Systems, methods and devices for paired plasticity

• US 9,089,707 B2
• Filed: 06/15/2009
• Issued: 07/28/2015
• Est. Priority Date: 07/02/2008
• Status: Active Grant

• Current Assignee: Board of Regents of the University of Texas System (University of Texas System)
• Original Assignee: Board of Regents of the University of Texas System (University of Texas System)
• Inventors: Cauller, Lawrence James, Engineer, Navzer, McIntyre, Christa, Rosellini, Will, Kilgard, Michael P
• Primary Examiner(s): Kahelin, Michael
• Assistant Examiner(s): FAIRCHILD, MALLIKA DIPAYAN
• Application Number:
  US12/485,040
• Publication Number:
  US 20100003656A1
• Time in Patent Office: 2,234 Days
• Field of Search: 607 1- 3, 607/45
• US Class Current: 1/1
• CPC Class Codes: A61F 11/00 Methods or devices for treatment of the ears or hearing sense implantable prostheses that substitute or replace internal ear parts, e.g. ear-drums, A61F2/18; methods or devices to cause a change in the state of auditory consciousness A61M21/00; electrotherapy applying electrical stimulation of the auditory system, or circuits therefor A61N1/36; radiotherapy using optical stimulation of the auditory system A61N5/06; electro-acoustic hearing aids H04R25/00; Non-electric hearing aids; Methods or devices for enabling ear patients to achieve auditory perception through physiological senses other than hearing sense; Protective devices for the ears, carried on the body or in the hand headwear, e.g. caps or helmets, with means for protecting the ears A42B1/0188, A42B3/16
• CPC Class Codes: A61M 2021/0016 by the smell sense
• CPC Class Codes: A61M 2021/0022 by the tactile sense, e.g. vibrations
• CPC Class Codes: A61M 2021/0027 by the hearing sense
• CPC Class Codes: A61M 2021/0044 by the sight sense
• CPC Class Codes: A61M 2021/0072 with application of electrical currents
• CPC Class Codes: A61M 2021/0077 with application of chemical or pharmacological stimulus
• CPC Class Codes: A61M 21/00 Other devices or methods to cause a change in the state of consciousness; Devices for producing or ending sleep by mechanical, optical, or acoustical means, e.g. for hypnosis
• CPC Class Codes: A61M 21/02 for inducing sleep or relaxation, e.g. by direct nerve stimulation, hypnosis, analgesia for massage A61H; electrotherapy A61N, e.g. applying alternating or intermittent electric currents for producing anaesthesia A61N1/36021
• CPC Class Codes: A61M 2205/3515 using magnetic means
• CPC Class Codes: A61M 2230/06 Heartbeat rate only
• CPC Class Codes: A61M 2230/08 Other bio-electrical signals
• CPC Class Codes: A61M 2230/10 Electroencephalographic signals
• CPC Class Codes: A61M 2230/205 partial oxygen pressure (P-O2)
• CPC Class Codes: A61M 2230/30 Blood pressure A61M2230/04 takes precedence
• CPC Class Codes: A61M 2230/432 partial CO2 pressure (P-CO2)
• CPC Class Codes: A61M 2230/50 Temperature
• CPC Class Codes: A61M 2230/60 Muscle strain, i.e. measured on the user
• CPC Class Codes: A61M 2230/65 Impedance, e.g. conductivity, capacity
• CPC Class Codes: A61N 1/36034 specified by the stimulation parameters
• CPC Class Codes: A61N 1/36053 : adapted for vagal stimulation A61N1/36114 takes precedence
• 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 1/36092 : Mental training
• CPC Class Codes: A61N 1/361 : Phantom sensations, e.g. tinnitus
• CPC Class Codes: A61N 1/36103 : Neuro-rehabilitation; Repair or reorganisation of neural tissue, e.g. after stroke
• CPC Class Codes: A61N 1/36139 : with automatic adjustment
• CPC Class Codes: A61N 1/36167 : Timing, e.g. stimulation onset
• CPC Class Codes: A61N 5/0618 : Psychological treatment
• CPC Class Codes: A61N 5/0622 : Optical stimulation for exciting neural tissue
• CPC Class Codes: G09B 19/00 : Teaching not covered by other main groups of this subclass teaching or practice apparatus for gun-aiming or gun-laying F41G3/26
• CPC Class Codes: G09B 19/003 : Repetitive work cycles; Sequence of movements
• CPC Class Codes: G09B 23/28 : for medicine
• CPC Class Codes: H04R 25/75 : Electric tinnitus maskers providing an auditory perception

