Discrimination of phantom hand sensations elicited by afferent electrical nerve stimulation in below-elbow amputees.

The necessity for a sensory feedback system that would enhance patient acceptability of motorized hand prostheses is now generally acknowledged. Afferent electrical stimulation of the nerves in the amputation stump can convey sensory feedback from prostheses with the advantage of eliciting sensations in the phantom image of the lost hand. Experiments with percutaneous nerve stimulation of the amputation stump in below-elbow amputees showed that with stable electrode conditions, amplitude modulated stimulation was better than frequency modulated stimulation in terms of accuracy, delay, and transinformation both with intermittent and uninterrupted stimulation. With unstable electrode conditions, different results were noticed, since amplitude modulated stimulation is very sensitive even to minor changes in electrode position. It is concluded that afferent electrical nerve stimulation with adequate training and stable electrodes had characteristics of accuracy, transinformation and delay which are good enough to make it a suitable method of conveying information in a prosthesis feedback system.     

Electrically evoked myoelectric signals.

Electrical stimulation of the nervous system is attracting increasing attention because of the possibilities it offers for physiological investigations, clinical diagnosis, muscle function assessment, noninvasive muscle characterization, and functional control of paralyzed extremities. Parameters of the myoelectric signal evoked by surface stimulation of a muscle motor point or by stimulation of a nerve trunk by means of implanted electrodes provide information about muscle performance and properties if the stimulation artifact is properly removed or suppressed. Comparison of these parameters with those obtained during voluntary contractions provides additional insight into muscle physiology. The relationships between myoelectric signal amplitude parameters, spectral parameters, and conduction velocity are discussed with special reference to muscle fatigue. This review focuses on a few methodological aspects concerning electrical stimulation of the peripheral nervous system, detection, and processing of the electrically evoked myoelectric signals in skeletal muscles. The state of the art of the following issues is discussed: (1) properties of voluntary and electrically evoked myoelectric signals; (2) techniques for evoking and detecting myoelectric signals; (3) techniques for suppression of stimulation artifacts; (4) effect of stimulation waveforms and electrode properties; (5) signal processing techniques for electrically evoked myoelectric signals; (6) physiological significance of myoelectric signal variables; (7) order of recruitment of motor units during electrical stimulation; (8) myoelectric manifestations of fatigue in electrically stimulated muscles; (9) assessment of crosstalk by electrical stimulation; and (10) applications in sport, rehabilitation, and geriatric medicine.     

Afferent electrical nerve stimulation: Human tracking performance relevant to prosthesis sensory feedback

Afferent electrical nerve stimulation has been suggested for use in prosthesis sensory feedback by several authors. This paper deals with some basic properties of afferent-nerve stimulation when applied continuously for 2 min with dynamic changes in the stimulation parameters. The stimulation was well tolerated but the adaptation was pronounced and had to be compensated. The accuracy, transinformation and delay of the response to afferent-nerve stimulation was studied in tracking experiments with different patterns and stimulation modes. It was found that accuracy was promoted by the use of current-amplitude modulation as opposed to current-pulse-frequency modulation. In addition, slowly changing stimulation patterns yielded higher accuracy than rapidly changing ones. Stimulation patterns consisting of a large number of distinct stimulation levels gave higher transinformation than patterns consisting of a small number of levels. Rapidly changing stimulation patterns yielded a shorter delay than slow patterns. In general, tracking with afferent electrical nerve stimulation yielded an accuracy and a transinformation of about 75% of that of visual tracking. The delay time was found to be three times that of visual tracking. In conclusion, afferent electrical nerve stimulation has properties that make it suitable for conveying sensory feedback from motorised prostheses.     

