Field of the Invention The present invention relates to therapeutic medical devices and methods, and more particularly to devices and methods for improving venous blood flow in a patient .

Background of the Invention Deep vein thrombosis (DVT) and pulmonary embolism (PE) con_. ^~ itute major health problems in the United States. I" has been estimated that 300,000 to 600,000 hospitalizations a year are attributable to DVT and PE conditions. Venous thromboembolism is also a significant risk in surgical patient populations where preoperative, operative and postoperative immobilization with concomitant loss of venous pump function causes blood stasis.

The use of prophylactic antithrombotic drugs for preventing DVT are known to the art. However, the efficacy of prophylactic administration of anticoagulants and antiplatelet agents has been disputed, and is certainly not absolute. An alternative approach, attractive because of its freedom from hemorrhagic side effects, is the use of physical techniques such as elastic stockings, passive leg exercise, electrical calf stimulation and external pneumatic compression of the legs. Pneumatic compression has been the most studied and appears to be an effective therapeutic technique. For example, the results of a comparison trial between sequential compression and uniform compression are disclosed in article by E. . Salzman, et al . , entitled Effect of

Optim±zat±on of Hemodynamics on Fibrinolytic Activi ty and Anti thrombotic Efficacy of External Pneumatic Calf Compression, Annals of Surgery, Vol. 206, No. 5, November (1987) , pp. 636-641. Salzman et al . also discloses the lack of commercially available systems for applying external pneumatic compression in an optimized manner, based on blood flow velocity and volumetric flow rate, etc. Antithrombotic modalities based on sequential pneumatic compression are also disclosed in articles by J.A. Caprini, et al . , entitled Role of Compression Modali ties in a Prophylactic Program for Deep Vein Thrombosis, Seminars in Thrombosis and Hemostasis, Vol. 14, Sup . , Thieme Medical Publishers, Inc., pp. 77-87, (1988) ; and Hull, et al. , entitled Effectiveness of Intermi ttent

Pneumatic Leg Compression for Preventing Deep Vein Thrombosis After Total Hip Replacement, Journal of the American Medical Association, Vol 263, No. 17, May, 2, 1990, pp. 2313-2317. Devices for performing sequential compression have also been patented. For example, U.S.

Patent No. 4,396,010 to Arkans, discloses a time-based sequential compression device for simultaneously inflating multiple limb sleeves. Time-based sequential compression devices are also publicly available from The Kendall Company, of Massachusetts. For example,

Figure 1 illustrates an experimentally derived graph of an inflation cycle for a Model 5325 sequential compression device, manufactured by The Kendall Company. It is believed, however, that none of these sequential compression devices and methods provide for optimum blood flow velocity and volumetric flow rate in recumbent patients.

Thus, notwithstanding these attempts to develop compression devices for preventing deep vein thrombosis and pulmonary embolism, there continues to be a need for a gradient sequential compression system which provides a high blood flow velocity and a highly

therapeutic prophylactic modality -_;> limbs of a recumbent user.

Summary of the Invention It _.s therefc—- ^» an object of the present invention to provide a 3tem and method for reducing the occurrence of deep vein thrombosis (DVT) and pulmonary embolism in recumbent users.

It is also an object of the present invention to provide a system and method for achieving a high venous blood flow rate in a limb of a user.

It is another objec~ of the present invention to provide a system and methθv_ of sequentially establishing a gradient of compressive forces, which is pressure-based. It ^*• s a further object of the present invention to ovide a system and method of regulating a gradient of compressive forces, using real-time feedback.

It is still a further object of the present invention to provide a system and method of providing a prophylactic modality to limbs of a user in an alternating sequence.

