Coordinated electrical and drug therapies

Abstract

A method includes providing one of electrical therapy or drug therapy to a recipient to treat a condition of the recipient, monitoring an efficacy of the provided electrical therapy or drug therapy in treating the condition of the recipient, and controlling the other of the electrical therapy or the drug therapy based on the monitoring.

Description

COORDINATED EEECTRICAE AND DRUG THERAPIESBACKGROUNDTechnical Field[oooi] The present disclosure relates generally to coordinating electrical and drug therapies to treat a condition of a recipient.Related Art

[0002] Medical devices have provided a wide range of therapeutic benefits to recipients over recent decades. Medical devices can include internal or implantable components / devices, external or wearable components / devices, or combinations thereof (e.g., a device having an external component communicating with an implantable component). Medical devices, such as traditional hearing aids, partially or fully- implantable hearing prostheses (e.g., bone conduction devices, mechanical stimulators, cochlear implants, etc.), pacemakers, defibrillators, functional electrical stimulation devices, and other medical devices, have been successful in performing lifesaving and / or lifestyle enhancement functions and / or recipient monitoring for a number of years.

[0003] The types of medical devices and the ranges of functions performed thereby have increased over the years. For example, many medical devices, sometimes referred to as “implantable medical devices,” now often include one or more instruments, apparatus, sensors, processors, controllers or other functional mechanical or electrical components that are permanently or temporarily implanted in a recipient. These functional devices are typically used to diagnose, prevent, monitor, treat, or manage a disease / injury or symptom thereof, or to investigate, replace or modify the anatomy or a physiological process. Many of these functional devices utilize power and / or data received from external devices that are part of, or operate in conjunction with, implantable components.SUMMARY

[0004] In one aspect, a method is provided. The first method comprises: providing one of electrical therapy or drug therapy to a recipient to treat a condition of the recipient; monitoring an efficacy of the provided electrical therapy or drug therapy in treating the condition of the recipient; and controlling the other of the electrical therapy or the drug therapy based on the monitoring.

[0005] In another aspect, a method is provided. The method comprises: delivering electrical stimulation signals to a recipient to treat a condition of the recipient; monitoring the recipient for one or more triggering events; and in response to detecting the one or more triggering events, delivering at least one drug to the recipient contemporaneously with the delivering of the electrical stimulation signals.

[0006] In yet another aspect, a method is provided. The method comprises: providing drug therapy to a recipient to treat a condition of the recipient; monitoring the recipient for one or more triggering events; and in response to detecting the one or more triggering events, providing electrical therapy in addition to the drug therapy to the recipient.

[0007] In still another method, a method is provided. The method comprises: providing drug therapy to a recipient to treat a condition of the recipient; suspending the drug therapy after a first duration of time has elapsed; providing electrical therapy to the recipient to treat the condition of the recipient after the drug therapy is suspended; and suspending the electrical therapy after the second duration of time has elapsed.

[0008] In yet another aspect, a medical device is provided. The medical device comprises: means for providing one of electrical therapy or drug therapy to a recipient to treat a condition of the recipient; means for monitoring an efficacy of the provided electrical therapy or drug therapy in treating the condition of the recipient; and means for controlling the other of the electrical therapy or the drug therapy based on the monitoring.

[0009] In yet another aspect, a medical device is provided. The medical device comprises: a stimulation device configured to deliver electrical stimulation signals to a recipient to treat a condition of the recipient; a drug delivery device configured to deliver at least one drug to the recipient; a sensor configured to measure a parameter of the recipient; and a computing device communicatively connected to the stimulation device, the drug delivery device and the sensor, the computing device being configured to monitor the recipient for one or more triggering events based on the parameter of the recipient, and, in response to detecting the one or more triggering events, to control the drug delivery device so as to deliver at least one drug to the recipient contemporaneously with the delivering of the electrical stimulation signals by the stimulation device.

[0010] In yet another aspect, a medical device is provided. The medical device comprises: a drug delivery device configured to provide drug therapy to a recipient to treat a condition of the recipient; a stimulation device configured to provide electrical therapy; a sensor configured to measure a parameter of the recipient; and a computing device communicatively connected to the drug delivery device, the stimulation device and the sensor, the computing device being configured to monitor the recipient for one or more triggering events based on the parameter of the recipient, and, in response to detecting the one or more triggering events, control the stimulation device so as to provide electrical therapy in addition to the drug therapy provided by the drug delivery device to treat the condition of the recipient.

[0011] In yet another aspect, a medical device is provided. The medical device comprises: a drug delivery device configured to provide drug therapy to a recipient to treat a condition of the recipient; a stimulation device configured to provide electrical therapy to the recipient to treat the condition; and a computing device communicatively connected to the drug delivery device and the stimulation device, the computing device being configured to control the drug delivery device so as to provide the drug therapy and to suspend the drug therapy after a first duration of time has elapsed, and to control the stimulation device so as to provide the electrical therapy to the recipient after the drug therapy is suspended, and to suspend the electrical therapy after a second duration of time has elapsed.BRIEF DESCRIPTION OF THE DRAWINGS

[0012] Embodiments of the present disclosure are described herein in conjunction with the accompanying drawings, in which:

[0013] FIG. 1A is a schematic, partial cross-sectional view illustrating anatomical structures of the human inner ear;

[0014] FIG. IB is a perspective view illustrating further details of a portion of the human inner ear of FIG. 1 A;

[0015] FIG. 1C is a block diagram of a vestibular stimulation device, in accordance with certain embodiments presented herein;

[0016] FIG. ID is a block diagram of a drug delivery device, in accordance with certain embodiments presented herein;

[0017] FIG. IE is a block diagram of a computing device that can control operation of the vestibular stimulation device of FIG. 1C and / or of the drug delivery device of FIG. ID, in accordance with certain embodiments presented herein;

[0018] FIG. 2 is a schematic view of a therapy network, in accordance with certain embodiments presented herein;

[0019] FIGS. 3, 4, 5, 6, 7, and 8 are flowcharts of methods for coordinating electrical therapy and drug therapy, in accordance with certain embodiments presented herein; and

[0020] FIG. 9 is a flowchart of a method for establishing a threshold parameter used to monitor a triggering event, in accordance with certain embodiments presented herein.DETAILED DESCRIPTION

[0021] Presented herein are techniques for coordinating drug therapy and electrical therapy to treat a condition of a recipient. In particular, in accordance with embodiments presented herein, drug therapy and electrical therapy are provided (e.g., concurrently, sequentially, etc.) in a coordinated manner based on the condition or another parameter related to the recipient. For example, in certain aspects, the techniques presented herein deliver electrical therapy and drug therapy (or a second type of electrical therapy) and control the level of one based on the efficacy of the other.

[0022] As used herein, “drug therapy” refers to the delivery of biological, bioactive, or other types of substances, such as therapeutic or pharmaceutical agents, chemicals, nanoparticles, ions, etc. (generally and collectively referred to herein as “drags” or “treatment substances”), to treat a condition / disorder experienced by a recipient. A drug can be delivered in a number of different manners (e.g., systemically, locally, etc.) using a number of different drug delivery systems and to treat a number of different conditions. Example pathways for drug delivery include oral, parenteral (injected), sublingual, topical, transdermal, nasal, ocular, rectal, and vaginal. In addition, drugs could be delivered via an implantable drug delivery device. However, drug delivery in accordance with embodiments presented herein is not limited to these pathways and drugs could be delivered via different routes in various embodiments. Example drug delivery systems that can be usedherein include, but are not limited to, microneedle patches, dermal patches, sprays, pills, nonbiodegradable implants, biodegradable implant, stand-alone implantable drug delivery devices, multi-function implantable medical devices (e.g., a device that delivers a drug and performs a second function, such as delivery of electrical stimulation to a recipient), nebulizers, pressurized metered-dose inhalers (MDIs), dry powder inhalers (DPIs), nanoscale drug delivery devices, etc.

