Method and apparatus for controlling an implantable medical device

• US 9,545,520 B2
• Filed: 01/14/2010
• Issued: 01/17/2017
• Est. Priority Date: 01/13/2009
• Status: Active Grant

• Current Assignee: Jeffrey A. Matos
• Original Assignee: Jeffrey A. Matos
• Inventors: Matos, Jeffrey A.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Morales, Jon Eric C
• Application Number:
  US12/657,155
• Publication Number:
  US 20110172740A1
• Time in Patent Office: 2,560 Days
• Field of Search: None
• US Class Current: 1/1
• CPC Class Codes: A61N 1/362 Heart stimulators heart defibrillators A61N1/39
• CPC Class Codes: A61N 1/37258 Alerting the patient
• CPC Class Codes: A61N 1/37264 Changing the program; Upgrading firmware
• CPC Class Codes: A61N 1/37282 characterised by communication with experts in remote locations using a network
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion
• CPC Class Codes: H04B 17/309 Measuring or estimating channel quality parameters
• CPC Class Codes: H04L 1/0003 by switching between different modulation schemes
• CPC Class Codes: H04L 1/0013 Rate matching, e.g. puncturing or repetition of code symbols
• CPC Class Codes: H04L 1/0015 characterised by the adaptation strategy
• CPC Class Codes: H04L 1/0026 Transmission of channel quality indication
• CPC Class Codes: H04W 24/02 Arrangements for optimising operational condition
• CPC Class Codes: H04W 4/023 using mutual or relative location information between multiple location based services [LBS] targets or of distance thresholds

Abstract

A system and methods of maintaining communication with a medical device for exchange of information, instructions, and programs, in a highly reliable manner. Apparatus and methods for accomplishing this task include:

• • 1) The inclusion of a locating device in the system, in close proximity to an implanted device, but which does not drain the implanted device battery. The locating device may be implanted or external to the body.
  • 2) The use of motion detection and global positioning system devices to locate elements within a communicating system for the medical device;
  • 3) The assessment of received signal quality by elements of the system;
  • 4) The use of a notification system for a device user who is moving out of range of communications; and
  • 5) Documenting the absolute and functional integrity of instructions received by the medical device.

Claims

1. A medical treatment system having an implantable medical device, which system provides location information pertaining to a person in whom the device is implanted, to facilitate communication between the device and a remote location, said system comprising:

(1) electronic medical apparatus adapted to be implanted in a human, a so-called implantable medical device (“

IMD”

), comprising, in combination;

(a) a first transmitting/receiving (“

T/R”

) device for at least one of

(i) transmitting information to, and

(ii) receiving at least one control signal from, at least one remote location;

(b) a medical treatment device, coupled to said first T/R device, for treating said patient;

(2) a first locator device, adapted to be located in the close vicinity of said human in whom said device is implanted, comprising a wireless first locator transmitting device, operative to transmit first locator signals;

(3) a plurality of second locator devices, each comprising;

(a) a second locator receiving device, operative to receive said first locator signals;

(b) a communication quality assessment device, coupled to said second locator receiving device, for assessing the quality of the received first locator signals, and for producing a communication quality signal in dependence upon the assessed quality of said first locator signals; and

(c) a second locator transmitting device, coupled to said communication quality assessment device, for transmitting said communication quality signal;

(4) a communication device, comprising

(a) a second T/R device, for;

(i) receiving said communication quality signals from each of the second locator transmitting devices, and

(ii) transmitting a low communication quality signal;

(b) a second T/R controlling device, coupled to said second T/R device, for (i) indicating a state in which the quality represented by each of said communication quality signals is less than an acceptable value, wherein said acceptable value corresponds to a minimum acceptable communication quality, and (ii) in response to said indication, causing said second T/R device to transmit a low communication quality signal;

wherein;

(a) each of said communication quality assessment devices determines information concerning the location of said first locator device based on at least one of;

(i) the detection of said first locator signals by said second locator device,

(ii) the absence of a detected first locator signal by said second locator device, and

(iii) the quality of said detected first locator signals;

(b) each of said second locator devices is operative to transmit said information concerning the location of said first locator device to said communication device; and

(c) said second T/R controlling device is operative to provide said low communication quality signal indicating that none of the second locator devices is receiving a first locator signal with quality greater than or equal to said acceptable value;

whereby (1) said first locator device provides information about the location of said IMD, without electrical interaction with the IMD; and

(2) said system indicates when said human in whom said IMD is implanted is out of communications range of said second T/R device.

