EP2453974A1 - Système pour utiliser la stimulation électrique des muscles pour augmenter le flux sanguin dans des parties du corps - Google Patents
Système pour utiliser la stimulation électrique des muscles pour augmenter le flux sanguin dans des parties du corpsInfo
- Publication number
- EP2453974A1 EP2453974A1 EP09847449A EP09847449A EP2453974A1 EP 2453974 A1 EP2453974 A1 EP 2453974A1 EP 09847449 A EP09847449 A EP 09847449A EP 09847449 A EP09847449 A EP 09847449A EP 2453974 A1 EP2453974 A1 EP 2453974A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- electrode
- operative
- body part
- electrodes
- electrical
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
- 230000000638 stimulation Effects 0.000 title claims abstract description 56
- 210000003205 muscle Anatomy 0.000 title claims abstract description 43
- 230000017531 blood circulation Effects 0.000 title claims abstract description 22
- 230000004118 muscle contraction Effects 0.000 claims abstract description 18
- 230000001965 increasing effect Effects 0.000 claims abstract description 12
- 238000004891 communication Methods 0.000 claims abstract description 11
- 230000004936 stimulating effect Effects 0.000 claims abstract description 9
- 239000002202 Polyethylene glycol Substances 0.000 claims description 6
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- 229920001223 polyethylene glycol Polymers 0.000 claims description 6
- YYPNJNDODFVZLE-UHFFFAOYSA-N 3-methylbut-2-enoic acid Chemical compound CC(C)=CC(O)=O YYPNJNDODFVZLE-UHFFFAOYSA-N 0.000 claims description 3
- 229920000954 Polyglycolide Polymers 0.000 claims description 3
- 230000008468 bone growth Effects 0.000 claims description 3
- 125000004386 diacrylate group Chemical group 0.000 claims description 3
- 239000000017 hydrogel Substances 0.000 claims description 3
- 229920000747 poly(lactic acid) Polymers 0.000 claims description 3
- 239000004633 polyglycolic acid Substances 0.000 claims description 3
- 239000004626 polylactic acid Substances 0.000 claims description 3
- 229920000642 polymer Polymers 0.000 claims description 3
- 230000029663 wound healing Effects 0.000 claims description 3
- 210000003414 extremity Anatomy 0.000 description 13
- 239000008280 blood Substances 0.000 description 9
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- 206010051055 Deep vein thrombosis Diseases 0.000 description 8
- 206010047249 Venous thrombosis Diseases 0.000 description 8
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- 230000008901 benefit Effects 0.000 description 5
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/0404—Electrodes for external use
- A61N1/0408—Use-related aspects
- A61N1/0452—Specially adapted for transcutaneous muscle stimulation [TMS]
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/0404—Electrodes for external use
- A61N1/0472—Structure-related aspects
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/36003—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of motor muscles, e.g. for walking assistance
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/36014—External stimulators, e.g. with patch electrodes
- A61N1/3603—Control systems
- A61N1/36034—Control systems specified by the stimulation parameters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
- A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
- A61H2201/10—Characteristics of apparatus not provided for in the preceding codes with further special therapeutic means, e.g. electrotherapy, magneto therapy or radiation therapy, chromo therapy, infrared or ultraviolet therapy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
- A61H2205/00—Devices for specific parts of the body
- A61H2205/10—Leg
- A61H2205/106—Leg for the lower legs
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/0404—Electrodes for external use
- A61N1/0408—Use-related aspects
- A61N1/0456—Specially adapted for transcutaneous electrical nerve stimulation [TENS]
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/0404—Electrodes for external use
- A61N1/0408—Use-related aspects
- A61N1/0464—Specially adapted for promoting tissue growth
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/0404—Electrodes for external use
- A61N1/0408—Use-related aspects
- A61N1/0468—Specially adapted for promoting wound healing
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/0404—Electrodes for external use
- A61N1/0472—Structure-related aspects
- A61N1/0484—Garment electrodes worn by the patient
Definitions
- the described invention relates in general to a system for increasing blood flow in certain body areas of a patient, and more specifically to an apparatus and method for increasing blood flow in the trunk and extremities for medical and non-medical purposes using electrical muscle stimulation, also referred to herein as neuromuscular stimulation.
