Stimulating medical device configured to affect biological matter

Abstract

A system, including a right side vestibular stimulation device and a left side vestibular stimulation device, wherein the system is configured to control the right side vestibular stimulation device and the left side device to adjust respective outputs based on a symptom of a motor disorder of a recipient of the system.

Description

STIMULATING MEDICAL DEVICE CONFIGURED TO AFFECT BIOLOGICAL MATTERBACKGROUND[oooi] 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.

[0002] 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

[0003] In an exemplary embodiment, there is a system, comprising a right side vestibular stimulation device and a left side vestibular stimulation device, wherein the system is configured to control the right side vestibular stimulation device and the left side device to adjust respective outputs based on a symptom of a motor disorder of a recipient of the system.BRIEF DESCRIPTION OF THE DRAWINGS

[0004] Embodiments are described below with reference to the attached drawings, in which:

[0005] FIG. 1 is a perspective view of an exemplary hearing prosthesis;

[0006] FIG. 2 presents a functional block diagram of an exemplary cochlear implant;

[0007] FIG. 3A and FIG. 3B and FIG. 4 present exemplary systems of communication between devices;

[0008] FIG. 5 presents an exemplary vestibular implant;

[0009] FIG. 6 is a schematic, partial cross-sectional view illustrating anatomical structures of the human inner ear;

[0010] FIG. 7 is a perspective view illustrating further details of a portion of the human inner ear of FIG. 6;[ooit] FIG. 8A is a schematic diagram illustrating a otolith stimulation system, in accordance with certain embodiments presented herein;

[0012] FIG. 8B is a simplified block diagram of the vestibular stimulation system of FIG. 2A, in accordance with certain embodiments presented herein;

[0013] FIG. 9 is a schematic three-dimensional diagram of a recipient’s inner ear having a stimulating assembly implanted therein, in accordance with certain embodiments presented herein;

[0014] FIG. 10 is a flowchart of a method, in accordance with certain embodiments presented herein;

[0015] FIG. 11 is a flowchart of a method, in accordance with certain embodiments presented herein;

[0016] FIG. 12 is a schematic diagram illustrating a fitting system with which aspects of the techniques presented herein can be implemented;

[0021] FIG. 8 is a flowchart of another method, in accordance with certain embodiments presented herein;

[0017] FIG. 13 is a flowchart of another method, in accordance with certain embodiments presented herein; and

[0018] FIG. 14 is a flowchart of another method, in accordance with certain embodiments presented herein;

[0019] FIG. 16 is an exemplary bilateral system;

[0020] FIGs. 17 and 18 present schematics disclosing additional embodiments;

[0021] FIG. 22 presents exemplary data;

[0022] FIGs. 19-21C and 23-38 present flowcharts for exemplary methods; and

[0023] FIGs. 39 and 40 present exemplary systems for an exemplary embodiment.DETAILED DESCRIPTION

[0024] Merely for ease of description, the techniques presented herein are sometimes described herein with reference by way of background to an illustrative medical device, namely a cochlear implant. This is because in some embodiments, but not necessarily all, features of such a prosthetic device have general and / or specific applicability to a vestibular implant, which in turn has general / and / or specific applicability to a motor disorder medical device (e.g., a motor disorder prosthesis) according to the teachings herein. However, it is noted that the techniques presented herein can also be used with a variety of other medical devices that, while providing a wide range of therapeutic benefits to recipients, patients, or other users, may benefit from setting changes based on the location of the medical device. In this regard, for example, as just noted, the techniques presented herein may be used to with a vestibular implant, with respect to a particular human being. But to be clear, the techniques presented herein are squarely applicable to the technology of motor disorder medical devices. The techniques presented herein are squarely applicable to the technology of vestibular devices (e.g., vestibular implants). Note that the two are not mutually exclusive.

[0025] And briefly, in an embodiment, a commercially available cochlear implant external component (a so-called sound processor) can be (is) modified to implement at least some of the teachings herein vis-a-vis motor organ stimulation and / or vestibular stimulation (e.g., by changing the software and / or firmware, and possibly changing a chip or some circuitry, but starting with an external cochlear implant component). The implant can be a modified implantable portion of a cochlear implant, for that matter. Note that these changes change the initial device from a cochlear implant to a motor disorder treatment implant and / or a vestibular implant.

[0026] Again, as will be noted below, some embodiments of the vestibular implant use at least some features of a cochlear implant. And thus, we first describe a cochlear implant. FIG. 1 is aperspective view of a cochlear implant, referred to as cochlear implant 100, implanted in a recipient, to which some embodiments detailed herein and / or variations thereof are applicable. Particularly, as will be detailed below, there are aspects of a cochlear implant that are utilized with respect to a vestibular implant, and thus there is utility in describing features of the cochlear implant for purposes of understanding a vestibular implant. The cochlear implant 100 is part of a system 10 that can include external components in some embodiments, as will be detailed below. Additionally, it is noted that the teachings detailed herein are also applicable to other types of hearing prostheses, such as, by way of example only and not by way of limitation, bone conduction devices (percutaneous, active transcutaneous and / or passive transcutaneous), direct acoustic cochlear stimulators, middle ear implants, and conventional hearing aids, etc. Indeed, it is noted that the teachings detailed herein are also applicable to so-called multi-mode devices. In an exemplary embodiment, these multi-mode devices apply both electrical stimulation and acoustic stimulation to the recipient. In an exemplary embodiment, these multi-mode devices evoke a hearing percept via electrical hearing and bone conduction hearing.

[0027] In view of the above, at least some embodiments detailed herein and / or variations thereof are directed towards a body- worn sensory supplement medical device (e.g., a vestibular prosthesis (more on this below), or the hearing prosthesis of FIG. 1, (or a device that uses at least one or more of the features of such)).

[0028] Some embodiments include the application of the teachings detailed herein to any type of sensory supplement medical device to which the teachings detailed herein are enabled for use therein in a utilitarian manner. In this regard, the phrase sensory supplement medical device refers to any device that functions to provide sensation to a recipient irrespective of whether the applicable natural sense is only partially impaired or completely impaired, or indeed never existed.

[0029] Returning back to FIG. 1, the recipient has an outer ear 101, a middle ear 105, and an inner ear 107. Components of outer ear 101, middle ear 105, and inner ear 107 are described below, followed by a description of cochlear implant 100.

[0030] In a fully functional ear, outer ear 101 comprises an auricle 110 and an ear canal 102. An acoustic pressure or sound wave 103 is collected by auricle 110 and channeled into and through ear canal 102. Disposed across the distal end of ear channel 102 is a tympanic membrane 104which vibrates in response to sound wave 103. This vibration is coupled to oval window or fenestra ovalis 112 through three bones of middle ear 105, collectively referred to as the ossicles 106 and comprising the malleus 108, the incus 109, and the stapes 111. Bones 108, 109, and 111 of middle ear 105 serve to filter and amplify sound wave 103, causing oval window 112 to articulate, or vibrate in response to vibration of tympanic membrane 104. This vibration sets up waves of fluid motion of the perilymph within cochlea 140. Such fluid motion, in turn, activates tiny hair cells (not shown) inside of cochlea 140. Activation of the hair cells causes appropriate nerve impulses to be generated and transferred through the spiral ganglion cells (not shown) and auditory nerve 114 to the brain (also not shown) where they are perceived as sound.

[0031] As shown, cochlear implant 100 comprises one or more components which are temporarily or permanently implanted in the recipient. Cochlear implant 100 is shown in FIG. 1 with an external device 142, that is part of system 10 (along with cochlear implant 100), which, as described below, is configured to provide power to the cochlear implant, where the implanted cochlear implant includes a battery that is recharged by the power provided from the external device 142.

[0032] In the illustrative arrangement of FIG. 1, external device 142 can comprise a power source (not shown) disposed in a Behind-The-Ear (BTE) unit 126. External device 142 also includes components of a transcutaneous energy transfer link, referred to as an external energy transfer assembly. The transcutaneous energy transfer link is used to transfer power and / or data to cochlear implant 100. Various types of energy transfer, such as infrared (IR), electromagnetic, capacitive and inductive transfer, may be used to transfer the power and / or data from external device 142 to cochlear implant 100. In the illustrative embodiments of FIG. 1, the external energy transfer assembly comprises an external coil 130 that forms part of an inductive radio frequency (RF) communication link. External coil 130 is typically a wire antenna coil comprised of multiple turns of electrically insulated single-strand or multi-strand platinum or gold wire. External device 142 also includes a magnet (not shown) positioned within the turns of wire of external coil 130. It should be appreciated that the external device shown in FIG. 1 is merely illustrative, and other external devices may be used with embodiments.

[0033] Cochlear implant 100 comprises an internal energy transfer assembly 132 which can be positioned in a recess of the temporal bone adjacent auricle 110 of the recipient. As detailedbelow, internal energy transfer assembly 132 is a component of the transcutaneous energy transfer link and receives power and / or data from external device 142. In the illustrative embodiment, the energy transfer link comprises an inductive RF link, and internal energy transfer assembly 132 comprises a primary internal coil 136. Internal coil 136 is typically a wire antenna coil comprised of multiple turns of electrically insulated single-strand or multi-strand platinum or gold wire.

[0034] Cochlear implant 100 further comprises a main implantable component 120 and an elongate electrode assembly 118. In some embodiments, internal energy transfer assembly 132 and main implantable component 120 are hermetically sealed within a biocompatible housing. In some embodiments, main implantable component 120 includes an implantable microphone assembly (not shown) and a sound processing unit (not shown) to convert the sound signals received by the implantable microphone in internal energy transfer assembly 132 to data signals. That said, in some alternative embodiments, the implantable microphone assembly can be located in a separate implantable component (e.g., that has its own housing assembly, etc.) that is in signal communication with the main implantable component 120 (e.g., via leads or the like between the separate implantable component and the main implantable component 120). In at least some embodiments, the teachings detailed herein and / or variations thereof can be utilized with any type of implantable microphone arrangement.

[0035] Main implantable component 120 further includes a stimulator unit (also not shown) which generates electrical stimulation signals based on the data signals. The electrical stimulation signals are delivered to the recipient via elongate electrode assembly 118.

[0036] Elongate electrode assembly 118 has a proximal end connected to main implantable component 120, and a distal end implanted in cochlea 140. Electrode assembly 118 extends from main implantable component 120 to cochlea 140 through mastoid bone 119. In some embodiments electrode assembly 118 may be implanted at least in basal region 116, and sometimes further. For example, electrode assembly 118 may extend towards apical end of cochlea 140, referred to as cochlea apex 134. In certain circumstances, electrode assembly 118 may be inserted into cochlea 140 via a cochleostomy 122. In other circumstances, a cochl eostomy may be formed through round window 121, oval window 112, the promontory 123 or through an apical turn 147 of cochlea 140.

[0037] Electrode assembly 118 comprises a longitudinally aligned and distally extending array 146 of electrodes 148, disposed along a length thereof. As noted, a stimulator unit generates stimulation signals which are applied by electrodes 148 to cochlea 140, thereby stimulating auditory nerve 114.

[0038] Thus, as seen above, one variety of implanted devices depends on an external component to provide certain functionality and / or power. For example, the recipient of the implanted device can wear an external component that provides power and / or data (e.g., a signal representative of sound) to the implanted portion that allow the implanted device to function. In particular, the implanted device can lack a battery and can instead be totally dependent on an external power source providing continuous power for the implanted device to function. Although the external power source can continuously provide power, characteristics of the provided power need not be constant and may fluctuate. Additionally, where the implanted device is an auditory prosthesis such as a cochlear implant, the implanted device can lack its own sound input device (e.g., a microphone). It is sometimes utilitarian to remove the external component. For example, it is common for a recipient of an auditory prosthesis to remove an external portion of the prosthesis while sleeping. Doing so can result in loss of function of the implanted portion of the prosthesis, which can make it impossible for recipient to hear ambient sound. This can be less than utilitarian and can result in the recipient being unable to hear while sleeping. Loss of function would also prevent the implanted portion from responding to signals representative of streamed content (e.g., music streamed from a phone) or providing other functionality, such as providing tinnitus suppression noise.

[0039] The external component that provides power and / or data can be worn by the recipient, as detailed above. While a wearable external device is worn by a recipient, the external device is typically in very close proximity and tightly aligned with an implanted component. The wearable external device can be configured to operate in these conditions. Conversely, in some instances, an unworn device can generally be further away and less tightly aligned with the implanted component. This can create difficulties where the implanted device depends on an external device for power and data (e.g., where the implanted device lacks its own battery and microphone), and the external device can need to continuously and consistently provide power and data in order to allow for continuous and consistent functionality of the implanted device.

[0040] FIG. 2 is a functional block diagram of a cochlear implant system 200 that is usable in an embodiment. The cochlear implant system 200 includes an implantable component 201 (e.g., implantable component 100 of FIG. 1) configured to be implanted beneath a recipient’s skin or other tissue 249, and an external device 240 (e.g., the external device 142 of FIG. 1).

[0041] The external device 240 can be configured as a wearable external device, such that the external device 240 is worn by a recipient in close proximity to the implantable component, which can enable the implantable component 201 to receive power and stimulation data from the external device 240. As described in FIG. 1, magnets can be used to facilitate an operational alignment of the external device 240 with the implantable component 201. With the external device 240 and implantable component 201 in close proximity, the transfer of power and data can be accomplished through the use of near-field electromagnetic radiation, and the components of the external device 240 can be configured for use with near-field electromagnetic radiation.

[0042] Implantable component 201 can include a transceiver unit 208, electronics module 213, which module can be a stimulator assembly of a cochlear implant, and an electrode assembly 254 (which can include an array of electrode contacts disposed on lead 118 of FIG. 1). The transceiver unit 208 is configured to transcutaneously receive power and / or data from external device 240. As used herein, transceiver unit 208 refers to any collection of one or more components which form part of a transcutaneous energy transfer system. Further, transceiver unit 208 can include or be coupled to one or more components that receive and / or transmit data or power. For example, the transceiver can include a coil for a magnetic inductive arrangement coupled to the transceiver unit 208. Other arrangements are also possible, including an antenna for an alternative RF system, capacitive plates, or any other utilitarian arrangement. In an example, the data modulates the RF carrier or signal containing power. The transcutaneous communication link established by the transceiver unit 208 can use time interleaving of power and data on a single RF channel or band to transmit the power and data to the implantable component 201. In some examples, the processor 244 is configured to cause the transceiver unit 246 to interleave power and data signals, such as is described in U.S. Patent Publication Number 2009 / 0216296 to Meskens. In this manner, the data signal is modulated with the power signal, and a single coil can be used to transmit power and data to the implanted component 201. Various types of energy transfer, such as infrared (IR), electromagnetic, capacitive and inductivetransfer, can be used to transfer the power and / or data from the external device 240 to the implantable component 201.

[0043] Aspects of the implantable component 201 can require a source of power to provide functionality, such as receive signals, process data, or deliver electrical stimulation. The source of power that directly powers the operation of the aspects of the implantable component 201 can be described as operational power. There are two exemplary ways that the implantable component 201 can receive operational power: a power source internal to the implantable component 201 (e.g., a battery) or a power source external to the implantable component. However, other approaches or combinations of approaches are possible. For example, the implantable component may have a battery but nonetheless receive operational power from the external component (e.g., to preserve internal battery life when the battery is sufficiently charged).

[0044] The internal power source can be a power storage element (not pictured). The power storage element can be configured for the long-term storage of power, and can include, for example, one or more rechargeable batteries. Power can be received from an external source, such as the external device 240, and stored in the power storage element for long-term use (e.g., charge a battery of the power storage element). The power storage element can then provide power to the other components of the implantable component 201 over time as needed for operation without needing an external power source. In this manner, the power from the external source may be considered charging power rather than operational power, because the power from the external power source is for charging the battery (which in turn provides operational power) rather than for directly powering aspects of the implantable component 201 that require power to operate. The power storage element can be a long-term power storage element configured to be a primary power source for the implantable component 201.

[0045] In some embodiments, the implantable component 201 receives operational power from the external device 240 and the implantable component 201 does not include an internal power source (e.g., a battery) / internal power storage device. In other words, the implantable component 201 is powered solely by the external device 240 or another external device, which provides enough power to the implantable component 201 to allow the implantable component to operate (e.g., receive data signals and take an action in response). The operational power candirectly power functionality of the device rather than charging a power storage element of the external device implantable component 201. In these examples, the implantable component 201 can include incidental components that can store a charge (e.g., capacitors) or small amounts of power, such as a small battery for keeping volatile memory powered or powering a clock (e.g., motherboard CMOS batteries). But such incidental components would not have enough power on their own to allow the implantable component to provide primary functionality of the implantable component 201 (e.g., receiving data signals and taking an action in response thereto, such as providing stimulation) and therefore cannot be said to provide operational power even if they are integral to the operation of the implantable component 201.

[0046] As shown, electronics module 213 includes a stimulator unit 214 (e.g., which can correspond to the stimulator of FIG. 1). Electronics module 213 can also include one or more other components used to generate or control delivery of electrical stimulation signals 215 to the recipient. As described above with respect to FIG. 1, a lead (e.g., elongate lead 118 of FIG. 1) can be inserted into the recipient’s cochlea. The lead can include an electrode assembly 254 configured to deliver electrical stimulation signals 215 generated by the stimulator unit 214 to the cochlea.

[0047] In the example system 200 depicted in FIG. 2, the external device 240 includes a sound input unit 242, a sound processor 244, a transceiver unit 246, a coil 247, and a power source 248. The sound input unit 242 is a unit configured to receive sound input. The sound input unit 242 can be configured as a microphone (e.g., arranged to output audio data that is representative of a surrounding sound environment), an electrical input (e.g., a receiver for a frequency modulation (FM) hearing system), and / or another component for receiving sound input. The sound input unit 242 can be or include a mixer for mixing multiple sound inputs together.

[0048] The processor 244 is a processor configured to control one or more aspects of the system 200, including converting sound signals received from sound input unit 242 into data signals and causing the transceiver unit 246 to transmit power and / or data signals. The transceiver unit 246 can be configured to send or receive power and / or data 251. For example, the transceiver unit 246 can include circuit components that send power and data (e.g., inductively) via the coil 247. The data signals from the sound processor 244 can be transmitted, using the transceiver unit 246, to the implantable component 201 for use in providing stimulation or other medical functionality.

[0049] The transceiver unit 246 can include one or more antennas or coils for transmitting the power or data signal, such as coil 247. The coil 247 can be a wire antenna coil having of multiple turns of electrically insulated single-strand or multi-strand wire. The electrical insulation of the coil 247 can be provided by a flexible silicone molding. Various types of energy transfer, such as infrared (IR), radiofrequency (RF), electromagnetic, capacitive and inductive transfer, can be used to transfer the power and / or data from external device 240 to implantable component 201.

[0050] FIG. 3 A depicts an exemplary system 210 according to an exemplary embodiment, including hearing prosthesis 100, which, in an exemplary embodiment, corresponds to cochlear implant 100 detailed above, and a portable body carried device (e.g., a portable handheld device as seen in FIG. 2A, a watch, a pocket device, etc.) 2401 in the form of a mobile computer having a display 2421. The system includes a wireless link 230 between the portable handheld device 2401 and the hearing prosthesis 100. In an embodiment, the prosthesis 100 is an implant implanted in recipient 99 (represented functionally by the dashed lines of box 100 in FIG. 3 A).

[0051] In an exemplary embodiment, the system 210 is configured such that the hearing prosthesis 100 and the portable handheld device 2401 have a symbiotic relationship. In an exemplary embodiment, the symbiotic relationship is the ability to display data relating to, and, in at least some instances, the ability to control, one or more functionalities of the hearing prosthesis 100. In an exemplary embodiment, this can be achieved via the ability of the handheld device 2401 to receive data from the hearing prosthesis 100 via the wireless link 230 (although in other exemplary embodiments, other types of links, such as by way of example, a wired link, can be utilized). As will also be detailed below, this can be achieved via communication with a geographically remote device in communication with the hearing prosthesis 100 and / or the portable handheld device 2401 via link, such as by way of example only and not by way of limitation, an Internet connection or a cell phone connection. In some such exemplary embodiments, the system 210 can further include the geographically remote apparatus as well. Again, additional examples of this will be described in greater detail below.

[0052] As noted above, in an exemplary embodiment, the portable handheld device 2401 comprises a mobile computer and a display 2421. In an exemplary embodiment, the display 2421 is a touchscreen display. In an exemplary embodiment, the portable handheld device 2401also has the functionality of a portable cellular telephone. In this regard, device 2401 can be, by way of example only and not by way of limitation, a smart phone, as that phrase is utilized generically. That is, in an exemplary embodiment, portable handheld device 2401 comprises a smart phone, again as that term is utilized generically.

[0053] It is noted that in some other embodiments, the device 2401 need not be a computer device, etc. It can be a lower tech recorder, or any device that can enable the teachings herein.

[0054] The phrase “mobile computer” entails a device configured to enable human-computer interaction, where the computer is expected to be transported away from a stationary location during normal use. Again, in an exemplary embodiment, the portable handheld device 2401 is a smart phone as that term is generically utilized. However, in other embodiments, less sophisticated (or more sophisticated) mobile computing devices can be utilized to implement the teachings detailed herein and / or variations thereof. Any device, system, and / or method that can enable the teachings detailed herein and / or variations thereof to be practiced can be utilized in at least some embodiments. (As will be detailed below, in some instances, device 2401 is not a mobile computer, but instead a remote device (remote from the hearing prosthesis 100. Some of these embodiments will be described below).)

[0055] In an exemplary embodiment, the portable handheld device 2401 is configured to receive data from a hearing prosthesis and present an interface display on the display from among a plurality of different interface displays based on the received data. Exemplary embodiments will sometimes be described in terms of data received from the hearing prosthesis 100. However, it is noted that any disclosure that is also applicable to data sent to the hearing prosthesis from the handheld device 2401 is also encompassed by such disclosure, unless otherwise specified or otherwise incompatible with the pertinent technology (and vice versa).

[0056] It is noted that in some embodiments, the system 210 is configured such that cochlear implant 100 and the portable device 2401 have a relationship. By way of example only and not by way of limitation, in an exemplary embodiment, the relationship is the ability of the device 2401 to serve as a remote microphone for the prosthesis 100 via the wireless link 230. Thus, device 2401 can be a remote mic. That said, in an alternate embodiment, the device 2401 is a stand-alone recording / sound capture device.

[0057] It is noted that in at least some exemplary embodiments, the device 2401 corresponds to an Apple Watch™ Series 1 or Series 2, as is available in the United States of America for commercial purchase as of January 10, 2021. In an exemplary embodiment, the device 2401 corresponds to a Samsung Galaxy Gear™ Gear 2, as is available in the United States of America for commercial purchase as of January 10, 2021. The device is programmed and configured to communicate with the prosthesis and / or to function to enable the teachings detailed herein.

[0058] In an exemplary embodiment, a telecommunication infrastructure can be in communication with the hearing prosthesis 100 and / or the device 2401. By way of example only and not by way of limitation, a telecoil 2491 or some other communication system (Bluetooth, etc.) is used to communicate with the prosthesis and / or the remote device. FIG. 2B depicts an exemplary quasi-functional schematic depicting communication between an external communication system 2491 (e.g., a telecoil), and the hearing prosthesis 100 and / or the handheld device 2401 by way of links 277 and 279, respectively (note that FIG. 3B depicts two-way communication between the hearing prosthesis 100 and the external audio source 2491, and between the handheld device and the external audio source 2491 - in alternate embodiments, the communication is only one way (e.g., from the external audio source 2491 to the respective device)). It is noted that unless otherwise noted, the embodiment of FIG. 3B is applicable to any body worn medical device / implanted device disclosed herein in some embodiments.

[0059] FIG. 3C depicts an exemplary external component 1440. External component 1440 can correspond to external component 142 of the system 10 (it can also represent other body worn devices herein / devices that are used with implanted portions). As can be seen, external component 1440 includes a behind-the-ear (BTE) device 1426 which is connected via cable 1472 to an exemplary headpiece 1478 including an external inductance coil 1458EX, corresponding to the external coil of figure 1. As illustrated, the external component 1440 comprises the headpiece 1478 that includes the coil 1458EX and a magnet 1442. This magnet 1442 interacts with the implanted magnet (or implanted magnetic material) of the implantable component to hold the headpiece 1478 against the skin of the recipient. In an exemplary embodiment, the external component 1440 is configured to transmit and / or receive magnetic data and / or transmit power transcutaneously via coil 1458EX to the implantable component, which includes an inductance coil. The coil 1458X is electrically coupled to BTE device 1426 via cable 1472.BTE device 1426 may include, for example, at least some of the components of the external devices / components described herein.

[0060] Figure 5 depicts an exemplary vestibular implant 500 according to one example. Some specific features are described utilizing the above noted cochlear implant of figure 1 in contacts for the various elements. In this regard, as noted above, some features of a cochlear implant are utilized with vestibular implants. That is, embodiments herein can use cross-over technologies. In the interest of textual and pictorial economy, various elements of the vestibular implant that generally correspond to the elements of the cochlear implant above are referenced utilizing the same numerals. Still, it is noted that some features of the vestibular implant 500 will be different from that of the cochlear implant above. By way of example only and not by way of limitation, there may not be a microphone on the behind-the-ear device 126. Alternatively, sensors that have utilitarian value in the vestibular implant can be contained in the BTE device 126. By way of example only and not by way of limitation, motion sensors can be located in BTE device 126. There also may not be a sound processor in the BTE device. Conversely, other types of processors, such as those that process data obtained from the sensors, will be present in the BTE device 126. Power sources, such as a battery, will also be included in the BTE device 126. Consistent with the BTE device of the cochlear implant of figure 1, a transmitter / transceiver will be located in the BTE device or otherwise in signal communication therewith.

[0061] The implantable component includes a receiver stimulator in a manner concomitant with the above cochlear implant. Here, vestibular stimulator comprises a main implantable component 120 and an elongate electrode assembly 1188 (where the elongate electrode assembly 1188 has some different features from the elongate electrode assembly 118 of the cochlear implant, some of which will be described shortly). In some embodiments, internal energy transfer assembly 132 and main implantable component 120 are hermetically sealed within a biocompatible housing. In some embodiments, main implantable component 120 includes a processing unit (not shown) to convert data obtained by sensors, which could be on board sensors implanted in the recipient, into data signals.

[0062] Main implantable component 120 further includes a stimulator unit (also not shown) which generates electrical stimulation signals based on the data signals. The electrical stimulation signals are delivered to the recipient via elongate electrode assembly 1188.

[0063] It is briefly noted that while the embodiment shown in figure 5 represents a partially implantable vestibular implant, embodiments can include a totally implantable vestibular implant, such as, where, for example, the motion sensors are located in the implantable portion, in a manner analogous to a cochlear implant.

[0064] Elongate electrode assembly 1188 has a proximal end connected to main implantable component 120, and extends through a hole in the mastoid 119, in a manner analogous to the elongate electrode assembly 118 of the cochlear implant, and includes a distal end that extends to the inner ear. In some embodiments, the distal portion of the electrode assembly 1188 includes a plurality of leads 510 that branch out away from the main body of the electrode assembly 118 to electrodes 520. Electrodes 520 can be placed at the base of the semicircular ducts as shown in figure 5. In an exemplary embodiment, one or more of these electrodes are placed in the vicinity of the vestibular nerve branches innervating the semicircular canals. In some embodiments, the electrodes are located external to the inner ear, while in other embodiments, the electrodes are inserted into the inner ear. Note also while this embodiment does not include an electrode array located in the cochlea, in other embodiments, one or more electrodes are located in the cochlea in a manner analogous to that of a cochlear implant.

[0065] Embodiments can be implemented in a dedicated vestibular stimulation implant, or a modified cochlear implant, or an implant that uses a modified cochlear implant electrode and / or a plurality of electrodes or a modified cochlear implant array. In an embodiment, the electrode(s) are implanted on, at or proximate a branch of the vestibular nerve in one ear or both ears. The exact location of the electrode(s) can depend on particular anatomical considerations at surgery. Embodiments can include implanting the electrode(s) / having the electrode(s) being implanted, very close to the inferior vestibular nerve containing afferents from the saccular macula and posterior semicircular canal. This can be verified from a CT scan or some other non- invasive inspection regime. Embodiments can have the electrode(s) within 10, 9, 8, 7, 6, 5, 4, 3, 2.5, 2, 1.5, 1, 0.75, 0.5, 0.25, 0.2, 0.15, or 0.1 mm, or less, or any value or range of values therebetween in 0.01 mm increments, from the inferior vestibular nerve, such as the nerve containing afferents from the saccular macula and posterior semicircular canal. The electrode(s) locations can be otolithic and / or saccular afferents. Embodiments can utilize vestibular stimulation and / or saccular stimulation. But any stimulation that can affect the basal ganglia can be used.

[0066] Embodiments can include a stimulation device that includes 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 or more electrodes, or any values or range of values therebetween in 1 increment (4-8, 2-8, etc.). The stimulation device, which again can be based on a cochlear implant / a modified cochlear implant, or a vestibular device, or any device that can provide electrical stimulation to enable the teachings herein, can provide a mono phase and / or a biphasic series of pulses, such as pulses having 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, or 60, or any value or range arise therebetween in one increment microseconds per phase, and can be delivered at any of the frequency’s detailed above or any other frequencies for that matter that can enable the teachings detailed herein. In an embodiment, one, two, three, four, five, or more electrodes are activated so that the stimulus is essentially a constant train of pulses.

[0067] There are a number of different types of motor disorders that cause unintended or uncontrollable movements of the body. For example, ataxia is one of the categories of neurological diseases / conditions which can affect a patients’ limb coordination, speech function, eye movement, and muscle control at different levels. Ataxia occurs when the part of the brain called the cerebellum is damaged. There are several types of ataxia, including: ataxia telangiectasia (AT), episodic ataxia, Friedreich's ataxia, multiple system atrophy (MSA) and spinocerebellar ataxia. This condition happens when the part of the brain called the cerebellum is damaged.

[0068] Parkinson’s Disease (Parkinson’s or PD) is another neurological disease and 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.

[0069] Patients with Parkinson’s disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the body’s autonomic functions such as digestion, heartrate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement- related symptoms of Parkinson’s disease.

[0070] Essential tremor is another disorder of the nervous system that causes a rhythmic shaking or tremor. It can affect almost any part of the body but the trembling most often occurs in the hands and is especially bothersome during the attempt to do simple tasks like drinking from a glass or writing with a pencil. Essential tremor may also affect one's head, voice, arms, or legs. While it is not the same as Parkinson's, the tremor of Parkinson's resembles essential tremor.

[0071] The signs and symptoms of motor disorders can vary. For example, patients with ataxia lose muscle control in their arms and legs, which may lead to a lack of balance, coordination, and trouble walking. Ataxia may affect the fingers, hands, arms, legs, body, speech, and even eye movement. The symptoms of Parkinson's can generally be divided into motor and nonmotor. Motor symptoms are those that affect movement of the body. These are the most obvious symptoms of the disease. The main motor symptoms of Parkinson's are tremors (e.g., head and / or hand tremors), slowness of movement (called “bradykinesia”), stiffness (“rigidity”), and poor balance (“postural instability” or “gait impairment”). These symptoms are usually mild in the early stages of the disease. The symptom of tremor caused by Parkinson's disease is the most noticeable when a person is at rest. The tremor of early Parkinson's is intermittent and may not be noticeable to others. Tremor usually becomes noticeable one hand at a time, spreading to the second hand over a period of a few years.

[0072] Many motor disorders progressively worsen over time, although the rate varies greatly from person to person. A number of treatments are available to help manage the symptoms and improve a person's quality of life. However, there is no cure for these diseases at this time.

[0073] Presented herein are techniques for specifically electrically stimulating a recipient’s vestibular system in order to treat motor disorders, such as ataxia or Parkinson’s. More specifically, in accordance with embodiments presented herein, one or more electrodes are implanted in a recipient so as to deliver electrical stimulation (e.g., current) signals to a portion of the vestibular in a manner that remediates motor disorder symptoms experienced by the recipient. In general, the vestibular stimulation presented herein can be delivered from / via one or electrodes implanted within (inside) the inner ear, or from / via one or more electrodes disposed at outer surface of the inner ear (e.g., implanted adjacent the inner ear).

[0074] We now present some additional details of an exemplary stand-alone vestibular stimulation system. However, we note that the techniques presented herein may also be partially or fully implemented by other types of implantable medical devices, the techniques presented herein may be implemented by auditory prosthesis systems that include one or more other types of auditory prostheses, such as cochlear implants, middle ear auditory prostheses, bone conduction devices, direct acoustic stimulators, electro-acoustic prostheses, auditory brain stimulators, combinations or variations thereof, etc. The techniques presented herein may also be implemented by dedicated tinnitus therapy devices and tinnitus therapy device systems. In further embodiments, the presented herein may also be implemented by, or used in conjunction with, 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.

[0075] Before describing some additional specific details of the techniques presented herein, relevant aspects of an example human inner ear are first described below with reference to FIGs. 6 and 7. In particular, shown in FIG. 6 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. 6, while the entire bony labyrinth 101 has been omitted from FIG. IB.

[0076] Within the bony labyrinth 101 is the membranous labyrinth 103, which is made up 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.

[0077] 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(B), within the posterior semicircular canal 104(B) isthe 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 are shown in FIGs. 6 and 7, one for each 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.

