text:
|Publication number
|Publication type
|Application number
|Publication date
|Jan 10, 2012
|Priority date
|Apr 12, 2004
|Fee status
|Also published as
|Publication number
|Anthony J Varrichio, Benjamin A Tranchina
|Original Assignee
|Advanced Neuromodulation Systems, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (10), Non-Patent Citations (1), Referenced by (2), Classifications (11), Legal Events (1)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation of U.S. application Ser. No. 11/105,188, filed Apr. 12, 2005, pending, which claims the benefit of U.S. Provisional Application No. 60/561,437, filed Apr. 12, 2004, and related to commonly assigned U.S. application Ser. No. 11/105,191, filed Apr. 12, 2005, pending, U.S. application Ser. No. 11/105,186, filed Apr. 12, 2005, pending, U.S. application Ser. No. 11/105,332, filed Apr. 12, 2005, now U.S. Pat. No. 7,180,760, U.S. application Ser. No. 11/105,190, filed Apr. 12, 2005, pending, and U.S. Provisional Application No. 60/648,556, filed Jan. 31, 2005, the disclosures of which are incorporated herein by reference.
The present invention is directed, in general, to pulse generation and, more specifically, to active discharge of a pulse generator.
In delivering constant current electrical stimulation pulses by an implantable pulse generator to electrodes implanted near a stimulation site, capacitive connections of the electrodes to a pulse generator circuit output driver can accumulate charge if balanced pulses are not employed, resulting in skewing the pulses over time. Simply using balanced pulses, however, dissipates twice the power.
Simple passive discharge, on the other hand, requires time to dissipate accumulated charge, potentially limiting the frequency at which pulses can be delivered. In addition, significant charge may remain accumulated between pulses, skewing the pulses over time.
To address the above-discussed deficiencies of the prior art, it is a primary object of an embodiment of the present invention to provide, for use in an implantable pulse generator, active discharge pulses following stimulation pulses and having opposite polarity of the stimulation pulses as well as programmable amplitude and duration. Approximately the same total net current flow is delivered during active discharge pulses as during the stimulation pulses, but in the opposite direction and optionally at a lower amplitude. By reducing the driving voltage and a variable load within the electrical path for delivery of the pulses, power dissipation during active discharge is reduced.
The foregoing has outlined rather broadly the features and technical advantages of the present invention in order that the detailed description of the invention that follows may be better understood. Additional features and advantages of the invention will be described hereinafter which form the subject of the claims of the invention. It should be appreciated by those skilled in the art that the conception and specific embodiment disclosed may be readily utilized as a basis for modifying or designing other structures for carrying out the same purposes of the present invention. It should also be realized by those skilled in the art that such equivalent constructions do not depart from the spirit and scope of the invention as set forth in the appended claims. The novel features which are believed to be characteristic of the invention, both as to its organization and method of operation, together with further objects and advantages will be better understood from the following description when considered in connection with the accompanying figures. It is to be expressly understood, however, that each of the figures is provided for the purpose of illustration and description only and is not intended as a definition of the limits of the present invention.
For a more complete understanding of the present invention, reference is now made to the following descriptions taken in conjunction with the accompanying drawing, in which:
Before undertaking the detailed description below, it may be advantageous to set forth definitions of certain words or phrases used throughout this patent document: the terms "include" and "comprise," as well as derivatives thereof, mean inclusion without limitation; the term "or" is inclusive, meaning and/or; the phrases "associated with" and "associated therewith," as well as derivatives thereof, may mean to include, be included within, interconnect with, contain, be contained within, connect to or with, couple to or with, be communicable with, cooperate with, interleave, juxtapose, be proximate to, be bound to or with, have, have a property of, or the like; the terms "couple" and "connect" refer to any direct or indirect connection between two or more components, unless specifically noted that a direct coupling or direct connection is present; and the term "controller" means any device, system or part thereof that controls at least one operation, whether such a device is implemented in hardware, firmware, software or some combination of at least two of the same. It should be noted that the functionality associated with any particular controller might be centralized or distributed, whether locally or remotely. Definitions for certain words and phrases are provided throughout this patent document, and those of ordinary skill in the art will understand that such definitions apply in many, if not most, instances to prior as well as future uses of such defined words and phrases.
The general principles of the present invention are described with respect to an implantable pulse generator (IPG) for generating electrical stimulation for application to a desired area of a body, such as a spinal cord stimulation (SCS) system. It will be understood that the concepts of the present invention are not limited to an implantable pulse generator for use in an spinal cord stimulation system, but has broad applicability, including but not limited to different types of implantable devices such as spinal and neural stimulators and sensors, deep brain stimulators, cochlear stimulators, drug delivery systems, muscle tissue stimulators, and the like, including sensors and sensing systems. Moreover, the concepts of the present invention are not limited to use with respect to an IPG or any particular form of IPG. For example, embodiments of the present invention may be implemented with respect to a fully implantable pulse generator, a radio frequency pulse generator, an external pulse generator, a micro-implantable pulse generator, etcetera.
Lead 102 includes a lead body 103 extending between a distal end 104 and a proximal end 105. Lead body 103 contains internal conductors, eight in the exemplary embodiment shown, extending a substantial distance of the length of lead 102 from the proximal end 105 towards the distal end 104, with the leads having lead connectors (not shown) at the proximal end 105 and terminating at exposed contact or ring stimulation electrodes 106-113 near the distal end 104. The conductors provide electrical connection from individual lead connectors to each of a corresponding one of electrodes 106-113. In the exemplary embodiment, the lead 102 is generally configured to transmit one or more electrical signals from implantable pulse generator 101 for application at, or proximate to, a spinal nerve or peripheral nerve, or other tissue via stimulation electrodes 106-113.
