EE 795 LECTURE 11

Functional Electrical Stimulation

 LECTURE OUTLINE

We will look at:

¾ Design of FES
¾ Electrodes and electrode-tissue behavior
¾ Nerve excitation
¾ Recruitment
¾ Clinical applications
Design of functional electrical stimulation:
In functional electrical stimulation (FES),
nerve stimulation is achieved by passing
current between two or more electrodes
implanted in or on the body.
In order for this system to produce functional
nerve activation, the appropriate spatial and
temporal patterns of stimulation must be
determined for the desired stimulus
response. This requires an understanding
of both the stimulus properties and the
resulting nerve response properties.
Design of FES (cont.):
Stimulus design considerations include
electrode properties such as:
¾ number and positions of electrodes,
¾ material,
¾ size,
¾ shape, and
stimulating current properties such as:
¾ strength, and
¾ waveform.
 Design of FES (cont.):
Example stimulus
waveform shapes:
¾ monophasic,
¾ biphasic,
¾ chopped,
¾ triphasic, and
¾ asymmetric,
and parameters:
¾ pulse amplitude,
¾ pulse width,
¾ interphase gap, and
¾ pulse rate.
(From Shepherd & Javel, Hear. Res. 1999)
 Stimulator

• Constant Current or Constant Voltage

• Early stimulators were constant voltage (easier
design)
• Modern stimulators mostly constant current
• Electrode/neural tissue interface has a complex
impedance Z, which is unknown and can change
over time, constant current provides set stimulus
strength and desired response regardless of Z
 Stimulus Parameters

• Pulse durations <50 µsec to 1 msec.

• Pulse trains for most FES applications, i.e. 20 – 30 Hz
for muscle stimulation.
• Waveforms mostly rectangular with monophasic or
balanced biphasic shapes.
• Intra-corporeal electrode (implanted) stimulators need
only deliver IS = several 10’s of mamps., with subsequent
voltages VS = ZIS several volts (all electronics)
• Surface electrode stimulators must deliver up to 100 ma
with subsequent voltages of several hundred volts (step-
up transformers or DC-DC converters necessary)
Electrodes and electrode-tissue behavior:
When a closed current loop is created by
implanting stimulating electrodes in body
tissue, the current carriers in the wires and
electrodes are electrons, whereas current
within the tissue is carried by ions, primarily
sodium, potassium and chloride.
An electrochemical reaction must therefore
take place at the electrode-tissue interface
that (in part) exchanges metal electrons for
ions in solution.
Electrodes and electrode-tissue behavior
(cont.):
For extracellular metal electrodes:
¾ anode ´ positive net charge in the
electrode, and
¾ cathode ´ negative net charge in the
electrode.
In the extracellular electrolyte, an opposite
charge develops that is separated from the
electrode by a molecular layer of water
adsorbed on the metal surface.
Electrodes and electrode-tissue behavior
(cont.):
This charged layer corresponds to a
charged capacitance.
Electrodes and electrode-tissue behavior
(cont.):
The equivalent electrical circuit of the
electrode-tissue interface will therefore
incorporate this capacitance in parallel with
a resistance that reflects the electrode-
electrolyte charge movement that results
from both reversible and irreversible
electrochemical Faradaic reactions.
An experimental set-up for analysing this
behaviour is shown on the next slide.
Electrodes and electrode-tissue behavior
(cont.):
Electrodes and electrode-tissue behavior
(cont.):
An RC voltage response is consequently
observed in the electrode-tissue interface
response to a current step.
Electrodes and electrode-tissue behavior
(cont.):
The operating characteristics of an electrode
depend on:
¾ the effective capacitance C and R per
unit area, and (C,R = f(IS, Freq) when IS >
1 ma/cm2
¾ the reversible or irreversible
electrochemical reaction between the
electrode and electrolyte.
A graphical scheme for analysing electrode
performance is shown on the next slide.
Electrodes and electrode-tissue behavior
(cont.):
Electrodes and electrode-tissue behavior
(cont.):
In the central region, the capacitance of the
electrode-electrolyte interface dominates. It
is desirable to operate within this region and
thus avoid Faradaic reactions at the
interface, but the charge delivered may not
be sufficient to achieve nerve activation.
Exceeding the limits of the linear region, i.e.,
delivering charge beyond points I or II (or
both), introduces Faradaic conditions (i.e.,
electrochemical reactions).
Electrodes and electrode-tissue behavior
(cont.):
For example, a stainless steel electrode that is
driven beyond point I by an anodic potential may
experience the irreversible reaction:

