Patent Publication Number: US-2021187279-A1

Title: Neurostimulation or electromyography cuff

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 16/371,417, filed Apr. 1, 2019, which is a continuation of U.S. patent application Ser. No. 15/872,272, filed on Jan. 16, 2018, now issued as U.S. Pat. No. 10,293,151 which issued on May 21, 2019, which is a divisional of U.S. patent application Ser. No. 14/649,025, filed on Jun. 2, 2015, now issued as U.S. Pat. No. 9,884,178, which issued on Feb. 6, 2018, which was a 371 of PCT Application No. PCT/US2013/073247, filed Dec. 5, 2013, which claimed priority to U.S. Provisional Patent Application Ser. No. 61/733,736, filed on Dec. 5, 2012, and to U.S. Provisional Patent Application Ser. No. 61/734,150, filed on Dec. 6, 2012, which are incorporated herein by reference in its entirety. 
    
    
     BACKGROUND 
     The present disclosure relates to systems, methods, and devices for thought-controlled neuromuscular stimulation. Generally, the system may be used to receive thought signals indicative of an intended action and provide electrical stimulation to a damaged or degenerated neuromuscular region to effectuate the intended action. Methods to produce a flexible neuromuscular stimulation cuff are also disclosed. The device may be a neuromuscular stimulation cuff which delivers stimulation to restore movement to parts of the body not under volitional control due to damaged or degenerated neural pathways from spinal cord injury, stroke, nerve damage, motor neural disease, and other conditions or injuries. The system can also be used in a patient that has some local neural or muscle degeneration for therapeutic or rehabilitation purposes. 
     Subcutaneous implantable neurostimulation cuffs have been commonly used to block pain and to restore function to damaged or degenerative neural pathways. These implantable cuffs are wrapped around a target nerve and generally include one or more electrodes arranged to stimulate the nerve. By including more than one electrode and/or a different geometry of electrodes, implantable cuffs such as the flat interface nerve electrode (FINE) have been able to achieve stimulation selectivity at the level of individual nerve vesicles. 
     Transcutaneous neurostimulation cuffs behave similarly to implantable cuffs, however there are important differences. Because the electrodes are placed against the skin, rather than through it, stimulation is preferably performed on skeletal muscle tissue or muscle groups, rather than peripheral nerves located deeper under the skin. Muscular stimulation may be preferable to stimulating major peripheral nerves, e.g. ulnar, median, radial nerves, as stimulating these nerves may cause a patient to feel a tingling sensation. By increasing the number and layout of electrodes in a neuromuscular cuff, similar to the direction taken with implanted nerve cuff designs, current generation neuromuscular stimulation cuffs have been able to selectively stimulate individual muscles or muscle groups. 
     Flexible transcutaneous cuffs have been developed which fit around a human appendage such as a forearm to control the wrist or fingers. These flexible cuffs may include sensors which record muscle activity, or EMG signals, and stimulate in response to the EMG signals. Thin film technologies have also become important in the development of functional electrostimulation (FES) devices. Devices incorporating thin film technology are often based on a polyimide substrate covered by a chromium, gold, or platinum film. 
     Current neuromuscular cuffs present many limitations, for example, their inability to receive a stimulation signal which is directly processed from thought signals. These neuromuscular cuffs are also not flexibly positioned over multiple stimulation points. Flexible electrode positioning is desirable when attempting to restore complex muscular movements through neuromuscular stimulation. Current neuromuscular cuffs are also incapable of accommodating a wide range of patient appendage geometries, e.g. varying circumferences, while also staying well adhered to the skin. 
     An effective wireless system for transmitting human brain signals directly to muscles, and thereby enabling movement through thought-control, has not yet been developed. Neuromuscular stimulation cuffs for such a system, e.g. which receive an input consisting of encoded “thought” signals and provide stimulation to muscular regions according to the signals, have also not been developed. 
