Abstract:
A non-invasive device for assisting the treatment of any kind of musculoskeletal disorder, including but not exclusive of those of joint, limb, and spine disorders, includes a brace, sleeve, flexible pad, or any combination of the three, a plurality of electrodes disposed thereon, wherein the plurality of electrodes transmit at least three electrophysical modalities, and a stimulation control unit having interactive software to establish a controlled sequence of transmission of the at least three electrophysical modalities and communicating the controlled sequence to the electrodes. The at least three electrophysical modalities are chosen from a group consisting of neuromodulating functional electrical stimulation, transcutaneous electrical nerve stimulation, pulsed electromagnetic field stimulation, and heat therapy stimulation. The stimulation control unit also provides feedback data using the electrodes for monitoring and integration with the interactive software to analyze and assess biomechanical, neuromuscular, and neurological responses to the device.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This patent application claims the benefit of, under Title 35, United States Code, Section 119(e), U.S. Provisional Patent Application No. 61/543,076, filed Oct. 4, 2011, the content of which is incorporated herein by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The invention relates to a rehab device and more specifically to a flexible sleeve, flexible pad and/or an orthotic brace, applied by itself or associated with and incorporated into any of these three devices, conforming to a patient&#39;s body and being capable of providing multiple electrical treatment modalities and biomechanical analysis for non-invasive treatment of an articulating joint and any associated soft tissue injury, inflammation or pathology related to any injury, disorder, disease, or other medical disability. 
       BACKGROUND OF THE INVENTION 
       [0003]    Osteoarthritis, posttraumatic arthritis, inflammatory arthritis such as rheumatoid arthritis, systemic lupus erythematosus and ankylosing spondylitis, and degenerative joint disease are all common musculoskeletal disorders that cause wear and tear on a joint. In particular, protective cartilage which cushions the bones at the joint can break down and wear away over time. When this happens, the bones rub against each other, causing pain, swelling, stiffness, and restricted movement. While osteoarthritis and other musculoskeletal disorders damage the joint, they also harm the muscles, tendons, ligaments, cartilage, nerves, and discs. 
         [0004]    Musculoskeletal diseases can affect any person of any age, and in many cases no cure exists. But several forms of treatment can slow the progression and severity of musculoskeletal joint, limb, or spine disorders involving the bones, cartilage, tendons, ligaments, muscles, nerves, or discs, as well as relieve pain and improve joint function. One typical form of treatment of arthritis and musculoskeletal soft tissue diseases involves bracing the joint—or an area near the joint—with an orthotic device. Orthotic devices, such as a knee brace, are known to provide unloading support and strength to an injured joint. Despite providing some therapeutic benefits, knee braces are known to cause muscle atrophy as a result of immobilizing the joint. As a means to prevent this negative effect, muscle stimulating means are combined with orthotic devices and other similar devices to assist in either inhibiting or preventing harmful deterioration of muscle mass. Furthermore, an orthotic device or other rehab device with stimulating means can control pain in the muscles and rehabilitate the injured joint and soft tissues without requiring physical penetration through the skin. As an example, this advantage is particularly important to patients with knee osteoarthritis who do not wish for an invasive surgical procedure or a total knee replacement, or patients who have medical contraindications to knee replacement. Therefore, orthotic devices that can simultaneously provide transcutaneous stimulation, unloading support for weight-bearing joints, and other mechanical therapeutic benefits to any joint in general offer an attractive option for alleviating pain and facilitating the rehabilitation of arthritic joints and muscles. 
         [0005]    Some orthotic devices use electrical currents as a form of stimulation to reduce pain and aid in muscle therapy. For example, U.S. Pat. No. 5,947,913 to Palumbo discloses a patellar stabilizing brace comprising a bracing means for applying a medial force on the patella, a generator producing neuromuscular electrical stimulation (NES), and a plurality of electrodes to transmit the electrical stimulation to a muscle mass. The generator is mounted on a sleeve that attaches to the brace using hook-and-loop VELCRO® fasteners while the electrodes are disposed along the sleeve, either penetrating it or passing beneath or above it. Thus, a patient wearing the stabilizing brace would experience periodic stimulation from the electrodes via a transcutaneous method. Further, a transcutaneous electrical nerve stimulation (TENS) unit for providing pain management can be attached to the stabilizing brace. However, without a controller, the Palumbo device lacked the capability for selectively stimulating certain muscles or implementing a programmed sequence of stimulation. 
         [0006]    Other efforts have been made to provide an orthotic device conveying some form of stimulation to aid in the therapy of osteoarthritis. For example, U.S. Pat. No. 7,783,348 to Gill et al. discloses a portable, non-invasive device for providing therapeutic treatment to a knee joint comprising a knee cuff which in turn comprises a thermal exchange component for applying thermal therapy, a signal generator for generating a pulsed electromagnetic field (PEMF) in stimulators, and a controller for storing a treatment mode and communicating the treatment mode to the signal generator and stimulators. However, the orthotic device disclosed in Gill does not provide unloading support or strength to the knee joint and thus does not relieve pressure off the part of the knee joint that is affected by osteoarthritis, arthritides, or soft tissue pathologies. Further, no electrical stimulation is provided in order to alleviate the pain associated with the osteoarthritis. 
         [0007]    U.S. Pat. No. 8,070,703 to Skahan et al. discloses a knee brace system comprising a substantially rigid brace structure having upper and lower supports for securing the brace to the patient&#39;s leg, liner segments attached to each support, and a plurality of electrodes attached to the liner segments which supply stimulation from an electrostimulation unit. Further, the liner segments can be removed and reattached to adjust their position in order to maintain stable contact between the electrodes and the patient&#39;s leg. Used in conjunction with the electrostimulation unit, the plurality of electrodes can provide an electrophysical modality, such as Surface Electrical Stimulation, NES, PEMF Stimulation, or TENS, to the patient&#39;s knee. However, Skahan does not provide for simultaneous or coordinated treatment of a combination of electrophysical modalities targeted at specific parts of the patient&#39;s knee, limb, and muscles. 