These and oiher objects, features and advantages of the present invention are provided by a compression system and method which provides cyclical squeezing and relaxing action to one or more limbs of a user. This occurs by sequentially establishing a decreasing gradient of compressive forces along the limbs in a proximal direction. In particular, the compression system includes one or more sleeves (e.g., calf, thigh, calf and thigh, etc.) which can be wrapped around and releasably secured to a limb(s) of a user. The sleeves have one or more inflatable chambers therein for retaining pressurized air upon inflation and for applying a compressive force to a limb. The compression system also includes a system controller for controlling transfers of pressurized air from an

external or internal source to the inflatable chambers of the sleeves during respective inflation cycles, and for venting the pressurized air during respective deflation cycles. Transfers of air from the system controller to the sleeves are preferably provided by pneumatic connecting means which can include first and second conduit means . First and second conduit means preferably include a plurality of separate conduits or conduit ribbon. According to a preferred embodiment, the system controller includes control means and first and second pluralities of feeder valves, responsive to control means, for enabling and disabling transfers of air from the source to respective ones of the inflatable chambers. Control means is provided for controlling the sequence by which the feeder valves are directionally opened and closed so that during an inflation cycle, a gradient of compressive forces can be sequentially established and maintained along a limb of a user for a predetermined time interval. In particular, control means is provided for opening only one of the feeder valves to the source of pressurized air at a time, so that each of the inflatable chambers is independently inflated and regulated (e.g., measured and adjusted) . Control means preferably includes a pressure transducer and means for sampling the pressures in each of the inflatable chambers and adjusting the pressures based on the samples so that the chambers are maintained at predetermined pressures, even if the limb sleeves are relatively loosely or tightly wrapped or the position of the limb is adjusted during operation.

According to an aspect of the present invention, the system controller includes first and second intermediate valves, connected between the source and the respective first and second pluralities of feeder valves. The intermediate valves, which are

responsive to control means as well, enable the transfer of air from the source to the first and second pluralities of feeder valves during respective first and second inflation cycles and vent air from the first and second pluralities of feeder valves during respective deflation cycles. In particular, the feeder valves and intermediate valves are directionally opened and closed to facilitate inflation, measurement and adjustment of the pressures in the limb sleeves. The system controller also preferably includes means for sensing whether pneumatic connecting means is attached thereto. Sensing means preferably includes an infrared sensor (s) . Control means also includes means, responsive to the sensing means, for automatically adjusting from a default two-limb mode of operation to a one-limb mode by preventing the occurrence of either the first or second inflation cycles if the respective first or second conduit means is disconnected from the system controller. The first and second inflation cycles are preferably 180° out of phase so that only one limb sleeve is being inflated at a time. The system controller also includes means for detecting low and high pressure fault conditions which can be caused by disconnected or occluded conduits, and sleeves that are wrapped too loosely or too tightly about a limb.

According to yet another aspect of the invention, compressive forces are applied to a limb of a user by sequentially compressing a distal portion and then a relatively proximal portion of the limb to provide respective first and second radially inwardly directed compressive forces thereto. The first compressive force is maintained above the second compressive force so that a decreasing pressure gradient is established in a proximal direction along the limb for a preselected time interval . The force is preferably maintained by measuring the compressive

forces and adjusting (i.e., increasing or decreasing) the compressive forces to maintain predetermined forces.

More particularly, the invention includes a method of applying compressive forces to a limb of a user using a multi-chambered inflatable limb sleeve surrounding the limb. The method includes the steps of pressurizing a first chamber of the limb sleeve to a first predetermined chamber pressure and then pressurizing a second chamber, disposed proximally relative to the first chamber, to a second preselected chamber pressure, after the first chamber reaches a first threshold pressure. The first threshold pressure may be less than or equal to the first predetermined pressure.

Preferably, the second chamber pressurizing step occurs after a pressure in the first chamber has been established at the first predetermined pressure for at least a first time interval. A step is also performed to regulate the pressures in the first and second chambers at their respective predetermined pressures, so that a constant pressure gradient is established therebetween. The regulating step may also include the steps of measuring a pressure in the first chamber while preventing depressurization of the second chamber and vice versa. Additionally, the regulating step may include the steps of measuring a pressure in the first chamber after it has been inflated to the first threshold pressure and then re-measuring a pressure in the first chamber, after the second chamber has been inflated to the second threshold pressure. The pressures in the chambers may also be adjusted by performing periodic reinflating steps (and also deflating steps) . Similar steps may also be performed to inflate third and fourth, etc. chambers of the limb sleeve, in sequence, so that a monotonically decreasing pressure gradient is established and

maintained in a proximal direction between the chambers of a sleeve (s) .