2. The medical treatment system defined in claim 1, wherein said first locator device and said IMD are mechanically linked, such that both are adapted to be implanted in said human in whom both said devices continue to be mechanically linked.

3. The medical treatment system defined in claim 1, wherein said IMD and said first locator device are adapted to be implanted in said human, but are not mechanically linked.

4. The medical treatment system defined in claim 3, wherein said first locator device is adapted to be implanted subcutaneously in said human and said IMD is adapted to be implanted at a deeper level than the subcutaneous layer.

5. The medical treatment system defined in claim 1, wherein said IMD is adapted to be implanted in said human and said first locator device is adapted to be located outside of said human, touching the outer surface of the skin of said human.

6. The medical treatment system defined in claim 1, wherein said IMD is adapted to be implanted in said human and said first locator device is adapted to be located outside of said human, and is physically linked to an article worn by said human.

7. The medical treatment system defined in claim 6, wherein said article of clothing includes at least one of:

a belt, a watch and jewelry.

8. The medical treatment system defined in claim 1, further comprising

(5) alarm apparatus, situated in proximity to at least one of (i) said person, and (ii) another person, comprising:

(a) a notification device for producing at least one output from the group consisting of a sound, a light and a vibration; and

(b) a receiving device, coupled to said notification device, for receiving said low communication quality signal;

wherein

said receiving device causes said notification device to produce said at least one output upon receipt of a low communication quality signal indicating an unacceptable quality communication between said first and said second locator device;

thereby to notify at least one of (i) said person and) said other person that the location of said first locator device requires attention.

9. The medical treatment system defined in claim 1, wherein at least one of said second locator devices further comprises a notification device, coupled to a respective one of said communication quality assessment devices, for producing at least one output from the group consisting of:

sound, a light and a vibration; and

wherein at least one of;

(i) the absence of a received first locator signal;

(ii) the receipt of an unacceptable quality first locator signal;

causes the production of said at least one output by said notification device;

thereby to notify at least one person that the location of said first locator device requires attention.

10. The medical treatment system defined in claim 1, wherein the IMD includes at least one sensor, coupled to said first T/R device for sensing a medical condition of said person and producing a sensor output signal in response to said medical condition, wherein said fir T/R device transmits a representation of said sensor output signal.

11. The medical treatment system defined in claim 10, wherein said sensor is further coupled to said medical treatment device and wherein said medical treatment device automatically applies an appropriate treatment to said patient in response thereto.

12. The medical treatment system defined in claim 1, wherein:

(a) at least one of said second locator transmitting devices is further operative to transmit a first assessment signal,

(b) said first locator device further comprises a first locator receiving device, coupled to said first locator transmitting device, for receiving said first assessment signal, and

(c) said first locator transmitting device is further operative to transmit a second assessment signal in response to receipt of said first assessment signal;

(d) said communication quality assessment device is operative to determine at least one of the receipt and the quality of the received second assessment signal, and to produce said communication quality signal in dependence upon the assessed quality of said second assessment signal;

wherein

(i) said second or device transmits said first assessment signal to said first locator device;

(ii) upon receipt of said first assessment signal, said first locator device transmits a second assessment signal to said second locator device; and

(iii) said communication quality assessment device assesses said second assessment signal;

thereby to assess the quality of communication between the two locator devices.

13. The medical treatment system defined in claim 1, wherein:

(a) said first T/R device is further operative to communicate with said second T/R device; and

(b) said communications device is adapted to be located in the close vicinity of at least one of said plurality of second locator devices;

whereby said communication quality signal, representing the quality of the first locator signal received by said second locator device, provides information concerning the expected quality of communication between said first T/R device and said second T/R device, without directly utilizing said first T/R device to provide said quality information.

