DWELL TIME ADJUSTMENTS FOR POSTURE STATE-RESPONSIVE THERAPY

• US 20100010390A1
• Filed: 04/30/2009
• Published: 01/14/2010
• Est. Priority Date: 07/11/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Davis, Jon P., Skelton, Dennis M.
• Granted Patent: US 8,219,206 B2
• Time in Patent Office: Days
• US Class Current: 600/595
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• CPC Class Codes: A61B 5/1116 Determining posture transitions
• CPC Class Codes: A61B 5/1118 Determining activity level
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: A61N 1/36062 Spinal stimulation
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/36535 controlled by body position or posture
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/3925 Monitoring; Protecting
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A medical device detects a patient posture state and adjusts therapy based on the detected posture state. A patient posture state may be transient. To avoid adjusting therapy in response to transient posture states, a dwell time may be imposed. Using the dwell time, only those posture states that are assumed by a patient for a minimum length of time will result in therapy adjustment. To help ensure that the dwell time is set to an appropriate length of time, patient therapy adjustment data may be analyzed. Therapy adjustments made during the dwell time may indicate that the dwell time is too long. Therapy adjustments made prior to the initiation of the dwell time may also indicate that the dwell time is too long. Therapy adjustments made by the patient after expiration of the dwell time may indicate that the dwell time is too short. Based on analysis of the therapy adjustment data, the dwell time can be adjusted to a length that is appropriate for the patient and/or posture state.

Claims

1. A method comprising:

delivering therapy to a patient;

detecting a posture state transition of a patient;

upon expiration of a dwell time for the posture state transition, adjusting the therapy based on the posture state transition;

detecting a patient adjustment of the therapy; and

adjusting the dwell time based on the patient adjustment.

2. The method of claim 1, wherein adjusting the dwell time comprises adjusting the dwell time if the patient adjustment is detected during or after the dwell time.

3. The method of claim 1, wherein adjusting the dwell time comprises adjusting the dwell time if the patient adjustment is detected prior to the dwell time.

4. The method of claim 1, wherein adjusting the dwell time comprises adjusting the dwell time if a number of patient adjustments detected during multiple instances of the posture state transition exceeds a threshold.

5. The method of claim 2, further comprising reducing the dwell time if the patient adjustment is detected during the dwell time.

6. The method of claim 5, wherein reducing comprises reducing the dwell time based on timing of the patient adjustment.

7. The method of claim 2, further comprising increasing the dwell time if the patient therapy adjustment is detected after the dwell time.

8. The method of claim 7, wherein increasing comprises increasing the dwell time based on timing of the patient adjustment.

9. The method of claim 1, further comprising determining whether the patient adjustment is consistent with the adjustment of therapy based on the posture state transition, wherein adjusting the dwell time comprises adjusting the dwell time based on the patient adjustment and the determination of whether the patient adjustment is consistent with the adjustment of therapy based on the posture state transition.

10. The method of claim 1, wherein the posture state transition comprises a transition from a first posture state to a second posture state, and wherein each of the first and second posture states comprises at least one of a posture or a combination of a posture and an activity level.

11. The method of claim 1, further comprising adjusting the therapy based on a plurality of different posture state transitions upon expiration of dwell times for the respective posture state transitions, wherein at least some of the dwell times are different for different posture state transitions.

12. The method of claim 11, wherein adjusting the dwell time comprises adjusting different dwell times for different posture state transitions based on patient adjustments associated with the respective dwell times.

13. The method of claim 1, further comprising delivering the therapy from an implantable medical device, wherein the therapy comprises electrical stimulation therapy.

14. A medical device comprising:

a posture state module that detects a posture state transition of a patient;

a therapy module that delivers therapy to a patient; and

a processor that, upon expiration of a dwell time for the posture state transition, adjusts the therapy based on the posture state transition, detects a patient adjustment of the therapy, and adjusts the dwell time based on the therapy adjustment.

15. The medical device of claim 14, wherein the processor adjusts the therapy if the patient adjustment is detected during or after the dwell time.

16. The medical device of claim 14, wherein the processor adjusts the dwell time if the patient adjustment is detected prior to the dwell time.

17. The medical device of claim 14, wherein the processor adjusts the dwell time if a number of patient adjustments detected during multiple instances of the posture state transition exceeds a threshold.

18. The medical device of claim 15, wherein the processor reduces the dwell time if the patient adjustment is detected during the dwell time.

19. The medical device of claim 18, wherein the processor reduces the dwell time based on timing of the patient adjustment.