As will be appreciated, the connectors for electrodes 106-113 are situated within a receptacle of the implantable pulse generator 101 and are therefore not visible in
As will be appreciated, any number of conductors and corresponding stimulation electrodes may be utilized within lead 102, and lead 102 is shown with eight conductors/electrodes for purposes of illustration only. In addition, other types, configurations and shapes of stimulation electrodes (and lead connectors) known to those skilled in the art may be used. An optional lumen (not shown) may extend through the lead 102 and may be used for different purposes, including the delivery of chemicals or drugs.
Lead body 103 is a structure typically having a round cross-section, as in the exemplary embodiment, although the cross-section of the lead body 103 may be configured in any number of cross-sectional shapes appropriate for the specific application. Lead body 103 generally includes a lead body insulator configured to surround and insulate the conductors and present a biocompatible external surface to the body tissue, while leaving stimulation electrodes 106-113 exposed.
As shown in
Stimulation system 100 also optionally includes an external programmer/controller 114 to program and/or control the implantable pulse generator 101 via a wireless communications link 115 between the implantable pulse generator 101 and the external programmer/controller 114. Implantable pulse generator 101 preferably includes an RF receiver (or transceiver) operative for wireless communications with an RF transmitter (or transceiver) 116 within programmer/controller 114. A controller 117 within programmer/controller 114 operates to control implantable pulse generator 101 via the wireless communications signals as described in further detail below.
When implantable pulse generator 101 is self-contained, the programmer/controller 114 may also provide power to the implantable pulse generator 101. Optionally, however, a separate power controller may be provided for charging the power source within implantable pulse generator 101. In some commercial embodiments, programmer/controller 114 is referred to as an external patient controller/programmer (EPP).
As shown in
Accordingly, a user of the stimulation system 100 may use the programmer/controller 114 to provide control signals for the operation of the implantable pulse generator 101 by operation of user controls (not shown) on programmer/controller 114 and functioning as inputs to controller 117. The controller 117 provides control signals to the transmitter 116, which transmits corresponding signals (and optionally power) to the receiver within the implantable pulse generator 101, which responsively varies the parameters of electrical signals transmitted through electrodes 106-113 to the stimulation site(s).
Current control mechanism 300 is also connected via a high-voltage protection circuit 303 and the electrodes at which the electrical stimulation pulse is to be delivered to another current source or sink (that is, if scale circuit 302 includes or is connected to a current sink, the electrodes are connected to a current source and vice versa). In this manner, current control 300 forms part of a current path including the electrodes and the patient's body. A shunt circuit 304 is used to selectively direct current around the electrodes and patient to an alternate current sink or source, within or connected to shunt circuit 304, under control of a single input bit.
The other terminal of transistor 303 is connected to the AMPOUT signal, which in turn is coupled to the VCATHODE signal. The VCATHODE signal is connected by one of switches 309 to an electrode or optionally by switch 310 to a VANODE signal, corresponding to the voltage driven on the selected anode electrode. The VANODE signal is connected by one of programmable switches 309 to an electrode, and selectively to one of (a) the VBATT voltage, available on an output of the voltage multiplier 311, (b) the VMULT voltage generated by voltage multiplier 311 or (c) the 2VBATT voltage generated by voltage multiplier 311.
The other terminal of transistor 306 (the one not connected to transistor 303) is connected to the SCALE input signal, to one input of operational amplifier 305, and to one terminal of scale circuit 302. Scale circuit 302 may be implemented, for example, by a digitally-controlled resistance that may be selectively varied. The variable output of scale circuit 302 is also connected to the same input of operational amplifier 305 as the terminal of transistor 306 and the SCALE input signal. The other terminal of scale circuit 302 is coupled to ground.
The variable output terminal of digital-to-analog converter 301 is connected to the other input of operational amplifier 305. The other terminal of digital-to-analog converter 301 is connected to a current mirror (not shown) transmitting a bias current IBIAS of approximately 800 nA through the digital-to-analog converter 301 to ground. The implementation of digital-to-analog converter 301 is preferably selected for monotonicity of the output function (e.g., a ladder resistor).
Current control 300 sets the amplitude of output current IOUT driven for the electrical stimulation pulse. Each of the outputs 312 for programmable switches 309 is connected through a capacitor (not shown) to one of the electrodes 106-113. Switches 309 programmably connect, with timing controlled by input signals PULSE and INVERTCLK, one or more of the electrodes 106-113 to the anode voltage VANODE and one or more of the electrodes 106-113 to the cathode voltage VCATHODE to deliver the electrical stimulation pulse to the desired location(s). In addition, each of outputs 312 may be selectively tri-stated (set to a high-impedance state), so that each electrode 106-113 may be connected as an anode, connected as a cathode, or tri-stated (off).
During operation, the universal custom output driver 206 stores switching patterns for controlling connection of switch outputs 312 within a memory (not shown). The switching patterns define parameters for electrical stimulation pulses, including the lead electrode 106-113 to be employed as anode and as cathode. For delivery of an electrical stimulation pulse according to embodiments of the invention, switches 309 connect at least one of the outputs 312 to the selected anode voltage VANODE, and at least one other of the outputs 312 to a cathode voltage VCATHODE (which is also the output voltage AMPOUT that may be employed for selective monitoring of any output pulse delivered). In this manner, an electrical pulse is selectively transmitted through selected one(s) of the electrodes 106-113 and returned through other selected one(s) of the electrodes 106-113 for delivery of that electrical pulse to the desired stimulation site(s) according to an embodiment.
The functionality of universal custom output driver 206 also includes inversion of the switching pattern(s) retrieved from the memory so that the previously selected anode electrode(s) becomes the cathode electrode(s) and the previously selected cathode electrode(s) becomes the anode electrode(s) (and all other electrodes remain unused). This functionality is employed for active discharge, as described in further detail below.
The universal custom output driver 206 also controls anode source voltage selection, selecting the anode voltage VANODE from one of twice a battery voltage 2VBATT, a voltage multiplier output voltage VMULT, and the battery voltage VBATT, all generated by capacitive voltage multiplier (VMult) 311 as described in further detail below.
