EMG signals detection and processing for on-line control of functional electrical stimulation.

The surface EMG signal detected from voluntarily activated muscles can be used as a control signal for functional neuromuscular electrical stimulation. A proper positioning of the recording electrodes in relation to the stimulation electrodes, and a proper processing of the recorded signals is required to reduce the stimulus artefact and the non-voluntary contribution (M-wave). Six orientations and six locations of the recording electrodes were investigated in the present work. A comb filter (with and without a blanking windowing) was applied to remove the signal components synchronously correlated to the stimulus. An operative definition of the signal to noise ratio and an efficiency index were implemented. It resulted that when the recording electrodes were located within the two stimulation electrodes the best orientation was perpendicular to the longitudinal line. However the best absolute indexes were obtained when the recording electrodes were located externally of the stimulation electrodes, and in that case the best orientation was longitudinal. Concerning the filtering procedure, the use of a blanking window before the application of the comb filter, gave the best performance.     

Selective motor unit recruitment via intrafascicular multielectrode stimulation

Recruitment of force via independent asynchronous firing of large numbers of motor units produces the grace and endurance of physiological motion. We have investigated the possibility of reproducing this physiological recruitment strategy by determining the selectivity of access to large numbers of independent motor units through intrafascicular multielectrode stimulation (IFMS) of the peripheral nerve. A Utah Slanted Electrode Array containing 100, 0.5-1.5 mm-long penetrating electrodes was inserted into the sciatic nerve of a cat, and forces generated by the 3 heads of triceps surea in response to electrical stimulation of the nerve were monitored via force transducers attached to their tendons. We found a mean of 17.4 +/- 4.9 (mean +/- SEM) electrodes selectively excited maximal forces in medial gastrocnemius before exciting another muscle. Among electrodes demonstrating selectivity at threshold, a mean of 7.3 +/- 2.7 electrodes were shown to recruit independent populations of motor units innervating medial gastrocnemius (overlap < 20%). Corresponding numbers of electrodes were reported for lateral gastrocnemius and soleus, as well. We used these stimulation data to emulate physiological recruitment strategies, and found that independent motor unit pool recruitment approximates physiological activation more closely than does intensity-based recruitment or frequency-based recruitment.     

Inductive stimulation

Electrical stimulation, which has long been known, has recently been complemented by electromagnetic stimulation. This method is based on the law of induction and employs coils in place of electrodes. The effect of this process is deduced from both the relationship between magnetic and electrical fields and the stimulating effect. A new type of stimulator has been developed from a resonant circuit, thus allowing nerves to be excited with low-frequency pulses up to fusion frequency.     

Feasibility of cardiac microimpedance measurement using multisite interstitial stimulation

This study was designed to test the hypothesis that analyses of central interstitial potential differences recorded during multisite stimulation with a set of interstitial electrodes provide sufficient data for accurate measurement of cardiac microimpedances. On theoretical grounds, interstitial current injected and removed using electrodes in close proximity does not cross the membrane, whereas equilibration of intracellular and interstitial potentials occurs distant from electrodes widely separated. Multisite interstitial stimulation should therefore give rise to interstitial potential differences recorded centrally that depend on intracellular and interstitial microimpedances, allowing independent measurement. Simulations of multisite stimulation with fine (25 microm) and wide (400 microm) spacing in one-dimensional models that included Luo-Rudy dynamic membrane equations were performed. Constant interstitial and intracellular microimpedances were prescribed for initial analyses. Discrete myoplasmic and gap-junctional components were prescribed intracellularly in later simulations. With constant microimpedances, multisite stimulation using 29 total electrode combinations allowed interstitial and intracellular microimpedance measurements at errors of 0.30% and 0.34%, respectively, with errors of 0.05% and 0.40% achieved using 6 combinations and 10 total electrodes. With discrete myoplasmic and junctional components, comparable accuracy was maintained following adjustments to the junctions to reflect uncoupling. This allowed uncoupling to be quantified as relative increases in total junctional resistance. Our findings suggest development of microfabricated devices to implement the procedure would facilitate routine measurement as a component of cardiac electrophysiological study.     

Motor effects of electrical and cholinergic stimulation of the cat's dorsal hippocampus

The effect of electrical stimulation of the dorsal hippocampus was studied in 17 adult cats with implanted electrodes and those effects of carbachol and dioxolane in a group of ten adult cats with a cannula and electrodes implanted in the above cited structure. Electrical stimulation induced a contralateral head-eye-body turning response in 3 cats (17.6%), only when it was associated with afterdischarge. On the other hand the cholinergic agonists evoked contralateral head-eye-body turning in nine out of ten cats in whom the injections were administered into the hippocampus. The fact that dioxolane, an exclusive muscarinic agonist evoked this behavior and that atropine sulfate blocked this response, favours the postulation that turning is due to activation of muscarinic receptors inside the dorsal hippocampus. Comparison was done between the hippocampal group with a group similarly studied with electrodes implanted in the pulvinar-lateralis posterior nucleus complex (P-LP), and in the caudate nucleus, in which the electrical stimulation evoked contralateral head-eye-body turning response without any EEG activation.     

