US20040011366A1 - System of implantable devices for monitoring and/or affecting body parameters - Google Patents

Abstract

A system for monitoring and/or affecting parameters of a patient's body and more particularly to such a system comprised of a system control unit (SCU) and one or more other devices, preferably battery-powered, implanted in the patient's body, i.e., within the envelope defined by the patient's skin. Each such implanted device is configured to be monitored and/or controlled by the SCU via a wireless communication channel. In accordance with the invention, the SCU comprises a programmable unit capable of (1) transmitting commands to at least some of a plurality of implanted devices and (2) receiving data signal from at least some of those implanted devices. In accordance with a preferred embodiment, the system operates in closed loop fashion whereby the commands transmitted by the SCU are dependent, in part, on the content of the data signals received by the SCU. In accordance with the invention, a preferred SCU is similarly implemented as a device capable of being implanted beneath a patient's skin, preferably having an axial dimension of less than 60 mm and a lateral dimension of less than 6 mm. Wireless communication between the SCU and the implanted devices is preferably implemented via a modulated sound signal, AC magnetic field, RF signal, or electric conduction.

Description

• This application claims the benefit of U.S. Provisional Application No. 60/042,447 filed Mar. 27, 1997 and U.S. patent application Ser. No. ______, filed Feb. 25, 1998 entitled “Battery-Powered Patient Implantable Device” which in turn claims the benefit of U.S. Provisional Application No. 60/039,164 filed Feb. 26, 1997.[0001]
BACKGROUND OF THE INVENTION
• The present invention relates to systems for monitoring and/or affecting parameters of a patient's body for the purpose of medical diagnosis and/or treatment. More particularly, systems in accordance with the invention are characterized by a plurality of devices, preferably battery-powered, configured for implanting within a patient's body, each device being configured to sense a body parameter, e.g., temperature, O[0002]₂content, physical position, etc., and/or to affect a parameter, e.g., via nerve stimulation.
• Applicants' parent application Ser. No. ______, entitled “Battery Powered Patient Implantable Device”, incorporated herein by reference, describes devices configured for implantation within a patient's body, i.e., beneath a patient's skin, for performing various functions including: (1) stimulation of body tissue, (2) sensing of body parameters, and (3) communicating between implanted devices and devices external to a patient's body.[0003]
SUMMARY OF THE INVENTION
• The present invention is directed to a system for monitoring and/or affecting parameters of a patient's body and more particularly to such a system comprised of a system control unit (SCU) and one or more devices implanted in the patient's body, i.e., within the envelope defined by the patient's skin. Each said implanted device is configured to be monitored and/or controlled by the SCU via a wireless communication channel.[0004]
• In accordance with the invention, the SCU comprises a programmable unit capable of (1) transmitting commands to at least some of a plurality of implanted devices and (2) receiving data signals from at least some of those implanted devices. In accordance with a preferred embodiment, the system operates in closed loop fashion whereby the commands transmitted by the SCU are dependent, in part, on the content of the data signals received by the SCU.[0005]
• In accordance with a preferred embodiment, each implanted device is configured similarly to the devices described in Applicants' parent application Ser. No. ______, and typically comprises a sealed housing suitable for injection into the patient's body. Each housing preferably contains a power source having a capacity of at least 1 microwatt-hour, preferably a rechargeable battery, and power consuming circuitry preferably including a data signal transmitter and receiver and sensor/stimulator circuitry for driving an input/output transducer.[0006]
• In accordance with a significant aspect of the preferred embodiment, a preferred SCU is also implemented as a device capable of being injected into one patient's body. Wireless communication between the SCU and the other implanted devices can be implemented in various ways, e.g., via a modulated sound signal, AC magnetic field, RF signal, or electrical conduction.[0007]
• In accordance with a further aspect of the invention, the SCU is remotely programmable, e.g., via wireless means, to interact with the implanted devices according to a treatment regimen. In accordance with a preferred embodiment, the SCU is preferably powered via an internal power source, e.g., a rechargeable battery. Accordingly, an SCU combined with one or more battery-powered implantable devices, such as those described in the parent application, form a self-sufficient system for treating a patient.[0008]
• In accordance with a preferred embodiment, the SCU and other implanted devices are implemented substantially identically, being comprised of a sealed housing configured to be injected into the patient's body. Each housing contains sensor/stimulator circuitry for driving an input/output transducer, e.g., an electrode, to enable it to additionally operate as a sensor and/or stimulator.[0009]
• Alternatively, the SCU could be implemented as an implantable but non-injectable housing which would permit it to be physically larger enabling it to accommodate larger, higher capacity components, e.g., battery, microcontroller, etc. As a further alternative, the SCU could be implemented in a housing configured for carrying on the patient's body outside of the skin defined envelope, e.g., in a wrist band.[0010]
• In accordance with the invention, the commands transmitted by the SCU can be used to remotely configure the operation of the other implanted devices and/or to interrogate the status of those devices. For example, various operating parameters, e.g., the pulse frequency, pulse width, trigger delays, etc., of each implanted device can be controlled or specified in one or more commands addressably transmitted to the device. Similarly, the sensitivity of the sensor circuitry and/or the interrogation of a sensed parameter, e.g., battery status, can be remotely specified by the SCU.[0011]
• In accordance with a significant feature of the preferred embodiment, the SCU and/or each implantable device includes a programmable memory for storing a set of default parameters. In the event of power loss, SCU failure, or any other catastrophic occurrence, all devices default to the safe harbor default parameters. The default parameters can be programmed differently depending upon the condition being treated. In accordance with a further feature, the system includes a switch preferably actuatable by an external DC magnetic field, for resetting the system to its default parameters.[0012]
• In an exemplary use of a system in accordance with the present invention, a patient with nerve damage can have a damaged nerve “replaced” by an implanted SCU and one or more implanted sensors and stimulators, each of which contains its own internal power source. In this exemplary system, the SCU would monitor a first implanted sensor for a signal originating from the patient's brain and responsively transmit command signals to one or more stimulators implanted past the point of nerve damage. Furthermore, the SCU could monitor additional sensors to determine variations in body parameters and, in a closed loop manner, react to control the command signals to achieve the desired treatment regimen.[0013]
