Abstract: Techniques for delivery of electrical neurostimulation therapy to a patient are disclosed. In one example, a processor controls delivery of electrical neurostimulation therapy to a patient by an electrical neurostimulation therapy device and via a plurality of combinations of a plurality of electrodes disposed along a lead inserted across an anatomical midline of a spinal cord of the patient and angled relative to the anatomical midline, the lead connected to the electrical neurostimulation therapy device. The processor determines, based on the electrical neurostimulation therapy, a location of a physiological midline of the spinal cord. The processor selects, based on the location of the physiological midline, at least one electrode of the plurality of electrodes for subsequent delivery of electrical neurostimulation therapy to the patient. Further, the processor displays a representation of the physiological midline and the anatomical midline relative to the spinal cord.

Abstract: Electrical stimulation therapy is provided to a patient in order to induce a patient sensation. The patient sensation may be selected from a number of patient sensations. A set of therapy parameter values are associated with each of the number of patient sensations. A user interface allows a user to adjust one or more characteristics of the patient sensation.

Abstract: Far field telemetry communications are conducted during recharge sessions between an external device and an implantable medical device. The two devices may not have been previously paired together for far field telemetry and may have been paired with other devices for far field telemetry during previous recharge sessions and/or programming sessions. Embodiments provide for temporary bonding of the two devices for far field telemetry during the recharge session. The implantable medical device of the recharge session may maintain a programming bond with an external device other than the external device conducting the recharge session. Safeguards against establishment of inadvertent programming sessions between the external device that has conducted a recharge session and implantable medical devices that may or may not be bonded to that external device are provided.

Abstract: The techniques of the disclosure describe example medical devices, systems, and methods for delivering electrical stimulation therapy to a patient. In one example, a medical device selects subsets of a plurality of therapy parameter sets that define electrical stimulation therapy, each subset including at least one therapy parameter set and less than all of the therapy parameter sets. Further, the medical device delivers, via a plurality of electrodes, electrical stimulation therapy according to each subset via a respective set of electrodes different from sets of electrodes of each other subset of the therapy parameter sets. The medical device iteratively delivers the electrical stimulation therapy according to the subsets of the therapy parameter sets via the respective sets of electrodes. Further, the medical device selects at least one subset of the therapy parameter sets that treat a condition of the patient for defining subsequent delivery of electrical stimulation to the patient.

Abstract: Techniques for therapy delivery are described. A processing circuit may adjust a first therapy parameter from a first level to a second level, and responsive to the adjustment of the first therapy parameter, compare a level of an evoked compound action potential (ECAP) generated from therapy delivery based on the adjusted first therapy parameter to an ECAP threshold. The processing circuit may adjust a second therapy parameter from a third level to a fourth level based on the comparison. The second therapy parameter is different than the first therapy parameter. The processing circuit may cause therapy delivery with the first therapy parameter at the second level and the second therapy parameter at the fourth level.

Abstract: Shielded sheaths are placed over implantable medical leads and/or implantable medical lead extensions to provide shielding from electromagnetic energy and to prevent heating at the electrodes. The shielded sheaths include insulative bodies with shield layers such as conductive braided wire or conductive foil tubular structures. The shielded sheath may be implanted at the time of implanting the lead and/or lead extension. The shielded sheath may also be implanted at a later time after the lead and/or lead extension has previously been implanted. The shielded sheath may be anchored onto the lead or lead extension.

Abstract: An external device transfers a key to an implantable medical device over a proximity communication and then establishes a first far field communication session with the implantable medical device where the key is used for the first communication session. This first communication session may occur before implantation while the implantable medical device is positioned outside of the sterile field so that using a proximity communication is easily achieved. Once the implantable medical device is passed into the sterile field for implantation, the external device may then establish a second far field communication session with the implantable medical device where the last key that was used for the first communication session is again used for the second communication session which avoids the need for another proximity communication to occur within the sterile field.

Abstract: In one aspect, a programmer for an implantable medical device comprises a user interface that receives user input corresponding to one or more selected stimulation therapy parameters for delivering stimulation therapy to a patient with the implantable medical device and presents an energy consumption estimate of a power source based on the selected stimulation therapy parameters; and a processor that determines one or more programming options that, if selected, would alter the selected stimulation therapy parameters and reduce the energy consumption estimate. The user interface presents at least one of the programming options to reduce the energy consumption estimate to the user with an indication that user selection of one or more of the presented programming options would alter the selected stimulation therapy parameters to reduce energy consumption of the implantable medical device.

Abstract: Far field telemetry communications are conducted during recharge sessions between an external device and an implantable medical device. The two devices may not have been previously paired together for far field telemetry and may have been paired with other devices for far field telemetry during previous recharge sessions and/or programming sessions. Embodiments provide for temporary bonding of the two devices for far field telemetry during the recharge session. The implantable medical device of the recharge session may maintain a programming bond with an external device other than the external device conducting the recharge session. Safeguards against establishment of inadvertent programming sessions between the external device that has conducted a recharge session and implantable medical devices that may or may not be bonded to that external device are provided.

Abstract: Techniques for delivery of electrical neurostimulation therapy to a patient are disclosed. In one example, a processor controls delivery of electrical neurostimulation therapy to a patient by an electrical neurostimulation therapy device and via a plurality of combinations of a plurality of electrodes disposed along a lead inserted across an anatomical midline of a spinal cord of the patient and angled relative to the anatomical midline, the lead connected to the electrical neurostimulation therapy device. The processor determines, based on the electrical neurostimulation therapy, a location of a physiological midline of the spinal cord. The processor selects, based on the location of the physiological midline, at least one electrode of the plurality of electrodes for subsequent delivery of electrical neurostimulation therapy to the patient. Further, the processor displays a representation of the physiological midline and the anatomical midline relative to the spinal cord.