Changes in paroxysmal brainwave patterns of epileptics by weak-field magnetic stimulation

In order to assess the effects of weak-field magnetic stimulation on brain electrical activity in epileptics, three patients suffering from mesial temporal lobe epilepsy (MTLE) were exposed to DC magnetic fields of 0.9 and 1.8 millitesla (mT). The EEG activity was recorded simultaneously from intracranial electrodes inserted through the foramen ovale (FO) and scalp electrodes. Significant enhancement of interictal epileptiform activity was observed in two patients, while in one patient, magnetic stimulation resulted in the cessation of interictal spike/wave trains.     

A nerve clamp electrode design for indirect stimulation of skeletal muscle

A nerve clamp electrode was developed to indirectly stimulate skeletal muscle innervated by α motor neurons as an alternative to conventional electrodes. The stimulating electrode device consists of a spring coil-activated nerve clamp mounted inside a 1-mL syringe barrel. Supramaximal pulses were generated by a Grass stimulator and delivered to the nerve segment via the nerve clamp electrode. The salient feature of the electrode is its ability to produce muscle contractions indirectly through stimulation of the attached nerve. Indirect muscle stimulation is critical for studying the paralytic actions of presynaptic-acting toxins such as botulinum neurotoxins (BoNT), a potent inhibitor of acetylcholine (ACh) release from α motor neurons. This device enables stimulation of muscle contraction indirectly as opposed to contraction from direct muscle stimulation. The electrode is able to stimulate indirect muscle contraction when tested on ex vivo preparations from rodent phrenic nerve-hemidiaphragm muscle in similar fashion to conventional electrodes. In addition, the electrode stimulated external intercostal nerve-muscle preparations. This was confirmed after applying BoNT serotype A, a potent inhibitor of ACh release, to induce muscle paralysis. Alternative methods, including suction and bipolar loop electrodes, were unsuccessful in stimulating indirect muscle contraction. Therefore, this novel electrode is useful for physiological assessment of nerve agents and presynaptic actions of toxins that cause muscle paralysis. This electrode is useful for stimulating nerve-muscle preparations for which the length of nerve is a concern.     

A system designed for the study of cell activity under electrical stimulation

Summary Indium tin oxide electrodes have been used to investigate in vitro effects of steady electric fields on rat bone marrow stromal cells. At voltages <0.8V, no medium decomposition takes place and an electrical double layer is formed at the electrodes. At the anode, the attachment of cells is enhanced but their proliferation is suppressed. Cell proliferation is resumed on removal of the field.     

Advances in functional electrical stimulation (FES)

This review discusses the advancements that are needed to enhance the effects of electrical stimulation for restoring or assisting movement in humans with an injury/disease of the central nervous system. A complex model of the effects of electrical stimulation of peripheral systems is presented. The model indicates that both the motor and sensory systems are activated by electrical stimulation. We propose that a hierarchical hybrid controller may be suitable for functional electrical stimulation (FES) because this type of controller acts as a structural mimetic of its biological counterpart. Specific attention is given to the neural systems at the periphery with respect to the required electrodes and stimulators. Furthermore, we note that FES with surface electrodes is preferred for the therapy, although there is a definite advantage associated with implantable technology for life-long use. The last section of the review discusses the potential need to combine FES and robotic systems to provide assistance in some cases.     

Validation of surface recordings of the diaphragm response to transcranial magnetic stimulation in humans.

The integrity of the central efferent motor pathways to the diaphragm can be assessed by using transcranial magnetic stimulation to measure the latency of the corresponding motor evoked potentials with surface electrodes. Because transcranial magnetic stimulation does not activate the diaphragm alone, signal contamination is a potential problem. To evaluate this issue, surface diaphragmatic motor-evoked potential latencies were compared with latencies recorded from diaphragm needle in 9 healthy volunteers. Surface latencies of muscles likely to contaminate the diaphragm signals (serratus anterior, pectoralis major, and tranversus abdominis) were also recorded. The latencies in response to nonfocal transcranial stimulation from surface electrodes were not significantly different from the needle ones (17 +/- 1.3 vs. 17.2 +/- 1.1 ms, respectively) but were significantly different from the latencies of the other muscles. In two cases, signal contamination appeared likely (serratus anterior in 1 case, abdominal muscles in 1 case). It is possible to reliably measure the latency of the diaphragm response to transcranial magnetic stimulation with adequately positioned surface electrodes.     

