Methodological optimization for eliciting robust median nerve somatosensory evoked potentials for realtime single trial applications

<i>Objective.</i>Single-trial measurement of median nerve somatosensory evoked potentials (SEPs) with noninvasive electroencephalography (EEG) is challenging due to low signal-to-noise ratio (SNR), limiting its use in real-time neurorehabilitation applications. We describe and evaluate methodological optimizations for eliciting reliable median nerve SEPs measurable in real time, with reduced reliance on post-processing.<i>Methods.</i>In twelve healthy participants, two sessions each, SEPs were assessed at three pulse widths (0.1, 0.5, 1 ms), at a low-frequency stimulation (0.5 Hz ± 10%), and at an intensity sufficient to evoke consistent and robust sensory nerve action potentials and compound muscle action potentials. The evoked potential operant conditioning system platform was used to monitor responses in real time. Feasibility was also evaluated in a participant with incomplete spinal cord injury (iSCI).<i>Results.</i>SEP P50 and N70 were reliably elicited in healthy participants, and in individual with iSCI, across all tested pulse widths with minimal discomfort. N70 amplitude increased significantly with pulse width (χ2= 17.64,<i>p</i>= 0.0001,<i>w</i>= 0.80), while P50 amplitude remained unchanged. SNR showed a significant pulse width-dependent increase (χ2= 7.82,<i>p</i>= 0.02,<i>w</i>= 0.35) with improvements of 40% and 52% at 0.5 and 1 ms, respectively. N70 single-trial separability significantly improved at 1 ms (AUC of 0.83,χ2= 8.17,<i>p</i>= 0.017), including the iSCI participant (0.84-less impaired hand, 0.79-more impaired hand). Test-retest reliability (intraclass correlation coefficient = 0.70-0.84,<i>p</i>< 0.05) was highest at 0.5 ms, indicating more consistent N70 and P50 measurements across sessions at a longer pulse width.<i>Significance.</i>Robust median nerve SEPs can be measured at single trials with methodological optimizations such as a longer pulse width (0.5-1 ms), low frequency (0.5 Hz), a consistent afferent excitation guided by nerve and muscle responses, and a robust EEG acquisition system. This setup can be useful for real time SEP-based brain computer interface applications for rehabilitation.