which leads to dissolution of the iron.

For cathodic potentials beyond point II the reaction
may be of the form:

which is again irreversible and produces a pH

increase that could cause tissue damage.
Electrodes and electrode-tissue behavior
(cont.):
On the other hand, for a platinum electrode the
anodic reaction may be:

which is reversible.
For cathodic potentials the reaction may be of the
form:

which is again reversible. Note that neither of

these reactions introduces new chemical species.
Electrodes and electrode-tissue behavior
(cont.):
For monophasic stimulation, the charge
continually builds up at the electrode
interface.
For anodic pulses, the build-up reaches
point I, after which electrochemical reactions
take place that result in the loss of charge.
For cathodic pulses, the build-up reaches
point II.
Consequently, monophasic stimuli are rarely
used for indwelling electrodes.
Electrodes and electrode-tissue behavior
(cont.):
¾ The build up of charge is normally avoided by
using charge-balanced biphasic current pulses.
¾ Charge balance is usually ensured by the use
of a capacitor in series with the electrode.
¾ In the ideal case, the operating point does not
drift from charge build-up, and the range of
charges delivered stays within the linear
(capacitive) region of the VE versus Q/A curve,
so that Faradaic charge losses are not
incurred.
Electrodes and electrode-tissue behavior
(cont.):
Electrodes and electrode-tissue behavior
(cont.):
If QP ≠ ¡QS, then steady-state operation must
involve some irreversible behaviour.

If the irreversible reaction produces OH¡, as per

Eqn. (12.3), this process may be tolerable,
because the blood can buffer some OH¡.
Electrodes and electrode-tissue behavior
(cont.):
Note:
¾ Comparable anodic irreversibility is
never tolerated, because the result is
irreparable electrode damage.
¾ The capacitive region may be expanded
by:
1. coating the electrode with a dielectric
(i.e., insulator) or,
2. roughening the electrode surface to
increase its effective surface area.
Electrodes and electrode-tissue behavior
(cont.):
Factors to consider when choosing
electrode material include:
1. passive biocompatibility with the tissue,
2. extent of reversible behaviour (capacitive
region + region of reversible
electrochemical reactions), and
3. mechanical compatibility with the tissue.
The most widely used electrode materials
are platinum, platinum-iridium and 316
stainless steel (SUS 316L).
Electrodes and electrode-tissue behavior
(cont.):
Types of electrodes for specific applications:
1. A — Brain: surface electrodes
a. Passive implants – minimal trauma to brain
tissue; become encapsulated mainly on the
superficial side.
b. Active implants – mainly platinum is used;
only low-intensity charged-balanced
biphasic stimulation is safe.
Electrodes and electrode-tissue behavior
(cont.):
1. B — Brain: penetrating electrodes
a. Passive implants – can cause trauma
to brain tissue.
b. Active implants – mainly silicon
based.
Electrodes and electrode-tissue behavior
(cont.):
2. Nerve (cuff electrodes)
Surround nerve bundle for confined
stimulation, reducing the required
current.
Electrodes and electrode-tissue behavior
(cont.):
3. Intramuscular (coiled-wire electrodes)
a. Passive implants – subjected to mechanical
strains; become encapsulated.
b. Active implants – actually stimulate motor
axons, not muscle fibers.
i. monophasic: some irreversible cathodic
processes tolerated for low currents;
ii. balanced biphasic: moderate-high currents can
be used without degrading electrode;
iii. imbalanced biphasic: moderate currents are
permissible because of blood buffering.
Clinical applications:
Because of the problems involved with
spatial selectivity and recruitment, FES has
been most successful in clinical applications
where these two issues are not so crucial,
for example:
¾ heart pacemakers, cochlear implants,
bladder control, respiratory control, gross
motor movements.
More challenging for clinical application are:
¾ fine motor control, retinal implants, etc.
Pacemakers:
¾ First major application of electrical
stimulation of excitable cells
¾ Stimulate just ventricles, or atria and
ventricles (dual-chamber)
¾ Typically platinum or platinum-iridium
electrodes, monopolar or bipolar
¾ Monophasic or biphasic waveforms used
¾ Both cathode make excitation and anode
break excitation are likely to occur
Cardiac Pacing
Functional electrical stimulation (FES)

