iCanClean Removes Motion, Muscle, Eye, and Line-Noise Artifacts from Phantom EEG.

The goal of this study was to test a novel approach (iCanClean) to remove non-brain sources from scalp EEG data recorded in mobile conditions. We created an electrically conductive phantom head with 10 brain sources, 10 contaminating sources, scalp, and hair. We tested the ability of iCanClean to remove artifacts while preserving brain activity under six conditions: Brain, Brain + Eyes, Brain + Neck Muscles, Brain + Facial Muscles, Brain + Walking Motion, and Brain + All Artifacts. We compared iCanClean to three other methods: Artifact Subspace Reconstruction (ASR), Auto-CCA, and Adaptive Filtering. Before and after cleaning, we calculated a Data Quality Score (0-100%), based on the average correlation between brain sources and EEG channels. iCanClean consistently outperformed the other three methods, regardless of the type or number of artifacts present. The most striking result was for the condition with all artifacts simultaneously present. Starting from a Data Quality Score of 15.7% (before cleaning), the Brain + All Artifacts condition improved to 55.9% after iCanClean. Meanwhile, it only improved to 27.6%, 27.2%, and 32.9% after ASR, Auto-CCA, and Adaptive Filtering. For context, the Brain condition scored 57.2% without cleaning (reasonable target). We conclude that iCanClean offers the ability to clear multiple artifact sources in real time and could facilitate human mobile brain-imaging studies with EEG.

Electrical Brain Activity during Human Walking with Parametric Variations in Terrain Unevenness and Walking Speed.

Mobile brain imaging with high-density electroencephalography (EEG) can provide insight into the cortical processes involved in complex human walking tasks. While uneven terrain is common in the natural environment and poses challenges to human balance control, there is limited understanding of the supraspinal processes involved with traversing uneven terrain. The primary objective of this study was to quantify electrocortical activity related to parametric variations in terrain unevenness for neurotypical young adults. We used high-density EEG to measure brain activity when thirty-two young adults walked on a novel custom-made uneven terrain treadmill surface with four levels of difficulty at a walking speed tailored to each participant. We identified multiple brain regions associated with uneven terrain walking. Alpha (8 - 13 Hz) and beta (13 - 30 Hz) spectral power decreased in the sensorimotor and posterior parietal areas with increasing terrain unevenness while theta (4 - 8 Hz) power increased in the mid/posterior cingulate area with terrain unevenness. We also found that within stride spectral power fluctuations increased with terrain unevenness. Our secondary goal was to investigate the effect of parametric changes in walking speed (0.25 m/s, 0.5m/s, 0.75 m/s, 1.0 m/s) to differentiate the effects of walking speed from uneven terrain. Our results revealed that electrocortical activities only changed substantially with speed within the sensorimotor area but not in other brain areas. Together, these results indicate there are distinct cortical processes contributing to the control of walking over uneven terrain versus modulation of walking speed on smooth, flat terrain. Our findings increase our understanding of cortical involvement in an ecologically valid walking task and could serve as a benchmark for identifying deficits in cortical dynamics that occur in people with mobility deficits.

Comparison of EEG Source Localization Using Simplified and Anatomically Accurate Head Models in Younger and Older Adults.