14. The medical treatment system defined in claim 13, wherein, based on the quality of each respective communication quality signal, said second T/R controlling device is operative to control a feature of communication with said first T/R device selected from the group consisting of:

(i) a power output for said second T/R device;

(ii) a signal sensitivity for said second T/R device;

(iii) at least one transmission frequency for said second T/R device;

(iv) an output signal modulation type for said second T/R device;

(v) a selection of a connection mode from the group consisting of (a) a radiofrequency link, (b) the Internet, (c) a hard wire connection, for said second T/R device;

(vi) a rate of information transfer by said second T/R device

(vii) a method of signal encoding by said second T/R device;

(viii) a message repetition frequency, for said second T/R device; and

(ix) a selection of at least one other communication device with which said second T/R device communicates.

15. The medical treatment system defined in claim 13, wherein said communication device is located at said remote location and further comprises:

(c) a first input device, coupled to said second T/R device, responsive to a technical expert, for producing at least one real time remote control signal for controlling said IMD;

and wherein (i) said communication device is further operative to transmit said control signal to said IMD in response to a command inputted by said technical expert, said first T/R device is operative to receive said control signal, and (iii) said medical treatment device is responsive to said control signal for applying a treatment represented by said signal.

16. The medical treatment system defined in claim 13, further comprising a remote station (RS) at said

(a) a first input device, responsive to a medical expert, for producing at least one real time remote control signal for controlling said IMD, wherein said first T/R device is operative to receive said control signal, and said medical treatment device is responsive to said control signal for applying a treatment represented by said signal;

and

(b) a third transmitting/receiving (T/R) device, coupled to said input device, for electronic communication with a T/R device selected from the group consisting of (i) the first T/R device of said remotely located IMD, and (ii) the second T/R device of said communication device, wherein said second T/R device is operative receive said control signal and re-transmit it to said first T/R device.

17. The medical treatment system defined in claim 16, wherein:

(a) said third T/R device is operative to receive said low communication quality signal from said second T/R device; and

(b) said remote station further comprises a third T/R controlling device, coupled to said third T/R device, for controlling a feature of communication between said third T/R device and said first T/R device;

thereby to permit said third T/R device to improve its communications with said first T/R device.

18. The medical treatment system defined in claim 16, wherein said third T/R device is operative to notify at least one of:

(a) said person;

(b) another person in the vicinity of said person;

of a received communication quality signal indication an unacceptable quality communication between said first, and said second locator device.

19. The medical treatment system defined in claim 18 further comprising:

alarm apparatus, situated in proximity to at least one of (i) said person, and (ii) another person, comprising;

(a) a notification device for producing at least one of a sound, a light and a vibration; and

(b) a receiving device, coupled to said notification device;

wherein

said medical expert inputs an alarm signal to said first input device, for transmission by said third T/R device to said alarm apparatus;

thereby to notify at least one of (i) said person, and (ii) another person, of said unacceptable quality communication.

20. The medical treatment system defined in claim 13, wherein:

(a) said first T/R device is operative to receive said low communication quality signal from said second T/R device; and

(b) said IMD further comprises a first T/R controlling device, coupled to said first T/R device, for controlling a feature of communication between said first T/R device and said second T/R device;

thereby to cause said first T/R device to improve its communications with said second T/R device.

21. The medical treatment system defined in claim 1, further comprising:

(1) at least one supplemental plurality of second locator devices, each comprising;

(a) a supplemental second locator receiving device, operative to receive said first locator signals;

(b) a supplemental communication quality assessment device, coupled to said supplemental second locator receiving device, for assessing the quality of the received first locator signals, and for producing a supplemental communication quality signal in dependence upon the assessed quality of said first locator signals; and

(c) a supplemental second locator transmitting device, coupled to said supplemental communication quality assessment device, for transmitting said supplemental communication quality signal;

(2) at least one supplemental communication device for assessing the quality of signals received by one respective supplemental plurality of second locator devices, each of said supplemental communication devices comprising

(a) a supplemental second T/R device, for;

(i) for receiving said communication quality signals from each of the supplemental second locator transmitting devices among the respective plurality, and

(ii) for transmitting a supplemental low quality signal;

(b) a supplemental second T/R controlling device, coupled to said supplemental second T/R device, for (i) indicating a state in which the quality represented by each of said communication quality signals is less than a supplemental acceptable value, wherein said supplemental acceptable value corresponds to a supplemental minimum acceptable communication quality, and in response to said indication, causing said supplemental second T/R device to transmit a supplemental low communication quality signal;

(3) an additional communications device, comprising an additional T/R device coupled to an additional T/R controlling device, for;

receiving said low communication quality signal;

receiving said at least one supplemental low communication quality signals; and

producing a global alarm signal upon receipt of low communication quality signals from each of (i) said communication device and (ii) each of said at least one supplemental communication devices.

