THERAPY ADJUSTMENT

• US 20110009928A1
• Filed: 09/21/2010
• Published: 01/13/2011
• Est. Priority Date: 04/30/2007
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Gerber, Martin T., Rondoni, John C.
• Granted Patent: US 8,126,567 B2
• Time in Patent Office: Days
• US Class Current: 607/62
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/3655 controlled by body or blood temperature
• CPC Class Codes: A61N 1/36557 controlled by chemical substances in blood
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36571 controlled by blood flow rate, e.g. blood velocity or cardiac output
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

Systems and methods for adjusting a therapy delivered to a patient include detecting a value of at least one sensed patient parameter and adjusting a therapy parameter value to accommodate different patient parameter values. A data structure including a plurality of patient parameter values and associated therapy parameter values may be stored within a medical device or a programming device. Upon detecting a patient parameter value, an associated therapy parameter value from the data structure may be selected. If no therapy parameter value is associated with the detected patient parameter value, an intermediate therapy parameter value may be generated by interpolating between the most recently implemented therapy parameter value and a stored therapy parameter value. In some embodiments, the rate of shifting between parameters of two stored or interpolated therapy parameter values may be based on the rate of change of the patient parameter value over time.

Claims

1. A method comprising:

sensing a first value of a patient parameter of a patient;

delivering therapy to the patient according to a first therapy parameter value associated with the first value of the patient parameter;

detecting a change from the first value of the patient parameter to a second value of the patient parameter;

determining a first rate of the change from the first value to the second value of the patient parameter;

identifying a second therapy parameter value based on the second value of the patient parameter;

determining a second rate based on the first rate of the change; and

adjusting the delivery of the therapy to the patient from the first therapy parameter value to the second therapy parameter value at the second rate.

2. The method of claim 1, wherein the second rate is substantially equal to the first rate.

3. The method of claim 1, wherein adjusting the delivery of the therapy to the patient from the first therapy parameter value to the second therapy parameter value at the second rate comprises interpolating at least one intermediate therapy parameter value between the first and second therapy parameter values and delivering the therapy according to the intermediate parameter value prior to delivering the therapy according the second therapy parameter value.

4. The method of claim 3, wherein the first and second therapy parameter values each comprise a respective value of at least one of an electrode configuration, an electrical stimulation pulse rate, an electrical stimulation pulse width, an electrical stimulation current amplitude, a fluid delivery dosage, a cycle of therapy delivery, the electrical stimulation current amplitude rate of change, or a fluid delivery rate.

5. The method of claim 1, wherein the parameter of the patient comprises a posture of the patient.

6. The method of claim 1, wherein detecting a change from the first value of the patient parameter to the second value of the patient parameter comprises:

receiving a first signal from an accelerometer, the first signal indicating the first value;

receiving a second signal from the accelerometer; and

comparing the first and second signals.

7. The method of claim 1, wherein the patient parameter comprises at least one of activity, heart rate, respiration rate, respiratory volume, core temperature, blood pressure, blood oxygen saturation, partial pressure of oxygen within blood, partial pressure of oxygen within cerebrospinal fluid, muscular activity, arterial blood flow, electromyogram (EMG), an electroencephalogram (EEG), an electrocardiogram (ECG) or galvanic skin response.

8. The method of claim 1, further comprising:

determining whether the second value of the patient parameter is transient based on the first rate;

delivering therapy according to a safe mode or suspending therapy if the second value is transient; and

delivering therapy according to the second parameter value if the second value is not transient.

9. The method of claim 1, wherein the therapy comprises electrical stimulation therapy, the first therapy parameter value comprises a first electrode combination, the second therapy parameter value comprises a second electrode combination, and adjusting the delivery of the therapy to the patient from the first therapy parameter value to the second therapy parameter value at the second rate comprises:

delivering electrical stimulation to a patient via the first electrode combination;

delivering electrical stimulation to the patient via the second electrode combination on a time-interleaved basis with the electrical stimulation delivered via the first electrode combination;

incrementally increasing an amplitude of the electrical stimulation delivered via the second electrode combination while the electrical stimulation delivered via the second electrode combination is delivered on a time-interleaved basis with the electrical stimulation delivered via the first electrode combination; and

incrementally decreasing an amplitude of the electrical stimulation delivered via the first electrode combination while the electrical stimulation delivered via the second electrode combination is delivered on a time-interleaved basis with the electrical stimulation delivered via the first electrode combination.

