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Lack of human morphometric data regarding the largest nerve fibers in the dorsal columns (DC's) of the spinal cord has lead to the estimation of the diameters of these fibers from clinical data retrieved from patients with a new spinal cord stimulation (SCS) system. These patients indicated the perception threshold of stimulation induced paresthesia in various body segments, while the stimulation amplitude was increased. The fiber diameters were calculated with a computer model, developed to calculate the effects of SCS on spinal nerve fibers. This computer model consists of two parts: 1) a three-dimensional (3-D) volume conductor model of a spinal cord segment in which the potential distribution due to electrical stimulation is calculated and 2) an electrical equivalent cable model of myelinated nerve fiber, which uses the calculated potential field to determine the threshold stimulus needed for activation. It is shown that the largest fibers in the medial DC's are significantly smaller than the largest fibers in the lateral parts. This finding is in accordance with the fiber distribution in cat, derived from the corresponding propagation velocities. Moreover, it is shown that the mediolateral increase in fiber diameter is mainly confined to the lateral parts of the DC's. Implementation of this mediolateral fiber diameter distribution of the DC's in the computer model enables the prediction of the recruitment order of dermatomal paresthesias following increasing electrical stimulation amplitude. Index Terms - Computer modeling, dorsal columns, fiber diameter, spinal cord stimulation.

A model is presented that calculates the single-fiber extracellular field and action potential (ap) of an active myelinated nerve fiber placed centrally or eccentrically inside a nerve with a cylindrical geometry, representing essentially a one-fascicle nerve. This one-fascicle nerve has the dimensions and conductivities of the rat peroneal nerve branch. The results show a wide variety of wave shapes to be measured, depending on the position of the intraneural electrode with respect to the fiber axis and to the nodes of Ranvier and depending on the presence of an isolating cuff around the nerve. Action potential shapes may range from the 'classical' quasi-biphasic one, to more triphasic, or even more complicated in the case of a short insulating cuff being present around the nerve. In the latter case, when measured bipolarly, ap-wave shapes become almost monophasic. Index Terms - Action potential (ap) recording, extracellular ap modeling, functional electric stimulation and recording, nerve cuff, selective recording.

Experimental analysis of transmembrane currents during action potentials in mammalian skeletal muscle fibers, using loose patch-clamp technique identifies three current components, namely a capacitive, an inward sodium and an outward potassium current. Potassium channel activity is unavailable for loose patch extracellular voltage-clamp stimulation and only sodium current occurs with extracellularly applied depolarization steps. The potassium current is, however, crucial for depolarization of the intracellular action potential of muscle fibers.

In epidural spinal cord stimulation it is likely that not only dorsal column fibers are activated, but that dorsal root fibers will be involved as well. In this investigation a volume conductor model of the spinal cord was used and dorsal root fibers were modeled by an electrical network including fiber excitation. The effects of varying some geometrical fiber characteristics, as well as the influence of the dorsal cerebrospinal fluid layer and the electrode configuration on the threshold stimulus for their excitation, were assessed. The threshold values were compared with those of dorsal column fibers. The results of this modeling study predict that, besides the well known influence of fiber diameter, the curvature of the dorsal root fibers and the angle between these fibers and the spinal cord axis were of major influence on their threshold values. Because of these effects, threshold stimuli of dorsal root fibers were relatively low as compared to dorsal column fibers. Excitation of the dorsal root fibers occurred near the entry point of the fibers.

An electrical network model of myelinated dorsal column nerve fibers is presented. The effect of electrical stimulation was investigated using both a homogeneous volume conductor and a more realistic model of the spinal cord. An important feature of dorsal column nerve fibers is the presence of myelinated collaterals perpendicular to the rostro-caudal fibers. It was found that transmembrane potentials, due to external monopolar stimulation, at the node at which a collateral is attached, is significantly influenced by the presence of the collateral. It is concluded that both excitation threshold and blocking threshold of dorsal column fibers are decreased up to 50% compared to unbranched fibers.

A model is designed to simulate the response of myelinated nerve fibers in a cylindrical fiber bundle to electrodes positioned selectively inside the musclebundle. The experimental model hopes to establish selectivity and eliminate discrepancies caused by movement and muscle contraction created by surface electrodes on the skin. The two-part model consists of a lumped electrical network and an analytical expression of the cylindrical geometry of the nerve bundle. Results show better spatial selectivity and lesser sensitivity to the surrounding medium with tripolar stimulation.

The prerequisites for stable crutch supported standing were analyzed in this paper. For this purpose, a biomechanical model of crutch supported paraplegic stance was developed assuming the patient was standing with extended knees. When using crutches during stance, the crutches will put a position constraint on the shoulder, thus reducing the number of degrees of freedom. Additional hip-joint stiffness was applied to stabilize the hip joint and, therefore, to stabilize stance. The required hip-joint stiffness for changing crutch placement and hip-joint offset angle was studied under static and dynamic conditions. Modeling results indicate that, by using additional hip-joint stiffness, stable crutch supported paraplegic standing can be achieved, both under static as well as dynamic situations. The static equilibrium postures and the stability under perturbations were calculated to be dependent on crutch placement and stiffness applied. However, postures in which the hip joint was in extension (C postures) appeared to the most stable postures. Applying at least 60 N · m/rad hip-joint stiffness gave stable equilibrium postures in all cases. Choosing appropriate hip-joint offset angles, the static equilibrium postures changed to more erect postures, without causing instability or excessive arm forces to occur. Index Terms—Biomechanics; control systems; data processing; modeling; orthosis; paraplegic standing; simulation. [ABSTRACT FROM AUTHOR]

Paraplegic persons can stand with hip-knee-ankle-foot orthoses (HKAFO) and crutches. However, current HKAFOs restrict body movement extensively, which may impede functional upper-body movements. A more compliant body support using a more compliant orthosis or well-controlled functional electrical stimulation system may increase freedom of movement to the user, but should not impede stability and required arm support. In the current study, we investigated the consequences of varying stiffness applied at the hip to postural stability and required crutch force during paraplegic stance. Experiments were performed on five paraplegic persons with spinal cord lesions varying from T1 to T12. Static postures and dynamic responses to perturbations were tested for varying hip stiffness and crutch placements. The minimal hip-joint stiffness for stable stance appeared to depend on lesion level. In contrast to the predictions of a previous modeling study, no statistically significant influences of hip-joint stiffness or crutch-to-foot distance on posture and applied crutch forces were found. It is hypothesized that the main reasons of this discrepancy are the active upper-body efforts the paraplegic HKAFO users are still able to exert and the remaining flexibility of the upper trunk and shoulder region, which is present despite the restrictions of the orthosis. Index TermsαBiomechanics; control systems; data processing; orthosis; paraplegic standing. [ABSTRACT FROM AUTHOR]