[0078] 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, 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. 7), allowing for the processing of balance.

[0079] 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 of the 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.

[0080] The utricle 112 and the saccule 114 each contain a macula, which is an organ that includes 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).

[0081] 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 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.

[0082] 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 traverse the foramina in the area vestibularis inferior and ends in the saccule 114. Third, posterior vestibular nerve branch 131 runs through the foramen singulare and supplies the ampulla 110 of the posterior semicircular duct 105(B), in more than 50% of the cases is part of the inferior branch.

[0083] Also shown in FIG. 6 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 is the 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.

[0084] Presented herein are techniques for treating of motor disorders, such as ataxia or Parkinson’s disease (Parkinson’s or PD), via specific electrical stimulation of the vestibular system (e.g., stimulation of the sacculus, inferior vestibular nerve, etc.) from an implantedlocation, either within or adjacent to the inner ear. In accordance with embodiments presented herein, the neuro -stimulation system includes a stimulating assembly, which comprises one or more electrodes, that is configured to be implanted into the recipient (e.g., adjacent to the otolith organs). The stimulating assembly can be implanted, via, for example, the recipient’s oval window, through an anterior opening such as an estapedotomy, stapedectomy or a portion of such operation, etc. Once the stimulating assembly is implanted, the system is configured to specifically electrically stimulate the vestibular system in a manner that remediates symptoms (e.g., motor or nonmotor symptoms) associated with a motor disorder.

[0085] FIGs. 8A and 8B illustrate further details of one example of a neuro-stimulation system in accordance with embodiments presented herein. More specifically, shown in FIG. 8A is a perspective view of a motor disorder stimulation system 130, which includes an implantable motor disorder stimulator 132, while FIG. 8B is a block diagram of the implantable motor disorder stimulator 132. For ease of description, FIGs. 8 A and 8B will be described together. Also for ease of illustration, certain components of the implantable motor disorder stimulator 132 are described with reference to the inner ear 100 of FIGs. 6 and 7.

[0086] The implantable motor disorder stimulator 132 comprises an implant body (main module) 134 and a stimulation arrangement 136, both of which are implantable within a recipient (i.e., implanted under the skin / tissue 131 of a recipient). The implant body 134 generally comprises a hermetically-sealed housing 138 in which Radio-Frequency (RF) interface circuitry 140, at least one processor 142, a memory device (memory) 144 storing motor disorder remediation logic 145, a stimulator unit 146, a rechargeable power source 148, and a wireless transmitter / receiver (transceiver) 150 are disposed. The implant body 134 also includes an internal / implantable coil 141 that is generally external to the housing 138, but which is connected to the RF interface circuitry 140 via a hermetic feedthrough (not shown in FIG. 8B).

[0087] The processor 142 may be formed by one or more processors (e.g., one or more Digital Signal Processors (DSPs), one or more uC cores, etc.), firmware, software, etc. arranged to perform operations described herein. That is, the processor 142 may 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 processor 142 may execute motor disorder remediation logic 145 and instruct the stimulator unit146 to generate and deliver electrical stimulation signals to the recipient. The processor 142 may also perform other operations, include data logging, battery monitoring and low- battery alarm, etc. The stimulator unit 146 may include, for example, one or more current sources, switches, etc., that collectively operate to generate and deliver the electrical stimulation signals to the recipient via the stimulation arrangement 136.

[0088] As shown in FIG. 8 A, the vestibular stimulation arrangement 124 comprises a lead 152 and a vestibular nerve stimulating (electrode) assembly 154. The stimulating assembly 154 comprises a plurality of stimulating elements 156 disposed in a carrier member 158 (e.g., a flexible silicone body). In this specific example, the stimulating assembly 154 comprises three (3) stimulating elements, and the stimulating elements comprise electrodes, referred to as electrodes 156(1), 156(2), and 156(3). As described further below, the electrodes 156(1), 156(2), and 156(3) function as an electrical interface to the recipient’s vestibular system. It is to be appreciated that this specific embodiment with three electrodes is merely illustrative and that the techniques presented herein may be used with stimulating assemblies having different numbers of electrodes, stimulating assemblies having different lengths, etc.

[0089] As described elsewhere herein, the stimulating assembly 154 is configured such that a surgeon can implant the stimulating assembly adjacent the otolith organs 111 via, for example, the recipient’s oval window 122. That is, the stimulating assembly 154 has sufficient stiffness and dynamics such that the stimulating assembly can be inserted through the oval window 122 and placed reliably within the bony labyrinth 101 adjacent the otolith organs 111 (e.g., sufficient stiffness to insert the stimulating assembly to the desired depth between the bony labyrinth 101 and the membranous labyrinth 103). In certain examples, the stimulating assembly 154 is configured to be placed adjacent the saccule 114.

[0090] The stimulating assembly 154 can have a stiffness allowing a single stroke atraumatic insertion to the required depth in the bone labyrinth 101. However, the stimulating assembly 154 may also have sufficient flexibility to deflect and avoid damage to the delicate anatomical structures of the inner ear 100. In addition, the lead 152 can have a configuration (e.g., length, flexibility, etc.) that allows for ease of surgical placement of the stimulating assembly 154 and that improves lead reliability (impact, fatigue, stress, etc.). In certain examples, the stimulating 1assembly 154 includes a removable or deformable stiffening member allowing placement of the stimulating assembly within the bony labyrinth 101.

[0091] As noted above, the implantable motor disorder stimulator 132 comprises RF interface circuitry 140 and a rechargeable power source 148 (e.g., one or more rechargeable batteries). The power source 148 can be recharged, for example, using power received from an external charger device via the RF interface circuitry 140. That is, although not shown in FIG. 8B, the external device 154 comprises an external coil configured to be inductively coupled with the implantable coil 141. When inductively coupled, the external coil and the implantable coil 141 form a closely-coupled wireless link by which power is transferred from a power source of the external device through the skin / tissue 131 of the recipient. In certain examples, the closely- coupled wireless link is a radio frequency (RF) link. However, various other types of energy transfer, such as infrared (IR), electromagnetic, capacitive and inductive transfer, may be used to transfer the power and / or data from the external device to the implantable motor disorder stimulator 132.

[0092] As described elsewhere herein, implantable motor disorder stimulators in accordance with certain embodiments presented herein do not necessarily need to rely on inputs from body motion sensors to deliver an effective treatment to the recipient. However, also shown in FIG. 8B is an optional one or more sensors 149 which may be used in certain embodiments. The one or more sensors 149 may include, for example, motion sensors such as accelerometers, gyroscopes, magnetometer, or sensor configured to, for example, to sense gravitoinertial accelerations (e.g., measure linear accelerations). In certain embodiments, the one or more motion sensors 149 are used to detect head shaking / head tremors, etc.

[0093] In accordance with certain embodiments, the implantable motor disorder stimulator 132 can operate with one or more external devices. FIGs. 8A and 8B illustrate one such example external device 155. (This device can correspond to the external devices detailed above, albeit in some instances modified to implement the teachings herein.)

[0094] In certain examples, at least one of the one or more external devices can include, for example, an external charger configured to provide power to the implantable motor disorder stimulator 132. In other examples, at least one of the one or more external devices can be configured to provide data to the implantable motor disorder stimulator 132 for use in delivering an effective treatment to the recipient. For example, at least one of the one or more externaldevices could be a mobile computing device (e.g., mobile phone) or a wearable device with one or more motion sensors (e.g., accelerometers, gyroscopes, magnetometer, etc.) configured to, for example, to sense kinematic data. In certain embodiments, the wearable device is configured to be worn on the wrist of the recipient (e.g., a smart watch) and can be used to detect hand shaking / hand tremors, while in other embodiments the wearable device is configured to be worn at the head of the recipient (e.g., Personal Sound Amplification Products (PSAPS), earbuds etc.) and can be used to detect head shaking / hand tremors. Multiple external devices can be used with the implantable motor disorder stimulator 132 at the same time, or at different times. Depending on their location and configuration, the one or more external devices can communicate with the implantable motor disorder stimulator 132 via the RF interface circuitry 140 and / or the wireless transceiver 150.

[0095] The use of sensors to detect kinematic data is merely illustrative and other sensors could be used in accordance with embodiments presented herein. For example, the sensor 149, or another sensor, can be a sensor configured to detect / capture Electromyography (EMG) signals (e.g., muscle response or electrical activity in response to a nerve's stimulation of the muscle), Electrocochleography (ECochG) signals (e.g., measure of neuroelectric events generated by cochlear structures and the auditory nerve in response to acoustic stimulation), local field potential (LFP) signals (e.g., measure of brain activity that reflects the highly dynamic flow of information across neural networks), neurochemical dynamic signals, etc.

[0096] In certain embodiments, the external device 155 and the implantable motor disorder stimulator 132 cooperate to perform Vestibular Response Telemetry (VRT). As used herein, Vestibular Response Telemetry refers to a process in which the implanted stimulating assembly is used to detect electrically evoked compound action potentials (ECAPs) from the vestibular nerve. More specifically, once the stimulating assembly is implanted, at least one of the electrodes of the stimulating assembly is used to deliver electrical stimulation to the recipient. The ECAPs, if any, evoked by the electrical stimulation are recorded via one or more of the other implanted electrodes for subsequent analysis, display, etc., at, for example, the external device 155. ECAPs may be obtained from, or at least attempted to be obtained from, any number of the electrode contacts 156(1 )-l 56(3). In certain embodiments, the ECAP (e.g., magnitudes) obtained from an electrode can be correlated with the effectiveness that stimulation signals delivered bythat electrode will have on the vestibular nerve. Such effects can be considered during the fitting process, described below.

[0097] The specific arrangement for implantable motor disorder stimulator 132, and more generally the system 130, shown in FIGs. 8 A and 8B are illustrative and presented by way of example and not by way of limitation. As such, it is noted that the implantable motor disorder stimulators and associated systems may have a number of different arrangements in which, for example, the various functional components shown in FIG. 8B are implemented at one or a plurality of separate components, devices, etc.

[0098] Provided below are further details relating to: (1) the implantation of a stimulating vestibular nerve assembly of an implantable motor disorder stimulator into a recipient, (2) the “fitting” or “programming” of an implantable motor disorder stimulator for a recipient to treat motor disorders, and (3) the operation of an implantable motor disorder stimulator to electrically stimulate a recipient’s vestibular system for treatment of a motor disorder. For ease of description, the techniques will primarily be described herein with reference to treatment of Parkinson’s and with reference to the implantable motor disorder stimulator 132, and more generally the system 130, shown in FIGs. 8 A and 8B. However, it is noted that the techniques presented herein can be applied to the treatment of other motor disorders with different system / device arrangements.

[0099] As noted above, a stimulating assembly in accordance with embodiments presented herein is configured to be implanted in the recipient so as to specifically stimulate (i.e., deliver / apply stimulation to) the recipient’s vestibular system, which can include stimulation of one or more of the oval window, the sacculus, the inferior vestibular nerve, etc. In certain embodiments, the stimulating assembly is implanted adjacent the otolith organs, in particular the saccule, of the recipient’s peripheral vestibular system via the recipient’s oval window. From a surgical perspective, the saccule is the most interiorly (distally) accessible point of the recipient’s peripheral vestibular system and is positioned immediately adjacent to the inferior branch of the vestibular nerve and near the vestibular ganglion. As such, implantation of the stimulating assembly adjacent to the saccule also places the electrodes of the stimulating assembly adjacent to the inferior branch of the vestibular nerve and the vestibular ganglion. Therefore, the positioning of the stimulating assembly adjacent to the saccule allows electrical stimulation ofthe inferior branch of the vestibular nerve and the vestibular ganglion that is either direct stimulation, or indirect stimulation through only the saccule. That is, the electrical stimulation (current) signals pass directly from the electrodes to the inferior branch of the vestibular nerve and / or to the vestibular ganglion, or from the electrodes to the inferior branch of the vestibular nerve and / or to the vestibular ganglion via the saccule. The positioning of the stimulating assembly adjacent to the saccule accordingly may ensure that the inferior branch of the vestibular nerve and the vestibular ganglion can be stimulated without having the stimulation pass through utricle (which if stimulated could potentially induce problems for the recipient). In general, the vestibular stimulation presented herein can be delivered from / via a stimulating assembly implanted within (inside) the inner ear, or from / via a stimulating assembly disposed at outer surface of the inner ear (e.g., implanted adjacent the inner ear).[ootoo] FIG. 9 is a schematic three-dimensional diagram of a recipient’s inner ear 400. FIG. 9 also illustrates the general location of a stimulating assembly 454 implanted in the inner ear 400 in accordance with embodiments presented herein. In FIG. 9, the stimulating assembly 454 is positioned adjacent to the saccule so as to enable electrical stimulation of the vestibular ganglion and inferior branch of the vestibular nerve (e.g., either direct stimulation or indirect stimulation through only the saccule).

[0101] As noted, the signs and symptoms of motor disorders can vary and can include both motor symptoms (e.g., head and hand tremors, slowness of movement (e.g., bradykinesia), stiffness (e.g. rigidity), poor balance (e.g., postural instability or gait impairment), etc., and nonmotor symptoms, such as cognitive changes, constipation, excessive sweating, fatigue, hallucinations and delusions, lightheadedness, etc.

[0102] In accordance with embodiments presented herein, a recipient is diagnosed with a motor disorder (e.g., by a neurologist or other medical practitioner) and then evaluated for suitability of having an implantable motor disorder stimulator, such as implantable motor disorder stimulator 132, implanted therein. If suitable, the implantable motor disorder stimulator 132 is then implanted in the recipient and, at some point thereafter, the implantable motor disorder stimulator 132 is activated (turned on) and “fit” to the recipient.

[0103] The “fitting” of an implantable motor disorder stimulator to a recipient, sometimes also referred to as “programming” or “mapping,” is a process to determine a set of configurationsettings and other data that defines the specific operational characteristics of the implantable motor disorder stimulator. In the case of implantable motor disorder stimulators presented herein, the fitting determines how the implantable motor disorder stimulator operates to deliver electrical stimulation signals (sometimes referred to herein as electrical stimulation or stimulation) to the vestibular system so to remediate symptoms of the motor disorder. That is, the fitting process is implemented to set the parameters of the electrical stimulation signal delivered to the sacculus, inferior vestibular nerve, etc., to affect a therapeutic motor benefit for the recipient, while limiting or minimizing cross-stimulation of non-target nerves, such as for example, the vagus nerve, the facial nerve, auditory nerve, etc.

[0104] In accordance with embodiments presented herein, vestibular stimulation to treat a recipient’s motor disorder can take a number of different forms. For example, as described in greater detail below, the vestibular stimulation can take the form of one or more continuous pulse trains generated independent of any sensor inputs relating to motion of the head of the recipient, angular accelerations of the head, hands, etc. That is, in certain embodiments, to ensure that the recipient continually experiences relief from symptoms of the motor disorder, electrical stimulation signals can be delivered for extended periods of time, while taking into account recipient-specific characteristics and the residual effects of the stimulation. In other embodiments presented herein, the vestibular stimulation can be delivered at a specific duty cycle that ensures that the recipient continually experiences relief from symptoms of the motor disorder. In still other embodiments, the vestibular stimulation can be delivered in response to one or more sensor inputs (e.g., the vestibular stimulation is dynamically activated when one or more symptoms of the motion disorder are detected). The optimal vestibular stimulation regime (e.g., continuous stimulation, periodic stimulation, dynamic stimulation, etc.), as well as the parameters / attributes of the stimulation signals delivered to the recipient, can be determined during the fitting process. In general, the vestibular stimulation presented herein can be delivered from / via a stimulating assembly implanted within (inside) the inner ear, or from / via a stimulating assembly disposed at outer surface of the inner ear (e.g., implanted adjacent the inner ear).

[0105] FIGs. 10 and 11 are flowcharts illustrating two example processes for fitting an implantable motor disorder stimulator to a recipient, in accordance with certain embodiments presented herein. Again, merely for ease of description, the fitting processes of FIGs. 10 and 11will be described with reference to the implantable motor disorder stimulators detailed herein by way of example.

[0106] Referring first to FIG. 10, shown is a fitting process / method 560. Method 560 begins at 562 where one or more subjective or objective measurements / evaluations are performed to register (e.g., identify and characterize) one or more target motor disorder symptoms of the recipient. In certain embodiments, registration of the one or more target motor disorder symptoms of the recipient can include an assessment of fine motor skills of the recipient. The fine motor skills of the recipient could be assessed, for example, via one or more handwriting tests (e.g., assessing handwriting of the recipient), an assessment of hand tremors or head tremors of the recipient, assessing a gait of the recipient, memory assessment (e.g., administration of one or more memory tests), etc. The assessment of the fine motor skills of the recipient could be based, for example, on visual observations, video graphic data, sensor data (e.g., smartwatch data, earbud data, etc.), or other information. For example, this process could utilize one or more sensors to obtain / capture one or more sensor inputs relating to kinematic data, such as linear acceleration, angular motion, or angular acceleration, of the head or hands of the recipient. In other embodiments, one or more intraoperative tests could be performed (e.g., to capture ECAP measurements from the vestibular system of the recipient) and the fine motor skills of the recipient based on the results of the one or more intraoperative tests.

[0107] In certain embodiments, registration of one or more target motor disorder symptoms of the recipient can include subjectively or objectively determining an initial baseline level for the one or more target motor symptoms of the recipient’s motion, such as determining an initial baseline level of the recipient’s head tremors, an initial baseline of the recipient’s hand tremors, a gait analysis to determine an initial baseline level of the recipient’s gait, etc. In certain embodiments, the registration of the one or more objective measurements the recipient’s motion disorder can include obtaining objective measurements from the recipient, such as VRT or other neural response measurements.

[0108] In certain embodiments, the registration of the one or more target motor disorder symptoms of the recipient’s motion disorder can be based on data captured by sensors to detect / capture Electromyography (EMG) signals (e.g., muscle response or electrical activity in response to a nerve's stimulation of the muscle), Electrocochleography (ECochG) signals (e.g.,measure of neuroelectric events generated by cochlear structures and the auditory nerve in response to acoustic stimulation), local field potential LFP) signals (e.g., measure of brain activity that reflects the highly dynamic flow of information across neural networks), neurochemical dynamic signals, etc.

[0109] At 564, initial stimulation parameters are set for use in delivering stimulation signals to the vestibular system via one or more of the electrode contacts 156(1)-156(3). The initial stimulation parameters can include, for example, the stimulation level (current level) for the stimulation signals, the dynamic range of the stimulation signals (e.g., threshold level and comfort level), stimulating signal timing, etc. For example, in one illustrative embodiment, the dynamic range can be set at 1 current level (CL) and the comfort level is set at 70% of threshold Vestibular Response Telemetry (VRT), if known. If no VRT is available, then the comfort level could be set at a predetermined value (e.g., 100CL).

[0110] Although not shown in FIG. 10, in certain embodiments the operations of 564 and / or 562 can optionally be preceded by one or more diagnostic operations. These diagnostic operations can include, for example, electrode contact impedance checks, one or more VRT measurements, etc.[oom] Returning to FIG. 10, at 566, vestibular stimulation is delivered to the recipient (e.g., electrical stimulation signals are delivered directly to the recipient’s vestibular system using or more of the electrode contacts 156(1 )- 156(3) of the implantable motor disorder stimulator 132. Initially, the parameters of the electrical stimulation signals are those selected at 564. However, as described further below, the stimulation parameters can be adjusted / changed during the fitting process to optimize the vestibular stimulation for treatment of the recipient’s motor disorder. As noted, the vestibular stimulation can be delivered from / via a stimulating assembly implanted within (inside) the inner ear, or from / via a stimulating assembly disposed at outer surface of the inner ear (e.g., implanted adjacent the inner ear).

[0112] At 568, further analysis / evaluation of the recipient’s motor disorder, subsequent to the initiation of the delivery of the vestibular stimulation, is performed. That is, the one or more target motor disorder symptoms following stimulation are evaluated relative to the one or more target motor disorder symptoms prior to stimulation (e.g., re-check head or hand tremors, recheck hand writing, re-check memory, etc. to see if there is improvement in response to thestimulation). In certain embodiments, this further analysis / evaluation can include the same or similar assessments as described at 562 to register (e.g., identify and characterize) a “present” or “instant” level of the one or more target motor disorder symptoms. Thereafter, the present level of the one or more target motor disorder symptoms is evaluated relative to (e.g., compared to) the baseline level of the one or more target motor disorder symptoms. The operations at 568 can include an objective or subjective evaluation of the one or more target motor symptoms, such as an objective or subjective evaluation of whether the recipient’s head or hand tremors have improved relative to the initial baseline level, an objective or subjective evaluation of whether the recipient’s gait has improved relative to the initial baseline level, analysis of further VRT or other neural response measurements, etc.

[0113] As noted above, vestibular stimulation to treat a recipient’s motor disorder can take a number of different forms, including continuous stimulation, periodic stimulation, dynamic stimulation, etc. As such, the phrase “subsequent to the initiation of simulation” can include determinations made in conjunction with any of these or other stimulation regimes, such as a determination made while stimulation signals are being delivered to the recipient, a determination made following delivery of stimulation signals to the recipient, etc.

[0114] Returning to the example of FIG. 10, if it is determined at 568 that the one or more target motor disorder symptoms have not decreased, then the method proceeds to 570 where the stimulation parameters (e.g., current level, frequency, pulse rate, pulse width, pulse gap, etc.) are adjusted to increase the effects of the vestibular stimulation. This adjustment can include, for example, increasing the current level of the stimulation signals, increasing the number of electrode contacts used to deliver the stimulation signals, changing which electrode contacts are used to deliver the stimulation, adjusting a timing of the stimulation signals, increasing a pulse width of the stimulation signals, decreasing a pulse gap between the pulses (or vice versa for other reasons) etc. After adjustment of the stimulation parameters, the method 560 then returns to 566 where vestibular stimulation is delivered to the recipient using the adjusted stimulation parameters.

[0115] Returning to 568, if it is determined that the one or more target motor disorder symptoms have decreased, then the method proceeds to 572 where a secondary determination is made as to whether the one or more target motor disorder symptoms have disappeared or are below athreshold level associated with the symptom (e.g., whether the head or hand tremors have disappeared and / or have been reduced to an acceptable level). If it is determined at 572 that the one or more target motor disorder symptoms have disappeared or are below a threshold level, then method 560 ends at 574. Method 560 reaching 574 means that the one or more target motor disorder symptoms disappeared or are below a threshold level, and no negative side effects of the stimulation, as described below, have been identified. In alternative embodiments, 574 can be replaced with one or more operational loops to further refine / optimize the stimulation signals for the recipient (e.g., fine tuning of the stimulation parameters).

[0116] Returning to 572, if it is determined that the one or more target motor disorder symptoms have not disappeared and / or are not below the threshold level, then method 560 further proceeds to 576 where another determination is made as to whether the recipient is experiencing perceptible side effects (e.g., discomfort) as a result of the vestibular stimulation. The determination of whether the recipient is experiencing side effects can include a determination of whether the recipient is experiencing any side effects, experiencing specific side effects, experiencing side effects that exceed a threshold level, etc. A number of different side effects can be evaluated at 576. In one specific example, the operations at 576 can include a determination of whether the vestibular stimulation has affected non-target areas (e.g., the vagus nerve, the facial nerve, auditory nerve, etc.) of the recipient, whether the vestibular stimulation has affected the recipient’s balance, etc.

[0117] If it is determined at 576 that the recipient is not experiencing perceptible side effects, then the method proceeds to 570 where the stimulation parameters are adjusted to increase the effects of the vestibular stimulation. As noted above, this adjustment can include, for example, increasing the current level of the stimulation signals, increasing the number of electrode contacts used to deliver the stimulation signals, adjusting a timing of the stimulation signals, etc. Thereafter, the method 560 then returns to 566 where vestibular stimulation is delivered to the recipient using the adjusted stimulation parameters.

[0118] Returning to 576, if it is determined that recipient is experiencing perceptible side effects, then the method proceeds to 578 where the stimulation parameters (e.g., current level, frequency, pulse rate, pulse gap, etc.) to reduce the perceptible effects of the vestibular stimulation. These adjustment can include, for example, decreasing the current level of the stimulation signals,changing which electrode contacts are used to deliver the stimulation, decreasing the number of electrode contacts used to deliver the stimulation signals, adjusting a timing of the stimulation signals, etc.

[0119] Thereafter, the method 560 proceeds to 580 where a determination is made as to whether or not the fitting process should be continued, given the recipient has experienced perceptible side effects as a result of vestibular stimulation. This determination can be based, for example, on whether there is an expectation that the adjusted stimulation parameters (at 578) have eliminated and / or reduced the perceptible side effects. If it is determined at 580 that the fitting process can continue, then method 560 returns to 566 where vestibular stimulation is delivered to the recipient using the adjusted stimulation parameters. However, if it is determined at 580 that the fitting process cannot continue, then method 560 ends at 582. Method 560 reaching 582 means that the one or more target motor disorder symptoms have not disappeared and / or are not below a threshold level, and that one or more negative side effects of the stimulation have been identified. This is an undesirable result and would result in a restart to the fitting process using new parameters, a new stimulation regime, etc. In certain embodiments, the operations of 566, 568, 570, 572, 576, 578, and / or 580 can be operated in a closed-loop (e.g., in an automated closed loop) that continues until the method reaches 574 or 580. This closed-loop function is generally represented in FIG. 10 by dashed box 561.

[0120] It is to be appreciated that the order of operations of method 560 shown in FIG. 10 are merely illustrative and that, in certain embodiments, various operations could be performed in a different order than as shown and described. It is also to be appreciated that certain operations could be added to, or omitted from, method 560 in accordance with alternative embodiments. As noted, FIG. 11 is a flowchart illustrating another example fitting method 660, in accordance with certain embodiments presented herein. It is to be appreciated that the methods 560 and 660 are not mutually exclusive and generally illustrative complementary and / or overlapping techniques for fitting an implantable motor disorder stimulator, such as implantable motor disorder stimulator 132, to a recipient.

[0121] Method 660 begins at 662 where the electrodes 156(1)-156(3) of vestibular nerve stimulation assembly 154, when implanted in the recipient, are used for Vestibular Response Telemetry (VRT), resulting in the capture of ECAPs from the recipient’s vestibular system. At664, the captured ECAPs are used to determine the threshold (minimum) stimulation / current level (CL) that will generate an ECAP for one or more of the electrodes 156(1)- 156(3). The minimum current level that will generate an ECAP for an electrode is referred to as the recipient’s “threshold level” for that electrode. The recipient’s threshold levels may be the same or different for each of the electrodes 156(1 )-l 56(3).

[0122] In certain examples, the recipient’s threshold level is determined for the “N” number of electrodes 156 having the highest ECAP magnitudes and / or lowest latencies (per the Vestibular Response Telemetry). In such examples, these N electrodes are the electrodes that will be used to deliver the electrical stimulation to the recipient. In one specific example, N=3 (i.e., the 3 electrodes with the highest ECAP magnitudes and / or lowest latencies are selected for use in stimulating the inferior branch of the vestibular nerve). The use of three electrodes may provide superior performance to the use of one or two electrodes (e.g., N=1 or N=2). For example, the use of three electrodes may stimulate more of the inferior branch of the vestibular nerve than the use of one or two electrodes (e.g., due to increased spread of excitation using three electrodes). If needed, non-activated electrodes 156 are deactivated by setting the current level to zero.

[0123] It is to be appreciated that operations described above with reference to 662 and 664 are optional. That is, the use of Vestibular Response Telemetry to obtain ECAPs and to determine the recipient’s threshold level based thereon may be beneficial in identifying current levels for use at the beginning of the fitting process, which may shorten the fitting process. However, the beginning current levels can also be estimated, although such estimation may lead to a longer fitting session.

[0124] Returning to the example of FIG. 11, at 666 initial stimulation parameters are set for use in delivering stimulation signals to the vestibular system via one or more of the electrode contacts 156(1 )-l 56(3). The initial stimulation parameters can include, for example, the dynamic range of the stimulation signals (e.g., threshold level and comfort level), stimulating timing, etc. The initial stimulation parameters may be the same or different for each of the electrode contacts 156(1)- 156(3).

[0125] After the initial stimulation parameters are set, at 668 the implantable motor disorder stimulator 132 is activated (i.e., turned on) and the implantable motor disorder stimulator 132 is used to stimulate the recipient’s vestibular system. At 668, the vestibular stimulation is deliveredin accordance with the “current” (currently instantiated) stimulation parameters, which initially comprise the initial vestibular stimulation parameters.

[0126] At 670, one or more determinations are made as whether or not the current stimulation parameters are optimal for treatment of the recipient’s disorder. In certain embodiments, the or more determinations at 670 can include an objective or subjective evaluation of one or more specific or target motor symptoms of the recipient’s motor disorder (target motor disorder symptoms), such as an objective or subjective evaluation of whether the recipient’s head or hand tremors have improved relative to the initial baseline level, tremors, an objective or subjective evaluation of whether the recipient’s gait has improved relative to the baseline level, analysis of further VRT or other neural response measurements, etc. The one or more determinations at 670 can also include an objective or subjective evaluation of whether the one or more target motor disorder symptoms have disappeared or are below a threshold level associated with the symptom (e.g., whether the head or hand tremors have disappeared and / or have been reduced to an acceptable level). Moreover, the one or more determinations at 670 can also or alternatively include a determination of whether the recipient is experiencing any perceptible side effects, which may include a determination of whether the recipient is experiencing specific side effects, experiencing side effects that exceed a threshold level, etc. A number of different side effects, such as whether the vestibular stimulation has affected the facial nerve of the recipient, can be evaluated at 670.

[0127] As noted above, the phrase “subsequent to the initiation of simulation” can include determinations made in conjunction with any of these or other stimulation regimes, such as a determination made while stimulation signals are being delivered to the recipient, a determination made following delivery of stimulation signals to the recipient, etc.

[0128] If it is determined at 670 that the current stimulation parameters are non-optimal (e.g., the recipient one or more target motor disorder symptoms have not disappeared and / or are not below a threshold level associated with the symptom, or the recipient is experiencing perceptible side effects), then method 660 proceeds to 672. At 672, the stimulation parameters are adjusted. For example, the current level of stimulation signals delivered via one or more of the electrodes may be increased (e.g., +2), the pulse rate could be changed, etc. Once selected, the adjustedstimulation parameters are instantiated in the implantable motor disorder stimulator 132 and become the “current” vestibular stimulation parameters.

[0129] After selection and instantiation of the adjusted stimulation parameters as the current vestibular stimulation parameters, method 660 returns to 668 where the adjusted stimulation parameters are used to stimulate the recipient’s vestibular system. The operations at 670, 672, and 668 are then iteratively repeated until a determination is made at 670 that the current stimulation parameters are optimal for treatment of the recipient’s motor disorder. Once it is determined at 670 that the current vestibular stimulation parameters are optimal, the method 660 ends at 674.

[0130] As noted above, the use of Vestibular Response Telemetry to obtain ECAPs, and determining the recipient’s threshold level based thereon, may be beneficial for fitting speeds up the fitting process (i.e., the threshold levels provide a good starting point for the fitting procedure, which means the time taken for the fitting process will be much shorter). However, it is also noted, the use of Vestibular Response Telemetry during fitting is optional and the fitting may instead be based on estimated current levels.

[0131] In certain examples, the ECAPs (e.g., magnitudes) obtained from an electrode can be correlated with the effectiveness that stimulation signals delivered by that electrode will have on the vestibular nerve. These effects can be considered during the fitting process of FIG. 11. For example, no ECAP is obtained from an implanted electrode (or the obtain ECAP is very low), then that electrode may be excluded from use in delivering stimulation signals to the vestibular nerve, the levels of the stimulation signals delivered from that electrode may be reduced, etc.

[0132] It is to be appreciated that the order of operations of method 660 shown in FIG. 11 are merely illustrative and that, in certain embodiments, various operations could be performed in a different order than as shown and described. It is also to be appreciated that certain operations could be added to, or omitted from, method 660 in accordance with alternative embodiments.

[0133] Shown in FIG. 12 is a block diagram illustrating an example fitting system 770 configured to execute aspects of the techniques presented herein. Fitting system 770 is, in general, a computing device that comprises a plurality of interfaces / ports 778(1)-778(N), a memory 780, a processor 784, and a user interface 786. The interfaces 778(1 )-778(N) may comprise, for example, any combination of network ports (e.g., Ethernet ports), wireless networkinterfaces, Universal Serial Bus (USB) ports, Institute of Electrical and Electronics Engineers (IEEE) 1394 interfaces, PS / 2 ports, etc. In the example of FIG. 12, interface 778(1) is configured to communicate with the motor disorder stimulation system 130 having components implanted in a recipient 771. For example, interface 778(1) can directly communicate with the implantable motor disorder stimulator 132 (e.g., via wireless transceiver 150), or communicate with the implantable motor disorder stimulator 132 via the external device 155 that, as noted above, is in communication with the implantable motor disorder stimulator 132. Interface 778(1) may be configured to communicate via a wired or wireless connection (e.g., telemetry, Bluetooth, etc.).

[0134] The user interface 786 includes one or more output devices, such as a display screen (e.g., a liquid crystal display (LCD)) and a speaker, for presentation of visual or audible information to a clinician, audiologist, or other user. The user interface 786 may also comprise one or more input devices that include, for example, a keypad, keyboard, mouse, touchscreen, etc.