20. The medical device of claim 15, wherein the processor increases the dwell time if the patient therapy adjustment is detected after the dwell time.

21. The medical device of claim 20, wherein the processor increases the dwell time based on timing of the patient adjustment.

22. The medical device of claim 14, wherein the processor determines whether the patient adjustment is consistent with the adjustment of therapy based on the posture state transition, and adjusts the dwell time based on the therapy adjustment and the determination of whether the patient adjustment is consistent with the adjustment of therapy based on the posture state transition.

23. The medical device of claim 14, wherein the posture state transition comprises a transition from a first posture state to a second posture state, and wherein each of the first and second posture states comprises at least one of a posture or a combination of a posture and an activity level.

24. The medical device of claim 14, wherein the processor adjusts the therapy based on a plurality of different posture state transitions upon expiration of dwell times for the respective posture state transitions, wherein at least some of the dwell times are different for different posture state transitions.

25. The medical device of claim 24, wherein the processor adjusts different dwell times for different posture state transitions based on patient adjustments associated with the respective dwell times.

26. The medical device of claim 14, wherein the medical device comprises an implantable medical device, and the therapy comprises electrical stimulation therapy.

27. A medical system comprising:

a medical device that detects a posture state transition of a patient, and delivers therapy to a patient upon expiration of a dwell time for the posture state transition;

an external programmer that receives a patient adjustment of the therapy; and

a processor that adjusts the dwell time based on the patient adjustment.

28. The medical system of claim 27, if the patient adjustment is detected during or after the dwell time.

29. The medical system of claim 27, wherein the processor adjusts the therapy if the patient adjustment is detected prior to the dwell time.

30. The medical system of claim 27, wherein the processor adjusts the dwell time if a number of patient adjustments detected during multiple instances of the posture state transition exceeds a threshold.

31. The medical system of claim 30, wherein the processor reduces the dwell time if the patient adjustment is detected during the dwell time, and wherein the processor reduces the dwell time based on timing of the patient adjustment.

32. The medical system of claim 30, wherein the processor increases the dwell time if the patient therapy adjustment is detected after the dwell time, and wherein the processor increases the dwell time based on timing of the patient adjustment.

33. The medical system of claim 27, wherein the processor adjusts the therapy based on a plurality of different posture state transitions upon expiration of dwell times for the respective posture state transitions, wherein at least some of the dwell times are different for different posture state transitions.

34. The medical system of claim 33, wherein the processor adjusts different dwell times for different posture state transitions based on patient adjustments associated with the respective dwell times.

35. The medical device of claim 27, wherein the medical device comprises an implantable medical device, and the therapy comprises electrical stimulation therapy, the medical system further comprising a telemetry interface that supports communication between the external programmer and the implantable medical device.

36. The medical device of claim 27, wherein the processor resides within the external programmer.

37. The medical device of claim 27, wherein the processor resides within the medical device.

38. A medical device comprising:

means for delivering therapy to a patient;

means for detecting a posture state transition of a patient;

means for, upon expiration of a dwell time for the posture state transition, adjusting the therapy based on the posture state transition;

means for detecting a patient adjustment of the therapy; and

means for adjusting the dwell time based on the therapy adjustment.

39. The medical device of claim 38, wherein the means for adjusting the dwell time comprises means for adjusting the dwell time if the patient adjustment is detected during or after the dwell time.

40. The medical device of claim 38, wherein the means for adjusting the dwell time comprises means for adjusting the dwell time if the patient adjustment is detected prior to the dwell time.

41. The medical device of claim 38, wherein the means for adjusting the dwell time comprises means for adjusting the dwell time if a number of patient adjustments detected during multiple instances of the posture state transition exceeds a threshold.

42. The medical device of claim 41, further comprising means for reducing the dwell time if the patient adjustment is detected during the dwell time, wherein the means for reducing comprises means for reducing the dwell time based on timing of the patient adjustment.

43. The medical device of claim 41, further comprising means for increasing the dwell time if the patient therapy adjustment is detected after the dwell time, wherein the means for increasing comprises means for increasing the dwell time based on timing of the patient adjustment.

44. The medical device of claim 38, further comprising means for adjusting the therapy based on a plurality of different posture state transitions upon expiration of dwell times for the respective posture state transitions, wherein at least some of the dwell times are different for different posture state transitions, and wherein the means for adjusting the dwell time comprises means for adjusting different dwell times for different posture state transitions based on patient adjustments associated with the respective dwell times.

45. The medical device of claim 38, further comprising delivering the therapy from an implantable medical device, wherein the therapy comprises electrical stimulation therapy.