Mechanical fatigue resistance of an implantable branched lead system for a distributed set of longitudinal intrafascicular electrodes
Open accessAbstract
Objective . A neural interface system has been developed that consists of an implantable stimulator/recorder can with a 15-electrode lead that trifurcates into three bundles of five individual wire longitudinal intrafascicular electrodes. This work evaluated the mechanical fatigue resistance of the branched lead and distributed electrode system under conditions designed to mimic anticipated strain profiles that would be observed after implantation in the human upper arm. Approach . Custom test setups and procedures were developed to apply linear or angular strain at four critical stress riser points on the lead and electrode system. Each test was performed to evaluate fatigue under a high repetition/low amplitude paradigm designed to test the effects of arm movement on the leads during activities such as walking, or under a low repetition/high amplitude paradigm designed to test the effects of more strenuous upper arm activities. The tests were performed on representative samples of the implantable lead system for human use. The specimens were fabricated using procedures equivalent to those that will be used during production of human-use implants. Electrical and visual inspections of all test specimens were performed before and after the testing procedures to assess lead integrity. Main results . Measurements obtained before and after applying repetitive strain indicated that all test specimens retained electrical continuity and that electrical impedance remained well below pre-specified thresholds for detection of breakage. Visual inspection under a microscope at 10× magnification did not reveal any signs of damage to the wires or silicone sheathing at the stress riser points. Significance . These results demonstrate that the branched lead of this implantable neural interface system has sufficient mechanical fatigue resistance to withstand strain profiles anticipated when the system is implanted in an arm. The novel test setups and paradigms may be useful in testing other lead systems.
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A 15-electrode array lead that trifurcates into three groups of five longitudinal intra-fascicular electrodes showed sufficient mechanical fatigue resistance.
“Another study proposed a 15-electrode array lead that trifurcates into three groups of five LIFEs, and showed that it had sufficient mechanical fatigue resistance.”
From Interfaces with the peripheral nervous system for the control of a neuroprosthetic limb: a review (2020) · cites this paper as [94]
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Cites
Peterson's Stress Concentration Factors
Pilkey, W. D., & Pilkey, D. F. (2007) · Wiley eBooks · doi:10.1002/9780470211106 · Cited by 717 · see citing works
Direct neural sensory feedback and control of a prosthetic arm
Dhillon, G. S., & Horch, K. W. (2005) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2005.856072 · Cited by 573 · see citing works
Self-citationPeters, K. M., Carrico, D. J., Perez-Marrero, R. A., Khan, A. U., Wooldridge, L., Davis, G. L., & MacDiarmid, S. (2010) · The Journal of Urology · doi:10.1016/j.juro.2009.12.036 · Cited by 489 · see citing works
Implanted Neural Interfaces: Biochallenges and Engineered Solutions
Grill, W. M., Norman, S. E., & Bellamkonda, R. V. (2009) · Annual Review of Biomedical Engineering · doi:10.1146/annurev-bioeng-061008-124927 · Cited by 488 · see citing works
Biomechanics of the Elbow During Baseball Pitching
Werner, S. L., Fleisig, G. S., Dillman, C. J., & Andrews, J. R. (1993) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.1993.17.6.274 · Cited by 475 · see citing works
Dynamics of the Shoulder and Elbow Joints of the Throwing Arm during a Baseball Pitch
Feltner, M. E., & Dapena, J. (1986) · International Journal of Sport Biomechanics · doi:10.1123/ijsb.2.4.235 · Cited by 409 · see citing works
Dynamic arm swinging in human walking
Collins, S. H., Adamczyk, P. G., & Kuo, A. D. (2009) · Proceedings of the Royal Society B Biological Sciences · doi:10.1098/rspb.2009.0664 · Cited by 405 · see citing works
Coppieters, M. W., & Butler, D. S. (2007) · Manual Therapy · doi:10.1016/j.math.2006.12.008 · Cited by 402 · see citing works
Functionally selective peripheral nerve stimulation with a flat interface nerve electrode
Tyler, D. J., & Durand, D. M. (2002) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2002.806840 · Cited by 398 · see citing works
Schachter, S. C., & Saper, C. B. (2020) · Thieme eBooks · doi:10.1055/b-0040-177306 · Cited by 397 · see citing works
Schachter, S. C., & Saper, C. B. (1998) · Epilepsia · doi:10.1111/j.1528-1157.1998.tb01151.x · Cited by 373 · see citing works
Topp, K. S., & Boyd, B. S. (2006) · Physical Therapy · doi:10.1093/ptj/86.1.92 · Cited by 361 · see citing works
Dhillon, G. S., Lawrence, S. M., Hutchinson, D. T., & Horch, K. W. (2004) · The Journal of Hand Surgery · doi:10.1016/j.jhsa.2004.02.006 · Cited by 354 · cited 1× · see citing works
“in multiple nerves in the upper arm of an amputee [5, 40, 41].”