A periodic adjusting step may also be performed to adjust the pressures in the chambers during an inflation cycle, by sampling (once or repeatedly) a pressure in a respective chamber to obtain a pressure sample and then adjusting the pressure by inflating or deflating the respective chamber, based on the value of the sample. Pressure samples from a respective chamber during an inflation cycle can also be averaged to determine whether a critical overpressure condition occurred during a prior inflation cycle and/or occurred multiple consecutive times during prior inflation cycles. If a critical overpressure condition has occurred, subsequent inflation cycles can be disabled to maintain the respective sleeve (s) in a continuously deflated state until the system is reset or the critical condition is corrected. Thus, instantaneous pressure spikes can be compensated to prevent the occurrence of shutdown when a single or relatively few aberrant ^" pressure samples have been measured.

According to still another aspect of the present invention, predetermined pressures in the range of 65-15 mmHg are sequentially established in limb sleeve(s) and maintained for predetermined time intervals in order to provide a prophylactic modality to limbs of a user and also achieve high venous blood flow rates to prevent DVT. Brief Description of the Drawings

Figure 1 is a graph illustrating an inflation cycle of a three chamber compression system, according to the prior art.

Figure 2 is a perspective view of a system controller according to a preferred embodiment of the present invention.

Figure 3A is a graph illustrating first and second inflation cycles, according to the present invention.

Figure 3B is a flow chart illustrating the operations performed by the system controller, during the first and second inflation cycles as illustrated by Figure 3A.

Figure 4 is a schematic diagram illustrating a compression system according to the present invention, including the system controller of Figure 2.

Figure 5 is a perspective view of a valve manifold and associated hardware connected thereto, as illustrated in Figure 2.

Figure 6A is a perspective view of pneumatic connecting means according to a preferred embodiment of the present invention.

Figure 6B is a cross-sectional view of pneumatic connecting means according to Figure 6A, taken along the lines 6B-6B' . Description of a Preferred Embodiment

The present invention will now be described more fully hereinafter with reference to the accompanying drawings, in which a preferred embodiment of a compression system and method is shown and described. This invention may, however, be embodied in different forms and should not be construed as limited to the embodiment set forth herein. Rather, this embodiment is provided so that this disclosure will be thorough and complete, and will fully convey the scope of the invention to those skilled in the art. Like numbers refer to like elements throughout .

Referring now to Figure 2, a preferred embodiment of a system controller 10 according to the present invention will be described. The system controller 10 includes a housing formed by top and bottom housing portions 13 and 11, respectively. The top housing portion 13 may include an on/off switch 12

and a sloped display 15 for visually communicating chamber inflation information (e.g., pressure levels, chamber status) , the mode of operation (e.g., one- or two-limb mode; and 2, 3 or 4-chamber mode) and alarm, alert and fault conditions. The display may also provide means, responsive to actuation by a user or health care professional, for preselecting the desired pressure levels to be achieved during a sleeve inflation cycle. Based on experiment, it was determined by the inventors herein that pressures ranging from 65-15 mmHg are most preferred.

The system controller 10 may also include an internal source of pressurized air 20 such as a compressor, however, an external pneumatic fitting or similar device (not shown) may be provided adjacent the controller housing for connecting the controller 10 to an external source of pressurized air. A bracket 19 is also provided for securing an electrical cord (not shown) during periods of nonuse. The system controller 10 also preferably includes a valve manifold 30 having a plurality of valves which facilitate inflation of limb sleeves 22 and 24. As illustrated by Figure 4, the limb sleeves are preferably four-chamber sleeves. Alternatively, a plurality of single-chamber sleeves may be provided as an equivalent substitute for a multi-chamber sleeve. The valves in the manifold 30 are also directionally coupled and controlled to facilitate measurement and adjustment of pressures in the limb sleeves 22, 24, as explained more fully hereinbelow with respect to Figure 4. Preferred means 50 for pneumatically connecting the system controller 10 to the limb sleeves is also illustrated by Figures 6A-6B. Pneumatic connecting means 50 preferably comprises first and second conduit means 54, such as a plurality of flexible conduits or conduit ribbon 56, as illustrated in Figure 6B.