Switches 309 are also employed to provide transition blanking, controlled one clock cycle blanking of the anode electrodes within the lead 102 upon a signal change for patient safety. Such blanking may be accomplished by selectively tri-stating the outputs 312 to provide blanking without altering the stored memory or register switching patterns. During delivery of an electrical stimulation pulse, switch 310, controlled by an input signal DISCHARGE, is normally open. Between pulses, switch 310 is closed to allow passive discharge of the capacitive connections between outputs 312 and corresponding electrodes 106-113.
In implementing universal custom output driver 206 according to embodiments of the present invention, power consumption is balanced against slew rate. Operational amplifiers having a slew rate acceptable for high frequency operation (i.e., short electrical stimulation pulse duration) typically have high power consumption, an important consideration for battery life and/or the interval between required recharging cycles. Low power amplifiers, on the other hand, have a poor slew rate that can constrain the frequency or duration of electrical stimulation pulses, or simply provide poor stimulation performance.
The electrical stimulation pulse delivered to the patient through the anode and cathode electrodes is a programmable constant current pulse produced by forcing a known voltage across a very low sampling resistor that is electrically connected in series with the patient via source follower 303 through the selected cathode. Embodiments of the present invention enables use of a low power (and lower cost) implementation for amplifier used in delivering that pulse by providing a pre-charge period for each pulse. As illustrated in
By pre-charging the internal electronics of the operational amplifier 305, which are biased using low internal voltages, and the output of operational amplifier 305 to an output voltage close to the threshold voltage at which transistor 306 begins conducting, the time required for the amplifier output voltage to be raised above that threshold voltage, turning transistor 306 on and initiating delivery of an electrical stimulation pulse through the anode and cathode electrodes, is reduced. Transistor 306 has a large width-to-length ratio to minimize resistance, which results in a high gate capacitance that can degrade slew rate. The constant current pulses delivered for electrical stimulation therefore have very fast rise times (slew rate).
To provide fast rise and fall times at low power consumption, an amplifier pre-charge period preceding the output pulse is employed, during which the amplifier is powered up but drives a low output current (about 100 microamperes) through the transistor 306 (by setting the scale circuit 302 to a high resistance value). Use of such a pre-charge period is facilitated according to embodiments since (a) a shunt path is provided, and (b) the amplifier output needs only to be operable for short, predictable periods of time, and may in fact be powered down (e.g., not a sleep mode) between pulses to reduce power consumption. The output current produced by pre-charging is shunted around the patient, with switch 308 closed by the SHUNT signal so that the delivered current passes through resistor 307. The output pulse to the patient starts immediately following the amplifier pre-charge period since the amplifier is already near the operating point (a change of only millivolts rather than volts is required).
The net pulse width of the output pulse delivered to the patient is the duration between the leading edge of the PULSE signal and the trailing edge of the INVERTCLK signal minus the amplifier pre-charge period. In the exemplary embodiment, the amplifier pre-charge period is programmable from 1-3 clock cycles in half-cycle steps. The reduction of the output pulse duration by the amplifier pre-charge period is automatic within universal custom output driver 206 of the illustrated embodiment, significantly reducing the burden on microcontroller or microprocessor 204.
In the illustrated embodiment of the present invention, transistor 306 at the output of operational amplifier 305, within the current sink path, is a field effect transistor (FET) rather than a bipolar junction transistor (BJT). This contributes to providing fast rise times following pre-charging, since a faster switching speed may be obtained.
To minimize wasted power during pre-charging, the resistance of scale circuit 302 is preferably set to the largest resistance value tolerable while still achieving acceptable rise time.
The amplitude of the constant current output IOUT of the illustrated embodiment is controlled by the combination of digital-to-analog converter 301 and scale circuit 302. To deliver the electrical stimulation pulse at the end of the amplifier pre-charge period according to embodiments of the invention, the resistance of scale circuit 302 is reduced to a value corresponding to the selected, desired output current range, and switch 308 is concurrently opened. The digital-to-analog converter 301 of embodiments controls the precise output current within the selected range for the electrical stimulation pulse that is delivered. At the end of the output pulse, the amplifier is clamped and the resistance of scale circuit 302 is again raised to a higher value.
Rather than employing a fixed resistor within the current sink path and varying the voltage input to operational amplifier 305, or alternatively fixing the voltage input to the operational amplifier 305 and employing a variable resistance in the current sink path, embodiments of the present invention provide both a digitally-controlled variable voltage input to operational amplifier 305 and a variable resistance within the current sink path to control the output current for an electrical stimulation pulse. Such use of dual variable controls over the current amplitude is facilitated at least in part because digital-to-analog converter 301 is monotonic, as described above.
Use of dual variable controls allows the scale circuit 302 to be employed to set a range for the output current IOUT, or as a coarse resolution control. Strictly by way of example, scale circuit 302 may be employed to select between one of the following ranges: 0-25.6 milliamperes (mA), 0-12.8 mA, 0-6.4 mA or 0-1.6 mA.
Digital-to-analog converter 301 is then employed to select a particular (stepped) output current IOUT within the selected range, or as a fine resolution control. In the exemplary embodiment, the resolution depends on the number of step increments provided by digital-to-analog converter 301 and the range selected by scale circuit 302. That is, scale circuit 302 of embodiments provides ratiometric output current accuracy through resistance adjustment while digital-to-analog converter 301 provides monotonic output current accuracy through voltage adjustment. For instance, using the above-described exemplary ranges, a digital-to-analog converter 301 capable of operation in 256 increments would have a resolution of 100 microamperes (μA) for the largest range of 0-25.6 mA, a resolution of 50 μA for the second-largest range of 0-12.8 mA, a resolution of 25 μA for the next-to-smallest range of 0-6.4 mA, and a resolution of 6.25 μA for the smallest range of 0-1.6 mA.