22. The medical treatment system defined in claim 21, wherein:

(a) said first T/R device is further operative to communicate with each of said supplemental second T/R devices; and

(b) each of said supplemental communications devices is adapted to be located in the close vicinity of at least one of said plurality of respective supplemental second locator devices;

whereby each of said supplemental communication quality signals, representing the quality of the first locator signal received by said respective second locator device, provides information concerning the expected quality of communication between said first T/R device and said respective supplemental second T/R device, without directly utilizing said first T/R device to provide said quality information.

23. The medical treatment system defined in claim 22, wherein

(A) each of at least two of said T/R controlling devices is further operative to cause said respective second T/R device to transmit a numerical value representing the quality of said respective received communication quality signals and supplemental communication quality signals;

and

(B) said additional communications device is operative to receive signals representing said numerical values and

(C) said additional T/R controlling device is operative to determine which one of the plurality of communication devices is associated with the greatest numerical value, and to cause said additional T/R device to transmit an optimization signal representing the identity of an optimum communications device representing said one communications device associated with said greatest value;

whereby said system is operative to determine

(A) the identity of one specific communications device among (i) said communications device and (ii) said at least one supplemental communications device

with the highest quality first locator signal; and

(B) the identity of one optimum second T/R device, associated with said one specific communications device;

thereby to determine, for said human situated at a given location, the optimum choice of second T/R device for communicating with said first T/R device.

24. The medical treatment system defined in claim 23, wherein at least one of said second T/R device and said supplemental T/R devices indicated by said optimization signal is operative to receive said optimization signal, and said respective second T/R controlling device is further operative to cause said selected second T/R device to communicate with said first T/R device.

25. The medical treatment system defined in claim 23, wherein at least one of said second T/R devices is operative to receive said optimization signal and to cause said respective second T/R controlling device to control a feature of communication with said first T/R device, selected from the group consisting of:

(i) a power output for said second T/R device;

(ii) a signal sensitivity for said second T/R device;

(iii) at least one transmission frequency for said second device;

(iv) an output signal modulation type said second T device;

(v) a selection of a connection mode from the group consisting of (a) a radiofrequency link, (b) the Internet, (c) a hard wire connection, for said second T/R device;

(vi) a rate of information transfer by said second T/R device

(vii) a method of signal encoding by said second T/R device;

(viii) a message repetition frequency, for said second T/R device; and

(ix) a selection of at least one other communication device with which said second T/R device communicates.

26. The medical treatment system defined in claim 23, wherein:

(a) said first T/R device is operative to receive said optimization signal from said additional T/R device;

(b) said IMD further comprises a first T/R controlling device, coupled to said first T/R device, for controlling the features of communication between said first T/R device and said second T/R device; and

(c) based on said received optimization signal, said first T/R controlling device is operative to cause said first T/R device to communicate with a particular second T/R device;

thereby to cause said first T/R device to optimize communications with the plurality of second T/R devices, based on the locations of each of the human and of the second T/R devices.

27. A medical treatment system having an implantable medical device, which system provides location information pertaining to a person in whom the device is implanted, to facilitate communication between the device and a remote location, said system comprising:

(1) electronic medical apparatus adapted to be implanted in a human, a so-called implantable medical device (“

IMD”

), comprising, in combination;

(a) a first transmitting/receiving (“

T/R”

) device for at least one of

(i) transmitting information to, and

(ii) receiving at least one control signal from, at least one remote location;

(b) a medical treatment device, coupled to said first T/R device, for treating said patient;

(2) a first locator device, adapted to be located in the close vicinity of said human, comprising;

(a) a first locator receiving device, operative to receive second locator signals;

(b) an energy storage device, coupled to said first locator receiving device, for storing energy;