Referring now to Figures 3A-B, a preferred method of applying compressive forces to a limb of a user using a multi-chambered inflatable limb sleeve includes inflating (i.e., pressurizing) a first chamber of the limb sleeve to a first predetermined chamber pressure, shown as 50 mmHg, during a first inflation cycle (shown by solid lines) . As will be understood by those skilled in the art, pressurization of a chamber causes a compression of the limb and provides a radially inwardly directed compressive force about the circumference of the limb. The predetermined chamber pressures may be user selected at the display, however respective default pressures are preferably fixed by the controller 10. Thereafter, at time B, a second chamber of the sleeve, which is disposed proximally relative to the first chamber, is pressurized to a second predetermined pressure level, shown as 45 mmHg, by time C. Time B preferably occurs after the pressure in the first chamber reaches a threshold pressure, and more preferably after the first chamber pressure has been established at a respective predetermined pressure for a predetermined time interval. The threshold pressure may be less than or equal the first predetermined pressure of 50 mmHg. As further illustrated, the time interval between times B and A is shown as 2.5 seconds, which is a default time interval. However, another predetermined time interval in the preferred range of 1-4 seconds may also be selected by a health care professional to achieve a preferred venous blood flow rate, based on the particular therapeutic application and medical needs of the recumbent user. According to an aspect of the present invention, means may be provided at the display 15 for allowing preselection of the desired time interval.

In the time interval between times B and A, a measurement (i.e., "sample") of the pressure in the

first chamber is taken at least once. Based on this sample, the pressure in the chamber is adjusted to the 50 mmHg level, if necessary. Adjustment of the pressure in a chamber can occur by either inflating the chamber if the pressure sample is too low or deflating the chamber if the pressure sample is too high. As illustrated, the pressure in the first chamber is adjusted from below 50 mmHg to above 50 mmHg at least once prior to time B. At time D, which preferably occurs 2.5 seconds after time C, the third chamber is inflated to a third predetermined pressure level, shown as 40 mmHg. This occurs at time E. In addition, during the time interval between times D and C, samples of the pressures in the first and second chambers are taken at least once and the pressures are independently adjusted to the 50 and 45 mmHg levels, if necessary. As explained more fully hereinbelow with respect to Figure 4, independent measurement of a pressure in a chamber occurs without depressurizing the other chambers. Furthermore, independent adjustment is achieved by pressurizing (or depressurizing) one chamber, while preventing pre surization (or depressurization) of the other chambers. At time F, which preferably occurs 2.5 seconds after time E, the fourth chamber is inflated to a fourth predetermined pressure level, shown as 30 mmHg. This occurs at time G. The 50, 45, 40 and 30 mmHg levels establish a monotonically decreasing pressure gradient in a proximal direction along the limb of a user. It was determined by the inventors herein that a dual gradient of 5 mmHg between the first and second chambers and 10 mmHg between the third and fourth chambers is most preferred. In addition, during the time interval between times F and E, samples of the pressures in the first, second and third chambers are taken at least once and

the pressures are independently adjusted to the 50, 45, and 40 mmHg levels, if necessary. And during the time interval between times G and H, samples of the pressures in each of the chambers are taken again and independent adjustments are made, if necessary. At time H, the chambers are simultaneously deflated. Time H preferably occurs 2.5 seconds after the pressure in the fourth chamber reaches a respective threshold pressure, and more preferably after the fourth chamber pressure has been established at 30 mmHg. Accordingly, times B, D, F and H preferably occur 2.5 seconds after times A, C, E and G, respectively. Alternatively, these time intervals may be preselected to be of varying length. As illustrated, inflation of a first limb sleeve occurs 180° (e.g., 30 seconds) out of phase with respect to inflation of a second limb sleeve. In other words, only one sleeve is preferably inflated at a time (although both could be simultaneously inflated) . Based on default settings which may be adjusted at the display 15, the inflation cycle for the second sleeve (shown by dotted lines) begins 30 seconds after the initiation of the first inflation cycle. Both the first and second inflation cycles preferably have default periods of 60 seconds, as illustrated.

