MODIFICATION PROFILES FOR POSTURE-RESPONSIVE THERAPY

• US 20100010392A1
• Filed: 04/30/2009
• Published: 01/14/2010
• Est. Priority Date: 07/11/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Bourget, Dennis, Davis, Jon P., Miesel, Keith A., Bourget, Duane, Skelton, Dennis M., Gokaldas, Shyam, Nolan, Joseph J., Zimmerman, James, Sahasrabudhe, Rajeev
• Granted Patent: US 8,401,666 B2
• Time in Patent Office: Days
• US Class Current: 600/595
• 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:

delivering therapy to a patient from a medical device; and

modifying the therapy according to a modification profile in response to a posture state transition of the patient, wherein the modification profile varies according to a type of the posture state transition.

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

3. The method of claim 2, wherein the modification profile defines a rate of change for the adjustment of the stimulation parameter value.

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

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

6. The method of claim 2, wherein the modification profile for a first posture state transition defines a first rate of change and a second rate of change for the adjustment to the stimulation parameter value.

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

8. The method of claim 7, wherein the first rate of change in the stimulation parameter value from the first value to the intermediate value is substantially immediate.

9. The method of claim 7, wherein the intermediate value is less than the first value and the second value.

10. The method of claim 7, wherein the intermediate value is associated with an unstable posture state and the second posture state is a stable posture state.

11. The method of claim 1, further comprising detecting the posture state transition via at least one accelerometer.

12. The method of claim 1, wherein the therapy is modified according to a first modification profile for a first type posture state transition and according to a second modification profile for a second type posture state transition.

13. The method of claim 12, wherein the first type posture state transition is defined by transition from a first posture state to a second posture state and the second type posture state transition is defined by transition from the second posture state to the first posture state.

14. The method of claim 13, wherein the first posture state comprises a lying down posture state and the second posture state comprises an upright posture state.

15. The method of claim 1, wherein modifying the therapy includes adjusting at least one therapy parameter value, and the modification profile for a first posture state transition defines a first rate of change for the adjustment to the therapy parameter value, the method further comprising:

detecting the first posture state transition;

adjusting the therapy parameter value according to the first rate of change during a transition time period in response to the detection of the first posture state transition; and

receiving an indication from a user during the transition time period, wherein the modification profile is changed to define a second 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.

16. The method of claim 1, wherein modifying the therapy comprises adjusting at least one therapy parameter value, wherein the adjustment to the at least one therapy parameter value commences after expiration of a dwell time period following the posture state transition defined by the modification profile.

17. The method of claim 16, further comprising:

detecting the posture state transition;

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

adjusting the dwell time period such that the dwell time period expires substantially immediately after receiving the indication from the user.

18. The method of claim 1, wherein the modification profile defines a dwell time for the therapy modification and a rate of change for the therapy modification.

19. The method of claim 18, wherein the modification profile for a first posture state transition defines a first dwell time and the modification profile for a second posture state transition defines a second dwell time.

20. The method of claim 19, wherein the rate of change for the modification profile for the first posture state transition is substantially the same as the rate of change for the modification profile for the second posture state transition.

21. The method of claim 1, wherein the therapy includes electrical stimulation therapy, and wherein modifying the therapy includes adjusting at least one stimulation parameter value, and the modification profile defines a length of time for the adjustment of the stimulation parameter value.

22. The method of claim 1, further comprising:

detecting a posture state transition from a first posture state to a second posture state; and

selecting the modification profile based on one or more of the first posture state and second posture state.

23. The method of claim 22, wherein the modification profile based on only one of the first posture state and second posture state.

24. The method of claim 1, wherein the therapy includes electrical stimulation therapy, and modifying the therapy includes adjusting at least one stimulation parameter value,

wherein the modification profile defines a dwell time and a first rate of change, and

wherein the at least one stimulation parameter value is adjusted according to the dwell time and first rate of change.

25. A therapy system comprising:

a therapy delivery module configured to deliver therapy to a patient;

a posture state module configured to detect a posture state transition of the patient; and

a processor configured to modify the therapy according to a modification profile in response to the posture state transition, wherein the modification profile varies according to a type of the posture state transition.

26. The therapy system of claim 25, wherein the therapy includes electrical stimulation therapy, and wherein the processor modifies the therapy by adjusting at least one stimulation parameter value.

