Abstract:
A vibrator apparatus is provided. The vibrator apparatus includes a body weight support to support the body weight of a subject. The body weight support is attached to at least one arm, which includes a first arm portion and a second arm portion. The second arm is adjustably positionable with respect to the first arm portion. The vibrator apparatus also includes a vibrator assembly mounted on the second arm portion of the arm. The second arm portion is positionable relative to the first arm portion to engage an abdominal region of the subject and apply localized inwardly-directed mechanical vibrations.

Description:
FIELD AND BACKGROUND OF THE INVENTION  
         [0001]    The present invention relates to a vibrator appliance, and particularly to one useful for a peritoneal dialysis (PD) treatment. The invention also relates to a dialysis method and particularly to one utilizing the novel vibrator appliance.  
           [0002]    Peritoneal dialysis (PD) is a medical treatment administered when there is insufficient functioning of the kidneys. It is performed by inserting a sterile plastic catheter into the abdominal cavity of the subject and instilling a dialysate solution to irrigate the peritoneum such that solutes transfer across the peritoneal membrane into the dialysate solution from the blood in the mesentery capillary network. This treatment does not require a machine, such as in hemodialysis, but does require much longer periods of time in order to achieve solute removal comparable to that of intermittent hemodialysis. Such a treatment is commonly performed in an ambulatory manner as a CAPD (Continuous Ambulatory Peritoneal Dialysis) treatment.  
           [0003]    CAPD is usually performed in four 6-hour sessions during each 24-hour period. In each session, the dialysate solution is instilled into the abdominal cavity of the subject and permitted to dwell therein for a period of six hours, following which the dialysate solution is drained, and a fresh dialysate solution is instilled. This relatively large number of sessions greatly disturbs the daily routine of the subject. It also increases the risk of infection.  
           [0004]    Various studies have been conducted on the application of mechanical vibrations for improving the efficiency of waste removal by PD (peritoneal dialysis); see  J.Rudov et al.  Nephron 46:364-366 (1987);  Levitt et al . Kidney International, Vol. 35, pp. 1145-1150 (1989); and Utsunomia-T et al.,  Nippon-Jinzo-Gakkai-Shi ; January 1995; 37(1):24-8. The Rudoy et al. publication (1987) describes an improvement in peritoneal transfer on human subjects when subjected to mechanical vibrations at a frequency of 24 Hz by a vibrator held by the patient perpendicular to the patient&#39;s abdomen; the Levitt et al. publication (1989) describes studies of the effects produced on the rate of peritoneal transfer in rats by shaking the rats; and the Japanese publication (1995) describes studies on the rate of peritoneal transfer in rats by vibrating the abdominal wall at the rate of 80 Hz.  
         OBJECTS AND BRIEF SUBJECT OF THE INVENTION  
         [0005]    Objects of the present invention are to provide a vibrator appliance particularly useful in peritoneal dialysis, and also an improved method of peritoneal dialysis. The apparatus and method of the present invention are particularly useful for CAPD, but may also be used for other PD treatments, such as APD (Automated Peritoneal Dialysis), and CCPD (Continuous Cycling Peritoneal Dialysis) usually administered at home during the nighttime.  
           [0006]    According to one aspect of the present invention, there is provided an appliance to enhance the rate of removal of solutes during a peritoneal dialysis treatment of a subject, comprising: a holder to be applied to the subject; and at least one vibrator device carried by the holder at a location thereof to engage the subject&#39;s abdomen and to apply localized, inwardly-directed mechanical vibrations thereto at a frequency of 1-15 Hz.  
           [0007]    As will be described more particularly below, surprisingly good results were produced when the vibrator device applies the mechanical vibrations at a frequency of 2-6 Hz,  
           [0008]    In the preferred embodiments of the invention described below, there are two vibrator devices carried by the holder at locations to engage the opposite sides of the subject&#39;s abdomen and oriented to apply inwardly-directed mechanical vibrations towards the central region of the subject&#39;s abdominal cavity.  
