Abstract:
Apparatus for stimulating osteogenesis in a living body comprises a portable, light weight, self-contained, low drain, battery powered stimulating instrument adapted to be carried by a patient during treatment for applying a high frequency alternating current treatment signal to the skin of the patient according to a treatment program and for generating a readable record of a parameter of the treatment signal during the treatment program, and a clinical control instrument in the custody of a person supervising the treatment program and connectable to the stimulation instrument when desired for monitoring the condition of the latter and for reading out data recorded therein during the treatment program.

Description:
This application is a division of the prior application of Richard S. Dugot, Ser. No. 350,440, filed Feb. 22, 1982 U.S. Pat. No. 4,459,988, for Electrical Stimulating Apparatus. 
    
    
     This invention relates to a system for stimulating osteogenesis in a living body and, more particularly, to a new and improved system of this character having miniaturized treatment units that are highly portable and economical in the use of energy, yet highly effective in operation. 
     BACKGROUND OF THE INVENTION 
     It is well known that osteogenesis in a living body can be stimulated by the application of suitable electric signals to the body. In Brighton et al. U.S. Pat. No. 3,842,841, for example, it is proposed to promote bone fracture healing through the use of a constant current applied between a cathode inserted into a fracture site and an anode taped to the skin. The current is supplied from a power pack strapped to the limb of a patient or to the outside of a cast encasing the limb. 
     Non-invasive techniques utilizing coils or electrodes energized by pulsed or undulating signals for the therapeutic treatment of cells and tissue in a living body have also been developed, as disclosed in Manning U.S. Pat. No. 3,893,462 and Ryaby et al. U.S. Pat. No. 4,105,017. In the former, electrodes or coils supplied with an undulating signal having a waveform whose rise time differs from its fall time are used in the treatment. Both the electrodes and the energy source may be cast in a potting compound compatible with the environment of the body, or embedded in the cast used to immobilize or support the limb of a body. In the latter, the treatment is adapted to be effected by coils in a treatment unit which may be strapped to the leg of a patient or incorporated in a cast and which may be plugged in to an external source of electrical energy in the form of current pulses of specific time-frequency-amplitude relations. 
     SUMMARY OF THE INVENTION 
     It is an object of the invention to provide new and improved non-invasive apparatus for stimulating osteogenesis that is easily portable and low in energy consumption, yet highly effective in operation. 
     Another object of the invention is to provide apparatus for stimulating osteogenesis of the above character having means enabling the treatment parameters for a predetermined course of treatment to be preset and adjusted initially by the treating physician. 
     A further object of the invention is to provide apparatus for stimulating osteogenesis of the above character having the capability of generating a readable record of a treatment parameter during a selected treatment program executed by the apparatus. 
     Still another object of the invention is to provide apparatus for stimulating osteogenesis of the above character in which the treatment parameter setting and adjusting means and the record generating means are accessible only to the physician or other person under whose direction the treatment is being carried out, and are not subject to tampering by the patient being treated. 
     The stimulation system of the invention comprises a portable, miniaturized, low drain, battery powered stimulation instrument adapted to be carried by a patient during treatment, and a clinical control instrument adapted to remain in the custody of the physician or other person directing the treatment program for periodically monitoring the condition of the stimulation instrument and for reading out, during a course of treatment, data recorded or registered therein. 
     The stimulation instrument incorporates means for generating a treatment signal to be applied to the body of the patient by electrodes, together with means for setting or adjusting one or more treatment parameters such as the character of the treatment current or voltage, and the frequency and length of the treatment time. These adjustments or settings are accessible only to the person directing the treatment and are not subject to tampering by the patient being treated. Also, the clinical control instrument and the portable stimulation instrument are provided with interfacing connection means enabling certain operating parameters to be monitored by the former. 
     The stimulation instrument may also incorporate means for automatically recording or registering values of certain treatment parameters of a course of treatment. Preferably, such recording or registering means is accessible only to the person responsible for the treatment through additional interfacing connection means enabling the stationary clinical control instrument to read out the recorded or registered values. 
