System, method, and apparatus for applying electrical stimulation

1 . A method for treating a medical condition by delivering electrical stimulation to a target peripheral nerve of a subject, comprising:

positioning a plurality of stimulation electrodes in a predetermined configuration proximate the target peripheral nerve;

positioning one or more recording electrodes remote from the stimulation electrodes at a location where electromyogram (EMG) responses to electrical stimulation of the target peripheral nerve can be detected;

localizing the target peripheral nerve by applying electrical stimulation pulses to the target peripheral nerve via the plurality of stimulation electrodes with different stimulation energies, monitoring via the recording electrodes the EMG responses elicited by each electrical stimulation pulse, and identifying pulse energies that elicit an acceptable activation of the target peripheral nerve;

in response to identifying pulse energies that elicit an acceptable activation of the target peripheral nerve, initially delivering stimulation to the target peripheral nerve by applying electrical stimulation pulses via the stimulation electrodes at the identified pulse energies that elicited the acceptable activation of the target peripheral nerve; and

thereafter delivering electrical stimulation to the target peripheral nerve to treat the medical condition by controlling the delivery of stimulation to the target peripheral nerve using closed-loop control in which EMG responses to the electrical stimulation pulses are monitored via the recording electrodes and stimulation parameters are adjusted in response to the monitored EMG responses, and

while electrical stimulation is being delivered to the target peripheral nerve under closed-loop control, performing an integrity check comprising applying, between stimulation pulses, a low-level current across the stimulation electrodes selected so as not to interfere with EMG measurements by the recording electrodes, and detecting a response to the low-level current via the stimulation electrodes to complete the integrity check.

2 . The method recited in claim 1 , wherein the stimulation parameters comprise at least one of an amplitude of the electrical stimulation pulses, a modulation pattern of the electrical stimulation pulses, the frequency of the electrical stimulation pulses, the duration of the electrical stimulation pulses, and the polarity of the stimulation electrodes.

3 . The method recited in claim 1 , wherein controlling the delivery of stimulation to the target peripheral nerve using closed-loop control comprises:

obtaining EMG measurements via the recording electrodes;

checking the EMG measurements for at least one of noise and voluntary EMG responses; and

applying the electrical stimulation pulses under closed-loop control in response to determining an acceptable level of noise and/or the absence of voluntary EMG responses.

4 . The method recited in claim 1 , wherein controlling the delivery of stimulation to the target peripheral nerve using closed-loop control comprises:

applying the electrical stimulation pulse; implementing a time delay;

recording EMG responses via the recording electrodes after the time delay; and

adjusting the stimulation parameters in response to the recorded EMG responses.

5 . The method recited in claim 4 , wherein the duration of the time delay is about 5 ms or less.

6 . The method recited in claim 4 , wherein adjusting the stimulation parameters in response to the recorded EMG responses under closed loop control comprises:

adjusting the stimulation parameters of subsequent stimulation pulses in response to the recorded EMG responses being outside a predetermined EMG window; and

maintaining the stimulation parameters of subsequent stimulation pulses in response to the recorded EMG responses being within the predetermined EMG window.

7 . The method recited in claim 4 , wherein adjusting the stimulation parameters in response to the recorded EMG responses under closed loop control comprises:

increasing the output of subsequent stimulation pulses in response to the recorded EMG responses being below a predetermined EMG window;

decreasing the output of subsequent stimulation pulses in response to the recorded EMG responses being above the predetermined EMG window; and

maintaining the output of subsequent stimulation pulses in response to the recorded EMG responses being within the predetermined EMG window.

8 . The method recited in claim 1 , further comprising:

detecting an unacceptable condition of the recording electrodes in response to failing to elicit an acceptable activation of the target peripheral nerve when localizing the target peripheral nerve during the localizing step; and

in response to detecting the unacceptable condition of the recording electrodes, controlling the delivery of stimulation to the target peripheral nerve using open-loop control in which stimulation is delivered to the target peripheral nerve using stimulation parameters applied without regard to the monitored EMG responses.

9 . The method recited in claim 8 , wherein each application of an electrical stimulation pulse under open-loop control comprises:

applying the electrical stimulation pulse; and

executing a time gap having a duration sufficient to maintain a stimulation period that is constant with a stimulation period of closed-loop control.

10 . The method recited in claim 9 , wherein the duration of the time gap is about 75 ms.

11 . The method recited in claim 8 , wherein the unacceptable condition of the recording electrodes comprises at least one of an unacceptable impedance measurement, an unacceptable noise measurement, or the detection of a voluntary EMG response.

12 . The method recited in claim 1 , wherein the nerve localization step comprises:

checking the sample measurements for at least one of noise and voluntary EMG responses;

controlling the delivery of stimulation to the target peripheral nerve using closed-loop control in response to determining an acceptable recording electrode impedance and an acceptable level of noise and/or the absence of voluntary EMG responses; and

controlling the delivery of stimulation to the target peripheral nerve using open-loop control in response to determining an unacceptable recording electrode impedance, an unacceptable level of noise, or the presence of voluntary EMG responses.

