Abstract: A therapeutic or diagnostic instrument includes first and second shaped wire members and that can be simultaneously inserted into a catheter tube and has predetermined bending elasticity, in which the first and second shaped wire members and are adapted to respectively have first and second curving parts that curve in a natural state, and when inserted into the catheter tube, curve the catheter tube at two desired positions correspondingly with the first and second curving parts.

Abstract: The invention relates to medical devices and, particularly, catheter medical devices. In an aspect is a nerve block catheter system comprising a dual-sheath catheter comprising an inner sheath and an outer sheath, wherein distal ends of the sheaths are connected, the inner sheath defines a fluid delivery lumen, and the outer sheath comprises a tissue lock movable between a collapsed position and an extended position, wherein the tissue lock forms a reversible tissue anchor when in the extended position, and an actuator connected to the proximate end of the catheter and configured to activate the tissue lock by sliding the outer sheath length-wise relative to the inner sheath.

Abstract: A method involves positioning an assembled indwelling assembly adjacent a patient, wherein the assembly includes an inner needle, a hub fixed to the inner needle, a hollow outer member in which the inner needle is positioned, a hub fixed to the hollow outer member, and an elongated member axially overlapping an intermediate portion of the hollow outer member. The method also includes moving a distal portion of the assembly to puncture a blood vessel of the patient with the sharp needlepoint while the elongated member contacts the hollow outer member, advancing the hollow outer member in a distal direction along the inner needle to insert a distal portion of the hollow outer member to a target position in the blood vessel, and moving the inner needle hub in a proximal direction such that the inner needle is pulled out from and entirely removed from the hollow outer member.

Abstract: A system for bypassing an anastomosis site in a hollow organ is provided. The system includes a sleeve configured for spanning the anastomosis site at an internal surface of the hollow organ and a band configured for attachment to an external surface of the hollow organ and limiting migration of the sleeve beyond the anastomosis site.

Abstract: A measuring balloon has an inner bulbous balloon formed from a non-compliant or semi-compliant material and has a central smaller diameter inner waist and two larger diameter bulbs on each side of the inner waist. A compliant outer waist bladder is located on the outside of the inner bulbous balloon adjacent to the inner waist and is inflated via a separate inflation lumen. The inner balloon is inflated at a higher pressure to dilate stenotic aortic valve leaflets, and provide alignment and positioning of the measuring balloon across the aortic annulus. The bladder waist is inflated to a lower pressure to make contact with the aortic valve annulus. Marker bands positioned on the outside of the measuring balloon provide determination of annulus diameter and ovality.

Abstract: Apparatus for delivering toxin and toxin fragments to a patient's nasal cavity provide for both release of the toxin and delivery of energy which selectively porates target cells to enhance uptake of the toxin. The use of energy-mediated delivery is particularly advantageous with light chain fragment toxins which lack cell binding capacity.

Abstract: Provided is a medical system including a first capsule type medical device, and a second capsule type medical device. The first and second capsule type medical devices operate in cooperation with each other in a body.

Abstract: The invention pertains to implantable medical devices for controlled delivery of therapeutic agents. Some devices according to the invention have a titanium reservoir, and a porous titanium oxide based membrane to control the rate of release of the therapeutic agent. The reservoir contains a formulation of the active agent, and means to promote water uptake into the reservoir upon implantation. In some embodiments the means include a gas with a higher solubility in than air water.

Abstract: A coupling for a medical instrument for connecting two lines, with a first coupling part, and with a second coupling part which can be inserted into the first coupling part in the longitudinal direction of the coupling parts. The coupling comprises first locking elements arranged on the first coupling part and second locking elements arranged on the second coupling part, the first locking elements being movable between a locking position, in which they engage with the second locking elements, and an unlocking position, in which they disengage from the second locking elements. The coupling further comprises retaining elements which are arranged on the first coupling part and which are movable between a retention position, in which they keep the first and second locking elements in engagement with each other, and a release position, in which the first and second locking elements can be disengaged.

Abstract: The present invention relates to methods of transvascular retrograde access placement and to devices that facilitate these methods. For purposes of the present invention, transvascular retrograde access placement generally comprises the insertion of a vascular catheter into a central blood vessel through the puncturing of the central blood vessel from the inside of the central blood vessel with a needle or other similarly configured device, or a needle-tipped guidewire of the present invention, and exiting that needle from the patient through the skin rather than the traditional approach of inserting a needle from the outside of the skin surface to the inside of a blood vessel.

