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Biomedical subjects

T Sinkjaer

Publications and source records attributed to T Sinkjaer.

At least 55 records · Page 3Linked to original sources

Analysis of bladder related nerve cuff electrode recordings from preganglionic pelvic nerve and sacral roots in pigs.

PURPOSE: Electrical stimulation of appropriate lower urinary tract (LUT) nerves may be used in bladder dysfunction to achieve continence and abolish hyper-reflexic detrusor contractions. It can also be used for consequent emptying of the bladder. To control the time course of the described functional phases, knowledge of bladder sensory information is needed. We investigated if the latter could be extracted from the LUT nerve activity. MATERIALS AND METHODS: In acute experiments using 10 pigs, tripolar cuff electrodes were placed unilaterally around the pelvic nerve and the S3 and S2 roots. The cuff electrode signals, filling rate and the bladder and rectal pressures were recorded during slow and fast bladder fillings/emptyings. RESULTS: Two pigs were excluded from the analysis because of no observed changes in the nerve signals in one animal, and because of electrical noise problems in the other animal. Fast bladder pressure increases resulted in a sudden pelvic nerve signal rise in 6 out of 7 pigs (3 out of 6 for the S3 nerve signal). Slow bladder pressure increase was reflected in the recorded nerve activity only in 3 out of 8 and in 3 out of 7 pigs for the pelvic and S3 cuff signals respectively. In 2 animals small spontaneous bladder contractions were clearly reflected in the pelvic nerve signal (contractions were observed only in 3 pigs). Except in one pig, there were no slow/fast bladder filling responses recorded in the S2 roots. It is shown that the recorded responses were afferent. CONCLUSIONS: Cuff electrodes can be used to record bladder afferent information from the pelvic nerve and the sacral root S3 in pig. Pelvic nerve recordings were more selective than the sacral root recordings. Nerve activity increases were more distinct and repeatable during rapid bladder pressure changes and small spontaneous bladder contractions than during slow bladder fillings.

Action Potentials↗

Soleus long-latency stretch reflexes during walking in healthy and spastic humans.

The present study was carried out to investigate the long-latency soleus stretch reflexes M2 (peak latency of approximately 85 ms) and M3 (peak latency of approximately 115 ms) during walking in healthy and spastic multiple sclerosis (MS) patients. An 8 degrees stretch was applied to the ankle extensors of the left leg in 8 healthy subjects during normal walking speed and 9 spastic MS patients and 10 age-matched healthy subjects during slow walking. When present in walking healthy subjects, M2 and M3 were modulated in a similar way and with the same amplitudes as previously described for the short latency soleus stretch reflex (M1). The spastic patients' soleus M1 was significantly less modulated during walking. The patients' M2 long-latency response was modulated in the same way as the age-matched healthy subjects. All patients' M3 responses were absent or much suppressed during walking. The origin and functional importance of the short- and long-latency stretch reflexes in healthy and spastic persons are discussed in relation to the above findings and the behaviour of the stretch reflexes during matched isometric contractions. M3 is argued to be part of a transcortical reflex in healthy subjects.

Adult↗

The influence of experimental muscle pain on the human soleus stretch reflex during sitting and walking.

OBJECTIVES: The stretch reflex is functionally important during human locomotion. Muscle pain has been found to increase the stretch reflex amplitude during sitting, possibly due to an altered fusimotor drive. To further study the importance of altered fusimotor activity due to muscle pain we investigated the combined effect of muscle pain and motor task on the soleus stretch reflex. METHODS: Stretch reflexes were elicited before, during and after experimentally induced muscle pain in soleus (i.m. infusion of 6% saline) in 3 experiments: (1) in the relaxed soleus muscle and before, during and after an isometric ramp contraction (500 ms, 0-10 Nm), (2) at 3 different time periods during walking, and (3) at matched pain intensity and soleus activity during sitting and walking. RESULTS: Infusion of hypertonic saline into the soleus muscle caused a significant facilitated stretch reflex in the relaxed muscle (P<0.01), but not during walking or during sitting and walking at matched soleus EMG and matched pain levels. The infusion of isotonic saline (non-painful) did not cause any changes (P = 0.75). CONCLUSIONS: The main findings of the present study were that experimental muscle pain facilitated the stretch reflex during pain in the relaxed muscle, but caused no changes in stretch reflex amplitude during sitting and walking at higher "functional" background EMG levels.

