Abstract:
A vest for a supine human has a one-piece cover with a front panel secured to a bladder coupled to a pulsator operable to subject the vest to repeated pulses of air which applies and releases pressure to the front of the thorax of a person. The bladder has an air chamber and a bottom transverse portion having an air receiving passage and openings to allow air to flow from the air receiving passage into the air chamber. A coil spring within the air receiving passage maintains the air receiving passage open to allow air and air pressure pulses to flow into the air chamber.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
   This application is a continuation-in-part of U.S. application Ser. No. 09/902,471 filed Jul. 10, 2001 now U.S. Pat. No. 6,676,614. 

   FIELD OF THE INVENTION 
   The invention is directed to a medical device and method to apply repetitive compression forces to the front thorax of a person to aid blood circulation, loosening and elimination of mucus from the lungs of a person and relieve muscular and nerve tensions. 
   BACKGROUND OF THE INVENTION 
   Clearance of mucus from the respiratory tract in healthy individuals is accomplished primarily by the body&#39;s normal mucociliary action and cough. Under normal conditions these mechanisms are very efficient. Impairment of the normal mucociliary transport system or hypersecretion of respiratory mucus results in an accumulation of mucus and debris in the lungs and can cause severe medical complications such as hypoxemia, hypercapnia, chronic bronchitis and pneumonia. These complications can result in a diminished quality of life or even become a cause of death. Abnormal respiratory mucus clearance is a manifestation of many medical conditions such as pertussis, cystic fibrosis, atelectasis, bronchiectasis, cavitating lung disease, vitamin A deficiency, chronic obstructive pulmonary disease, asthma, and immotile cilia syndrome. Exposure to cigarette smoke, air pollutants and viral infections also adversely affect mucociliary function. Post surgical patients, paralyzed persons, and newborns with respiratory distress syndrome also exhibit reduced mucociliary transport. 
   Chest physiotherapy has had a long history of clinical efficacy and is typically a part of standard medical regimens to enhance respiratory mucus transport. Chest physiotherapy can include mechanical manipulation of the chest, postural drainage with vibration, directed cough, active cycle of breathing and autogenic drainage. External manipulation of the chest and respiratory behavioral training are accepted practices as defined by the American Association for Respiratory Care Guidelines, 1991. The various methods of chest physiotherapy to enhance mucus clearance are frequently combined for optimal efficacy and are prescriptively individualized for each patient by the attending physician. 
   Cystic fibrosis (CF) is the most common inherited life-threatening genetic disease among Caucasians. The genetic defect disrupts chloride transfer in and out of cells, causing the normal mucus from the exocrine glands to become very thick and sticky, eventually blocking ducts of the glands in the pancreas, lungs and liver. Disruption of the pancreatic glands prevents secretion of important digestive enzymes and causes intestinal problems that can lead to malnutrition. In addition, the thick mucus accumulates in the lung&#39;s respiratory tracts, causing chronic infections, scarring, and decreased vital capacity. Normal coughing is not sufficient to dislodge these mucus deposits. CF usually appears during the first 10 years of life, often in infancy. Until recently, children with CF were not expected to live into their teens. However, with advances in digestive enzyme supplementation, anti-inflammatory therapy, chest physical therapy, and antibiotics, the median life expectancy has increased to 30 years with some patients living into their 50&#39;s and beyond. CF is inherited through a recessive gene, meaning that if both parents carry the gene, there is a 25 percent chance that an offspring will have the disease, a 50 percent chance they will be a carrier and a 25 percent chance they will be genetically unaffected. Some individuals who inherit mutated genes from both parents do not develop the disease. The normal progression of CF includes gastrointestinal problems, failure to thrive, repeated and multiple lung infections, and death due to respiratory insufficiency. While some patients experience grave gastrointestinal symptoms, the majority of CF patients (90 percent) ultimately succumb to respiratory problems. 
   A demanding daily regimen is required to maintain the CF patient&#39;s health, even when the patient is not experiencing acute problems. A CF patient&#39;s CF daily treatments may include:
         Respiratory therapy to loosen and mobilize mucus;   Inhalation therapy with anti-inflammatory drugs, bronchodilators and antibiotics for infections;   Oral and intravenous antibiotics to control infection;   Doses of Pulmozyme to thin respiratory mucus;   20 to 30 pancreatic enzyme pills taken with every meal to aid digestion;   a low-fat, high-protein diet;   Vitamins and nutritional supplements; and   Exercise.
