Methods and apparatuses for improving peripheral nerve function

Abstract

Methods and apparatuses for sensory electrical stimulation of the peripheral nervous system to improve human motor function and performance are described. Methods and devices may be used to enhance physical performance of athletes, professionals, and gamers or improve motor function (hand, finger and limb movement) in patients rehabilitating from neurological deficits and impairments caused by stroke, traumatic brain injury and other neurologic or non-neurologic conditions. These apparatuses and methods may be used for physical training and mental training (to improve memory and functional performance including motor coordination, limb-eye coordination, occupational and recreational skills) through periodic or sustained sensory electrical stimulation. Treatment plans may be based on biomarkers and may be used alone or in combination with other apparatuses. Learning and feedback techniques individualize treatment parameters depending on the subject's neurologic and motor function in diseased patients and healthy users.

What is claimed is: 
     
         1 . An apparatus for enhancing performance on manual tasks involving finger individuation by closed-loop electrical stimulation, the apparatus comprising:
 a stimulator adapted to be worn on user's arm, hand or arm and hand, the stimulator having one or more electrodes, a power source, a controller, wherein the stimulator is configured to deliver an electrical stimulation from the electrodes to one or more of the user's radial, ulnar and median nerves when worn;   a non-transitory computer-readable storage medium storing a program thereon, wherein the program causes a processor to:   present a manual training task involving finger individuation, estimate a performance metric based on the finger individuation,   adjust the electrical stimulation based on the performance metric, and transmit the adjusted stimulation parameters to the stimulator.   
     
     
         2 . The apparatus of  claim 1 , wherein the stimulator comprises a wrist band, a patch, or a smart glove. 
     
     
         3 . The apparatus of  claim 1 , wherein the stimulator comprises one or more haptic feedbacks. 
     
     
         4 . The apparatus of  claim 1 , wherein the stimulator comprises one or more motion sensors. 
     
     
         5 . The apparatus of  claim 1 , further comprising one or more position sensors configured to determine the position of a portion of the subject's body. 
     
     
         6 . The apparatus of  claim 1 , wherein the stimulator comprises a housing enclosing the controller and wireless communication circuit and a shell configured to secure the housing and the one or more electrodes against the subject's body. 
     
     
         7 . The apparatus of  claim 1 , wherein the electrical stimulator comprises one or more of: an optical output, a vibrotactile output or an audible output. 
     
     
         8 . The apparatus of  claim 1 , wherein the controller is configured to provide secondary output during a stimulation period when the stimulator is delivering an electrical stimulation from the electrodes, wherein the secondary output comprises at least one or more of: a tactile output, a visual output, a vibrational output. 
     
     
         9 . The apparatus of  claim 1 , wherein the program causes a processor to: present a manual training task comprising a game. 
     
     
         10 . The apparatus of  claim 1 , wherein the program causes a processor to estimate the performance metric based on a rate of button pressing of a game controller. 
     
     
         11 . The apparatus of  claim 10 , wherein the non-transitory computer-readable storage medium storing the program is configured to operate on a processor a smartphone or tablet. 
     
     
         12 . The apparatus of  claim 1 , wherein the program causes the processor to iteratively present the manual training task, estimate the performance metric, adjust the electrical stimulation, and transmit the adjusted stimulation parameters. 
     
     
         13 . A method of improving a subject's peripheral nerve function by closed-loop control of applied stimulation, the method comprising:
 applying an electrical stimulation to a peripheral nerve for longer than 10 minutes, wherein the electrical stimulation is sub-sensory or nearly sub-sensory; performing a training task involving activation of the peripheral nerve;   measuring at least one of: a biomarker from the subject and a performance indicator from the training task;   adjusting the electrical stimulation based on at least one of the measured biomarker and performance indicator; and   repeating the steps of applying, preforming, measuring and adjusting at least once per day for a plurality of days.   
     
     
         14 . The method of  claim 13 , wherein applying comprises applying the electrical stimulation transdermally. 
     
     
         15 . The method of  claim 13 , wherein applying comprises applying via an implanted electrode. 
     
     
         16 . The method of  claim 13 , wherein applying comprises applying to at least one of: the radial nerve, the ulnar nerve and the median nerve. 
     
     
         17 . The method of  claim 13 , wherein applying comprises applying electrical stimulation from a wearable wrist band, a patch, a smart sole or shoe insert, a smart shoe, a smart anklet, a smart sock or a smart glove. 
     
     
         18 . The method of  claim 13 , wherein measuring the biomarker comprises measuring an electroencephalogram (EEG) from the subject and measuring the change in delta or theta wave portion of the EEG. 
     
     
         19 . The method of  claim 13 , wherein measuring the performance indicator comprises determining a performance metric based on the finger individuation. 
     
     
         20 . A method of improving a subject's performance on manual tasks involving finger individuation, the method comprising:
 applying a transdermal electrical stimulation to one or more of the subject's radial, ulnar and median nerves;   performing a manual training task involving finger individuation and estimating a performance metric based on the finger individuation; and   adjusting the transdermal electrical stimulation based on the performance metric; and   repeating the steps of applying performing and adjusting over a plurality of days.