Systems and methods for adjusting electrical therapy based on impedance changes

• US 8,311,639 B2
• Filed: 07/08/2009
• Issued: 11/13/2012
• Est. Priority Date: 07/08/2009
• Status: Active Grant

• Current Assignee: Nevro Corporation
• Original Assignee: Nevro Corporation
• Inventors: Parker, Jon, Walker, Andre B., Singh, Udai
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US12/499,769
• Publication Number:
  US 20110009927A1
• Time in Patent Office: 1,224 Days
• Field of Search: 607/62
• US Class Current: 607/62
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/3605 Implantable neurostimulators for stimulating central or peripheral nerve system
• CPC Class Codes: A61N 1/36071 Pain
• CPC Class Codes: A61N 1/36139 with automatic adjustment
• CPC Class Codes: A61N 1/36142 for improving safety

Abstract

System and methods for adjusting electrical therapy based on impedance changes are disclosed herein. A method in accordance with a particular embodiment includes applying a therapeutic electrical signal to a patient via an implanted portion of a patient stimulation system that includes a signal delivery device in electrical communication with a target neural population of the patient. The electrical signal is delivered in accordance with a signal delivery parameter having a first value. Using the implanted portion of the patient stimulation system, a change in an impedance of an electrical circuit that includes the signal delivery device is detected. Based at least in part on the detected impedance change, the method can further include automatically adjusting the value of the signal delivery parameter from the first value to a second value different from the first, without human intervention.

Claims

1. A method for controlling a patient therapy device, comprising:

applying a therapeutic electrical signal to a patient via an implanted portion of a patient stimulation system that includes a signal delivery device in electrical communication with a target neural population of the patient, the electrical signal being delivered in accordance with a signal delivery parameter having a first value;

using the implanted portion of the patient stimulation system, detecting a change in an impedance of an electrical circuit that includes the signal delivery device; and

based at least in part on the detected impedance change, automatically adjusting the value of the signal delivery parameter from the first value to a second value different than the first value, without human intervention, wherein the electrical signal is applied to a first contact set, and wherein automatically adjusting the value of the signal delivery parameter includes applying the electrical signal to a second contact set having a different member than the first contact set.

2. A method for controlling a patient therapy device, comprising:

applying a therapeutic electrical signal to a patient via an implanted portion of a patient stimulation system that includes a signal delivery device in electrical communication with a target neural population of the patient, the electrical signal being delivered in accordance with a signal delivery parameter having a first value;

using the implanted portion of the patient stimulation system, detecting a change in an impedance of an electrical circuit that includes the signal delivery device, wherein detecting a change in an impedance includes detecting an increase in impedance; and

based at least in part on the detected impedance change, automatically adjusting the value of the signal delivery parameter from the first value to a second value different than the first value, without human intervention, wherein the implanted portion of the stimulation system includes a constant current source having a compliance voltage level with a first value, and wherein automatically adjusting the value of the signal delivery parameter includes;

increasing the compliance voltage level from the first value to a second value higher than the first; and

increasing a strength of the signal beyond a strength available with the first value.

3. The method of claim 2 wherein detecting a change in an impedance of an electrical circuit includes detecting a change in an impedance of an electrical circuit that includes the target neural population.

4. The method of claim 2 wherein applying a therapeutic electrical signal includes applying the electrical signal via an implanted electrical contact carried by the signal delivery device and exposed to the patient'"'"'s tissue.

5. The method of claim 2 wherein applying a therapeutic electrical signal includes applying the signal to the patient'"'"'s spinal cord region.

6. The method of claim 2 wherein detecting a change in an impedance includes detecting a change in impedance resulting from a build up of scar tissue on the signal delivery device.

7. The method of claim 2 wherein detecting a change in an impedance includes detecting a change in impedance resulting from a change in position of the signal delivery device relative to the patient.

8. The method of claim 2 wherein detecting a change in an impedance includes detecting a change in impedance resulting from change in the patient'"'"'s posture.

9. The method of claim 2 wherein detecting a change in an impedance includes detecting a change in impedance by monitoring the therapeutic electrical signal.

10. The method of claim 2 wherein detecting a change in an impedance includes applying an electrical signal in addition to the therapeutic electrical signal and detecting a change in impedance by monitoring the additional electrical signal.

11. A method for controlling a patient therapy device, comprising:

applying a therapeutic electrical signal to a patient via an implanted portion of a patient stimulation system that includes a signal delivery device in electrical communication with a target neural population of the patient, the electrical signal being delivered in accordance with a signal delivery parameter having a first value;

using the implanted portion of the patient stimulation system, detecting a change in an impedance of an electrical circuit that includes the signal delivery device, wherein detecting a change in an impedance includes detecting a decrease in impedance, and wherein detecting a decrease includes detecting a decrease caused by proximity of the electrical contacts of the signal delivery device to cerebral spinal fluid; and

based at least in part on the detected impedance change, automatically adjusting the value of the signal delivery parameter from the first value to a second value different than the first value, without human intervention.

