Hand and distal joint tremor are most coherent with the activity of elbow flexors and wrist extensors in persons with essential tremor.

Essential tremor (ET) affects millions of people. Although frontline treatment options (medication, deep brain stimulation, and focused ultrasound ablation) have provided significant relief, many patients are unsatisfied with the outcomes. Peripheral suppression techniques, such as injections of botulinum toxin or sensory electrical stimulation of muscles, are gaining popularity, but could be optimized if the muscles most responsible for a patient's tremor were identified. The purpose of this study was to quantify the relationship between the activity in various upper limb muscles and the resulting tremor in patients with ET. Surface electromyogram (sEMG) from the 15 major superficial muscles of the upper limb and displacement of the hand and upper limb joints were recorded from 22 persons with ET while they performed kinetic and postural tasks representative of activities of daily living. We calculated the peak coherence (frequency-dependent correlation) in the tremor band (4-8 Hz) between the sEMG of each muscle and the displacement in each major degree of freedom (DOF). Averaged across subjects with ET, the highest coherence was found between elbow flexors (particularly biceps brachii and brachioradialis) and the distal DOF (forearm, wrist, and hand motion), and between wrist extensors (extensor carpi radialis and ulnaris) and the same distal DOF. These coherence values represent the upper bound on the proportion of the tremor caused by each muscle. We conclude that, without further information, elbow flexors and wrist extensors should be among the first muscles considered for peripheral suppression techniques in persons with ET.NEW & NOTEWORTHY We characterized the relationships between activity in upper limb muscles and tremor in persons with essential tremor using coherence, which provides an upper bound on the proportion of the tremor due to each muscle. Averaged across subjects and various tasks, tremor in the hand and distal joints was most coherent with elbow flexors and wrist extensors. We conclude that, without further information, these muscle groups should be among the first considered for peripheral suppression techniques.

Essential Tremor accentuates the pattern of tremor-band coherence between upper-limb muscles.

Although Essential Tremor is one of the most common movement disorders, current treatment options are relatively limited. Peripheral tremor suppression methods have shown potential, but we do not currently know which muscles are most responsible for patients' tremor, making it difficult to optimize suppression methods. The purpose of this study was to quantify the relationships between the tremorogenic activity in muscles throughout the upper limb. Muscle activity was recorded from the 15 major superficial upper-limb muscles in 24 subjects with Essential Tremor while they held various postures or made upper-limb movements. We calculated the coherence in the tremor band (4-12 Hz) between the activity of all muscle pairs and the time-varying phase difference between sufficiently coherent muscle pairs. Overall, the observed pattern somewhat mirrored functional relationships: agonistic muscle pairs were most coherent and in phase, whereas antagonist and unrelated muscle pairs exhibited less coherence and were either consistently in phase, consistently antiphase, consistently out of phase (unrelated pairs only), or else inconsistent. Patients exhibited significantly more coherence than control subjects (p<0.001) in the vast majority of muscle pairs (95 out of 105). Furthermore, differences between patients and controls were most pronounced among agonists; thus, the coherence pattern existing in control subjects was accentuated in patients with ET. We conclude that tremor-band activity is broadly distributed among the muscles of the upper limb, challenging efforts to determine which muscles are most responsible for a patient's tremor.

An Accurate and Real-Time Method for Resolving Superimposed Action Potentials in MultiUnit Recordings.