Abstract: Shielded sheaths are placed over implantable medical leads and/or implantable medical lead extensions to provide shielding from electromagnetic energy and to prevent heating at the electrodes. The shielded sheaths include insulative bodies with shield layers such as conductive braided wire or conductive foil tubular structures. The shielded sheath may be implanted at the time of implanting the lead and/or lead extension. The shielded sheath may also be implanted at a later time after the lead and/or lead extension has previously been implanted. The shielded sheath may be anchored onto the lead or lead extension.

Abstract: Techniques for performing lead functionality tests, e.g., lead impedance tests, for implantable electrical leads are described. In some of the described embodiments, an implantable medical device determines whether a patient is in a target activity state, e.g., an activity state in which lead impedance testing will be unobtrusive, such as when a patient is asleep, or capture information of particular interest, such as when the patient is active, in a particular posture, or changing postures. The implantable medical device performs the lead functionality test based on this determination. Additionally, in some embodiments, the implantable medical device may group a plurality of measurements for a single lead functionality test into a plurality of sessions, and perform the measurement sessions interleaved with delivery of therapeutic stimulation.

Abstract: An external device transfers a key to an implantable medical device over a proximity communication and then establishes a first far field communication session with the implantable medical device where the key is used for the first communication session. This first communication session may occur before implantation while the implantable medical device is positioned outside of the sterile field so that using a proximity communication is easily achieved. Once the implantable medical device is passed into the sterile field for implantation, the external device may then establish a second far field communication session with the implantable medical device where the last key that was used for the first communication session is again used for the second communication session which avoids the need for another proximity communication to occur within the sterile field.

Abstract: An external device transfers a key to an implantable medical device over a proximity communication and then establishes a first far field communication session with the implantable medical device where the key is used for the first communication session. This first communication session may occur before implantation while the implantable medical device is positioned outside of the sterile field so that using a proximity communication is easily achieved. Once the implantable medical device is passed into the sterile field for implantation, the external device may then establish a second far field communication session with the implantable medical device where the last key that was used for the first communication session is again used for the second communication session which avoids the need for another proximity communication to occur within the sterile field.

Abstract: An external device transfers a key to an implantable medical device over a proximity communication and then establishes a first far field communication session with the implantable medical device where the key is used for the first communication session. This first communication session may occur before implantation while the implantable medical device is positioned outside of the sterile field so that using a proximity communication is easily achieved. Once the implantable medical device is passed into the sterile field for implantation, the external device may then establish a second far field communication session with the implantable medical device where the last key that was used for the first communication session is again used for the second communication session which avoids the need for another proximity communication to occur within the sterile field.

Abstract: A medical electrical stimulator provides selective control of stimulation via a combination of two or more electrodes coupled to respective regulated current paths and one or more electrodes coupled to unregulated current paths. Constant current sources may control the current that is sourced or sunk via respective regulated current paths. An unregulated current path may sink or source current to and from an unregulated voltage source that serves as a reference voltage. Unregulated electrodes may function as unregulated anodes to source current from a reference voltage or unregulated cathodes to sink current to a reference voltage.

Abstract: An external device transfers a key to an implantable medical device over a proximity communication and then establishes a first far field communication session with the implantable medical device where the key is used for the first communication session. This first communication session may occur before implantation while the implantable medical device is positioned outside of the sterile field so that using a proximity communication is easily achieved. Once the implantable medical device is passed into the sterile field for implantation, the external device may then establish a second far field communication session with the implantable medical device where the last key that was used for the first communication session is again used for the second communication session which avoids the need for another proximity communication to occur within the sterile field.

Abstract: In some examples, a method may include delivering an electrical stimulation therapy to a patient, the electrical stimulation therapy comprising a first electrical stimulation pulse delivered to the patient via a first electrode and a second electrical stimulation pulse delivered to the patient via a second electrode, wherein the first electrical stimulation pulse and second electrical stimulation pulse are delivered as paired pulses with respect to each other and a combination of the first electrical stimulation pulse and the second electrical stimulation pulse evoke a compound action potential within the patient; sensing the compound action potential evoked by the combination of the first electrical stimulation pulse and the second electrical stimulation pulse; and adjusting one or more parameters of the electrical stimulation therapy based on the sensed compound action potential.

Abstract: The disclosure provides techniques for parameter-directed shifting of electrical stimulation electrode combinations. An external programmer permits a user to shift electrode combinations, e.g., along the length of a lead or leads. The external programmer accepts shift input and causes an electrical stimulator to shift electrode combinations as indicated by the input. Different sets of electrodes may have different electrode counts. For example, an array of electrodes carried by one lead may have a greater number of electrodes than an array of electrodes carried on another lead. The disclosure provides techniques for shifting electrode combinations among leads with different electrode counts. For example, an external programmer may execute shifts in a series of shift operations, where the number of shift operations along the length of a lead having a greater electrode count is greater than the number of shift steps along the length of a lead having a lesser electrode count.

Abstract: The techniques of the disclosure describe example medical devices, systems, and methods for interleaving a plurality of low-frequency electrical stimulation pulse trains delivered by a plurality of sets of electrodes of an implantable medical device (IMD) to effectively deliver a combined high-frequency electrical pulse train to a target tissue area. In one example, each set of the plurality of sets of electrodes has a unique anode and cathode. In another example, a clinician adjusts the size or shape of the target tissue area receiving the combined high-frequency electrical pulse train by selecting different combinations of the plurality of sets of electrodes.