[0135] The memory 780 comprises implantable motor disorder stimulator fitting logic 781 that may be executed to fit an implantable motor disorder stimulator. For example, the implantable motor disorder stimulator fitting logic 781 can be executed by processor 784 to perform aspects of methods 560 and 660, described above, or other methods in accordance with the fitting techniques presented herein.

[0136] Memory 780 may comprise read only memory (ROM), random access memory (RAM), magnetic disk storage media devices, optical storage media devices, flash memory devices, electrical, optical, or other physical / tangible memory storage devices. The processor 784 is, for example, a microprocessor or microcontroller that executes instructions for the implantable motor disorder stimulator fitting logic 781. Thus, in general, the memory 780 may comprise one or more tangible (non-transitory) computer readable storage media (e.g., a memory device) encoded with software comprising computer executable instructions and when the software is executed (by the processor 784) it is operable to perform the techniques described herein.

[0096] As noted above, FIG. 12 illustrates an example fitting system, while FIGs. 10 and 11 illustrate two example methods for fitting methods, for use with an implantable motor disorder stimulator, such as implantable motor disorder stimulator 132. The fitting of the implantable motor disorder stimulator 132 can occur shortly after initial implantation, but can also be performedregularly / periodically thereafter to ensure that the stimulation remains optimal for the current stage of the recipient’s motor disorder. That is, as noted, most motor disorders are progressive and the recipient’s symptoms will become worse over time. As such, the above fitting methods, or modified versions thereof, could be conducted on a regular or periodic basis to adjust the stimulation settings to account for the motor disorder progression.

[0137] After the implantable motor disorder stimulator 132 is implanted and fit to the recipient, the implantable motor disorder stimulator will operate, in real-time, to electrically stimulate the recipient’s vestibular system (e.g., sacculus, inferior vestibular nerve, oval window, etc.) so as to remediate symptoms of the recipient’s motor disorder. For example, in the context of Parkinson’s, the implantable motor disorder stimulator 132 can be fit to the recipient so as to reduce, minimize, or potentially eliminate head tremors, hand tremors, improve gait, etc.

[0138] As described above, vestibular stimulation to treat a recipient’s motor disorder can take a number of different forms, including continuous stimulation, periodic stimulation, dynamic stimulation, etc. The optimal vestibular stimulation regime (e.g., continuous stimulation, periodic stimulation, dynamic stimulation, etc.), as well as the parameters / attributes of the stimulation signals delivered to the recipient, can be determined during a fitting process, as described above.

[0139] As noted, in certain embodiments, the vestibular stimulation can take the form of one or more continuous pulse trains generated independent of any sensor inputs relating to motion of the head of the recipient, angular accelerations of the head, hands, etc. That is, in certain embodiments, to ensure that the recipient continually experiences relief from symptoms of the motor disorder, electrical stimulation signals can be delivered the vestibular system for extended periods of time, while taking into account recipient-specific characteristics and the residual effects of the stimulation. In certain such examples, the electrical stimulation signals are delivered to the recipient continually constantly through the day (e.g., continually deliver stimulation signals for 8 hours, 12 hours, 14 hours, etc.).

[0140] As noted, an implantable motor disorder stimulator in accordance with embodiments presented generally includes one or more electrode contacts (e.g., three electrode contacts, five electrode contacts, etc.) implanted in the recipient adjacent to the vestibular system. In examples in which a plurality of electrode contacts are implanted, one or all of the electrode contacts may be used to deliver vestibular stimulation to the recipient and the stimulation may be the same ordifferent for different electrodes. For example, multiple electrodes may deliver pulse trains that are generated using the same fixed stimulation parameters. Alternatively, an implantable motor disorder stimulator may deliver at least a first continuous pulse train to a first one of the plurality of stimulating elements and deliver at least a second continuous pulse train to a second one of the plurality of stimulating elements, where the first and second pulse trains are generated in accordance with different stimulation parameters (e.g., different current levels, different pulse rates, etc.). Again, the different stimulation parameters for the different pulse trains are determined during the fitting process, where the differences may be based on the electrode positioning, ECAP responses, subjective recipient feedback, etc.

[0141] As noted above, the implantable motor disorder stimulator is configured to remediate motor symptoms associated with a motion disorder. In other words, an implantable motor disorder stimulator electrically stimulates the recipient’s vestibular nerve (e.g., the inferior branch of the vestibular nerve and / or the vestibular ganglion) in a manner (e.g., timing, stimulation parameters, etc.) that improves, e.g., stabilizes, the recipient’s motor function. In these embodiments, the stimulation signals are generated and delivered independent of any sensor data.

[0142] As noted, in accordance with embodiments presented herein, the electrical stimulation signals are delivered so that the recipient continually experiences relief from one or more motor symptoms of a motor disorder. Also as noted above, in certain embodiments, the vestibular stimulation is delivered for extended periods of time, while taking into account recipient specific characteristics and the residual effects of the stimulation. In certain examples, the electrical stimulation signals are delivered to the recipient continually constantly through the day (e.g., continually deliver stimulation signals for 8 hours, 12 hours, 14 hours, etc.).

[0143] For certain recipients, the vestibular stimulation may produce residual effects for some period of time after cessation of the stimulation. These residual effects may be leveraged in certain embodiments to implement periodic stimulation patterns (e.g., deliver vestibular stimulation at a specific duty cycle that ensures that the recipient continually experiences relief from symptoms of the motor disorder). For example, an implantable motor disorder stimulator in accordance with embodiments presented herein could deliver stimulation signals to the vestibular system at a specific duty cycle over the course of the day or use of the device. In one example, animplantable motor disorder stimulator could operate at a fifty (50) percent duty cycle (e.g., continuously deliver stimulation signals for 30 minutes, followed by no stimulation for the following 30 minutes), a forty (40) percent duty cycle (e.g., continuously deliver stimulation signals for 24 minutes, followed by no stimulation for the following 36 minutes), a sixty (60) percent duty cycle (e.g., continuously deliver stimulation signals for 36 minutes, followed by no stimulation for the following 24 minutes), and so on. The use of such duty cycles may be possible due to residual effects of the stimulation signals in the vestibular system for some period of time after cessation of the stimulation.

[0144] The residual effects of vestibular stimulation may be different for different recipients, thus the selected duty cycles may be different for different recipients (e.g., recipient-specific) and could be determined during the fitting process. However, as noted above, implantable motor disorder stimulators in accordance with embodiments presented herein are configured to treat chronic motor disorders and, accordingly, electrical stimulation signals so that the recipient continually experiences relief from motor disorder systems. Therefore, the duty cycles are selected so that the stimulator will deliver stimulation signals before the residual effects of prior stimulation cease. For example, if a recipient’s residual effects last 60 minutes, the vestibular stimulation may use a duty cycle where the device only pauses stimulation for 45 minutes. Therefore, the selected duty cycles (i.e., pauses in stimulation) are based on the recipient-specific information, such as their personal residual effects to vestibular nerve stimulation.

[0145] In still other embodiments, the vestibular stimulation can be delivered in response to one or more sensor inputs (e.g., the vestibular stimulation is dynamically activated when one or more symptoms of the motion disorder are detected). For example, as noted above, the implantable motor disorder stimulator 132 could include one or more sensors 149 and / or the implantable motor disorder stimulator 132 could communicate with an external device (e.g., mobile phone, smart watch, etc.) that includes one or more sensors. In these embodiments, the sensors could be used to detect symptoms of a motor disorder, such as head tremors or hand tremors, and generate sensor data representing attributes of the detected symptoms.

[0146] In one example dynamic activation arrangement, one or more sensors could detect head or hand tremors, and provide sensor data representing an amount of tremor detect (e.g., small amount of tremor, large amount of tremor, tremor exceeding a threshold level, etc.). Theinformation included in the sensor data could be used to activate / control delivery of vestibular stimulation via the implantable motor disorder stimulator 132. This activation can include dynamically generating stimulation signals based on the content of the sensor data, activating one or more previously determined stimulation programs (e.g., initiate delivery of continuous stimulation for a period of time), etc. As such, in certain embodiments, the motor disorder stimulation system 130 operates in a closed-loop to detect motor disorder symptoms and activate vestibular stimulation to remediate the detected motor disorder symptoms, including real-time stimulation parameter adjustments based on attributes of the motor disorder symptoms experienced by the recipient.

[0147] Current treatments for motor disorders, such as Parkinson’s, include drug treatments or therapies. Drug treatments or therapies may involve, for example, the administration of a dopamine precursor that is converted to dopamine within the central nervous system (i.e., Levodopa (L-dopa)). Other types of drug therapies are also available. Unfortunately, drug therapies frequently become less effective or ineffective over time for an undesirably large population of Parkinson’s patients. For example, a Parkinson’s patient may require multiple drugs in combination to extend the time period of efficacy of drug therapies. Drug treatments additionally have a significant likelihood of inducing undesirable physical side effects; motor function complications such as uncontrollable involuntary movements (dyskinesias) are a particularly common side effect.

[0148] In accordance with certain embodiments presented herein, the vestibular stimulation can be used in combination with drug treatments or therapies in order to treat a recipient’s motor disorder. For example, as noted, in the context of Parkinson’s, certain drug treatments are intended to trigger the generation of dopamine. The vestibular stimulation techniques presented herein may also to trigger the generation of dopamine. As a result, the combination of vestibular stimulation and drug treatment could, for example, reduce the required drug dosage and, potentially, extend the period of time over which the drug treatment remains effective / provide a longer period of time over which the drug dosage could be increased. Conversely, the combination of vestibular stimulation and drug treatment could enable lower use of lower current levels for vestibular stimulation to achieve a therapeutic effect.

[0149] FIG. 13 is a flowchart of a method 890 in accordance with embodiments presented herein. Method 890 begins at 892 where fine motor skills of a recipient of an implantable motor disorder stimulator device are assessed. At 894, the implantable motor disorder stimulator device delivers electrical stimulation signals to a vestibular system of the recipient. One or more parameters of the electrical stimulation signals are set based on the assessing of the fine motor skills of the recipient.

[0150] FIG. 14 is a flowchart of a method 990 in accordance with embodiments presented herein. Method 990 begins at 992 where at least one of hand or head tremors of a recipient are sensed. At 994, electrical stimulation signals are delivered to a vestibular system of the recipient based on the sensing of the at least one of the hand tremors or head tremors of the recipient.

[0151] FIG. 15 is a flowchart of a method 1090 in accordance with embodiments presented herein. Method 1090 begins at 1092 where electrical stimulation signals are delivered, via at least one electrode configured to be implanted at an inner ear of a recipient, to a peripheral vestibular system of the inner ear. At 1094, one or more target motor disorder symptoms of the recipient are monitored following initiation of delivery of the electrical stimulation signals. At 1096, one or more parameters of the electrical stimulation signals are adjusted based on the monitoring of the one or more target motor disorder symptoms of the recipient.

[0152] Additional example implementations of a vestibular stimulator are described in relation to European Patent Application No. 19382629.4 and European Patent Application No. 19382632.8, both of which were filed on Jul. 24, 2019. Embodiments can include one or more or all of the features therein.

[0153] The various components of the system disclosed herein for vestibular stimulation, etc., can be disposed in same or separate housings. FIG. 16 shows an exemplary bilateral system. FIG. 16 depicts a high-level functional diagram of an exemplary system 10500 applied to a recipient 999 (view is a top view - that is a view looking downward onto the recipient’s head), with left and right auricle 110L and 11 OR, respectively. It is noted that the embodiment of FIG. 16 depicts one of many applications of the teachings detailed herein and / or variations thereof with respect to human physiology. In this regard, while the embodiment of FIG. 16 is depicted in terms of the utilization of two behind-the-ear (BTE) devices (respective external components as detailed above by way of example), it is to be noted that in alternativeembodiments, the teachings detailed herein and / or variations thereof can be implemented at other locations on the human body, as will be further described below.

[0154] System 10500 includes an external device 100 (here, a BTE device, but in an alternative embodiment, this could be an off-the-ear (OTE) device) configured to transcutaneous communicate with a right side vestibular implant implantable component. In the exemplary embodiment depicted in FIG. 15, this is any of the vestibular stimulation devices detailed herein. System 10500 also includes a second device 340. This second device is configured to have the functionality of device 100 and can correspond to a left side device of such configuration (the devices can be agnostic as to which side on which they are used / worn), depending on the embodiment and / or the scenario of use. In an exemplary embodiment, device 340 is a BTE or OTE device. Also seen are respective implantable components 1001 and 1341 of the respective vestibular implants which are in transcutaneous communication with the respective BTE devices. Components 1001 and 1341 can correspond to the implantable components detailed above and / or below.

[0155] Embodiments can include a medical device where there is an architecture for a combined auditory treatment system (e.g., with a cochlear implant or other hearing prosthesis) and motor disorder treatment system.

[0156] In an embodiment, the systems herein are configured to obtain gait and / or tremor and / or movement information by extracting such from one or more sensors placed at one or more different locations on the recipient's body (e.g., in a smart watch, phone, gait monitor, step counter, accelerometer(s) or another device having one or more sensors). Extraction of movement information can be used to determine manifestation of symptoms of motor disorders.

[0157] FIG. 17 illustrates an example system 1000 for treating at least symptoms / managing symptoms of a motor disorder of a recipient who is a human. The illustrated system 1000 includes a vestibular implant 1100 and a stimulator 1200.

[0158] The vestibular stimulator 1100 is a portion of the system 1000 configured to stimulate vestibular system. The vestibular stimulator 1100 can include a vestibular stimulator signal generator 1120 and a stimulation assembly 1140, which can be disposed in the same or separate housings.

[0159] The vestibular stimulator signal generator 1120 can be a component that controls the stimulation provided by the assembly 1140, such as by being or including one or more processors that provide signals. For example, the vestibular stimulator signal generator 1120 can be configured to provide stimulation signals to the stimulation assembly 1140.

[0160] The assembly 1140 can take any of a variety of forms. The assembly 1140 can include one or more stimulation electrodes (e.g., 1, 2, 3, 4, 5, or any value or range of values therebetween in 1 increment or more band electrodes). The assembly 1140 can be or include an implantable assembly configured to apply electrical stimulation to an otolith region, semicircular canals, other vestibular tissue / biological matter of the recipient, or combinations thereof using the one or more electrodes. Any tissue / biological matter where there is utilitarian value with respect to applying stimulation thereto can be used in some embodiment.

[0161] Additional example implementations of a vestibular stimulator that can act as one or both of the vestibular stimulator signal generator 1120 and the stimulator assembly 1140 are described in relation to European Patent Application No. 19382629.4 and European Patent Application No. 19382632.8, both of which were filed on Jul. 24, 2019. Embodiments can include one or more or all of the features therein.

[0162] The stimulator 1200 can be a portion of the system 1000 configured to cause a sensory percept (e.g., audio, visual, or tactile precepts) for the recipient, such as in a bimodal device that stimulates the vestibular and evokes a hearing percept.

[0163] The stimulator 1200 can be configured to target one or more non -vestibular sensor channels of the recipient with stimulation. The stimulator 1200 can include a stimulation generator 1220 to evoke a hearing percept, etc., and a stimulation assembly 1240, disposed in a same or separate housings.

[0164] The stimulation signal generator 1220 can be a component configured to generate one or more output signals to cause stimulation via the stimulation assembly 1240.

[0165] The stimulation assembly 1240 can be a component configured to cause one or more sensory percepts in the recipient, and can be a cochlear implant electrode array. The one or more sensory channels can include, for example, a visual sensory channel, an auditory sensory channel, a tactile sensory channel, other sensor channels, or combinations thereof.

[0166] Where the sensory channel is an audio sensory channel, the stimulation assembly 1240 can be configured to cause audio percepts in the recipient that can be based on ambient sound. In an example, the stimulation assembly 1240 can be a headset with speakers or can be a cochlear implant electrode array. The stimulator 1200 can be a wearable or implantable auditory prosthesis medical device, such as a bone conduction device or a cochlear implant. In such examples, the stimulation assembly 1240 can be or include a vibratory bone conduction actuator or an electrode assembly of a cochlear implant. The signal generator 1220 can provide signals to the stimulation assembly 1240 to vary characteristics of the audio percept.

[0167] In some examples, the stimulator 1200 can further include a sound processing path 5510. The signal generator 1220 can be configured to inject signals into the sound processing path 5510 based on ambient sound.

[0168] While the system 1000 can be a single-purpose system (e.g., to solely treat motor dysfunctions), the system can also be a multi-purpose system, as just noted. For example, in addition to providing treatment to treat motor disfunction symptoms, the stimulator 1200 can cause stimulation to compensate for a dysfunctional auditory system of the recipient. In such an example, the signal generator 1220 can also be a signal generator to treat the sensory defect. For instance, the stimulator 1200 can be an auditory prosthesis configured to cause hearing percepts in the recipient that are indicative of the auditory environment around the recipient. Such a stimulator 1200 can further include a sound processing path configured to convert an environmental sound input signal into an auditory stimulation signal to cause stimulation via the stimulation assembly 1240.

[0169] The various components of the system 1000 can be disposed in same or separate housings. As illustrated, the system 1000 can include a wearable housing 1020 in which the vestibular stimulation signal generator 1120, auditory signal generator 1220, and the sound processing path 5510 are disposed. The wearable housing 1020 can be configured to be worn by the recipient, such as via a headband, magnetic connection, hair clip, or via another technique. As further illustrated, the system 1000 can include an implantable housing 1040. The implantable housing 1040 can at least partially include the assembly 1140 and the stimulation assembly 1240. For example, the assemblies 1140, 1240 can extend from the implantable housing 1040. The implantable housing 1040 can be constructed from or coated with abiocompatible material. In some examples, the implantable housing 1040 further includes one or more of the vestibular stimulation signal generator 1120, the auditory signal generator 1220, and / or the sound processing path 5510. While the various components can be separated into a wearable housing 1020 and an implantable housing 1040, in some examples, the components can be disposed entirely in the wearable housing 1020 or the implantable housing 1040. For example, some implementations can implement the vestibular stimulator 200 as a totally-implantable device.

[0170] As illustrated, there is one stimulator 1200 disposed on one side of the recipient's head. In other examples, the recipient can have multiple different stimulators 1200. In an example, there is a bi-lateral configuration where there are both left- and right-side stimulators 1200. Such components can be configured to stimulate respective left and right vestibular and / or left and right cochlea or other tissue / biological matter of the recipient. In some examples, the multiple components can cooperate with each other to provide substantially the same or different stimulation. In some examples, the sidedness of the stimulation (e.g., more intense signals on one side rather than the other) can indicate a particular balance state.

[0171] As illustrated, some examples of the system 1000 can further include one or more sensors 2420 disposed in various locations throughout the system 1000. The sensors 2420 can be, for example, one or more sensors for detecting data used for the tremor or movement or speech or gait information, such as accelerometers, gyroscopes, piezoelectric sensors, other sensors, or combinations thereof. Additional example sensors 2420 include physiological sensors, such as heartbeat, galvanic skin response sensors, blood pressure sensors, electromyography sensors, other sensors, or combinations thereof. Still further examples of the sensors 2420 include microphones and light sensors, among others. The sensors 2420 can include components disposed within or connected to (e.g., via wired or wireless connections) the components of the system 1000. In some examples, the sensors 2420 include software sensors, such as software that obtains data from one or more of the sensors 2420 and produces additional data based thereon. For example, a software sensor can be configured to obtain data from one or more gyroscopes and accelerometers to produce gait data regarding the recipient. The gait data can relate to how the recipient is walking, running, or otherwise moving. Such data can describe whether the recipient is limping, lurching, or otherwise has an abnormal gate that can be indicative of a balance issue.

[0172] As further illustrated, some examples of the system 1000 can further include a computing device 1300. The computing device 1300 can be a computing device associated with the recipient of the stimulator 1200. In many examples, the computing device 1300 is a cell phone, tablet, smart watch, step counter, or heart rate monitor, but the computing device 1300 can take other forms. Although described primarily in the context of the recipient, the computing device 1300 can be a computing device owned or primarily used by a parent or caregiver for the recipient. The computing device 1300 can have one or more processors configured to perform operations based on instructions stored in memory of the computing device 1300. The computing device can further include one or more interfaces for interacting with a user (e.g., via a touchscreen) or other devices (e.g., a wireless transceiver). In the illustrated example, the computing device 1300 includes one or more sensors 2420 and a control application 1320.

[0173] The control application 1320 can be a computer program stored as computer-executable instructions in memory of the computing device 1300 that, when executed, performs one or more tasks relating to the system 1000. The control application 1320 can cooperate with one or both of the stimulator 1200. For instance, the control application 1320 can control when and how stimulation is provided by the vestibular stimulator and / or the cochlea stimulator and otherwise when and how signals are provided by the stimulator 1200. In some examples, such control of the functioning of components of the system 1000 can be performed automatically by the control application 1320 or based on input received from a user of the computing device 1300. The control application 1320 can further provide data from one or more signals from sensors 242 of the computing device 1300 to the stimulator 1200 for use by the signal generator 1220 or the generator 1120. The computing device 1300 can connect to one or both of the stimulator generators directly and separately, or through the stimulator 1200, for example, a wireless radiofrequency communication protocol (e.g., BLUETOOTH). The control application 1320 can transmit or receive data from one or both of the stimulator components of stimulator 1200. Where the stimulator 1200 includes the sound processing path 5510, the control application 1320 can be configured to stream audio as input into the sound processing path 5510, such as from a microphone of the sensors 2420 or an application running on the computing device 1300 (e.g., a video or audio application). In other examples, another application running on the computing device 1300 can stream audio to the sound processing path 5510.

[0174] As described above, the components of the system 1000 can take any of a variety of forms. An example apparatus that can be used to implement one or both of the stimulators is described in FIG. 18. And in this regard, FIG. 18 is a functional block diagram of an example apparatus 2000 that can be used to implement one or both of the stimulation types herein (vestibular tissue / biological matter and cochlea for example). In the illustrated example, the apparatus 2000 includes a first device 2020 acting as an external processor device and a second device 2500 acting as an implanted stimulator device. In examples, the second device 2500 is an implantable stimulator device configured to be implanted beneath a recipient's tissue (e.g., skin). In examples, the second device 2500 includes a biocompatible housing. The first device 2020 can be a device configured to couple with (e.g., wirelessly) the second device 2500 to provide additional functionality, such as stimulation control signals or charging. While the apparatus 2000 is shown as having both implantable and external components, implementations of the apparatus 2000 can be entirely external or entirely implantable.

[0175] In the illustrated example, the first device 2020 includes one or more sensors 2420, a processor 2440, a transceiver 2460, and a power source 2480. The one or more sensors 2420 can be units configured to produce data based on sensed phenomena (e.g., those detailed herein). In an example where the stimulation system 200 is an auditory prosthesis system, the one or more sensors 2420 can include sound input sensors, such as a microphone, a telecoil, wireless audio sources (e.g., a BLUETOOTH transceiver), an electrical input for an FM hearing system, and / or another component for receiving sound input. The processor 2440 can be a component (e.g., a central processing unit) configured to control stimulation provided by the second device 2500. The stimulation can be controlled based on data from the sensor 2420, a stimulation schedule, or other data. Where the stimulation system 2000 implements an auditory prosthesis, the processor 2440 can be configured to convert sound signals received from the sensor(s) 2420 (e.g., acting as a sound input unit) into external device signals 2510, using, for example, a sound processing path as is described elsewhere herein. The transceiver 2460 is a component configured to send signals 2510, such as power signals, data signals, other signals, or combinations thereof (e.g., by interleaving the signals). The transceiver 2460 can be configured to receive power or data. Stimulation signals can be generated by the processor 2440 and transmitted, using the transceiver 2460, to the second device 2500 for use in providing stimulation.

[0176] In the illustrated example, the second device 2500 includes an electronics module 2100, a stimulator assembly 2300, a transceiver 2460, a power source 2480, and a coil 2560. The second device 2500 further includes a hermetically sealed, biocompatible housing enclosing one or more of the components.

[0177] The electronics module 2100 can include one or more other components to provide stimulation. In many examples, the electronics module 2100 includes one or more components for receiving a signal and converting the signal into the stimulation signal 2150. The electronics module 2100 can further include a stimulator unit. The electronics module 2100 can generate or control delivery of the stimulation signals 2150 to the stimulator assembly 2300 to stimulate tissue / biological matter proximate the stimulation assembly 2300. Here, there is a cochlear implant electrode array 1240 that includes electrodes 2320. In examples, the electronics module 2100 includes one or more processors (e.g., central processing units) coupled to memory components (e.g., flash memory) storing instructions that when executed cause performance of an operation described herein. In examples, the electronics module 2100 generates and monitors parameters associated with generating and delivering the stimulus (e.g., output voltage, output current, or line impedance). In examples, the electronics module 2100 generates a telemetry signal (e.g., a data signal) that includes telemetry data. The electronics module 2100 can send the telemetry signal to the first device 2020 or store the telemetry signal in memory for later use or retrieval.

[0178] The apparatus 2000 can include one or more stimulator assemblies 2300 that can be one or more components configured to provide stimulation to target tissue / biological matter. In the illustrated example, there are two stimulator assemblies 2300 with one corresponding to implantable assembly 1140 to stimulate the vestibular system (or whatever is being stimulated to treat the motor disorder) and the implantable stimulation assembly 1240 (to stimulate the cochlea). Further in the illustrated example, the stimulator assemblies 2300 are electrode assemblies that includes arrays of electrodes 2320 disposed on a lead configured to be inserted into the recipient's cochlea. The stimulator assembly 2300 can be configured to deliver stimulation signals 2150 (e.g., electrical stimulation signals) generated by the electronics module 2100 to the cochlea to cause a hearing percept in the recipient. In some examples, the stimulator assembly 2300 is a vibratory actuator disposed inside or outside of a housing of the second device 2500 and configured to generate vibrations. The vibratory actuator receives thestimulation signals 2150 and, based thereon, generates a mechanical output force in the form of vibrations. The actuator can deliver the vibrations to the skull of the recipient in a manner that produces motion or vibration of the recipient's skull, thereby causing a hearing percept by activating the hair cells in the recipient's cochlea via cochlea fluid motion. In addition or instead, the actuator can deliver the vibrations to cause tactile percepts in the recipient.

[0179] The transceivers 2460 can be components configured to transcutaneously receive or transmit a signal 2510 (e.g., a power signal or a data signal). The transceiver 2460 can be a collection of one or more components that form part of a transcutaneous energy or data transfer system to transfer the signal 251 between the first device 202 and the second device 250. Various types of signal transfer, such as electromagnetic, capacitive, and inductive transfer, can be used to usably receive or transmit the signal 2510. The transceiver 2460 can include or be electrically connected to the coil 2560.

[0180] The coils 2560 can be components configured to receive or transmit a signal 2510, typically via an inductive arrangement formed by multiple turns of wire. In examples, in addition to or instead of a coil, other arrangements can be used, such as an antenna or capacitive plates. Magnets 2340 can be used to align respective coils 2560 of the first device 2020 and the second device 2500. For example, the coil 2560 of the second device 2500 can be disposed in relation to (e.g., in a coaxial relationship) with a magnet 2340 to facilitate orienting the coil 2560 in relation to the coil 256 of the first device 2020 via a magnetic connection 2350. The coil 256 of the first device 2020 can also be disposed in relation to (e.g., in a coaxial relationship with) a magnet 2340.

[0181] The power source 2480 of the respective devices can be configured to provide operational power to other components. The power sources 2480 can be or include one or more rechargeable batteries. Power for the batteries can be received from a source and stored in the battery. The power can then be distributed to the other components of the second device 2500 as needed for operation.

[0182] It is noted that while particular components are described in conjunction with this, technology disclosed herein can be applied in any of a variety of circumstances. The above discussion is not meant to suggest that the disclosed techniques are only suitable for implementation within systems akin to that illustrated in and described with respect to the figure.In general, 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.

[0183] The various components of the system 1000 can cooperate to treat / mitigate / reduce symptoms of motor dysfunction of a recipient of the system 1000. An exemplary process will now be described.

[0184] The process can include obtaining data from the one or more sensors 2420. Such data can include, for example, accelerometer data, gyroscope data, or magnetometer data, etc. That data can describe rotation around one or more axes, such as pitch, yaw, or roll axes of a limb or some body part of the human. Obtaining the data from one or more sensors 2420 can include obtaining data from physiological sensors, such as heartbeat, galvanic skin response sensors, electromyography sensors, or other sensors. In some examples, one or more of the sensors 2420 are disposed remote from the component obtaining the data. The obtaining can include wirelessly obtaining the data from a remote sensor 2420. For instance, in an example, the balance signal generator 122 obtains the data from the commuting device 1300. The process can include stimulating the recipient's vestibular system. The stimulator can include the vestibular signal generator 1120 generating a signal that causes the stimulation assembly 1140 to stimulate the recipient's vestibular system. The stimulation can be controlled automatically or manually. For example, a user interface (e.g., a switch, button, touch screen, or wirelessly connected control) can be provided (e.g., at the computing device 1300) to permit the recipient or a caregiver thereof to engage or disengage the stimulation. Such a user interface can also be used to modify an intensity or other parameters of the stimulation being provided.

[0185] The process can include generating stimulation signals. The stimulation signals can be generated using, for example, a processor 2440 or an electronics module 2100 associated with the stimulator 1100. The generation of the signals can cause the stimulation to be substantially constant, intermittent, performed in response to a schedule, or performed based on the sensor data. The stimulation signals can be signals usable to control the delivery of stimulation. For example, the stimulation can include electrically stimulating the vestibular system with one or more electrodes of the assembly 1140.

[0186] Referring back to FIG. 16, we note that embodiments can instead include a unilateral system (components on one side only). Still, in an example, there is a bilateral configuration where there are both left- and right-side vestibular stimulators. Such components can be configured to stimulate respective left and right vestibular or other tissue / biological matter of the recipient. In some examples, the multiple components can cooperate with each other to provide substantially the same or different stimulation. In some examples, the sidedness of the stimulation (e.g., more intense signals on one side rather than the other) can be varied to implement the teachings herein (more on this below).

[0187] Some examples of the system 10500 any of the features of system 10500 can be in system 1000 and vice versa, in the interests of textual economy) can further include one or more sensors 2420 (see FIG. 17 and / or FIG. 18) disposed in various locations throughout the system. The sensors 2420 can be, for example, one or more sensors for detecting data used for the determination of when and / or how to provide output, such as accelerometers, gyroscopes, piezoelectric sensors, other sensors, or combinations thereof. Any of the sensors in WO 2023222361 can be used in some embodiments. Additional example sensors 2420 include physiological sensors, such as heartbeat, galvanic skin response sensors, blood pressure sensors, electromyography sensors, other sensors, or combinations thereof. Still further examples of the sensors 2420 include microphones and light sensors, among others. The sensors 2420 can include components disposed within or connected to (e.g., via wired or wireless connections) the components of the system 10500. In some examples, the sensors 2420 include software sensors, such as software that obtains data from one or more of the sensors 2420 and produces additional data based thereon. For example, a software sensor can be configured to obtain data from one or more gyroscopes and accelerometers to produce, for example, gait data regarding the recipient and / or tremor data regarding the recipient (e.g., hand(s) shaking). The data can relate to how the recipient is walking, running, or otherwise moving and / or how much and / or wear the recipient is shaking, or at least what side the recipient is shaking (or shaking more relative to the other side (e.g., which side of the sagittal plane). Such data can describe whether the recipient is limping, lurching, or otherwise has an abnormal gait by way of example.

[0188] As further illustrated, some examples of the system 10500 can further include a computing device. The computing device can be a computing device associated with the recipient of the stimulator(s). In many examples, the computing device is a cell phone, tablet,smart watch, step counter, or heart rate monitor, but the computing device can take other forms. The computing device can be in signal communication with one or both of the external components (or even one or both of the implantable components). Although described primarily in the context of the recipient, the computing device can be a computing device owned or primarily used by a parent or caregiver for the recipient. The computing device can have one or more processors configured to perform operations based on instructions stored in memory of the computing device. The computing device can further include one or more interfaces for interacting with a user (e.g., via a touchscreen) or other devices (e.g., a wireless transceiver). In the illustrated example, the computing device includes one or more sensors 2420 and a control application.

[0189] Exemplary embodiments include devices, systems for, and / or methods of affecting tissue / biological matter of a human in general, and tissue / biological matter in / of the head of the human in particular. In an exemplary embodiment, the devices, systems for, and / or methods of affecting tissue / biological matter affect the tissue / biological matter of the basal ganglia. In an exemplary embodiment, any one or more of the devices and / or systems disclosed herein are configured to affect the tissue / biological matter of the human in accordance with one or more or all of the teachings detailed herein. By way of example only and not by way of limitation, circuitry can be implemented in the external device and / or the implantable device of any of the components detailed herein to control the output of electrical stimulation to implement any one or more of the teachings detailed herein, providing that the art enables such, unless otherwise noted. In this regard, any disclosure herein of a device and / or system corresponds to such configured to execute any one or more of the functionalities and / or method actions detailed herein, such as by way of example, through the use of circuitry configured to do so and / or the utilization of firmware and / or software, providing that the art enables such. In an exemplary embodiment, the external component, such as a BTE device can include circuitry configured to generate a control signal that is provided to the external inductance coil which transcutaneously induces a current flow in the implanted inductance coil so as to transfer command signals and / or power signals to the implanted component so that the implanted component can execute one or of the stimulations (or not stimulate depending on the scenario or the embodiment) detailed herein so as to execute one or more of the methods and / or functionalities detailed herein. In the interest of textual economy, any method action and / or functionality disclosed herein correspondsto a disclosure of a device and / or system, such as a device and / or system disclosed herein or a modified version thereof, that implements that method action and / or functionality, and vice versa, unless otherwise indicated, providing that the art enables such.

