Neurostimulation responsive to posture
An implantable device is configured to control application of a neural stimulus as defined by a stimulus parameter; measure via the measurement circuitry a characteristic of a neural compound action potential response evoked by the stimulus; and compute, using the stimulus parameter and the measured characteristic of the evoked neural compound action potential response, a characteristic of an evoked response that would be obtained from the neural stimulus if the patient were in a reference posture. A posture of the patient can be estimated from the computed characteristic and/or the computed characteristic can be used as a feedback variable of a feedback loop. Multidimensional histograms of datasets comprising at least one of the stimulus parameter and a feedback variable can be stored.
1 . An implantable device for controllably applying a neural stimulus, the device comprising:
a plurality of electrodes including one or more stimulus electrodes and one or more sense electrodes;
a stimulus source for providing a stimulus to be delivered from the one or more stimulus electrodes to a neural pathway of a patient in order to give rise to an evoked action potential on the neural pathway;
measurement circuitry for recording a neural compound action potential signal sensed at the one or more sense electrodes; and
a control unit configured to:
control application of a neural stimulus as defined by a stimulus parameter;
measure via the measurement circuitry a characteristic of a neural compound action potential response evoked by the stimulus;
compute, using the stimulus parameter and the measured characteristic of the evoked neural compound action potential response, a characteristic of an evoked response that would be obtained from the neural stimulus if the patient were in a reference posture; and
estimate a posture of the patient from the computed characteristic.
2 . The implantable device of claim 1 , wherein the estimate of posture comprises a ratio of a measured amplitude of the neural compound action potential response to the computed characteristic, the computed characteristic comprising an amplitude of an evoked response that would be obtained from the neural stimulus if the patient were in the reference posture.
3 . The implantable device of claim 1 , wherein the control unit is further configured to:
implement, using the computed characteristic as a feedback variable, a feedback controller which completes a feedback loop, the feedback controller configured to control the stimulus parameter so as to maintain the feedback variable at a setpoint.
4 . The implantable device of claim 3 , wherein the feedback controller is configured to use the estimate of posture to control the stimulus parameter.
5 . The implantable device of claim 3 , wherein the feedback controller is configured to use the estimate of posture to estimate a distance between the electrodes and the neural pathway.
6 . The implantable device of claim 5 , wherein the feedback controller is configured to estimate the distance by scaling the estimate of posture by the distance between the electrodes and the neural pathway in the reference posture.
7 . The implantable device of claim 1 , wherein the control unit is further configured to:
implement, using the measured characteristic as a feedback variable, a feedback controller which completes a feedback loop, the feedback controller configured to control the stimulus parameter so as to maintain the feedback variable at a setpoint.
8 . The implantable device of claim 1 , wherein the control unit is further configured to determine a variation in recruitment across postures from the posture estimate.
9 . The implantable device of claim 1 , wherein computing the characteristic comprises solving C=({circumflex over (V)}/M 0 +T 0 ) k {circumflex over (V)} for {circumflex over (V)}, where {circumflex over (V)} is the computed characteristic and comprises a computed amplitude, C=I k V, I is the stimulus parameter, Vis the measured characteristic of the evoked neural compound action potential response, and M 0 and T 0 are parameters of a growth curve of the patient in the reference posture.
10 . An automated method of controlling a neural stimulus, the method comprising:
applying the neural stimulus to a neural pathway of a patient in order to give rise to an evoked action potential on the neural pathway, the stimulus being defined by a stimulus parameter;
measuring a characteristic of a neural compound action potential response evoked by the stimulus;
computing, using the stimulus parameter and the measured characteristic of the evoked neural compound action potential response, a characteristic of an evoked response that would be obtained from the neural stimulus if the patient were in a reference posture; and
estimating a posture of the patient from the computed characteristic.
11 . The method of claim 10 , wherein the estimate of posture comprises a ratio of a measured amplitude of the neural compound action potential response to the computed characteristic, the computed characteristic comprising an amplitude of an evoked response that would be obtained from the neural stimulus if the patient were in the reference posture.
12 . The method of claim 10 , further comprising:
implementing, using the computed characteristic as a feedback variable, a feedback controller which completes a feedback loop, the feedback controller configured to control the stimulus parameter so as to maintain the feedback variable at a setpoint.
13 . The method of claim 12 , further comprising using, by the feedback controller, the estimate of posture to control the stimulus parameter.
14 . The method of claim 10 , further comprising:
implementing, using the measured characteristic as a feedback variable, a feedback controller which completes a feedback loop, the feedback controller configured to control the stimulus parameter so as to maintain the feedback variable at a setpoint.
15 . The method of claim 10 , further comprising determining a variation in recruitment across postures from the posture estimate.
16 . The method of claim 10 , wherein computing the characteristic comprises solving C=({circumflex over (V)}/M 0 +T 0 ) k I for {circumflex over (V)}, where {circumflex over (V)} is the computed characteristic and comprises a computed amplitude, C=I k V, I is the stimulus parameter, V is the measured characteristic of the evoked neural compound action potential response, and M 0 and T 0 are parameters of a growth curve of the patient in the reference posture.