Therapy adjustment

• US 7,769,464 B2
• Filed: 04/30/2007
• Issued: 08/03/2010
• 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.
• Primary Examiner(s): Layno; Carl H
• Assistant Examiner(s): Kimball; Jeremiah T
• Application Number:
  US11/799,035
• Publication Number:
  US 20080269812A1
• Time in Patent Office: 1,191 Days
• Field of Search: 607/2, 607/62
• US Class Current: 607/59
• 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

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 program to accommodate different patient parameter values. A data structure including a plurality of patient parameter values and associated therapy programs may be stored within a medical device or a programming device. Upon detecting a patient parameter value, an associated therapy program from the data structure may be selected. If no therapy program is associated with the detected patient parameter value, an intermediate program that best suits the detected patient parameter value may be generated by interpolating between the most recently implemented therapy program and a stored therapy program. In some embodiments, the rate of shifting between parameters of two stored or interpolated therapy programs 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 parameter of a patient;

delivering therapy to the patient according to a first therapy program associated with the first value of the patient parameter in a data structure comprising a plurality of patient parameter values and associated therapy programs;

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

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

generating an intermediate therapy program that provides efficacious therapy to the patient when the second value of the patient parameter is observed by interpolating at least one therapy parameter between therapy parameters of the first and second therapy programs.

2. The method of claim 1, further comprising delivering the therapy according to the intermediate therapy program.

3. The method of claim 2, further comprising delivering the therapy according to the second therapy program after delivering the therapy according to the intermediate therapy program.

4. The method of claim 2, further comprising delivering the therapy according to the first therapy program after delivering the therapy according to the intermediate therapy program.

5. The method of claim 2, wherein the therapy comprises electrical stimulation therapy and delivering the therapy according to the intermediate therapy program comprises:

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

delivering electrical stimulation to the patient via a second electrode combination of the intermediate therapy program 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.

6. The method of claim 2, wherein the therapy comprises electrical stimulation therapy and delivering the therapy according to the intermediate therapy program comprises:

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

delivering electrical stimulation to the patient via a second electrode combination of the intermediate therapy program; 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.

7. The method of claim 2, wherein delivering the therapy according to the intermediate therapy program comprises delivering the therapy according to the intermediate therapy program until a change in the patient parameter value is detected.

8. The method of claim 1, wherein the therapy parameter comprises 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, a rate of change of the electrical stimulation current amplitude, or a fluid delivery rate.

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

10. The method of claim 1, wherein detecting the change from the first value of the patient parameter to the second value 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.

11. The method of claim 10, wherein the accelerometer comprises one or more multi-axis accelerometers, one or more single-axis accelerometers or a combination of multi-axis and single-axis accelerometers.

12. The method of claim 1, wherein the sensed 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.

13. The method of claim 1, further comprising determining a first rate of the change from the first patient parameter value to the second patient parameter value, wherein delivering the therapy according to the intermediate therapy program comprises adjusting the delivery of the therapy to the patient from the first therapy program to the intermediate therapy program at a second rate based on the first rate.

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

15. The method of claim 1, wherein generating the intermediate therapy program comprises implementing a linear interpolation algorithm to interpolate the at least one therapy parameter between therapy parameters of the first and second therapy programs.

16. The method of claim 1, wherein generating the intermediate therapy program comprises implementing a nonlinear interpolation algorithm to interpolate the at least one therapy parameter between therapy parameters of the first and second therapy programs.

17. The method of claim 1, wherein the data structure comprises a plurality of electrode combinations and generating the intermediate therapy program comprises interpolating at least one electrode combination between electrode combinations of the first and second therapy programs.

18. The method of claim 1, further comprising:

determining whether the second value of the patient parameter is stable prior to generating the intermediate program;

delivering therapy according to the intermediate program if the second value is stable; and

delivering therapy according to a safe mode or suspending therapy if the second value is not stable.

19. A system comprising:

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

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

a memory that stores a data structure comprising a plurality of patient parameter values and associated therapy programs, wherein the therapy programs each comprise at least one therapy parameter; and

a processor that controls the medical device to deliver the therapy to the patient according to a first therapy program associated with a first value of the patient parameter detected via the sensor, detect a change in the first value to a second value of the patient parameter detected via the sensor, identify a third value of the patient parameter within the data structure that is closest to the second value, wherein the third value is associated with a second therapy program within the data structure, and interpolate at least one therapy parameter between therapy parameters of the first and second therapy programs to generate an intermediate therapy program that provides efficacious therapy to the patient when the second value of the patient parameter is observed.

20. The system of claim 19, wherein the therapy parameter comprises 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, a rate of change of the electrical stimulation current amplitude, or a fluid delivery rate.

21. The system of claim 19, 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 the multi-axis and single-axis accelerometers, a bonded piezoelectric crystal, a mercury switch or a gyro.

22. The system of claim 19, wherein the patient parameter comprises a posture of the patient.

23. The system of claim 19, 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.

24. The system of claim 19, wherein the medical device comprises at least one of an electrical stimulator or a fluid delivery device.

25. The system of claim 19, wherein the medical device comprises the sensor.

26. The system of claim 19, wherein the sensor is separate from the medical device.

27. The system of claim 19, wherein the processor controls the medical device to deliver the therapy according to the intermediate therapy program.

28. The system of claim 27, wherein the processor controls the medical device to deliver the therapy according to the second therapy program after delivering the therapy according to the intermediate therapy program.

29. The system of claim 27, wherein the processor controls the medical device to deliver the therapy according to the first therapy program after delivering the therapy according to the intermediate therapy program.

30. The system of claim 27, wherein the processor controls the medical device to deliver therapy according to the intermediate therapy program until a change in the patient parameter value is detected.

31. The system of claim 19, wherein the therapy parameter comprises an electrode combination, and the processor interpolates at least one electrode combination between electrode combinations of the first and second therapy programs to generate the intermediate therapy program.

32. The system of claim 19, wherein the processor further determines a first rate of the change from the first patient parameter value to the second patient parameter value and controls the medical device to adjust the delivery of the therapy to the patient from the first therapy program to the intermediate therapy program at a second rate based on the first rate.

33. The system of claim 32, wherein the second rate is substantially equal to the first rate.

34. The system of claim 19, wherein the processor determines whether the second value of the patient parameter is stable prior to generating the intermediate program, delivers therapy according to the intermediate program if the second value is stable, and delivers therapy according to a safe mode or suspends therapy if the second value is not stable.

35. The system of claim 19, wherein the processor implements a linear interpolation algorithm to generate the intermediate therapy program.

36. The system of claim 19, wherein the processor implements a nonlinear interpolation algorithm to generate the intermediate therapy program.

37. A computer-readable medium comprising instructions that cause a processor to control a therapy delivery device to:

receive input indicating a sensed parameter of a patient;

associate a first value of the patient parameter with a first therapy program by referencing a data structure comprising a plurality of patient parameter values and associated therapy programs;

deliver therapy to the patient according to the first therapy program;

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

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

generate an intermediate therapy program that provides efficacious therapy to the patient when the second value of the patient parameter is observed by interpolating at least one therapy parameter between therapy parameters of the first and second therapy programs.