[0023] As used herein, “electrical therapy” refers to the delivery of electrical stimulation signals (current signals) to a recipient. Electrical stimulation signals can be delivered in a number of different manners using a number of different medical devices and to treat a number of different conditions. However, merely for ease of description, the techniques presented herein are primarily described with reference to an implantable device in the form of a vestibular stimulation device. However, it is to be appreciated that the techniques presented herein may also be partially or fully implemented by any of a number of different types of devices, including consumer electronic device (e.g., mobile phones), wearable devices (e.g., smartwatches), hearing devices, implantable medical devices, consumer electronic devices, etc. As used herein, the term “hearing device” is to be broadly construed as any device that delivers sound signals to a user in any form, including in the form of acoustical stimulation, mechanical stimulation, electrical stimulation, etc. As such, a hearing device can be a device for use by a hearing-impaired person (e.g., hearing aids, middle ear auditory prostheses, bone conduction devices, direct acoustic stimulators, electro-acoustic hearing prostheses, auditory brainstem stimulators, bimodal hearing prostheses, bilateral hearing prostheses, dedicated tinnitus therapy devices, tinnitus therapy device systems, combinations or variations thereof, etc.) or a device for use by a person with normal hearing (e.g., consumer devices that provide audio streaming, consumer headphones, earphones and other listening devices). In other examples, the techniques presented herein can be implemented by, or used in conjunction with, various implantable medical devices, such as cochlear implants, visual devices (i.e., bionic eyes), sensors, pacemakers, drug delivery systems, defibrillators, functional electrical stimulation devices, catheters, seizure devices (e.g., devices for monitoring and / or treating epileptic events), sleep apnea devices, electroporation devices, etc.

[0024] The coordination of drug therapy and electrical therapy, as described herein, can result in improved outcomes for a recipient. For example, drug therapy or electrical therapy alone may not effectively treat the condition, can have decreased effectiveness over time, and / or can cause sideeffects or other discomfort to the recipient. Thus, using one of drug therapy or electrical therapy without the other of drug therapy or electrical therapy may not desirably treat the condition. However, using drug therapy and electrical therapy with one another can effectively treat the condition while maintaining treatment effectiveness and avoiding causing potential side effects and / or other discomfort to the recipient. As such, drug therapy and electrical therapy can be controlled to cooperatively treat the condition of the recipient.

[0025] For example, the condition of the recipient can include a motor disorder that causes unintended or uncontrollable movements of the body. On example motor disorder includes Parkinson’s Disease (Parkinson’s or PD), which occurs when nerve cells (neurons) in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical (neurotransmitter) that helps the cells of the brain communicate (transmits signals, “messages,” between areas in the brain). When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brain’s commands for body movement. The loss of dopamine causes the movement symptoms seen in patients with Parkinson’s disease. Other examples of motor disorders that can be treated using the discussed drug therapy and electrical therapy control include essential tremor and ataxia. Additionally, the drug therapy and electrical therapy control discussed herein can be used to treat other types of conditions, including non-motor related disorders (e.g., hearing disorders) or conditions.

[0026] Before describing details of the techniques presented herein, relevant aspects of an example human inner ear are first described below with reference to FIGs. 1 Aand IB. In particular, shown in FIG. 1A is the bony labyrinth 101, which is the bony outer wall of an inner ear 100. The bony labyrinth 101 includes three sections / parts, referred to as the vestibule 102, which includes the Otolith organs 111, the semicircular canals 104, and the cochlea 106. The vestibule 102, the semicircular canals 104, and the cochlea 106 are cavities that are internally lined with periosteum and that contain a fluid known as perilymph. For ease of illustration, a portion of the bony labyrinth 101 forming the vestibule 102 has been omitted from FIG. 1A, while the entire bony labyrinth 101 has been omitted from FIG. IB.

[0027] Within the bony labyrinth 101 is the membranous labyrinth 103, which consists of the semicircular ducts 105, the otolith organs 111 (i.e., the utricle 112 and the saccule 114), and the cochlear duct 116. The membranous labyrinth 103 is filled with a fluid known as endolymph, and is surrounded by the perilymph of the bony labyrinth 101. The membranous labyrinth 103 is also suspended from the bony labyrinth 101 by fine connective tissue strands.

[0028] As shown, the bony labyrinth 101 includes three (3) semicircular canals 104, referred to as the superior or anterior semicircular canal 104(A), the posterior semicircular canal 104(B), and the horizontal or lateral semicircular canal 104(C). Within the superior semicircular canal 104(A) is the superior semicircular duct 105(A), within the posterior semicircular canal 104(B) is the posterior semicircular duct 105(B), and within the horizontal semicircular canal 104(C) is the horizontal semicircular duct 105(C). The semicircular ducts 105 are situated superoposterior to the vestibule 102 and each have a swelling at one end, known as an ampulla 110 (i.e., three ampullae 110 are shown in FIGs. 1 A and IB, one for each semicircular duct 105). The semicircular ducts 105, the utricle 112, and the saccule 114 are sometimes collectively referred to as the “peripheral vestibular apparatus” or the “peripheral vestibular system” 125.

[0029] The semicircular ducts 105(A), 105(B), and 105(C) are half-circular, interconnected tubes that are aligned approximately orthogonally to one another (i.e., at right angles to each other) so that they measure motions in all three planes. Specifically, the lateral duct 105(C) is aligned roughly horizontally in the head, while the superior 105(A) and posterior ducts 105(B) are aligned roughly at a 45 degree angle to a vertical through the center of the individual’s head. The semicircular ducts 105(A), 105(B), and 105(C) are each maximally sensitive to angular accelerations (head rotations) that lie in the plane of the duct. The result of this arrangement is that three semicircular ducts 105(A), 105(B), and 105(C) can uniquely specify the direction and amplitude of any arbitrary head rotation. That is, upon movement of the head, the flow of endolymph within the ducts 105 changes speed and / or direction. Sensory receptors in the ampullae 110 detect these changes and send signals to the brain via the vestibular nerve 118 (FIG. IB), allowing for the processing of balance.

[0030] As noted, the membranous labyrinth 103 also includes the utricle 112 and the saccule 114, which are collectively referred to as the otolith organs 111. The utricle 112 and the saccule 114 are two membranous sacs located in the vestibule 102, which detect movement or acceleration ofthe head in the horizontal and vertical planes, respectively (i.e., linear accelerations). The utricle 112 is the larger of the two, receiving the three semi-circular ducts 105. The saccule 114 is globular in shape and receives the cochlear duct 116.

[0031] The utricle 112 and the saccule 114 each contain a macula, which is an organ consisting of a patch of hair cells covered by a gelatinous membrane containing particles of calcium carbonate, called otoliths. Motions of the head cause the otoliths organs 111 to pull on these hair cells, stimulating the vestibular nerve 118, which allow the individual to perceive linear acceleration, both horizontally and vertically, and gravity control (i.e., gravitoinertial information).

[0032] The vestibular nerve 118 is one of the two branches of the vestibulocochlear nerve (the other being the auditory nerve 119), which functions to relay / transmit sensory information transmitted by the vestibular hair cells located in the two otolith organs (i.e., the utricle 112 and the saccule 114) and the three semicircular ducts 105 via the vestibular (Scarpa’s) ganglion 121. Again, as noted, information from the otolith organs 111 reflects gravity and linear accelerations of the head, while information from the semicircular ducts 105 reflects rotational movement of the head.

[0033] The peripheral vestibular nerve fibers are generally divided into three branches. First, the superior vestibular nerve branch 126 passes through the foramina in the area vestibularis superior and ends in the utricle 112 and in the ampullae 110 of the superior and horizontal semicircular ducts 105(A) and 105(C), respectively. Second, the inferior vestibular nerve branch 128 traverses the foramina in the area vestibularis inferior and ends in the saccule 114. Third, the posterior vestibular nerve branch 131 runs through the foramen singulare and supplies the ampulla 110 of the posterior semicircular duct 105(B).

[0034] Also shown in FIG. 1A is the round window 120 and the oval window 122. The round window 120 and oval window 122 are the two openings from the middle ear (not shown) into the inner ear 100. The round window 120 is situated inferior to (below) and posterior to (behind) the oval window 122, from which it is separated by the promontory (rounded elevation). The oval window 122 is sealed by a membrane (oval window membrane) and leads from the middle ear to the vestibule of the inner ear 100. Vibrations that contact the tympanic membrane (ear drum) in the outer ear (not shown) travel through the three ossicles (i.e., malleus, incus, and stapes) of the middle ear and into the inner ear 100 via the oval window 122. That is, the oval window 122 isthe intersection of the middle ear with the inner ear 100 and is directly contacted by the stapes. The round window 120 is also sealed by a membrane (round window membrane), which vibrates with opposite phase to vibrations entering the inner ear 100 through the oval window 122. The round window 120 allows fluid in the cochlea 106 to move.

