Every year 1.4 million people will suffer from a traumatic brain injury (TBI). The Centers for Disease Control (CDC) estimates that there are over 5.3 million TBI survivors living in the United States, or about two percent of the population, living with long-term effects or in need of lifelong help. Estimations have been made that with both the direct and indirect costs of medical bills and productivity loss in the United States the total cost for TBI was 60 billion dollars in 2000. Sensory stimulation consists of visual, tactile, auditory, gustatory, and-olfactory stimuli that attempt to increase the levels of conscio-µsness in TBI patients by enhancing synaptic reinnervation in the brain. Sensory stimulation has been around since the 1980's and has been found to be beneficial for TBI patients, however, no guidelines have been created for nurses and other health care providers to perform this program. By making guidelines for nurses and other health care providers that outline the proper procedure of this treatment, the cost for care of TBI patients will decrease, therefore positively impacting the health care system.

La stimulation cérébrale profonde (SCP) est une procédure chirurgicale utilisée dans le traitement de divers contextes pathologiques. Ce système, composé d’électrodes implantées dans une région cible du cerveau et d’un neurostimulateur reliés par un fil, permet de délivrer un courant électrique dans une région voulue du cerveau. À ce jour, les mécanismes d’action de la SCP et les effets cellulaires qu’elle engendre demeurent mal connus. Cette problématique découle du fait qu’il existe peu de prototypes de micro-stimulation dans le domaine de la recherche, sans compter que ceux-ci ne répondent pas bien aux critères de cette recherche. Mes travaux de maîtrise visaient donc à développer un système de microstimulation pouvant être utilisé chez la souris et de développer et valider toutes les techniques nécessaires à l’implantation de ce système chez la souris. Au terme de ces travaux, nous avons développé un système de micro-stimulation : 1) utilisable chez la souris 2) pour des protocoles de stimulation chronique de longue durée (jusqu’à 1 mois), 3) possédant des paramètres électriques, semblables à ceux utilisés chez l’humain en clinique, 4) pouvant être ajustés à différents contextes pathologiques. Nous avons aussi développé toutes les techniques nécessaires à son implantation chez la souris. Cet outil novateur permettra d’approfondir notre connaissance des mécanismes d’action et des mécanismes cellulaires sous-jacents aux effets de la SCP et pourra mener, à long terme, à l’identification de nouvelles cibles thérapeutiques. / Deep brain stimulation (DBS) is a surgical procedure used in the treatment of various pathologies. This system, composed of electrodes implanted in a target area in the brain and of a neurostimulator connected by a wire, allows the delivery of an electrical current in a specific area in the brain. To this day, mechanisms of action and cellular effects resulting from DBS remain poorly understood because of a lack of micro-stimulation tools available in the domain and by the fact that these tools do not properly address requirements of this research. To address this challenge, the objectives of my master’s research were to develop a micro-stimulation system usable in mice and to develop and validate required techniques to make this system work in small-sized rodents. Through this study, we have developed a micro-stimulation system that is : 1) usable in mice, 2) able to sustain a long term chronic stimulation (up to 1 month), 3) similar to those used in human in terms of electrical parameters and 4) offering the possibility of adjusting those parameters to various pathological contexts. We also developed the required techniques for its use in mice. This novel tool will allow to deepen our knowledge on the mechanisms of action and cellular mechanisms underlying DBS effects and possibly lead to the identification of new therapeutic targets.