 
A lung transplant may be the only hope for patients with end stage cystic fibrosis.
       

   Virtually all patients with CF require respiratory therapy as a daily part of their care regimen. The buildup of thick, sticky mucus in the lungs clogs airways and traps bacteria, providing an ideal environment for respiratory infections and chronic inflammation. This inflammation causes permanent scarring of the lung tissue, reducing the capacity of the lungs to absorb oxygen and, ultimately, sustain life. Respiratory therapy must be performed, even when the patient is feeling well, to prevent infections and maintain vital capacity. Traditionally, care providers perform Chest Physical Therapy (CPT) one to four times per day. CPT consists of a patient lying in one of twelve positions while a caregiver “claps” or pounds on the chest and back over each lobe of the lung. To treat all areas of the lung in all twelve positions requires pounding for half to three-quarters of an hour along with inhalation therapy. CPT clears the mucus by shaking loose airway secretions through chest percussions and draining the loosened mucus toward the mouth. Active coughing is required to ultimately remove the loosened mucus. CPT requires the assistance of a caregiver, often a family member but a nurse or respiratory therapist if one is not available. It is a physically exhausting process for both the CF patient and the caregiver. Patient and caregiver non-compliance with prescribed protocols is a well-recognized problem that renders this method ineffective. CPT effectiveness is also highly technique sensitive and degrades as the giver becomes tired. The requirement that a second person be available to perform the therapy severely limits the independence of the CF patient. 
   Artificial respiration devices for applying and relieving pressure on the chest of a person have been used to assist in lung breathing functions, and loosening and eliminating mucus from the lungs of CF persons. Subjecting the person&#39;s chest and lungs to pressure pulses or vibrations decreases the viscosity of lung and air passage mucus, thereby enhancing fluid mobility and removal from the lungs. These devices use vests having air-accommodating bladders that surround the chests of persons. Mechanical mechanisms, such as solenoid or motor-operated air valves, bellows and pistons are disclosed in the prior art to supply air under pressure to diaphragms and bladders in regular pattern or pulses. The bladder worn around the thorax of the CF person repeatedly compresses and releases the thorax at frequencies as high as 25 cycles per second. Each compression produces a rush of air through the lobes of the lungs that shears the secretions from the sides of the airways and propels them toward the mouth where they can be removed by normal coughing. External chest manipulation with high frequency chest wall oscillation was reported in 1966. Beck G J.  Chronic Bronchial Asthma and Emphysema. Rehabilitation and Use of Thoracic Vibrocompression, Geriatrics  (1966); 21: 139–158. 
   G. A. Williams in U.S. Pat. No. 1,898,652 discloses an air pulsator for stimulating blood circulation and treatment of tissues and muscles beneath the skin. A reciprocating piston is used to generate air pressure pulses which are transferred through a hose to an applicator having a flexible diaphragm. The pulsating air generated by the moving piston imparts relatively rapid movement to the diaphragm which subjects the person&#39;s body to pulsing forces. 
   J. D. Ackerman et al in U.S. Pat. No. 2,588,192 disclose an artificial respiration apparatus having a chest vest supplied with air under pressure with an air pump. Solenoid-operated valves control the flow of air into and out of the vest in a controlled manner to pulsate the vest, thereby subjecting the person&#39;s chest to repeated pressure pulses. 
   R. F. Gray in U.S. Pat. No. 3,078,842 discloses a bladder for cyclically applying an external pressure to the chest of a person. A pressure alternator applies air pressure to the bladder. A pulse generator applies air pressure to the bladder to apply pressure pulses to the chest of the person. 
   R. S. Dillion in U.S. Pat. No. 4,590,925 uses an inflatable enclosure to cover a portion of a person&#39;s extremity, such as an arm or leg. The enclosure is connected to a fluid control and pulse monitor operable to selectively apply and remove pressure on the person&#39;s extremity. 
   W. J. Warwick and L. G. Hansen in U.S. Pat. Nos. 4,838,263 and 5,056,505 disclose a chest compression apparatus having a chest vest surrounding a person&#39;s chest. A motor-driven rotary valve allows air to flow into the vest and vent air therefrom to apply pressurized pulses to the person&#39;s chest. An alternative pulse pumping system has a pair of bellows connected to a crankshaft with rods operated with a dc electric motor. The speed of the motor is regulated with a controller to control the frequency of the pressure pulses applied to the vest. The patient controls the pressure of the air in the vest by opening and closing the end of an air vent tube. 