To where should the electrical stimulus be

applied?
Some electrode types:
1. Cuff electrode around nerve bundle
pros: activates all the motor units in a muscle
cons: simultaneous activation of all motor units;
activates more than one muscle; stimulates
afferent (ascending) sensory nerve fibers
2. Surface electrodes over muscle
pros: only activates some motor units in a muscle;
only activates one muscle or muscle group
cons: simultaneous activation of all muscle fibers in
a motor unit; stimulates afferent (ascending)
sensory nerve fibers
Motor Unit Recruitment:
For nerve cuff electrodes, larger motor units tend
to be recruited first. For surface electrodes MU
proximity and size affect recruitment order.
However, under physiological conditions for motor
units, small diameter fibers innervating slow
oxidative (SO) muscle fibers tend to be recruited
before larger diameter fibers innervating fast
glycolytic (FG) muscle fibers.
Thus, the natural order of recruitment is reversed
in FES.
Recruitment (cont.):
One approach to combat this recruitment-order
problem is to utilize two electrodes.
The first electrode supplies a large depolarizing
current that excites fibers with a large range of
diameters.
The second electrode supplies a small
hyperpolarizing current that prevents action
potential propagation on the large diameter fibers
excited by the first electrode.
The hyperpolarizing pulse must be designed with a
ramp that prevents anode-break excitation.
Effects of Pulse Width
Upper limb stimulation:
¾ Stimulates peripheral nerve fibers of
motor neurons
¾ Used in spinal cord injury or stroke
patients
Lower limb stimulation:
¾ Footdrop control
¾ Standing control
Bladder control:
¾ Intradural or extradural electrodes
¾ Stimulation can lead to bladder and
sphincter contraction – intermittent
stimulation can overcome this problem
Phrenic nerve stimulator:
¾ Provides diaphragm pacing to aid
respiration
¾ Bilateral stimulation for symmetrical
activation of the diaphragm
Stimulating Electrode
Cochlear Implant
 Magnetic Stimulation

• Pros: Provides higher amplitude induced voltage

fields deep in tissue than can be provided by
direct surface electrode stimulation (no
attenuation of magnetic field, even for bone)
• Cons:
• More complex equipment
• Magnetic fields tend to be unfocused unless
compensating coil arrangements are used.
Effect of stimulating Waveshape
Electrical Stimulation
Effect of magnetic Pulse Waveshape
Effect of Current Direction
Trans-Cranial Magnetic Stimulation
• Treat severely depressed patients who are
resistant to pharmacology
• Alternate is periodic applications of
electro-shock (ECT) treatment
• 30% of patients respond
• Would like to increase percentage of
responders
 Figure 11
Other subjects respond as their head size is such that standard
methods place the coil over the site of possible dysfunction
(detectable using QEEG)

Standard positioning
method correctly
places coil at the
appropriate site to
effect an
antidepressant
response

Possible site
of correctable dysfunction
 Other Application Areas

• Stop Epileptic Seizures

• Control some migraine attacks
• Cognitive stimulation
• ?