Electrode assembly and method for signaling a monitor

• US 6,233,472 B1
• Filed: 06/29/1998
• Issued: 05/15/2001
• Est. Priority Date: 06/06/1995
• Status: Expired due to Fees

• Current Assignee: Patient Comfort LLC
• Original Assignee: Patient Comfort LLC
• Inventors: Bennett, Henry L., Simon, Bruce Jay, Cram, Jeffrey R.
• Primary Examiner(s): Dvorak, Linda C. M.
• Assistant Examiner(s): Ruddy, David M.
• Application Number:
  US09/107,098
• Time in Patent Office: 1,051 Days
• Field of Search: 600/383, 600/546, 600/554, 600/557, 600/26, 607/46, 607/47, 607/62, 607/63, 607/139, 607/140, 607/141, 128/898
• US Class Current: 600/383
• CPC Class Codes: A61B 2562/0217 Electrolyte containing
• CPC Class Codes: A61B 5/282 Holders for multiple electrodes for introduction into the body A61B5/287
• CPC Class Codes: A61B 5/296 for electromyography [EMG]
• CPC Class Codes: A61B 5/4041 Evaluating nerves condition
• CPC Class Codes: A61B 5/4821 Determining level or depth of anaesthesia A61B5/1106 takes precedence

Abstract

An electrode assembly adapted to be attached to the skin over selected facial muscle groups picks up signals to be analyzed by an anesthesia adequacy monitor that measures the level of awareness of a living animal, typically a human being. The electrode assembly also includes a stimulator that stimulates a facial nerve to determine the level of paralysis, or neuro muscular block, of the facial muscles. Also disclosed is a method of manufacturing the electrode assembly by printing a pattern of electrically conductive material through a silk-screen or an ink type process onto a flexible layer, and then coating the result with a non-conducting adhesive except at points corresponding to sensing points for the desired muscle groups. Finally, a method for using such sensing and stimulating devices is shown in determining and maintaining an appropriate level of patient awareness, muscle paralysis, and analgesia under anesthesia.

Claims

1. An apparatus for indicating the consciousness of a person, comprising in combination:

(A) an array of facial muscle sensors adapted to generate sensor signals representing the simultaneous activity of at least four different facial muscle areas, each of which elicit distinctive patterns of facial expressions of the person;

(B) a sensor signal processor operatively coupled to the sensors to receive the sensor signals from the facial muscle sensors and, based on the sensor signals, automatically generate an output signal indicating the consciousness of the person;

wherein the facial muscle sensors are surface electromyograms adapted to be physically attached the person'"'"'s face in positions allowing the monitoring of the different facial muscles; and

also having;

(i) a facial muscle stimulator adapted to activate a facial nerve in at least one of said facial muscle areas, and (ii) a facial nerve processor adapted to (a) receive sensor signals from the facial muscles sensors in said nerve-activated facial muscle area, (b) determine a paralysis level for said nerve-activated facial muscle area, and (c) adjust the sensor signal processor'"'"'s generation of at least a portion of the output signal according to the determined paralysis level, whereby the output signal indicates the consciousness of the person despite partial paralysis of the nerve-activated facial muscle area.

2. The consciousness indicating apparatus of claim 1 wherein said facial muscle areas are selected from among the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbilaris oculi area.

3. The consciousness indicating apparatus of claim 1 wherein the facial muscle stimulator includes a first facial muscle stimulator providing a first carrier signal at a first predetermined frequency to one facial muscle area and a second facial muscle stimulator providing a second carrier signal at a second predetermined frequency to the one facial muscle area, whereby the first and second facial muscle stimulators cooperatively stimulate a facial nerve in the one facial muscle area at a third stimulation frequency comprising the difference between the first and second predetermined frequencies.

4. The consciousness indicating apparatus of claim 3 wherein said facial muscle areas are selected from among the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbilaris oculi area.

5. The consciousness indicating apparatus claim 4 also having an artifact filter for filtering the sensor signals received by the sensor signal processor to remove an artifact representing muscle activity caused by known stimulus to the person not indicative of the person'"'"'s consciousness, whereby the output signal generated by the sensor signal processor indicates the consciousness of the person without unwanted distortion from such artifact.

6. The consciousness indicating apparatus of claim 5 wherein the artifact filter includes an artifact detector connected to an external device to provide a detection signal to the artifact filter upon activation of the external device.

