ECE 795:

Quantitative
Electrophysiology
Notes for Lecture #10
Thursday, November 29, 2007
14. FUNDAMENTALS OF
FUNCTIONAL ELECTRICAL
STIMULATION (FES)
We will look at:
¾ Design issues for FES
¾ Subthreshold response to extracellular
stimulation
¾ Suprathreshold response to extracellular
stimulation
¾ Nerve excitation
¾ Recruitment
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Design of functional electrical stimulation:
In functional electrical stimulation (FES),
nerve stimulation is achieved by passing
current between two or more electrodes
implanted in 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. 3
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. 4
Design of FES (cont.):
A crucial point in understanding FES is the
difference between intracellular and extracellular
stimulation.

(Rattay, Neurosci. 1999)

5
Subthreshold response to an external point
current stimulus:
Consider the
source-fiber
geometry
shown to the
right.

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Subthreshold response to an external point
current stimulus (cont.):
The resulting extracellular field is:

where I0 is the current strength, σe is the

conductivity of the extracellular medium, and
r is the distance from the source to an
arbitrary field point.
Note that the effect of the fiber on the field is
typically ignored. 7
Subthreshold response to an external point
current stimulus (cont.):
Reformulating Eqn. (6.25) gives:

where z now defines the axial (longitudinal)

coordinate.
The transmembrane current im must also
equal the intrinsic ionic plus capacitive
current of the membrane.
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Subthreshold response to an external point
current stimulus (cont.):
Replacing φi by vm + φe and im by iion +
cm∂vm/∂t in Eqn. (7.71) gives:

At rest, vm = 0 for all z ⇒ ∂2vm/∂z2 = 0 and

iion = vm/rm = 0. Consequently, when the
stimulus is first applied:

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Subthreshold response to an external point
current stimulus (cont.):
Thus, the region where excitation is possible
is where ∂2φe/∂z2 is positive, because this
will make ∂vm/∂t initially positive.
Conversely, regions where ∂2φe/∂z2 is
negative will hyperpolarize, because this will
make ∂vm/∂t initially negative.
Consequently, the function ∂2φe/∂z2 has
been named the activating function.
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Subthreshold response to an external point
current stimulus (cont.):

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Suprathreshold response to an external
point stimulus:
A space-clamped patch of membrane
subjected to an external point stimulus has a
threshold potential that is relatively
independent of the stimulus duration.
In contrast, a fiber has higher threshold
potentials for shorter stimuli, an effect that is
strongest when the source is very close to
the fiber and grows weaker as the source is
moved away from the fiber.
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Suprathreshold response to an external
point stimulus (cont.):

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Suprathreshold response to an external
point stimulus (cont.):

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Suprathreshold response to an external
point stimulus (cont.):

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Suprathreshold response to an external
point stimulus (cont.):
The effect of stimulus duration and distance
from the fiber on the threshold potential
results from the hyperpolarized regions that
flank the depolarized region. The membrane
potential decay is accelerated by the flow of
current from the depolarized region into the
surrounding hyperpolarized regions. As the
source is moved away from the fiber, the
hyperpolarized regions move away from the
depolarized region, diminishing the effect.
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Nerve excitation:
To evaluate the pattern of nerve activation
that is produced by a particular electrode
configuration, we must consider:
¾ the geometry of the electrode(s) and
nerve fibers,
¾ the conductivities of the medium in which
the electrode(s) and nerve fibers lie, and
¾ the properties of the nerve fiber
membrane, either subthreshold (i.e.,
linear) or suprathreshold (i.e., nonlinear).
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Nerve excitation (cont.):
Consider the linear-core-conductor model of a
myelinated fiber being stimulated by a bipolar
electrode pair (i.e., delivering equal and opposite
current).

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Nerve excitation (cont.):
For this configuration, excitation will occur below
the cathode if the stimulating current is large
enough.
The strength-duration behaviour can be described
as:

where IR is the rheobase current and K is an

experimentally-determined constant that depends
on the electrode geometry, medium conductivities,
etc., as well as the membrane properties.
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Nerve excitation (cont.):
A result of this strength-duration behaviour
is that charge is wasted in stimulating a
nerve fiber if the duration of the pulse is
much larger than the chronaxie, which is
defined in this case as:

Note that we wish to minimize the total charge

delivered in order to avoid electrochemical
reactions at the electrode-electrolyte interface. 20
Nerve excitation (cont.):
Thus, short pulse durations are highly
desirable based on this criterion.

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 Nerve excitation (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.
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(From Shepherd & Javel, Hear. Res. 1999)
Nerve excitation (cont.):
The injected primary current pulse is
designed to achieve nerve activation.
The secondary pulse in a biphasic current
waveform is introduced to mitigate a build up
of charge at the electrode-tissue interface.
However, this secondary pulse will be
hyperpolarizing, and consequently it may
suppress action potential generation.
Adding an inter-phase delay can avoid this
problem.
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Nerve excitation (cont.):
The effect of inter-phase delay on action
potential generation is illustrated below.

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Nerve excitation (cont.):
Another important factor is the electrode-
fiber geometry.
Consider stimulation of the peripheral nerve
via a cuff electrode as shown below.

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Nerve excitation (cont.):
Modelling cuff-electrode stimulation using
the equivalent circuit illustrated below gives
rise to the activation pattern shown on the
next slide.

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Nerve excitation (cont.):

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Nerve excitation (cont.):
Stimulation using a surface electrode produces the
activation pattern shown on the next slide if the
neuron is normal to the surface.

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Nerve excitation (cont.):

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Nerve excitation
(cont.):
In contrast, the
activation pattern is
quite different if the
electrode is adjacent
to the fiber.
In this case, the
flanking
hyperpolarized
regions may block
action potential
generation.
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Nerve excitation (cont.):

31
Nerve excitation (cont.):
When modelling the response of myelinated fibers,
it may be sufficient to just included active
(nonlinear) membrane properties in the node
closest to the electrode.

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Nerve excitation
(cont.):
However, if the
electrode is more
distant from the fiber,
or close to the soma
or dendrites, then
more complicated
excitation patterns
can result.

(Rattay, IEEE Trans.

Biomed. Eng. 1998)

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Nerve
excitation
(cont.):

(Rattay, IEEE Trans.

Biomed. Eng. 1998)

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Recruitment:
Control of both the pulse width and the pulse rate
can be utilized to affect which fibers are recruited.

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Recruitment (cont.):
In myelinated nerve, the fiber diameter d can
have a strong effect on the threshold current
Ith.
The diameter has a direct effect through the
axoplasmic resistance per unit length ri.
An indirect effect of the diameter results
from the fact that the internodal segment
length (i.e., the distance between nodes of
Ranvier) is proportional to the fiber diameter.

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Recruitment (cont.):
Ith versus fiber diameter and electrode-fiber
distance.

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Recruitment (cont.):
Ith versus fiber diameter and pulse duration.

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Recruitment (cont.):
Ith versus pulse duration for nerve and
muscle.

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Recruitment (cont.):
Considering the results of the simulations and
experimental data shown in the previous three
slides, large diameter fibers tend to be recruited
before small diameter fibers.
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.
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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.
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