   C. N. Hansen in U.S. Pat. Nos. 5,453,081 and 5,569,170 discloses an air pulsating apparatus for supplying pulses of air to an enclosed receiver, such as a vest located around a person&#39;s chest. The apparatus has a casing with an internal chamber containing a diaphragm. An electric operated device connected to the diaphragm is operated with a pulse generator to vibrate the diaphragm to pulse the air in the chamber. A hose connects the chamber with the vest to transfer air and air pulses to the vest which applies pressure pulses to the person&#39;s chest. 
   N. P. Van Brunt and D. J. Gagne in U.S. Pat. Nos. 5,769,797 and 6,036,662 disclose an oscillatory chest compression device having a wall with an air chamber and a diaphragm mounted on the wall and exposed to the air chamber. A rod pivotally connected to the diaphragm and rotatably connected to a crankshaft transmits force to the diaphragm during rotation of the crankshaft. An electric motor drives the crankshaft at selected controlled speeds to regulate the frequency of the air pulses generated by the moving diaphragm. An air flow generator, shown as a blower, delivers air to the air chamber to maintain the pressure of the air in the chamber. Controls for the motors that move the diaphragm and rotate the blower are responsive to the air pressure pulses and pressure of the air in the air chamber. These controls have air pressure responsive feedback systems that regulate the operating speeds of the motors to control the pulse frequency and air pressure in the vest. 
   C. N. Hansen and G. E. McNamara disclose in U.S. Pat. Nos. 6,254,556 and 6,605,050 a vest used to apply repetitive pressure pulses to the front, sides and back of the thorax of a person. The vest has a cover with a pocket accommodating an air core. The air core has a plurality of upright air chambers and a bottom manifold passage connected to an air pressure pulsator. Air introduced into the manifold passage flows through a central back opening in the air core into the chambers thereby apply air pressure and pressure pulses to both the front, sides, and back of the chest of the person wearing the vest. 
   SUMMARY OF THE INVENTION 
   The invention comprises a vest used to apply pressure and repetitive pressure pulses to the front of the upper body or thorax of a person. The vest can be used by persons in prone positions, such as a person confined to a bed or a generally horizontal support. The vest has a one-piece outer cover comprising a flexible non-elastic sheet member or fabric. The cover has a front panel, a back panel, and shoulder members joining the front and back panels. The middle of the cover has a generally circular opening of a size to slip over a person&#39;s head to locate the vest around the person&#39;s thorax. Releasable fasteners connect the front and back panels to retain the vest around the person&#39;s thorax. A bladder having an internal chamber is secured to the inside surface of the front panel of the cover. The bladder has a flexible outside wall adapted to be located adjacent the front of the thorax of the person wearing the vest. The flexible wall can be in surface contact with the outer skin of the front of the person&#39;s thorax. The bottom portion of the bladder has a sleeve with an elongated air passage accommodating a flexible open member that allows air to flow in the air passage and into the air chamber. The bottom portion of the bladder is connected with a flexible hose to an air pulsator operable to generate air pressure and air pressure pulses which are transmitted to the air chamber of the bladder. The pressure forces and pressure pulses subjected to the bladder transmit repetitive pressure pulses to the front of the thorax of the person wearing the vest to enhance airway clearance and lung functions. 
