US20080077192A1 - System and method for neuro-stimulation - Google Patents

Abstract

A neuro-stimulation system employs a includes a stimulator which may include electrode devices and/or vibration elements. A controller may be employed to drive the stimulating elements with an electrical signal. In response to the electrical signal, the stimulating elements deliver electrical and/or mechanical stimulation to the body part. The stimulation may be an aperiodic stimulation and/or may be a subthreshold stimulation. In one embodiment, the stimulator is disposable and the processor determines usage of the stimulator and ensures that the stimulator is limited to a certain amount of use. Neuro-stimulation systems may be applied to sensory cells of body parts during movement of the body parts to induce neuroplastic changes. Such movement may involve a variety of therapeutic applications, e.g. in stroke patient therapy.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• This application is a continuation-in-part of U.S. application Ser. No. 10/429,252 filed May 5, 2003, the contents of which are incorporated herein by reference. U.S. application Ser. No. 10/429,252 claims the benefit of U.S. Provisional Patent Application No. 60/377,202 filed May 3, 2002, the contents of which are incorporated herein by reference. This application also claims the benefit of U.S. Provisional Patent Application No. 60/880,026 filed Jan. 12, 2007, the contents of which are incorporated herein by reference.
BACKGROUND OF INVENTION
• 1. Field of Invention
• The present invention is generally directed to a system for providing neuro-stimulation, and more particularly, to a system that employs electrical current and/or mechanical vibration to deliver subthreshold and/or aperiodic stimulation to enhance detection and communication of sensory information.
• 2. Description of the Related Art
• The nervous system of mammals is a complex set of interrelated and interacting sub-systems. The sub-systems are categorized and named both by their anatomic positions and by their function. At the highest level, the nervous system is divided into central and peripheral nervous systems. The central nervous system (CNS) is comprised of the brain and spinal cord; the peripheral nervous system (PNS) subsumes all the remaining neural structures found outside the CNS. The PNS is further divided functionally into the somatic (voluntary) and autonomic (involuntary) nervous systems. The PNS can also be described structurally as being comprised of afferent (sensory) nerves, which carry information toward the CNS, and efferent (motor) nerves, which carry commands away from the CNS.
• Interconnections between afferent and efferent nerves are found in the spinal cord and brain. Taken together, certain groupings of afferent and efferent nerves constitute sensorimotor “loops” that are required to achieve coordinated movements in the face of perturbations from the environment and changes in volitional intent. In the periphery (trunk, upper extremities, and lower extremities), afferent nerves carry sensory information arising from special neurons that are sensitive to pain, temperature, and mechanical stimuli such as touch and vibration at the skin surface, and position, force, and stretch of deeper structures such as muscles, tendons, ligaments, and joint capsule. The term “proprioception” generally applies to sensory information directly relevant to limb position sense and muscle contraction. Combined with tactile (touch) sensation, mechanical sensory information is collectively known as “somatosensation.”
• Specialized “mechanoreceptor” neurons transduce mechanical stimuli from the body's interaction with the environment into electrical signals that can be transmitted and interpreted by the nervous system. Pacinian corpuscles in the skin fire in response to touch pressure. Muscle spindles, found interspersed in skeletal muscle tissue, report on the state of stretch of the surrounding muscle. Golgi tendon organs sense the level of force in the tendon. Free nerve endings in structures surrounding joints (ligaments, meniscus, etc.) provide additional information about joint position. Some of these mechanoreceptor systems are thought to interact directly via excitatory and inhibitory synapses and descending pathways to modulate the performance or interpretation of signals from other mechanoreceptor systems.
• Sensory cells of all types are typically threshold-based units. That is, if the stimulus to a sensory cell is of insufficient magnitude, the cell will not activate and begin signaling. Such a stimulus is called “subthreshold.” A stimulus that is above the threshold is called “suprathreshold.”
• Connections within the nervous system-brain, spinal cord, and peripheral nerves are highly changeable in the face of demands placed on the body. New forms of activity, pathologies, and injuries all can lead to durable changes, both beneficial and deleterious, in the nervous system. In healthy individuals, these neurological changes allow for the acquisition of new physical skills, a process termed “motor learning.” Following certain types of soft tissue injury (e.g. rupture of the anterior cruciate ligament of the knee, a structure known to be rich in mechanoreceptors), and subsequent medical efforts such as surgery used to repair the damage, the nervous system can undergo compensatory changes to accommodate for loss of the natural sensory neurons. Similar PNS and CNS nervous system changes account for some individuals' ability to regain lost motor function following spinal or brain injuries. Taken together, these structural changes in the nervous systems—the creation of new useful interconnections or the pruning away of unused pathways—are termed “neuroplasticity” or “neuroplastic changes.”
• Recent research has established that afferent (sensory) activity from the periphery is one of the key drivers of neuroplastic changes in the nervous system, both in the PNS and CNS.
• Stimulation below perception levels (i.e. subthreshold stimulation) used to enhance the function of sensory cells is described in U.S. Pat. Nos. 5,782,873 and 6,032,074 to Collins, the entire contents of which are incorporated by reference. Collins discloses a method and apparatus for improving the function of sensory cells by effectively lowering their threshold of firing. Briefly, a subthreshold stimulation, or subsensory stimulation or “bias signal,” is input to the sensory neuron thereby predisposing the neuron to firing, without actually causing it to fire. In some embodiments, the stimulation may have an aperiodic waveform. In one particular embodiment, the bias signal is a broadband signal containing many frequencies, often termed “white noise.” Since sensory cells are typically threshold-based units, lowering the sensory cell threshold decreases the level of outside stimulus needed to cause the sensory cell to respond (i.e. fire). Thus, the sensory cell, in the presence of the bias signal, is expected to respond to stimulus intensities that would normally be considered subthreshold to the neuron in the absence of noise. Both electrical and mechanical modalities of bias signal, used individually or in combination, may be used to effect the lowering of sensory neuron detection threshold. In other words, the stimulation essentially energizes sensory neurons based on a principle termed “stochastic resonance” (SR), so that they are predisposed to fire in response to stimuli from the environment. By increasing the sensitivity of mechanoreceptors, it is possible effectively to boost the flow of sensory information traveling from muscles, joints, and skin to the body's control centers in a fashion that is concordant with normal function.
• One exemplary clinical use of increased sensory information is in the rehabilitation of individuals who suffer loss of sensorimotor function following stroke. According to the American Stroke Association, stroke is the leading cause of serious, long-term disability in the U.S., with the annual cost of stroke-related care expected to exceed $58 billion in 2006. Approximately 700,000 cases of stroke occur each year in the U.S. As a result, over 460,000 patients a year are left with motor impairments, the most common of which is hemi-paresis, a weakness or partial paralysis of the body. In addition, a majority of the 5.5 million stroke survivors in the U.S. have some degree of impairment. While many patients improve with current physical rehabilitation therapy, most are left with significant motor deficits. Full recovery from stroke is uncommon. Thus, additional techniques for reversing the motor deficits caused by stroke are necessary. Boosting sensory traffic using the present invention is one such technique. A similar exemplary clinical use is physical rehabilitation for individuals who have suffered traumatic brain injury. Further exemplary clinical uses arise in treatment of individuals who have a temporary or permanent loss of sensory function resulting from aging, disease, or physical injury. For such individuals, the therapy is directed less toward driving neuroplastic changes and more toward providing an ongoing sensory boost as a palliative treatment for a chronic sensory condition.
SUMMARY OF THE INVENTION
• Embodiments of the present invention provide neuro-stimulation systems that deliver stimulation to enhance the function of sensory cells. In view of the foregoing, an exemplary application applies a neuro-stimulation system to reverse the sensorimotor deficits caused by stroke. Focusing on mechanical sensory neurons in the periphery, embodiments of the present invention take advantage of the interplay between mechanoreceptors and neuromuscular performance. These sensory neurons provide touch, motion, and force feedback that is contributes to coordinated movement, acquisition of motor skills, and reestablishing sensorimotor function following injury. As such, embodiments of the present invention apply stimulation to mechanoreceptors to increase their ability to transmit sensory information. The mechanoreceptors receiving stimulation may include, for instance, subcutaneous mechanoreceptors as well as receptors in deeper structures. This stimulation enhances mechanical sensory information provided to the spinal cord and brain.
• A neuro-stimulation system according to an exemplary embodiment may employ a controller which includes a user interface, a power supply, at least one electrical connector, and a processor with software. According to values entered into the user interface, the controller determines an electrical signal directed from the power supply to the electrical connector. The neuro-stimulation system also includes a stimulator detachably coupled to the controller via the electrical connector. The stimulator has a plurality of stimulating elements, including, optionally, at least one electrode device and/or at least one vibration element. The stimulator also includes an attachment element to attach the stimulator to a body part. The controller is operable, via the user interface, to drive at least one of the stimulating elements with an electrical signal, which in turn deliver electrical and/or mechanical stimulation to the body part. The vibration elements and/or electrodes may be driven to deliver stimulation that is subthreshold and/or stimulation that has an aperiodic waveform. In one particular embodiment, the stimulator is disposable and the processor determines usage of the stimulator and ensures that the stimulator is limited to a certain amount of use.
• In an exemplary application, the neuro-stimulation system above is employed adjunctive to movement of a body part. For example, such movement may be employed as a part of post-stroke rehabilitative therapy. By applying stimulation from the neuro-stimulation system in proximity to the region of the body affected by stroke, the neuroplastic process (the creation of new sensorimotor pathways that allow healthy areas of the brain to assume the functions of the damaged portion) is enhanced. This therapy is particularly effective when used in conjunction with physical rehabilitation procedures. As such, preferred embodiments of the neuro-stimulation system may have small, lightweight components which facilitate the application of stimulation during physical therapy and do not interfere with the therapy with wires, connection cables, etc.
• Other embodiments of the present invention may have other configurations and shapes for delivering controlled stimulation to any sensory cells of any body part according to a variety of therapeutic applications. Some embodiments may include only electrodes while others include only vibrating elements for delivering stimulation. For some applications, it may be preferable to include all components of a neuro-stimulation system in a single housing that is applied to the targeted body part. On the other hand, for other applications, it may be preferable to include the stimulator in an application body, i.e., a housing applied to the body part, while the controller has a separate housing which may be placed at a distance from the application body. Moreover, in other embodiments, a neuro-stimulation system may be incorporated within the structure of another distinct device, e.g., a wearable garment, where the application of stimulation improves an operator's ability to use the device or to enhance the effectiveness of the device. In yet other embodiments, stimulator elements (whether strictly electrical, mechanical, or both) may be implanted under the skin of the subject. The controller that is attached to the implanted stimulator elements may itself also be implanted, with connecting means traversing under the skin to the stimulator elements. In addition, the controller may remain extracorporeal with connecting means passing through the skin to the implanted stimulator elements.
• Still other aspects, features, and advantages of the present invention are readily apparent from the following detailed description, by illustrating a number of exemplary embodiments and implementations, including the best mode contemplated for carrying out the present invention. The present invention is also capable of other and different embodiments, and its several details can be modified in various respects, all without departing from the spirit and scope of the present invention. Accordingly, the drawings and descriptions are to be regarded as illustrative in nature, and not as restrictive.
BRIEF DESCRIPTION OF THE FIGURES
• FIG. 1 is a flow chart of a method for enhancing the function of a sensory cell.
• FIG. 2 is a flow chart of a method of locating an input area.
• FIG. 3 is a flow chart of a method of generating a bias signal.
• FIG. 4 is a schematic depiction of a system for enhancing the function of a sensory cell.
• FIGS. 5A-5B illustrates an system for enhancing sensorimotor performance.
• FIG. 6 is illustrates a signal generator of the present invention.
• FIG. 7 illustrates wearable device, as one embodiment of the present invention.
• FIG. 8A-8B illustrate wearable device, as another embodiment of the present invention.
• FIG. 9 illustrates a signal input device of the present invention.
• FIG. 10A illustrates an exemplary embodiment of a neuro-stimulation system, including a stimulator for delivering electrical and/or mechanical stimulation and a controller for driving the stimulator.
• FIG. 10B illustrates the exemplary neuro-stimulation system ofFIG. 10A coupled to an attachment element for securing the neuro-stimulation system to a body part.
• FIG. 11 illustrates a graph of success in executing a motor task versus time for six study groups in a stroke rehabilitation study examining the effects of sensory enhancement stimulation when applied during post-stroke rehabilitative therapy.
• FIG. 12 illustrates yet another graph of success in executing a motor task versus time for the six study groups in the stroke rehabilitation study ofFIG. 11.
• FIG. 13A illustrates the exemplary neuro-stimulation system ofFIG. 10A secured to a subject's arm for use during post-stroke rehabilitative therapy.
• FIG. 13B further illustrates the exemplary neuro-stimulation system ofFIG. 10A secured to a subject's arm for use during post-stroke rehabilitative therapy.
• FIG. 14A illustrates the stimulator of the exemplary neuro-stimulation system ofFIG. 10A.
• FIG. 14B further illustrates the stimulator of the exemplary neuro-stimulation system ofFIG. 10A.
• FIG. 15A illustrates the controller of the exemplary neuro-stimulation system ofFIG. 10A.
• FIG. 15B further illustrates the controller of the exemplary neuro-stimulation system ofFIG. 10A.
• FIG. 16 illustrates the circuit of the exemplary neuro-stimulation system ofFIG. 10A.
• FIG. 17 illustrates an exemplary method for operating the exemplary neuro-stimulation system ofFIG. 10A.
• FIG. 18 illustrates an exemplary method for employing a read-write storage device for limiting use of a disposable stimulator for an exemplary embodiment of a neuro-stimulation system.
• FIG. 19 illustrates a recharging base for the exemplary neuro-stimulation system ofFIG. 10A.
• FIG. 20A illustrates a chart of the spectral content of exemplary mechanical stimulation for an exemplary embodiment of a neuro-stimulation system.
• FIG. 20B illustrates a chart of the spectral content of exemplary electrical stimulation for an exemplary embodiment of a neuro-stimulation system.
• FIG. 20C illustrates a chart of exemplary random noise signal corresponding to stimulation by an exemplary embodiment of a neuro-stimulation system.
• FIG. 21A illustrates an exemplary configuration for a neuro-stimulation system which may be employed to direct stimulation to any sensory cells of any body part to enhance detection of a sensory signal by a subject.
• FIG. 21B illustrates another exemplary configuration for a neuro-stimulation system which may be employed to direct stimulation to any sensory cells of any body part to enhance detection of a sensory signal by a subject.
• FIG. 21C illustrates yet another exemplary configuration for a neuro-stimulation system which may be employed to direct stimulation to any sensory cells of any body part to enhance detection of a sensory signal by a subject.
• FIG. 22A illustrates an exemplary neuro-stimulation system for application to an internal organ.
• FIG. 22B illustrates an exemplary neuro-stimulation system having a catheter-like configuration with a plurality of electrodes, each of which may be selectively driven.
DETAILED DESCRIPTION
• Throughout this specification and the drawing figures associated with this specification, numerical labels of previously shown or discussed features may be reused in another drawing figure to indicate similar features.
• The preferred embodiments of the present invention provide a method and system for improving sensorimotor performance of humans, non-human mammals, and non-mammalian animals, hereinafter termed “subjects.” Improvements in sensorimotor performance are meant to include immediate, i.e., acute, effects, such as improved dynamic joint stability, and more durable effects as would result from neuroplastic changes in the PNS or CNS. The method comprises inputting a bias signal to sensory cells of the subject, so as to improve the function of those sensory cells by effectively lowering their threshold of firing, while the subject engages in physical activity. Such physical activity may or may not be specifically pre-defined depending upon the desired outcome. Acting in conjunction with this preferred method is a preferred apparatus that comprises a wearable device and other electromechanical components that provide a convenient and secure means of delivering the bias signal to the subject. As used herein, the term “bias signal” will be taken to mean a subthreshold form of stimulation to a sensory neuron, whether electrical or mechanical in nature, whose waveform may be periodic, aperiodic, deterministic, or non-deterministic and may contain one or many frequencies.
