Abstract:
A wearable defibrillation system includes an output device and a motion sensor. The output device emits a sound or a vibration for the patient, who responds by deliberately tapping the system. The motion sensor registers the tapping, and interprets it as a reply from the patient. The reply can be that the patient is conscious, or convey data that the patient enters by tapping the right number of times, or that the patient wants attention, and so on. Since the patient does not need direct access to the wearable defibrillation system for tapping it, he or she can wear it under their other garments, which helps preserve their dignity and privacy.

Description:
CROSS REFERENCE TO RELATED PATENT APPLICATIONS 
       [0001]    This patent application is a continuation of U.S. patent application Ser. No. 14/014,987, filed on Aug. 30, 2013, which claims priority from U.S. Provisional Patent Application Ser. No. 61/704,966, filed on Sep. 24, 2012, titled: “WEARABLE MEDICAL DEVICE RESPONDING TO MECHANICAL TAPPING AS MEANS OF COMMUNICATION”, the disclosure of which is hereby incorporated by reference for all purposes. 
     
    
     BACKGROUND 
       [0002]    When people suffer from some types of heart arrhythmia, the result may be that blood flow to various parts of the body is reduced. Some arrhythmias may even result in a Sudden Cardiac Arrest (SCA). SCA leads to death very quickly, e.g. within 10 minutes, unless treated in the interim. 
         [0003]    People who have had a heart attack have an increased risk of SCA, and therefore it is recommended that they receive an Implantable Cardioverter Defibrillator (“ICD”). An ICD has internal electrodes, and continuously monitors the person&#39;s electrocardiogram (“ECG”). If certain types of heart arrhythmia are detected, then the ICD delivers an electric shock through the heart. 
         [0004]    People with increased risk of an SCA are sometimes given a wearable external defibrillator system. The recipients typically include those who have had a heart attack, or SCA, or are considered at risk, but have not yet had an ICD implanted. A wearable defibrillator system typically includes a harness, vest, or other garment for wearing by the patient. The system includes a defibrillator and external electrodes, which are attached on the inside of the harness, vest, or other garment. When the patient wears the system, the external electrodes may then make good electrical contact with the person&#39;s skin, and therefore can help monitor the patient&#39;s ECG. If a shockable heart arrhythmia is detected, then the defibrillator delivers the appropriate electric shock through the body, and thus through the heart. 
       BRIEF SUMMARY 
       [0005]    The present description gives instances of wearable defibrillation systems, software, and methods, the use of which may help overcome problems and limitations of the prior art. 
         [0006]    In one embodiment, a wearable defibrillation system includes an output device and a motion sensor. The output device emits a sound or a vibration for the patient, who responds by deliberately tapping the system. The motion sensor registers the tapping, and interprets it as a reply from the patient. The reply can be that the patient is conscious, or convey data that the patient enters by tapping the right number of times, or that the patient wants attention, and so on. 
         [0007]    Advantages over the prior art arise from the fact that the motion needed by the patient for tapping is less exact than, say, finding and pushing buttons. In fact, such buttons need not be provided, saving in cost. And less dexterity is required from the patient, while tapping the system in a stressful situation. Moreover, since the patient does not need direct access to the wearable defibrillation system for tapping it, he or she can wear it under their other garments, which helps preserve their dignity and privacy. Embodiments can also help people who are hard of hearing, by having a query from the system encoded as a different pattern of vibrations, and so on. 
         [0008]    These and other features and advantages of this description will become more readily apparent from the following Detailed Description, which proceeds with reference to the drawings, in which: 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0009]      FIG. 1  is a diagram of components of a wearable defibrillator system, made according to embodiments. 
           [0010]      FIG. 2  is a diagram showing components of an external defibrillator, such as the one shown in  FIG. 1 , and which is made according to embodiments. 
           [0011]      FIGS. 3A and 3B  are diagrams showing sample sequences of events according to embodiments. 
           [0012]      FIG. 4  is a flowchart for illustrating methods according to embodiments. 
           [0013]      FIG. 5  is a flowchart for illustrating methods according to embodiments. 
           [0014]      FIG. 6A  is a diagram showing a sample sequence of events according to embodiments. 
           [0015]      FIG. 6B  is a diagram showing a sample sequence of events according to embodiments. 
           [0016]      FIGS. 7A and 7B  are diagrams showing sample sequences of events according to additional embodiments. 
           [0017]      FIG. 8  is a flowchart for illustrating methods according to additional embodiments. 
           [0018]      FIG. 9  is a flowchart for illustrating methods according to additional embodiments. 
           [0019]      FIG. 10  is a diagram showing a sample sequence of events according to additional embodiments. 
       
    
    
     DETAILED DESCRIPTION 
       [0020]    As has been mentioned, the present description is about wearable defibrillation systems. Embodiments are now described in more detail. 
         [0021]      FIG. 1  depicts components of a wearable defibrillator system, which is intended to be worn by a patient  82 . Patient  82  may also be referred to as person  82 , and wearer  82  since he or she wears components of the wearable defibrillator system. 