   The vest cover has side flaps on the opposite sides of the back panel. A plurality of loop pads secured to the flaps cooperate with hook pads attached to opposite sides of the front panel to retain the vest around the thorax of a person. The loop and hook pads are VELCRO fasteners that releasably connect the front and rear panels and retain the vest in an adjusted position relative to the thorax of a person. The loop and hook pads permit circumferential adjustment of the vest to fit the girth of the thorax of the person. The bladder has an inside wall secured to the inside surface of the front panel and a flexible outside wall. The inside and outside walls surround an air chamber. The outside wall has a plurality of small holes that allow air to ventilate from the air chamber and deflate the bladder. Horizontal divider seals connecting the inner and outer walls of the bladder separate an air passage from the air chamber. The horizontal divide seals are spaced from each other providing a plurality of openings to allow air to flow from the air passage into the air chamber. Spacers, shown as loop pads, located through the openings between the seals ensure upward air flow from the air passage into the air chamber. The pulsing of air in the air chamber applies inward and upward pressure pulses to the front of the thorax of the person to facilitate airway clearance of secretions and lung functions. The open member is a flexible wire coil spring located in the air passage that maintains the air passage open to allow air to flow along the length of the air passage. The wire coil spring and non-elastic cover extended around the air passage limits inward pressure of the lower front end of the vest on the abdomen of the person. The coil spring is attached to a tubular clamp which extends through openings in the lower end of the bladder and cover. The clamp has an open end to allow the air pulsator to be connected to the clamp with an elongated hose to supply air pressure and air pressure pulses to the air in the air passage and air chamber of the bladder. The coil spring extends transversely along the bottom of the front panel of the vest. The back panel being flat and flexible does not inhibit a person wearing the vest from lying on a bed or support. The comfort of a supine person is not compromised. 

   
     DESCRIPTION OF THE DRAWINGS 
       FIG. 1  is a front elevational view of the respiratory vest located on a supine person and connected to an air pulsator; 
       FIG. 2  is a transverse sectional view of the respiratory vest and person of  FIG. 1 ; 
       FIG. 3  is an enlarged sectional view taken along line  3 — 3  of  FIG. 1 ; 
       FIG. 4  is an enlarged outside front and rear plan view of the respiratory vest of  FIG. 1 ; 
       FIG. 5  is an enlarged inside front and rear plan view of the respiratory vest of  FIG. 1 ; 
       FIG. 6  is a side elevational view of the left side of the respiratory vest of  FIG. 4 ; 
       FIG. 7  is a side elevational view of the right side of the respiratory vest of  FIG. 4 ; 
       FIG. 8  is a top plan view of the left side of  FIG. 4 ; 
       FIG. 9  is a bottom plan view of the respiratory vest of  FIG. 4 ; 
       FIG. 10  is a transverse sectional view of bottom of the front of the respiratory vest of  FIG. 5 ; 
       FIG. 11  is an enlarged sectional view taken along line  11 — 11  of  FIG. 5 ; and 
       FIG. 12  is an enlarged sectional view taken along line  12 — 12  of  FIG. 5 . 
   

   DESCRIPTION OF PREFERRED EMBODIMENT 
   A pulsating apparatus, indicated generally at  10  in  FIG. 1 , includes a respiratory vest  11  and an air pressure and air pulse generator  12 , known as a pulsator. Pulsating apparatus  10  is used to apply repetitive pressure pulses to the front of a person&#39;s thorax to enhance respiratory functions and provide secretion and mucus clearance therapy. An elongated flexible hose or tube  61  connecting vest  11  to generator  12  transfers air pressure and air pressure pulses from generator  12  to vest  11 . An example of generator  12  is disclosed in U.S. Pat. No. 6,547,749 incorporated herein by reference. Other types of air pressure and pulse generators can be used to supply air pressure and pressure pulses to vest  11 . Examples of air pressure and air pulse generators are disclosed in U.S. Pat. Nos. 1,898,652; 2,588,192; 2,918,917; 3,078,842; 4,838,263; 5,569,170 and 6,036,662. 
   As shown in  FIG. 1 , air pressure and pulse generator  12  is mounted in a case  62  having an open top and a cover  63  hinged to case  62  operable to close case  62 . A handle  64  pivotally mounted on case  62  is used as a hand grip to facilitate transport of generator  12 . Case  62  and cover  63  have overall dimensions that allow the case to be an aircraft carryon item. 
   Air pressure and pulse generator  12  has a top member  66  mounted on case  62  enclosing the operating elements of the pulsator. Top member  66  is not readily removable from case  62  to prohibit unauthorized adjustments and repairs of the operating components of the air pressure and pulse generator  12 . Top member  66  supports a main electric power switch  67  and a front panel  68  having an operating timer  69 , a pulse frequency control knob  71  and an air pressure control knob  73 . Knobs  71  and  72  are manually rotated to adjust the frequency of the air pressure pulses and the air pressure in vest  11 . Frequency control knob  71  and regulates a motor controller which controls the air pulse frequency from 5 to 25 cycles per second. The adjustment of the air pressure in vest  11  is controlled by turning knob  72 . The air pressure in vest  11  is controlled between 0.1 and 1.0 psi. 