Abstract: A system for wound treatment includes adjunctive wound therapy devices and substrates comprising multiple first reservoirs and multiple second reservoirs. Selected ones of the multiple first reservoirs include a reducing agent, and first reservoir surfaces of selected ones of the multiple first reservoirs are proximate to a first substrate surface. Selected ones of the multiple second reservoirs include an oxidizing agent, and second reservoir surfaces of selected ones of the multiple second reservoirs are proximate to the first substrate surface.

Abstract: A modular biomedical implant includes a processor, an electrode array, and a cable. The first end of the cable is attached to the electrode array and a second end of the cable terminates in a first array of contacts. A second array of contacts is electrically connected to the processor. A separate anisotropic conductor is disposed between the first array of contacts and the second array of contacts and forms electrical connections between the first array of contacts and the second array of contacts. A method for replacing a processor of a modular biomedical implant is also provided.

Abstract: An introducer for a medical lead, the introducer having an arcuate component for creating an arcuate path in a patient. When used to percutaneously implant a medical device such as a medical lead with electrodes, the implanted lead has an arcuate configuration. The implanted lead can be used to at least partially encircle or bracket a region of chronic pain and provide therapeutic electrical signals to the region.

Abstract: Devices and methods of use for introduction and implantation of an electrode as part of a minimally invasive technique. An implantable baroreflex activation system includes a control system having an implantable housing, an electrical lead, attachable to the control system, and an electrode structure. The electrode structure is near one end of the electrical lead, and includes a monopolar electrode, a backing material having an effective surface area larger than the electrode, and a releasable pivotable interface to mate with an implant tool. The electrode is configured for implantation on an outer surface of a blood vessel and the control system is programmed to deliver a baroreflex therapy via the monopolar electrode to a baroreceptor within a wall of the blood vessel.

Abstract: The present invention includes devices and methods for lead, conduit or other medical fixture placement in tissues or organs. The device is configured to permit the placement foot, such as a suction foot, to articulate to a desired position with respect to the target tissue, while the lead, conduit or other medical fixture is releasably attached to the placement foot to permit it to be released from the placement foot after stabilization on the target tissue site. In a preferred embodiment, the invention features an articulating dual suction foot device, an inner lead conduit or guide and foot contained within an outer lead conduit or guide and foot, with the inner conduit or guide configured to extend from the outer conduit or guide, and to be further articulated once extended.

Abstract: An elevated feedthrough is attachable to a top or a side of an active implantable medical device. The feedthrough includes a conductive ferrule and a dielectric substrate. The dielectric substrate is defined as comprising a body fluid side and a device side disposed within the conductive ferrule. The dielectric substrate includes a body fluid side elevated portion generally raised above the conductive ferrule. At least one via hole is disposed through the dielectric substrate from the body fluid side to the device side. A conductive fill is disposed within the at least one via hole forming a hermetic seal and electrically conductive between the body fluid side and the device side. A leadwire connection feature is on the body fluid side electrically coupled to the conductive fill and disposed adjacent to the elevated portion of the dielectric substrate.

Abstract: An exemplary method includes performing a capture threshold assessment using a bipolar electrode configuration, deciding if capture occurred for a maximum energy value of the capture threshold assessment and, if capture did not occur, then performing a lead impedance test for the lead associated with the bipolar electrode configuration. Such a test may aim to detect an insulation defect and/or a conductor defect. Other exemplary methods, devices, systems, etc., are also disclosed.

Abstract: A method for treating a patient suffering from loss of muscle control and/or function in a body region after a stroke includes epidurally applying electrical stimulation to a spinocerebellar tract of the patient (e.g., at or above the vertebral level of the spinal cord where the sensory and motor mapping for the body region are located), thereby increasing cortical excitability and facilitating the patient regaining muscle control and/or function in the body region. The method may include using cortical mapping to determine a cortical region having a residual motor response in or near the body region, implanting an electrode in a lateral epidural space, and applying the electrical stimulation in a manner that causes excitability in the cortical region having the residual motor response, wherein the stimulation is applied by the implanted electrode. The method may include exercising the body region while simultaneously applying the electrical stimulation.