     By incorporating the space and energy consuming measuring and read-out capability into the clinical control instrument, the portability of the stimulation instrument is vastly improved and the life of the batteries therein is substantially increased. Moreover, since the clinical control instrument need not have the same limitations of weight and energy as the stimulation instrument, it can house larger and more accurate measuring and read-out means so that better accuracy of read-out can be obtained. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     For a better understanding of the invention, reference is made to the following detailed description of several preferred embodiments, taken in conjunction with the accompanying drawings, in which: 
     FIGS. 1a and 1b, positioned with FIG. 1b above FIG. 1a, form a schematic diagram of a typical circuit for a stimulation instrument constructed according to the invention; 
     FIG. 2a illustrates a housing for the circuit of FIG. 1; 
     FIG. 2b illustrates a removable cover for the housing shown in FIG. 2a; 
     FIGS. 3a and 3b, positioned with FIG. 3b above FIG. 3a, illustrate schematically a clinical control instrument constructed according to the invention for use with stimulation instruments of the kind shown in FIGS. 1a, 1b, 2a and 2b; and 
     FIG. 4 illustrates a housing for the clinical control instrument of FIGS. 3a and 3b. 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     In FIGS. 1a and 1b, a stimulation instrument according to the invention comprises a stimulation signal generator 10 for supplying electrical signals to be applied to the body of a patient to be treated by means of electrodes 11 and 12, a settable timing circuit 13 for energizing the stimulating circuit 10 continuously or periodically in accordance with a predetermined treatment program, and a recording or registering circuit 14 for recording certain parameters of the treatment program for read-out at the conclusion of the treatment program by a stationary or portable clinical control instrument in the custody of the physician or other person directing the treatment. 
     THE STIMULATION SIGNAL GENERATOR 
     While the stimulating circuit 10 may be adapted to practice any one of several known techniques for treating a patient, it will be described first in a form in which the electrical constants of the body of the patient between the electrodes 11 and 12 (FIG. 1a) are included in a series resonant circuit incorporating positive feedback means to maintain the frequency of the stimulating signal always at the resonant frequency of the series resonant circuit. The resonant circuit includes the electrodes 11 and 12 connected in series with inductors L1 and L2 to the secondary windings 15 and 16 of a transformer 17 having a primary winding 18. 
     The stimulating current flowing through the windings 15 and 16 (i.e., the current emitted at the electrodes 11 and 12) is measured by the voltage across the resistors 19 and 20 connected in series therewith which is supplied to a differential instrumentation amplifier of known type 21. The amplifier 21 comprises the operational amplifiers 22, 23 and 24 connected in circuit to provide at the pin 8 of the amplifier 23 an output signal proportional to the stimulating current which is fed back through a conductor 25 to a terminal 26. The terminal 26 is adapted to be bridged to a terminal 27 which supplies the feedback signal to a potentiometer 28. 
     The signal from the adjustable contact of the potentiometer 28 is fed through a resistor 29 and the capacitors 30 and 31 to the input pin 3 of a conventional amplifier 32, which may be an LM386 integrated circuit. The output of the amplifier 32 is supplied from the pin 5 thereof through a capacitor 33 to the primary winding 18 of the transformer 17, and also through a conductor 34 to a terminal 35 on a multiple terminal connector 36. 
     Desirably, the stimulating signal generator 10 should be provided with automatic gain control. To this end, the output signal from the operational amplifier 23 may be supplied through a resistor 37 to an operational amplifier 38 functioning as a peak detector to provide a DC control signal varying as a function of the stimulating signal. The operational amplifiers 22, 23, 24 and 38 may be conventional TL064 integrated circuit chips, for example. 
     The DC control signal is fed through a conductor 39 and a resistor 40 to the control electrode of a transistor 41, which may be of the type designated 2N5958, for example, connected in a circuit forming a conductive shunt in parallel with the potentiometer 28, the resistor 29 and the capacitor 30. It will be understood that any change of the control signal will produce a corresponding change in the conductivity of the shunting circuit, causing it to function as an automatic gain control. 
