Collecting gait information for evaluation and control of therapy

• US 8,744,587 B2
• Filed: 03/26/2007
• Issued: 06/03/2014
• Est. Priority Date: 03/24/2006
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Miesel, Keith A., Heruth, Kenneth T., Molnar, Gregory F.
• Primary Examiner(s): Heller, Tammie K
• Application Number:
  US11/691,423
• Publication Number:
  US 20070250134A1
• Time in Patent Office: 2,626 Days
• Field of Search: 607/48, 607/49, 600/595
• US Class Current: 607/48
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• CPC Class Codes: A61B 5/0022 Monitoring a patient using a global network, e.g. telephone networks, internet
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/031 Intracranial pressure
• CPC Class Codes: A61B 5/1038 Measuring plantar pressure during gait
• CPC Class Codes: A61B 5/112 Gait analysis
• CPC Class Codes: A61B 5/1123 Discriminating type of movement, e.g. walking or running A61B5/1116, A61B5/112 take precedence
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/4082 Diagnosing or monitoring movement diseases, e.g. Parkinson, Huntington or Tourette
• CPC Class Codes: A61B 5/4094 Diagnosing or monitoring seizure diseases, e.g. epilepsy
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/7246 using correlation, e.g. template matching or determination of similarity
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61B 5/7282 Event detection, e.g. detecting unique waveforms indicative of a medical condition A61B5/4094, A61B5/4818, A61B5/349, A61B5/0823 take precedence
• CPC Class Codes: A61B 5/7405 using sound
• CPC Class Codes: A61B 5/742 using visual displays A61B5/339 takes precedence
• CPC Class Codes: A61B 5/7455 characterised by tactile indication, e.g. vibration or electrical stimulation
• CPC Class Codes: A61M 5/1723 using feedback of body parameters, e.g. blood-sugar, pressure measurement of body parameters A61B5/00
• CPC Class Codes: A61N 1/36003 of motor muscles, e.g. for walking assistance
• CPC Class Codes: A61N 1/36067 Movement disorders, e.g. tremor or Parkinson disease stimulating motor muscle A61N1/36003
• CPC Class Codes: A61N 1/36082 : Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease
• CPC Class Codes: A61N 1/3615 : Intensity
• CPC Class Codes: G16Z 99/00 : Subject matter not provided for in other main groups of this subclass

Abstract

A medical device delivers a therapy to a patient. The medical device or another device may periodically determine an activity level or gait parameter of the patient, and associate each determined level or parameter with a current therapy parameter set. A value of at least one activity metric is determined for each of a plurality of therapy parameter sets based on the activity levels or parameters associated with that therapy parameter set. Whether the patient is currently experiencing or anticipated to experience gait freeze caused by their neurological disorder, such as Parkinson'"'"'s disease, may also be determined. Gait freeze events may be associated with current therapy parameters and used to determine activity metric values. In some examples, the activity metric associated with certain therapy parameters may be presented to a user.

Claims

1. A method comprising:

delivering to a patient, from an implantable medical device, at least one of a movement disorder therapy, Parkinson'"'"'s disease therapy, epilepsy therapy, tremor therapy, or deep brain stimulation;

monitoring gait of the patient based on a signal generated by an implantable sensor that varies as a function of patient activity; and

detecting a gait freeze event based on the signal.

2. The method of claim 1, further comprising, for each of a plurality of therapy parameter sets used by the implantable medical device to control delivery of the therapy to the patient, determining a value of at least one metric based on the gait of the patient during delivery of the therapy by the implantable medical device according to the therapy parameter set.

3. The method of claim 2, further comprising:

periodically determining a value of a gait parameter based on the signal; and

associating each of the gait parameter values with a therapy parameter set currently used by the medical device to deliver the therapy to the patient when the gait parameter value was determined,

wherein determining a value of at least one metric for each of the plurality of therapy parameter sets comprises determining the value of the metric based on gait parameter values associated with the therapy parameter sets.

4. The method of claim 3, wherein determining a value of a gait parameter comprises determining at least one of a gait asymmetry value, a gait arrhythmicity value, a gait variability value, or a stride length.

5. The method of claim 2, further comprising:

detecting a plurality of gait freeze events based on the signal; and

associating each of the gait freeze events with a therapy parameter set currently used by the medical device to deliver the therapy to the patient when the gait freeze event was detected,

wherein determining a value of at least one metric for each of the plurality of therapy parameter sets comprises determining the value of the metric based on the gait freeze events associated with the therapy parameter sets.

6. The method of claim 5, wherein the signal varies as a function of posture, and detecting a plurality of gait freeze events based on the signal comprises detecting both a substantial cessation of activity and rhythmic posture variations in a standing posture.

7. The method of claim 5, wherein detecting a plurality of gait freeze events comprises detecting at least some of the gait freeze events prior to occurrence.