La stimulation électrique (SE) semble favoriser la cicatrisation des plaies par ses effets sur les fibroblastes. Cependant, son interaction avec les kératinocytes n'a pas été bien établie. Le polypyrrole (PPy) en tant que biomatériau conducteur est un excellent candidat pour délivrer les SE aux cellules, ce qui devient plus évident avec le développement de la nouvelle membrane souple à base de PPy. Cependant, les faibles propriétés mécaniques limitent l'utilisation de cette membrane. La présente étude visait à améliorer la résistance mécanique de la membrane à base de PPy et étudier les comportements cellulaires et moléculaires des kératinocytes après exposition à des SE via cette nouvelle membrane PPy. Premièrement, la membrane souple à base de PPy a été renforcée par électrofilage, de manière synergique, avec des fibres de polyuréthane (PU) et de polylactide (PLLA). Des tests mécaniques ont confirmé que la résistance à la traction de la membrane a été considérablement augmentée. Ensuite, les kératinocytes ont été cultivés sur la membrane PPy renforcée, puis stimulés par des intensités électriques de 100 ou 200 mV mm⁻¹ pendant 6 ou 24 heures. Les cellules stimulées présentaient une capacité proliférative considérablement accrue. Les sécrétions d'IL-6, IL-1α, IL-8, GROα, FGF2 et VEGF-A ont également augmenté. Fait intéressant, l'SE de 24 heures a induit une « mémoire de stimulation » car les cellules stimulées ont montré une augmentation significative de formation de colonies (CFE) après 6 jours après l'exposition à la stimulation électrique. De plus, l'expression des kératines 5, 14 et 10/13 était significativement augmentée par la SE. La SE a augmenté l'expression de la phosphorylation des kinases ERK1/2. L'expression des protéines des kératinocytes de la peau humaine peut être activée par des stimulations électriques appropriées pour favoriser la cicatrisation des plaies cutanées. La membrane PPy souple renforcée peut servir de pansement conducteur pour faciliter l'exposition de la plaie à une stimulation électrique pour favoriser sa cicatrisation. / Keratinocytes as the principal skin cell type play a major role in wound closure. In the meantime, electrical stimulation (ES) has been found effective in promoting wound healing. However, the role of ES on keratinocytes has not been well established. Polypyrrole (PPy), especially the recently developed soft PPy membrane, is an electrically conductive biomaterial and a good candidate to deliver ES to cells. However, the weak mechanical strength of the soft PPy membrane has limited its practical use. The present work was to enhance the mechanical strength of this soft PPy membrane and to investigate the cellular and molecular behaviors of the keratinocytes underwent ES via this novel PPy membrane. Firstly, the soft PPy membrane was synergically reinforced with polyurethane (PU) and poly (L-lactic acid) (PLLA) fibers through electrospinning technology. Mechanical tests confirmed the significantly increased tensile strength, which rendered the originally fragile PPy membrane strong enough to stand ordinary manipulations without compromising its electrical properties. Afterwards, HaCaT keratinocytes were cultured on the PU/PLLA reinforced PPy membranes under electrical intensities of 100 and 200 mV mm⁻¹ for 6 or 24 hr. The electrically stimulated cells exhibited a considerably increased proliferative ability. Meanwhile, secretions of the IL-6, IL-1α, IL-8, GROα, FGF2 and VEGF-A increased as well. Interestingly, the 24 hr ES induced a "stimulus memory" by showing a significant rise in colony forming efficiency (CFE) 6 days post-ES. Additionally, the expressions of keratin 5, keratin 14, keratin 10 and keratin 13 were significantly modulated by ES. Finally, the phosphorylation of ERK1/2 kinases was regulated by ES. The overall results demonstrated that the proliferation, differentiation, and protein expression of human skin keratinocytes can be activated through appropriate ES to benefit skin wound healing. Moreover, the PU/PLLA reinforced soft PPy membrane may server as a conductive wound dressing to facilitate ES to wound.

<p>Modulation of neural activity with electrical stimulation is a widespread therapy for treating neurological disorders and diseases. Two notable applications that have had striking clinical success are deep brain stimulation (DBS) for the treatment of movement disorders (e.g., Parkinson's disease) and spinal cord stimulation (SCS) for the treatment of chronic low back and limb pain. In these therapies, the battery life of the stimulators is much less than the required duration of treatment, requiring patients to undergo repeated battery replacement surgeries, which are costly and obligate them to incur repeatedly the risks associated with surgery. Further, deviations in lead position of 2-3 mm can preclude some or all potential clinical benefits, and in some cases, generate side-effects by stimulation of non-target regions. Therefore, despite the success of DBS and SCS, their efficiency and ability to activate target neural elements over non-target elements, termed selectivity, are inadequate and need improvement.</p><p>We combined computational models of volume conduction in the brain and spine with cable models of neurons to design novel electrode configurations for efficient and selective electrical stimulation of nervous tissue. We measured the efficiency and selectivity of prototype electrode designs in vitro and in vivo. Stimulation efficiency was increased by increasing electrode area and/or perimeter, but the effect of increasing perimeter was not as pronounced as increasing area. Cylindrical electrodes with aspect (height to diameter) ratios of > 5 were the most efficient for stimulating neural elements oriented perpendicular to the axis of the electrode, whereas electrodes with aspect ratios of < 2 were the most efficient for stimulating parallel neural elements.</p><p>Stimulation selectivity was increased by combining two or more electrodes in multipolar configurations. Asymmetric bipolar configurations were optimal for activating parallel axons over perpendicular axons; arrays of cathodes with short interelectrode spacing were optimal for activating perpendicular axons over parallel axons; anodes displaced from the center of the target region were optimal for selectively activating terminating axons over passing axons; and symmetric tripolar configurations were optimal for activating neural elements based on their proximity to the electrode. The performance of the efficient and selective designs was not be explained solely by differences in their electrical properties, suggesting that field-shaping effects from changing electrode geometry and polarity can be as large as or larger than the effects of decreasing electrode impedance.</p><p>Advancing our understanding of the features of electrode geometry that are important for increasing stimulation efficiency and selectivity facilitates the design of the next generation of stimulation electrodes for the brain and spinal cord. Increased stimulation efficiency will increase the battery life of IPGs, increase the recharge interval of rechargeable IPGs, and potentially reduce stimulator volume. Greater selectivity may improve the success rate of DBS and SCS by mitigating the sensitivity of clinical outcomes to malpositioning of the electrode.</p> / Dissertation