Accuracy of electroencephalography (EEG) source localization relies on the volume conduction head model. A previous analysis of young adults has shown that simplified head models have larger source localization errors when compared with head models based on magnetic resonance images (MRIs). As obtaining individual MRIs may not always be feasible, researchers often use generic head models based on template MRIs. It is unclear how much error would be introduced using template MRI head models in older adults that likely have differences in brain structure compared to young adults. The primary goal of this study was to determine the error caused by using simplified head models without individual-specific MRIs in both younger and older adults. We collected high-density EEG during uneven terrain walking and motor imagery for 15 younger (22±3 years) and 21 older adults (74±5 years) and obtained [Formula: see text]-weighted MRI for each individual. We performed equivalent dipole fitting after independent component analysis to obtain brain source locations using four forward modeling pipelines with increasing complexity. These pipelines included: 1) a generic head model with template electrode positions or 2) digitized electrode positions, 3) individual-specific head models with digitized electrode positions using simplified tissue segmentation, or 4) anatomically accurate segmentation. We found that when compared to the anatomically accurate individual-specific head models, performing dipole fitting with generic head models led to similar source localization discrepancies (up to 2 cm) for younger and older adults. Co-registering digitized electrode locations to the generic head models reduced source localization discrepancies by  âˆ¼  6 mm. Additionally, we found that source depths generally increased with skull conductivity for the representative young adult but not as much for the older adult. Our results can help inform a more accurate interpretation of brain areas in EEG studies when individual MRIs are unavailable.

Uneven terrain versus dual-task walking: differential challenges imposed on walking behavior in older adults are predicted by cognitive and sensorimotor function.

Aging is associated with declines in walking function. To understand these mobility declines, many studies have obtained measurements while participants walk on flat surfaces in laboratory settings during concurrent cognitive task performance (dual-tasking). This may not adequately capture the real-world challenges of walking at home and around the community. Here, we hypothesized that uneven terrains in the walking path impose differential changes to walking speed compared to dual-task walking. We also hypothesized that changes in walking speed resulting from uneven terrains will be better predicted by sensorimotor function than cognitive function. Sixty-three community-dwelling older adults (65-93 yrs old) performed overground walking under varying walking conditions. Older adults were classified into two mobility function groups based on scores of the Short Physical Performance Battery. They performed uneven terrain walking across four surface conditions (Flat, Low, Medium, and High unevenness) and performed single and verbal dual-task walking on flat ground. Participants also underwent a battery of cognitive (cognitive flexibility, working memory, inhibition) and sensorimotor testing (grip strength, 2-pt discrimination, pressure pain threshold). Our results showed that walking speed decreased during both dual-task walking and across uneven terrain walking conditions compared to walking on flat terrain. Participants with lower mobility function had even greater decreases in uneven terrain walking speeds. The change in uneven terrain speed was associated with attention and inhibitory function. Changes in both dual-task and uneven terrain walking speeds were associated with 2-point tactile discrimination. This study further documents associations between mobility, executive functions, and somatosensation, highlights the differential costs to walking imposed by uneven terrains, and identifies that older adults with lower mobility function are more likely to experience these changes to walking function.

iCanClean Improves Independent Component Analysis of Mobile Brain Imaging with EEG.

Motion artifacts hinder source-level analysis of mobile electroencephalography (EEG) data using independent component analysis (ICA). iCanClean is a novel cleaning algorithm that uses reference noise recordings to remove noisy EEG subspaces, but it has not been formally tested in a parameter sweep. The goal of this study was to test iCanClean's ability to improve the ICA decomposition of EEG data corrupted by walking motion artifacts. Our primary objective was to determine optimal settings and performance in a parameter sweep (varying the window length and r2 cleaning aggressiveness). High-density EEG was recorded with 120 + 120 (dual-layer) EEG electrodes in young adults, high-functioning older adults, and low-functioning older adults. EEG data were decomposed by ICA after basic preprocessing and iCanClean. Components well-localized as dipoles (residual variance < 15%) and with high brain probability (ICLabel > 50%) were marked as 'good'. We determined iCanClean's optimal window length and cleaning aggressiveness to be 4-s and r2 = 0.65 for our data. At these settings, iCanClean improved the average number of good components from 8.4 to 13.2 (+57%). Good performance could be maintained with reduced sets of noise channels (12.7, 12.2, and 12.0 good components for 64, 32, and 16 noise channels, respectively). Overall, iCanClean shows promise as an effective method to clean mobile EEG data.

Uneven terrain treadmill walking in younger and older adults.