     BRIEF DESCRIPTION 
     The present disclosure relates to systems, methods, and devices for thought-controlled neuromuscular stimulation. Included is a neuromuscular stimulation cuff which receives a thought signal indicative of an intended action, and in response, stimulates a damaged neuromuscular region to effectuate the intended action. The neuromuscular cuff may include a flexible design, e.g., including a plurality of electrodes arranged on flexible fingers across a single conductive layer. The flexible fingers allow for variable sized neuromuscular regions, e.g. paralyzed limbs, to fit within the neuromuscular cuff. The fingers may also allow for increased electrode positioning choices for reanimation of complex muscle movements. The neuromuscular cuff may further include an array of electrogel discs which provide enhanced electrical contact as well as keep cuff adhered to the skin during stimulation-induced movement. 
     In some embodiments, a system for thought-controlled neuromuscular stimulation includes a sensor for monitoring or recording neural signals from a patient, a neural signal processor for receiving the neural signals and processing the neural signals into a re-encoded signal, and a neuromuscular stimulation cuff for delivering stimulation to the patient according to the re-encoded signal. 
     In other embodiments, a method for thought-controlled neuromuscular stimulation includes receiving neurological signals from a patient indicative of an intended action, processing neurological signals, generating a re-encoded signal, and delivering neuromuscular stimulation to the patient according to the re-encoded signal to effectuate the intended action. 
     In yet other embodiments, a device for neuromuscular stimulation includes a flexible printed circuit board having at least one finger and a plurality of electrogel discs disposed on the at least one finger. 
     In additional different embodiments, a method for producing a neuromuscular cuff includes providing a layer of polyimide, etching a conductive copper circuit including a plurality of electrodes into the layer of polyimide to form an etched circuit layer, adhering a cover layer onto the etched circuit layer to form a flexible printed circuit board (PCB), and cutting at least one finger from the flexible PCB. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The following is a brief description of the drawings, which are presented for the purposes of illustrating the exemplary embodiments disclosed herein and not for the purposes of limiting the same. 
         FIG. 1  is an overview diagram of one embodiment of a system for thought-controlled neuromuscular stimulation. 
         FIG. 2  is a block diagram for the decoding and re-encoding architecture operating within the system of  FIG. 1 . 
         FIG. 3  is a flow diagram for one embodiment of a method for providing thought-controlled neuromuscular stimulation. 
         FIG. 4  is a perspective drawing of a neuromuscular stimulation cuff device according to an exemplary embodiment, shown in place on a human arm. 
         FIG. 5  is a diagram for a concept design for fabricating one embodiment of the neuromuscular stimulation cuff device. 
         FIG. 6  is a diagram for an etched circuit layer for fabricating one embodiment of the neuromuscular stimulation cuff device. 
         FIG. 7  is a close-up view diagram of the etched circuit layer of  FIG. 6 . 
         FIG. 8  is an alternative close-up view diagram of the etched circuit layer of  FIG. 6 . 
         FIG. 9  is a diagram for a coverlay layer used in fabricating one embodiment of the neuromuscular stimulation cuff device. 
         FIG. 10  is a diagram for a silkscreen layer used in fabricating one embodiment of the neuromuscular stimulation cuff device. 
         FIG. 11  is a stack-up diagram used in fabricating one embodiment of the neuromuscular stimulation cuff device. 
         FIG. 12  is a flow diagram for one embodiment of a method for producing a neuromuscular cuff. 
         FIG. 13  is an exemplary photograph showing individual finger movement within a system for thought-controlled neuromuscular stimulation. 
         FIG. 14  is an exemplary photograph showing two neuromuscular cuff devices according to one embodiment disposed on a preparation bench. 
         FIG. 15  is an exemplary photograph showing two neuromuscular cuff devices according to the embodiment of  FIG. 14 . 
         FIG. 16  is an exemplary photograph showing two neuromuscular cuff devices according to a different embodiment. 