Abstract

Systems, methods and devices for paired training include timing controls so that training and neural stimulation can be provided simultaneously. Paired trainings may include therapies, rehabilitation and performance enhancement training. Stimulations of nerves such as the vagus nerve that affect subcortical regions such as the nucleus basalis, locus coeruleus or amygdala induce plasticity in the brain, enhancing the effects of a variety of therapies, such as those used to treat tinnitus, stroke, traumatic brain injury and post-traumatic stress disorder.

Claims

1. A method of training for treating a motor deficit resulting from stroke in a patient, comprising:

assessing a patient'"'"'s motor deficit caused by a stroke;

selecting a skilled motor task based on the patient'"'"'s motor deficit;

providing a repeated paired training therapy by repeatedly performing the selected skilled motor task, wherein each performance of the selected skilled motor task is paired with a vagus nerve stimulation pulse train by presenting the vagus nerve stimulation pulse train during the performance of the selected motor task, and not presenting a vagus nerve stimulation pulse train between performances of the selected skilled motor task, wherein the vagus nerve stimulation pulse train is generated by a subcutaneous device that provides electrical stimulation to the patient'"'"'s vagus nerve;

repeatedly performing the paired skilled motor task; and

reducing the patient'"'"'s motor deficit,

wherein the method further comprises the action of sensing respective beginnings of the performances of the selected skilled motor tasks, and applying the respective vagus nerve stimulation pulse trains based on the sensed beginnings of the performances, and wherein the paired vagus nerve stimulation pulse trains end before the end of the respective skilled motor tasks.

2. The method of claim 1, wherein the stroke is an ischemic stroke.

3. The method of claim 1, wherein the vagus nerve stimulation pulse train has a current amplitude of 0.8 milliamperes.

4. The method of claim 1, wherein the vagus nerve stimulation pulse train has a duration of 500 milliseconds.

5. The method of claim 1, wherein the paired skilled motor task is repeated at least 300 times.

6. The method of claim 1, wherein the vagus nerve stimulation pulse trains begin at the same time as the beginning of the respective skilled motor tasks.

7. The method claim 1, wherein the vagus nerve stimulation pulse trains begin after the beginning of the respective skilled motor tasks.

8. A method of training for treating a motor deficit resulting from an event experienced by a patient, comprising:

repeatedly performing a selected skilled motor task and sensing respective beginnings of the performances of the selected skilled motor task, wherein at least some of the repeated performances of the selected skilled motor task are accompanied by a simultaneous vagus nerve stimulation pulse train based on the sensed beginnings of the performances, wherein the accompanied vagus nerve stimulation pulse trains end before the end of the respective skilled motor tasks; and

wherein the vagus nerve stimulation pulse train is generated by a device that provides electrical stimulation to the patient'"'"'s vagus nerve; and

reducing the patient'"'"'s motor deficit due to the repeated performance of the selected skilled motor task in association with the respective vagus nerve stimulation.

9. The method of claim 8, wherein the event is a stroke.

10. The method of claim 8, wherein the vagus nerve stimulation pulse train has a current amplitude of 0.8 milliamperes.

11. The method of claim 8, wherein the vagus nerve stimulation pulse train has a duration of 500 milliseconds.

12. The method of claim 8, wherein the paired skilled motor task is repeated at least 300 times.

13. The method of claim 8, further comprising assessing a patient'"'"'s motor deficit caused by the event, and selecting the skilled motor task based on the patient'"'"'s motor deficit.

14. The method of claim 8, further comprising not presenting a vagus nerve stimulation pulse train between performances of the selected skilled motor task.