• The method and system according to the preferred embodiments of the present invention are useful, for example, to enhance sensorimotor function in healthy individuals as well as in individuals with disorders, diseases and/or injuries. For example, the method and system could be used by healthy individuals striving to learn a new motor skill, such as might be required for athletic activity. In another example, the method and system could be applied to individuals with elevated sensory thresholds or other neurological dysfunction, such as might arise from aging, peripheral neuropathies, or strokes.
• FIG. 1 is a flow chart of a method for enhancing the function of a sensory neuron according to one embodiment of the present invention. Instep102, an area associated with the sensory cell whose function is to be enhanced and to which a bias signal is to be input is located. The located area is hereinafter referred to as the input area. Once the input area has been located, the bias signal is generated instep104. Then instep106, the bias signal is input to the input area so as to effectively lower the threshold of sensory cells with which the input area is associated.
• FIG. 2 is a flow chart showing one embodiment of locating an input area according tostep102. Locating the input area depends, inter alia, on the sensory system whose function is to be improved and the method by which a bias signal may be input to sensory cells associated with the sensory system. Step202 is a preliminary step in which an identification scheme is undertaken to identify a particular sensory system whose function is to be enhanced. The identification scheme, to some extent, depends on the cooperation of the individual. That is, this step is similar to a diagnosis, however, the individual need not be suffering from any disease or disorder to be subject to the enhancement process contemplated herein. In one embodiment, the sensory system whose function is to be enhanced is one whose function has been degraded by disease.
• In an alternative embodiment, the sensory system to be enhanced is one that functions normally. Instep204, the most appropriate way of inputting a bias signal to the target sensory system is determined. The most appropriate input means depends on a number of factors including, the target sensory system, the nature of the transduction system for the target sensory system, the present state of the target sensory system (i.e., whether it is impaired or in any way dysfunctional), and the nature of the signal which is to be determined (e.g., the amplitude and frequency content of the signal). Input means that are appropriate in certain circumstances include, but are by no means limited to, nerve cuffs, implanted electrodes, surface electrodes, muscle stimulators, tendon stimulators and magnetic field stimulators.
• Once the most appropriate input means is determined instep204, the input area is determined in step206. The location of an input area depends on the same factors as the determination of the most appropriate input means. The location of the input area, however, varies for a particular input means depending on, among other factors, whether the target sensory system is in any way dysfunctional, the cause and location of any such dysfunctionality, and the nature of the stimulator to be used. More specifically, if a dysfunctionality caused by some physical damage to sensory cells is present in the sensory system, it may be necessary to locate the input area such that the bias signal will bypass the physical damage causing the dysfunctionality. Further, the fact that some stimulators, e.g. implanted electrodes or vibratory elements, may require invasive procedures while others, e.g., surface electrodes or vibratory elements, require only noninvasive procedures is also a factor to consider.
• Once the input area is determined and the input means installed, the bias signal to be input is generated.FIG. 3 shows one embodiment of a method of generating a bias signal. In an initial step302, the bias signal is calibrated. That is, an optimal level for the bias signal is determined. Depending on the determinations ofsteps204 and206, there exists a particular form of bias signal for which the signal detection ability of a given neuron in the target sensory system is optimally enhanced. For example, a bias signal having parameters with certain predetermined values will give rise to optimal enhancement. Calibration helps to ensure that certain parameters of the bias signals generated will be adjusted to achieve optimal enhancement. Examples of signal parameters of the bias signal that may be calibrated are amplitude (whether measured as peak-to-peak, RMS, or some other method), frequency or frequency content (as determined perhaps by signal spectrum analysis), offset (D.C. bias), intensity, and variance (e.g. the computed time-based standard deviation in signal amplitude). Calibration is typically accomplished prior to installation of the enhancement system and may be accomplished intermittently while the enhancement system is installed. If calibration is to take place while the enhancement system is installed, then it is desirable to install the enhancement system so it is accessible from the outside of the body so that calibration may be accomplished noninvasively.
• In one embodiment, the calibration is accomplished by inputting an input signal of interest to a sensory cell coupled with a bias signal produced by the enhancement system. The response of the sensory cell to the combined input is recorded as a function of a parameter of interest in the bias signal. That is, the response of the sensory cell is recorded as a parameter of interest in the bias signal is modulated. Using the recorded results, the coherence between the combined input and the response of the sensory cell is then characterized by computing some measure such as the cross-correlation coefficient described below. The response of the sensory cell is maximally enhanced when the coherence measure is maximized. This maximally enhanced response corresponds to some value or range of values of the bias signal parameter of interest that can be determined by, for example, examining a record of the bias signal. Thus, an optimal value or range of values for the parameter of interest of the bias signal is determined. The process can be repeated using other input signals and parameters of interest thereby determining a bias signal with optimal parameters for input signals with varying parameters.
• According to one embodiment of the present invention, the bias signal is optimized by examining the cross-correlation coefficient, C₁:${\mathrm{<figure-callout\; label="C"\; filenames="US20080077192A1-20080327-D00009.png,US20080077192A1-20080327-D00016.png"\; state="\{\{state\}\}">C</figure-callout>}}_1=\frac{C_0}{\sqrt{\stackrel{\_}{{\mathrm{<figure-callout\; label="S"\; filenames="US20080077192A1-20080327-D00009.png,US20080077192A1-20080327-D00016.png"\; state="\{\{state\}\}">S</figure-callout>}}^2\left(t\right)}}\sqrt{\stackrel{\_}{{\left(R\left(t\right)-\stackrel{\_}{R\left(t\right)}\right)}^2}}}$$\mathrm{where}$${\mathrm{<figure-callout\; label="C"\; filenames="US20080077192A1-20080327-D00020.png,US20080077192A1-20080327-D00021.png"\; state="\{\{state\}\}">C</figure-callout>}}_0=\stackrel{\_}{S\left(t\right)R\left(t\right)}$
  where S(t) is the input signal, R(t) is the output of the sensory neuron or sensory system (e.g., the neural mean firing rate signal or the neural spike train), and the overbar denotes an average over time. S(t) and R(t) can be measured with any appropriate transducers, for example, a needle electrode may be used to measure the output of a neuron. Maximizing C₁corresponds to maximizing the coherence between the input signal S(t) and the neuron's output R(t). The value of C₁for a given input signal will depend upon the parameter of interest of the bias signal. Thus, a bias signal having parameters which will produce the desired output R(t) may be determined.
• The results of the calibration process may be utilized, for example, by modulating the bias signal in response to an input signal or by determining a set of parameter values which, on average, will achieve optimal enhancement for any input signal. In the first instance, parameter values for the bias signal are, for example, tabulated against parameters of the input signal. Upon occurrence of an input signal, certain parameters of the input signal are measured, and a bias signal having corresponding parameter values is generated by, for example, referencing the tabulated results. In this way, the bias signal is modulated or optimized for each particular input signal. In the second instance, a single set of parameter values which will achieve optimal enhancement for most signals is calculated and used to generate a bias signal which is for use in response to every input.
• After the input device has been calibrated and installed, in one embodiment, an input signal to the neuron is detected. As will be explained in conjunction withFIG. 4, one embodiment of a system for enhancing the function of a sensory neuron includes signal detection capabilities, for example, a transducer and signal processor. Thus, instep304, input signals to the neuron are detected using the signal detection capabilities.
• Once an input signal is detected instep304, a bias signal is generated instep306. As explained above with respect to the calibration process, the bias signal has either parameters which are modulated depending on certain parameters of each input signal or a constant, non-modulated, set of parameters which are designed to optimally enhance the function of a sensory cell in response to most input signals. If a bias signal having a non-modulated set of parameters is used, then a somewhat simpler input system is used. In general, the nature of the bias signal to be used, that is, modulated or non-modulated, depends on the nature of the sensory system to be enhanced. Once the bias signal is generated, it is input to the neuron instep106.
• In the embodiments described above, a bias signal is produced only in response to the detection of an input signal to the neuron. In an alternative embodiment, after the input device has been calibrated and installed, a bias signal is continuously generated and input to the neuron. That is, an input signal does not need to be detected. In a method according to this embodiment, the bias signal is either modulated or non-modulated. If the bias signal is modulated, then the continuously generated bias signal is modulated as described above, when an input signal is detected. If a non-modulated bias signal is used in this embodiment, then a simplified input system may be used. As discussed above, whether a modulated or non-modulated bias signal is used depends upon, inter alia, the nature of the system to be enhanced.
• In another embodiment, a distributed enhancement process is used. In this embodiment, the enhancement process described above is modified such that a bias signal is generated and input to neurons at a plurality of locations to stimulate an array of sensory cells and thereby provide a distributed enhancement effect. In this distributed enhancement system, as above, either a continuous or non-continuous, and modulated or non-modulated bias signals may be used. As one example, if the sensory function of the urinary tract is to be enhanced, a bias signal may be input to a number of distributed points around the bladder so that improved fullness sensation is obtained.
• One embodiment of anenhancement system400 for implementing the method for enhancing the function of a sensory neuron is shown inFIG. 4.Enhancement system400 comprises atransducer402, a signal processor404, aninput device408 and acontroller410.Enhancement system400 operates on electrical signals. An input signal to a sensory cell is typically initiated by contact with the outside world which contact is generally not in the form of an electrical signal. An input signal might be initiated by, for example, a touch, a movement of a body segment, a sound wave or light. One function oftransducer402 is to detect input signal initiating contacts and convey the contact toenhancement system400 generally and signal processor404 specifically. Another function oftransducer402 is to convert an input signal initiating contact into a signal in a form that is usable byenhancement system400. The mechanism used fortransducer402 depends on the sensory system targeted. As an example, if the auditory system is being targeted for enhancement,transducer402 may take the form of a stimulating electrode or an array of stimulating electrodes arranged in the vicinity of the ear. As another example, if the proprioceptive system is being targeted for enhancement,transducer402 is a tendon stimulator, implemented by way of a piezoelectric transducer, installed or attached via elastic straps to a tendon or parent muscle associated with the sensory cells whose function is to be enhanced. As still another example, if the vibration or touch-pressure sensation system is being targeted for enhancement,transducer402 is a surface electrode installed or applied over the skin of the area of the body containing the cells to be stimulated. Such an electrode is attached using flexible electrode/skin interfaces.
• Signal processor404 produces a bias signal to be input to the sensory system targeted for enhancement throughinput device408. Signal processor404 is electrically connected totransducer402,input device408 andcontroller410. As discussed above, a bias signal may be either continuous or non-continuous and modulated or non-modulated. The form of signal processor404 depends upon the desired form of the bias signal to be produced. In one embodiment, where a non-continuous, modulated bias signal is desired, signal processor404 preferably includes both signal detection capabilities and look-up table capabilities to store parameter values for the bias signal. In another embodiment, where a constant, non-modulated bias signal is desired, signal processor404 does not necessarily require signal detection capabilities and look-up table capabilities. In one embodiment, signal processor404 is either a special function IC or a general micro-processor and is preferably small, lightweight and portable. Further, signal processor404 preferably includes signal conditioning and data acquisition abilities. In one embodiment, a PCMCIA chip or card is used as signal processor404.
• Signal processor404 also includescalibration module406.Calibration module406 enables adjustment of the bias signal produced by signal processor404. For example, for optimal enhancement, signal processor404 produces a bias signal having predetermined parameters (for example, a predetermined amplitude and frequency) in response to a particular signal received fromtransducer402. If these predetermined parameters of bias signal are not properly adjusted, the bias signal will not optimally enhance the function of the targeted sensory system.Calibration module406 enables these predetermined parameters to be adjusted so that an optimal bias signal is produced. Calibration is typically accomplished prior to installation ofenhancement system400 and may be accomplished intermittently whileenhancement system400 is installed. If calibration is to take place whileenhancement system400 is installed, then it is desirable to install signal processor404 so it is accessible from the outside of the body so that calibration may be accomplished noninvasively. In an alternative embodiment, signal processor404 is provided with remote access capability enabling calibration to take place noninvasively whether or not signal processor is accessible from outside of the body.
• Input device408 conveys the bias signal produced by signal processor404 to the targeted sensory system. Depending on what the targeted sensory system is,input device408 might take a number of different forms as discussed above. Input devices that are appropriate in certain circumstances include, nerve cuffs, implanted electrodes, surface electrodes, muscle stimulators, tendon stimulators, and magnetic field stimulators. The manner in whichinput device408 conveys the bias signal to the targeted sensory system depends on the form ofinput device408 and the targeted sensory system. For example, a nerve cuff or implanted electrode is suitable for use when the urinary tract is the targeted sensory system and is typically implanted surgically and conveys the bias signal to the sensory components of the system. A muscle or tendon stimulator, on the other hand, is more suited to mechanically stimulate the proprioceptive system. Such a stimulator mechanically stimulates the proprioceptive system by vibrating a muscle or tendon associated with that system, for example a muscle in the vicinity of a joint. Muscle or tendon stimulators can be applied noninvasively using, for example, an elastic band. In one embodiment, where the targeted sensory system is the vibration or touch-pressure sensation system, a surface electrode-based system is used asinput device408. Specifically, the glove electrode, the sock electrode, and the sleeve electrode, sold under the name ELECTRO-MESH™ may be used asinput device408. The surface electrode system is placed over the body part of interest, e.g., the hand or foot. Still further,input device408 may be a magnetic field stimulator used either noninvasively or invasively. For example, a magnetic field stimulator may be used to stimulate cutaneous sensory neurons by positioning the stimulator on the exterior of the body in the vicinity of the sensory cells to be stimulated using elastic bands. A magnetic field stimulator may be used invasively, for example, by surgically implanting the stimulator to stimulate sensory neurons in the area of the bladder.
• Controller410 controls interaction betweentransducer402, signal processor404 andinput device408. The implementation forcontroller410 depends upon, among other things, the form of bias signal desired. That is, where a non-continuous, modulated bias signal is desired,controller410 may be implemented using a microprocessor. In a simpler embodiment, where a continuous, non-modulated bias signal is desired,controller410 may be implemented using a switch that simply activates the enhancement signal. Alternatively, signal processor404 may be adequate, so thatcontroller410 is unnecessary for such an embodiment. By way of example only,controller410 comprises a microprocessor with suitable programming, or any digital controller. In one embodiment,controller410 is implemented with the aforementioned PCMCIA chip or card.