[0035] Presented herein are techniques for treating of certain conditions (e.g., Parkinson’s disease) via drug therapy and electrical therapy. In some embodiments, electrical therapy includes electrical stimulation of the vestibular system (e.g., stimulation of the vestibular nerve 118, of the saccule 114, and / or of the Scarpa's ganglion 121 and not its projections or the hair cells) from an implanted location. Drug therapy can include delivery of a drug (e.g., locally or systemically) to the vestibular system, among other parts of the recipient. Indeed, although the description herein includes discussion regarding the vestibular system, such embodiments are merely examples, and electrical stimulation and / or drug delivery can be provided to any other suitable part of the recipient (e.g., the cochlea, the nervous system, etc.).

[0036] FIG. 1C depicts an embodiment of a vestibular stimulation device 148 configured to be implanted in an endolymphatic space 154 of the recipient within the vestibular system, such as via the oval window 122. The vestibular stimulation device 148 includes a stimulator unit 150, a lead 140, and a stimulating assembly 156. The stimulating assembly 156 includes one or more electrodes 158 that collectively form an electrode array 160 configured to stimulate portions of the recipient to provide electrical therapy to the recipient. For instance, the stimulating assembly 156 is connected to the stimulator unit 150 via the lead 140, and the stimulator unit 150 is configured to generate and deliver stimulation signals to the recipient via the one or more electrodes 158. In certain examples, the stimulator unit 150 can also receive signals from the electrode array 160. In some embodiments, the stimulating assembly is inserted between adjacent bones 152 of the inner ear 100 to extend the electrode array 160 into the endolymphatic space 154 (e.g., to stimulate a nerve of the vestibular system). In additional or alternative embodiments, the electrical stimulation provided by the vestibular stimulation device 148 is an estravestibular stimulation, which can be provided to a bone of a vestibule (e.g., one of the adjacent bones 152, which can be a drilled bony bed besides the oval window 122), a promontory of the inner ear 100, and the like, and / or intravestibular stimulation, which can be provided to a nerve of or adjacent to the vestibular system. The electrical stimulation provided by the vestibular stimulation device 148 can treatcertain conditions of the recipient. As an example, the electrical stimulation can trigger generation of dopamine to help treat a symptom of Parkinson’s disease.

[0037] The vestibular stimulation device 148 can also include other components not shown in FIG. 1C. As an example, the vestibular stimulation device 148 can include a power source, radiofrequency (RF) circuitry, and / or an internal coil to provide power for operating other components (e.g., the stimulator unit 150) of the vestibular stimulation device 148. For instance, the power source (e.g., power storage, such as a battery) stores electric power that can be output, and the internal coil can communicate with a separate device (e.g., an external power component) that provides RF signals, which are converted to power via the RF circuitry, such as for storage in the power source. However, various other types of energy transfer, such as infrared (IR), electromagnetic, capacitive, and / or inductive transfer, can be used to transfer power to enable operation of the vestibular stimulation device 148.

[0038] FIG. ID depicts an embodiment of a drug delivery device 170 configured to dose and deliver a drug, a treatment substance, or any other suitable chemical substance to target tissue 171 of the recipient to provide drug therapy to the recipient. In accordance with

[0039] By way of example, the target tissue 171 is a part of the vestibular system, such as the endolymphatic space 154. However, the target tissue 171 can additionally or alternatively include another part of the recipient, such as a part of the muscular system for intermuscular drug delivery (e.g., into a neck muscle) and / or a part of the nervous system (e.g., basal ganglia, deep brain tissue, the central nervous system). The drug delivery device 170 includes a drug delivery housing 172 that encloses a reservoir 174 and a pump 176. The reservoir 174 is configured to store the drug, and the pump 176 is configured to direct the drug from the reservoir 174 and out of the drug delivery housing 172. For instance, a conduit 178 fluidly couples the drug delivery housing 172 (e.g., the reservoir 174) to the target tissue 171, and the pump 176 is configured to direct drug from the reservoir 174, through the conduit 178, and into the target tissue 171 to deliver the drug to the recipient. In some embodiments, the drug includes levodopa, which can help treat Parkinson’s disease. Additionally or alternatively, the drug includes another chemical, such as dopamine. In any case, the drug is used to treat the same condition / symptom that the vestibular stimulation device 148 treats via electrical stimulation. That is, operation of the vestibular stimulation device 148 to provide electrical stimulation and operation of the drug delivery device to provide a drugenables similar effects (e.g., a similar biochemical effect) to treat the condition / symptom of the recipient, though possibly by using different mechanisms. For instance, providing drug therapy can increase the amount of dopamine within the recipient, whereas providing electrical therapy can increase functionality of bioreceptors to receive dopamine. As such, both drug therapy and electrical therapy can increase processing of dopamine by the recipient, albeit through different manners. Although a single reservoir 174 and pump 176 are shown in FIG. ID, it should be noted that the drug delivery device 170 can include multiple reservoirs 174 and / or multiple pumps 176, which can cooperatively be used to dose and deliver different types of drugs to the target tissue 171, such as to treat different conditions.

[0040] Although separate devices are shown to deliver electrical therapy and drug therapy, it should be noted that in some embodiments, a single integral device is configured to provide both electrical therapy and drug therapy. By way of example, a single component can include the vestibular stimulation device 148 and the drug delivery device 170. In either case, electrical therapy and drug therapy can be provided to the same part of the recipient or to different parts of the recipient (e.g., by positioning the vestibular stimulation device 148 and the drug delivery device 170 at different locations).

[0041] FIG. IE depicts a computing device 180 that controls the vestibular stimulation device 148 and / or the drug delivery device 170. For example, the computing device 180 can be a part of the vestibular stimulation device 148 and / or of the drug delivery device 170, or the computing device 180 can be a separate component (e.g., an external device, a mobile device, a remote control device) communicatively coupled to the vestibular stimulation device 148 and / or to the drag delivery device 170. In either case, the computing device 180 is configured to perform at least some operations discussed herein. It is to be appreciated that the arrangement for the computing device 180 shown in FIG. IE is merely illustrative and that aspects of the techniques presented herein can be implemented at a number of different types of systems / devices including any combination of hardware, software, and / or firmware configured to perform the functions described herein.

[0042] The computing device 180 includes at least one processing unit 183 and a memory 184. The processing unit 183 includes one or more hardware or software processors (e.g., Central Processing Units, one or more Digital Signal Processors (DSPs), one or more uC cores) that canobtain and execute instructions. The processing unit 183 can be implemented as firmware elements, partially or fully implemented with digital logic gates in one or more application-specific integrated circuits (ASICs), partially in software, etc. In general, the processing unit 183 can communicate with and control the performance of other components of the computing device 180. The memory 184 is one or more software or hardware-based computer-readable storage media operable to store information accessible by the processing unit 183. The memory 184 can store, among other things, instructions, as well as other data. The memory 184 can include transitory memory or non-transitory memory. The memory 184 can also include one or more removable or non-removable storage devices. In examples, the memory 184 can include random access memory (RAM), ferroelectric random access memory (FRAM), read only memory (ROM), EEPROM (Electronically-Erasable Programmable Read-Only Memory), flash memory, optical disc storage, magnetic storage, solid state storage, or any other physical / tangible memory media usable to store information for later access. By way of example, and not limitation, the memory 184 can include wired media such as a wired network and / or direct-wired connection, and wireless media such as acoustic, radiofrequency (RF), infrared, and / or other wireless media or combinations thereof. In certain embodiments, the memory 184 comprises logic that, when executed by the processing unit 183, enables the processing unit 183 to implement applications or to perform aspects of the techniques presented. For example, the memory 184 includes logic 195 used to control operation of the vestibular stimulation device 148 and logic 196 used to control operation of the drug delivery device 170.

