Controlling coughing and swallowing

• US 9,375,568 B2
• Filed: 08/30/2013
• Issued: 06/28/2016
• Est. Priority Date: 08/31/2012
• Status: Expired due to Fees

• Current Assignee: University of Florida Research Foundation, Incorporated (State University System of Florida), The United States of America As Represented By The Secretary of Agriculture
• Original Assignee: US Department of Veterans Affairs (Government of the United States of America), University of Florida Research Foundation, Incorporated (State University System of Florida)
• Inventors: Pitts, Teresa Elizabeth, Bolser, Donald Clementz, Dixon, Warren E., McCoy, Sean Conrad
• Primary Examiner(s): Voorhees, Catherine
• Assistant Examiner(s): Dinga, Roland
• Application Number:
  US14/424,551
• Publication Number:
  US 20150209583A1
• Time in Patent Office: 1,033 Days
• Field of Search: 607/20, 607/42
• US Class Current: 1/1
• CPC Class Codes: A61B 5/0823 Detecting or evaluating cough events
• CPC Class Codes: A61B 5/296 for electromyography [EMG]
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/395 Details of stimulation, e.g. nerve stimulation to elicit EMG response
• CPC Class Codes: A61B 5/4205 Evaluating swallowing
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 7/008 Detecting noise of gastric tract, e.g. caused by voiding
• CPC Class Codes: A61N 1/0452 Specially adapted for transcutaneous muscle stimulation [TMS]
• CPC Class Codes: A61N 1/0456 Specially adapted for transcutaneous electrical nerve stimulation [TENS]
• CPC Class Codes: A61N 1/36003 of motor muscles, e.g. for walking assistance
• CPC Class Codes: A61N 1/3601 of respiratory organs
• CPC Class Codes: A61N 1/36031 using physiological parameters for adjustment
• CPC Class Codes: A61N 1/36034 specified by the stimulation parameters

Abstract

To protect an airway of a patient, it is important for the patient to be able to swallow and cough effectively. To promote an effective cough or swallow, electrodes are positioned upon skin of the neck of the patient, the electrodes configured for both capturing electromyographic (EMG) information, and for transmitting a stimulating electrical signal to the body. A microphone is positioned upon or near the neck to capture audio information emanating from the body of the patient. Software analyzes the EMG and audio information to identify an attempted or needed cough or swallow, and causes the electrodes to apply an electrical stimulus to the neck of the patient to produce a more efficacious cough or swallow. An additional microphone can be positioned to capture ambient noise, so that such noise can be reduced in the audio information of the first microphone.

Claims

1. A method of protecting an airway of a patient, comprising:

monitoring muscle movement information of the patient with a muscle monitoring device;

monitoring patient audio information using a first acoustic signal transducer positioned upon an electrode and oriented to detect sound emanating from the body of the patient;

monitoring environmental audio information using a second acoustic signal transducer positioned upon an electrode and oriented to detect sound emanating from an environment outside of the body of the patient;

electronically processing the patient and environmental audio information to reduce environmental audio information within the patient audio information to improve detection of sounds emanating from the body;

analyzing the muscle movement information and the electronically processed audio information by at least one electronic device to identify an attempted cough or swallow; and

applying an electrical stimulus to the neck of the patient using a conductor of an electrode when the analysis indicates an attempted cough or swallow, varying at least one of an amplitude or frequency during the stimulus, the applied electrical stimulus operative to promote an efficacious cough or swallow.

2. The method of claim 1, wherein the electrical stimulus including a voltage within a range of greater than zero volts and less than 20 volts.

3. The method of claim 1, wherein the frequency is varied, and wherein the frequency is swept between at least about 4 Hz to not more than about 30 Hz.

4. The method of claim 1, wherein an electrical stimulus is applied before the patient has attempted to swallow, and an electrical stimulus is applied between about 1 millisecond to about 0.5 seconds after the patient has attempted to swallow or has swallowed.