• The novel features of the invention are set forth with particularity in the appended claims. The invention will be best understood from the following description when read in conjunction with the accompanying drawings.[0014]
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a simplified block diagram of the system of the present invention comprised of implanted devices, e.g., microstimulators, microsensors and microtransponders, under control of an implanted system control unit (SCU);[0015]
• FIG. 2 comprises a block diagram of the system of FIG. 1 showing the functional elements that form the system control unit and implanted microstimulators, microsensors and microtransponders;[0016]
• FIG. 3A comprises a block diagram of an exemplary implanted device, as shown in the parent application, including a battery for powering the device for a period of time in excess of one hour in response to a command from the system control unit;[0017]
• FIG. 3B comprises a simplified block diagram of controller circuitry that can be substituted for the controller circuitry of FIG. 3A, thus permitting a single device to be configured as a system control unit and/or a microstimulator and/or a microsensor and/or a microtransponder;[0018]
• FIG. 4 is a simplified diagram showing the basic format of data messages for commanding/interrogating the implanted microstimulators, microsensors and microtransponders which form a portion of the present invention;[0019]
• FIG. 5 shows an exemplary flow chart of the use of the present system in an open loop mode for controlling/monitoring a plurality of implanted devices, e.g., microstimulators, microsensors;[0020]
• FIG. 6 shows a flow chart of the optional use of a translation table for communicating with microstimulators and/or microsensors via microtransponders;[0021]
• FIG. 7 shows a simplified flow chart of the use of closed loop control of a microstimulator by altering commands from the system control unit in response to status data received from a microsensor;[0022]
• FIG. 8 shows an exemplary injury, i.e., a damaged nerve, and the placement of a plurality of implanted devices, i.e., microstimulators, microsensors and a microtransponder under control of the system control unit for “replacing” the damaged nerve;[0023]
• FIG. 9 shows a simplified flow chart of the control of the implanted devices of FIG. 8 by the system control unit;[0024]
• FIGS.[0025]10A and10BD show two side cutaway views of the presently preferred embodiment of an implantable ceramic tube suitable for the housing the system control unit and/or microstimulators and/or microsensors and/or microtransponders;
• FIG. 11 illustrates an exemplary battery suitable for powering the implantable devices which comprise the components of the present invention; and[0026]
• FIG. 12 shows an exemplary housing suitable for an implantable SCU having a battery enclosed within that has a capacity of at least 1 watt-hour.[0027]
DESCRIPTION OF THE PREFERRED EMBODIMENTS
• The present invention is directed to a system for monitoring and/or affecting parameters of a patient's body and more particularly to such a system comprised of a system control unit (SCU) and one or more devices implanted in a patient's body, i.e., within the envelope defined by the patient's skin. Each such implantable device is configured to be monitored and/or controlled by the SCU via a wireless communication channel.[0028]
• In accordance with the invention, the SCU comprises a programmable unit capable of (1) transmitting commands to at least some of a plurality of implanted devices and (2) receiving data signals from at least some of those implanted devices. In accordance with a preferred embodiment, the system operates in closed loop fashion whereby the commands transmitted by the SCU are dependent, in part, on the content of the data signals received by the SCU.[0029]
• In accordance with a preferred embodiment, each implanted device is configured similarly to the devices described in Applicants' parent application Ser. No. ______ and typically comprises a sealed housing suitable for injection into the patient's body. Each housing preferably contains a power source having a capacity of at least 1 microwatt-hour, preferably a rechargeable battery, and power consuming circuitry preferably including a data signal transmitter and receiver and sensor/stimulator circuitry for driving an input/output transducer.[0030]
• FIG. 1 (essentially corresponding to FIG. 2 of the parent application) and FIG. 2 show an[0031]exemplary system300 made of implanteddevices100, preferably battery powered, under control of a system control unit (SCU)302, preferably also implanted beneath a patient'sskin12. As described in the parent application, potential implanted devices100 (see also the block diagram shown in FIG. 3A) include stimulators , e.g.,100a, sensors e.g.,100c, and transponders, e.g.,100d.The stimulators, e.g.,100a, can be remotely programmed to output a sequence of drive pulses to body tissue proximate to its implanted location via attached electrodes. The sensors, e.g.,100c, can be remotely programmed to sense one or more physiological or biological parameters in the implanted environment of the device, e.g., temperature, glucose level, O₂content, etc. Transponders, e.g.,100d,are devices which can be used to extend the interbody communication range between stimulators and sensors and other devices, e.g., a clinician'sprogrammer172 and thepatient control unit174. Preferably, these stimulators, sensors and transponders are contained in sealed elongate housing having an axial dimension of less than 60 mm and lateral dimension of less than 6 mm. Accordingly, such stimulators, sensors and transponders are respectively referred to as microstimulators, microsensors, and microtransponders. Such microstimulators and microsensors can thus be positioned beneath the skin within a patient's body using a hypodermictype insertion tool176.
• As described in the parent application, microstimulators and microsensors are remotely programmed and interrogated via a wireless communication channel, e.g., modulated AC magnetic, sound (i.e., ultrasonic), RF or electric fields, typically originating from control devices external to the patient's body, e.g., a clinicians's[0032]programmer172 orpatient control unit174. Typically, the clinician'sprogrammer172 is used to program a single continuous or one time pulse sequence into each microstimulator and/or measure a biological parameter from one or more microsensors. Similarly, thepatient control unit174 typically communicates with the implanteddevices100, e.g.,microsensors100c, to monitor biological parameters. In order to distinguish each implanted device over the communication channel, each implanted device is manufactured with an identification code (ID)303 specified in address storage circuitry108 (see FIG. 3A) as described in the parent application.
• By using one or more such implantable devices in conjunction with the[0033]SCU302 of the present invention, the capabilities of such implanted devices can be further expanded. For example, in an open loop mode (described below in reference to FIG. 5), theSCU302 can be programmed to periodically initiate tasks, e.g., perform real time tasking, such as transmitting commands to microstimulators according to a prescribed treatment regimen or periodically monitor biological parameters to determine a patient's status or the effectiveness of a treatment regimen. Alternatively, in a closed loop mode (described below in reference to FIGS.7-9), theSCU302 periodically interrogates one or more microsensors and accordingly adjust the commands transmitted to one or more microstimulators.