Adolescent↗

Reduced short and long latency reflexes during voluntary tracking movement of the human wrist joint.

In six healthy human subjects we compared changes in the strength of Hoffmann (H), short latency (30-55 ms) and long latency (55-100 ms) stretch reflexes of flexor carpi radialis (FCR) muscle during movement and isometric contractions. In one set of experiments, stretches were imposed to the wrist during voluntarily tracked sinusoidal movement and during matched isometric contractions to compare short and long latency stretch reflex responses. In the second set, H-reflexes were compared during similar matched conditions. All reflexes decreased significantly (P < 0.05) during the voluntary tracking movement. The H-reflex was reduced during the wrist flexion, on average, by 33% of its value obtained during the isometric condition. Compared with their values during isometric conditions, the short latency stretch reflex and long latency stretch reflex during movement were reduced by 52 and 40%, respectively. From the pattern changes of the stretch reflexes and the H-reflex, a movement-induced presynaptic inhibition combined with pronounced muscle spindle unloading is proposed to play an important role in decreasing the strength of the stretch reflexes during the tracking task as compared with a matched isometric contraction.

Adult↗

Adaptive restriction rules provide functional and safe stimulation pattern for foot drop correction.

We report on our advances in sensory feedback data processing and control system design for functional electrical stimulation (FES) assisted correction of foot drop. We have applied 2 methods of signal purification on the bin integrated electroneurogram (i.e., optimized low pass filtering and wavelet denoising) before training adaptive logic networks (ALN). ALN generated stimulation control pulses, which correspond to the swing phase of the impaired leg when dorsal flexion of the foot is necessary to provide safe ground clearance. However, the obtained control signal contained sporadic stimulation spikes in the stance phase, which can collapse the subject, and infrequent broken stimulation pulses in the swing phase, which can result in unpredictable consequences. In this study, we have introduced adaptive restriction rules (ARR), which are initially used as previously reported and then dynamically adapted during the use of the system. Our results suggest that ARR provide a safer and more reliable stimulation pattern than fixed restriction rules.

Adult↗

On statistical properties of whole nerve cuff recordings.

Whole nerve cuff electrodes can record an electric signal generated by the superposition of single fiber action potentials (AP's). Using a simple stochastic model for the superposition of AP's, the statistical properties of nerve cuff signals are mathematically derived in this study. Consequences of common signal processing methods like rectification and time-averaging are also explained. The nerve cuff signals are found to be approximately identically, independently distributed Gaussian signals with zero mean and varying variance. The spectral properties of the cuff signals generated by single AP shape or different AP shapes are also addressed and investigated by examining the properties of the autocorrelation functions of the nerve cuff signals. The theoretical results were found to be in accordance with computer simulations and processing of actual recorded data.

Action Potentials↗

Control of FES thumb force using slip information obtained from the cutaneous electroneurogram in quadriplegic man.

A tetraplegic volunteer was implanted with percutaneous intramuscular electrodes in hand and forearm muscles. Furthermore, a sensory nerve cuff electrode was implanted on the volar digital nerve to the radial side of the index finger branching off the median nerve. In laboratory experiments a stimulation system was used to produce a lateral grasp (key grip) while the neural activity was recorded with the cuff electrode. The nerve signal contained information that could be used to detect the occurrence of slips and further to increase stimulation intensity to the thumb flexor/adductor muscles to stop the slip. Thereby the system provided a grasp that could catch an object if it started to slip due to, e.g., decreasing muscle force or changes in load forces tangential to the surface of the object. This method enabled an automatic adjustment of the stimulation intensity to the lowest possible level without loosing the grip and without any prior knowledge about the strength of the muscles and the weight and surface texture of the object.