[0043] In the illustrated example of FIG. IE, the computing device 180 further includes a network adapter 186 that provides network access (e.g., access to at least one network 189). The network adapter 186 can provide wired or wireless network access and can support one or more of a variety of communication technologies and protocols, such as ETHERNET, cellular, BLUETOOTH, near-field communication, and / or RF, among others. The network adapter 186 can include one or more antennas and associated components configured for wireless communication according to one or more wireless communication technologies and protocols. For instance, the network adapter 186 enables communication between the computing device 180 and a user device 200 (e.g., a desktop computer, a laptop computer, a mobile phone, a tablet) via the network 189, such as to provide a notification or information to a user (e.g., the recipient, a clinician, a relative, a friend, a caretaker) of the user device 200 to prompt manual performance of a therapy and / or to indicatelow power of the vestibular stimulation device 148, of the drug delivery device 170, and / or of the computing device 180. In some embodiments, the computing device 180 also includes one or more input devices 187 and / or one or more output devices 188. The one or more input devices 187 are devices over which the computing device 180 receives input from a user. By way of example, the one or more input devices 187 can include physically-actuatable user-interface elements (e.g., buttons, switches, or dials), a keypad, a keyboard, a mouse, a touchscreen, and / or a voice input device, among other input devices that can accept user input. The one or more output devices 188 are devices by which the computing device 180 is able to provide output to a user. The one or more output devices 188 can include a display 190 (e.g., a liquid crystal display (LCD)) and / or one or more speakers 191 , among other output devices, for presentation of visual or audible information / notification. The computing device 180 can further include other components, such as a system bus, component interfaces, a graphics system, a power source (e.g., a battery), among other components.

[0044] In certain embodiments, the computing device 180 is communicatively coupled to a sensor 202, which can be implanted in the recipient. The sensor 202 is configured to monitor a parameter of the recipient, which can be indicative of the condition of the recipient for which the computing device 180 controls the vestibular stimulation device 148 and the drug delivery device 170 to treat and / or an efficacy of therapy provided via operation of the vestibular stimulation device 148 and / or of the drug delivery device 170 to treat the condition. By way of example, the parameter includes a biomarker of the recipient, a level of drug in the recipient, a stimulation level, a stimulation rate, a stimulation location, a body activity or kinematic data (e.g., motor control, movement) of the recipient, a time / duration of operation of the vestibular stimulation device 148 and / or of the drug delivery device 170, a schedule of operation of the vestibular stimulation device 148 and / or of the drug delivery device 170, another suitable parameter, or any combination thereof. The computing device 180 (e.g., the processing unit 183, such as via the network adapter 186) receives the parameter and controls operation of the vestibular stimulation device 148 and / or of the drug delivery device 170 based on the parameter to treat the condition of the recipient. Thus, the computing device 180 can operate the vestibular stimulation device 148 and / or the drug delivery device 170 more appropriately based on the parameter received from the sensor 202. As an example, the computing device 180 can operate to treat the condition more effectively and / or to avoid causing occurrence of undesirable side effects or discomfort to the recipient.

[0045] FIG. 2 is a schematic view of a therapy network 250 used for treating a condition of a recipient 252. The therapy network 250 includes the vestibular stimulation device 148 and the drug delivery device 170, as well as an individual 254 separate from the recipient 252. For example, the individual 254 can include a clinician, a relative, a friend, a caretaker, or any other suitable individual associated with treatment of the recipient 252. As discussed herein, the vestibular stimulation device 148 and the drug delivery device 170 can be controlled to treat the recipient 252. For example, operation of the vestibular stimulation device 148 to deliver electrical stimulation (e.g., of the vestibular system of the recipient 252) provides electrical therapy for the recipient 252, and operation of the drug delivery device 170 to dose and / or output a drug (e.g., to the vestibular system of the recipient 252) provides drug therapy for the recipient 252. Thus, electrical therapy and drug therapy can be controlled via the vestibular stimulation device 148 and the drug delivery device 170, respectively, for treating the condition of the recipient 252. Additionally or alternatively, treatment can be provided by the individual 254 and / or by the recipient 252 themselves. By way of example, the individual 254 and / or the recipient 252 can apply a drug (e.g., a pill, a liquid, an oral dose, an injection) to provide drug therapy without usage of the drug delivery device 170. In certain embodiments, a notification can be output (e.g., via the computing device 180) to prompt the individual 254 and / or the recipient 252 to apply the drug. Thus, actions performed by the vestibular stimulation device 148, by the drug delivery device 170, by the individual 254, and / or by the recipient 252 can cooperatively treat the condition of the recipient 252 in a desirable manner, such as to remedy the condition of the recipient 252 more effectively without causing discomfort to the recipient 252.

[0046] It should be noted that additional or alternative therapies can also be provided to the recipient 252. By way of example, electrical therapy provided to different parts of the recipient (e.g., deep brain stimulation, vestibular nerve stimulation) can be selectively controlled. Indeed, any combination of therapies that can treat the condition of the recipient 252 can be controlled based on various criteria to treat the condition more appropriately and / or acutely.

[0047] Each of FIGs. 3, 4, 5, 6, 7, 8, 9 illustrates a respective method associated with coordinated electrical therapy and drug therapy. In some embodiments, the operations of each method are performed by a single entity, such as the computing device 180 through control of the vestibular stimulation device 148 and of the drug delivery device 170. In additional or alternative embodiments, different operations of the methods can be performed by different entities. It shouldbe noted that any of the methods can be performed in a different manner than depicted. As an example, certain operations can be performed differently, performed in a different order, and / or not performed. Additionally, it should be noted that the methods can be performed in any suitable manner with respect to one another, such as sequentially (e.g., in response to one another) and / or in parallel (e.g., concurrently).

[0048] FIG. 3 is a flowchart of a method 300 for coordinating electrical therapy and drug therapy to treat a condition of a recipient, in accordance with certain embodiments presented herein. At block 302, one of electrical therapy or drug therapy is provided. That is, electrical stimulation or a drug is provided to the recipient to treat the condition. At block 304, an efficacy of the provided therapy to treat the condition is determined. At block 306, the other of the electrical therapy or the drug therapy is controlled based on the monitoring of the efficacy of the provided therapy to treat the condition. Thus, both electrical therapy and drug therapy are cooperatively used to treat the condition.

[0049] In some embodiments, the efficacy of the provided therapy is determined based on a measured parameter (e.g., in comparison to a measurement taken before the therapy is provided). As an example, the measured parameter indicates the presence and / or severity of a symptom related to the condition. As another example, the measured parameter is related to the provided therapy to indicate its efficacy (e.g., at its provided state). In additional or alternative embodiments, the efficacy of the provided therapy is determined based on a time or duration related to the provided therapy, such as a schedule that indicates potential efficacy of the provided therapy at various times. FIGs. 4, 5, 6, 7, and 8 illustrate various methods of different possible embodiments of the method 300.

[0050] FIG. 4 is a flowchart of a method 350 for coordinating electrical therapy and drug therapy to treat a condition of a recipient. At block 352, electrical therapy is initially provided. The electrical therapy includes providing electrical stimulation signals to electrically stimulate a part of the recipient. At block 354, triggering events are monitored while the electrical therapy is being provided. In accordance with the techniques presented herein, the monitored triggering events are events that, if they occur, indicate that therapy for the recipient is to be adjusted. If no triggering event is detected, the method 350 returns to 352 where electrical therapy continues to be providedwithout making any changes. The operations of 352 and 354 are repeated until a triggering event is detected at 354.

[0051] Once a triggering event is detected at 354, method 350 continues to 356. At 356, the electrical therapy is adjusted / modified based on the triggering event and then delivered to the recipient. For example, a stimulation level of the electrical stimulation signals is adjusted (e.g., increased to provide more intense stimulation), a rate of the electrical stimulation signals is adjusted (e.g., increased to provide electrical stimulation signals more frequently), a location of the electrical stimulation signals is adjusted (e.g., to provide electrical stimulation signals to a different part of the recipient), and so forth.

[0052] At block 360, the triggering events are again monitored while the electrical therapy (e.g., the adjusted electrical therapy) continues to be provided. If no triggering event is detected, the method 350 returns to 356 where electrical therapy continues to be provided without making any further changes. The operations of 356 and 360 are repeated until a triggering event is detected at 360.

[0053] Once a triggering event is detected at 360, method 350 continues to 362. At 362, drug therapy is then provided. That is, a drug is provided to the recipient (e.g., automatically via a drug delivery device, manually via a user, such as a recipient or a separate individual). For example, additional adjustments of the electrical therapy may not be desirable (e.g., the stimulation level has reached a threshold), so drug therapy can be provided to continue effective treatment of the condition of the recipient.