OBJECTIVE: Spike sorting of muscular and neural recordings requires separating action potentials that overlap in time (superimposed action potentials (APs)). We propose a new algorithm for resolving superimposed action potentials, and we test it on intramuscular EMG (iEMG) and intracortical recordings. METHODS: Discrete-time shifts of the involved APs are first selected based on a heuristic extension of the peel-off algorithm. Then, the time shifts that provide the minimal residual Euclidean norm are identified (Discrete Brute force Correlation (DBC)). The optimal continuous-time shifts are then estimated (High-Resolution BC (HRBC)). In Fusion HRBC (FHRBC), two other cost functions are used. A parallel implementation of the DBC and HRBC algorithms was developed. The performance of the algorithms was assessed on 11,000 simulated iEMG and 14,000 neural recording superpositions, including two to eight APs, and eight experimental iEMG signals containing four to eleven active motor units. The performance of the proposed algorithms was compared with that of the Branch-and-Bound (BB) algorithm using the Rank-Product (RP) method in terms of accuracy and efficiency. RESULTS: The average accuracy of the DBC, HRBC and FHRBC methods on the entire simulated datasets was 92.16±17.70, 93.65±16.89, and 94.90±15.15 (%). The DBC algorithm outperformed the other algorithms based on the RP method. The average accuracy and running time of the DBC algorithm on 10.5 ms superimposed spikes of the experimental signals were 92.1±21.7 (%) and 2.3±15.3 (ms). CONCLUSION AND SIGNIFICANCE: The proposed algorithm is promising for real-time neural decoding, a central problem in neural and muscular decoding and interfacing.

Biomechanical Analysis of Body Movements of Myoelectric Prosthesis Users During Standardized Clinical Tests.

OBJECTIVE: The objective clinical evaluation of user's capabilities to handle their prosthesis is done using various tests which primarily focus on the task completion speed and do not explicitly account for the potential presence of compensatory motions. Given that the excessive body compensation is a common indicator of inadequate prosthesis control, tests which include subjective observations on the quality of performed motions have been introduced. However, these metrics are then influenced by the examiner's opinions, skills, and training making them harder to standardize across patient pools and compare across different prosthetic technologies. Here we aim to objectively quantify the severity of body compensations present in myoelectric prosthetic hand users and evaluate the extent to which traditional objective clinical scores are still able to capture them. METHODS: We have instructed 9 below-elbow prosthesis users and 9 able-bodied participants to complete three established objective clinical tests: Box-and-Blocks-Test, Clothespin-Relocation-Test, and Southampton-Hand-Assessment-Procedure. During all tests, upper-body kinematics has been recorded. RESULTS: While the analysis showed that there are some correlations between the achieved clinical scores and the individual body segment travel distances and average speeds, there were only weak correlations between the clinical scores and the observed ranges of motion. At the same time, the compensations were observed in all prosthesis users and, for the most part, they were substantial across the tests. CONCLUSION: The sole reliance on the currently available objective clinical assessment methods seems inadequate as the compensatory movements are prominent in prosthesis users and yet not sufficiently accounted for.

Blind identification of the spinal cord output in humans with high-density electrode arrays implanted in muscles.

Invasive electromyography opened a new window to explore motoneuron behavior in vivo. However, the technique is limited by the small fraction of active motoneurons that can be concurrently detected, precluding a population analysis in natural tasks. Here, we developed a high-density intramuscular electrode for in vivo human recordings along with a fully automatic methodology that could detect the discharges of action potentials of up to 67 concurrently active motoneurons with 99% accuracy. These data revealed that motoneurons of the same pool receive common synaptic input at frequencies up to 75 Hz and that late-recruited motoneurons inhibit the discharges of those recruited earlier. These results constitute an important step in the population coding analysis of the human motor system in vivo.

Fundamental Concepts of Bipolar and High-Density Surface EMG Understanding and Teaching for Clinical, Occupational, and Sport Applications: Origin, Detection, and Main Errors.

Surface electromyography (sEMG) has been the subject of thousands of scientific articles, but many barriers limit its clinical applications. Previous work has indicated that the lack of time, competence, training, and teaching is the main barrier to the clinical application of sEMG. This work follows up and presents a number of analogies, metaphors, and simulations using physical and mathematical models that provide tools for teaching sEMG detection by means of electrode pairs (1D signals) and electrode grids (2D and 3D signals). The basic mechanisms of sEMG generation are summarized and the features of the sensing system (electrode location, size, interelectrode distance, crosstalk, etc.) are illustrated (mostly by animations) with examples that teachers can use. The most common, as well as some potential, applications are illustrated in the areas of signal presentation, gait analysis, the optimal injection of botulinum toxin, neurorehabilitation, ergonomics, obstetrics, occupational medicine, and sport sciences. The work is primarily focused on correct sEMG detection and on crosstalk. Issues related to the clinical transfer of innovations are also discussed, as well as the need for training new clinical and/or technical operators in the field of sEMG.