         FIG. 17  is an exemplary photograph showing a rigidizer and the primary side of a neuromuscular cuff device according to yet another embodiment. 
         FIG. 18  is an exemplary photograph showing the positioning of a patient&#39;s arm region over two neuromuscular cuff devices according to the embodiment of  FIG. 14 . 
         FIG. 19  is an exemplary photograph showing two neuromuscular cuff devices according to the embodiment of  FIG. 14  which are wrapped around a patient&#39;s arm region in preparation for neuromuscular stimulation. 
         FIG. 20  is an exemplary photograph showing two neuromuscular cuff devices according to the embodiment of  FIG. 14  which are alternatively wrapped around a patient&#39;s arm region in preparation for neuromuscular stimulation. 
     
    
    
     DETAILED DESCRIPTION 
     A more complete understanding of the processes and apparatuses disclosed herein can be obtained by reference to the accompanying drawings. These figures are merely schematic representations based on convenience and the ease of demonstrating the existing art and/or the present development, and are, therefore, not intended to indicate relative size and dimensions of the assemblies or components thereof. 
     Although specific terms are used in the following description for the sake of clarity, these terms are intended to refer only to the particular structure of the embodiments selected for illustration in the drawings and are not intended to define or limit the scope of the disclosure. In the drawings and the following description below, it is to be understood that like numeric designations refer to components of like function. 
     With reference to  FIG. 1  and  FIG. 2 , a system for thought-controlled neuromuscular stimulation may include a cortical implant  102  implanted into the cerebral cortex region of the brain. The cortical implant  102  in one embodiment includes a microelectrode sensing array, as depicted in  FIG. 1 . The microelectrode sensing array includes multiple channels (e.g.  96  channels) and may be wired to an amplifier which further amplifies signals received by the microelectrode array. The cortical implant  102  records “brain waves,” more particularly neural signals which are representative of a varied set of mental activities. Neural signals include electrical signals produced by neural activity in the nervous system including action potentials, multi-unit activity, local field potential, ECoG, and EEG. These neural signals are sent wirelessly or, alternatively, through a wired connection, from the cortical implant  102  to a receiver on a neural signal processor device  104  for processing of the neural signals. In another embodiment, a scalp based interface, headset, or other sensor  102  picks up electroencephalogram (EEG) signals and sends them to the receiver on the neural signal processor device  104 . 
     The neural signal processor  104  may include a processor including neural decoding algorithms  106  and/or control algorithms  108 . These algorithms  106 ,  108  allow for a received neural signal input to be decoded and subsequently re-encoded for use in neuromuscular stimulation. For example, a received neural signal may be isolated to predict arm and/or hand movements a patient is thinking about. The neural signal processor  104  may also include an oscilloscope or other signal waveform viewing and/or manipulation device. The neural signal processor also preferably includes an isolated pulse stimulator  111  which receives a processed signal and generates a pulse signal for use in neuromuscular stimulation by an attached neuromuscular stimulation cuff  110 . 
     With reference to  FIG. 2 , the system for thought control at a more complex architectural level includes the cortical implant or sensor  102  and the neural signal processor  104  which allow for the recording of neural signals and the initial processing of the signals, respectively. Initial signal processing may include analog to digital conversion, normalization, and/or other filtering and processing methods known by one having ordinary skill in the art. Initially processed signals are then decoded by the neural decoding algorithms  106 . In exemplary embodiments, the neural decoding algorithms  106  include force-based algorithms with firing-rate estimators. 