         [0022]    One of the components of a wearable defibrillator system according to embodiments is a support structure, which is configured to be worn by patient  82 . The support structure can be any structure suitable for wearing, such as a harness, a vest, one or more belts, another garment, and so on. The support structure can be implemented in a single component, or multiple components. For example, a support structure may have a top component resting on the shoulders, for ensuring that the defibrillation electrodes will be in the right place for defibrillating, and a bottom component resting on the hips, for carrying the bulk of the weight of the defibrillator. A single component embodiment could be with a belt around at least the torso. Other embodiments could use an adhesive structure or another way for attaching to the person, without encircling any part of the body. There can be other examples. 
         [0023]    In  FIG. 1 , a generic support structure  170  is shown relative to the body of person  82 , and thus also relative to his or her heart  85 . Structure  170  could be a harness, a vest, one or more belts, a garment, as per the above; it could be implemented in a single component, or multiple components, and so on. Structure  170  is wearable by person  82 , but the manner of wearing it is not depicted, as structure  170  is depicted only generically in  FIG. 1 . 
         [0024]    A wearable defibrillator system is configured to defibrillate the person, by delivering electrical charge to the person&#39;s body in the form of an electric shock.  FIG. 1  shows a sample external defibrillator  100 , and sample defibrillation electrodes  104 ,  108 , which are coupled to external defibrillator  100  via electrode leads  105 . Defibrillator  100  and defibrillation electrodes  104 ,  108  are coupled to support structure  170 . As such, all components of defibrillator  100  may be therefore coupled to support structure  170 . When defibrillation electrodes  104 ,  108  make good electrical contact with the body of person  82 , defibrillator  100  can administer, via electrodes  104 ,  108 , a brief, strong electric pulse  111  through the body. Pulse  111 , also known as a defibrillation shock, goes also through heart  85 , in an attempt to restart it, for saving the life of person  82 . 
         [0025]    A prior art defibrillator typically decides whether to defibrillate or not based on an electrocardiogram (“ECG”) of the patient. However, defibrillator  100  can defibrillate or not also based additionally on other inputs. 
         [0026]    The wearable defibrillator system may also include an output device  171 , for communicating with patient  82 . Output device  171  may be a part of a user interface  270  that is described later with reference to  FIG. 2 . 
         [0027]    In some embodiments, when the charge is intended to be delivered imminently by defibrillator  100  as electric pulse  111 , output device  171  emits an alarming human-perceptible indication for patient  82  to notice. The emitting can be performed in a number of ways. For example, output device  171  may include a vibration mechanism, and the alarming human-perceptible indication includes an emitted vibration. For another example, output device  171  may include a speaker, and the alarming human-perceptible indication includes an emitted sound. The sound can be a specific tone, which the patient has been trained to understand that it means defibrillation is imminent. Or, the sound can be an express announcement. 
         [0028]    The wearable defibrillator system may also optionally include a monitoring device  180 , which can also be called an outside monitoring device. Monitoring device  180  is configured to monitor at least one local parameter. A local parameter can be a parameter of patient  82 , or a parameter of the wearable defibrillation system, or a parameter of the environment, as will be described later. It is also based on such parameters that the wearable defibrillator system may decide whether or not to shock the patient. 
         [0029]    Optionally, monitoring device  180  is physically coupled to support structure  170 . In addition, monitoring device  180  can be communicatively coupled with other components that are coupled to support structure  170 , such as a communication module, as will be deemed necessary by a person skilled in the art in view of this disclosure. Moreover, monitoring device  180  may be independently able to become communicatively coupled with other devices and components that are not necessarily coupled to support structure  170 , such as a mobile phone, wireless access point (i.e. internet), and so on. 
         [0030]    The wearable defibrillator system may also optionally include a motion sensor  181 . Sensor  181  may be coupled to support structure  170  as a standalone component, or by being part of monitoring device  180 , or the later described monitoring device  280 . Motion sensor  181  may be made as is known in the art. 
         [0031]    Motion sensor  181  is intended to provide a way for patient  82  to communicate with the wearable defibrillator system. Patient  82  can cause sensor  181  to detect a motion such as tapping, flicking, wiggling or shaking sensor  181 , or support structure  170  near where sensor  181  is coupled to it. Such a motion is referred to as motion or “tapping” in this document. Preferably, patient  82  has been instructed where sensor  181  is located, and which deliberate motion or tapping would succeed in causing sensor  181  to detect a motion. The detected motion can become registered in the system as an entry by patient  82 . The inference as to what mechanical motion is due to intentional activity by patient  82  can be processor based, waveform based, and so on. In addition, filters can also be used to identify and disregard artifact signals from motion sensor  181  that are not due to intentional tapping by patient  82 . 