Online Tracking of the Phase Difference Between Neural Drives to Antagonist Muscle Pairs in Essential Tremor Patients.

Transcutaneous electrical stimulation has been applied in tremor suppression applications. Out-of-phase stimulation strategies applied above or below motor threshold result in a significant attenuation of pathological tremor. For stimulation to be properly timed, the varying phase relationship between agonist-antagonist muscle activity during tremor needs to be accurately estimated in real-time. Here we propose an online tremor phase and frequency tracking technique for the customized control of electrical stimulation, based on a phase-locked loop (PLL) system applied to the estimated neural drive to muscles. Surface electromyography signals were recorded from the wrist extensor and flexor muscle groups of 13 essential tremor patients during postural tremor. The EMG signals were pre-processed and decomposed online and offline via the convolution kernel compensation algorithm to discriminate motor unit spike trains. The summation of motor unit spike trains detected for each muscle was bandpass filtered between 3 to 10 Hz to isolate the tremor related components of the neural drive to muscles. The estimated tremorogenic neural drive was used as input to a PLL that tracked the phase differences between the two muscle groups. The online estimated phase difference was compared with the phase calculated offline using a Hilbert Transform as a ground truth. The results showed a rate of agreement of 0.88 ± 0.22 between offline and online EMG decomposition. The PLL tracked the phase difference of tremor signals in real-time with an average correlation of 0.86 ± 0.16 with the ground truth (average error of 6.40° ± 3.49°). Finally, the online decomposition and phase estimation components were integrated with an electrical stimulator and applied in closed-loop on one patient, to representatively demonstrate the working principle of the full tremor suppression system. The results of this study support the feasibility of real-time estimation of the phase of tremorogenic neural drive to muscles, providing a methodology for future tremor-suppression neuroprostheses.

Development of functional organization within the sensorimotor network across the perinatal period.

In the mature human brain, the neural processing related to different body parts is reflected in patterns of functional connectivity, which is strongest between functional homologs in opposite cortical hemispheres. To understand how this organization is first established, we investigated functional connectivity between limb regions in the sensorimotor cortex in 400 preterm and term infants aged across the equivalent period to the third trimester of gestation (32-45 weeks postmenstrual age). Masks were obtained from empirically derived functional responses in neonates from an independent data set. We demonstrate the early presence of a crude but spatially organized functional connectivity, that rapidly matures across the preterm period to achieve an adult-like configuration by the normal time of birth. Specifically, connectivity was strongest between homolog regions, followed by connectivity between adjacent regions (different limbs but same hemisphere) already in the preterm brain, and increased with age. These changes were specific to the sensorimotor network. Crucially, these trajectories were strongly dependent on age more than age of birth. This demonstrates that during the perinatal period the sensorimotor cortex undergoes preprogrammed changes determining the functional movement organization that are not altered by preterm birth in absence of brain injury.

Intramuscular EMG-Driven Musculoskeletal Modelling: Towards Implanted Muscle Interfacing in Spinal Cord Injury Patients.

OBJECTIVE: Surface EMG-driven modelling has been proposed as a means to control assistive devices by estimating joint torques. Implanted EMG sensors have several advantages over wearable sensors but provide a more localized information on muscle activity, which may impact torque estimates. Here, we tested and compared the use of surface and intramuscular EMG measurements for the estimation of required assistive joint torques using EMG driven modelling. METHODS: Four healthy subjects and three incomplete spinal cord injury (SCI) patients performed walking trials at varying speeds. Motion capture marker trajectories, surface and intramuscular EMG, and ground reaction forces were measured concurrently. Subject-specific musculoskeletal models were developed for all subjects, and inverse dynamics analysis was performed for all individual trials. EMG-driven modelling based joint torque estimates were obtained from surface and intramuscular EMG. RESULTS: The correlation between the experimental and predicted joint torques was similar when using intramuscular or surface EMG as input to the EMG-driven modelling estimator in both healthy individuals and patients. CONCLUSION: We have provided the first comparison of non-invasive and implanted EMG sensors as input signals for torque estimates in healthy individuals and SCI patients. SIGNIFICANCE: Implanted EMG sensors have the potential to be used as a reliable input for assistive exoskeleton joint torque actuation.