[0190] In an exemplary embodiment, there is a method referring now to figure 19 which shows an exemplary flowchart for an exemplary method, method 1900, there is a method that comprises method action 1910, which entails identifying a side of a human vis-a-vis an anatomical body plane of the human experiencing a motor disorder symptom. Method 1900 further includes method action 1920, which entails providing stimulation to tissue / biological matter of a head of the human based on the identified side. There are some variations and permutations of this method, and the method actions presented with respect to figure 19 are presented by way of example only and not by way of limitation. In an exemplary embodiment, the action of providing stimulation is executed to reduce and / or eliminate and / or manage the symptom. In an exemplary embodiment, the action of providing stimulation reduces and / or eliminates and / or manages the symptom. That is, the method actually reduces and / or eliminates and / or manages the symptom. In an exemplary embodiment, this action does so in an efficacious manner, and thus would be indicative of a successful implementation of method 1900. It is briefly noted in the interest of textual economy, that any disclosure herein of any method and / or any method action corresponds to a disclosure of executing that method and / or method action in an efficacious manner, unless otherwise noted.

[0191] In an exemplary embodiment, the tissue / biological matter to which the stimulation is applied is tissue / biological matter of a middle ear of the human. In an exemplary embodiment, the tissue / biological matter to which the stimulation is applied is a vestibular system of the human. As will be detailed below, the stimulation can be applied in various locations of the vestibular system of the human. In an exemplary embodiment, the tissue / biological matter to which the stimulation is applied is an inner ear of the human. In an exemplary embodiment, the tissue / biological matter to which the stimulation is applied is / are one or more of the semicircular canals. In an exemplary embodiment, the tissue / biological matter to which stimulation is applied is tissue / biological matter adjacent to the vestibular system where the stimulation can affect the vestibular system and / or other tissue / biological matter, such as by way of example only and not by way of limitation, basal ganglia tissue / biological matter. In anembodiment, the tissue / biological matter to which stimulation is applied is the basal ganglia tissue / biological matter.

[0192] In an embodiment, the anatomical body plane is the coronal plane. In an embodiment, the anatomical body plane is horizontal plane. In an embodiment, the plane is the sagittal plane, which can be the median plane and / or the parasagittal plane. Herein, any reference to the sagittal plane refers to the median plane thereof unless otherwise noted in the interests of textual economy.

[0193] In an exemplary embodiment, the method further comprises identifying a side of the human to which the stimulation will be provided based on the identified side of the human. In this exemplary embodiment, the provided stimulation is provided on the identified side.

[0194] In an exemplary embodiment of method 1900, the action of providing stimulation provides stimulation on a sagittal side of the head (e.g., left) opposite to a sagittal side (e.g., right) where a physiological reaction of tissue / biological matter in the human due to the stimulation is greater than that of corresponding tissue / biological matter on a sagittal side opposite to that where the greater physiological reaction occurs. Alternatively, a measured physiological property and / or a change thereof is greater than that of the corresponding tissue / biological matter. Any reference to a reaction corresponds to a physiological property and vice versa. Thus, in an exemplary embodiment, the action of providing stimulation provides stimulation on a sagittal side of the head opposite to a sagittal side where a property of tissue / biological matter in the human that changes due to the stimulation is greater than that of corresponding tissue / biological matter on a sagittal side opposite to that where the greater change in the property occurs.

[0195] In the interests of textual economy, reference to tissue / biological matter (the two are not necessarily the same - we present this for the purposes of a thorough disclosure) in the human where there is a reaction and / or where a property is measured (e.g., basal ganglia tissue / biological matter) corresponds to an alternate disclosure of an area within the head that affects function in the head, such as by way of example only and not by way of limitation, dopamine transport in motor related brain areas. In an embodiment, this is an adjustment in such. In an embodiment, this is an increase in such. Indeed, any reference to affecting basal ganglia tissue corresponds to a corresponding disclosure of affecting dopamine transport in motor related brainareas, all in the interest of textual economy. Accordingly, by way of example only and not by way of limitation, disclosure of stimulation applied to the vestibula system that affects the basal ganglia tissue / biological matter corresponds to a disclosure of stimulation applied to the vestibular system that affects dopamine transport in motor related brain areas, unless otherwise noted, providing that the art enables such. In an embodiment, the reference to tissue corresponds to an alternate disclosure of biological matter and / or capture tissue, cells or receptors. Note that this is also the case for vestibular tissue. Any such disclosure of tissue corresponds to an alternate disclosure of vestibular biological matter.

[0196] In an exemplary embodiment, the reaction and / or property in the tissue / biological matter on one side is present while the reaction and / or property in the tissue / biological matter on the other side is not present. Corollary to this is that in an exemplary embodiment, the reaction and / or property in the tissue / biological matter on one side is an efficacious reaction / the change in the property is an efficacious change whereas there is also a reaction / change in the property in the tissue / biological matter on the other side, but such is not efficacious. In the interest of textual economy, any disclosure herein of non-reaction / non change in the property or the absence of a given feature / property corresponds to a corollary disclosure where such a reaction / change in property / feature may be present, but such is not efficacious. And any disclosure herein of any reaction or the presence of the given feature or a change in a property / presence of a property corresponds to a corollary disclosure where the reaction and / or presence of the given feature / property is efficacious (a property could be present, but it is not efficacious (e.g., it is too small or has not been reduced enough). All unless otherwise noted.

[0197] Conversely, in an exemplary embodiment, on a per unit basis, the reaction in the tissue / biological matter the property of the tissue / biological matter is present on / in tissue / biological matter in both sides, and both can be efficacious. In an exemplary embodiment, a quantitative value of the reaction / property / change in property in absolute terms is less than, greater than and / or equal to 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 325 or 350, 375, 400, 425, 450, 475, 500, 550, 600, 650, 700, 750 or 800% or any value or range of values therebetween in 0.1% increments (e.g., 83.7%, 33.3%, 44.9% to 66.5%, etc.) greater on one side than the other. Briefly, it is noted that in theory, the numbers could be much higher than this if there is no reaction / no change in property or measured property on oneside (hence some of the larger numbers). However, assuming there is a reaction / property / change in property on both sides, including an efficacious reaction, etc., on both sides, the value could be less than, greater than and / or equal to 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 325, or 350%, or any value or range of values therebetween in 0.1% increments (e.g., 83.7%, 33.3%, 44.9% to 66.5%, etc.) greater on one side than the other).

[0198] Note that the aforementioned percentages can be based on non-dimensional and / or unitized values. Some specific values will be described below.

[0199] In an exemplary embodiment, a quantitative value of an increase in the reaction / property relative to that which was the case before the stimulation (and before an effective time where the baseline would be returned if there was prior stimulation) is less than, greater than, and / or equal to 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 325, 350, 375, 400, or 450%, or any value or range of values therebetween in 0.1% increments (e.g., 94.5%, 54.3%, 55.9% to 107.2%, etc.) greater on one side than the other. Again, these values could be much higher if one side does not produce a reaction / the property does not change, the property is not present, and thus the larger numbers noted above could apply.

[0200] As noted above, the numbers can be measured from a baseline / from the state of the tissue / biological matter prior to stimulation, and thus tissue / biological matter that does not have the “benefit” of the stimulation. Corollary to this is that stimulation can be present and then halted, and there could be a carryover time where the tissue / biological matter still benefits from the stimulation, albeit potentially less so, and thus there is a reaction or otherwise the property is still influenced by the stimulation. Accordingly, in an exemplary embodiment, the aforementioned baselines are baselines where, for example, stimulation has not been applied to one or both sides or anywhere for that matter in a human (electrical stimulation) for at least and / or equal to (or sometimes less than) 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 35, 40, 45, 50, 55, 60, 75, 90, 120, 150, 175, 200, 250, 300, 350, 400, 450, 500, 600, 700, 800, 900, 1000, 1250, 1500, 1750, or2000 or more minutes, or any value or range of values therebetween in 0.1 minute increments (e.g., 16.6, 307.5, 88.8 to 1045.3 minutes, etc.). It is noted that these values may not necessarily return the tissue / biological matter to the ultimate baseline corresponding to the case where there was never any stimulation applied previously. These values are presented for purposes of control so that an apples to apples comparison can be made. That is, in some embodiments, the baseline is a baseline that would exist if no electrical stimulation had ever been applied to the tissue or even to the human, or at least none had been applied for days or weeks or months prior to the measurements taken to evaluate the implementation of the method. In other embodiments, the baseline is that which exists in a controlled manner, such as after a period of time has elapsed, irrespective of whether or not that amount of time is sufficient to bring the tissue / biological matter back to the “never stimulated” state.

[0201] And note that the stimulated tissue or otherwise the tissue to which the electrical stimulation is applied (e.g., the tissue in contact with the electrodes or immediately adjacent thereto) need not be and in the embodiment under explanation is not the same as the tissue where the property is measured and / or the reaction occurs or otherwise the tissue that is the subject of the evaluation.

[0202] In an exemplary embodiment, the tissue to which stimulation is applied and / or a location of 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or more or all of the electrodes (mean, median and / or mode of any of these numbers) of the stimulation device is greater than and / or equal to 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, or 5 inches or more, or any value or range of values therebetween in l / 32ndof an inch increments from the tissue / biological matter where the measurements are taken / the tissue / biological matter where the reaction occurs / the property is measured, etc.

[0203] To round this out, in an embodiment, the electrical stimulation is applied for less than, greater than and / or equal to 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8. 1.9, 2, 2.25, 2.5, 2.75, 3, 3.5, 4, 4.5, 5, 5.5, 6, 7, 8, 9 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 35, 40, 45, 50, 55, 60, 75, 90, 120, 150, 175, 200, 250, 300, 350, 400, 450, 500, 600, 700, 800, 900, 1000, 1250, 1500, 1750, 2000, 2250, 2500, 2750, 3000, 3250, 3500, 4000, 4500, or more seconds in a continuous manner to the given tissue on a given side of the human (relative to the mode of electrical application - pulsing, pausing, etc. - all of this as opposed to affirmatively halting or otherwise stopping stimulation where suchis not part of a stimulation regime, or otherwise the duty cycle of the system). In an exemplary embodiment, it could be that the electrical stimulation is applied for hours even a day or more, such as, for example, less than, greater than, and / or equal to two or three or four or five or six or seven or eight hours or more or ’ / 2a day a full day or a day and a half of stimulation, etc.

[0204] In an exemplary embodiment, the action of providing stimulation provides stimulation on a sagittal side of the head so as to increase a measure of basal ganglion activity on an opposite sagittal side above an increase in the measure in basal ganglion activity on the stimulation sagittal side. In an exemplary embodiment, there is another method, with reference to figure 20, which shows an algorithm for an exemplary method, method 2000, which includes method action 2010, which entails the action of executing method 1900. Method 2000 further includes method action 2020, which includes the action of identifying an occurrence of a symptom of the motor disorder afflicting the human, wherein the action of identifying the side of the human is based on the identified occurrence of the symptom of the motor disorder. In an exemplary embodiment, this can be executed by utilizing any one or more of the sensors detailed herein to sense the occurrence of the symptom. By way of example only and not by way of limitation, sensors located on the fingers of the human, such as rings, which can have accelerometers and / or miniature gyroscopes or other movement sensing devices can be in signal communication by a wired and / or wireless system with any one or more of the components of the devices and / or systems detailed herein, where the sensors can relay data based on movement of the fingers to the pertinent component of the device, where the device analyzes the relay data and determines that for example tremors or a shaking spell has occurred (as differentiated from normal movements). This could also be from one or more sensors on a wrist or one or more sensors on one or more arms, etc., which could detect arm shaking or hand shaking, etc. In an embodiment, a light capture arrangement, such as a video camera could detect facial movements to identify the occurrence of the symptom, if such is an uncontrolled movement of the mouth or lips or jaw or eyes, etc. Eyeglasses that have sensors could repeatedly take images of the eyelids to determine uncontrolled blinking for example. The system could have a microphone that captures speech of the person and determines based on the speech whether the speech is slurred or not, which would be a symptom of the motor disorder in some embodiments. The gait of the person can be sensed, and data from such sensors that sense the gait of the person can be evaluated to determine if the gait is indicative of a symptom of the motor disorder afflicting the human. Of course, in anembodiment, the human could input data into the system and / or device indicating the occurrence of the system.

[0205] Corollary to this, is that in an exemplary embodiment, method 1900 further includes the action of identifying an occurrence of hand tremor and / or slurred speech and / or unsteady gait or irregular gate of the human resulting from the motor disorder, wherein the action of identifying the side of the human is based on the idented occurrence of hand tremor. In this regard, if the right hand is shaking or otherwise experiencing a tremor, the side identified would be the right side, and vice versa for the left side.

[0206] And while the embodiment just described has been presented in terms of one side experiencing the symptom and the other side not experiencing the symptom, in another scenario or otherwise in an alternate embodiment, both sides could be experiencing the symptoms, one side could be experiencing the symptom more than the other side / the magnitude of the symptom would be greater on one side than the other. In an exemplary embodiment, a non- dimensional and / or unitized value of the given symptom is less than, greater than and / or equal to 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 325, 350, 375, 400, 425, 450, 475, 500, 550, 600, 650, 700, 750, 800, 850, 900, 1000, 1250, 1500, 1750, 2000, or 2500%, or any value or range of values therebetween in 0.1% increments greater on one side than the other, and note that these values can be much larger if the symptom on one side is present and the symptom on the other side is not present (and thus greater than 2500% for example). In an exemplary embodiment, in absolute value of a voltage and / or current output of a sensor on the right hand can be compared to that of a sensor on the left hand to determine the aforementioned percentages. Any measurement regime or system that enables the quantification of a symptom for apples to apples comparison that can enable the teachings detailed herein can be utilized by way of example only and not by way of limitation. In an exemplary embodiment,

[0207] Various symptoms and manifestations of motor disorders have been described above and are described below. Embodiments include identifying any one or of those symptoms or, in the case of an automated sensing and identification system, identifying latent variables indicative of any one or more of those symptoms or otherwise utilizing data based on latent variablesindicative of any one or more of the symptoms, wherein the action of identifying the side of the human is based on identified symptom / latent variable.

[0208] Of course, embodiments can include a manual input arrangement. By way of example only and not by way of limitation, a person experiencing a symptom could utter or otherwise state that he or she is experiencing a symptom, such as, for example, “my left hand is shaking” or “my right hand is shaking more than my left hand” or “I need to be able to walk without dragging my left leg.” A system could include a microphone with speech to text or speech to machine-readable data software that could identify keywords and deduce the symptom that the human is trying to convey to the system. In an embodiment, the human could activate an application on his or her smart phone or smart device and input the symptom. Any device, system, and / or method of providing data to the system so that the system can execute any one or more of the method actions associated with method 1900 or the related methods can be utilized in at least some exemplary embodiments.

[0209] In this regard, by way of example only and not by way of limitation, there is a medical device comprising a means for identifying a side of the human vis-a-vis an anatomical body plane of the human experiencing motor disorder symptom. This medical device further includes a means for providing stimulation to tissue of a head of the human based on the identified side. This medical device can have other means for implementing any one or more of the method actions just detailed associated with method 1900 by way of example only and not by way of limitation. The medical device can include a means for controlling any one or more of the other means in accordance with any one or more of the teachings detailed herein. In an exemplary embodiment, there is a medical device comprising a computing device configured to identify side of the human vis-a-vis an anatomical body plane of the human experiencing a motor disorder symptom. The medical device can also include a stimulation device configured to provide stimulation to tissue of a head of the human based on the identified side. Again, this medical device can include a device configured to implement or otherwise a device having the functionality of any one or more of the method actions detailed herein associated with method 1900 and the variations and permutations thereof just detailed.

[0210] Figure 21 provides an exemplary algorithm for an exemplary method, method 2100, which includes method action 2110, which includes the action of identifying an occurrence of asymptom of a motor disorder in a human. The identification of the system can correspond to any of the identification regimes and / or methods detailed herein, and can be executed by utilizing any one or more of the devices and / or systems for identification detailed herein or any other that can enable the teachings detailed herein. Method 2100 further includes method action 2120, which includes the action of providing stimulation to tissue one anatomical side of the human. In an exemplary embodiment, the stimulation to tissue can be to the tissue of the vestibular system or tissue proximate thereto. The stimulation can be provided to any of the tissue detailed herein in some embodiments. In an exemplary embodiment, the action of providing stimulation manages at least one effect of the motor disorder. This can be a reduction in the severity of the symptom or another symptom and / or a pause in the symptom or another symptom (the pause could be long enough for the person to execute a given task for example). Note that reduction in the severity includes the elimination of the symptom entirely, or at least effective elimination. In this embodiment, the action of providing stimulation on one anatomical side of the human is done differently relative to any stimulation provided to tissue on an opposite anatomical side of the human based on the symptom. By way of example only and not by way of limitation, in the case of a bilateral stimulation system, stimulation could be provided to one side and not the other. That is, no stimulative output could be provided from the device on one side while stimulative the output is provided on the other, and certainly stimulative output of a meaningful or otherwise non-de minimus amount. In an exemplary embodiment, a frequency of the electrical current output on one side could be different than that of the other (different in a meaningful or efficacious way). In an exemplary embodiment, the current density for a given period of time can be larger on one side than the other. In an exemplary embodiment, taking the lowest value as the denominator, the frequency and / or current density could be less than, greater than and / or equal to 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90,100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280,290, 300, 325, 350, 375, 400, 425, 450, 475, 500, 550, 600, 650, 700, 750, 800, 850, 900, 950,1000, 1500, 2000, 2500, or 3000%, or any value or range of values therebetween in 0.1% increments greater on one side than the other (note that zero current / no output on one side with thus results in a current density that is greater than 3000% greater on one side than the other). Any of the temporal periods for stimulation provided herein can be utilized for the given period of time in the interest of textual economy, and the aforementioned values for seconds couldcorrespond to minutes again in the interest of textual economy. In an exemplary embodiment, a length of continuous stimulation could be greater on one side versus the other, where the longer length could be any of the aforementioned percentages greater than the shorter length. By continuous stimulation, this would not mean a duty cycle for example, but would correspond to for example, a period of non-stimulation that is distinct from any patterned stimulation regime preceding or following the non-stimulation. A distinct and recognizable pause in the stimulation would indicate a beginning and / or end of a continuous stimulation period. Voltage could be different with respect to electrodes on one side versus the other, and again, any of the aforementioned percentages can be utilized where the lower voltage as the denominator. Moreover, a number of active electrodes on one side can be greater than the other. By way of example only and not by way of limitation, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 electrodes, or any value or range of values therebetween in one electrode increments can be active on one side and 0, 1 , 2, 3, 4, 5, 6, 7, 8, or 9 electrodes, or any value or range of values therebetween in one electrode increment could be active on the other side (all not including the ground / return). In an exemplary embodiment, the phase of the stimulation can be different on one side versus the other. By way of example only and not by way of limitation, monopolar and / or bipolar and / or tripolar and / or multi-polar stimulation can be utilized on one side, and a different type of stimulation could be utilized on the other. The maximum amplitude of a given stimulation pulse could be greater on one side than the other, again where the aforementioned percentages can be utilized in the interest of textual economy where the smaller amplitude is the denominator. In an exemplary embodiment, the amplitude could be current level.

[0211] Still, in an embodiment, the overall current density for a given period of time applied on one side is different than on the other based on the symptom.

[0212] In an exemplary embodiment, the symptom of the motor disorder occurrence is more prominent on one anatomical side than on the opposite anatomical side or is only identifiable on the one anatomical side. It could be that the symptom exists but the sensors cannot detect the symptom or otherwise the output from the sensors yields an inconclusive result when the output is analyzed. It could be that the human is simply numb or otherwise conditioned to a certain level of a symptom where the symptom is tolerable or otherwise the person has developed coping mechanisms for that level. In any event, in an exemplary embodiment, the provided stimulation is provided on the one anatomical side. Note that this does not exclude providingstimulation on the other side. That said, in some embodiments, the provided stimulation is provided on the one anatomical side, and no stimulation is provided on the other anatomical side. In an exemplary embodiment, any of these are the case for any of the aforementioned temporal periods referred to herein in the interest of textual economy.

[0213] In an embodiment, the provided stimulation provided on the one anatomical side induces a response in tissue / biological matter in the head of the human that is greater on the opposite side than in comparable tissue / biological matter on the one anatomical side. The quantification of the greater response is mentioned above, and will be detailed below. But briefly, the above noted values can be applicable to the quantification of this exemplary embodiment.

[0214] In an embodiment, the identified symptom occurrence is hand tremor in a left hand or right hand of the human and the provide stimulation affects tissue / biological matter in the head of the human on the left sagittal side or the right sagittal side if the hand tremor is on the left hand or right hand, respectively. In an embodiment, the tissue / biological matter in the head is basal ganglia tissue / biological matter. In an embodiment, the stimulation activates tissue / biological matter on an opposite side of the sagittal plane from where the stimulation is provided, which activation treats the motor disorder on the side of the provided simulation. As will be detailed below, the stimulation activates the ipsilateral nerve relative to the stimulator but the activation of the basal ganglia resulting from the stimulation is on the contralateral side. In an embodiment, the aforementioned comparable tissue / biological matter also experiences a neural response, wherein the comparable tissue / biological matter is closer to the stimulation than the tissue / biological matter on the opposite side. In an embodiment, the tissue / biological matter on the opposite side is less than, greater than and / or equal to 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5 or 10 or more or any value or range of values therebetween in 0.1 increments times further than the comparable tissue / biological matter from the closest electrode to either that is outputting the stimulation.

[0215] In an embodiment, the provided stimulation provided on the one anatomical side induces a response in a dopamine transporter tissue / biological matter in the head of the human that is greater on the opposite side than in comparable dopamine transporter tissue / biological matter on the one anatomical side. Again, any of the quantification values detailed above can beutilized to characterize the relative greatness of this embodiment for the purposes of textual economy. In an embodiment, the response is an increase in a measured phenomenon.

[0216] In an embodiment, there is a method, comprising identifying an occurrence of an effect of a motor disorder in a human. The method also includes selecting one sagittal side of the human to which electrical stimulation is to be applied to tissue of the human. The method also includes providing stimulation to the tissue of the human on the selected one sagittal side. In this embodiment, the action of providing stimulation treats the effect of the motor disorder and the action of selecting the one anatomical side of the human is based on which side the effect of the disorder occurrence is greater.

[0217] In an embodiment, the provided stimulation provided on the one sagittal side induces a response in a dopamine receptor tissue / biological matter in the head of the human that is greater on the opposite sagittal side than in comparable dopamine transporter tissue / biological matter on the one sagittal side. In an embodiment, the tissue / biological matter is basal ganglia tissue / biological matter.

[0218] Returning to the concept where embodiments can include the implementation of a bilateral system (but note that any of the teachings detailed herein can be implemented in a unilateral system where there is a stimulator implanted on only one side of the recipient providing that the art enables such, and vice versa) in an exemplary embodiment, there is a system, comprising a right side (right ear) vestibular stimulation device and a left side (left ear) vestibular stimulation device. The system is configured to control the right side vestibular stimulation device and the left side device to adjust respective outputs based on a symptom of a motor disorder of a recipient of the system.

[0219] In an embodiment, the system is configured to vary stimulation output of the right side vestibular stimulation device to affect tissue / biological matter on a left sagittal side of the human and vice versa. The variation of stimulation output can correspond to any of those detailed herein. In an embodiment, the system is configured to vary stimulation output of the right side vestibular stimulation device to increase a reaction in tissue / biological matter on a left sagittal side of the human and to increase a reaction in comparable tissue / biological matter on the right sagittal side of the human but less so than the increase in the tissue / biological matter on the left sagittal side and vice versa. The qualifications detailed above with respect toreactions and / or properties that are greater on one side versus the other or incorporated herein by reference in the interest of textual economy.

[0220] In an exemplary embodiment, the system is configured to control the respective outputs of the stimulation devices to increase a reaction in tissue / biological matter on opposite sides of the sagittal side. In an embodiment, the system is configured to prevent output of the right side vestibular stimulation device while enabling output of the left side vestibular stimulation device to increase a reaction in tissue / biological matter in a right sagittal side of the human and vice versa. By way of example only and not by way of limitation, this can be executed by any one or more of the above-noted methods detailed above for any of the above-noted temporal periods. In an exemplary embodiment, the prevention of output can be implemented by halting or otherwise suspending output from the external component on the right side. This can be done by placing the external coil in a deactivated state or otherwise where the external coil on that site is not transmitting, and thus the implant is not receiving a control and / or power signal and thus will not provide output. That said, in the case of a totally implantable system, the prevention of output could be achieved by preventing current signals from being provided to the electrode contacts of that device on that side. Note that the right side device could be on or otherwise activated and otherwise in a state where it could provide output if instructed to, but it has been instructed not output. Any device system and / or method of preventing output can be utilized in at least some exemplary embodiments. In a sense, active output has been suspended for a given period of time.

[0221] Consistent with the teachings above, the tissue / biological matter in which the reaction occurs is basal ganglia tissue / biological matter. And consistent with the teachings above, in an exemplary embodiment, the system includes one or more sensors configured to detect the occurrence of the symptom. Any of the sensors detailed herein can be utilized in at least some exemplary embodiments. In an exemplary embodiment, the system is further configured to analyze output from the one or more sensors (e.g., automatically) and evaluate a severity of the symptom and / or extract locational data therefrom. One or both of these can be utilized to identify the sagittal side on which the symptom is greatest and / or is manifesting itself for the purposes detailed herein.

[0222] Embodiments include adjusting the dopamine production. This as opposed to adjusting the reception of dopamine in the human. But note that these are not mutually exclusive. At least some of the actions detailed herein can result in adjustment of dopamine production and adjustment of dopamine reception. Note also it could be that for a single action applied to the recipient, it could be that there is an opposite effect on dopamine production relative to dopamine reception. It can also be that some actions affect one and not the other, at least not effectively or otherwise in a manner that is meaningful from a treatment and / or clinical standpoint.

[0223] In this regard, in at least some exemplary embodiments, there are devices and systems for, and methods of, adjusting dopamine production, such as, for example, increasing dopamine production. This can be executed, for example, by way of utilization of the electrical stimulation detailed above. Other embodiments include utilizing other types of treatments or executing other actions, such as for example targeted drug application or targeted drug therapy for example.

[0224] In view of the above, in an embodiment, there is a method, such as that represented by the flowchart of FIG. 21 A, method 2130, which includes method action 2140, which includes identifying a symptom and / or disorder related to a dopamine related phenomenon in a human. This can be executed in accordance with any of the teachings detailed herein. Indeed, in an embodiment, this corresponds to any of the actions associated therewith detailed herein. In an embodiment, method action 2140 entails identifying one or more of an occurrence of a symptom of a motor disorder in a human, an occurrence of a symptom of a vestibular disorder in the human, an existence of a motor disorder in the human and / or an existence of a vestibular disorder in the human. All of these being examples of a dopamine related phenomenon in a human. Note also that the dopamine related phenomenon can be a dopamine production / receptor deficiency / dopamine production / receptor aberrant state (whether too little or otherwise). In this embodiment, method 2130 includes method action 2150, which includes providing electrical stimulation to biological matter of the human. This can be done in accordance with any of the teachings detailed herein.

[0225] In an embodiment, the provided stimulation adjusts dopamine production and / or reception in the human. In an embodiment, the provided stimulation increases dopamine production in the human.

[0226] Concomitant with the teachings above, in an embodiment, instead of or in addition to adjusting dopamine production, the provided stimulation adjusts dopamine reception in the human. And in some embodiments, the provided stimulation increases dopamine reception in the human. In an embodiment, the reception is the reception by the spiral ganglion cells.

[0227] In some embodiments of the embodiment of method 2130, the dopamine therapeutic drugs (such as those that adjust reception and / or production of dopamine) are not being provided to the human at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100, 125, 150 or 175 or 200 days or more, or any value or range of values therebetween in 1 day increments before the action of providing stimulation of method action 2150 and / or during the action of providing stimulation.

[0228] In an embodiment, the adjustment treats at least one of the effect or the existence of the disorder.

[0229] Also, in accordance with the teachings herein, the action of providing electrical stimulation is provided on one sagittal side of the human, and this is done to one or both of (i) induce a response in a dopamine receptor biological matter in the head of the human that is greater on the opposite sagittal side than in comparable dopamine transporter biological matter on the one sagittal side or (ii) induce a response in a dopamine producing biological matter in the head of the human.

[0230] FIG. 21 B presents an exemplary flowchart for an exemplary method, method 2160, that includes method action 2170, which includes identifying in a human an ailment and / or symptoms of an ailment related to a phenomenon associated with dopamine. This can be a motor dysfunction or a symptom thereof. This can be a motor disorder or a symptom thereof. This could be some other diseases and / or symptoms. This could be the underlying issue of dopamine production abnormalities (which includes lack of production / deficient production) and / or dopamine receptor abnormalities (which includes reception deficiencies / lack of reception). The teachings herein can be used to treat BVD and symptoms thereof

[0231] Method 2160 includes method action 2180, which includes adjusting dopamine reception and / or production in the human to treat the ailment and / or symptom. In an embodiment, this entails providing stimulation to tissue of the human to adjust the reception and / or production, concomitant with the teachings herein. In an embodiment, this stimulation can be electricalstimulation. And of course, consistent with the teachings above, the dopamine reception and / or production is increased by way of the adjusting. The reception of dopamine can be adjusted. The production of dopamine can be adjusted. The reception of dopamine can be increased. The production of dopamine can be increased.

[0232] FIG. 21 C provide another flowchart for an exemplary method, method 2185, which includes method action 2190, which includes executing method actions 2170 and 2180. Method 2185 further includes method action 2195, which includes providing stimulation to the human on a side of a human relative to an opposite side of the human to execute the adjustment, wherein the side of the human to which stimulation is provided is opposite the side where the adjustment takes place. This is done in accordance, in some embodiments, with the teachings above.

[0233] Returning to the concept of reactions in the tissue / biological matter resulting from the applied stimulation, such as stimulation to the vestibular system, figure 22 shows an exemplary chart showing the results of the reaction in the tissue / biological matter. Here, there are two exemplary data points for human being at two different ages, ages 51 years and 58 years. This exemplary data is for both humans having a vestibular stimulation system. In this exemplary embodiment, the lower values associated with the square data points correspond to the state of the system where the device is off. That is another way of saying that the device is not stimulating. And in this exemplary embodiment, the device has not stimulated for any one or more of the periods of time so as to set the bottom data points as baseline data points. Put another way, the tissue / biological matter where the reaction is measured or otherwise evaluated is tissue / biological matter that has not been influenced by prior stimulation or, to the extent that the tissue / biological matter was influenced by prior stimulation, the baseline for that tissue / biological matter can provide conveyance of the teachings detailed herein.

[0234] The vertical axis is striatum DVR. This is an indication of receptor sensitivity of cells in the dopaminergic areas of the basal ganglia.

[0235] As seen, when the stimulation devices are activated (“on” condition), the values of striatum DVR increase accordingly, as represented by the triangles. In an exemplary embodiment, there is utilitarian value to have the values between the two downward sloping lines. In an exemplary embodiment, these can be considered a range for normal humans. In thisexemplary embodiment, the two humans are afflicted with a motor disorder, here, Parkinson’s disease.

[0236] As can be seen in FIG. 22, the increase for the contralateral side is greater than that for the ipsilateral side when the stimulator is activated. That is, stimulating the vestibular tissue / biological matter on one side of the sagittal plane results in an increase in striatum DVR of the basal ganglia tissue / biological matter on the opposite side of the sagittal plane that is greater than the increase in striatum DVR of the basal ganglia tissue / biological matter on the one side. Any of the above noted quantifications can be utilized to characterize the differences in increase in some embodiments and are incorporated herein by reference in the interest of textual economy.

[0237] It is noted that FIG. 22 is for a single stimulation device / unilateral stimulation device. Stimulation occurs on only one side of the sagittal plane.

[0238] The point is that by providing stimulation to the vestibular system on one side of the recipient, an increase in receptor activity or otherwise the ability of the basal ganglia tissue / biological matter to receive dopamine occurs in the basal ganglia tissue / biological matter on the opposite side that is greater than the increase that occurs in the basal ganglia tissue / biological matter on the stimulation side. This can have utilitarian value in at least some exemplary embodiments by selecting the basal ganglia tissue / biological matter, or more specifically, identifying the basal ganglia tissue / biological matter on a given sagittal side to experience the greatest increase in activity of a dopaminergic synapses relative to the tissue / biological matter on the opposite sagittal side so as to manage a symptom of a motor disorder manifesting itself on the opposite side.

[0239] Put another way, because the basal ganglia tissue / biological matter on one side of the sagittal plane influences motor control on the opposite side, if there is a symptom on the opposite side relating to motor control, such as hand tremors, the basal ganglia tissue / biological matter on the one side should be targeted, and vice versa. Because providing stimulation on the side opposite the side on which the targeted basal ganglia tissue / biological matter is located will increase the activity of dopaminergic synapses / increase striatum DVR of the targeted tissue / biological matter, if a symptom occurs on one side of the human relative to another side, or otherwise occurs with greater magnitude or severity on one side relative to another side, thestimulation should be applied to that side so as to achieve the greatest increase of the synapses / DVR in the basal ganglia on the opposite side. This is counterintuitive to what one would expect, which is that applying stimulation to the vestibular system closest to the targeted basal ganglia tissue / biological matter would result in an increase in the ability of that tissue / biological matter to accept dopamine that is greater than that which is the case for the basal ganglia tissue / biological matter on the opposite side from where the vestibular system is stimulated.