13 . The method recited in claim 1 , wherein the plurality of stimulation electrodes comprises three or more stimulation electrodes, and wherein localizing the target peripheral nerve comprises applying electrical stimulation pulses to the target peripheral nerve via different combinations of the plurality of stimulation electrodes with different stimulation energies, monitoring via the recording electrodes the EMG responses elicited by each electrical stimulation pulse, and identifying both the stimulation electrode combinations and the pulse energies that elicit an acceptable activation of the target peripheral nerve.

14 . The method recited in claim 13 , wherein initially delivering stimulation to the target peripheral nerve comprises applying electrical stimulation pulses via the identified combinations of stimulation electrodes at the identified pulse energies that elicited the acceptable activation of the target peripheral nerve; and

wherein delivering electrical stimulation to the target peripheral nerve to treat the medical condition by controlling the delivery of stimulation to the target peripheral nerve using closed-loop control comprises delivering electrical stimulation via the identified combinations of stimulation electrodes.

15 . The method recited in claim 1 , wherein stimulating the peripheral nerve comprises stimulating the tibial nerve, and wherein monitoring the EMG responses via the recording electrodes comprises recording EMG signals that result from recruitment of the tibial nerve's motor fibers.

16 . The method recited in claim 15 , wherein positioning a plurality of stimulation electrodes comprises positioning the plurality of stimulation electrodes at a location between the medial malleolus and the Achilles tendon, and wherein positioning one or more recording electrodes comprises positioning the one or more recording electrodes on the bottom of the subject's foot near the abductor hallucis and the flexor hallucis brevis.

17 . The method recited in claim 1 , wherein the medical condition comprises pelvic floor dysfunction.

18 . The method recited in claim 1 , wherein the medical condition comprises bladder dysfunction.

19 . The method recited in claim 1 , wherein the medical condition comprises urinary incontinence, which comprises at least one of urge incontinence, overactive bladder (OAB), mixed incontinence, and overflow incontinence.

20 . The method recited in claim 1 , wherein the medical condition comprises voiding dysfunction, which comprises at least one of urinary incontinence, urinary retention conditions, high urinary frequency, high frequency of voiding, low frequency of voiding, underactive bladder, symptoms of bladder/pelvic pressure/pain, detrusor hyperrflexia, and voiding disorders caused by nerve damage, including interstitial cystitis.

21 . The method recited in claim 1 , wherein the medical condition comprises bowel dysfunction.

22 . The method recited in claim 1 , wherein the medical condition comprises constipation, idiopathic constipation, fecal incontinence, problems with fecal movement, problems with fecal voiding, and problems with fecal containment.

23 . The method recited in claim 1 , wherein the medical condition comprises improving pelvic floor function bowel dysfunction.

24 . The method recited in claim 1 , wherein delivering electrical stimulation to the target peripheral nerve to treat the medical condition comprises stimulating the ulnar nerve and/or median nerve for pain management in carpal tunnel syndrome, hypertension management, and nerve conduction study/nerve injury diagnosis for median/ulnar nerve neuropathy.

25 . The method recited in claim 1 , wherein delivering electrical stimulation to the target peripheral nerve to treat the medical condition comprises stimulating the ulnar nerve and/or median nerve to treat carpal tunnel syndrome or hypertension.

26 . The method recited in claim 1 , wherein delivering electrical stimulation to the target peripheral nerve to treat the medical condition comprises stimulating the ulnar nerve and/or median nerve to perform a nerve conduction study or nerve injury diagnosis.

27 . The method recited in claim 1 , wherein delivering electrical stimulation to the target peripheral nerve to treat the medical condition comprises applying the electrical stimulation pulses to the peripheral nerve to enhance nerve regeneration after peripheral nerve injury.

28 . The method recited in claim 1 , wherein delivering electrical stimulation to the target peripheral nerve to treat the medical condition comprises applying the electrical stimulation pulses to the peripheral nerve to treat pelvic pain.

29 . The method recited in claim 1 , wherein delivering electrical stimulation to the target peripheral nerve to treat the medical condition comprises applying the electrical stimulation pulses to the peripheral nerve to treat peripheral neuropathy.

30 . A system for treating a medical condition by applying electrical stimulation to a target peripheral nerve of a subject, comprising:

a plurality of electrical stimulation electrodes; one or more recording electrodes; and

a control unit for controlling the operation of the stimulation electrodes and the recording electrodes according to the method of claim 1 .

31 . A controller for controlling the operation of a plurality of electrical stimulation electrodes and one or more recording electrodes to treat a medical condition by applying electrical stimulation to a target peripheral nerve of a subject according to the method of claim 1 .