     The decoded signal output of the neural decoding algorithms  106  is further processed by the stimulation control algorithms  108 . In exemplary embodiments, the stimulation control algorithms  108  produce an output of peak current amplitude modulated, pulse width modulated, or frequency modulated pulse trains going to the cuff electrodes. The pulse train can also be a non-stationary Poisson type train where average pulse rate (frequency) is modulated. This may help reduce muscle fatigue as it more closely matches to the body&#39;s natural nervous system. An example of using poisson-distributed impulse trains to characterize neurons in a region of the brain is disclosed in Pienkowski et al., Wiener-Volterra Characterization of Neurons in Primary Auditory Cortex Using Poisson-Distributed Impulse Train Inputs, J. Neurophysiology (March 2009). Stimulation control algorithms  108  may be altered through input received from a training profile  107 . The training profile  107  may include training profile data representative of past user training sessions, e.g. motion demonstrations or coaching periods. Training data may be used to alter and/or define simulation control algorithms  108  during signal processing. Incorporating training data into stimulation control algorithms  108  through a model-based approach yields more accurate decoding, e.g. patient thoughts accurately translated into a complex motion, than prior position-based decoding efforts have shown. Additionally or alternatively, wrist-hand position feedback  109  may be used to alter and/or define stimulation control algorithms  108  during signal processing. 
     Signal control algorithm  108  output may be sent to the isolated pulse generator  111 , where the signal is converted into a waveform that is suitable for neurostimulation. Suitable waveforms may include monophasic and biphasic pulses with a voltage between 80 to 300 Volts. However, even higher voltages may be used as long as safe current levels are maintained and proper insulation is used. In exemplary embodiments, the waveform is a monophasic pulse with a peak current of 0-20 mA which is modulated to vary strength of muscle contraction, frequency of 50 Hz, and a pulse width duration of 500 ms. The output of the isolated pulse generator  111  is sent to the neuromuscular stimulation cuff  110  to deliver functional electrostimulation to the patient. 
     With reference to the flow diagram set forth in  FIG. 3 , a method for providing thought-controlled neuromuscular stimulation S 100  starts at S 101 . At S 102  neurological signals are received from a patient indicative of an intended action. For example, neurological signals may be received though cortical implant  102 . At S 104  the neurological signals are processed, which may include analog to digital conversion or filtering. At S 106 , the digitized signals are decoded by at least one neural decoding algorithm  106 . At S 108 , the decoded signals are processed by at least one stimulation control algorithm  108 . At S 110 , the method alternatively includes altering the stimulation control algorithms  108  by training data which is stored in the training profile  107 . At S 112 , the method alternatively includes altering the stimulation control algorithms  108  based on movement data, e.g. wrist-hand position feedback  109 . At S 114 , the output of the at least one signal control algorithm  108  is converted into a re-encoded signal consisting of multiple pulse trains, each pulse train going to a corresponding electrode  114 . At S 114 , neuromuscular stimulation is delivered to the patient by sending the re-encoded signal to the neuromuscular stimulation cuff  110 . 
     In another embodiment, the method for providing thought-controlled neuromuscular stimulation S 100  further includes at S 117  delivering neuromuscular stimulation to the patient by selectively delivering stimulation to at least one pair of electrodes  114  within a neuromuscular cuff  110  to effectuate the intended action. 
     In yet another embodiment, the method S 100  further includes S 103  recording neurological signals from a patient. These neurological signals may be sensed from, e.g., a forearm or wrist region with neural pathway damage. Recording may also occur at a neurologically intact region such as a functional leg, for which stimulation pulses can be provided for stimulating commonly tied motions in damaged limbs, e.g. arms and legs. Commonly tied motions include hip and arm movements or pivoting movements. In the same embodiment, method S 100  at S 118  may further include delivering neuromuscular stimulation to the patient by selectively stimulating to at least one pair of electrodes within the neuromuscular cuff  110  based on the re-encoded signal. 
     With reference to  FIG. 4 , an exemplary embodiment of the neuromuscular stimulation cuff  110  includes a flexible printed circuit board (PCB)  112  upon which electrodes  114  and hydrogel discs  116  are arranged in an electrogel disc array  118 . The neuromuscular stimulation cuff  110  fits over a damaged or degenerative neuromuscular region  120 , e.g. a patient&#39;s arm as illustrated. The flexible PCB  112  may be comprised of a single layer of flexible polyimide material. Up to approximately twenty electrodes  114  may be individually etched onto each finger  124  of the flexible PCB  112  as a copper layer. In exemplary embodiments, the flexible PCB  112  has a total of eighty electrodes  114  disposed over four fingers  124 . The electrodes  114  may be subsequently plated with a conductive metal such as gold, palladium, or silver for greater conductivity. 
