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Slack JC, Zeiser SL, Yadav AP. The role of stimulus periodicity on spinal cord stimulation-induced artificial sensations in rodents. J Neural Eng 2024; 21:026003. [PMID: 38382104 PMCID: PMC10912903 DOI: 10.1088/1741-2552/ad2b89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/26/2024] [Accepted: 02/21/2024] [Indexed: 02/23/2024]
Abstract
Objective.Sensory feedback is critical for effectively controlling brain-machine interfaces and neuroprosthetic devices. Spinal cord stimulation (SCS) is proposed as a technique to induce artificial sensory perceptions in rodents, monkeys, and humans. However, to realize the full potential of SCS as a sensory neuroprosthetic technology, a better understanding of the effect of SCS pulse train parameter changes on sensory detection and discrimination thresholds is necessary.Approach.Here we investigated whether stimulation periodicity impacts rats' ability to detect and discriminate SCS-induced perceptions at different frequencies.Main results.By varying the coefficient of variation (CV) of interstimulus pulse interval, we showed that at lower frequencies, rats could detect highly aperiodic SCS pulse trains at lower amplitudes (i.e. decreased detection thresholds). Furthermore, rats learned to discriminate stimuli with subtle differences in periodicity, and the just-noticeable differences from a highly aperiodic stimulus were smaller than those from a periodic stimulus.Significance.These results demonstrate that the temporal structure of an SCS pulse train is an integral parameter for modulating sensory feedback in neuroprosthetic applications.
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Affiliation(s)
- Jacob C Slack
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States of America
| | - Sidnee L Zeiser
- Department of Biomedical Engineering, Purdue University Indianapolis, Indianapolis, IN, United States of America
| | - Amol P Yadav
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States of America
- Department of Neurosurgery, UNC School of Medicine, Chapel Hill, NC, United States of America
- Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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2
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Zhu C, Esteller R, Block J, Lechleiter K, Frey R, Moffitt MA. Exploratory evaluation of spinal cord stimulation with dynamic pulse patterns: a promising approach to improve stimulation sensation, coverage of pain areas, and expected pain relief. FRONTIERS IN PAIN RESEARCH 2024; 4:1339892. [PMID: 38361978 PMCID: PMC10867969 DOI: 10.3389/fpain.2023.1339892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/28/2023] [Indexed: 02/17/2024] Open
Abstract
Background The societal burden of chronic pain and the contribution-in-part to the opioid crisis, is a strong motivation to improve and expand non-addictive treatments, including spinal cord stimulation (SCS). For several decades standard SCS has consisted in delivery of tonic pulses with static parameter settings in frequency, pulse width, and amplitude. These static parameters have limited ability to personalize the quality of paresthesia, the dermatomal coverage, and thus may affect SCS efficacy. Further, static settings may contribute to the build-up of tolerance or loss of efficacy of the therapy over time in some patients. Methods We conducted an acute exploratory study to evaluate the effects of SCS using time-dynamic pulses as compared to time-static (conventional tonic) stimulation pulses, with the hypotheses that dynamic pulse SCS may enable beneficial tailoring of the sensation and the patient's expectation for better pain relief with SCS. During a single clinic visit, consented subjects undergoing a standard SCS trial had their implanted leads temporarily connected to an investigational external stimulator capable of delivering time-static and six categories of time-dynamic pulse sequences, each characterized by continuously varying a stimulation parameter. Study subjects provided several assessments while blinded to the stimulation pattern, including: drawing of paresthesia maps, descriptions of sensation, and ratings for comfort and helpfulness to pain relief. Results Even without optimization of the field location, a majority of subjects rated sensations from dynamic stimulation as better or equal to that of static stimulation for comfortableness and for helpfulness to pain relief. The initial data showed a gender and/or pain dermatomal location related preference to a stimulation pattern. In particular, female subjects and subjects with pain at higher dermatomes tended to rank the sensation from dynamic stimulation better. Dynamic stimulation produced greater pain coverage without optimization; in 70% (9/13) of subjects, maximal pain coverage was achieved with a dynamic stimulation pattern. There was also greater variety in the words used by patients to describe stimulation sensation in the free text and free form verbal descriptions associated with dynamic stimulation. Conclusions With the same electrode configuration and comparable parameter settings, acute SCS using dynamic pulses produced more positive ratings, expanded paresthesia coverage, and greater variation in sensation as compared to SCS using static pulses, suggesting that dynamic stimulation has the potential to improve capabilities of SCS for the treatment of chronic pain. Further study is warranted. Trial Registration This study was registered at ClinicalTrials.gov under ID NCT02988713, November 2016 (URL: https://clinicaltrials.gov/ct2/show/NCT02988713).
