An official website of the United States government
Neuromuscular electrical stimulation (NMES) targeting the muscle belly is commonly used to restore muscle strength in individuals with neurological disorders. However, early onset of muscle fatigue is a major limiting factor. Transcutaneous nerve stimulation (TNS) can delay muscle fatigue compared with traditional NMES techniques. However, the recruitment of Ia afferent fibers has not be specifically targeted to maximize muscle activation through the reflex pathway, which can lead to more orderly recruitment of motor units, further delaying fatigue. This preliminary study assessed the distribution of M-wave and H-reflex of intrinsic and extrinsic finger muscles. TNS was delivered using an electrode array placed along the medial side of the upper arm. Selective electrode pairs targeted the median and ulnar nerves innervating the finger flexors. High-density electromyography (HD EMG) was utilized to quantify the spatial distribution of the elicited activation of finger intrinsic and extrinsic muscles along the hand and forearm. The spatial patterns were characterized through isolation of the M-wave and H-reflex across various stimulation levels and EMG channels. Our preliminary results showed that, by altering the stimulation amplitude, distinct M-wave and H-reflex responses were evoked across EMG channels. In addition, distinct stimulation locations appeared to result in varied levels of reflex recruitment. Our findings indicate that it is possible to adjust stimulation parameters to maximize reflex activation, which can potentially facilitate physiological recruitment order of motoneurons.
more »
« less
Activation of Superficial and Deep Finger Flexors through Transcutaneous Nerve Stimulation
Objective: Functional electrical stimulation (FES) is a common technique to elicit muscle contraction and help improve muscle strength. Traditional FES over the muscle belly typically only activates superficial muscle regions. In the case of hand FES, this prevents the activation of the deeper flexor muscles which control the distal finger joints. Here, we evaluated whether an alternative transcutaneous nerve-bundle stimulation approach can activate both superficial and deep extrinsic finger flexors using a high-density stimulation grid. Methods: Transverse ultrasound of the forearm muscles was used to obtain cross-sectional images of the underlying finger flexors during stimulated finger flexions and kinematically-matched voluntary motions. Finger kinematics were recorded, and an image registration method was used to capture the large deformation of the muscle regions during each flexion. This deformation was used as a surrogate measure of the contraction of muscle tissue, and the regions of expanding tissue can identify activated muscles. Results: The nerve-bundle stimulation elicited contractions in the superficial and deep finger flexors. Both separate and concurrent activation of these two muscles were observed. Joint kinematics of the fingers also matched the expected regions of muscle contractions. Conclusions: Our results showed that the nerve-bundle stimulation technique can activate the deep extrinsic finger flexors, which are typically not accessible via traditional surface FES. Significance: Our nerve-bundle stimulation method enables us to produce the full range of motion of different joints necessary for various functional grasps, which could benefit future neuroprosthetic applications.
more »
« less
- Award ID(s):
- 1847319
- PAR ID:
- 10220195
- Date Published:
- Journal Name:
- IEEE Journal of Biomedical and Health Informatics
- ISSN:
- 2168-2194
- Page Range / eLocation ID:
- 1 to 1
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
More Like this
-
-
Stable precision grips using the fingertips are a cornerstone of human hand dexterity. However, our fingers become unstable sometimes and snap into a hyperextended posture. This is because multilink mechanisms like our fingers can buckle under tip forces. Suppressing this instability is crucial for hand dexterity, but how the neuromuscular system does so is unknown. Here we show that people rely on the stiffness from muscle contraction for finger stability. We measured buckling time constants of 50 ms or less during maximal force application with the index finger—quicker than feedback latencies—which suggests that muscle-induced stiffness may underlie stability. However, a biomechanical model of the finger predicts that muscle-induced stiffness cannot stabilize at maximal force unless we add springs to stiffen the joints or people reduce their force to enable cocontraction. We tested this prediction in 38 volunteers. Upon adding stiffness, maximal force increased by 34 ± 3%, and muscle electromyography readings were 21 ± 3% higher for the finger flexors (mean ± SE). Muscle recordings and mathematical modeling show that adding stiffness offloads the demand for muscle cocontraction, thus freeing up muscle capacity for fingertip force. Hence, people refrain from applying truly maximal force unless an external stabilizing stiffness allows their muscles to apply higher force without losing stability. But more stiffness is not always better. Stiff fingers would affect the ability to adapt passively to complex object geometries and precisely regulate force. Thus, our results show how hand function arises from neurally tuned muscle stiffness that balances finger stability with compliance.more » « less
