This application relates to Implantable Medical Devices (IMDs), generally, and more specifically to implantable neurostimulator devices having implantable pulse generators (IPGs).
Implantable stimulation devices are devices that generate and deliver electrical stimuli to body nerves and tissues for the therapy of various biological disorders, such as pacemakers to treat cardiac arrhythmia, defibrillators to treat cardiac fibrillation, cochlear stimulators to treat deafness, retinal stimulators to treat blindness, muscle stimulators to produce coordinated limb movement, spinal cord stimulators to treat chronic pain, cortical and deep brain stimulators to treat motor and psychological disorders, and other neural stimulators to treat urinary incontinence, sleep apnea, shoulder subluxation, etc. The description that follows will generally focus on the use of the invention within a Spinal Cord Stimulation (SCS) system, such as that disclosed in U.S. Pat. 6,516,227. However, the present invention may find applicability in any implantable medical device system, including a Deep Brain Stimulation (DBS) system.
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Transmission of the magnetic field 55 from either of chargers 40 or 60 to the IPG 10 occurs wirelessly and transcutaneously through a patient’s tissue via inductive coupling.
The magnetic portion of the electromagnetic field 55 induces a current Icoil in the secondary charging coil 30 within the IPG 10, which current is received at power reception circuitry 81. Power reception circuitry 81 can include a tuning capacitor 80, which is used to tune the resonance of the LC circuit in the IPG to the frequency of the magnetic field. One skilled will understand that the capacitors 45 or 80 may be placed in series or in parallel with their respective coils (inductances) 44/66 or 30, although it is preferred that the capacitor 45 be placed in series with the coil 44/66 in the charger 40/60, while the capacitor 80 is placed in parallel with the coil 30 in the IPG 10. The power reception circuitry 81 further includes a rectifier 82 used to convert AC voltage across the coil 30 to DC a DC voltage Vdc. Power reception circuitry 81 may further include other conditioning circuitry such as charging and protection circuitry 84 to generate a Voltage Vbat which can be used to provide regulated power to the IPG 10, and to generate a current Ibat which is used to charge the battery 14. The frequency of the magnetic field 55 can be perhaps 80 kHz or so.
The IPG 10 can also communicate data back to the external charger 40 or 60, and this can occur in different manners. As explained in the above-referenced 2017/0361113 publication, the IPG 10 may employ reflected impedance modulation to transmit data to the charger, which is sometimes known in the art as Load Shift Keying (LSK), and which involves modulating the impedance of the charging coil 30 with data bits provided by the IPG 10′s control circuitry 86. The IPG may also use a communications channel separate from that used to provide power to transmit data to the charger, although such alternative channel and the antenna required are not shown for simplicity. The charger 40 or 60 can include demodulation circuitry 68 to recover the transmitted data, and to send such data to the charger’s control circuitry 72. Such data as telemetered from to the charger 40/60 from the IPG 10 can include information useful for the charger to know during charging, such as the IPG’s temperature (as sensed by temperature sensor 87, e.g., thermistor), the voltage Vbat of the IPG’s battery 14, or the charging current Ibat provided to the battery. Charger 40/60 can use such telemetered data to control production of the magnetic field 55, such as by increasing or decreasing the magnitude of the magnetic field 55 (by increasing or decreasing Icharge), or by starting or stopping generation of the magnetic field 55 altogether. As explained in the above-referenced 2017/0361113 publication, the charger 40/60 may also be used to determine the alignment of the charging coil 44/66 to the IPG 10, and may include alignment indicators (LEDs or sounds) that a user can review to determine how to reposition the charger to be in better alignment with the IPG 10 for more efficient power transfer.
