IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. BME-28, NO.
5, MAY 1981
A Technique for Collision Block of Peripheral Nerve:
Frequency Dependence
CHRISTOPHER VAN DEN HONERT
Abstract-A previously reported stimulation technique which elicits
a unidirectionally propagated nerve action potential has been evaluated
with repetition rates from 10 to 100 Hiz. Block of propagation in one
direction from the stimulus site was sustained up to 50 Hz with mono-
phasic stimulation and 30 Hz with biphasic stimulation. The use of
long stimulating pulses produces pronounced degradation of the block
at high frequencies.
A demonstration of collision block of spastic motor discharge using
this technique is presented, and potential clinical applications are
discussed.
INTRODUCTION
IN A companion paper [13] we described an electrical stim-
ulation technique which elicits a unidirectionally propagated
action potential in peripheral nerve. That technique was de-
veloped with the objective of implementing a collision motor
nerve block. The proposed block is effected by introducing
a stream of antidromic action potentials on the nerve which
annihilate by collision the naturally arising activity.
In this paper we examine the response to repetitive stimula-
tion using the previously reported monophasic stimulus wave-
form, as well as a similar charge-balanced waveform.
EXPERIMENTAL PROCEDURES
The effects of repetitive stimulation were studied in four
cats. In three preparations, the experimental methods de-
scribed earlier [13] were employed. They are briefly summa-
rized here. Trains of regulated current stimuli were delivered
to the sciatic nerve through an asymmetrical tripolar insulated
cuff electrode (one cathode between two anodes). 70-80 per-
cent of the stimulus current flowed from the blocking anode
6 mm distal to the cathode. The remaining 20-30 percent
flowed from the secondary anode 8 mm proximal to the cath-
ode. The monophasic stimulus current waveform consisted
of a rectangular leading edge and plateau phase followed by
an exponential falling phase.
When biphasic stimuli were employed, a capacitor was
connected in series with each anode. Both capacitors were
allowed to discharge through the cathode during the inter-
stimulus interval. The discharge time constant was sufficiently
long (100 ms) compared to pulse repetition rate that the re-
Manuscript received May 22, 1980; revised January 2, 1981, and
February 2, 1981. This work was supported by the National Institutes
of Health, Neural Prostheses Program, under Contract N01-NS-2-2314
and Grant GM 01090-16.
C. van den Honert was with the Department of Biomedical Engineer-
ing, Case Western Reserve University, Cleveland, OH 44106. He is now
with Central Research Laboratories, 3M Company, St. Paul, MN 55144.
J. T. Mortimer is with the Applied Neural Control Laboratory, Case
Western Reserve University, Cleveland, OH 44106.
0018-9294/81/0500-0379$00.75 © 1981 IEEE
379
AND J. THOMAS MORTIMER
L\ MONOPHASIC
HH
PF
IK- TT
L .1
Ir
0- *. ......BIPHASIC
P PLATEAU PHASE
F = FALLING PHASE TIME CONSTANT
T = INTER-PULSE INTERVAL
Ir = REVERSE CURRENT
Fig. 1. Monophasic and biphasic blocking current waveforms. The total
current was divided unequally between two anodes (20-25 percent
carried by the proximal anode) sharing a common cathode. The am-
plitude of the reverse current Ir is exaggerated for clarity.
verse current flowing during the interpulse interval was essen-
tially constant in the steady state (Fig. 1). The steady-state
stimulus had no dc current component. Steady state (when
reverse current had reached 99 percent of its final value) was
achieved after 0.5 s at all frequencies.
The purpose of these experiments was to confirm the ab-
sence of any orthodromically propagated activity in response
to the blocking stimulus. EMG was recorded from medial
gastrocnemius. The EMG signal was numerically rectified
and integrated by an on-line PDP-1 1/03 computer during the
10 ms interval following the onset of the stimulus as a mea-
sure of orthodromic neural activity. This value was compared
with the maximal response elicited by whole nerve stimulation
using 100 us bipolar current pulses.
An additional experiment was performed without proximal
nerve transection as a preliminary test of the block in the
presence of natural efferent traffic, with spinal connections
intact. Fine platinum blocking electrodes were wrapped
around the nerve branch to the soleus muscle of a decerebrate
cat (decerebration at the level of the superior colliculi). The
electrodes were partially insulated by draping the nerve branch
across a trough of thin plastic sheet. With the exception of the
nerves to medial gastrocnemius and soleus, all branches of the
sciatic nerve distal to the popliteal fossa were cut. Force was
recorded isometrically from soleus and medial gastrocnemius.
EMG was recorded from soleus with intramuscular stainless
steel wires. Background force in the two innervated muscles
was triggered reflexly by cutaneous electrical stimulation of
the contralateral hindlimb (crossed extensor reflex). 2 s bursts
of monophasic blocking stimuli at 20 or 30 Hz were then de-
livered to the soleus nerve in the presence of the background
activation.
 -<~1.0
380 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. BME-28, NO. 5, MAY 1981