Electric field stimulation of human osteosarcoma-derived cells: a dose-response study.

In vitro electrical stimulation of human osteosarcoma-derived cells resulted in increased cell adherence and current directed cell migration. We have developed an electrical exposure system in which two steel electrodes imbedded in media-based agar, poured in a standard culture dish, are used to apply electric field signals to cells in culture without ion contamination from the electrodes. The cells were exposed to a 100 Hz pulsed DC electric signal at peak field strengths of 1, 10, 100, and 625 mV/cm in the culture media. The data showed no change in cell adherence at 1 and 10 mV/cm, an increase in adherence at 100 mV/cm, and a decrease in both adherence and cell proliferation at 625 mV/cm. Electric field stimulation in vivo has been found useful in accelerating the healing of fractures and non-unions, and the repair of surgical and cancer-related skeletal defects.     

Frontal distribution of early cortical somatosensory evoked potentials to median nerve stimulation

The topography of early frontal SEPs (P20 and N26) to left median nerve stimulation was studied in 30 normal subjects and 3 patients with the left frontal bone defect. The amplitudes of P20 and N26 were maximum at the frontal electrode (F4) contralateral to the stimulation and markedly decreased at frontal electrodes ipsilateral to the site of stimulation. There was, however, no latency difference of P20 and N26 between ipsilateral and contralateral frontal electrodes. These results suggest that the origin of the ipsilateral and contralateral P20 and N26 is the same. The wide distribution of P20 and N26 over both frontal areas could be explained by assuming a smearing effect from generators actually located in the rolandic fissure and motor cortex.     

Deep brain stimulation: Challenges at the tissue-electrode interface and current solutions

Deep brain stimulation (DBS) is used to treat the motor symptoms of Parkinson's disease patients by stimulating the subthalamic nucleus. However, optimization of DBS is still needed since the performance of the neural electrodes is limited by the body's response to the implant. This review discusses the issues with DBS, such as placement of electrodes, foreign body response, and electrode degradation. The current solutions to these technical issues include modifications to electrode material, coatings, and geometry.     

Relationship between the frequency of self stimulation and the strength and duration of stimulation

In experiments on thirteen rats with electrodes in the lateral hypothalamus, with a simultaneous change in current intensity I and of stimulation duration T, two variants were obtained of the empirical response surface of the self-stimulation (SS) frequency: with the maximum SS frequency, located within the surface boundaries (peak variant), and with the maximum at one of its boundaries (side variant). An equation has also been deduced on the regression of SS frequency on the parameters I and T, which quite accurately defines the experimental and rated data (R = 0.57 divided by 0.97). It has been established that current intensity has a greater effect on SS frequency as compared with the stimulation duration and that the influences of these parameters are relatively independent of one another.     

Chronic paleocerebellar stimulation for the treatment of neuromuscular disorders. Four case report.

4 patients suffering severe neuromuscular diseases were subjected to a subtentorial implantation of electrodes over the anterior cerebellar lobe surface. Chronic stimulation was applied for 90 min to 7 h daily, with a rate of 20--180 Hz, 6--10 V and a schedule of 15 min "on", 15 min "off". Some improvement was observed in 3 patients treated with high frequency stimulation. 1 patient suffered seizures after three months of chronic stimulation. In 2 cases, posterior fossa explorations were necessary for revision of the stimulation apparatus and marked meningeal proliferation surrounding the electrodes was observed. Light and electron microscopic examination of the biopsies showed loss of Purkinje cells and gliofibrillar reaction. Effectiveness and side effects of chronic stimulation of the cerebellum are discussed.     

Differential sensitivity to rotation measured on potentials evoked by electrical stimulation of the guinea-pig ear

Responses to electrical stimulation of the ear applied between round-window and vertex electrodes were recorded in awake guinea-pigs from the same electrodes or from separate vertex/mastoid subdermal needle electrodes. They were averaged during opposite phases of sinusoidal rotation or before and after constant velocity rotation. In both cases the responses were subtracted from each other and yielded differential per- or post-rotatory “electrovestibular” responses. For comparison, responses were also recorded in the same animals and conditions of electrical stimulation during silence and during presentation of a broad-band noise. The difference yielded “electroacoustic” responses. In round-window records, electrovestibular and electroacoustic responses presented typical compound nerve action potential patterns. Electrovestibular responses could be recorded for head angular velocities as low as 3° sec⁻¹ at 0.1 Hz. Response amplitude showed a logarithmic relation to head velocity. Changes in amplitude, as a function of time after rotation, were comparable to those reported for vestibular nerve fibre responses. In vertex/mastoid records, electroacoustic responses presented a sequence of peaks similar to the click-evoked auditory brain-stem responses, and electrovestibular responses presented two peaks, presumably representing contributions of central vestibular structures. Such “electrovestibulography” permits the study of an individual ear and makes available to the investigator a large range of vestibular stimulation conditions.     