BackgroundSelf-citationOddo, C. M., Raspopović, S., Artoni, F., Mazzoni, A., Spigler, G., Petrini, F. M., Giambattistelli, F., Vecchio, F., Miraglia, F., Zollo, L., et al. (2016) · eLife · doi:10.7554/elife.09148 · Cited by 328 · see citing works
Deep brain stimulation for Parkinson's disease: Surgical technique and perioperative management
Machado, A. G., Rezai, A. R., Kopell, B. H., Gross, R. E., Sharan, A. D., & Benabid, A. (2006) · Movement Disorders · doi:10.1002/mds.20959 · Cited by 326 · see citing works
Davis, T. S., Wark, H. A. C., Hutchinson, D. T., Warren, D. J., O’Neill, K., Scheinblum, T., Clark, G. A., Normann, R. A., & Greger, B. (2016) · Journal of Neural Engineering · doi:10.1088/1741-2560/13/3/036001 · Cited by 314 · see citing works
Comparison of Kinematic and Temporal Parameters between Different Pitch Velocity Groups
Matsuo, T., Escamilla, R. F., Fleisig, G. S., Barrentine, S. W., & Andrews, J. R. (2001) · Journal of Applied Biomechanics · doi:10.1123/jab.17.1.1 · Cited by 299 · see citing works
FREQUENCY AND VELOCITY OF PEOPLE WALKING
Pachi, A., & Ji, T. (2005) · The Structural Engineer · Cited by 271 · see citing works
Schiefer, M., Tan, D., Sidek, S. M., & Tyler, D. J. (2016) · Journal of Neural Engineering · doi:10.1088/1741-2560/13/1/016001 · Cited by 255 · see citing works
MacDiarmid, S., Peters, K. M., Shobeiri, S. A., Wooldridge, L. S., Rovner, E. S., Leong, F. C., SIEGEL, S. W., Tate, S. B., & FEAGINS, B. A. (2009) · The Journal of Urology · doi:10.1016/j.juro.2009.08.160 · Cited by 224 · see citing works
The Development of the Nucleus® Freedom™ Cochlear Implant System
Patrick, J., Busby, P., & Gibson, P. (2006) · Trends in Amplification · doi:10.1177/1084713806296386 · Cited by 214 · see citing works
Self-citationImplantable functional neuromuscular stimulation in the tetraplegic hand
Keith, M. W., Peckham, P. H., Thrope, G. B., Stroh, K. C., Smith, B., Buckett, J. R., Kilgore, K. L., & Jatich, J. W. (1989) · The Journal Of Hand Surgery · doi:10.1016/s0363-5023(89)80017-6 · Cited by 212 · see citing works
Biomimetic approaches to bionic touch through a peripheral nerve interface
Saal, H. P., & Bensmaia, S. J. (2015) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2015.06.010 · Cited by 179 · cited 1× · see citing works
“For many clinical applications, approaches that target peripheral nervous system structures may have advantages over those that target central nervous system structures, such as a reduction in the risks associated with implantation [24] and providing access to simpler, better understood neural codes [25].”