In operation according to embodiments of the invention, scale circuit 302 is programmably controlled to automatically select the smallest range permitting delivery of the target output current amplitude. For example, if an output current amplitude of 6.2 mA is desired for an electrical stimulation pulse, scale circuit 302 of an embodiment will automatically be set for the above-described exemplary range of 0-6.4 mA, rather than the higher ranges of 0-12.8 mA or 0-25.6 mA. Selection of the smallest range including the desired stimulation pulse amplitude both reduces power dissipation by the output driver to conserve power and allows maximum (fine) stimulation pulse amplitude adjustment resolution to be used in any adjustment by the patient.
A benefit of the coarse and fine resolution approach described above is that the finer resolution inherently achieved at lower output current ranges is better suited for patient adjustment. If a large amplitude current pulse is required for stimulation (say, 20 mA), coarse adjustment (e.g., in increments of 100 μA) will be acceptable to the patient, who might not perceive any difference if finer resolution adjustment (e.g., in increments of 6.25 μA) were provided at that output current pulse amplitude level.
In embodiments of the present invention, scale circuit 302 serves three functions: selection of the output current IOUT or range during delivery of the electrical stimulation pulse; scaling of the output current IOUT by 1:1, 1:2 or 1:4 during the active discharge (described below); and scaling of the output current IOUT to a low level during the amplifier pre-charge period, as described above. From the above, it should be appreciated that the use of digital-to-analog converter 301 and scale circuit 302 of embodiments of the present invention provides control with respect to the output pulse current for providing scaling (e.g., magnitude selection), ramping (e.g., selection of incrementally larger or smaller magnitudes within a series of pulses), stimulation pulse/active discharge pulse ratio selection (e.g., 1:1, 1:2, or 1:4 ratio selection), and pulse wave shaping (e.g., selection of different magnitudes within a pulse to provide a stepped pulse etcetera).
In addition to contributing to providing fast rise times through pre-charging, the use of field effect transistor 306, digital-to-analog converter 301 and scale circuit 302 in combination with operational amplifier 305 in the present invention improves relative accuracy (versus less-important absolute accuracy) during scaling of the output pulse current. Use of field effect transistor 306 also facilitates direct error measurement based on the gate voltage, and results in less overhead voltage being "thrown away." Use of digital-to-analog converter 301 and scale circuit 302 further facilitates scaling for active discharge, described below.
In addition to enabling pre-charging of operational amplifier 305, the shunt path provided by resistance 307 and switch 308, under the control of SHUNT signal, improves reliability of operation and patient safety by preventing delivery of leakage current to the stimulation site between pulses. Optionally an overvoltage or other exceptional condition may also close switch 308 to make the shunt path available in lieu of driving current through the patient.
Switch 310, around switches 309 and electrode outputs 312, could optionally be switched in conjunction with switch 308, providing a low-resistance path around the lead 102 to minimize any current flowing through the electrodes should a current pulse be inadvertently delivered.
As previously described, the electrodes 106-113 within lead 102 are connected to switches 309 by capacitors (not shown). Because field effect transistor 306 is employed within the current sink path of the illustrated embodiment rather than a bipolar junction transistor (for which a base current is required in order to have collector current), simply removing power does not ensure that passive discharge (capacitive bleed-off) does not include delivery of an inadvertent and potentially stimulating current to the electrodes. In addition, where high pulse rates are used—e.g., occurring at frequencies above approximately 250 Hertz (Hz)—passive discharge may not fully discharge the capacitors and may result in charge accumulation, as illustrated in
In embodiments of the present invention, following delivery of an electrical stimulation current pulse, a signal having the opposite polarity is driven to discharge the capacitors, as depicted in
In addition, despite the direction-specific nature of stimulation pulses, inadvertent stimulation may be further avoided by driving the (negative) active discharge pulse with 1/nth of the magnitude and n times the duration of the stimulation pulse. That is, the active discharge pulse may have one-fourth the current amplitude of the electrical stimulation pulse just delivered, but four times the duration, resulting in substantially the same net charge or current flow. The capacitive connections between the pulse generator circuit and the electrodes may thus be substantially fully discharged (although nominal remaining charge or reverse charge is acceptable, and may be depleted by passive discharge between pulses). The scale circuit 302 provides the necessary scaling of the current magnitude, while active discharge timing control to the operational amplifier 305 provide scaling of the active discharge pulse width (duration). In the present invention, the current and pulse width scaling is programmable to 1:1, 2:1 or 4:1 (i.e., n=1, n=2 or n=4).
By delivering consecutive pulses of opposite polarity but equal charge, the net charge remaining on the output capacitors connecting switches 309 to electrodes 106-113 is reduced to near zero. Passive discharge, facilitated by switch 310, should easily dissipate any remaining charge accumulation before the next stimulation pulse is initiated.
Those skilled in the art will note that active discharge could as much as double (200%) the power consumed during delivery of stimulation pulses, shortening the battery life or recharge cycle interval. In the present invention, however, both the anode voltage and the pulse current can be controlled simultaneously (or individually), with the pulse current controlled by the variable output of digital-to-analog converter 301, the variable resistance of scale circuit 302, or a combination of the two. Simultaneous selection of (a) a different anode source voltage than used for delivery of the stimulation pulse, and (b) a lower variable output value of scale circuit 302 may reduce overall power consumption for active discharge, taken together with stimulation, from 200% to 125%. That is, the same current is driven between the electrodes, but at less power since the resistance (provided by scale circuit 302) within the sink path is reduced. Alternatively, power consumption may be somewhat reduced by adjustment of only one of the anode source voltage and the variable output of digital-to-analog converter 301 alone, with a corresponding adjustment of the variable output for scale circuit 302. In either case, however, active discharge is asymmetrical and current amplitude, without variation of the driving voltage and the sink path resistance.
