoltaic circuits were able to deliver 0.038 mC/cm(2) (0.75 nC/phase) per photodiode with 50- μm platinum electrodes, and 0.54-mC/cm(2) (11 nC/phase) per photodiode with 50-μ m SIROF electrodes driven with 0.5-ms pulses of light at 25 Hz. The same pulses applied to photoconductive circuits with the same electrodes were able to deliver charge injections as high as 0.38 and 7.6 mC/cm(2) (7.5 and 150 nC/phase), respectively. We demonstrate photovoltaic stimulation of rabbit retina in-vitro, with 0.5-ms pulses of 905-nm light using peak irradiance of 1 mW/mm(2). Based on the experimental data, we derive electrochemical and optical safety limits for pixel density and charge injection in various circuits. While photoconductive circuits offer smaller pixels, photovoltaic systems do not require an external bias voltage. Both classes of circuits show promise for the development of high-resolution optoelectronic retinal prostheses.

An ultra-high input impedance ECG amplifier for long-term monitoring of athletes

We present a new, low-power electrocardiogram (ECG) recording system with an ultra-high input impedance that enables the use of long-lasting, dry electrodes. The system incorporates a low-power Bluetooth module for wireless connectivity and is designed to be suitable for long-term monitoring during daily activities. The new system using dry electrodes was compared with a clinically approved ECG reference system using gelled Ag/AgCl electrodes and performance was found to be equivalent. In addition, the system was used to monitor an athlete during several physical tasks, and a good quality ECG was obtained in all cases, including when the athlete was totally submerged in fresh water.