We developed a method for altering terrain unevenness on a treadmill to study gait kinematics. Terrain consisted of rigid polyurethane disks (12.7 cm diameter, 1.3-3.8 cm tall) which attached to the treadmill belt using hook-and-loop fasteners. Here, we tested four terrain unevenness conditions: Flat, Low, Medium, and High. The main objective was to test the hypothesis that increasing the unevenness of the terrain would result in greater gait kinematic variability. Seventeen younger adults (age 20-40 years), 25 higher-functioning older adults (age 65+ years), and 29 lower-functioning older adults (age 65+ years, Short Physical Performance Battery score < 10) participated. We customized the treadmill speed to each participant's walking ability, keeping the speed constant across all four terrain conditions. Participants completed two 3-minute walking trials per condition. Using an inertial measurement unit placed over the sacrum and pressure sensors in the shoes, we calculated the stride-to-stride variability in step duration and sacral excursion (coefficient of variation; standard deviation expressed as percentage of the mean). Participants also self-reported their perceived stability for each condition. Terrain was a significant predictor of step duration variability, which roughly doubled from Flat to High terrain for all participant groups: younger adults (Flat 4.0%, High 8.2%), higher-functioning older adults (Flat 5.0%, High 8.9%), lower-functioning older adults (Flat 7.0%, High 14.1%). Similarly, all groups exhibited significant increases in sacral excursion variability for the Medium and High uneven terrain conditions, compared to Flat. Participants were also significantly more likely to report feeling less stable walking over all three uneven terrain conditions compared to Flat. These findings support the hypothesis that altering terrain unevenness on a treadmill will increase gait kinematic variability and reduce perceived stability in younger and older adults.

Characterizing and Removing Artifacts Using Dual-Layer EEG during Table Tennis.

Researchers can improve the ecological validity of brain research by studying humans moving in real-world settings. Recent work shows that dual-layer EEG can improve the fidelity of electrocortical recordings during gait, but it is unclear whether these positive results extrapolate to non-locomotor paradigms. For our study, we recorded brain activity with dual-layer EEG while participants played table tennis, a whole-body, responsive sport that could help investigate visuomotor feedback, object interception, and performance monitoring. We characterized artifacts with time-frequency analyses and correlated scalp and reference noise data to determine how well different sensors captured artifacts. As expected, individual scalp channels correlated more with noise-matched channel time series than with head and body acceleration. We then compared artifact removal methods with and without the use of the dual-layer noise electrodes. Independent Component Analysis separated channels into components, and we counted the number of high-quality brain components based on the fit of a dipole model and using an automated labeling algorithm. We found that using noise electrodes for data processing provided cleaner brain components. These results advance technological approaches for recording high fidelity brain dynamics in human behaviors requiring whole body movement, which will be useful for brain science research.

Evaluating a novel MR-compatible foot pedal device for unipedal and bipedal motion: Test-retest reliability of evoked brain activity.

The purpose of this study was to develop and evaluate a new, open-source MR-compatible device capable of assessing unipedal and bipedal lower extremity movement with minimal head motion and high test-retest reliability. To evaluate the prototype, 20 healthy adults participated in two magnetic resonance imaging (MRI) visits, separated by 2-6 months, in which they performed a visually guided dorsiflexion/plantar flexion task with their left foot, right foot, and alternating feet. Dependent measures included: evoked blood oxygen level-dependent (BOLD) signal in the motor network, head movement associated with dorsiflexion/plantar flexion, the test-retest reliability of these measurements. Left and right unipedal movement led to a significant increase in BOLD signal compared to rest in the medial portion of the right and left primary motor cortex (respectively), and the ipsilateral cerebellum (FWE corrected, p < .001). Average head motion was 0.10 ± 0.02 mm. The test-retest reliability was high for the functional MRI data (intraclass correlation coefficients [ICCs]: >0.75) and the angular displacement of the ankle joint (ICC: 0.842). This bipedal device can robustly isolate activity in the motor network during alternating plantarflexion and dorsiflexion with minimal head movement, while providing high test-retest reliability. Ultimately, these data and open-source building instructions will provide a new, economical tool for investigators interested in evaluating brain function resulting from lower extremity movement.