• The nature and amplitude of the bias signal is controlled in accordance with the type of sensory cell to which the bias signals are applied. Repetitive waveform, pulse or DC signals of the type typically used for other types of injury treatment (e.g. pain suppression, bone healing) are often be avoided in the practice of the present invention, as sensory cells can adapt to simple deterministic signals thereby reducing or eliminating over time the effect of such signals on the sensory cells. Instead, in accordance with the invention, non-deterministic noise signals, such as random, aperiodic noise signals, or recorded repetitions of noise signals are preferably used, so that the sensory cells do not adapt to the noise signals over the extended period of noise signal application that occurs during a physical training regimen. These signals can be continuously generated signals such as those created by known instruments, including a computer random number generator, a noise diode, or thermal noise from a resistor or other electrical component. Sampled signals, such as signals stored in a storage device (RAM, ROM, etc.), or periodically recorded noisy signals, may also be employed.
• The sensory cell areas containing neurons to be affected by bias signals may be found at different depths in the human body, causing different signal transmission filtering characteristics to exist between certain of the sensory cells and the signal input device. In a preferred embodiment, the bias signal can be combined with other signal types to overcome this problem. For example, a chirped signal can be formed by overlaying a noise signal with a swept frequency signal that regularly sweeps through a signal frequency range. This combined signal may be tailored to permit the amplification of frequency ranges that are normally attenuated by transmission in the body. Thus, the signal is compensated at the skin-surface level for expected attenuations that would occur prior to it reaching the target sensory cell. This technique might also be used to reduce the effort required to determine an efficacious signal since it might contain all desired frequency ranges.
• Another method of the present invention involves enhancing various neurophysiologic functions by applying an externally produced bias signal to a sensory cell area, as described above, while the subject is performing a pre-defined physical activity. Neurophysiologic functions enhanced by this method of the present invention include, for example, limb position sense enhancement, increase release of growth hormones, enhanced peripheral neuroplastic changes, and enhanced central, including cortical, neuroplastic changes.
• Most physical training regimens are undertaken to induce, among other things, motor learning, i.e. the acquisition of new motor skills or the regaining of motor skills that have been lost due to injury or disease. To achieve the aforementioned sensorimotor performance enhancements, while a subject performs a specified physical activity bias signals are applied to sensory cells involved in the specific physical activity to lower the threshold at which such cells are triggered by the external stimuli resulting from the activity. By making the sensory cells more responsive, the number of action potentials produced for any given amount of external stimuli is increased, thereby improving the rate and/or quality of motor learning resulting from the activity.
• Coordinated motion of the extremities, for example, requires precise interplay between descending volitional signals from the brain, muscle contraction, limb movement, and interaction with the environment. This tight control is reliant, in part, on sensory feedback of a mechanical nature from the extremities involved in the motion. Somatosensory information, e.g. tactile information from foot sole and proprioceptive information from knee joint, is clearly important both to normal gait and to more vigorous activities such as jumping and landing. The method of the present invention is effective to boost coordinated sensory information from the mechanoreceptors involved in limb position sense during movement of the extremities. This added information content during movement provides a means for improved sensorimotor control. Such improvements result in enhanced balance, corrected gait patterns, and prevention of injuries by avoiding, for example, hyperextension of joints.
• In one embodiment of the invention, a bias signal is provided during a training regimen to a plurality of structures that participate in stability of a joint in a subject, to thereby promote joint sensation and feedback to enhance stability in the subject. For example, at least one input device, e.g. an electrode, can be placed at or near the articular space such that sensory cells in or adjacent to the ligaments, the joint capsule and meniscus, are stimulated. The bias signal is provided at a level below the perception threshold of the sensory cells associated with the structures as well as below the cutaneous pain threshold.
• In another preferred embodiment, the bias signal can be provided to at least two structures that maintain joint stability and are on opposite sides of the joint such that the performance of the sensory cells contained in these structures are enhanced. Preferably, a bias signal is provided at or adjacent to the joint and at least two different antagonist muscles on opposite sides of a joint where the action of these muscles determines the relative flexion and extension of the joint.
• The bias signal can be provided simultaneously to each of the structures or it can occur sporadically at each of the structures. Preferably, the bias signal is repeatedly provided to each of the structures, e.g., the bias signal is repeated such that the bias signal is simultaneously provided to each of the structures or the bias signal is repeated such that the bias signal is sporadically provided to each of the structures a plurality of times.
• Specific bias signal ranges are applicable to specific types of bias signals used in accordance with this invention. For example, electrical signals are preferably applied within a current density range of about 1 μA/in²to about 1000 μA/in²and a frequency range of about 0 Hz to about 10,000 Hz the skin surface of a recipient. Mechanical signals preferably have a displacement at the skin surface within the range of about 1 μm to about 10 mm and frequencies within the range of about 0 Hz to about 1000 Hz. Mechanical signals can be remotely controlled by providing mechanical actuators on the skin surface that receive remotely generated waveform signals from a remote transmitter and convert these signals to mechanical signals. In wireless systems, electrical signals can also be transmitted from a remote transmitter to electrodes that apply electrical signals to a subject. All bias signals are preferably designed to allow for complex constructive and/or destructive patterns.
• Naturally-occurring growth hormones, as another example, are released in humans by the pituitary gland. These hormones are part of the body's system of changing the architecture of muscle and bone in response to changes in activity. For example, increases in muscle bulk in response to exercise are partly caused by increased amounts of circulating growth hormone in the body. Recent research has established that afferent signals from the periphery, specifically those arising from muscle, spur release of specific types of growth hormone from the pituitary (McCall, et al., 2000). In accordance with the present invention, sensory feedback neurons are made more active by applying bias signals to lower the sensory cell threshold during a physical training regimen. For example, sensory information from muscle spindles that boost release of growth hormone in response to activity is increased. This is especially beneficial to individuals, e.g. strength trainers, working to regain muscle bulk and bone integrity following trauma or prolonged periods of inactivity. In some cases, the increase in growth hormone release may be sufficient to eliminate the need for growth hormone replacement therapies and the need for growth hormone supplements.
• Interconnections and efficiency of sensorimotor pathways in the periphery are a manifestation of the acquisition of new motor skills. That is, a key result of training and practice is the creation of these new pathways. Indeed, even increases in strength are due as much to neurologic changes as to increases in muscle mass, especially early in strength building regimens. Recent research has shown that afferent activity spurs the creation of new synapses (“synaptogenesis”), one of the underlying neurophysiologic processes of peripheral neuroplasticity (Wong, et al., 2000). Applying bias signals to an input area in accordance with the method of the present invention increases information-rich sensory traffic from the periphery drives neuroplastic changes in the periphery. A common perception of strength training is that it involves only muscularity, and that neurology is not a consideration. In actuality, neurological factors are central to the development and maintenance of muscular strength. In the initial stages of a strength training regimen, muscle mass does not increase significantly but strength does as a result of the neuromuscular learning process. By applying bias signals to an input area in accordance with the method of the present invention, the time for completing this process is significantly reduced by lowering the threshold for the sensory cells involved during this stage of the strength training. As a result, information-rich traffic from the periphery drives neuroplastic changes in the periphery that, among other things, increases the rate by which muscle mass formed.
• Strength training performed in accordance with the present invention is also effective in enhancing crossover strength changes in human appendages such as the arms or the legs. Strength training research has shown that when only one appendage is subjected to a strength training regimen, the strength of the untrained appendage increases to some degree. Thus, if one appendage is immobilized by a cast or brace, the strength of the immobilized appendage can be enhanced by using the method of the present invention to lower the sensory cell thresholds in the opposite appendage during a strength training regimen for the opposite appendage.
• Many athletic training programs are directed to the improvement of balance that is required when weight is rapidly transferred from side to side. Balance enhancement training regimens have included prolonged repetitive side-to-side motion to promote motor learning that results in enhanced balance. Again, in combination with this side-to-side training regimen, the present invention involves lowering affected sensory cell thresholds during the training to achieve with greater rapidity enhanced balance.
• Moreover, both normal acquisition of new motor skills, and the process of regaining motor skills following injuries such as stroke, rely on the elimination and creation of new connections throughout the sensory and motor cortices. Recent research has established that sensory activity from the periphery is one of the underlying drivers of these beneficial neuroplastic changes in the brain (McKay, et al., 2002). Applying a bias signal to an input area in accordance with the method of the present invention also increases afferent traffic thereby accelerating the improvement of motor skills.
• FIGS. 5A-5C, illustrate one preferred system for applying input signals in accordance with the method of the present invention as applied during a physical training regimen. The system comprises alower extremity garment500 that extends from the waist of a user down both legs. Abelt502 secures the garment at the waist while foot straps504 which extend beneath the user's feet hold the garment snugly against the body during lower body motion. Foot straps are preferably composed of neoprene or other known elastic material.Garment500 preferably includes a plurality of belt straps506 positioned circumferentially around the waist section of thegarment500. The loose ends of straps506 fold overbelt502 and attach togarment500 via Velcro or other known fastening means to, in effect, form a belt-loop that securely retainsbelt502 at waist level.
• Garment500 is designed for the application of input signals at and below the knee. Consequently, the legs of the garment have closures508 that permitinput device510 to be positioned at selected positions relative to the knee, calf and/or lower leg muscles while also being maintained in place togarment500.External caps511 clip through the garment and ontoinput device510, so as to securely holdinput device510 in place.Signal input devices510, therefore, can be placed at virtually any position on the garment as necessary for various applications and to accommodate the anatomy of the subject. To fitgarment500 to a user,input devices510 are first placed on the skin of a user relative to specific muscles, joints, etc.Garment500 is then carefully donned overinput devices510 andexternal caps511 are clipped throughgarment500 to holdinput devices510 in place.Garment500 is preferably formed of neoprene or any known stretchable material that enables the garment to closely conform to the subject and securely hold theinput devices510 securely against the subject's skin to prevent displacement of theinput devices510 during the prolonged motion involved in an exercise regimen.
• Cables512 electrically connect theinput devices510 to asignal generator514.Signal generator514 provides power to inputdevice510 on the inner surface of the garment so that changes in the position of the electrodes can be adjusted within the area ofinput devices510.Cables512 are preferably secured togarment500 such that there are no loose cables to impede body movement. In a preferred embodiment,cables512 extending fromsignal generator514 are secured within side pockets516 ofgarment500.Cables512 extend through pockets516 into a conduit520 that extends downward along the leg portions ofgarment500. Conduit520 branches into multiple conduits at knee level, so as to accommodateinput devices510 positioned at various positions on and about the lower leg.Input devices510 can be attached at any position along the length ofcables512. A cable guide522 made of plastic or similar material surround conduit520 so as to maintain the opening of conduit520 into pocket516. The conduit opening maintained by cable guide522 allowscable512 to be fed into and out of the length of conduit520 with considerable ease.
• Cable512 is preferably of sufficient length to permitcontroller514 to slide from the side ofbelt502 to the back of thebelt502. Thus,signal generator514 can be repositioned at various positions alongbelt502, so as not to restrict movement required by specific exercises.Signal generator514 can also be worn at other locations or hand held. Generally, the placement ofsignal generator514 is determined based upon location of the joint to be stabilized, the comfort of the subject and/or the ease of motion by the subject. To eliminatecables512,signal generator514 may include one or more wireless transmitters operative to transmit signals to signalgenerator514 and/orinput devices510.
• Signal generator514, as shown inFIG. 6, includes a signal processor404, acontroller410, control dials606, a display608, atest button610, and aninfrared port612. Display608 shows graphic information that is of interest to the user or clinician such as current stimulation program, remaining battery life, stimulation levels, active channels, errors etc. Infrared port612 (or wireless or cabled, etc.) provides a link to a computer station that permits the downloading of custom stimulation patterns and waveforms.Test button610 permits the confirmation of appropriate controller function. Controls dials606 are operative to vary the amplitude of the noise signals provided to thesignal input devices510 so as to maintain the signals below the threshold level of the sensory cells targeted, as well as below the subcutaneous threshold level. The electrical current density at eachsignal input device510 is determined by the current amplitude and the size of the electrode. The current density must be maintained within an acceptable range. In the case of electrical stimulation, channels may be electrically isolated from one another or may share a common ground.
• Input devices510 can apply, through the skin, input signals to the structure associated with joint orientation. As earlier noted, theinput devices510 in the garment can be surface electrodes, muscle stimulators, tendon stimulators, and magnetic field stimulators, vibratory stimulators, e.g. small electromagnetic rotary motors or flat motors (i.e. pancake motors), piezoelectric actuators, ferrofluid magnetic actuators, or electrorheologic actuators, or other known signal input device The signal input devices are appropriately sized and arranged to localize stimulation to a desired structure. For example, knee electrodes and actuators are sized as to not impede or restrict motion and to limit (target) the stimulation to the sensory neurons of interest.Signal generator514 can be programmed to vary the intensity and timing of the signals. For example, when more than oneinput device510 is used, the location and polarity of the signals can be varied. Similarly, the stimulation can simultaneously occur at each ofinput devices510, or the stimulation can occur sporadically between each ofinput devices510. The power and frequency of stimulation can also be controlled. The signal is at a level below the perception threshold of sensory cells associated with the various structures that play a role in the joint's stability. Thus, the signal is at a level below that required to trigger the sensory cells in those structures.
• The level of the signal supplied bysignal generator514 may also be enough to stimulate other cells that are located in structures not directly involved in joint stability. For example, sensory cells within the skin may perceive a signal supplied through aninput device510 placed upon the skin, but the level is still below the threshold required to stimulate the sensory cells of the structure, e.g., such as the hamstring below the skin, which is associated with the stability of the knee joint. Such low level signals are described in Collins et al., U.S. Pat. No. 5,782,873.
• In another preferred embodiment, provided is astructure700 for placingsignal input devices510 in contact with the subject's skin, as shown inFIG. 7. A plurality ofarms704 extend fromcentral hubs708 which, whenstructure700 is properly worn, are positioned on opposite sides of the joint of interest. The portion ofarms704 immediately adjacent to thecentral hubs708 is composed of an expandable material, e.g. rubber.Arms704 are preferably biased inwards inward to a degree, such as to securely engage the leg whenstructure700 is positioned on the extremity.Arms704 also include a plurality ofinput devices510 positioned such that whenstructure700 is properly positioned on the extremity,input devices510 are positioned on those areas of the leg where the bias signal is to be applied in accordance with the method of the present invention.
• At least one of thearms704 includes acable outlet706 that is electrically wired to each ofinput devices510.Outlet706 accommodateselectrical connector702 ofcable512 such that when the other end ofcable512 is connected to signalgenerator514, an electrical connection is established betweensignal generator514 andinput devices510.Cable512 is preferably composed of a stretchable and strain resistant material to reduce the likelihood ofcable512 becoming detached fromoutlet706 orsignal generator514 during use.