Proof of concept for multiple nerve transfers to a single target muscle.

Surgical nerve transfers are used to efficiently treat peripheral nerve injuries, neuromas, phantom limb pain, or improve bionic prosthetic control. Commonly, one donor nerve is transferred to one target muscle. However, the transfer of multiple nerves onto a single target muscle may increase the number of muscle signals for myoelectric prosthetic control and facilitate the treatment of multiple neuromas. Currently, no experimental models are available. This study describes a novel experimental model to investigate the neurophysiological effects of peripheral double nerve transfers to a common target muscle. In 62 male Sprague-Dawley rats, the ulnar nerve of the antebrachium alone (n=30) or together with the anterior interosseus nerve (n=32) was transferred to reinnervate the long head of the biceps brachii. Before neurotization, the motor branch to the biceps' long head was transected at the motor entry point. Twelve weeks after surgery, muscle response to neurotomy, behavioral testing, retrograde labeling, and structural analyses were performed to assess reinnervation. These analyses indicated that all nerves successfully reinnervated the target muscle. No aberrant reinnervation was observed by the originally innervating nerve. Our observations suggest a minimal burden for the animal with no signs of functional deficit in daily activities or auto-mutilation in both procedures. Furthermore, standard neurophysiological analyses for nerve and muscle regeneration were applicable. This newly developed nerve transfer model allows for the reliable and standardized investigation of neural and functional changes following the transfer of multiple donor nerves to one target muscle.

Synergistic Organization of Neural Inputs from Spinal Motor Neurons to Extrinsic and Intrinsic Hand Muscles.

Our current understanding of synergistic muscle control is based on the analysis of muscle activities. Modules (synergies) in muscle coordination are extracted from electromyographic (EMG) signal envelopes. Each envelope indirectly reflects the neural drive received by a muscle; therefore, it carries information on the overall activity of the innervating motor neurons. However, it is not known whether the output of spinal motor neurons, whose number is orders of magnitude greater than the muscles they innervate, is organized in a low-dimensional fashion when performing complex tasks. Here, we hypothesized that motor neuron activities exhibit a synergistic organization in complex tasks and therefore that the common input to motor neurons results in a large dimensionality reduction in motor neuron outputs. To test this hypothesis, we factorized the output spike trains of motor neurons innervating 14 intrinsic and extrinsic hand muscles and analyzed the dimensionality of control when healthy individuals exerted isometric forces using seven grip types. We identified four motor neuron synergies, accounting for >70% of the variance of the activity of 54.1 ± 12.9 motor neurons, and we identified four functionally similar muscle synergies. However, motor neuron synergies better discriminated individual finger forces than muscle synergies and were more consistent with the expected role of muscles actuating each finger. Moreover, in a few cases, motor neurons innervating the same muscle were active in separate synergies. Our findings suggest a highly divergent net neural inputs to spinal motor neurons from spinal and supraspinal structures, contributing to the dimensionality reduction captured by muscle synergies.SIGNIFICANCE STATEMENT We addressed whether the output of spinal motor neurons innervating multiple hand muscles could be accounted for by a modular organization, i.e., synergies, previously described to account for the coordination of multiple muscles. We found that motor neuron synergies presented similar dimensionality (implying a >10-fold reduction in dimensionality) and structure as muscle synergies. Nonetheless, the synergistic behavior of subsets of motor neurons within a muscle was also observed. These results advance our understanding of how neuromuscular control arises from mapping descending inputs to muscle activation signals. We provide, for the first time, insights into the organization of neural inputs to spinal motor neurons which, to date, has been inferred through analysis of muscle synergies.