• FIG. 2 shows the[0034]system300 of the present invention comprised of (1) one or moreimplantable devices100 operable to sense and/or stimulate a patient's body parameter in accordance with one or more controllable operating parameters and (2) the SCU,302. TheSCU302 is primarily comprised of (1) ahousing206, preferably sealed and configured for implantation beneath the skin of the patient's body as described in the parent application in reference to the implanteddevices100, (2) asignal transmitter304 in thehousing206 for transmitting command signals, (3) asignal receiver306 in thehousing206 for receiving status signals, and (4) aprogrammable controller308, e.g., a microcontroller or state machine, in thehousing206 responsive to received status signals for producing command signals for transmission by thesignal transmitter304 to otherimplantable devices100. The sequence of operations of theprogrammable controller308 is determined by an instruction list, i.e., a program, stored inprogram storage310, coupled to theprogrammable controller308. While theprogram storage310 can be a nonvolatile memory device, e.g., ROM, manufactured with a program corresponding to a prescribed treatment regimen, it is preferably that at least a portion of theprogram storage310 be an alterable form of memory, e.g., RAM, EEPROM, etc., whose contents can be remotely altered as described further below. However, it is additionally preferable that a portion of theprogram storage310 be nonvolatile so that a default program is always present. The rate at which the program contained within theprogram storage310 is executed is determined byclock312, preferably a real time clock that permits tasks to be scheduled at specified times of day.
• The[0035]signal transmitter304 andsignal receiver306 preferably communicate with implanteddevices100 using sound means, i.e., mechanical vibrations, using a transducer having a carrier frequency modulated by a command data signal. In a preferred embodiment, a carrier frequency of 100 KHz is used which corresponds to a frequency that freely passes through a typical body's fluids and tissues. However, such sound means that operate at any frequency, e.g., greater than 1 Hz, are also considered to be within the scope of the present invention. Alternatively, thesignal transmitter304 andsignal receiver306 can communicate using modulated AC magnetic, RF, or electric fields.
• The clinician's[0036]programmer172 and/or thepatient control unit174 and/or other external control devices can also communicate with the implanteddevices100, as described in the parent application, preferably using a modulated AC magnetic field. Alternatively, such external devices can communicate with theSCU302 via atransceiver314 coupled to theprogrammable controller308. Since, in a preferred operating mode, thesignal transmitter304 andsignal receiver306 operate using sound means, aseparate transceiver314 which operates using magnetic means is used far communication with external devices. However, asingle transmitter304/receiver306 can be used in place oftransceiver314 if a common communication means is used.
• FIG. 3A comprises a block diagram of an exemplary implanted device[0037]100 (as shown in FIG. 2 of the parent application) which includes abattery104, preferably rechargeable, for powering the device for a period of time in excess of one hour and responsive to command signals from a remote device, e.g., theSCU302. As described in the parent application, theimplantable device100 is preferably configurable to alternatively operate as a microstimulator and/or microsensor and/or microtransponder due to the commonality of most of the circuitry contained within. Such circuitry can be further expanded to permit a common block of circuitry to also perform the functions required for theSCU302. Accordingly, FIG. 3B shows an alternative implementation of thecontroller circuitry106 of FIG. 3A that is suitable for implementing a microstimulator and/or a microsensor and/or a microtransponder and/or theSCU302. In this implementation theconfiguration data storage132 can be alternatively used as theprogram storage310 when theimplantable device100 is used as theSCU302. In this implementation,XMTR168 corresponds to thesignal transmitter304 and theRCVR114bcorresponds to the signal receiver306 (preferably operable using sound means via transducer138) and the RCVR114aandXMTR146 correspond to the transceiver314 (preferably operable using magnetic means via coil116).
• In a preferred embodiment, the contents of the[0038]program storage310, i.e., the software that controls the operation of theprogrammable controller308, can be remotely downloaded, e.g., from the clinician'sprogrammer172 using data modulated onto an AC magnetic field. In this embodiment, it is preferable that the contents of theprogram storage310 for eachSCU302 be protected from an inadvertent change. Accordingly, the contents of theaddress storage circuitry108, i.e., theID303, is preferably used as a security code to confirm that the new program storage contents are destined for theSCU302 receiving the data. This feature is significant if multiple patient's could be physically located, e.g., in adjoining beds, within the communication range of the clinician'sprogrammer172.
• In a further aspect of the present invention, it is preferable that the[0039]SCU302 be operable for an extended period of time, e.g., in excess of one hour, from aninternal power supply316. While a primary battery, i.e., a nonrechargeable battery, is suitable for this function, it is preferable that thepower supply316 include a rechargeable battery, e.g.,battery104 as described in the parent application, that can be recharged via an AC magnetic field produced external to the patient's body. Accordingly, thepower supply102 of FIG. 3A (described in detail in the parent application) is thepreferred power supply316 for theSCU302 as well.
• The battery-powered[0040]devices100 of the parent invention are preferably configurable to operate in a plurality of operation modes, e.g., via a communicated command signal. In a first operation mode,device100 is remotely configured to be a microstimulator, e.g.,100aand100b.In this embodiment,controller130 commandsstimulation circuitry110 to generate a sequence of drive pulses through electrodes112 to stimulate tissue, e.g., a nerve, proximate to the implanted location of the microstimulator, e.g.,100aor100b.In operation, aprogrammable pulse generator178 andvoltage multiplier180 are configured with parameters (see Table I) corresponding to a desired pulse sequence and specifying now much to multiply the battery voltage (e.g., by summing charged capacitors or similarly charged battery portions) to generate a desired compliance voltage V_c. Afirst FET182 is periodically energized to store charge into capacitor183 (in a first direction at a low current flow rate through the body tissue) and asecond FET184 is periodically energized to dischargecapacitor183 in an opposing direction at a higher current flow rate which stimulates a nearby nerve. Alternatively, electrodes can be selected that will form an equivalent capacitor within the body tissue.