     In some embodiments, electrodes  114  both stimulate a neuromuscular region  120  by stimulating individual muscles and/or groups of muscles, as well as monitor or record skeletal muscle activity, specifically electromyography (EMG) signals. Sensed EMG data pertaining to a sensed muscle target may be used in methods for closed or open loop stimulation of the muscle target. Sensed EMG data may also be analyzed in deciding whether to reposition the neuromuscular stimulation cuff  110  within the neuromuscular region  120  or to turn off individual electrodes  114  within the electrogel disc array  118 . 
     Hydrogel discs  116  may be rolled over the electrodes  114  to provide enhanced electrical and mechanical coupling. When appropriately aligned, the hydrogel discs  116  completely cover the electrodes  114  and effectively form conductive electrogel discs  117 . Put another way, the electrodes are located between the base layer and the hydrogel discs. Electrical coupling is enhanced in that hydrogel provides greater conductive contact with the skin than is achievable with a bare metal-plated electrode surface. Additionally, a carrier signal provided to any of the electrogel discs  117  in the electrogel array  118  may conduct through the tissues of a patient and be released at any other electrogel disc  117  provided in the array  118 . Enhanced mechanical coupling is provided through the exemplary adherence characteristics of hydrogel to the skin. Hydrogel discs  116  may stay coupled to the skin even during complex patient movement. The hydrogel discs are commercially available as a tape which may be rolled on an electrode surface. One such example includes AmGel 2550 from AmGel Technologies. In the exemplary embodiment of the neuromuscular cuff shown in  FIG. 4 , the hydrogel discs are provided through custom spaced hydrogel discs located on AmGel 2550 rolled hydrogel tape. 
     The electrogel disc array  118  is spread over a plurality of fingers  124 , wherein the fingers  124  are cut from the flexible PCB  112  to provide additional flexibility in the placement of electrogel discs  117 . Reanimation of complex motion may require stimulating muscles which are not located directly along the dimensions of a conventionally shaped neuromuscular cuff  110 . By wrapping fingers  124  around different muscular regions, e.g. the lower wrist and thumb, complex motions such as thumb movement may be reanimated more effectively than with limited placement options. 
       FIGS. 5-11  are views of various layers of the neuromuscular stimulation cuff, and are separated for convenience and understanding. With reference to  FIG. 5 , one embodiment of the neuromuscular stimulation cuff device  110  may be fabricated in accordance with a concept design  500 . Dimensions of and between the various components of the concept design  500  are indicated in millimeters (mm). The concept design  500  includes, as shown here, a single layer of polyimide base material  522 . In some embodiments, the polyimide base material is a DuPont AP8523E polyimide which is 50 μm (micrometers) thick and rolled-annealed copper clad at 18 μm thick. This base material serves as a substrate for the other layers of the neuromuscular stimulation cuff. The base material  522  is cut into four fingers  524 , where the electrodes will be located. The fingers can be attached to each other, for example by five webbings  525  which run between adjacent fingers. An optional fork  526  of polyimide material is located at one end of the fingers. The fork connects all of the fingers, and is provided for structural support for design and mounting. Drilled holes  527  are provided in the fork  526  for support and/or mounting purposes. In some embodiments, the four drilled holes  527  are approximately 2.387 mm in diameter with a tolerance of +/0.076 mm. Headers  528  extend from the end of each finger opposite that of the fork. These headers are thinner than the fingers and connect the fingers  524  to a rigidizer  530 . Though not illustrated, webbings can also be provided between adjacent headers as well if desired. The rigidizer  530  is an inflexible circuit board used for interfacing with the neural signal processor  104 . Drilled holes  531  are additionally located on the rigidizer  530  which represent connector pin insertion points. In exemplary embodiments, eighty drilled holes  531  are approximately 1.016 mm in diameter with a tolerance of +/−0.05 mm. 