Model-based evaluation of the short-circuited tripolar cuff configuration

Recordings of neural information for use as feedback in functional electrical stimulation are often contaminated with interfering signals from muscles and from stimulus pulses. The cuff electrode used for the neural recording can be optimized to improve the S/I ratio. In this work, we evaluate a model of both the nerve signal and the interfering signals recorded by a cuff, and subsequently use this model to study the signal to interference ratio of different cuff designs and to evaluate a recently introduced short-circuited tripolar cuff configuration. The results of the model showed good agreement with results from measurements in rabbits and confirmed the superior performance of the short-circuited tripolar configuration as compared with the traditionally used tripolar configuration.     

Intelligent multifunction myoelectric control of hand prostheses

Intuitive myoelectric prosthesis control is difficult to achieve due to the absence of proprioceptive feedback, which forces the user to monitor grip pressure by visual information. Existing myoelectric hand prostheses form a single degree of freedom pincer motion that inhibits the stable prehension of a range of objects. Multi-axis hands may address this lack of functionality, but as with multifunction devices in general, serve to increase the cognitive burden on the user. Intelligent hierarchical control of multiple degree-of-freedom hand prostheses has been used to reduce the need for visual feedback by automating the grasping process. This paper presents a hybrid controller that has been developed to enable different prehensile functions to be initiated directly from the user's myoelectric signal. A digital signal processor (DSP) regulates the grip pressure of a new six-degree-of-freedom hand prosthesis thereby ensuring secure prehension without continuous visual feedback.     

外部电场作用下的视神经纤维兴奋性的仿真研究

基于刺入式电极的视神经视觉假体,为盲人的视觉修复提供了新的可能性。为了对该视神经假体的电刺激策略和微电极设计提供理论支持,基于真实的电极结构,在COMSOL软件中建立刺入式微电极的外部电场仿真模型,并将其与利用NEURNO软件实现的神经纤维双层电缆模型结合,系统地研究电极与视神经纤维的相对位置、电刺激脉冲宽度以及电极几何结构的改变对视神经纤维兴奋阈值的影响。不同电极位置、刺激脉宽刺激下阈值变化规律的仿真结果,与以往报道的动物实验和仿真实验结果相符,证明了所建模型的有效性。 根据仿真结果,对刺入式视神经假体中刺激脉宽的选择和电极几何结构的设计,建议如下：窄脉宽刺激有利于降低能量消耗;电极锥度的设计要在满足电极力学特性及易于植入视神经的基础上,尽可能地减小,以降低纤维兴奋的阈值;电极的暴露面积越小,纤维兴奋所需的电流阈值越低,但电荷密度阈值越高;较低的电流阈值有利于减少能量消耗,但过高的电荷密度阈值却容易造成组织损伤,因此电极暴露面积的设计需要在耗能与安全性之间进行综合考虑。电极绝缘层厚度的改变对视神经纤维的兴奋阈值没有明显的影响,但从电极插入的难易考虑,应尽可能减小绝缘层厚度。以上结果对人体其他部位神经纤维的电刺激同样具有参考价值     

Intelligent multifunction myoelectric control of hand prostheses

Intuitive myoelectric prosthesis control is difficult to achieve due to the absence of proprioceptive feedback, which forces the user to monitor grip pressure by visual information. Existing myoelectric hand prostheses form a single degree of freedom pincer motion that inhibits the stable prehension of a range of objects. Multi-axis hands may address this lack of functionality, but as with multifunction devices in general, serve to increase the cognitive burden on the user. Intelligent hierarchical control of multiple degree-of-freedom hand prostheses has been used to reduce the need for visual feedback by automating the grasping process. This paper presents a hybrid controller that has been developed to enable different prehensile functions to be initiated directly from the user's myoelectric signal. A digital signal processor (DSP) regulates the grip pressure of a new six-degree-of-freedom hand prosthesis thereby ensuring secure prehension without continuous visual feedback.     