7. The consciousness indicating apparatus of claim 1 also including a display operatively connected to the sensor signal processor to display a consciousness level for the person indicated by the output signal generated by the signal processor.

8. The consciousness indicating apparatus of claim 2 also including a display operatively connected to the sensor signal processor to display a consciousness level for the person indicated by the output signal generated by the signal processor.

9. The consciousness indicating apparatus of claim 3 also including a display operatively connected to the sensor signal processor to display a consciousness level for the person indicated by the output signal generated by the signal processor.

10. The consciousness indicating apparatus of claim 4 also including a single computing device to perform the computing for the sensor computing processor and the facial nerve processor.

11. The apparatus of claim 1 in which the array of facial muscle sensors is also adapted to generate sensor signals representing the simultaneous activity of a fifth different facial muscle area.

12. The apparatus of claim 3 in which the array of facial muscle sensors is also adapted to generate sensor signals representing the simultaneous activity of a fifth different facial muscle area.

13. The apparatus of claim 4 in which the array of facial muscle sensors is also adapted to generate sensor signals representing the simultaneous activity of a fifth different facial muscle area.

14. The apparatus of claim 6 in which the array of facial muscle sensors is also adapted to generate sensor signals representing the simultaneous activity of a fifth different facial muscle area.

15. The consciousness indicating apparatus of claim 1 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

16. The consciousness indicating apparatus of claim 15 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

17. The consciousness indicating apparatus of claim 3 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

18. The consciousness indicating apparatus of claim 17 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

19. The consciousness indicating apparatus of claim 4 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

20. The consciousness indicating apparatus of claim 19 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

21. The consciousness indicating apparatus of claim 5 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

22. The consciousness indicating apparatus of claim 21 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

23. The consciousness indicating apparatus of claim 6 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

24. The consciousness indicating apparatus of claim 23 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

25. The consciousness indicating apparatus of claim 1 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

26. The consciousness indicating apparatus of claim 25 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

99. The apparatus of claim 9 in which the array of facial muscle sensors is also adapted to generate sensor signals representing the simultaneous activity of a fifth different facial muscle area.

27. An apparatus for indicating the consciousness of a person, comprising in combination:

an array of facial muscle sensors adapted to generate sensor signals representing the simultaneous activity of at least four different facial muscle areas, each of which elicit distinctive patterns of facial expressions of the person;

a sensor signal processor operatively coupled to the sensors to receive the sensor signals from the facial muscle sensors and, based on the sensor signals, automatically generate an output signal indicating the consciousness of the person;

wherein the facial muscle sensors are surface electromyograms adapted to be physically attached to the person'"'"'s face in positions allowing the monitoring of the different facial muscles;

wherein said facial muscle areas are selected from among the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbilaris oculi area; and

in which the array of facial muscle sensors is also adapted to generate sensor signals representing the simultaneous activity of a fifth different facial muscle area.

28. The consciousness indicating apparatus of claim 27 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

29. The consciousness indicating apparatus of claim 28 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

30. An apparatus for indicating the consciousness of a person, comprising in combination:

an array of facial muscle sensors adapted to generate sensor signals representing the simultaneous activity of at least four different facial muscle areas, each of which elicit distinctive patterns of facial expressions of the person;

a sensor signal processor operatively coupled to the sensors to receive the sensor signals from the facial muscle sensors and, based on the sensor signals, automatically generate an output signal indicating the consciousness of the person;

also including a display operatively connected to the sensor signal processor to display a consciousness level for the person indicated by the output signal generated by the signal processor; and

in which the array of facial muscle sensors is also adapted to generate sensor signals representing the simultaneous activity of a fifth different facial muscle area.

31. An apparatus for indicating the consciousness of a person, comprising in combination:

at least one facial muscle sensor grouping adapted to generate a first sensor signal representing the activity of a first facial muscle area that elicits a first portion of the facial expression of the person;

a facial muscle stimulator adapted to activate a facial nerve in said first facial muscle area;

a processor apparatus operatively coupled to the at least one facial muscle sensor grouping to (i) receive at least the first sensor signal from a first facial muscle sensor grouping, (ii) determine a paralysis level for the facial muscle area based on the first sensor signal received subsequent to activation of the facial nerve by the facial muscle stimulator, and (iii) generate an output signal based on at least the first sensor signal and the determined paralysis level, whereby the output signal indicates the consciousness of the person despite partial paralysis of the nerve-activated first facial muscle area; and

wherein the facial muscle stimulator includes a first facial muscle stimulator providing a first carrier signal at a first predetermined frequency to the facial muscle area, and a second facial muscle stimulator providing a second carrier signal at a second predetermined frequency to the first facial muscle area, whereby the first and second facial muscle stimulators cooperatively stimulate a facial nerve in the first facial muscle area at a third stimulation frequency comprising the difference between the first and second predetermined frequencies.