- the causative factors surrounding the precipitation of DVT are known and include vessel wall and valvular damage and blood stasis resulting from immobilization during or following surgery. Removal of endogenous fibrinolysis which is produced by contracting muscles may also be a causative factor.
- Muscle contractions are an integral component of the physiology of circulation.
- SCDs sequential compression devices
- SCDs are typically used as an adjunct therapy to facilitate blood flow to the lower extremities.
- electrical stimulation is superior to SCDs. While cardiac output dropped 20% below baseline, the electrical stimulation group increased 20% (Faghri, IEEE 591 : 62-69; March 1997).
- NMES Neuromuscular stimulation
- This involuntary effect is particularly advantageous for (i) surgical patients who are anesthetized or under a local epidural block; (ii) patients who are bedridden due to disability, age, or disease; or (iii) are paralyzed from spinal cord injury, stroke, or other neurological injuries or diseases. This effect would also be useful for people who are prevented from moving for long periods of time, such as those on long-duration flights or during extended period of sleep.
- a system for electrically stimulating muscles and increasing blood flow in one or more body parts includes at least one electrode adapted to be placed circumferentially (i.e., completely) around a body part such as an arm or leg wherein the at least one electrode is operative to deliver electrical impulses sufficient to induce muscle contractions in the body part; at least one stimulation module in electrical communication with the at least one electrode, wherein the at least one stimulation module is operative to provide electrical impulses to the at least one electrode; and at least one control module in electrical communication with the at least one stimulation module, wherein the at least one control module is operative to control the characteristics of the electrical impulses.
- a system for electrically stimulating muscles and increasing blood flow to a body part includes at least two electrodes adapted to be placed circumferentially around a body part, wherein each of the at least two electrodes is operative to deliver electrical impulses sufficient to induce muscle contractions in the body part; at least one stimulation module in electrical communication with each of the at least two electrodes, wherein the at least one stimulation module is operative to provide electrical impulses to each of the at least two electrodes; and at least one control module in electrical communication with the at least one stimulation module, wherein the at least one control module is operative to control the characteristics of the electrical impulses.
- a device for electrically stimulating muscles or muscle groups includes at least one electrode adapted to be placed circumferentially (i.e., completely) around a body part such as an arm, leg, or trunk, wherein the at least one electrode is operative to deliver electrical impulses sufficient to induce muscle contractions in the body part.
- FIG. 1 depicts an exemplary embodiment of the electrical muscle stimulation system of the present invention wherein multiple electrical stimulation assemblies have been placed on multiple body parts of an individual;
- FIG. 2 illustrates the placement of an exemplary embodiment of the electrical stimulation system of the present invention wherein a single electrical stimulation assembly has been placed on the lower portion of one leg of an individual;
- FIG. 3 is a cross-sectional view of a limb segment depicting the flow of an electrical current into both agonist and antagonist muscle groups from the circumferential electrode of the present invention
- FIG. 4 is a longitudinal view of a limb segment depicting the flow of an electrical current generated by the circumferential electrodes of the present invention.
- FIG. 5 is a graph depicting an exemplary order of stimulation for pushing blood proximally using the electrical muscle stimulation system of the present invention.
- the present invention relates to a neuromuscular stimulation system (NMES) for use in treating DVT and other medical and non-medical conditions by inducing singular and or co-contractions of muscle groups to increase blood and oxygen flow in those muscles.
- NMES neuromuscular stimulation system
- Other intended uses and benefits of the present invention include wound healing, muscle strengthening, and stimulation of bone growth.
- first and second general embodiments of this invention provide a system for electrically stimulating muscles and increasing blood flow in one or more body parts such as the trunk or extremities; and a third general embodiment of this invention provides a device in the form of a circumferential electrode for electrically stimulating muscles or muscle groups, wherein the electrode is capable of completely encircling a human body part for increasing blood circulation.