         [0032]    In some embodiments, where an alarming human-perceptible indication is emitted to warn that the charge will be delivered imminently, patient  82  has the opportunity to tap support structure  170  near motion sensor  181 . Sensor  181  will detect a motion, which will notify the wearable defibrillation system that patient  82  is conscious, and should not be administered a shock. In that case, the charge delivery is canceled, which means that the charge will not delivered as planned. The cancellation may take place without necessarily needing anyone to do anything else. After the cancellation, it would require a new detection of the patient signals for there to be another, subsequent intention for the charge to be delivered. 
         [0033]    In preferred embodiments, patient  82  is only given a fixed amount of time to tap support structure  170  near motion sensor  181 . This amount of time is also called a react interval, and it starts when the alarming human-perceptible indication is emitted. 
         [0034]    In some of those embodiments, output device  171  may further emit a count-down human-perceptible indication. This indication may be in any way so as to communicate a duration of the react interval, and it may be by merely announcing how much time is left, providing an explicit count-down, intensity of indication, and so on. 
         [0035]      FIG. 2  is a diagram showing components of an external defibrillator  200 , made according to embodiments. These components can be, for example, in external defibrillator  100  of  FIG. 1 . The components shown in  FIG. 2  can be provided in a housing  201 , which is also known as casing  201 . 
         [0036]    External defibrillator  200  is intended for a patient who would be wearing it, such as person  82  of  FIG. 1 . Defibrillator  200  may further include a user interface  270  for a user  282 . User  282  can be patient  82 , also known as wearer  82 , if conscious. Or user  282  can be a local rescuer at the scene, such as a bystander who might offer assistance, or a trained person. Or, user  282  might be in remote communication with a remote rescuer, such as a trained person. Optionally, the user interface can be implemented instead as a smartphone or small computer that is communicatively coupled with defibrillator  200 , and so on. It will be appreciated however, that user interface  270  may perform fewer functions for input, because some input functions will be performed by deliberate tapping of motion sensor  181 , as described later in this document. 
         [0037]    Defibrillator  200  may include a monitoring device  280 , which can also be called an internal monitoring device because it is incorporated within housing  201 . Monitoring device  280  can monitor patient parameters, system parameters and/or environmental parameters. In other words, internal monitoring device  280  can be the same, or complementary to outside monitoring device  180  of  FIG. 1 , and can be provided in addition to it, or instead of it. Allocating which of the system parameters are to be monitored by which monitoring device can be done according to design considerations. 
         [0038]    Patient physiological parameters include, for example, those physiological parameters that can be of any help in detecting by the wearable defibrillation system whether the patient is in need of a shock, plus optionally their history. Example such parameters include the patient&#39;s ECG, blood oxygen level, blood flow, blood pressure, blood perfusion, pulsatile change in light transmission or reflection properties of perfused tissue, heart sounds, breathing sounds and pulse. Accordingly, appropriate monitoring devices could be a pulse oximeter, a Doppler device for detecting blood flow, a cuff for detecting blood pressure, illumination detectors and maybe sources for detecting color change in tissue, a device that can detect artery wall movement, a device with a microphone, and so on. Pulse detection is taught at least in Physio-Control&#39;s U.S. Pat. No. 8,135,462, which is hereby incorporated by reference in its entirety. In addition, a person skilled in the art may implement other ways of performing pulse detection. 
         [0039]    In some embodiments, the local parameter is a trend that can be detected in a monitored physiological parameter of patient  82 . A trend can be detected by comparing values of parameters at different times. Parameters whose detected trends can particularly help a cardiac rehabilitation program include: a) cardiac function (ejection fraction), b) heart rate variability at rest or during exercise, c) heart rate profile during exercise and measurement of activity vigor, such as from the profile of an accelerometer signal and informed from adaptive rate pacemaker technology, d) heart rate trending, e) perfusion, such as from SpO2, CO2, f) respiratory function, respiratory rate, etc., g) motion, level of activity, and so on. Once a trend is detected, it can be stored and/or reported via a communication link, along perhaps with a warning. From the report, a physician monitoring the progress of patient  82  will know about a condition that is not improving or deteriorating. 
         [0040]    Patient state parameters include recorded aspects of patient  82  such as motion, posture, whether they have spoken recently plus maybe also what they said, and so on, plus optionally the history of these parameters. Monitoring device  180  or monitoring device  280  may include a motion detector, which can be made in many ways as is known in the art. Or, one of these monitoring devices could include a location sensor such as GPS, which informs of the location, and the rate of change of location over time. Many motion detectors output a motion signal that is indicative of the motion of the detector, and thus of the patient&#39;s body. Patient state parameters can be very helpful in narrowing down the determination of whether SCA is indeed taking place. For example, it is known how to infer the activities and likely severity of the patient condition by interpreting motion signals. For instance, if the patient stops moving at a time when they are expected to be moving or continue moving, or exhibits other behavior that indicates that SCA may be taking place, that can be cause for increased scrutiny, and initiative to contact the patient and/or a remote doctor or caregiver. 