   Respiratory mucus clearance is applicable to many medical conditions, such as pertussis, cystic fibrosis, atelectasis, bronchiectasis, cavitating lung disease, vitamin A deficiency, chronic obstructive pulmonary disease, asthma, and immobile cilia syndrome. Post surgical patients and paralyzed persons confined to beds in prone positions with respiratory distress syndrome have reduced mucociliary transport. Apparatus  10  provides high frequency chest wall oscillations or pulses to enhance mucus clearance in a person  13  with reduced mucociliary transport who are confined to a bed or generally horizontal support  15 . 
   Vest  11  located around the person&#39;s upper body or thorax  14  is supported on the person&#39;s shoulders  16  and  17 . As shown in  FIG. 3 , vest  11  expanded into substantial surface contact with the exterior of the front of the thorax  14  functions to apply repeated compression or pressure pulses, shown by arrows  18  to the anterior or front portions of a person&#39;s lungs  19  and  21 . The reaction of lungs  19  and  21  and trachea  22  to the pressure pulses causes repetitive expansion of the lung tissue when the pressure pulses are in the low pressure phase of the pressure cycle. The pressure pulses subjected to lungs  19  and  21  and trachea  22  provide secretions and mucus clearance therapy. The thoracic cavity occupies only the upper part of the thoracic cage and contains right and left lungs  19  and  21 , heart  23 , arteries  24  and  26 , and rib cage  27 . The repeated pressure pulses applied to thorax  14  stimulates heart  23  and blood flow in arteries  24  and  26  and veins in the chest cavity. Muscular and nerve tensions are also relieved by the repetitive pressure pulses imparted to the front portion of thorax  14 . The lower part of the thoracic cage comprises the abdominal cavity  29  which reaches upward as high as the lower tip of the sternum so as to afford considerable protection to the large and easily injured abdominal organs, such as the liver, spleen, stomach, and kidneys. The two cavities are separated by a dome-shaped diaphragm  28 . Rib cage  27  has twelve ribs on each side of the trunk. The ribs consist of a series of thin, curved, rather elastic bones which articulate posteriorly with the thoracic vertebrae. The spaces between successive ribs are bridged by intercostal muscles. The rib cage  29  aids in the distribution of the pressure pulses to the anterior portions of lungs  19  and  21  and trachea  22 . 
   As shown in  FIG. 4 , vest  11  has an outside or anterior cover  31  comprising a flexible and generally non-elastic sheet, such as a nylon fabric. Other types of materials and fabrics can be used for cover  31 . Cover  31  has a generally rectangular front panel  32  and a generally rectangular rear panel  33  connected to front panel  32  with shoulder portions  43  and  44 . The central section of cover  31  has an opening  34  of a size to slip over the head of person  13  as shown in  FIG. 1 . The opposite sides of cover  31  have concave edges  37  and  38  to allow vest  11  to extend under the person&#39;s shoulder  16  and  17 . As shown in  FIGS. 5 ,  6  and  7  releasable fasteners, shown as hook-type pads  39  and  41 , are secured to the outside of side flaps  46  and  47  located on opposite sides of rear panel  33 . Pads  39  and  41  comprise rows of three spaced pads located adjacent the outside edges of flaps  46  and  47 . Pads  39  and  41  can be loop-type pads adapted to be releasably attached to hook-type pads, known as VELCRO fasteners. Pads  39  and  41  can each be a single pad secured to flaps  46  and  47 . Other types of releasable fasteners, such as releasable adhesives, can be used to attach flaps  46  and  47  to front panel  32 . Front panel  32  has a transverse generally tubular bottom portion  36  and upright side edges  48  and  49 . A plurality of loop-type pads  51  and  52  are secured to front panel  32  adjacent side edges  48  and  49 . Pads  51  and  52  interact with pads  39  and  41  to releasably hold vest  11  about the thorax of person  13 . Pads  39 ,  41  and  51 ,  52  are conventional VELCRO fasteners. 