10 HZ
X40-. A' - 10 HZ

20 HZ -..

20 HZ
w
In 30 HZ U)
z
0
P-
0
0L
Un
w 40
m
0- ........
30 HZ
C33 40 HZ
w
1 40 --
0
L: w
a

. 40 HZ
o
50 HZ w
z 40

1 00 HZ :I N ?N. 50 HZ

0 5 10 15 20
0 5 10 15 20
TIME (SEC)
TIME (SEC) Fig. 3. Frequency dependence of monophasic block with long stimuli.
2.8 mA peak, P = 6 ms, F = 1 ms. Same preparation as Fig. 2.
Fig. 2. Frequency dependence of monophasic block with short stimuli.
2.8 mA peak, P = 0.47 ms, F = 0.5 ms. This was the shortest stimulus
which sustained block on a single pulse basis. Each point represents 15 T
the rectified integrated value of a single EMG response in a 20 s train
of stimuli at 10-50 Hz (10 s at 100 Hz). The nonzero baseline is due
to integration of noise in the signal.
-J
I
x
10
RESULTS
PLATEAU
Monophasic Stimulation w
, PHASE (MS)

Typical results from the three cut-nerve preparations are w ,, .-.

B--Cl.
W0. 47

illustrated in Figs. 2-5. Fig. 2 shows the EMG response to w

4~~~~~~........ -----o
6.0 .

trains of short monophasic stimuli. At frequencies up to o

z
5
50 Hz, block of the orthodromic response was well sustained 0
w
for the entire 20 s train. At 100 Hz, the block was degraded, U,

with some responses exceeding 10 percent of maximal. This I,

-n
train was terminated after 10 s when it became apparent that
the block had deteriorated. 0
With a 6 ms stimulus plateau phase, block deteriorated 10 20 30 40 50

rapidly with repetitive stimulation (Fig. 3), with some re- FREQUENCY (HZ)
sponses exceeding 40 percent of maximal at 50 Hz. The late Fig. 4. Average integrated EMG response over 20 s with monophasic
falloff at 40 ;and 50 Hz with 6 ms plateau probably resulted stimuli. 2.8 mA peak, F= 0.5, 0.5, 0.8, and 1 ms with P= 0.47, 1,
from synaptic fatigue rather than recovery of the block, as 2, and 6 ms, respectively.
indicated by a substantial broadening of the individual EMG
responses. In all cases, degradation of the block was charac- old is exceeded. This difficulty is minimized by passing the
terized by discharge at the trailing edge of the stimulus. smallest possible reverse current over the greatest available
In Fig. 4 the average integrated response over 20 s stimulus time (i.e., the entire interpulse interval). The amplitude of
trains is plotted for stimulus plateau phase widths of 0.47, the reverse current must rise with increasing frequency as
1, 2, and 6 ms. Slight degradation of the block is evidenced less time is available between stimuli for charge reversal.
at high frequencies with pulsewidths of 1. and 2 ms. At 6 ms, Fig. 5 shows the integrated EMG response to biphasic pulse
the block is poor even at 10 Hz. (The values at 40 and 50 Hz trains lasting 1 min (4.7 mA, 400.us plateau phase, 250 Ms
with 6 ms plateau are artificially low due to the synaptic falling phase time constant) of 10-40 Hz. Block is reasonably
fatigue noted earlier.) well sustained between 10 and 30 Hz (reverse current of
0.047-0.094 mA). At 40 Hz, with a reverse current ampli-
Biphasic Stimulation tude of 0.12 mA, considerable degradation of the block is
The dc component of the stimulus may be eliminated by evident. This train was terminated after 10 s when serious
reversing the current flow between pulses such that the net deterioration of the block developed. In all cases, block
charge transfer is zero. During current reversal, the blocking degradation arose from excitation at the onset of the reverse
"anode" becomes cathodic and may cause excitation if thresh- current.
VAN DEN HONERT AND MORTIMER: COLLISION BLOCK-FREQUENCY DEPENDENCE 381

0I- 200 9 s
10 HZ
2SEC-2OHz
x
10009 IM MG
;:i 20 HZ

Z0 8 .
. A.
w
30 HZ
. A 200 91
1 s

,. . ia - 2SEC-30Hz

40 HZ
450 \
MG

0 15 30 45 60
Fig. 6. Isometric active force from soleus (S) and medial gastrocnemius
(MG) muscles of decerebrate cat. Long bar indicates duration of cu-
T I ME (SEC)
taneous stimulation of contralateral hindlimb. Short bar indicates 2 s
burst of blocking stimuli at 20 Hz (upper traces) and 30 Hz (lower
Fig. 5. Frequency dependence of biphasic block. 4.7 mA peak, P = traces). Blocking stimuli: 3.0 mA peak, P = 0.5 ms, F = 0.8 ms. Note
0.43 ms, F = 0.25 ms. Reverse current amplitude (Ir): 0.047, 0.069, vertical scale differences of medial gastrocnemius force traces at 20
0.094, and 0.122 mA at 10, 20, 30, and 40 Hz, respectively. and 30 Hz.