According to an aspect of the present invention, 30 seconds also sets the maximum inflation time. Thus, a sleeve will automatically be deflated if time H does not occur before 30 seconds has elapsed from the initiation of inflation. Alternatively, the second inflation cycle could begin automatically at time H (i.e., after all chambers in the first sleeve have been inflated for the requisite 2.5 seconds) , rather than at the 30 second mark. In this latter case, the inflation cycle period for each sleeve would typically vary from cycle to cycle, as would be understood by those skilled in the art.

Referring now to Figure 3B, operations 70 performed by the system controller 10 during the first and second inflation cycles are summarized. In particular, the operations begin with the first sleeve and then an operation is performed to inflate the most distal chamber in the sleeve that is uninflated, Block 72. Thereafter, an operation is performed to determine whether a respective predetermined pressure in the chamber has been reached, Block 73. If not, pressurization is continued. However, if the respective predetermined pressure for the chamber has been reached, an interval timer is started, Block 74. Thereafter, the most distal chamber of the sleeve is preferably selected, Block 75, and then measured to obtain a pressure sample, while preventing depressurization of the other chambers, Block 76. Based on the respective pressure sample, an operation is then performed to adjust (+/-) the chamber pressure, Block 77. This is repeated for each of the next proximal chambers which have already been inflated, Blocks 78-79. Alternatively, this order of sampling the pressures (i.e., distal → proximal) may be reversed. Once the time interval (e.g. 2.5 seconds) has elapsed, Block 80, the timer is reset (Block 81) and then a check is performed to see if all chambers have been inflated, Block 82. If not, the next uninflated chamber is selected, Block 72, and the operations are repeated. If the most proximal chamber has been inflated for the requisite elapsed time interval, then all chambers are deflated, Block 83. This begins the deflation cycle for the respective sleeve. The next sleeve is then selected, Block 84, and operations begin at Block 72, so that inflation of the next sleeve preferably occurs 180° out of phase with the previous sleeve (i.e., 30 seconds after commencement of inflation for the previous sleeve) .

According to another aspect of the present invention, operations can also be performed in parallel with those operations illustrated by Block 72-83. In particular, a check is performed to determine if a prior inflation cycle has occurred, Block 71. If not, the normal operations (Blocks 72-82) are continued. If a prior inflation cycle has occurred, the pressure samples obtained from the prior cycle (or prior cycles) are averaged for each chamber, Block 84. Based on these averages, a check is performed to determined whether an excessive pressure condition has occurred, Block 85. If it has, subsequent inflation cycles are terminated until the system is reset, otherwise normal operations are continued. The system can be reset by accessing the display 15. According to this aspect of the present invention, instantaneous spikes in the pressures of one or more chambers can be compensated to prevent the occurrence of shutdown when a single or relatively few aberrant pressure samples have been measured during an inflation cycle or during consecutive inflation cycles (e.g., 5) . As described below with respect to Figure 4, these operations are preferably performed by a system controller 10 having a preferred microprocessor-based control means 40. Control means 40 may also perform the function of detecting an occluded conduit and causing the display 15 to indicate a high pressure alert condition. For example, if a chamber inflating operation causes an excessive pressure (e.g., 100 mmHg) to be measured, control means 40 can automatically cause shutdown and alert the user.