         [0041]    In some embodiments, patient data of patient  82  is monitored. The patient data includes both the physiological parameters and state parameters of patient  82 . The value of the physiological parameter becomes better informed from the motion profile, as is the appropriate threshold for determining whether an actionable episode is taking place. The threshold can be adjusted accordingly. For example, if the person is running, then a somewhat higher pulse rate may be tolerated until a time after they stop, and so on. 
         [0042]    System parameters of a wearable defibrillation system can include system identification, battery status, system date and time, reports of self-testing, records of data entered, records of episodes and intervention, and so on. 
         [0043]    Environmental parameters can include ambient temperature and pressure. A humidity sensor may provide information as to whether it is raining. Presumed patient location could also be considered an environmental parameter. The patient location could be presumed if monitoring device  180  or  280  includes a Global Positioning System (GPS) sensor. 
         [0044]    Defibrillator  200  typically includes a defibrillation port  210 , such as a socket in housing  201 . Defibrillation port  210  includes nodes  214 ,  218 . Defibrillation electrodes  204 ,  208 , for example similar to electrodes  104 ,  108  of  FIG. 1 , can be plugged in defibrillation port  210 . Plugging can be from their leads, such as leads  105  of  FIG. 1 , so as to make electrical contact with nodes  214 ,  218 , respectively. It is also possible that defibrillation electrodes  204 ,  208  are connected continuously to defibrillation port  210 , instead. Either way, defibrillation port  210  can be used for guiding, via electrodes, to the wearer the electrical charge that has been stored in energy storage module  250 . 
         [0045]    Defibrillator  200  may optionally also have an ECG port  219  in housing  201 , for plugging in ECG electrodes  209 , which are also known as ECG leads. It is also possible that ECG electrodes  209  can be connected continuously to ECG port  219 , instead. ECG electrodes  209  can help sense an ECG signal, e.g. a 12-lead signal, or a signal from a different number of leads, especially if they make good electrical contact with the body of the patient. ECG electrodes  209  can be attached to the inside of support structure  170  for making good electrical contact with the patient, similarly as defibrillation electrodes  204 ,  208 . 
         [0046]    Defibrillator  200  also includes a measurement circuit  220 . Measurement circuit  220  receives physiological signals from ECG port  219 , if provided. Even if defibrillator  200  lacks ECG port  219 , measurement circuit  220  can obtain physiological signals through nodes  214 ,  218  instead, when defibrillation electrodes  204 ,  208  are attached to the patient. In these cases, a person&#39;s ECG signal can be sensed as a voltage difference between electrodes  204 ,  208 . Plus, impedance between electrodes  204 ,  208  and/or the connections of ECG port  219  can be sensed. Sensing the impedance can be useful for detecting, among other things, whether these electrodes  204 ,  208  and/or ECG electrodes  209  are not making good electrical contact with the patient&#39;s body. These physiological signals can be sensed, and information about them can be rendered by circuit  220  as data, or other signals, etc. 
         [0047]    Defibrillator  200  also includes a processor  230 . Processor  230  may be implemented in any number of ways. Such ways include, by way of example and not of limitation, digital and/or analog processors such as microprocessors and digital-signal processors (DSPs); controllers such as microcontrollers; software running in a machine; programmable circuits such as Field Programmable Gate Arrays (FPGAs), Field-Programmable Analog Arrays (FPAAs), Programmable Logic Devices (PLDs), Application Specific Integrated Circuits (ASICs), any combination of one or more of these, and so on. 
         [0048]    Processor  230  can be considered to have a number of modules. One such module can be a detection module  232 . Processor  230 , running detection module  232 , is a sample embodiment of a logic device configured to determine whether a monitored parameter has reached a specific threshold. For example, the monitoring parameter can be input from monitoring device  280 , if provided. For another example, detection module  232  can include a ventricular fibrillation (“VF”) detector. The patient&#39;s sensed ECG from measurement circuit  220  can be used by the VF detector to determine whether the patient is experiencing VF. Detecting VF is useful, because VF is a precursor to SCA. 
         [0049]    Another such module in processor  230  can be an advice module  234 , which generates advice for what to do. The advice can be based on outputs of detection module  232 . There can be many types of advice according to embodiments. As one example, a Shock Advisory Algorithm can render the advice to shock the patient by delivering a charge, as opposed to not shock the patient. Such can be, for example, when the patient&#39;s condition has reached or exceeded an advised defibrillation threshold. Shocking can be for defibrillation, pacing, and so on. 
         [0050]    If the advice is to shock, some external defibrillator embodiments proceed with shocking, or may advise a remote attendant to do it, and so on. As another example, the advice can be to administer CPR, and defibrillator  200  may further issue prompts for it, and so on. 
         [0051]    Processor  230  can include additional modules, such as other module  236 , for other functions. In addition, if monitoring device  280  is indeed provided, it may be operated in part by processor  230 , etc. 