12. The method of claim 11 wherein automatically adjusting the value of the signal delivery parameter includes halting delivery of the electrical signal.

13. The method of claim 11 wherein automatically adjusting the value of the signal delivery parameter includes changing at least one of a strength, pulse width, and duty cycle of the signal.

14. The method of claim 11 wherein automatically adjusting a signal delivery parameter includes automatically adjusting a compliance margin in accordance with which the electrical signal is delivered, in response to the detected impedance change.

15. A method for controlling a patient therapy device, comprising:

applying a therapeutic electrical signal to a patient via an implanted portion of a patient stimulation system that includes a signal delivery device in electrical communication with a target neural population of the patient, the electrical signal being delivered in accordance with a signal delivery parameter having a first value;

using the implanted portion of the patient stimulation system, detecting a change in an impedance of an electrical circuit that includes the signal delivery device; and

based at least in part on the detected impedance change, automatically adjusting the value of the signal delivery parameter from the first value to a second value different than the first value, without human intervention, wherein detecting a change in an impedance includes detecting a change in impedance as a function of time and wherein the method further comprises establishing a trend for future changes in impedance.

16. The method of claim 15 wherein detecting a change in an impedance includes detecting an increase in impedance.

17. The method of claim 16 wherein automatically adjusting the value of the signal delivery parameter includes increasing a number of implanted electrical contacts to which the electrical signal is directed.

18. The method of claim 16 wherein the electrical signal is applied to a first implanted electrical contact set, and wherein automatically adjusting the value of the signal delivery parameter includes applying the electrical signal to a second implanted electrical contact set having different members than the first contact set.

19. The method of claim 16 wherein automatically adjusting the value of the signal delivery parameter includes increasing a strength of the signal.

20. The method of claim 16 wherein detecting an increase in an impedance includes detecting an increase correlated with an increase in power provided to the signal delivery device.

21. The method of claim 16 wherein detecting an increase in an impedance includes detecting an open circuit.

22. The method of claim 21 wherein automatically adjusting the value of the signal delivery parameter includes reducing a strength of the electrical signal and then ramping up the strength of the electrical signal after the circuit is closed.

23. The method of claim 15 wherein detecting a change in an impedance includes detecting a decrease in impedance.

24. The method of claim 23 wherein automatically adjusting the value of the signal delivery parameter includes decreasing a strength of the electrical signal.

25. The method of claim 23 wherein detecting a decrease includes detecting a decrease caused by an electrical short between electrical contacts of the signal delivery device.

26. The method of claim 15 wherein automatically adjusting a signal delivery parameter includes automatically adjusting a compliance value in accordance with which the electrical signal is delivered, in response to the detected impedance change.

27. A method for controlling a patient therapy device, comprising:

applying a therapeutic electrical signal to a patient via a patient stimulation system that includes a signal delivery electrical contact in electrical communication with a target neural population of the patient, the electrical signal having a signal delivery parameter with a first value;

automatically identifying changes in an impedance of an electrical circuit that includes the signal delivery electrical contact, as a function of time;

based at least in part on identifying the changes in impedance as a function of time, predicting a future value of the impedance; and

based at least in part on the predicted future value of the impedance, automatically performing a task, including;

automatically adjusting the value of the signal delivery parameter from the first value to a second value different than the first value, without human intervention; and

applying a second therapeutic electrical signal to the patient using the second value of the signal delivery parameter.

28. The method of claim 27 wherein automatically performing a task includes automatically comparing the identified changes in impedance as a function of time with a target rate of impedance change.

29. The method of claim 27 wherein automatically identifying changes in an impedance as a function of time includes automatically identifying the changes as a function of time using a portion of the patient stimulation system that is implanted in the patient, without human intervention.

30. The method of claim 27 wherein automatically identifying changes in an impedance as a function of time includes automatically identifying the changes as a function of time using a portion of the patient stimulation system that is external to the patient.

31. The method of claim 27 wherein predicting a future value of the impedance includes extrapolating the future value based on past values.

32. A patient therapy system, comprising:

a patient-implantable portion that includes a pulse generator and a signal delivery device having an electrical contact positioned to be in electrical communication with a target neural population of a patient when implanted;

an impedance detector carried by the implantable portion, the impedance detector being operatively coupled to an electrical circuit that includes the electrode to detect an impedance of the electrical circuit; and

a processor carried by the patient-implantable portion, the processor having a computer-readable medium programmed with instructions that, when executed;

receive an indication of an impedance change from the impedance detector; and

based at least in part on the detected impedance change and without human intervention, automatically adjust a value of a signal delivery parameter in accordance with which the patient-implantable portion delivers an electrical signal to the electrical contact, wherein the electrical signal is applied to a first contact set, and wherein automatically adjusting the value of the signal delivery parameter includes applying the electrical signal to a second contact set having a different member than the first contact set.

