Nick Donaldson

High-volume FES-cycling partially reverses bone loss in people with chronic spinal cord injury

Spinal cord injury (SCI) leads to severe bone loss in the paralysed limbs and to a resulting increased fracture risk thereof. Since long bone fractures can lead to comorbidities and a reduction in quality of life, it is important to improve bone strength in people with chronic SCI. In this prospective longitudinal cohort study, we investigated whether functional electrical stimulation (FES) induced high-volume cycle training can partially reverse the loss of bone substance in the legs after chronic complete SCI. Eleven participants with motor-sensory complete SCI (mean age 41.9+/-7.5 years; 11.0+/-7.1 years post injury) were recruited. After an initial phase of 14+/-7 weeks of FES muscle conditioning, participants performed on average 3.7+/-0.6 FES-cycling sessions per week, of 58+/-5 min each, over 12 months at each individuals highest power output. Bone and muscle parameters were investigated in the legs by means of peripheral quantitative computed tomography before the muscle conditioning (t1), and after six (t2) and 12 months (t3) of high-volume FES-cycle training. After 12 months of FES-cycling, trabecular and total bone mineral density (BMD) as well as total cross-sectional area in the distal femoral epiphysis increased significantly by 14.4+/-21.1%, 7.0+/-10.8% and 1.2+/-1.5%, respectively. Bone parameters in the femoral shaft showed small but significant decreases, with a reduction of 0.4+/-0.4% in cortical BMD, 1.8+/-3.0% in bone mineral content, and 1.5+/-2.1% in cortical thickness. These decreases mainly occurred between t1 and t2. No significant changes were found in any of the measured bone parameters in the tibia. Muscle CSA at the thigh increased significantly by 35.5+/-18.3%, while fat CSA at the shank decreased by 16.7+/-12.3%. Our results indicate that high-volume FES-cycle training leads to site-specific skeletal changes in the paralysed limbs, with an increase in bone parameters at the actively loaded distal femur but not the passively loaded tibia. Thus, we conclude that high-volume FES-induced cycle training has clinical relevance as it can partially reverse bone loss and thus may reduce fracture risk at this fracture prone site.

An Integrated Implantable Stimulator That is Fail-Safe Without Off-Chip Blocking-Capacitors

We present a neural stimulator chip with an output stage (electrode driving circuit) that is fail-safe under single-fault conditions without the need for off-chip blocking-capacitors. To miniaturize the stimulator output stage two novel techniques are introduced. The first technique is a new current generator circuit reducing to a single step the translation of the digital input bits into the stimulus current, thus minimizing silicon area and power consumption compared to previous works. The current generator uses voltage-controlled resistors implemented by MOS transistors in the deep triode region. The second technique is a new stimulator output stage circuit with blocking-capacitor safety protection using a high-frequency current-switching (HFCS) technique. Unlike conventional stimulator output stage circuits for implantable functional electrical stimulation (FES) systems which require blocking-capacitors in the microfarad range, our proposed approach allows capacitance reduction to the picofarad range, thus the blocking-capacitors can be integrated on-chip. The prototype four-channel neural stimulator chip was fabricated in XFABs 1-mum silicon-on-insulator CMOS technology and can operate from a power supply between 5-18 V. The stimulus current is generated by active charging and passive discharging. We obtained recordings of action potentials and a strength-duration curve from the sciatic nerve of a frog with the stimulator chip which demonstrate the HFCS technique. The average power consumption for a typical 1-mA 20-Hz single-channel stimulation using a book electrode, is 200 muW from a 6 V power supply. The silicon area occupation is 0.38 mm2 per channel.

Multiple-electrode nerve cuffs for low-velocity and velocity-selective neural recording

In the paper, a method using multiple-electrode nerve cuffs is presented that enables electroneurographic signals (ENG) to be recorded selectively by action potential velocity. The theory uses a one-dimensional model of the electrodes in the cuff. Using this model, the transfer function for a single tripole is derived, and it is shown that more than one tripole signal can be recorded from within a cuff. When many tripole signals are available and are temporally aligned by artificial delays and summed, there is a significant increase in the amplitude of the recorded action potential, depending on the cuff length and the action potential velocity, with the greatest gain occurring for low velocities. For example, a cuff was considered that was constrained by surgical considerations to 30 mm between the end electrodes. For action potentials with a velocity of 120 ms−1, it was shown that, as the number of tripoles increased from one, the peak energy spectral density of the recorded output increased by a factor of about 1.6 with three tripoles, whereas, for 20 ms−1, the increase was about 19, with ten tripoles. The time delays and summation act as a velocity-selective filter. With consideration of the energy spectral densities at frequencies where are maximum (to give the best signal-to-noise ratio), the tuning curves are presented for these velocity-selective filters and show that useful velocity resolution is possible using this method. For a 30 mm cuff with nine tripoles, it is demonstrated that it is possible to resolve at least five distinct velocity bands in the range 20–120 ms−1.

Design of a low-noise preamplifier for nerve cuff electrode recording

This paper discusses certain important issues involved in the design of a nerve signal preamplifier for implantable neuroprostheses. Since the electroneurogram signal measured from cuff electrodes is typically on the order of 1 /spl mu/V, a very low-noise interface is essential. We present the argument for the use of BiCMOS technology in this application and then describe the design and evaluation of a complete preamplifier fabricated in a 0.8-/spl mu/m double-metal double-poly process. The preamplifier has a nominal voltage gain of 100, a bandwidth of 15 kHz, and a measured equivalent input-referred noise voltage spectral density of 3.3 nV//spl radic/Hz at 1 kHz. The total input-referred rms noise voltage in a bandwidth 1 Hz-10 kHz is 290 nV, the power consumption is 1.3 mW from /spl plusmn/2.5-V power supplies, and the active area is 0.3 mm/sup 2/.