10. The method of claim 1, wherein the therapy comprises electrical stimulation therapy, the first therapy parameter value comprises a first electrode combination, the second therapy parameter value comprises a second electrode combination, and adjusting the delivery of the therapy to the patient from the first therapy parameter value to the second therapy parameter value at the second rate comprises:

delivering electrical stimulation to a patient via the first electrode combination;

delivering electrical stimulation to the patient via the second electrode combination; and

reducing an amplitude delivered to a first electrode of the first electrode combination while increasing an amplitude in a second electrode of the second electrode combination.

11. The method of claim 1, wherein the parameter of the patient comprises a first patient parameter, the method further comprising:

sensing a third value of a second patient parameter;

detecting a change from the third value of the patient parameter to a fourth value of the second patient parameter;

determining a third rate of change from the third value to the fourth value of the second patient parameter, wherein determining the second rate comprises determining the second rate based on the first rate and the third rate.

12. The method of claim 11, wherein determining the second rate comprises determining an average of the first and third rates.

13. A system comprising:

a medical device that is configured to deliver a therapy to a patient;

a sensor that is configured to sense a parameter of the patient;

a memory configured to store a data structure comprising a plurality of values of the patient parameter and associated therapy parameter values; and

a processor configured to control the medical device to deliver the therapy to the patient according to a first therapy parameter value associated with a first value of a patient parameter detected via the sensor, detect a change from the first value of the patient parameter to a second value of the patient parameter, determine a first rate of the change from the first value to the second value of the patient parameter, identify a second therapy parameter value associated with the second value of the patient parameter via the data structure stored within the memory, determine a second rate based on the first rate, and control the medical device to adjust the delivery of the therapy to the patient from the first therapy parameter value to the second therapy parameter value at the second rate.

14. The system of claim 13, wherein the second rate is substantially equal to the first rate.

15. The system of claim 13, wherein the sensor comprises at least one of a physiological parameter sensor, one or more multi-axis accelerometers, one or more single-axis accelerometers, a combination of multi-axis and single-axis accelerometers, a bonded piezoelectric crystal, a mercury switch or a gyro.

16. The system of claim 13, wherein the patient parameter comprises a posture of the patient.

17. The system of claim 13, wherein the patient parameter comprises at least one of activity, heart rate, respiration rate, respiratory volume, core temperature, blood pressure, blood oxygen saturation, partial pressure of oxygen within blood, partial pressure of oxygen within cerebrospinal fluid, muscular activity, arterial blood flow, electromyogram (EMG), an electroencephalogram (EEG), an electrocardiogram (ECG) or galvanic skin response.

18. The system of claim 13, wherein the medical device comprises at least one of an electrical stimulator or a fluid delivery device.

19. The system of claim 13, wherein the processor determines whether the second value of the patient parameter is transient based on the first rate, delivers therapy according to a safe mode or suspends therapy if the second value is transient, and delivers therapy according to the second parameter value if the second value is not transient.

20. A computer-readable medium comprising instructions that cause a processor to:

receive input indicating a first value a sensed parameter of a patient;

identify a first therapy parameter value associated with the first value of the patient parameter;

deliver therapy to the patient according to the first therapy parameter value;

detect a change from the first value of the patient parameter to a second value of the patient parameter;

determine a first rate of change from the first value to the second value of the patient parameter;

identify a second therapy parameter value associated with the second value of the patient parameter;

determine a second rate based on the first rate of the change; and

adjust the delivery of the therapy to the patient from the first therapy parameter value to the second therapy parameter value at the second rate.

21. The computer-readable medium of claim 20, wherein the instructions that cause the processor to identify the second therapy parameter value associated with the second value of the patient parameter cause the processor to:

identify a third value of the patient parameter within a data structure that is closest to the second value of the patient parameter, wherein the third value is associated with a third therapy parameter value within the data structure; and

generate the second therapy parameter value by interpolating at least one therapy parameter between therapy parameters of the first and third therapy parameter values.

22. A system comprising:

means for sensing a patient parameter of a patient;

means for delivering therapy to the patient that delivers therapy to the patient according to a first therapy parameter value associated with a first value of the patient parameter;

means for detecting a change from the first value of the patient parameter to a second value of the patient parameter;

means for determining a first rate of the change from the first value to the second value of the patient parameter;

means for identifying a second therapy parameter value based on the second value of the patient parameter;

means for determining a second rate based on the first rate of the change; and

means for controlling the means for delivering therapy to adjust delivery of therapy to the patient from the first therapy parameter value to the second therapy parameter value at the second rate.

23. The system of claim 22, further comprising means for interpolating at least one intermediate therapy parameter value between the first and second therapy parameter values, wherein the means for delivering the therapy delivers therapy to the patient according to the intermediate parameter value prior to delivering the therapy according the second therapy parameter value.