(c) a first locator transmitting device, coupled to said energy storage device, operative to transmit first locator signals;

(3) a plurality of second locator devices, each comprising;

(a) a second locator transmitting device, operative to transmit second locator signals, for receipt by said first locator receiving device;

(b) a second locator receiving device, operative to receive said first locator signals;

(c) a communication quality assessment device, coupled to said second locator receiving device, for assessing the quality of said received first locator signals, and for producing a communication quality signal in dependence upon the assessed quality of said first locator signals; and

(d) a second locator quality signal transmitting device, coupled to said communication quality assessment device, for transmitting said communication quality signal;

(4) a communication device, comprising

(a) a second T/R device, for;

(i) receiving said communication quality signals from each of the second locator transmitting devices and

(ii) transmitting a low communication quality signal;

(b) a second T/R controlling device, coupled to said second T/R device, for (i) indicating a state in which the quality represented by each of said communication quality signals is less than an acceptable value, wherein said acceptable value corresponds to a minimum acceptable communication quality, and (ii) in response to said indication, causing said second T/R device to transmit a low communication quality signal;

wherein;

(a) each of said communication quality assessment devices determines information concerning the location of said first locator device based on at least one of;

(i) the detection of said first locator signals by said second locator device,

(ii) the absence of a detected first locator signal by said second locator device, and

(iii) the quality of said detected first locator signals;

(b) each of said second locator devices is operative to transmit said information concerning the location of said first locator to said communication device; and

(c) said second T/R controlling device is operative to provide said low communication quality signal indicating that none of the second locator devices is receiving a first locator signal with quality greater than or equal to said acceptable value;

whereby (1) said first locator device provides information about the location of said IMD, without electrical interaction with the IMD; and

(2) said system indicates when said human in whom said IMD is implanted is out of communications range of said second T/R device.

28. The medical treatment system defined in claim 27, wherein said first locator device and said IMD are mechanically linked, such that both are adapted to be implanted in said human in whom both said devices continue to be mechanically linked.

29. The medical treatment system defined in claim 27, wherein said IMD and said first locator device are adapted to be implanted in said human, but are not mechanically linked.

30. The medical treatment system defined in claim 29, wherein said first locator device is adapted to be implanted subcutaneously in said human and said IMD is adapted to be implanted at a deeper level than the subcutaneous layer.

31. The medical treatment system defined in claim 27, wherein said IMD is adapted to be implanted in said human and said first locator device is adapted to be located outside of said human, touching the outer surface of the skin of said human.

32. The medical treatment system defined in claim 27, wherein said IMD is adapted to be implanted in said human and said first locator device is adapted to be located outside of said human, and is physically linked to an article worn by said human.

33. The medical treatment system defined in claim 32, wherein said article of clothing includes at least one of:

a belt, a watch and jewelry.

34. The medical treatment system defined in claim 27, further comprising:

(5) alarm apparatus, situated in proximity to at least one of (i) said person, and another person, comprising;

(a) a notification device for producing at least one output from the group consisting of a sound, a light and a vibration; and

(b) a receiving device, coupled to said notification device, for receiving said low communication quality signal;

wherein

said receiving device causes said notification device to produce said at least one output upon receipt of a communication quality signal indicating an unacceptable quality communication between said first and said second locator device;

thereby to notify at least one of (i) said person and said other person that the location of said first locator device requires attention.

35. The medical treatment system defined in claim 27, wherein at least one of said second locator devices further comprises a notification device, coupled to a respective one of said communication quality assessment devices, for producing at least one output from the group consisting of:

a sound, a light, and a vibration; and

wherein at least one of;

(i) the absence of a received first locator signal;

(ii) the receipt of an unacceptable quality first locator signal;

causes the production of said at least one output by said notification device;

thereby to notify at least one person that the location of said first locator device requires attention.

36. The medical treatment system defined in claim 27, wherein the IMD includes at least one sensor, coupled to said first T/R device for sensing a medical condition of said person and producing a sensor output signal in response to said medical condition, wherein said first T/R device transmits a representation of said sensor output signal.

37. The medical treatment system defined in claim 36, wherein said sensor is further coupled to said medical treatment device and wherein said medical treatment device automatically applies an appropriate treatment to said patient in response thereto.