• In another aspect of the invention, provided is ajoint covering structure800, as shown inFIGS. 8A-8B on a knee joint, having a plurality ofinput devices510, and preferably asignal generator514, incorporated into or positioned thereon.Input devices510 are positioned so as to engage the appropriate combination of muscles and joints to which the bias signal is to be applied in accordance with the method of the present invention.Joint structure800 is preferably designed to wrap around the joint and fasten upon itself by Velcro or other known fastening means. Alternatively,joint structure800 can be configured to slide onto and off of the joint.Joint structure800 is preferably made of fabric, but can also be made of plastic, rubber, or other material, as long as at least a portion of the structure is made of a flexible material which allows theinput devices510 to remain in place during the flexing and extending of the joint. As illustrated, the ridgedportion802 ofstructure800 is comprised of thicker material capable of assistively bracing the joint. Athinner portion804 ofstructure800 is positioned over the joint so as to allow bending of the joint without displacing theinput devices510.
• In another aspect of the invention, provided is anelectrode applicator900, as shown inFIG. 9, which provides a means to customize the position of, or distance between, signal input devices510 (e.g. skin surface electrodes) for a subject receiving treatment in accordance with the method of present invention. Areas of flexible, electricallyconductive layer902, such as conductive rubber, provide an electrically conductive means betweenwires908 and signalinput devices510. Covering and surrounding theconductive layer902 on the outer surface of the structure is a nonconductive material904. These two layers of conductive902 and non-conductive materials904 are permanently affixed to one another. Also coveringconductive layer902 on its inner, or skin surface, side is anon-conductive film906 which is removably affixed to theconductive layer902. By removingnon-conductive film906, the inner surface ofconductive layer902 is exposed, allowing asignal input device510 to be affixed to theconductive layer902.Non-conductive film906 is scored or otherwise segmented in a pattern which allows for portions of thenon-conductive film906, rather than the entire film, to be removed. In this way, the majority of theconductive layer902 remains covered by thenon-conductive film906 during use.Signal input devices510 are composed of a thin, electrically conductive material, such as hydrogel, that provides the electrical interface between theconductive layer902 and the subject's skin.
• The apparatus used for performing the method of the present invention is unique relative to known units used for improving sensorimotor performance (e.g. motor learning) or the treatment of injuries and rehabilitation from the effect of an injury. In such known units, electrodes are mounted on braces or wraps and include free, untethered electrical conductors, all of which will inhibit the motion required for the performance of an effective physical training regimen.
• While the above illustrated embodiments are directed to pants, a joint stabilizer, and a brace, the term wearable device as used herein, refers to any structure capable of holdinginput devices510 in place at a desired location.
• The embodiments described herein have been shown as a lower body wearable device for illustrative purposes only. Similar embodiments capable of holding signal input devices in place that are designed to the upper body including the arms and torso of an individual, are within the spirit and scope of present invention. The upper body wearable device may be combined with the lower body wearable device to permit input devices to be positioned and operated simultaneously along both the upper and lower body in accordance with the method of the invention.
• Referring now toFIGS. 10A and 10B, a noninvasive, surface neuro-stimulation system2000 is illustrated. The neuro-stimulation system2000 may be applied to a patient non-sterilely and in an in-patient/out-patient setting. As shown, the neuro-stimulation system2000 employs astimulator2100 and acontroller2200, which may be detachably coupled to each other. Thestimulator2100 is placed into contact with a body part of a subject, or patient, to deliver electrical current and/or mechanical vibration. Thecontroller2200 is operated to control the delivery of the electrical current and/or mechanical vibration through thestimulator2100 according to the neuro-stimulation therapies described herein.
• Advantageously, embodiments, such as the neuro-stimulation system2000, enable the simultaneous use of electrical current and mechanical vibration to provide neuro-stimulation. In particular, the application of both electrical and mechanical stimulation provides broader targeting of mechanoreceptors. Electrical stimulation and mechanical stimulation reach different mechanoreceptors. For example, electrical stimulation may reach structures that lie deeper below a body part surface, while mechanical stimulation may reach structures that lie closer to the surface. A further unexpected benefit of applying both types of stimulation over the exclusive application of either electrical stimulation or mechanical stimulation is that all receptors are consistently activated during stimulation, and the body does not become confused by the activation of some receptors over other receptors in a particular sensory cell area.
• Scientists and clinicians working in the field of stroke rehabilitation have established the critical link between mechanical sensory information (touch, pressure, and joint angle sense) produced during rehabilitation activities and the restoration of brain function. As such, in a preferred application, the neuro-stimulation system2000 may be applied to rehabilitate stroke patients. Demonstrating the utility of such an application, a study in stroke rehabilitation was performed in an established animal model (developed by Dr. Jeffrey Kleim at the University of Florida).
• The animal model used in the study reliably reproduces strokes in the motor cortex, so that post-stroke recovery of function may be quantified during a rehabilitation period. This model generally provides an excellent test-bed for comparing putative therapeutic interventions, which may include techniques, devices, or drugs. In this animal model, during a pre-stroke period which typically spans about 10 days, rats are trained to perform a task and they are graded according to their ability to perform the task. For example, the task may require the rats to reach around an obstacle to obtain food, and the rats are graded according to their proficiency, or accuracy, in reaching for food. At the end of the specified pre-stroke period, the rats are given a stroke in the motor cortex, and their task proficiency is measured over a period of several days after the stroke. According to clinicians, this animal model produces behaviors that are similar to those that the clinicians typically observe in stroke patients undergoing rehabilitation.
• In this study, sensory enhancement stimulation was employed during rehabilitation to demonstrate that sensory enhancement stimulation improves neuroplasticity, or the formation of lasting functional changes in the brain. Using sixty animals in six treatment groups (including controls), the study tested whether sensory stimulation used in conjunction with physical rehabilitation would improve the reacquisition of skill versus rehabilitation without such stimulation. Stimulation below the sensory or motor threshold was delivered during rehabilitation sessions through implanted electrodes. Furthermore, three different stimulation amplitudes (RMS) were tested.
• The charts ofFIGS. 11 and 12 present the resulting data for the six study groups in the study: a control group (no stroke), a group receiving no rehabilitation, a group receiving rehabilitation without stimulation, and three groups S1, S2, S3 receiving rehabilitation with three different amplitudes of stimulation, respectively. The charts indicate that the application of sensory enhancement stimulation in the study significantly accelerated and improved the endpoint in the reacquisition of skill when compared to rehabilitation without stimulation.
• Accordingly, the neuro-stimulation system2000 provides a tool for delivering sensory enhancement stimulation for improved stroke rehabilitation. For example,FIGS. 13A and 13B illustrate the application of the neuro-stimulation system2000 to two respective location on a subject's arm for use during rehabilitative therapy. The neuro-stimulation system2000 may be fitted with anattachment element2500, such as the arm band also shown inFIG. 10B, that enables the neuro-stimulation system2000 to be secured to the subject's arm as illustrated inFIG. 13. Of course, the neuro-stimulation system2000 may employ other attachment elements and may be applied to other parts of the subject's body which may require rehabilitation.
• FIGS. 14A and 14B show an embodiment of astimulator2100. Thestimulator2100 has one ormore contact areas2102A and2102B which are placed into contact with selected sites on the subject's body, and electrical and/or mechanical stimulation is delivered to the selected sites. As illustrated inFIG. 14A, thestimulator2100 may be formed from laminated layers2104, such as bonded layers of polycarbonate or the like, which can conform to a body part and enable sufficient contact with the selected stimulation sites.
• In the particular embodiment shown inFIGS. 14A and 14B, thestimulator2100 has a generally elongate shape with twocontact areas2102A and2102B at opposing ends. As illustrated in detail inFIG. 14B, thecontact area2102A is positioned at the end of anarm2104A that is approximately 7.5 inches long, while thecontact area2104B is positioned at the end of anarm2104B that angles from thearm2104A by approximately 15 degrees and is approximately 5.5 inches long. Moreover, thecontact areas2102A and2102B are substantially circular with diameters of approximately 1.5 inches. As such, the shape shown inFIG. 14B accommodates application of thestimulator2100 to a subject's arm as shown inFIG. 13. In general, however, astimulator2100 in other embodiments may have a shape that best accommodates its application to a particular body part, and thus the shape is not limited to the examples described herein.
• Preferably, thestimulator2100 employs at least oneelectrode device2110 and at least onevibration element2120 for delivering electrical and mechanical stimulation, respectively. As such, in the embodiment ofFIGS. 14A and 14B, each of thecontact areas2102A and2102B haselectrode pair2110 and avibration element2120. Theelectrode device2110 refers to a source electrode and return electrode for electrical stimulation, although the source electrode and return electrode may be a part of an integral structure, or, alternatively, parts of separately applicable structures.
• Theelectrodes2110 may be screen-printed carbon and may be electrically connected to the stimulation site via a medical grade conductive hydrogel, such as a polyarylacetylene (PAA) hydrogel or similar material with biocompatibility data for skin contact. Preferably, electrical signals from theelectrodes2110 are only conducted through thecontact areas2102A and2102B in contact with the stimulation areas. In the embodiment ofFIGS. 14A and 14B, the electrodes at eachcontact area2102A and2102B may have a diameter of approximately 1.25 inches.
• Additionally, adhesive may be employed on portions of thestimulator2100 to secure thestimulator2100 to the subject's body and position the contact areas2102 at the selected stimulation sites. For example, a thin adhesive ring surrounding the gel at the contact areas2102 may be employed to aid in securing the contact areas2102 to the stimulation sites. A medical grade double sided adhesive with biocompatibility data for skin contact may be employed. In general, the adhesive properties of thestimulator2100 as well as the supporting connection to thecontroller2200 is adequate to support thestimulator2100. Advantageously, the neuro-stimulation system2000 also stays attached to the patient during therapy. In some cases, medical tape may be employed to aid in support. However, it is noted that the use of adhesive required to support thecontroller2200 entirely may be too aggressive especially for the fragile skin of elderly patients. Thus, the use of anattachment element2500, such as an arm band, may be preferred. A release liner (not shown) may be employed on the contact side of thestimulator2100 to cover the hydrogel and adhesive and to ensure clean contact surfaces before application of thestimulator2100 to the subject.
• Thevibration elements2120 may be piezoelectric elements and may be mechanically coupled to the subject via the gel and surrounding adhesive. In the embodiment ofFIGS. 14A and 14B, thevibration elements2120 at eachcontact area2102A and2102B may have a diameter of approximately 1.25 inches and a maximum thickness of approximately 0.03 inches. Thevibration elements2120 may include two piezoelectric elements mounted side-by-side, and may be formed from lead zirconium titanate (PZT) mounted on a nickel plate.
• Operation of theelectrodes2110 and thevibration elements2120 is achieved through acircuit2130. As shown inFIGS. 14A and 14B, aflex circuit2130 is routed throughout thestimulator2100 to connect theelectrodes2110 and thevibration elements2120 to thecontroller2200. For example, theflex circuit2130 may employ low resistance silver (Ag) or silver/silver chloride (Ag/AgCl).
• Additionally, thestimulator2100 may employ an internal electrically-erasable read-write memory device2140, such as an EEPROM, which is connected to theflex circuit2130. Theflex circuit2130 provides power, ground, and signals to thememory device2140. Thememory device2140 records and stores data on the operation of thestimulator2100. As described further below, thecontroller2200 may write data to thememory device2140 when thestimulator2100 is coupled to thecontroller2200.
• In some cases, to ensure the proper functioning of eachstimulator2100, thestimulator2100 may have a specified shelf life, e.g. one year. In addition, thestimulator2100 may be limited to a single use, after which it must be discarded. Furthermore, to prevent overuse during a single application, eachstimulator2100 may have a specified stimulator life, e.g. three hours, which sets the maximum amount of time thestimulator2100 may be used during the single use. In one embodiment, thecontroller2200 may be employed to prevent repeated use of thestimulator2100 and to track the stimulator's total amount of use against the specified stimulator life. In particular, as described further below, thecontroller2200 may store usage data regarding the use of a stimulator in thememory device2140.
• While thestimulator2100 may be limited to a single use and a maximum usage time on the order of a few hours, thecontroller2200 may have a significantly longer life. For example, the design life for thecontroller2200 may be approximately four years, with annual battery replacement. As such, thecontroller2200 is generally reusable. On the other hand, due to the limits on its use, asingle stimulator2100 is disposable and not reusable. Therefore, asingle controller2200 is typically used with a plurality ofstimulators2100.
• Thestimulator2100 has aconnector2150 that enables thestimulator2100 to be detachably coupled to thecontroller2200. Electrical signals may be sent and/or received via theconnector2150. As such, theconnector2150 connects theflex circuit2130 to thecontroller2200. In the embodiment ofFIGS. 14A and 14B, theconnector2150 may be an n-pin connector, e.g. 9-pin connector, approximately 1 inch long.
• As shown inFIG. 15B, thecontroller2200 has aconnection port2250 which correspondingly receives, or engages, theconnector2150 of thestimulator2100. For example, theconnection port22 may receive the nine pins for theconnector2150 shown inFIG. 15B. Through this connection with thestimulator2100, thecontroller2200 may control the delivery of electrical and/or mechanical stimulation by thestimulator2100.
• FIGS. 15A and 15B show that thecontroller2200 has ahousing2202 which is defined by the assembly of afront housing section2204 and aback housing section2206. Thehousing sections2204 and2206 may be molded from a material such as acrylonitrile butadiene styrene (ABS) or the like. In the embodiment ofFIGS. 15A and 15B, thecontroller2200 may have overall dimensions of approximately 3.5″×2.5″×1.25″ and may have an overall weight of approximately 100 g. As such, thecontroller2200 is sufficiently lightweight and compact for easy application, as particularly shown inFIG. 13.
• FIG. 15A illustrates auser interface2210 positioned on a side of thefront housing section2204. Theuser interface2210 may include agraphic display2212 for presenting operational information to a user and input controls, such as a light-touch membrane keypad2214, for receiving operational instructions from a user.
• In particular, thegraphic display2212 may provide the user with information regarding the status of the stimulator life, battery life, stimulation time, and the electrical and stimulation output levels. For example, in the embodiment ofFIGS. 15A and 15B, thegraphic display2212 may be a monochrome graphic display with 128 (W)×64 (H) pixels, which provide yellow, blue, green, or similarly colored graphic elements on a black background. As such, thegraphic display2212 may employ an organic light emitting diode (OLED). The overall dimensions of the graphic display may be approximately 1.9″×1.3″.
• Meanwhile, as shown inFIG. 15A, thekeypad2214 may have apower key2215 to allow the user to turn the controller on and off. In addition, thekeypad2214 may haveadjustment keys2216 and2217 to adjust the stimulation levels up and down, respectively. As discussed further below, thekeys2215,2216, and2217 may be employed in a variety of sequences or combinations to provide input for the operation of thecontroller2100. Thekeypad2214 may be a membrane keypad formed, for example, from polycarbonate or the like. In the embodiment ofFIGS. 15A and 15B, the overall dimensions of the keypad may be approximately 1.5″×0.75″.
• FIG. 15B also shows that aclip2208, or other similar structure, may be positioned on a side of theback housing section2206 to work with anattachment element2500 for securing thecontroller2200 to the subject. For example, theclip2208 may be employed to attach thecontroller2200 to thearm band2500 described previously with reference toFIG. 10B.
• The diagram ofFIG. 16 illustrates electrical components and connections that may be employed for the neuro-stimulation system2000. It is understood, however, thatFIG. 16 merely presents an example embodiment, and in no way limits the electrical components and connections that may be employed in other embodiments.
• As shown inFIG. 16, thecontroller2200 houses apower supply2220 and an embeddedprocessor2230, which are connected to each other. Theprocessor2230 is also connected to thegraphic display2212 and thekeypad2214. In the embodiment ofFIG. 16, the flying leads ofpower supply2220 may be directly soldered for connection to theprocessor2230. The graphic display may be connected via 0.5 mm SMT ZIF (18 conductor), and thekeypad2214 may be connected via 1 mm SMT ZIF (4 conductor).