Intramuscular Stimulation of Muscle Afferents Attains Prolonged Tremor Reduction in Essential Tremor Patients.

This study proposes and clinically tests intramuscular electrical stimulation below motor threshold to achieve prolonged reduction of wrist flexion/extension tremor in Essential Tremor (ET) patients. The developed system consisted of an intramuscular thin-film electrode structure that included both stimulation and electromyography (EMG) recording electrodes, and a control algorithm for the timing of intramuscular stimulation based on EMG (closed-loop stimulation). Data were recorded from nine ET patients with wrist flexion/extension tremor recruited from the Gregorio Marañón Hospital (Madrid, Spain). Patients participated in two experimental sessions comprising: 1) sensory stimulation of wrist flexors/extensors via thin-film multichannel intramuscular electrodes; and 2) surface stimulation of the nerves innervating the same target muscles. For each session, four of these patients underwent random 60-s trials of two stimulation strategies for each target muscle: 1) selective and adaptive timely stimulation (SATS) - based on EMG of the antagonist muscle; and 2) continuous stimulation (CON) of target muscles. Two patients underwent SATS stimulation trials alone while the other three underwent CON stimulation trials alone in each session. Kinematics of wrist, elbow, and shoulder, together with clinical scales, were used to assess tremor before, right after, and 24 h after each session. Intramuscular SATS achieved, on average, 32% acute (during stimulation) tremor reduction on each trial, while continuous stimulation augmented tremorgenic activity. Furthermore, tremor reduction was significantly higher using intramuscular than surface stimulation. Prolonged reduction of tremor amplitude (24 h after the experiment) was observed in four patients. These results showed acute and prolonged (24 h) tremor reduction using a minimally invasive neurostimulation technology based on SATS of primary sensory afferents of wrist muscles. This strategy might open the possibility of an alternative therapeutic approach for ET patients.

Deep Learning for Robust Decomposition of High-Density Surface EMG Signals.

Blind source separation (BSS) algorithms, such as gradient convolution kernel compensation (gCKC), can efficiently and accurately decompose high-density surface electromyography (HD-sEMG) signals into constituent motor unit (MU) action potential trains. Once the separation matrix is blindly estimated on a signal interval, it is also possible to apply the same matrix to subsequent signal segments. Nonetheless, the trained separation matrices are sub-optimal in noisy conditions and require that incoming data undergo computationally expensive whitening. One unexplored alternative is to instead use the paired HD-sEMG signal and BSS output to train a model to predict MU activations within a supervised learning framework. A gated recurrent unit (GRU) network was trained to decompose both simulated and experimental unwhitened HD-sEMG signal using the output of the gCKC algorithm. The results on the experimental data were validated by comparison with the decomposition of concurrently recorded intramuscular EMG signals. The GRU network outperformed gCKC at low signal-to-noise ratios, proving superior performance in generalising to new data. Using 12 seconds of experimental data per recording, the GRU performed similarly to gCKC, at rates of agreement of 92.5% (84.5%-97.5%) and 94.9% (88.8%-100.0%) respectively for GRU and gCKC against matched intramuscular sources.

An fMRI Compatible Smart Device for Measuring Palmar Grasping Actions in Newborns.