38. The medical treatment system defined in claim 27, wherein:

(a) said first locator device further comprises a first locator communication quality assessment device, coupled to said first locator receiving device and to said first locator transmitting device, for assessing the quality of the received second locator signals and for producing first locator communication quality signals in dependence upon the assessed quality of said second locator signals;

(b) said first locator transmitting device is operative to transmit said first locator transmitting device is operative to said second locator devices;

(c) each of said second locator devices further comprise a second locator transmitting device controller, coupled to said respective second, locator receiving device, for receipt of said first locator communication quality signals, and coupled to at least one of;

(I) said respective second locator transmitting device, for controlling at least one of;

(i) the power output of said respective second locator transmitting device;

(ii) the transmitter frequency of said respective second locator transmitting device;

(iii) the repetition rate of said respective second locator transmitting device; and

(iv) the direction of transmission of said respective second locator transmitting device; and

(II) said respective second locator quality signal transmitting device, to control a feature of communication selected from the group consisting of;

(i) a power output for said respective second locator quality signal transmitting device;

(ii) at least one transmission frequency for said respective second locator quality signal transmitting device;

(iii) an output signal modulation type for said respective second locator quality signal transmitting device;

(iv) a selection of a connection mode from the group consisting of (a) a radiofrequency link, (b) the Internet, (c) a hard wire connection, for said respective second locator quality signal transmitting device;

(v) a rate of information transfer by said respective second locator quality signal transmitting device;

(vi) a method of signal encoding by said respective second locator quality signal transmitting device;

(vii) a message repetition frequency, for said respective second locator quality signal transmitting device; and

(viii) a selection of at least one other communication device with which said respective second locator quality signal transmitting device communicates;

thereby to improve communication between (i) said second locator devices and (ii) at least one of said first locator device and another device.

39. The medical treatment system defined in claim 27, wherein:

(a) said first locator device further comprises a first locator communication quality assessment device coupled to said first locator receiving device and to said first locator transmitting device for assessing the quality of the received second locator signals, and for producing first locator communication quality signals, in dependence upon the assessed quality of said second locator signals;

(b) said first locator transmitting device is operative to transmit said first locator communication quality signals to said second locator device;

(c) said second locator receiving device is further coupled to said second locator quality signal transmitting device, to re-transmit said first locator communication quality signals;

(d) said second T/R devices is operative to receive said re-transmitted first locator communication quality signals; and

(e) said second T/R controlling device is operative to control a mode of communication between said second T/R device and said first R device, in dependence upon said first locator communication quality signals;

thereby to improve communication to said IMD.

40. The medical treatment system defined in claim 39, wherein:

(a) said second T/R device is operative to re-transmit said received first locator communication quality signals;

(b) said first T/R device is operative to receive said re-transmitted first locator communication quality signals;

(c) said IMD further comprises a first T/R controlling device, coupled to said first T/R device, for controlling the mode of communication between said first T/R device and said second T/R device;

thereby to cause said first T/R device to improve communication with said second T/R device.

41. The medical treatment system defined in claim 39, further comprising a remote station (RS) at said remote location comprising:

(a) a first input device, responsive to a technical expert, for producing at least one real time remote control signal for controlling said IMD;

(b) a third transmitting/receiving (T/R) device, coupled to said input, device, for electronic, communication with at least one of (i) the first T/R device of said remotely located IMD, and (ii) the second T/R device of said communication device;

(c) a third T/R controlling device, coupled to said third T/R device, for controlling a feature of communication between said third T/R device and at least one of said first T/R device and said second T/R device; and

(d) said second T/R device is operative to re-transmit said received first locator communication quality signals;

wherein;

(i) said third T/R device receives said re-transmitted first locator communication quality signals; and

(ii) said third T/R controlling device controls a feature of communication of said third T/R device based on said first locator communication quality signals;

thereby to cause said third T/R device to improve its communications.

42. The system defined in claim 27, wherein said energy storage device is adapted to store energy contained in said incoming electrical signals, and wherein said transmitted second locator signals, received by said first locator receiver, supply energy for powering said first locator device.