Adult↗

The stretch reflex and H-reflex of the human soleus muscle during walking.

Due to the complexity of applying a well-defined stretch during human walking, most of our knowledge about the short latency stretch reflex modulation in humans is based on H-reflex studies. To illuminate the difference between the two methodologies, both types of reflexes were evoked in the same subjects, same experiment. Stretch reflexes were evoked via a stretch device capable of evoking stretch reflexes of the human soleus muscles during walking. H-reflexes were elicited by an electrical stimulation of the tibial nerve at the popliteal fossa at the knee. A significantly different modulation of the two reflexes was found in the late stance where the stretch reflex decreased in relation to the H-reflex. This was consistent with the unloading of the muscle spindles during the push-off in the late stance, suggesting a complex alpha-gamma coactivation, if any, at this time of the step. The soleus stretch reflex and H-reflex were compared during the stance phase of walking and sitting at matched soleus activity. No difference was found in the amplitude of the stretch reflex. However, there was a significant decrease of the H-reflex during the stance phase of walking, consistent with a task-specific presynaptic mediated reflex control. It is proposed that the short latency stretch reflex during walking is not sensitive to such a presynaptic inhibition.

Adult↗

Interfacing the body's own sensing receptors into neural prosthesis devices.

Functional Electric Stimulation (FES) is today available as a tool in muscle activation used in picking up objects, in standing and walking, in controlling bladder emptying, and for breathing. Despite substantial progress over nearly three decades of development, many challenges remain to provide a more efficient functionality of FES systems. The most important of these is an improved control of the activated muscles. Instead of artificial sensors for feedback, new developments in electrodes to do long-term and reliable recordings from peripheral nerves emphasize the use of the body's own sensors. These are already installed and optimised through millions of years of natural evolution. This paper presents recent results on a system using electrical stimulation of motor nerves to produce movement and using the natural sensors as feedback signals to control the stimulation that can replicate some of the functions of the spinal cord and its communication with the brain. We have used the nerve signal recorded from cutaneous nerves in two different human applications: (1) to replace the external heel switch of a system for correction of spastic drop foot by peroneal stimulation, and (2) to provide an FES system for restoration of hand grasp with sensory feedback from the fingertip. For the bladder function, the sacral root stimulator is a useful control tool in emptying the bladder. To decide when to stimulate, we are at present carrying out experiments on pigs and cats using cuff electrodes on the pelvic nerve and sacral roots to record the neural information from bladder afferents. This information can potentially be used to inhibit unwanted bladder contractions and to trigger the FES system and thereby bladder emptying. Future research will show whether cuffs and other types of electrodes can be used to reliably extract signals from the large number of other receptors in the body to improve and expand on the use of natural sensors in clinical FES systems.

Adult↗

Evidence that a transcortical pathway contributes to stretch reflexes in the tibialis anterior muscle in man.

1. In human subjects, stretch applied to ankle dorsiflexors elicited three bursts of reflex activity in the tibialis anterior (TA) muscle (labelled M1, M2 and M3) at mean onset latencies of 44, 69 and 95 ms, respectively. The possibility that the later of these reflex bursts is mediated by a transcortical pathway was investigated. 2. The stretch evoked a cerebral potential recorded from the somatosensory cortex at a mean onset latency of 47 ms in nine subjects. In the same subjects a compound motor-evoked potential (MEP) in the TA muscle, evoked by magnetic stimulation of the motor cortex, had a mean onset latency of 32 ms. The M1 and the M2 reflexes thus had too short a latency to be caused by a transcortical pathway (minimum latency, 79 ms (47 + 32)), whereas the later part of the M2 and all of the M3 reflex had a sufficiently long latency. 3. When the transcranial magnetic stimulation was timed so that the MEP arrived in the TA muscle at the same time as the M1 or M2 reflexes, no extra increase in the potential was observed. However, when the MEP arrived at the same time as the M3 reflex a significant (P < 0.01) extra-facilitation was observed in all twelve subjects investigated. 4. Peaks evoked by transcranial magnetic stimulation in the post-stimulus time histogram of the discharge probability of single TA motor units (n = 28) were strongly facilitated when they occurred at the same time as the M3 response. This was not the case for the first peaks evoked by electrical transcranial stimulation in any of nine units investigated. 5. We suggest that these findings are explained by an increased cortical excitability following TA stretch and that this supports the hypothesis that the M3 response in the TA muscle is - at least partly - mediated by a transcortical reflex.