- the electrode is supplied with electrical impulses to induce muscle contractions and may be shifted proximally or distally on the body part without degradation of muscle contraction while providing for concurrent agonist and antagonist muscle regeneration.
- FIG. 1 depicts an exemplary embodiment of neuromuscular stimulation system
- Each assembly 20 typically includes a first circumferential electrode 22 and a second circumferential electrode 24, both of which are in electrical communication with a stimulation module 26, which is connected to each circumferential electrode by at least one wire 28 (see FIG. 2).
- Stimulation module 26 typically communicates with control module 40 by wireless means, as depicted by reference number 27.
- Each assembly 20 typically includes a fabric sleeve 30, which acts as a substrate or support for the components thereof.
- One or more sleeves 30 may be included in a larger garment- like item 32, which may connect sleeves 30 to one another for the purpose a facilitating proper placement of system 10 on a user thereof.
- FIG. 2 illustrates the placement of an assembly 20 on the lower portion of one leg of an individual.
- FIG. 3 provides a cross-sectional view of a limb segment depicting the flow of an electrical current into both agonist muscle 50 and antagonist muscle 52 from circumferential electrode 22.
- An electrical field 56 is generated by electrode 22 and passes through skin 54 into the muscles of the limb upon which electrode 22 has been placed.
- FIG. 4 is a longitudinal view of a limb segment depicting the flow of an electrical current generated by the circumferential electrodes of the present invention.
- electrodes 22 and 24 have been placed in sequence (i.e., tandem) on the leg of a patient for the purpose of creating electrical field 56.
- FIG. 5 provides a graph that depicts an exemplary method of electrical stimulation for pushing blood proximally using an exemplary embodiment of neuromuscular stimulation system 10.
- each muscle group (agonist and antagonist) being treated is typically controlled by one set of circumferential electrodes 22, 24 and one integrated stimulation module 26, which coordinates the electrical impulses between the electrodes, which may be controlled remotely from the electrodes.
- stimulation module 26 is equipped with electronics and battery power used deliver adequate stimulation.
- Each stimulation module 26 receives a wireless signal 27 from control module 40 for properly coordinating the contraction of muscle groups.
- Stimulation module 26 may also include electronic means for monitoring contractions of a body part and providing selected electrical impulses to the circumferential electrodes.
- stimulation module 26 has a width of approximately two inches or less and may be extensible in length.
- control module 40 is also capable of monitoring the status of equipment, electrode impedance, compliance and blood flow and then delivering this information to clinicians. Control module 40 may be used to adjust the level of electrical stimulation in accordance with the need for increased or decreased blood flow in or out of the treated limb in a closed-loop feedback manner.
- the circumferential electrodes of the present invention are typically 1-2 inches in width and the area of coverage is significantly higher than the conventional electrodes typically used in NMES.
- the current density (CD) of the circumferential electrodes is significantly lower, even at high intensity outputs, meaning they are more comfortable than conventional electrodes.
- a conventional electrode would have an area of 2 x 4 inches equaling 8 square inches; whereas a circumferential electrode (around a typical thigh) would have an area 1 x 25 inches equaling 25 square inches.
- the electrical impulse parameters for each circumferential electrode include an amplitude of about 0.1-150 mA; a pulse width of about 0.1- 400 microseconds; a frequency of 25-50 Hz; and a duty cycle of about 5-10 seconds ON, and about 10-60 seconds OFF.
- circumferential electrodes 22, 24 utilize either an adhesive or non-adhesive biogel to interface with the patient's skin.
- This biogel may include hydrogel polymers, polymerized polyethylene glycol diacrylate, polylactic acid, polyglycolic acid, polymerized polyethylene glycol dimethylacrylate and mixtures thereof.
- the circumferential electrodes of the present invention are extensible in length (including the biogel) to accommodate expansion in girth as muscle contracts so as to not constrict the limbs and to maintain electrode-to-skin contact; and are flexible for accommodating the contours of limbs which may vary widely due to variations in underlying muscle and bone.