[0240] Thus, embodiments include applying stimulation to a vestibular system on one side of the sagittal plane to target basal ganglia tissue / biological matter on the opposite side of that plane, and vice versa. Embodiments include doing this even though there could be respective vestibular stimulators on both sides, and thus there is a stimulator, or, more accurately, output from the stimulator could be applied at a location closer to the basal ganglia tissue / biological matter than that of the other stimulator. Embodiments thus include the counterintuitive action of purposely applying stimulation to tissue / biological matter further away from the targeted basal ganglia tissue / biological matter than that which can otherwise be the case (because there are two stimulator devices implanted in the human).

[0241] Accordingly, in an exemplary embodiment, there is the action of applying stimulation to a vestibular system on one side of the sagittal plane to increase the ability of basal ganglia tissue / biological matter on the opposite side of the plane to accept dopamine at a level higher than that which would result if the stimulation was applied to a vestibular system on the same side of the plane as the basal ganglia tissue / biological matter. And note that any of the above-noted qualification details can be applicable to this exemplary embodiment, which is incorporated herein by reference for the purposes of purpose of textual economy.

[0242] Accordingly, exemplary embodiments include increasing the ability of the remaining dopamine transporters of tissue / biological matter, such as the basal ganglia tissue / biological matter, to accept dopamine. Also, exemplary embodiments include increasing a number of dopamine transporters. In an exemplary embodiment, all of this is done or otherwise achieved as a result of stimulation of the vestibular system in general, and application of stimulation to the vestibular system on a side of the sagittal plane opposite from the side on which the tissue / biological matter targeted for the just noted increases is present.

[0243] In an exemplary embodiment, these actions increase both volume and the density of the receptors relative to that which would otherwise be the case. The volume and / or density can be increased by any of the percentages herein by way of textual economy.

[0244] The point is that stimulation on one side of the sagittal plane in general, and stimulating the vestibular system on one side of the plane in particular, results in an unexpected greater increase in the ability of basal ganglia tissue / biological matter on the opposite side to accept dopamine relative to the tissue / biological matter on the stimulation side / the side where the vestibular system to which stimulation was applied was located.

[0245] Note that this does not mean that both vestibular systems are not stimulated in at least some embodiments. Also, as the graph of figure 22 shows, it is not as if the ipsilateral stimulation does not affect the ipsilateral basal ganglia tissue / biological matter. Thus, in some embodiments, stimulation is applied to both vestibular systems. This can be done to achieve a cumulative effect. However, there is utilitarian value with respect to limiting an amount of stimulation applied by the implanted stimulations devices both with respect to short-term factors and long-term factors. With respect to the short-term, longer battery life will be achieved, or more accurately, longer use of the overall system for a given battery charge will be achieved. This can have utilitarian value with respect to a human that utilizes the system frequently or otherwise where the batteries have been depleted or otherwise have not been recharged in the manner which otherwise should have been the case or could have been the case. With respect to long-term, the implants are expected to last a lifetime. The implants are expected to last and can have been implanted less than, greater than and / or equal to 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55 or 60 years or more or any value or range of values therebetween in one month increments. Current discharge or otherwise the use of electrodes to stimulate tissue / biological matter can result in corrosion of the electrodes. Thus, the lower the current density or otherwise the less current that is applied by a given electrode, the longer the electrode should last, all other things being equal. Accordingly, if utilitarian value of a system can be achieved while only stimulating from one side or otherwise reducing the stimulation on one side relative to another side or otherwise while reducing an amount of electrical current that is applied by a given electrode, a longevity of a given implants can be extended. It thus makes sense to “limit” the amount of stimulation from the system. Because it is now known which side stimulation is to be applied to obtain the greatest increase in the targeted basal ganglia tissue / biological matter, the teachingsdetailed herein can be utilized to increase the longevity of the system relative to that which would otherwise be the case. Put another way, for the same effect on a given basal ganglia tissue / biological matter, less current can be applied by utilizing the contralateral stimulation techniques detailed herein (the corollary of the increase in reaction using the contralateral stimulation techniques detailed herein). Alternatively and / or in addition to this, because a given stimulation amount will result in a greater increase in reaction in the targeted basal ganglia tissue / biological matter, the efficacy will be greater, and thus the amount of time that stimulation is applied will be reduced or otherwise can be reduced, and thus the amount of current that is applied can be reduced relative to that which would otherwise be the case, all other things being equal.

[0246] Put another way, by utilizing the contralateral stimulation techniques detailed herein, the efficacy of a given stimulation can be improved, and thus the amount of current applied by a given electrode could be reduced relative to that which would otherwise be the case, all other things being equal.

[0247] By way of example only and not by way of limitation, say that the contralateral stimulation is applied at the maximum level possible or otherwise the maximum level that is comfortable, etc. There could be utilitarian value to then introducing the ipsilateral stimulation if the contralateral stimulation by itself is not sufficient to reduce or otherwise manage the symptoms. Still, the default in at least some exemplary embodiments is to provide stimulation on the side opposite from the basal ganglia tissue / biological matter that is targeted, and thus provide stimulation on the side where the symptoms manifest themselves or otherwise where the symptom is greater.

[0248] In an exemplary scenario, say a person is trying to write with his or her right hand, which person suffers from Parkinson’s disease. The person is having difficulty writing owing to the symptoms of the disease. Conventional wisdom would indicate that the basal ganglia on the left side should be targeted to increase acceptance of dopamine because that is the tissue / biological matter that influences the motor functions of the right side of the body. Conventional wisdom would thus apply stimulation to the left side vestibular system because that is closest to the left side basal ganglia tissue / biological matter. But in accordance with the teachings detailed herein, the stimulation would be applied to the right side vestibular system because that is whatwould result in the greatest increase in the ability of the left side basal ganglia tissue / biological matter to accept dopamine as opposed to providing stimulation on the other side, all other things being equal.

[0249] Also, the concept of longevity can be applicable to identifying the side of the body where a given symptom is more severe, even though the symptom exists on both sides of the body. There is utilitarian value with respect to managing or otherwise attempting to reduce the severity of the more severe symptom. In an exemplary embodiment, it could be that the less severe symptoms are tolerable or otherwise manageable by the person without treatment. But note that it is not as if the stimulation does not affect basal ganglia tissue / biological matter on both sides of the sagittal plane. As shown in figure 22, the stimulation affects tissue / biological matter on both sides. And in this regard, in at least some exemplary embodiments, even though the reaction is less on / in tissue / biological matter on one side relative to the other, that lower effect could still be sufficient to reduce and / or eliminate the symptom on the opposite side because that symptom is not as severe as the symptom on the other side. Put another way, because it is known that the stimulation will affect tissue / biological matter on both sides of the sagittal plane, but affect tissue / biological matter more so on one side, the tissue / biological matter to be targeted for the greater effect should be the tissue / biological matter that controls the motor functions on the side with the more severe symptoms of the motor disorder. That is, by identifying the side with the more severe symptom, the basal ganglia tissue / biological matter that will have the greatest effect on the side with the more severe symptom can be targeted, and because the tissue / biological matter on the other side will have a lower effect but still will have an effect, there is balance in the treatment. Again, this can have utilitarian value with respect to longevity of the device, and otherwise avoiding overstimulation. In the end, providing more stimulation than that which is necessary or utilitarian is something that is desirable to be avoided if only with respect to doctrine.

[0250] Thus, the teachings detailed herein provide a more accurate understanding of how vestibular system stimulation affects basal ganglia tissue / biological matter, which is utilized to manage or otherwise implement stimulation regimes in a counterintuitive manner to achieve any one or more of the utilitarian results detailed herein.1

[0251] Figure 23 presents an exemplary flowchart for an exemplary method, method 2300, which includes method action 2310, which includes the action of identifying the occurrence of a symptom of a motor disorder of a human. Method 2300 further includes method action 2320, which includes the action of operating a motor disorder stimulation system to stimulate tissue / biological matter of the human based on the identified occurrence. In an exemplary embodiment, concomitant with the teachings above, the action of operating the system includes controlling stimulation output of the system based on the anatomical side of which the identified occurrence is occurring.

[0252] In an exemplary embodiment, the system is a bilateral system. In an exemplary embodiment, the action of operating the system includes applying stimulation to tissue / biological matter on a same anatomical side of the recipient as the identified occurrence. In an exemplary embodiment, the action of operating the system includes also applying stimulation to tissue / biological matter on an opposite anatomical side of the recipient from the identified occurrence. This can be done, for example, in a scenario where single-sided stimulation is not sufficient to provide the reduction and / or elimination of the symptom desired by the recipient. Still, in an exemplary embodiment, the action of applying stimulation on the opposite anatomical side from the identified occurrence is done as a last resort. In an exemplary embodiment, the default is to apply stimulation only to one side, and in some embodiments, this is done for at least some of the reasons detailed above by way of example only.

[0253] In an exemplary embodiment, a current density the stimulation applied to the tissue / biological matter on the opposite anatomical side of the recipient is greater than a current density of the stimulation applied to the tissue / biological matter on the same anatomical side as the identified occurrence. This can be done, for example, because more stimulation is needed to affect the pertinent basal ganglia tissue / biological matter because the “less effective stimulation side” is being utilized in this exemplary embodiment.

[0254] In an exemplary embodiment, the action of controlling stimulation includes applying output of the system on a first sagittal side of the human to evoke a reaction in tissue / biological matter on a second sagittal side of the human to reduce the symptom, wherein the symptom manifests itself on the first sagittal side. In an exemplary embodiment, the symptom also manifests itself on the second side or otherwise the side opposite the first side, but that symptomhas manifested itself in a manner that is less severe than that which is the case on the first side. In a variation of method 2300, the action of controlling stimulation includes applying output of the system on a first sagittal side of the human to evoke a reaction in tissue / biological matter on a second sagittal side of the human that is stronger than a reaction in comparable tissue / biological matter on the first sagittal side of the human to reduce the symptom, wherein the symptom manifests itself on the first sagittal side (or manifests itself more on that side than the other side). Any of the factors detailed above or otherwise the quantification teachings detailed above can be utilized to evaluate the severity of manifestation.

[0255] Consistent with the teachings above, a symptom of a motor disorder of the human is also present on the second sagittal side, which symptom is not as severe as the symptom on the first side.

[0256] Embodiments include balancing the quantification of the severity of the symptoms. In an exemplary embodiment, if the “imbalance” between the severity of the symptoms on given sides are greater than and / or equal to a certain ratio, single-sided stimulation will be applied. But if the imbalance between the severity of the symptoms the given sides are less than a certain ratio, bilateral stimulation will be applied. But note that the amount of bilateral stimulation or otherwise the output or otherwise the current density from each of the stimulator’s might be relatively low as compared to the scenario where the ratio was higher where stimulation was applied by only one device. In this regard, the overall magnitude of a given symptom can be taken into account. If for example, the symptoms on the left side are say three times worse than the symptoms on the right side, but the symptoms on the left side are not severe, but just a medium irritant read in a minor irritant, the vestibular system on the left side would be stimulated and the vestibular system on the right side would not be stimulated in an exemplary scenario, but the output of the stimulator on the left side might also be lower relative to a scenario where, for example, the symptoms on the left side were debilitating. Indeed, the output would be lower in such a situation (the output would be higher for the debilitating symptom than for the irritating symptom). If one side was debilitating and the other side was very very uncomfortable and irritating, the output from one or both stimulators could be relatively high. The point is that the amount of stimulation is not just based on the ratio of severity between the sides, but it is also based on the severity of the symptoms and one or both sides. Methods take this into account, and devices and / or systems are configured to take this into account.

[0257] In an exemplary embodiment, method 2300 is a method of treating at least symptoms of Parkinson’s disease. Note that method 2300 is not so limited however. This is simply an exemplary embodiment.

[0258] In an embodiment of method 2300, the symptom is automatically identified by the system. In an exemplary embodiment, the system is a bilateral system as noted above, and the action of operating the system includes applying stimulation to tissue / biological matter on a same anatomical side of the recipient as the identified occurrence and applying no stimulation to tissue / biological matter on an opposite anatomical side of the recipient from the identified occurrence.

[0259] In an exemplary embodiment, the stimulations and the non-stimulations / no stimulations are applied for any one or more of the temporal periods detailed herein, and the temporal periods need not be the same. In this regard, in an exemplary embodiment, there can be a period of applied stimulation to one side and non-applied stimulation to the other, and then a period where stimulation is applied to both sides, and then a period where stimulation is applied to only the one side and not the other side, and so on.

[0260] Below is an exemplary chart showing the application of stimulation represented by On and the non-application of stimulation represented by Off for an exemplary method for the left and right vestibular implants (left on left side, and right on right side):On OffOn OnOn OffOn OnOn OffOn OnOn OffOn OnOn OffOn OnOn OffOn OnOn OffOn OnOn OffOn OnOn OffOn OnOn OffOn On

[0261] It is noted that in an exemplary method, the method could end after any one or more of the periods just detailed. And for the purposes of textual economy, the reverse could be applied for the left and right stimulators.

[0262] And note that while the embodiment above does not indicate that the left stimulator is ever turned off, in an exemplary embodiment, there can be a period of “Off Off’ for both stimulators. In an exemplary embodiment, such a period can be inserted in any one or more or all of the locations between any one or more of the periods detailed above, in the interest of textual economy (and the reverse can also be applied to the left and right stimulators, again in the interests of textual economy). Note that the time periods need not be the same length. Any of those detailed herein can be applicable to any of the periods detailed above.

[0263] Note that any of the two pairs of states can be moved anywhere else in at least some exemplary embodiments. In at least some exemplary embodiments, this depends on the particular recipient, etc.

[0264] Consistent with the concepts detailed above, embodiments include medical devices or otherwise systems configured to implement one or more or all of the method actions associated with method 2300 and / or method 2100. There are thus means for executing any one or more of the method actions detailed herein associated with the just detailed method methods. As noted above, any one or more of the devices detailed herein can be configured to implement any one or more of the method actions and / or functionalities detailed herein unless otherwise noted, providing that the art enables such.

[0265] Figure 24 provides an exemplary flowchart for an exemplary method, method 2400, according to an exemplary embodiment, which includes method action 2410, which includes theaction of identifying a motor disorder of the human. Method 2400 further includes method action 2420, which includes the action of determining that the human is a candidate for a vestibular implant to treat symptoms of the motor disorder. Method 2400 further includes method action 2430, which includes identifying a sagittal side of the human in which symptoms resulting from the motor disorder manifest themselves in method action 2440, which includes determining a sagittal side of the human for implantation based at least in part on the identified side. It is noted that in some embodiments, method action 2430 may not be executed and / or method action 2440 can be executed based on other factors instead of the identified side.

[0266] In an exemplary embodiment, method 2400 further includes the actions of identifying a state of hearing in a first ear of the human and identifying a state of hearing in a second ear of the human. In an exemplary embodiment, the action of determining the sagittal side includes determining such also based on the identified states of hearing in the two ears. In this regard, there is utilitarian value with respect to providing the implant on the side of the human that will least likely affect the human’s ability to hear. In this regard, if the human has hearing or otherwise good hearing in one ear, and no hearing or less than good hearing in the other ear, or otherwise the other ear because hearing that is not as good as the hearing of the one ear, the other ear would be more likely to be the candidate for the implantation side in a unilateral system. The idea being is that the implantation could affect the hearing of the recipient, and the implant should be placed on the side with the “worse” hearing, or more accurately that is a factor for determining where to implant the vestibular stimulation device. In an exemplary embodiment, the identified sagittal side of the human is the same side as the side in which the symptoms manifest themselves. In an embodiment, the identified sagittal side of the human is the opposite side in which the symptoms manifest themselves and the person has at least partial hearing in the first ear, wherein the first ear is on the sagittal side in which symptoms manifest themselves. Here, the ability to hear was the controlling factor. In further to this concept, in an exemplary embodiment, the person is deaf in the second ear, and the second ear is on the sagittal side opposite from which the symptoms manifest themselves.

[0267] A variation of method 2400 can further include the action of determining a sagittal side of the human in which basal ganglia tissue / biological matter reacts more to electrical stimulation applied to vestibular tissue / biological matter on one sagittal side vs. the opposite side. Here, the action of determining the sagittal side includes determining such also based onthe determined sagittal side of the human in which basal ganglia tissue / biological matter reacts more to electrical stimulation. The identified sagittal side of the human can be the side determined to result in the basal ganglia tissue / biological matter reacting more to the electrical stimulation. Again, this is relative to the basal ganglia tissue / biological matter on the other side of the plane. In an exemplary embodiment, the identified sagittal side of the human is the opposite side from the side in which the basal ganglia tissue / biological matter reacts more to the electrical stimulation.

[0268] Another variation of method 2400 includes the action of determining which sagittal side basal ganglia tissue / biological matter will experience a greater reaction from electrical stimulation applied to the vestibular tissue / biological matter on the side in which the symptoms manifest themselves. The variation of the method can also include determining the sagittal side for implantation based at least in part on the determined side basal ganglia tissue / biological matter will experience the greater reaction from the electrical stimulation.

[0269] By way of example only and not by way of limitation, in an exemplary embodiment, the determined side basal ganglia tissue / biological matter will experience the greater reaction from the electrical stimulation is a side opposite the side in which the symptoms manifest themselves. Also by way of example only and not by way of limitation, the determined sagittal side of the human for implantation is the side opposite the determined side basal ganglia tissue / biological matter will experience the greater reaction from the electrical stimulation is a side opposite the side in which the symptoms manifest themselves. For example, the second symptoms resulting from the motor disorder also manifest themselves on a side opposite the side in which the symptoms manifest themselves and / or the second symptoms are less severe than the symptoms.

[0270] Consistent with the teachings above, in an exemplary embodiment, the second symptoms are hand tremors.

[0271] Embodiments include addressing dopamine related issues utilizing a tactical approach to the body. Selective targeting vs. whole body targeting (or side of body targeting vs. agnostically targeting the side of the body) are applied in some embodiments. Embodiments include identifying tissue with inferior dopamine receptor activity (e.g., via nuclear medicine) relative to other tissue and targeting portions of the body to interface with the teachings herein that will impact that tissue more than other tissue. Embodiments include identifying the basal ganglionwith the worst dopamine receptor activity (relative). This can be done with, for example, nuclear medicine, or any other technique that can enable such. Embodiments include identifying a side of the body having the worst dopamine production and / or levels. Embodiments can also include targeting the side of the body for application of stimulation based on what side will impact that basal ganglion with the worst dopamine receptor activity the most and / or which side will impact dopamine production the most (relatively speaking). Embodiments includes electrical stimulation as the stimulation. Embodiments include implanting the electrical stimulating device, or at least the output thereof, on the side of the body (the sagittal side) that will impact that basal ganglion the most / more than the other and / or on the side of the body that will result in the greatest increase in dopamine production.

[0272] Embodiments include placing and / or implanting the electrical stimulation device on the side of the body where the impact on the reception of dopamine will have the most effect relative to the other side. Embodiments include implanting the electrical stimulation device on the side of the body where the impact on the dopamine production will have the most effect relative to the other side. In these embodiments, the relative effect is related to efficacy.

[0273] In an embodiment, this can provide enhanced / optimized, or otherwise utilitarian outcomes for bilateral vestibular disfunction (BVD) treatment. In an embodiment, if there are any motor disorders, they can also be addressed. This can provide additional utilitarian value. In an embodiment, the focus of such an arrangement can be bilateral vestibular disfunction (BVD) and / or motor disorders (e.g., Parkinson’s disease) and / or one but not the other (BVD but not motor disorder, motor disorder but not BVD).

[0274] In this regard, some of the teachings, at least some, can be utilized to determine with respect to a treatment for BVD, which side to implant a vestibular implant, or otherwise which side to implant / position the output / electrodes, in what would otherwise be an agnostic decision process as to which side to implant / position the electrodes. That is, under normal circumstances, one could put the implant on either side (when there is only to be one implant to be implanted), and without the decision process just detailed and as will be described further below, it could be no more than the recipient’s opinion as to which side would look best (worst) with a BTE or the OTE or even an ITE (in the ear device) there could be other reasons, such as which side has the better hearing. Still there could be no substantive efficacious reason to pickone side or the other under normal circumstances. Here, with the teachings herein, the side to choose would / could be based on which tissue can benefit the most from electrical stimulation vis-a-vis a phenomenon associated with dopamine (e.g., which spiral ganglion has poorer dopamine receptor properties, and targeting that one vs. the one on the other side).

[0275] In some embodiments, the side to implant the implant (the implantation side), or at least the side where the electrodes will be located, is chosen based on a secondary consideration of best impacting dopamine production and / or reception. In some embodiments, it may not matter (there might not be any motor disorder experienced by the recipient, ever). But if it does matter, embodiments can take the greatest advantage possible by picking one side over the other side to maximize this secondary benefit.

[0276] Conceptual basis for targeting a given side of a human for electrical stimulation so as to maximize or otherwise improve dopamine related issues when only one side can be targeted for stimulation (for whatever reason, if only because it is desired only to provide one implant initially into a human, whether there are definitive plans to implant another implant in the human at a later date, or if it is simply impossible to provide another implant for whatever reason or otherwise undesirable to do so, again for whatever reason). With reference to the data on figure 22, it can be seen that providing stimulation to one side of the human will result in an increase in the underlying physical phenomenon relative to that which would be the case when the stimulation is applied to the other side, albeit where the increase in the underlying physical phenomenon is with respect to the entire body vis-a-vis taking into account both sides. In an exemplary embodiment, the increase can be an absolute value, or can be relative, and thus can be a percentage, which percentage can be based on the baseline / initial values for the given phenomenon or based on an absolute value for that matter. The control can be the absolute increase or the percentage increase again taking into account the baseline as the denominator in the percentage calculations. It could be that the decision is based on whether or not one side can be reconciled with the other side at least with respect to the initial conditions. That is, by way of example, the side having the lowest value could be the ultimate target side providing that the electrical stimulation or what have you can increase that side to the value corresponding to the other side, thus providing a modicum of parity. The idea is that the overall lowest performance side is being targeted. But again, alternatively, the controlling factor can be what side has the greatest increase, and note that the two are not mutually exclusive.

[0277] In view of the above, FIG. 24A presents an exemplary flowchart for an exemplary method, method 2450, that includes method action 2452, which includes obtaining data based on data indicative of dopamine activity related to respective sides of a human, wherein viability of an electrical stimulation treatment has been identified for the human, which treatment includes, at least initially, implantation of electrodes of a given implantable electrical stimulation device on only one side of the human. In an exemplary embodiment, the human has been identified as a candidate for a vestibular implant by way of example, where the viability of the electrical stimulation treatment is the viability of a vestibular implant treatment. This vestibular implant treatment can entail the implantation of the vestibular implants detailed herein or variations thereof. That said, the embodiments of method action 2452 is not so limited. It could be that the electrical stimulation treatment can be a cochlear implant treatment by way of example and the derivative nature of the implant could also impact dopamine activity related phenomenon in the human, whether that is the adjustment of dopamine receptors and / or dopamine production. Indeed, the cochlear implant can be combined with electrodes that impact dopamine activity. These electrodes could be placed outside the cochlea but along with the device utilizing a “targets of opportunity approach” because the surgeon or the like is already implanting the device into the recipient, and it is simple enough (relative) to utilize the device that has additional electrodes that will impact dopamine activity. It could be that the electrical stimulation from a cochlear implant, by itself, can be sufficient to impact dopamine activity.

[0278] In any event, whatever the circumstances, this human has been deemed to be someone for whom the implant treatment or otherwise the electrical stimulation treatment, including a vestibular implant treatment is viable. And to be clear, in an exemplary embodiment, there is a method that also includes the action of determining the viability of that treatment for the human and / or otherwise determining that the human should be implanted with an electrical stimulation device. This action need not be executed by the actor who executes method 2450. That said, the extension of method 2450 could include the action of determining such.

[0279] Returning to the specifics of method action 2452, the action of obtaining data based on data indicative of dopamine activity related to respective sides of the human need not be executed by the person who actually developed the data. And that data may not necessarily need to be the exact data developed by that person, hence the phrase obtaining data based on data. This includes the actual underlying data that is developed, and derivative data or otherwise datathat has been developed based thereon, such as, for example, weighted data or an evaluation of the data or summary of the data. This covers the underlying raw data and data developed therefrom.

[0280] The data indicative of dopamine activity can be data relating to dopamine production and / or dopamine receptor activity. The data could be data indicative of respective basal ganglia on cell dopamine receptor activity by way of example. The data could be specific to specific tissue, or can be more general, where the dopamine activity and / or production for one side of the body (sides demarked by the sagittal plane) dopamine activity and / or production for the opposite side of the body is developed or otherwise obtained. And note that dopamine concentrations and / or values can be a proxy for dopamine production. In an exemplary embodiment, a concentration of dopamine can be indicative of the ability of one side of the body to produce dopamine. This could also be indicative of dopamine activity or otherwise dopamine receptor activity. Any data that can be indicative of dopamine activity in general, and the specific dopamine activities detailed herein, that can have utilitarian value in implementing the teachings detailed herein can be utilized in at least some exemplary embodiments, providing that the art enables such. Any device and / or system to or method of obtaining the data can be utilized in some exemplary embodiments, providing that the art enables such unless otherwise noted.

[0281] In an exemplary embodiment of method action 2452, the obtained data will indicate dopamine activity related to the sides, and the data can be compared to determine, for example, which side has “better” dopamine receptor activity by way of example and / or which side has “better” dopamine production activity by way of example. Better of course is a relative term. For the most part, better would be “higher.” That said, it could be that for whatever reason, better could be lower. Thus, embodiments can include determining which side has better dopamine activity and / or which side has higher dopamine activity and / or which side has lower dopamine activity, whether that activity is with respect to dopamine reception and / or dopamine production. And that raises the point that it could be that one side has higher / elevated dopamine production but lower dopamine reception or vice versa relative to the other side. It also could be that one side has the same dopamine production numbers, or at least effectively the same, as the other side, but a higher or lower dopamine reception rating and / or vice versa.

[0282] Method action 2452 can be executed by simply obtaining a value or rating of dopamine production activity and / or dopamine receptor activity for the given sides.

[0283] Method 2450 further includes method action 2454, which entails identifying the side of the human for the electrodes to be implanted based on the obtained data. Here, the idea is that the electrodes can be implanted on the side that results in the “best” outcome with respect to improving or otherwise adjusting dopamine activity, however that result is deemed to be the best. By way of example only and not by way of limitation, it could be that one side of the body has inferior dopamine receptor activity relative to the other side of the body. The side of the body into which the electrodes will be implanted will be the side that impacts that one side of the body that has inferior dopamine receptor activity. In an exemplary embodiment, in accordance with the teachings herein, the implant side would be on the opposite side having the inferior dopamine receptor activity. This can also be the case with respect to dopamine production activity.

[0284] This concept can have utilitarian value with respect to scenarios where, for example, there is no particular controlling side for which the electrical stimulation implant in general, and the electrodes thereof in particular, should be implanted with respect to efficacy of the system. Again as noted above, with respect to efficacy, implantation side could be an agnostic decision. In an exemplary embodiment, the forward thinking concepts would take into account respective dopamine activity on the sides, and utilize that as a basis to determine on what side the electrodes should be implanted. That is, the dopamine activity considerations can transform what otherwise would be an agnostic decision to a decision based on efficacy. Thus, for example, it could be that with respect to treatment of, for example, bilateral vestibular disorder, where either side would be normally acceptable and thus there is no “better” side, the side that would impact dopamine activity the most is selected as the implantation side so that if, for example, the human develops a motor disorder or the like, later in life, the implant could be utilized in accordance with the treatments detailed herein. Indeed, it could be that the implant forestalls or otherwise prevents the development of the motor disorder or otherwise prevents or forestalls the onset of symptoms of the motor disorder. And to be clear, it could be that the recipient has no motor disorder at the time of implantation or at the time that it is deemed utilitarian to provide the recipient with the implant, or at least the symptoms of such at that time. It is the possibility that the disorder could develop or otherwise symptoms could develop, even in the abstract, that serves as a basis for choosing the side of the human for implantation. This possibility can bebased on a statistical analysis that indicates that there is a given likelihood that the person will develop the motor disorder or otherwise the symptoms associated with the motor disorder. It could also be that there is no statistical basis to infer or otherwise indicate that the human recipient will experience a motor disorder ailment in his or her lifetime beyond general probabilities for a populace as a whole. But when given an agnostic choice as to what side of the recipient the implant should be positioned, the side that has the dopamine activity metrics that are inferior to the other side can be utilized as a control to determine which side the electrical stimulating device in general, and the electrodes thereof in particular, should be implanted.

[0285] In an exemplary embodiment, the human recipient has no more than a 1, 2, 3, 4, 5, 10, 15, 20, 25, 30, 35, 40, 45, or 50%, or any value or range of values therebetween in 1% increment greater chance than a cohort for his or her age and / or race and / or sex of developing a motor disorder at the time that method 2450 is executed. In an embodiment, there have been no symptoms of a motor disorder or a diagnosis of a motor disorder for at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, or 25 months, or any value or range of values therebetween in 1 day increments prior to the execution of method 2450. Thus, in some embodiments of method 2450 and 2460, the human does not suffer from a motor disorder (or at least a diagnosed disorder). In other embodiments, the human does suffer from a motor disorder / a diagnosed motor disorder.

[0286] Still, in some embodiments, the human suffers from bilateral vestibular disfunction (and is diagnosed as such), and the method is a treatment for such.

[0287] Consistent with a specific embodiment having utilitarian value herein, figure 24B presents an exemplary method, method 2460, that includes method action 2462, that includes obtaining data based on data indicative of respective basal ganglion cell dopamine receptor activity related to respective sides of a human, wherein viability of a vestibular implant treatment has been identified for the human, which includes, at least initially, implantation of the vestibular implant on only one side of the human. The method further includes action 2464, that includes identifying the side of the human for the vestibular implant to be implanted based on the obtained data. Thus, referring back to method 2450, it can be seen that in an exemplary embodiment, the action of method action 2452 is such that the data is indicative of respective dopamine receptor activity related to respective sides of the human, and in an exemplaryembodiment, the data is indicative of respective basal ganglion cell dopamine receptor activity related to respective sides of the human.

[0288] Continuing with the specifics of an exemplary embodiment, the obtained data can be indicative of a first side of the human having basal ganglion tissue that has inferior (or superior) dopamine receptor activity relative to basal ganglion tissue of a second side of the human opposite the first side. Also, in an embodiment, the action of identifying the side of the human includes identifying the side of the human for implantation that expectedly will improve dopamine receptor activity of the basal ganglion tissue of the first side (or the second side if the first side has the superior receptor activity) more than that which expectedly would be the case with implantation on an opposite side of the human.

[0289] In some embodiments, the action of identifying the side of the human is agnostic to issues beyond (i) basal ganglion cell dopamine receptor activity and / or (ii) basal ganglion cell dopamine receptor activity and cosmetics. In some embodiments, the basis for identifying the side of the human is totally based on the obtained data obtained in method actions 2452 or 2462 / based on nothing else. In an embodiment, the medical basis (as distinguished from, for example, a cosmetic basis or a vanity basis) for identifying the side of the human is based on the obtained data obtained in method actions 2452 or 2462. Corollary to all of this is that in an embodiment, the identified side is based on the side that has the best or worst dopamine characteristics.

[0290] In an embodiment, the methods herein further include implanting the implant, or at least the electrodes thereof, on the side that is identified.

[0291] Figure 25 provides another exemplary flowchart for an exemplary method, method 2500, which includes method action 2510, which includes the action of varying output of the motor disorder stimulation device applied to a human afflicted with a motor disorder. Some specifics of the variation of the output of the motor disorder stimulation device will be described below. Method 2500 further includes method action 2520, which includes the action of evaluating a reaction in the human resulting from the varying output. Method 2530 includes the action of setting control settings of the motor disorder stimulation device based on the evaluation.

[0292] In an exemplary embodiment of this exemplary method, the action of setting the control settings fits the device to a human. This can be analogous to fitting a cochlear implant to a human, etc. In an exemplary embodiment, the motor disorder relates to Parkinson’s disease andthe reaction is based on a reaction of basal ganglia tissue / biological matter on one sagittal side of the human.

[0293] In an exemplary embodiment, the motor disorder stimulation device is a unilateral stimulation device. Conversely, in another exemplary embodiment, the stimulation device is part of a bilateral stimulation device. In an embodiment, the set control settings provide electrical stimulation to a sagittal side of the human opposite the side of the basal ganglia tissue / biological matter. In an exemplary embodiment, the set control settings provide more electrical stimulation to a sagittal side of the human opposite the side of the basal ganglia tissue / biological matter then to the side of the basal ganglia tissue / biological matter.

[0294] In an exemplary embodiment, the reaction is a change in a symptom of the motor disorder. In an embodiment, the reaction is based on one or more of gait, speech, body tremor, limb tremor, hand tremor, and / or head movement. Eye movement and / or eyelid movement can also be a basis for the reaction. In an embodiment, the evaluation is based on objective measurements. In an embodiment, the evaluation is based on subjective measurements.

