Adaptation of neurostimulation therapy to age-related physiological changes
Disclosed is a method of adapting the operation of an implantable device for delivering neurostimulation therapy to a patient. The method comprises: delivering the neurostimulation therapy to electrically excitable tissue of the patient according to at least one therapy parameter; measuring a physiological characteristic of the patient; adjusting the at least one therapy parameter according to a schedule of adjustment and the measured physiological characteristic; and repeating the delivering, measuring, and adjusting.
1. A method of adapting the operation of an implantable device for delivering neurostimulation therapy to a patient, the method comprising:
delivering the neurostimulation therapy to electrically excitable tissue of the patient according to at least one therapy parameter;
measuring a physiological characteristic of the patient;
adjusting the at least one therapy parameter according to a schedule of adjustment and the measured physiological characteristic; and
repeating the delivering, measuring, and adjusting;
wherein the adjusting the at least one therapy parameter comprises determining whether the measured physiological characteristic indicates physical ageing of the patient at a rate different from an expected rate, and adjusting the at least one therapy parameter according to the schedule of adjustments if the measured physiological characteristic does not indicate physical ageing of the patient at a rate different from the expected rate.
2. The method of claim 1 wherein the schedule of adjustment is a predefined schedule stored in the device.
3. The method of claim 1 wherein the schedule of adjustment is altered based on the measured physiological characteristic.
4. The method of claim 3 wherein, if the measured physiological characteristic indicates physical ageing of the patient at a rate different from an expected rate, a commensurate alteration to the schedule is made.
5. The method of claim 4 wherein checks for possible alterations to the schedule are made on a predetermined schedule.
6. The method of claim 4 wherein checks for possible alterations to the schedule are triggered by a clinical reprogramming session.
7. The method of claim 1 wherein the measured physiological characteristic comprises one or more of: the patient's ECAP threshold measured in a reference posture; the patient's sensitivity to the neurostimulation therapy in a reference posture; the patient's ECAP conduction velocity; the patient's ECAP dispersion; the patient's maximum tolerable stimulus intensity in a reference posture; the patient's therapeutic window in a reference posture; the patient's ECAP latency; the patient's activation plot variation with posture; the patient's daily activity; a reaction time of the patient; a measurement of grip strength of the patient; a measurement of maximum heart rate of the patient during activity; and a measurement of forced expiratory volume of the patient.
8. The method of claim 1 wherein the neurostimulation therapy is delivered in a dosed loop manner, in which measurements are obtained of the electrical excitation effected by the neurostimulation, and the measurements are used in a feedback loop to control subsequent neurostimulation.
9. The method of claim 8 wherein the schedule provides for the at least one therapy parameter to be one or more of: ECAP detector parameters; charge delivered per stimulus pulse; Stimulus frequency; ECAP target value; Feedback controller gain; and maximum stimulus intensity.
10. The method of claim 1 wherein the neurostimulation therapy is delivered in an open loop manner.
11. The method of claim 10 wherein the schedule of adjustment provides for the at least one therapy parameter to be adjusted in a gradual manner corresponding to patient aging.
12. An implantable device for delivering neurostimulation therapy to a patient, the device comprising:
an electrode array comprising a plurality of electrodes;
a pulse generator connectable to the electrode array, the pulse generator configured to generate a stimulus pulse via the stimulus electrodes to electrically excitable tissue of the patient; and
a controller configured to:
control the pulse generator to generate the stimulus pulse according to at least one therapy parameter;
measure a physiological characteristic of the patient;
adjust the at least one therapy parameter according to a schedule of adjustment and the measured physiological characteristic; and
repeat the generate, measure, and adjust;
wherein the controller is further configured to adjust the at least one therapy parameter by determining whether the measured physiological characteristic indicates physical ageing of the patient at a rate different from an expected rate, and adjusting the at least one therapy parameter according to the schedule of adjustments if the measured physiological characteristic does not indicate physical ageing of the patient at a rate different from the expected rate.
13. The implantable device of claim 12 wherein the schedule of adjustment is a predefined schedule stored in the device.
14. The implantable device of claim 12 wherein the controller is further configured to alter the schedule of adjustment based on the measured physiological characteristic.
15. The implantable device of claim 14 wherein the controller is further configured to determine if the measured physiological characteristic indicates physical ageing of the patient at a rate different from an expected rate, and if so to make a commensurate alteration to the schedule.
16. The implantable device of claim 15 wherein the controller is further configured to make checks for possible alterations to the schedule on a predetermined schedule.
17. The implantable device of claim 12 wherein the measured physiological characteristic comprises one or more of: the patient's ECAP threshold measured in a reference posture; the patient's sensitivity to the neurostimulation therapy in a reference posture; the patient's ECAP conduction velocity; the patient's ECAP dispersion; the patient's maximum tolerable stimulus intensity in a reference posture; the patient's therapeutic window in a reference posture; the patient's ECAP latency; the patient's activation plot variation with posture; the patient's daily activity; a reaction time of the patient; a measurement of grip strength of the patient; a measurement of maximum heart rate of the patient during activity; and a measurement of forced expiratory volume of the patient.
18. The implantable device of claim 12 , wherein the controller is further configured to deliver neurostimulation therapy in a closed loop manner, by obtaining measurements of the electrical excitation effected by the neurostimulation, and using the measurements in a feedback loop to control subsequent neurostimulation.
19. The implantable device of claim 18 wherein the schedule provides for the at least one therapy parameter to be one or more of: ECAP detector parameters; charge delivered per stimulus pulse; Stimulus frequency; ECAP target value; Feedback controller gain; and maximum stimulus intensity.
20. The implantable device of claim 12 wherein the controller is further configured to deliver the neurostimulation therapy in an open loop manner.
21. The implantable device of claim 20 wherein the schedule of adjustment provides for the at least one therapy parameter to be adjusted in a gradual manner corresponding to patient aging.