Automatic neural stimulation based on activity

Abstract

A system for providing neural stimulation, including an activity monitor to sense activity and provide a signal indicative of the activity and a neural stimulator. The neural stimulator includes a pulse generator to provide a neural stimulation signal adapted to provide a neural stimulation therapy, and a modulator to receive the signal indicative of the activity and modulate the neural stimulation signal based on the signal indicative of the activity to change the neural stimulation therapy.

1 . A system for providing neural stimulation, comprising: an activity monitor to sense activity and provide a signal indicative of the activity; and a neural stimulator, including: a pulse generator to provide a neural stimulation signal adapted to provide a neural stimulation therapy; and a modulator to receive the signal indicative of the activity and modulate the neural stimulation signal based on the signal indicative of the activity to change the neural stimulation therapy. 
   
   
       2 . The system of  claim 1 , wherein the activity monitor is adapted to provide at least one signal to distinguish rest and exercise, and the pulse generator and the modulator are adapted to cooperate to respond to rest by providing the neural stimulation signal and to respond to exercise by withdrawing the neural stimulation signal. 
   
   
       3 . The system of  claim 1 , wherein the signal indicative of the activity includes a signal indicative of an activity level, and the modulator is adapted to set a neural stimulation level based on the activity level. 
   
   
       4 . The system of  claim 1 , wherein the modulator is adapted to compare at least one sensed activity parameter to at least one reference parameter, and modulate the neural stimulation signal based on results of the comparison. 
   
   
       5 . The system of  claim 4 , wherein the modulator is adapted to determine a difference between the at least one reference parameter and the at least one sensed activity parameter, and modulate the neural stimulation based on the difference. 
   
   
       6 . The system of  claim 5 , wherein the modulator is adapted to change an intensity of the neural stimulation in proportion to the difference. 
   
   
       7 . The system of  claim 5 , wherein the modulator is adapted to dynamically adjust the at least one reference parameter based on sensed activity over a period of time. 
   
   
       8 . The system of  claim 1 , wherein the pulse generator and the modulator are adapted to provide the neural stimulation signal when the sensed activity is below a threshold and withhold the neural stimulation signal when the sensed activity is above the threshold. 
   
   
       9 . The system of  claim 1 , wherein the sensed activity is associated with an unintended physiologic response, and the pulse generator and the modulator are adapted to adjust the neural stimulation to abate the unintended response. 
   
   
       10 . The system of  claim 1 , wherein the stimulation signal has an amplitude, and the modulator includes a modulator to modulate the amplitude based on the signal indicative of the activity. 
   
   
       11 . The system of  claim 1 , wherein the stimulation signal has a frequency, and the modulator includes a modulator to modulate the frequency based on the signal indicative of the activity. 
   
   
       12 . The system of  claim 1 , wherein the pulse generator is adapted to generate an neural stimulation pulse train, and the modulator includes a modulator to change a duration of a neural stimulation pulse train. 
   
   
       13 . The system of  claim 1 , wherein the activity monitor includes a heart rate sensor. 
   
   
       14 . The system of  claim 1 , wherein the activity monitor includes a respiration monitor. 
   
   
       15 . The system of  claim 14 , wherein the respiration monitor includes a minute ventilation monitor. 
   
   
       16 . The system of  claim 14 , wherein the respiration monitor includes a respiration rate monitor. 
   
   
       17 . The system of  claim 1 , wherein the activity monitor includes a motion monitor. 
   
   
       18 . The system of  claim 17 , wherein the motion monitor includes an accelerometer. 
   
   
       19 . The system of  claim 17 , wherein the motion monitor is adapted to use electromyography (EMG) to evaluate muscle movement. 
   
   
       20 . The system of  claim 17 , wherein the motion monitor is adapted to use global positioning system (GPS) technology. 
   
   
       21 . The system of  claim 1 , wherein the activity monitor includes a stroke volume monitor. 
   