  TABLE I
  Stimulation Parameters

  Current:	continuous current charging of
  	storage capacitor
  Charging currents:	1, 3, 10, 30, 100, 250, 500 μa
  Current Range:	0.8 to 40 ma in nominally 3.2% steps
  Compliance Voltage:	selectable, 3-24 volts in 3 volt
  	steps
  Pulse Frequency (PPS):	1 to 5000 PPS in nominally 30% steps
  Pulse Width:	5 to 2000 μs in nominally 10% steps
  Burst On Time (BON):	1 ms to 24 hours in nominally 20%
  	steps
  Burst Off Time (BOF):	1 ms to 24 hours in nominally 20%
  	steps
  Triggered Delay to BON:	either selected BOF or pulse width
  Burst Repeat Interval:	1 ms to 24 hours in nominally 20%
  	steps
  Ramp On Time:	0.1 to 100 seconds (1, 2, 5, 10
  	steps)
  Ramp Off Time:	0.1 to 100 seconds (1, 2, 5, 10
  	steps)

• In a next operation mode, the battery-powered[0041]implantable device100 can be configured to operate as a microsensor, e.g.,100c, that can sense one or more physiological or biological parameters in the implanted environment of the device. In accordance with a preferred mode of operation, thesystem control unit302 periodically requests the sensed data from each microsensor100cusing its ID stored inaddress storage108, and responsively sends command signals to microstimulators, e.g.,100aand100b,adjusted accordingly to the sensed data. For example,sensor circuitry188 can coupled to the electrodes112 to sense or otherwise used to measure a biological parameter, e.g., temperature, glucose level, or O₂content and provided the sensed data to thecontroller circuitry106. Preferably, the sensor circuitry includes a programmable bandpass filter and an analog to digital (A/D) converter that can sense and accordingly convert the voltage levels across the electrodes112 into a digital quantity. Alternatively, the sensor circuitry can include one or more sense amplifiers to determine if the measured voltage exceeds a threshold voltage value or is within a specified voltage range. Furthermore, thesensor circuitry188 can be configurable to include integration circuitry to further process the sensed voltage. The operation modes of thesensor circuitry188 is remotely programable via the devices communication interface as shown below in Table II.

  TABLE II
  Sensing Parameters

  	Input voltage range:	5 μv to 1 V
  	Bandpass filter rolloff:	24 dB
  	Low frequency cutoff choices:	3, 10, 30, 100, 300, 1000 Hz
  	High frequency cutoff choices:	3, 10, 30, 100, 300, 1000 Hz
  	Integrator frequency choices:	1 PPS to 100PPS
  	Amplitude threshold
  	4 bits of resolution
  	for detection choices:

• Additionally, the sensing capabilities of a microsensor include the capability to monitor the battery status via path[0042]124 from the chargingcircuit122 and can additionally include using theultrasonic transducer138 or thecoil116 to respectively measure the magnetic or ultrasonic signal magnitudes (or transit durations) of signals transmitted between a pair of implanted devices and thus determine the relative locations of these devices. This information can be used to determine the amount of body movement, e.g., the amount that an elbow or finger is bent, and thus form a portion of a closed loop motion control system.
• In another operation mode, the battery-powered[0043]implantable device100 can be configured to operate as a microtransponder, e.g.,100d.In this operation mode, the microtransponder receives (via the aforementioned receiver means, e.g., AC magnetic, sonic, RF or electric) a first command signal from theSCU302 and retransmits this signal (preferably after reformatting) to other implanted devices (e.g., microstimulators, microsensors, and/or microtransponders) using the aforementioned transmitter means (e.g., magnetic, sonic, RF or electric). While a microtransponder may receive one mode of command signal, e.g., it may retransmit the signal in another mode, e.g., ultrasonic. For example, clinician'sprogrammer172 may emit a modulated magnetic signal using amagnetic emitter190 to program/command the implanteddevices100. However, the magnitude of the emitted signal may not be sufficient to be successfully received by all of the implanteddevices100. As such, amicrotransponder100dmay receive the modulated magnetic signal and retransmit it (preferably after reformatting) as a modulated ultrasonic signal which can pass through the body with fewer restrictions. In another exemplary use, thepatient control unit174 may need to monitor amicrosensor100cin a patient's foot. Despite the efficiency of ultrasonic communication in a patient's body, an ultrasonic signal could still be insufficient to pass from a patient's foot to a patient's wrist (the typical location of the patient control unit174). As such, amicrotransponder100dcould be implanted in the patient's torso to improve the communication link.
• FIG. 4 shows the basic format of an[0044]exemplary message192 for communicating with the aforementioned battery-powereddevices100, all of which are preconfigured with an address (ID), preferably unique to that device, in theiridentification storage108 to operate in one or more of the following modes (1) for nerve stimulation, i.e., as a microstimulator, (2) for biological parameter monitoring, i.e., as a microsensor, and/or (3) for retransmitting received signals after reformatting to other implanted devices, i.e., as a microtransponder. Thecommand message192 is primarily comprised of a (1) start portion194 (one or more bits to signify the start of the message and to synchronize the bit timing between transmitters and receivers, (2) a mode portion196 (designating the operating mode, e.g., microstimulator, microsensor, microtransponder, or group mode), (3) an address (ID) portion198 (corresponding to either theidentification address108 or a programmed group ID), (4) a data field portion200 (containing command data for the prescribed operation), (5) an error checking portion202 (for ensuring the validity of themessage192, e.g., by use of a parity bit), and (6) a stop portion204 (for designating the end of the message192). The basic definition of these fields are shown below in Table III. Using these definitions, each device can be separately configured, controlled and/or sensed as part of a system or controlling one or more neural pathways within a patient's body.

  TABLE III
  Message Data Fields

  	MODE	ADDRESS (ID)
  	00 = Stimulator	8 bit identification address
  	01 = Sensor	8 bit identification address
  	02 =Transponder	4 bit identification address
  	03 =Group	4 bit group identification
  		address

  Data Field Portion

  	Program/Stimulate =	select operating mode
  	Parameter/
  	Preconfiguration
  	Select =	select programmable parameter in
  		program mode or preconfigured
  		stimulation or sensing parameter
  		in other modes
  	Parameter Value =	program value