In addition to communicating data to the charger, the IPG is typically also configured to communicate with one or more other external devices. An example of such other external devices is a patient’s external remote controller (RC). The RC can be as described in U.S. Pat. Application Publication 2015/0080982 or U.S. Patent No. 11,000,688, for example, and may comprise a stand-alone dedicated controller configured to work with the IPG 10. The RC may also comprise a general purpose mobile electronics device such as a smart phone, which has been programmed with a Medical Device Application (MDA) allowing it to work as a wireless controller for the IPG 10, as described in U.S. Pat. Application Publication 2015/0231402. The RC typically includes a user interface, including means for entering commands (e.g., buttons or icons) and a display. The RC’s user interface enables a patient to adjust stimulation parameters.
The IPG 10 can include an antenna allowing it to communicate bi-directionally with external devices, such as the RC. The antenna can be the same coil used for charging or an additional coil, and communication can be by LSK, as described above, for example. The IPG 10 may also include a Radio-Frequency (RF) antenna. The antenna may be within the header 23 or within the case 12. The RF antenna may comprise a patch, slot, or wire, and may operate as a monopole or dipole. The RF antenna may communicate using far-field electromagnetic waves, and may operate in accordance with any number of known RF communication standards, such as Bluetooth, Bluetooth Low Energy (BTE), Zigbee, MICS, and the like.
A patient implanted with an IPG typically spends a significant amount of time charging the IPG’s rechargeable battery. Inefficient charging, such as charging their device too often or not often enough, or charging with the charger improperly aligned with the IPG, can cause several problems. One problem is that the patient may simply spend more time than necessary charging. Another problem is that improper charging may adversely effect battery life. Still another problem is that if the patient waits too long to charge their battery, their battery might run out of charge. Accordingly, there is a need in the art for detecting when a patient is not practicing efficient charging so that the patient can be encouraged and instructed.
Aspects of this disclosure relate to a cloud-based system for monitoring recharging of a rechargeable battery of an implantable pulse generator (IPG), the system comprising: a remote server configured to: receive via internet, data indicative of one or more measurements obtained from the IPG during the recharging, use the data to determine if one or more recharging efficiency metrics is outside of a predetermined range, and if one or more recharging efficiency metrics is outside of the predetermined range, send an alert via internet to the patient and/or a clinician. According to some embodiments, receiving data indicative of one or more measurements obtained from the IPG during the recharging, comprises receiving the data from a patient’s remote controller (RC) associated with the IPG. According to some embodiments, the RC comprises a smartphone. According to some embodiments, the smartphone comprises a medical device application (MDA) configured to periodically send the data to the remote server. According to some embodiments, the data indicative of one or more measurements obtained from the IPG during the recharging comprises one or more of: time stamps, IPG battery voltage measurements, IPG temperatures, and IPG battery charge currents. According to some embodiments, the one or more recharging efficiency metrics comprises a duration of charging. According to some embodiments, the one or more recharging efficiency metrics comprises a frequency of charging. According to some embodiments, the one or more recharging efficiency metrics comprises battery health. According to some embodiments, the one or more recharging efficiency metrics comprises alignment of an external charging coil with a charging coil configured within the IPG. According to some embodiments, determining alignment of the external charging coil with the charging coil comprises using temperature data from the IPG. According to some embodiments, the one or more recharging efficiency metrics comprises an initial battery voltage value when charging is initiated. According to some embodiments, determining if one or more recharging efficiency metrics is outside of a predetermined range comprises identifying a charging session using the data. According to some embodiments, identifying a charging session is based on one or more of identifying a change in battery voltage as a function of time, identifying a charging current, and identifying the presence of an external magnetic field. According to some embodiments, sending an alert via internet to the patient and/or a clinician comprises sending an alert to the patient’s RC.