         [0008]    While the prior art orthotic devices may provide benefits over conventional braces, they still suffer from several disadvantages. One of such disadvantages is that the orthotic devices do not provide multiple forms of pain management with a comprehensive therapeutic treatment of limb, joint or spine disorders involving the bones, cartilage, tendons, ligaments, muscles, nerves, and/or discs that suffer from arthritis or other damage. Another such disadvantage of the prior art is that they do not incorporate biofeedback monitoring and data to improve response to treatment. The prior art orthotic devices provide selective therapy and pain relief limited to a few bodily parts, such as only the muscles and joint. Consequently, such treatment allows for restoration of certain bodily parts while allowing continued deterioration of other bodily parts. 
       SUMMARY OF THE INVENTION 
       [0009]    An object of the present invention is to remedy the problem of selective treatment and pain relief, without the use of feedback information, of orthotic devices. The present invention accommodates a patient with a brace, sleeve, soft pliable pad, or any combination of the three that can be adapted to any area of the body for unloading support, rehabilitation, and therapeutic treatment, and a plurality of electrodes for transmitting a combination of different electrophysical modalities for improved rehabilitation and pain management of joint, limb or spine disorders involving the bones, cartilage, tendons, ligaments, muscles, nerves, or discs. The plurality of electrophysical modalities include neuromodulating functional electrical stimulation (FES) for muscle contractions, transcutaneous electrical nerve stimulation (TENS) for pain management, pulsed electromagnetic field (PEMF) stimulation for cartilage/tissue rejuvenation and pain control, and heat therapy for pain relief. Noted herein, the term “electrodes” encompasses any conductive materials and devices, including electrical coils, electrical plates, electrical conductors, and conductive fabrics and gels. 
         [0010]    It is another object of the present invention to provide an orthotic device that can transmit a plurality of electrophysical modalities in a controlled sequence or in a simultaneous manner to the patient&#39;s joint, limb, spine, other bodily area. With controlled application of different forms of stimulation, an improved therapy of bodily parts suffering from musculoskeletal conditions is accomplished. 
         [0011]    It is an additional object to provide an orthotic device that can apply a plurality of electrophysical modalities to targeted areas of the body, thus enhancing rehabilitative treatment of certain joint, limb, and spine disorders involving the bones, cartilage, tendons, ligaments, muscles, nerves, and/or discs. 
         [0012]    These and other objectives are achieved by providing an orthotic device utilizing a brace, sleeve, or flexible pad—alone or in combination—to which electrodes are attached and distributed along an inner surface of the brace, sleeve, or flexible pad and a stimulation control unit, wherein the control unit directs the electrodes to transmit a plurality of electrophysical modalities to a patient&#39;s limb. As a result of the sleeve or flexible pad being attached to either the brace or directly to the patient&#39;s skin, or a combination of both attachment methods, the brace, sleeve, and/or flexible pad provides medial and lateral unloading support against weight-bearing forces exerted on the limb or provides stabilizing forces or range of motion to the area involved. 
         [0013]    These and other objectives are also achieved by providing a non-invasive device for treating bodily parts suffering from deterioration caused by a musculoskeletal disorder, wherein said device includes a brace, sleeve, or flexible pad for unloading support, a plurality of electrodes disposed on the brace, sleeve, or flexible pad, and a stimulation control unit controlling the electrodes for transmission of at least three electrophysical modalities chosen from a group consisting of neuromodulating FES, TENS, PEMF stimulation, and heat therapy stimulation. The stimulation control unit also provides for a user to program a controlled sequence of transmission of the at least three electrophysical modalities. In some embodiments, the controlled sequence is defined by each of the electrodes transmitting one of the at least three electrophysical modalities simultaneously. In other embodiments, the controlled sequence is defined by all of the electrodes simultaneously transmitting the same one of the at least three electrophysical modalities. In yet other embodiments, the controlled sequence is defined by a series transmission of the at least three electrophysical modalities by all of the electrodes. In further embodiments, the controlled sequence is defined by select groups of electrodes transmitting simultaneously or sequentially one of the at least three electrophysical modalities. The above embodiments are not exhaustive of all controlled sequences with which the stimulation control unit can be programmed. 
         [0014]    Other objectives of the invention are achieved by providing a non-invasive device for treating musculoskeletal bodily parts suffering from deterioration caused by a musculoskeletal disorder, wherein said device includes a brace for unloading support, a sleeve or flexible pad, a plurality of electrodes disposed on the sleeve or flexible pad, and a stimulation control unit controlling the electrodes for transmission of at least three electrophysical modalities chosen from a group consisting of FES, TENS, PEMF stimulation, and heat therapy stimulation. The sleeve or flexible pad also includes fasteners for removably attaching the sleeve or flexible pad to an inner surface of the brace and thus allowing for the brace to be easily removed from or attached to the sleeve or flexible pad. 
         [0015]    Further objectives are achieved by providing a non-invasive device for treating a musculoskeletal disorder, including a brace, sleeve, or flexible pad for unloading support, a plurality of electrodes disposed on the brace, sleeve, or flexible pad, a stimulation control unit controlling the electrodes for transmission of at least three electrophysical modalities chosen from a group consisting of FES, TENS, PEMF stimulation, and heat therapy stimulation, and a plurality of conductors operably connecting the electrodes to the stimulation control unit. The conductors provide for two-way communication between the electrodes and the stimulation control unit. In particular, the stimulation control unit communicates a controlled sequence of transmission of the at least three electrophysical modalities to each of the electrodes while the electrodes supply anatomical data to the control unit. 
         [0016]    Additional objectives are achieved by providing a non-invasive device for treating a musculoskeletal disorder, including a brace, sleeve, or flexible pad, a plurality of electrodes disposed on the brace, sleeve, or flexible pad, a stimulation control unit controlling the electrodes for transmission of at least three electrophysical modalities chosen from a group consisting of FES, TENS, PEMF stimulation, and heat therapy stimulation, and a plurality of transmitter-receiver units individually disposed within each of the electrodes and the stimulation control unit. The transmitter-receiver units provide two-way wireless communication, which allows the stimulation control unit to manage specific electrodes according to a controlled sequence of transmission of the electrophysical modalities. The electrodes provide feedback data to the control unit for in-depth analysis of anatomical responses. 