32. The consciousness indicating apparatus of claim 31 wherein the first and second facial stimulators each also comprise a facial muscle sensor.

33. The consciousness indicating apparatus of claims 32 includes (i) at least a second facial muscle sensor grouping including the second facial muscle stimulator, said second grouping being adapted to generate a second sensor signal representing the activity of a second facial muscle area that elicits a second portion of the facial expression of the person, and (ii) the processor apparatus is operatively connected to the second facial muscle sensor grouping to also receive the second sensor signal and utilize the second sensor signal to generate the output signal.

34. The consciousness indicating apparatus of claim 33 wherein each facial muscle sensor grouping includes a surface electromyogram adapted to be physically attached the person'"'"'s on face in position allowing the monitoring of a facial muscle.

35. The consciousness indicating apparatus claim 34 also having an artifact filter for filtering the sensor signals received by the processor apparatus to remove an artifact representing muscle activity caused by known stimulus to the person not indicative of the person'"'"'s consciousness, whereby the output signal generated by the processor indicates the consciousness of the person with reduced distortion from such artifact.

36. The consciousness indicating apparatus of claim 35 wherein the artifact filter includes an artifact detector connected to an external device adapted to interact with the person, said detector providing a detection signal to the artifact filter upon activation of the external device to interact with the person.

37. The consciousness indicating apparatus of claim 31 also including a display operatively connected to the sensor signal processor to display a consciousness level for the person indicated by the output signal generated by the signal processor.

38. The consciousness indicating apparatus of claim 33 also including a display operatively connected to the sensor signal processor to display a consciousness level for the person indicated by the output signal generated by the signal processor.

39. The consciousness indicating apparatus of claim 34 also including a display operatively connected to the sensor signal processor to display a consciousness level for the person indicated by the output signal generated by the signal processor.

40. The consciousness indicating apparatus of claim 35 also including a display operatively connected to the sensor signal processor to display a consciousness level for the person indicated by the output signal generated by the signal processor.

41. The consciousness indicating apparatus of claim 36 also including a display operatively connected to the sensor signal processor to display a consciousness level for the person indicated by the output signal generated by the signal processor.

42. The consciousness indicating apparatus of claim 31 also including second, third, fourth, and fifth facial muscle sensor groupings adapted to respectively generate second, third, forth, and fifth sensor signals from distinct facial muscle areas on the person, and wherein the processor apparatus is operatively coupled to each such facial muscle sensor grouping to also receive, and to generate the output signal also on, the second, third, fourth, and fifth sensor signals.

43. The consciousness indicating apparatus of claim 32 also including second, third, fourth, and fifth facial muscle sensor groupings adapted to respectively generate second, third, forth, and fifth sensor signals from distinct facial muscle areas on the person, and wherein the processor apparatus is operatively coupled to each such facial muscle sensor grouping to also receive, and to base the output signal also on, the second, third, fourth, and fifth sensor signals.

44. The consciousness indicating apparatus of claim 33 also including third, fourth, and fifth facial muscle sensor groupings adapted to respectively generate third, forth, and fifth sensor signals from distinct facial muscle areas on the person, and wherein the processor apparatus is operatively coupled to each such facial muscle sensor grouping to also receive, and to generate the output signal based also on, the third, fourth, and fifth sensor signals.

45. The consciousness indicating apparatus of claim 34 also including third, fourth, and fifth facial muscle sensor groupings adapted to respectively generate third, forth, and fifth sensor signals from distinct facial muscle areas on the person, and wherein the processor apparatus is operatively coupled to each such facial muscle sensor grouping to also receive, and to generate the output signal based also on, the third, fourth, and fifth sensor signals.