[0054] At block 364, the triggering events are again monitored while the while the drug therapy is provided. Moreover, a drug level (e.g., a concentration, an overall amount) within the recipient could also be monitored. At block 364, a determination is made regarding whether a triggering event is detected.

[0055] If no triggering event is detected, then method 350 proceeds to 366 where the drug therapy is suspended and electrical therapy is provided. However, if a triggering event is detected at 363, then a further determination is made at 368 regarding whether the drug level within the recipient is below a threshold level. If the drug level is below the threshold level, the drug therapy continues to be provided (e.g., at block 362). In some embodiments, the same drug therapy continues to be provided. In additional or alternative embodiments, the drug delivery is adjusted (e.g., to changean amount of a drug delivery, a concentration of a drug delivery, and / or a frequency of drug delivery). If the drug level is at or above the threshold level, the drug therapy is suspended and electrical therapy is provided. By way of example, the drug level being at or above the threshold level can cause discomfort (e.g., side effects) to the recipient and / or reduce the effectiveness of the drug over time. Thus, it can be desirable to maintain the drug level below the threshold level to treat the condition of the recipient without causing recipient discomfort and / or reducing effectiveness of the drug.

[0056] Although FIG. 4 depicts drug therapy as being provided after adjusted electrical therapy is provided, it should be noted that in additional or alternative embodiments, drug therapy can be provided before adjusted electrical therapy is provided (e.g., electrical therapy can be adjusted after a triggering event is detected with respect to block 364). In further embodiments, electrical therapy may not be adjusted at all (e.g., the provided electrical therapy remains steady).

[0057] In certain embodiments, the triggering event indicates the presence and / or severity of a symptom related to the condition. By way of example, a parameter associated with a symptom related to the condition is monitored. The parameter can, for example, include a body activity of the user, such as bradykinesia, tremor occurrence, fine motor control, handwriting, speech (e.g., slurring of speech, slowing of speech), an electroencephalogram (e.g., electrocochleography) recording, an electromyography recording, muscle rigidity, muscle tension, gait, equilibrioception, another suitable parameter, or any combination thereof. In such examples, control of the electrical therapy and the drug therapy is responsive to remedy (e.g., improve, reduce) the symptoms. Additionally or alternatively, the triggering event indicates a likelihood that a symptom related to the condition will begin. For example, a parameter that indicates a potential impending onset of the symptom related to the condition is monitored. For instance, stress can worsen the condition of the recipient (e.g., increase a presence and / or severity of a symptom). Thus, a parameter indicative of a stress level or stressor of the recipient can be monitored. As an example, the parameter can include a biochemical level (e.g., of cortisol, of dopamine) of the recipient. As another example, the parameter can indicate a schedule (e.g., a sleep schedule) of the recipient, and the schedule can indicate certain times (e.g., hours of a day, days of a week) that are related to increased stress of the recipient to indicate potential efficacy of therapy at various times. In such an example, the schedule can be input by a user (e.g., the recipient, a clinician) for implementation. In either case, the triggering event indicative of a stress level of the recipient can promptadjustment of therapy (e.g., adjustment of electrical therapy, initiation of drug therapy) to treat the condition of the recipient, potentially before a symptom occurs or worsens (e.g., to change a body activity of the user). In further embodiments, the triggering event can include the drug level. By way of example, the drug therapy can be initiated upon determining the drug level is below the threshold level. As such, drug therapy can be continually provided (e.g., with electrical therapy) until the drug level is at the threshold level, upon which electrical therapy is provided without drug therapy. In any of these examples, the triggering event can indicate an efficacy of a provided therapy.

[0058] To this end, the triggering events can be detected by utilizing a sensor configured to monitor the parameter. As an example, the sensor can be implanted in the recipient to detect the parameter (e.g., a symptom). As another example, the sensor is external to the recipient. For instance, the sensor can be wearable (e.g., on the head of the recipient) or otherwise equipped (e.g., a part of a user device) by the recipient. For instance, the sensor can include motion sensors, such as an accelerometer, a gyroscope, a magnetometer, an inertial measurement unit, and the like. The sensor can additionally or alternatively include an electrode (e.g., a subdermal electrode, an earbud electrode), a glucose sensor, or any other suitable sensor. Further still, the sensor can include a time sensor or clock to monitor a duration of time (e.g., with respect to a schedule).

[0059] In some embodiments, one of electrical therapy and drug therapy is provided at a time. That is, electrical therapy without drug therapy is initially provided. Then, upon determination that drug therapy is to be provided (e.g., in response to detection of one or more triggering events), electrical therapy is suspended such that drug therapy without electrical therapy is provided. However, in additional or alternative embodiments, both electrical therapy and drug therapy can be provided. That is, electrical therapy is initially provided, and drug therapy supplements the electrical therapy such that a drug and electrical stimulation signals are contemporaneously provided.

[0060] FIG. 5 is a flowchart of a method 400 for coordinating electrical therapy and drug therapy to treat a condition of a recipient. At block 402, drug therapy is provided. At block 404, while the drug therapy is being provided, triggering events (e.g., indicative of efficacy of the drug therapy) are monitored and a determination is made regarding whether a triggering event is detected. If notriggering event is detected, the drug therapy continues to be provided (e.g., via block 402) without making any changes.

[0061] However, if a triggering event is detected, electrical therapy is provided at block 408. Monitoring of the triggering events is continued while electrical therapy is provided. At block 410, triggering events (e.g., indicative of efficacy of the drug therapy) are again monitored and a determination is made regarding whether a triggering event is detected. In response to determining the triggering event is detected (e.g., to indicate a symptom of the condition of the recipient remains present / severe), electrical therapy continues to be provided to treat the condition. In certain embodiments, the electrical therapy is adjusted (e.g., by adjusting a stimulation level, by adjusting a stimulation rate, by adjusting a stimulation location) upon determining the triggering event is detected to treat the condition more suitably. However, at block 412, in response to determining a triggering event is not detected, the electrical therapy is suspended. For example, the absence of the triggering event indicates the condition has been desirably treated such that electrical therapy does not have to be provided. In some embodiments, after suspending electrical therapy, drug therapy is provided (e.g., via block 402).

[0062] In one example, drug therapy can help improve efficacy of electrical therapy. For instance, the drug is delivered to a part of the recipient (e.g., a nerve) to enable the part of the recipient to be more receptive to electrical stimulation signals. Thus, initially providing the drug therapy can enable subsequent electrical therapy to treat the condition more acutely.

[0063] Furthermore, in certain embodiments, the drug therapy can be adjusted (e.g., based on a detection of a triggering event), such as by changing an amount of a drug delivery, a concentration of a drug delivery, and / or a frequency of drug delivery. In such embodiments, triggering events can be monitored after the drug therapy is adjusted to determine whether the drug therapy is to be further adjusted and / or the electrical therapy is to be provided.

[0064] In certain implementations, the electrical therapy is provided to supplement the drug therapy. By way of example, the drug therapy is provided by dosing and / or outputting a drug at a relatively low dosage below a particular threshold (e.g., a threshold that otherwise can potentially introduce side effects and / or reduce effectiveness of the drug over time) to avoid causing discomfort of the recipient and / or to prolong the effectiveness of the drug for treating the condition. However, the relatively low dosage of the drug at may not sufficiently treat the condition. Assuch, the electrical therapy can supplement the drug therapy to further treat the condition while keeping the drug below the particular threshold. Additionally or alternatively, one of the drug therapy or the electrical therapy is provided at a given time. In any of these examples, excess drug therapy and / or electrical therapy can be avoided using the method 400.

[0065] FIG. 6 is a flowchart of a method 450 for coordinating electrical therapy and drug therapy to treat a condition of a recipient. At block 452, drug therapy is provided for a first duration of time. At block 454, after the first duration of time has elapsed, the drug therapy is suspended. At block 456, after the drug therapy is suspended, electrical therapy is provided for a second duration of time. At block 458, after the second duration of time has elapsed, the electrical therapy is suspended. After the electrical therapy is suspended, the drug therapy can be provided again, such as for the first duration of time or for a third duration of time that is different from the first duration of time. In this way, the method 450 includes alternating between providing drug therapy or electrical therapy.