         [0017]    Other objectives of the invention are achieved by providing a non-invasive device for treating a musculoskeletal disorder having a brace, sleeve, or flexible pad, a plurality of electrodes disposed on the brace, sleeve or flexible pad, each electrode transmitting a plurality of electrophysical modalities, and a stimulation control unit having a neuromuscular feedback component and a neurofeedback mechanism to dynamically control the transmission of a FES modality and a TENS modality, respectively. The neurofeedback mechanism further comprises pain assessment and pain measurement algorithms, which provide subjective and objective analyses of pain and correlations thereof. When integrated with the feedback control loops of the control unit, these algorithms assess anatomical and neurological responses to the TENS modality. The stimulation control unit also includes a biomechanical component for monitoring biomechanical response and analyzing range of motion of a limb and joint. With the electrodes—or other electrically conductive elements—incorporated into the non-invasive device, the biomechanical component, the neuromuscular feedback component, and the neurofeedback mechanism can be utilized alone or in combination to provide feedback to the control unit. This feedback can come in the form of either individual data point readouts, sent at once or in a sequential data point progression, or multiple data point readouts, sent at a single time point or over sequential time points. Using this feedback, the stimulation control unit dynamically controls the transmission of the FES, TENS, PEMF stimulation and heat therapy stimulation modalities. 
         [0018]    Also thus provided is a method of transmitting electrophysical modalities to a bodily part with a non-invasive device, including the steps of at least programming a controlled sequence of transmission of at least three electrophysical modalities, wherein the controlled sequence comprises at least a transmission of one of the electrophysical modalities by one or more electrodes, transmitting the electrophysical modality transcutaneously, observing and recording a response of a muscle mass via a neuromuscular feedback component, and adjusting the controlled sequence according to the response by adjusting a magnitude of the electrophysical modality. Another method of transmitting electrophysical modalities includes the above steps as well as adjusting a duration of the transmission of the electrophysical modality. Yet another method of transmitting electrophysical modalities with a non-invasive device includes the steps of at least programming a controlled sequence of transmission of at least three electrophysical modalities, wherein the controlled sequence comprises at least a transmission of a first modality of the electrophysical modalities by one or more electrodes, transmitting the first modality transcutaneously, observing and recording a response of a muscle mass via a neuromuscular feedback component, and adjusting the controlled sequence by changing the first modality to a second modality. 
         [0019]    Yet another method of controlling and assessing the response of transmission of electrophysical modalities to a bodily part include using a neurofeedback mechanism. The neurofeedback mechanism monitors and records activity in at least one nerve and adjusts the controlled sequence according to the activity either by tuning the magnitude and/or duration of a first modality or changing the first modality to a second modality. As examples, the neurofeedback mechanism may be implemented into the non-invasive device by incorporating any one or combination of a Nerve Conduction Test, Electromyogram, or Somatosensory Evoked Potential. Such configurations establish feedback loops to analyze and assess nerve function, which is useful for instance when nerve irritation or nerve compromise is part of the patient&#39;s medical problem. The neurological monitoring of the present invention is especially beneficial to patients recovering from operations involving the nervous system or patients having non-operative musculoskeletal pathology where improved function resulting from use of the invention might pose risk to or cause otherwise occult changes to the musculoskeletal system&#39;s anatomic or physiologic integrity. With the neurofeedback mechanism, the control unit generally carries out two major tasks: (1) selective activation of stimulating electrodes with appropriate timing, and (2) recording, processing and displaying of electrophysiologic signals of the limb detected by the electrodes. A healthcare professional (e.g. neurophysiologist) can thus observe and document in real-time the electrophysiologic signals as they change under the influence of the electrophysical modalities, whether it be TENS, FES, PEMF stimulation, or heat therapy stimulation. 
         [0020]    Additional methods of transmitting electrophysical modalities to a bodily part include using a biomechanical component for analyzing biomechanical response—such as computerized gait analysis and range of motion analysis—of the limb and adjusting one or more of the modalities in the controlled sequence of transmission according to the biomechanical response and outcome of the computerized analysis. 
         [0021]    Each of the neuromuscular feedback component, neurofeedback mechanism, and biomechanical component can be adjusted through the stimulation control unit via interactive software. The interactive software further provides the capability of interfacing with other medical application programs developed by third-parties. 
         [0022]    Information obtained from the various biomechanical, neuromuscular and neuro feedback loops can be utilized in CAD (Computer Aided Design) and CAM (Computer Aided Manufacturing) considerations when performing brace “fittings” or customizing individual braces. This would also apply to braces manufactured and sold “off the shelf” with standard sizes and features. For example, a generic brace or universal brace module can be applied to the patient during a trial or fitting session, and with data from the modalities and biofeedback information collated during the fitting session, one can manufacture and develop a personalized brace tailored specifically for that particular patient&#39;s needs, anatomy, and body mechanics. Moreover, a improved generic brace for wide segments of the population with more general needs can be developed and modified based on overall data collected from the above described feedback information. 
         [0023]    Further provided is a non-invasive device for treating a joint disorder, including a brace, sleeve, or flexible pad for unloading support or other force or support-related purposes, a sleeve or flexible pad removably attached to an inner surface of the brace, a plurality of electrodes disposed on the sleeve or flexible pad, and a stimulation control unit which controls the electrodes to transmit a plurality of electrophysical modalities comprising FES, TENS, PEMF stimulation, and heat therapy stimulation. 
         [0024]    The non-invasive orthotic rehabilitation device according to the present invention improves the treatment and rejuvenation of bodily parts, including muscles, cartilage, ligaments and bones, that have been adversely affected by a joint disease. It increases the efficacy of pain relief by applying different forms of pain management electrophysical modalities to the bodily parts. Furthermore, with the device transmitting at least three electrophysical modalities, the present invention avoids the tendency of rejuvenating one bodily part while allowing other bodily parts, including joints, limbs, bones, cartilage, tendons, ligaments, muscles, nerves, or discs, to deteriorate. 
         [0025]    Other features and aspects of the invention will become apparent from the following detailed description, taken in conjunction with the accompanying drawings, which illustrate by way of example, the features in accordance with embodiments of the invention. The summary is not intended to limit the scope of the invention, which is defined solely by the claims attached thereto. The summary presents as an example a knee unloading brace. Similar applications include, but are not limited to: weight-bearing braces, loading braces, unloading braces of any kind, such as for the ankle, knee, or hip, range of motion and stabilization braces for the ankle (e.g. ankle support systems and air casts), knee (e.g. patellar cutout braces), and hip, cervical, thoracic and lumbar spine braces (e.g. TLSO), as well as finger, wrist, elbow, and shoulder braces and related medical devices. 