           [0009]    According to another aspect of the invention, there is provided a method of administering a peritoneal dialysis treatment to a subject comprising a vibration session including: instilling a dialysate solution into the peritoneal cavity of the subject; applying external localized mechanical vibrations to the front side of the abdomen of the subject at a frequency of 1-15 Hz and an amplitude of 1-20 mm; and draining the dialysate solution from the subject&#39;s abdominal cavity. As indicated above, and as will be more fully described below, surprisingly good results were obtained when the mechanical vibrations were applied, at a frequency of 2-6 Hz and at a amplitude of 5-10 mm, especially when two vibrator heads were used engaging the front side of the subject&#39;s abdomen on opposite sides of its center line and oriented to direct mechanical vibrations to the central region of the subject&#39;s abdominal cavity.  
           [0010]    Thus, it was found that applying the vibrations at a frequency of over 15 Hz did not permit the vibrations to propagate deeply into the body cavity, and therefore the 24 Hz frequency mentioned in the J.Rudoy et al. publication cited above only produced a limited improvement in the peritoneal dialysis treatment. It was also found that applying the vibrations at a frequency of less than 1 Hz also produced very limited benefits. Surprisingly good results were found in the frequency range of 2-6 Hz, which produced an improvement of up to 150% in the solute removal rate, as compared to an improvement of about 30-40% when applying the mechanical vibrations at a frequency of 24 Hz as described in the J.Rudoy et al. publication.  
           [0011]    The optimum rate, preferably within the 2-6 Hz range, can be determined emperically for each subject, according to the size, build and weight of the subject.  
           [0012]    The vibrational amplitudes are preferably in the range of 1-20 mm, best results having been obtained with amplitudes of 5-10 mm. These amplitudes are inversely related to the frequency; that is, at the lower end of the above frequency range the vibrational amplitudes would be at the higher end of the amplitude range, and vice versa. Preferably, the combination of amplitude and frequency should be just below the level producing significant pain or discomfort to the subject, e.g., at the second limit of ISO Standard 2631.  
           [0013]    Further features and advantages of the invention will be apparent from the description below.  
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0014]    The invention is herein described, by way of example only, with reference to the accompanying drawings, wherein:  
         [0015]    [0015]FIG. 1 illustrates one type of vibrator appliance constructed in accordance with the present invention utilizing an electrically-actuated vibrator;  
         [0016]    [0016]FIG. 2 illustrates a rotary-motor type vibrator that may be used in the appliance of FIG. 1;  
         [0017]    [0017]FIG. 3 illustrates a solenoid-type of vibrator that may be used in the appliance of FIG. 1;  
         [0018]    [0018]FIG. 4 illustrates a piston-type vibrator appliance constructed in accordance with the present invention;  
         [0019]    [0019]FIG. 5 illustrates an air-bag type vibratory appliance constructed in accordance with the present invention;  
         [0020]    [0020]FIG. 6 illustrates a moving-belt type vibrator appliance constructed in accordance with the present invention;  
         [0021]    [0021]FIG. 7 illustrates another vibratory appliance including a belt supporting two electric motors rotating eccentric weights;  
         [0022]    [0022]FIG. 8 illustrates a further appliance in which the vibrations are effected by a pair of motors which cyclically tension and relax a belt applied to the wearer&#39;s abdomen;  
         [0023]    [0023]FIG. 9 is a plan view illustrating a further type of appliance constructed in accordance with the present invention;  
         [0024]    [0024]FIG. 10 is a rear view of the appliance of FIG. 9;  
         [0025]    [0025]FIG. 11 is a plan view illustrating a still further appliance constructed in accordance with the present invention;  
         [0026]    [0026]FIG. 12 is a rear view of the appliance of FIG. 11;  
         [0027]    [0027]FIG. 13 is a plan view of a still further appliance constructed in accordance with the present invention;  
         [0028]    [0028]FIG. 14 is a front view of the appliance of FIG. 13;  
         [0029]    [0029]FIG. 15 is an artist&#39;s view of one form of vibrator appliance constructed in accordance with the present invention; and  
         [0030]    [0030]FIG. 16 illustrates a dialysis set particularly useful with the appliance and method of the present invention.  
