Perspectives on new electrode technology for stimulating peripheral nerves with implantable motor prostheses

The limits of present electrode technology are being reached in current motor prostheses for restoring functional movement in paralyzed people. Improved devices require electrodes and stimulation methods that will activate muscles selectively and independently with less implanted hardware. A practical functional neuromuscular stimulation (FNS) system may need to employ extraneural, intraneural, epimysial, or intramuscular electrodes or a combination of these types. The limitations of current muscle electrodes and the anatomy of peripheral nerve innervation of muscle have pointed to stimulation of peripheral nerve trunks as a promising area for investigation. Attempts to use conventional (extraneural) peripheral nerve electrodes for selective activation of muscles in chronic applications have met with only limited success. Intraneural (intrafascicular) electrodes offer the advantages of greater selectivity and lower power requirements, but these may be offset by the difficulty of inserting delicate electrodes through the collagenous epineurium and perineurium while avoiding unacceptable amounts of trauma. Cuff electrodes require more power than intrafascicular ones but may provide more stable recruitment patterns over time, and the opportunity for retrieval and replacement