         [0026]    The embodiments as discussed above are illustrative and are not intended to exhaust all possible arrangements, modifications, and variations of features of the invention—such as any other neuro-electrodes/electrical impulse type electrodes or feedback combinations—which are ascertainable by those skilled in the art. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0027]      FIG. 1  is a front view of an orthotic device transmitting a plurality of electrophysical modalities according to an exemplary embodiment of the present invention. 
           [0028]      FIG. 2  is a side view of the orthotic device shown in  FIG. 1 . 
           [0029]      FIG. 3  is a cut-away perspective view of the inside of the orthotic device shown in  FIG. 1 . 
           [0030]      FIGS. 4A and 4B  are block diagrams illustrating a stimulation control unit in communication with electrodes for controlling the transmission of a plurality of electrophysical modalities according to an exemplary embodiment of the present invention. 
           [0031]      FIG. 5A  is a front view of a stimulation control unit for controlling the transmission of a plurality of electrophysical modalities according to an exemplary embodiment of the present invention. 
           [0032]      FIG. 5B  is a front view of the stimulation control unit of  FIG. 5A  removably attached to the brace of  FIG. 1 . 
           [0033]      FIGS. 6A and 6B  are top views of an electrode in wired communication and wireless communication with a stimulation control unit, respectively. 
           [0034]      FIG. 7  is a bottom view of the electrode shown in  FIG. 6A . 
           [0035]      FIG. 8  is a side elevation view of the electrode shown in  FIG. 6A . 
           [0036]      FIG. 9  is a front view of an orthotic device transmitting a plurality of electrophysical modalities according to a second embodiment of the present invention. 
           [0037]      FIG. 10  is a cut-away perspective view of an orthotic device transmitting a plurality of electrophysical modalities according to a third embodiment of the present invention. 
           [0038]      FIG. 11  is a front view of an orthotic device transmitting a plurality of electrophysical modalities according to a fourth embodiment of the present invention. 
           [0039]      FIG. 12  is a cut-away perspective view of an orthotic device transmitting a plurality of electrophysical modalities according to a fifth embodiment of the present invention. 
           [0040]      FIG. 13  is a cut-away perspective view of an orthotic device transmitting a plurality of electrophysical modalities according to a sixth embodiment of the present invention. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0041]    As used herein, the terms “lateral,” “medial,” “anterior,” “posterior,” “upper,” and “lower” characterize certain elements of the orthotic device, and in particular, describe the relative proximity of the given element to the central longitudinal axis of the body (i.e. limb) of the user when the orthotic device is mounted thereon. The term lateral means away from a vertical central longitudinal axis of the body, the term medial means toward a vertical central longitudinal axis of the body, the term anterior means toward the front of the body, the term posterior means toward the back of the body, the term upper means higher up on the body above a joint, and the term lower means lower down on the body below a joint. 
         [0042]    As used herein, the terms “electrode” and electrodes” encompass electrical coils, electrical plates, electrical conductors, conductive fabrics and gels, and any other conductive materials and devices. 
         [0043]    Referring to the figures in detail and first to  FIGS. 1-2 , there is shown an exemplary embodiment of a non-invasive, orthotic device with electrodes for transmitting electrophysical modalities.  FIG. 1  shows the orthotic device  10  with electrodes  16  disposed along the entire length of a brace  11 . The orthotic device  10  includes a brace  11  having one support member  12 , a plurality of electrodes  16  attached to the brace  11 , and a stimulation control unit  22 , wherein the stimulation control unit  22  directs the electrodes  16  to transmit electrophysical modalities in a transcutaneous manner to the user&#39;s limb, such as the user&#39;s leg  27 . The support member  12  has an upper portion  13  conforming to the leg  27  above the knee  28  (i.e. thigh) and a lower portion  14  conforming to the user&#39;s leg  27  below the knee  28  (i.e. calf). The upper and lower portions  13 ,  14  each have at least one brace fastener  15  adapted to secure the support member  12  to the leg  27 . The brace fasteners  15  can comprise different materials and different configurations that provide a secure, non-slip engagement of the support member  12  to the leg  27 . For example, the brace fastener  15  can comprise a VELCRO® strap which is threaded through a retainer (not shown) disposed on the support member  12 . Further, the brace fasteners  15  are removably attached to an outer surface  33  (see  FIG. 3 ) of the support member  12 , such that the brace fasteners  15  can be repositioned along the upper portion  13  and lower portion  14  to achieve a secure engagement. 
         [0044]    When a secure engagement between the support member  12  and the leg  27  is created, the support member  12  provides medial and lateral unloading support for weight-bearing forces exerted on the leg  27  and the knee  28 . The support member  12  can also provide comfort to the knee  28 . In another embodiment, the support member  12  provides stabilizing forces to the leg  27  and the knee  28 . In yet another embodiment, the support member  12  provides range of motion to the leg  27 . 
         [0045]    The brace  11  further comprises a pair of brace hinges  17  mounted on the brace  11  at opposing sides of the knee  28  where the upper portion  13  meets the lower portion  14 . The brace hinges  17  provide for a pivoting motion between the upper portion  13  and the lower portion  14  along an axis  18 . The brace hinges  17  thus allow for articulation of the leg  27  or can maintain the leg  27  in one or more selected positions while constantly providing medial and lateral unloading support. As shown in  FIG. 2 , the brace  11  also includes an anterior patella opening  29  extending the perimeter of the knee  28  and a posterior knee pit opening  31  extending the perimeter of the knee pit  30  when the orthotic device  10  is worn by the user. The patella opening  29  and the knee pit opening  31  provide the necessary openings to avoid any interference the brace  11  may have with the knee  28  and knee pit  30 , respectively, when the leg  27  articulates. 