     Adjustment of the gain control function may be effected by adjusting the voltage supplied to the transistor 41 from the slider of a potentiometer 42. The potentiometer 42 is grounded at one end and its other end is connected through a voltage dropping resistor 43 to a reference voltage source such as a type AD580 device 44 energized by a suitable source of electrical energy such as a conventional 7.5 volt mercury battery 45, for example. 
     Where it is desired to supply to the electrodes 11 and 12 a stimulating signal of a predetermined waveform without incorporating the electrical constants of the body of the patient in a series resonance circuit as described above, the inductors L1 and L2 should be omitted or shorted out, the terminal 26 disconnected from the terminal 27, and the latter connected to an output terminal 46 of a suitable external oscillator. To provide a symmetrical stimulating signal of square waveform, an oscillator comprising a timer 47 such as an ICL7555 integrated circuit may be connected in the known manner as shown, to supply a square wave signal at a frequency of, say, 60 KHz from the pin 3 thereof through a capacitor 48 and a resistor 49 to the terminal 46. 
     If an asymmetrical square wave signal is desired, it can be provided by connecting the resistors 50 and 51 and a potentiometer 52 to the 6, 7 and 8 pins of the timer 47, omitting the resistor 53 and connecting the terminal 54 to the terminal 55, as shown. The degree of asymmetry can be adjusted by means of the potentiometer 52. 
     Alternatively, if a stimulating signal of sine waveform is desired, the potentiometer 52 and the resistors 50 and 51 should be omitted, the resistor 53 replaced, and the terminal 46 connected to the terminal 27 and to a terminal 56 having a filter including a capacitor 57 and an inductance 58 connected between it and ground, as shown. 
     THE PROGRAM TIMER 
     The program timer 13 (FIG. 1b) comprises a conventional oscillator-divider 59, which may be an MC14521B integrated circuit, for example, connected to operate at a frequency of, say, 291 Hz and to provide a selection of timing signals from, say, one every fifteen minutes to one every eight hours. Thus, timing signals one hour, two hours, four hours and eight hours apart may be supplied periodically from the 13, 14, 15 and 1 pins of the oscillator divider 59 to the contacts 60, 61, 62 and 63 of a switch 64 having a movable contact 65 which supplies a selected timing signal over a conductor 66 to a conventional J-K flip-flop circuit 67. The flip-flop circuit 67 may be a CD4027 integrated circuit, wired in the known manner as a divide-by-three circuit to provide a control signal for the final timing circuit which is on for two periods and off for one, if desired. 
     The final timing signal appears at the pin 2 of the flip-flop 67 and is supplied over a conductor 68 through a resistor 69 to the base of a transistor 70 which operates as a switch to connect the positive terminal of the battery 45 to the conductor 71 to energize the stimulating signal generator 10 when the &#34;on-off&#34; switch 74 is closed. 
     The pin 2 of the oscillator divider 59 and the pin 7 of the flip-flop 67 are connected together to receive a pulse from the battery 45 through a conductor 72 and a capacitor 73 when the on-off switch 74 is closed initially. This pulse simultaneously resets the oscillator divider 59 and sets the flip-flop 67, so that the treatment program starts immediately thereafter. 
     THE PROGRAM REGISTER 
     The program register may be a conventional counter, such as an MC14553B integrated circuit, connected to register and maintain in memory the accumulated treatment time, preferably in hours, in any given treatment program. To this end, when the pin 2 of the flip-flop 67 goes low to initiate active treatment, a signal is transmitted through an OR gate 75 to the pin 11 of the counter 14, which begins to count the time in hours of actual stimulation. The accumulated treatment time is stored in the counter 14, the contents of which are provided in the form of a binary coded decimal (BCD) reading having three digits multiplexed at the output pins 9, 7, 6 and 5 of the counter 14 which are connected to the Q0, Q1, Q2 and Q3 terminals, respectively, of the connector 36. (FIG. 1b). 
     Multiplexing is achieved by the counter providing a low logic signal at only one of the lines D1, D2 and D3 at any one time. BCD data for each digit will appear in turn as each line D1, D2 and D3 goes low. The BCD data may be read out by the clinical control unit, as will be described below. 
