System, method, and apparatus for applying transcutaneous electrical stimulation
A system, method, and apparatus for treating a medical condition by applying transcutaneous electrical stimulation to a target peripheral nerve of a subject. Electrical stimulation is applied to the peripheral nerve via a stimulation electrode pattern under closed-loop control in which EMG responses are monitored and used to adjust stimulation parameters. In response to detecting an unacceptable recording, electrical stimulation is applied to the peripheral nerve under open-loop control.
1. A method for applying transcutaneous electrical stimulation to a target peripheral nerve of a subject, comprising:
positioning a plurality of stimulation electrodes on a skin surface proximate the targeted peripheral nerve, the stimulation electrodes being spaced from each other in a predetermined configuration;
positioning one or more recording electrodes on a skin surface at a location where electromyogram (EMG) responses to electrical stimulation of the targeted peripheral nerve can be detected;
stimulating the peripheral nerve by applying transcutaneous electrical stimulation pulses via the stimulation electrodes under closed-loop control in which EMG responses are monitored via the recording electrodes and stimulation parameters can be adjusted in response to the monitored EMG responses; and
in response to detecting a predetermined condition of the recording electrodes, applying transcutaneous electrical stimulation pulses via the stimulation electrodes according to the stimulation parameters under open-loop control in which the stimulation parameters are maintained irrespective of a feedback signal from the recording electrodes.
2. The method recited in claim 1 , wherein the predetermined condition of the recording electrodes comprises an impedance measurement that falls outside a predetermined range.
3. The method recited in claim 1 , wherein the step of applying transcutaneous electrical stimulation pulses further comprises monitoring for mechanomyogram (MMG) responses to the transcutaneous electrical stimulation pulses and applying the transcutaneous electrical stimulation pulses under closed-loop control in which the stimulation parameters are adjusted in response to the monitored MMG responses.
4. The method recited in claim 1 , wherein the step of applying transcutaneous electrical stimulation pulses comprises detecting impedances of the recording electrodes and, in response to detecting an impedance of the recording electrodes that falls outside a predetermined range, applying the transcutaneous electrical stimulation pulses.
5. The method recited in claim 1 , further comprising:
obtaining sample measurements via the recording electrodes;
checking the sample measurements for noise;
checking the sample measurements for voluntary EMG responses;
applying the transcutaneous electrical stimulation pulses under closed-loop control in response to determining a level of noise that falls within a predetermined range and the absence of voluntary EMG responses; and
applying the transcutaneous electrical stimulation pulses under open-loop control in response to determining a level of noise that falls outside a predetermined range or the presence of voluntary EMG responses.
6. The method recited in claim 1 , wherein the step of stimulating the peripheral nerve by applying transcutaneous electrical stimulation pulses comprises:
applying the transcutaneous electrical stimulation pulses;
recording, via the recording electrodes, EMG responses occurring a predetermined time after applying the transcutaneous electrical stimulation pulses; and
adjusting the stimulation parameters in response to the recorded EMG responses.
7. The method recited in claim 1 , wherein the duration of the predetermined time is 5 ms or less.
8. The method recited in claim 6 , wherein adjusting the stimulation parameters in response to the recorded EMG responses under closed loop control comprises:
increasing the amplitude of subsequent transcutaneous electrical stimulation pulses in response to the recorded EMG responses being below a predetermined EMG window;
decreasing the amplitude of subsequent transcutaneous electrical stimulation pulses in response to the recorded EMG responses being above the predetermined EMG window; and
maintaining the amplitude of subsequent transcutaneous electrical stimulation pulses in response to the recorded EMG responses being within the predetermined EMG window.
9. The method recited in claim 1 , wherein each application of an electrical stimulation pulse under open-loop control comprises:
applying the electrical stimulation pulse; and
executing a time delay having a duration sufficient to maintain a constant stimulation period.
10. The method recited in claim 9 , wherein the duration of the time delay is 75 ms.
11. The method recited in claim 1 , wherein stimulating the peripheral nerve comprises stimulating the tibial nerve.
12. The method recited in claim 1 , wherein stimulating the peripheral nerve comprises stimulating the tibial nerve at a location between the medial malleolus and the Achilles tendon.
13. The method recited in claim 1 , wherein monitoring EMG responses comprises recording EMG signals that result from recruitment of the tibial nerve's motor fibers.
14. The method recited in claim 1 , wherein monitoring EMG responses comprises positioning the recording electrodes on the bottom of the subject's foot near the abductor hallucis and the flexor hallucis brevis to record the EMG signals.
15. The method recited in claim 1 , wherein stimulating the peripheral nerve comprises stimulating the tibial nerve to treat overactive bladder, sexual dysfunction, or plantar fasciitis.
16. The method recited in claim 1 , wherein stimulating the peripheral nerve comprises stimulating at least one of the ulnar nerve and/or and the median nerve for pain management in carpal tunnel syndrome, hypertension management, and nerve conduction study/nerve injury diagnosis for median/ulnar nerve neuropathy.
17. The method recited in claim 1 , wherein stimulating the peripheral nerve comprises stimulating at least one of the ulnar nerve and the median nerve to treat carpal tunnel syndrome or hypertension.
18. The method recited in claim 1 , wherein stimulating the peripheral nerve comprises stimulating at least one of the ulnar nerve and the median nerve to perform a nerve conduction study or nerve injury diagnosis.
19. The method recited in claim 18 , wherein:
stimulating at least one of the ulnar nerve and the median nerve comprises positioning the stimulating electrodes on the inside of the lower arm 0 to 20 cm from the wrist line; and
recording EMG responses comprises at least one of positioning the recording electrodes on the base of thumb to record signal from abductor/flexor pollicis brevis and positioning the recording electrodes on the base of pinky to record signal from abductor/flexor digiti minimi brevis.
20. The method recited in claim 1 , wherein stimulating the peripheral nerve comprises applying the transcutaneous electrical stimulation pulses to the peripheral nerve to enhance nerve regeneration after peripheral nerve injury.
21. A system for applying transcutaneous electrical stimulation to a peripheral nerve of a subject, comprising:
a plurality of electrical stimulation electrodes, the stimulation electrodes being spaced from each other in a predetermined configuration;
one or more recording electrodes;
a structure for supporting the stimulation electrodes and the recording electrodes; and
a control unit for controlling the operation of the stimulation electrodes and the recording electrodes, wherein the control unit is configured to perform the method of claim 1 .