Decerebrate Preparation reach threshold potential. The natural frequency of alpha

The results from the decerebrate preparation are shown in motor discharge typically falls in the range of 5-25 Hz, and
Fig. 6. Following the onset of the cutaneous stimulation to seldom exceeds 40 Hz [1], [2], [5], [6], [12].
the contralateral hindlimb, a background force developed in Monophasic Stimulation
both soleus and medial gastrocnemius muscles. During appli-
cation of the 2 s blocking stimulus train (3 mA, 0.5 ms plateau, The frequency limitation of orthodromic block must be re-
0.7 ms falling phase time constant), force from soleus dropped lated to the time required by the nerve to recover to its normal
as much as 80 percent at 20 Hz and 90 percent at 30 Hz.
resting state. A strong hyperpolarization develops under the
Force from medial gastrocnemius rose dramatically during blocking anode during the stimulus pulse, which would be
the blocking burst, suffering a transient drop with 30 Hz expected to produce a concomitant loss of sodium inactiva-
stimulation. tion [8], [9]. At high repetition rates, the resting level of
Efforts to demonstrate greater force drop in soleus at higher inactivation is not fully restored between stimuli, resulting
stimulus rates were hindered by pronounced locomotive ten- in an increase in residual excitability at that anode after appli-
dencies of the animal which repeatedly disrupted positioning cation of several stimuli. The membrane there is thus more
of the blocking electrodes. Walking movements may have susceptible to excitation at the trailing edge of the stimulus,
caused the transient drop in force from medial gastrocnemius either by anode break (with long pulses) or late action cur-
noted above. Such movements were often triggered by vir- rents (with short pulses), as described in a companion paper
tually any stimulation (block, electrocutaneous, tactile, or [13]. This interpretation is consistent with the observation
ipsilateral peroneal nerve stump). that high frequency block failure with monophasic trains was
always characterized by excitation at the trailing edge of the
DISCUSSION stimulus after delivery of several pulses. With increasing pulse
Sustained block requires repetitive generation of antidromic width, this effect is aggravated by the greater loss of sodium
impulses. The frequency of natural discharge establishes a inactivation caused by the stimulus and the reduced recovery
lower bound on the stimulation rate required. At least one time available between stimuli.
antidromic impulse must be generated to eliminate each nat-
ural action potential on any given axon. A generally more Biphasic Stimulation
severe theoretical limitation is imposed by nerve length. By With biphasic stimulation, block failure is directly attribut-
the analysis of Iggo [4], complete block would require a stim- able to excitation by the reverse current. The hyperexcitable
ulus rate of V/2d Hz where V represents a nerve conduction membrane beneath the blocking anode is subject to excitation
velocity and d the distance between the stimulus site and the when that electrode becomes cathodic. The amplitude of the
soma. In practice, a lower frequency would suffice if: 1) re- reverse current (I,) is given by
fractory period is included in the analysis; 2) a partial block
is adequate; or 3) integration of synaptic inputs to the soma Ir = QITr
is reset by antidromic invasion. Property 3) would reduce the where Q is the charge to be transferred and Tr is the available
required stimulation rate to the natural discharge frequency of time between stimuli. Q must be equal to the charge trans-
the nerve such that the soma never has an opportunity to ferred by the stimulus pulse. Ir is thus minimized by employ-
382 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. BME-28, NO. 5, MAY 1981
ing the shortest stimulus adequate to sustain block. This mini-
mizes Q and maximizes Tr for any given repetition rate. As
the repetition rate is increased, Ir rises as Tr decreases, ulti-
mately becoming suprathreshold. This limifs the usable fre-
quency range associated with biphasic stimulation.
Higher stimulation frequencies may be employed with mono-
phasic than with biphasic stimuli. However, the clinical use
of monophasic stimulation is restricted by tissue damage con-
siderations. Studies of cortical stimulation [10] and intra-
muscular stimulation [7] indicate that if a safe level for
monophasic stimulation exists, the charge levels injected must
be less than those acceptable with biphasic waveforms. Mono-
phasic stimulation may be usable in applications requiring
short term infrequent block, but long term chronic block will
surely necessitate biphasic stimulation, thus reducing the avail-
able frequency range.
Block of Natural Discharge
The results of the decerebrate preparation indicate that