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Affiliation(s)
- Changfang Zhu
- Research and Development, Boston Scientific Neuromodulation, Valencia, CA, United States
| | - Rosana Esteller
- Research and Development, Boston Scientific Neuromodulation, Valencia, CA, United States
| | - Jessica Block
- Research and Development, Boston Scientific Neuromodulation, Valencia, CA, United States
| | - Kristen Lechleiter
- Clinical Research, Boston Scientific Neuromodulation, Valencia, CA, United States
| | - Robert Frey
- Pacific Pain Management Inc., Ventura, CA, United States
| | - Michael A. Moffitt
- Research and Development, Boston Scientific Neuromodulation, Valencia, CA, United States
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3
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Jadidi AF, Jensen W, Zarei AA, Lontis ER, Atashzar SF. From pulse width modulated TENS to cortical modulation: based on EEG functional connectivity analysis. Front Neurosci 2023; 17:1239068. [PMID: 37600002 PMCID: PMC10433172 DOI: 10.3389/fnins.2023.1239068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Modulation in the temporal pattern of transcutaneous electrical nerve stimulation (TENS), such as Pulse width modulated (PWM), has been considered a new dimension in pain and neurorehabilitation therapy. Recently, the potentials of PWM TENS have been studied on sensory profiles and corticospinal activity. However, the underlying mechanism of PWM TENS on cortical network which might lead to pain alleviation is not yet investigated. Therefore, we recorded cortical activity using electroencephalography (EEG) from 12 healthy subjects and assessed the alternation of the functional connectivity at the cortex level up to an hour following the PWM TENS and compared that with the effect of conventional TENS. The connectivity between eight brain regions involved in sensory and pain processing was calculated based on phase lag index and spearman correlation. The alteration in segregation and integration of information in the network were investigated using graph theory. The proposed analysis discovered several statistically significant network changes between PWM TENS and conventional TENS, such as increased local strength and efficiency of the network in high gamma-band in primary and secondary somatosensory sources one hour following stimulation. Our findings regarding the long-lasting desired effects of PWM TENS support its potential as a therapeutic intervention in clinical research.
