The standard electrical stimulation waveform used for electrical activation of nerve is a rectangular pulse or a charge balanced rectangular pulse, where the pulse width is typically in the range of ∼100 µsec through ∼1000 µsec. In this work, we explore the effects of a continuous sinusoidal waveform with a frequency ranging from 5 through 20 Hz, which was named the Low Frequency Alternating Current (LFAC) waveform. The LFAC waveform was explored in the Bioelectronics Laboratory as a novel means to evoke nerve block. However, in an attempt to evoke complete nerve block on a somatic motor nerve, increasing the amplitude of the LFAC waveform unexpectedly produced nerve activation, and elicited a strong non-fatiguing muscle contraction in the anesthetized rabbit model (unpublished observation). The present thesis aimed to further explore the phenomenon to measure the effect of LFAC waveform frequency and amplitude on nerve activation.<div><br></div><div>In freshly excised canine cervical vagus nerve (n=3), it was found that the LFAC waveform at 5, 10, and 20 Hz produced burst modulated activity. Compound action potentials (CAP) synchronous to the stimuli was absent from the electroneurogram (ENG) recordings. When applied <i>in-vivo</i>, LFAC was capable of activating the cervical vagus nerve fibers in anaesthetized swine (n=5) and induced the Hering-Breuer reflex. Additionally, when applied <i>in-vivo</i> to anesthetized Sprague Dawley rats (n=4), the LFAC waveform was able to activate the left sciatic nerve fibers and induced muscle contractions.</div><div><br></div><div>The results demonstrate that LFAC activation was stochastic, and asynchronous to the stimuli unlike conventional pulse stimulation where nerve and muscle response simultaneously and synchronously to stimulus. The activation thresholds were found to be frequency dependent. As the waveform frequency increases the required current amplitude decreases. These experiments also implied that the LFAC phenomenon was most likely to be fiber type-size dependent but that more sophisticated exploration should be addressed before reaching clinical applications. In all settings, the LFAC amplitude was within the water window preventing irreversible electrochemical reactions and damages to the cuff electrodes or nerve tissues. This thesis also reconfirms the preliminary LFAC activation discovery and explores multiple methods to evaluate the experimental observations, which suggest the feasibility of the LFAC waveform at 5, 10, and 20 Hz to activate autonomic and somatic nerve fibers. LFAC appears to be a promising new technique to activate peripheral nerve fibers.</div>

Indiana University-Purdue University Indianapolis (IUPUI) / The standard electrical stimulation waveform used for electrical activation of nerve is a rectangular pulse or a charge balanced rectangular pulse, where the pulse width is typically in the range of ∼100 µsec through ∼1000 µsec. In this work, we explore the effects of a continuous sinusoidal waveform with a frequency ranging from 5 through 20 Hz, which was named the Low Frequency Alternating Current (LFAC) waveform. The LFAC waveform was explored in the Bioelectronics Laboratory as a novel means to evoke nerve block. However, in an attempt to evoke complete nerve block on a somatic motor nerve, increasing the amplitude of the LFAC waveform unexpectedly produced nerve activation, and elicited a strong non-fatiguing muscle contraction in the anesthetized rabbit model (unpublished observation). The present thesis aimed to further explore the phenomenon to measure the effect of LFAC waveform frequency and amplitude on nerve activation. In freshly excised canine cervical vagus nerve (n=3), it was found that the LFAC waveform at 5, 10, and 20 Hz produced burst modulated activity. Compound action potentials (CAP) synchronous to the stimuli was absent from the electroneurogram (ENG) recordings. When applied in-vivo, LFAC was capable of activating the cervical vagus nerve fibers in anaesthetized swine (n=5) and induced the Hering-Breuer reflex. Additionally, when applied in-vivo to anesthetized Sprague Dawley rats (n=4), the LFAC waveform was able to activate the left sciatic nerve fibers and induced muscle contractions. The results demonstrate that LFAC activation was stochastic, and asynchronous to the stimuli unlike conventional pulse stimulation where nerve and muscle response simultaneously and synchronously to stimulus. The activation thresholds were found to be frequency dependent. As the waveform frequency increases the required current amplitude decreases. These experiments also implied that the LFAC phenomenon was most likely to be fiber type-size dependent but that more sophisticated exploration should be addressed before reaching clinical applications. In all settings, the LFAC amplitude was within the water window preventing irreversible electrochemical reactions and damages to the cuff electrodes or nerve tissues. This thesis also reconfirms the preliminary LFAC activation discovery and explores multiple methods to evaluate the experimental observations, which suggest the feasibility of the LFAC waveform at 5, 10, and 20 Hz to activate autonomic and somatic nerve fibers. LFAC appears to be a promising new technique to activate peripheral nerve fibers.

<p dir="ltr">Sinusoidal low frequency alternating current (LFAC) stimulation is a novel mode of electrical modulation observed in the Bioelectroics Lab in 2017. LFAC is capable of blocking the single fiber action potentials (APs) of the earthworm with only a few 100's of µA. The goal of this dissertation was to further explore and characterize the LFAC waveform to determine it's feasibility as a method for block in the mammalian peripheral nervous system (PNS). To better understand the mechanisms of LFAC block (LFACb), a blend of \textit{in-silico} modeling work was explored and the predictions were validated with <i>ex-vivo</i> and <i>in-vivo</i> experiments. </p><p dir="ltr"> This dissertation is divided into five chapters. The first chapter will explore the history of bioelectricity, the current state of <i>in-silico</i> modeling and methods of nerve block used in the PNS. The second chapter explores a major modeling assumption, the conductivity and permittivity of the nerve laminae of a mammalian nerve bundle. Four point electrochemical impedance spectroscopy (EIS) was performed on excised canine vagus nerve to evaluate the electrical properties of the perineurium and epineurium. This study's result, found that the corner frequency of the perineurium (2.6kHz) and epineurium (370Hz) were much lower than previously assumed. This explain a major difference between LFACb and the more established kilohertz frequency alternating current (kHFAC) block. The third chapter revisits the initial earthworm experiments during the discovery of LFACb. The effect of conduction slowing was observed in these earthworm experiments and were also seen in a mammalian canine vagus nerve and in the Horn-Yoshida-Schild (HYS) autonomic unmyelinated axon mode. These experiments showed that LFACb occurs as a cathodic block in which the sodium channels are held inactive. Chapter 4 explored the window between LFACb and LFAC activation (LFACa). The window between the two states was describes by LFAC amplitude and LFAC frequency in an <i>in-vivo</i> rat sciatic nerve and an <i>in-silico</i> model of a myelinated motor neuron, the McIntyre-Richardson-Grill (MRG) axon model. Geometrical effects were also observed by varying the bipolar pair of contacts used to deliver the LFACb waveform from an asymmetrical tripolar cuff electrode. Plantar flexor force measurements and electromyography (EMG) of the lateral gastrocnemius (LG) and soleus (Sol) were used to quantify the effects of the LFAC waveform. Convergence between <i>in-silico</i> modeling and <i>in-vivo</i> results showed promise that modeling efforts could be used with confidence to explore the LFAC block-activation more completly. LFACa was found to be highly dependent on frequency with increasing frequency lowering the threshold of activation. LFACb was shown to be mostly invariant to frequency. The final chapter takes the information found in this dissertation and summarizes it. Future work on LFAC is also proposed and the hypothesized results presented with the findings from this dissertation and available literature. </p>