Motion and Muscle Artifact Removal Validation Using an Electrical Head Phantom, Robotic Motion Platform, and Dual Layer Mobile EEG.

Motion and muscle artifacts can undermine signal quality in electroencephalography (EEG) recordings during locomotion. We evaluated approaches for recovering ground-truth artificial brain signals from noisy EEG recordings. We built an electrical head phantom that broadcast four brain and four muscle sources. Head movements were generated by a robotic motion platform. We recorded 128-channel dual layer EEG and 8-channel neck electromyography (EMG) from the head phantom during motion. We evaluated ground-truth electrocortical source signal recovery from artifact contaminated data using Independent Component Analysis (ICA) to determine: (1) the number of isolated noise sensor recordings needed to capture and remove motion artifacts, (2) the ability of Artifact Subspace Reconstruction to remove motion and muscle artifacts at contrasting artifact detection thresholds, (3) the number of neck EMG sensor recordings needed to capture and remove muscle artifacts, and (4) the ability of Canonical Correlation Analysis to remove muscle artifacts. We also evaluated source signal recovery by combining the best practices identified in aims 1-4. By including isolated noise and EMG recordings in the ICA decomposition, we more effectively recovered ground-truth artificial brain signals. A reduced subset of 32-noise and 6-EMG channels showed equivalent performance compared to including the complete arrays. Artifact Subspace Reconstruction improved source separation, but this was contingent on muscle activity amplitude. Canonical Correlation Analysis also improved source separation. Merging noise and EMG recordings into the ICA decomposition, with Artifact Subspace Reconstruction and Canonical Correlation Analysis preprocessing, improved source signal recovery. This study expands on previous head phantom experiments by including neck muscle source activity and evaluating artificial electrocortical spectral power fluctuations synchronized with gait events.

FES Cycling in Stroke: Novel Closed-Loop Algorithm Accommodates Differences in Functional Impairments.

OBJECTIVE: The objective of this paper was to develop and test a novel control algorithm that enables stroke survivors to pedal a cycle in a desired cadence range despite varying levels of functional abilities after stroke. METHODS: A novel algorithm was developed which automatically adjusts 1) the intensity of functional electrical stimulation (FES) delivered to the leg muscles, and 2) the current delivered to an electric motor. The algorithm automatically switches between assistive, uncontrolled, and resistive modes to accommodate for differences in functional impairment, based on the mismatch between the desired and actual cadence. Lyapunov-based methods were used to theoretically prove that the rider's cadence converges to the desired cadence range. To demonstrate the controller's real-world performance, nine chronic stroke survivors performed two cycling trials: 1) volitional effort only and 2) volitional effort accompanied by the control algorithm assisting and resisting pedaling as needed. RESULTS: With a desired cadence range of 50-55 r/min, the developed controller resulted in an average rms cadence error of 1.90 r/min, compared to 6.16 r/min during volitional-only trials. CONCLUSION: Using FES and an electric motor with a two-sided cadence control objective to assist and resist volitional efforts enabled stroke patients with varying strength and abilities to pedal within a desired cadence range. SIGNIFICANCE: A protocol design that constrains volitional movements with assistance and resistance from FES and a motor shows potential for FES cycles and other rehabilitation robots during stroke rehabilitation.

TheraBracelet Stimulation During Task-Practice Therapy to Improve Upper Extremity Function After Stroke: A Pilot Randomized Controlled Study.