     Desirably, the counter 14 should be inhibited from counting when improper conditions obtain, as when the battery voltage is low or the treatment signals fall below an acceptable level. To this end, one terminal of the OR gate 75 is connected by a conductor 76 to receive the output of an OR gate 77 which is adapted to receive outputs both from an operational amplifier 78 over a conductor 79 and from an operational amplifier 80 over a conductor 81. The amplifier 78 is connected as a comparator which compares the positive battery voltage, received over the conductor 82 and divided by a voltage divider as shown, with a standard reference voltage received through the conductor 83 from the reference voltage source 44. 
     The operational amplifier 80 is adapted to compare the DC control signal on the conductor 39, which is a function of the stimulation signal supplied to the treatment electrodes 11 and 12, with a standard cut-off threshold voltage received over a conductor 85 from a potentiometer 86 supplied with a reference voltage from the standard voltage source 44. 
     It will be understood that if either the battery voltage falls below a specified value or the treatment signal falls below an acceptable level, the OR gate 77 will supply a signal to the OR gate 75 inhibiting the counter 14 from counting. If desired, a visible or audible signal indicative of such unfavorable conditions can be generated by utilizing the signal from the OR gate 77 to render a transistor 87 conducting to activate an LED device 88 and/or a device 89 for generating an audible signal in circuit therewith. 
     The stimulation instrument circuitry shown in FIGS. 1a and 1b may conveniently be contained in a housing 90 (FIGS. 2a and 2b) made of plastic or other suitable material. Preferably, the housing 90 has an inner curved surface 91 adapted to fit a limb or other curved body portion of a patient. The electrodes 11 and 12 are preferably connected by conductive e.g. silver cement to leads 92 and 93 which extend from the housing 90. The electrode surfaces must, of course, not react adversely with any body fluid that may be on the skin surface, and they must not injure the skin surface. Preferably, they comprise pads of stainless steel material cut from a sheet and deburred to smooth out the edges thereof. 
     The electrodes are preferably placed on the skin of the patient&#39;s body at the area to be treated and can be held in place by a plaster cast, suitable potting material, or the like. The housing 90 can also be secured to the patient by the plaster cast. If this method of securement is employed, preferably only the electrode (upper) end portion of the housing should be received by the cast, so that a removable cover 94 can be easily accessed and removed. Of course, other means of securement such as by straps or braces can also be used. 
     The removable cover 94 of housing 90 allows access to one or more batteries 45, for enabling easy removal and replacement thereof. The removable cover also allows access to adjustable screws 95, 96 and 97 for setting the level adjustment potentiometer 28 (FIG. 1a), the gain control adjustment potentiometer 42, and the cut-off threshold adjustment potentiometer 86, respectively. When the cover 94 is removed, access can also be had to the multiple terminal connector 36, to allow a connection to be made to a clinical unit, described below, to enable readout of information stored in the registers and other information about the treatment program, as well as to allow resetting of the registers and calibration of the stimulation unit. 
     THE CLINICAL CONTROL INSTRUMENT 
     The clinical control instrument 98 (FIGS. 3a and 3b) for use with the above-described stimulation instrument comprises a 14 pin D-type connector plug 36a which is adapted to be plugged into the connector 36 of the stimulation instrument (FIGS. 1a and 1b) to enable the stored accumulated treatment time in the counter 14 of the latter to be read-out, and to allow read-out of the stimulation signal values of treatment voltage, treatment current, signal frequency, and of stimulation instrument battery voltage. 
     When the read-out plug 36a is connected to the connector 36 of the stimulation instrument, the battery line 72 of the latter is connected through the engaged battery terminals in the connectors 36 and 36a and the conductors 100 and 101 to the latch line 102, and BCD data representing the accumulated treatment time in hours will appear on lines Q0, Q1, Q2 and Q3 and will be supplied over the conductors 103, 104, 106 and 107 to the 6, 2, 1 and 7 pins of a BCD to seven-segment display driver 107, which may be a 9374 integrated circuit, for example. The seven-segment display driver 107 provides seven-segment information at its output pins 9 through 15 to three light emitting diode (LED) readout devices 108, 109 and 110, which may be common anode type MP 7650 display devices, providing a three-digit numeric display. 
