Method and apparatus for application of a neural stimulus
A method of applying a neural stimulus with an implanted electrode array involves applying a sequence of stimuli configured to yield a therapeutic effect while suppressing psychophysical side effects. The stimuli sequence is configured such that a first stimulus recruits a portion of the fibre population, and a second stimulus is delivered within the refractory period following the first stimulus and the second stimulus being configured to recruit a further portion of the fibre population. Using an electrode array and suitable relative timing of the stimuli, ascending or descending volleys of evoked responses can be selectively synchronised or desynchronised to give directional control over responses evoked.
1. A neuromodulation system comprising:
an implantable device for suppressing pain by applying a neural stimulus, the implantable device comprising:
a plurality of electrodes including at least one stimulus electrode and at least one sense electrode;
a stimulus source for providing stimuli to be delivered from the at least one stimulus electrode to an electrically excitable tissue in a dorsal column of a patient;
measurement circuitry for measuring a neural response sensed at the at least one sense electrode and evoked in response to a stimulus; and
an accelerometer configured to measure one or more of orientation and movement of the implantable device; and
a processor configured to:
receive, from the implantable device, the measured neural response and one or more of the measured orientation and the measured movement; and
adjust programming parameters of the implantable device based on the measured neural response and one or more of the measured orientation and the measured movement,
wherein the adjusted programming parameters configure the implantable device to apply therapeutic stimuli to the patient.
2. The neuromodulation system of claim 1 , wherein the implantable device further comprises a control unit configured to control the stimulus source to provide the therapeutic stimuli according to the programming parameters.
3. The neuromodulation system of claim 2 , wherein controlling the stimulus source according to the programming parameters comprises:
altering a parameter of the therapeutic stimuli based on the measured neural response and the one or more of the measured orientation and the measured movement, according to the programming parameters; and
controlling the stimulus source to provide the therapeutic stimuli according to the programming parameters.
4. The neuromodulation system of claim 1 , wherein the processor is configured to adjust the programming parameters of the implantable device by:
measuring a posture of the patient using the measure of orientation from the accelerometer;
adjusting a parameter of the stimuli based on the measured neural response; and
recording the adjusted parameter in association with the measured posture.
5. The neuromodulation system of claim 4 , wherein the processor is configured to record the adjusted parameter in association with the measured posture in a table of program parameters versus posture parameters.
6. The neuromodulation system of claim 4 , wherein the adjusting the parameter of the stimuli is carried out by a control unit of the implantable device according to a feedback loop.
7. The neuromodulation system of claim 6 , wherein the feedback loop comprises:
controlling the stimulus source to provide the stimuli;
measuring the neural response to the stimuli;
comparing the measured neural response and a previously measured neural response;
altering the parameter of the stimuli based on the comparing; and
iteratively performing the controlling, measuring, comparing, and altering to bring the measured neural response equal to the previously measured neural response.
8. The neuromodulation system of claim 7 , wherein the altering takes into account the measured posture.
9. The neuromodulation system of claim 7 , wherein the previously measured neural response is a neural response measured under an initially programmed set of conditions.
10. The neuromodulation system of claim 1 , wherein the processor is part of an external computing device in communication with the implantable device.
11. The neuromodulation system of claim 1 , wherein the programming forms part of an automated device fitting procedure for the implantable device.
12. The neuromodulation system of claim 1 , wherein the accelerometer is configured to measure at least orientation of the implantable device.
13. The neuromodulation system of claim 1 , wherein the accelerometer is configured to measure at least movement of the implantable device.