Polona Pečlin

Heart function influenced by selective mid-cervical left vagus nerve stimulation in a human case study

Heart function influenced by selective mid-cervical left vagus nerve stimulation in a human case study

Alternative Paradigm of Selective Vagus Nerve Stimulation Tested on an Isolated Porcine Vagus Nerve

Alternative paradigm for spatial and fibre-type selective vagus nerve stimulation (VNS) was developed using realistic structural topography and tested in an isolated segment of a porcine cervical left vagus nerve (LVN). A spiral cuff (cuff) containing a matrix of ninety-nine electrodes was developed for selective VNS. A quasitrapezoidal stimulating pulse (stimulus) was applied to the LVN via an appointed group of three electrodes (triplet). The triplet and stimulus were configured to predominantly stimulate the B-fibres, minimizing stimulation of the A-fibres and by-passing the stimulation of the C-fibres. To assess which fibres made the most probable contribution to the neural response (NR) during selective VNS, the distribution of conduction velocity (CV) within the LVN was considered. Experimental testing of the paradigm showed the existence of certain parameters and waveforms of the stimulus, for which the contribution of the A-fibres to the NR was slightly reduced and that of the B-fibres was slightly enlarged. The cuff provided satisfactory fascicle discrimination in selective VNS as well as satisfactory fascicle discrimination during NR recording. However, in the present stage of development, fibre-type VNS remained rather limited.

Evaluation of NiTi Superelastic Retraction Coil Springs for orthodontic tooth movement in rats.

The purpose of this investigation was to assess mechanical properties of Superelastic Retraction Coil Springs for orthodontic use. To reach a goal, a test frame, comprising measuring force transducers was developed. To perform metallographic analyses of the nickel-titanium wire the samples of Superelastic Retraction Coil Springs were observed by scanning electron microscope. For in vivo testing, twenty male Wistar rats, 11-12 weeks of age, were used (Group I with Superelastic Retraction Coil Springs, Group II controls). To simulate human distraction as close as possible, all the applied Superelastic Retraction Coil Springs were modified. The Superelastic Retraction Coil Springs creating a constant force of 25 cN were then attached between the upper left first molars and upper left incisors. Results showed that the reproducible force of 25 cN was shown over a range of 1-11 mm extension. Results also showed that the distance between aforementioned teeth, measured on days 0, 7, 14, 21, 24, 32, 37 and 40, decreased in Group I. Contrary, in Group II the distance between the teeth increased during the study (p<0.001).

Electrochemical and Electrophysiological Performance of Platinum Electrodes Within the Ninety‐Nine‐Electrode Stimulating Nerve Cuff

The trend in neural prostheses using selective nerve stimulation for electrical stimulation therapies is headed toward single-part systems having a large number of working electrodes (WEs), each of which selectively stimulate neural tissue or record neural response (NR). The present article reviews the electrochemical and electrophysiological performance of platinum WE within a ninety-nine-electrode spiral cuff for selective nerve stimulation and recording of peripheral nerves, with a focus on the vagus nerve (VN). The electrochemical properties of the WE were studied in vitro using the electrochemical impedance spectroscopy (EIS) technique. The equivalent circuit model (ECM) of the interface between the WE and neural tissue was extracted from the EIS data and simulated in the time domain using a preset current stimulus. Electrophysiological performance of in-space and fiber-type highly selective vagus nerve stimulation (VNS) was tested using an isolated segment of a porcine VN and carotid artery as a reference. A quasitrapezoidal current-controlled pulse (stimulus) was applied to the VN or arterial segment using an appointed group of three electrodes (triplet). The triplet and stimulus were configured to predominantly stimulate B-fibers and minimize the stimulation of A-fibers. The EIS results revealed capacitive charge transfer predominance, which is a highly desirable property. Electrophysiological performance testing indicated the potential existence of certain parameters and waveforms of the stimulus for which the contribution of the A-fibers to the NR decreased slightly and that of the B-fibers increased slightly. Findings show that the design of the stimulating electrodes, based on the EIS and ECM results, could act as a useful tool for nerve cuff development.

Evaluation of the Efficacy and Robustness of a Second Generation Implantable Stimulator in a Patient With Hemiplegia During 20 Years of Functional Electrical Stimulation of the Common Peroneal Nerve

We evaluated the efficacy and robustness of a second generation implantable stimulator for correcting drop foot (DF) in a patient with left-sided hemiplegia over 20 years of functional electrical stimulation (FES) of the common peroneal nerve (CPN). Dorsal flexion and eversion of the affected foot was partially restored by FES of the superficial region of the CPN innervating mostly the tibialis anterior (TA) and partly peroneus longus (PL) and peroneus brevis (PB) muscles. The reasons for implant failure during the long-term follow-up assessment were analyzed and resolving procedures were identified. The stimulator had an average failure rate of once every three years, due to repetitive mechanical load on the lead wires of its internal and/or external unit, and had to be serviced once per year to replace the heel switch integrated into the shoe sole. FES-associated mechanical trauma to the CPN elicited a thickening of the connective tissue around the CPN and a slightly compromised conduction velocity of the CPN. FES of the CPN, with the second generation implantable stimulator, improved gait parameters of the affected leg during the 20 years period. Long-term, daily FES enables a functional and reliable recruitment of nerve fibers, thus providing a sufficient dorsal flexion and optimal eversion of the affected foot to sustain unassisted, almost normal gait. Therefore, the presented implant is suitable for very long-term FES of the CPN.