         [0052]    Defibrillator  200  optionally further includes a memory  238 , which can work together with processor  230 . Memory  238  may be implemented in any number of ways. Such ways include, by way of example and not of limitation, nonvolatile memories (NVM), read-only memories (ROM), random access memories (RAM), any combination of these, and so on. Memory  238 , if provided, can include programs for processor  230 , and so on. The programs can be operational for the inherent needs of processor  230 , and can also include protocols and ways that decisions can be made by advice module  234 . In addition, memory  238  can store prompts for user  282 , if they are a local rescuer. Moreover, memory  238  can store data. The data can include patient data, system data and environmental data, for example as learned by monitoring device  280  and monitoring device  180 . The data can be stored in memory  238  before it is transmitted out of defibrillator  200 , or stored there after it is received by it. 
         [0053]    Defibrillator  200  may also include a power source  240 . To enable portability of defibrillator  200 , power source  240  typically includes a battery. Such a battery is typically implemented as a battery pack, which can be rechargeable or not. Sometimes, a combination is used, of rechargeable and non-rechargeable battery packs. Other embodiments of power source  240  can include an AC power override, for where AC power will be available, an energy storage capacitor, and so on. In some embodiments, power source  240  is controlled by processor  230 . 
         [0054]    Defibrillator  200  additionally includes an energy storage module  250 , which can thus be coupled to the support structure of the wearable system. Module  250  is where some electrical energy is stored, when preparing it for sudden discharge to administer a shock. Module  250  can be charged from power source  240  to the right amount of energy, as controlled by processor  230 . In typical implementations, module  250  includes a capacitor  252 , which can be a single capacitor or a system of capacitors, and so on. As described above, capacitor  252  can store the charge for delivering to the patient. 
         [0055]    Defibrillator  200  moreover includes a discharge circuit  255 . Circuit  255  can be controlled to permit the energy stored in module  250  to be discharged to nodes  214 ,  218 , and thus also to defibrillation electrodes  204 ,  208 . Circuit  255  can include one or more switches  257 . Those can be made in a number of ways, such as by an H-bridge, and so on. 
         [0056]    User interface  270  can be made in any number of ways. For example, interface  270  may include a screen, to display what is detected and measured, provide visual feedback to rescuer  282  for their resuscitation attempts, and so on. Interface  270  may also include a speaker, to issue voice prompts, etc. Sounds, images, vibrations, and anything that can be perceived by user  282  can also be called human perceptible indications. Interface  270  may additionally include various controls, such as pushbuttons, keyboards, touchscreens, a microphone, and so on. In addition, discharge circuit  255  can be controlled by processor  230 , or directly by user  282  via user interface  270 , and so on. 
         [0057]    Defibrillator  200  can optionally include a communication module  290 , for establishing one or more wireless communication links. Module  290  may also include an antenna, portions of a processor, and other sub-components as may be deemed necessary by a person skilled in the art. This way, data and commands can be communicated, such as patient data, episode information, therapy attempted, CPR performance, system data, environmental data, and so on. Optionally, module  290  can establish at least one wired communication link, such as via a USB cable, and so on. 
         [0058]    Defibrillator  200  can optionally include other components. 
         [0059]    The above-mentioned devices and/or systems perform functions, processes and/or methods, as described in this document. The functions, processes and/or methods may be implemented by one or more devices that include logic circuitry. Such a device can be alternately called a computer, a device, and so on. It may be a standalone device or computer, such as a general purpose computer, or part of a device that has one or more additional functions. The logic circuitry may include a processor that may be programmable for a general purpose, or dedicated, such as microcontroller, a microprocessor, a Digital Signal Processor (DSP), and so on, or processor  230 . 
         [0060]    The logic circuitry may also include storage media, for example memory  238 . Such a storage medium can be a non-transitory computer-readable medium. These storage media, individually or in combination with others, can have stored thereon programs that the processor may be able to read, and execute. More particularly, the programs can include instructions in the form of code, which the processor may be able to execute upon reading. Executing is performed by physical manipulations of physical quantities, and may result in the functions, processes and/or methods to be performed. In addition, these storage media may store data. 
         [0061]    Moreover, methods and algorithms are described below. These methods and algorithms are not necessarily inherently associated with any particular logic device or other apparatus. Rather, they are advantageously implemented by programs for use by a computing machine, such as a general-purpose computer, a special purpose computer, a microprocessor, etc. 
         [0062]    Often, for the sake of convenience only, it is preferred to implement and describe a program as various interconnected distinct software modules or features, individually and collectively also known as software. This is not necessary, however, and there may be cases where modules are equivalently aggregated into a single program, even with unclear boundaries. In some instances, software is combined with hardware, in a mix called firmware. 
         [0063]    This detailed description also includes flowcharts, display images, algorithms, and symbolic representations of program operations within at least one computer readable medium. An economy is achieved in that a single set of flowcharts is used to describe both programs, and also methods. So, while flowcharts described methods in terms of boxes, they also concurrently describe programs. 
         [0064]      FIGS. 3A and 3B  are diagrams showing sample sequences of events according to embodiments, each along a time axis. In  FIG. 3A , according to event  330 , a condition is detected about patient  82 . The condition could be such that the patient needs to be shocked, from all of what the system was able to determine. 