Adult↗

Non-noxious stimulation of the glenohumeral joint capsule elicits strong inhibition of active shoulder muscles in conscious human subjects.

Information about the function of joint afferents in humans is scarce. Therefore, we investigated the influence of non-noxious electrical stimulation of the glenohumeral joint capsule on the activity of shoulder muscles in conscious human subjects. Stimulation electrodes were inserted in the joint capsule during arthroscopy. Only when the anterior inferior part of the capsule including the glenohumeral ligament was stimulated a strong and rather long latent general inhibition in voluntarily activated shoulder muscles was observed (average latency and duration: 33 ms and 76 ms, respectively). The inhibition was followed by an excitation and a few but inconsistent oscillations in the muscle activity. The results suggests a potent proprioceptive feedback pathway for the motor control of the human shoulder joint. However, further investigations are needed to clarify the involvement of several possible afferent pathways.

Adult↗

The H-reflex in the passive human soleus muscle is modulated faster than predicted from post-activation depression.

The purpose of the present study was to investigate the influence of afferent activity (mainly homonymous Ia-afferent activity) on the modulation (post-activation depression) of the soleus H-reflex during isolated and passive sinusoidal ankle joint rotations at a speed and amplitude comparable to slow walking. The H-reflex modulation was measured in the relaxed soleus muscle on human subjects during different imposed patterns of 20 degrees haversine ankle joint rotations (0.5-0.6 Hz) while they were sitting comfortably in a chair. Eighteen healthy males and four male patients with clinically complete spinal cord lesion above the soleus motoneuron pool participated in the study. During a single dorsi-plantar flexion rotation the H-reflex was depressed to 27+/-7% (mean+/-S.E.M.) of the initial level within 600 ms. The course of this depression was reversed when the dorsi-flexion velocity started to decrease. At the end of the dorsi-flexion movement the depression was already relieved to a level of 73+/-6% of the initial level. The H-reflex returned more slowly to the initial level within 2 s after the end of the movement cycle. During two consecutive ankle joint rotations and continuous ankle joint rotations both at 0.5 Hz the H-reflex was modulated but also generally depressed while the movement was imposed. The reflex only returned to the reference level after the movements were stopped. These observations indicate the action of a fast and a slow mechanism in the post-activation depression of the soleus H-reflex. The H-reflex modulations observed in the spinal cord injured patients were comparable to the reflex modulations observed in the healthy subjects, except the depressions were smaller. This suggests that a major part of the amplitude of the H-reflex modulation observed in healthy subjects was caused by peripheral and spinal influences. The fast 500 ms recovery of the H-reflex had a time course comparable to presynaptic inhibition. The slow 2 s recovery after the end of a given imposed movement may be explained by a change in the probability of transmitter release from the homonymous soleus Ia-afferent synaptic terminals after repeated activations.

Adult↗

Degeneration and regeneration in rabbit peripheral nerve with long-term nerve cuff electrode implant: a stereological study of myelinated and unmyelinated axons.