33. The system of claim 32 wherein automatically adjusting a value of a signal delivery parameter includes automatically adjusting at least one of a compliance value and a compliance margin in accordance with which the electrical signal is delivered.

34. A patient therapy system, comprising:

a patient-implantable portion that includes a pulse generator and a signal delivery device having an electrical contact positioned to be in electrical communication with a target neural population of a patient when implanted;

an impedance detector carried by the implantable portion, the impedance detector being operatively coupled to an electrical circuit that includes the electrode to detect an impedance of the electrical circuit; and

a processor carried by the patient-implantable portion, the processor having a computer-readable medium programmed with instructions that, when executed;

receive an indication of an impedance change from the impedance detector; and

based at least in part on the detected impedance change and without human intervention, automatically adjust a value of a signal delivery parameter in accordance with which the patient-implantable portion delivers an electrical signal to the electrical contact, wherein the implantable portion includes a constant current source having a compliance voltage level with a first value, and wherein automatically adjusting the value of the signal delivery parameter includes decreasing the compliance level from the first value to a second value less than the first value.

35. The system of claim 34 wherein the processor is programmed with instructions that, when executed, automatically adjust an amplitude of the electrical signal.

36. A patient therapy system, comprising:

a patient-implantable portion that includes a pulse generator and a signal delivery device having an electrical contact positioned to be in electrical communication with a target neural population of a patient when implanted;

an impedance detector carried by the implantable portion, the impedance detector being operatively coupled to an electrical circuit that includes the electrode to detect an impedance of the electrical circuit; and

a processor carried by the patient-implantable portion, the processor having a computer-readable medium programmed with instructions that, when executed;

receive an indication of an impedance change from the impedance detector, wherein receiving an indication of an impedance change includes receiving an indication of an open circuit; and

based at least in part on the detected impedance change and without human intervention, automatically adjust a value of a signal delivery parameter in accordance with which the patient-implantable portion delivers an electrical signal to the electrical contact.

37. The system of claim 36 wherein automatically adjusting the value of the signal delivery parameter includes reducing a strength of the electrical signal and then ramping up the strength of the electrical signal after the circuit is closed.

38. A patient therapy system, comprising:

a patient-implantable portion that includes a pulse generator and a signal delivery device having an electrical contact positioned to be in electrical communication with a target neural population of a patient when implanted;

an impedance detector carried by the implantable portion, the impedance detector being operatively coupled to an electrical circuit that includes the electrode to detect an impedance of the electrical circuit; and

a processor carried by the patient-implantable portion, the processor having a computer-readable medium programmed with instructions that, when executed;

receive an indication of an impedance change from the impedance detector; and

based at least in part on the detected impedance change and without human intervention, automatically adjust a value of a signal delivery parameter in accordance with which the patient-implantable portion delivers an electrical signal to the electrical contact, wherein the pulse generator outputs a therapeutic electrical signal and a diagnostic signal, and wherein the impedance detector is coupled to the electrical circuit to detect a characteristic of a diagnostic electrical signal.

39. The system of claim 38 wherein the processor is programmed with instructions that, when executed, automatically terminate the electrical signal.

40. The system of claim 38 wherein the implantable portion includes a constant current source having a compliance voltage level with a first value, and wherein automatically adjusting the value of the signal delivery parameter includes:

increasing the compliance voltage level from the first value to a second value higher than the first; and

increasing a strength of the signal beyond a strength available with the first value.

41. A patient therapy system, comprising:

a patient-implantable portion that includes a pulse generator and a signal delivery device having an electrode positioned to be in electrical communication with a target neural population of a patient when implanted;

an impedance detector operatively coupled to an electrical circuit that includes the electrode to detect an impedance of the electrical circuit; and

a processor having a computer-readable medium programmed with instructions that when executed;

automatically identifies changes in the impedance of the electrical circuit as a function of time;

based at least in part on identifying the changes in impedance as a function of time, predicts a future value of the impedance; and

based at least in part on the predicted future value of the impedance, automatically performs a task, wherein automatically performing a task includes comparing the identified impedance changes with a predetermined schedule of impedance changes.

42. The system of claim 41 wherein automatically performing a task includes automatically issuing a notification.

43. A patient therapy system, comprising:

a patient-implantable portion that includes a pulse generator and a signal delivery device having an electrode positioned to be in electrical communication with a target neural population of a patient when implanted;

an impedance detector operatively coupled to an electrical circuit that includes the electrode to detect an impedance of the electrical circuit; and

a processor having a computer-readable medium programmed with instructions that when executed;

automatically identifies changes in the impedance of the electrical circuit as a function of time;

based at least in part on identifying the changes in impedance as a function of time, predicts a future value of the impedance; and

based at least in part on the predicted future value of the impedance, automatically performs a task, wherein identifying changes in impedance includes identifying intermittent impedance increases, and wherein predicting a future value of the impedance includes predicting a failure of the signal delivery device.

44. The system of claim 43 wherein the processor is carried by the patient-implantable pulse generator.