Referring now to Figure 4, a compression system according to the present invention will be described. In particular, the compression system comprises the system controller 10. The controller 10 has means for controlling transfers of air from a source of pressurized air 20 (e.g., a compressor) to

inflatable chambers of first and second limb sleeves 22, 24, respectively. As illustrated, each limb sleeve (or combinations of single- and dual-chamber sleeves) comprises a plurality of inflatable chambers 22a-d and 24a-d. For purposes of illustration only, dotted-lines have been used to show pneumatic connections and solid- lines have been used to show electrical connections. The system controller 10 further comprises first and second pluralities of feeder valves 26, 28 for enabling and disabling transfers of air from the pressurized air source 20 to the inflatable chambers 22a-d and 24a-d. In particular, each of the first plurality of feeder valves 26a* is connected to respective ones of the chamber- ,_,2a-d and each of the second plurality of feeder valves 28a-d is connected to respective ones of the chambers 24a-d. The feeder valves are preferably Model 35 Series valves, which are publicly available from MAC Valves Inc. of Wixom, Michigan. Independent inflation control means 40 is also provided for opening only one of the feeder valves 26a-d, 28a-d at a time during a respective first or second inflation cycle. Control means 40 is preferably microprocessor-based. For example, a multi-purpose microprocessor 42 may be provided to perform command and control operations, based on instructions contained in memory 44, such as programmable read-only memory (PROM) . A multi-purpose microprocessor, such as a Motorola Semiconductor Corp., Model MC68HC11A1 microprocessor may be used. Control means 40 also preferably performs the function of regulating pressures in each of the inflatable chambers 22a-d and 24a-d.

Accordingly, regulation means is provided by the controller 10 for measuring the pressures in each of the chambers and for adjusting the pressures by intermittently inflating (and deflating) respective

chambers to maintain pressure levels in the chambers at predetermined values, as illustrated by Figure 3A. Means for performing chamber pressure measurements preferably comprises a pressure transducer 46. According to a preferred aspect of the present invention, only one pressure transducer for the entire system, as opposed to one transducer for each sleeve chamber, is required to independently measure the pressures in each of the chambers, without depressurizing any of the other chambers. The pressure transducer is preferably a Model MPX5050GP transducer, which is publicly available from Motorola Semiconductor Corp. of Phoenix, Arizona.

The system controller also preferably comprises intermediate valve means, shown as three-way intermediate valves 25 and 27. The intermediate valves are preferably Model 170 Series valves, which are also publicly available from MAC Valves Inc. In response to control signals provided by control means 40, the intermediate valves perform the function of enabling and disabling transfers of air from the source 20 to respective first and second pluralities of feeder valves 26 and 28 during the first and second inflation cycles. A pressure relief valve 34 is also provided in case pressures within the controller 10 exceed a safe level .

Sensing means 36 is also provided for sensing whether pneumatic connecting means 50 is attached to the controller 10. Sensing means preferably comprise an infrared sensor (and may include other means) to detect whether respective male connecting members 52 have been releasably secured within output ports 17a and 17b, as illustrated by Figures 5 and 6A. Control means 40 also performs the function of automatically preventing the occurrence of the first inflation cycle if the respective means 50 is not pneumatically connected to output port 17a, and preventing the

occurrence of the second inflation cycle if means 50 is not connected to output port 17b. Thus, the system has the capability of automatically adjusting to one-limb or two-limb operation. In particular, control means 40 will prevent the occurrence of..the first inflation cycle by continuously providing a disable (e.g., deenergizing) signal to intermediate valve 25 if means 50 is disconnected from the output port 17a.

The system controller 10 may also include means, responsive to actuation from the display 15, for configuring the controller 10 in a 2, 3, ..., N-chamber mode of operation. For example, a controller 10 having a 2-sleeve/4-chamber default configuration, as illustrated and described herein, can be readily converted to a 3-chamber or 2-chamber system by selecting the desired mode at the display 15. In addition, the controller 10 may also include means, preferably responsive to actuation from the display, for configuring the controller 10 in a customized mode of operation which allows sleeves of different length to be used. Thus, a first sleeve having four chambers may used on one limb and a second sleeve having two or three chambers may be used on another limb. As will be understood by those skilled in the art, these customized modes of operation may be controlled by the microprocessor 42. Selecting means, such as a membrane switch 16, may be provided at the display 15 for selecting these modes of operation.