5. The method of claim 3, wherein the muscle monitoring device is an EMG sensor, and the electrical stimulus is applied after detecting behavior specific markers in an EMG signal of the EMG sensor.

6. The method of claim 1, wherein monitoring muscle movement includes analyzing EMG information of the muscle monitoring device by one or more computer processors, the processors operative to initiate the application of the electrical stimulus.

7. The method of claim 1, wherein the patient may indicate to the at least one electronic device that a swallow or cough is impending.

8. The method of claim 1, wherein the at least one electronic device is at least one computer processor operative to initiate the application of the electrical stimulus.

9. The device of claim 1, wherein the conductor of the electrode is used to gather EMG information.

10. The device of claim 1, wherein the first and second acoustic signal transducer, and the conductor, are positioned upon the same electrode.

11. An airway protection system for protecting an airway of a patient, the system comprising:

a muscle monitor device configured to communicate information relating to an attempted cough or swallow of the patient;

a first audio transducer positioned to preferentially receive sounds emanating from the body of the patient with respect to sounds originating in an environment outside the body;

a second audio transducer positioned to preferentially receive sounds emanating from an environment outside the body with respect to sounds originating within the body;

at least one computer processor executing software stored on non-transitory media, the software configured for

analyzing sound information received from the first and second audio transducers to reduce sounds originating in the environment outside the body in the sound information from the first audio transducer,

analyzing information communicated by the muscle monitor device, and the analyzed sound information, to identify an attempted cough or swallow; and

a signal generator configured to apply an electrical stimulus to the neck of the patient responsive to the computer processor when the software analysis indicates an attempted cough or swallow, the signal generator configured to vary frequency during the stimulus, the applied electrical stimulus operative to promote an efficacious cough or swallow.

12. The device of claim 11, wherein the signal generator is further configured to maintain a voltage greater than zero.

13. An airway protection system for protecting an airway of a patient, the system comprising:

a muscle movement sensor configured to communicate information relating to an attempted cough or swallow of the patient;

an audio monitor device configured to communicate first audio information of sounds emanating from the body of the patient, and second audio information emanating from an environment external to the body of the patient; and

at least one computer processor executing software stored on non-transitory media, the software configured for analyzing the first and second audio information to reduce sounds emanating from an environment external to the body of the patient that are present in the first audio information, the software further configured to analyze the information communicated by the muscle movement sensor and the analyzed sound information to identify an attempted cough or swallow; and

a signal generator configured to apply an electrical stimulus to the neck of the patient responsive to the computer processor when the software analysis indicates an attempted cough or swallow, the signal generator configured to vary frequency while maintaining greater than 0 volts during the stimulus, the applied electrical stimulus operative to promote an efficacious cough or swallow.

14. The system of claim 13, wherein the muscle movement sensor comprises at least two electrodes positionable upon skin of the patient, the at least two electrodes configured for capturing electromyographic information and for transmitting a signal from the signal generator to the body.

15. The device of claim 14, wherein the first audio information is obtained from a first microphone attached to at least one of the at least two electrodes, and the second audio information is obtained from a second microphone attached to one of the at least two electrodes.

16. The device of claim 15, wherein the first and second microphones are configured within a single bidirectional microphone.

17. The system of claim 13, wherein the audio monitor device comprises a first microphone positioned to favor the capture of audio information emanating from the body of the patient, and a second microphone positioned to favor the capture of audio information emanating from an environment external to the body.

18. The device of claim 13, wherein the first audio information is obtained from a first audio transducer positioned upon an electrode and oriented to receive sounds emanating from the body of the patient, and the second audio transducer is positioned upon the electrode and is oriented to receive sounds emanating from an environment external to the body of the patient.

19. The device of claim 18, wherein the first audio transducer is positioned upon a first side of the electrode that is adhered to the body, and the second audio transducer is positioned upon a second, opposite side of the electrode relative to the first electrode.

20. The device of claim 13, wherein the signal generator is further configured to vary frequency between 4 and 30 Hz.