Grasping is one of the first dominant motor behaviors that enable interaction of a newborn infant with its surroundings. Although atypical grasping patterns are considered predictive of neuromotor disorders and injuries, their clinical assessment suffers from examiner subjectivity, and the neuropathophysiology is poorly understood. Therefore, the combination of technology with functional magnetic resonance imaging (fMRI) may help to precisely map the brain activity associated with grasping and thus provide important insights into how functional outcomes can be improved following cerebral injury. This work introduces an MR-compatible device (i.e., smart graspable device (SGD)) for detecting grasping actions in newborn infants. Electromagnetic interference immunity (EMI) is achieved using a fiber Bragg grating sensor. Its biocompatibility and absence of electrical signals propagating through the fiber make the safety profile of the SGD particularly favorable for use with fragile infants. Firstly, the SGD design, fabrication, and metrological characterization are described, followed by preliminary assessments on a preterm newborn infant and an adult during an fMRI experiment. The results demonstrate that the combination of the SGD and fMRI can safely and precisely identify the brain activity associated with grasping behavior, which may enable early diagnosis of motor impairment and help guide tailored rehabilitation programs.

Non-invasive analysis of motor neurons controlling the intrinsic and extrinsic muscles of the hand.

OBJECTIVE: We present a non-invasive framework for investigating efferent commands to 14 extrinsic and intrinsic hand muscles. We extend previous studies (limited to a few muscles) on common synaptic input among pools of motor neurons in a large number of muscles. APPROACH: Seven subjects performed sinusoidal isometric contractions to complete seven types of grasps, with each finger and with three combinations of fingers in opposition with the thumb. High-density surface EMG (HD-sEMG) signals (384 channels in total) recorded from the 14 muscles were decomposed into the constituent motor unit action potentials. This provided a non-invasive framework for the investigation of motor neuron discharge patterns, muscle coordination and efferent commands of the hand muscles during grasping. Moreover, during grasping tasks, it was possible to identify common neural information among pools of motor neurons innervating the investigated muscles. For this purpose, principal component analysis (PCA) was applied to the smoothed discharge rates of the decoded motor units. MAIN RESULTS: We found that the first principal component (PC1) of the ensemble of decoded motor neuron spike trains explained a variance of (53.0 ± 10.9) % and was positively correlated with force (R = 0.67 ± 0.10 across all subjects and tasks). By grouping the pools of motor neurons from extrinsic or intrinsic muscles, the PC1 explained a proportion of variance of (57.1 ± 11.3) % and (56.9 ± 11.8) %, respectively, and was correlated with force with R = 0.63 ± 0.13 and 0.63 ± 0.13, respectively. SIGNIFICANCE: These observations demonstrate a low dimensional control of motor neurons across multiple muscles that can be exploited for extracting control signals in neural interfacing. The proposed framework was designed for hand rehabilitation perspectives, such as post-stroke rehabilitation and hand-exoskeleton control.

Wearable multichannel haptic device for encoding proprioception in the upper limb.

OBJECTIVE: We present the design, implementation, and evaluation of a wearable multichannel haptic system. The device is a wireless closed-loop armband driven by surface electromyography (EMG) and provides sensory feedback encoding proprioception. The study is motivated by restoring proprioception information in upper limb prostheses. APPROACH: The armband comprises eight vibrotactile actuators that generate distributed patterns of mechanical waves around the limb to stimulate perception and to transfer proportional information on the arm motion. An experimental study was conducted to assess: the sensory threshold in eight locations around the forearm, the user adaptation to the sensation provided by the device, the user performance in discriminating multiple stimulation levels, and the device performance in coding proprioception using four spatial patterns of stimulation. Eight able-bodied individuals performed reaching tasks by controlling a cursor with an EMG interface in a virtual environment. Vibrotactile patterns were tested with and without visual information on the cursor position with the addition of a random rotation of the reference control system to disturb the natural control and proprioception. MAIN RESULTS: The sensation threshold depended on the actuator position and increased over time. The maximum resolution for stimuli discrimination was four. Using this resolution, four patterns of vibrotactile activation with different spatial and magnitude properties were generated to evaluate their performance in enhancing proprioception. The optimal vibration pattern varied among the participants. When the feedback was used in closed-loop control with the EMG interface, the task success rate, completion time, execution efficiency, and average target-cursor distance improved for the optimal stimulation pattern compared to the condition without visual or haptic information on the cursor position. SIGNIFICANCE: The results indicate that the vibrotactile device enhanced the participants' perceptual ability, suggesting that the proposed closed-loop system has the potential to code proprioception and enhance user performance in the presence of perceptual perturbation.