植入性运动修复术中新电极技术对刺激外周神经作用的展望

揭示了电极技术和刺激技术新方法,即用比现行的运动修复术系统小得多的植入物的有选择地激活外周神经干某个部分的方法。第一部分回顾了神经受机械和电刺激后,可能出现的问题即有关原理在今后电极技术中的应用,第于部分是有关神经选择性刺激方面的问题;第三部分提供了纵轴方向神经束内电极进行神经刺激和记录的结果。     

Neurotrophin-eluting hydrogel coatings for neural stimulating electrodes

Improved sensory and motor prostheses for the central nervous system will require large numbers of electrodes with low electrical thresholds for neural excitation. With the eventual goal of reducing stimulation thresholds, we have investigated the use of biodegradable, neurotrophin-eluting hydrogels (i.e., poly(ethylene glycol)-poly(lactic acid), PEGPLA) as a means of attracting neurites to the surface of stimulating electrodes. PEGPLA hydrogels with release rates ranging from 1.5 to 3 weeks were synthesized. These hydrogels were applied to multielectrode arrays with sputtered iridium oxide charge-injection sites. The coatings had little impact on the iridium oxide electrochemical properties, including charge storage capacity, impedance, and voltage transients during current pulsing. Additionally, we quantitatively examined the ability of neurotrophin-eluting, PEGPLA hydrogels to promote neurite extension in vitro using a PC12 cell culture model. Hydrogels released neurotrophin (nerve growth factor, NGF) for at least 1 week, with neurite extension near that of an NGF positive control and much higher than extension seen from sham, bovine serum albumin-releasing boluses, and a negative control. These results show that neurotrophin-eluting hydrogels can be applied to multielectrode arrays, and suggest a method to improve neuron-electrode proximity, which could result in lowered electrical stimulation thresholds. Reduced thresholds support the creation of smaller electrode structures and high density electrode prostheses, greatly enhancing prosthesis control and function.     

Human ability to discriminate various parameters in afferent electrical nerve stimulation with particular reference to prostheses sensory feedback

Afferent electrical nerve stimulation is an approach showing many promises with regard to sensory feedback for powered prostheses. It is well tolerated, can transmit fairly high amounts of information, and has several characteristics making it superior to electrocutaneous and vibrotactile devices when applied to prostheses. The feedback information is transferred in modulated form either by means of the current pulse amplitude (a.m.) or by the current pulse frequency (f.m.) A.M. stimulation should be applied in such a way that it gives rise to characteristic changes in the distribution of paresthesias with changing current. Used in this way it is not dependent upon minor changes in electrode position, it is easy to learn and gives high rates of information, even in untrained subjects. The number of channels that can be used in each nerve is, however, limited because of the large amount of axons necessary to achieve the spatial spread. F.M. stimulation is more difficult to learn than a.m. but gives the same rate of information transfer when used in trained individuals. Like a.m. it is not dependent upon minor changes in electrode position, but a smaller number of axons is needed to achieve discrimination. Thus several channels can be used in each nerve. Both with a.m. and f.m. stimulation a trained subject can discriminate five or six discrete levels with a rate of correct recognition of more than 75%, the amount of transmitted information being about 1·8 bits per symbol.     

Sensory-feedback system compatible with myoelectric control

Progress in the development of a system to provide sensory feedback of the pinch force of an artificial hand is described. Design criteria relating to electrocutaneous stimulation and compatibility with myoelectric control are discussed. Details of a practical system, presently in use by two amputees prior to full-scale clinical evaluation, are presented.     