46. The consciousness indicating apparatus of claim 35 also including third, fourth, and fifth facial muscle sensor groupings adapted to respectively generate third, forth, and fifth sensor signals from distinct facial muscle areas on the person, and wherein the processor apparatus is operatively coupled to each such facial muscle sensor grouping to also receive, and to generate the output signal based also on, the third, fourth, and fifth sensor signals.

47. The consciousness indicating apparatus of claim 36 also including third, fourth, and fifth facial muscle sensor groupings adapted to respectively generate third, forth, and fifth sensor signals from distinct facial muscle areas on the person, and wherein the processor apparatus is operatively coupled to each such facial muscle sensor grouping to also receive, and to generate the output signal based also on, the third, fourth, and fifth sensor signals.

48. The consciousness indicating apparatus of claim 41 also including third, fourth, and fifth facial muscle sensor groupings adapted to respectively generate third, forth, and fifth sensor signals from distinct facial muscle areas on the person, and wherein the processor apparatus is operatively coupled to each such facial muscle sensor grouping to also receive, and to generate the output signal based also on, the third, fourth, and fifth sensor signals.

49. The consciousness indicating apparatus of claim 33 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

50. The consciousness indicating apparatus of claim 49 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

51. The consciousness indicating apparatus of claim 34 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

52. The consciousness indicating apparatus of claim 51 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

53. The consciousness indicating apparatus of claim 39 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

54. The consciousness indicating apparatus of claim 53 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

55. The consciousness indicating apparatus of claim 42 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

56. The consciousness indicating apparatus of claim 55 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

57. The consciousness indicating apparatus of claim 43 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

58. The consciousness indicating apparatus of claim 57 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

59. The consciousness indicating apparatus of claim 45 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

60. The consciousness indicating apparatus of claim 59 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

61. The consciousness indicating apparatus of claim 35 wherein said facial muscle areas are selected from among the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

62. The consciousness indicating apparatus of claim 46 wherein said facial muscle areas are selected from among the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

63. The consciousness indicating apparatus of claim 53 wherein said facial muscle areas are selected from among the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

64. The consciousness indicating apparatus of claim 54 wherein said facial muscle areas are selected from among the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

65. An apparatus for indicating the consciousness of a person, comprising in combination:

at least one facial muscle sensor grouping adapted to generate a first sensor signal representing the activity of a first facial muscle area that elicits a first portion of the facial expression of the person;

a facial muscle stimulator adapted to activate a facial nerve in said first facial muscle area;

a processor apparatus operatively coupled to the at least one facial muscle sensor grouping to (i) receive at least the first sensor signal from a first facial muscle sensor grouping, (ii) determine a paralysis level for the facial muscle area based on the first sensor signal received subsequent to activation of the facial nerve by the facial muscle stimulator, and (iii) generate an output signal based on at least the first sensor signal and the determined paralysis level, whereby the output signal indicates the consciousness of the person despite partial paralysis of the nerve-activated first facial muscle area; and

also including second, third, fourth, and fifth facial muscle sensor groupings adapted to respectively generate second, third, forth, and fifth sensor signals from distinct facial muscle areas on the person, and wherein the processor apparatus is operatively coupled to each such facial muscle sensor grouping to also receive, and to generate the output signal based also on, the second, third, fourth, and fifth sensor signals.

66. The consciousness indicating apparatus of claim 65 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

67. The consciousness indicating apparatus of claim 66 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

68. The consciousness indicating apparatus of claim 65 wherein said facial muscle areas are selected from among the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

69. The consciousness indicating apparatus of claim 65

also including a display operatively connected to the sensor signal processor to display a consciousness level for the person indicated by the output signal generated by the signal processor.

70. The consciousness indicating apparatus of claim 69 wherein the sensor signal processor generates at least a portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

71. The consciousness indicating apparatus of claim 70 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

72. An apparatus for indicating the consciousness of a person, comprising in combination:

(A) an array of facial muscle sensors adapted to generate sensor signals representing the simultaneous activity of at least four different facial muscle areas, each of which elicit distinctive patterns of facial expressions of the person;

(B) a sensor signal processor operatively coupled to the sensors to receive the sensor signals from the facial muscle sensors and, based on the sensor signals, automatically generate an output signal indicating the consciousness of the person;

wherein the facial muscle sensors are surface electromyograms adapted to be physically attached the person'"'"'s face in positions allowing the monitoring of the different facial muscles; and

wherein the sensor signal processor generates at least a patterned portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