- Neuromuscular stimulation system 10 and the various components thereof may be provided as a portable kit that includes instructions for proper placement of the electrodes and proper use of the system.
- a primary advantage of the present invention is that circumferential electrodes 22,
- the circumferential electrodes 24 transmit electrical current through the patient's skin and body in a highly efficient manner.
- the electrical current generated by these circumferential electrodes travels in a perpendicular fashion with respect to the planar surface of the electrode and then along a parallel pathway, in the long direction of the limb segment (see FIGS 3-4).
- These aspects of the disclosed circumferential electrodes results in much less discomfort to the patient.
- the reduced level of discomfort is also due to lower current densities emitted by the circumferential electrodes as compared to more traditional electrodes.
- the circumferential electrodes of the present invention do not have to be placed accurately to effectively excite muscle tissue. These electrodes may be shifted proximally or distally, while still inducing muscle contractions without compromising the quality of stimulation or level of comfort.
- the disclosed circumferential electrodes reduce the number of required electrodes and stimulation channels by one-half, making a NMES system utilizing these electrodes far easier to operate than known systems.
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Radiology & Medical Imaging (AREA)
- Biomedical Technology (AREA)
- Engineering & Computer Science (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Biophysics (AREA)
- Heart & Thoracic Surgery (AREA)
- Physical Education & Sports Medicine (AREA)
- Electrotherapy Devices (AREA)
Abstract
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US22570309P | 2009-07-15 | 2009-07-15 | |
PCT/US2009/057838 WO2011008222A1 (fr) | 2009-07-15 | 2009-09-22 | Système pour utiliser la stimulation électrique des muscles pour augmenter le flux sanguin dans des parties du corps |
Publications (2)
Publication Number | Publication Date |
---|---|
EP2453974A1 true EP2453974A1 (fr) | 2012-05-23 |
EP2453974A4 EP2453974A4 (fr) | 2013-05-22 |
Family
ID=43449638
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP20090847449 Withdrawn EP2453974A4 (fr) | 2009-07-15 | 2009-09-22 | Système pour utiliser la stimulation électrique des muscles pour augmenter le flux sanguin dans des parties du corps |
Country Status (2)
Country | Link |
---|---|
EP (1) | EP2453974A4 (fr) |
WO (1) | WO2011008222A1 (fr) |
Families Citing this family (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
GB201211316D0 (en) * | 2012-06-26 | 2012-08-08 | Sky Medical Technology Ltd | Method and device for increasing microcirculation |
CA2914190A1 (fr) * | 2013-06-21 | 2014-12-24 | Bodyflow International Pty Ltd Acn 114 356 231 | Traitement d'ulceres de la peau |
ES1138809Y (es) * | 2015-03-26 | 2015-07-28 | Lailla María Olga Salcedo | Estimulador del flujo sanguineo para los miembros inferiores |
KR102669633B1 (ko) * | 2016-06-30 | 2024-05-24 | 노보큐어 리미티드 | 신체에 대한 종양 치료장의 길이 방향 전달을 위한 어레이들 |
WO2021178040A1 (fr) * | 2020-03-03 | 2021-09-10 | Garwood Medical Devices, Llc | Électrode pouvant être enroulée circonférentiellement destinée à être utilisée avec des implants chirurgicaux métalliques |
Citations (11)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4727878A (en) * | 1985-09-26 | 1988-03-01 | The University Of Michigan | Functional electrical stimulation for pressure sore inhibition |
US5674262A (en) * | 1996-01-26 | 1997-10-07 | Kinetic Concepts, Inc. | Pneumatic compression and functional electric stimulation device and method using the same |
