Kinesthetic system for promoting rhythmic breathing by tactile stimulation

A desired pattern, such as a desired breathing pattern for a respiratory ventilator, is encouraged by the operation of a kinesthetic device, preferably by a kinesthetic device which emulates human touch.

FIELD OF THE INVENTION 
The present invention relates to a kinesthetic breathing performance system 
and method. 
BACKGROUND OF THE INVENTION 
To use a respiratory ventilator, a patient has to adapt or change his or 
her ingrained breathing pattern, as explained, e.g., in U.S. Pat. No. 
3,991,304 to Hillsman, the disclosure of which is incorporated herein by 
reference. The Hillsman patent addresses this problem by providing a 
system which displays an ideal breathing pattern on a video screen, which 
can be watched and followed by the patient. But this is not a satisfactory 
solution, particularly since respiratory patients are often not able to 
see, or at least not able to respond well to visual stimuli. Also, the 
Hillsman approach does nothing to reduce anxiety and disorientation, which 
are the natural result of being connected to a ventilator. 
Other related prior art patents include U.S. Pat. No. 2,771,069 to Baron, 
U.S. Pat. No. 2,821,189 to Hofmann, U.S. Pat. No. 3,403,674 to 
Alimanestiano, U.S. Pat. No. 3,547,106 to Bornmann, U.S. Pat. No. 
3,552,388 to Zelenka, U.S. Pat. No. 3,730,173 to Deaton, U.S. Pat. No. 
4,064,869 to Defares et al., and U.S. Pat. No. 4,984,568 to Persaud, the 
disclosures of which are incorporated herein by reference. 
U.S. Pat. No. 2,771,069 to Baron discloses a bed which is pivoted in 
synchronization with a respiratory device to promote a desired respiration 
pattern. In operation, the head of the bed is positioned downwardly so 
that a patient can exhale air. When the bed is tilted up, air is inhaled 
by the patient. However, the system disclosed in the Baron patent is 
complicated and cumbersome, and it would increase a patient's anxiety and 
disorientation rather than promote a relaxed and ultimately fruitful 
response. 
Similarly, the Defares patent discloses an apparatus for regulating 
breathing. The apparatus has a tone generator for producing audible tones 
for regulating the breathing patterns of a patient. The Defares device 
includes a sensor which is attached to a patient's chest containing a tube 
which is alternately expanded and contracted to the rhythm of the 
patient's breathing. When the breathing rhythm is out of synchronization 
with a clock control counter, a hyperventilation signal is produced which 
activates a generator. The generator tones are alternately progressively 
increased and decreased to produce two different tones signalling abnormal 
breathing. However, a recovering patient's responses to auditory tones may 
be severely limited by medication, causing an inability to concentrate. 
Additionally, noises made by other equipment might interfere with the 
patient's ability to hear tones. 
The Bornmann patent discloses a device which imparts mechanical stimulation 
to arouse an infant which has stopped breathing. However, that mechanical 
stimulation fails to promote rhythmic breathing. The Hofmann patent 
discloses a respiration stimulation device where breathing rhythms are 
controlled by applying low frequency current to alternate muscle groups 
controlling the inspiration and exhalation muscles. The Deaton patent 
discloses a device for monitoring the respiration and/or heartbeat of a 
patient through any conventional device such as an apnea monitor. When 
respiration appears to be abnormal, a stream of pressurized air is 
directed against the patient's body. The Zelenka patent discloses a 
baby-patting machine. The Alimanestiano and Persaud patents disclose 
massaging devices. 
SUMMARY OF THE INVENTION 
In view of the foregoing, it should be apparent that there still exists a 
need in the art to provide a satisfactory system for helping a recovering 
patient control his/her breathing in accordance with a medically desired 
pattern and a need for a system which can help a patient learn and sustain 
a desired breathing pattern, while at the same time providing a gentle 
calming influence to reduce that patient's anxiety and disorientation. 
Finally, the prior art fails to provide a device which promotes rhythmic 
breathing without audio interference or visual interruption. 
It is therefore, an object of this invention to provide a kinesthetic 
producing apparatus or method that promotes a desired psychological effect 
on a user by emulating human touch. 
It is also an object of this invention to produce the kinesthetic effect in 
response to timing signals from a machine which evidences a user's 
psycho/physiological condition. 