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Affiliation(s)
- Armita Faghani Jadidi
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Winnie Jensen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Ali Asghar Zarei
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Eugen Romulus Lontis
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - S. Farokh Atashzar
- Department of Electrical and Computer Engineering, New York University, New York, NY, United States
- Department of Mechanical and Aerospace Engineering, New York University, New York, NY, United States
- Department of Biomedical Engineering, New York University, New York, NY, United States
- NYU WIRELESS, New York University (NYU), New York, NY, United States
- NYU Center for Urban Science and Progress (CUSP), New York University (NYU), New York, NY, United States
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4
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Valle G, Iberite F, Strauss I, D'Anna E, Granata G, Di Iorio R, Stieglitz T, Raspopovic S, Petrini FM, Rossini PM, Micera S. A Psychometric Platform to Collect Somatosensory Sensations for Neuroprosthetic Use. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:619280. [PMID: 35047903 PMCID: PMC8757828 DOI: 10.3389/fmedt.2021.619280] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Somatosensory neuroprostheses exploit invasive and non-invasive feedback technologies to restore sensorimotor functions lost to disease or trauma. These devices use electrical stimulation to communicate sensory information to the brain. A sensation characterization procedure is thus necessary to determine the appropriate stimulation parameters and to establish a clear personalized map of the sensations that can be restored. Several questionnaires have been described in the literature to collect the quality, type, location, and intensity of the evoked sensations, but there is still no standard psychometric platform. Here, we propose a new psychometric system containing previously validated questionnaires on evoked sensations, which can be applied to any kind of somatosensory neuroprosthesis. The platform collects stimulation parameters used to elicit sensations and records subjects' percepts in terms of sensation location, type, quality, perceptual threshold, and intensity. It further collects data using standardized assessment questionnaires and scales, performs measurements over time, and collects phantom limb pain syndrome data. The psychometric platform is user-friendly and provides clinicians with all the information needed to assess the sensory feedback. The psychometric platform was validated with three trans-radial amputees. The platform was used to assess intraneural sensory feedback provided through implanted peripheral nerve interfaces. The proposed platform could act as a new standardized assessment toolbox to homogenize the reporting of results obtained with different technologies in the field of somatosensory neuroprosthetics.
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Affiliation(s)
- Giacomo Valle
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland
| | | | - Ivo Strauss
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Edoardo D'Anna
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Institute of Bioengineering, Lausanne, Switzerland
| | - Giuseppe Granata
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Policlinic A. Gemelli Foundation, Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Di Iorio
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Policlinic A. Gemelli Foundation, Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center, BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Stanisa Raspopovic
- Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland
| | - Francesco M Petrini
- Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland
| | - Paolo M Rossini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Policlinic A. Gemelli Foundation, Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Institute of Bioengineering, Lausanne, Switzerland
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5
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Jadidi AF, Stevenson AJT, Zarei AA, Jensen W, Lontis R. Effect of Modulated TENS on Corticospinal Excitability in Healthy Subjects. Neuroscience 2022; 485:53-64. [PMID: 35031397 DOI: 10.1016/j.neuroscience.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
Conventional transcutaneous electrical nerve stimulation (TENS) has been reported to effectively alleviate chronic pain, including phantom limb pain (PLP). Recently, literature has focused on modulated TENS patterns, such as pulse width modulation (PWM) and burst modulation (BM), as alternatives to conventional, non-modulated (NM) sensory neurostimulation to increase the efficiency of rehabilitation. However, there is still limited knowledge of how these modulated TENS patterns affect corticospinal (CS) and motor cortex activity. Therefore, our aim was to first investigate the effect of modulated TENS patterns on CS activity and corticomotor map in healthy subjects. Motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) were recorded from three muscles before and after the application of TENS interventions. Four different TENS patterns (PWM, BM, NM 40 Hz, and NM 100 Hz) were applied. The results revealed significant facilitation of CS excitability following the PWM intervention. We also found an increase in the volume of the motor cortical map following the application of the PWM and NM (40 Hz). Although PLP alleviation has been reported to be associated with an enhancement of corticospinal excitability, the efficiency of the PWM intervention to induce pain alleviation should be validated in a future clinical study in amputees with PLP.
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Affiliation(s)
- Armita Faghani Jadidi
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark.