[0066] In some embodiments, the drug therapy and the electrical therapy are provided for respective durations of time that are preset or predetermined. In other words, the drug therapy and the electrical therapy are alternated based on an established schedule. By way of example, the drug therapy is provided at certain times of a day, whereas the electrical therapy is provided at other times of the day. In additional or alternative embodiments, the drug therapy and the electrical therapy are provided for respective durations of time based on triggering events. That is, detection of a triggering event causes switching from the drug therapy to the electrical therapy and / or from the electrical therapy to the drug therapy. Thus, the drug therapy and / or the electrical therapy can be more selectively provided. In either case, one of the drug therapy or the electrical therapy is being provided without the other of the drug therapy or the electrical therapy. As such, a washout period in which no drug is being provided to the recipient (e.g., via the drug therapy) is established to enable adequate elimination of the drug from the recipient (e.g., via metabolism), thereby limiting accumulation of the drug (e.g., below a threshold level) within the recipient to avoid potential side effects and / or reduced effectiveness of the drug that could otherwise be caused by excessive amounts of the drug in the recipient.

[0067] FIG. 7 is a flowchart of a method 500 for coordinating electrical therapy and drug therapy to treat a condition of a recipient. By way of example, the method 500 can include similaroperations as those described with respect to the method 400 and / or the method 450. At block 502, drug therapy is provided using a first dosage (e.g., a first amount, a first frequency, a first concentration). At block 504, the drug therapy from block 502 is suspended. At block 506, electrical therapy is provided for a first duration of time. The first duration of time during which the electrical therapy is provided without the drug therapy can provide a washout period in which the drug previously provided at the first dosage is metabolically and naturally eliminated from the recipient. At block 508, after the first duration of time has elapsed, drug therapy is provided using a second dosage of the drug. At block 510, the drug therapy from block 508 is suspended. At block 512, electrical therapy is provided for a second duration of time to provide a washout period in which the drug previously provided at the second dosage is metabolically and naturally eliminated from the recipient. For example, the first dosage of the drug and the second dosage of the drug are different from one another. Thus, the first duration of time and the second duration of time can provide varying washout periods to eliminate the different dosages of the drug more suitably, such as to avoid accumulation of the drug in the recipient that can otherwise cause discomfort to the recipient and / or reduce effectiveness of the drug over time. In addition, the electrical therapies can be provided during the washout periods to enable sufficient elimination of drug from the recipient, while still treating the condition of the recipient.

[0068] In some embodiments, the dosage of the drug can be increased across different performances of drug therapy. In other words, the first dosage of the drug provided at block 502 includes a relatively lower dosage and the second dosage of the drug provided at block 508 includes a relatively higher dosage. For example, a determination is made that the drug therapy using the first dosage of the drug does not adequately treat the condition of the recipient. Thus, the dosage of the drug is increased to treat the condition of the recipient more acutely using the second dosage. In additional or alternative embodiments, the dosage of the drug can be reduced across different performances of drug therapy. That is, the first dosage of the drug provided at block 502 includes a relatively higher dosage and the second dosage of the drug provided at block 508 includes a relatively lower dosage. By way of example, it is desirable to wean the recipient off the drug (e.g., as a result of an improved condition). The decrease in dosage of the drug can help taper the drug delivery and avoid potential discomfort that otherwise can occur as a result of a sudden and complete termination in intake of the drug. In either case, the dosage of the drug canbe incrementally adjusted at different performances of drug therapy, and the electrical therapy can be performed therebetween to continue treatment of the recipient.

[0069] A similar approach can also be provided with respect to electrical therapy. That is, the electrical therapy (e.g., a stimulation level, a stimulation rate, a stimulation location) can be adjusted across different performances, and drug therapy can be provided between different performances of electrical therapy. As such, electrical therapy can be incrementally adjusted, such as increased or decreased. Indeed, both drug therapy and electrical therapy can be incrementally adjusted while drug therapy and electrical therapy are alternately provided.

[0070] FIG. 8 is a flowchart of a method 550 for coordinating electrical therapy and drug therapy to treat a condition of a recipient. At block 552, a sleep schedule of the recipient is determined, such as based on a user input. The sleep schedule can include different periods of time associated with a sleep time, during which the recipient is asleep, and a wake time, during which the recipient is awake. At block 554, electrical therapy or drug therapy is initiated at a sleep time according to the sleep schedule. Thus, the electrical therapy or drug therapy can help treat and manage the condition of the recipient during the sleep time. At block 556, electrical therapy or drug therapy is initiated within a threshold time before the wake time according to the sleep schedule. For example, the presence and / or severity of a symptom related to the condition of the recipient can increase during the wake time as compared to during the sleep time. As such, the electrical therapy or drug therapy can be initiated before the wake time to provide a sufficient amount of time for the electrical therapy or of the drug therapy to become effective such that the condition of the recipient is better treated by the wake time. The electrical therapy or drug therapy can also continue to be performed during the wake time, such as until another sleep time is determined.

[0071] In some embodiments, one of electrical therapy or drug therapy without the other of electrical therapy or drug therapy is provided during the sleep time. In additional or alternative embodiments, both electrical therapy and drug therapy is provided during the sleep time. Moreover, in certain embodiments, any of the electrical therapy or drug therapy control discussed herein can be performed during the wake time (e.g., initiated within the threshold time before the wake time). That is, drug therapy supplemented by electrical therapy, electrical therapy supplemented by drug therapy, alternation between drug therapy and electrical therapy, and so forth can be performed during the wake time. 1

[0072] As an example, drug therapy (e.g., a low dosage of a drug, such a single pill) alone can adequately treat the condition of the recipient during the sleep time. However, the drug therapy alone may not be able to adequately treat the condition of the recipient during the wake time. Thus, electrical therapy and / or additional drug therapy (e.g., a higher dosage of the drug) is initiated at the threshold time before the wake time. As another example, electrical therapy alone is used to treat the condition of the recipient during the sleep time, and the electrical therapy is adjusted and / or drug therapy is provided at the threshold time before the wake time. In either example, electrical therapy and drug therapy are selectively operated to treat the condition of the recipient according to the sleep schedule.

[0073] For any of the depicted methods 300, 350, 400, 450, 500, 550, it should be noted that there can be an instance in which neither drug therapy nor electrical therapy is being provided. For example, a determination is made that the condition of the recipient is sufficiently treated. In response, drug therapy and electrical therapy can be suspended to avoid excessive operation, which can otherwise be costly and / or resource intensive. Additionally or alternatively, a user (e.g., the recipient, a clinician) can indicate suspension of drug therapy and / or of electrical therapy.

[0074] FIG. 9 is a flowchart of a method 600 for operating a calibration mode and a therapy mode of a device. Specifically, the therapy mode includes operation to control drug therapy and / or electrical therapy (e.g., using any of the methods 300, 350, 400, 450, 500, 550) to treat a condition of a recipient, and the calibration mode establishes criteria, such as triggering events, used for operating the therapy mode to treat the condition of the recipient. At block 602, a parameter of a recipient is monitored during the calibration mode. For example, the calibration mode is in operation while a symptom related to the condition of the recipient is not substantially present / severe and / or while no therapy is being provided to the recipient, such as during fitting of the device to the recipient. Thus, during the calibration mode, the parameter of the recipient can represent a baseline that indicates when therapy does not have to be provided to the recipient to treat the condition.

[0075] For instance, the parameter can include any of the parameters discussed herein, such as a parameter indicative of a symptom related to the condition (e.g., the parameter includes a body activity, such as a tremor level / frequency or a brain signal recording) and / or a likelihood that a symptom related to the condition will begin (e.g., the parameter includes a biomarker, such ascortisol level or dopamine level). In some embodiments, the recipient can be requested to perform an action during the calibration mode to enable effective monitoring of the parameter. As an example, the parameter can include fine motor control, and the recipient can be requested to interact with a touch screen (e.g., of a mobile phone) to enable movement of the recipient that can be monitored to evaluate fine motor control. As another example, the parameter can include gait, and the recipient can be requested to walk to enable movement of the recipient that can be monitored to evaluate gait.