It is another object of this invention to provide a method and apparatus 
for establishing a patient's breathing pattern by stroking a ventilator 
patient's body, which, for example, would include an arm, wrist or 
shoulder, in rhythm with the desired breathing pattern. Patients appear to 
be most responsive to this physical or tactile stimulation, and are able 
to synchronize their breathing with the sensed cyclical mechanical motion. 
The stroking motion also has a gentle soothing effect. 
It is also an object of this invention to provide a device which produces a 
kinesthetic motion that can be set to a desired heart rate, breath rate or 
any other rate that feels comfortable. 
It is yet a further object of this invention to provide kinesthetic 
biofeedback which initiates a touch signal to the body of a patient in 
response to the signal generated by any machine, such as the 
electrocardiogram heart rate signal, or a blood pressure, or breath rate 
signal or a muscle contraction signal whereby the kinesthetic motion is 
prompted by the signal from each device rather than being prompted 
continuously so as to calm or stabilize the patient only when necessary. 
It is yet an additional object of this invention to use a kinesthetic 
effect as an alarm, such as to wake or remind a user, or as a meditation 
or sleep inducement device where the rate and pressure of the kinesthetic 
effect can be varied, as desired. 
It is yet another object of the invention to provide a kinesthetic touch 
system where the rate of reciprocation can be programmed in advance. 
Moreover, the kinesthetic device pressure can also be adjusted. 
It is a further object of the invention to provide a kinesthetic device 
which is portable. It can also be worn comfortably under a patient's 
clothing. 
Briefly described, these and other objects of the invention are carried out 
in its apparatus aspects by a breathing performance system which 
kinesthetically provides cyclical or rhythmic breathing encouragement or 
relaxation to a patient. The tactile stimulation is provided by a portable 
mechanical device which emulates human touch in synchronization with the 
desired breathing pattern set in a device. 
The invention is carried out in accordance with its method aspects by 
locating a kinesthetic device with respect to a patient. The device is 
then cyclically operated in synchronization with a desired breathing 
pattern thereby encouraging the patient to breathe in a desired breathing 
pattern. 
Other features of the present invention will be apparent from the following 
detailed description and drawings which illustrate preferred embodiments 
of the invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
Referring now to the drawings, wherein like reference numerals represent 
like elements, there is shown in FIG. 1 a preferred embodiment of the 
invention used with a respiratory ventilator. However, numerous other 
applications for this invention are contemplated which will also be 
described as further embodiments. The respiratory ventilator system, which 
is constructed in accordance with the principles of the present invention, 
is designated generally by reference numeral 10. 
The respiratory ventilator system 10 includes a respiratory ventilator 12, 
a portable kinesthetic device 14 for providing tactile stimulation to the 
body 16 of a patient, and a controller 18 operatively connected to an 
output of the ventilator 12 for synchronizing the operation of the device 
14 with the cyclical operation of the ventilator 12. The control means 18 
can be electrical, mechanical or based on any other known technology. 
Details of one example of controller 18 are shown in FIGS. 6-7 with 
respect to console 60. 
The kinesthetic device 14 is formed of a flexible pad 20, rollers 22, and a 
transmission means 24 for moving the rollers 22 back and forth in the 
directions indicated by arrows 26 and 28. The elements of the kinesthetic 
device 14 are contained within a cushioned sterilizable case 30. The 
device is fully enclosed in a sterilizable covering 31, as shown in FIG. 
2A. The casing is releasably attached to the patient's body 16 (such as 
the patient's arms, legs or torso) by flexible tape, VELCRO.RTM. brand, 
hook and loop fastener, belts or any other desirable strap (not 
illustrated). For pediatric use, a stuffed toy animal or doll or any other 
appropriate design or decoration (not illustrated) can be substituted for 
the external casing 31 so that the kinesthetic device 14 is located within 
the toy, animal, doll or other device, as shown in FIG. 2B while the 
controller 18 is mounted on the back of the doll (not shown). As a result 
of this arrangement, the kinesthetic device can calm a young patient. 
Alternatively, the toy, doll, animal or other device is mounted on the 
kinesthetic device covering 31 so that the device 14 is externally 
located. 
Moreover, the device 14 can be provided in or with a mattress cover pad. In 
this application, as shown in FIG. 2C, the device 14 is sufficiently 
proportioned to provide a kinesthetic effect substantially across the 
mattress. 
