Guided programming with feedback

• US 8,527,059 B2
• Filed: 08/29/2011
• Issued: 09/03/2013
• Est. Priority Date: 03/23/2006
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: DeMulling, Delight D., McConnell, Debbie A., Goetz, Steven M., Herman, Cari, Dewing, Wende L.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Sarcione, Jessica
• Application Number:
  US13/220,113
• Publication Number:
  US 20110313485A1
• Time in Patent Office: 736 Days
• Field of Search: 607/30, 607/31, 607/59
• US Class Current: 607/59
• CPC Class Codes: A61N 1/36003 of motor muscles, e.g. for walking assistance
• CPC Class Codes: A61N 1/36014 External stimulators, e.g. with patch electrodes external pacemakers A61N1/3625
• CPC Class Codes: A61N 1/36071 Pain
• CPC Class Codes: A61N 1/36082 Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/3688 configured for switching the pacing mode, e.g. from AAI to DDD
• CPC Class Codes: A61N 1/372 Arrangements in connection with the implantation of stimulators
• CPC Class Codes: A61N 1/37241 providing test stimulations
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37252 Details of algorithms or data aspects of communication system, e.g. handshaking, transmitting specific data or segmenting data
• CPC Class Codes: A61N 1/37264 Changing the program; Upgrading firmware

Abstract

Example techniques involve generating test stimulation programs based upon specific patient feedback to guide the programming process for stimulation therapy. The patient describes positive effects and adverse effects of the test stimulation by listing and/or rating specific types of effects, both positive and adverse, and the location of each effect. In this manner, a programming device, i.e. a programmer, uses the feedback to generate subsequent test stimulation programs. Initially, programs with unipolar electrode configurations are tested, but the programmer may generate bipolar electrode configurations to test if the patient rates the unipolar electrode combinations poorly. After the stimulation programs are tested and rated, the programmer sorts the tested programs based upon the feedback and presents the tested programs to the user. The user selects the best tested program to use for chronic stimulation therapy. Additionally, the patient may utilize the guided programming technique for continued therapy optimization.

Claims

1. A method for screening a plurality of stimulation therapy programs for delivery of deep brain stimulation (DBS) by an implantable medical device (IMD) using an external programming device, the method comprising:

for each of a plurality of electrode combinations including at least one electrode on a DBS lead coupled to the IMD, controlling the IMD, with the external programming device, to incrementally ramp up an amplitude of DBS delivered via the electrode combination through a plurality of amplitude values;

presenting, via the external programming device, a user interface configured to receive user input that logs at least one of a beneficial effect or an adverse effect at each of the plurality of amplitude values for each of the plurality of electrode combinations, wherein the user interface enables the user to enter one or both of a rating value from a predetermined scale of rating values or a textual description of the beneficial effects and adverse effects;

storing, with the external programming device, the rating values or textual descriptions of the beneficial or adverse effects in association with the electrode combinations and amplitude values for which beneficial or adverse effects occurred; and

displaying, via the external programming device, the electrode combinations for which DBS amplitude has been incrementally ramped up in conjunction with amplitude values, and associated rating values and textual descriptions.

2. The method of claim 1, wherein the user interface enables the user to manually type the textual descriptions.

3. The method of claim 1, wherein the user interface enables the user to enter a location for each of the beneficial and adverse effects.

4. The method of claim 1, further comprising prompting, after each amplitude value increment and via the external programming device, the user to log the at least one of a beneficial effect or an adverse effect.

5. The method of claim 1, wherein presenting the user interface configured to receive user input that logs the at least one of the beneficial effect or the adverse effect at each of the amplitude values comprises presenting icons selectable by the user for entry of rating values.

6. The method of claim 1, wherein displaying, via the programming device, the electrode combinations for which DBS amplitude has been incrementally ramped up in conjunction with amplitude values, and associated rating values and textual descriptions comprises presenting at least one icon adjacent to electrode combinations for which DBS amplitude has been incrementally ramped up, the icon indicating that DBS amplitude has been incrementally ramped up for the adjacent electrode combination.

7. The method of claim 1,

further comprising, prior to controlling the IMD to incrementally ramp up DBS amplitude for the electrode combinations, prompting, by the external programming device, the user to enter at least one of a lead type, lead location, therapy target, or patient symptom,

wherein presenting the user interface configured to receive user input that logs beneficial effects and adverse effects comprises presenting different selectable textual descriptions of beneficial effects and adverse effects to the user based on the at least one of the lead type, lead location, therapy target, or patient symptom.

8. The method of claim 1, wherein displaying the electrode combinations for which DBS amplitude has been incrementally ramped up in conjunction with amplitude values, and associated rating values and textual descriptions, comprises:

receiving input from the user via the external programming device;

comparing, by the external programming device, the logged beneficial and adverse effects to the input; and

selecting a subset of the electrode combinations for display based on the comparison.