     
    
     DESCRIPTION OF PREFERRED EMBODIMENTS  
       [0031]    The vibrator appliance illustrated in FIG. 1 includes a holder  2  of a closed loop configuration to enclose the wearer&#39;s abdomen, indicated by broken lines AB. Holder  2  carries two vibrators  3   a ,  3   b , each slidably mounted on the holder by a slide  4   a ,  4   b , to enable each vibrator to be located so as to apply mechanical vibrations to opposite sides of the abdomen of the subject.  
         [0032]    Holder  2  includes a back frame  2   a , and a front frame  2   b  mounting the two vibrators  3   a ,  3   b . One end of front frame  2   b  is pivotal, by hinge  5 , to the respective end of the back frame  2   a  for opening and closing the holder. The opposite end of front frame  2   b  is lockable to the respective end of the back frame  2   a  by a lock, schematically shown at  6 , for locking the holder in its closed condition. Both the back frame  2   a  and the front frame  2   b  include width-adjusting means, as shown at  7  and  8 , respectively, for adjusting the size of the holder to fit persons of different sizes. Such width adjustment means  7 ,  8  may be of any conventional construction, such as slidable or telescoping sections in the respective frames.  
         [0033]    Holder  2  may be worn by the subject in a self-supporting manner with the two vibrators  3   a ,  3   b  engaging the front side of the subject&#39;s abdomen, on opposite sides of its center line. Thus, when the two vibrators  3   a ,  3   b  are energized, they produce mechanical vibrations which are inwardly-directed towards the center region of the subject&#39;s abdominal cavity.  
         [0034]    In the embodiment illustrated in FIG. 1, the two vibrators  3   a ,  3   b , are electrically-driven. FIG. 2 illustrates one example of such a vibrator, in the form of a rotary motor  10  rotating a disc  11  eccentrically mounting an arm  12  enclosed within a bellows  13  having a head  14  engageable with the user&#39;s abdomen such that energization of motor  10  reciprocates the eccentric arm  12  and its head  14  to apply mechanical vibrations to the wearer&#39;s abdomen. FIG. 3 ilustrates another example of vibrator, in the form of a solenoid  15  reciprocating an armature  16  enclosed within a bellows  17  and having a head  18  engaging the wearer&#39;s abdomen to apply mechanical vibrations thereto upon the energization of the solenoid. A still further example, including an electric motor driving eccentric weights is described below with reference to FIG. 7. The displacements of the vibrations may be adjusted or changed by changing the eccentricity of arm  12  in the appliance of FIG. 2, the current through the solenoid  15  in the appliance of FIG. 3, and the weights in the appliance of FIG. 7.  
         [0035]    The use of the vibrator appliance illustrated in FIGS.  1 - 3  has been found to enable a CAPD treatment to be divided into two 12-hour sessions, rather than four 6-hour sessions as in the conventional CAPD treatment. Following is one example of such a two-session treatment:  
         [0036]    In each session, dialysate solution is instilled into the abdominal cavity of the subject, and the two vibrators  3   a ,  3   b  are driven to cause them to apply mechanical vibrations to the abdomen, at a frequency of 1-15 Hz, at a vibrational amplitude of 1-20 mm, and for a period of 15-60 minutes. After this dwell period, the dialysate solution is drained from the suject; fresh dialysate solution is instilled and permitted to dwell in the subject for the remaining 12-hour period of that session; and the dialysate solution is then drained. This completes one 12-hour session, whereupon the next 12-hour session is started, and the foregoing sequence of steps is repeated. As indicated earlier, when the frequency was 2-6 Hz, the vibrational amplitude was 5-10 mm, and the dwell period was from about 30-40 minutes, surpringly improved results were obtained producing an improvement of up to about 150%, as compared to a 30-40% improvement mentioned in the above-cited J.Rudoy et al. publication using 24 Hz vibrations.  
         [0037]    These improved results enabled the normal four session CAPD treatment to be reduced to two sessions, each session involving e.g., a 40-minute dwell period accompanied by the vibrations, and immediately followed by, e.g., an 11-hour 20-minute dwell period not accompanied by vibrations. Thus, the 40-minute dwell period accompanied by vibrations was found to remove substantially the same amount of solutes as a normal 6-hour session in the conventional CAPD treatment. Such a 2-session regimen is not only much more convenient and substantially less disruptive of the daily routine of the patient than the usual 4-session regimen, but also substantially reduces the possibility of infection.  