43. The medical treatment system defined in claim 27, wherein:

(a) said first T/R device is further operative to communicate with said second T/R device; and

(b) said communications device is adapted to be located in the close vicinity of at least one of said plurality of second locator devices;

whereby said communication quality signal, representing the quality of the first locator signal received by said second locator device, provides information concerning the expected quality of communication between said first T/R device and said second T/R device, without directly utilizing said first T/R device to provide said quality information.

44. The medical treatment system defined in claim 43, wherein said communication device is located at said remote location and further comprise:

(c) a first input device, coupled to said second T/R device, responsive to a technical expert, for producing at least one real time remote control signal for controlling said IMD;

and wherein (i) said communication device is further operative to transmit said control signal to said IMD in response to a command inputted by said technical expert, (ii) said first T/R device is operative to receive said control signal, and (iii) said medical treatment device is responsive to said control signal for applying a treatment represented by said signal.

45. The medical treatment system defined in claim 43, wherein, based on the quality of each respective communication quality signal, said second T/R controlling device is operative to control a feature of communication with said first T/R device selected from the group consisting of:

(i) a power output for said second T/R device;

(ii) a signal sensitivity for said second device;

(iii) at least one transmission frequency for said second T/R device;

(iv) an output signal modulation type for said second T/R device;

(v) a selection of a connection mode from the group consisting of (a) a radiofrequency link, (b) the Internet, (c) a hard wire connection, for said second T/R device;

(vi) a rate of information transfer by said second T/R device

(vii) a method of signal encoding by said second T/R device;

(viii) a message repetition frequency, for said second T/R device; and

(ix) a selection of at least one other communication device with which said second T/R device communicates.

46. The medical treatment system defined in claim 43, further comprising a remote station (RS) at said remote location including:

(a) a first input device, responsive to a medical expert, for producing at least one real time remote control signal for controlling said IMD, wherein said first T/R device is operative to receive said control signal, and said medical treatment device is responsive to said control signal for applying a treatment represented by said signal; and

(b) a third transmitting/receiving (T/R) device, coupled to said input device, for electronic communication with a T/R device selected from the group consisting of (i) the first T/R device of said remotely located IMD, and (ii) the second T/R device of said communication device, wherein said second T/R device is operative receive said control signal and re-transmit it to said first T/R device.

47. The medical treatment system defined in claim 46, wherein:

(a) said third T/R device is operative receive said low communication quality signal from said second T/R device; and

(b) said remote station further comprises a third T/R controlling device, coupled to said third T/R device, for controlling a feature of communication between said third T/R device and said first T/R device;

thereby to permit said third T/R device to improve its communications with said first T/R device.

48. The medical treatment system defined in claim 46, wherein said third T/R device is operative to notify at least one of:

(a) said person;

(b) another person in the vicinity of said person;

of a received communication quality signal indicating an unacceptable quality communication between said first and said second locator device.

49. The medical treatment system defined in claim 48 further comprising:

alarm apparatus, situated in proximity to at least one of (i) said person, and (ii) another person, comprising;

(a) a notification device for producing at least one of a sound, a light and a vibration; and

(b) a receiving device, coupled to said notification device;

wherein

said medical expert inputs an alarm signal to said first input device, for transmission by said third T/R device to said alarm apparatus;

thereby to notify at least one of (i) said person, and (ii) another person, of said unacceptable quality communication.

50. The medical treatment system defined in claim 43, wherein:

(a) said first T/R device is operative to receive said low communication quality signal from said second T/R device; and

(b) said IMD further comprises a first T/R controlling device, coupled to said first T/R device, for controlling a feature of communication between said first T/R device and said second T/R device;

thereby to permit said first T/R device to improve its communications with said second T/R device.