9. An external programming device for screening a plurality of stimulation therapy programs for delivery of deep brain stimulation (DBS) by an implantable medical device (IMD), the external programming device comprising:

a communication interface for communicating with the IMD;

a user interface; and

a processor configured to;

for each of a plurality of electrode combinations including at least one electrode on a DBS lead coupled to the IMD, control the IMD to incrementally ramp up an amplitude of DBS delivered via the electrode combination through a plurality of amplitude values,

control the user interface to receive user input that logs at least one of a beneficial effect or an adverse effect at each of the plurality of amplitude values for each of the plurality of electrode combinations, wherein the user interface enables the user to enter one or both of a rating value from a predetermined scale of rating values or a textual description of the beneficial effects and adverse effects,

store the rating values or textual descriptions of the beneficial or adverse effects in association with the electrode combinations and amplitude values for which beneficial or adverse effects occurred, and

display, via the user interface, the electrode combinations for which DBS amplitude has been incrementally ramped up in conjunction with amplitude values, and associated rating values and textual descriptions.

10. The external programming device of claim 9, wherein the user interface is configured to enable the user to manually type the textual descriptions.

11. The external programming device of claim 9, wherein the user interface is configured to enable the user to enter a location for each of the beneficial and adverse effects.

12. The external programming device of claim 9, wherein the processor is configured to prompt, after each amplitude value increment and via the user interface, the user to log the at least one of a beneficial effect or an adverse effect after each amplitude value increment.

13. The external programming device of claim 9, wherein the user interface is configured to present icons selectable by the user for entry of rating values.

14. The external programming device of claim 9, wherein the user interface is configured to present at least one icon adjacent to electrode combinations for which DBS amplitude has been incrementally ramped up, the icon indicating that DBS amplitude has been incrementally ramped up for the adjacent electrode combination.

15. The external programming device of claim 9,

wherein, prior to controlling the IMD to incrementally ramp up DBS amplitude for the electrode combinations, the processor is configured to prompt the user, via the user interface, to enter at least one of a lead type, lead location, therapy target, or patient symptom, and

wherein the processor is configured to control the user interface to present different selectable textual descriptions of beneficial effects and adverse effects to the user based on the at least one of the lead type, lead location, therapy target, or patient symptom.

16. The external programming device of claim 9, wherein the processor is configured to:

receive input from the user via the user interface;

compare the logged beneficial and adverse effects to the input; and

select a subset of the electrode combinations for display based on the comparison.

17. A non-transitory computer-readable storage medium comprising instructions that cause a processor of an external programming device configured to communicate with an implantable medical device (IMD) to screen a plurality of stimulation therapy programs for delivery of deep brain stimulation (DBS) by the IMD, the instructions causing the processor to:

for each of a plurality of electrode combinations including at least one electrode on a DBS lead coupled to the IMD, control the IMD to incrementally ramp up an amplitude of DBS delivered via the electrode combination through a plurality of amplitude values;

present, via the external programming device, a user interface configured to receive user input that logs at least one of a beneficial effect or an adverse effect at each of the plurality of amplitude values for each of the plurality of electrode combinations, wherein the user interface enables the user to enter one or both of a rating value from a predetermined scale of rating values or a textual description of the beneficial effects and adverse effects;

store the rating values or textual descriptions of the beneficial or adverse effects in association with the electrode combinations and amplitude values for which beneficial or adverse effects occurred; and

displaying, via the external programming device, the electrode combinations for which DBS amplitude has been incrementally ramped up in conjunction with amplitude values, and associated rating values and textual descriptions.

18. The computer-readable storage medium of claim 17, wherein the user interface enables the user to manually type the textual descriptions.

19. The computer-readable storage medium of claim 17,

further comprising instructions that cause the processor to, prior to controlling the IMD to incrementally ramp up DBS amplitude for the electrode combinations, prompt the user to enter at least one of a lead type, lead location, therapy target, or patient symptom,

wherein the instructions that cause the processor to present the user interface configured to receive user input that logs beneficial effects and adverse effects comprise instructions that cause the processor to present, via the user interface, different selectable textual descriptions of beneficial effects and adverse effects to the user based on the at least one of the lead type, lead location, therapy target, or patient symptom.

20. The computer-readable storage medium of claim 17, wherein the instructions that cause the processor to display, via the user interface, the electrode combinations for which DBS amplitude has been incrementally ramped up in conjunction with amplitude values, and associated rating values and textual descriptions, comprise instructions that cause the processor to:

receive input from the user via the external programming device;

compare the logged beneficial and adverse effects to the input; and

select a subset of the electrode combinations for display based on the comparison.