Selective and dynamically co-ordinated functional electrical stimulation (FES) of paralysed/paretic limbs in upper motor neuron lesioned people depends on optimal contact at the neural interface. Implanted nerve cuff electrodes may form a stable electrical neural interface, but may also inflict nerve damage. In this study the immediate and long-term effects of cuff implantation on the number and sizes of myelinated and unmyelinated axons have been evaluated with unbiased stereological techniques. Cuff electrodes were implanted in rabbit tibial nerves just below the knee joint, and the stereological analyses were carried out 2 weeks and 16 months after implantation. Myelinated axons were analysed at standardised levels proximal to, underneath, and distal to the cuff; unmyelinated axons underneath the cuff. A 27% loss of myelinated axons was found underneath and distal to the nerve cuff 2 weeks post surgery. All axonal sizes were equally lost except for the very smallest. At 16 months post surgery the number of myelinated axons was restored to control values at both levels. Except for the presence of regenerative sprouts at 2 weeks post surgery, no changes in the number or sizes of unmyelinated axons were revealed at either 2 weeks or 16 months post surgery. Our study demonstrates that implanted cuff electrodes may cause an initial loss of myelinated axons but with subsequent regeneration.

Anatomy, Artistic↗

Experimental muscle pain increases the human stretch reflex.

In this study we investigated the effect of human experimental muscle pain on H- and stretch reflexes as indicators of changes in muscle spindle sensitivity. Fourteen healthy, male volunteers participated in the study. Muscle pain was produced by infusion of 5% hypertonic saline over a period of 10-15 min in m. soleus and in m. tibialis anterior. Reflexes were elicited in the relaxed and active soleus muscle (10-15 Nm ankle torque) before, during and after muscle pain. Control measurements were made with infusions of 0.9% isotonic saline. Surface electromyograms (EMG) were measured from the soleus muscle, and torque was measured from the ankle joint. With pain in the soleus muscle the mechanical stretch reflex response (ankle torque) increased significantly (P = 0.0007) as compared to before pain. With pain in the tibialis anterior muscle both the mechanical and EMG responses increased significantly (P = 0.001; P = 0.0003) as compared to before pain. The H-reflex showed no significant changes during the infusions in either muscles. This study has demonstrated a muscle pain-related increase in the amplitude of the stretch reflex without a corresponding increase in the H-reflex amplitude. One explanation could be an increased dynamic sensitivity of the muscle spindles during muscle pain caused by an increased firing rate in the dynamic gamma-motoneurones. However, the data could not support the vicious cycle model because the excitability of the alpha-motoneurone pool was unchanged.

Adult↗

Digital signal processing algorithms for the detection of afferent nerve activity recorded from cuff electrodes.

Due to the very poor signal-to-noise ratios (SNR's) usually encountered with whole nerve-cuff signals, the processing method typically applied, rectification and windowed (bin)-integration (RBI), can have serious shortcomings in extracting reliable information. In order to improve detection accuracy, these signals were further analyzed using statistical signal detection algorithms based on their second and higher order spectra (HOS). A comparison with both analog and digital RBI processing suggests that the statistical methods, due to their ability to separate the signal and noise subspaces, are superior. It was determined that the noise typically encountered with nerve-cuff electrode signals is normally (Gaussian) distributed. Therefore, third-order statistics can be applied to, ideally, completely reject the noise component. When cutaneous nerve recordings from the calcaneal nerve (innervating the heel area) were used in a drop-foot correction neural prosthesis, the detection percentage and the insensitivity to algorithm parameters were increased through the use of these statistical methods as to warrant their real-time implementation, and the inherent additional processing hardware that entails.

Adult↗

Primate red nucleus discharge encodes the dynamics of limb muscle activity.

We studied the dynamical relationship between magnocellular red nucleus (RNm) discharge and electromyographic (EMG) activity of 10-15 limb muscles in two monkeys during voluntary limb movement. Recordings were made from 158 neurons during two different kinds of limb movement tasks. One was a tracking task in which the subjects were required to acquire targets displayed on an oscilloscope by rotating one of six different single degree of freedom manipulanda. During this task, we recorded the angular position of the manipulandum. The monkeys also were trained in several free-form food-retrieval tasks that were much less constrained mechanically. There was generally significantly greater neuronal discharge during the free-form tasks than during the tracking task. During both types of tasks, cross-correlation and impulse response functions calculated between RNm and EMG were predominantly pulse-shaped, indicating that the dynamics of the RNm discharge were very similar to those of the muscle activity. There was no evidence during either task for a substantial dynamical transformation (e.g., integration) between the two signals as had been previously suggested. In only 15% of the cases, did these correlations have step or pulse-step dynamics. There was a relatively broad, unimodal distribution of lag times between RNm and EMG, based on the time of occurrence of the peak correlation. During tracking, the mode of this distribution was approximately 50 ms, with 80% of the lags falling between -100 and 200 ms. During the free-form task, the mode was between 0 and 20 ms, with 65% of the lags between -100 and 200 ms. A positive lag indicates that RNm discharge preceded EMG. The shape and timing of both the cross-correlation and the impulse response functions were consistent with a model in which many RNm neurons contribute mutually correlated signals which are simply summed within the spinal cord to produce a muscle activation signal.