27. The therapy system of claim 26, wherein the modification profile defines a rate of change for the adjustment of the stimulation parameter value.

28. The therapy system of claim 27, wherein the modification profile for a first posture state transition from an upright posture state to an upright and active posture state defines a first rate of a change, and the modification profile for a second posture state transition from an upright posture state to a lying down posture state defines a second rate of a change, and wherein the first rate of change is less than the second rate of change.

29. The therapy system of claim 28, wherein the second rate of change defines a substantially immediate change in the stimulation parameter value from a first value associated with the upright posture state to a second value associated with the lying down posture state.

30. The therapy system of claim 26, wherein the modification profile for a first posture state transition defines a first rate of change and a second rate of change for the adjustment to the stimulation parameter.

31. The therapy system of claim 30, wherein the first rate of change defines a first change in the stimulation parameter value from a first value associated with a first posture state to an intermediate value, and the second rate of change defines a change in the stimulation parameter value from the intermediate value to a second value associated with a second posture state.

32. The therapy system of claim 31, wherein the first rate of change in the stimulation parameter value from the first value to the intermediate value is substantially immediate.

33. The therapy system of claim 31, wherein the intermediate value is less than the first value and the second value.

34. The therapy system of claim 31, wherein the intermediate value is associated with an unstable posture state and the second posture state is a stable posture state.

35. The therapy system of claim 25, wherein the posture state module comprises at least one accelerometer, and the posture state module is configured to detect the posture state transition of the patient via the at least one accelerometer.

36. The therapy system of claim 25, wherein the processor is configured to modify the therapy according to a first modification profile for a first type posture state transition and according to a second modification profile for a second type posture state transition.

37. The therapy system of claim 36, wherein the first type posture state transition is defined by transition from a first posture state to a second posture state, and the second type posture state transition is defined by transition from the second posture state to the first posture state.

38. The therapy system of claim 37, wherein the first posture state comprises a lying down posture state and the second posture state comprises an upright posture state.

39. The therapy system of claim 25, wherein the processor modifies the therapy by adjusting at least one therapy parameter value, wherein the modification profile for a first posture state transition defines a first rate of change for the adjustment to the therapy parameter value, wherein the posture state module is configured to detect the first posture state transition, wherein the processor is configured to adjust the therapy parameter value during a transition time period defined according to the first rate of change in response to the detection of the first posture state transition, receive an indication from a user during the transition time period and change the modification profile to define a second 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.

40. The therapy system of claim 25, wherein the processor modifies the therapy by adjusting at least one therapy parameter value, wherein the adjustment to the at least one therapy parameter value is configured to commence after expiration of a dwell time period following the posture state transition defined by the modification profile.

41. The therapy system of claim 40, wherein the posture state module is configured to detect the posture state transition, wherein the processor is configured to receive an indication from a user during the dwell time period, and adjust the dwell time period such that the dwell time period expires substantially immediately after receipt of the indication from the user in response to receipt of the indication.

42. The therapy system of claim 25, wherein the modification profile defines a dwell time for the therapy modification and a rate of change for the therapy modification.

43. The therapy system of claim 42, wherein the modification profile for a first posture state transition defines a first dwell time and the modification profile for a second posture state transition defines a second dwell time.

44. The therapy system of claim 43, wherein the rate of change for the modification profile for the first posture state transition is substantially the same as the rate of change for the modification profile for the second posture state transition.

45. The therapy system of claim 25, wherein the therapy includes electrical stimulation therapy, and wherein the processor modifies the therapy at least by adjusting at least one stimulation parameter value, and the modification profile defines a length of time for the adjustment of the stimulation parameter value.

46. The therapy system of claim 25, wherein the posture state module is configured to detect a posture state transition from a first posture state to a second posture state, and the processor is configured to select the modification profile based on one or more of the first posture state and the second posture state.

47. The therapy system of claim 46, wherein the processor selects the modification profile based on only one of the first posture state and the second posture state.

48. The therapy system of claim 25, wherein the therapy includes electrical stimulation therapy, and the processor modifies the therapy at least by adjusting at least one stimulation parameter value,

wherein the modification profile defines a dwell time and a first rate of change, and

wherein the processor adjusts the at least one stimulation parameter value according to the dwell time and first rate of change.