         [0065]    According to next event  340 , an alarm is emitted. The alarm can be the above-mentioned alarming human-perceptible indication by output device  171 , which is made when there is intent to administer a defibrillation shock imminently. 
         [0066]    In some embodiments, event  340  also starts a react interval. According to an optional embodiment, the duration of the react interval is additionally communicated. For example, according to optional event  345 , a count-down is emitted. The count-down can be a human-perceptible indication, such as an audible announcement, and so on. If the react interval passes, then according to an event  380  a defibrillation shock is administered, by having charge be delivered to the patient through electrodes. 
         [0067]      FIG. 3B  shows some of the same events as  FIG. 3A . Differently, during the react interval, according to an event  360 , the motion sensor is tapped. Tapping has been presumably from patient  82 , and a motion has been detected from the tapping. When event  360  takes place, event  380  does not take place at the time that it would have, which it did in  FIG. 3A . In other words, the administration  380  of the defibrillation shock has been canceled, as the charge delivery has been canceled. The availability of tapping so as to cause event  360  is a safeguard, for the rare case that the system improperly determined that the shock was needed. The error is proved by the fact that patient  82  tapped the system, which meant he was conscious and therefore not in need of a shock. The safeguard prevents a shock according to event  380 , a shock that would have been very uncomfortable for patient  82  if he were conscious. As another observation, since event  360  took place, the react interval is not defined beyond the time of event  360 . 
         [0068]      FIG. 4  shows a flowchart  400  for describing methods according to embodiments. The methods of flowchart  400  may also be practiced by system embodiments described above. 
         [0069]    According to an operation  440 , an alarming human-perceptible indication is emitted. The alarming indication can signify that administration of a defibrillation shock is imminent, as mentioned above. Operation  440  could be event  340 . Emitting the alarming indication can optionally start a react interval, as in  FIG. 3A . 
         [0070]    According to another, optional operation  445 , a count-down human-perceptible indication is emitted, which communicates a duration of the react interval, as per the above. Operation  445  could be event  345 , as described above. 
         [0071]    According to another, optional operation  450 , it is inquired whether the react interval has passed. If not, then according to another, optional operation  460 , it is inquired whether a motion has been detected. If yes, then that is similar to event  360  of  FIG. 3B  and then, according to a next operation  470 , the administration of the defibrillation shock is canceled. If, at operation  460  no motion is detected, execution returns to operation  445 , and then to operation  450 . 
         [0072]    If, at operation  450 , the react interval has passed and no motion has been detected at operation  460 , then according to another operation  480 , the defibrillation shock is administered to the patient imminently, such as in operation  380  of  FIG. 3A . 
         [0073]      FIG. 5  shows a flowchart  500  for describing methods according to embodiments. The methods of flowchart  500  may be practiced by patient  82 , using embodiments described above. 
         [0074]    According to an operation  510 , a patient may wear a support structure of a wearable defibrillator system that includes a motion sensor. For example, the patient may wear support structure  170  an motion sensor  181 . In addition, the patient may wear one or more further garments, in a manner that the one or more further garments completely cover the support structure and the motion sensor. 
         [0075]    According to another operation  540 , the patient may perceive an alarming indication that the wearable defibrillator system will administer a shock imminently. The indication may be spoken outright, or it may be a sound that the patient has been instructed means that the shock will be administered imminently. The indication may be emitted by operation  440  of  FIG. 4 , which may have started a react interval. 
         [0076]    According to another operation  545 , the patient may perceive a count-down indication, such as could have been emitted by operation  445 . Such an operation could communicate a duration of the react interval, and let patient  82  know how much time he or she has to react by tapping support structure  170 . 
         [0077]    A decision box  550  shows how time passes during the react interval. Before the react interval has passed, operation  545  may be repeated. In addition, according to another, optional operation  560 , the patient taps support structure  170 . This tapping is akin to event  360  of  FIG. 3B , which is detected as a motion at operation  460  of  FIG. 4 . If operation  560  happens then, according to another operation  570 , the shock may not be received imminently, and the react interval is ended. If, however, the react interval passes then, according to another, optional operation  580 , the shock is received imminently, i.e. as planned. 
         [0078]      FIG. 6A  is a diagram showing a sample sequence of events according to embodiments. The human perceptible indications are emitted by a speaker, as voice. It will be recognized that this sequence is like the sequence of  FIG. 3A , except with additionally registering an inadvertent tap. 
         [0079]      FIG. 6B  is a diagram showing a sample sequence of events according to embodiments. The human perceptible indications are emitted by a speaker, as voice. It will be recognized that this sequence is like the sequence of  FIG. 3B , along with a confirmation step, such as is described below. 
         [0080]      FIGS. 7A and 7B  are diagrams showing sample sequences of events according to additional embodiments, each with respect to a time axis. These embodiments are for the patient to use tapping to communicate with the device for additional purposes than described above. 
         [0081]    In  FIG. 7A , according to an event  735 , a query is input. In many embodiments, a processor of the wearable defibrillation system, such as processor  230 , is capable of inputting the query, which is intended to be answered for the system by the patient, as will be seen later in this document. 