Since the combined stimulation and active discharge pulses have a total duration of up to five times the desired stimulation pulse width, a malfunction resulting in the stimulation and active discharge pulses being delivered in the same direction (rather than opposite directions) at the stimulation site could present a hazard to the patient. For this reason, output switches 309 are preferably monitored to confirm polarity change and mitigate the potential hazard.
Voltage multiplier 311 depicted in
To provide the different anode voltages (e.g., �VBATT, VBATT, 1� VBATT, 2VBATT, 2�VBATT, 3VBATT and/or 4VBATT) employed for both precise current magnitude control and reduced power active discharge, a switch capacitive voltage multiplier 311 is implemented by a charge multiplier (charge pump) using level shifters and field effect transistors driven by a non-overlapping clock. Conventional techniques for implementing a charge multiplier using level shifters may be employed, using an array of selectable low impedance switches to charge and discharge a set of pump capacitors into larger output capacitors to produce the desired output voltage from the voltage multiplier (VMult) 311.
For reliability, high-voltage field effect transistors are generally preferred, for example, for output switching (or in level shifting or connection by the transmission gate network in the implementation of the present invention) of the higher voltages produced by the voltage multiplier. Such high-voltage field effect transistors consume a much larger area (three to five times as much) than low-voltage field effect transistors having similar conductivity, and are substantially less power efficient.
In addition, capacitive multipliers exhibit acceptable efficiency in generating exact multiples of an input voltage, but poor efficiency in between such voltage points. It would be useful to provide fractional multiples of the input voltage at an output (i.e., �VBATT, 1�VBATT, and/or 2�VBATT).
Accordingly, in embodiments of the present invention, a combination of high-voltage, medium-voltage, and low-voltage field effect transistors 606-608 are employed in different portions of the voltage multiplier 311 depending on the voltage level produced. High-voltage field effect transistors are employed for level shifting, in the transmission gate network, and for output switching of, for example, 4VBATT voltages. Medium-voltage field effect transistors are employed for level shifting, in the transmission gate network, and for output switching of 2VBATT voltages. Low-voltage field effect transistors are employed in the transmission gate network and for output switching of VBATT voltages.
For the higher output voltages (e.g., 3VBATT or 4VBATT), the output switches 607-608 of the illustrated embodiment are clocked by a higher voltage signal consistent with the output voltage being switched. Accordingly, the received clock signal is level shifted up to the appropriate voltage level (e.g., from 2.2 V up to 14 V). Use of three separate level shifters would unduly complicate clock synchronization. Accordingly, in embodiments of the present invention, all clocks instead are synchronized through a single up level shifter 600, which shifts the clock signal up to the maximum voltage level. The clock signal is then level shifted back down as needed in level shifters/delay units 604-605. Since high-voltage field effect transistors require longer switching speeds, use of high-voltage field effect transistors to level shift up to the highest voltage (and partially back down, as appropriate), and medium-voltage and low-voltage field effect transistors in level shifting back down to the medium and low voltages, reduces the complexity of synchronization, requiring that less delay be introduced in level shifters/delay units 604-605.
The clock signals are passed through the transmission gate network, but preferably only to those switching devices 607-608 necessary to output the appropriate voltage transmitted by level shifters 601-602. The transmission gates within network 603 are preferably pull-up and/or pull-down transmission gates, such that when a transmission gate is off, the corresponding switching device within field effect transistors 607-608 is also off. Since source-drain connections are used to pass voltages through the transmission gate network 603, (gate) capacitance effects are reduced, lowering the power consumed by voltage multiplier 311.
The minimum number of high-voltage field effect transistors possible are preferably employed to level shift up to the maximum voltage. Medium-voltage and low-voltage field effect transistors are then used to truncate down to other desired output voltages (less than the maximum). Power consumption from charging and discharging the gates of the medium-voltage and low-voltage field effect transistors is thereby reduced, since level shifting down requires less through-current than level shifting up. In addition, this configuration of high-voltage, medium-voltage and low-voltage field effect transistors reduces control clock speed requirements.
Use of high-voltage field effect transistors to level shift up to the maximum then truncating down using medium-voltage and low-voltage field effect transistors suggests the use of a non-overlapping clock at the highest voltage, and to maintain synchronous timing through the network. However, using a non-overlapping clock at each stage also minimizes through-current and switched capacitance.
Switch SW3 connects the lower terminal of capacitor C3 to either the battery voltage VBATT, the ground voltage GND, the upper terminal of capacitor C1 (and, depending on the state of switch SW5, possibly also the doubled battery voltage output terminal 2 VBATT), or the upper terminal of capacitor C2. Switch SW4 connects the upper terminal of capacitor C3 to either the battery voltage VBATT, the output voltage terminal VMULT, or the doubled battery voltage output terminal 2 VBATT.
Switch SW5 connects the upper terminal of capacitor C1 (and, depending on the states of switches SW3 and SW6, possibly also the lower terminals of capacitors C2 and/or C3) to either the battery voltage VBATT or to the doubled battery voltage output terminal 2 VBATT. Switch SW6 connects the lower terminal of capacitor C2 to either the battery voltage VBATT, the ground voltage GND, or the upper terminal of capacitor C1. Switch SW7 selectively connects the output voltage terminal VMULT to the doubled battery voltage output terminal 2 VBATT.
In accordance with the known art, switches SW1-SW7 are controlled for charge doubling. For instance, the voltage 2 VBATT may be generated by connecting the lower terminal of capacitor C1 to the ground voltage GND and the upper terminal of capacitor C1 to the batter voltage VBATT during charge mode, then connecting the lower terminal of capacitor C1 to the battery voltage VBATT and the upper terminal of capacitor C1 to the doubled battery voltage output terminal 2 VBATT in pump mode. Similarly, charging capacitors C1-C3 to the battery voltage VBATT in charge mode, then connecting the capacitors C1-C3 in series, with the lower terminal of capacitor C1 connected to the battery voltage VBATT and the upper terminal of capacitor C3 to the output voltage terminal VMULT to produce the voltage 4 VBATT at the output voltage terminal VMULT.