BackgroundNumber of Pedometer-Assessed Steps Taken Per Day by Adults: A Descriptive Meta-Analysis
Bohannon, R. W. (2007) · Physical Therapy · doi:10.2522/ptj.20060037 · Cited by 174 · see citing works
Chronically implanted intrafascicular recording electrodes
Lefurge, T., Goodall, E., Horch, K., Stensaas, L., & Schoenberg, A. (1991) · Annals of Biomedical Engineering · doi:10.1007/bf02368469 · Cited by 172 · see citing works
Self-citationRegeneration microelectrode array for peripheral nerve recording and stimulation
Kovacs, G. T. A., Storment, C. W., & Rosen, J. M. (1992) · IEEE Transactions on Biomedical Engineering · doi:10.1109/10.256422 · Cited by 164 · see citing works
Marsolais, E. B., & Kobetic, R. (1986) · PubMed · Cited by 136 · see citing works
Functional Neuromuscular Stimulation Neuroprostheses for the Tetraplegic Hand
Keith, M. W., Peckham, P. H., Thrope, G. B., Buckett, J. R., Wuolle, K. S., & MENGER, V. (1988) · Clinical Orthopaedics and Related Research · doi:10.1097/00003086-198808000-00005 · Cited by 115 · see citing works
An intrafascicular electrode for recording of action potentials in peripheral nerves
Malagodi, M. S., Horch, K. W., & Schoenberg, A. A. (1989) · Annals of Biomedical Engineering · doi:10.1007/bf02368058 · Cited by 107 · see citing works
Self-citationInterfaces with the Peripheral Nerve for the Control of Neuroprostheses
del Valle, J., & Navarro, X. (2013) · International Review of Neurobiology · doi:10.1016/b978-0-12-420045-6.00002-x · Cited by 105 · see citing works
Comparison of natural and artificial control of movement
Procházka, A. (1993) · IEEE Transactions on Rehabilitation Engineering · doi:10.1109/86.242403 · Cited by 104 · see citing works
Phillips, J. B., Smit, X., Zoysa, N. D., Afoke, A., & Brown, R. A. (2004) · The Journal of Physiology · doi:10.1113/jphysiol.2004.061804 · Cited by 103 · see citing works
Interfacing the Somatosensory System to Restore Touch and Proprioception: Essential Considerations
Weber, D. J., Friesen, R., & Miller, L. E. (2012) · Journal of Motor Behavior · doi:10.1080/00222895.2012.735283 · Cited by 98 · see citing works
Prevention of Mechanical Failures in Implanted Spinal Cord Stimulation Systems
Henderson, J. M., Schade, C. M., Sasaki, J., Caraway, D. L., & Oakley, J. C. (2006) · Neuromodulation Technology at the Neural Interface · doi:10.1111/j.1525-1403.2006.00059.x · Cited by 97 · see citing works
Fabrication and characteristics of an implantable, polymer-based, intrafascicular electrode
Lawrence, S. M., Dhillon, G. S., & Horch, K. W. (2003) · Journal of Neuroscience Methods · doi:10.1016/s0165-0270(03)00231-0 · Cited by 93 · see citing works
Self-citationDurability of implanted electrodes and leads in an upper-limb neuroprosthesis
Kilgore, K. L., Peckham, P. H., Keith, M. W., Montague, F. W., Hart, R. L., Gazdik, M. M., Bryden, A. M., Snyder, S. A., & Stage, T. G. (2003) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2003.11.0457 · Cited by 85 · see citing works
Kundu, A., Harreby, K. R., Yoshida, K., Boretius, T., Stieglitz, T., & Jensen, W. (2014) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2013.2267936 · Cited by 83 · see citing works
Intrafascicular stimulation of monkey arm nerves evokes coordinated grasp and sensory responses
Ledbetter, N. M., Ethier, C., Oby, E. R., Hiatt, S. D., Wilder, A. M., Ko, J. H., Agnew, S. P., Miller, L. E., & Clark, G. A. (2013) · Journal of Neurophysiology · doi:10.1152/jn.00688.2011 · Cited by 69 · see citing works
Memberg, W. D., Peckham, P. H., Thrope, G. B., Keith, M. W., & Kicher, T. P. (1993) · IEEE Transactions on Rehabilitation Engineering · doi:10.1109/86.242426 · Cited by 60 · see citing works
Stress-strain phenomena in denervated peripheral nerve trunks
SUNDERLAND, S., & BRADLEY, K. C. (1961) · Brain · doi:10.1093/brain/84.1.125 · Cited by 53 · cited 1× · see citing works
“The silicone tubing wall is stiffer than what is expected in the nerve tissue [55].”