         [0046]    The plurality of electrodes  16  disposed along the length of the support member  12  are removably attached to an inner surface  32  (see  FIG. 3 ) of the support member  12 . As such, the electrodes  16  do not interfere with the function of the brace fasteners  15 , which are disposed on the outer surface  33 . The electrodes  16  can be positioned anywhere and in any configuration (e.g. parallel, series, staggered, etc.) on the inner surface  32 , including the anterior and posterior of both the upper portion  13  and the lower portion  14 . As shown in  FIG. 1 , the electrodes  16  are disposed on the posterior of both the upper and lower portions  13 ,  14  in a substantially series-parallel configuration. In  FIG. 2 , the electrodes  16  are disposed on a side of the support member  12  at the posterior and anterior of both upper and lower portions  13 ,  14 . However, to maximize the treatment benefits of the electrophysical modalities, the electrodes  16  can be positioned closely around specific parts of the leg  27  that require concentrated therapy and pain relief compared to other parts of the leg  27 . 
         [0047]    The orthotic device  10  also includes conductors  19  each having a proximal end  20  operably connected to the stimulation control unit  22  and a distal end  21  operably connected to at least one of the electrodes  16 . The conductors  19  provide for communication between the stimulation control unit  22  and the electrodes  16  in order to control the transmission of the electrophysical modalities. In one embodiment, the stimulation control unit  22  directs the electrodes  16  to transmit electrophysical modalities, wherein the electrophysical modalities comprise at least three electrophysical modalities chosen from a group consisting of neuromodulating FES  23 , TENS  24 , PEMF stimulation  25 , and heat therapy stimulation  26 . In another embodiment, the stimulation control unit  22  directs the electrodes  16  to transmit electrophysical modalities comprising FES  23 , TENS  24 , PEMF stimulation  25 , and heat therapy stimulation  26 . 
         [0048]    The stimulation control unit  22  further establishes a controlled sequence of transmission of the electrophysical modalities. In one embodiment, the controlled sequence of transmission is defined by a first group of electrodes transmitting a first modality of the electrophysical modalities, a second group of electrodes transmitting a second modality of the electrophysical modalities, and a third group of electrodes transmitting a third modality of the electrophysical modalities, wherein the first, second, and third groups simultaneously transmit the first, second and third modalities, respectively. In a second embodiment, the controlled sequence of transmission is defined by the electrodes simultaneously transmitting the same electrophysical modalities. In a third embodiment, the controlled sequence of transmission is defined by the electrodes transmitting in series one of the electrophysical modalities. In yet another embodiment, the controlled sequence of transmission is defined by the serial transmission of each of the electrophysical modalities by all electrodes. Note, the above examples are representative but not exhaustive of the controlled sequence of transmission of electrophysical modalities performed by the orthotic device embodying the present invention. 
         [0049]      FIG. 4A  shows a block diagram of one embodiment of the stimulation control unit. The stimulation control unit  22  comprises a power source  34  for supplying energy to the control unit  22 , a microcontroller  35  for controlling the electrodes  16  according to the controlled sequence of transmission of the at least three electrophysical modalities chosen from the group consisting FES  23 , TENS  24 , PEMF stimulation  25 , and heat therapy stimulation  26 , an input unit  36  for manipulating and programming the controlled sequence of transmission into the microcontroller  35 , and a monitor  37  for displaying the controlled sequence of transmission and a status of each of the electrodes  16 . In one embodiment, the power source  34  comprises an energy cell or portable battery pack. In another embodiment, energy is supplied to the stimulation control unit  22  through an electrical cord (not shown) having one end connected to the control unit  22  and another end connected to an electrical socket. With regards to the input unit  36 , one embodiment of this element comprises an alpha-numeric keypad or keyboard. In an alternative embodiment, the input unit  36  is combined with the monitor  37  to provide a touch screen interface responsive to a touch by the user. 
         [0050]    With the input unit  36  and the monitor  37  coupled to the microcontroller  35 , the user can create one or more controlled sequences of transmission of the electrophysical modalities, save the controlled sequences, and select at a later time any one of the saved controlled sequences. Once the user makes a selection, the microcontroller  35  communicates the controlled sequence to each of the electrodes  16  via the conductors  19 . In one embodiment, the stimulation control unit  22  also includes a neuromuscular feedback component  38  connected to the microcontroller  35  and electrodes  16  via conductors  19 . With the electrodes  16 , the neuromuscular feedback component  38  observes and records a response in a muscle mass upon the transmission of a FES modality  23 . The neuromuscular feedback component  38  then adjusts the FES modality  23  according to the response and controlled sequence of transmission. Specifically, the neuromuscular feedback component  38  can change a parameter (e.g. magnitude or duration) of the FES modality  23 . The neuromuscular feedback component  38  may also modify the controlled sequence of transmission by adjusting the electrophysical modality from FES  23  to TENS  24 , PEMF stimulation  25 , or heat therapy stimulation  26 . In another embodiment, the stimulation control unit  22  includes a neurofeedback mechanism  39  connected to the microcontroller  35  and the electrodes  16  via conductors  19 . Similar to the configuration of the neuromuscular feedback component  38 , the neurofeedback mechanism  39  observes and records a response in a nerve or group of nerves upon the transmission of a TENS modality  24 . The neurofeedback mechanism  39  then adjusts the TENS modality  24  according to the response. For example, the neurofeedback component  38  can change the magnitude or duration of the TENS modality  24  or modify the controlled sequence of transmission by adjusting the electrophysical modality from TENS  24  to FES  23 , PEMF stimulation  25 , or heat therapy stimulation  26 . The neurofeedback mechanism  39  can be based on incorporating a Nerve Conduction Test, Electromyograph, Somatosensory Evoked Potential (SSEP), or other neuro-electrode/electrical impulse type electrode. In yet another embodiment, the stimulation control unit  22  includes both the neuromuscular feedback component  38  and the neurofeedback mechanism  39  to adjust the controlled sequence of transmission. 