49. A computer-readable storage medium comprising instructions for causing one or more processors to perform a method, the method comprising:

controlling a medical device to deliver therapy to a patient; and

modifying the therapy according to a modification profile in response to a posture state transition of the patient, wherein the modification profile varies according to a type of the posture state transition.

50. A therapy system comprising:

means for delivering therapy to a patient; and

means for modifying the therapy according to a modification profile in response to a posture state transition of the patient, wherein the modification profile varies according to a type of the posture state transition.

51. A method comprising:

delivering therapy to a patient from a medical device;

detecting a posture state transition of the patient;

selecting a modification profile based on the posture state transition; and

modifying the therapy according to the modification profile based on the detection of the posture state transition.

52. The method of claim 51, wherein the therapy includes electrical stimulation therapy, and wherein modifying the therapy includes adjusting at least one stimulation parameter value.

53. The method of claim 52, wherein the modification profile defines a rate of change for the adjustment of the stimulation parameter value.

54. The method of claim 53, wherein the modification profile for a first posture state transition from an upright posture state to an upright and active posture state defines a first rate of a change, and the modification profile for a second posture state transition from the upright posture state to a lying down posture state defines a second rate of a change, and wherein the first rate of change is less than the second rate of change.

55. The method of claim 54, wherein the second rate of change defines a substantially immediate change in the stimulation parameter value from a first value associated with the upright posture state to a second value associated with the lying down posture state.

56. The method of claim 52, wherein the modification profile for a first posture state transition defines a first rate of change and a second rate of change for the adjustment to the stimulation parameter.

57. The method of claim 56, wherein the first rate of change defines a first change in the stimulation parameter value from a first value associated with a first posture state to an intermediate value, and the second rate of change defines a second change in the stimulation parameter value from the intermediate value to a second value associated with a second posture state.

58. The method of claim 57, wherein the first rate of change in the stimulation parameter value from the first value to the intermediate value is substantially immediate.

59. The method of claim 57, wherein the intermediate value is less than the first value and the second value.

60. The method of claim 57, wherein the intermediate value is associated with an unstable posture state and the second posture state is a stable posture state.

61. The method of claim 51, wherein the posture state transition is detected via at least one accelerometer.

62. The method of claim 51, wherein the therapy is modified according to a first modification profile for a first type posture state transition and according to a second modification profile for a second type posture state transition.

63. The method of claim 62, wherein the first type posture state transition is defined by transition from a first posture state to a second posture state and the second type posture state transition is defined by transition from the second posture state to the first posture state.

64. The method of claim 63, wherein the first posture state comprises a lying down posture state and the second posture state comprises an upright posture state.

65. The method of claim 51, wherein modifying the therapy includes adjusting at least one therapy parameter value, and wherein the modification profile for the posture state transition defines a rate of change for the adjustment to the therapy parameter value, the method further comprising:

adjusting the therapy parameter value according to the first rate of change during a transition time period in response to the detection of the posture state transition; and

receiving an indication from a user during the transition time period, wherein the modification profile is changed to define a second 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.

66. The method of claim 51, wherein modifying the therapy comprises adjusting at least one therapy parameter value, wherein the adjustment to the at least one therapy parameter value commences after expiration of a dwell time period following the posture state transition defined by the modification profile.

67. The method of claim 66, further comprising:

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

adjusting the dwell time period such that the dwell time period expires substantially immediately after receiving the indication from the user.

68. The method of claim 51, wherein detecting the posture state transition comprises detecting a transition from a first posture state to a second posture state, and wherein selecting the modification profile based on the posture state transition comprises selecting the modification profile based on at least one of the first posture state or the second posture state.

69. The method of claim 68, wherein selecting the modification profile based on the posture state transition comprises selecting the modification profile based on only one of the first posture state or the second posture state.

70. The method of claim 51, wherein the modification profile defines a dwell time and a rate of change for the therapy modification.

71. The method of claim 70, wherein the modification profile for a first posture state transition defines a first dwell time and the modification profile for a second posture state transition defines a second dwell time.

72. The method of claim 71, wherein the rate of change for the modification profile for the first posture state transition is substantially the same as the rate of change for the modification profile for the second posture state transition.