-
Hand impairment is prevalent in individuals after stroke. Regaining independent finger control is especially challenging. An objective and continuous assessment of finger impairment could inform clinicians and allow them to prescribe targeted therapies. The objective of this preliminary work was to quantify the neuromuscular factors that contribute to impairment in independent finger control in chronic stroke survivors. We obtained high-density electromyographic (HD-EMG) signals of extrinsic finger muscles and fingertip forces, while stroke or control participants were instructed to produce independent finger forces. We observed an impaired ability to isolate individual muscle compartment activation (i.e., co-activation of muscle compartment). This muscle co-activation pattern correlated with finger independence as well as clinical assessment scales on hand impairment. Our preliminary work showed that HD-EMG recordings can be used to continuously monitor activation abnormalities of small finger muscles in contribution to impaired finger independence. With further development, the outcomes can provide a basis for clinical decision making to reduce hand impairments of stroke survivors.more » « less
-
Abstract Objective. Brain–machine interfaces (BMIs) have shown promise in extracting upper extremity movement intention from the thoughts of nonhuman primates and people with tetraplegia. Attempts to restore a user’s own hand and arm function have employed functional electrical stimulation (FES), but most work has restored discrete grasps. Little is known about how well FES can control continuous finger movements. Here, we use a low-power brain-controlled functional electrical stimulation (BCFES) system to restore continuous volitional control of finger positions to a monkey with a temporarily paralyzed hand. Approach. We delivered a nerve block to the median, radial, and ulnar nerves just proximal to the elbow to simulate finger paralysis, then used a closed-loop BMI to predict finger movements the monkey was attempting to make in two tasks. The BCFES task was one-dimensional in which all fingers moved together, and we used the BMI’s predictions to control FES of the monkey’s finger muscles. The virtual two-finger task was two-dimensional in which the index finger moved simultaneously and independently from the middle, ring, and small fingers, and we used the BMI’s predictions to control movements of virtual fingers, with no FES. Main results. In the BCFES task, the monkey improved his success rate to 83% (1.5 s median acquisition time) when using the BCFES system during temporary paralysis from 8.8% (9.5 s median acquisition time, equal to the trial timeout) when attempting to use his temporarily paralyzed hand. In one monkey performing the virtual two-finger task with no FES, we found BMI performance (task success rate and completion time) could be completely recovered following temporary paralysis by executing recalibrated feedback-intention training one time. Significance. These results suggest that BCFES can restore continuous finger function during temporary paralysis using existing low-power technologies and brain-control may not be the limiting factor in a BCFES neuroprosthesis.more » « less
-
Converging evidence in human and animal models suggests that exogenous stimulation of the motor cortex (M1) elicits responses in the hand with similar modular structure to that found during voluntary grasping movements. The aim of this study was to establish the extent to which modularity in muscle responses to transcranial magnetic stimulation (TMS) to M1 resembles modularity in muscle activation during voluntary hand movements involving finger fractionation. EMG was recorded from eight hand-forearm muscles in nine healthy individuals. Modularity was defined using non-negative matrix factorization to identify low rank approximations (spatial muscle synergies) of the complex activation patterns of EMG data recorded during high density TMS mapping of M1 and voluntary formation of gestures in the American Sign Language alphabet. Analysis of synergies as a set, and individually, revealed greater than chance similarity between those derived from TMS and those derived from voluntary movement. Both datasets included synergies dominated by single intrinsic hand muscles presumably to meet the demand for highly fractionated finger movement. These results suggest a cortical role in combining corticospinal connectivity to individual intrinsic hand muscles with modular mulit-muscle activation via synergies.more » « less
- Free Publicly Accessible Full Text
-
Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1109/JBHI.2020.3041669