         [0038]    The two vibrators may be operated at the same constant frequency, at different frequencies, or with changing frequencies. They may be operated in the same phase or in different phases. One or both vibrators may also be operated in a continuously changing phase angle. Best results were obtained when both vibrators were operated within the range of 2-4.5 Hz, with one vibrator operating at a slightly different frequency than the other (such as 2.5 Hz and 2.6 Hz, respectively) to produce alternating in-phase and out-of-phase movements of the subject&#39;s abdomen. The subject may be in a sitting, lying or standing position during the first part of each session when the vibrations are applied, but best results were obtained when the subject was in a sitting or supine position.  
         [0039]    [0039]FIG. 4 illustrates a vibrator appliance, similar to that of FIG. 1 except that the vibrators, therein designated  23   a ,  23   b , respectively, are in the form of fluid pistons movable within cylinders to apply the vibrations to the wearer&#39;s abdomen. In FIG. 4, each of the vibrators  23   a ,  23   b  is shown as including a bellows  24   a ,  24   b , enclosing the piston of the respective vibrator. The pistons in vibrators  23   a ,  23   b , may be operated pneumatically or hydraulically. FIG. 4 schematically illustrates a pump or compressor  25  for operating these pistons. In all other respects, the vibrator appliance illustrated in FIG. 4 is constructed and operates in substantially the same manner as described above with respect to FIG. 1, and therefore the corresponding elements of the appliance are identified by the same reference numerals to faciliate understanding.  
         [0040]    [0040]FIG. 5 illustrates another form of vibrator appliance wherein the holder is in the form of a belt  32  to enclose the subject, and the vibrators are in the form of inflatable air bags  33   a ,  33   b  carried by the belt on the opposite sides of the wearer&#39;s abdomen. The air bags  33   a ,  33   b  are inflatable and deflatable at the desired frequency by a compressor  35 .  
         [0041]    Belt  32  includes a stiff back  36  and a front adjustment  37  for adjusting the belt to fit persons of different sizes. While FIG. 5 illustrates a compressor  35  for both vibrators, it will be appreciated each vibrator could be provided with its own compressor particularly if they are to be operated at different frequencies or phases. The same apllies with respect ot the appliance of FIG. 4.  
         [0042]    [0042]FIG. 6 illustrates a further vibrator appliance, in which the holder includes a frame  40  to engage the back of the wearer, a first belt  41  to be applied around the wearer, and a second belt  42  to be applied around the first belt  41 . This appliance also includes two vibrators applying mechanical vibrations to the opposite sides of the wearer&#39;s abdomen. In this case, each vibrator includes a plurality of plates  43  pivotally mounted at one end to the inner belt  41 , and at the opposite end to the outer belt  42 . The arrangement is such that when belt  42  is reciprocated, in the direction of arrows  44 , the two groups of plates  43  are pivotted through a plurality of positions from 0° to 180°, and during such pivotal movements of these plates, they apply mechanical vibrations to the wearer&#39;s abdomen. Thus, when the plates are 0° to the two belts  41 ,  42 , the vibrational amplitude is zero, but as the plates move to positions of 90° to the two belts, they apply mechanical vibrations to the wearer&#39;s abdomen at amplitudes corresponding to the widths of the plates.  
         [0043]    Each vibrator thus includes one group of plates  43  pivotally mounted between the two belts  41 ,  42 . The width of each plate  43  decreases from the rear side to the front side of the respective vibrator so that the vibrational amplitudes are correspondingly decreased from the rear side towards the front side of the vibrator.  
         [0044]    [0044]FIG. 6 schematically illustrates the front belt  42  as being reciprocated by a pair of motors  45 ,  46 , at the opposite ends of the rear frame  40 . An adjustment  47  for the rear frame  40 , and an adjustment  48  for the two belts  41 ,  42 , enable the appliance to fit persons of different sizes.  