     With reference to  FIG. 6 , an etched circuit layer  600  for fabricating the neuromuscular stimulation cuff device  110  is shown. The etched circuit layer  600  is located on the surface of the polyimide substrate  622 , upon which copper electrodes  640  and connective copper traces  642  are etched. The electrodes  640  and traces  642  run along the four fingers  624  of the substrate  622 . The traces  642  run longitudinally down the four headers  628  to electrically connect the electrodes  642  to the rigidizer  630 . The rigidizer  630  is an inflexible circuit board used for interfacing with the neural signal processor  104 . The traces  642  continue onto rigidizer  630  and end, in this exemplary embodiment, at eighty connective points  632 , which represents twenty connective points  632  per finger  624 . Each of the eighty connective points  632  corresponds to an individual electrode  640 , electrically connected through an individual trace  642 . 
       FIG. 7  is a closer view of the etched circuit layer  600  of  FIG. 6 . The substrate  622 , electrodes  640 , and traces  642  are more particularly seen here. Each electrode  640  is individually connected to a single trace  642 , and the trace  642  runs down header  628  to the rigidizer  630  (not shown). In some embodiments, the traces  642  are approximately 0.127 mm in width. As illustrated here, each electrode  640  includes at least one ear  641  which is used to support the electrode  640  upon the substrate  622 . As seen here, each electrode includes a central area  643  and three ears  641 . The central area has a circular shape and is used as an electrical contact. Each ear extends beyond the perimeter of the central area. As illustrated here, two ears are separated by 60 degrees, and are separated from the third ear by 150 degrees. 
     Referring to  FIG. 8 , the etched circuit layer illustrated in  FIG. 6  may include electrodes  640  that are approximately 12 mm in diameter (not counting the ear) and spaced 15 mm apart. This 15 mm spacing between electrodes would dictate the custom spacing required for subsequent application of hydrogel discs  114 . 
       FIG. 9  illustrates a coverlay layer  700  which would be placed over the electrodes and traces. The coverlay layer can be made from a single layer of polyimide  722 , which is preferably thinner than the substrate upon which the electrodes and traces are copper-etched. In one embodiment, the coverlay layer is a DuPont LF0110 polyimide material which is a 25 μm thick coverfilm. A further thickness of 25 μm of acrylic adhesive can be used for adhering the coverlay layer  700  to the etched circuit layer  600 . The coverlay layer includes a fork  726 , fingers  724 , headers  728 , and rigidizer section  730  which corresponds to these areas on the base substrate  522  and the etched circuit layer  600 . Cutouts  740  are left in the fingers to expose the central area of the electrodes, and on the rigidizer section  730  for the electrical connectors. 
     The coverlay layer  700 , when applied over the etched circuit layer  600 , covers the copper traces  642  etched on the fingers  724  and the headers  728 . The coverlay layer  700  does not cover the central area  643  of the electrodes, but does cover the ears  641 , thus fixing the electrodes in place between the substrate and the coverlay layer. In addition, the electrical connectors in the rigidizer section  730  will remain uncovered. The exposed central area of the electrodes  640  are preferably plated with a conductive metal such as tin, platinum, or gold. In one embodiment, exposed copper electrodes are plated with electroless-nickel-immersion-gold (ENIG) at the level of 3-8 ul gold over 100-150 ul nickel. 
