Programming posture responsive therapy

• US 9,919,159 B2
• Filed: 09/07/2016
• Issued: 03/20/2018
• Est. Priority Date: 07/11/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Skelton, Dennis M., Davis, Jon P., Sahasrabudhe, Rajeev M., Gokaldas, Shyam, Nolan, Joseph J., Bourget, Dennis J., Bourget, Duane L., Miesel, Keith A., Zimmerman, James
• Primary Examiner(s): Porter, Jr., Allen
• Application Number:
  US15/258,756
• Publication Number:
  US 20160375259A1
• Time in Patent Office: 559 Days
• Field of Search: 607 59, 607 62
• 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

A programming session for an implantable medical device that includes a posture responsive therapy mode includes at least two phases. In a first phase, a first set of therapy parameter values are modified while the posture responsive therapy mode is deactivated. In the posture responsive therapy mode, the medical device automatically selects one or more therapy parameter values that define therapy delivered to a patient based on a detected posture state. In a second phase, the posture responsive therapy mode is activated and a second set of therapy parameter values are adjusted after observing a patient response to the posture responsive therapy delivered with the first set of therapy parameter values selected during the first phase. The second set of therapy parameter values may, for example, define the patient posture states or the modification profiles with which the medical device adjusts therapy upon detecting a posture state transition.

Claims

1. A method comprising:

controlling the delivery of electrical neurostimulation therapy to a patient from a medical device according to a posture state of the patient;

detecting a first posture state transition of the patient;

modifying, based on the detection of the first posture state transition, the electrical neurostimulation therapy according to a first modification profile defined for the first posture state transition, wherein the first modification profile defines a first rate of change for an adjustment of at least one parameter of the therapy delivered to the patient;

detecting, subsequently, a second posture state transition of the patient; and

modifying, based on the detection of the second posture state transition, the electrical neurostimulation therapy according to a second modification profile defined for the second posture state transition, wherein the second modification profile defines a second rate of change for an adjustment of the at least one parameter of the electrical neurostimulation therapy delivered to the patient that is different than the first rate of change defined by the first modification profile, and

wherein at least one of the controlling, detecting, determining, and modifying are performed via one or more processors.

2. The method of claim 1, wherein the at least one parameter of the electrical neurostimulation therapy comprises an amplitude of the electrical neurostimulation therapy.

3. The method of claim 2, wherein the amplitude of the electrical neurostimulation therapy comprises one of a voltage amplitude value or current amplitude value of the electrical neurostimulation therapy.

4. The method of claim 1, wherein the first posture state transition comprises a transition from an upright posture state to an upright and active posture state, and the second posture state transition comprises a transition from the upright posture state to a lying down posture state, 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 at least one parameter 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 1, wherein the first rate of change includes a third rate of change and a fourth rate of change for the adjustment to the at least one stimulation parameter value.

7. The method of claim 6, wherein the third rate of change defines a first change in the at least one stimulation parameter value from a first value associated with a first posture state to an intermediate value, and the fourth rate of change defines a second change in the at least one 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 third rate of change in the at least one 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 1, wherein the first posture state transition comprises a transition from an upright posture state to a lying down posture state, and the second posture state transition comprises a transition from the lying down posture state to the upright posture state, wherein the first rate of change is greater than the second rate of change.

11. The method of claim 1, wherein the electrical neurostimulation therapy comprises spinal cord stimulation therapy.

12. A therapy system comprising:

a therapy delivery module configured to deliver electrical neurostimulation therapy to a patient from a medical device; and

at least one processor configured to control the delivery of the electrical neurostimulation therapy to the patient from the medical device according to a posture state of the patient, detect a first posture state transition of the patient, modify, based on the detection of the first posture state transition, the therapy according to a first modification profile defined for the first posture state transition, wherein the first modification profile defines a first rate of change for an adjustment of at least one parameter of the electrical neurostimulation therapy delivered to the patient, detect, subsequently, a second posture state transition of the patient, and modify, based on the detection of the second posture state transition, the electrical neurostimulation therapy according to a second modification profile defined for the second posture state transition, wherein the second modification profile defines a second rate of change for an adjustment of the at least one parameter of the electrical neurostimulation therapy delivered to the patient that is different than the first rate of change defined by the first modification profile.

13. The therapy system of claim 12, wherein the at least one parameter of the electrical neurostimulation therapy comprises an amplitude of the electrical neurostimulation therapy.

14. The therapy system of claim 13, wherein the amplitude of the electrical neurostimulation therapy comprises one of a voltage amplitude value or current amplitude value of the electrical neurostimulation therapy.

15. The therapy system of claim 12, wherein the first posture state transition comprises a transition from an upright posture state to an upright and active posture state, and the second posture state transition comprises a transition from the upright posture state to a lying down posture state, and wherein the first rate of change is less than the second rate of change.

16. The therapy system of claim 15, wherein the second rate of change defines a substantially immediate change in the at least one parameter from a first value associated with the upright posture state to a second value associated with the lying down posture state.

17. The therapy system of claim 12, wherein the first rate of change includes a third rate of change and a fourth rate of change for the adjustment to the at least one stimulation parameter value.

18. The therapy system of claim 17, wherein the third rate of change defines a first change in the at least one stimulation parameter value from a first value associated with a first posture state to an intermediate value, and the fourth rate of change defines a second change in the at least one stimulation parameter value from the intermediate value to a second value associated with a second posture state.

19. The therapy system of claim 18, wherein the third rate of change in the at least one stimulation parameter value from the first value to the intermediate value is substantially immediate.

20. The therapy system of claim 18, wherein the intermediate value is less than the first value and the second value.

21. The therapy system of claim 12, wherein the first posture state transition comprises a transition from an upright posture state to a lying down posture state, and the second posture state transition comprises a transition from the lying down posture state to the upright posture state, wherein the first rate of change is greater than the second rate of change.

22. The therapy system of claim 12, wherein the electrical neurostimulation therapy comprises spinal cord stimulation therapy.