For portability and to emulate human touch, the kinesthetic device 14 is 
light weight. Additionally, the case 30 is waterproof and electric shock 
proof in order to avoid any shock to the patient. The covering 31 may be 
connected to the case 30 by hook and loop type connectors (not 
illustrated) so as to be exchangeable for a new clean covering or for 
sterilization after one or more uses. Other conventionally known 
connectors may be used to attach covering 31 to case 30. 
The device 14 is proportioned to easily fit under a user's shirt. This easy 
portability provides the user with numerous applications. For example, the 
user can wear the device to promote relaxation, to reduce blood pressure 
or to relieve stress. The device can also be worn to bed so that it can 
wake the wearer gently at a programmed hour, without disturbing others. 
Alternately, the kinesthetic device can be used to soothe the wearer--thus 
promoting sleep. Other applications include use of the device for sports 
or musical training, for birthing training in pre-labor classes or for use 
in conjunction with any equipment or biofeedback devices. 
In the ventilator application, the ventilator 12 is operated according to a 
desired breathing pattern and the transmission means 24 follows this 
pattern. In other words, the pattern is the output of the ventilator 
translated and communicated by the controller 18 to the kinesthetic device 
14. This control pattern causes the rollers 22 to move back and forth 
against the pad 20. As a result, tactile stimulation is provided to the 
body 16 in synchronization with the desired breathing pattern. 
The transmission means 24 is formed of a head unit 32 which is connected to 
the rollers 22 by leaf spring supports 34 and flexible rods 36 (FIG. 3). 
There are two round shafts 38 for slidably supporting the head unit 32, 
and a central threaded shaft 40 for driving the head unit 32 back and 
forth. Preferably, the shafts 38 pass through respective bushings 42. 
These bushings 42 prevent binding and reduce friction. 
The shaft 40 is threaded into a nut 44 (FIG. 2) which is fixed with respect 
to the head unit 32. Thus, alternating clockwise and counterclockwise 
rotation of the shaft 40 causes the head unit 32 to move back and forth in 
the directions 26 and 28. The torque for rotating the shaft 40 is provided 
by a motor 46. The motor 46 is controlled by the synchronizing means 18. 
Preferably, the motor 46 is insulated to control noise, to avoid electric 
shock and to reduce breakage from handling. 
Preferably, the pad 20 is made of a soft, flexible material that will 
transmit the "feel" of the rollers 22 as they travel back and forth. 
Preferably, as shown in FIG. 3, the device 14 has means for controlling 
the temperature of the pad 20 to promote patient comfort and to provide a 
calming effect. For example, the pad 20 may have integral heating elements 
50 for gently heating the patient's skin. To emulate human touch, the pad 
20 may be formed of suede, ultrasuede or a soft leather, although other 
soft materials may be suitable, particularly if a hypoallergenic material 
is desired. Considerations in selecting the material for the covering 31 
include sterility and durability within the expected environment of use, 
and compatibility with various medical conditions, such as trauma 
infection and/or burns. 
The rollers 22 are freely rotatably supported by the four flexible rods 36. 
The opposite ends of the rods 36 are held in place by the respective leaf 
spring supports 34, as illustrated in FIG. 3. The flexibility of the rods 
36 and the supports 34 is such that the rollers 22 deflect inwardly and 
follow the contour of the flexible pad 20 as the pad 20 follows the 
contour of the patient's body 16. Preferably, each individual roller 22 
has bevelled edges 48 to prevent binding as the flexible rods 36 are 
deflected inwardly. Preferably, the leaf spring supports 34 are 
independently connected to the movable head unit 32. Such independent 
suspension allows the rollers 22 to smoothly traverse any surface 
irregularities on the patient's body 16. 
As an alternate embodiment, a small breath biofeedback machine can be used. 
The device comprises a vibrating beeper without rollers that can be 
properly instructed to receive messages from electrodes measuring muscular 
contractions placed on both the chest and abdomen. This device can be used 
with any other breath monitoring system. A digital clock and episode 
counter then measures the number of episodes of erratic or chest breathing 
during the course of time period and records it in real time (much like a 
Halter monitor). However, this device would be inconspicuous, it would 
measure the breath rate rather than the electrocardiogram, and it would 
alert the wearer to take a deep breath, to clam down and to lower the 
breath to the abdomen. The beeper could be worn inside the shirt or on the 
belt like an ordinary beeper. 