| | | | - Ali Asghar Zarei
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark
| | - Winnie Jensen
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark
| | - Romulus Lontis
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark
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6
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Edhi MM, Heijmans L, Vanent KN, Bloye K, Baanante A, Jeong KS, Leung J, Zhu C, Esteller R, Saab CY. Time-dynamic pulse modulation of spinal cord stimulation reduces mechanical hypersensitivity and spontaneous pain in rats. Sci Rep 2020; 10:20358. [PMID: 33230202 PMCID: PMC7683561 DOI: 10.1038/s41598-020-77212-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/30/2020] [Indexed: 12/22/2022] Open
Abstract
Enhancing the efficacy of spinal cord stimulation (SCS) is needed to alleviate the burden of chronic pain and dependence on opioids. Present SCS therapies are characterized by the delivery of constant stimulation in the form of trains of tonic pulses (TPs). We tested the hypothesis that modulated SCS using novel time-dynamic pulses (TDPs) leads to improved analgesia and compared the effects of SCS using conventional TPs and a collection of TDPs in a rat model of neuropathic pain according to a longitudinal, double-blind, and crossover design. We tested the effects of the following SCS patterns on paw withdrawal threshold and resting state EEG theta power as a biomarker of spontaneous pain: Tonic (conventional), amplitude modulation, pulse width modulation, sinusoidal rate modulation, and stochastic rate modulation. Results demonstrated that under the parameter settings tested in this study, all tested patterns except pulse width modulation, significantly reversed mechanical hypersensitivity, with stochastic rate modulation achieving the highest efficacy, followed by the sinusoidal rate modulation. The anti-nociceptive effects of sinusoidal rate modulation on EEG outlasted SCS duration on the behavioral and EEG levels. These results suggest that TDP modulation may improve clinical outcomes by reducing pain intensity and possibly improving the sensory experience.
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Affiliation(s)
- Muhammad M Edhi
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Lonne Heijmans
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA.,Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Kevin N Vanent
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA
| | - Kiernan Bloye
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA
| | - Amanda Baanante
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA
| | - Ki-Soo Jeong
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Jason Leung
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Changfang Zhu
- Boston Scientific Neuromodulation, Valencia, CA, 91355, USA
| | | | - Carl Y Saab
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA. .,Department of Neuroscience, Brown University, Providence, RI, 02903, USA. .,Carney Institute for Brain Science, Brown University, Providence, RI, 02912, USA. .,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, 44195, USA. .,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA.
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7
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Jadidi AF, Asghar Zarei A, Lontis R, Jensen W. Modulation of Corticospinal Excitability by Two Different Somatosensory Stimulation Patterns; A Pilot Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3573-3576. [PMID: 33018775 DOI: 10.1109/embc44109.2020.9175393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Following amputation, almost two-thirds of amputees experience unpleasant to painful sensations in the area of the missing limb. Whereas the mechanism of phantom limb pain (PLP) remains unknown, it has been shown that maladaptive cortical plasticity plays a major role in PLP. Transcutaneous electrical nerve stimulation (TENS) generating sensory input is believed to be beneficial for PLP relief. TENS effect may be caused by possible reversing reorganization at the cortical level that can be evaluated by changes in the excitability of the corticospinal (CS) pathway. Excitability changes are dependent on the chosen stimulation patterns and parameters. The aim of this study was to investigate the effect of two TENS patterns on the excitability of the CS tract among healthy subjects. We compared a non-modulated TENS as a conventional pattern with pulse width modulated TENS pattern. Motor evoked potentials (MEPs) from APB muscles of stimulated arm (TENS-APB) and contralateral arm (Control-APB) were recorded. We applied single TMS pulses on two subjects for each TENS pattern. The results showed that both patterns increase the CS excitability, while the effects of the conventional TENS is stronger. However, the amplitude of MEPs from control-APB after TENS delivery remained almost the same.Clinical Relevance- The primary results revealed changes in the activity of CS pathway for both patterns. A future study on a larger population is needed to provide strong evidence on the changes in CS excitability. The evaluation part with more factors such as changes in intracortical inhibition (ICI) may be beneficial to find an optimal modulated TENS pattern to enhance pain alleviation process in PLP.