• Additionally, each[0045]device100 can be programmed with a group ID (e.g., a 4 bit value) which is stored in itsconfiguration data storage132. When adevice100, e.g., a microstimulator, receives a group ID message that matches its stored group ID, it responds as if the message was directed to itsidentification address108. Accordingly, a plurality of microstimulators, e.g.,100aand100b,can be commanded with a single message. This mode is of particular use when precise timing is desired among the stimulation of a group of nerves.
• The following describes exemplary commands, corresponding to the[0046]command message192 of FIG. 4, which demonstrate some of the remote control/sensing capabilities of the system of devices which comprise the present invention:
• Write Command—Set a microstimulator/microsensor specified in the[0047]address field198 to the designated parameter value.
• Group Write Command—Set the microstimulators/microsensors within the group specified in the[0048]address field198 to the designated parameter value.
• Stimulate Command—Enable a sequence of drive pulses from the microstimulator specified in the[0049]address field198 according to previously programmed and/or default values.
• Group Stimulate Command—Enable a sequence of drive pulses from the microstimulators within the group specified in the[0050]address field198 according to previously programmed and/or default values.
• Unit Off Command—Disable the output of the microstimulator specified in the[0051]address field198.
• Group Stimulate Command—Disable the output of the microstimulators within the group specified in the[0052]address field198.
• Read Command—Cause the microsensor designated in the[0053]address field198 to read the previously programmed and/or default sensor value according to previously programmed and/or default values.
• Read Battery Status Command—Cause the microsensor designated in the[0054]address field198 to return its battery status.
• Define Group Command—Cause the microstimulator/microsensor designated in the[0055]address field198 to be assigned to the group defined in themicrostimulator data field200.
• Set Telemetry Mode Command—Configure the microtransponder designated in the[0056]address field198 as to its input mode (e.g., AC magnetic, sonic, etc.), output mode (e.g., AC magnetic, sonic, etc.), message length, etc.
• Status Reply Command—Return the requested status/sensor data to the requesting unit, e.g., the SCU.[0057]
• Download Program Command—Download program/safe harbor routines to the device, e.g., SCU, microstimulator, etc., specified in the[0058]address field198.
• FIG. 5 shows a block diagram of an exemplary open loop control program, i.e., a[0059]task scheduler320, for controlling/monitoring a body function/parameter. In this process, theprogrammable controller308 is responsive to the clock312 (preferably crystal controlled to thus permit real time scheduling) in determining when to perform any of a plurality of tasks. In this exemplary flow chart, theprogrammable controller308 first determines inblock322 if is now at a time designated as T_EVENT1(or at least within a sampling error of that time), e.g., at 1:00 AM. If so, theprogrammable controller308 transmits a designated command to microstimulator A (ST_A) inblock324. In this example, the control program continues where commands are sent to a plurality of stimulators and concludes inblock326 where a designated command is sent to microstimulator X (ST_X). Such a subprocess, e.g., a subroutine, is typically used when multiple portions of body tissue require stimulation, e.g, stimulating a plurality of muscle groups in a paralyzed limb to avoid atrophy. Thetask scheduler320 continues through multiple time event detection blocks until inblock328 it determines whether the time T_EVENTMhas arrived. If so, the process continues atblock330 where, in this case, a single command is sent to microstimulator M (ST_M). Similarly, inblock332 thetask scheduler320 determines when it is the scheduled time, i.e., T_EVENT0, to execute a status request from microsensor A (SE_A). Is so, a subprocess, e.g., a subroutine, commences atblock334 where a command is sent to microsensor A (SE_A) to request sensor data and/or specify sensing criteria. Microsensor A (SE_A) does not instantaneously respond. Accordingly, theprogrammable controller308 waits for a response in block336. Inblock338, the returned sensor status data from microsensor A (SE_A) is stored in a portion of the memory, e.g., a volatile portion of theprogram storage310, of theprogrammable controller308. Thetask scheduler320 can be a programmed sequence, i.e., defined in software stored in theprogram storage310, or, alternatively, a predefined function controlled by a table of parameters similarly stored in theprogram storage310. A similar process can be used where theSCU302 periodically interrogates eachimplantable device100 to determine its battery status.
• FIG. 6 shows an exemplary use of an optional translation table[0060]340 for communicating between theSCU302 and microstimulators, e.g.,100a, and/or microsensors, e.g.,100c, via microtransponders, e.g.,100d.A microtransponder, e.g.,100d,is used when the communication range of theSCU302 is insufficient to reliably communicate with other implanteddevices100. In this case, theSCU302 instead directs a data message, i.e., a data packet, to an intermediary microtransponder, e.g.,100d,which retransmits the data packet to adestination device100. In an exemplary implementation, the translation table340 contains pairs of corresponding entries, i.e.,first entries342 corresponding to destination addresses andsecond entries344 corresponding to the intermediary microtransponder addresses. When theSCU302 determines, e.g., according to a timed event designated in theprogram storage310, that a command is to be sent to a designated destination device (see block346), theSCU302 searches thefirst entries342 of the translation table340, for the destination device address, e.g., ST_M. TheSCU302 then fetches the correspondingsecond table entry344 inblock348 and transmits the command to that address. When thesecond table entry344 is identical to its correspondingfirst table entry342, theSCU302 transmits commands directly to the implanteddevice100. However, when thesecond table entry344, e.g., T_N, is different from thefirst table entry342, e.g., ST_M, theSCU302 transmits commands via an intermediary microtransponder, e.g.,100d.The use of the translation table340 is optional since the intermediary addresses can, instead, be programmed directly into a control program contained in theprogram storage310. However, it is preferable to use such a translation table340 in that communications can be redirected on the fly by just reprogramming the translation table340 to take advantage of implanted transponders as required, e.g., if communications should degrade and become unreliable. The translation table340 is preferably contained in programmable memory, e.g., RAM or EPROM, and can be a portion of theprogram storage310. While the translation table340 can be remotely programmed, e.g., via a modulated signal from the clinician'sprogrammer172, it is also envisioned that theSCU302 can reprogram the translation table340 if the communications degrade.
• FIG. 7 is an exemplary block diagram showing the use of the system of the present invention to perform closed loop control of a body function. In[0061]block352, theSCU302 requests status from microsensor A (SE_A). TheSCU302, inblock354, then determines whether a current command given to a microstimulator is satisfactory and, if necessary, determines a new command and transmits the new command to the microstimulator A inblock356. For example, if microsensor A (SE_A) is reading a voltage corresponding to a pressure generated by the stimulation of a muscle, theSCU302 could transmit a command to microstimulator A (ST_A) to adjust the sequence of drive pulses, e.g., in magnitude, duty cycle, etc., and accordingly change the voltage sensed by microsensor A (SE_A). Accordingly, closed loop, i.e., feedback, control is accomplished. The characteristics of the feedback (position, integral, derivative (PID)) control are preferably program controlled by theSCU302 according to the control program contained inprogram storage310.