Voluntary and tremorogenic inputs to motor neuron pools of agonist/antagonist muscles in essential tremor patients.

Pathological tremor is an oscillation of body parts at 3-10 Hz, determined by the output of spinal motor neurons (MNs), which receive synaptic inputs from supraspinal centers and muscle afferents. The behavior of spinal MNs during tremor is not well understood, especially in relation to the activation of the multiple muscles involved. Recent studies on patients with essential tremor have shown that antagonist MN pools receive shared input at the tremor frequency. In this study, we investigated the synaptic inputs related to tremor and voluntary movement, and their coordination across antagonist muscles. We analyzed the spike trains of motor units (MUs) identified from high-density surface electromyography from the forearm extensor and flexor muscles in 15 patients with essential tremor during postural tremor. The shared synaptic input was quantified by coherence and phase difference analysis of the spike trains. All pairs of spike trains in each muscle showed coherence peaks at the voluntary drive frequency (1-3 Hz, 0.2 ± 0.2, mean ± SD) and tremor frequency (3-10 Hz, 0.6 ± 0.3) and were synchronized with small phase differences (3.3 ± 25.2° and 3.9 ± 22.0° for the voluntary drive and tremor frequencies, respectively). The coherence between MN spike trains of antagonist muscle groups at the tremor frequency was significantly smaller than intramuscular coherence. We predominantly observed in-phase activation of MUs between agonist/antagonist muscles at the voluntary frequency band (0.6 ± 48.8°) and out-of-phase activation at the tremor frequency band (126.9 ± 75.6°). Thus MNs innervating agonist/antagonist muscles concurrently receive synaptic inputs with different phase shifts in the voluntary and tremor frequency bands.NEW & NOTEWORTHY Although the mechanical characteristics of tremor have been widely studied, the activation of the affected muscles is still poorly understood. We analyzed the behavior of motor units of pairs of antagonistic wrist muscle groups in patients with essential tremor and studied their activity at voluntary movement- and tremor-related frequencies. We found that the phase relation between inputs to antagonistic muscles is different at the voluntary and tremor frequency bands.

A thin-film multichannel electrode for muscle recording and stimulation in neuroprosthetics applications.

OBJECTIVE: We propose, design and test a novel thin-film multichannel electrode that can be used for both recording from and stimulating a muscle in acute implants. APPROACH: The system is built on a substrate of polyimide and contains 12 recording and three stimulation sites made of platinum. The structure is 420 µm wide, 20 µm thick and embeds the recording and stimulation contacts on the two sides of the polyimide over an approximate length of 2 cm. We show representative applications in healthy individuals as well as tremor patients. The designed system was tested by a psychometric characterization of the stimulation contacts in six tremor patients and three healthy individuals determining the perception threshold and current limit as well as the success rate in discriminating elicited sensations (electrotactile feedback). Also, we investigated the possibility of using the intramuscular electrode for reducing tremor in one patient by electrical stimulation delivered with timing based on the electromyographic activity recorded with the same electrode. MAIN RESULTS: In the tremor patients, the current corresponding to the perception threshold and the current limit were 0.7 ± 0.2 and 1.4 ± 0.7 mA for the wrist flexor muscles and 0.4 ± 0.2 and 1.5 ± 0.7 mA for the extensors. In one patient, closed-loop stimulation resulted in a decrease of the tremor power >50%. In healthy individuals the perception threshold and current limits were 0.9 ± 0.6 and 2.1 ± 0.6 mA for the extensor carpi radialis muscle. The subjects could distinguish four or six stimulation patterns (two or three stimulation sites × two stimulation current amplitudes) with true positive rate >80% (two subjects) and >60% (one subject), respectively. SIGNIFICANCE: The proposed electrode provides a compact multichannel interface for recording electromyogram and delivering electrical stimulation in applications such as neuroprostheses for tremor suppression and closed-loop myoelectric prostheses.