Abstract: The present disclosure relates to methods, devices, and systems used for the treatment of mood, anxiety, cognitive, and behavioral disorders (collectively, neuropsychiatric disorders) via stimulation of the superficial elements of the trigeminal nerve (“TNS”). More specifically, minimally invasive systems, devices and methods of stimulation of the superficial branches of the trigeminal nerve located extracranially in the face, namely the supraorbital, supratrochlear, infraorbital, auriculotemporal, zygomaticotemporal, zygomaticoorbital, zygomaticofacial, nasal and mentalis nerves (also referred to collectively as the superficial trigeminal nerve) are disclosed herein.

Abstract: A bionic cochlea includes a fluid filled vessel having a flexible window disposed in one of its walls. The flexible window flexes when exposed to an acoustic pulse to produce an acoustic pressure pulse in the fluid inside the vessel. A plurality of piezoelectric nanowires is disposed within the fluid filled vessel. The piezoelectric nanowires vibrate in response to acoustic pressure pulses transmitting through the fluid and produce electrical signals. Electrical wires in communication with the piezoelectric nanowires receive the produced electrical signals and pass these signals to the mammalian auditory nerve.

Abstract: There is provided a hearing assistance system comprising an auditory prosthesis device for neural stimulation of a patient's hearing at one of the patient's ears and a hearing aid for acoustic stimulation of the patient's hearing at the same one or the other one of the patient's ears. The system includes at least one microphone for capturing an input audio signal from ambient sound; and a fundamental frequency estimation unit for estimating the fundamental frequency and at least part of its harmonics at least for voiced segments of the input audio signal and for supplying a corresponding output signal.

Abstract: A device for electrical stimulation of neural and/or muscular tissue. The device includes a cochlear implant being equipped with a power source, a speech processor, a microphone adapted to deliver sound signals to said speech processor, a current stimulator, at least an array of electrodes attached to the stimulator, and at least a signal sensor other than the microphone. The device further includes a signal transformation unit, said signal sensors being adapted to capture relevant input information and to deliver a corresponding input signal to the transformation unit, the latter allowing to transform said input signal received from the signal sensors into a modulated electrical output signal adapted to be treated by the speech processor of the cochlear implant.

Abstract: An implantable pulse generator (IPG) that generates spinal cord stimulation signals for a human body has a programmable signal generator that can generate the signals based on stored signal parameters without any intervention from a processor that controls the overall operation of the IPG. While the signal generator is generating the signals the processor can be in a standby mode to substantially save battery power.

Abstract: A method for managing hypertension through renal nerve denervation and vagus nerve stimulation is provided. Renal nerves are disrupted to inhibit a sympathetic nervous system. Thereafter, an implantable neurostimulator, including a pulse generator, is configured to deliver electrical therapeutic stimulation in a manner that results in creation and propagation (in both afferent and efferent directions) of action potentials within neuronal fibers of a patient's cervical vagus nerve. A maintenance dose of the electrical therapeutic stimulation is delivered to the vagus nerve via the pulse generator to restore cardiac autonomic balance through continuously-cycling, intermittent and periodic electrical pulses.

Abstract: A method for implanting a neurostimulation lead within a patient includes measuring impedances of electrodes on the lead in order to correctly position the lead relative to a target tissue region. The electrodes are circumferentially segmented electrodes that are spaced from each other about the longitudinal axis of the lead. When the difference between the impedances of the electrodes exceeds a threshold value, the lead is in the correct position. In accordance with another embodiment, impedance measurements are used to select which one of the electrodes is closest to the target tissue region. By determining which electrode has the highest impedance and which electrode has the lowest impedance, the type of tissue adjacent to each electrode can be determined based on the conductivity properties of the tissue. The target tissue region may be a spinal cord, a posterior longitudinal ligament, white matter, or gray matter.

Abstract: In various examples, an apparatus includes a stimulation lead including an elongate body including a distal end and a proximal end. At least one first electrode is disposed proximate the distal end of the elongate body and is configured to stimulate a first target nerve. At least one second electrode is disposed between the at least one first electrode and the proximal end of the elongate body and is configured to stimulate a second target nerve. At least one first fixation structure is disposed between the at least one second electrode and the proximal end of the elongate body. The at least one first fixation structure is configured to anchor the stimulation lead proximate the sacrum, wherein the at least one first fixation structure is located on the elongate body and spaced a first distance proximally along the elongate body from the at least one first electrode.

