Neuromuscular monitoring is described that uses a novel lead assembly and a monitor that can select the appropriate electrodes on the lead assembly and calibrate the stimulation signals applied to the patient through the lead assembly. The monitoring can also set a noise floor value to reduce the likelihood of an erroneous train of four calculations. The present system can automatically sense train of four response of a patient and reduce the likelihood of false train of four indications.

Presented herein are objective techniques for determining the upper limit of the dynamic range (i.e., the comfort level) of implanted stimulating contacts through the use of electrocochleography (ECoG) measurements to indirectly detect the onset and duration of a recipient's stapedius reflex. In particular, stimulation is delivered to a recipient's cochlea to trigger the onset of the stapedius reflex and the resulting acoustic impedance change is detected by monitoring the acoustically evoked ECoG.

In some implementations, the device may include a neural stimulation system having: an implantable closed-loop neural stimulation device for controllably delivering neural stimuli via one or more stimulus electrodes, the device having the one or more stimulus electrodes and a feedback controller configured to adjust a stimulus intensity parameter so as to maintain a measured neural response intensity at a target response intensity; and a processor configured to: estimate an out-of-compliance current limit for each of the one or more stimulus electrodes; estimate a closed-loop current requirement for the implantable closed-loop neural stimulation device; compare the out-of-compliance current limit for each of the one or more stimulus electrodes to the closed-loop current requirement; and take a mitigating action based on the comparison.

In some implementations, the device may include a neural stimulation system having: an implantable closed-loop neural stimulation device for controllably delivering neural stimuli via one or more stimulus electrodes, the device having the one or more stimulus electrodes and a feedback controller configured to adjust a stimulus intensity parameter so as to maintain a measured neural response intensity at a target response intensity; and a processor configured to: estimate an out-of-compliance current limit for each of the one or more stimulus electrodes; estimate a closed-loop current requirement for the implantable closed-loop neural stimulation device; compare the out-of-compliance current limit for each of the one or more stimulus electrodes to the closed-loop current requirement; and take a mitigating action based on the comparison.

An access device for accessing an intervertebral disc having an outer shield comprising an access shield with a larger diameter (16-30 mm) that reaches from the skin down to the facet line, with an inner shield having a second smaller diameter (5-12 mm) extending past the access shield and reaches down to the disc level. This combines the benefits of the direct visual microsurgical/mini open approaches and the percutaneous, ultra-MIS techniques.

An automated system, method, apparatus, device and/or computer program product for detecting positioning effect is set forth, the apparatus according to an exemplary embodiment may include an output operable to couple to one or more stimulating electrodes to stimulate one or more peripheral nerves of the patient, an input operable to couple to one or more recording electrodes to record resultant electrical waveforms generated by a nervous system of a patient in response to the stimulating module, and one or more processors operable to identify the positioning effect based on the resultant electrical waveforms.

One aspect of the present disclosure relates to a system that can prevent unintended signal components (noise) in an electric waveform that can be used for at least one of neural stimulation, block, and/or sensing. The system can include a signal generator to generate a waveform that includes an intended electric waveform and unintended noise. The system can also include a signal transformer device (e.g., a very long wire) comprising a first coil and a second coil. The first coil can be coupled to the signal generator to receive the waveform and remove the unintended noise from the electric waveform. The second coil can pass the electric waveform to an electrode. The second coil can be coupled to a capacitor that can prevent the waveform from developing noise at an electrode/electrolyte interface between an electrode and a nerve.

Disclosed herein is a device, and method for treating heart failure by electrically modulating a splanchnic nerve with an implantable device.

An automated method of controlling neural stimulation. A neural stimulus is applied to a neural pathway in order to give rise to an evoked action potential on the neural pathway, and the stimulus is defined by at least one stimulus parameter. A neural compound action potential response evoked by the stimulus is measured. From the measured evoked response a feedback variable such as observed ECAP voltage (V) is derived. A feedback loop is completed by using the feedback variable to control the at least one stimulus parameter value for a future stimulus. The method adaptively compensates for changes in a gain of the feedback loop caused by electrode movement relative to the neural pathway. A compensating transfer function is applied to the feedback variable, the compensating transfer function being configured to compensate for both (i) a distance-dependent transfer function of stimulation, and (ii) a distance dependent transfer function of measurement which is distinct from (i).

Wireless implantable medical devices, in particular stents, for operably coupling to and functionally interfacing with tissue, such as vascular tissue, adjacent to the implantable medical device, having integrally formed electronic circuitry configured to sense and/or stimulate tissue, such as nerves, adjacent to or in proximity to the situs of the implantable medical device and capable of transmitting signals from the stent to a remote receiver to interrogate conditions in the body or receive signals to stimulate tissue.