Animals↗

Sensitivity of H-reflexes and stretch reflexes to presynaptic inhibition in humans.

The sensitivity of soleus H-reflexes, T-reflexes, and short-latency stretch reflexes (M1) to presynaptic inhibition evoked by a weak tap applied to the biceps femoris tendon or stimulation of the common peroneal nerve (CPN) was compared in 17 healthy human subjects. The H-reflex was strongly depressed for a period lasting up to 300-400 ms (depression to 48 +/- 23%, mean +/- SD, of control at a conditioning test interval of 70 ms) by the biceps femoris tendon tap. In contrast, the short-latency soleus stretch reflex elicited by a quick passive dorsiflexion of the ankle joint was not depressed. The soleus T-reflex elicited by an Achilles tendon tap was only weakly depressed (92 +/- 8%). The H-reflex was also significantly more depressed than the T-reflex at long intervals (>15 ms) after stimulation of CPN (H-reflex 63 +/- 14%, T-reflex 91 +/- 13%; P < 0. 01). However, the short-latency (2 ms) disynaptic reciprocal Ia inhibition evoked by stimulation of CPN was equally strong for H- and T-reflexes (H-reflex 72 +/- 10%, T-reflex 67 +/- 13%; P = 0.07). Peaks in the poststimulus time histogram (PSTH) of the discharge probability of single soleus motor units (n = 53) elicited by an Achilles tendon tap had a longer duration than peaks evoked by electrical stimulation of the tibial nerve (on average 5.0 ms as compared with 2.7 ms). All parts of the electrically evoked peaks were depressed by the conditioning biceps femoris tendon tap (average depression to 55 +/- 27% of control; P < 0.001). A similar depression was observed for the initial 2 ms of the peaks evoked by the Achilles tendon tap (69 +/- 48%; P < 0.001), but the last 2 ms were not depressed. Conditioning stimulation of the CPN at long intervals (>15 ms) also depressed all parts of the electrically evoked PSTH peaks (n = 34; average 65%; P < 0.001) but had only a significant effect on the initial 2 ms of the peaks evoked by the Achilles tendon tap (85%; P < 0.001). We suggest that the different sensitivity of mechanically and electrically evoked reflexes to presynaptic inhibition is caused by a difference in the shape and composition of the excitatory postsynaptic potentials underlying the two reflexes. This difference may be explained by a different composition and/or temporal dispersion of the afferent volleys evoked by electrical and mechanical stimuli. We conclude that it is not straightforward to predict the modulation of stretch reflexes based on observations of H-reflex modulation.

Adult↗

Natural versus artificial sensors applied in peroneal nerve stimulation.

We have attempted to quantify the performance of natural versus artificial sensors when used in a closed-loop functional electrical stimulation system. Peroneal nerve stimulation was applied during gait to a multiple sclerosis subject with a drop foot. Stimulation was applied only during the swing phase to provide artificially induced dorsiflexion of the foot. Detection of the onset of the stance phase was accomplished using a standard heel contact switch mounted inside the subject's shoe (the artificial sensor) and using processed nerve signals derived from an implanted nerve-cuff electrode (the natural sensor). A detection percentage of at least 85% was achieved using the afferent nerve signal information only. When muscle activity (also recorded in the cuff) and additional information about the gait cycle were incorporated, functional detection ratios approaching 100% were achieved.

Adult↗