Cutaneous mechanisms of isometric ankle force control

The sense of force is critical in the control of movement and posture. Multiple factors influence our perception of exerted force, including inputs from cutaneous afferents, muscle afferents and central commands. Here, we studied the influence of cutaneous feedback on the control of ankle force output. We used repetitive electrical stimulation of the superficial peroneal (foot dorsum) and medial plantar nerves (foot sole) to disrupt cutaneous afferent input in 8 healthy subjects. We measured the effects of repetitive nerve stimulation on (1) tactile thresholds, (2) performance in an ankle force-matching and (3) an ankle position-matching task. Additional force-matching experiments were done to compare the effects of transient versus continuous stimulation in 6 subjects and to determine the effects of foot anesthesia using lidocaine in another 6 subjects. The results showed that stimulation decreased cutaneous sensory function as evidenced by increased touch threshold. Absolute dorsiflexion force error increased without visual feedback during peroneal nerve stimulation. This was not a general effect of stimulation because force error did not increase during plantar nerve stimulation. The effects of transient stimulation on force error were greater when compared to continuous stimulation and lidocaine injection. Position-matching performance was unaffected by peroneal nerve or plantar nerve stimulation. Our results show that cutaneous feedback plays a role in the control of force output at the ankle joint. Understanding how the nervous system normally uses cutaneous feedback in motor control will help us identify which functional aspects are impaired in aging and neurological diseases.     

Comparisons of the sensation perceived and intradental nerve activity following temperature changes in human teeth

Summary The relationship between the intradental nerve responses and subjective sensory ratings evoked by thermal stimulation of the teeth was studied in man. Recordings were taken from a total of 12 thermally sensitive units from the inferior dental nerve following thermal tooth stimulation, of which seven responded to both heating and cooling, two were exclusively cold-sensitive and three exclusively heat-sensitive. The early and late sensory responses following both cold and heat stimulation of the tooth were observed. The late sensory responses were more unstable than the early sensory responses. The mean threshold of the early sensory responses to tooth cooling was 13.6±1.9° C (n = 9) and that to heat stimulation was 48.4±4.8° C (n=10). The firing frequency of the heat-sensitive, but not the cold sensitive, units increased linearly in proportion to the increase in magnitude of the early sensory ratings.     

A comparison of alternative means of providing sensory feedback on upper limb prostheses

Sensory feedback has been used, by a number of workers, to inform the central nervous system of the present state of an artificial limb. Although both electrical stimulation and electromechanical vibrations have been used, there appears to be no evidence of a direct comparison of the advantages and disadvantages of these methods. Such a comparison is made here. It is shown that the information transmission capabilities of both systems are more or less identical. The electrical system has some advantages in reducing the number of items in a myoelectric control system with feedback, but the mechanical vibration system has the advantage of a universal psychological acceptance. Crosstalk prohibits the use of two electrical feedback, channels and it is recommended that, where two channels are required, one should be electrical and the other a mechanical vibration.     

Control of upper-limb prostheses: a case for neuroelectric control.

A discussion is presented on the control aspects of upper-limb prostheses, with emphasis on the areas of necessary improvements in current designs. Arguments are presented to indicate that it should be possible to obtain a substantial improvement in prostheses control by properly training the amputee, improving the dynamics response of the prostheses, and improving the quality of the forward-path control signal. Augmentation of feedback information, although useful, may not be essential. The limitations of the myoelectric (muscle) signal as a forward-path control signal, especially for multiple degrees-of-freedom prostheses, is discussed. Most of the limitations of the myoelectric signal can be overcome if the neuroelectric (nerve) signal is used as a forward-path control signal. Results of a series of experiments which demonstrate the feasibility of constructing an electrode capable of being implanted around severed nerves and of detecting neuroelectric signals for prolonged periods of time are presented. A possible scheme for employing neuroelectric control is also presented.     

Input from proprioceptors in the extrinsic ocular muscles to the vestibular nuclei in the giant toad,Bufo marinus