• FIG. 8 shows an exemplary injury treatable by embodiments of the[0062]present system300. In this exemplary injury, the neural pathway has been damaged, e.g, severed, just above the a patient's left elbow. The goal of this exemplary system is to bypass the damaged neural pathway to permit the patient to regain control of the left hand. AnSCU302 is implanted within the patient's torso to control plurality of stimulators, ST₁-ST₃, implanted proximate to the muscles respectively controlling the patient's thumb and fingers. Additionally, microsensor1 (SE₁) is implanted proximate to an undamaged nerve portion where it can sense a signal generated from the patient's brain when the patient wants hand closure. Optional microsensor2 (SE₂) is implanted in a portion of the patient's hand where it can sense a signal corresponding to stimulation/motion of the patient's pinky finger and microsensor3 (SE₃) is implanted and configured to measure a signal corresponding to grip pressure generated when the fingers of the patient's hand are closed. Additionally, an optional microtransponder (T₁) is shown which can be used to improve the communication between theSCU302 and the implanted devices.
• FIG. 9 shows an exemplary flow chart for the operation of the[0063]SCU302 in association with the implanted devices in the exemplary system of FIG. 8. Inblock360, theSCU302 interrogates microsensor1 (SE₁) to determine if the patient is requesting actuation of his fingers. If not, a command is transmitted in block362 to all of the stimulators (ST₁-ST₃) to open the patient's hand, i.e., to de-energize the muscles which close the patient's fingers. If microsensor1 (SE₁) senses a signal to actuate the patient's fingers, theSCU302 determines inblock364 whether the stimulators ST₁-ST₃are currently energized, i.e., generating a sequence of drive pulses. If not, theSCU302 executes instructions to energize the simulators. In a firstoptional path366, each of the stimulators are simultaneously (subject to formatting and transmission delays) commanded to energize inblock366a.However, the command signal given to each one specifies a different start delay time (using the BON parameter). Accordingly, there is a stagger between the actuation/closing of each finger.
• In a second[0064]optional path368, the microstimulators are consecutively energized by a delay Δ. Thus, microstimulator1 (ST₁) is energized in block368a, a delay is executed within theSCU302 in block368b, and so on for all of the microstimulators. Accordingly,paths366 and368 perform essentially the same function. However, inpath366 the interdevice timing is performed by the clocks within each implanteddevice100 while inmath368, theSCU302 is responsible for providing the interdevice timing.
• In[0065]path370, theSCU302 actuates a first microstimulator (ST₁) in block370aand waits inblock370bfor its corresponding muscle to be actuated, as determined by microsensor2 (SE₂), before actuating the remaining stimulators (ST₂-ST₃) inblock370c.This implementation could provide more coordinated movement in some situations.
• Once the stimulators have been energized, as determined in[0066]block364, closed loop grip pressure control is performed inblocks372aand372bby periodically reading the status of microsensor3 (SE₃) and adjusting the commands given to the stimulators (ST₁-ST₃) accordingly. Consequently, this exemplary system has enabled the patient to regain control of his hand including coordinated motion and grip pressure control of the patient's fingers.
• Referring again to FIG. 3A, a[0067]magnetic sensor186 is shown. In the parent application, it was shown that such asensor186 could be used to disable the operation of an implanteddevice100, e.g., to stop the operation of such devices in an emergency situation, in response to a DC magnetic field, preferably from an externally positionedsafety magnet187. A further implementation is disclosed herein. Themagnetic sensor186 can be implemented using various devices. Exemplary of such devices are devices manufactured by Nonvolatile Electronics, Inc. (e.g., their AA, AB, AC, AD, or AG series), Hall effect sensors, and subminiature reed switches. Such miniature devices are configurable to be placed within the housing of the disclosedSCU302 andimplantable devices100. While essentially passive magnetic sensors, e.g., reed switches, are possible, the remaining devices include active circuitry that consumes power during detection of the DC magnetic field. Accordingly, it is preferred thatcontroller circuitry302 periodically, e.g., once a second, provide power themagnetic sensor186 and sample the sensor'soutput signal374 during that sampling period.
• In a preferred implementation of the[0068]SCU302, theprogrammable controller308 is a microcontroller operating under software control wherein the software is located within theprogram storage310. TheSCU302 preferably includes aninput376, e.g., a non maskable interrupt (NMI), which causes asafe harbor subroutine378, preferably located within theprogram storage310, to be executed. Additionally, failure or potential failure modes, e.g., low voltage or over temperature conditions, can be used to cause thesafe harbor subroutine378 to be executed. Typically, such a subroutine could cause a sequence of commands to be transmitted to set each microstimulator into a safe condition for the particular patient configuration, typically disabling each microstimulator. Alternatively, the safe harbor condition could be to set certain stimulators to generate a prescribed sequence of drive pulses. Preferably, thesafe harbor subroutine378 can be downloaded from an external device, e.g., the clinician'sprogrammer172, into theprogram storage310, a nonvolatile storage device. Additionally, it is preferable that, should the programmable contents of the program storage be lost, e.g., from a power failure, a default safe harbor subroutine be used instead. This default subroutine preferably stored in nonvolatile storage that is not user programmable, e.g., ROM, that is otherwise a portion of theprogram storage310. This default subroutine is preferably general purpose and typically is limited to commands that turn off all potential stimulators.
• Alternatively, such programmable[0069]safe harbor subroutines378 can exist in the implantedstimulators100. Accordingly, a safe harbor subroutine could be individually programmed into each microstimulator that is customized for the environments of that microstimulator and a safe harbor subroutine for theSCU302 could then be designated that disables theSCU302, i.e. causes theSCU302 to not issue subsequent commands to other implanteddevices100.
• FIGS.[0070]10A and10BD show two side cutaway views of the presently preferred construction of the sealedhousing206, thebattery104 and the circuitry (implemented on one ormore IC chips216 to implement electronic portions or the SCU302) contained within. In this presently preferred construction, thehousing206 is comprised of an insulatingceramic tube260 brazed onto a first end cap forming electrode112avia abraze262. At the other end of theceramic tube260 is ametal ring264 that is also brazed onto theceramic tube260. The circuitry within, i.e., a capacitor183 (used when in a microstimulator mode),battery104, IC chips216, and aspring266 is attached to an opposing second endcap forming electrode112b.A drop of conductive epoxy is used to glue thecapacitor183 to the end cap112aand is held in position byspring266 as the glue takes hold. Preferably, the IC chips216 are mounted on acircuit board268 over which half circularlongitudinal ferrite slates270 are attached. Thecoil116 is wrapped around theferrite plates270 and attached toIC chips216. Agetter272, mounted surrounding thespring266, is preferably used to increase the hermeticity of theSCU302 by absorbing water introduced therein. Anexemplary getter272 absorbs 70 times its volume in water. While holding the circuitry and theend cap112btogether, one can laser weld theend cap112bto thering264. Additionally, a platinum, iridium, or platinum-iridium disk or plate274 is preferably welded to the end caps of theSCU302 to minimize the impedance of the connection to the body tissue.