     The common anode lines 111, 112 and 113 of the display devices 108, 109 and 110 are connected to the respective collectors of the drive transistors 114, 115 and 116, which may be 2N2907 type transistors, for example. The emitters of each of the three display devices 108, 109 and 110 are tied to the battery (high logic) line 100, and the respective bases thereof are connected through the conductors 117, 118 and 119, respectively, to the connectors D1, D2 and D3. Since only one of the connectors D1, D2 and D3 will be low at any one time, only one of the drive transistors 114, 115 and 116 will conduct at any one time. 
     The seven-segment information corresponding to the BCD data appearing on the connectors Q0, Q1, Q2 and Q3 is supplied to each of the display devices 108, 109 and 110 as shown. Since the counter 14 in the stimulation instrument (FIG. 1b) will sequentially provide BCD data for each of the three digits and will sequentially provide a low logic signal on each of the three connectors D1, D2 and D3 in turn, the three seven-segment display devices 108, 109 and 110 will provide a three-digit readout of the elapsed time in hours which is stored in the counter 14 of the stimulation unit. The counter 14 can be reset to zero by momentarily closing a contact switch 120 which will provide a high signal to the &#34;Reset&#34; pin 13 of the counter 14. 
     The signal proportional to the stimulating treatment current in the stimulation instrument is supplied from the engaged &#34;Current&#34; connectors through a conductor 121 (FIG. 3a), a capacitor 122 and a resistor 123 to an operational amplifier 124 which is connected to function as a peak detector and to provide at the output pin 7 thereof a DC signal proportional to the treatment current. The operational amplifier may be a TL064 integrated circuit chip, for example. The output signal is supplied through a calibration potentiometer 125 and a voltage divider 126 to the input pin 11 of an analog-to-digital converter (ADC) 127. 
     The ADC 127 provides a BCD output at pins 16, 15, 1 and 2 to a BCD to seven-segment converter 128 which provides seven-segment display information to three seven-segment display devices 129, 130 and 131 connected in multiplex fashion through the transistors 132, 133 and 134 to the pins 5, 3 and 4 of the ADC unit 127. The three display devices 129, 130 and 131 will display a three digit number between 00.0 and 99.9 representing the treatment current in milliamperes in fixed decimal point format. The ADC 127 may be an AD2020 integrated circuit, the BCD to seven-segment converter 128 may be a 9374 type chip, and the seven-segment display devices 129, 130 and 131 may be common anode LED readout devices of type HP 7650, for example. 
     A voltage proportional to, and at the same frequency as the signal between electrodes 11 and 12 is also supplied through the engaged &#34;Signal&#34; connector terminals to the clinical instrument (FIG. 3a) for readout. This voltage is fed through a conductor 135 to an AC voltage measuring circuit comprising an operational amplifier 136, which may be a TL064 integrated circuit, for example, connected in the known manner to function as a peak voltage detector. 
     The signal at the output pin 1 of the peak detector 136 is supplied through a calibration potentiometer 137 to one pole 138F (FIG. 3b) of a DPDT momentary contact slide switch 138. In FIG. 3b, the switch 138 is shown with its switching slide members in their normal unactuated (lower) positions connecting the terminal 138E to the terminal 138F and the terminal 138B to the terminal 138C. The terminal 138E is also connected to the terminal 139C of a similar DPDT momentary contact slide switch 139, shown with its switching slide members in their normal unactuated (lower) positions. With the switches 138 and 139 in the illustrated positions, the output signal of the peak detector 136 is supplied through the calibration potentiometer 137, the closed switch contacts 138E and 138F and 139B and 139C, and a voltage divider 140, to the input pin 11 of an ADC unit 141. 
     The ADC unit 141 provides a BCD output at the pins 16, 15, 1 and 2 which is fed to a BCD to seven-segment converter 142. The converter 142 provides seven-segment display information to three seven-segment displays 143, 144 and 145 connected in multiplex fashion through the transistors 146, 147 and 148 to the pins 5, 3 and 4, respectively, of the ADC unit 141, as shown. The three display devices 143, 144 and 145 will display a three digit number between 00.0 and 99.9 representing the treatment voltage in volts in fixed decimal point format. The ADC unit 141, the converter 142, and the display devices 143, 144 and 145 may be of the type described above for the current display. Also, since the terminals 138B and 138C are connected together, an LED 149, which is preferably of a distinguishing color such as green, is energized, indicating that the numerical information being displayed by the seven-segment display devices 143, 144 and 145 is voltage information. 