BACKGROUND: Peripheral sensory stimulation has been used in conjunction with upper extremity movement therapy to increase therapy-induced motor gains in patients with stroke. The limitation is that existing sensory stimulation methods typically interfere with natural hand tasks and thus are administered prior to therapy, requiring patients' time commitment. To address this limitation, we developed TheraBracelet. This novel stimulation method provides subthreshold (ie, imperceptible) vibratory stimulation to the wrist and can be used during hand tasks/therapy without interfering with natural hand tasks. OBJECTIVE: The objective was to determine the feasibility of using TheraBracelet during therapy to augment motor recovery after stroke. DESIGN: The design was a triple-blinded pilot randomized controlled trial. METHODS: Twelve chronic stroke survivors were assigned to the treatment or control group. All participants completed 2-hour task practice therapy sessions thrice weekly for 2 weeks. Both groups wore a small vibrator on the paretic wrist, which was turned on to provide TheraBracelet stimulation for the treatment group and turned off for the control group to provide sham stimulation. Outcome measures (Box and Block Test [BBT] and Wolf Motor Function Test [WMFT]) were obtained at baseline, 6 days after therapy, and at follow-up 19 days after therapy. RESULTS: The intervention was feasible with no adverse events. The treatment group significantly improved their BBT scores after therapy and at follow-up compared with baseline, whereas the control group did not. For WMFT, the group × time interaction was short of achieving significance. Large effect sizes were obtained (BBT d = 1.43, WMFT d = 0.87). No indication of desensitization to TheraBracelet stimulation was observed. LIMITATIONS: The limitation was a small sample size. CONCLUSIONS: TheraBracelet could be a promising therapy adjuvant for upper extremity recovery after stroke.

Use of imperceptible wrist vibration to modulate sensorimotor cortical activity.

Peripheral sensory stimulation has been used as a method to stimulate the sensorimotor cortex, with applications in neurorehabilitation. To improve delivery modality and usability, a new stimulation method has been developed in which imperceptible random-frequency vibration is applied to the wrist concurrently during hand activity. The objective of this study was to investigate effects of this new sensory stimulation on the sensorimotor cortex. Healthy adults were studied. In a transcranial magnetic stimulation (TMS) study, resting motor threshold, short-interval intracortical inhibition, and intracortical facilitation for the abductor pollicis brevis muscle were compared between vibration on vs. off, while subjects were at rest. In an electroencephalogram (EEG) study, alpha and beta power during rest and event-related desynchronization (ERD) for hand grip were compared between vibration on vs. off. Results showed that vibration decreased EEG power and decreased TMS short-interval intracortical inhibition (i.e., disinhibition) compared with no vibration at rest. Grip-related ERD was also greater during vibration, compared to no vibration. In conclusion, subthreshold random-frequency wrist vibration affected the release of intracortical inhibition and both resting and grip-related sensorimotor cortical activity. Such effects may have implications in rehabilitation.

Influence of Elbow Flexion and Stimulation Site on Neuromuscular Electrical Stimulation of the Biceps Brachii.

Functional electrical stimulation (FES) can help individuals with physical disabilities by assisting limb movement; however, the change in muscle geometry associated with limb movement may affect the response to stimulation. The aim of this paper was to quantify the effects of elbow flexion and stimulation site on muscle torque production. Contraction torque about the elbow was measured in 12 healthy individuals using a custom elbow flexion testbed and a transcutaneous electrode array. Stimulation was delivered to six distinct sites along the biceps brachii over 11 elbow flexion angles. Flexion angle was found to significantly influence the optimal (i.e., torque-maximizing) stimulation site ( ), with post hoc analysis indicating a proximal shift in optimal stimulation site with increased flexion. Similarly, the biceps stimulation site was found to significantly influence the flexion angle at which peak torque occurred ( ), with post hoc analysis indicating an increase in peak-torque flexion angle as stimulation site is moved proximally up the biceps. Since maximizing muscle force per unit stimulation is a common goal in rehabilitative FES, future efforts could examine methods which compensate for the shift in optimal stimulation site during FES-induced limb movement.

Exploring the feasibility and use of accelerometers before, during, and after a camp-based CIMT program for children with cerebral palsy.