• An[0071]exemplary battery104 is described more fully below in connection with the description of FIG. 11. Preferably, thebattery104 is made from appropriate materials so as to provide a power capacity of at least 1 microwatt-hour, preferably constructed from a battery having an energy density of about 240 mW-Hr/cm³. A Li—I battery advantageously provides such an energy density. Alternatively, an Li—I—Sn battery provides an energy density up to 360 mW-Hr/cm³. Any of these batteries, or other batteries providing a power capacity of at least 1 microwatt-hour may be used with implanted devices of the present invention.
• The battery voltage V of an exemplary battery is nominally 3.6 volts, which is more than adequate for operating the CMOS circuits preferably used to implement the IC chip(s)[0072]216, and/or other electronic circuitry, within theSCU302. The battery voltage V, in general, is preferably not allowed to discharge below about 2.55 volts, or permanent damage may result. Similarly, thebattery104 should preferably not be charged to a level above about 4.2 volts, or else permanent damage may result. Hence, a charging circuit122 (discussed in the parent application) is used to avoid any potentially damaging discharge or overcharge.
• The[0073]battery104 may take many forms, any of which may be used so long as the battery can be made to fit within the small volume available. As previously discussed, thebattery104 may be either a primary battery or a rechargeable battery. A primary battery offers the advantage of a longer life for a given energy output but presents the disadvantage of not being rechargeable (which means once its energy has been used up, the implanted device no longer functions). However, for many applications, such as one-time-only muscle rehabilitation regimens applied to damaged or weakened muscle tissue, theSCU302 and/ordevices100 need only be used for a short time (after which they can be explanted and discarded, or simply left implanted as benign medical devices). For other applications, a rechargeable battery is clearly the preferred type of energy choice, as the tissue stimulation provided by the microstimulator is of a recurring nature.
• The considerations relating to using a rechargeable battery as the[0074]battery104 of theimplantable device100 are presented, inter alia, in the book,Rechargeable Batteries, Applications Handbook, EDNSeries for Design Engineers, Technical Marketing Staff of Gates Energy Products, Inc. (Butterworth-Heinemann 1992). The basic considerations for any rechargeable battery relate to high energy density and long cycle life. Lithium based batteries, while historically used primarily as a nonrechargeable battery, have in recent years appeared commercially as rechargeable batteries. Lithium-based batteries typically offer an energy density of from 240 mW-Hr/cm³to 360 mW-Hr/cm³. In general, the higher the energy density the better, but any battery construction exhibiting an energy density resulting in a power capacity greater than 1 microwatt-hour is suitable for the present invention.
• One of the more difficult hurdles facing the use of a[0075]battery104 within theSCU302 relates to the relatively small size or volume inside thehousing206 within which the battery must be inserted. Atypical SCU302 made in accordance with the present invention is no larger than about 60 mm long and 8 mm in diameter, preferably no larger than 60 mm long and 6 mm in diameter, and includes even smaller embodiments, e.g., 15 mm long with an O.D. of 2.2 mm (resulting in an I.D. of about 2 mm). When one considers that only about ¼ to ½ of the available volume within thedevice housing206 is available for the battery, one begins to appreciate more fully how little volume, and thus how little battery storage capacity, is available for theSCU302.
• FIG. 11 shows an[0076]exemplary battery104 typical of those disclosed in the parent application. Specifically, a parallel-connected cylindrical electrode embodiment is shown where each cylindrical electrode includes a gap or slit242; with thecylindrical electrodes222 and224 on each side of thegap242 forming a common connection point fortabs244 and246 which serve as the electrical terminals for the battery. Theelectrodes222 and224 are separated by asuitable separator248. Thegap242 minimizes the flow of eddy currents in the electrodes. For this embodiment, there are four concentriccylindrical electrodes222, the outer one (largest diameter) of which may function as thebattery case234, and threeconcentric electrodes224 interleaved between theelectrodes222, with six concentric cylindrical separator layers248 separating eachelectrode222 or224 from the adjacent electrodes.
• Accordingly, a preferred embodiment of the present invention is comprised of an implanted[0077]SCU302 and a plurality of implanteddevices100, each of which contains its ownrechargeable battery104. As such, a patient is essentially independent of any external apparatus between battery chargings (which generally occur no more often than once an hour). However, for some treatment regimen, it may be adequate to use a power supply analogous to that described in U.S. Pat. No. 5,324,316 that only provides power while an external AC magnetic field is being provided, e.g., fromcharger118. Additionally, it may be desired, e.g., from a cost standpoint, to implement theSCU302 as an external device, e.g., within a watch-shaped housing that can be attached to a patient's wrist in a similar manner to thepatient control unit174.
• The power consumption of the[0078]SCU302 is primarily dependent upon the circuitry implementation, preferably CMOS, the circuitry complexity and the clock speed. For a simple system, a CMOS implemented state machine will be sufficient to provide the required capabilities of theprogrammable controller308. However, for more complex systems, e.g., a system where anSCU302 controls a large number of implanteddevices100 in a closed loop manner, a microcontroller may be required. As the complexity of such microcontrollers increases (along with its transistor count), so does its power consumption. Accordingly, a larger battery having a capacity of 1 watt-hour is preferred. While a primary battery is possible, it is preferable that a rechargeable battery be used. Such larger batteries will require a larger volume and accordingly, cannot be placed in the injectable housing described above. However, a surgically implantable device within a larger sealed housing, e.g., having at least one dimension in excess of 1 inch, will serve this purpose when used in place of the previously discussedinjectable housing206. FIG. 12 shows an exemplaryimplantable housing380 suitable for such a device.
• While the invention herein disclosed has been described by means of specific embodiments and applications thereof, numerous modifications and variations could be made thereto by those skilled in the art without departing from the scope of the invention set forth in the claims. For example, a system including multiple SCUs, e.g., one external and one internal, is considered to be within the scope of the present invention. Additionally, while the use of a single communication channel for communication between one or more SCUs and the other implanted devices has been described, a system implemented using multiple communication channels, e.g., a first sonic channel at a first carrier frequency and a second sonic channel at a second carrier frequency, is also considered to be within the scope of the present invention.[0079]

