Modification profiles for posture-responsive therapy

• US 8,401,666 B2
• Filed: 04/30/2009
• Issued: 03/19/2013
• Est. Priority Date: 07/11/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Skelton, Dennis M., Davis, Jon P., Sahasrabudhe, Rajeev, Gokaldas, Shyam, Nolan, Joseph J., Bourget, Dennis, Bourget, Duane, Miesel, Keith A., Zimmerman, James
• Primary Examiner(s): STOKLOSA, JOSEPH A
• Application Number:
  US12/433,856
• Publication Number:
  US 20100010392A1
• Time in Patent Office: 1,419 Days
• Field of Search: 607 17- 20, 607/62
• US Class Current: 607/62
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• CPC Class Codes: A61B 5/1116 Determining posture transitions
• CPC Class Codes: A61B 5/1118 Determining activity level
• CPC Class Codes: A61N 1/36071 Pain
• CPC Class Codes: A61N 1/36132 using patient feedback
• CPC Class Codes: A61N 1/36135 using physiological parameters
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• 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
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 80/00 ICT specially adapted for facilitating communication between medical practitioners or patients, e.g. for collaborative diagnosis, therapy or health monitoring

Abstract

In general, the disclosure describes techniques for modifying therapy provided to a patient by a medical device. The techniques may be applicable to electrical stimulation therapy or other therapies. Modification of therapy may include adjustment of one or more therapy parameter values that define one or more characteristics of stimulation therapy delivered to a patient. The therapy modification may be based on activity of a patient that is detected by an IMD, such as a change in a detected posture state occupied by the patient. Different therapy modifications may be applied for different changes in detected posture state. An IMD may modify therapy based on a transition from one posture state to another posture state, and apply different modifications for different transitions. In some aspects, the modification may include a profile, such as a ramp up or ramp down in a parameter value over a period of time. The profile may be different for different posture transitions. A ramp slope may be steeper for one transition than for another transition. When a patient transitions from an upright to a lying posture state, for example, the profile may be especially abrupt. In some examples, a modification profile may define a dwell time.

Claims

1. A method comprising:

controlling the delivery of therapy to a patient from a medical device according to a posture state of the patient;

detecting a first posture state transition of the patient;

modifying the therapy according to a first modification profile defined for the first posture state transition, wherein the first modification profile defines a first rate of change for an adjustment of at least one parameter of the therapy delivered to the patient;

detecting, subsequently, a second posture state transition of the patient; and

modifying the therapy according to a second modification profile defined for the second posture state transition, wherein the second modification profile defines a second rate of change for an adjustment of the at least one parameter of the therapy delivered to the patient that is different than the first rate of change defined by the first modification profile, and

wherein at least one of the controlling, detecting, determining, and modifying are performed via one or more processors.

2. The method of claim 1, wherein the therapy includes electrical stimulation therapy, and wherein the at least one parameter of the therapy comprises at least one stimulation parameter value of the electrical stimulation therapy.

3. The method of claim 1, wherein the first posture state transition comprises a transition from an upright posture state to an upright and active posture state, and the second posture state transition comprises a transition from the upright posture state to a lying down posture state, and wherein the first rate of change is less than the second rate of change.

4. The method of claim 3, wherein the second rate of change defines a substantially immediate change in the at least one parameter from a first value associated with the upright posture state to a second value associated with the lying down posture state.

5. The method of claim 2, wherein the first rate of change includes a third rate of change and a fourth rate of change for the adjustment to the at least one stimulation parameter value.

6. The method of claim 5, wherein the third rate of change defines a first change in the at least one stimulation parameter value from a first value associated with a first posture state to an intermediate value, and the fourth rate of change defines a second change in the at least one stimulation parameter value from the intermediate value to a second value associated with a second posture state.

7. The method of claim 6, wherein the third rate of change in the at least one stimulation parameter value from the first value to the intermediate value is substantially immediate.

8. The method of claim 6, wherein the intermediate value is less than the first value and the second value.

9. The method of claim 6, wherein the intermediate value is associated with an unstable posture state and the second posture state is a stable posture state.

10. The method of claim 1, wherein detecting the first posture state transition of the patient comprises detecting the first posture state transition via at least one accelerometer.

11. The method of claim 1, wherein modifying the therapy according to the first modification profile defined for the first posture state transition includes adjusting at least one therapy parameter value according to the first rate of change during a transition time period, the method further comprising

receiving an indication from a user during the transition time period, wherein the first modification profile is changed to define a third rate of change that is greater than the first rate of change in response to the receipt of the indication from the user during the transition time period.

12. The method of claim 1, wherein the adjustment to the at least one therapy parameter defined by the first rate of change commences after expiration of a dwell time period following the detection of the first posture state transition, wherein the dwell time is defined by the first modification profile.

13. The method of claim 12, further comprising:

receiving an indication from a user during the dwell time period; and

adjusting the dwell time period defined by the first modification profile such that the dwell time period expires substantially immediately after receiving the indication from the user.

14. The method of claim 1, wherein the first modification profile defines a dwell time for the therapy modification.

15. The method of claim 1, wherein the first modification profile defines a length of time for the adjustment to the at least one parameter.

16. The method of claim 1,

wherein the first posture state transition comprises a first posture state transition from a first posture state to a second posture state,

the method further comprising determining the first modification profile defined for the posture state transition based on one or more of the first posture state and second posture state.

17. The method of claim 16, wherein determining the first modification profile based on one or more of the first posture state and second posture state comprises determining the modification profile based on only one of the first posture state and second posture state.

18. The method of claim 1, further comprising:

receiving an indication from a user defining the first modification profile; and

defining the first modification profile based on the received indication.