• Thepower supply2220 generates the required voltage and current for operating theprocessor2230 as well as theelectrodes2110, thevibration elements2120, and thegraphic display2212. For example, the power supply may be a lightweight rechargeable lithium ion battery pack. However, in other embodiments, the neuro-stimulation system2000 may employ disposable non-rechargeable batteries or other types of power sources. Generally, a lightweightportable power supply2220 is preferred over sources such as an electrical outlet to make thecontroller2200 also lightweight and portable. In the embodiment ofFIG. 16, thebattery2220 may have a nominal voltage of 3.6 VDC. With a minimum capacity of approximately 1,600 mAh, thebattery2220 may provide approximately 3 hours of run time between charges. With a charge voltage of 4.2 VDC, the charge time for therechargeable battery2220 may be approximately 4 hours. As known, thebattery2220 may include an internal power control module to minimize over charge/discharge. For repeated use of therechargeable battery2220, thebattery2220 is chargeable to preferably at least 75% of original capacity after 500 cycles.
• The display, keypad, mechanical stimulation, and electrical stimulation are controlled by theprocessor2230. Theprocessor2230 may, for example, be a central printed circuit board (PCB) formed from G-10 which serves as the central point of connectivity and contains all the hardware and software required to generate and control the stimulation applied through thestimulator2100. In the embodiment ofFIG. 16, theprocessor2230 includes: a field-effect transistor switch (FET SW)2231; a microcontroller (μC)2232 with non-volatile random access memory (nov-RAM)2233; aDC supply2234; DC-to-DC converters2235 and2236; amechanical stimulation drive2237; anelectrical stimulation drive2238; and asound device2239.
• In the embodiment ofFIG. 16, thekeypad2214 may employ four circuits corresponding with thepower key2215, up and downadjustment keys2216 and2217, as well as ground. Thekeypad2214 may employ TTL level signals, as well as single pole single throw (SPST) switches which are normally open.
• When thepower key2215 on thekeypad2214 is pressed, theFET switch2231 is correspondingly turned on and power from thepower supply2220 is provided via theFET switch2231 to the rest of thecontroller2200. Once themicrocontroller2232 receives power and is activated, it holds theFET switch2231 on. When themicrocontroller2232 determines a shut down, it turns theFET switch2231 off. In the embodiment ofFIG. 16, theFET switch2231 may employ signal level controls and may have a rating of 4.2 V at 500 mA (min).
• Themicrocontroller2232 with thenon-volatile memory2233 hosts the firmware and provides overall control for the neuro-stimulation system2000. Themicrocontroller2232 may be a single chip microcontroller, which has a speed that is sufficient to support the input/output and the random signal generation described herein. The features of themicrocontroller2232 may include: integrated power on reset circuitry, integrated clock oscillator, integrated RAM and program memory, internal RTC with external xtl, integrated 12-bit analog-to-digital converter, two integrated 12-bit digital-to-analog converters, integrated voltage reference, and sufficient digital signal processing (DSP) capability to support white noise generation and filtering (10 Hz-100 Hz).
• In addition, the microcontroller2132 has sufficient input/output (I/O) capacity to support: input from a battery voltage monitor, input from power key2115, input from up and down adjustment keys2116 and2117, input from thestimulator2100 for StimEnable and SatDetect signals described herein, input and output from thenon-volatile RAM2233, input and output from theEEPROM2140 of thestimulator2100, input and output from thegraphic display2112, ISP input, output for thesound device2239, output for themechanical stimulation drive2237, and output for theelectrical stimulation drive2238.
• In the embodiment ofFIG. 16, themicrocontroller2232 may have an output current of approximately 100 mA (min) and may have a regulation of +/−1% ripple. Moreover, the programming of themicroprocessor2232 may employ ISP. Meanwhile,non-volatile RAM2233 provides a minimum of four kilobytes with a memory address of 0xA0 and a serial memory interface.
• Theprocessor2230 includes theDC supply2234, which receives input voltage (V_bat) from thepower supply2220 and produces regulated and filtered voltage for the control circuitry. In the embodiment ofFIG. 16, theDC supply2234 receives a nominal input battery voltage from thepower supply2220 of approximately 3.6 VDC, and may produce an output voltage of approximately 3.0 VDC and output current of 100 mA (min). Furthermore, theDC supply2234 may have a regulation of +/−1% ripple.
• Theprocessor2230 may also employ a sound device2139, such as a signal level audio transducer, that sounds or beeps when the keypad is pressed or during an alert or alarm condition. In the embodiment ofFIG. 16, the sound device2135 may have an audio output level of at least 60 dB at 30 cm.
• In addition, theprocessor2230 also includes the DC-to-DC converter2235, which receives input voltage from thepower supply2220 and generates the higher voltage rails required to drive the electrical and mechanical stimulation circuitry, described further below. In the embodiment ofFIG. 16, the DC-to-DC converter2235 may receive an input voltage (V_bat) of approximately 3 VDC and produce an output voltage of approximately 30 VDC and an output current of approximately 30 mA (typ) for the delivery of electrical and mechanical stimulation.
• Furthermore, theprocessor2230 also includes the DC-to-DC converter2236, which receives input voltage from thepower supply2220 and generates the voltage for operation of thegraphic display2112. In the embodiment ofFIG. 16, the DC-to-DC converter2236 may receive an input voltage (V_bat) of approximately 3 VDC and produce an output voltage of approximately 12 VDC and an output current of approximately of +/−500 mA (typ) for thegraphic display2112. The data transfer to thegraphic display2112 may be serial. The logic voltage may be approximately 2.4 VDC to 3.5 VDC and the supply voltage may be approximately 12 VDC (typ).
• Receiving the voltage from the DC-to-DC converter2235, themechanical stimulation drive2237 and theelectrical stimulation drive2238 provide the output to drive thevibration elements2120 and theelectrodes2110 of thestimulator2100. In particular, themicrocontroller2232 generates, sets amplitude, filters, and delivers the aperiodic signal that drives thevibration elements2120 and theelectrodes2110.
• In the embodiment ofFIG. 16, an H-Bridge amplifier configuration is used to push and pull the outputs. Themechanical stimulation drive2237 may employ voltage control. The digital-to-analog conversion may be 10 bit (min), or equivalent resolution. The voltage-to-voltage conversion may be: 1.3 V in=+30 V out; 650 mV in=0 V out; 0 V in=−30 V out; 0 to 1.3 V. With an input voltage of 0 to 1.3 V, the output voltage may be: −30 V to +30 V (max, +/−3 sigma); −20 V to +20 V (+/−2 sigma); −10V to +10V (typ, +/−1 sigma). The output current may be −30 mA to +30 mA (max). The waveform produced by themechanical stimulation drive2237 is aperiodic with a Gaussian distribution and the frequency spectrum may be 10 Hz (or lower) to 100 Hz. Filtering may have a pass band ripple of less than 0.5 dB and equivalent roll off above 100 Hz to a 6-pole Butterworth. Output may also need additional low pass filtering due to a 1 ms pulse width. Thus, a low pass (LP)filter2240 provides additional filtering to “smooth out” the 1 ms pulse width transitions in the vibration drive. TheLP filter2240 may employ a 3 Pole Chebychev, with a pass band of 10 Hz to 125 Hz.
• In the embodiment ofFIG. 16, theelectrical stimulation drive2238 may employ current control. The digital-to-analog conversion may be 10 bit (min), or equivalent resolution. The voltage-to-current conversion may be: 1.3 V in=+150 μA out; 650 mV in=0 μA out; 0 V in=−150 μA out. With an input voltage of 0 to 1.3 V, the output current may be: −150 μA to +150 μA (max, +/−3 sigma); −100 μA to +100 μA (+/−2 sigma); −50 μA to +50 μA (typ, +/−1 sigma). The output voltage may be −30 V to +30 V (max). The waveform produced by theelectrical stimulation drive2238 is aperiodic having a Gaussian distribution with a hold output of 1 ms/level, while the spectrum is defined by the 1 ms hold time (no additional filtering is required). The hardware current limit is +/−150 μA. ASatDetect signal2242 is issued if the target current cannot be achieved (skin Z is too high) or if the electrodes are not connected.
• The graphs in FIGS.20A-C represent aperiodic outputs which may be produced by themechanical stimulation drive2237 and theelectrical stimulation drive2238.FIGS. 20A and 20B demonstrate that the spectral content of the mechanical stimulation and the electrical stimulation, respectively, is within a defined narrow band, whileFIG. 20C shows that output is random over time. Advantageously, both the randomness and the frequency content enable targeting of the appropriate receptors. In other words, different receptors may respond to different stimulation frequencies, so the aperiodic stimulation helps to promote a response from receptors which may have such varying response characteristics. As a further advantage, by randomly and unpredictably applying a range of frequencies, aperiodic stimulation avoids the effect of adaptation where the response to specific frequencies diminishes, or is wiped out, with repeated and predictable exposure to the same specific frequencies. As shown inFIG. 20C, the noise is normally distributed about a mean, so the signal may be electrically expressed as a Gaussian distribution. The aperiodic sequence preferably does not repeat itself within 20 seconds.
• In the embodiment ofFIG. 16, the stimulation output from themicrocontroller2231 is a current, with maximum value of 0.5 mA. When converted to a voltage signal across a 2.61 kΩ sense resistor the input to both themechanical stimulation drive2237 and theelectrical stimulation drive2238 is biased to 0.65 VDC. Therefore, a setting of 100% represents waveforms that span the entire range, i.e. 0 VDC to 1.3 VDC. A 50% setting in either electrical or mechanical stimulation spans an output range of 0.325 VDC to 0.975 VDC.
• The output from themechanical stimulation drive2237 and/or theelectrical stimulation drive2238 of theprocessor2230 is transmitted to thestimulator2100 via the detachable coupling of theconnection port2250 and theconnector2150. As described previously, this coupling may employ a 9-pin connection. Themechanical stimulation drive2237 drives thevibration elements2120 of thestimulator2100, while theelectrical stimulation drive2238 drives theelectrodes2110 of thestimulator2100.
• With further reference to the embodiment ofFIG. 16, theelectrodes2110 may employ dual carbon electrodes with a resistance of 500 ohms (max) (measured from each electrode surface to contact with the flex circuit). Thevibration elements2120 may employ two parallel piezo elements, with piezoelectric bimorph technology. The input power to thevibration elements2120 may be approximately 150 mW (max), and the oscillating range of thevibration elements2120 may be approximately DC to 20 kHz.
• In the embodiment ofFIG. 16, thestimulator2100 employs anEEPROM2140. TheEEPROM2140 may have a size of 1 K (128×8) (min) with a memory address of 0xA1. The power supply to theEEPROM2140 may be approximately 1.8 to 5.5 VDC. The package for theEEPROM2140 may be 8 pin, SOIC SMT. For chip select, the A0 address bit must be decoded.
• When thestimulator2100 is connected to thecontroller2200, theEEPROM2140 may be serially connected to theprocessor2130, so that theprocessor2230 may read and write to theEEPROM2140. In particular, as described previously, thecontroller2200 may employ theEEPROM2140 to track usage data, such as the total amount of use against a specified stimulator life for thestimulator2100.
• Additionally, as further illustrated byFIG. 16, theflex circuit2130 provides a way for thecontroller2200 to detect the presence of thestimulator2100 by shorting pin3 (V_bat) topin7. As such, when thestimulator2100 is attached to thecontroller2200, theStimEnable line2241 goes high, informing themicrocontroller2232 to switch on the DC-to-DC converter2235 (30 V step up) to power themechanical stimulation drive2237 andelectrical stimulation drive2238.
• FIG. 17 illustrates a controller state diagram and operation of the example embodiment shown inFIG. 16. As such, the state diagram ofFIG. 17 merely presents a non-limiting example of operation of the neuro-stimulator2000.
• Operation of thecontroller2200 is governed by the embedded software ofprocessor2230. Instep6002, thepower key2215 is operated, or pressed, to power up thecontroller2200. As described previously, theprocessor2230 is able to detect whether astimulator2100 is coupled to thecontroller2200. If thecontroller2200 is not connected to astimulator2100, thegraphic display2112 displays the life ofbattery2220 instep6004 and thecontroller2200 shuts down automatically after 2 minutes, as described further below. Otherwise, when thecontroller2200 powers up, the graphic display (OLED)2112 displays the life ofbattery2220 and life of thestimulator2100.
• Instep6006, the power key2115 is pressed again to allow the electrical stimulation with thestimulator2100 to be set, instep6008. In step6008A, the up adjustment key2116 may be pressed to increase the electrical stimulation up to any value below a predetermined maximum, e.g. 100%. For example, pressing the up adjustment key2116 once increases the electrical stimulation by 5% of its entire range. On the other hand, instep6008B, the down adjustment key2117 may be pressed to decrease the electrical stimulation down to any value above a predetermined minimum, e.g. 0%. For example, pressing the down adjustment key2117 once decreases the electrical stimulation by 5% of its entire range. In response to step6008, theprocessor2230, with theelectrical stimulation drive2238, drives theelectrodes2110 of thestimulator2100 with a current that corresponds with the given setting. When the electrical stimulation level is changed, with the up and down adjustment keys2116 and2117 and even shutdown with the power key2115, the change is preferably executed in a ramped manner. A sudden change may be perceived as uncomfortable to the patient. As such, a slew rate of approximately 0.2 μA/ms (or 1 μA every 5 ms) may be employed.
• Instep6010, the power key2115 is pressed again to allow the mechanical stimulation with thestimulator2100 to be set, instep6012. Instep6012A, the up adjustment key2116 may be pressed to increase the mechanical stimulation up to any value below a predetermined maximum, e.g. 100%. For example, pressing the adjustment key2116 once increases the mechanical stimulation by 5% of its entire range. Instep6012B, the down adjustment key2117 may be pressed to decrease the mechanical stimulation down to any value above a predetermined minimum, e.g. 0%. For example, pressing the adjustment key2117 once decreases the mechanical stimulation by 5% of its entire range. In response to step6012, theprocessor2230, with themechanical stimulation drive2237, drives thevibration elements2120 of thestimulator2100 with a voltage that corresponds with the given setting.
• Instep6014, the power key2115 is pressed again to lock the stimulation levels set insteps6008 and6012. Electrical and/or mechanical stimulation continues inrun mode6015 with the set values.
• Step6016 evaluates conditions for shut down and causes automatic shut down of thecontroller2200 when the conditions are met. These conditions are indicated by “Cond 1” and “Cond 2” inFIG. 17.
• Thus, during therun mode6015, the power key2115 may be pressed and held for a specified duration, e.g. two seconds, to cause the controller to be turned off instep6016. Thecontroller2200 does not exitrun mode6015 until the power key2115 is pressed for the specified duration.
• In addition, the voltage of thebattery2220 is also measured during operation. If the remaining charge inbattery2220 falls below 3.2 V, for example, thecontroller2200 automatically shuts down instep6016.
• As described previously, theprocessor2230 holds theFET switch2231 on. However, instep6016, theFET switch2231, and thus thecontroller2200, may be turned off automatically in the following time-out situations:
• • the power key2115 has not been pressed for a period of time, e.g. 2 minutes, to advance to step6008 after thecontroller2200 has been powered up instep6002.
  • the power key2115 has not been pressed for a period of time, e.g. 5, minutes, to advance to step6012 after the level of electrical stimulation has been set instep6008.
  • the power key2115 has not been pressed for a period of time, e.g. 5 minutes, to advance to runmode6015 after the level of mechanical stimulation has been set instep6012.
  • no keys are pressed for a period time, e.g. 2 minutes, after thecontroller2200 has been powered up instep6002 and nostimulator2100 is coupled to thecontroller2200.
  • no keys are pressed for a period of time, e.g. 2 minutes, after the diagnostic mode has been executed instep6003.
• As discussed previously, theprocessor2230 determines and tracks the stimulator life by reading and writing to usage data on theEEPROM2140 of thestimulator2100.FIG. 18 illustrates an example technique for determining and tracking the stimulator life. Initially, instep6105, theprocessor2230 reads a code location on theEEPROM2140.Step6110 determines whether a unique code has already been written to the code location. If theprocessor2230 detects a unique code, this indicates that thestimulator2100 has already been used, so theprocessor2230 proceeds to step6115 where a message is issued for the operator indicating that thestimulator2100 must be replaced. If theprocessor2230 does not detect a unique code, this indicates that theconnected stimulator2100 is new. In this case, instep6120, theprocessor2230 writes a unique code to the code location to indicate that thestimulator2100 has been used. Furthermore, instep6125, theprocessor2230 records a value, e.g. “100%,” on the EEPROM as the initial value for the stimulation life. Once the initial value of the stimulator life has been recorded instep6125, the process continues to step6130 where theprocessor2230 reads the current value for the stimulator life.Step6135 determines whether theprocessor2230 is inrun mode6015. If so, instep6140, theprocessor2230 decrements the value of the stimulator life by a certain value, or percentage.Step6145 then determines whether the current value for the stimulator life has reached zero. If the current value for the stimulator life has reached zero, instep6150, theprocessor2230 ends therun mode6015 and issues a message for the operator indicating that thestimulator2100 must be replaced. If the current value for the stimulator life has not reached zero, the process proceeds to step6155 where theprocessor2230 waits for a specified period of time, e.g. one minute, before proceeding again to step6130.
• As shown inFIG. 17, rather than executingstep6002, the power key2115 and up and down adjustment keys2116 and2117 may be operated simultaneously instep6003 to power up thecontroller2200 and to enter a diagnostic mode where software revision, error message count, and other diagnostic information are be displayed.
• As discussed previously, thegraphic display2112 may display symbols, text information, and other graphic elements which provide the operator information regarding the operation of the neuro-stimulation system2000. During the operation of the embodiment ofFIG. 16, thegraphic display2112 may show:
• A battery symbol with a varying number of “bars” that indicate the approximate remaining charge in thebattery2220. For example:

