Methods, systems, and devices for pairing vagus nerve stimulation with motor therapy in stroke patients

Patent metadata

Field	Value
Publication number	US-12151104-B2
Application number	US-202318310935-A
Country	US
Kind code	B2
Filing date	May 2, 2023
Priority date	Jul 2, 2008
Publication date	Nov 26, 2024
Grant date	Nov 26, 2024

Abstract

A motor-deficit-therapeutic method (for treatment of a patient who has hemiparesis) includes: providing, to the patient afflicted with a hemiparesis, a neurostimulator configured to stimulate a vagus nerve of the patient using electrical, magnetic, optical, acoustic or mechanical stimulation; and initiating stimulation of the vagus nerve by the neurostimulator so that at least a portion of the stimulation occurs at least during performance by the patient of a motor therapy session which is hemiparesis-therapeutic, thereby improving the patient's hemiparesis.

First claim

What is claimed is:

1. A motor-deficit-therapeutic method for treatment of a patient who has hemiparesis, the method comprising:
providing, to the patient afflicted with a hemiparesis, a neurostimulator configured to stimulate a vagus nerve of the patient using electrical, magnetic, optical, acoustic or mechanical stimulation; and
initiating stimulation of the vagus nerve by the neurostimulator so that at least a portion of the stimulation occurs at least during performance by the patient of a motor therapy session which is hemiparesis-therapeutic, thereby improving the patient's hemiparesis.

2. The method of claim 1 , wherein:
the neurostimulator is further configured to provide a series of electrical pulse trains; or
the neurostimulator is further configured to provide a programmed sequence of electrical pulse trains.

3. The method of claim 1 , wherein:
the neurostimulator is further configured to provide an electrical pulse train in response to a received signal.

4. The method of claim 1 , wherein:
the motor therapy session includes one or more tasks;
during the motor therapy session, at least one of the one or more tasks undergoes one or more repetitions;
at least one task includes one or more associated voluntary muscle movements; and
two or more sessions comprise a treatment plan.

5. The method of claim 4 , wherein:
a timing of the stimulation is based on completion of one of the one or more repetitions.

6. The method of claim 4 , wherein:
for at least one of the one or more tasks which undergoes one or more repetitions, there are substantially no task-associated voluntary muscle movements during an interval between a given one of the associated one or more voluntary muscle movements and a subsequent one of the associated one or more voluntary muscle movements, the interval having a duration, T, which is greater than zero, T>0.

7. The method of claim 4 , wherein:
the motor therapy session is motor-deficit-therapeutic; and
performance by the patient of the one or more voluntary muscle movements includes one or more of:
moving one or more extremities of the patient based on the associated task;
reaching at least one hand of the patient towards a targeted object;
touching a targeted object;
grasping the targeted object with at least one hand of the patient; or
moving the targeted object while the targeted object is being grasped with at least one hand of the patient.

8. The method of claim 4 , wherein:
each session includes about 3 to about 5 tasks;
in each session, each of the tasks undergoes about 30 to about 75 repetitions; and
a duration of each session is in a range of about 30 minutes to about 120 minutes.

9. The method of claim 4 , wherein:
for at least one of the one or more tasks, performance by the patient of the one or more associated voluntary muscle movements includes:
a planning stage which precedes a corresponding one of the one or more associated voluntary muscle movements.

10. The method of claim 1 , wherein:
the stimulation of the vagus nerve does not directly stimulate motor cortex neurons.

11. The method of claim 1 , wherein:
the stimulation of the vagus nerve triggers a corresponding release of neuromodulators in motor cortex of the patient during performance by the patient of the motor therapy session.

12. The method of claim 11 , wherein:
neuromodulators in the corresponding release of neuromodulators in motor cortex of the patient include acetylcholine and norepinephrine.

13. The method of claim 1 , wherein:
current comprising the electrical stimulation of the patient's vagus nerve has an amplitude of no less than about 0.8 milliamperes.

14. The method of claim 1 , wherein:
the stimulation is electrical stimulation.

15. The method of claim 1 , wherein:
the hemiparesis is improved by improving a motor function of the patient.

16. The method of claim 1 , wherein:
the hemiparesis is improved by lessening a motor deficit of the patient.

17. The method of claim 1 , wherein:
a timing of the stimulation is based on a successful aspect of one or more voluntary muscle movements by the patient.

18. A method for treatment of a patient who has hemiparesis, the method comprising:
for each of one or more tasks that are intended to be performed, instructing the patient to perform the corresponding task at least once, the corresponding task including one or more associated voluntary muscle movements, and the corresponding task being rehabilitative for hemiparesis; and
during at least partial overlap of at least one of the one or more tasks,
stimulating a vagus nerve of the patient using electrical, magnetic, optical, acoustic or mechanical stimulation thereby improving the patient's hemiparesis.

19. The method of claim 18 , wherein:
the stimulating of the vagus nerve resulting in raised levels of corresponding neuromodulators in motor cortex of the patient, the raised levels of the corresponding neuromodulators creating an opportunity of enhanced hemiparesis rehabilitation for a corresponding period (opportunity period); and
the at least partial overlap pairs the at least one of the one or more tasks and the opportunity period thereby improving the patient's hemiparesis.

20. The method of claim 19 , wherein:
the neuromodulators include acetylcholine and norepinephrine.

21. The method of claim 18 , wherein:
the vagus nerve is a driver of an ascending neuromodulatory system.

22. The method of claim 18 , wherein:
the stimulating of the vagus nerve does not directly stimulate motor cortex neurons.

23. The method of claim 18 , wherein, for at least one of the one or more tasks, performance by the patient of the one or more associated voluntary muscle movements includes one or more of:
moving one or more extremities of the patient based on a current task to be performed;
reaching at least one hand of the patient towards a targeted object;
touching a targeted object;
grasping the targeted object with at least one hand of the patient; or
moving the targeted object while the targeted object is being grasped with at least one hand of the patient.

24. The method of claim 18 , wherein:
performance at least once of each the one or more tasks comprises a session; and
two or more sessions comprise a treatment plan (TP).

25. The method of claim 24 , wherein:
during the session, at least one of the one or more tasks undergoes one or more repetitions;
at least one task includes one or more associated voluntary muscle movements; and
a timing of the stimulation is based on completion of one of the one or more repetitions.

26. The method of claim 24 , wherein:
each session includes about 3 to about 5 tasks;
in each session, each of the tasks undergoes about 30 to about 75 repetitions; and
a duration of each session is in a range of about 30 minutes to about 120 minutes.

27. The method of claim 18 , wherein:
for at least one of the one or more tasks, there are substantially no task-associated voluntary muscle movements during an interval between a given one of the one or more associated voluntary muscle movements that comprise the corresponding task and a subsequent one of the one or more associated voluntary muscle movements that comprise the corresponding task, the interval having a duration, T, which is greater than zero, T>0.

28. The method of claim 18

Assignees

• Univ Texas

Inventors

• Kilgard Michael P
• Engineer Navzer
• Pierce David Michael
• Rennaker Robert L

Classifications

• G09B23/28 Primary

  for medicine · CPC title

• A61N2007/0026

  Stimulation of nerve tissue · CPC title

• A61N7/00

  Ultrasound therapy (lithotripsy A61B17/22, A61B17/225; massage using supersonic vibration A61H23/00 {; using ultrasound for introducing media into the body A61M37/0092}) · CPC title

• A61N2/006

  for magnetic stimulation of nerve tissue · CPC title

• A61N1/37247

  User interfaces, e.g. input or presentation means · CPC title