Surface electrical stimulation has the potential to be a powerful and non-invasive treatment for a variety of medical conditions but currently it is difficult to obtain consistent evoked responses. A viable clinical system must be able to adapt to variations in individuals to produce repeatable results. To more fully study the effect of these variations without performing exhaustive testing on human subjects, a system of computer models was created to predict motor and sensory axon activation in the median nerve due to surface electrical stimulation at the elbow. An anatomically-based finite element model of the arm was built to accurately predict voltages resulting from surface electrical stimulation. In addition, two axon models were developed based on previously published models to incorporate physiological differences between sensory and motor axons. This resulted in axon models that could reproduce experimental results for conduction velocity, strength-duration curves and activation threshold. Differences in experimentally obtained action potential shape between the motor and sensory axons were reflected in the models. The models predicted a lower threshold for sensory axons than motor axons of the same diameter, allowing a range of sensory axons to be activated before any motor axons. This system of models will be a useful tool for development of surface electrical stimulation as a method to target specific neural functions.

Abstract-Surface electrical stimulation (SES) is being investigated as a noninvasive method to evoke natural sensations distal to electrode location. This may improve treatment for phantom limb pain as well as provide an alternative method to deliver sensory feedback. The median and/or ulnar nerves of 35 subjects were stimulated at the elbow using surface electrodes. Strength-duration curves of hand sensation were found for each subject. All subjects experienced sensation in their hand, which was mostly described as a paresthesia-like sensation. The rheobase and chronaxie values were found to be lower for the median nerve than the ulnar nerve, with no significant difference between sexes. Repeated sessions with the same subject resulted in sufficient variability to suggest that recalculating the strength-duration curve for each electrode placement is necessary. Most of the recruitment curves in this study were generated with 28 to 36 data points. To quickly reproduce these curves with limited increase in error, we recommend 10 data points. Future studies will focus on obtaining different sensations using SES with the strength-duration curve defining the threshold of the effective parameter space.

Objective Target selectivity of deep brain stimulation (DBS) therapy is critical, as the precise locus and pattern of the stimulation dictates the degree to which desired treatment responses are achieved and adverse side effects are avoided. There is a clear clinical need to improve DBS technology beyond currently available stimulation steering and shaping approaches. We introduce orientation selective neural stimulation as a concept to increase the specificity of target selection in DBS. Approach This concept, which involves orienting the electric field along an axonal pathway, was tested in the corpus callosum of the rat brain by freely controlling the direction of the electric field on a plane using a three-electrode bundle, and monitoring the response of the neurons using functional magnetic resonance imaging (fMRI). Computational models were developed to further analyze axonal excitability for varied electric field orientation. Main results Our results demonstrated that the strongest fMRI response was observed when the electric field was oriented parallel to the axons, while almost no response was detected with the perpendicular orientation of the electric field relative to the primary fiber tract. These results were confirmed by computational models of the experimental paradigm quantifying the activation of radially distributed axons while varying the primary direction of the electric field. Significance The described strategies identify a new course for selective neuromodulation paradigms in DBS based on axonal fiber orientation.

When combined with patient-specific tissue anisotropy and patient-specific anatomical morphologies of neural pathways responsible for therapy and side effects, orientation-selective DBS approaches show potential to significantly improve clinical outcomes of DBS therapy for a range of existing and investigational clinical indications.