  	0 Bar:	3.20 V to 3.29 V
  		(outline of symbol flashes and alert, e.g. beep,
  		issued by sound device 2239)
  	1 Bar:	3.30 V to 3.39V
  	2 Bar:	3.40 V to 3.49V
  	3 Bar:	3.50 V to 3.54V
  	4 Bar:	3.55 V to 3.59V
  	5 Bar:	3.60 V or Higher

• A stimulator life symbol with a bar graph symbol showing, e.g. by percentage, the remaining time left in the life of thestimulator2100, when theconnector2200 is connected thestimulator2100. For example:

  	0 Bar:	less than 5% remaining (outline of symbol flashes
  		and alert, e.g. beep, issued by sound device 2239)
  	1 Bar:	6% to 19%
  	2 Bar:	20% to 39%
  	3 Bar:	40% to 59%
  	4 Bar:	60% to 79%
  	5 Bar:	80% to 100%

• • A stimulator time counter showing hour and minute which tracks the elapsed treatment time during run mode. When the controller is not in run mode, the hour and minute are not displayed.
  • Mechanical and electrical stimulation symbols which display the output levels, e.g. by percentage, from themechanical stimulation drive2237 and theelectrical stimulation drive2238. For example, the mechanical stimulation symbol may indicate a value from 0% to 100%, where 0% represents no application of mechanical stimulation and 100% represents the application of +/−30 V to thevibration elements2120. The mechanical stimulation symbol may flash when the mechanical stimulation is set to 100%. Meanwhile, the electrical stimulation symbol may indicate a value of 0% to 100%, where 0% represents no application of electrical stimulation and 100% represents the application of +/−150 μA to theelectrodes2110. The electrical stimulation symbol may flash when the electrical stimulation is set to 100%.
  • A message area which the operator with warning messages. A corresponding alert, e.g. beep, may be issued by thesound device2239. Any single key press turns the alert off. For example, the messages may include:
    • “REPLACE STIMULATOR” when the stimulator life is less than 5%
    • “CHARGE BATTERY” when the battery voltage is less than 3.29 V
    • “SKIN PREP ERROR” when a SatDetect signal is received
    • “DISCONNNECT ERROR” when the StimEnable line indicates that thecontroller2200 and thestimulator2100 are not coupled.
• During operation, thesound device2239 may be sounded when any key on the keypad2114 is pressed. For example, thesound device2239 may issue a single short beep of approximately 200 ms. As discussed previously, thesound device2239 may also be sounded when an alert condition occurs. For example, thesound device2239 may issue a short beep every 2 seconds. An issued alert may be acknowledged and ended by pressing any key on the keypad2114.
• As discussed previously, in the embodiment ofFIG. 16, thecontroller2200 may employ a rechargeable lithium ion battery pack for thepower supply2220. Therefore, in this embodiment, the neuro-stimulation system2000 also employs a charging device for recharging the lithium ion battery pack after its charge has been depleted. Referring now toFIG. 19, a charging device, or console,2300 is illustrated. The chargingconsole2300 may be formed from ABS, or a similar material. In particular, the chargingconsole2300 includes twocradles2310, which may individually receive and detachably connect acontroller2200 to aseparate charging circuit2330. As shown inFIG. 19, thecradles2310 correspond in shape with at least a part of thecontrollers2200 and permit thecontrollers2200 to slide into the cradles and be stably positioned. In addition to sliding thecontrollers2200 into thecradles2310, thecontrollers2200 may snap into thecradles2310 to further secure thecontrollers2200 in place.
• As shown inFIGS. 15B and 16, acontroller2200 may haveelectrical contacts2260, which provide an electrical connection with therechargeable battery2220. Correspondingly, as shown inFIGS. 16 and 19, the chargingconsole2300 may haveelectrical contacts2360, which engage theelectrical contacts2260 of thecontroller2200 when thecontroller2200 is stably positioned in thecradle2310. As shown, theelectrical contacts2260 are positioned on an end surface of thecontroller2200. When the end of thecontroller2200 is received into thecradle2310, theelectrical contacts2260 of thecontroller2200 are aligned for conductive contact with theelectrical contacts2360 of the chargingconsole2300. In one embodiment, the connection between thecontroller2200 and the chargingconsole2300 may employ pogo-pin, or similar spring-biased, contacts.
• The twocharging circuits2330 are illustrated inFIG. 16. The chargingcircuits2330 may be printed circuit boards based on Micrel, or equivalent, linear charging chip sets. The chargingcircuits2330 may draw power from a conventional universalinput wall module2400 which is plugged into a conventional electrical wall outlet. The input voltage into thewall module2400 may range from approximately 115 VAC to 230 VAC (min). The line may have a frequency of approximately 50 Hz to 60 Hz. The output voltage from thewall module2400 may be approximately 5 VDC to 16 VDC with an output current of approximately 2.5 A (min).
• Meanwhile, the charge current in the chargingcircuits2330 may be approximately 1.2 Amps with a charge voltage of approximately 4.2 VDC. As indicated previously, in the embodiment ofFIG. 16, the charge time may be approximately 4 hours. The chip set may provide for an internal shutdown when the end of the charging is reached. In addition, anLED indicator2320 may be employed to indicate that the battery is fully charged. For instance, it may switch from an amber color to green when charging is complete.
• In sum, embodiments of the neuro-stimulation system2000 may provide astimulator2100 detachably coupled to awearable controller2200, which has auser interface2210 including agraphic display2212 and akeypad2214. Preferred embodiments of the neuro-stimulation system2000 have small, lightweight components which facilitate the application of stimulation during therapy and do not interfere with the therapy with wires, connection cables, etc. Furthermore, through theuser interface2210, embodiments may permit an operator to manually set the mechanical stimulation level and/or the electrical stimulation level. Accordingly, thevibration elements2120 and/orelectrodes2110 may be driven to deliver stimulation that has an aperiodic waveform and/or stimulation that is subthreshold. Through thegraphic display2212, embodiments may display data, such as information on the stimulator life and battery life as well as the electrical and mechanical stimulation settings. Other embodiments may also have the ability to detect when thecontroller2200 is attached to thestimulator2100. Further embodiments have the ability to track the remaining life in thestimulator2100.
• While thecontroller2200 has been described previously with respect to thestimulator2100 as shown for example inFIG. 10A, it is understood that thecontroller2200, or any aspects thereof, may be employed with other embodiments of a stimulator, or stimulator system, such as those described herein.
• As described previously, the neuro-stimulation system2000 may be applied to provide sensory enhancement stimulation during stroke rehabilitation and improve neuroplasticity, i.e. the formation of lasting functional changes in the brain. For instance, the neuro-stimulation system2000 may be applied to a subject's arm, as illustrated inFIGS. 13A and13B, while the arm undergoes movement associated with post-stroke rehabilitative physical therapy.
• Research in clinical neuroscience has established that recovery of CNS or PNS function following injury (e.g. stroke) in many circumstances depends very strongly on the level of personal involvement and commitment to progress on the part of the sufferer. That is, if the subject is not closely involved and directly participating in the rehabilitation initiative, progress will be slowed or perhaps blocked. This need for personal motivation and participation is often cited as explanatory for the failure of “passive rehabilitation” to generate demonstrable functional outcomes.
• On this basis, modern rehabilitation regimens rely increasingly on methods that directly engage the subject in the process. One example is constraint induced movement therapy (CIMT) to address hemiparesis. The subject's functioning extremity, e.g. right arm, is mechanically blocked from use for long periods of time thereby forcing the subject to use their affected extremity. Another example is customized physical therapy in which the regiment is designed specifically around tasks and abilities that are important to an individual subject. Common to these and other forms of participatory rehabilitation is that the subject's own brain is volitionally striving toward movements and capabilities of personal importance to them.
• More recently, the use of virtual reality (VR) systems has gained clinical momentum as another form of participatory rehabilitation. As part of a rehabilitation regimen, subjects interact with a VR system that reacts in real time to their attempts to use affected extremities. Often the VR system is essentially a computer video game system that displays real-time images on a monitor that react to or are controlled by the subject. Such a system can be adjusted to the subject's particular circumstance to motivate certain types of attempted movements. As such, a further embodiment of the present invention combines subthreshold neuro-stimulation with VR systems. An example VR system which may be employed is the Nintendo® Wii gaming system. In this embodiment, stimulation devices, such as the devices described herein, would be placed on the skin, or implanted under the skin, and would deliver subthreshold neuro-stimulation during VR-guided activities. As is the case with other forms of rehabilitation, boosting sensory traffic during VR rehabilitation sessions improves neuroplastic remodeling outcomes. Like other embodiments described herein, this embodiment takes advantage of the interplay between subthreshold stimulation and physical rehabilitation. The individual receives the heretofore unanticipated benefit of receiving subthreshold stimulation while moving the target body segments. Since by definition subsensory stimulation does not by itself evoke nerve activity, the embodiment employs physical activity to ultimately cause the nerve activity. The subthreshold stimulation effectively and uniquely boosts the natural sensory signaling in a fashion that is directly useful to the central nervous system.
• However, it is understood that the application of subthreshold neuro-stimulation for stroke rehabilitation is merely exemplary.FIG. 21A illustrates a configuration for a neuro-stimulation system3000A which may be broadly employed to direct stimulation to any sensory cells of any body part to enhance detection of a sensory signal from the sensory cells. In particular, as shown inFIG. 21A, the neuro-stimulator system3000A includes astimulator3100A which delivers stimulation to abody part1. To control and drive thestimulator3200A, the neuro-stimulation system3000A includes at least apower supply3220A and aprocessor3230A, which collectively may be referred to as acontroller3200A (illustrated with a dotted line inFIG. 21A). Thestimulator3100A andcontroller3200A in this embodiment may be respectively similar to thestimulator2100 and thecontroller2200 of the neuro-stimulator system2000 described above.
• Theprocessor3230A receives electrical power from thepower supply3220A and sends an electrical driving signal to the stimulator3100, which is operably coupled to theprocessor3230A. Thestimulator3100A includes astimulating element3105A. The stimulatingelement3105A may include one or more electrode devices for delivering electrical stimulation, one or more vibration elements for delivering mechanical stimulation, or any combination thereof. Unlike thestimulator2100 above, thestimulator3100A in some embodiments may be configured to include only electrodes or only vibrating elements, rather than both forms of stimulating elements. The processor3230 is operable to drive either electrode devices and/or a vibration elements with the electrical driving signal. Thestimulator3100A has acontact surface3102A which is positioned to deliver stimulation from simulatingelement3105A to the targetedbody part1. Accordingly, in response to the electrical driving signal, thestimulator3100A provides stimulation to thebody part1. Preferably, the stimulation is aperiodic stimulation and/or subthreshold stimulation, providing the advantages described previously.
• Although a stimulator may be detachably coupled to a controller as with the neuro-stimulator2000 above, a stimulator and a controller may also be integrally or fixedly coupled to each other. As illustrated with the embodiment ofFIG. 21A, thestimulator3100A may be included with theprocessor3230A and thepower supply3220A in a single application body, or housing,3001A. Thissingle application body3001A may then be applied to thebody part1 to deliver the stimulation.
• Of course, different components of a neuro-stimulation system may be organized and coupled in any number of combinations and housed in any number of devices or bodies. Thus, referring toFIG. 21B, a neuro-stimulation system3000B is illustrated, where apower supply3220B is separated from anapplication body3001B housing astimulator3100B and aprocessor3230B. For example, thepower supply3220B inFIG. 21B may be a battery pack or a conventional electrical outlet that is detachably coupled to theapplication body3001B. Theapplication body3001B is positioned to deliver stimulation to abody part1 through acontact surface3102B.
• Meanwhile,FIG. 21C illustrates a neuro-stimulation system3000C, where astimulator3100C is housed in anapplication body3001C while acontroller3200C, i.e. apower supply3220C and aprocessor3230C, is in aseparate controller housing3002C. The stimulator3100 is detachably or fixedly coupled to thecontroller3200C via acoupling mechanism3050C, such as a flexible cable, that enables theprocessor3230C to deliver a driving signal to astimulating element3105C from a distance. Theapplication body3001C is positioned to deliver stimulation through acontact surface3102C. Advantageously, because theapplication body3001C does not house the power supply3230 and the processor3230, theapplication body3001C may be sized or configured to enable easy handling and positioning on abody part1 for the delivery of stimulation, while the controller3200 is placed conveniently at a distance.
• Attachment elements, such as an elastic strap or, a strap with snaps, hook-and-loop fasteners, or other fasteners may be employed to secure the stimulator and/or the controller into desired positions. In the embodiment ofFIG. 22C, an attachment element may position theapplication body3001C over thebody part1 targeted for stimulation, while another attachment element may secure thecontroller housing3002C to another part of the body for comfort and convenience.
• FIGS.21A-C illustrate contact surfaces that make direct contact with thebody part1, for example at a skin surface, to deliver the desired stimulation. However, the actual stimulating element, e.g. electrode and/or vibration element, does not have to contact thebody part1 directly. Rather, as shown inFIG. 21A, the electrical or mechanical stimulation may be transmitted from the stimulatingelement3105A within theapplication body3001A to thecontact surface3102A. For example, the stimulatingelement3105A may be embedded within theapplication body3001A, while theouter contact surface3102A actually makes contact with thebody part1. In this example, theapplication body3001A, or some structure thereof, may be formed from a material that allows an electrical signal or vibration to travel from the stimulatingelement3105A to thecontact surface3102A.
• Various applications of the neuro-stimulation systems, as shown in FIGS.21A-C, may be employed to deliver sensory enhancing stimulation to anybody part1.
• In one embodiment, thebody part1 includes aspects of the body that aid in swallowing, including the tongue, pharynx, and esophagus, and a neuro-stimulation system is applied to improve swallowing function, especially for patients suffering from dysphagia. As such, an application body housing a stimulator may be applied externally across the neck to deliver electrical or mechanical stimulation to the tongue, pharynx, and/or esophagus. Alternatively, a small application body may be applied in the throat, especially for patients with severe or chronic disorders. The application of stimulation enhances the sensory information required by the swallowing function and improves control of this swallowing function. In some embodiments, the swallowing function to be improved is the sensation of the presence of a solid or liquid bolus in the throat. In other embodiments, the swallowing function to be improved is timing of swallowing muscle contraction relative to movement of solid or liquid bolus in the throat. In further embodiments, the swallowing function to be improved is the timing of the closure of the trachea relative to the movement of solid or liquid bolus in the throat.
• In another embodiment, thebody part1 is the heart and a neuro-stimulation system is applied to improve cardiac function for patients who suffer from congestive heart failure. A key function of healthy heart muscle is the regulation of contractions based on its internal stretch (from filling), which uses mechanoreceptors similar to muscle spindles found in striated muscle. Poor cardiac function results when this mechanism is compromised. As such, an application body housing a stimulator may be applied outside or inside the chest cavity to deliver stochastic resonance stimulation to the heart muscle, making the heart more resistant to overfilling, which may improve cardiac function in patients suffering from congestive heart failure.
• In an additional embodiment, thebody part1 includes the lungs, and a neuro-stimulation system may be applied to improve lung sensation/function in asthmatic patients. An application body is noninvasively applied to the surface of the chest where sub-threshold stimulation may be most effectively transferred to the intercostals muscle. A stimulator in the application body may provide electrical and/or mechanical stimulation from any number of electrodes and/or vibrating elements, which are driven by a controller. In a particular embodiment, the configuration ofFIG. 21C may be employed where thecontroller3200C is kept in acontroller housing3002C separated by a distance from theapplication body3001C. Thecontroller housing3002C, for example, may approximately have the size of a pack of cigarettes and may be secured to an attachment element, such as a wrist band, via a belt-clip. Thus, thecoupling mechanism3050C may include control and signal wires which extend run from thecontroller housing3002C to theapplication body3001C positioned at the chest. Accordingly, the stimulation from thestimulator3100C increases the awareness of lung state during asthmatic attacks and offers better control of breathing during these attacks. The expansion and/or contraction of the lung thus increases with the stimulation of the intercostals muscle in the chest region.
• In yet another embodiment, a neuro-stimulation system may be applied as a therapy for patients suffering from Parkinson's disease. For example, an application body housing a stimulator may be applied to an affected muscle to deliver a noninvasive, sub-threshold electrical and/or mechanical stimulation to improve the patient's ability to sense muscle position and offer better control of muscle flexion. Thus, unwanted motions or movements in affected muscles or muscle groups associated with Parkinson's disease are minimized.