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8
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Willsey MS, Lu CW, Nason SR, Malaga KA, Lempka SF, Chestek CA, Patil PG. Distinct perceptive pathways selected with tonic and bursting patterns of thalamic stimulation. Brain Stimul 2020; 13:1436-1445. [PMID: 32712343 PMCID: PMC10788093 DOI: 10.1016/j.brs.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Novel patterns of electrical stimulation of the brain and spinal cord hold tremendous promise to improve neuromodulation therapies for diverse disorders, including tremor and pain. To date, there are limited numbers of experimental studies in human subjects to help explain how stimulation patterns impact the clinical response, especially with deep brain stimulation. We propose using novel stimulation patterns during electrical stimulation of somatosensory thalamus in awake deep brain stimulation surgeries and hypothesize that stimulation patterns will influence the sensory percept without moving the electrode. METHODS In this study of 15 fully awake patients, the threshold of perception as well as perceptual characteristics were compared for tonic (trains of regularly-repeated pulses) and bursting stimulation patterns. RESULTS In a majority of subjects, tonic and burst percepts were located in separate, non-overlapping body regions (i.e., face vs. hand) without moving the stimulating electrode (p < 0.001; binomial test). The qualitative features of burst percepts also differed from those of tonic-evoked percepts as burst patterns were less likely to evoke percepts described as tingling (p = 0.013; Fisher's exact test). CONCLUSIONS Because somatosensory thalamus is somatotopically organized, percept location can be related to anatomic thalamocortical pathways. Thus, stimulation pattern may provide a mechanism to select for different thalamocortical pathways. This added control could lead to improvements in neuromodulation - such as improved efficacy and side effect attenuation - and may also improve localization for sensory prostheses.
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Affiliation(s)
- Matthew S Willsey
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - Charles W Lu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Sam R Nason
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Karlo A Malaga
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, Bucknell University, Lewisburg, PA, USA
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Cynthia A Chestek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Electrical Engineering, University of Michigan, Ann Arbor, MI, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA; Robotics Graduate Program, University of Michigan, Ann Arbor, MI, USA
| | - Parag G Patil
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
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9
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Bockbrader MA, Francisco G, Lee R, Olson J, Solinsky R, Boninger ML. Brain Computer Interfaces in Rehabilitation Medicine. PM R 2019; 10:S233-S243. [PMID: 30269808 DOI: 10.1016/j.pmrj.2018.05.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/22/2018] [Accepted: 05/31/2018] [Indexed: 12/24/2022]
Abstract
One innovation currently influencing physical medicine and rehabilitation is brain-computer interface (BCI) technology. BCI systems used for motor control record neural activity associated with thoughts, perceptions, and motor intent; decode brain signals into commands for output devices; and perform the user's intended action through an output device. BCI systems used for sensory augmentation transduce environmental stimuli into neural signals interpretable by the central nervous system. Both types of systems have potential for reducing disability by facilitating a user's interaction with the environment. Investigational BCI systems are being used in the rehabilitation setting both as neuroprostheses to replace lost function and as potential plasticity-enhancing therapy tools aimed at accelerating neurorecovery. Populations benefitting from motor and somatosensory BCI systems include those with spinal cord injury, motor neuron disease, limb amputation, and stroke. This article discusses the basic components of BCI for rehabilitation, including recording systems and locations, signal processing and translation algorithms, and external devices controlled through BCI commands. An overview of applications in motor and sensory restoration is provided, along with ethical questions and user perspectives regarding BCI technology.
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Affiliation(s)
- Marcia A Bockbrader
- Department of Physical Medicine & Rehabilitation, The Ohio State University, 480 Medical Center Dr, Columbus, OH 43210; and Neurological Institute, Ohio State University Wexner Medical Center, Columbus, OH(∗).