US5871534A (en) * | 1998-07-08 | 1999-02-16 | Messick; Genevieve M. | Apparatus for treating pelvic floor dysfunctions using transcutaneous electrical stimulation of the muscles |
US6282448B1 (en) * | 1998-06-10 | 2001-08-28 | Amiram Katz | Self applied and self adjusting device and method for prevention of deep vein thrombosis with movement detection |
US20020188332A1 (en) * | 1998-06-11 | 2002-12-12 | Cprx Llc | Stimulatory device and methods to electrically stimulate the phrenic nerve |
US20030100932A1 (en) * | 2000-12-23 | 2003-05-29 | Nuron Limited | Apparatus for the diagnosis and therapy of neuro-muscular and other tissue disorders |
JP2005052223A (ja) * | 2003-08-06 | 2005-03-03 | Gifu Univ | 末梢血液循環改善具 |
WO2006054118A1 (fr) * | 2004-11-22 | 2006-05-26 | Skytech Medical Ltd | Dispositif |
US20060276855A1 (en) * | 2003-09-03 | 2006-12-07 | Fides Finanz-Invest Gmbh & Co. Kg | Device for muscle stimulation |
US20070270917A1 (en) * | 2006-05-22 | 2007-11-22 | Empire Bio-Medical Devices Inc. | Method and device for enhanced blood flow |
US20080097530A1 (en) * | 2006-10-23 | 2008-04-24 | Muccio Philip | System for tissue stimulation and regeneration |
Family Cites Families (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
ATE348646T1 (de) * | 2000-02-17 | 2007-01-15 | Neurodan As | Implantierbares system zur neuralmessung und nervenstimulation |
US6829510B2 (en) * | 2001-12-18 | 2004-12-07 | Ness Neuromuscular Electrical Stimulation Systems Ltd. | Surface neuroprosthetic device having an internal cushion interface system |
WO2004108209A1 (fr) * | 2003-06-06 | 2004-12-16 | Prizm Medical, Inc. | Stimulateur electrique et systeme de connexion d'electrodes pour vetements |
-
2009
- 2009-09-22 EP EP20090847449 patent/EP2453974A4/fr not_active Withdrawn
- 2009-09-22 WO PCT/US2009/057838 patent/WO2011008222A1/fr active Application Filing
Patent Citations (11)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4727878A (en) * | 1985-09-26 | 1988-03-01 | The University Of Michigan | Functional electrical stimulation for pressure sore inhibition |
US5674262A (en) * | 1996-01-26 | 1997-10-07 | Kinetic Concepts, Inc. | Pneumatic compression and functional electric stimulation device and method using the same |
US6282448B1 (en) * | 1998-06-10 | 2001-08-28 | Amiram Katz | Self applied and self adjusting device and method for prevention of deep vein thrombosis with movement detection |
US20020188332A1 (en) * | 1998-06-11 | 2002-12-12 | Cprx Llc | Stimulatory device and methods to electrically stimulate the phrenic nerve |
US5871534A (en) * | 1998-07-08 | 1999-02-16 | Messick; Genevieve M. | Apparatus for treating pelvic floor dysfunctions using transcutaneous electrical stimulation of the muscles |
US20030100932A1 (en) * | 2000-12-23 | 2003-05-29 | Nuron Limited | Apparatus for the diagnosis and therapy of neuro-muscular and other tissue disorders |
JP2005052223A (ja) * | 2003-08-06 | 2005-03-03 | Gifu Univ | 末梢血液循環改善具 |
US20060276855A1 (en) * | 2003-09-03 | 2006-12-07 | Fides Finanz-Invest Gmbh & Co. Kg | Device for muscle stimulation |
WO2006054118A1 (fr) * | 2004-11-22 | 2006-05-26 | Skytech Medical Ltd | Dispositif |
US20070270917A1 (en) * | 2006-05-22 | 2007-11-22 | Empire Bio-Medical Devices Inc. | Method and device for enhanced blood flow |
US20080097530A1 (en) * | 2006-10-23 | 2008-04-24 | Muccio Philip | System for tissue stimulation and regeneration |
Non-Patent Citations (1)
Title |
---|
See also references of WO2011008222A1 * |
Also Published As
Publication number | Publication date |
---|---|
EP2453974A4 (fr) | 2013-05-22 |
WO2011008222A1 (fr) | 2011-01-20 |
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