73. The consciousness indicating apparatus of claim 72 wherein the sensor signal processor also generates at least a summed portion of the output signal based on the summation of the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

74. A method of determining the consciousness of a person, the method comprising the steps of:

(A) mounting at least four facial muscle activity sensors so that each activity sensor generates an activity signal based on the level of activity of a different facial muscle group on the person;

(B) processing said activity signals to generate a first output signal based on the summation of the activity signals for the sensed facial muscle groups; and

also including as step (C);

stimulating a nerve in at least one of the sensed facial muscle groups and determining the level of paralysis from the muscle activity sensed by a facial muscle sensor.

75. The consciousness determining method of claim 74 also including as step (D):

calibrating the first output signal based on the paralysis level determined in step (C).

76. The consciousness determining method of claim 74 also including as step (D):

reporting to a monitor the paralysis level determined in step (C).

77. The consciousness determining method of claim 75 also including as step (E):

reporting to a monitor the paralysis level determined in step (C) and the first output signal as calibrated in step (D).

78. The consciousness determining method of claim 75 wherein in step (B):

processing said activity signals to generate a second output signal based on the differences between the activity signals for the sensed facial muscle groups.

79. The consciousness determining method of claim 76 also including in step (B):

processing said activity signals to generate a second output signal based on the differences between the activity signals for the sensed facial muscle groups.

80. The consciousness determining method of claim 77 also including in step (B):

processing said activity signals to generate a second output signal based on the differences between the activity signals for the sensed facial muscle groups; and

including in step (E) also reporting the second output signal to the monitor in order to provide an indicator of the consciousness the person.

81. The consciousness determining method of claim 78 also including as step (E):

reporting the first and second output signals and paralysis level to a monitor in order to provide an indicator of the consciousness the person.

82. The consciousness determining method of claim 79 also including as step (E):

reporting the first and second output signals to a monitor in order to provide an indicator of the consciousness the person.

83. The consciousness determining method of claim 77 also including in step B:

filtering the activity signals to remove from the first output signal an artifact representing muscle activity caused by stimulus to the person not indicative of the person'"'"'s consciousness.

84. The consciousness determining method of claim 80 also including in step B:

filtering the activity signals to remove from at least one output signal an artifact representing muscle activity caused by stimulus to the person not indicative of the person'"'"'s consciousness.

85. The consciousness determining method of claim 82 also including in step B:

filtering the activity signals to remove from at least one output signal an artifact representing muscle activity caused by stimulus to the person not indicative of the person'"'"'s consciousness.

86. The consciousness determining method of claim 75 wherein, in step A, the four facial muscle areas are selected from among the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

87. The consciousness determining method of claim 83 wherein, in step A, the four facial muscle areas are selected from among the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

88. The consciousness determining method of claim 85 wherein, in step A, the four facial muscle areas are selected from among the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

89. The consciousness determining method of claim 75 wherein, in step A, five facial muscle activity sensors are mounted, respectively, on the following five muscle areas:

the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

90. The consciousness determining method of claim 83 wherein, in step A, five facial muscle activity sensors are mounted, respectively, on the following five muscle areas:

the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

91. The consciousness determining method of claim 85 wherein, in step A, five facial muscle activity sensors are mounted, respectively, on the following five muscle areas:

the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

92. A method of determining the consciousness of a person, the method comprising the steps of:

(A) mounting at least four facial muscle activity sensors so that each activity sensor generates an activity signal based on the level of activity of a different facial muscle group on the person;

(B) processing said activity signals to generate a first output signal based on the summation of the activity signals for the sensed facial muscle groups; and

wherein, in step (A), five facial muscle activity sensors are mounted, respectively, on the following five muscle areas;

the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

93. A method of determining the consciousness of a person, the method comprising the steps of:

(A) mounting at least four facial muscle activity sensors so that each activity sensor generates an activity signal based on the level of activity of a different facial muscle group on the person;

(B) processing said activity signals to generate a first output signal based on the summation of the activity signals for the sensed facial muscle groups;

also including as step (C);

reporting the first and second output signals to a monitor in order to provide an indicator of the consciousness the person; and

wherein, in step (A), five facial muscle activity sensors are mounted, respectively, on the following five muscle areas;

the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

94. A method of determining the consciousness of a person, the method comprising the steps of:

(A) mounting at least four facial muscle activity sensors so that each activity sensor generates an activity signal based on the level of activity of a different facial muscle group on the person;