         [0051]    According to another embodiment of the present invention, the stimulation control unit  22  has a biomechanical component  46  connected to the electrodes  16  via conductors  19 . As an alternative, a separate set of conductors can be used to operably connect the biomechanical component  46  to the electrodes  16 . Regardless of whether conductors  19  or a separate set of conductors are used, the biomechanical component  46  monitors biomechanical response in the limb and performs computerized gait analysis and range of motion analysis throughout the operation of the orthotic device  10 . Based on the biomechanical response and analysis viewed within the context of the controlled sequence of transmission, the biomechanical component  46  can adjust the FES modality  23  and/or the TENS modality  24 . Moreover, the biomechanical component  46  can adjust the PEMF stimulation  25  and/or the heat therapy stimulation  26  according to the biomechanical response. With regards to the PEMF stimulation  25 , the biomechanical component  46  can vary several aspects of the electromagnetic field, including the frequency, intensity, the type of waveform (e.g. sine, square, triangle, sawtooth, or random), and therapy time. The biomechanical component  46  will adjust the PEMF stimulation  25  to maximize its therapeutic benefit on the user&#39;s leg  27  and knee  28 . Similarly, the biomechanical component  46  can adjust the heat therapy stimulation  26  by either increasing or decreasing the temperature applied to the user&#39;s body to promote healing in the limb, joint, muscles, and other bodily parts. In particular, pain relief and vasodilation for muscle relaxation can be accomplished by transmitting warm-to-hot temperatures to the limb and joint while transmitting cool-to-cold temperatures reduces inflammation and decreases pain and spasms. By incorporating, either alone or in combination, the neuromuscular feedback component  38 , neurofeedback mechanism  39 , and the biomechanical component  46  with the microcontroller  35 , a dynamic feedback control of the transmission of electrophysical modalities can be achieved. The feedback from each of the electrodes  16  can be unique, individual data point readouts, sent to any of the three feedback components either all at once or in a sequential data point progression. Alternatively, the feedback from each of the electrodes  16  can be multiple data point readouts acquired at single time point or over sequential time points. 
         [0052]    The data obtained from the biomechanical, neuromuscular, and neuro feedback loops is not only beneficial in providing a real-time, intelligent form of control but can be used in CAD (Computer Aided Design) and CAM (Computer Aided Manufacturing) considerations for brace “fitting” or customization of braces. For example, data from the modalities and biofeedback information can be collated during a brace fitting session to manufacture and develop a customized brace tailored for a particular individual&#39;s needs, anatomy, and body mechanics. In another example, an improved generic brace for wide segments of the population with general needs (as opposed to unique medical conditions) can be developed and modified based on overall data collected from the described feedback information. 
         [0053]      FIG. 4B  shows a block diagram of a second embodiment of the stimulation control unit according to the present invention. In this embodiment, the stimulation control unit  22  comprises a power source  34 , a microcontroller  35 , an input unit  36 , a monitor  37 , and a transmitter-receiver unit  40 . Further, each of the electrodes  16  comprises a transmitter-receiver unit  40 . The transmitter-receiver units  40  establish wireless communication between the stimulation control unit  22  and the electrodes  16 , thus providing control of the electrodes  16 . The transmitter-receiver units  40  also communicate muscle responses and nerve activity from the electrodes  16  to the neuromuscular feedback component  38  and neurofeedback mechanism  39 , respectively. Biomechanical response and range of motion data is also sent back wirelessly from the electrodes  16  to the biomechanical component  46 . 
         [0054]      FIG. 5A  is a front view of the stimulation control unit  22  as embodied in  FIG. 4A . Using the input unit  36 , the user can program a controlled sequence of transmission into control unit  22  while viewing a system interface displayed on monitor  37 . As shown in  FIG. 5B , the stimulation control unit  22  also includes a unit fastener  41  adapted to removably attach the control unit  22  to the outer surface  33  of the support member  12 . In one embodiment, the unit fastener  41  can comprise VELCRO® hook-and-loop fastening means. In another embodiment, the unit fastener  41  can comprise a clip which attaches to one of the brace fasteners  15 . 
         [0055]      FIGS. 6A and 6B  are top views of two embodiments of the electrode  16 . In  FIG. 6A , the electrode  16  comprises a signal generator  42  connected to conductor  19 , a temperature unit  44  and a transmission layer  43 , which come in direct contact with the user&#39;s leg  27 . Signal generator  42  receives and interprets the controlled sequence of transmission from the stimulation control unit  22  and supplies an electrical current to either temperature unit  44  or transmission layer  43  for generating one of the electrophysical modalities. If the electrode  16  is directed to transmit either FES  23 , TENS  24 , or PEMF stimulation  25 , the signal generator  42  supplies the electrical current to the transmission layer  43  which in turn transmits the stimulation to the leg  27 . Further, the transmission layer  43  is adapted to monitor a response or activity of a bodily part (e.g. muscle or nerve) and communicate the response back to the microcontroller  35 , neuromuscular feedback component  38 , neurofeedback mechanism  39 , and biomechanical component  46 . If the electrode  16  is directed to transmit heat therapy stimulation  26 , the signal generator  42  supplies electrical current to the temperature unit  44 . The temperature unit  44 , which further comprises electrical coils or other similar mechanisms for producing different temperatures, interprets and uses the electrical current to provide either heating or cooling to the user&#39;s leg  27 . In all embodiments, the electrodes are designed to detect and send electrical impulses and may require special features, such as a conductive gel, to provide for appropriate conductive characteristics. 
         [0056]    As illustrated in  FIG. 6B , another embodiment of electrode  16  comprises a signal generator  42  connected to a transmitter-receiver unit  40 , a temperature unit  44  and transmission layer  43 . With the transmitter-receiver unit  40 , commands from the stimulation control unit  22  are received wirelessly by the electrodes  16  while responses in bodily parts that are observed by the electrodes  16  are sent back to the microcontroller  35 , neuromuscular feedback component  38 , neurofeedback mechanism  39 , and biomechanical component  46 . 
         [0057]      FIG. 7  shows a bottom view of electrode  16 . To removably attach the electrode  16  to support member  12 , electrode  16  comprises a fastening layer  45  disposed on a side opposite the signal generator  42 , transmission layer  43 , and temperature unit  44 . The fastening layer  45  is adapted to removably attach the electrode  16  to the inner surface  32  of support member  12 . In one example, the fastening layer  45  can be made of VELCRO® or some other material that provides adhesion or engagement between the electrode and brace to achieve a secure attachment. Discussed in further detail below, the fastening layer is also adapted to removably attach an electrode to an inner surface of a sleeve or flexible pad, either alone or in combination with a brace. 
