Abstract
Sequential stimulation during one muscle contraction of several compartments of a motor nerve, using multiple-electrodes, allows individual nerve-muscle compartments to be stimulated at fairly low frequencies. This provides time for recovery even during muscle contraction. However, the whole muscle is stimulated at near to its optimum fusion frequency, which provides smooth muscle contraction. This stimulation system imitates the natural activation of skeletal muscle. The new phrenic nerve stimulator described utilises the principle of sequential motor nerve stimulation. It also incorporates a sigh function. The sigh current recruits additional axons at certain intervals and thus creates and keeps available a reserve of conditioned muscle. Clinical advantages result: the conditioning phase after the beginning of long-term phrenic nerve stimulation for electroventilation is shortened and muscle fatigue is delayed. A need of increase of gas exchange can be answered by increasing tidal volume instead of respiration rate alone.
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Baer, G. A. andTalonen, P. P. (1987) International symposium on implanted phrenic nerve stimulators for respiratory insufficiency (meeting summary).Ann. Clin. Res.,19, 399–402.
Brummer, S. B. andTurner, M. J. (1975) Electrical stimulation of the nervous system: the principle of safe charge injection with noble metal electrodes.Bioelectrochem. Bioenergetics,2, 13–25.
Brummer, S. B. andTurner, M. J. (1977a) Electrochemical considerations for safe electrical stimulation of the nervous system with platinum electrodes.IEEE Trans.,BME-24, 59–63.
Brummer, S. B. andTurner, M. J. (1977b) Electrical stimulation with Pt electrodes: II—Estimation of maximum surface redox (theoretical non-gassing) limits. —Ibid. -24, 440–443.
Dymond, A. M. (1976) Characteristics of the metal-tissue interface of stimulation electrodes. —Ibid. -23, 204–280.
Edwards, R. H. T. (1979) The diaphragm as a muscle: mechanics underlying fatigue.Am. Rev. Respirat. Dis.,119, 81–84.
Edwards, R. H. T. andFaulkner, J. A. (1985) Structure and function of the respiratory muscle. In the thorax, PartA. Roussos, C. andMacklem, P. T. (Eds.), InLung biology in health and disease, Vol. 29.Lenfant, C. (Ed.), Marcel Dekker, 297–362.
Glenn, W. W. L. (1978) Diaphragm pacing: present status.Pace,1, 357–370.
Glenn, W. W. L., Phelps, M. andGersten, L. M. (1978) Diaphragm pacing in the treatment of central alveolar hypoventilation. InSleep apnea syndromes. 333–345.Guileminault, C. andDement, W. (Eds.), Kroc Found. Series, Vol. 2, A. R. Liss Inc., New York, 333–345.
Glenn, W. W. L., Hogan, J. F. andPhelps, M. L. (1980) Ventilatory support of the quadriplegic patient with respiratory paralysis by diaphragm pacing.Surg. Clin. N. Am.,60, 1055–1078.
Glenn, W. W. L., Hogan, J. F., Loke, J. S. O., Ciesielski, T. E., Phelps, M. L. andRowedder, R. (1984) Ventilatory support by pacing of the conditioned diaphragm in quadriplegia.N. Engl. J. Med.,310, 1150–1155.
Glenn, W. W. L. andPhelps, M. L. (1985) Diaphragm pacing by electrical stimulation of the phrenic nerve. Review article.Neurosurg.,17, 974–984.
Glenn, W. W. L. andSairenji, H. (1985) Diaphragm pacing in the treatment of chronic ventilatory insufficiency. InThe thorax, Part B. 1407–1440.Roussos, C. andMacklem, P. T. (Eds.), Marcel Dekker Inc., New York, Basel, 1407–1440.
Henneman, E., Somjen, G. andCarpenter, D. O. (1965) Functional significance of cell size in spinal motoneurons.J. Neurophysiol.,28, 560–580.
Holle, J., Moritz, E., Thoma, H. andLischka, A. (1974) Die Karusselstimulation, eine neue Methode zur elektrophrenischen Langzeitbeatmung.Wien. Klin. Wochenschr.,86, 23–27.
Kaneyuki, T., Hogan, J. F., Glenn, W. W. L. andHolcomb, W. G. (1977) Diaphragm pacing: evaluation of current waveforms for effective ventilation.J. Thor. Cardiovasc. Surg.,74, 109–115.