Brain stimulation using electromagnetic sources: theoretical aspects.

We prove that, at the frequencies generally proposed for extracranial stimulation of the brain, it is not possible, using any superposition of external current sources, to produce a three-dimensional local maximum of the electric field strength inside the brain. The maximum always occurs on a boundary where the conductivity jumps in value. Nevertheless, it may be possible to achieve greater two-dimensional focusing and shaping of the electric field than is currently available. Towards this goal we have used the reciprocity theorem to present a uniform treatment of the electric field inside a conducting medium produced by a variety of sources: an external magnetic dipole (current loop), an external electric dipole (linear antenna), and surface and depth electrodes. This formulation makes use of the lead fields from magneto- and electroencephalography. For the special case of a system with spherically symmetric conductivity, we derive a simple analytic formula for the electric field due to an external magnetic dipole. This formula is independent of the conductivity profile and therefore embraces spherical models with any number of shells. This explains the "insensitivity" to the skull's conductivity that has been described in numerical studies. We also present analytic formulas for the electric field due to an electric dipole, and also surface and depth electrodes, for the case of a sphere of constant conductivity.     

Roles of electric field and fiber structure in cardiac electric stimulation.

This study investigated roles of the variation of extracellular voltage gradient (VG) over space and cardiac fibers in production of transmembrane voltage changes (DeltaV(m)) during shocks. Eleven isolated rabbit hearts were arterially perfused with solution containing V(m)-sensitive fluorescent dye (di-4-ANEPPS). The epicardium received shocks from symmetrical or asymmetrical electrodes to produce nominally uniform or nonuniform VGs. Extracellular electric field and DeltaV(m) produced by shocks in the absolute refractory period were measured with electrodes and a laser scanner and were simulated with a bidomain computer model that incorporated the anterior left ventricular epicardial fiber field. Measurements and simulations showed that fibers distorted extracellular voltages and influenced the DeltaV(m). For both uniform and nonuniform shocks, DeltaV(m) depended primarily on second spatial derivatives of extracellular voltages, whereas the VGs played a smaller role. Thus, 1) fiber structure influences the extracellular electric field and the distribution of DeltaV(m); 2) the DeltaV(m) depend on second spatial derivatives of extracellular voltage.     

Sinusoidal galvanic stimulation of the labyrinths and postural responses

We studied the effect of sinusoidal stimulation of the labyrinths on postural reflexes in man, using a 0.3 Hz current of alternating polarity and +/- 1 mA intensity for stimulation. The test subjects were tested binaurally by the bipolar method (BB), with two electrodes on the mastoid processes, and binaurally by the monopolar method (BM), with electrodes localized bilaterally on the mastoid process and the hand. Stabilographic postural parameters were measured in 22 subjects in five experimental situations. Each situation lasted 60 s. Body sway, detected by astabilometer, was recorded on a Philips FM tape-recorder and then analysed off-line on a PDP-11/34 computer. On BB stimulation of the labyrinths, the variance of body sway in the left-right (LR) direction increased more than in the anteroposterior (AP) direction. In BM stimulation, only the variance of LR sway increased. Other posturographic parameters displayed a similar effect. From the aspect of body sway frequency, BB stimulation produced a peak in the course of the power spectral density of the lateral stabilogram at 0.3 Hz. In this experimental situation, a habituation effect was manifested, depending on the subject. It can be stated that binaural bipolar (BB) stimulation of the labyrinths selectively influences lateral body sway, while the increase in AP body sway in this situation is merely a concomitant phenomenon.     

Nerve stimulation with a multi-contact cuff electrode: validation of model predictions

The recruitment characteristics of muscle selective nerve stimulation by a multi-contact nerve cuff electrode, as predicted by computer modeling, have been investigated in acute experiments on rabbits. A nerve cuff containing five or six dot electrodes was placed around the sciatic nerve in five rabbits. M-waves were recorded with wire electrodes from the lateral gastrocnemius, soleus, tibialis anterior, and extensor digitorum longus muscles. The muscle recruitment performances of three contact configurations (monopole, transverse bipole, transverse tripole) were compared. The selectivity was quantified by the recruitment of two muscles (one extensor and one flexor) in response to a particular stimulus. The results showed that only in a few cases, transverse bi- and tripolar stimulation provided a better selectivity than monopolar stimulation. Neither of the two extensors, nor of the two flexors could be stimulated separately. In accordance with the results of the modeling studies, bi- and tripolar stimulation required higher stimulus currents than monopolar stimulation, whereas maximum recruitment and slopes of recruitment curves were lower. The rabbit sciatic nerve appears to be a less suitable preparation for reproducible selectivity experiments, due to the variability in the number and size of the fascicles and their position in this nerve.