         [0058]    As illustrated in  FIG. 8 , the fastening layer  45  is in contact with the inner surface  32  to securely attach the electrode  16  to the support member  12 . Once the user positions the orthotic device  10  on his or her leg  27 , the electrode  16  is placed in direct contact with the leg  27 , allowing for transmission of the electrophysical modalities to be accomplished transcutaneously. Further, the electrode  16  with signal generator  42 , temperature unit  44  (not shown), transmission layer  43 , and fastening layer  45  still maintains a small footprint. As such, the electrode  16  lies substantially flush with the inner surface  32  of support member  12 . 
         [0059]    Referring to  FIG. 9 , there is shown a second embodiment of the non-invasive, orthotic device according to the present invention.  FIG. 9 , in particular, shows an orthotic device  50  having a sleeve  51 , electrodes  52  disposed on the sleeve  51 , a stimulation control unit  56 , and a plurality of conductors  53  each having a proximal end  55  connected to the stimulation control unit  56  and a distal end  54  connected to one or more electrodes  52 . The sleeve  51  is made of a material having elastic properties and has a tubular shape designed to fit over and conform to the user&#39;s leg  61  and knee  62 . More specifically, the sleeve is capable of conforming to any configuration that accommodates the anatomical aspects of the bodily area in question. Further, the sleeve  51  maintains constant contact with the leg  61  and knee  62  while allowing flexibility for motion of the leg  61  and knee  62 . Like electrodes  16  (see  FIGS. 6A ,  6 B, and  7 ), each electrode  52  has a fastening layer for removably attaching the electrode  52  to an inner lining of the sleeve  51 , a signal generator for supplying an electrical current needed to generate the electrophysical modalities, a transmission layer adapted to transmit FES  57 , TENS  58  and PEMF  59 , and a temperature unit adapted to provide heat therapy stimulation  60 . Once the user wears the sleeve  51 , the transmission layer and temperature unit of each electrode  52  is placed in direct contact with the user&#39;s leg  61 . In cases involving treatment of anatomical body parts other than the user&#39;s leg, the sleeve, when worn, is also capable of placing the transmission layer and temperature unit in direct contact with the body part. 
         [0060]    In another embodiment, the electrodes  52  can removably attach to an outer lining of the sleeve  51  such that the transmission layers of the electrodes  52  are in contact with the sleeve  51 . With the sleeve  51  comprising conductive fabric, the electrodes  52  can transmit transcutaneously the electrophysical modalities through the sleeve  51  to the user&#39;s leg  61 . Therefore, in this particular embodiment, the electrodes  52  are not (and need not be) in direct contact with the user&#39;s leg  61 . 
         [0061]    Referring to  FIG. 10 , there is shown a third embodiment of the non-invasive, orthotic device according to the present invention.  FIG. 10 , in particular, shows an orthotic device  70  having a brace  71 , a pair of brace hinges  73  disposed on the brace  71 , a sleeve  75 , electrodes  78 , conductors  79 , and a stimulation control unit  80  for establishing a controlled sequence of transmission of electrophysical modalities. The electrodes  78  are removably attached to an inner lining of the sleeve  75  such that the electrodes  78  are in direct contact with the user&#39;s leg  85 . The sleeve  75  further comprises sleeve fasteners  76  disposed on the outer lining of the sleeve  75  (also shown as  63  in  FIG. 9 ). The sleeve fasteners  76  are adapted to releasably engage the inner surface (not shown) of the brace  71  when the user positions his leg  85  into the brace  71 . Once the user is wearing the brace  71 , the sleeve fasteners  76  provide a secure attachment between the sleeve  75  and the brace  71  preventing any slipping motion between the two elements. On the other hand, if the user needs to take off the brace  71 , the user merely releases the sleeve fasteners  76  from the inner surface of the brace  71 . The orthotic device  70  further comprises brace fasteners  74  disposed on an outer surface  72  to secure the brace  71  to the leg  85 . When a secure engagement is created, the brace  71  provides medial and lateral unloading support for weight-bearing forces exerted on the leg  85  and knee  86 . 
         [0062]    Through the conductors  79 , the stimulation control unit  80  directs the electrodes  78  to transmit at least three electrophysical modalities chosen from the group consisting FES  81 , TENS  82 , PEMF  83 , and heat therapy stimulation  84 . The stimulation control unit  80  is further adapted to removably attach to the outer surface  72  of the brace  71 . Alternatively, the stimulation control unit  80  can be a separate stand-alone unit in wireless communication with the electrodes  78 . 
         [0063]    Referring to  FIG. 11 , a fourth embodiment of the non-invasive, orthotic device is shown.  FIG. 11  illustrates an orthotic device  100  comprising a flexible pad  101 , a plurality of electrodes  102  disposed on the flexible pad  101 , a stimulation control unit  104 , and one or more conductors  103  each having a proximal end connected to the stimulation control unit  104  and a distal end connected to one or more electrodes  102 . The flexible pad  101  is made of any material having flexible and elastic characteristics, such as fabric, plastic, or latex rubber, which allows it to conform to any anatomical aspects of the user&#39;s leg  110 , knee  111 , or other body part. In one embodiment, the flexible pad  101  also has an adhesive portion disposed on an inner lining (not shown) of the flexible pad  101  and adapted to removably attach to any part of the user&#39;s leg  110 . As one example, the adhesive portion comprises a pressure-sensitive adhesive composition. In another example, the adhesive portion can be composed of medical tape. Other materials which can provide a secure, temporary attachment to any part of a user&#39;s body can also be used for the adhesive portion. In a different embodiment, the flexible pad  101  uses other means of fastening (e.g. VELCRO® straps) instead of an adhesive portion to secure the pad to the user&#39;s body. Where VELCRO straps® are used, the flexible pad can have configurations that resemble existing medical support pads, such as knee pads, leg pads, or lumbar spine pads. 
         [0064]    Each of the electrodes  102  comprises a fastening layer for removably attaching the electrode to the inner lining of the flexible pad  101 . The fastening layer can comprise VELCRO® or other material that creates a secure engagement between the electrode  102  and the flexible pad  101 . Alternatively, the adhesive portion on the inner lining of the flexible pad  101  can be used to removably attach the electrode  102 . 
