A model of motor and sensory axon activation in the median nerve using surface electrical stimulation.

Surface electrical stimulation has the potential to be a powerful and non-invasive treatment for a variety of medical conditions but currently it is difficult to obtain consistent evoked responses. A viable clinical system must be able to adapt to variations in individuals to produce repeatable results. To more fully study the effect of these variations without performing exhaustive testing on human subjects, a system of computer models was created to predict motor and sensory axon activation in the median nerve due to surface electrical stimulation at the elbow. An anatomically-based finite element model of the arm was built to accurately predict voltages resulting from surface electrical stimulation. In addition, two axon models were developed based on previously published models to incorporate physiological differences between sensory and motor axons. This resulted in axon models that could reproduce experimental results for conduction velocity, strength-duration curves and activation threshold. Differences in experimentally obtained action potential shape between the motor and sensory axons were reflected in the models. The models predicted a lower threshold for sensory axons than motor axons of the same diameter, allowing a range of sensory axons to be activated before any motor axons. This system of models will be a useful tool for development of surface electrical stimulation as a method to target specific neural functions.

Natural Sensations Evoked in Distal Extremities Using Surface Electrical Stimulation.

BACKGROUND: Electrical stimulation is increasingly relevant in a variety of medical treatments. In this study, surface electrical stimulation was evaluated as a method to non-invasively target a neural function, specifically natural sensation in the distal limbs. METHOD: Electrodes were placed over the median and ulnar nerves at the elbow and the common peroneal and lateral sural cutaneous nerves at the knee. Strength-duration curves for sensation were compared between nerves. The location, modality, and intensity of each sensation were also analyzed. In an effort to evoke natural sensations, several patterned waveforms were evaluated. RESULTS: Distal sensation was obtained in all but one of the 48 nerves tested in able-bodied subjects and in the two nerves from subjects with an amputation. Increasing the pulse amplitude of the stimulus caused an increase in the area and magnitude of the sensation in a majority of subjects. A low frequency waveform evoked a tapping or tapping-like sensation in 29 out of the 31 able-bodied subjects and a sensation that could be considered natural in two subjects with an amputation. This waveform performed better than other patterned waveforms that had proven effective during implanted extra-neural stimulation. CONCLUSION: Surface electrical stimulation has the potential to be a powerful, non-invasive tool for activation of the nervous system. These results suggest that a tapping sensation in the distal extremity can be evoked in most able-bodied individuals and that targeting the nerve trunk from the surface is a valid method to evoke sensation in the phantom limb of individuals with an amputation for short term applications.

Surface electrical stimulation to evoke referred sensation.

Surface electrical stimulation (SES) is being investigated as a noninvasive method to evoke natural sensations distal to electrode location. This may improve treatment for phantom limb pain as well as provide an alternative method to deliver sensory feedback. The median and/or ulnar nerves of 35 subjects were stimulated at the elbow using surface electrodes. Strength-duration curves of hand sensation were found for each subject. All subjects experienced sensation in their hand, which was mostly described as a paresthesia-like sensation. The rheobase and chronaxie values were found to be lower for the median nerve than the ulnar nerve, with no significant difference between sexes. Repeated sessions with the same subject resulted in sufficient variability to suggest that recalculating the strength-duration curve for each electrode placement is necessary. Most of the recruitment curves in this study were generated with 28 to 36 data points. To quickly reproduce these curves with limited increase in error, we recommend 10 data points. Future studies will focus on obtaining different sensations using SES with the strength-duration curve defining the threshold of the effective parameter space.