         [0082]    Inputting the query may arise in a number of ways. In some embodiments, an unscheduled motion may be detected, and the query is input responsive to the unscheduled motion. The unscheduled motion may be, for example, if patient  82  wants to engage the system. A motion is unscheduled if it does not appear to be in response to a human-perceptible indication by the system that conveys a query. Because motions may happen at random, preferably the query is input responsive to a number of unscheduled motions that follow a pattern, such as three in a short burst and with similar intervals between successive tappings. In some embodiments, patient data is monitored, and the query is input responsive to a value of the patient data exceeding a threshold. The value, for example may be cause for concern; in such cases, the system may want to act, first by asking whether the patient is feeling well. 
         [0083]    After inputting the query, according to an event  740 , the processor may cause the output device to emit a questioning human-perceptible indication, such as a sound or vibration, and which conveys the query. After having caused the query to be expressed, the answer will be expected in terms of detected motions, which will be generated by patient  82  tapping support structure  170 . In some embodiments, the output device includes a vibration mechanism, and the questioning human-perceptible indication conveys the query as a vibrations pattern. For example, the query could have a first meaning if the pattern of vibrations is a first pattern, and a second, different meaning if the pattern of vibrations is a second, different pattern. The patterns could be different types of vibrations, such as continuous versus pulsating versus increasing/decreasing in intensity or amplitudes, versus different amplitudes, sequences, and so on. The patterns could also encode different messages within a type, for example like Morse code, or numbers of vibrations. 
         [0084]    Preferably, the answer will arrive within a preset time interval, which can be called a respond interval. The respond interval can start at the time of event  740 , namely when the questioning human-perceptible indication is caused to be emitted. So, in some embodiments, if no detection signal is received within the respond interval, the processor causes the output device to emit another human-perceptible indication, such as event  741 . The other human-perceptible indication may be the same as the first, or different. 
         [0085]      FIG. 7B  shows some of the same events as  FIG. 7A . Differently, according to an event  760 , the motion sensor is tapped during the respond interval. Tapping has been presumably by patient  82 , and a motion has been detected from the tapping. Tapping may be the answer expected by patient  82 . Event  760  may interrupt the respond interval, similarly with how event  360  interrupts the react interval in  FIG. 3B . 
         [0086]    In such embodiments, the wearable defibrillator system may also include a component that will perform an action, as per event  790 . The action will be responsive to the motions detected per event  760 , after the questioning human-perceptible indication is emitted per event  740 . However, in some embodiments, the action is performed only if the detection signal is received within the respond interval, and not otherwise. 
         [0087]    There are many possible embodiments for the component and the action. For example, the component can be a communication module such as communication module  290 . In such cases, the action can include transmitting a communication to a third party, such as would happen in an emergency. The third party would not be the patient, but could be a person located remotely. For another example, the component can include a memory, such as memory  238 . In such cases, the action can include storing patient data in the memory, such as would happen if the patient wanted data to be captured if he were feeling ill. Or, the action could include storing in the memory a reply to the query, with the reply being in accordance with the detected motion. This could happen, for example, when the system permits patient  82  to set parameters. One example is that the query could be: “on a scale of 1-5, 5 being the best, how do you feel now?”, and the number of motions, caused by the number of tappings, would indicate the reply. In other words, the reply can have a first value if the detected motion is inferred to have been caused by a first number of tappings by the patient, and a different, second value if the detected motion is inferred to have been caused by a different, second number of tappings. In addition, the query itself can be stored in memory  238 . 
         [0088]    Patient  82  may become uncertain as to how many of their tappings actually became registered, and that can be a problem where the number matters. The uncertainty can be addressed in at least two ways where patient  82  receives feedback. 
         [0089]    First, in some embodiments, the device can emit an echo for each tapping that it registers. An echo can be a sound, a vibration, or other human-perceptible indication. An echo human-perceptible indication can be caused to be emitted for each detected motion that is interpreted to have been caused by each tapping. Emitting can be by the output device, or another device. 
         [0090]    Second, before event  790 , in some embodiments a confirmation is first asked for when patient  82  is presumed to have stopped tapping—perhaps after a long enough pause. According to an event  770 , a confirming human-perceptible indication is caused to be emitted. Typically, this kind of indication conveys a proposed interpreted reply, and asks for one or two tappings for confirming or rejecting the proposed interpreted reply. In such cases, the action of event  790  can be performed only if the motion sensor is tapped again, such as per event  761 , in which case another detection signal is received from the motion sensor. 
         [0091]      FIG. 8  shows a flowchart  800  for describing methods according to embodiments. The methods of flowchart  800  may also be practiced by a processor of a wearable defibrillator system that is worn by a patient, and has a motion sensor and an output device, such as described above. 
         [0092]    According to an optional operation  815 , there is monitoring for whether an unscheduled motion is detected, or multiple motions following a pattern. While not, execution returns to operation  815 . If yes, then according to another operation  835 , a query is input, similarly with event  735 . 