[0076] At block 604, a threshold value (e.g., a threshold range) is determined based on the parameter of the recipient during the calibration mode. The threshold value indicates when therapy is to be provided to the recipient (e.g., when a symptom related to the condition of the recipient is present and / or severe). For instance, a parameter value being below the threshold value can indicate therapy does not have to be provided to treat the condition of the recipient. However, the parameter value being at or above the threshold value can indicate that therapy is to be provided to treat the condition of the recipient.

[0077] At block 606, the threshold value is used to operate the therapy mode. That is, drug therapy and electrical therapy are controlled based on the threshold value. In this manner, the threshold value can be used to monitor a triggering event, such as by monitoring the parameter of the recipient, comparing the parameter to the threshold value, and controlling the drug therapy and the electrical therapy based on comparison of the parameter to the threshold value (e.g., one of the drug therapy or the electrical therapy is provided in response to the parameter being at or above the threshold value). By establishing the threshold value during the calibration mode, the therapy mode can be more appropriately operated for the recipient. For instance, a trigger to treat the condition of the recipient can be more accurately determined by referencing the threshold value to provide the drug therapy and the electrical therapy. That is, excessive provision of the drug therapy and / or of the electrical therapy (e.g., when the condition of the recipient does not need to be treated) can be avoided to reduce potential costs and / or other resource consumption associated with providing the drug therapy and / or the electrical therapy. Indeed, because the threshold value can differ between recipients, monitoring the parameter during the calibration mode to determine a particular threshold value for each recipient enables the drug therapy and the electrical therapy to be more suitably operated for the different recipients.

[0078] As should be appreciated, while particular uses of the technology have been illustrated and discussed above, the disclosed technology can be used with a variety of devices in accordance with many examples of the technology. The above discussion is not meant to suggest that the disclosed technology is only suitable for implementation within systems akin to that illustrated in the figures. In general, additional configurations can be used to practice the processes and systems herein and / or some aspects described can be excluded without departing from the processes and systems disclosed herein.

[0079] This disclosure described some aspects of the present technology with reference to the accompanying drawings, in which only some of the possible aspects were shown. Other aspects can, however, be embodied in many different forms and should not be construed as limited to the aspects set forth herein. Rather, these aspects were provided so that this disclosure was thorough and complete and fully conveyed the scope of the possible aspects to those skilled in the art.

[0080] As should be appreciated, the various aspects (e.g., portions, components, etc.) described with respect to the figures herein are not intended to limit the systems and processes to the particular aspects described. Accordingly, additional configurations can be used to practice the methods and systems herein and / or some aspects described can be excluded without departing from the methods and systems disclosed herein.

[0081] According to certain aspects, systems and non-transitory computer readable storage media are provided. The systems are configured with hardware configured to execute operations analogous to the methods of the present disclosure. The one or more non-transitory computer readable storage media comprise instructions that, when executed by one or more processors, cause the one or more processors to execute operations analogous to the methods of the present disclosure.

[0082] Similarly, where steps of a process are disclosed, those steps are described for purposes of illustrating the present methods and systems and are not intended to limit the disclosure to a particular sequence of steps. For example, the steps can be performed in differing order, two or more steps can be performed concurrently, additional steps can be performed, and disclosed steps can be excluded without departing from the present disclosure. Further, the disclosed processes can be repeated.

[0083] Although specific aspects were described herein, the scope of the technology is not limited to those specific aspects. One skilled in the art will recognize other aspects or improvements that are within the scope of the present technology. Therefore, the specific structure, acts, or media are disclosed only as illustrative aspects. The scope of the technology is defined by the following claims and any equivalents therein.

[0084] It is also to be appreciated that the embodiments presented herein are not mutually exclusive and that the various embodiments may be combined with another in any of a number of different manners.

Claims

CLAIMSWhat is claimed is:

1. A method, comprising: providing one of electrical therapy or drug therapy to a recipient to treat a condition of the recipient; monitoring an efficacy of the provided electrical therapy or drug therapy in treating the condition of the recipient; and controlling the other of the electrical therapy or the drug therapy based on the monitoring.

2. The method of claim 1 , wherein providing one of the electrical therapy or the drug therapy comprises: providing the electrical therapy, and wherein controlling the other of the electrical therapy or the drug therapy comprises supplementing the electrical therapy with the drug therapy.

3. The method of claim 2, further comprising: suspending the drug therapy in response to a drug level within the recipient reaching a threshold level.

4. The method of claim 2, further comprising: adjusting the electrical therapy based on the monitoring, wherein the electrical therapy is supplemented with the drug therapy after adjusting the electrical therapy based on the monitoring.

5. The method of claim 4, wherein providing the electrical therapy comprises: delivering electrical stimulation signals to the recipient, and wherein adjusting the electrical therapy comprises adjusting at least one of a stimulation level of the electrical stimulation signals, a rate of the electrical stimulation signals, or a location of the electrical stimulation signals.

6. The method of claim 1 , wherein providing one of the electrical therapy or the drug therapy comprises:providing the drug therapy, and wherein providing the other of the electrical therapy or the drug therapy comprises supplementing the drug therapy with the electrical therapy.

7. The method of claim 1 , wherein providing one of the electrical therapy or the drug therapy comprises: providing the drug therapy for a first duration of time, and wherein providing the other of the electrical therapy or the drug therapy comprises providing the electrical therapy without the drug therapy for a second duration of time after the first duration of time.

8. The method of claim 7, wherein providing the drug therapy for the first duration of time comprises: providing a drug at a first dosage for the first duration of time, and wherein the method further comprises providing the drug at a second dosage for a third duration of time after the second duration of time, the second dosage being different from the first dosage.

9. The method of claim 7, wherein providing the drug therapy for the first duration of time comprises: providing the drug therapy without the electrical therapy for the first duration of time.

10. The method of claim 1, wherein the electrical therapy comprises: delivering electrical stimulation signals to a vestibular system of the recipient.

11. The method of claim 1, wherein monitoring the efficacy of the provided electrical therapy or drug therapy in treating the condition of the recipient comprises: monitoring a biomarker indicative of a stress level.

12. The method of claim 11, wherein the biomarker comprises at least one of a cortisol level or a dopamine level.

13. The method of claim 1 , wherein providing one of the electrical therapy or the drug therapy comprises providing the drug therapy, and wherein providing the drug therapy comprises:providing a dosage of a drug, and wherein monitoring the efficacy of the provided electrical therapy or drug therapy in treating the condition of the recipient includes monitoring a level of the drug in the recipient.

14. The method of claim 1, wherein monitoring the efficacy of the provided electrical therapy or drug therapy in treating the condition of the recipient comprises monitoring a body activity of the recipient.

15. The method of claim 14, wherein the body activity of the recipient comprises at least one of bradykinesia, fine motor control, handwriting, speech, an electroencephalogram recording, an electromyography recording, muscle rigidity, gait, or equilibrioception of the recipient.

16. The method of claim 1, wherein monitoring the efficacy of the provided electrical therapy or drug therapy in treating the condition of the recipient comprises monitoring a sleep schedule of the recipient.

17. The method of claim 16, wherein controlling the other of the electrical therapy or the drug therapy to the recipient comprises: initiating the electrical therapy or the drug therapy at a sleep time of the recipient according to the sleep schedule.

18. The method of claim 16, wherein controlling the other of the electrical therapy or the drug therapy to the recipient comprises: initiating the other of the electrical therapy or the drug therapy within a threshold time before a wake time according to the sleep schedule.

19. The method of claim 1 , wherein the drug therapy comprises: dosing a drug that targets at least one of a vestibular system, a basal ganglia, the brain, a central nervous system, or a muscle of the recipient.

20. The method of claim 1, wherein the drug therapy comprises dosing levodopa to the recipient.

21. The method of claim 1, wherein the condition comprises a symptom of Parkinson’s disease.

22. The method of claim 1, further comprising: monitoring a parameter of the recipient during a period of time in which neither the electrical therapy nor the drug therapy is provided to the recipient; and determining a threshold value based on the parameter of the recipient, wherein the monitoring of the efficacy of the provided electrical therapy or drug therapy is based on the threshold value.

23. The method of claim 22, wherein monitoring the efficacy of the provided electrical therapy or drug therapy comprises: monitoring the parameter of the recipient during an additional period of time in which one of the electrical therapy or the drug therapy is provided to the recipient; and comparing the parameter to the threshold value.