   As shown in  FIGS. 3 , and  5 , an air core or bladder, indicated generally at  53 , is secured to the inside surface of front panel  32 . A bladder  53  has an outer sheet member or wall  54  joined to an inner sheet member or wall  56 . An adhesive or bonding material attaches outer sheet member  54  to panel  32 . An air chamber  57  is located between sheet members  54  and  56 . Sheet members  54  and  56  are flexible walls of plastic or fabric having inside layers or coatings of air impervious urethane plastic. The inner sheet member  56  has a plurality of upright rows of holes  58 ,  59 ,  60  and  65  to allow air to vent or allow air to flow from chamber  57  to atmosphere. Other types of air impervious flexible sheet members can be used for bladder  53 . As shown in  FIG. 5 , bladder  53  covers the entire inside surface of front panel  32 . 
   As shown in  FIGS. 10 and 12 , the bottom portion  36  of the front panel  32  is a linear sleeve having an elongated transverse passage  101  accommodating a flexible open member shown as a coil spring  102 . Spring  102  is a flexible metal coil spring that keeps passage  101  open for free flow of air and minimum interference of air pulses in passage  101 . Other structures, such as a porous tube, in the air passage  101  can be used to provide for continuous air flow through passage  101  and into chamber  57 . A tubular clamp  103  secured to the air inlet end of spring  102  accommodates the end of hose  61  to allow air from hose  61  to flow into passage  101 . A pair of horizontal seals  104  and  105  joining linear sections of inner and outer sheet members  54  and  56  separate chamber  57  from passage  101  and confine coil spring  102  to passage  101 . Seals  104  and  105  are spaced from each other and adjacent sides of bladder  53  to provide openings or passages  106 ,  107  and  108  to allow air to flow from passage  101  into chamber  57  of bladder  53 . Upright seals  109  and  111  are joined to middle portions of seals  104  and  105  to direct air pulses upwardly into chamber  57 . Seal  109  is parallel to and located between rows of holes  58  and  59 . Seal  111  is parallel to and located between rows of holes  60  and  65 . The air pulses, shown by arrows  110  in  FIG. 10 , directed upwardly in air chamber  37  exert upwardly and inwardly pulsed pressure forces to the front of the thorax of person  13  to enhance airway clearance of secretions and function of the lungs. 
   As shown in  FIGS. 10 ,  11  and  12 , spacers  112 ,  113  and  114  extend through openings  106 ,  107  and  108  to maintain the passages open to ensure air flow and air pressure pulses from transverse passage  101  into air chamber  37 . Spacers  112 ,  113  and  114  are rectangular loop pads  116  secured with an adhesive to the inside surface of inner member  56 . The pads can be secured to the inside surface of outer member  54 . Other types of spacers, such as short tubes, can be used to ensure air flow between passage  101  and air chamber  57 . 
   In use, vest  11  is placed about the thorax of person  13  by pulling the vest over the person&#39;s head and locating the front panel  32  adjacent the front of the person&#39;s thorax. The rear panel  33  being a single sheet member is located adjacent the person&#39;s back. Flaps  46  and  47  are pulled over opposite side portions of front panel  32  to fit the vest around the person&#39;s thorax. Hook and loop pads  39 ,  52  and  41 ,  51  are pressed together to lock the flaps  46  and  47  to front panel  32 . Flaps  46  and  47 , as shown in  FIG. 1 , are above bottom portion  36  of vest  11  and above coil spring  102 . The coil spring and non-elastic cover  31  extended around the spring and the location of the spring below flaps  46  and  47  limits inward pressure on the abdomen and organs therein and reduces stress on the digestive system. Air pulsator  12  is then connected with hose  61  to clamp  103 . The operation of air pulsator  12  is started by turning switch  67  ON and setting timer  69  to the desired operating cycle. The rate of pulsation is controlled with control  71 . The air flows from hose  61  into air passage  101  and openings  106 ,  107  and  108  upwardly into air chamber  37  of bladder  53 . The pulsing of air in chamber  37  applies repetitive pressure pulses to the front of the thorax of the person&#39;s body. The operation of air pulsator  12  is described in U.S. Pat. No. 6,547,749. The air pulsator of U.S. Pat. No. 6,547,749 is incorporated herein by reference. Other types of air pressure and air pulse generators can be used to provide air pressure and air pressure pulses to vest  11 . 
   The present disclosure is a preferred embodiment of the supine pulsating vest. It is understood that the supine pulsating vest is not to be limited to the specific materials, constructions and arrangements of structures shown and described. It is understood that changes in parts, materials, arrangement and locations of structures may be made without departing from the invention.