         [0093]    According to another, optional operation  820 , patient data is monitored. According to another operation  830 , it is inquired whether a value of the monitored patient data exceeds a threshold. While not, execution returns to operation  820 . If yes, then again operation proceeds to operation  835 . 
         [0094]    After operation  835 , according to another operation  840 , the output device is caused to emit a questioning human-perceptible indication that conveys the query, similarly with event  740 . 
         [0095]    According to another operation  860 , a detection signal is received from the motion sensor. The detection signal may be interpreted to indicate that the patient has tapped the system, as would correspond to event  760 . According to another, optional operation  865 , an echo human-perceptible indication is further caused to be emitted, as above. The echo indications provide feedback to the patient. 
         [0096]    According to another, optional operation  850 , it is inquired whether the detection signal is received within a respond interval. The respond interval would start when the indication is caused to be emitted, such as from event  740 . If not, execution may return to operation  840 , or the output device may be caused to emit a different human-perceptible indication, and so on. 
         [0097]    If yes, then according to another operation  890 , an action is caused to be performed, responsive to the detection signal. The action being performed would be akin per event  790 . Again, there are many possibilities for actions, such as causing a communication module to transmit a communication to a third party, and storing data in a memory. The data could be patient data, a reply to the query perhaps as inferred from the inferred number of tappings, and so on. 
         [0098]    According to another, optional operation, a confirming human-perceptible indication is caused to be emitted. The confirming indication may convey a proposed interpreted reply, as per the above. In such embodiments, the action can be performed only if another detection signal is then received from the motion sensor, which would serve as a confirmation by the patient. 
         [0099]      FIG. 9  shows a flowchart  900  for describing methods according to embodiments. The methods of flowchart  900  may be practiced by patient  82 , using embodiments described above. 
         [0100]    According to an operation  910 , a patient may wear a support structure of a wearable defibrillator system, such as support structure  170 . The system may include a motion sensor. 
         [0101]    According to another, optional operation  915 , the patient may preliminarily tap proximately to the support structure, so as to draw the attention of the system. Tapping proximately to the support structure tapping means on the structure or close to it, so as to cause the motion sensor to move, and thus detect a motion and generate a detection signal. This preliminary tapping will be unscheduled, from the point of view of the system, and may result in an unscheduled motion being detected as per operation  815 . The tapping of operation  915  can be in a pattern designed to engage the system, and so on. 
         [0102]    According to another operation  940 , the patient may perceive a questioning indication that conveys a query from the system. Operation  940  may be event  740  of  FIG. 7 . The questioning indication of operation  940  may be spoken outright, or it may be a sound, a vibration and so on. The questioning indication may be emitted by operation  840  of  FIG. 8 , which may have started a respond interval. 
         [0103]    According to another, optional operation  960 , the patient taps support structure  170 . This tapping is akin to event  760  of  FIG. 7B , and is intended to convey a reply in response to the query. In some embodiments, the number of tappings is meaningful. For example, a first number of tappings may convey a reply with a first value, and a second, different number of tappings may convey a reply with a second, different value. 
         [0104]    According to another, optional operation, a confirming indication is perceived by the patient from the system. The confirming indication may convey a proposed interpreted reply, as per the above. In such embodiments, the patient may tap again the support structure in response to the confirming indication. 
         [0105]    In the methods described above, each operation can be performed as an affirmative step of doing, or causing to happen, what is written that can take place. Such doing or causing to happen can be by the whole system or device, or just one or more components of it. In addition, the order of operations is not constrained to what is shown, and different orders may be possible according to different embodiments. Moreover, in certain embodiments, new operations may be added, or individual operations may be modified or deleted. The added operations can be, for example, from what is mentioned while primarily describing a different system, device or method. 
         [0106]      FIG. 10  is a diagram showing a sample sequence of events according to additional embodiments. The human perceptible indications are emitted by a speaker, as voice. 
         [0107]    This description includes one or more examples, but that does not limit how the invention may be practiced. Indeed, examples or embodiments of the invention may be practiced according to what is described, or yet differently, and also in conjunction with other present or future technologies. 
         [0108]    A person skilled in the art will be able to practice the present invention in view of this description, which is to be taken as a whole. Details have been included to provide a thorough understanding. In other instances, well-known aspects have not been described, in order to not obscure unnecessarily the present invention. 
         [0109]    Other embodiments include combinations and sub-combinations of features described herein, including for example, embodiments that are equivalent to: providing or applying a feature in a different order than in a described embodiment, extracting an individual feature from one embodiment and inserting such feature into another embodiment; removing one or more features from an embodiment; or both removing a feature from an embodiment and adding a feature extracted from another embodiment, while providing the advantages of the features incorporated in such combinations and sub-combinations. 
         [0110]    The following claims define certain combinations and subcombinations of elements, features and steps or operations, which are regarded as novel and non-obvious. Additional claims for other such combinations and subcombinations may be presented in this or a related document.