Claims (33)

We claim:

1. A system for monitoring and/or affecting at least one parameter of a patient's body, said system comprising:

at least one implantable device operable to sense and/or stimulate a patient's body parameter in accordance with one or more controllable operating parameters; and

a system control unit for controlling said controllable operating parameters, said system control unit comprising:

a sealed elongate housing configured for implantation in a patient's body;

a signal transmitter in said housing for transmitting command signals;

a signal receiver in said housing for receiving status signals; and

a programmable controller in said housing responsive to received status signals for producing command signals for transmission by said signal transmitter to said implantable devices.

2. The system ofclaim 1 wherein said sealed housing has an axial dimension of less than 60 mm and a lateral dimension of less than 6 mm suitable for injection into the patient's body.

3. The system of claim A1 comprising at least one said implantable device operable as a sensor and at least one said implantable operable as a stimulator and wherein said controller is responsive to status data signals received from said sensor for generating said addressable command data signals to said stimulator to perform closed loop control of the operation of said stimulator.

4. The system ofclaim 1 wherein said system control unit additionally comprises a power source contained within said sealed housing for providing operating power to said data signal transmitter, said data signal receiver, and said programmable controller.

5. The system ofclaim 1 wherein said signal receiver includes a coil responsive to status signals defined by a modulated magnetic field.

6. The system ofclaim 1 wherein said signal receiver includes a transducer responsible to status signals defined by a modulated ultrasonic signal.

7. The system ofclaim 1 wherein said signal transmitter includes means for transmitting command signals in the form of a modulated magnetic field.

8. The system ofclaim 1 wherein said signal transmitter includes means for transmitting command signals in the form of a modulated ultrasonic signal.

9. The system ofclaim 1 wherein said system control unit additionally includes:

at least one electrode;

sensor/stimulator circuitry; and wherein

said sensor stimulator circuitry is configurable to generate a data signal representative of an electrical signal conducted by said electrode and/or supply a sequence of drive pulses to said electrode.

10. The system ofclaim 1 wherein each of said implantable devices includes a power source having a capacity of at least 1 microwatt-hour.

11. The system ofclaim 10 wherein each said implantable device includes means for monitoring status of its power source and said system control unit is configured to transmit command signals to each said implantable device and to responsively receive status signals corresponding to said power source status.

12. The system ofclaim 1 further including:

program storage means in said housing for specifying the operation of said programmable controller; and

means to modify said program storage means in response to signals received by said signal receiver.

13. The system orclaim 12 wherein said program storage means includes means to cause said system control unit to transmit a programmable list of command signals to said implantable devices.

14. The system ofclaim 13 wherein said means to cause said system control unit to transmit a programmable list of command signals includes:

a magnetic sensor for generating a signal responsive to a DC magnetic field; and wherein

said programmable list of command signals is transmitted in response to said magnetic sensor signal.

15. A system control unit configured for implantation in a patient's body for controlling/monitoring the operation of one or more other implantable addressable devices, said system control unit comprising:

a sealed elongate housing;

a data signal transmitter for wireless transmission of command data signals;

a data signal receiver for wireless reception of status data signals;

a controller capable of accepting status data signals from said data signal receiver and sending addressable command data signals to said data signal transmitter in response thereto to control and/or monitor the operation of one or more other implantable devices in accordance with one or more controllable operating parameters;

program storage means for specifying the operation of said controller; and wherein

said data signal transmitter, data signal receiver, said controller, and said program storage means are disposed within said sealed housing.

16. The system control unit ofclaim 15 wherein said sealed housing has an axial dimension of less than 60 mm and a lateral dimension of less than 6 mm suitable for injection into the patient's body.

17. The system control unit ofclaim 15 additionally comprising a power source contained within said sealed housing for providing operating power to said data signal transmitter, said data signal receiver, said controller, and said program storage means.

18. The system control unit ofclaim 15 wherein said data signal receiver includes a coil responsive to a status data signal defined by a modulated magnetic field.

19. The system control unit ofclaim 15 wherein said data signal receiver includes a transducer responsive to a status data signal defined by a modulated ultrasonic signal.

20. The system control unit ofclaim 15 wherein said transmitter includes means for transmitting a command data signal in the form of a modulated magnetic field.

21. The system control unit ofclaim 15 wherein said transmitter includes means for transmitting a command data signal in the form of a modulated ultrasonic signal.

22. The system control unit ofclaim 15 further including means to modify said program storage means in response to signals received by said data signal receiver.

23. The system control unit ofclaim 15 additionally including:

at least one electrode;

sensor/stimulator circuitry; and wherein

said sensor stimulator circuitry is configurable to generate a data signal representative of an electrical signal conducted by said electrode and/or supply a sequence of drive pulses to said electrode.

24. A system for monitoring and/or affecting at least one parameter of a patient's body, said system comprising:

a system control unit positioned outside of the patient's body comprising:

means for providing wireless transmission of command data signals;

means for providing wireless reception of status data signals; and

means capable of accepting status data signals from said data signal receiver and sending addressable command data signals to said data signal transmitter in response thereto to control and/or monitor the operation of one or more implantable devices; and

at least one addressable device configured for implantation in a patient's body responsive to said command data signals, said implantable devices selected from one or more of the following groups:

stimulators having at least one electrode configured to produce an electrical current for stimulating body tissue to affect a parameter of the patient's body; and

sensors having at least one electrode configured to produce a data signal corresponding to an electrical signal conducted by said electrode and representative of a parameter of the patient's body; and wherein

each of said implantable devices includes a power source having a power capacity of at least 1 microwatt-hour.

25. The system ofclaim 24 wherein said implantable devices include:

at least one stimulator and at least one sensor; and wherein

said system control unit is responsive to status data signals received from said sensor for generating said addressable command data signals to said stimulator to perform closed loop control of the operation of said stimulator.

26. The system ofclaim 24 wherein said groups of implantable devices further include transponders for transmitting a data signal related to a command signal received by said transponder.

27. The system ofclaim 24 wherein said implantable devices include:

at least one stimulator, at least one sensor and at least one transponder; and wherein

said system control unit is responsive to status data signals received from said sensor for generating said addressable command data signals to said stimulator to perform closed loop control of the operation of said stimulator.

28. The system ofclaim 27 wherein said status data signal received from said sensor is received via said transponder.

29. The system ofclaim 27 wherein said stimulator is responsive to said command data signals received via said transponder.

30. The system ofclaim 24 wherein said wireless reception means includes a coil responsive to a status data signal defined by a modulated magnetic field.

31. The system ofclaim 24 wherein said wireless reception means includes a transducer responsive to a status data signal defined by a modulated ultrasonic signal.

32. The system ofclaim 24 wherein said wireless transmission means includes means for transmitting a command data signal in the form of a modulated magnetic field.

33. The system ofclaim 24 wherein said wireless transmission means includes means for transmitting a command data signal in the form of a modulated ultrasonic signal.

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