title: Selective activation of the human tibial and common peroneal nerves with a flat interface nerve electrode.
abstract: OBJECTIVE
  Electrical stimulation has been shown effective in restoring basic lower extremity motor function in individuals with paralysis. We tested the hypothesis that a flat interface nerve electrode (FINE) placed around the human tibial or common peroneal nerve above the knee can selectively activate each of the most important muscles these nerves innervate for use in a neuroprosthesis to control ankle motion.
  
  
  METHODS
  During intraoperative trials involving three subjects, an eight-contact FINE was placed around the tibial and/or common peroneal nerve, proximal to the popliteal fossa. The FINE's ability to selectively recruit muscles innervated by these nerves was assessed. Data were used to estimate the potential to restore active plantarflexion or dorsiflexion while balancing inversion and eversion using a biomechanical simulation.
  
  
  RESULTS
  With minimal spillover to non-targets, at least three of the four targets in the tibial nerve, including two of the three muscles constituting the triceps surae, were independently and selectively recruited in all subjects. As acceptable levels of spillover increased, recruitment of the target muscles increased. Selective activation of muscles innervated by the peroneal nerve was more challenging.
  
  
  CONCLUSIONS
  Estimated joint moments suggest that plantarflexion sufficient for propulsion during stance phase of gait and dorsiflexion sufficient to prevent foot drop during swing can be achieved, accompanied by a small but tolerable inversion or eversion moment.
authors.affiliation: Louis Stokes Cleveland Department of Veterans' Affairs Medical Center, Cleveland OH, USA. Department of Biomedical Engineering, Case Western Reserve University, Cleveland OH, USA. MetroHealth Medical Center, Cleveland OH, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Schiefer
authors.forename: M
authors.initials: M
authors.lastname: Freeberg
authors.forename: G J C
authors.initials: GJ
authors.lastname: Pinault
authors.forename: J
authors.initials: J
authors.lastname: Anderson
authors.forename: H
authors.initials: H
authors.lastname: Hoyen
authors.forename: D J
authors.initials: DJ
authors.lastname: Tyler
authors.forename: R J
authors.initials: RJ
authors.lastname: Triolo
mesh_terms: D004558:Electric Stimulation / Q000295:instrumentation*; D004567:Electrodes, Implanted; D004576:Electromyography; D004867:Equipment Design; D005684:Gait / Q000502:physiology; D006801:Humans; D007596:Joints / Q000502:physiology; D007717:Knee / Q000294:innervation / Q000502:physiology; D009068:Movement / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D010543:Peroneal Nerve / Q000033:anatomy & histology / Q000502:physiology*; D011999:Recruitment, Neurophysiological; D013979:Tibial Nerve / Q000033:anatomy & histology / Q000502:physiology*
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