Also disclosed herein is a method for monitoring recharging of a rechargeable battery of an implantable pulse generator (IPG), the method comprising: at a remote server, receiving via internet, data indicative of one or more measurements obtained from the IPG during the recharging, using the data to determine if one or more recharging efficiency metrics is outside of a predetermined range, and if one or more recharging efficiency metrics is outside of the predetermined range, sending an alert via internet to the patient and/or a clinician. According to some embodiments, receiving data indicative of one or more measurements obtained from the IPG during the recharging, comprises receiving the data from a patient’s remote controller (RC) associated with the IPG. According to some embodiments, the RC comprises a smartphone. According to some embodiments, the smartphone comprises a medical device application (MDA) configured to periodically send the data to the remote server. According to some embodiments, the data indicative of one or more measurements obtained from the IPG during the recharging comprises one or more of: time stamps, IPG battery voltage measurements, IPG temperatures, and IPG battery charge currents. According to some embodiments, the one or more recharging efficiency metrics comprises a duration of charging. According to some embodiments, the one or more recharging efficiency metrics comprises a frequency of charging. According to some embodiments, the one or more recharging efficiency metrics comprises battery health. According to some embodiments, the one or more recharging efficiency metrics comprises alignment of an external charging coil with a charging coil configured within the IPG. According to some embodiments, determining alignment of the external charging coil with the charging coil comprises using temperature data from the IPG. According to some embodiments, the one or more recharging efficiency metrics comprises an initial battery voltage value when charging is initiated. According to some embodiments, determining if one or more recharging efficiency metrics is outside of a predetermined range comprises identifying a charging session using the data. According to some embodiments, identifying a charging session is based on one or more of identifying a change in battery voltage as a function of time, identifying a charging current, and identifying the presence of an external magnetic field. According to some embodiments, sending an alert via internet to the patient and/or a clinician comprises sending an alert to the patient’s RC.
The invention may also reside in the form of a programed external device (via its control circuitry) for carrying out the above methods, a programmed IPG (via its control circuitry) for carrying out the above method, a system including a programmed external device and IPG for carrying out the above methods, or as a computer readable media for carrying out the above methods stored in an external device, IPG, remote server, or the like.
The present disclosure is directed to methods and systems for detecting sub-optimal or inefficient charging practices. Examples of sub-optimal or inefficient charging practices include charging too often, not often enough, and/or charging with improper alignment of the charger with respect to the IPG’s receiving coil. The methods and systems may alert the patient when poor charging practices are detected and may provide informational materials, for example, to encourage the patient to improve. Sub-optimal charging may also indicate problems with battery health or with the stimulation program(s) being implemented, and the instant methods and systems may bring such problems to the patient’s and/or clinician’s attention.
In the illustrated embodiment, the IPG 10 is configured to record certain parameters/data and measurements related to charging in a charging log 412, which will be explained in more detail below. According to some embodiments, the information contained within the charging log may be transmitted to the RC 402 and then to the remote server 408 via the internet. According to some embodiments, the IPG may automatically transmit the charging log to the patient’s RC upon completion of each charging session. According to other embodiments, the RC may prompt the patient to cause the IPG data to be uploaded to the RC. In either case, the RC may transmit the IPG data/charging log to the remote server 408. One or more charging algorithms 414 at the remote server 408 may use the information from the charging log to determine information about the patient’s charging practices, as described in more detail below. Stated differently, the algorithm(s) 414 use the data from the IPG to determine values for one or more charging efficiency metrics. Examples of charging efficiency metrics are described in more detail below, but may include how often the patient recharges their IPG, how low the battery is allowed to get between recharging sessions, battery health, alignment of the charger with the IPG, etc.
According to some embodiments, the algorithm(s) 414 may be embodied as instructions stored on non-transitory computer-readable media at the server. Such non-transitory media may include one or more non-transitory computer-readable storage mediums including, non-volatile memory, magnetic disks (fixed, floppy, and removable) and tape, optical media such as CD-ROMs and digital video disks (DVDs), and semiconductor memory devices such as Electrically Programmable Read-Only Memory (EPROM), Electrically Erasable Programmable Read-Only Memory (EEPROM), and USB or thumb drive. The instructions, when executed, perform the algorithms described herein. One skilled in the art will additionally recognize that execution of the instructions can be facilitated by control circuitry such as a microprocessor, microcomputer, an FPGA, other digital logic structures, etc., which is capable of executing programs in a computing device.