Referring again to Figures 3A and 4, the operations performed by the system controller 10 during the first and second inflation cycles will be described. It should be noted that this description of operations is provided as an illustrative example and should not otherwise be construed as limiting the scope of the invention. The operations begin with the steps of connecting each of the chambers of the first and second limb sleeves 22 and 24 to respective conduits of

first and second conduit ribbons 56, and then inserting respective male connecting members 52, at the source ends of the conduits, into each of the output ports 17a and 17b. Thereafter the controller is turned on by accessing the on/off switch 12. This causes the controller 10 and particularly control means 40 to perform various diagnostic start-up operations, such as performing a check, which is responsive to sensing means 36, to determine whether one or more of the sleeves is disconnected.

Means 40 controls operations for inflating the first chamber 22a to 50 mmHg by providing a first control signal (e.g., logic 0) to feeder valves 26a and 28a-d and to the second intermediate valve 27. Second control signals (e.g., logic 1) are also provided to feeder valves 26b-d, along the solid control lines, as shown. Second control signals are also provided to the first intermediate valve 25 and to a source valve 32, which is connected to the source of pressurized air 20. These valves are preferably three-way, normally-open, solenoid controlled valves, as illustrated. Accordingly, the application of a second or "energizing" control signal to the solenoid of each valve causes the output of the valve to be directionally coupled to a first input, shown as opposite the input side of the valve. However, the application of a first or "deenergizing" signal to the solenoid of each valve causes the output to be directionally coupled to a second input (or vent) , shown as orthogonal to the output side of the valve.

As will be understood by those skilled in the art, these initial operations will cause the source of pressurized air 20 to be pneumatically connected to the first chamber 22a and inflation will begin. Chambers 22b-d and chambers 24a-d are disconnected from the source and are not inflated at this time.

In particular, feeder valves 26b-d will be held in an energized but blocking state, as shown by the pneumatic termination ( 1) , and feeder valves

28a-d and the second intermediate valve 27 will be held in a deenergized and open stat*-*-. As shown, the feeder valves 26a-d and 28a-d have 1 I modified so that the first input is plugged. In a-αition, an energizing signal is also generated to open the source valve 32 and the first intermediate valve 25. A deenergizing signal is also generated to open the feeder valve 26a, which is now in a normally-open position and can accept pressurized air from the source 20.

Because the volume of the first chamber 22a will typically vary depending on the size of the sleeve and limb (and also whether the sleeve is loosely or tightly wrapped around the limb) control means 40 also performs special startup control operations, which occur primarily during the first 5-10 inflation cycles for a respective sleeve. In particular, during the initial inflation cycle for each sleeve, the controller inflates each chamber for a respective predetermined default time interval (retained in PROM 44) and then takes a measurement to determine whether the default time interval was long enough (or too long) to achieve the desired pressure level. If the measurement is too low, control means 40 will automatically increase the time interval so that during the next inflation cycle, the updated inflation time interval will be longer to correspond to the actual time needed for this chamber to inflate properly. These operations, which provide real-time feedback, typically occur repeatedly for each chamber during the first 5-10 inflation cycles or until the system "levels-out" at the desired inflation times. Because the respective inflation times are stored in volatile memory 48, such as RAM, these operations will need to be repeated every time the system is turned-on or reset. The PROM 44 may also contain a maximum fill

time interval, so that if a chamber is not properly inflated in that interval, control means 40 will generate a fail-to-fill alert. This condition typically occurs when one of the conduits is disconnected from a chamber.

These special control operations will also need to be performed if the user-selected pressure levels, described above with reference to Figure 2, are greater than or less than the default pressure levels of 50,45,40 and 30 mmHg. Moreover, if during the course of operation, the user or health care professional actuates the display 15 and adjusts the default pressure levels to new values, these special start-up control operations will automatically be performed again to generate new inflation times and adjust the system to the new pressure levels.