This thesis describes a series of experiments to investigate the effect of thermal stimulation on corticospinal excitability using transcranial magnetic stimulation (TMS). Experiment I showed that innocuous cooling or warming of a single digit, produced short-lasting and mixed patterns of modulation only during actual thermal stimulation, with the inhibition being the most common pattern observed. In line with this finding, cooling stimulation applied to a larger area (i.e. multi-digits) produced variable but more sustained modulation in motor evoked potential (MEP) amplitude in the post-cooling phase (Exp II). Notably, the responses to cooling in terms of either suppressed or enhanced corticospinal excitability tended to be fairly consistent in a given individual with repeated applications. When examining possible sources of the observed variable MEP modulation, we found that individual characteristics such as age, sex and changes in skin temperature had no major influences. We hypothesized that the variability of responses might be related to individual differences in the excitability of intra-cortical circuits involved in sensorimotor integration. To test this hypothesis, we performed Experiment III using conditioning TMS paradigms. This experiment revealed that TMS markers of sensorimotor integration (SAI and SAF levels) were good predictors of individual variations in cooling-induced modulation in corticospinal excitability. This provided evidence supporting the role of SAI and SAF as markers to predict individual’s response to focal thermal stimulation. The identification of such predictors could enhance the therapeutic applicability of this form of stimulation in neurorehabilitation. Collectively, these findings advance our understanding of the neurophysiological basis of thermal stimulation and shed light on the development of a more rational application of neurofacilitation techniques based on afferent stimulation in clinical populations, such as stroke survivors.

Problem investigated: Chronic wounds are not only a major burden to the patient arising from general pain and discomfort but also generate economic costs to both these individuals and the health care system. Various electrical stimulation regimes have been employed to study the effects of electrical stimulation on wound healing both in vivo and in vitro. In was hypothesised that electrical stimulation using various waveforms can modulate cell function, particularly cell migration. The aim of this thesis was to study the effects of electrical stimulation on cellular migration, in particular endothelial cells and fibroblasts, key cell types involved in wound healing. The impact of collagen matrix on cell migration was also assessed. Methods: Cells were seeded on either glass or collagen I substrate and stimulated with various electrical regimes via platinum electrodes connected to a constant current source. Cell migration was accessed by manual tracking of cell nuclei over a period of 3 hours from digital time-lapse images acquired during stimulation. Data from cell tracking were analysed for directional migration, migration rates and mean square displacement. Results: No directional cell migration for both endothelial cells and fibroblasts were observed when stimulated with either alternating or biphasic currents. However, surface substrate had impacted on cell motility with opposite effects being observed for the two cell types. Endothelial cells tended to migrate at a faster rate on collagen I substrate than on glass, compared with fibroblasts, which displayed a slower rate of migration on collagen I substrate. Significant changes in mean square displacement of biphasic current stimulated cells on collagen I substrate compared to unstimulated cells were also observed. Conclusion: This thesis has illustrated cell migration can be modulated by electrical stimulation, in particular asymmetric biphasic current. It has also been demonstrated surface substrate can impact cell migration.