19. The method of claim 1, further comprising:

receiving an indication from a user defining the first posture state transition for the first modification profile; and

defining the first posture state transition for the first modification profile based on the received indication.

20. The method of claim 1, wherein the first posture state transition comprises a transition from a first posture state to a second posture state, and the second posture state transition comprises a transition from the second posture state to the first posture state.

21. A therapy system comprising:

a therapy delivery module configured to deliver therapy to a patient from a medical device; and

at least one processor configured to control the delivery of therapy to the patient from the medical device according to a posture state of the patient, detect a first posture state transition of the patient, modify the therapy according to a first modification profile defined for the first posture state transition, wherein the first modification profile defines a first rate of change for an adjustment of at least one parameter of the therapy delivered to the patient, detect, subsequently, a second posture state transition of the patient, and modify the therapy according to a second modification profile defined for the second posture state transition, wherein the second modification profile defines a second rate of change for an adjustment of the at least one parameter of the therapy delivered to the patient that is different than the first rate of change defined by the first modification profile.

22. The therapy system of claim 21, wherein the therapy includes electrical stimulation therapy, and wherein the at least one parameter of the therapy comprises at least one stimulation parameter value of the electrical stimulation therapy.

23. The therapy system of claim 21, wherein the first posture state transition comprises a transition from an upright posture state to an upright and active posture state, and the second posture state transition comprises a transition from an upright posture state to a lying down posture state, and wherein the first rate of change is less than the second rate of change.

24. The therapy system of claim 23, wherein the second rate of change defines a substantially immediate change in the at least one stimulation parameter from a first value associated with the upright posture state to a second value associated with the lying down posture state.

25. The therapy system of claim 22, wherein the first rate of change includes a third rate of change and a fourth rate of change for the adjustment to the at least one stimulation parameter value.

26. The therapy system of claim 25, wherein the third rate of change defines a first change in the at least one stimulation parameter value from a first value associated with a first posture state to an intermediate value, and the fourth rate of change defines a change in the at least one stimulation parameter value from the intermediate value to a second value associated with a second posture state.

27. The therapy system of claim 26, wherein the third rate of change in the at least one stimulation parameter value from the first value to the intermediate value is substantially immediate.

28. The therapy system of claim 26, wherein the intermediate value is less than the first value and the second value.

29. The therapy system of claim 26, wherein the intermediate value is associated with an unstable posture state and the second posture state is a stable posture state.

30. The therapy system of claim 21, wherein the posture state module comprises at least one accelerometer, and the at least one processor is configured to detect the posture state transition of the patient via the at least one accelerometer.

31. The therapy system of claim 21, wherein the at least one processor is configured to adjust the at least one therapy parameter during a transition time period according to the first rate of change, receive an indication from a user during the transition time period and change the first modification profile to define a third rate of change that is greater than the first rate of change in response to the receipt of the indication from the user during the transition time period.

32. The therapy system of claim 21, wherein the at least one processor is configured to adjust the at least one therapy parameter after expiration of a dwell time period following the detection of the first posture state transition, wherein the dwell time is defined by the first modification profile.

33. The therapy system of claim 32, wherein the at least one processor is configured to receive an indication from a user during the dwell time period, and adjust the dwell time period defined by the first modification profile such that the dwell time period expires substantially immediately after receipt of the indication from the user in response to receipt of the indication.

34. The therapy system of claim 21, wherein the modification profile defines a dwell time for the therapy modification.

35. The therapy system of claim 21, wherein the first modification profile defines a length of time for the adjustment to the at least one parameter value.

36. The therapy system of claim 21, wherein the first posture state transition comprises a transition from a first posture state to a second posture state, and wherein the at least one processor is configured to determine the first modification profile defined for the posture state transition based on one or more of the first posture state and the second posture state.

37. The therapy system of claim 36, wherein the at least one processor is configured to determine the modification profile based on only one of the first posture state and the second posture state.

38. The therapy system of claim 21, wherein the at least one processor is configured to receive an indication from a user defining the first modification profile, and define the first modification profile based on the received indication.

39. The therapy system of claim 21, wherein the at least one processor is configured to receive an indication from a user defining the first posture state transition for the modification profile, and define the first posture state transition for the modification profile based on the received indication.

40. The therapy system of claim 21, wherein the first posture state transition comprises a transition from a first posture state to a second posture state, and the second posture state transition comprises a transition from the second posture state to the first posture state.

41. A non-transitory computer-readable storage medium comprising instructions for causing one or more processors to:

control a medical device to deliver therapy to a patient according to a posture state of the patient;

detect a posture state transition of the patient;

modify the therapy according to a first modification profile defined for the first posture state transition, wherein the first modification profile defines a first rate of change for an adjustment of at least one parameter of the therapy delivered to the patient

detect, subsequently, a second posture state transition of the patient; and

modify the therapy according to a second modification profile defined for the second posture state transition, wherein the second modification profile defines a second rate of change for an adjustment of the at least one parameter of the therapy delivered to the patient that is different than the first rate of change defined by the first modification profile.

42. A therapy system comprising:

means for controlling the delivery of therapy to a patient from a medical device according to a posture state of the patient;

means for detecting a posture state transition of the patient;

means for modifying the therapy according to a first modification profile defined for the first posture state transition, wherein the first modification profile defines a first rate of change for an adjustment of at least one parameter of the therapy delivered to the patient

means for detecting, subsequently, a second posture state transition of the patient; and

means for modifying the therapy according to a second modification profile defined for the second posture state transition, wherein the second modification profile defines a second rate of change for an adjustment of the at least one parameter of the therapy delivered to the patient that is different than the first rate of change defined by the first modification profile.