| | - Gerard Francisco
- Department of Physical Medicine & Rehabilitation, The University of Texas, Houston, TX(†)
| | - Ray Lee
- Department of Orthopaedic and Rehabilitation, Schwab Rehabilitation Hospital, University of Chicago, Chicago, IL(‡)
| | - Jared Olson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO(§)
| | - Ryan Solinsky
- Spaulding Rehabilitation Hospital, Boston; and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA(¶)
| | - Michael L Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh; and VA Pittsburgh Health Care System, Pittsburgh, PA(#)
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10
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Grill WM. Temporal Pattern of Electrical Stimulation is a New Dimension of Therapeutic Innovation. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2018; 8:1-6. [PMID: 30906909 DOI: 10.1016/j.cobme.2018.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Artificial activation of the nervous system requires selection of appropriate stimulation parameters including stimulation amplitude, stimulation pulse duration, and stimulation pulse repetition rate. The temporal pattern of stimulation, i.e., the timing between stimulation pulses, is a novel dimension of stimulation parameter tuning. The effects evoked by artificial activation of the nervous system are dependent on the pattern of stimulation, and different patterns of stimulation, even when delivered at the same average rate, evoke different functional effects, different changes in synaptic plasticity, and even different patterns of gene expression. Non-regular temporal patterns of stimulation offer the opportunity to improve the efficacy and efficiency of therapeutic stimulation as well as to manipulate other processes in the nervous system. The potential design space for sequences of varying interpulse intervals is exceedingly large and sound approaches to design stimulation patterns are required as an empirical approach is not practical.
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Affiliation(s)
- Warren M Grill
- Departments of Biomedical Engineering, Electrical and Computer Engineering, Neurobiology, and Neurosurgery, Duke University, Durham NC
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11
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Serruya MD, Harris JP, Adewole DO, Struzyna LA, Burrell JC, Nemes A, Petrov D, Kraft RH, Chen HI, Wolf JA, Cullen DK. Engineered Axonal Tracts as "Living Electrodes" for Synaptic-Based Modulation of Neural Circuitry. ADVANCED FUNCTIONAL MATERIALS 2018; 28:1701183. [PMID: 34045935 PMCID: PMC8152180 DOI: 10.1002/adfm.201701183] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Brain-computer interface and neuromodulation strategies relying on penetrating non-organic electrodes/optrodes are limited by an inflammatory foreign body response that ultimately diminishes performance. A novel "biohybrid" strategy is advanced, whereby living neurons, biomaterials, and microelectrode/optical technology are used together to provide a biologically-based vehicle to probe and modulate nervous-system activity. Microtissue engineering techniques are employed to create axon-based "living electrodes", which are columnar microstructures comprised of neuronal population(s) projecting long axonal tracts within the lumen of a hydrogel designed to chaperone delivery into the brain. Upon microinjection, the axonal segment penetrates to prescribed depth for synaptic integration with local host neurons, with the perikaryal segment remaining externalized below conforming electrical-optical arrays. In this paradigm, only the biological component ultimately remains in the brain, potentially attenuating a chronic foreign-body response. Axon-based living electrodes are constructed using multiple neuronal subtypes, each with differential capacity to stimulate, inhibit, and/or modulate neural circuitry based on specificity uniquely afforded by synaptic integration, yet ultimately computer controlled by optical/electrical components on the brain surface. Current efforts are assessing the efficacy of this biohybrid interface for targeted, synaptic-based neuromodulation, and the specificity, spatial density and long-term fidelity versus conventional microelectronic or optical substrates alone.