Selective Stimulation of Autonomic Nerves and Recording of Electroneurograms in a Canine Model

The article presents the results of modeling, design, and experimental testing of a multielectrode spiral cuff (CUFF) to determine to what extent a CUFF could be used for selective stimulation of different types of nerve fibers within particular compartments and for selective recording of electoneurograms (ENGs) from particular compartments of the peripheral autonomic nerve. The CUFF was implanted on the left cervical vagus nerve (LVN) of a dog. The relative positions of the particular nerve regions that innervated the cardiovascular (CV) and respiratory system (RS) were identified by delivering the stimuli to the particular group of three electrodes (GTE). The stimuli caused both selective stimulation of mainly B fibers within the particular compartments, and differential block of A fibers by membrane hyperpolarization. It was shown that when the stimuli were delivered to GTE9, the heart rate began to fall and when the stimuli were delivered to GTE4, the rate of breathing decreased. The defined and randomly chosen GTEs were used also as recording GTEs while CV or RS were stimulated by carotid artery massage, epinephrine injection, and noninvasive positive end-expiratory pressure ventilation (NIPEEPV). Results demonstrate that the function of a particular internal organ can be modulated via the selective stimulation of the innervating compartment of the peripheral nerve. Results also showed that stimulations elicited site-specific changes in ENG power spectra recorded from the particular compartments of the LVN.

Analysis of compound action potentials elicited with specific current stimulating pulses in an isolated rat sciatic nerve

Abstract The ability to selectively stimulate Aα, Aβ-fibers and Aδ-fibers in an isolated rat sciatic nerve (SNR) was assessed. The stimulus used was a current, biphasic pulse with a quasitrapezoidal cathodic phase and rectangular anodic phase where parameters were systematically varied: intensity of the cathodic phase (ic); width of the cathodic phase (tc); width of the cathodic exponential decay (texp) and time constant of the exponential decay (τexp). A SNR was stimulated using a pair of hook electrodes while conduction velocity (CV) and compound action potentials (CAP) were measured at two sites along the SNR using another two pairs of electrodes. Results showed that the highest CAP1 (8.5–9 mV), shall be expected when parameters of the stimulus were within the following range: ic=3.8–4 mA, tc=350–400 μs and texp=330–440 μs. Results also showed that with ascending tc and texp, CV of the corresponding superficial region of the SNR was reduced in both, conduction velocity of CAP1 and conduction velocity of CAP2. It was concluded that action potentials (APs) were activated in the Aβ-fibers and Aδ-fibers along with a slight AP inhibition in the Aβ-fibers. The obtained results, could serve as a tool for developing multi-electrode systems that potentially enable fiber-type selective stimulation of nerve fibers.

An improved method of crafting a multi-electrode spiral cuff for the selective

This article reviews an improved methodology and technology for crafting a multi-electrode spiral cuff for the selective activation of nerve fibres in particular superficial regions of a peripheral nerve. The analysis, structural and mechanical properties of the spot welds used for the interconnections between the stimulating electrodes and stainless-steel lead wires are presented. The cuff consisted of 33 platinum electrodes embedded within a self-curling 17-mm-long silicone spiral sheet with a nominal internal diameter of 2.5 mm. The weld was analyzed using scanning electron microscopy and nanohardness tests, while the interconnection was investigated using destructive load tests. The functionality of the cuff was tested in an isolated porcine vagus nerve. The results of the scanning electron microscopy show good alloying and none of the typical welding defects that occur between the wire and the platinum foil. The results of the destructive load tests show that the breaking loads were between 3.22 and 5 N. The results of the nanohardness testing show that the hardness of the weld was different for the particular sites on the weld sample. Finally, the results of the functional testing show that for different stimulation intensities both the compound action potential deflection and the shape are modulated.

Fabrication and testing of a multi-electrode spiral nerve cuff

The methodology, technology of fabrication and testing a multi-electrode spiral cuff for selective activation of fibres in particular superficial regions of a peripheral nerve is presented.

Twenty-nine-year stimulation of the common peroneal nerve in a hemiplegic patient

Functional electrical stimulation (FES) of the common peroneal nerve (CPN), to correct gait, has been shown to be a useful means for the restoration of functional movement in the lower extremities of hemiplegic individuals. Motor function over a twenty-nine year period of selective stimulation of the CPN with an implantable stimulator to correct drop-foot in a 56 year old patient with left-sided hemiplegia, was evaluated. Partial restoration of dorsal flexion and well balanced eversion of the affected foot was achieved by selective stimulation of superficial region of the CPN innervating mostly the tibialis anterior and partly peroneus longus and peroneus brevis muscles. It was shown that the system is suitable for very long-term FES providing improved muscle function. Namely, even after 29 years of daily FES of the CPN, a functional and reliable recruitment of fibres within the CPN was still achieved, thus providing an appropriate dorsal flexion and eversion of the affected foot. It was found that the stimulation-associated-mechanical trauma to the CPN elicited some minor non-age-related loss of the larger myelinated nerve fibres. Electrophysiological and biomechanical measurements however, have not revealed any functional signs which could be attributed to the damage of the CPN.