BackgroundMaterial considerations for peripheral nerve interfacing
Kim, Y.-T., & Romero-Ortega, M. I. (2012) · MRS Bulletin · doi:10.1557/mrs.2012.99 · Cited by 47 · see citing works
Investigating mechanical behaviour at a core–sheath interface in peripheral nerve
Tillett, R. L., Afoke, A., Hall, S. M., Brown, R. A., & Phillips, J. B. (2004) · Journal of the Peripheral Nervous System · doi:10.1111/j.1085-9489.2004.09411.x · Cited by 42 · see citing works
Thota, A. K., Kuntaegowdanahalli, S., Starosciak, A. K., Abbas, J. J., Orbay, J., Horch, K. W., & Jung, R. (2015) · Journal of Neuroscience Methods · doi:10.1016/j.jneumeth.2014.07.020 · Cited by 41 · see citing works
Self-citationKazama, S., Nishiyama, K., Machii, M., Tanaka, K., Amano, T., 野村, 友., Ohuchi, M., Kasahara, S., Nie, M., & Ishihara, A. (1993) · Japanese Heart Journal · doi:10.1536/ihj.34.193 · Cited by 41 · see citing works
Electrode characterization for functional application to upper extremity FNS
Kilgore, K. L., Peckham, P. H., Keith, M. W., & Thrope, G. B. (1990) · IEEE Transactions on Biomedical Engineering · doi:10.1109/10.43606 · Cited by 40 · see citing works
Smith, B. T., Betz, R. R., Mulcahey, M. J., & Triolo, R. J. (1994) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/0003-9993(94)90668-8 · Cited by 37 · see citing works
Implantable electrode lead in a growing limb
Akers, J. M., Smith, B., & Betz, R. R. (1999) · IEEE Transactions on Rehabilitation Engineering · doi:10.1109/86.750550 · Cited by 12 · see citing works
Long‐Term Performance of Epimyocardial Pacing Leads in Adults: Comparison with Endocardial Leads
Helguera, M. E., Maloney, J. D., Woscoboinik, J., Trohman, R. G., McCarthy, P. M., Morant, V. A., Wilkoff, B. L., CASTLE, L. W., & Pinski, S. L. (1993) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.1993.tb01603.x · Cited by 12 · see citing works
A 20-year study of endocardial pacing lead EMT 588:Lead Durability and Nature of Failure
LEVANDER‐LINDGREN, M. (1988) · Scandinavian Journal of Thoracic and Cardiovascular Surgery · doi:10.3109/14017438809106041 · Cited by 10 · see citing works
Flagged first, then by citations
5 of the 56 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Piech, D. K., Johnson, B. C., Shen, K., Ghanbari, M. M., Li, K. Y., Neely, R. M., Kay, J. E., Carmena, J. M., Maharbiz, M. M., & Muller, R. (2020) · Nature Biomedical Engineering · doi:10.1038/s41551-020-0518-9 · Cited by 442 · see citing works
A review for the peripheral nerve interface designer
Larson, C. E., & Meng, E. (2020) · Journal of Neuroscience Methods · doi:10.1016/j.jneumeth.2019.108523 · Cited by 133 · see citing works
Guidelines to Study and Develop Soft Electrode Systems for Neural Stimulation
Schiavone, G., Kang, X., Fallegger, F., Gandar, J., Courtine, G., & Lacour, S. P. (2020) · Neuron · doi:10.1016/j.neuron.2020.10.010 · Cited by 119 · see citing works
Interfaces with the peripheral nervous system for the control of a neuroprosthetic limb: a review
Yildiz, K. A., Shin, A. Y., & Kaufman, K. R. (2020) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-020-00667-5 · Cited by 113 · see citing works
Conformable hybrid systems for implantable bioelectronic interfaces
Fallegger, F., Schiavone, G., & Lacour, S. P. (2020) · Advanced Materials · doi:10.1002/adma.201903904 · Cited by 113 · see citing works
The development of neural stimulators: a review of preclinical safety and efficacy studies
Shepherd, R. K., Villalobos, J., Burns, O., & Nayagam, D. A. X. (2018) · Journal of Neural Engineering · doi:10.1088/1741-2552/aac43c · Cited by 81 · see citing works
Advanced technologies for intuitive control and sensation of prosthetics
Wolf, E. J., Cruz, T. H., Emondi, A. A., Langhals, N. B., Naufel, S. N., Peng, G. C. Y., Schulz, B. W., & Wolfson, M. B. (2019) · Biomedical Engineering Letters · doi:10.1007/s13534-019-00127-7 · Cited by 39 · see citing works
Overcoming failure: improving acceptance and success of implanted neural interfaces
Dalrymple, A. N., Jones, S. T., Fallon, J. B., Shepherd, R. K., & Weber, D. J. (2025) · Bioelectronic Medicine · doi:10.1186/s42234-025-00168-7 · Cited by 36 · see citing works
Bionic Intrafascicular Interfaces for Recording and Stimulating Peripheral Nerve Fibers
Jung, R., Abbas, J. J., Kuntaegowdanahalli, S. S., & Thota, A. K. (2017) · Bioelectronics in Medicine · doi:10.2217/bem-2017-0009 · Cited by 28 · see citing works
