ImpediBands: Body Coupled Bio-Impedance Patches for Physiological Sensing Proof of Concept

Wearable Devices Based on Bioimpedance Test in Heart-Failure: Design Issues

Heart-failure (HF) is a severe medical condition. Physicians need new tools to monitor the health status of their HF patients outside the hospital or medical supervision areas, to better know the evolution of their patients' main biomarker values, necessary to evaluate their health status. Bioimpedance (BI) represents a good technology for sensing physiological variables and processes on the human body. BI is a non-expensive and non-invasive technique for sensing a wide variety of physiological parameters, easy to be implemented on biomedical portable systems, also called "wearable devices". In this systematic review, we address the most important specifications of wearable devices based on BI used in HF real-time monitoring and how they must be designed and implemented from a practical and medical point of view. The following areas will be analyzed: the main applications of BI in heart failure, the sensing technique and impedance specifications to be met, the electrode selection, portability of wearable devices: size and weight (and comfort), the communication requests and the power consumption (autonomy). The different approaches followed by biomedical engineering and clinical teams at bibliography will be described and summarized in the paper, together with results derived from the projects and the main challenges found today.

Physics-informed neural networks for modeling physiological time series for cuffless blood pressure estimation

The bold vision of AI-driven pervasive physiological monitoring, through the proliferation of off-the-shelf wearables that began a decade ago, has created immense opportunities to extract actionable information for precision medicine. These AI algorithms model input-output relationships of a system that, in many cases, exhibits complex nature and personalization requirements. A particular example is cuffless blood pressure estimation using wearable bioimpedance. However, these algorithms need training over significant amount of ground truth data. In the context of biomedical applications, collecting ground truth data, particularly at the personalized level is challenging, burdensome, and in some cases infeasible. Our objective is to establish physics-informed neural network (PINN) models for physiological time series data that would use minimal ground truth information to extract complex cardiovascular information. We achieve this by building Taylor's approximation for gradually changing known cardiovascular relationships between input and output (e.g., sensor measurements to blood pressure) and incorporating this approximation into our proposed neural network training. The effectiveness of the framework is demonstrated through a case study: continuous cuffless BP estimation from time series bioimpedance data. We show that by using PINNs over the state-of-the-art time series models tested on the same datasets, we retain high correlations (systolic: 0.90, diastolic: 0.89) and low error (systolic: 1.3 ± 7.6 mmHg, diastolic: 0.6 ± 6.4 mmHg) while reducing the amount of ground truth training data on average by a factor of 15. This could be helpful in developing future AI algorithms to help interpret pervasive physiologic data using minimal amount of training data.

On the development of low power wearable devices for assessment of physiological vital parameters: a systematic review

Aim

Smart wearable devices for continuous monitoring of health conditions have bbecome very important in the healthcare sector to acquire and assess the different physiological parameters. This paper reviews the nature of physiological signals, desired vital parameters, role of smart wearable devices, choices of wearable devices and design considerations for wearable devices for early detection of health conditions.

Subject and methods

This article provides designers with information to identify and develop smart wearable devices based on the data extracted from a literature survey on previously published research articles in the field of wearable devices for monitoring vital parameters.

Results

The key information available in this article indicates that quality signal acquisition, processing and longtime monitoring of vital parameters requires smart wearable devices. The development of smart wearable devices with the listed design criteria supports the developer to design a low power wearable device for continuous monitoring of patient health conditions.

Conclusion

The wide range of information gathered from the review indicates that there is a huge demand for smart wearable devices for monitoring health conditions at home. It further supports tracking heath status in the long term via monitoring the vital parameters with the support of wireless communication principles.

Continuous cuffless blood pressure monitoring with a wearable ring bioimpedance device

Smart rings provide unique opportunities for continuous physiological measurement. They are easy to wear, provide little burden in comparison to other smart wearables, are suitable for nocturnal settings, and can be sized to provide ideal contact between the sensors and the skin at all times. Continuous measuring of blood pressure (BP) provides essential diagnostic and prognostic value for cardiovascular health management. However, conventional ambulatory BP measurement devices operate using an inflating cuff that is bulky, intrusive, and impractical for frequent or continuous measurements. We introduce ring-shaped bioimpedance sensors leveraging the deep tissue sensing ability of bioimpedance while introducing no sensitivity to skin tones, unlike optical modalities. We integrate unique human finger finite element model with exhaustive experimental data from participants and derive optimum design parameters for electrode placement and sizes that yields highest sensitivity to arterial volumetric changes, with no discrimination against varying skin tones. BP is constructed using machine learning algorithms. The ring sensors are used to estimate arterial BP showing peak correlations of 0.81, and low error (systolic BP: 0.11 ± 5.27 mmHg, diastolic BP: 0.11 ± 3.87 mmHg) for >2000 data points and wide BP ranges (systolic: 89-213 mmHg and diastolic: 42-122 mmHg), highlighting the significant potential use of bioimpedance ring for accurate and continuous estimation of BP.