To better illustrate the method of the present invention, the human 
breathing cycle can be broken down into four approximate phases, as 
illustrated in FIG. 4, wherein: t(1)=active inhalation, during which the 
patient's lungs are expanding; t(2)=inhalation hold, during which the 
lungs remain expanded; t(3)=active exhalation; and t(4)=rest. In the 
illustrated embodiment, the rollers 22 are reciprocated at a rate which 
approximates the desired breathing rate. As noted previously, the instant 
invention can be used to kinesthetically produce desired rates for any 
psycho/physiological phenomenon, including heart rate, breath rate, blood 
pressure, etc. or as an alarm "touch" signal whose rate is predetermined. 
Rates can also be programmably reactivated or deactivated to produce 
desired effects. In particular, the rollers 22 are moved in the pattern 
illustrated in FIG. 5, wherein point A represents the position of the 
rollers 22 at the beginning of a forward stroke, and point B represents 
the position of the rollers 22 at the end of the stroke. Preferably, 
inhalation is represented by a forward stroke (e.g., moving the rollers 22 
away from the motor 46), and exhalation is represented by a reverse 
stroke, such that in FIG. 5: t(1) =forward stroke (active inhalation); 
t(2)=rest (inhalation hold); t(3)=reverse stroke (active exhalation); and 
t(4)=rest. 
The control unit 18 includes a control console for setting and displaying 
operating parameters. An exemplary stand-alone control console 60, which 
is microprocessor based, for use in a hospital setting is illustrated in 
FIG. 6. The console 60 has an electrical conduit 61 for obtaining signals 
from the ventilator 12 and/or from an auxiliary source, and an electrical 
conduit 63 for sending signals to the kinesthetic device 14 (i.e., signals 
for controlling the temperature of the heating elements 50 and signals for 
controlling the motion of the rollers 22). Since the console 60 is 
microprocessor based, it is also configurable to the different signal 
configurations for different ventilators or other equipment, and can be 
programmed flexibly. The console 60 also includes a timing means (not 
shown) for timing the operations of motor 46 to reciprocate the movable 
head unit 32 through time periods t(1) through t(4). 
Preferably, the console 60 has an AC/DC converter such that electrical 
power for the kinesthetic device 14 can be supplied from the hospital's 
conventional AC power outlets. An analog-to-digital conversion device is 
also connected to conduit 61 in the event that the console 60 is used with 
an analog ventilator. A removable/rechargeable battery pack 52 (FIG. 1) is 
also provided such that the system can be used without access to AC-power, 
such as during field use. When the device 14 is to be used in the field, a 
control console 62 (FIG. 7) is preferably incorporated into the top of the 
device 14. 
The transition from field to hospital use can be easily accomplished by 
simply plugging the kinesthetic device 14 into the console 60 connected, 
for example, to a ventilator thereby overriding console 62. Alternatively, 
the console 62 can be synchronized without direct connection to the 
ventilator. The console 62 is protected by a hinged cover 63. 
Details of the controller 18 are shown in FIG. 8. The controller 18 
receives inputs from a monitoring device 12, such as a ventilator, a heart 
rate monitor, or any other psycho/physiological measuring device. The 
controller 18 can also be programmed to operate without the monitoring 
device 12. However, when used with device 12, the output from that device 
is converted into a digital signal by an analog-to-digital converter 102. 
The digital output is then supplied to a microprocessor 104. The 
microprocessor 104 is programmed to translate the digital input in 
accordance with pre-set levels provided by the operator through console 
60, 62 and stored in memory 106. In addition to levels, the memory 106 
contains manufacturer signal specifications that enable microprocessor 104 
to effectively operate with more than one device 12. Thus, memory 106 
would contain, for example, signal information for different ventilator 
models enabling the controller 18 to be compatible across a wide spectrum 
of different ventilators. 
The microprocessor 104 also receives feedback signals from the kinesthetic 
device 14. These signals can represent the temperature of the elements 50, 
the speed of the motor 46, the status of the battery 52 and/or the 
pressure applied by the rollers 22. The feedback signals are used by the 
microprocessor 104 to adjust, terminate or initiate control signals to 
device 14 through control line 110. 
A real time clock 112 also is provided which provides time and date 
information to the microprocessor, to effect control, such as to set an 
alarm in advance. 