In addition, voltage multiplier 311 of the illustrated embodiment of the present invention is also capable of producing half-step increments for the output voltage. For instance, capacitors C2-C3 may be connected in series and jointly charged to the battery voltage VBATT in charge mode, then connected at the common point (the upper terminal of capacitor C2 and the lower terminal of capacitor C3) to the output voltage terminal VMULT to produce the voltage � VBATT. While not implemented by the exemplary embodiment of voltage multiplier 311, the principle described above for generating half-step increments of the battery voltage VBATT could be readily extended to efficiently generate other fractional multiples of the battery voltage (e.g., ⅓ VBATT, � VBATT, ⅔ VBATT, � VBATT, etc.).
In delivery of constant current electrical stimulation pulses, the output of universal custom output driver 206 is optionally voltage limited in the present invention (implemented as a programmable mode).
A comparator 702 compares a voltage-divided value of the output of voltage multiplier 311 to the output of digital-to-analog converter 301. As long as the voltage-divided output of voltage multiplier 311 is less than the output of digital-to-analog converter 301, the clock divider 701 is allowed to run, causing the voltage multiplier to produce more voltage. Once the voltage-divided output of voltage multiplier 311 reaches the output of digital-to-analog converter, however, the clock divider 701 is stopped, causing voltage multiplier 311 to stop producing additional voltage and holding the existing voltage until delivery of a current pulse attenuates that voltage. When the voltage-divided output of voltage multiplier 311 again drops below the output of digital-to-analog converter 301, the clock divider 701 is restarted, together with production of additional voltage by voltage multiplier 311.
Voltage limited operation of constant current pulse delivery by the output driver 206 provides increased safety. If a jump in the resistance of the current sink path occurs (e.g., the patient moves, significantly increasing the resistance between the anode and cathode electrodes selected from electrodes 106-113), the amplitude of the voltage delivered could spike. Limiting the voltage used to drive the current pulse prevents an unsafe jump in the amplitude of the voltage across the electrodes 106-113.
In addition, because the voltage multiplier 311 is not operated continuously, the power consumed by output driver 206 is reduced. Thus, while not helpful for heavy load conditions or high duty cycle and/or fast pulse conditions, constant current voltage limited operation may be employed with less power being consumed and greater patient safety provided.
Although the present invention and its advantages have been described in detail, it should be understood that various changes, substitutions and alterations can be made herein without departing from the spirit and scope of the invention as defined by the appended claims. Moreover, the scope of the present application is not intended to be limited to the particular embodiments of the process, machine, manufacture, composition of matter, means, methods and steps described in the specification. As one of ordinary skill in the art will readily appreciate from the disclosure of the present invention, processes, machines, manufacture, compositions of matter, means, methods, or steps, presently existing or later to be developed that perform substantially the same function or achieve substantially the same result as the corresponding embodiments described herein may be utilized according to the present invention. Accordingly, the appended claims are intended to include within their scope such processes, machines, manufacture, compositions of matter, means, methods, or steps.
|Cited Patent
|Filing date
|Publication date
|Jan 12, 1976
|Nov 22, 1977
|Medtronic, Inc.
|Synchronous pacemaker with upper rate stabilization and method of use
|Mar 24, 1986
|Dec 1, 1992
|Case Western Reserve University
|Functional neuromuscular stimulation system
|Feb 14, 1996
|Jan 14, 1997
|Heartstream, Inc.
|Electrotherapy method
|Feb 2, 1995
|Feb 11, 1997
|Pacesetter, Inc.
|Methods and apparatus for applying charge-balanced antiarrhythmia shocks
|Apr 1, 1996
|Dec 8, 1998
|Pacesetter Ab
|Back-up pulse generator
|Dec 17, 1999
|May 17, 2005
|Transneuronix, Inc.
|Gastric stimulator apparatus and method for use
|May 21, 2001
|Jun 20, 2002
|Neurocontrol Corporation
|Percutaneous intramuscular stimulation system
|Jul 25, 2003
|Oct 21, 2004
|John Erickson
|High frequency pulse generator for an implantable neurostimulator
|Mar 19, 1996
|Oct 2, 1996
|Pacesetter AB
|Back-up pulse generator
|May 10, 1999
|Dec 9, 1999
|Neurocontrol Corporation
|Percutaneous intramuscular stimulation system
|European Patent Office, International Search Report for PCT/US2005/012480 dated Aug. 24, 2005.
|Citing Patent
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|U.S. Classification
|International Classification
|Cooperative Classification
|European Classification


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Poll watcher in Detroit threatened with gun, 911 call rejected...
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This morning, a legally credentialed poll watcher was threatened and intimidated while attempting to perform his legally allowed duties of observing the election process at precinct polling location 289 in Detroit. The poll watcher, a lawyer, was confronted by a voter in line, who demanded the poll watcher produce his credentials, which he did.
However, the voter said that wasn't good enough and that he had "a badge and a gun" and told the poll watcher get out of the precinct. Rather than allow the situation to escalate, the poll watcher left before the voter produced a badge or brandished a gun. Fearing for his safety, the poll watcher exited and called 911, however the Detroit Police refused to respond to the call – neglecting the fact that a voter alleged to have a 'badge' and a 'gun' in a precinct, putting other voters at risk.
link to www.washingtontimes.com
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You Republicans forgot what happened over the vote in the sixties.
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Woman Reveals Mortifying First Date Bathroom Incident in Twitter Rant
Warning for young children, the elderly, and those with respiratory problems. 22 PA counties are under a Code Orange for May 25th.