collision block is capable of inhibiting muscular contraction
with spinal connections intact. The blocking stimulus clearly
evoked a powerful excitatory reflex by recruitment of affer-
ents, as evidenced by the substantial force increase recorded
from the synergist medial gastrocnemius. It must be assumed
that the drive to soleus was similarly increased above the level
produced by the crossed extensor reflex activation. Even in
the presence of that input, the force from soleus dropped sub-
stantially during the block. The force fluctuations during
block probably reflect variations in stretch reflex drive to
the motor neurons, rather than direct excitation by the stim-
ulus (block failure). EMG recordings from soleus rarely indi-
cated any direct excitation. While these results by no means
provide a rigorous evaluation of collision block of natural
discharge, they do demonstrate its fundamental feasibility.
Possible Complications
Block threshold is typically an order of magnitude above
excitation threshold of the motor axons. With stimuli of this
intensity, the principal complication envisioned in implement-
ing a collision block would be excitation of afferents within
the nerve. Such excitation may lead to noxious sensations or
reflex side effects. An individual assessment of these effects
would be required for each potential application. In general,
activation of the monosynaptic stretch reflex could increase
stimulus frequency requirements by raising the discharge level
of the motor neurons. Simultaneous block of synergists may
also be required. It is advantageous to position the electrodes
beyond the most distal branch point of the nerve in order to
avoid stimulation of cutaneous or other afferents. In some
cases, deafferentation by transection of dorsal roots may be
appropriate.
One potential application of collision block is in control
of urinary sphincter spasticity of spinal cord injury patients.
Sphincter spasticity has complicated efforts to induce bladder
evacuation with electrical stimulation [11]. In this case,
noxious sensations would be eliminated by somatosensory
loss. Reflex activation would probably necessitate bilateral
block.
Collision block may also be useful in managing chronic in-
tractable hiccups. Some detection method could conceivably
synchronize a short burst of blocking pulses with the onslaught
of the massive phrenic nerve discharge. Glenn et al. [3] have
employed electrical stimulation of the phrenic nerve as a means
of controlling hiccups by diaphragm fatigue.
REFERENCES
[1] R. W. Clark, E. S. Luschei, and D. S. Hoffman, "Recruitment
order, contractile characteristics, and firing patters of motor units
in the temporalis muscle of monkeys," Exp. Neurol., no. 61, pp.
31-52, 1978.
[2] B. Derfler and L. J. Goldberg, "Spike train characteristics of single
motor units in the human masseter muscle," Exp. Neurol., no.
61, pp. 592-608, 1978.
[3] W.W.L. Glenn, A. A. Liebow, and G. E. Lindskog, Thoracic and
Cardiovascular Surgery with Related Pathology. New York:
Appleton, 1975.
[4] A. Iggo, "The electrophysiological identification of single nerve
fibres, with particular reference to the slowest conducting vagal
afferents in the cat," J. Phol., no. 142, pp. 110-126, 1958.
[5] M. Kato and J. Tanji, "Volitionally controlled single motor units
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[7] J. T. Mortimer, D. Kaufman, and U. Roessmann, "Tissue reaction
to intra-muscular electrical stimulation," presented at the 58th
FASEB Meeting, Atlantic City, NJ; Abstr. in Fed. Proc., Apr.
1974.
[8] Y. Palti, "Description of axon membrane ionic conductances and
currents," in Biophysics and Physiology of Excitable Membranes,
W. J. Adelman, Jr., Ed. Cincinnati, OH: Van Nostrand Reinhold,
1971,pp. 168-182.
[9] -, "Analysis and reconstruction of axon membrane action po-
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W. J. Adelman, Jr., Ed. Cincinnati, OH: Van Nostranrd Reinhold,
1971, pp. 206-214.
[10] R. H. Pudenz, L. A. Bullara, D. Dru, and M. D. Talhalla, "Elec-
trical stimulation of the brain II: Effects on the blood brain bar-
rier," Surg. Neurol., no. 4, pp. 265-270, 1976.
[11] J. G. Susset, "The electrical drive of the urinary bladder and
sphincter," in Neural Organization and its Relevance to Pros-
thetics, W. S. Fields, Ed. New York: Intercontinental Medical,
1973, pp. 319-342.
[12] J. Tanji and M. Kato, "Firing rate of individual motor units in
voluntary contraction of abductor digiti minimi in man," Exp.
Neurol., no. 40, pp. 771-783, 1973.
[13] C. van den Honert and J. T. Mortimer, "A technique for collision
block of peripheral nerve: Single stimulus analysis," this issue,
pp. 373-378.
Christopher van den Honert, for a photograph and biography, see this
issue, p. 378.
J. Thomas Mortimer, for a photograph and biography, see this issue,
p. 378.