In response to the algorithm’s determinations, information 416, such as alerts, instructional information, and the like, may be transmitted back to the patient’s RC, as explained in more detail below. The server 408 may send alerts/information to the clinician’s office 410, which may prompt the clinician to take certain actions, such as transmitting information 416 to the patient’s RC, contacting the patient, and/or remotely reprogramming the patient’s stimulation parameters, as described in more detail below. It should be noted that the system 400 may be configured differently than illustrated in
According to some embodiments, relevant data can be recorded into the charging log 412 periodically, when charging is detected. For example, when charging is detected, data may be recorded every ten minutes, every five minutes, or every one minute. Data may be recorded for some period of time once charging is completed. For example, assume that once charging is detected, data is collected every five minutes. Once charging has stopped, and additional six data points may be collected, for example, meaning that data collection continues for an additional thirty minutes after charging has stopped.
Charging may be detected by sensing the presence of a charging magnetic field. For example, the IPG may be configured with a sensor, such as a Reed sensor, a Hall effect sensor, or the like. Charging may also be detected by determining that the charge on the battery is increasing, and/or by detecting a non-zero charging current Ibat (
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At step 602, the algorithm collects data from the IPG. For example, the algorithm may receive the charging log 412 from IPG. At step 604, the algorithm may parse the received log/data to identify charging sessions. For example, the algorithm may look for beginning of charging session data and end of charging session data, as described above. At step 606, the algorithm can calculate the number of charging sessions, the number of charging sessions within a given period of time (i.e., a charging frequency), and/or the duration of charging sessions. For example, the algorithm may determine the number of times per week the patient recharges their IPG. Alternatively, the algorithm may determine the length of time between charging sessions. The algorithm can also determine the durations of the charging sessions. At step 608, the algorithm may compare the number of charges/charging frequency to an expected value to determine if the patient is charging their device often enough (or too often). For example, the algorithm may compare the amount of charging to an expected threshold value or a range between upper and lower threshold values. The expected charging times may be predicted, for example, based on knowledge of the particular IPG, the particular battery, etc., as well as a calculation of the energy required for the particular stimulation program(s) the patient is using. U.S. Pat. No. 9,327,135, the entire contents of which are hereby incorporated herein by reference, describes methods of predicting charging frequency/duration requirements based on information about the IPG’s stimulation parameter/programs. The expected charging times may also be based on accumulated historic data for the patient’s behavior, as well as accumulated data from many patients.
Based on the comparison of the recorded charging behavior with expected values/ranges, the algorithm may alert the clinician and/or the patient (Step 610). The algorithm and/or the clinician may use the system to provide feedback to the patient or to take other actions (Step 612). If the charging behavior comports with expected/recommended practice, the algorithm may issue the patient a message informing them as such, and encouraging them to continue, for example. The clinician may be updated as to the behavior for their records. However, if the charging behavior deviates from recommended practice, then the algorithm may cause the server to send the patient a message letting them know of the problem. The message may be a reminder to charge more or less often, as the case may be. The message may include training materials, videos, links to web-based information, and the like. Likewise, the clinician may be notified so they can provide corrective instruction. Also, if the clinician notices that the patient’s battery is running low more often than expected, the clinician may reprogram the patient’s IPG to use a less power-intensive stimulation program. The clinician may instruct the patient to make an appointment so that the IPG can be reprogrammed. Alternatively, according to some embodiments, the clinician may use the system 400 (
Algorithm 600 (
At step 702, the algorithm may make one or more determinations concerning the charging of the IPG, such as the ones enumerated in the figure. According to some embodiments, step 702 may involve determining/predicting the health of the IPG’s battery. According to some embodiments, the battery’s health may be evaluated based on the voltage v. time curve (dV/dT) during charging. According to some embodiments, the battery’s health may be evaluated based on the final battery voltage at the end of a charging session (Vfinal) or the maximum voltage (Vmax) of the battery. According to some embodiments, the battery’s health may be evaluated based on the duration of charging required to reach Vmax. Any of these data may be evaluated by comparing the values to absolute expected values or thresholds. For example, if any or all of dV/dT, Vmax, or Vfinal are less than an expected or threshold value, then a decline of the battery’s health may be suspected. Likewise, a decline of the battery’s health may be indicated if the duration of the charging time required for the battery to fully charge exceeds an expected value or a threshold. According to some embodiments, changes in values compared to historically recorded values for these data may indicate a decline in battery health. For example, if dV/dT, Vmax, and/or Vfinal decrease over time, or if the charging duration increases over time, that may indicate failing battery health. If the algorithm determines/predicts that the health of the battery is declining, then the algorithm may alert the patient and/or the clinician as such.