Lieberman, D. A., Faulkner, J. A., Craig, A. B. andMaxwell A. C. (1973) Performance and histochemical composition of guinea pig and human diaphragm.J. Appl. Physiol.,34, 233–237.
Lilly, J. C. andHughes, J. R. (1955) Brief, noninjurious electric waveform for stimulation of the brain.Science,121, 468–469.
McComas, A. J. (1977)Neuromuscular function and disorders. Butterworths, London, 66–85.
Oda, T., Glenn, W. W. L., Fukuda, Y., Hogan, J. F. andGorfien, J. (1981) Evaluation of electrical parameters for diaphragm pacing: an experimental study.J. Surg. Res.,30, 142–153.
Patton, H. D. (1965) Special properties of nerve trunk and tracts. InNeurophysiology, 2nd ednRuch, T. C., Patton, H. D. andWoodbury, J. W. (Eds.), W. B. Saunders Philadelphia, London, 73–94.
Peckham, P. H., van der Meulen, J. P. andReswick, J. B. (1970) Electrical activation of skeletal muscle by sequential stimulation. InThe nervous system and electrical currents.Wulfson, N. andSances, A. Jr. (Eds.), Plenum Press, New York, 45–50.
Roussos, C. S. andMacklem, P. T. (1977) Diaphragmatic fatigue in man.J. Appl. Physiol: Respirat. Environ. Exercise Physiol.,43, 189–197.
Sairenji, H., Hogan, J. F. andGlenn, W. W. L. (1984) Influence of phrenic nerve stimulation on diaphragm blood flow. InProgress in artificial organs.Atsumi, K., Maekawa, M., Ota, K. (Eds.), Cleveland, ISAO Press, 946–952.
Salmons, S. (1980) Functional adaptation in skeletal muscle.Trends Neurosci.,3, 134–137.
Salmons, S. andHenriksson, J. (1981) The adaptive response of skeletal muscle to increased use.Muscle & Nerve,4, 94–105.
Talonen, P., Malmivuo, J., Baer, G., Markkula, H. andHäkkinen, V. (1983) Transcutaneous, dual channel phrenic nerve stimulator for diaphragm pacing.Med. & Biol. Eng. & Comput.,21, 21–30.
Talonen, P., Baer, G., Huhti, M. andHäkkinen, V. (1985a) Control of muscle force by sequential motor unit stimulation of peripheral nerves. Proc. 14th Int. Conf. on Med. & Biol. Eng. and 7th Int. Conf. on Med. Physics, Espoo, Finland, 11th–16th Aug. 1985,Med. & Biol. Eng. & Comput.,23, Suppl., Part 1, 396–397.
Talonen, P., Baer, G., Häkkinen, V. andMarkkula, H. (1985b) Diaphragmatic pacing: technical and clinical progress during treatment of three patients. Proc. 14th Int. Conf. on Med. & Biol. Eng. and 7th Int. Conf. on Med. Physics, Espoo, Finland, 11th–16th Aug. 1985,Med. & Biol. Eng. & Comput.,23, Suppl., Part 1, 408–409.
Tanae, H., Holcomb, W. G., Yasuda, R., Hogan, J. F. andGlenn, W. W. L. (1973) Electrical nerve fatigue: advantages of an alternating bidirectional waveform.J. Surg. Res.,15, 14–21.
Thoma, H. (1975) Vorrichtung zur örtlich und zeitlich variablen elektrischen Reizstrom-Langzeitstimulation eines Reizobjektes wie Nerven und Muskeln. Austrian patent 330342.
Weinman, J. (1965) Biphasic stimulation and electrical properties of metal electrodes.J. Appl. Physiol.,20, 787–790.
Woodbury, B. J., Gordon, A. M. andConrad, J. T. (1965) Muscle. InNeurophysiology, 2nd edn.Ruch, T. C., Patton, H. D. andWoodbury, J. W. (Eds.), W. B. Saunders, Philadelphia, London, 113–152.
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Talonen, P.P., Baer, G.A., Häkkinen, V. et al. Neurophysiological and technical considerations for the design of an implantable phrenic nerve stimulator. Med. Biol. Eng. Comput. 28, 31–37 (1990). https://doi.org/10.1007/BF02441674
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DOI: https://doi.org/10.1007/BF02441674