         [0045]    [0045]FIG. 7 illustrates another appliance, including a belt  50  having a back adjustment  51  and a front adjustment  52  to enable the appliance to be fitted to different size individuals. Belt  50  carries a pair of vibrators  53   a ,  53   b  on its opposite sides to engage the opposite sides of the wearer&#39;s abdomen. Each vibrator  53   a ,  53   b  includes an electric motor  54   a ,  54   b , driving a pair of eccentric weights  55   a ,  55   b  which, upon energization of the respective motors, apply mechanical vibrations to the wearer&#39;s abdomen.  
         [0046]    [0046]FIG. 8 illustrates an even more simplified construction, including a back frame  60  having an adjustment  61 , and front belts  62 ,  63  having a front adjustment  64 . The back frame  60  carries a pair of electric motors  65 ,  66  engaging the opposite ends of belts  62 ,  63  such that energization of the electric motors cyclically tensions and relaxes the belts to cause them to apply mechanical vibrations to the opposite sides of the wearer&#39;s abdomen engaged by the belts.  
         [0047]    [0047]FIGS. 9 and 10 illustrate another appliance  70  also including a holder in the form of a loop to be worn by the subject in a self-supporting manner. In this case, the appliance includes two base members  71 ,  72  coupled together by a hinge  73  and mounted to a stiff or rigid back plate  74  adapted to engage the back of the subject. The base members  71 ,  72  mount electrical motors  75 ,  76  which are eccentrically coupled to one end of a pair of flexible belts  77 ,  78  adapted to engage the front side of the subject&#39;s abdomen. The opposite ends of belts  77 ,  78  are coupled together by a locking device or buckle  79 .  
         [0048]    A pair of vibrator heads  80 ,  81  are carried by the two belts  77 ,  78 . Heads  80 ,  81  extend inwardly of the loop to contact the front side of the subject&#39;s abdomen on opposite sides of its center line and are oriented towards the central region of the subject&#39;s abdominal cavity. Thus, when the two electrical motors  75 ,  76  are energized, their eccentric connections to the flexible belt  77 ,  78  cyclically tension and relax the belts causing the vibrator heads  80 ,  81  to apply mechanical vibrations directed to the central region of the subject&#39;s abdominal cavity.  
         [0049]    The front buckle or lock  79  is adjustable to permit the diameter of the loop to be adjusted according to the size of the subject. The two vibrator heads  80 ,  81  are slidable on the belts  77 ,  78  to permit them to be optimally positioned in order to direct the mechanical vibrations to the central region of the subject&#39;s abdominal cavity. The two hinged base members  71 ,  72  may also be adjustable on the back plate  74 . Thus, as shown in FIG. 10, the back plate  74  carries two parallel screws  82 ,  83  rotate together by another screw  84 . Screws  82 ,  83  on the back plate  74  are received within nuts  85 ,  86  on the two base members  71 ,  72 , such that rotation of the two screws  82 ,  83  by the common screw  84  moves the two base members  71 ,  72  up or down according to the direction of rotation of screws  84 .  
         [0050]    [0050]FIGS. 11 and 12 illustrate a similar appliance as in FIGS. 9 and 10, and therefore the same reference numerals have been used for the same parts. In the appliance of FIGS. 11 and 12, however, the ends of the two base members  71 ,  72  are not hinged together, but rather are formed with parallel slots  91 ,  92  receiving threaded pins  93 ,  94 . In addition, each base member  71 ,  72  has secured thereto a transverse rigid strip  95 ,  96  adapted to be received within grooves  97 ,  98  formed in the back plate  74 . Strips  95 ,  96  carried by the base members  71 ,  71 , and grooves  97 ,  98  in the back plate  74 , are formed with a plurality of openings extending along the length of the strips and grooves, respectively, adapted to selectively receive threaded pins  99 . Thus, by threading pins  99  in selected openings in the strips  95 ,  96 , and grooves  97 ,  98 , the position of the base members  71 ,  72  may be adjusted along the length of the back plate; and by tightening the threaded pins  93 ,  94  in their respective slots  91 ,  92 , the diameter of the appliance may be adjusted to fit different sized persons.  