Abstract: Systems and methods for closed loop spinal cord stimulation are provided. The systems and methods position a first electrode proximate to a dorsal column. The first electrode is electrically coupled to an implantable pulse generator (IPG). The systems and methods further program the IPG to deliver excitation pulses to the first electrode based on a stimulation level. The excitation pulses are emitted from the first electrode. The systems and methods further position a second electrode proximate to a dorsal root. The second electrode is electrically coupled to the IPG. The systems and methods further measure at the second electrode a first evoked potential waveforms resulting from the excitation pulses.

Abstract: An implantable pulse generator (IPG) that generates spinal cord stimulation signals for a human body includes a timing generator and high frequency generator. The timing generator generates timing signals that represent stimulation signals for multiple channels. The high frequency generator determines whether to modulate the timing signals and modulates them at a burst frequency according to stored burst parameters if the decision is yes. The high frequency generator can also independently control the pulse frequency of each channel according to the stored parameters. As such, the IPG provides the ability to generate both the low frequency and high frequency stimulation signals at different frequencies in different channels according to user programming in order to provide maximum flexibility in treatment.

Abstract: Techniques and systems for monitoring cardiac arrhythmias and delivering electrical stimulation therapy using a subcutaneous device (e.g. subcutaneous implantable (SD)) is described. In one or more other embodiments, SD is implanted into a patient's heart. Electrical signals are then sensed which includes moderately lengthened QRS duration data from the patient's heart. A determination is made as to whether cardiac resynchronization pacing therapy (CRT pacing) is appropriate based upon the moderately lengthened QRS duration in the sensed electrical signals. The CRT pacing pulses are delivered to the heart using electrodes. In one or more embodiments, the SD can switch between fusion pacing and biventricular pacing based upon data (e.g. moderately lengthened QRS, etc.) sensed from the heart.

Abstract: Generally, the disclosure is directed one or more methods or systems of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes. Pacing using the right ventricular electrode and a first one of the left ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes. Pacing using the right ventricular electrode and a second one of the ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes. Employing sums of the measured activation times to select one of the left ventricular electrodes for delivery of subsequent pacing pulses.

Abstract: An implantable pulse generator includes a core assembly, a seal plug, and an outer layer overmolded over the core assembly adjacent the seal plug. The core assembly defines a core hole extending through the core assembly from a core interior to a core outer surface. The core hole has a hole outer portion and a hole inner portion. A first diameter of the hole outer portion is less than a second diameter of the hole inner portion. The seal plug is positioned in the core hole and has a plug outer portion aligned with the hole outer portion and a plug inner portion aligned with the hole inner portion. A third diameter of the plug outer portion is less than a fourth diameter of the plug inner portion. The outer layer leaves a top of the seal plug exposed.

Abstract: A leadless cardiac pacemaker that does not require a separate hermetic housing surrounding the battery and electronics compartments is provided. The cardiac pacemaker can include a battery disposed in a battery housing and a set of electronics disposed in an electronics housing. In some embodiments, the battery housing and the electronics housing can comprise an external surface of the pacemaker. The pacemaker can include a first set of welds separating the battery from the set of electronics, and a second set of welds separating the set of electronics and the battery from an exterior of the housing. Various embodiments for achieving dual-redundant welds are also provided.

Abstract: The energy harvester module of the capsule comprises: a primary oscillating structure subjected to an external low-frequency stress; a secondary oscillating structure comprising an elastic element and able to vibrate in high-frequency resonance; and an electrostatic structure with a first electrode coupled to the primary structure and a second electrode coupled to the secondary structure. The electrodes exert a mutual attraction between them driving the secondary structure away from its stable equilibrium position with tensioning of the elastic element, up to a limit beyond which the secondary structure is released by relaxation effect to vibrate at a resonance frequency. A transducer coupled to the secondary structure converts these high frequency vibration movements into electrical energy.

Abstract: A delivery system is disclosed having an implant retainer configured to releasably hold an implant unit and maintain the implant unit in a fixation location relative to target tissue in a subject's body during an implantation procedure. A first suture guide portion may be disposed on a first side of the implant retainer and configured to guide a suture needle during the implantation procedure. A second suture guide portion may be disposed on a second side of the implant retainer, opposite the first side, and configured to guide the suture needle after the suture needle exits the first suture guide portion.