51. The medical treatment system defined in claim 27, further comprising:

(1) at least one supplemental plurality of second locator devices, each comprising;

(a) a supplemental second locator transmitting device, operative to transmit second locator signals, for receipt by said first locator receiving device;

(b) a supplemental second locator receiving device, operative to receive said first locator signals;

(c) a supplemental communication quality assessment device, coupled to said supplemental second locator receiving device, for assessing the Quality of the received first locator signals, and for producing a supplemental communication quality signal in dependence upon the assessed quality of said first locator signals; and

(d) a supplemental second locator quality signal transmitting device, coupled to said supplemental communication quality assessment device, for transmitting said supplemental communication quality signal;

(2) at least one supplemental communication device for assessing the quality of signals received by one respective supplemental plurality of second locator devices, each of said supplemental communication devices comprising

(a) a supplemental second T/R device, for;

(i) for receiving said communication quality signals from each of the supplemental second locator quality signal transmitting devices among the respective plurality, and

(ii) for transmitting a supplemental low quality signal;

(b) a supplemental second T/R controlling device, coupled to said supplemental second T/R device, for (i) indicating a state in which the quality represented by each of said communication quality signals is less than a supplemental acceptable value, wherein said supplemental acceptable value corresponds to a supplemental minimum acceptable communication quality, and (ii) in response to said indication, causing said supplemental second T/R device to transmit a supplemental low communication quality signal;

(3) an additional communications device, comprising an Additional T/R device coupled to an additional T/R controlling device, for;

receiving said low communication quality signal;

receiving said at least one supplemental low communication quality signals; and

producing a global alarm signal upon receipt of low communication quality signals from each of (i) said communication device and (ii) each of said at least one supplemental communication devices.

52. The medical treatment system defined in claim 51, wherein:

(a) said first T/R device is further operative to communicate with each of said supplemental second T/R devices; and

(b) each of said supplemental communications devices is adapted to be located in the close vicinity of at least one of said plurality of respective supplemental second locator devices;

whereby each of said supplemental communication quality signals, representing the quality of the first locator signal received by said respective second locator device, provides information concerning the expected quality of communication between said first T/R device and said respective supplemental second T/R device, without directly utilizing said first T/R device to provide said quality information.

53. The medical treatment system defined in claim 52, wherein

(A) each of at least two of said T/R controlling devices is further operative to cause said respective second T/R device to transmit a numerical value representing the quality of said respective received communication quality signals and supplemental communication quality signals;

and

(B) said additional communications device is operative to receive signals representing said numerical values and

(C) said additional T/R controlling device is operative to determine which one of the plurality of communication devices is associated with the greatest numerical value, and to cause said additional T/R device to transmit an optimization signal representing the identity of an optimum communications device representing said one communications device associated with said greatest value;

whereby said system is operative to determine

(A) the identity of one specific communications device among (i) said communications device and (ii) said at least one supplemental communications device

with the highest quality first locator signal; and

(B) the identity of one optimum second T/R device, associated with said one specific communications device;

thereby to determine, for said human situated at a given location, the optimum choice of second T/R device for communicating with said first T/R device.

54. The medical treatment system defined in claim 53, wherein at least one of said second T/R device and said supplemental T/R devices indicated by said optimization signal is operative to receive said optimization signal, and said respective second T/R controlling device is further operative to cause said selected second T/R device to communicate with said first T/R device.

55. The medical treatment system defined in claim 53, wherein at least one of said second T/R devices is operative to receive said optimization signal and to cause said respective second T/R controlling device to control a feature of communication with said first T/R device, selected from the group consisting of:

(i) a power output for said second T/R device;

(ii) a signal sensitivity for said second T/R device;

(iii) at least one transmission frequency for said second T/R device;

(iv) an output signal modulation type for said second T/R device;

(v) a selection of a connection mode from the group consisting of (a) a radiofrequency link, (b) the Internet, (c) a hard wire connection, for said second T/R device;

(vi) a rate of information transfer by said second T/R device

(vii) a method of signal encoding by said second T/R device;

(viii) a message repetition frequency, for said second T/R device; and

(ix) a selection of at least one other communication device with which said second T/R device communicates.

56. The medical treatment system defined in claim 53, wherein:

(a) said first T/R device is operative to receive said optimization signal from said additional T/R device;

(b) said IMD further comprises a first T/R controlling device, coupled to said first T/R device, for controlling the features of communication between said first T/R device and said second T/R device; and

(c) based on said received optimization signal, said first T/R controlling device is operative to cause said first T/R device to communicate with a particular second T/R device;

thereby to cause said first T/R device to optimize communications with the plurality of second T/R devices, based on the locations of each of the human and of the second T/R devices.