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Though the odds appeared long against the Tachi Palace Hotel and
Casino hosting mixed martial arts events in 2013, live fights will
in fact return to the venue this year. Sherdog.com Friday confirmed
the news with TPF matchmaker Richard
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on third-round strikes.
Jeff Sherwood contributed to this report.
On May 8, the UFC will travel to Rotterdam for its first show in the Netherlands, and while there are no fights in the Octagon this weekend, there are plenty of updates for upcoming shows, starting w read news >>
Cory Hendricks fights through an injured foot to submit Khalil Rountree and swing the competition back to Team Claudia after the first fight. read news >>
Conor McGregor has had enough of the back-and-forth. He wants Nate Diaz, and he's not holding back until he gets his way. In a NSFW Instagram post Sunday, McGregor called on UFC President Dana White read news >>
Finding it harder to get fights in his region, Drew Brokenshire is stepping out in an attempt to take his career to the next level. read news >>
Check out the Invicta FC 17: Evinger vs. Schneider weigh-in results and video replay ahead of Saturday night's event in California. read news >>
Invicta FC 17 was quite the night of fights. Charmaine Tweet put Latoya Walker's lights out with a smooth spinning backfist. Angela Hill established herself as a top strawweight by taking Livia Renat read news >>
The big hitters were on display during the UFC Fight Night Rotterdam prelim fights as Rustam Khabilov, Magnus Cedenblad, Josh Emmett and Reza Madadi all claimed victories. read news >>
Put aside the talk of wrestling. Yes, Phil Davis thinks his is the best. Forget about Muhammed "King Mo" Lawal's punching power. Spoiler alert: Davis isn't worried about it. The real key to Friday's read news >>
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At 15 years old, Alma (Helene Bergsholm) is feeling confined in a small mountain town in Norway. She's miserable and confused in the usual teenage sense, flipping off the town sign whenever she passes it, and dreaming of life elsewhere. Specifically, she's dreaming of a boy in her class, Artur (Matias Myren), whom she imagines climbing in her bedroom window on moonlit nights. When not indulging in this fantasy, she rings up a sizeable bill on a phone sex line. But the coming of age story in Turn me on, dammit (Få meg på, for faen)—its title tweaked and opening 30 March at the Angelika Film Center and The Elinor Bunin Munroe Film Center—takes a turn when an encounter with Artur doesn't go quite as Alma hopes. As she negotiates a spate of rumors at school, the film reveals a delicate sense of comedy, attuned to the acute embarrassments, social minefields, and roaring squalls of adolescence. It understands the passing fancies and worries of the teenager, whether it's Alma's pointless aggression with her single mother or her friend Saralou's (Malin Bjørhovde) habit of writing chatty letters to death row prisoners in Texas. The movie knows that these things will pass, even if the kids do not.
See PopMatters' review.
Derik Hultquist "My New Orleans" (audio) (premiere) // Music
Super Furry Animals "BingBong" (Singles Going Steady) // Music
U.S. Girls "New Age Thriller" (Singles Going Steady) // Music
From Hungary to Hollywood: "The Undesirable"
// Short Ends and Leader
"At just over an hour, a lot happens in this broadly gestured, melodramatic story set in Transylvania.READ the article


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DEFINITION of 'Subsequent Offering'
An offering of additional shares after the issuing company has already had an initial public offering (IPO). In a subsequent offering, the new shares are usually issued from the company's treasury, and the net offering proceeds go the company. Since a subsequent offering increases the company's shares outstanding, it has a dilutive effect, i.e., it dilutes the stakes of existing shareholders.
BREAKING DOWN 'Subsequent Offering'
A company may seek to complete a subsequent offering for a number of reasons. Investment demand for its shares may be high even after the initial offering, or it may look to raise capital to capitalize on new opportunities. Another reason could be that the company is looking to bolster its cash reserves at an opportune time, because it foresees funding challenges ahead. This may especially be the case for development-stage technology and biotechnology companies, which often have huge capital requirements in the initial years.
DilutionA reduction in the ownership percentage of a share of stock caused ...
Secondary Offering1. The issuance of new stock for public sale from a company that ...
OfferingThe issue or sale of a security by a company. It is often used ...
Treasury OfferingThe issuance of an additional class of security already existing ...
Follow-On OfferingAn issue of shares of stock that comes after a company has already ...
Open OfferA secondary market offering that is similar to a rights issue ...
Investing Basics
How Does Dilution Work?Dilution refers to the reduction in the percentage equity ownership of a company due to additional equity being issued to other owners.
Forex Education
The Dangers Of Share DilutionInvestors need to be aware of the existence of dilutive securities and how they can affect existing shareholders.
Investing Basics
What's a Secondary Offering?A secondary offering is the issuance of new stock from a company that has already made its initial public offering.
Fundamental Analysis
Calculating Basic Earnings Per ShareBasics earnings per share measures the amount of net income earned per share of outstanding stock.
IPO Winners For 2011These IPOs didn't get hyped like LinkedIn and Groupon, but they were much more successful.
Investing Basics
Why Do Companies Care About Their Stock Prices?Read on to learn more about the nature of stocks and the true meaning of ownership.
Bonds & Fixed Income
What Are Corporate Actions?Be a savvy investor - learn how corporate actions affect you as a shareholder.
Investing Basics
What Are Corporate Actions?Corporate actions are processes that change a company's stock. Here are a few examples.
Fundamental Analysis
How To Pick Winning Penny StocksCheap doesn't always equal good. When choosing penny stocks, investors would be wise to note several key factors that affect the way these stocks trade.
Initial Public Offering (IPO) ExplainedAn initial public offering (IPO) marks the start of a company's publicly traded life. Find out why companies undergo IPOs, and how the process works.