According to some embodiments, at step 702 the algorithm may determine if the patient is properly aligning their charger with their IPG during charging. If the patient inconsistently aligns their charger with the IPG, the voltage v. time curve (dV/dT) may vary during a charging session and/or may vary from charging session to charging session. Likewise, higher than expected temperature during charging (i.e., thermistor value) may indicate poor alignment. Longer than expected charging durations may also indicate poor alignment. Any of dV/dT, temperature, and/or charging duration may be compared expected or threshold values to diagnose poor alignment. If poor alignment is detected, the algorithm may alert the patient. According to some embodiments, the algorithm may alert the patient during the course of a charging session if one or more of these values changes. For example, if the data indicates that charging is efficient at the beginning of a charging session but then changes, the algorithm may send an alert to the patient asking them if they moved the position of their charger or otherwise changed positions. According to some embodiments, the algorithm may provide training information to the patient, such as links to videos or other instructions regarding proper alignment. According to some embodiments, the algorithm may notify the clinician of improper charging alignment so that they can address the issue during the patient’s next visit.
According to some embodiments, the algorithm can determine if the patient is routinely charging the IPG’s battery at the proper time, that is, when the battery voltage is at the proper stage of depletion. As known to those of skill in the art, repeatedly charging a rechargeable battery when the battery is already substantially charged may speed the degradation of the battery. Also, repeatedly allowing the battery to completely drain may be damaging. According to some embodiments, the algorithm may track the voltages at a beginning of charging sessions to determine the typical state of the battery when the patient begins recharging. In other words, the algorithm may determine if the patient tends to charge the battery too soon, i.e., when there is substantial charge remaining, or too late, i.e., when the battery is almost dead. For example, the algorithm may provide alerts to the patient if they are recharging the battery when there is greater than 80 % or less than 20 % charge remaining.
According to some embodiments the charging algorithm 416 may make determinations based on the data received from the IPG (e.g., from the charging log 412) combined with data/information from other sources. For example, the algorithm may be configured to issue charging alerts and/or suggest optimum times for charging sessions, based on information concerning the patient’s activities, schedule, routine, lifestyle, etc., which the patient may provide using the MDA of their RC, for example. Alternatively, patient activity information may be determined based on sensor data, such as accelerometer data. The accelerometer may be configured as part of the IPG or may be another device, such as a wearable accelerometer. The algorithm may use such information to suggest charging times that are convenient for the patient, such as when the patient is awake and not asleep and also when the patient is not in the middle of an activity. According to some embodiments, the algorithm may use historic data collected from the patient to derive such suggestions.
Although particular embodiments of the present invention have been shown and described, it should be understood that the above discussion is not intended to limit the present invention to these embodiments. It will be obvious to those skilled in the art that various changes and modifications may be made without departing from the spirit and scope of the present invention. Thus, the present invention is intended to cover alternatives, modifications, and equivalents that may fall within the spirit and scope of the present invention as defined by the claims.
This is a non-provisional of U.S. Provisional Pat. Application Serial No. 63/269,917, filed Mar. 25, 2022, to which priority is claimed, and which is incorporated herein by reference.
Number | Date | Country | |
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63269917 | Mar 2022 | US |