         [0051]    [0051]FIGS. 13 and 14 illustrate another appliance  100  which includes a loop enabling the appliance to be worn by the user in a self-supporting manner, but further includes a pair of shoulder harnesses  102 ,  103  to aid the loop in supporting the appliance on the subject.  
         [0052]    The appliance  100  illustrated in FIGS. 13 and 14 includes a base member  104  at the front of the appliance, i.e., to engage the front side of the subject&#39;s abdomen, and a back plate  105  at the opposite side of the appliance to engage the subject&#39;s back. The base member  104  is connected to the back plate  105  by a pair of flexible belts  101   a ,  101   b , to thereby define the closed loop  101  enabling the appliance to be worn by the subject. Each of the flexible belts includes a locking member or buckle  106 ,  107  of the type which permits the lenght of the belt to be adjusted and locked, to thereby enable the appliance to fit different sized persons.  
         [0053]    Base member  104  at the front side of the appliance carries an electrical motor  111  having an output shaft  112  eccentrically coupled at its opposite ends to a pair of shaped vibrator heads  113 ,  114  carried by plates  115 ,  116  pivotally mounted to he base member  104 . Each of the eccentric couplings between the motor output shaft  112  and the vibrator heads  113 ,  114  includes a dashpot device  117 ,  118  pivotally mounted to plates  115 ,  116 . Each dashpot device  117 ,  118  includes an adjustment, indicated by screws  117   a ,  118   a , which permits manual adjustment of the retarding action of the respective dashpot. The retarding action of each dashpot may also be remotely adjusted via electrical or hydraulic means. These adjustments may be used not only for adjusting the cushioning forces applied by the vibrator heads  113 ,  114  against the subject&#39;s abdomen, but also for changing the relative phases of the forces so applied, upon rotation of the electrical motor  111 .  
         [0054]    [0054]FIG. 15 illustrates the external appearance of a vibrator appliance  120  constructed in accordance with the present invention. The appliance includes a backrest  121 , a seat  122  and a pair of arms  123 ,  124 , each having a rear section  123   a ,  124   a , pivotally mounted to the backrest  121 , and a front section  123   b ,  124   b , carrying a vibrator head  125 ,  126  to engage the front side of the subject&#39;s abdomen. The rear arm sections  123   a ,  124   a  are pivotally mounted to the backrest  121 , as schematically indicated by integral hinge  127 , and may be fixed in any pivotted position by any suitable means such as a screw and nut arrangement (not shown). Similarly, the front arm sections  123   b ,  124   b  are pivotally mounted to their respective rear arm sections  123   a ,  123   b , as indicated by integral hinges  127 , and may also be fixed in any pivotted position, to thereby enable the appliance to be used with respect to persons of different sizes. The vibrator heads  125 ,  126  carried by the front arm sections  123   b ,  124   b , may be driven electrically, hydraulically, or pneumatically, according to any of the above-described arrangements.  
         [0055]    [0055]FIG. 16 illustrates a dialysis set particularly useful with respect to the above-described appliance. The illustrated set includes two supply bags  131 ,  132  for containing fresh dialysis solution, and a drainage bag  133  to receive the solution after drained from the subject. The three bags are connected to a connector  134  for the dialysis catheter (not shown) by tubing generally designated  135 . Tubing  135  includes two tubes  136 ,  137 , connected at one of their ends to the respective supply bag  131 ,  132 , and at their opposite ends to a third tube  138  leading to the catheter connector  134 . Tube  138  is connected to a fourth tube  139  leading to the drainage bag  133 .  
         [0056]    Each tube  136 ,  137  includes a valve  140 ,  141  which is normally closed, but which can be manipulated to open and thereby to permit the respective supply bag  131 ,  132  to instill its fluid to the patient via the catheter connected to connector  134 . Valves  140 ,  141  may be breakaway valves which are normally closed, but which may be manually broken-away to open the valve.  