PURPOSE: The aim of this pilot study was to determine the feasibility and use accelerometers before, during, and after a camp-based constraint-induced movement therapy (CIMT) program for children with hemiplegic cerebral palsy. METHODS: A pre-test post-test design was used for 12 children with CP (mean = 4.9 yrs) who completed a 30-hour camp-based CIMT program. The accelerometer data were collected using ActiGraph GT9X Link. Children wore accelerometers on both wrists one day before and after the camp and on the affected limb during each camp day. Three developmental assessments were administered pre-post CIMT program. RESULTS: Accelerometers were successfully worn before, during, and directly after the CIMT program to collect upper limb data. Affected upper limb accelerometer activity significantly increased during the CIMT camp compared to baseline (p< 0.05). Significant improvements were seen in all twelve children on all assessments of affected upper limb function (p< 0.05) measuring capacity and quality of affected upper limb functioning. CONCLUSION: Accelerometers can be worn during high intensity pediatric CIMT programs to collect data about affected upper limb function. Further study is required to determine the relationship between accelerometer data, measure of motor capacity, and real-world performance post-CIMT.

The Time-Varying Nature of Electromechanical Delay and Muscle Control Effectiveness in Response to Stimulation-Induced Fatigue.

Neuromuscular electrical stimulation (NMES) and Functional Electrical Stimulation (FES) are commonly prescribed rehabilitative therapies. Closed-loop NMES holds the promise to yield more accurate limb control, which could enable new rehabilitative procedures. However, NMES/FES can rapidly fatigue muscle, which limits potential treatments and presents several control challenges. Specifically, the stimulation intensity-force relation changes as the muscle fatigues. Additionally, the delayed response between the application of stimulation and muscle force production, termed electromechanical delay (EMD), may increase with fatigue. This paper quantifies these effects. Specifically, open-loop fatiguing protocols were applied to the quadriceps femoris muscle group of able-bodied individuals under isometric conditions, and the resulting torque was recorded. Short pulse trains were used to measure EMD with a thresholding method while long duration pulse trains were used to induce fatigue, measure EMD with a cross-correlation method, and construct recruitment curves. EMD was found to increase significantly with fatigue, and the control effectiveness (i.e., the linear slope of the recruitment curve) decreased with fatigue. Outcomes of these experiments indicate an opportunity for improved closed-loop NMES/FES control development by considering EMD to be time-varying and by considering the muscle recruitment curve to be a nonlinear, time-varying function of the stimulation input.

Switched Tracking Control of the Lower Limb During Asynchronous Neuromuscular Electrical Stimulation: Theory and Experiments.

Neuromuscular electrical stimulation (NMES) induces muscle contractions via electrical stimuli. NMES can be used for rehabilitation and to enable functional movements; however, a fundamental limitation is the early onset of fatigue. Asynchronous stimulation is a method that can reduce fatigue by utilizing multiple stimulation channels to segregate and switch between different sets of recruited motor units. However, switching between stimulation channels is challenging due to each channel's differing response to stimulation. To address this challenge, a switched systems analysis is used in the present work to design a controller that allows for instantaneous switching between stimulation channels. The developed controller yields semi-global exponential tracking of a desired angular trajectory for a person's knee-joint. Experiments were conducted in six able-bodied individuals. Compared to conventional stimulation, the results indicate that asynchronous stimulation with the developed controller yields longer durations of successful tracking despite different responses between the stimulation channels.

Switched Control of Cadence During Stationary Cycling Induced by Functional Electrical Stimulation.

Functional electrical stimulation (FES) can be used to activate the dysfunctional lower limb muscles of individuals with neurological disorders to produce cycling as a means of rehabilitation. However, previous literature suggests that poor muscle control and nonphysiological muscle fiber recruitment during FES-cycling causes lower efficiency and power output at the cycle crank than able-bodied cycling, thus motivating the investigation of improved control methods for FES-cycling. In this paper, a stimulation pattern is designed based on the kinematic effectiveness of the rider's hip and knee joints to produce a forward torque about the cycle crank. A robust controller is designed for the uncertain, nonlinear cycle-rider system with autonomous, state-dependent switching. Provided sufficient conditions are satisfied, the switched controller yields ultimately bounded tracking of a desired cadence. Experimental results on four able-bodied subjects demonstrate cadence tracking errors of 0.05 ±1.59 and 5.27 ±2.14 revolutions per minute during volitional and FES-induced cycling, respectively. To establish feasibility of FES-assisted cycling in subjects with Parkinson's disease, experimental results with one subject demonstrate tracking errors of 0.43 ± 4.06 and 0.17 ±3.11 revolutions per minute during volitional and FES-induced cycling, respectively.