8. The method of claim 5, further comprising:

analyzing the metric to determine a therapy parameter set that terminates gait freeze events; and

providing the therapy to the patient via the medical device according to the determined therapy parameter set.

9. The method of claim 2, further comprising displaying a list of the plurality of therapy parameter sets in conjunction with the metric values for the therapy parameter sets.

10. The method of claim 1, further comprising providing stimulation therapy to the patient from the medical device via an attached lead in response to the gait freeze event to terminate the gait freeze event.

11. The method of claim 1, further comprising providing a gait cue to the patient from at least one of the medical device and a programming device that communicates with the medical device in response to the gait freeze event to terminate the gait freeze event.

12. A system comprising:

an implantable medical device that delivers at least one of a movement disorder therapy, Parkinson'"'"'s disease therapy, epilepsy therapy, tremor therapy, or deep brain stimulation to a patient;

an implanted sensor that generates a signal that varies as a function of activity of the patient; and

a processor that monitors gait of the patient based on the signal, and detects a gait freeze event based on the signal.

13. The system of claim 12, wherein the processor, for each of a plurality of therapy parameter sets used by the implantable medical device to control delivery of the therapy to the patient, determines a value of at least one metric based on the gait of the patient during delivery of the therapy by the implantable medical device according to the therapy parameter set.

14. The system of claim 13, wherein the processor:

periodically determines a value of a gait parameter based on the signal;

associates each of the gait parameter values with a therapy parameter set currently used by the medical device to deliver the therapy to the patient when the gait parameter value was determined; and

determines the value of the metric based on gait parameter values associated with the therapy parameter sets.

15. The system of claim 13, wherein the processor:

detects a plurality of gait freeze events based on the signal;

associates each of the gait freeze events with a therapy parameter set currently used by the medical device to deliver the therapy to the patient when the gait freeze event was detected; and

determines the value of the metric based on the gait freeze events associated with the therapy parameter sets.

16. The system of claim 15, wherein the processor:

analyzes the metric to determine a therapy parameter set that terminates gait freeze events; and

directs the medical device to provide the therapy to the patient according to the determined therapy parameter set.

17. The system of claim 15, wherein the processor controls the medical device to provide stimulation therapy to the patient via an attached lead in response to the gait freeze event to terminate the gait freeze event.

18. The system of claim 15, wherein the processor controls the medical device to provide a gait cue to the patient in response to the gait freeze event to terminate the gait freeze event.

19. The system of claim 15, further comprising a programming device that communicates with the medical device and provides a gait cue to the patient in response to the gait freeze event to terminate the gait freeze event.

20. The system of claim 13, further comprising a user interface that displays a list of the plurality of therapy parameter sets in conjunction with the metric values for the therapy parameter sets.

21. The system of claim 12, wherein the processor comprises a processor of the medical device.

22. A computer-readable storage medium comprising instructions that cause a processor to:

deliver therapy from an implantable medical device to a patient;

monitor gait of the patient based on a signal generated by an implantable sensor that varies as a function of patient activity; and

detect a gait freeze event based on the signal,

wherein the therapy comprises at least one of a movement disorder therapy, Parkinson'"'"'s disease therapy, epilepsy therapy, tremor therapy, or deep brain stimulation.

23. The computer-readable storage medium of claim 22, further comprising instructions that cause a processor to, for each of a plurality of therapy parameter sets used by the implantable medical device to deliver therapy to the patient, determine a value of at least one metric based on the gait of the patient during delivery of the therapy by the implantable medical device according to the therapy parameter set.

24. The computer-readable storage medium of claim 23, further comprising instructions that cause a processor to:

periodically determine a value of a gait parameter based on the signal; and

associate each of the gait parameter values with a therapy parameter set currently used by the medical device to deliver the therapy to the patient when the gait parameter value was determined,

wherein the instructions that cause a processor to determine a value of at least one metric for each of the plurality of therapy parameter sets comprise instructions that cause a processor to determine the value of the metric based on gait parameter values associated with the therapy parameter sets.

25. The computer-readable storage medium of claim 23, further comprising instructions that cause a processor to:

detect a plurality of gait freeze events based on the signal; and

associate each of the gait freeze events with a therapy parameter set currently used by the medical device to deliver the therapy to the patient when the gait freeze event was detected,

wherein the instructions that cause a processor to determine a value of at least one metric for each of the plurality of therapy parameter sets comprise instructions that cause a processor to determine the value of the metric based on the gait freeze events associated with the therapy parameter sets.

26. The computer-readable storage medium of claim 22, further comprising instructions that cause a processor to control delivery of a gait cue to the patient by at least one of the medical device or a programming device that communicates with the medical device in response to the gait freeze event to terminate the gait freeze event.