       FIG. 10  is a diagram for a silkscreen layer  800  that can be used in fabricating the neuromuscular stimulation cuff device  110 . The silkscreen layer  800  is applied to the combination of the etched circuit layer  600  and coverlay layer  700  to identify individual electronic elements. A first silkscreen identification number  850  is provided to each electrode  840  so that it may be more easily found after visual inspection. In one embodiment, first silkscreen identification numbers  850  span from A1-A20 and D1-D20 to represent eighty individual electrodes  840 . A second silkscreen identification number  852  identifies the connection ports for a rigidizer  830 . In one embodiment, second silkscreen identification numbers  852  span from J1-J4. Both first and second silkscreen identification numbers  850 ,  852  are provided on a secondary side of the neuromuscular stimulation cuff  110 , or side facing away from exposed electrodes  740 . In an exemplary embodiment, silkscreen identification numbers  850 ,  852  are provided by white epoxy nonconductive ink. 
     Referring now to  FIG. 11 , various embodiments of the neuromuscular stimulation cuff device may be fabricated according to stack-up diagram  900 . A polyimide base material provides a substrate  950  upon which various components are fixed. A secondary side rigidizer  830  is laminated to a secondary surface of the substrate  950 . The etched circuit layer  600  is fabricated onto a primary surface of the substrate (opposite the secondary surface), and includes electrodes and traces. The coverlay layer  700  is subsequently adhered to the etched circuit layer  600  which covers the traces and leaves exposed portions of the electrodes. The combination of the substrate  950 , etched circuit layer  600 , and coverlay layer  700  is defined as the flexible PCB  912 . Primary rigidizer  730  is stacked upon the coverlay layer to complete the electrical connection required to interface the flexible PCB with the neural signal processor  104 . 
     With reference to the flow diagram set forth in  FIG. 12 , one embodiment of a method for producing a neuromuscular cuff S 200  starts at S 201 . At S 202  a single layer of polyimide base material  950  is provided. At S 204 , an etched circuit layer is fabricated onto the polyimide base material  950  by etching a conductive copper circuit into the polyimide. At S 206  a polyimide coverlay layer  700  is adhered to the etched circuit layer  600 . Adhering the coverlay layer  700  to the etched circuit layer  600  completes the formation of the flexible PCB  912 . At S 208 , a plurality of fingers  724  may optionally be cut from the flexible PCB  912  to provide additional contact points for stimulation of muscles or sensing EMG signals. At S 210 , finger webbings  725  may optionally be cut from the flexible PCB  912  to separate the fingers  724  and provide additional flexibility, such as to accommodate limb twisting (such as the forearm) while maintaining contact. At S 212 , hydrogel may optionally be rolled over fingers  724  to with electrodes create electrogel discs  117 . At S 214 , a rigidizer  630 ,  730 ,  830  is attached to the flexible PCB  912  for interfacing with the neural signal processor  104 . At S 216 , the flexible PCB  912  is interfaced with the neural signal processor  104 . 
     With reference to  FIG. 13 , individual finger movement within a system for thought-controlled neuromuscular stimulation  1000  is demonstrated. A neuromuscular cuff  1010  according to one embodiment is wrapped over a damaged or degenerative neuromuscular region  1020 . The neuromuscular cuff  1010  is interfaced with a neurological signal processor  1004  through attached rigidizer  1030 . The rigidizer is attached to a connection port  1005  on the neural signal processor  1004 . Received neurological signals indicative of patient thinking about moving their first two digits has been decoded and re-encoded into pulse train signals transmitted to various electrodes on the neuromuscular stimulation cuff  1010 . Using a specific number and spacing of electrodes/electrogel discs  1014 ,  1017  in neuromuscular stimulation cuff  1010  has allowed for high resolution and non-invasive neuromuscular stimulation which effectuates the intention of the patient. 
     Electrogel discs  1017  operate in pairs when reanimating motion. Individual digit movement may be effectuated through the operation of two to three pairs (4 to 6 units) of electrogel discs  1017  which are stimulating in tandem. Selecting particular pairs of electrogel discs  1017  to reanimate motion as indicated by a decoded brain signal is advantageously performed by the neuromuscular stimulation cuff  1010 , as each electrogel disc  1017  is connected to the neurological signal processor  1004  individually along a single trace etched into a conductive layer of flexible polyimide material. 