Summary Extracellular unit records were made from the left brain stem of decerebrate, paralysed giant toads (Bufo marinus) during passive movement of the ipsilateral eye. Units in the vestibular nuclear complex (VN) were identified by their short-latency responses to electrical stimulation of the anterior branch of the ipsilateral VIII cranial nerve.Of 58 units in the region of VN, as judged from field potentials to VIII nerve stimulation, fourteen gave phasic excitatory responses to passive movement of the eye and were also identified as vestibular nuclear units. A further twelve units which responded to eye-movement could not be assigned to VN; the remaining 32 units were in VN but did not respond to passive eye-movement. Also, of 16 units whose recording sites were identified histologically in the VN complex, 11 gave responses to vestibular nerve stimulation and to passive eye-movement and 5 responded to eye-movement only.Control experiments eliminated auditory, visual and cutaneous sources for the signal produced by passive eye-movement; thus, the signal must have arisen from intraorbital proprioceptors. Units in VN were also found which were excited by electrical stimulation of the intraorbital part of the fourth (trochlear) nerve; this provides strong evidence that proprioceptors in the extrinsic ocular muscles (EOM) are included in the receptors which provide the signal to VN during passive eye-movement.The effects of vestibular stimulation and of passive eye-movement were found to interact upon units in VN. When passive eye-movement and vestibular stimulation were paired the response to the second stimulus was significantly reduced over a range of interstimulus intervals.The conclusions are that orbital proprioceptive signals, including those from the EOM, project to the vestibular nuclei in the toad and, there, are able to influence processing of vestibular afferent signals. We suggest, therefore, that orbital proprioceptive signals may play a part in oculomotor control. The significance of the results is discussed in relation to the strategic position of the VN in the oculomotor control system.     

Peripheral Inhibition of Eel Lateral Line Receptors as Caused by Antidromic Sensory Terminal Invasion

No evidence of efferent inhibitory activity on eel lateral line sensory cells has been found in a number of different types of experiments. Proximal transection of the lateral line nerve induces no changes in the ongoing activity from the sensory cells, even in the uncurarized, un-anesthetized animal. Stimulation of peripheral nerve filaments induces no inhibition of afferent spontaneous and/or evoked activity, either ipsilaterally or contralaterally. No spontaneous or evoked efferent activtiy could be recorded from proximal nerve filaments. Antidromic invasion of sensory terminals resets the ongoing spontaneous activity. In the intervening interval the mechanical and electrical thresholds of these sensory units are similarly elevated. Antidromic invasion is suggested to be the phenomenon reported as peripheral inhibition by Hashimoto et al. (1970).     

A prototype flexible microelectrode array for implant-prosthesis applications

This paper describes techniques for the fabrication of flexible microelectrodes for recording and stimulation within the human body. The intention of the effort was to develop a prototype microelectrode array for selective electrical stimulation of the cochlear nerve in cases of profound sensory deafness. The prototype array is formed on both sides of a thin-film plastic insulating substrate^? and consists of platinum conductor-elements, 0·3 μm thick and 12·7 μm wide, terminating at electrode surfaces, 250 μm wide. Metallisation of the substrate is accomplished by sputtering, and the electrode patterns are defined by photolithographic-etching techniques. Insulation of the array is achieved by dip coating in Silastic. Short term (nonstimulated) animal-tolerance studies indicate that the electrodes are biologically inert. Long-term implant studies are currently in progress, and experiments are planned to determine tissue-reaction and electrolytic-dissolution effects due to prolonged electrical stimulation. Microelectrodes using the fabrication techniques described can be applied, in practically any geometry desired, to the development of functional sensory and motor prostheses.     

Sensory feedback for powered limb prostheses

Conclusions The results of these tests confirm that a prosthesis is easier to control with sensory feedback and that the proposed technique is acceptable to patients as well as to professionals working in this field. Work in this Institute is now directed toward development of the feedback system to a form suitable for inclusion in a prosthesis. This requires miniaturisation, minimisation of power drain, and, hopefully, provision for use of common electrodes for stimulation and control.     

Chronically implanted intrafascicular recording electrodes

A newly designed intrafascicular electrode for chronic neural recording was studied by implanting 12 electrodes in the radial nerves of 6 cats for 6 months. Action potentials were monitored at specified intervals throughout the experiment. The number and size of the signals recorded suggest that this type of electrode provides information that is appropriate for feedback control in functional electrical stimulation (FES) systems. Histology of the nerve revealed that the implants are biocompatible and that little damage is caused by the presence of the electrode.