Long-term intensive electrically stimulated cycling by spinal cord-injured people: effect on muscle properties and their relation to power output.

Inactivity and muscular adaptations following spinal cord injury (SCI) result in secondary complications such as cardiovascular disease, obesity, and pressure sores. Functional electrically stimulated (FES) cycling can potentially reduce these complications, but previous studies have provided inconsistent results. We studied the effect of intensive long‐term FES cycle training on muscle properties in 11 SCI subjects (mean ± SEM: 41.8 ± 2.3 years) who had trained for up to 1 hour/day, 5 days/week, for 1 year. Comparative measurements were made in 10 able‐bodied (AB) subjects. Quadriceps maximal electrically stimulated torque increased fivefold (n = 5), but remained lower than in AB individuals. Relative force response at 1 HZ decreased, relaxation rate remained unchanged, and fatigue resistance improved significantly. Power output (PO) improved to a lesser extent than quadriceps torque and not to a greater extent than has been reported previously. We need to understand the factors that limit PO in order to maximize the benefits of FES cycling. Muscle Nerve 38: 1304–1311, 2008

Very Low-Noise ENG Amplifier System Using CMOS Technology

In this paper, we describe the design and testing of a system for recording electroneurographic signals (ENG) from a multielectrode nerve cuff (MEC). This device, which is an extension of the conventional nerve signal recording cuff, enables ENG to be classified by action potential velocity. In addition to electrical measurements, we provide preliminary in vitro data obtained from frogs that demonstrate the validity of the technique for the first time. Since typical ENG signals are extremely small, on the order of 1 1 muV, very low-noise, high-gain amplifiers are required. The ten-channel system we describe was realized in a 0.8 mum CMOS technology and detailed measured results are presented. The overall gain is 10 000 and the total input-referred root mean square (rms) noise in a bandwidth 1 Hz-5 kHZ is 291 nV. The active area is 12 mm2 and the power consumption is 24 mW from plusmn2.5 V power supplies

Influence of different stimulation frequencies on power output and fatigue during FES-cycling in recently injured SCI people

This study investigated whether power output during 30 min sessions of functional electrical stimulation (FES)-cycling can be increased by using stimulation frequencies higher than 30 Hz. The stimulation frequencies of FES-cycling training sessions of 19 recently injured para- and tetraplegics were randomly set at 30, 50, or 60 Hz and power output (PO) was measured continually. The mean PO of the 30 min, the PO of the last minute of each session, and the minimum PO were significantly greater at 60 and 50 Hz than at 30 Hz (ANOVA without cross-product). A 19% and 25% higher mean PO was reached at 50 and 60 Hz, respectively, compared to 30 Hz. The PO of the last minute of each session was almost always higher than the mean PO of the whole session and also higher at higher frequencies, which indicates that no muscle fatigue could be detected in 30 min FES-cycling at any of the tested frequencies.

Optimal control of ankle joint moment: toward unsupported standing in paraplegia

This paper considers part of the problem of how to provide unsupported standing for paraplegics by feedback control. In this work our overall objective is to stabilize the subject by stimulation only of his ankle joints while the other joints are braced. We investigate the problem of ankle joint moment control. The ankle plantarflexion muscles are first identified with pseudorandom binary sequence signals, periodic sinusoidal signals, and twitches. The muscle is modeled in Hammerstein form as a static recruitment nonlinearity followed by a linear transfer function. A linear-quadratic-Gaussian (LQG)-optimal controller design procedure for ankle joint moment was proposed based on the polynomial equation formulation. The approach was verified by experiments in the special Wobbler apparatus with a neurologically intact subject, and these experimental results are reported.

On cuff imbalance and tripolar ENG amplifier configurations

Electroneurogram (ENG) recording techniques benefit from the use of tripolar cuffs because they assist in reducing interference from sources outside the cuff. However, in practice the performance of ENG amplifier configurations, such as the quasi-tripole and the true-tripole, has been widely reported to be degraded due to the departure of the tripolar cuff from ideal behavior. This paper establishes the presence of cuff imbalance and investigates its relationship to cuff asymmetry, cuff end-effects and interference source proximity. The paper also presents a comparison of the aforementioned amplifier configurations with a new alternative, termed the adaptive-tripole, developed to automatically compensate for cuff imbalance. The output signal-to-interference ratio of the three amplifier configurations were compared in vivo for two interference signals (stimulus artifact and M-wave) superimposed on compound action potentials. The experiments showed (for the first time) that the two interference signals result in different cuff imbalance values. Nevertheless, even with two distinct cuff imbalances present, the adaptive-tripole performed better than the other two systems in 61.9% of the trials.

A Stimulator ASIC Featuring Versatile Management for Vestibular Prostheses

This paper presents a multichannel stimulator ASIC for an implantable vestibular prosthesis. The system features versatile stimulation management which allows fine setting of the parameters for biphasic stimulation pulses. To address the problem of charge imbalance due to rounding errors, the digital processor can calculate and provide accurate charge correction. A technique to reduce the data rate to the stimulator is described. The stimulator ASIC was implemented in 0.6-μ m high-voltage CMOS technology occupying an area of 2.27 mm2. The measured performance of the ASIC has been verified using vestibular electrodes in saline.