[0295] In an exemplary embodiment, the evaluation is performed by the recipient of the stimulation device. Thus, in an embodiment, method 2500 is a method of self fitting. That said, in an embodiment, the action of evaluating / method action 2520 is executed by a clinician or a healthcare professional.

[0296] Referring back to the feature where the reaction is based on reaction of basal ganglia tissue / biological matter on one side of the human, in an exemplary embodiment, activity in the basal ganglia can be measured / is measured as part of the method. As an aside, this can be a factor in determining what side to implant a unilateral stimulation device. But more particularly, in an exemplary embodiment associated with fitting the stimulation device, the activity in the basal ganglia can be monitored based on different stimulation types and / or regimes for fitting purposes such as in the trial and error phase of the fitting method to evaluate how the basal ganglia reacts two different stimulation types and / or regimes. Current level and / or frequency and / or phase or other features of the stimulation can be varied, thus varying the output of the stimulation device. Note also that in the instance of a bilateral system, stimulation from one side can be varied relative to stimulation from the other side so as to fit the bilateral system to the recipient.

[0297] An embodiment that can parallel the method 2500 can include utilizing a test system or the like to evaluate the effects of electrical stimulation pre-implantation. Here, it could be that test electrodes, such as, for example, trans tympanic probes, could be extended through the tympanic membrane, and placed against the outer wall of the inner ear, as close to the target tissue as possible. Stimulation could be provided to affect the reception of dopamine and / or the production of dopamine. Relatively high values of stimulation might be required because this is not a totally implanted device, or otherwise because the electrical current must travel further to reach the intended nerves and / or the other intended tissue. Still, such can be utilized to provide a decent gauge or otherwise an estimate of how the electrical stimulation will affect the reception and / or production of dopamine. Indeed, it could be that such provides very good evaluation owing to the dichotomy that stimulation on one side has the above-described effect on the other side of the sagittal plane. In this regard, at least some of the implementations detailed herein might not necessarily require an implanted device, but instead could be implemented utilizing trans tympanic probes for example, in any event, the method 2500 can be varied so that instead of an implanted device or otherwise a motor disorder stimulation device, the device that is utilized is a test device or a non-implantable stimulation device. The reaction in method action 2520 can be the reaction to dopamine reception and / or dopamine production, whether or not there is variation of output. Again, the goal here could be to simply gauge the effects of stimulation on dopamine production and / or reception.

[0298] FIG. 26 provides another exemplary flowchart for an exemplary method, method 2600, which includes method action 2610, which includes the action of outputting electrical energy from a motor disorder stimulation apparatus to tissue / biological matter of a human to reduce symptoms of a motor disorder of the human over different temporal periods. The number of different temporal periods can be 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100, 150, 200, 250, or 300 or more, or any value or range of values therebetween in one increments. The length of the respective temporal periods can be any of the periods of time detailed herein, and the lengths need not be the same and otherwise can be different from one or more or all of the temporal periods, all in the interest of textual economy. Method 2600 further includes method action 2620, which includes the action of respectively implementing different electrical energy output regimes, on which the respective outputted energy is based, of the motor disorder stimulation apparatus to prolong life of one ormore electrical contacts of the apparatus relative to that which would otherwise be the case. Recall above that it was noted that electrical stimulation has a corrosive effect on the electrodes. The application of electrical current from the electrodes erodes the electrodes. The electrodes of a vestibular stimulation device according to at least some of the exemplary embodiments detailed herein utilize relatively small electrodes, and, the number of electrodes are limited, this is compared to, for example, a cochlear implant electrode array. By way of example only and not by way of limitation, a stimulation device to stimulate the vestibular on one side may have no more than and / or equal to or less than 10, 9, 8, 7, 6, 5, 4, 3, 2, or 1 or any value or range of values therebetween in one increment electrodes (and the device on the opposite may be similarly constrained, and note that the number of electrodes need not be the same on both devices). Note that these values do not include the so-called return electrode or otherwise the common electrode. Also, in an exemplary embodiment, the outside area of the respective electrodes can have an area of less than and / or equal to 0.4, 0.35, 0.3, 0.25, 0.2, 0.15, 0.14, 0.13, 0.12, 0.11, 0.10, 0.09, 0.08, 0.07, 0.06, 0.05, 0.04, 0.03, 0.02 or 0.01 mm2or any value or range of values therebetween in 0.005 mm2increments. Embodiments utilize relatively small and thin electrodes relative to for example the cochlear implant electrode arrays that are commercially available on February 21, 2024, in the United States of America, European Union, the People’s Republic of China, etc. or otherwise which are licensed and permitted by the respective regulatory agencies of those jurisdictions. Consistent with the teachings above, there is utilitarian value with respect to limiting the amount of current that is applied by a given electrode while still achieving utilitarian value of the medical device for the purposes of treating symptoms of motor control, etc. The idea is to prolong electrode life relative to that which would otherwise be the case in the absence of the teachings detailed herein.

[0299] The greater the current density the greater the dissolution of the electrode, and vice versa, all other things being equal.

[0300] Embodiments include cycling the electrodes / using a given electrode only some of the time and then utilizing another electrode during the other times, and so on. If there are three electrodes on a stimulation device on one side of the recipient, embodiments include splitting the current density about equally between those three electrodes. This can be done with respect to time on in time for a given electrode for example and / or with respect to evaluating the total amount of current that is applied to a given electrode. The temporal basis would likely be easierto implement, because that would not require current monitoring and / or current logging, but the latter might yield more accurate results, because the exact value or a true value of current delivered will be available as opposed to an estimate or a proxy based on time, or otherwise utilizing time of energized and of the given electrode as a latent variable for current density and / or for dissolution status.

[0301] In any event, returning back to method 2600, in an exemplary embodiment, the apparatus includes at least a first electrical contact and a second electrical contact and the action of implementing different regimes includes varying enablement of the first contact and the second contact for output of the electrical energy for the different temporal periods. That is, the first contact would be available for current delivery during some periods and then the first contact would not during others, and in an exemplary embodiment, the second contact would be available during the periods or at least some of the periods where the first contact was not available. In an exemplary embodiment, the apparatus is a bilateral stimulation apparatus and the first contact is a right side contact and the second contact is a left side contact.

[0302] It is briefly noted that in the interest of textual economy, the numbers of contacts can be multiplied by 2, 3, 4, 5, 6, 7, 8, 9 or 10 or more or any value or range of values therebetween in one increments and the methods can be adapted accordingly, with the idea being that the enablement times are roughly equal for all of the contacts, or at least within five or 10 or 15 or 20 or 30% or any value or range of values therebetween in 1% increments.

[0303] In an embodiment, the different regimes result in different current densities for respective contacts of the apparatus. In an exemplary embodiment, the different current regimes result in similar current densities for respective contacts of the apparatus.

[0304] Again where the apparatus is a bilateral stimulation apparatus, the different regimes vary respective current densities of respective sides of the apparatus.

[0305] In an embodiment, the motor disorder manifests symptoms on both sagittal sides of the human, the stimulation to one sagittal side effects symptoms on both sides, but more so on one side than the other and the different output regimes vary stimulation output on respective sides so stimulation output on a given side is reduced relative to a more efficacious output for that side.

[0306] Again where the apparatus is a bilateral stimulation apparatus, in an exemplary embodiment, the motor disorder manifests symptoms on both sagittal sides of the human and the stimulation to one sagittal side effects symptoms on both sides, but more so on one side than the other. In an embodiment, the different output regimes alternately suspend output on respective sides even though output would produce more efficacious output for the suspended sides.

[0307] In an embodiment, a first output regime is a stead state regime and the second output regime is a ramp down regime. In this regard, it is noted that there is a hysteresis effect for example, or otherwise a period of residual effect that results from the stimulation. In this regard, one or more of the reactions detailed herein will be present after stimulation is halted. This may be present for varying lengths of time depending on the person and other conditions. And the “magnitude” of the reaction may be different during those periods of time.

[0308] By way of example only and not by way of limitation, the ability of the basal ganglia tissue / biological matter to accept dopamine after stimulation is stopped may be stronger in some people than in others after a certain period of time has elapsed since the time that the stimulation has halted. It could drop off very quickly to an almost negligible level in some but not in others. It could be that the ability to accept dopamine remains at an acceptable level for a relatively lengthy period of time after stimulation is halted. Of course, in at least some scenarios, the ability will decrease over time since the cessation of stimulation. Embodiments take all of this into account to determine how much stimulation should be provided to provide an efficacious treatment of the symptoms of the motor disorder with the goal of limiting the amount of current provided through one or more of the electrodes or otherwise reducing the current density or otherwise limiting the current density.

[0309] By way of example only and not by way of limitation, if it is known that say the ability to accept dopamine remains at an acceptable level or an efficacious level for a half-hour after stimulation is halted, where previously stimulation was applied for one hour, the stimulation regime could be to stimulate for one hour and then halt stimulation for a half-hour, and so on. The stimulation would provide a boost to the receptors to keep the receptors at an acceptable performance level or otherwise a desired performance level, which performance level corresponds to an efficacious treatment of the symptoms or otherwise a desired treatment of the symptoms.

[0310] Still with reference to a bilateral system, as seen above, there is some “crosstalk” between the stimulation applied on one side and the effect on the basal ganglia tissue / biological matter on both sides. This crosstalk can be leveraged to manage the stimulation regimes of both stimulators of a bilateral system. And in this regard, it is possible that one side stimulation can be utilized to affect basal ganglia tissue / biological matter on both sides of the sagittal plane, albeit that the one side stimulation will affect one side more than the other. And here, the stimulators can be coordinated so that they do not stimulate at the same time, or at least not always, or otherwise there are times when only one stimulates and then the other stimulates. All of this in an effort to, for example, prolong the life of the electrodes.

[0311] Also, as noted above, the stimulation regimes can include ramp down regimes. The stimulation regimes can include ramp up regimes. Here, the idea is that a stimulator need not operate at full power or otherwise output current at the highest level possible, or even at a standard average level. Instead, as one stimulator ramps down, the other stimulator can ramp up. By way of example only and not by way of limitation, the amount of current that is output by one of the stimulators can increase during a temporal period while the amount of current that is output by the other stimulator can decrease during a temporal period. By coordinating the ramp ups and ramp downs, the electrode lies can be prolonged while still providing efficacious treatment or otherwise achieving efficacious treatment.

[0312] In this regard, embodiments can focus on achieving a constant effect as opposed to a constant amount of charge provided to the human. In an embodiment, the effect can be analogous to a heating system of a house that maintains a temperature therein. The temperature is set at a certain value, but in reality, the heater is activated when the temperature falls to a certain level, and that is deactivated when the temperature reaches a higher level. The same concept can be applied here, except that a goal is to maintain the ability of the basal ganglia tissue / biological matter to accept dopamine within a certain range. The goal can also be to reduce a severity of the symptoms to an acceptable level and otherwise keep the symptoms within or otherwise below that acceptable level.

[0313] Thus, embodiments include implementing different electrical energy output regimes that take into account residual effects of stimulation, recognizing that even after stimulation is halted or after stimulation is reduced, the results of the simulation are still present in the basal gangliatissue / biological matter, if only in reduced amounts, for certain periods of time, which fact pattern allows for reduced amounts of electrical stimulation while still achieving efficacious results relative to that which would otherwise be the case, all things being equal. All of this can have utilitarian effect of prolonging the life of the electrode contacts.

[0314] In an exemplary embodiment, again where the apparatus is a bilateral stimulation apparatus, the action of implementing different electrical energy output regimes includes implementing a regime that ramps up stimulation on one side and a implementing a regime that ramps down stimulation on the opposite side. This can happen during the same temporal period and / or can happen during different temporal.

[0315] In an exemplary embodiment, the action of implementing the regimes includes implementing the ramp up regime for stimulation on one side while implementing in a coordinated manner the ramp down regime for stimulation on the opposite side. Further, the action of implementing different electrical energy output regimes can include implementing a first stimulation regime on one side and a implementing a second stimulation regime different from the first on the opposite side while providing an apparent constant effect on reducing the symptoms of the motor disorder. It is apparent to the recipient of the bilateral stimulation apparatus and / or a healthcare professional for example. Of course the concept of concept constant is not an absolute. This is presented in terms of the concept of a person who constantly feels fine over a period of five days, even though the person might have some gas or might stub his or her toe, etc.

[0316] Consistent with the teachings above, in an exemplary embodiment, the apparatus includes at least a first electrical contact and a second electrical contact, the apparatus is a bilateral stimulation apparatus, the first contact is a right side contact and the second contact is a left side contact and the action of implementing different regimes includes implementing a regime that cycles between the first contact and the second contact for output of the electrical energy for the different temporal periods. And again, there can be three or four or five or six contacts or more, etc., and the cycling can go through each of the contacts or some of the contacts and not others.

[0317] In an exemplary embodiment, the apparatus includes at least a first electrical contact and a second electrical contact located on one sagittal side of the human and the action of implementing different regimes includes implementing a regime that cycles between the firstcontact and the second contact for output of the electrical energy for the different temporal periods.

[0318] Again returning to an embodiment where the apparatus is a bilateral stimulation apparatus, in an exemplary scenario, the motor disorder manifests symptoms on both sagittal sides of the human and stimulation to one sagittal side effects basal ganglia tissue / biological matter on both sides, but more so on the side opposite the stimulation side than the other. In an embodiment, the different output regimes vary stimulation output on respective sides so stimulation output on a given side is reduced relative to a more efficacious output for that side. In an embodiment, the different output regimes alternately suspend output on respective sides even though output would produce more efficacious output for the suspended sides.

[0319] As noted above, a bilateral apparatus will include a plurality of electrical contacts, any unilateral apparatus may include two or more contacts (there could be two or more contacts on each side in a bilateral apparatus). Either way, in an exemplary embodiment, the action of implementing different regimes includes a halting regime that halts output from all of the plurality of contacts and the method includes relying on a residual effect of stimulation that occurred during a stimulation regime executed prior to the period of implementation of the hating regime. The period of reliance on the residual effect can be a period that is less than greater than and / or equal to 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100, 110, 120, 125, 150, 175, 200, 250, 300, 350 or 400% or more or any value or range of values therebetween in 1% increments of the period of stimulation immediately preceding the period of reliance. The higher values could be an extreme occurrence, but such could exist in some exemplary embodiments. Thus, in an exemplary embodiment, the different regimes are unique to the human relative to another human who has a comparable stimulation apparatus and comparable motor disorder.

[0320] Still, in an exemplary embodiment, the implementation of the different regimes can be based on a severity of the symptoms during various temporal periods. If a person is experiencing severe symptoms, it is less likely or potentially just not going to come to fruition that the electrode longevity actions will be undertaking during such a period. Conversely, if the symptoms are minimal or nonexistent, a more aggressive electrode longevity regime might be implemented.

[0321] In an exemplary embodiment, one of the regimes includes an apparatus prolonging regime and another regime includes an efficacy increasing regime and the action of implementing the different regimes includes switching to the efficacy increasing regime upon an increase of severity of the symptoms during a temporal period in which the prolonging regime is being implemented. In an exemplary embodiment, the severity of the symptoms can be reported by the human, while in other embodiments, the severity of the symptoms can be detected utilizing the sensors detailed herein.

[0322] By way of example only and not by way of limitation, one of the regimes includes an apparatus prolonging regime and another regime includes an efficacy increasing regime and the action of implementing the different regimes includes switching to the prolonging regime upon a decrease in severity of the symptoms during a temporal period in which the efficacy increasing regime is being implemented. This can be done automatically or manually. This can be done automatically based on input from the recipient. Accordingly, in some embodiments, the action of implementing is executed automatically based on detected symptoms and / or the absence of detected symptoms. In an exemplary embodiment of method 2600, one of the output regimes is an output halting regime and suspension of an enacted output halting regime is executed based on when after implementation of the halting regime one or more symptoms return and / or increase in magnitude to a certain level. Accordingly, the trigger for changing regimes occurs with respect to an actual return or increase of symptoms. Conversely, in an alternate embodiment, or in addition to this, the trigger for changing regimes could be temporal based. In this regard, a sufficient amount of data could be compiled to “know” the recipient, or otherwise forecast with reasonable accuracy how long it will take from the cessation of stimulation or otherwise a significant reduction in stimulation for symptoms to return or otherwise rise to a level that is unacceptable. Accordingly, a set time could be utilized to transition between the regimes. That said, a blend of this can be implemented. For example, if the recipient is having a bad day or otherwise experiencing more symptoms or relatively a higher amount or severity of symptoms, shorter time periods for halting stimulation can be utilized. Conversely, if the recipient is having an otherwise good day, or otherwise experiencing fewer symptoms are relatively lower amount or severity of symptoms, longer times for halting stimulation can be utilized. Thus, in an exemplary embodiment, again where one of the output regimes is an output halting regime, suspension of an enacted output halting regime is automatically executed basedon how long after implementation of the halting regime one or more symptoms return and / or increase in magnitude to a certain level, wherein the return and / or increase in magnitude is automatically detected.

[0323] Still, as noted above, much of this can be personalized for a specific human, or otherwise developed for that particular person. Accordingly, in an exemplary embodiment of method 2600 can further include developing a personalized overall regime implementing the various different output regimes personalized to the human.

[0324] Below is an exemplary chart showing the application of stimulation represented by On and the non-application of stimulation represented by Off for an exemplary method for the left and right vestibular implants (left on left side, and right on right side):On OffOff OnOn OffOn Ramp DownOn OffRamp Down Ramp UPOff OnRamp Up OnOn OnOff Ramp DownOff OffRamp Up OffOn OnOff OffRamp Up Ramp UpOn OnRamp Down Ramp DownOff OffOn OffOn Ramp upRamp Up OnOn Ramp DownRamp Down OffOff Ramp UpOff OnRamp Up OnOn OnRamp Down OnOff OnOff Ramp DownRamp up OffOn Ramp UpOn OnRamp Down Ramp DownOff OffRamp Up Ramp UpOn Off

[0325] It is noted that in an exemplary method, the method could end after any one or more of the periods just detailed. And for the purposes of textual economy, the reverse could be applied for the left and right stimulators.

[0326] In view of the above, it can be seen that stimulation can be ultimately provided by the two devices. The devices can be ramped up and ramp down at the same time ordering different intervals. Both can be ramped up at the same time and both can be ramped down at the same time and one can be ramped up while the other is ramp down, etc. The ramping (up or down can be executed simultaneously or during nonoverlapping periods.

[0327] Note that the time periods need not be the same length. Any of those detailed herein can be applicable to any of the periods detailed above.

[0328] Note that any of the two pairs of states can be moved anywhere else in at least some exemplary embodiments. In at least some exemplary embodiments, this depends on the particular recipient, etc.

[0329] Still, in particular, it is noted that the ramping periods will likely occur during the periods of residual benefit. In this regard, it is envisioned that the ramp-up periods will occur at times where the residual benefit is starting to wane, and the ramp-down periods will occur at the beginning of the residual benefit period, or will indicate the beginning of such period.

[0330] Still with respect to providing an extended longevity of the device in the short term and / or the long term, in an exemplary embodiment, there is a system, comprising at least one implantable electrode and circuitry to variably apply current to the at least one implantable electrode. This can correspond to any of the devices detailed herein unless otherwise noted, or otherwise excluded by the following. Thus, in this exemplary embodiment, the system is a vestibular stimulation system, and the system is configured to control the current applied to the at least one implantable electrode to prolong a short term and / or long term longevity of the system relative to that which would otherwise be the case. With respect to the short-term, this could be the battery life, whether the battery is in the external component or it is an implanted battery, such as in the case of a totally implantable system. With respect to the latter, this can correspond to extending the life of the electrodes.

[0331] In an exemplary embodiment, the teachings detailed herein can extend the short-term and / or long term longevity of the system or component of the system (one side stimulator vs. both or a batter for one side as opposed to the other) by at least and / or equal to 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100, 125, 150, 200, 250, 300, 350, 400, 450, 500, 600, 700 or 800 or more percent or any value or range of values therebetween in 1% increments relative to that which would otherwise be the case, all other things being equal, and note that the values for the shortterm need not be the same as the long term, as this is presented for purposes of textual economy.

[0332] In an exemplary embodiment, the system is configured to control the current applied to the at least one implantable electrode to prolong a long term longevity of the system relative to that which would otherwise be the case. This has been described above, but briefly, this can entail halting current flow or utilizing the ramp up and / or ramp down regimes as detailed herein. This can also entail limiting a ceiling on the current provided to the implantable electrode.

[0333] It is briefly noted that the temporal periods for ramp up and ramp down can be any of those detailed herein by way of textual economy. That said, in at least some exemplary embodiments, the ramp up period will be shorter than the ramp down period and visa-versa insome other embodiments. In an exemplary embodiment, the ramp-up period is 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100, 125, 150, 200, 250, 300, 350, 400, 450, 500, 600, 700 or 800 or more percent or any value or range of values therebetween in 1% increments of the ramp down period, and vice versa in other embodiments. Again, the length of time of the given stimulation regime will be based on the efficacious results thereof for a given individual. In these results will vary, and thus the time will vary.

[0334] In an exemplary embodiment, stimulation output will be at a constant current outside of the ramp-up and / or ramp down periods. That said, the current can be constant during those temporal periods, but the duty cycle could be varied for ramp-up and / or ramp down purposes. Returning back to the constant current concept, in an embodiment, a binary regime can exist where when the stimulator is in a steady state, the stimulation current is applied in one manner and one manner only and then outside of the ramp-up and ramp down regimes, the stimulator does not output current. This is but one embodiment and in alternate embodiments this can be different.

[0335] In an exemplary embodiment, the system is configured to control the current applied to the at least one implantable electrode to prolong a longevity of the electrode relative to that which would otherwise be the case. Conversely, again, with respect to the short-term, the system is configured to control the current applied to the at least one implantable electrode to prolong a longevity of a battery supply relative to that which would otherwise be the case. This can have utilitarian value with respect to a scenario where a battery is not charged or otherwise has not been sufficiently charged or where the battery has been depleted at least partially owing to heavy use of the system. This can provide a middle ground with respect to prolonging the longevity of the system while balancing the efficacy of the system. There could be utilitarian value with respect to having the recipient to experience moderate symptoms over a longer period of time as opposed to experiencing minor symptoms over a first period of time and then experiencing severe symptoms at a second period of time, which could render the person helpless or otherwise debilitate the person. Accordingly, teachings detailed herein include methods of evaluating the power capacity of the system to determine how to manage output so as to balance short-term needs with respect to long-term needs (relative to the battery).

[0336] Referring back to the teachings above, in an exemplary embodiment, the system is a bilateral stimulation system and the system is configured to alternately enable and / or disable stimulation channels of the system, and thus control the current applied to the at least one electrode, to prolong a short term and / or long term longevity of the system relative to that which would otherwise be the case. This can be the on off regimes detailed above, which can have utilitarian value with respect to both of the longevity terms.

[0337] In an exemplary embodiment, such as where the system is a bilateral stimulation system, the system is configured to vary respective sagittal side current density and thus control the current applied to the at least one electrode, to prolong a short term and / or long term longevity of the system relative to that which would otherwise be the case. Also, by way of example, the system is configured to control the current applied to the at least one implantable electrode to reduce a corrosive effect on the electrode relative to that which would otherwise be the case.

[0338] Irrespective of whether or not the system is a bilateral system or a unilateral system, in an exemplary embodiment, the system includes a plurality of implanted stimulating electrode contacts and the system is configured to cycle through respective contacts of the plurality of electrode contacts to prolong a long term longevity of the system relative to that which would otherwise be the case. In an embodiment, the cycling is equal, or more accurately, the amount of time that a given electrode is in the cycle is roughly equal to the amount of time that another electrode is in the cycle. In an exemplary embodiment, the cycling time for one or more or all of the electrodes or any of the number of electrodes identified herein is within 20, 19, 18, 17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6, 5, 4, 3, 2 or 1 % or any value or range of values therebetween in 0.1% increments of the lowest time of cycling from one electrode.

[0339] In an embodiment, the contact has a surface area of less than 0.3 mm2or less than 0.2 mm2or less than 0.1 mm2or less than 0.05 mm2. The surface area of the contact can have any of the service areas detailed herein or otherwise can be less than any of the surface areas detailed herein.

[0340] And as noted above, such as where systems are a bilateral stimulation system, the system is a bilateral stimulation system, the system is configured to ramp up and ramp down stimulation on respective sides to vary the current density on those respective sides. The ramp up and ramp down regimes can be any of those detailed herein.

[0341] It is briefly noted that the residual time / the period of residual benefit can extend for potentially minutes or hours after completion of the ramp down time and / or after stimulation is halted. The period of the residual time may or may not be dependent on the period of stimulation time. This can be subjected to a given human. This also can be based on the amount of current that was applied. By way of example. If the current flow was high over a short period of time, the residual period might be the same as if the current was lower but over a longer period of time. The manner in which the current is provided can also influence the residual benefit period.

[0342] In an exemplary embodiment, the stimulation time can be X and the residual benefit time can be less than greater than and / or equal to 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3, 3.5, 4, 4.5, 5, 5.5 or 6 times X or any value or range of values therebetween in 0.01 increments. For the purposes of textual economy, X can be any of the temporal periods detailed herein.

[0343] Figure 27 presents an exemplary flowchart for an exemplary method, method 2700, which includes method action 2710, which includes the action of applying electrical stimulation to a head of the human. This can be done in accordance to any of the teachings detailed herein. Method 2700 also includes method action 2720, which includes the action of subsequent to the action of applying electrical stimulation in method action 2710, halting the application of stimulation. In an exemplary embodiment of this exemplary embodiment, the action of applying and halting the stimulation are very so executed over a temporal period, which period can correspond to any of the more lengthy temporal periods detailed herein. By way of example only and not by way of limitation, the period is at least and / or equal to 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 130, 140, 150, 200, 250 or 300 weeks or months or any value or range of values therebetween in one day increments.

[0344] In this exemplary embodiment, the action of applying the stimulation at least one of (i) temporally delays a commencement of a therapeutic substance treatment associated with a disorder in a head of the human beyond that which would otherwise be normally recommended for that person, all other things being equal or (ii) prolongs survival of tissue / biological matterin the head and / or prolongs dopamine transport in motor-related brain areas relative to that which would otherwise be the case, all other things being equal.

[0345] By way of example only and not by way of limitation, a treatment for the symptoms of Parkinson’s disease can be the application of levodopa. And here, that is the exemplary therapeutic substance according to this method. The problem is that there is only so much the human being can tolerate, and over time, a human being develops resistance to the treatment. The point is, there is utilitarian value with respect to delaying the point in time where treatment with that therapeutic substance begins, and there will be a point in time where treatment with that therapeutic substance can no longer be implemented or otherwise there will be little to no efficacy with respect to the treatment. In an embodiment, the stimulation could delay the start of levodopa treatment by stimulating dopamine production / receptor efficiency and by the same mechanism could delay the loss of efficiency (in the event where electrical stimulation is started before and continues during Levodopa treatment).

[0346] In an exemplary embodiment, the stimulation techniques detailed herein can delay the point in time where a treatment involving that therapeutic substance begins. Corollary to this is that the stimulation techniques detailed herein can delay the point in time where the treatment utilizing that therapeutic substance no longer works or otherwise cannot be implemented.

[0347] In an embodiment, the stimulation techniques detailed herein prolongs the efficacy of that therapeutic substance longer than that which would otherwise be the case.

[0348] In an embodiment, the action of applying the stimulation temporally delays a point where the therapeutic substance treatment will likely become ineffective, all other things being equal.

[0349] Note that in an embodiment, any one or more or all of the occurrences can occur in a given method.

[0350] Cochlear embodiment, by way of example only and not by way of limitation, the action of applying the stimulation delays the commencement of the therapeutic substance treatment by at least and / or equal to 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3, 3.5, 4, 4.5, 5, 5.5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 30, 35, 40, 45, 50, 55 or 60 times or any value or range of values therebetween in 0.1 increments. In an exemplary embodiment, the stimulationprolongs dopamine transport in motor-related brain areas relative to that which would otherwise be the case by any of the aforementioned time periods just detailed for the delay of commencement of the therapy, by way of textual economy. In an exemplary embodiment, stimulation delays the point where the therapeutic substance treatment will likely become ineffective by any of the affirmation time periods just detailed by way of textual economy, all other things being equal. And it is noted that the results need not be the same. These values are presented for purposes of textual economy. The date of commencement could be prolonged by time period of 33 times that which would have otherwise been the case, and the date that the therapy becomes ineffective could be prolonged by a time period of 7.5 times that which would otherwise have been the case, etc. And note that these values are presented with respect to whether or not the stimulation therapy was utilized. For example, the ineffective date could be prolonged relative to the commencement date, or the ineffective date could be the absolute date as measured against that which would have otherwise been the case.

[0351] In an exemplary embodiment, the therapeutic substance treatment is a treatment to manage motor deficiency symptoms. By way of example, such symptoms can be the symptoms of Parkinson’s disease.

[0352] In an embodiment, there is a method, comprising treating symptoms of a motor disorder by (i) applying electrical stimulation to a part of a head of a human and (ii) providing a therapeutic substance to the human. In this embodiment, the application of electrical stimulation affects function in the head of the human, which function is needed at least in part for the therapeutic substance to have efficacy. In an embodiment, the function is dopamine transport in motor-related brain areas. In an embodiment, the transport is needed at least in part for the therapeutic substance to have efficacy. In an embodiment, the stimulation affects tissue / biological matter of the head, such as the basal ganglia tissue / biological matter.

[0353] Concomitant with the teachings above, the electrical stimulation delays and / or slows deterioration of the function. In an embodiment the electrical stimulation prolongs efficacy of the therapeutic substance.

[0354] In an embodiment, the application of stimulation adjusts a number of receptors of dopamine. In an embodiment, the adjustment is an increase. In an embodiment, the increase is greater than and / or equal to 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70,80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 325, 350, 375, 400, 450, 500, 600, 700, 800, 900, 1000, 1250, 1500, 1750 or 2000% or any value or range of values therebetween in 0.1% increments, all other things being equal. In an embodiment, the application of stimulation activates and / or stimulates dopaminergic synapses. In an embodiment, this adjusts the synapse. In an embodiment, this increases the synapse by any of the just noted percentages for purposes of textual economy.

[0355] In an embodiment, the application of stimulation adjusts an ability of dopamine receptors to accept dopamine. In an embodiment, the application of stimulation increases an ability of dopamine receptors to accept dopamine. In an exemplary embodiment, the increase again can be any of the just noted percentages presented for purposes of textual economy. In an embodiment, the action of applying electrical stimulation begins and occurs over at least one month prior to the providing of the therapeutic substance. In an embodiment, the action of applying electrical stimulation begins and occurs over any one or more of the temporal periods detailed herein prior to providing the therapeutic substance, again by way of textual economy. In an embodiment, the action of applying electrical stimulation begins and occurs over at least six months prior to the providing of the therapeutic substance, although in an exemplary embodiment, this can be any of the temporal periods detailed herein. In an embodiment, the action of applying electrical stimulation begins and occurs over at least 18 months prior to the providing of the therapeutic substance, but again, this can be any of the temporal periods detailed herein is of textual economy. In an embodiment, the action of applying electrical stimulation begins and occurs over at least six months prior to the providing of the therapeutic substance and overlaps for at least six months with the providing of the therapeutic substance, but there again, these can be any of the temporal values detailed herein.

[0356] In an embodiment, the action of providing a therapeutic substance occurs over a first temporal period corresponding to a period where the therapeutic substance has efficacy and the first temporal period is longer due to the application of the electrical stimulation than that which would otherwise be the case, all other things being equal. The length of time that it is longer can be any of those periods detailed herein. Thus, in an embodiment, the first temporal period is at least 30% longer than that which would otherwise be the case, all other things being equal.

[0357] In an embodiment, the first temporal period is at least 100% longer than that which would otherwise be the case, all other things being equal. In an embodiment, the part of the head is an inner ear of the human and the function is associated with the basal ganglia tissue / biological matter.

[0358] In an embodiment, the therapeutic substance is a substance that crosses a blood-brain barrier. Consistent with the Parkinson’s disease related treatment, the therapeutic substance adjusts dopamine reception relative to that which would otherwise be the case in the absence of the therapeutic substance, all other things being equal. In an embodiment, the dopamine reception is increased. In an embodiment, the increase is at greater than and / or equal to 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 325, 350, 375, 400, 450, 500, 600, 700, 800, 900, 1000, 1250, 1500, 1750 or 2000% or any value or range of values therebetween in 0.1% increments, all other things being equal.

[0359] Of course, consistent with the teachings above, the method is implemented to delay a date of a beginning of the providing of therapeutic substance. Corollary to this is that the method is implemented to meaningfully delay a date of a beginning of the providing of therapeutic substance.

[0360] In an embodiment, the method is implemented to meaningfully delay a date of cessation of efficacy of therapeutic substance relative to that which would otherwise be the case, all other things being equal and / or the method delays a date of cessation of efficacy of therapeutic substance by at least 6 months relative to that which would otherwise be the case, all other things being equal, or any of the temporal periods detailed herein.