(B) processing said activity signals to generate a first output signal based on the summation of the activity signals for the sensed facial muscle groups;

also including in step (B);

filtering the activity signals to remove from the first output signal an artifact representing muscle activity caused by stimulus to the person not indicative of the person'"'"'s consciousness; and

wherein, in step (A), five facial muscle activity sensors are mounted, respectively, on the following five muscle areas;

the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

95. An apparatus for indicating the consciousness of a person, comprising, in combination:

an array of facial muscle sensors adapted to generate sensor signals representing the simultaneous activity of at least four different facial muscle areas, each of which elicit distinctive patterns of facial expressions of the person;

a sensor signal processor operatively coupled to the sensors to receive the sensor signals from the facial muscle sensors and, based on the sensor signals, automatically generate an output signal indicating the consciousness of the person;

a facial muscle stimulator adapted to activate a facial nerve in at least one of said facial muscle areas; and

a facial nerve processor adapted to (a) receive sensor signals from the facial muscles sensors in said nerve-activated facial muscle area, (b) determine a paralysis level for said nerve-activated facial muscle area, and (c) adjust the sensor signal processor'"'"'s generation of at least a portion of the output signal according to the determined paralysis level, whereby the output signal indicates the consciousness of the person despite partial paralysis of the nerve-activated facial muscle area.

96. An apparatus for indicating the consciousness of a person, comprising, in combination:

an array of facial muscle sensors adapted to generate sensor signals representing the simultaneous activity of at least four different facial muscle areas, each of which elicit distinctive patterns of facial expressions of the person;

a sensor signal processor operatively coupled to the sensors to receive the sensor signals from the facial muscle sensors and, based on the sensor signals, automatically generate an output signal indicating the consciousness of the person; and

in which the array of facial muscle sensors is also adapted to generate sensor signals representing the simultaneous activity of a fifth different facial muscle area.

97. An apparatus for indicating the consciousness of a person, comprising, in combination:

facial muscle sensor grouping, each adapted to generate a first sensor signal representing the activity of a first facial muscle area that elicits a first portion of the facial expression of the person;

a facial muscle stimulator adapted to activate a facial nerve in said first facial muscle area;

a processor apparatus operatively coupled to said each facial muscle sensor grouping to (i) receive at least the first sensor signal from a first facial muscle sensor grouping, (ii) determine a paralysis level for the facial muscle area based on the first sensor signal received subsequent to activation of the facial nerve by the facial muscle stimulator, and (iii) generate an output signal based on at least the first sensor signal and the determined paralysis level, whereby the output signal indicates the consciousness of the person despite partial paralysis of the nerve-activated first facial muscle area; and

the sensor signal processor generates at least a patterned portion of the output signal based on relative differences among the sensor signals and thereby the different activities of the different facial muscle areas represented by the sensor signals.

98. A method of determining the consciousness of a person, the method comprising the steps of:

(A) mounting at least five facial muscle activity sensors so that each activity sensor generates an activity signal based on the level of activity of a different facial muscle group on the person;

(B) processing said activity signals to generate a first output signal based on the summation of the activity signals for the sensed facial muscle groups; and

wherein, in step (A), five facial muscle activity sensors are mounted, respectively, on the following five muscle areas;

the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbicularis oculi area.

100. An apparatus for indicating the consciousness of a person, comprising in combination:

an array of facial muscle sensors adapted to generate sensor signals representing the simultaneous activity of at least four different facial muscle areas, each of which elicit distinctive patterns of facial expressions of the person;

a sensor signal processor operatively coupled to the sensors to receive the sensor signals from the facial muscle sensors and, based on the sensor signals, automatically generate an output signal indicating the consciousness of the person;

wherein the facial muscle sensors are surface electromyograms adapted to be physically attached to the person'"'"'s face in positions allowing the monitoring of the different facial muscles;

wherein said facial muscle areas are selected from among the frontalis area, the corrugator area, the zygomatic area, the masseter area, and the orbilaris oculi area; and

in which the array of facial muscle sensors is also adapted to generate sensor signals representing the simultaneous activity of a fifth different facial muscle area.