Why is an increase in capital stock on a company's balance sheet a bad sign for stockholders?Understand what capital stock represents for a company and understand the significance for investors when a company initiates ... Read Answer >>
Why should investors consider the fully diluted share amount?Learn about the importance of considering the fully diluted shares, how it could affect a stock's share price and how dilution ... Read Answer >>
How do I calculate earnings per share with simple capital and complex capital structure?Learn the difference between simple and complex capital structures and how the structure affects a company's calculations ... Read Answer >>
What is the difference between an IPO and a seasoned issue?Learn how companies issue IPO securities when they first go public and seasoned issue shares if they sell more shares in ... Read Answer >>
What is the difference between weighted average shares outstanding and basic weighted ...Outstanding shares refers to stock that is currently held by investors, including shares held by the public, and restricted ... Read Answer >>
What are the advantages and disadvantages for a company going public?An initial public offering (IPO) is the first sale of stock by a company. Small companies looking to further the growth of ... Read Answer >>


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10 Steps to Pick the Right Doctor
Whether you need a primary care doctor or a specialist, these 10 steps will ensure you find the right doctor for you. View Slideshow
Dr. Grambau's Experience
- Pulmonology
Board Certifications
- Internal Medicine
- Pulmonary Disease
- Bronchoscopy
- Thoracentesis
Conditions Dr. Grambau Treats
Dr. Grambau does not have any conditions listed. If you are Dr. Grambau and would like to add conditions you treat, please update your free profile.
Background Check for Dr. Grambau
Malpractice Claims not available
- Healthgrades does not collect malpractice information for Michigan.
- No sanctions history found for the years that Healthgrades collects data.
0 Board Actions
- No board actions found for the years that Healthgrades collects data.
Awards & Recognitions
Education & Training
Medical School
- University Of Michigan Medical School
- Graduated in 1973
Internship Hospital
- University Mich Med Center
- Complete in 1974
Residency Hospital
- University Of Michigan Hospitals
Fellowship Hospital
- University Of Michigan Hospitals
Languages Spoken by Dr. Grambau & Staff
- English


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Data from satellites help in preserving environmentThe data derived from Indian Remote Sensing Satellites is world class and has been useful in policy formulation and decision making with regard to preserving environment, said Chandrashekhar Jha, group director of Forestry and Environmental Studies ... The Hindu, 1 month ago
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SPIE : Space Agency Leaders Sound Need at SPIE Asia-Pacific Remote Sensing for Collaboration, Constancy in Remote Sensing of Earth
NEW DELHI, India, and BELLINGHAM, Washington, USA (PRWEB) April 11, 2016 High-level leaders from several nations' space agencies provided insider perspectives on programs for monitoring natural and manmade impacts on the environment, as featured ...4 Traders, 1 month ago Space Agency Leaders Sound Need at SPIE Asia-Pacific Remote Sensing for Collaboration, Constancy in Remote Sensing of Earth Earth Imaging Journal, 1 month ago
Call to curtail quake loss
Silchar, May 14: Ajoy Kumar Ray, director of the Indian Institute of Engineering Science and Technology, Shibpur, West Bengal, today called for retrofitting old houses to minimise loss of lives and properties in case of an earthquake since Assam ...Calcutta Telegraph, 1 week ago
National Hydrology Project: To assess India's water resources
Over the years, natural calamities like flood and famine have dealt a crushing blow to the Indian economy. While the recent floods in Chennai caused unprecedented loss of life and property, the 2013 Uttarakhand flash floods had resulted in damage ...PaGaLGuY, 1 month ago IIT-B takes up surface water management study Times of India, 1 month ago President Shri Pranab Mukherjee Urges for Multi-Disciplinary Approach to Water During India Water Week -2016 Shipping And Marine Events, 1 month ago Uma Bharti Calls for Paradigm Shift in Water Resource Management India Water Week-2016 Concludes Press Information Bureau, 1 month ago
GEOSPATIAL : Nagaland GIS & Remote Sensing Centre provides full spectrum services
Since its inception, the Nagaland State GIS and Remote Sensing Centre has been providing full spectrum of innovative geospatial services and solutions, application software, geospatial data engineering and analytics services to facilitate all line ...4 Traders, 1 month ago Nagaland GIS & Remote Sensing Centre provides full spectrum services NetIndia123.com, 1 month ago
Bengaluru's urban sprawl the worst: study
A team of researchers from the Indian Institutes of Science (IISc) has found that Bengaluru has the worst urban sprawl.The team conducted this research using remote-sensing satellite data since 1990.Times of India, 2 months ago
Nurturing the art of science
There have been plans to upgrade the science curriculum in India but not much has changed over time. Students more commonly associate Isaac Newton with an apple and Albert Einstein with a high IQ than their contribution to their respective fields.Deccan Herald, 16 hours ago
Chinese, Indian archaeologists mull exploring birthplace of Buddhism
ZHENGZHOU - Chinese and Indian archaeologists are currently discussing a cultural cooperation project in the birthplace of Buddhism. The Institute of Archaeology under the Chinese Academy of Social Sciences will collaborate with Indian ...CHINAdaily.com.cn, 1 day ago Chinese and Indian archaeologists mull exploring birthplace of Buddhism Arabstoday.net, 19 hours ago China Exclusive: Chinese, Indian archaeologists mull exploring birthplace of Buddhism People.com.cn, 1 day ago
Daily Current Affairs - 18th May, 2016, Wednesday
1. Govt launches Swachh Office drive across India a) The government has launched a 15-day Swachh Office drive In order to improve cleanliness across government offices. b) The Union Urban Development Minister Venkaiah Naidu directed ...PaGaLGuY, 4 days ago
McKinsey alumnus Deepak Garg taps geeks in bid to rule trucking in India
Deepak Garg's company Rivigo Services deploys Internet-connected trucks loaded with sensors that feed data to coders, who then try to work out how to cut travel times while improving reliability, customer experience New Delhi: Looking for a business ...Livemint.com, 1 week ago McKinsey Alumni Tap Geeks in Bid to Dominate Trucking in India La Repubblica, 1 week ago
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