[0361] It is briefly noted that some diseases and / or symptoms, such as those detailed herein by way of example, respond favorably (with respect to the goal of treatment) to increase(s) in / of dopamine production and / or an improvement (increase) in receptor activity of receptors of dopamine. Conversely, other diseases can respond favorably to decreases in dopamine production and / or inhibiting or otherwise delaying or otherwise retarding the production and / or reception of dopamine / retarding dopamine receptors relative to that which would otherwise be the case. With respect to the latter, for example, it can be that in some scenarios, the symptoms that are desired to be suppressed or eliminated or otherwise reduced and / or the underlyingdisease which is desired to be controlled and / or eliminated, can be suppressed or eliminated or otherwise reduced or otherwise controlled by way of decreasing and / or retarding, etc., the production of dopamine and / or the reception of dopamine. Embodiments thus include treating any one or more diseases in accordance with at least some of the pertinent teachings detailed herein by adjusting dopamine receptor activity and / or the production of dopamine as would be utilitarian to treat the disease and / or to treat a given symptom associated with that disease.

[0362] With respect to diseases and symptoms that respond favorably to decreases in dopamine production and / or receptor activity, it can be that excess dopamine can have side effects. It is believed that excess dopamine in the brain may contribute to the development of the disorder known as schizophrenia. Anxiety and / or paranoia and / or delusions / hallucinations, could exist or otherwise be a side effect of excess dopamine.

[0363]

[0364] In an embodiment, the vestibular implant electrodes can be operatively placed within the labyrinth while preserving vestibular function / sensitivity, but providing robust electrical stimulation of the vestibular periphery. That said, in an embodiment, stimulation is provided to the saccule, otolith and / or the vestibular nerve. In an embodiment, the tissue / biological matter stimulated is the vestibular nerve via the vestibular space and its components including saccule, utricule, etc. Also, stimulation can be applied to the semi-circular canals and / or otoliths. Stimulation can be applied to any location having utilitarian value. Any reference to stimulation to one location / tissue / biological matter corresponds to an alternate disclosure of stimulating or applying stimulation to any one or more or all of the other tissue / biological matter s or anatomical structures detailed herein providing that the art enables such, unless otherwise noted.

[0365] Each array of the vestibular implant can have a sufficient number of electrodes to permit both monopolar and bipolar stimulation or tripolar or multipolar, as well as to provide sufficient redundancy in the event of individual electrode failure. A suitable reference electrode can also be provided as a return path for monopolar stimulation.

[0366] Some embodiments include implantation away from the ampulla of the lateral canal.

[0367] Embodiments can include electrode placement near the ampullae of the semicircular canals for activation of the vestibular system.

[0368] Embodiments include devices and systems that, and methods of, relying, at least in part, on the physical phenomenon identified herein as residual inhibition and concepts that would be corollary there to, even if not based on such. In this regard, with respect to residual inhibition, the electrical stimulation provided to the tissue of the human to manage or otherwise treat the ailments herein or otherwise affect a result in the human, can have prompt effects, but also have residual effects. Here, we will discuss the concept of residual inhibition associated with tinnitus as a straightforward example. It is noted that the residual effects can also be applicable for the treatment of other diseases or otherwise other ailments, such as, for example, motor disorders and / or balance disorders, etc. In this regard, the teachings detailed herein associated with one corresponds to an alternate disclosure associated with those teachings for the other, in the interest of textual economy, providing that the art enables such, unless otherwise noted.

[0369] In some embodiments, the stimuli outputted by a tinnitus treatment device or a motor disorder treatment device or a balance device can be provided continuously without variation (with respect to the continuity and / or all aspects (amplitude, base frequency, pulse width, etc.) and / or can be discontinuous (at temporally different times than any continuously provided stimuli). The discontinuation of providing of stimuli can be based on environmental conditions, such as, for example, if the sound input from the environment is already providing the relief, or if the light environment is sufficient that an imbalance situation is less likely to result, etc., stimulus can be halted or not even started. If prior sound in the ambient environment has reduced its tinnitus by a desired amount, whatever amount that is, there can be utilitarian value in stopping or otherwise halting further stimulation and / or not starting stimulation, at least if the tinnitus does not return in a relatively quick manner or otherwise in a time period that is deemed unacceptable to the human. Put another way, a regime where stimulation is provided discontinuously can be implemented where the stimulation has an effect of reducing the tinnitus. If the human indicates that the tinnitus is gone, the stimulation would be halted. This indication could be provided by way of example into a remote device such as a smart phone or smart device that is in communication with the other components of the system. Conversely, in some instances, it is that the testing develops data indicating that after a certain amount of time or otherwise after a certain amount of stimulation or otherwise after certain actions are taken utilizing the treatment detailed herein, the tinnitus is reduced to an acceptable level, or the symptoms of the motor disorder are reduced to an acceptable level, which can includecompletely eliminated, at least with respect to perception, and thus the system can be “programmed” to act on that data. And in an alternate embodiment, it could be that the system is not programmed for example or otherwise control settings, etc., are not developed based on this data. Instead, a treatment regime is prescribed or otherwise developed that takes into account the concept of residual inhibition. More on this below.

[0370] In an embodiment, there is at least and / or equal to 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, or 34, or any value or range of values therebetween in 1 increment distinct settings that are developed, that have different stimulation frequency regimes. In an embodiment, there are method actions that include storing any number or ranges of numbers of the aforementioned settings in or otherwise setting the settings of the treatment device so that in use, the device will utilize those settings to treat the ailment / symptoms. These could be stored in the device proper, or a remote device (e.g., a smart phone) or be located on a remote server and accessed via the internet, etc., or could be on a personal computer and accessed via Bluetooth, etc. And note that there could be submaps or sub setting groups that can be ultimately used and not used and / or switched out for others that may be utilitarian. This substitution could be automatic or manual. Note also that there could be different maps and / or setting groups, etc., for severity of the symptoms. For example, one map could be used if tinnitus or shaking is severe and the other map could be used if tinnitus or shaking is less severe, for example.

[0371] Embodiments include developing duration time periods from data developed during tests based evaluating residual effects for a given recipient.

[0372] Note in an embodiment, the development of duration data and / or frequency data can be extrapolated from the expected residual symptom suppression for that particular person. Indeed, an embodiment includes developing an expected residual inhibition data set or forecast or otherwise expectation based on the test data / screening data. In an embodiment, this expected residual inhibition data can be utilized to develop a map or otherwise to fit the prosthesis to the recipient. In other embodiments, this can be utilized to develop the therapy regime / instructions for the recipient.

[0373] Also, in an exemplary embodiment, the teachings herein are directed towards providing stimulation in a continuous manner. This is the opposite of how a cochlear implant typicallyworks, where there is no stimulation in the event of the recipient being located in an area where there is no sound, or at least the sound is below that which would be deemed utilitarian to evoke a hearing percept based thereon, and the device can be configured to do so (which could entail bypassing certain features or purposely triggering a feature, such as with a standard artificial sound input, such as from a noise generator or tone generator).

[0374] Embodiments include developing a prescription for stimulation frequency. Methods include developing a tinnitus therapy prescription or a motor disorder prescription or a balance treatment prescription for the human. The phrase prescription is utilized herein in a manner that describes actions to be taken by the human who suffers from the ailment with or without additional instructions or guidance from a healthcare professional. This can also describe actions that require additional input from a healthcare professional.

[0375] In an embodiment, the prescription can include the duration and / or frequency of use, time of use, etc., of the stimulation to be applied by the stimulation device. Note that these parameters can be set for the beginning and / or the end of the use. And by beginning of use, it is meant the commencement of the continuous stimulation, and by the end of use it is meant the discontinuity of the stimulation.

[0376] The prescription can have any of the use profiles or treatment profiles or settings or parameters detailed herein, such as those detailed above or below that are based on the testing, whether such as for the initial screening or specific testing beyond screening or unrelated to screening.

[0377] In an embodiment, the prescription can be for a device that is an implantable device or a non-implantable device. The prescription can include any one or more of the map settings for example as detailed herein, to be utilized with a given device.

[0378] In an embodiment, the prescription provides for residual inhibition implementation utilizing the device. In this regard, as noted above, it can be that the recipient might experience residual inhibition of a symptom / continued benefits after stimulation is discontinued. By way of example only, the duration of stimulation and / or the timing of the commencement of stimulation could be identified for the prescription based on the recognition of the temporal periods of the residual inhibition that should result for the particular recipient. This as opposed to a prescription that does not take into account or otherwise does not provide for residualinhibition implementation utilizing the device. A prescription could be developed that provides for non-continuous stimulation, but such does not necessarily take into account residual inhibition.

[0379] In an exemplary embodiment, the device treats the symptoms even when not stimulating by relying on residual stimulation. In an exemplary embodiment, the device reduces the percept of tinnitus for example, or a magnitude of a motor disorder, by at least at 50, 55, 60, 65, 70, 75, 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100%, or any value or range of values therebetween in 0.1% increments, and this occurs for any of the aforementioned temporal periods. In an exemplary embodiment, the device reduces the percept of tinnitus for example or the reduction of a tremor by any of these percentages after stimulation is ceased owing to residual inhibition. In this regard, the reduction can be according to any of the aforementioned percentages for any of the temporal periods detailed herein.

[0380] In an embodiment, in addition to executing one or more of the method actions above, the method(s) further include at least 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, or 100, or any value or range of values therebetween in 0.25 day increments after a given point, operating the device to manage any one or more of the ailments detained herein, such as tinnitus or Parkinsons Disease or a balance disorder, wherein the action of operating includes automatically activating the device after a period of deactivation, wherein the time of activation is based on residual inhibition of tinnitus by way of example only, or motor disorder symptoms, also by way of example, due to activation of the device prior to the period of deactivation. In an embodiment, this method action can be repeated at least 5, 10, 15 20, 25, 30, 35, 40, 50, 60, 70, 80, 90, or 100, or any value or range of values therebetween in 1 increment times after any one or more of the noted time periods after a given point in time (e.g., switch-on, or after a break-in period, from the initial fitting, etc.). In an embodiment of these methods, the human experiences no noticeable tinnitus or tremors or other symptoms of the ailment during a majority of the periods of deactivation. In an embodiment, the human experiences no noticeable symptoms during at least 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, or 100%, or any value or range of values therebetween in 1% increments of the periods of deactivation. In an embodiment, if the human experiences noticeable symptoms, it is at a level that is no more than 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, or 60%, or any value or range of values therebetween in 1% increments of that which the recipient normally perceives without treatment. Note that thevalues need not be the same in the various periods of deactivation. To be clear, any values or range of values provided herein are not required to be the same at different times and / or for different applications, but are instead presented by way of textual economy.

[0381] Also note that while embodiments have focused in part on symptoms, other embodiments also include utilizing the residual effects of the electrical stimulation to adjust dopamine reception and / or dopamine production, consistent with the teachings detailed herein. In this regard, the effects of dopamine reception results in a latency associated with motor disorders, or more accurately, the symptoms associated therewith. Embodiments include utilizing the residual effect to maintain a given reception of dopamine and / or production of dopamine, at least within a range, while utilizing the discontinuity of stimulation concepts. That is, some embodiments include scenarios where upon cessation of the stimulation, the dopamine production and / or dopamine reception continues within acceptable values for a period of time analogous to how the residual effect can suppress the effects of, for example, tinnitus, even though there is no continuous stimulation. Accordingly, any disclosure herein related to the utilization of inhibition or related concepts to affect a symptom corresponds to an alternate disclosure of affecting the dopamine production and / or reception and otherwise utilizing such to continue adjustment of such, providing that the art enables such, unless otherwise noted, in the interest of textual economy.

[0382] In an embodiment, after switch-on or after fitting, during normal use, the treatment device is used (provides stimulation) for less than, greater than and / or equal to 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 50, 60, 70, 80, 90, 100, 125, 150, 175, 200, 300, 400, 500, 600, 700, 800, 900, 1000, 1250, 1500, 1750, or 2000 or more minutes or 30, 35, 40, 50, 60, 70, 80, 90, 100, 125, 150, 175, 200, 300 or more hours, or any value or range of values therebetween in one second increments (e.g., 10 minutes and 3 seconds, 33 minutes, 305 to 555 minutes and 17 seconds, etc.). In an exemplary embodiment, the stimulation is provided continuously for any one or more of those just detailed values as would be enabled by the art, in the interests of textual economy. In an exemplary embodiment, the stimulation is provided discontinuously over one or more of those values (i.e., for a period of 33 minutes, the first and / or second stimulation would be provided discontinuously, so there would be stimulation for less than 33 minutes). In an embodiment, the total time of actual stimulation for any one or more of the just detailed periods can be less than, greater than and / or equal to 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 50,I l l60, 70, 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98 or 99% or any value or range of values therebetween in 0.1% increments of the total time period (e.g., for a period of 33 minutes with stimulation at 50% of the total time period, that would be stimulation provided for 16.5 minutes) just detailed as enabled by the art. In an embodiment, the discontinuous stimulation is divided up into 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 50, 60, 70, 80, 90, 100, 125, 150, 175, 200, 300, 400, 500, 600, 700, 800, 900, 1000, 1250, 1500, 1750, 2000, 2500, 3000, 3500, 4000, 5000, 6000, 7000, 8000, 9000, 10000, 12500, 15000, or 20000 or more blocks, or any value or range of values therebetween in 1 block increments, and the blocks may or may not be the same and / or the time between a given block of stimulation may or may not be the same. The continuous stimulation is located between those blocks. This can have utilitarian value with respect to avoiding constant and / or ongoing delivery of stimulation, which can be undesirable for various reasons. Indeed, the equipment can be physically incompatible with sleeping or showering as noted above. The external device may also simply be something that is desired to not be seen in public or under certain circumstances for cosmetic reasons. This could also prolong battery life and / or electrode life.

[0383] Embodiments thus include a system that is trained for example to create a personalized stimulation protocol for tinnitus or motor disorders or balance disorders or dopamine management (reception and / or production) and / or other conditions. The protocol can be arranged to titrate stimulation levels, while balancing between stimulation on (continuous stimulation, even if there are spaces between stimulation pulses) and stimulation off states (stimulation discontinued). Implementations of use of the device for stimulation and the nonstimulation and simulation on / stimulation off can be implemented based on data developed regarding residual inhibition of a given phenomenon of the given person in accordance with the teachings detailed herein. Embodiments include balancing the concept or otherwise the requirements of constant stimulation / on-state simulation against periodic stimulation and utilizing interleaved on and off periods relying on residual inhibition. Put another way, there is a price to pay for constant on stimulation over long periods, such as an entire day or an entire waking period. This price is balanced against the results of periodic stimulation interleaved by periodic non-stimulation.

[0384] Embodiments can include a trainable system for example, and this system can include default habitual usage of the device and / or user adjustments and / or user responses to adjustmentsand / or other preferences, such as the subjective tolerability of non-stimulated state. All of which can be balanced against the price of one-state stimulation.

[0385] In an exemplary embodiment, there are actions that include obtaining data is indicative of the human increasing an output of the device, and the map adjustment increases a magnitude of stimulation by the device. In an embodiment, the use indicates a time period between an affirmative activation of the device by the recipient and a beginning of a prior period of inactivation immediately prior to the affirmative activation. This could be indicative of the lapsing of residual inhibition, where the recipient activates the device to obtain inhibition of a given symptom. In an exemplary embodiment, the adjustment of the control regime and / or the new control regime reduces a time that elapses between automatic activation and an end of an immediate prior activation. This could be because, for example, the previous time period between automatic activation and an end of an immediate prior activation is too long. The residual inhibition could wear off before the automatic activation. In an exemplary embodiment, the opposite can be the case.

[0386] In an embodiment, there is an action of evaluating the data that includes analyzing the data to identify a statistically significantly reliable temporal value for residual inhibition and the action of adjusting the control regime and / or developing the new control regime sets an automatic activation time of the device after an end of a prior activation. The statistically significant reliable temporal value would be something that is based on a statistical analysis of the usage data. Various statistical approaches can be implemented providing that such has utilitarian value providing that the art enables such. In an exemplary embodiment, a 90thpercentile or 95thpercentile confidence level could be the goal and / or is achieved.

[0387] In an embodiment, data is received / obtained that is related to a regular usage of the tinnitus treatment device for the person and the developed product has a map feature different from a current map feature of the device. In an exemplary embodiment, the product can be any of the products detailed herein, such as a prescription for the use of the device or control settings or parameters for the device. Any of the parameters detailed herein can be developed by the system based on the input and then such can be outputted by the output system providing that the art enables such, unless otherwise noted. In an embodiment, the information utilized in the analysis relates to an instantaneous usage of the device by the person. For example, if therecipient makes a sudden change to the device and such is correlated to a changing environment for example, or such as correlated to a temporal period that has elapsed since the device was switched off (so for example here, the sudden change is activation) where this can be extrapolated from log data that is input into the subsystem, which log data can be developed in accordance with the teachings herein, the product could be a control setting or a set of control parameters for the device that automatically activates and / or deactivates the tinnitus treatment device. In this regard, the activation can be considered a latent variable indicative of the residual inhibition wearing off, at least to a level where the tinnitus becomes noticeable or otherwise sufficiently irritable to the person so that he or she activates the device again.

[0388] FIG. 28 presents an exemplary flowchart for an exemplary method, method 2800, that includes method 2810, that includes obtaining an electrical stimulation device, which can be any of the devices detailed herein, such as the vestibular implant, a tinnitus treatment device (implantable or non-implantable), etc. Method 2800 further includes method action 2820, which includes operating the electrical stimulation device to manage a symptom of an ailment of a human into which the device is implanted relying on residual stimulation to reduce stimulation electric charge outputted by the device. Here, this includes utilizing intermittent stimulation / non-continuous stimulation techniques in accordance with the teachings above, which results in the reduction of stimulation electric charge outputted by the device. But note also that this can correspond to the reduction in amplitude or otherwise the total electric charge that is outputted per unit time, albeit taking into account that the charge outputted is alternating current, so there is no buildup of charge in the tissue. In this regard, embodiments include reducing an amount of stimulation relative to that which would otherwise be the case. In embodiments, this can be achieved by the intermittent stimulation. Indeed, it could be that when the stimulation is activated, the short-term stimulation quantity that is measured is higher than that which would otherwise be the case for other types of stimulation regimes. It is that overall, the average (mean median and / or mode)...

Claims

Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2CLAIMSWhat is claimed is:

1. A method, comprising: identifying a side of a human vis-a-vis an anatomical body plane of the human experiencing a motor disorder symptom; and providing stimulation to biological matter of a head of the human based on the identified side, wherein the action of providing stimulation is executed to reduce and / or eliminate and / or manage the symptom.

2. The method of claim 1, wherein: the biological matter is a middle ear of the human.

3. The method of claim 1, wherein: the biological matter is a vestibular system of the human.

4. The method of claims 1, 2 or 3, wherein the anatomical body plane is the sagittal plane.

5. The method of claims 1, 2, 3 or 4, further comprising identifying a side of the human to which the simulation will be provided based on the identified side of the human, wherein the provided stimulation is provided on the identified side.

6. The method of claims 1, 2, 3, 4 or 5, wherein the action of providing stimulation provides stimulation on a sagittal side of the head opposite to a sagittal side where a physiological reaction of biological matter in the human due to the stimulation is greater than that of corresponding biological matter on a sagittal side opposite to that where the greater physiological reaction occurs.

7. The method of claims 1, 2, 3, 4 or 5, wherein the action of providing stimulation provides stimulation on a sagittal side of the head so as to increase a measure of basal ganglia activity onAtty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 an opposite sagittal side above an increase in the measure in basal ganglia activity on the stimulation sagittal side.

8. The method of claims 1, 2, 3, 4, 5, 6 or 7, further comprising identifying an occurrence of a symptom of the motor disorder afflicting the human, wherein the action of identifying the side of the human is based on the idented occurrence of the symptom of the motor disorder.

9. The method of claims 1, 2, 3, 4, 5, 6 or 7, further comprising identifying an occurrence of hand tremor of the human resulting from the motor disorder, wherein the action of identifying the side of the human is based on the idented occurrence of hand tremor.

10. The method of claims 1, 2, 3, 4, 5, 6 or 7, wherein the action of providing stimulation provides stimulation on a sagittal side of the head opposite to a sagittal side where a property of biological matter in the human that changes due to the stimulation is greater than that of corresponding biological matter on a sagittal side opposite to that where the greater change in the property occurs.

11. A method, comprising: identifying an occurrence of a symptom of a motor disorder in a human; and providing stimulation to biological matter on one anatomical side of the human, wherein the action of providing stimulation manages at least one effect of the motor disorder, and the action of providing stimulation on one anatomical side of the human is done differently relative to any stimulation provided to biological matter on an opposite anatomical side of the human based on the symptom.

12. The method of claim 11, wherein: the symptom of the motor disorder occurrence is more prominent on the one anatomical side than on the opposite anatomical side or is only identifiable on the one anatomical side; and the provided stimulation is provided on the one anatomical side.

13. The method of claims 11 or 12, wherein:Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 the provided stimulation provided on the one anatomical side induces a response in biological matter in the head of the human that is greater on the opposite side than in comparable biological matter on the one anatomical side.

14. The method of claims 11, 12 or 13, wherein: the identified symptom occurrence is hand tremor in a left hand or right hand of the human; and the provide stimulation to biological matter is biological matter in the head of the human on the left sagittal side or the right sagittal side if the hand tremor is on the left hand or right hand, respectively.

15. The method of claim 14, wherein: the stimulation activates biological matter on an opposite side of the sagittal plane from where the stimulation is provided, which activation treats the motor disorder on the side of the provided simulation.

16. The method of claim 13, wherein: the biological matter in the head is basal ganglia biological matter.

17. The method of claim 13, wherein: the comparable biological matter also experiences a response, wherein the comparable biological matter is closer to the stimulation than the biological matter on the opposite side.

18. The method of claims 11, 12, 13, 14, 15, 16 or 17, wherein: the provided stimulation provided on the one anatomical side induces a response in a dopamine transporter biological matter in the head of the human that is greater on the opposite side than in comparable dopamine transporter biological matter on the one anatomical side.

19. A method, comprising: identifying an occurrence of an effect of a motor disorder in a human;Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 selecting one sagittal side of the human to which electrical stimulation is to be applied to biological matter of the human; and providing stimulation to the biological matter of the human on the selected one sagittal side, wherein the action of providing stimulation treats the effect of the motor disorder, and the action of selecting the one anatomical side of the human is based on which side the motor disorder occurrence is greater.

20. The method of claim 19, wherein: the provided stimulation provided on the one sagittal side induces a response in a dopamine receptor biological matter in the head of the human that is greater on the opposite sagittal side than in comparable dopamine transporter biological matter on the one sagittal side.

21. A method, comprising: varying output of a motor disorder stimulation device applied to a human afflicted with a motor disorder; evaluating a reaction in the human resulting from the varying output; and setting control settings of the motor disorder stimulation device based on the evaluation, wherein the motor disorder stimulation device is part of a bilateral stimulation system22. The method of claim 21, wherein: the action of setting the control settings fits the device to the human.

23. The method of claim 21, wherein: the motor disorder relates to Parkinson disease; and the reaction is based on a reaction of basal ganglia biological matter on one sagittal side of the human.

24. The method of claim 23, wherein:Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 the set control settings provide electrical stimulation to a sagittal side of the human opposite the side of the basal ganglia biological matter.

25. The method of claim 23, wherein: the set control settings provide more electrical stimulation to a sagittal side of the human opposite the side of the basal ganglia biological matter than to the side of the basal ganglia biological matter.

26. The method of claims 21, 22, 23, 24 or 25, wherein: the reaction is a change in a symptom of the motor disorder.

27. The method of claims 21, 22, 23, 24, 25 or 26, wherein: the reaction is based on one or more of gait, speech, body tremor, limb tremor, hand tremor or head movement.

28. The method of claims 21, 22, 23, 24, 25 or 26, wherein: the evaluation is based on objective measurements.

29. The method of claims 21, 22, 23, 24, 25 or 26, wherein: the evaluation is based on subjective measurements.

30. The method of claims 21, 22, 23, 24, 25, 26, 27, 28 or 29, wherein: the evaluation is executed by a recipient of the motor disorder stimulation device.

31. A system, comprising: a right side vestibular stimulation device; and a left side vestibular stimulation device, wherein the system is configured to control the right side vestibular stimulation device and the left side device to adjust respective outputs based on a symptom of a motor disorder of a recipient of the system.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR232. The system of claim 31, wherein: the system is configured to vary stimulation output of the right ear vestibular stimulation device to affect biological matter on a left sagittal side of the human and vis-a-versa.

33. The system of claims 31 or 32, wherein: the system is configured to vary stimulation output of the right side vestibular stimulation device to increase a reaction in biological matter on a left sagittal side of the human and to increase a reaction in comparable biological matter on the right sagittal side of the human and vis-a-versa.

34. The system of claims 31, 32 or 33, wherein: the system is configured to vary stimulation output of the right side vestibular stimulation device to increase a reaction in biological matter on a left sagittal side of the human and to increase a reaction in comparable biological matter on the right sagittal side of the human but less so than the increase in the biological matter on the left sagittal side and vis-a-versa.

35. The system of claims 31, 32 or 33, wherein: the system is configured to control the respective outputs of the stimulation devices to increase a reaction in biological matter on opposite sides of the sagittal side.

36. The system of claims 31, 32, 33, 34 or 35, wherein: the system is configured to prevent output of the right side vestibular stimulation device while enabling output of the left side vestibular stimulation device to increase a reaction in biological matter in a right sagittal side of the human and vis-a-versa.

37. The system of claims 31, 32, 33, 34 or 35, wherein: the system is configured to prevent output of the right side vestibular stimulation device while enabling output of the left side vestibular stimulation device to increase a reaction in biological matter in a right sagittal side of the human more so than an increase in a reaction in comparable biological matter in a left sagittal side of the human and vis-a-versa.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR238. The system of claim 37, wherein: the biological matter is basal ganglia biological matter.

39. The system of claims 31, 32, 33, 34, 35, 36, 37 or 38, wherein: the system includes one or more sensors configured to detect the occurrence of the symptom.

40. The system of claim 39, wherein: the system is configured to analyze output from the one or more sensors and evaluate a severity of the symptom and / or extract locational data therefrom.

41. A method, comprising: identifying the occurrence of a symptom of a motor disorder of a human; and operating a motor disorder stimulation system to stimulate biological matter of the human based on the identified occurrence, wherein the action of operating the system includes controlling stimulation output of the system based on the anatomical side of which the identified occurrence is occurring.

42. The method of claim 41, wherein: the system is a bilateral system; and the action of operating the system includes applying stimulation to biological matter on a same anatomical side of the recipient as the identified occurrence.

43. The method of claim 42, wherein: the action of operating the system includes also applying stimulation to biological matter on an opposite anatomical side of the recipient from the identified occurrence.

44. The method of claim 43, wherein: a current density of the stimulation applied to the biological matter on the opposite anatomical side of the recipient is greater than a current density of the stimulation applied to the biological matter on the same anatomical side as the identified occurrence.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR245. The method of claims 41, 42, 43 or 44, wherein: the action of controlling stimulation includes applying output of the system on a first sagittal side of the human to evoke a reaction in biological matter on a second sagittal side of the human to reduce the symptom, wherein the symptom manifests itself on the first sagittal side.

46. The method of claims 41, 42, 43 or 44, wherein: the action of controlling stimulation includes applying output of the system on a first sagittal side of the human to evoke a reaction in biological matter on a second sagittal side of the human that is stronger than a reaction in comparable biological matter on the first sagittal side of the human to reduce the symptom, wherein the symptom manifests itself on the first sagittal side.

47. The method of claim 45, wherein: a symptom of a motor disorder of the human is also present on the second sagittal side, which symptom is not as severe as the symptom on the first sagittal side.

48. The method of claims 41, 42, 43, 44, 45, 46 or 47, wherein: the method is a method of treating at least symptoms of Parkinson’s disease.

49. The method of claims 41, 42, 43, 44, 45, 46, 47 or 48, wherein: the symptom is automatically identified by the system.

50. The method of claims 41, 42, 43, 44, 45, 46, 47 or 48, wherein: the symptom is a bilateral system, and the action of operating the system includes applying stimulation to biological matter on a same anatomical side of the recipient as the identified occurrence and applying no stimulation to biological matter on an opposite anatomical side of the recipient from the identified occurrence.

51. A method, comprising: identifying a motor disorder of a human;Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 determining that the human is a candidate for a vestibular implant to treat symptoms of the motor disorder; and identifying a sagittal side of the human in which symptoms resulting from the motor disorder manifest themselves; and determining a sagittal side of the human for implantation based at least in part on the identified side.

52. The method of claim 51, further comprising: identifying a state of hearing in a first ear of the human; and identifying a state of hearing in a second ear of the human, wherein the action of determining the sagittal side includes determining such also based on the identified states of hearing in the two ears.

53. The method of claims 51 or 52, wherein: the identified sagittal side of the human is the same side as the side in which the symptoms manifest themselves.

54. The method of claim 52, wherein: the identified sagittal side of the human is the opposite side in which the symptoms manifest themselves; and the person has at least partial hearing in the first ear, wherein the first ear is on the sagittal side in which symptoms manifest themselves.

55. The method of claim 54, wherein: the person is deaf in the second ear, and the second ear is on the sagittal side opposite from which the symptoms manifest themselves.

56. The method of claims 51, 52, 53, 54 or 55, further comprising: determining a sagittal side of the human in which basal ganglia biological matter reacts more to electrical stimulation applied to vestibular biological matter on one sagittal side vs. the opposite side, whereinAtty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 the action of determining the sagittal side includes determining such also based on the determined sagittal side of the human in which basal ganglia biological matter reacts more to electrical stimulation.

57. The method of claim 56, wherein: the identified sagittal side of the human is the side determined to result in the basal ganglia biological matter reacting more to the electrical stimulation.

58. The method of claim 56, wherein: the identified sagittal side of the human is the opposite side from the side in which the basal ganglia biological matter reacts more to the electrical stimulation.

59. The method of claims 51, 52, 53, 54, 55, 56, 57 or 58, further comprising: determining which sagittal side basal ganglia biological matter will experience a greater reaction from electrical stimulation applied to the vestibular biological matter on the side in which the symptoms manifest themselves; and determining the sagittal side for implantation based at least in part on the determined side basal ganglia biological matter will experience the greater reaction from the electrical stimulation.

60. The method of claim 59, wherein: the determined side basal ganglia biological matter will experience the greater reaction from the electrical stimulation is a side opposite the side in which the symptoms manifest themselves.

61. The method of claim 60, wherein: the determined sagittal side of the human for implantation is the side opposite the determined side basal ganglia biological matter will experience the greater reaction from the electrical stimulation is a side opposite the side in which the symptoms manifest themselves.

62. The method of claim 60, wherein:Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 second symptoms resulting from the motor disorder also manifest themselves on a side opposite the side in which the symptoms manifest themselves.

63. The method of claim 62, wherein: the second symptoms are less severe than the symptoms.

64. The method of claim 62, wherein: the second symptoms are hand tremors.

65. A method, comprising: outputting electrical energy from a motor disorder stimulation apparatus to biological matter of a human to reduce symptoms of a motor disorder of the human over different temporal periods; an respectively implementing different electrical energy output regimes, on which the respective outputted energy is based, of the motor disorder stimulation apparatus to prolong life of one or more electrical contacts of the apparatus relative to that which would otherwise be the case.

66. The method of claim 65, wherein: the apparatus includes at least a first electrical contact and a second electrical contact; and the action of implementing different regimes includes varying enablement of the first contact and the second contact for output of the electrical energy for the different temporal periods.

67. The method of claims 65 or 66, wherein: the apparatus is a bilateral stimulation apparatus; and the first contact is a right side contact and the second contact is a left side contact.

68. The method of claims 65 or 66, wherein: the different regimes result in different current densities for respective contacts of the apparatus.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR269. The method of claims 65, 66, 67 or 68, wherein: the apparatus is a bilateral stimulation apparatus; the different regimes vary respective current densities of respective sides of the apparatus.

70. The method of claims 65, 66, 67, 68 or 69, wherein: the apparatus is a bilateral stimulation apparatus; the motor disorder manifests symptoms on both sagittal sides of the human; stimulation to one sagittal side effects symptoms on both sides, but more so on one side than the other; the different output regimes vary stimulation output on respective sides so stimulation output on a given side is reduced relative to a more efficacious output for that side.

71. The method of claims 65, 66, 67, 68 or 69, wherein: the apparatus is a bilateral stimulation apparatus; the motor disorder manifests symptoms on both sagittal sides of the human; stimulation to one sagittal side effects symptoms on both sides, but more so on one side than the other; the different output regimes alternately suspend output on respective sides even though output would produce more efficacious output for the suspended sides.

72. The method of claims 65, 66, 67, 68 or 69, wherein: a first output regime is a steady state regime; and the second output regime is a ramp down regime.

73. The method of claims 65, 66, 67, 68, 69, 70, 71 or 72, wherein: the apparatus is a bilateral stimulation apparatus; the action of implementing different electrical energy output regimes includes implementing a regime that ramps up stimulation on one side and a implementing a regime that ramps down stimulation on the opposite side.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR274. The method of claim 73, wherein: the action of implementing the regimes includes implementing the ramp up regime for stimulation on one side while implementing in a coordinated manner the ramp down regime for stimulation on the opposite side.

75. The method of claims 65, 66, 67, 68 or 69, wherein: the apparatus is a bilateral stimulation apparatus; the action of implementing different electrical energy output regimes includes implementing a first stimulation regime on one side and a implementing a second stimulation regime different from the first on the opposite side while providing an apparent constant effect on reducing the symptoms of the motor disorder.