15. A method of training for treating a motor deficit resulting from an event experienced by a patient, comprising:

repeatedly performing a selected skilled motor task and sensing respective beginnings of the performances of the selected skilled motor task, wherein at least some of the repeated performances of the selected skilled motor task are paired with a vagus nerve stimulation pulse train based on the sensed beginnings of the performances, wherein the paired vagus nerve stimulation pulse trains end before the end of the respective skilled motor tasks; and

, wherein the vagus nerve stimulation pulse train is generated by a device that provides electrical stimulation to the patient'"'"'s vagus nerve

reducing the patient'"'"'s motor deficit due to the repeated performance of the selected skilled motor task in association with the respective vagus nerve stimulation.

16. The method of claim 15, wherein the vagus nerve stimulation pulse trains begin at the same time as the beginning of the respective skilled motor tasks.

17. The method of claim 15, wherein the vagus nerve stimulation pulse trains begin after the beginning of the respective skilled motor tasks.

18. The method of claim 15, wherein the applied respective vagus nerve stimulation pulse trains are applied simultaneously with the respective performances.

19. The method of claim 15, further comprising the action of automatically sensing respective beginnings of the performances of the selected skilled motor tasks.

20. The method of claim 15, further comprising not presenting a vagus nerve stimulation pulse train between performances of the selected skilled motor task.

21. A method of training for treating a motor deficit resulting from an event experienced by a patient, comprising:

repeatedly performing a selected skilled motor task and sensing respective beginnings of the performances of the selected skilled motor task, wherein all of the repeated performances of the selected skilled motor task are paired with a vagus nerve stimulation pulse train, wherein the paired vagus nerve stimulation pulse trains do not begin prior to the beginning of the skilled motor task and end before the end of the skilled motor task; and

wherein the vagus nerve stimulation pulse train is generated by a device that provides electrical stimulation to the patient'"'"'s vagus nerve; and

reducing the patient'"'"'s motor deficit due to the repeated performance of the selected skilled motor task in association with the respective vagus nerve stimulation.

22. The method of claim 21, further comprising not presenting a vagus nerve stimulation pulse train between performances of the selected skilled motor task.

23. The method of claim 21, wherein the vagus nerve stimulation pulse train end after the beginning of the pairing event.

24. The method of claim 21, wherein the vagus nerve stimulation pulse train begins after the end of the preliminary event.

25. A method of training for treating a motor deficit resulting from an event experienced by a patient, comprising:

assessing a patient'"'"'s motor deficit caused by the event;

selecting a skilled motor task based on the patient'"'"'s motor deficit;

repeatedly performing the selected skilled motor task and sensing respective beginnings of the performances of the selected skilled motor task, wherein the repeated performances of the selected skilled motor task is paired with a vagus nerve stimulation pulse train by presenting the vagus nerve stimulation pulse train during the performance of the selected motor task based on the sensed beginnings of the performances, wherein the paired vagus nerve stimulation pulse trains end before the end of the respective skilled motor tasks; and

wherein the vagus nerve stimulation pulse train is generated by a device that provides electrical stimulation to the patient'"'"'s vagus nerve; and

reducing the patient'"'"'s motor deficit due to the repeated performance of the selected skilled motor task paired with the vagus nerve stimulation.

26. The method of claim 25, wherein the vagus nerve stimulation pulse trains begin at the same time as the beginning of the respective skilled motor tasks.

27. The method of claim 25, wherein the vagus nerve stimulation pulse trains begin after the beginning of the respective skilled motor tasks.

28. The method of claim 25, further comprising the action of sensing respective beginnings of the performances of the selected skilled motor tasks, and applying the respective vagus nerve stimulation pulse trains after the beginnings of the performances based on the sensed beginnings of the performances.

29. The method of claim 28, wherein the applied respective vagus nerve stimulation pulse trains are applied simultaneously with the respective performances.

30. The method of claim 25, wherein the applied respective vagus nerve stimulation pulse trains are applied simultaneously with the respective performances.

31. The method of claim 25, further comprising the action of automatically sensing respective performances of the selected skilled motor tasks.

32. The method of claim 25, further comprising not presenting a vagus nerve stimulation pulse train between performances of the selected skilled motor task.