• In a further embodiment, a neuro-stimulation system may be applied to manage pain. Contrary to Transcutaneous Electrical Nerve Stimulation (TENS) which manages pain by overloading a sensory channel, the neuro-stimulation system in this embodiment applies subthreshold stimulation in a less invasive technique to ground the sensory channel instead of overloading it. In some cases, the pain is caused by musculoskeletal hyperextension or excursion resulting from proprioceptive deficit in the body part. For example, back pain may be caused by a proprioceptive deficit in a person's trunk and in one embodiment, neuro-stimulation may be applied to increase stability and strength to manage this back pain.
• In yet a further embodiment, thebody part1 is the forehead and, a neuro-stimulation system may be applied to reduce chronic/tension headaches. For instance, an application body housing a stimulator may be applied noninvasively to affected muscles or muscle groups in the forehead area where sub-threshold stimulation may be applied to control tension and relieve chronic pain due to uncontrollable muscle spasms. The stimulator in the application body may provide electrical and/or mechanical stimulation from any number of electrodes and/or vibrating elements, which are driven by a controller.
• In another embodiment, thebody part1 employs a prosthetic device, and a neuro-stimulation system may be applied to improve function with the prosthetic device. Generally, sensors on prostheses (proprioception, pressure, etc.) are introduced to pectoral sensory pathways and successfully decoded by the brain. The brain forms new neural connections to process and use the information from the sensors on the prosthesis. This embodiment applies stochastic resonance stimulation in conjunction with the signals from the sensors to promote neural development and to increase the sensitivity of the pectoral nerves to these signals. For example, a stimulator may be incorporated with the prosthetic device to deliver electrical and/or mechanical stimulation during use of the prosthetic device.
• In yet another embodiment, a neuro-stimulation system may be applied to reduce phantom limb sensations by those who have lost a limb. In particular, an application body housing a stimulator may be applied to deliver stochastic resonance stimulation to severed nerves associated with the missing limb or to surrounding intact nerves. Such stimulation encourages the brain to dissociate the neural connections causing phantom limb or phantom pain sensations. Applying the stimulation to severed nerves provides the brain with greater information about the current state of the body, alerting the brain of the loss of the limb. Applying the stimulation to surrounding intact nerves encourages the brain to focus on the neural connections that are not associated with the damage.
• In a further embodiment, a neuro-stimulation system may be employed for strength training in patients with a sensory deficit. Recent studies have shown that people who actually did certain physical exercises, e.g. finger exercises, gained no more strength than people who did no physical exercise but simply thought about doing the exercise for the same amount of time. Thus, a stimulator may deliver stochastic resonance stimulation to the joints of a patient with a sensory deficit. Such stimulation may result in a faster increase strength by making the brain more aware of body movement.
• In yet a further embodiment, a neuro-stimulation system may be employed as a therapy for arousal dysfunction. An application body housing a stimulator may be applied to appropriate areas to deliver stimulation and improve sexual sensory function in these areas.
• In another embodiment, thebody part1 may be a finger tip that is used to read Braille, and a neuro-stimulation system may be employed to improve sensory function corresponding to Braille reading ability. The contact surface for delivery of stimulation is a surface with Braille which is then coupled to a stimulator. Stochastic resonance stimulation applied to finger tips has been shown to improve detection of small stimuli. The use of the Braille system for vision impaired reading of text requires precision on the part of the reader to identify small raised dots on paper. This effort can be difficult when the reader is new to Braille, the print is small, or the pages are worn. Therefore, the stimulator3100 of the neuro-stimulator system3000 may provide stochastic resonance stimulation to the finger tip to improve a person's ability to detect the raised dots of Braille text. This embodiment is an example of an external device, e.g. the Braille surface, that is provided with a stimulation source and when a body part, e.g. the finger tip, contacts or interacts with the external device, the stimulation source applies the stimulation to sensory cells of the body part to enhance sensory function associated with the body part. Other examples of such external devices are provided herein.
• In yet another embodiment, thebody part1 may be the nasal septum while the contact surface may be sized and configured to accommodate stable positioning on the nasal septum. As such, the neuro-stimulation system may be applied to improve the olfactory function of a human. The application of a sub-threshold electrical and/or mechanical signal to the nasal septum increases sensation and provides an improvement in the sense of smell. Therefore, one or more stimulators are positioned to apply a sub-threshold signal to the nasal septum. Preferably, to promote comfort and ease of use, only a small stimulator is positioned on the nasal septum while the controller is positioned elsewhere. Thus, referring toFIG. 21C, thestimulator3100C may be housed in anapplication body3001C and thecontroller3200C may have aseparate housing3002C. In particular, thehousing3002C for thecontroller3200C may be shaped like a cigarette pack, which can conveniently placed in a shirt pocket or worn on the waist via a belt clip.
• Similarly, yet another embodiment of the neuro-stimulator may be employed to improve the olfactory function of a canine. Canines are often used in tasks requiring the use of smell as a way of locating an object or person. These tasks include searching for missing persons, detecting explosives, and locating contraband such as drugs. Thus, in this application, referring toFIG. 21C, thebody part1 is a canine's nose, and theapplication body3001C housing thestimulator3100C is configured to fit across the nose with a first attachment element while thecontroller3200C in ahousing3002C may be separately mounted on another part of the canine with a second attachment element, such as a dog collar.
• Further embodiments of the neuro-stimulator system may be employed to improve auditory sensory function and detection of audio signals. In some embodiments, the neuro-stimulation system provides an electrical or audio noise signal with hearing assistive devices, e.g. hearing aids, cochlear implants, etc., to improve the auditory function of their users and the effectiveness of these devices. With such embodiments, the hearing assistive device may act as theapplication body3001A which houses the complete neuro-stimulation system3000A, as depicted inFIG. 21A. When employed to improve auditory function, thebody part1 includes aspects of the auditory system which affect the auditory nerves, while the stimulator sends a signal that may be received by the auditory system. Although FIGS.21A-C illustrate a contact surface positioned in direct contact with thebody part1, it is understood that other embodiments may deliver stimulation to thebody part1 without direct contact. For example, a stimulation in the form of sound may be delivered across a space between the stimulator3100 and thebody part1. As such, to improve a subject's ability to hear particular sounds, the neuro-stimulation system3000 may combine a noise signal with the particular sounds that are transmitted over a space to the subject. For example, audio recordings that require transcription may be combined with a noise signal to improve the transcriber's ability to detect the audio. In another example, audio signals from a sonar system may be combined with a noise signal to improve the monitor's ability to detect faint sonar signals.
• Another embodiment of the neuro-stimulation system is employed to improve visual function, where thebody part1 is the eye. In this embodiment, the neuro-stimulation system may add noise to the visual signal, or light, from the object being viewed. For example, vision is used extensively in the scrutiny of images (x-ray, etc.) for medical diagnosis or in the screening of packages and contents for security purposes. The neuro-stimulation system may generate noise in a band of visual wavelengths, and the noise may be transmitted along with the images, such as those from a security screening monitor. The stimulation from the transmitted noise may improve the ability to detect weak information being received by the eye. Similar to the improvement of auditory function described previously, stimulation in the form of visual signals may be delivered across a space between the stimulator and thebody part1.
• Yet another embodiment of the neuro-stimulation system is employed to improve tasting function, where thebody part1 is a tongue. A discriminating palate is key to the process of taste testing used in the culinary arts, brewing, etc. As such, the contact surface of a stimulator may be placed into contact with areas of the tongue surface to deliver electrical or mechanical stimulation from the simulating element3105 to the gustatory (taste nerve) cells. Such stimulation improves the ability of the subject to taste. Due to relatively limited access to the tongue inside the mouth, referring toFIG. 21C thestimulator3100C may employ anapplication body3001C that is separate from thehousing3002C of thecontroller3200C. Thus, components of the neuro-stimulation system3000C, i.e. thecontroller3200C, do not have to be positioned on the tongue, and theapplication body3001C may be conveniently sized and configured to be easily and comfortably positioned on the tongue inside the mouth.
• While FIGS.21A-C illustrate general configurations for a neuro-stimulation system, FIGS.22A-B illustrate specific example embodiments of neuro-stimulation systems that may be applied to address particular medical conditions. As illustrated inFIG. 22A, a neuro-stimulation system4000 is employed to deliver electrical stimulation, stochastic resonance or otherwise, to an internal organ. Use of this embodiment may include applying stimulation to: the bladder and colon as therapy for incontinence; the stomach as therapy for disorders involving the feeling of fullness; the gall bladder as therapy for bile secretion; or the esophagus, intestines, urethra, and bile duct for peristaltic encouragement or improvement. As shown inFIG. 22A, theapplication body4001 of thestimulator4100 is an expandable material, such as a mesh, which is positioned over an organ, or body part,1. Theapplication body4001 accommodates expansion and contraction of the organ during normal function, e.g. during filling of the bladder, etc. Thestimulating elements4105 may be electrodes which are distributed over thestimulation application body4001 to provide diffuse application of electrical stimulation over targeted surfaces of theorgan1. During application, theexpandable material4001 is trimmed to accommodate the size of the targetedorgan1 and may be sutured at selected points to the surface of theorgan1. In addition to serving asattachment elements4500, the suture points help keep theapplication body4001 in tension across theorgan1. Thestimulator4100 may be composed of one or more resorbable materials, including resorbable conducting metals or polymers for theelectrodes4105. As such, additional procedures to remove thestimulator4100 are unnecessary. As further illustrated inFIG. 22A, thestimulator4100 is coupled to aremote controller4200, which includes apower source4220 andprocessor4230 to drive the electrodes and deliver electrical stimulation to theorgan1.
• FIG. 22B illustrates yet another embodiment of the neuro-stimulator5000 which may deliver stimulation to multiple points of abody part1. In particular,FIG. 21E shows astimulation application body5001 which has a catheter-like structure having aproximal end5001A and a distal end5001B. The stimulator5100 may be applied subcutaneously. Thestimulating elements5105 include a plurality of electrodes which are spaced longitudinally along thestimulation application body5001 to provide electrical stimulation to multiple parts of abody part1. Each stimulatingelement5105 receives an electrical signal via a conductor, such as a wire, that extends longitudinally to theproximal end5001A which is operably coupled to acontroller5200. Thecontroller5200 has aprocessor5230 which delivers electrical signals from apower source5220 to selected electrodes along theapplication body5001. As such, theprocessor5230 can define any combination and sequence of electrical stimulation sources and sinks along theapplication body5001. Thus, the neuro-stimulation system5100 inFIG. 22B provides a customizable configuration which facilitates application of stimulation to different regions of the body and which may suit the varying needs of patients.
• Although an application body in a neuro-stimulation system may be specially shaped or configured to accommodate a particular body part to deliver stimulation, other neuro-stimulation systems may incorporate a stimulator into the structure of another device, such as a consumer product, which is initially intended to provide other functions outside of stimulation delivery. As such, the device, or a part thereof, becomes an application body for stimulation delivery. Combining a neuro-stimulation system with another device may improve an operator's ability to use the device or may enhance the effectiveness of the device. The prosthetic device combined one or more simulators or the hearing assistive device combined with one or more stimulators, described previously, provide examples of neuro-stimulation systems that incorporate a stimulator within another device.
• In another example, a stimulator may be incorporated into a gun or rifle to deliver stimulation that improves a person's ability to shoot a gun. Accurate gun shooting is required especially in long range targeting, such as sniping. One aspect of accurate gun shooting is the ability of the shooter to control the precise action of a hair trigger and maintain gun stock position relative to the shooter's body as the projectile is fired from the gun. An embodiment of a neuro-stimulation system may incorporate a stimulator with a vibrating stimulating element into the trigger and/or the gun stock. As such, the gun may provide stochastic resonance stimulation to a trigger finger through the gun trigger and/or to a region of the body between the arm and torso through the gun stock. In this example, parts of the gun act as application bodies for the delivery of sensory enhancement stimulation.
• In yet another example, an embodiment of a neuro-stimulation system may incorporate stimulators into a waterproof shower mat to deliver stochastic resonance stimulation to a person's feet and reduce the likelihood that the person will fall in the shower. In a particular embodiment, the shower mat may be battery powered and may employ force sensors in the mat to determine where the foot is making contact and allow focused delivery of stimulation to areas of the mat where the person is standing. As discussed previously, the delivery of such stimulation to the feet enhances human balance, reducing the likelihood of falling.
• In a further example, an embodiment of a neuro-stimulation system may incorporate a stimulator into a sock, which delivers stochastic resonance stimulation to a foot. The stimulating element may be formed from a flexible polymer which vibrates from an electrical signal received from a controller coupled to the stimulator. The sock conforms to the shape of the foot and remains in contact with areas of the bottom of the foot without requiring any load on the bottom of the sock. Advantageously, the sock may be used by diabetics and other similar individuals who are not physically active and do not spend a significant amount of time on their feet to place a load on the sock. Even while seated or lying down, the sock maintains contact with the soles of the foot, so that the foot receives the effect of stimulation delivered by the stimulator. The benefits of applying such a stimulation to the bottom of the foot were described previously. In a particular embodiment, the controller may deliver different driving signals to the stimulating element depending on the load on the sock, i.e. load differences between standing and sitting. As such, a sensor may be employed to indicate the loading state of the sock to the controller, so that the driving signal may be correspondingly adjusted.
• Therefore, embodiments of the present invention provide a variety of configurations and shapes for delivering controlled stimulation to any sensory cells of any body part according to a variety of therapeutic applications. In some preferred embodiments, subthreshold and/or aperiodic stimulation is applied to enhance transmission and detection of sensory information. In some applications, this results in improved neuromuscular performance.
• It is understood that while the embodiments described herein may provide subthreshold and/or a periodic stimulation, the embodiments may also be capable of providing supra-threshold stimulation. In particular, supra-threshold stimulation may be applied as technique to determine, e.g. iteratively, a person's sensory threshold during initial system setup and before the subthreshold and/or a periodic stimulation is applied.
• However, the foregoing specific embodiments of the present invention as set forth in the specification herein are for illustrative purposes only. Various deviations and modifications can be made within the spirit and scope of this invention, without departing from the main theme thereof. It will be appreciated by persons skilled in the art that the present invention is not limited by what has been particularly shown and described herein above. While the present invention has been described in connection with a number of exemplary embodiments, and implementations, the present inventions are not so limited, but rather cover various modifications, and equivalent arrangements, which fall within the purview of prospective claims. All dimensions, and the like, provided herein are exemplary.

Claims (80)

1. A system for providing neuro-stimulation to a body part, the system comprising:

a controller including:

a user interface;

a power supply;

at least one electrical connector; and

a processor with software, the processor determining, according to values entered into the user interface, an electrical signal directed from the power supply to the at least one electrical connector; and

a stimulator adapted to be detachably coupled to the controller via the at least one electrical connector, the stimulator including:

a plurality of stimulating elements, including at least one electrode device and at least one vibration element; and

an attachment element to attach the stimulator to a body part,

wherein the controller is operable to drive at least one of the stimulating elements with an electrical signal, and in response to the electrical signal, at least one of the stimulating elements provides a stimulation for the body part, the stimulation being at least one of a subthreshold stimulation and an aperiodic stimulation.