Closed-Loop Asynchronous Neuromuscular Electrical Stimulation Prolongs Functional Movements in the Lower Body.

Neuromuscular electrical stimulation (NMES) is commonly used in rehabilitative settings and is also used for assistive purposes to create functional movements, where it is termed functional electrical stimulation (FES). One limitation of NMES/FES is early onset of muscle fatigue. NMES-induced fatigue can be reduced by switching between multiple stimulation channels that target different motor units or synergistic muscles (i.e., asynchronous stimulation). However, switching stimulation channels introduces additional complexity due to the need to consider the switching dynamics and differing muscle response to stimulation. The objective of this study was to develop and test a closed-loop controller for asynchronous stimulation. The developed closed-loop controller yields asymptotic tracking of a desired trajectory for a person's knee-shank complex despite switching between stimulation channels. The developed controller was implemented on four able-bodied individuals with four-channel asynchronous stimulation as well as single-channel conventional stimulation. The results indicate that asynchronous stimulation extends the duration that functional movements can be performed during feedback control. This result is promising for the implementation of asynchronous stimulation in closed-loop rehabilitative procedures and in assistive devices as a method to reduce muscle fatigue while maintaining a person's ability to track a desired limb trajectory.

Comparing the Induced Muscle Fatigue Between Asynchronous and Synchronous Electrical Stimulation in Able-Bodied and Spinal Cord Injured Populations.

Neuromuscular electrical stimulation (NMES) has been shown to impart a number of health benefits and can be used to produce functional outcomes. However, one limitation of NMES is the onset of NMES-induced fatigue. Multi-channel asynchronous stimulation has been shown to reduce NMES-induced fatigue compared to conventional single-channel stimulation. However, in previous studies in man, the effect of stimulation frequency on the NMES-induced fatigue has not been examined for asynchronous stimulation. Low stimulation frequencies are known to reduce fatigue during conventional stimulation. Therefore, the aim of this study was to examine the fatigue characteristics of high- and low-frequency asynchronous stimulation as well as high- and low-frequency conventional stimulation. Experiments were performed in both able-bodied and spinal cord injured populations. Low frequency asynchronous stimulation is found to have significant fatigue benefits over high frequency asynchronous stimulation as well as high- and low-frequency conventional stimulation, motivating its use for rehabilitation and functional electrical stimulation (FES).

Comparing the force ripple during asynchronous and conventional stimulation.

INTRODUCTION: Asynchronous stimulation has been shown to reduce fatigue during electrical stimulation; however, it may also exhibit a force ripple. We quantified the ripple during asynchronous and conventional single-channel transcutaneous stimulation across a range of stimulation frequencies. METHODS: The ripple was measured during 5 asynchronous stimulation protocols, 2 conventional stimulation protocols, and 3 volitional contractions in 12 healthy individuals. RESULTS: Conventional 40 Hz and asynchronous 16 Hz stimulation were found to induce contractions that were as smooth as volitional contractions. Asynchronous 8, 10, and 12 Hz stimulation induced contractions with significant ripple. CONCLUSIONS: Lower stimulation frequencies can reduce fatigue; however, they may also lead to increased ripple. Future efforts should study the relationship between force ripple and the smoothness of the evoked movements in addition to the relationship between stimulation frequency and NMES-induced fatigue to elucidate an optimal stimulation frequency for asynchronous stimulation.