24. The method of claim 23, further comprising determining the parameter is at or above the threshold value, wherein controlling the other of the electrical therapy or the drug therapy based on the monitoring comprises providing the other of the electrical therapy or the drug therapy in response to determining the parameter is at or above the threshold value.

25. A method, comprising: delivering electrical stimulation signals to a recipient to treat a condition of the recipient; monitoring the recipient for one or more triggering events; and in response to detecting the one or more triggering events, delivering at least one drug to the recipient contemporaneously with the delivering of the electrical stimulation signals.

26. The method of claim 25, further comprising:monitoring the recipient for the one or more triggering events over a period of time during which the at least one drug and the electrical stimulation signals are contemporaneously delivered to the recipient; and adjusting the delivering of the at least one drug to the recipient based on the monitoring of the recipient over the period of time.

27. The method of claim 26, wherein monitoring the recipient for the one or more triggering events over the period of time comprises detecting an absence of the one or more triggering events, and adjusting the delivering of the at least one drug the recipient comprises suspending the delivering of the at least one drug to the recipient in response to detecting the absence of the one or more triggering events,.

28. The method of claim 26, wherein monitoring the recipient for the one or more triggering events over the period of time comprises determining a level of the at least one drug is at or above a threshold level, and adjusting the delivering of the at least one drug the recipient comprises suspending the delivering of the at least one drug to the recipient in response to determining the level of the at least one drug is at or above the threshold level.

29. The method of claim 25, wherein the one or more triggering events comprise at least one of a body activity of the recipient, a biomarker indicative of a stress level of the recipient, a schedule of the recipient, or a level of the at least one drug.

30. The method of claim 25, further comprising receiving a parameter from a sensor, wherein the monitoring of the recipient for the one or more triggering events is based on the parameter.

31. The method of claim 25, further comprising adjusting the delivering of the electrical stimulation signals in response to detecting the one or more triggering events, wherein the at least one drug is delivered in response to detecting the one or more triggering events after the delivering of the electrical stimulation signals is adjusted.

32. The method of claim 25, further comprising:monitoring a parameter of the recipient during a period of time in which neither the electrical stimulation signals nor the at least one drug are delivered to the recipient; and determining a threshold value based on the parameter of the recipient, wherein the monitoring of the recipient for the one or more triggering events is based on the threshold value.

33. The method of claim 32, wherein monitoring the recipient for the one or more triggering events comprises: monitoring the parameter during an additional period of time in which the electrical stimulation signals are delivered to the recipient; comparing the parameter to the threshold value; and in response to determining the parameter is at or above the threshold value, detecting the one or more triggering events.

34. A method, comprising: providing drug therapy to a recipient to treat a condition of the recipient; monitoring the recipient for one or more triggering events; and in response to detecting the one or more triggering events, providing electrical therapy in addition to the drug therapy to treat the condition of the recipient.

35. The method of claim 34, wherein the one or more triggering events comprise at least one of a body activity of the recipient, a biomarker indicative of a stress level of the recipient, a schedule of the recipient, or a level of a drug delivered during the drug therapy.

36. The method of claim 34, wherein providing the drug therapy to the recipient comprises delivering a drug to the recipient and maintaining a dosage of the drug below a threshold level.

37. The method of claim 34, further comprising: determining an absence of the one or more triggering events; and in response to determining the absence of the one or more triggering events, suspending the electrical therapy.

38. The method of claim 34, wherein providing the drug therapy comprises delivering a drug to a nerve of the recipient, and providing the electrical therapy comprises delivering an electrical stimulation signal to the nerve.

39. The method of claim 34, further comprising: monitoring a parameter of the recipient during a period of time in which neither the drug therapy nor the electrical therapy is provided to the recipient; and determining a threshold value based on the parameter of the recipient, wherein monitoring of the recipient for the one or more triggering events based on the threshold value.

40. The method of claim 39, wherein monitoring the recipient for the one or more triggering events comprises: monitoring the parameter during an additional period of time in which the drug therapy is provided to the recipient; comparing the parameter to the threshold value; and in response to determining the parameter is at or above the threshold value, detecting the one or more triggering events.

41. A method, comprising: providing drug therapy to a recipient to treat a condition of the recipient; suspending the drug therapy after a first duration of time has elapsed; providing electrical therapy to the recipient to treat the condition of the recipient after the drug therapy is suspended; and suspending the electrical therapy after a second duration of time has elapsed.

42. The method of claim 41 , wherein the first duration of time and the second duration of time are based on a sleep schedule of the recipient.

43. The method of claim 42, wherein the first duration of time is associated with a sleep time of the sleep schedule, and the second duration of time is associated with a wake time of the sleep schedule.

44. The method of claim 43, wherein providing the electrical therapy comprises initiating the electrical therapy at a threshold time before the wake time of the sleep schedule and providing the electrical therapy during the wake time of the sleep schedule.

45. The method of claim 41, further comprising providing additional drug therapy to the recipient after the electrical therapy is suspended.

46. The method of claim 45, wherein providing the drug therapy comprises providing a drug at a first dosage to the recipient, and providing the additional drug therapy to the recipient comprises providing the drug at a second dosage, different from the first dosage, to the recipient.

47. The method of claim 46, further comprising: determining an efficacy of the drug therapy; and increasing the first dosage to the second dosage of the drug based on the efficacy of the drug therapy.

48. The method of claim 41, further comprising: providing initial electrical therapy to the recipient before the drug therapy is provided to the recipient; and suspending the initial electrical therapy after an initial duration of time has elapsed before the drug therapy is provided to the recipient.

49. The method of claim 48, wherein providing the initial electrical therapy comprises providing first electrical stimulation signals to the recipient, providing the electrical therapy comprises providing second electrical stimulation signals to the recipient, and the second electrical stimulation signals are adjusted from the first electrical stimulation signals.

50. The method of claim 49, wherein the second electrical stimulation signals comprise at least one of a different stimulation level, a different stimulation rate, or a different stimulation location as compared to the first electrical stimulation signals.

51. A medical device, comprising: means for providing one of electrical therapy or drug therapy to a recipient to treat a condition of the recipient; means for monitoring an efficacy of the provided electrical therapy or drug therapy in treating the condition of the recipient; and means for controlling the other of the electrical therapy or the drug therapy based on the monitoring.

52. A medical device according to claim 51, configured to perform a method according to any one of claims 1 to 24.

53. A medical device, comprising: a stimulation device configured to deliver electrical stimulation signals to a recipient to treat a condition of the recipient; a drug delivery device configured to deliver at least one drug to the recipient; a sensor configured to measure a parameter of the recipient; and a computing device communicatively connected to the stimulation device, the drug delivery device and the sensor, the computing device being configured to monitor the recipient for one or more triggering events based on the parameter of the recipient, and, in response to detecting the one or more triggering events, to control the drug delivery device so as to deliver at least one drug to the recipient contemporaneously with the delivering of the electrical stimulation signals by the stimulation device.

54. A medical device according to claim 53, configured to perform a method according to any one of claims 25 to 33.

55. A medical device, comprising: a drug delivery device configured to provide drug therapy to a recipient to treat a condition of the recipient; a stimulation device configured to provide electrical therapy; a sensor configured to measure a parameter of the recipient; anda computing device communicatively connected to the drug delivery device, the stimulation device and the sensor, the computing device being configured to monitor the recipient for one or more triggering events based on the parameter of the recipient, and, in response to detecting the one or more triggering events, control the stimulation device so as to provide electrical therapy in addition to the drug therapy provided by the drug delivery device to treat the condition of the recipient.

56. A medical device according to claim 55, configured to perform a method according to any one of claims 34 to 40.

57. A medical device, comprising: a drug delivery device configured to provide drug therapy to a recipient to treat a condition of the recipient; a stimulation device configured to provide electrical therapy to the recipient to treat the condition; and a computing device communicatively connected to the drug delivery device and the stimulation device, the computing device being configured to control the drug delivery device so as to provide the drug therapy and to suspend the drug therapy after a first duration of time has elapsed, and to control the stimulation device so as to provide the electrical therapy to the recipient after the drug therapy is suspended, and to suspend the electrical therapy after a second duration of time has elapsed.

58. A medical device according to claim 57, configured to perform a method according to any one of claims 41 to 50.

59. A medical device configured to carry out a method according to any one of claims 1 to 50.

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