2. The system according toclaim 1, wherein the controller has an operational mode in which only the at least one electrode device provides the stimulation.

3. The system according toclaim 1, wherein the controller has an operational mode in which only the at least one vibration element provides the stimulation.

4. The system according toclaim 1, further comprising a battery charging console, the battery charging console receiving power from an external power supply and providing power from the external power supply to at least one rechargeable battery through a recharging contact when the controller is received by the battery charging console, wherein the power supply includes the at least one rechargeable battery.

5. The system according toclaim 1, wherein the stimulator further comprises a data storage device storing usage data for the stimulator.

6. The system according toclaim 5, wherein the usage data includes a total amount of time that the stimulator has been employed to provide stimulation for the body part.

7. The system according toclaim 6, wherein, when the stimulator is detachably connected to the controller, the processor updates the total amount of time as the stimulator provides stimulation for the body part.

8. The system according toclaim 7, wherein, when the stimulator is detachably connected to the controller, the processor does not deliver the electrical signal to the stimulator if the processor determines that the total amount of time exceeds a time limit value.

9. The system according toclaim 5, wherein the usage data includes a usage indicator indicating whether the stimulator has been used.

10. The system according toclaim 9, wherein, after the stimulator is detachably coupled to the controller and the processor determines from the usage indicator that the stimulator has not been previously used, the processor communicates data to the usage indicator indicating that the stimulator has been used.

11. The system according toclaim 10, wherein, after the stimulator is detachably coupled to the controller and the processor determines from the usage indicator that the stimulator has been previously used, the processor does not deliver the electrical signal to the stimulator.

12. The system according toclaim 5, wherein the stimulator further includes a flex circuit connecting the at least one electrode device, the at least one vibration element, and the data storage device, and the processor is connected to the flex circuit when the stimulator is detachably connected to the controller.

13. The system according toclaim 12, wherein the at least one electrical connector comprises a n-pin connector, and the processor detects a coupling with the stimulator by detecting a short between two pins created by the flex circuit when the controller and the stimulator are detachably coupled via the n-pin connector.

14. The system according toclaim 1, wherein the stimulation is directed to sensory cells of the body part to enhance detection of an external signal by a subject, the sensory cells corresponding to a sensory function of the body part.

15. A method of enhancing sensorimotor performance in a subject comprising the steps of:

inputting an aperiodic signal to at least one sensory cell area of the subject;

moving at least one body segment of the subject relative to another simultaneous with the step of inputting an aperiodic signal to at least one sensory cell area of the subject, wherein the at least one body segment utilizes sensory cells within the sensory cell area that is involved in the sensorimotor performance to be enhanced; and

inducing neuroplastic changes in the nervous system of the subject by inputting the aperiodic signal for a period of time long enough that the subject's sensorimotor performance is enhanced.

16. The method according toclaim 15, wherein the step of moving comprises moving according to a virtual reality system.

17. The method according toclaim 15, wherein the step of moving comprises moving according to physical therapy.

18. The method according toclaim 15, wherein the physical therapy is device-augmented therapy.

19. The method according toclaim 18, wherein the device-augmented therapy uses a treadmill or an exercise bicycle.

20. The method according toclaim 15, wherein the aperiodic signal is provided at a subthreshold level.

21. The method according toclaim 15, further comprising the step of inputting a subthreshold signal to the at least one sensory cell area of the subject.

22. A method for providing neuro-stimulation to a body part with a neuro-stimulation device having a stimulator configured to provide at least one of an aperiodic stimulation and a subthreshold stimulation, the method comprising the step of applying, via the stimulator, at least one of an aperiodic stimulation and a subthreshold stimulation to at least one body part to mitigate muscle tension, contracture, or spasm resulting from neurodegenerative disease.

23. A method for providing neuro-stimulation to a body part with a neuro-stimulation device having a stimulator configured to provide at least one of an aperiodic stimulation and a subthreshold stimulation, the method comprising the step of applying, via the stimulator, at least one of an aperiodic stimulation and a subthreshold stimulation to an intercostal muscle in a chest area of an asthmatic patient to improve lung function.

24. A method for providing neuro-stimulation to a body part with a neuro-stimulation device having a stimulator configured to provide at least one of an aperiodic stimulation and a subthreshold stimulation, the method comprising the step of applying, via the stimulator, at least one of an aperiodic stimulation and a subthreshold stimulation to an area where pain is felt by a subject.

25. The method according toclaim 24, wherein the pain is caused by musculoskeletal hyperextension or excursion resulting from proprioceptive deficit in the body part.

26. A method for providing neuro-stimulation to a body part with a neuro-stimulation device having a stimulator configured to provide at least one of an aperiodic stimulation and a subthreshold stimulation, the method comprising the step of applying, via the stimulator, at least one of an aperiodic stimulation and a subthreshold stimulation to a joint of a subject with a sensory deficit to enhance awareness of body movement and increase muscle strength.

27. A method for providing neuro-stimulation to a body part with a neuro-stimulation device having a stimulator configured to provide at least one of an aperiodic stimulation and a subthreshold stimulation, the method comprising the step of applying, via the stimulator, at least one of an aperiodic stimulation and a subthreshold stimulation to swallowing organs to improve swallowing function.

28. The method according toclaim 27, wherein the swallowing function to be improved is the sensation of the presence of a solid or liquid bolus in the throat.

29. The method according toclaim 27, wherein the swallowing function to be improved is timing of swallowing muscle contraction relative to movement of solid or liquid bolus in the throat.

30. The method according toclaim 27, wherein the swallowing function to be improved is the timing of the closure of the trachea relative to the movement of solid or liquid bolus in the throat.

31. A method for improving cardiac function with a neuro-stimulation device having a stimulator configured to provide at least one of an aperiodic stimulation and a subthreshold stimulation, the method comprising applying, via the stimulator, at least one of an aperiodic stimulation and a subthreshold stimulation to a heart muscle, whereby resistance to overfilling is enhanced.

32. The method according toclaim 22,23,24,25,27,28,29,30, or31 wherein the stimulation comprises electrical stimulation.

33. The method according toclaim 22,23,24,25,27,28,29,30, or31 wherein the stimulation comprises mechanical stimulation.

34. The method according toclaim 22,23,24,25,27,28,29,30, or31 wherein the stimulation comprises electrical and mechanical stimulation.

35. A method for enhancing sensory function in a subject, the method comprising:

providing a stimulation source to an external device, wherein the stimulation source provides a stimulation including at least one of a subthreshold stimulation and an aperiodic stimulation; and

receiving, with the external device, an interaction with a body part,

wherein the stimulation source applies the stimulation to sensory cells of the body part during the contact to enhance sensory function associated with the body part.

36. The method according toclaim 35, wherein the interaction provides a tactile signal to the body part, and the stimulation enhances detection of the tactile signal with the sensory cells.

37. The method according toclaim 36, wherein the body part is a fingertip, and the stimulation enhances detection of the tactile signal with the sensory cells.

38. The method according toclaim 37, wherein the external device is a surface with Braille and the step of receiving an interaction comprises receiving the fingertip into a contact with the Braille surface.

39. The method according toclaim 37, wherein the external device is a trigger of a firearm and the step of receiving an interaction comprises receiving the fingertip into contact with the trigger of a firearm.

40. The method according toclaim 35, wherein the external device is a gun stock and the interaction provides a tactile signal through the gun stock to the body part, and the stimulation enhances detection of the gun stock position with the sensory cells.

41. The method according toclaim 35, wherein the body part is a sexual organ, and the stimulation enhances detection of the tactile signal with the sensory cells.

42. The method according toclaim 35, wherein the interaction provides an olfactory signal to a nose, and the stimulation enhances detection of the olfactory signal with the sensory cells.

43. The method according toclaim 42, wherein the subject is a canine.

44. The method according toclaim 43, wherein the step of receiving an interaction with the body part exposes the nose of the canine to contraband.

45. The method according toclaim 35, wherein the interaction provides a visual signal to an eye, and the stimulation enhances detection of the visual signal with the sensory cells.

46. The method according toclaim 35, wherein the interaction provides an aural signal to an ear, and the stimulation enhances detection of the aural signal with the sensory cells.

47. The method according toclaim 46, wherein the external device is a hearing assistive device.

48. The method according toclaim 35, wherein the interaction provides a flavor signal to a tongue, and the stimulation enhances detection of the flavor signal with the sensory cells.

49. A firearm for enhancing accuracy in shooting applications, the firearm comprising:

a controller including:

a power supply;

an electrical connector; and

a processor determining an electrical signal directed from the power supply to the electrical connector; and

at least one stimulator operably coupled to the controller via the electrical connector and positioned on at least one of a trigger and a gun stock, the at least one stimulator including at least one of an electrode device and a vibration element,

wherein, the processor is operable to drive at least one of the electrode device and the vibration element with the electrical signal, and

in response to the electrical signal, at least one of the electrode device and the vibration element provides a stimulation to sensory cells in contact with at least one of the trigger and the gun stock.

50. The system according toclaim 50, wherein the controller has an operational mode in which the electrical signal has an aperiodic waveform.

51. The system according toclaim 50, wherein the controller has an operational mode in which the stimulation to the body part is subthreshold.

52. A system for providing neuro-stimulation through contact with a body part, the system comprising:

a stimulator including:

a flexible, expandable attachment element having a surface area corresponding to a body part surface area and configured to be attached to the body part surface area; and

at least one electrode device attached to the attachment element to be positioned over the surface area of the body part,

wherein the stimulation is configured to provide at least one of an aperiodic stimulation and a subthreshold stimulation.

53. The system according toclaim 53, wherein the attachment element is a mesh.

54. The system according toclaim 53, wherein the attachment element is bioresorbable.

55. A system for providing neuro-stimulation through contact with a body part, the system comprising:

a stimulator including:

a flexible, expandable attachment element having a surface area corresponding to a body part surface area and configured to be attached to the body part surface area; and

at least one electrode device attached to the attachment element to be positioned over the surface area of the body part,

wherein the stimulation is configured to provide at least one of an aperiodic stimulation and a subthreshold stimulation.

the method comprising:

attaching the attachment element over the surface area of the body part;

applying, via the stimulator, at least one of an aperiodic stimulation and a subthreshold stimulation to the body part.

56. The method according toclaim 56, wherein the step of attaching the attachment element comprises attaching the attachment element to the body part via sutures.

57. The method according toclaim 56, wherein the body part is the bladder, colon, stomach, gall bladder, esophagus, intestines, urethra, or bile duct.

58. A mat comprising:

a top surface for contact a foot of a subject;

a bottom surface for contact with a floor;

a controller including:

a power supply;

an electrical connector; and

a circuit determining an electrical signal directed from the power supply to the electrical connector; and

a stimulator operably coupled to the controller via the electrical connector and operably coupled to the top surface,

wherein the processor is operable to drive the stimulator with the electrical signal, and in response to the electrical signal, the stimulator provides a stimulation to the top surface, the stimulation being at least one of an aperiodic stimulation and a subthreshold stimulation.

59. The mat according toclaim 59, further comprising force sensors to detect a position of the foot, wherein the stimulator focuses delivery of the stimulation to the position.

60. A catheter comprising:

an elongate body,

a plurality of stimulators positioned along the elongate body,

wherein the one or more of the stimulators are configured to provide a stimulation, wherein the stimulation is at least one of an aperiodic stimulation or subthreshold stimulation.

61. A system for enhancing sensorimotor performance in a subject comprising:

a wearable device to which is secured at least one signal input device, wherein the at least one signal input device is repositionable on the wearable device; and

a signal generator for generating a bias signal, wherein the signal generator is communicatively coupled to the at least one signal input device.

62. The system ofclaim 62, wherein the signal generator includes a power source, a signal processor and a controller.

63. The system ofclaim 63, wherein the signal processor includes a calibration module for adjusting the bias signal produced by the signal processor.

64. The system ofclaim 62, wherein the wearable device is adapted to forcibly press the signal input device to the subject's skin surface.

65. The system ofclaim 62, wherein the wearable device is composed of stretchable fabric.

66. The system ofclaim 62, wherein the signal generator is repositionable and removably attached to the wearable device.

67. The system ofclaim 62, wherein the signal input device is electrically connected to the signal generator.

68. The system ofclaim 62, wherein the signal generator is communicatively coupled to the signal input device by an electrical conductor, at least a portion of the electrical conductor being secured within the wearable device and protected by the wearable device.

69. A method of increasing growth hormone release in a subject comprising the step of:

increasing afferent signaling to the pituitary gland and growth hormone release by inputting at least one bias signal to at least one sensory cell area of a subject while the subject is performing a physical activity utilizing sensory cells within the sensory cell area, the bias signal causing the sensory cells to produce the growth hormone.

70. A method of increasing growth hormone release in a subject comprising the step of:

increasing afferent signaling to the pituitary gland and growth hormone release by inputting at least one bias signal to at least one sensory cell area of a subject while the subject is performing a physical activity which utilizes sensory cells within the sensory cell area,

wherein inputting the at least one bias signal improves the function of the sensory cells, the system comprising a wearable device to which at least one respositionable signal input device is secured, and a signal generator communicatively coupled to the at least one signal input device.

71. A system for improving neuroplasticity in a subject in accordance with the method of:

inputting at least one bias signal to at least one sensory cell area of a subject while the subject is performing a pre-defined physical activity which utilizes sensory cells within the sensory cell area and which are involved in the sensorimotor performance to be enhanced, wherein inputting the at least one bias signal improves the function of the sensory cells, and wherein the neuroplasticity is at least one of central neuroplasticity and peripheral neuroplasticity,

the system comprising:

a wearable device to which is secured at least one signal input device, wherein the at least one signal input device is repositionable on the wearable device; and

a signal generator for generating a bias signal, wherein the signal generator is communicatively coupled to the at least one signal input device.

72. The system ofclaim 72, wherein the signal generator includes a power source, a signal processor and a controller.

73. The system ofclaim 73, wherein the signal processor includes a calibration module for adjusting the bias signal produced by the signal processor.

74. The system ofclaim 72, wherein the wearable device is adapted to forcibly press the signal input device to the subject's skin surface.

75. The system ofclaim 72, wherein the wearable device is composed of stretchable fabric.

76. The system ofclaim 72, wherein the signal generator is repositionable and removably attached to the wearable device.

77. The system ofclaim 72, wherein the signal input device is electrically connected to the signal generator.

78. The system ofclaim 72, wherein the signal generator is communicatively coupled to the signal input device by an electrical conductor, at least a portion of the electrical conductor being secured within the wearable device and protected by the wearable device.

79. A method of enhancing sensorimotor performance in a subject comprising the steps of:

inputting a stimulation to at least one sensory cell area of the subject, the stimulation being at least one of an aperiodic stimulation and a subthreshold stimulation;

moving, according to a virtual reality system, at least one body segment of the subject relative to another simultaneous with the step of inputting a stimulation to at least one sensory cell area of the subject, wherein the at least one body segment utilizes sensory cells within the sensory cell area that is involved in the sensorimotor performance to be enhanced; and

inducing neuroplastic changes in the nervous system of the subject by inputting the stimulation for a period of time long enough that the subject's sensorimotor performance is enhanced.

80. A method of enhancing sensorimotor performance in a subject comprising the steps of:

moving, according to a virtual reality system, at least one body segment of the subject relative to another, wherein the at least one body segment utilizes sensory cells within the sensory cell area that is involved in the sensorimotor performance to be enhanced; and

inducing neuroplastic changes in the nervous system of the subject by moving the at least one body segment according to the virtual reality system for a period of time long enough that the subject's sensorimotor performance is enhanced.

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