76. The method of claims 65, 66, 67, 68 or 69, wherein: the apparatus includes at least a first electrical contact and a second electrical contact; the apparatus is a bilateral stimulation apparatus; the first contact is a right side contact and the second contact is a left side contact; and the action of implementing different regimes includes implementing a regime that cycles between the first contact and the second contact for output of the electrical energy for the different temporal periods.

77. The method of claims 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75 or 76, wherein: the apparatus includes at least a first electrical contact and a second electrical contact located on one sagittal side of the human; and the action of implementing different regimes includes implementing a regime that cycles between the first contact and the second contact for output of the electrical energy for the different temporal periods.

78. The method of claims 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75 or 76, wherein: the apparatus is a bilateral stimulation apparatus; the motor disorder manifests symptoms on both sagittal sides of the human;Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 stimulation to one sagittal side effects basal ganglia biological matter on both sides, but more so on the side opposite the stimulation side than the other; the different output regimes vary stimulation output on respective sides so stimulation output on a given side is reduced relative to a more efficacious output for that side.

79. The method of claims 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77 or 78, wherein: the apparatus is a bilateral stimulation apparatus; the motor disorder manifests symptoms on both sagittal sides of the human; stimulation to one sagittal side effects basal ganglia biological matter on both sides, but more so on the side opposite the stimulation side than the other; the different output regimes alternately suspend output on respective sides even though output would produce more efficacious output for the suspended sides.

80. The method of claims 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77 or 78, wherein: the apparatus includes a plurality of electrical contacts; and the action of implementing different regimes includes a halting regime that halts output from all of the plurality of contacts; and the method includes relying on a residual effect of stimulation that occurred during a stimulation regime executed prior to the period of implementation of the halting regime.

81. The method of claims 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 89 or 80, wherein: the different regimes are unique to the human relative to another human who has a comparable stimulation apparatus and comparable motor disorder.

82. The method of claims 65, 66, 67, 68, 69, 70, 71, 72, 73 or 74, wherein: implementation of the different regimes is based on a severity of the symptoms during various temporal periods.

83. The method of claims 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, or 81, wherein:Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 one of the regimes includes an apparatus prolonging regime and another regime includes an efficacy increasing regime; and the action of implementing the different regimes includes switching to the efficacy increasing regime upon an increase of severity of the symptoms during a temporal period in which the prolonging regime is being implemented.

84. The method of claims 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, or 81, wherein: one of the regimes includes an apparatus prolonging regime and another regime includes an efficacy increasing regime; and the action of implementing the different regimes includes switching to the prolonging regime upon a decrease in severity of the symptoms during a temporal period in which the efficacy increasing regime is being implemented.

85. The method of claims 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82 or 83, wherein: the action of implementing is executed automatically based on detected symptoms and / or the absence of detected symptoms.

86. The method of claims 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82 or 83, wherein: one of the output regimes is an output halting regime; and suspension of an enacted output halting regime is executed based on when after implementation of the halting regime one or more symptoms return and / or increase in magnitude to a certain level.

87. The method of claims 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, or 86, wherein: one of the output regimes is an output halting regime; and suspension of an enacted output halting regime is automatically executed based on how long after implementation of the halting regime one or more symptoms return and / or increase inAtty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 magnitude to a certain level, wherein the return and / or increase in magnitude is automatically detected.

88. The method of claims 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86 or 87, wherein: the method includes developing a personalized overall regime implementing the various different output regimes personalized to the human.

89. A system, comprising: at least one implantable electrode; and circuitry to variably apply current to the at least one implantable electrode, wherein the system is a vestibular stimulation system, and the system is configured to control the current applied to the at least one implantable electrode to prolong a short term and / or long term longevity of the system relative to that which would otherwise be the case.

90. The system of claim 89, wherein: the system is configured to control the current applied to the at least one implantable electrode to prolong a long term longevity of the system relative to that which would otherwise be the case.

91. The system of claim 89, wherein: the system is configured to control the current applied to the at least one implantable electrode to prolong a longevity of the electrode relative to that which would otherwise be the case.

92. The system of claims 89, 90 or 91, wherein: the system is configured to control the current applied to the at least one implantable electrode to prolong a longevity of a battery supply relative to that which would otherwise be the case.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR293. The system of claims 89, 90, 91 or 92, wherein: the system is a bilateral stimulation system; the system is configured to alternately enable and / or disable stimulation channels of the system, and thus control the current applied to the at least one electrode, to prolong a short term and / or long term longevity of the system relative to that which would otherwise be the case.

94. The system of claims 89, 90, 91 or 92, wherein: the system is a bilateral stimulation system; the system is configured to vary respective sagittal side current density and thus control the current applied to the at least one electrode, to prolong a short term and / or long term longevity of the system relative to that which would otherwise be the case.

95. The system of claims 89, 90, 91, 92, 93 or 94, wherein: the system is configured to control the current applied to the at least one implantable electrode to reduce a corrosive effect on the electrode relative to that which would otherwise be the case.

96. The system of claims 89, 90, 91, 92, 93, 94 or 95, wherein: the system includes a plurality of implanted stimulating electrode contacts; and the system is configured to cycle through respective contacts of the plurality of electrode contacts to prolong a long term longevity of the system relative to that which would otherwise be the case.

97. The system of claims 89, 90, 91, 92, 93, 94, 95 or 96, wherein: the contact has a surface area of less than 0.3 mm2.

98. The system of claims 89, 90, 91, 92, 93, 94, 95, 96 or 97, wherein: the contact has a surface area of less than 0.2 mm2.

99. The system of claims 89, 90, 91, 92, 93, 94, 95, 96, 97 or 98, wherein: the contact has a surface area of less than 0.1 mm2.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2100. The system of claims 89, 90, 91, 92, 93, 94, 95, 96 or 97, wherein: the contact has a surface area of less than 0.05 mm2.

101. The system of claims 89, 90, 91, 92, 93, 94, 95, 96 or 97, wherein: the system is a bilateral stimulation system; the system is configured to ramp up and ramp down stimulation on respective sides to vary the current density on those respective sides.

102. A method, comprising: applying electrical stimulation to a head of a human; and subsequent to the action of applying stimulation, halting the application of stimulation, wherein the actions of applying and halting are variously executed over a period of at least a month, and the action of applying the stimulation at least one of: temporally delays a commencement of a therapeutic substance treatment associated with a disorder in a head of the human beyond that which would otherwise be normally recommended for that person, all other things being equal; or prolongs dopamine transport in motor-related brain areas relative to that which would otherwise be the case, all other things being equal.

103. The method of claim 102, wherein: the action of applying the stimulation temporally delays a commencement of a therapeutic substance treatment associated with a disorder in a head of the human beyond that which would otherwise be normally recommended for that person, all other things being equal.

104. The method of claims 101, 102 or 103, wherein: the action of applying the stimulation prolongs dopamine transport in motor-related brain areas relative to that which would otherwise be the case, all other things being equal.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2105. The method of claims 101, 102, 103 or 104, wherein: the action of applying the stimulation temporally delays a commencement of a therapeutic substance treatment associated with a disorder in a head of the human beyond that which would otherwise be normally recommended for that person, all other things being equal; and the action of applying the stimulation temporally delays a point where the therapeutic substance treatment will likely become ineffective, all other things being equal.

106. The method of claims 101, 102, 103, 104 or 105, wherein: the action of applying the stimulation temporally delays a commencement of a therapeutic substance treatment of a disorder in a head of the human beyond that which would otherwise be normally recommended for that person, all other things being equal; and the action of applying the stimulation prolongs dopamine transport in motor-related brain areas relative to that which would otherwise be the case, all other things being equal.

107. The method of claims 101, 102, 103, 104, 105 or 106, wherein: the action of applying the stimulation temporally delays a commencement of a therapeutic substance treatment associated with a disorder in a head of the human beyond that which would otherwise be normally recommended for that person, all other things being equal; and the therapeutic substance treatment is a treatment to manage motor deficiency symptoms.

108. The method of claims 101, 102, 103, 104, 105 or 106, wherein: the action of applying the stimulation temporally delays a commencement of a therapeutic substance treatment associated with a disorder in a head of the human beyond that which would otherwise be normally recommended for that person, all other things being equal; and the therapeutic substance treatment is a treatment to manage motor deficiency symptoms.

109. The method of claims 101, 102, 103, 104, 105 , 106, 107 or 108, wherein:Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 the action of applying the stimulation temporally delays a commencement of a therapeutic substance treatment associated with a disorder in a head of the human beyond that which would otherwise be normally recommended for that person, all other things being equal; and the therapeutic substance treatment is a treatment to manage symptoms of Parkinsons disease.

110. The method of claims 101, 102, 103, 104, 105 , 106, 107 or 108, wherein the electrical stimulation is applied by an implanted electrode implanted in the head of the human.

111. A method, comprising: treating symptoms of a motor and / or vestibular disorder by: applying electrical stimulation to a part of a head of a human; and providing a therapeutic substance to the human, wherein the application of electrical stimulation affects function in the head of the human, which function is needed at least in part for the therapeutic substance to have efficacy.

112. The method of claim 111, wherein: the electrical stimulation delays and / or slows deterioration of the function.

113. The method of claims 111 or 112, wherein: the electrical stimulation prolongs efficacy of the therapeutic substance.

114. The method of claims 111 or 112, wherein: the application of stimulation increases a number of receptors of dopamine.

115. The method of claims 111 or 112, wherein: the application of stimulation activates and / or stimulates dopaminergic synapses.

116. The method of claims 111 or 112, wherein:Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 the application of stimulation adjusts an ability of dopamine receptors to accept dopamine.

117. The method of claims 111, 112, 113, 114, 115 or 116, wherein: the application of stimulation increases the ability of dopamine receptors to accept dopamine.

118. The method of claims 111 or 112, wherein: the action of applying electrical stimulation begins and occurs over at least six months prior to the providing of the therapeutic substance.

119. The method of claims 111 or 112, wherein: the action of applying electrical stimulation begins and occurs over at least 18 months prior to the providing of the therapeutic substance.

120. The method of claims 111, wherein: the action of applying electrical stimulation begins and occurs over at least six months prior to the providing of the therapeutic substance and overlaps for at least six months with the providing of the therapeutic substance.

121. The method of claims 111, 112, 113, 114, 115, 116, 117, 118, 119 or 120, wherein: the action of providing a therapeutic substance occurs over a first temporal period corresponding to a period where the therapeutic substance has efficacy; and the first temporal period is longer due to the application of the electrical stimulation than that which would otherwise be the case, all other things being equal.

122. The method of claims 111, 112, 113, 114, 115, 116, 117, 118, 119 or 120, wherein: the first temporal period is at least 30% longer than that which would otherwise be the case, all other things being equal.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2123. The method claims 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, or 122, wherein: the first temporal period is at least 100% longer than that which would otherwise be the case, all other things being equal.

124. The method of claims 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122 or 123, wherein: the part of the head is an inner ear of the human; the function is associated with the basal ganglia biological matter.

125. The method of claims 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122 or 123, wherein: the therapeutic substance is a substance that crosses a blood-brain barrier.

126. The method of claims 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122 or 123, wherein: the therapeutic substance adjusts dopamine reception relative to that which would otherwise be the case in the absence of the therapeutic substance, all other things being equal.

127. The method of claims 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125 or 126, wherein: the therapeutic substance increases dopamine reception relative to that which would otherwise be the case in the absence of the therapeutic substance, all other things being equal.

128. The method of claims 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122 or 123, wherein: the method is implemented to delay or meaningfully delay a date of a beginning of the providing of therapeutic substance.

129. The method of claims 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125 or 126, wherein:Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 the method delays a date of a beginning of the providing of therapeutic substance by at least 6 months.

130. The method of claims 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122 or 123, wherein: the method delays a date of a beginning of the providing of therapeutic substance by at least 18 months relative to that which would otherwise be the case, all other things being equal.

131. The method claims 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122 or 123, wherein: the method is implemented to meaningfully delay a date of cessation of efficacy of therapeutic substance relative to that which would otherwise be the case, all other things being equal.

132. The method of claims 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122 or 123, wherein: the method delays a date of cessation of efficacy of therapeutic substance by at least 6 months relative to that which would otherwise be the case, all other things being equal.

133. The method of claims 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, or 132, wherein: the method delays a date of cessation of efficacy of therapeutic substance by at least 18 months relative to that which would otherwise be the case, all other things being equal.

134. The method of claims 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132 or 133, wherein: the action of applying the stimulation temporally delays a commencement of a therapeutic substance treatment associated with a disorder in a head of the human beyond that which would otherwise be normally recommended for that person, all other things being equal; and the therapeutic substance treatment is a Levodopa treatment.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2135. A method comprising: identifying a side of a human vis-a-vis an anatomical body plane of the human experiencing a motor disorder symptom; and selecting a basal ganglion of the human to evoke a response based on the identified side, wherein the action of evoking the response is executed to reduce and / or eliminate the symptom.

136. The method of claim 135, wherein: the anatomical body plane is the sagittal plane.

137. The method of claim 135 or 136, wherein: the action of selecting and the action of identifying are executed automatically.

138. The method of claim 135, 136 or 137, further comprising: providing stimulation to a side of a head of the human opposite the selected basal ganglion to evoke the response.

139. The method of claim 138, wherein: the action of providing stimulation is executed using a bilateral vestibular stimulation device.

140. The method of 139, wherein: the symptom is a symptom of Parkinson’s disease.

141. A method, comprising: identifying a region of a human experiencing a motor disorder symptom, a vestibular dysfunction symptom and / or a dopamine dysfunction symptom more severe than a motor disorder symptom, a vestibular dysfunction symptom and / or a dopamine dysfunction symptom of another region of the human; and providing stimulation to tissue of a head of the human based on the identified region.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2142. The method of claim 141 wherein: the action of identifying includes identifying a region of a human experiencing a motor disorder symptom more severe than a motor disorder symptom of another region of the human.

143. The method of claims 141 or 142, wherein: the action of identifying includes identifying a region of a human experiencing a vestibular dysfunction symptom more severe than a vestibular dysfunction symptom of another region of the human144. The method of claims 141, 142 or 143, wherein: the action of identifying includes identifying a region of a human experiencing a dopamine dysfunction symptom more severe than a dopamine dysfunction symptom of another region of the human.

145. The method of claims 141, 142, 143 or 144, wherein: the action of identifying includes identifying a region of a human experiencing a motor disorder symptom, a vestibular dysfunction symptom and a dopamine dysfunction symptom more severe than a motor disorder symptom, a vestibular dysfunction symptom and a dopamine dysfunction symptom of another region of the human.

146. The method of claims 141, 142, 143, 144 or 145, wherein: the action of providing stimulation to issue of a head of the human based on the identified region includes providing stimulation on a sagittal side opposite the identified region.

147. The method of claims 141, 142, 143, 144, 145 or 146, wherein: the action of providing stimulation is executed using a bilateral vestibular stimulation system.

148. The method of claims 141, 142, 143, 144, 145, 146 or 147, wherein: the action of identifying includes identifying a region of a human experiencing a motor disorder symptom, a vestibular dysfunction symptom and / or a dopamine dysfunction symptomAtty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 more severe than a motor disorder symptom, a vestibular dysfunction symptom and / or a dopamine dysfunction symptom of another region of the human.

149. A method, comprising: obtaining data based on data indicative of dopamine activity related to respective sides of a human, wherein viability of an electrical stimulation treatment has been identified for the human, which treatment includes, at least initially, implantation of electrodes of a given implantable electrical stimulation device on only one side of the human; and identifying the side of the human for the electrodes to be implanted based on the obtained data.

150. The method of claim 149, wherein: the data is indicative of respective dopamine receptor activity related to respective sides of the human.

151. The method of claims 149 or 150, wherein: the data is indicative of respective basal ganglion cell dopamine receptor activity related to respective sides of the human.

152. The method of claims 149, 150, or 151, wherein: the obtained data is indicative of a first side of the human having basal ganglion tissue that has inferior dopamine receptor activity relative to basal ganglion tissue of a second side of the human opposite the first side; and the action of identifying the side of the human includes identifying the side of the human for implantation that expectedly will adjust dopamine receptor activity of the basal ganglion tissue of the first side more than that which expectedly would be the case with implantation on an opposite side of the human.

153. The method of claims 149, 150, 151 or 152, wherein:Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 the obtained data is indicative of a first side of the human having basal ganglion tissue that has inferior dopamine receptor activity relative to basal ganglion tissue of a second side of the human opposite the first side; and the action of identifying the side of the human includes identifying the side of the human for implantation that expectedly will improve dopamine receptor activity of the basal ganglion tissue of the first side more than that which expectedly would be the case with implantation on an opposite side of the human.

154. The method of claims 149, 150, 151 or 152, wherein: the action of identifying the side of the human is agnostic to issues beyond: basal ganglion cell dopamine receptor activity; or basal ganglion cell dopamine receptor activity and cosmetics.

155. The method of claims 149, 150, 151 or 152, wherein: the basis for identifying the side of the human is totally based on the obtained data.

156. The method of claims 149, 150, 151, 152, 153, 154 or 155, wherein: the human does not suffer from a motor disorder.

157. The method of claims 149, 150, 151, 152, 153, 154 or 155, wherein at least one of: the human suffers from bilateral vestibular disfunction, and the method is a treatment for such; or the human suffers from a motor disorder, and the method is a treatment for such.

158. A method, comprising: identifying a symptom and / or disorder related to a dopamine related phenomenon in a human; and providing electrical stimulation to biological matter of the human, wherein the provided stimulation adjusts dopamine production and / or reception in the human.

159. The method of claim 158, wherein:Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 the provided stimulation adjusts dopamine production in the human.

160. The method of claims 158 or 159, wherein: the provided stimulation increases dopamine production in the human.

161. The method of claims 158 or 159, wherein: the provided stimulation adjusts dopamine reception in the human.

162. The method of claims 158 or 159, wherein: the provided stimulation increases dopamine reception in the human.

163. The method of claims 158, 159, 160, 161 or 162, wherein: dopamine therapeutic drugs are not being provided to the human at least a week before the action of providing stimulation.

164. The method of claims 158, 159, 160, 161 or 162, wherein: the adjustment treats at least one of the effect or the existence of the disorder.

165. The method of claims 158, 159, 160, 161 or 162, wherein the symptom and / or disorder is one or more of: an occurrence of a symptom of a motor disorder in a human; an occurrence of a symptom of a vestibular disorder in the human; an existence of a motor disorder in the human; or an existence of a vestibular disorder in the human.

166. The method of claims 158, 159, 160, 161, 162, 163, 164 or 165, wherein: the action of providing electrical stimulation is provided on one sagittal side of the human to one or both of (i) induce a response in a dopamine receptor biological matter in the head of the human that is greater on the opposite sagittal side than in comparable dopamine transporter biological matter on the one sagittal side or (ii) induce a response in a dopamine producing biological matter in the head of the human.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2167. A method, comprising: identifying in a human an ailment and / or symptoms of an ailment related to a physical phenomenon associated with dopamine; and adjusting dopamine reception and / or production in the human to treat the ailment and / or symptom.

168. The method of claim 167, further comprising: providing stimulation to tissue of the human to adjust the reception and / or production.

169. The method of claim 168, wherein the stimulation is electrical stimulation.

170. The method of claim 167, wherein the dopamine reception and / or production is increased.

171. The method of claim 167, wherein the dopamine reception is adjusted.

172. The method of claim 171, wherein the dopamine reception is increased.

173. The method of claim 167, further comprising: providing stimulation to the human on a side of a human relative to an opposite side of the human to execute the adjustment, wherein the side of the human to which stimulation is provided is opposite the side where the adjustment takes place.

174. A method, comprising: obtaining an implantable electrical stimulation device; and operating the electrical stimulation device to manage a symptom of an ailment of a human into which the device is implanted relying on residual stimulation to reduce stimulation electric charge outputted by the device.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2175. The method of claim 174, wherein the reduction of stimulation electric charge outputted by the device prolongs a battery life of the device and / or electrode life of the device.

176. The method of claim 174, wherein the reduction of stimulation electric charge outputted by the device prolongs a battery life of the device and / or electrode life of the device by at least 20% relative to that which would otherwise be the case in the absence of the operation in reliance on residual stimulation.

177. The method of claim 174, wherein the reduction of stimulation electric charge outputted by the device prolongs a battery life of the device and / or electrode life of the device by at least 50% relative to that which would otherwise be the case in the absence of the operation in reliance on residual stimulation.

178. The method of claim 174, wherein the reduction of stimulation electric charge outputted by the device reduces the stimulation electric charge by at least 50% while mitigating the tinnitus of the human so that a time of tinnitus experienced over at least a seven (7) day period is less than 25% relative to that which would, on a statistical basis for that human, otherwise have been the case without device.

179. The method of claim 174, wherein: the device is an implantable tinnitus management device; and the ailment is tinnitus.

180. The method of claim 174, wherein: the device is an implantable vestibular stimulation device; and the ailment is a motor disorder and / or a balance disorder.

181. The method of claim 174, wherein the device includes one or more implanted electrodes, and the reduction of stimulation electric charge outputted by the device reduces a yearly rate of electrode dissolution by at least 50%.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2182. A method, comprising:(i) utilizing an electrical stimulation device during a respective temporal period with a frequency of stimulation to mitigate symptoms of a disorder of a human;(ii) evaluating if the utilization during the respective temporal period was suitable for the human;(iii) if the utilization during the respective temporal period was suitable, setting a new frequency of stimulation for the device that is lower than that used for the preceding respective temporal period and repeating actions “i” and “ii” at the lower frequency of stimulation, and then executing actions “iii” or “iv” as applicable based on the respective evaluation;(iv) if the utilization during the respective temporal period was not suitable, one of:(a) evaluating if the frequency of stimulation used for the last respective temporal period increased battery life by a predetermined value, and if so, setting a frequency of stimulation for the device above the frequency of stimulation used for the last respective temporal period, and then executing “i” and “ii,” and then executing action “iii” or “iv” as applicable based on the respective evaluation, and if not, setting the device to operate at the frequency of stimulation used for the last respective temporal period or a higher frequency of stimulation used for the last respective temporal period; or(b) setting the device to operate at the frequency of stimulation used for the last respective temporal period or a higher frequency of stimulation higher than that used for the last respective temporal period.

183. The method of claim 182, wherein: upon the commencement of the method, the device has access to at least two (2) settings for respective different frequency of stimulations, one of which is a conservative frequency of stimulation ensuring clinical utilitarian value, the other of which is the setting the device is set to operate at the frequency of stimulation used for the last respective temporal period.

184. The method of claim 182, wherein:Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 prior to the commencement of the method, the device has access to at least two (2) settings for respective different frequency of stimulations, one of which is a conservative frequency of stimulation ensuring clinical utilitarian value, the other of which is the setting the device utilized to execute action “i" at the beginning of the method.

185. The method of claim 182, wherein: actions “ii” and “iii” and “iv” are executed by a healthcare professional.

186. The method of claim 182, wherein: actions “ii” and “iii” and “iv” are executed by the human.

187. The method of claim 182, wherein: method action “iv” is executed, and method action “a” is executed, where the evaluation of the frequency of stimulation used for the last respective temporal period increased battery life by the predetermined value.

188. The method of claim 182, wherein: method action “iv” is executed, and method action “a” is executed, where the evaluation of the frequency of stimulation used for the last respective temporal period increased battery life by the predetermined value, wherein the predetermined value is at least 5%.

189. A method, comprising:(i) utilizing an electrical stimulation device during a respective temporal period with a frequency of stimulation to mitigate symptoms of a disorder of a human;(ii) evaluating if the utilization during the respective temporal period provided clinical utilitarian value for the human;(iii) if the utilization during the respective temporal period provided clinical utilitarian value, executing an objective measure related to the symptoms mitigated by the disorder, and setting the device to operate at the respective frequency of stimulation or at a higher frequency of stimulation than the respective frequency of stimulation and at a closed loop system thresholdAtty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 based on one or more results of the objective measure for closed loop operation of the device; and(iv) if the utilization during the respective temporal did not provide clinical utilitarian value, increasing the frequency of stimulation and repeating actions “i” and “ii” at the increased frequency of stimulation, and then executing actions “iii” or “iv” as applicable based on the respective evaluation.

190. The method of claim 189, wherein: actions “i,” “ii” and “iii” and “iv” are executed by a healthcare professional.

191. The method of claim 189, wherein: the objective measure measures hand tremor.

192. The method of claim 189, wherein: the objective measure measures tinnitus magnitude.

193. The method of claim 189, wherein: the clinical benefit is only a partial reduction in the symptom.

194. The method of claim 189, wherein: the closed loop system of the device monitors one or more symptoms of the disorder and is triggered upon a monitored symptom reaching and / or exceeding the threshold.

195. The method of claim 194, wherein: reaching and / or exceeding the threshold triggers an increase in stimulation upon a determination that a threshold for an accelerometer positioned at or near a hand of the human has been met and / or passed.

196. The method of claim 194, wherein: the threshold is set with a safety factor.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2197. A method, comprising: operating a stimulation device to electrically stimulate tissue of a human at a first frequency of stimulation; executing an objective measure monitoring of a physical phenomenon of the human; evaluating whether a result of the monitoring indicates the physical phenomenon is at and / or above a threshold; if the result is above the threshold, triggering electrical stimulation and / or increasing a feature of the electrical stimulation; and if the result does not meet the above the threshold requirement, evaluating a current frequency of stimulation of the device, and based on the evaluation, adjusting the current frequency of stimulation or maintaining the current frequency of stimulation.

198. The method of claim 197, wherein: if the result is above the threshold, the feature of the electrical stimulation is increased, which includes increasing a frequency of electrical stimulation.

199. The method of claim 197, wherein: if the result is above the threshold, the electrical stimulation is increased, which includes increasing a frequency of electrical stimulation for a specific duration.

200. The method of claim 197, wherein: evaluating the current frequency of stimulation of the device includes determining if the current frequency of stimulation is higher than an average frequency of stimulation, and if so, lowering a frequency of stimulation going forward immediately or after a duration of time.

201. The method of claim 200, wherein: the action of lowering the frequency of stimulation returns the device to a usual stimulation frequency.

202. The method of claim 197, wherein:Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 evaluating the current frequency of stimulation of the device includes determining if the current frequency of stimulation is higher than an average frequency of stimulation, and if not, maintaining the current frequency of stimulation.

203. The method of claim 197, wherein: the objective measurement monitoring is directly related to a clinical utilitarian feature of the stimulation device.

204. The method of claim 197, wherein: the method is a closed loop method where the actions of operating, executing and evaluating are repeated over and over until an affirmative action to end the loop is taken by the human.

205. The method of claim 197, wherein: the action of executing the objective measure monitoring is an event triggered event; the method further comprises: executing an environmental assessment of an environment of the human prior to executing the objective measure monitoring; and evaluating whether a result of the assessment indicates an environment that presents difficulties for the human, wherein the result is an environment that causes difficulties for the human, thus triggering the execution of the objective measure monitoring.

206. The method of claim 205, wherein: the action of executing the environmental assessment and evaluating whether the result of the assessment is a subsequent occurrence of such, wherein a precedent environmental assessment of an environment of the human and a precedent evaluation of such results in an environment that does not cause difficulties for the human; and the method further includes evaluating a current frequency of stimulation of the device, and based on the evaluation, adjusting the current frequency of stimulation or maintaining the current frequency of stimulation.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2207. A method, comprising: operating stimulation device to electrically stimulate tissue of a human at a first frequency of stimulation; executing an environmental assessment of an environment of the human; evaluating whether a result of the assessment indicates an environment that presents difficulties for the human; if the result is an environment that causes difficulties for the human: executing an objective measure monitoring of a physical phenomenon of the human; evaluating whether a result of the monitoring indicates the physical phenomenon is above a threshold; if the result is above the threshold, triggering electrical stimulation and / or increasing electrical stimulation; and if the result does not meet the above the threshold requirement, maintaining the current frequency of stimulation; if the result is an environment that does not cause difficulties for the human: evaluating a current frequency of stimulation of the device, and based on the evaluation, adjusting the current frequency of stimulation or maintaining the current frequency of stimulation.

208. The method of claim 207, wherein: the device includes one or more sensors configured to sense the environment and provide input for the environmental assessment.

209. The method of claim 207, wherein: the device is a tinnitus treatment device; and the environment is a sound environment that triggers tinnitus in the human and thus presents difficulties for the human.

210. The method of claim 207, wherein: the device is a vestibular implant; andAtty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 the environment is a low level light environment that presents difficulties for the human.

211. The method of claim 207, wherein: the device is a motor disorder treatment device; and the environment is a high-stimulus environment.

212. The method of claim 207, wherein: the result is an environment that does not cause difficulties for the human, and the method includes evaluating a current frequency of stimulation of the device, and based on the evaluation, adjusting the current frequency of stimulation.

213. The method of claim 207, wherein: the result is an environment that does not cause difficulties for the human, and the method includes evaluating a current frequency of stimulation of the device, and based on the evaluation, maintaining the current frequency of stimulation.

214. The method of claim 207, wherein: the environment is an environment that induces stress in the human.

215. The method of claim 207, wherein: the environment is an environment that has elevated level(s) of energy relative to a prior environment.

216. The method of claim 215, wherein: the elevated level(s) of energy is established by a heightened ambient temperature.

217. A non-transitory computer readable medium, having recorded thereon, a computer program for executing at least a portion of a method, the computer program including: code for controlling a stimulation device to electrically stimulate tissue of a human at a first frequency of stimulation;Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 code for executing an objective measure monitoring of a physical phenomenon of the human; code for evaluating whether a result of the monitoring indicates the physical phenomenon is at and / or above a threshold; code for determining if the result is above the threshold, triggering electrical stimulation and / or increasing a feature of the electrical stimulation; and code for determining if the result does not meet the above the threshold requirement, evaluating a current frequency of stimulation of the device, and based on the evaluation, adjusting the current frequency of stimulation or maintaining the current frequency of stimulation.

218. The medium of claim 217, wherein: the medium includes code so that, upon a determination that the result is above the threshold, the feature of the electrical stimulation is increased, which includes increasing a frequency of electrical stimulation.

219. The medium of claim 217, wherein: the medium includes code so that, upon a determination that the result is above the threshold, the electrical stimulation is increased, which includes increasing a frequency of electrical stimulation for a specific duration.

220. The medium of claim 217, wherein: the code for evaluating the current frequency of stimulation of the device includes code for determining if the current frequency of stimulation is higher than an average frequency of stimulation, and if so, lowering a frequency of stimulation going forward immediately or after a duration of time.

221. The medium of claim 220, wherein: the medium includes code for lowering the frequency of stimulation returns the device to a usual stimulation frequency.Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 1. The medium of claim 217, wherein: the code for evaluating the current frequency of stimulation of the device includes code for determining if the current frequency of stimulation is higher than an average frequency of stimulation, and if not, maintaining the current frequency of stimulation.

223. The medium of claim 217, wherein: the medium includes code to establish a closed loop method where the actions of operating, executing and evaluating are repeated over and over until an affirmative action to end the loop is taken by the human.

224. A system, comprising: a stimulation arrangement configured to electrically stimulate tissue of a human at a first frequency of stimulation and; a scene classifier configured to automatically assess an environment of the human, wherein the system is configured to automatically evaluate whether a result of the assessment indicates an environment that presents difficulties for the human, and the system is configured to automatically: execute an objective measure monitoring of a physical phenomenon of the human if the result is an environment that causes difficulties for the human; evaluate whether a result of the monitoring indicates the physical phenomenon is above a threshold if the result is an environment that causes difficulties for the human; trigger electrical stimulation and / or increasing electrical stimulation if the result is above the threshold; maintain the current frequency of stimulation if the result does not meet the above the threshold requirement; and evaluate, if the result is an environment that does not cause difficulties for the human, a current frequency of stimulation of the device, and based on the evaluation, adjusting the current frequency of stimulation or maintaining the current frequency of stimulation.

225. The system of claim 224, wherein:Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 the stimulation arrangement is an implantable stimulation arrangement.

226. The system of claims 224 or 225, wherein: the stimulation arrangement is a tinnitus treatment device; and the scene classifier is a sound scene classifier.

227. The system of claims 224, 225 or 226, wherein: the stimulation arraignment is a vestibular implant; and the scene classifier is a light level classifier.

228. The system of claims 224, 225, 226 or 227, wherein: the scene classifier is located in a smart device remote from the stimulation arrangement.

229. The system of claims 224, 225, 226 or 227, wherein: the stimulation arrangement is a stimulation prosthesis and the scene classifier is part of the stimulation prosthesis.

230. The system of claims 224, 225, 226, 227, 228 or 229, wherein: the system includes a smart device remote from the stimulation arrangement; and the smart device is configured to automatically evaluate whether a result of the assessment indicates an environment that presents difficulties for the human, and trigger the stimulation arrangement via a Bluetooth connection therewith.

231. A vestibular stimulation system, comprising: at least one implantable electrode; and a receiver-stimulator including a wireless transceiver and an antenna in signal communication therewith, wherein the receiver-stimulator is configured to apply current to the at least one implantable electrode based on a received signal received at the antenna and transceiver by the wireless transceiver,Atty. Docket No. 5441-218EP2 F - 2025-02-12 Client Ref. No. CID03748EPPR2 the receiver-stimulator includes logic circuitry arranged to control the current applied to the at least one implantable electrode to prolong a short term and / or long term longevity of the system relative to that which would otherwise be the case.

Images