         [0065]    The electrodes  102  each have a signal generator for creating at least three electrophysical modalities chosen from the group consisting of FES  105 , TENS  106 , PEMF stimulation  107 , and heat therapy stimulation  108 , a transmission layer adapted to transmit the FES  105 , TENS  106 , and PEMF stimulation  107 , and a temperature unit adapted to provide the heat therapy stimulation  108 . When the flexible pad  101  is applied to the user&#39;s leg  110 , direct contact is made between the user&#39;s leg and the transmission layer and temperature unit of the electrodes  102 . This direct contact allows for transcutaneous transmission of the electrophysical modalities from the electrodes  102  to the user&#39;s leg  110 . 
         [0066]    Referring to  FIG. 12 , there is shown a fifth embodiment of the non-invasive, orthotic device according to the present invention.  FIG. 12  illustrates an orthotic device  120  comprising a brace  121 , a pair of brace hinges  122  disposed on opposite sides of the brace  121 , one or more brace fasteners  123  for securing the brace  121  to a leg  133 , a flexible pad  124 , a plurality of electrodes  125 , one or more conductors  126 , and a stimulation control unit  127  for programming a controlled sequence of transmission of electrophysical modalities (FES  128 , TENS  129 , PEMF stimulation  120 , heat therapy stimulation  131 ). Having a similar configuration as the third embodiment of the orthotic device shown in  FIG. 10 , the electrodes  127  are removably attached to an inner lining of the flexible pad  124  so that the electrodes  125  maintain direct contact with the user&#39;s leg  133 . The pad  124  further comprises pad fasteners  132  (also shown as  109  in  FIG. 11 ) disposed on an outer lining of the pad  124  and adapted to releasably engage the inner surface (not shown) of the brace  121 . Once the user applies the flexible pad  124  to his leg  133  and subsequently positions the brace  121  on his leg  133 , the pad fasteners  132  create a secure attachment between the flexible pad  124  and the brace  121 . If the user needs to take off the brace  121 , the user merely releases the pad fasteners  132  to separate the flexible pad  124  from the inner surface of the brace  121 . 
         [0067]    Further, the pad fasteners  132  promote consistent positioning of the electrodes  125  on the user&#39;s leg  133  between different treatment sessions of the orthotic device  120 . Specifically, after completing a first treatment session, the user can leave the flexible pad  124  (and electrodes  125 ) attached to the brace  121  when the brace is removed from the leg  133 . When a second treatment session must be conducted, the user simply places the brace  121  on his leg  133  to dispose the electrodes  125  in the same positions (on the leg  133 ) that they had during the first treatment session. Other means can also be used to promote consistent positioning of electrodes on the limb from one treatment session to another. Anatomical landmarks, skin markers, contours of the sleeve/pad, sleeve/pad cutout locations and fitting parameters, and other positioning characteristics unique to the patient allow for the same electrode positioning features to be incorporated into the sleeve or pad thus maintaining position consistency while donning or removing the sleeve or pad from one treatment session to the next. 
         [0068]    This particular feature of the present invention therefore promotes improved therapeutic treatment by ensuring consistent transmission of electrophysical modalities to specific parts of the user&#39;s leg from one treatment session to another. 
         [0069]    The one or more conductors  126  connect the stimulation control unit  127  to the electrodes  125 , which allows the control unit  127  to supply the electrodes  125  with the controlled sequence of transmission of the electrophysical modalities. The stimulation control unit  127  also includes a unit fastener (not shown) for removably attaching the control unit to the flexible pad  124  or the brace  121 . In another embodiment, the stimulation control unit  127  can be a stand-alone wireless unit having no physical attachment to either the flexible pad  124  or the brace  121 . 
         [0070]      FIG. 13  shows a sixth embodiment of the non-invasive, orthotic device comprising a back brace.  FIG. 13 , in particular, shows an orthotic device  140  having a brace  141  positioned around a user&#39;s torso  147 , a plurality of brace fasteners  142 , one or more flexible pads  143 , a plurality of electrodes  144 , one or more conductors  145 , and a stimulation control unit  146 . With the electrodes  144  removably attached to an inner lining (not shown) of the flexible pad  143 , an adhesive portion disposed on the inner lining provides the means for attaching the flexible pad  143  to the torso  147 . Accordingly, direct contact is made between the electrodes  144  and the torso  147 . Further, the flexible pads  143  are removably attached to an inner surface of the brace  141  via one or more pad fasteners  148 . Once the user is wearing the brace  141 , the pad fasteners  148  provide a secure attachment between the flexible pads  143  and the brace  141  and prevent any slipping motion between these two elements. 
         [0071]    For all previously discussed embodiments of the present invention, the stimulation control unit also includes the capability of defining user privileges. In particular, the control unit can be configured to provide complete control to a medical practitioner (e.g. doctor, nurse, physical therapist) but only limited control to a patient. The medical practitioner has access to all the features of the control unit, allowing the practitioner to select and/or adjust different parameters for programming a controlled sequence of transmission of a plurality of electrophysical modalities. Further, the medical practitioner can define what privileges the patient can have in operating the orthotic device. In one instance, the patient may only have control over a few of the electrophysical modalities used in the controlled sequence of transmission. For example, the patient may only be able to adjust the heat therapy stimulation modality of a controlled sequence of transmission involving TENS, FES, PEMF, and the heat therapy stimulation modalities. In another instance, the medical practitioner can limit the scope in which the patient can manipulate the transmission of any one of the electrophysical modalities. For example, the patient may have access through the control unit to adjust only the duration and not the magnitude of the FES modality. In view of the above, the stimulation control unit provides a means for user-defined privileges such that patients have restricted access to certain electrophysical modalities and limited control in adjusting certain parameters of the electrophysical modalities. This capability provides a safeguard against a patient inadvertently adjusting the controlled sequence of transmission such that a less-than-optimum form of treatment is provided. 
         [0072]    Although the invention has been described with reference to particular arrangement of parts, features, and the like, these are not intended to exhaust all possible arrangements or features, and indeed many modifications and variations will be ascertainable to those of skill in the art. The present invention is designed so that any electrical or mechanical treatment modalities that are available but have not been incorporated into the description of the invention, or that become available as technology advances, are considered part of the invention and incorporated by modifying the electrical and mechanical parts and protocols associated with them to the extent that such additional electrical or mechanical advances encompass any combination of the above described four or more treatment modalities.