         [0057]    In use of the dialysis set illustrated in FIG. 16, the two supply bags  131 ,  132  would be mounted at a higher elevation than the catheter connector  134 , and the drainage bag  133  would be mounted at a lower elevation than the catheter connector. In addition, an external clamp (not shown) would be applied to tube  139  to prevent the dialysis solution from passing to the drainage bag  133  during instillation phase. With a clamp thus applied to tube  139 , valve  140  would be manipulated to open, thereby permitting the fluid to flow by gravity from supply bag  131  via the catheter into the abdominal cavity, whereupon the vibrator appliance would be energized to enhance the rate of solute removal. After the appropriate dwell time, the clamp would be removed from tube  139  to permit the solution to drain into the drainage bag  133 , whereupon the clamp would then be reapplied to tube  139  and valve  141  of supply bag  132  would be opened to permit the solution in that bag to flow by gravity into the abdominal cavity of the subject.  
         [0058]    The dialysis set illustrated in FIG. 16 may thus be connected to the patient&#39;s catheter during two successive exchanges, thereby substantially reducing the possibility of an infection and also reducing the disruption to the patient&#39;s daily routine.  
         [0059]    Generally speaking, it was found that a 40-minute dialysate treatment accompanied by mechanical vibrations applied in any of the above-described appliances effects about the same solute transfer as a 6-hour dialysate treatment not accompanied by mechanical vibrations. Accordingly, such an appliance permits various treatments to be applied, according to the nature of each case and the convenience of the subject. Following are examples of such treatments:  
         [0060]    (1) Each 24-hour day is divided into two 12-hour periods, each period including a vibration session for 15-60 minutes, and a non-vibration session with fresh dialysate solution for the remainder of the period.  
         [0061]    (2) Each 24-hour day includes four vibration sessions of 15-60 minutes each, spaced about six hours apart.  
         [0062]    (3) Each 24-hour day is divided into four 6-hour periods, at least one of these periods including a vibration session for 15-60 minutes, and a non-vibration session with fresh dialysate solution for the remainder of the period, each of the remaining periods being a non-vibration session with fresh dialysate.  
         [0063]    (4) Each 24-hour day includes a vibration session for 15-60 minutes, a non-vibration session with fresh dialysate solution for 10-11.5 hours, and another vibration session with fresh dialysate for 15-60 minutes.  
         [0064]    (5) Each 24-hour day includes six equally-spaced 1-1.5 hours each, each period including instilling fresh dialysate solution for 10-15 minutes, a dwell accompanied by vibrations for 30-60 minutes, and removing the dialysate solution for 15-20 minutes.  
         [0065]    In all the above treatments except treatment (4) above, each session (vibrating or non-vibrating) should involve the instillation of 2-2.5 liters of the dialysate fluid. However, in treatment (4) above, since there are a total of only three sessions during the 24-hour day, each session should involve the instillation of about 2.5-3.0 liters of the dialysate fluid.  
         [0066]    Each vibration session should be between 15-60 minutes, a 40 minute period having been found to be preferred in most cases. In addition, after each vibration session the dialysate should be drained and fresh dialysate added for the next session.  
         [0067]    When the vibrator appliance is used for a continuous 24-hour day (CAPD) treatment, it may be constructed as described above so as to be worn on the user, thereby enabling the user to perform daily routines in the least-disruptive manner. However, when the vibrator appliance is not to be used continuously, it may be incorporated in a self-supporting structure, such as a chair as described above, or a stand or table.  
         [0068]    It was further surprisingly found that when the vibrator appliance was operated at the lower frequencies, e.g., 1-3 Hz, it promoted sleep on the part of the wearer. Actually, during clinical experiments, the wearers frequently went to sleep when the appliance was operated at these lower frequencies 1-3 Hz, but immediately awoke when the vibrations were stopped or the frequency was increased to the 2-6 Hz range. The illustrated appliance may therefore be advantageously used also for promoting sleep.  
         [0069]    While the invention has been described with respect to several preferred embodiments, it will be appreciated that these are set forth merely for purposes of example, and that many variations may be made. For example, in all the described devices, the two vibrators can be operated at the same frequency but with different phases, at different frequencies, or at progressively changing frequencies. In addition, whereas the above described embodiments include two vibrators engaging opposite sides of the subject&#39;s abdomen, a different number of vibrators could be used. Also, the dashpot devices illustrated in FIGS. 13 and 14 may be used with any of the other vibrator devices between the vibrator heads and the respective drives. Many other variations, modifications and applications of the invention will be apparent.