If the default time intervals for inflating each of the respective chambers is assumed accurate for purposes of illustration, then chamber 22a will inflate to the first predetermined pressure at time A, as shown. At time A, the deenergizing signal is applied to the source valve 32 to cause it to switch to its normally open position. When this occurs, the source will vent air through the controller housing to the surrounding atmosphere. The application of the deenergizing signal to the source valve also closes off the system so that the pressure transducer can accurately sample the pressure in the first chamber 22a. Control means 40 also regulates the pressure in the first chamber 22a by adjusting it to the first predetermined pressure if the sample is outside an acceptable pressure tolerance. For example, a short inflating or deflating step can be performed to adjust the pressure in the first chamber 22a. In order to deflate the first chamber 22a, the second or energizing control signal can be temporarily removed from the

first intermediate valve 25 in order to vent some of the air from the chamber through the feeder valve 26A and first intermediate valve 25. Alternatively, the energizing signal can also be temporarily reapplied to the source valve to obtain another "burst" of air into the first chamber 22A. To hold the first chamber 22a at 50 mmHg, an energizing signal is applied to feeder valve 26a to cause it to enter a blocking state, as shown by the pneumatic termination ( 1) . After the predetermined time interval of 2.5 second has elapsed from time A, control means 40 begins operations at time B for inflating the second chamber 22b by applying an energizing signal to the source valve 32 and first intermediate valve 25 and applying a deenergizing signal to feeder valve 26b, while holding feeder valves 26a and 26c-d in an energized or blocking state.

At time C, the second chamber 22b will be inflated to 45 mmHg and then control means 40 will deenei-ize the source valve 32 and energizes feeder valve 26b to thereby cause the source to vent to atmosphere while the feeder valve 26b blocks the escape of air from the second chamber 22b. Measurement of the pressures in the first and second chamber can then be independently performed by first applying a temporary deenergizing signal to feeder valve 26a to open it and then taking a pressure sample, followed by adjustment, if necessary. Next, a temporary deenergizing signal is applied to feeder valve 26b, so that the pressure transducer 46 can sample the pressure in the second chamber 22b as well. Then while feeder valve 26b is still open, control means 40 can again perform the necessary operations to separately adjust the pressures in the second chamber 22b. As will be understood by those skilled in the art, the above-described operations are again repeated at times D-G, so that at time H, control means 40 can

provide a deenergizing signal to the first intermediate valve 25 and to each of the feeder valves 26a-d so that all chambers vent through the first intermediate valve 25. Analogous operations are also performed by control means 40 to inflate and regulate the second sleeve 24. In particular, deenergizing signals are maintained at each of the feeder valves 26a-d and first intermediate valve 25 so that the first sleeve 22 remains in a deflated state. To begin inflation of the first chamber 24a, control means 40 provides energizing signals to the source valve 32, the second intermediate valve 27 and to feeder valves 28b-d to maintain them in the blocking state. Accordingly, a connection is provided between the source 20 and first chamber 24a at the beginning of the second inflation cycle.

As described above, means, such as a membrane switch at the display 15, may also be provided to allow adjustment of the controller 10 so that a 2, 3, ..., N- chamber mode of operation may be readily achieved in either sleeve. For example, a controller 10 having a 2-sleeve/4-chamber default configuration as described herein, can be converted to a 3-chamber system by selecting this mode at the display 15. Based on this selection, control means 40 would disable normal operations for inflating fourth chambers 22d, 24d by continuously providing energizing signals to feeder valves 26d or 28d to maintain them in a blocking state. Similarly, four chamber operation in the first sleeve and two chamber operation in the second sleeve can be selected. In this mode, control means 40 would disable normal operations for inflating third and fourth chambers 24c-d, by continuously providing energizing signals to feeder valves 28c-d to continuously maintain them in a blocking state during the second inflation cycle.

Referring now to Figure 5, the valve manifold 30 is illustrated in greater detail. In particular, the first and second output ports 17a-b and associated conduits 17c-d, are also provided for pneumatically connecting each of the outputs of the feeder valves 26a-d and 28a-d to respective ones of the conduits 54. In addition, energizing and deenergizing control signals from control means 40 to feeder valves 26a-d and 28a-d and first and second intermediate valves 25, 27 are provided by electrical connections 29, as shown. The drawings and specification disclose typical preferred embodiments of the present invention and, although specific terms are employed, they are used in a generic and descriptive sense only and not for purposes of limitation, the scope of the invention being set forth in the following claims.