   
       22 . The system of  claim 1 , wherein the activity monitor includes a tidal volume monitor. 
   
   
       23 . The system of  claim 1 , wherein the activity monitor includes a monitor of nerve activity. 
   
   
       24 . The system of  claim 1 , wherein the activity monitor includes a monitor of cardiac output. 
   
   
       25 . The system of  claim 1 , wherein the activity monitor includes a sensor to sense at least one blood pressure parameter. 
   
   
       26 . The system of  claim 25 , wherein the at least one blood pressure parameter includes mean arterial pressure, a pulse pressure, an end systolic pressure, or an end diastolic pressure. 
   
   
       27 . The system of  claim 1 , wherein the activity monitor includes a monitor to measure at least one electrogram measurement. 
   
   
       28 . The system of  claim 1 , further comprising an implantable medical device, wherein the implantable medical device includes the activity monitor and the neural stimulator. 
   
   
       29 . The system of  claim 1 , further comprising an implantable neural stimulator (NS) device and an implantable cardiac stimulator, wherein the implantable NS device includes the neural stimulator and the implantable cardiac stimulator includes the activity monitor. 
   
   
       30 . The system of  claim 1 , wherein the modulator is adapted to modulate the neural stimulation signal based on a circadian rhythm and based on the signal indicative of the activity to change the neural stimulation therapy. 
   
   
       31 . The system of  claim 30 , wherein the modulator is adapted to more aggressively reduce neural stimulation intensity with increased activity during daytime, but less aggressively reduce neural stimulation with increased activity during nighttime. 
   
   
       32 . A neural stimulator, comprising: an implantable pulse generator to provide a neural stimulation signal adapted to provide a neural stimulation therapy; and means for modulating the neural stimulation signal based on a signal indicative of activity to change an intensity of the neural stimulation therapy. 
   
   
       33 . The neural stimulator of  claim 32 , wherein the means for modulating the neural stimulation signal includes means for detecting an activity level and means for modulating the neural stimulation signal based on the activity level. 
   
   
       34 . The neural stimulator of  claim 32 , wherein the means for modulating the neural stimulation signal includes means for applying neural stimulation only if the signal indicative of activity is less than a threshold. 
   
   
       35 . The neural stimulator of  claim 32 , wherein the means for modulating the neural stimulation signal includes means for modulating the neural stimulation signal based on a circadian rhythm and based on the signal indicative of activity. 
   
   
       36 . A method, comprising: sensing activity; and automatically controlling neural stimulation based on the sensed activity. 
   
   
       37 . The method of  claim 36 , further comprising determining periods of rest and periods of exercise using the sensed activity, wherein controlling neural stimulation includes applying neural stimulation during rest and withdrawing neural stimulation during exercise. 
   
   
       38 . The method of  claim 36 , wherein sensing activity includes sensing an activity level, and controlling neural stimulation includes setting a neural stimulation level based on the activity level. 
   
   
       39 . The method of  claim 36 , further comprising comparing at least one acquired activity parameter to at least one reference parameter, wherein controlling neural stimulation includes modulating the neural stimulation signal based on results of the comparison. 
   
   
       40 . The method of  claim 39 , wherein modulating the neural stimulation signal based on results of the comparison includes determining a difference between the at least one reference parameter and the at least one sensed activity parameter, and modulating the neural stimulation based on the difference. 
   
   
       41 . The method of  claim 36 , wherein controlling neural stimulation includes providing neural stimulation when the sensed activity is below a threshold, and not providing the neural stimulation when the sensed activity is above the threshold. 
   
   
       42 . The method of  claim 36 , wherein the activity is associated with an undesired physiologic response, wherein controlling neural stimulation includes adjusting the neural stimulation to abate the undesired physiologic response. 
   
   
       43 . The method of  claim 36 , wherein sensing activity includes sensing heart rate, sensing respiration, sensing motion, sensing stroke volume, sensing tidal volume, sensing nerve activity, sensing cardiac output, or sensing nerve activity.