Therapy adjustment

• US 7,822,481 B2
• Filed: 04/30/2007
• Issued: 10/26/2010
• 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:
  US11/799,112
• Publication Number:
  US 20080269843A1
• Time in Patent Office: 1,275 Days
• Field of Search: 607/2, 607/62
• 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 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;

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 program 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 program to the second therapy program 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 program to the second therapy program at the second rate comprises interpolating at least one intermediate therapy program comprising at least one therapy parameter between the therapy parameters of the first and second therapy programs and delivering the therapy according to the intermediate program prior to delivering the therapy according the second therapy program.

4. The method of claim 3, 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, 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 value 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.

7. The method of claim 6, wherein the accelerometer comprises one or more multi-axis accelerometers, one or more single-axis accelerometers or a combination of the multi-axis and single-axis accelerometers.

8. 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.

9. The method of claim 1, wherein the therapy comprises at least one of electrical stimulation therapy or fluid delivery therapy.

10. 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 program if the second value is not transient.

11. The method of claim 1, wherein the therapy comprises electrical stimulation therapy and adjusting the delivery of the therapy to the patient from the first therapy program to the second therapy program at the second rate 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 second 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.

12. The method of claim 1, wherein the therapy comprises electrical stimulation therapy and adjusting the delivery of the therapy to the patient from the first therapy program to the second therapy program at the second rate 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 second 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.

13. 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.

14. The method of claim 13, wherein determining the second rate comprises determining an average of the first and third rates.

15. 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 programs, wherein the therapy programs each comprise at least one therapy parameter; and

a processor configured to control the medical device to deliver the therapy to the patient according to a first therapy program 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 program 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 program to the second therapy program at the second rate.

16. The system of claim 15, wherein the second rate is substantially equal to the first rate.

17. The system of claim 15, 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.

18. The system of claim 15, wherein the patient parameter comprises a posture of the patient.

19. The system of claim 15, 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.

20. The system of claim 15, wherein the medical device comprises at least one of an electrical stimulator or a fluid delivery device.

21. The system of claim 15, wherein the medical device comprises the sensor.

22. The system of claim 15, wherein the sensor is separate from the medical device.

23. The system of claim 15, 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 program if the second value is not transient.

24. A non-transitory 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 program associated with the first value of the patient parameter;

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;

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

identify a second therapy program 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 program to the second therapy program at the second rate.

25. The computer-readable medium of claim 24, wherein the instructions that cause the processor to identify the second therapy program 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 the second value of the patient parameter, wherein the third value is associated with a third therapy program within the data structure; and

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