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Affiliation(s)
- Mijail D Serruya
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - James P Harris
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
| | - Dayo O Adewole
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA; Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Laura A Struzyna
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA; Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Justin C Burrell
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
| | - Ashley Nemes
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
| | - Dmitriy Petrov
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
| | - Reuben H Kraft
- Computational Biomechanics Group, Department of Mechanical & Nuclear Engineering, Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA 16801, USA
| | - H Isaac Chen
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
| | - John A Wolf
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
| | - D Kacy Cullen
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
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12
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De Jaeger M, van Hooff RJ, Goudman L, Valenzuela Espinoza A, Brouns R, Puylaert M, Duyvendak W, Moens M. High-Density in Spinal Cord stimulation: Virtual Expert Registry (DISCOVER): Study Protocol for a Prospective Observational Trial. Anesth Pain Med 2017; 7:e13640. [PMID: 29441289 PMCID: PMC5800302 DOI: 10.5812/aapm.13640] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/26/2017] [Accepted: 04/29/2017] [Indexed: 01/21/2023] Open
Abstract
Background Spinal cord stimulation (SCS) is a proven and effective treatment for neuropathic pain
conditions such as failed back surgery syndrome (FBSS). The hypothesis that different
settings for SCS parameters activate unique, pain-relieving mechanisms has boosted the
development of various SCS paradigms. High density spinal cord stimulation (HD-SCS) is
one of those promising, novel stimulation forms characterized by subthreshold
stimulation, delivering more pulses per second and a higher pulse density to the spinal
cord than conventional SCS. Objectives The aim of DISCOVER is to gather evidence about the effectiveness, feasibility, and
(possible) side effects of HD stimulation. Methods The prospective, non-interventional, multi-center, clinical study, DISCOVER, is
currently restricted to Belgium where 19 neuromodulation centers were selected. Patient
recruitment started in October 2016 and is expected to end in October 2017. Subjects
included are (1) patients with insufficient pain relief from conventional SCS or (2)
neurostimulation-naïve patients suited for SCS. Patients will be assessed 1 month, 3
months, and 12 months after conversion to HD-SCS settings. Each patient’s visit will
include: a numerical rating scale (NRS), Oswestry disability index (ODI), Pittsburgh
sleep quality index (PSQI), EQ-5D, a pain map, registration of SCS settings, and a list
of used pain medication. Conclusions Although promising results have been reported, adequate registration of its
effectiveness and (possible) side-effects remains an unmet need. Main results are
expected in 2019.
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Affiliation(s)
- Mats De Jaeger
- Department of Neurosurgery, Universitair Ziekenhuis Brussel,
Laarbeeklaan 101, 1090 Brussels, Belgium
- Corresponding author: Mats De Jaeger, Vrije
Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium. Tel: +32-2699844,
E-mail:
| | - Robbert-Jan van Hooff
- Department of Radiology, Universitair Ziekenhuis Brussel,
Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel,
Laarbeeklaan 101, 1090 Brussels, Belgium
- Pain in Motion: International Research Group
- Faculty of Physical Education and Physiotherapy, Department of
Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel (VUB), Laarbeeklaan
103, 1090 Brussels, Belgium
| | - Alexis Valenzuela Espinoza
- Interuniversity Center for Health Economics Research (I-CHER),
Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Raf Brouns
- Department of Neurology, Universitair Ziekenhuis Brussel,
Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Martine Puylaert
- Department of Anesthesiology and Multidisciplinary Pain Center,
Ziekenhuis Oost Limburg (ZOL), Schiepse Bos 6, 3600 Genk, Belgium
| | - Wim Duyvendak
- Department of Neurosurgery, Virga Jessa Hasselt Hospital,
Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel,
Laarbeeklaan 101, 1090 Brussels, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel,
Laarbeeklaan 101, 1090 Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel
(VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
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13
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Miller JP, Eldabe S, Buchser E, Johanek LM, Guan Y, Linderoth B. Parameters of Spinal Cord Stimulation and Their Role in Electrical Charge Delivery: A Review. Neuromodulation 2016; 19:373-84. [DOI: 10.1111/ner.12438] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/07/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Jonathan P. Miller
- Functional and Restorative Neurosurgery Center and Department of Neurological Surgery, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center; Cleveland OH USA
| | - Sam Eldabe
- The James Cook University Hospital; Middlesbrough UK
| | - Eric Buchser
- Anaesthesia and Pain Management Services at the Neuromodulation Centre; Hospital de Morges, Morges; Switzerland
| | - Lisa M. Johanek
- Department of Medical Affairs, Medtronic, PLC; Minneapolis MN USA
| | - Yun Guan
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Bengt Linderoth
- Functional Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet; Stockholm Sweden
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