The control output 110 is provided to a digital to analog converter 114. If 
the control signal relates to controlling motor 46, then the converted 
analog signal is switched to oscillator 16 which provides the driving 
voltage to motor 46 in device 14. 
Preferably, the device 14 can be selectively operated in different modes. 
In a BPM mode, only the desired or optional breaths-per-minute are input 
into the device 14 and the four segments (t(1)-t(4)) of each cycle are 
proportionally determined according to a standard breathing pattern. In a 
manual control mode, each of the segments (t(1)-t(4)) is manually input 
into the device 14 by an operator. The device 14 may also be operated in 
an automatic or preset mode at a standard breaths-per-minute rate and with 
standard segments (t(1)-t(4)). 
The illustrated kinesthetic devices can be used in emergency, surgical and 
postoperative settings, and in non-medical settings in connection with 
providing a kinesthetic effect having a predetermined rate to achieve a 
desired impact on a user. Thus, the present invention is not limited to 
use with a ventilator. It can be used, for example, as a breathing coach 
for a mother undergoing labor or as a classroom teaching aid for expectant 
parents practicing Lamaze-type breathing techniques. 
The invention can also be used in occupational and/or sports therapy for 
improving recovery/performance by regulating the patient's breathing or 
for training for athletic competition in order to train athletes to 
regulate their breathing. The invention may also be used for musical 
training exercises for singers and for instrumentalists and the invention 
can also be used to focus appropriate rhythmic breathing for a treadmill, 
for an EKG monitor, for an oxygen tank, to aid in the treatment of 
emphysema, to assist in a patient's recovery from polio, and for 
anxiety/panic physiology control. The device can also promote and/or 
initiate breathing for infants who are susceptible to Sudden Infant Death 
Syndrome. The device can also be used as a preventive for anxiety/stress 
control to reduce heart rate and blood pressure, to reduce 
hyperventilation, to promote relaxation and/or sleep and to reduce 
emotional sequela from defibrillator action. 
The systems described herein may advantageously be used in coordination 
with oscillator-based devices, tone frequency modulators, sub-harmonic 
generators, music, electromagnetic devices, acupuncture and/or alpha wave 
controllers in order to further calm the patient and promote the desired 
rhythmic breathing pattern or other desired rates. 
The present invention is not limited to the systems shown and described 
herein. The Kinesthetic systems can include mechanical motion devices or 
devices having stationary arrays of transducers. 
The mechanical devices can include a series of transducers which are 
typically rollers such as plastic rods, tubes, etc. to directly deliver a 
tactile sense of touch to the surface of the users skin. The plastic 
rollers can be sterilized as well as disposable. The stimulation is 
applied to the skin by moving the series of transducers over the surface 
of the skin in a mechanical manner dictated by a software program, 
hardware and feedback signal which determines the position, motion, level, 
and composition of the stimulation applied to the surface of the skin. 
The array devices employ an array or "cluster" of electronic or mechanical 
devices such as audio speakers, vibrators, etc. designed to directly 
deliver a tactile sense of touch to the surface of the user's skin in a 
fixed location. The feeling of motion and touch is simulated by switching 
on and off individual or groups of transducers located on or near the skin 
surface. This changes the user's sense of position, motion, level, and 
composition of the stimulation applied to the surface of the skin. The 
operation of the transducers is controlled by a software program, hardware 
and feedback signal. 
The devices perform their intended function when placed on or near the skin 
surface. The devices can have different surface textures of the material 
contacting the skin to change the "feel" of the device to the user. 
Specific transducers can be used to induce any combination of motion, 
audio frequencies, air flow, temperature, pressure electrical stimulation, 
or any other method of stimulation that can be delivered by electrical or 
mechanical means. 
The devices can be completely controlled by a software program that drives 
a programmable controller, analog and digital I/O, and different 
transducers, motors, etc. used for positioning the transducers on the 
user's skin to stimulate an intended area. 
The devices are also capable of accepting one or more feedback signals as 
input to determine and/or vary its mode of operation. The feedback signal 
could come from any source including the user or supervisor adjusting a 
knob or switch, a signal from another piece of equipment such as a 
monitoring device for blood pressure, temperature, respiration, or an 
input from a pre-recorded signal such as an audio tape. The scope of the 
invention is to be determined according to the following claims.