Reduced Muscle Fatigue Using Continuous Subthreshold Kilohertz Stimulation of Peripheral Nerves

Functional electrical stimulation (FES) is a prevalent technique commonly used to activate muscles in individuals with neurological disorders. Traditional FES strategies predominantly utilize low-frequency (LF) stimulation, which evokes synchronous action potentials, leading to rapid muscle fatigue. To address these limitations, we introduced a subthreshold high-frequency (HF) stimulation method that employed continuous, charge-balanced subthreshold current pulses at kilohertz frequencies, designed to evoke motor unit (MU) activation similar to voluntary activation. We evaluated the effectiveness of HF stimulation on the reduction of muscle fatigue across different force levels (10%, 25%, and40% of maximum force). The HF stimulation utilized continuous charge-balanced, brief pulses of 80 μs (at a 10 kHz frequency) targeted the ulnar/median nerve bundles. We compared the fatigue effects with conventional LF stimulation and voluntary muscle contractions. Our results indicated that HF stimulation maintained more sustained force outputs and muscle activation over a prolonged time compared with LF stimulation. The HF stimulation also evoked a more dispersed muscle activation pattern, similar to voluntary muscle contractions. These findings suggest that HF stimulation can significantly enhance the sustainability of muscle contractions and reduce muscle fatigue, potentially improving the efficacy and applicability of FES in clinical and home-based settings for individuals with neurological impairments.