Self-citationMechanics and bio-interface engineering in flexible biosensors for continuous health monitoring
Qaiser, N., Suryaprabha, T., Vetrano, F., Hwang, B., & El‐Atab, N. (2026) · npj Flexible Electronics · doi:10.1038/s41528-025-00524-2 · Cited by 28 · see citing works
Inflammation neuroscience: neuro‐immune crosstalk and interfaces
Tarnawski, L., & Olofsson, P. S. (2021) · Clinical & Translational Immunology · doi:10.1002/cti2.1352 · Cited by 23 · see citing works
Q-PINE: A quick to implant peripheral intraneural electrode
Strauss, I., Niederhoffer, T., Giannotti, A., Panarese, A. M., Bernini, F., Gabisonia, K., Ottaviani, M. M., Petrini, F. M., Recchia, F. A., Raspopović, S., et al. (2020) · Journal of Neural Engineering · doi:10.1088/1741-2552/abc52a · Cited by 19 · see citing works
A Study on Biocompatible Polymer-Based Packaging of Neural Interface for Chronic Implantation
Park, H., Choi, W., Oh, S.-H., Kim, Y.-J., Seok, S., & Kim, J. (2022) · Micromachines · doi:10.3390/mi13040516 · Cited by 15 · see citing works
Qin, C., Yue, Z., Wallace, G. G., & Chen, J. (2022) · ACS Applied Bio Materials · doi:10.1021/acsabm.2c00679 · Cited by 14 · see citing works
Remote Stimulation of Sciatic Nerve Using Cuff Electrodes and Implanted Diodes
Sridharan, A., Chirania, S., Towe, B. C., & Muthuswamy, J. (2018) · Micromachines · doi:10.3390/mi9110595 · Cited by 6 · see citing works
Accelerating neurotechnology development using an Agile methodology
Thota, A. K., & Jung, R. (2024) · Frontiers in Neuroscience · doi:10.3389/fnins.2024.1328540 · Cited by 5 · see citing works
Self-citationNeural Implants Without Electronics: A Proof-of-Concept Study on a Human Skin Model
Kiele, P., Braig, D., Weis, J., Baslan, Y., Pasluosta, C. F., & Stieglitz, T. (2020) · IEEE Open Journal of Engineering in Medicine and Biology · doi:10.1109/ojemb.2020.2981254 · Cited by 4 · see citing works
Li, L., Jiang, C., Wang, H., Xie, H., & Li, L. (2021) · Journal of the mechanical behavior of biomedical materials/Journal of mechanical behavior of biomedical materials · doi:10.1016/j.jmbbm.2021.104364 · Cited by 2 · see citing works
Regnacq, L., Thota, A. K., Sanabria, A. O., McPherson, L. M., Renaud, S., Romain, O., Bornat, Y., Abbas, J. J., Jung, R., & Kölbl, F. (2025) · Journal of Neural Engineering · doi:10.1088/1741-2552/adc62a · Cited by 1 · see citing works
Self-citationDevelopment of a miniaturized, reconnectable, and implantable multichannel connector
Choi, G. J., Yoo, H. J., Cho, Y. K., Shim, S., Yun, S., Sung, J., Lim, Y., Jun, S. B., & Kim, S. J. (2022) · Journal of Neural Engineering · doi:10.1088/1741-2552/ac99ff
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Consulting Patent Associate, G. A. L., & Ravi, S. (2026) · INDIAN DRUGS · doi:10.53879/id.63.02.p0005
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Hwang, G. M., Falcone, J., Monaco, J. D., Pinard, C. R., Mollick, J., Miller, R. L., Gage, S. L., Kanaev, A. V., Kim, S. M., Lukaszew, R. A., et al. (2026) · Journal of Neural Engineering · doi:10.1088/1741-2552/ae8d5b
- Authors
- Pena, A. E., Kuntaegowdanahalli, S. S., Abbas, J. J., Patrick, J., Horch, K. W., & Jung, R.
- Affiliations
- Florida International University (US)
- Arizona State University (US)
- Cochlear (Australia) (AU)
- Corresponding author
- Jung, R
- Venue
- Journal of Neural Engineering
- Publisher
- IOP Publishing
- Published
- 2017-11-10
- Volume
- 14
- Issue
- 6
- Pages
- 066014
- ISSN
- 1741-2552 (ISSN-L)
- 1741-2560
- PMC
- PMC5736390
- OpenAlex
- W2768835188
- Cited by
- 22
- References
- 56
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 3 · 2018: 2 · 2017: 1
- FWCI
- 1.47
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Neural Engineering (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Biomedical Imaging and Bioengineering (NIH-R01-EB008578)
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neural Engineering
- Physical Sciences › Engineering › Biomedical Engineering › Muscle activation and electromyography studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- implantable neural interfaces, intrafascicular electrodes, stress concentrators, electrical continuity, neurostimulation
- MeSH terms
- Arm, Electrodes, Implanted, Equipment Design, Humans, Materials Testing, Polyesters, Silicones, Stress, Mechanical, Electric Impedance, Printing, Three-Dimensional
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