     The voltage signal is also supplied from the conductor 135 (FIG. 3a) through a resistor 150 into a frequency measuring circuit comprising a BCD counter 151 (FIG. 3b) and a frequency-to-voltage converter 152. The counter 151 may be a MC14518B Dual BCD counter whose pins are connected in a divide-by-one hundred mode, so that the output signal at pin 6 has a frequency which is one-hundredth the treatment signal frequency of, say, 60 KHz. This scaled down output signal is fed to the input pin 1 of the frequency-to-analog voltage converter 152. By thus scaling down the frequency, the required accuracy can be achieved at reduced cost by using an LM2917 type integrated circuit chip, for the converter 152. Of course, frequency division is not necessary and available frequency to analog voltage converters that are sufficiently accurate in the 60 KHz range can be used. 
     The output signal at the pins 4 and 7 of the converter 152 is an analog voltage which is proportional to the frequency of the treatment signal. This output signal is supplied through a potentiometer calibrator 153 which is connected to one pole 138D of the DPDT switch 138. 
     When the DPDT switch 138 is actuated (i.e., has its slide member in the upper position), the terminal 138D is connected to the terminal 138E and the terminal 138A is connected to the terminal 138B. Assuming that the DPDT switch 139 is not actuated, the ADC 141 will receive the output signal from the frequency to voltage converter 152, to cause the frequency of the stimulation signal, in units of KHz, to be displayed by the seven-segment display devices 143, 144 and 145 in fixed decimal point fashion. Also, since the terminal 138A is connected to the terminal 138B, an LED 155, which is preferably a different color from the LED 149 such as yellow, is energized, indicating that the numerical information being displayed by display devices 143, 144 and 145 is frequency information. 
     When the DPDT switch 139 is actuated (i.e., has its slide members in the upper position), the terminal 139A is connected to the terminal 139B and the terminal 139D is connected to the terminal 139E (FIG. 3a). Now the signal being measured and fed into the ADC unit 141 is the battery voltage in the stimulation instrument, received over the conductor 100, and the display devices 143, 144 and 145 will display the DC battery voltage in fixed decimal point format. Also, an LED 156, which is preferably a different color from the LEDs 149 and 155, such as red, is energized, indicating that the numerical information being displayed is battery voltage information. 
     The power supply for the clinical control instrument may be provided by a DC battery source 157 (FIG. 3b), having a potential of, say, 9.6 volts. The power from the battery is supplied to the circuits in the clinical control instrument upon closure of an on-off switch 158 through a conductor 159 at, say, 9.6 volts relative to the ground line 160. A voltage regulator 161, which may be a 78L06 integrated circuit, supplies 6 volts DC to the frequency to voltage converter 152, and also through a resistor to a comparator 162, which may be an LM358 integrated circuit. The comparator constantly monitors the supply voltage from the battery by receiving the supply voltage signal as an input at pin 3 and comparing this input to the regulated 6 volt input at pin 2. When the voltage at the pin 3 of the regulator 161 drops below 6 volts, the comparator 162 will output a low logic signal and the pilot light LED 163 will no longer be lighted, indicating a need for replacement or recharging of the battery. A recharge input plug 164 is provided for receiving a source of recharging power for the battery and to supply power to the circuit while the battery is recharging. 
     A voltage regulator 165, which may be a 78L05 integrated circuit, provides 5 volts DC to a bus line 166 for the various components as illustrated. 
     Output receptacles 167 and 168 (FIG. 3a) provide for connection of the voltage and current lines, respectively, to an oscilloscope, to enable the waveform of the treatment signal to be viewed, if desired. 