Abstract: Methods and systems of applying treatment to a subject experiencing cardiac distress. In one example, there is provided a defibrillation electrode. The defibrillation electrode includes a non-volatile memory element and a circuit configured to store an indication of a level of energy delivered to a subject during the application of a defibrillation shock to the subject in the non-volatile memory element.

Abstract: Disclosed herein are atmospheric pressure pin-to-hole pulsed spark discharge devices and methods for creating plasma. The devices include a conduit for fluidically communicating a gas, a plasma, or both, therethrough, portion of the conduit capable of being connected to a gas supply, and a second portion of the conduit capable of emitting a plasma; a positive electrode comprising a sharp tip; and a ground plate electrode. Disclosed are methods for treating a skin ulcer using non-thermal plasma include flowing a gas through a cold spark discharge zone simultaneously with the creation of a pulsed spark discharge to give rise to a non-thermal plasma emitted from a conduit, the non-thermal plasma comprising NO; and contacting a skin ulcer with said non-thermal plasma for sufficient time and intensity to give rise to treatment of the skin ulcer.

Abstract: A method for producing an irradiation plan for a target volume includes preparing a modulation curve that characterizes modulation of particle numbers at target points in the target volume that lie one behind another in a direction of the beam. The method also includes determining a current position of the target volume and defining a plurality of target points that fully cover the target volume in the current position. Particle numbers are assigned to the plurality of current target points using the modulation curve.

Abstract: A therapeutic apparatus (400, 500) comprising a radiotherapy apparatus (402), a mechanical positioning system, and a magnetic resonance imaging system (404). The radiotherapy apparatus comprises a radiotherapy source (408). The radiotherapy apparatus is adapted for rotating the radiotherapy source at least partially around a subject support. The therapeutic apparatus further comprises a memory containing machine executable instructions (468, 470, 472, 474, 476).

Abstract: A patient safety system (PSS) (100) uses optical tracking in a linear accelerator treatment room to prevent gross setup errors. A patient (150) undergoes a computed tomography (CT) treatment-simulation scan while a CT ball bearing (BB) is on patient's surface. The CT BB is replaced with an infrared reflective marker (IRRM) (160) before radiotherapy treatment starts. Coordinates of the CT BB relative to an isocenter of the treatment room are used as reference for tracking. The coordinate system of an optical tracking system is converted to a coordinate system of the treatment room. The PSS evaluates setup accuracy for a radiotherapy session by comparing real-time position of the single IRRM determined by the optical tracking technology with a predicted reference position, and displays results on a graphical user interface. The PSS stops radiation when a deviation between real-time coordinates and predicted coordinates of the IRRM (160) exceeds a predefined threshold.

Abstract: A combined magnetic resonance (MR) and radiation therapy system includes a bore-type magnet with a magnet radiation translucent region which allows radiation beams to travel radially through the magnet and a split-type gradient coil includes a gradient coil radiation translucent region aligned to the magnet radiation translucent region. A radiation source, disposed laterally to the magnet, administers a radiation dose through the magnet and gradient coil radiation translucent regions to an examination region. A dosage unit determines the actual radiation dose delivered to each voxel of a target volume and at least one non-target volume based on a pre-treatment, intra-treatment, and/or post-treatment image representation of the target volume and the at least one non-target volume. A planning processor updates at least one remaining radiation dose of a radiation therapy plan based on the determined actual radiation dose.

Abstract: Receiving machine-readable information about an anchor point, analyzing that information to determine if connecting a load to the anchor point would be safe, and reporting the results of this analysis to a user.

Abstract: An apparatus and method for extinguishing and/or suppressing an electrical fire within a wooden conduit. The apparatus includes a source of pressurized fire suppressant coupled to fluid dispenser by a flexible hose. The fluid dispenser includes a coupling element securable to the flexible hose and a body element formed from a tubular wall with a plurality of fluid passage apertures for distribution of the fire suppressant. A leading element of the fluid dispenser is available for securement to a draw line for pulling the fluid dispenser through the conduit. Further disclosed is the method for extinguishing and/or suppressing the electrical fire which includes mixing of a non-conductive fire suppressant fluid, and distributing the fluid throughout the wooden conduit by drawing the fluid dispenser through the conduit with either a fish line or a discarded electrical wire.