<p>Epidural cortical stimulation (ECS) is a developing therapy for many neurological disorders. However, the mechanisms by which ECS has its effects are unknown, and this lack of understanding has limited the development and optimization of this promising therapy. This dissertation investigates the effects of ECS on the neurons in the cortex and how these effects vary with electrode geometry and location as well as the electrical and geometrical properties of the anatomy.</p><p>The effects of ECS on cortical neurons were investigated using a three dimensional computational model of the human precentral gyrus and surrounding anatomy. An epidural electrode was placed above the gyrus, and the model was solved using the finite element method. The outputs of the model included distributions of electric potential, the second spatial derivative of potential (activating function), and current density. The distributions of electric potential were coupled to compartmental models of cortical neurons to quantify the effects of ECS on cortical neurons. A sensitivity analysis was performed to assess how thresholds and distributions of activating function were impacted by changes in the geometrical and electrical properties of the model. In vivo experiments of epidural electrical stimulation of cat motor cortex were performed to measure the effects of stimulation parameters and electrode location on thresholds for evoking motor responses.</p><p>During ECS, the region of cortex directly underneath the electrode was activated at the lowest thresholds, and neurons deep in the sulcus could not be directly activated without coactivation of neurons located on the crowns or lips of the gyri. The thresholds for excitation of cortical neurons depended on stimulation polarity as well as the orientation and position of the neurons with respect to the electrode. In addition, the patterns and spatial extent of activation were influenced by the geometry of the cortex and surrounding layers, the dimensions of the electrodes, and the positioning of the lead. In vivo thresholds for evoking motor responses were dependent on electrode location and stimulation polarity, and bipolar thresholds were often different from monopolar thresholds through the respective anode and cathode individually. The effects of stimulation polarity and electrode location on thresholds for evoking motor responses paralleled results of the computational model. Experimental evidence of indirect effects of ECS, mediated by synaptic interactions between neural elements, revealed an opportunity for further development of the computational model. The outcome of this dissertation is an improved understanding of the factors that influence the effects of ECS on cortical neurons, and this knowledge will help facilitate the rational implantation and programming of ECS systems.</p> / Dissertation

No description available.

This thesis describes experiments designed to investigate the effects of neuromuscular electrical stimulation (NMES) on corticospinal (CS) excitability in humans. NMES delivered at 100 Hz was more effective for increasing CS excitability than 10-, 50-, or 200-Hz NMES. CS excitability increases occurred after 24 min of 100-Hz NMES, were strongest in the stimulated muscle, and were mediated primarily at a supraspinal level. NMES of the common peroneal nerve of the leg increased CS excitability in multiple leg muscles, whereas NMES of the median nerve of the hand increased CS excitability in only the muscle innervated by that nerve. Additionally, CS excitability for the hand increased after 40 min of relatively high intensity and frequency NMES but not after 2 h of lower intensity and frequency NMES. These results have implications for identifying optimal NMES parameters to augment CS excitability for rehabilitation after central nervous system injury.

Willfully controlling the focus of an extracellular stimulus remains a significant challenge in the development of neural prosthetics and therapeutic devices. In part, this challenge is due to the vast set of complex interactions between the electric fields induced by the microelectrodes and the complex morphologies and dynamics of the neural tissue. Overcoming such issues to produce methodologies for targeted neural stimulation requires a system that is capable of (1) delivering precise, localized stimuli a function of the stimulating electrodes and (2) recording the locations and magnitudes of the resulting evoked responses a function of the cell geometry and membrane dynamics. In order to improve stimulus delivery, we developed microfabrication technologies that could specify the electrode geometry and electrical properties. Specifically, we developed a closed-loop electroplating strategy to monitor and control the morphology of surface coatings during deposition, and we implemented pulse-plating techniques as a means to produce robust, resilient microelectrodes that could withstand rigorous handling and harsh environments. In order to evaluate the responses evoked by these stimulating electrodes, we developed microscopy techniques and signal processing algorithms that could automatically identify and evaluate the electrical response of each individual neuron. Finally, by applying this simultaneous stimulation and optical recording system to the study of dissociated cortical cultures in multielectode arrays, we could evaluate the efficacy of excitatory and inhibitory waveforms. Although we found that the proximity of the electrode is a poor predictor of individual neural excitation thresholds, we have shown that it is possible to use inhibitory waveforms to globally reduce excitability in the vicinity of the electrode. Thus, the developed system was able to provide very high resolution insight into the complex set of interactions between the stimulating electrodes and populations of individual neurons.