     With reference to  FIG. 14 , two neuromuscular cuff devices  1010  according to one embodiment are disposed on a preparation bench  1070 . The preparation bench  1070  may be used to keep cuff devices  1010  flat and roll hydrogel tape across electrodes  1016 . Properly adhered hydrogel discs  116  (not shown) should fully cover the surface of electrodes  1014 . 
     With reference to  FIG. 15 , two neuromuscular cuff devices  1010  according to the embodiment of  FIG. 14  are shown. The cuff devices  1010  each include a fork  1026  for additional support when designing and/or placing the cuff devices  1010  over a damaged or degenerative neuromuscular region (not shown). 
     With reference to  FIG. 16 , two neuromuscular cuff devices  1100  according to a different embodiment are shown. A fork  1126  is provided at one end of each cuff for additional design and/or structural support, similar to the fork  626  in  FIG. 6 . Here, a second fork  1127  is also provided located along the headers  1128 . Put another way, the fingers  1126  are bracketed by a fork on each end. The additional fork  1127  provides additional support in combination with fork  1126  for situations when the neuromuscular cuff  1110  must be stretched flat across a surface. Additional fork  1127  can also maintains fingers  1124  within the same damaged or degenerative neuromuscular region  1120  (not shown), which effectively concentrates stimulation and prevents flexibility. 
     With reference to  FIG. 17 , the primary side of another embodiment of the neuromuscular cuff  1200  is shown. Hydrogel discs  1216  have been applied to electrodes  1214  (not shown, covered), forming an electrogel disc array  1218 . Two of the four fingers  1224  still include the hydrogel tape before being separated from hydrogel discs  1216 . Electrogel discs  1217  are not connected to each other within the array  1218  so that the electrogel discs  1217  may be independently stimulated. 
     While not exposed to the air, copper traces  1242  are viewable through the polyimide cover layer  700 . A secondary side rigidizer  1230  is shown by folding the primary side over at the headers  1228 . Connectors  1234  on the secondary side rigidizer  1230  allow for the neuromuscular stimulation cuff  1200  to be interfaced with the neural signal processor  104  (not shown). Each pin  1236  within connector  1234  is electrically connected with a single electrogel disc  1217 . 
     With reference to  FIG. 18 , a patient&#39;s arm including damaged or degenerative neuromuscular region  1020  is placed over two neuromuscular cuff devices  1010  according to the embodiment of  FIG. 14 . Flexible headers  1028  may be used as support while positioning the device  1010  under an arm. 
     With reference to  FIG. 19 , two neuromuscular cuff devices  1010  in an exemplary embodiment are wrapped around a patient&#39;s arm region  1020  in preparation for neuromuscular stimulation. The two cuff devices  1010  together provide 160 separate electrodes for stimulating finger or wrist movements. Fingers  1024  the neuromuscular cuff to fit around the arm region  1020  at points of varying circumference. Hydrogel discs  1016  (not shown) keep both cuffs  1010  adhered to the arm. 
     With reference to  FIG. 20 , two neuromuscular cuff devices  1010  according to the embodiment of  FIG. 14  are alternatively wrapped around a patient&#39;s arm region in preparation for neuromuscular stimulation. Only two fingers  1024  of one of the neuromuscular cuff devices  1010  are being utilized in combination with all fingers  1024  on the other cuff device  1010 . More or less electrodes can be used, as shown in  FIG. 20 , depending on the nature of the damage to a patent&#39;s neuromuscular region  1020  and the type of movement one wishes to reanimate through neuromuscular stimulation. 
     The present disclosure has been described with reference to exemplary embodiments. Obviously, modifications and alterations will occur to others upon reading and understanding the preceding detailed description. It is intended that the present disclosure be construed as including all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.