Abstract: The flame arrester is optimized for installation within fuel containers. The flame arrester has an elongate, generally cylindrical skeletal frame having opposing first and second ends. The first end is configured as a mounting flange adapted for permanent, immovable installation within the tank or container and the second end may include a spring-loaded check valve. The frame is covered by a woven or nonwoven textile material, or alternatively, by a porous or foraminous sheet material. Fuel and vapors pass through the cylindrical textile wall, the porosity of the textile serving to prevent flame propagation through the textile material. The frame is formed of a flexible, fuel-impervious plastic material to allow the flame arrester to be bent or curved for installation within a curved tube.

Abstract: A sprinkler system installation for fire suppression within a cold environment uses a dry sprinkler assembly connected to a piping network by a flexible hose and supported in a substrate of a structure separating the cold environment from a temperature controlled warm environment. Sleeves of insulating material surround a conduit of the assembly and engage both the conduit and the substrate to seal and provide support. Escutcheons are also provided on opposite sides of the substrate which effect a clamping action on the assembly.

Abstract: Aspects of the present disclosure involve an exercise device including a base member, a pair of tower members, and a strap. The base member includes a substantially planar bottom surface, a top surface opposite the bottom surface, and an opening extending through the top and bottom surfaces. The pair of tower members extends upward from opposite ends of the top surface of the base member. The strap releasably secures to each of the pair of tower members at a chosen height and with a chosen amount of slack. The strap includes a handle positioned between a first end and a second end of the strap, wherein the chosen amount of slack of the strap is adjustable by coupling the strap to each of the pair of tower members at different positions on the strap.

Abstract: The instant invention provides a fitness equipment for facilitating both push up and wriggling excises without occupying a large storage space. The instant invention discloses a push-up twisting plate; which is made up of two circular, rotating bases and each base has a detachable handle. The handles can be easily removed by the user by applying a rotational force on the handle and an opposing rotational force on the base. To assemble the push-up twisting plate, the user can repeat the same motion, but in reverse.

Abstract: An exercise machine including a support frame, one or more arched frames and a grip frame detachably coupled together in a circular sequence is described. A locking control mechanism can allow detaching or attaching one end of the grip frame from the arched frames to configure the machine in an operating configuration or a collapsed configuration. The arched frames in an operating configuration are arranged substantially parallel to each other to allow a user positioned in between the arched frames to perform exercise movements. When one end of the grip frame is detached from the arched frame, the arched frames, the grip frame and the support frames may be folded (or foldable) into a collapsed configuration with the arched frames substantially stacked together covering each other. The arched frames, the support frame and the grip frame can remain coupled in sequence in the collapsed configuration.

Abstract: Embodiments of the present invention have left and right guide links that are pivotally attached to the frame, typically to an upper part of the frame, and left and right foot support links each having a mid-portion pivotally interconnected with a lower end of the respective guide link. Reciprocal motion of the guide links causes the foot support links to move along a path having a horizontal component of motion (i.e. fore and aft). Left and right vertical control links are coupled to a vertical cam drive such that the vertical cam drive reciprocates the vertical control links. The vertical control links are each coupled to a forward portion of the respective foot support link such that the reciprocating control links cause foot receiving areas at the rear of the respective foot support links to reciprocate along a path having a vertical component of motion (i.e. upwardly and downwardly).

Abstract: A treadmill and desk assembly which allows a user to comfortably exercise while simultaneously running or walking. The desk includes a work panel, an adjustable leg, and a base frame. The work panel is connected normal to the adjustable leg, which in turn is connected to and supported by the base frame. The treadmill includes a first guiding member, a second guiding member, a front housing, a belt, a front roller, and a rear roller. The first guiding member and the second guiding member are adjacently connected to the front housing. The front roller and the rear roller are connected in between the first guiding member and the second guiding member. The belt is tensionably positioned about the front roller and the rear roller, thus allowing for relative rotation. The front housing is sized to fit and interlock with a treadmill-receiving cavity of the desk.

Abstract: An elliptical exercise device has a frame and guide link pivotally attached thereto. A foot support link is pivotally connected to a lower attachment point of each guide link so that when the guide links pivot relative to the frame, foot receiving areas of the foot support links move in a path of travel having a horizontal component of motion. Vertical control tracks are pivotally connected to the frame and support the foot support links. A vertical drive is coupled to the forward portion of the frame and vertical control elements connect the vertical drive to the vertical control tracks.