     The components of the clinical control instrument may be contained in a housing 169, shown in FIG. 4. As can be seen, three-digit numerical information representative of the accumulated treatment in hours is provided on display devices 108, 109 and 110, and when this information has been noted, the counter 14 in the stimulation instrument can be reset to zero by actuating the reset switch 120. Also, three-digit information representative of the treatment current, in milliamperes, is provided in fixed decimal format by the display devices 129, 130 and 131 adjacent the on-off power switch 172 and the pilot light LED 163. 
     The third three-digit display comprising the display devices 143, 144 and 145 will display in fixed decimal format the AC treatment voltage, the frequency of the treatment signal, and the battery voltage in the stimulation instrument by selective operation of the switches 138 and 139, as described above. 
     The different colored LEDs 149, 155 and 156 will indicate whether AC voltages, frequency or battery voltage, respectively, is being displayed in the display devices 143, 144 and 145. 
     The connectors 168 and 167 for connection to oscilloscopes for observation of the current and voltage, respectively, and the connector 164 for charging the battery, are mounted on the side panel of the clinical instrument housing 169, as shown. A cable which extends through the side panel contains the conductors to interconnect the stimulation instrument connector 36 to the clinical instrument connector 36a. 
     OPERATION 
     In operation, the stimulation signal generator 10 is set initially to supply a stimulation signal of the desired character to the electrodes 11 and 12 (FIG. 1a), the switch 64 is adjusted to select a desired treatment program, and the on-off switch 74 is then closed. This supplies a pulse through the capacitor 73 to the pin 2 of the oscillator divider 59 and to the pin 7 of the flip-flop 67 to reset the former and set the latter. As a result, the treatment program begins immediately without waiting for random &#34;on condition&#34; of the flip-flop 67 to occur. Pin 2 of the flip-flop 67 now goes low and supplies a pulse over the conductor 68 to render the transistor 70 conducting to supply energy from the battery to energize the system. At the same time, the pulse from the pin 2 of the flip-flop 67 passes to the OR gate 75, which supplies a signal to the pin 11 of the counter 14 and renders the latter operative to begin counting. 
     Treatment current will continue to be supplied from the electrodes 11 and 12 for twice the duration of the period of time set by the switch 64. If an eight-hour period was selected initially, at the conclusion of sixteen hours the pin 2 will go high and supply a signal over the conductor 68 to turn off the transistor 70. The same signal is supplied to the OR gate 75 which inhibits the counter 14 from counting further. These conditions continue for the next eight hours, after which the stimulation signal generator 19 and the counter 14 again resume operations for another sixteen-hour period. 
     Operation throughout the treatment period continues in the manner described above, the stimulation signal being supplied to the electrodes 11 and 12 for sixteen hours and discontinued for eight hours, and the counter 14 registering a count for each hour during the sixteen-hour treatment period. 
     It will be understood that by appropriate positioning of the switch 64, other treatment duty cycles can be selected, including continuous application of the treatment signal. 
     In the event the battery voltage becomes too low for proper operation or the stimulation signal supplied to the electrodes 11 and 12 does not have the proper value, the OR gate 77 will supply a signal to the OR gate 75 to inhibit the counter 14 from counting further. Simultaneously, the transistor 87 is rendered conducting to operate the audible signal 89 or the LED 88, warning the patient that the stimulation instrument is not operating properly. 
     When the doctor or other person supervising the treatment wishes to monitor the operation of the stimulation instrument, he plugs the connector 36a on the clinical instrument into the connector 36 in the latter and closes the on-off switch 158. The accumulated hours of treatment, signal frequency, voltage and current can be determined by operation of the appropriate switches on the face of the clinical instrument housing 169 described. Also, the counter 14 in the stimulation instrument can be reset by momentary depression of the reset button 120, the connectors 36 and 36a can then be separated, and the stimulation instrument made available again for a treatment cycle. 
     It will be understood that the stimulation instruments are highly portable and economical in the use of energy, yet highly effective in operation. Also, they are not subject to tampering by the patient or persons other than the one supervising the treatment. Moreover, by providing a separate portable or stationary clinical instrument for monitoring and readout which is not limited as to weight or energy requirements, better readout accuracy can be obtained. 
     The specific embodiments described above are intended only to be illustrative and are susceptible in form and detail within the scope of the following claims.