Feasibility Analysis and Implementation of Head-Mounted Electrical Impedance Respiratory Monitoring

The respiratory rate is one of the crucial indicators for monitoring human physiological health. The purpose of this paper was to introduce a head-mounted respiratory monitoring solution based on electrical impedance sensing. Firstly, we constructed a finite element model to analyze the feasibility of using head impedance for respiratory sensing based on the physiological changes in the pharynx. After that, we developed a circuit module that could be integrated into a head-mounted respiratory monitoring device using a bioelectrical impedance sensor. Furthermore, we combined adaptive filtering and respiratory tracking algorithms to develop an app for a mobile phone. Finally, we conducted controlled experiments to verify the effectiveness of this electrical impedance sensing system for extracting respiratory rate. We found that the respiration rates measured by the head-mounted electrical impedance respiratory monitoring system were not significantly different from those of commercial respiratory monitoring devices by a paired t-test (p > 0.05). The results showed that the respiratory rates of all subjects were within the 95% confidence interval. Therefore, the head-mounted respiratory monitoring scheme proposed in this paper was able to accurately measure respiratory rate, indicating the feasibility of this solution. In addition, this respiratory monitoring scheme helps to achieve real-time continuous respiratory monitoring, which can provide new insights for personalized health monitoring.

Continuous cuffless monitoring of arterial blood pressure via graphene bioimpedance tattoos

Continuous monitoring of arterial blood pressure (BP) in non-clinical (ambulatory) settings is essential for understanding numerous health conditions, including cardiovascular diseases. Besides their importance in medical diagnosis, ambulatory BP monitoring platforms can advance disease correlation with individual behaviour, daily habits and lifestyle, potentially enabling analysis of root causes, prognosis and disease prevention. Although conventional ambulatory BP devices exist, they are uncomfortable, bulky and intrusive. Here we introduce a wearable continuous BP monitoring platform that is based on electrical bioimpedance and leverages atomically thin, self-adhesive, lightweight and unobtrusive graphene electronic tattoos as human bioelectronic interfaces. The graphene electronic tattoos are used to monitor arterial BP for >300 min, a period tenfold longer than reported in previous studies. The BP is recorded continuously and non-invasively, with an accuracy of 0.2 ± 4.5 mm Hg for diastolic pressures and 0.2 ± 5.8 mm Hg for systolic pressures, a performance equivalent to Grade A classification.

A Wearable Bioimpedance Chest Patch for Real-Time Ambulatory Respiratory Monitoring

OBJECTIVE

This paper aims to introduce a wearable solution and a low-complexity algorithm for real-time continuous ambulatory respiratory monitoring.

METHODS

A wearable chest-worn patch is designed using a bioimpedance (BioZ) sensor to measure the changes in chest impedance caused by breathing. Besides, a medical-grade infrared temperature sensor is utilized to monitor body temperature. The computing algorithm implemented on the patch enables computation of breath-by-breath respiratory rate and chest temperature in real-time. Two wireless communication protocols are included in the system, namely Bluetooth and Long Range (LoRa), which enable both short-range and long-range data transmission.

RESULTS

The breathing rate measured in static (i.e., standing, sitting, supine, and lateral lying) and dynamic (i.e., walking, running, and cycling) positions by our device yielded an accuracy of more than 97.8% and 98.5% to the ground truth, respectively. Additionally, the devices performance is evaluated in real-world scenarios both indoors and outdoors.

CONCLUSION

The proposed system is capable of measuring breathing rate throughout a variety of daily activities. To the best of our knowledge, this is the first BioZ-based wearable patch capable of detecting breath-by-breath respiratory rate in real-time remotely under unrestricted ambulatory conditions.

SIGNIFICANCE

This study establishes a strategy for continuous respiratory monitoring that could aid in the early detection of cardiopulmonary disorders in everyday life.

A Non-invasive Radial Arterial Compliance Measuring Method using Bio-Impedance

Arterial compliance is one of the essential indicators of certain types of cardiovascular disease, with both systematic and local compliance exhibiting significance. Radial arterial compliance (RAC) has been regarded as an important type of local compliance in several long-term pathophysiological studies. Bio-Impedance (Bio-Z) is a non-invasive signal which can be used to unobtrusively monitor blood volume changes, captured using wearable sensors. In this paper, a compliance monitoring technique based on Bio-Z is proposed for long-term RAC measurements. Both the distensibility-blood pressure (BP) relation and compliance-mean artery pressure relation are analyzed to observe interparticipant compliance variations from four healthy participants, by controlling the blood flow in a way similar to the oscillometric method for BP measurement. A Bio-Z based compliance index (DBZI) is proposed that can be leveraged for continuous and unobtrusive sensing paradigms. A consecutive seven-day experiment shows that the mean and standard deviation values of the difference between the median value of the Bio-Z based beat-by-beat calculated compliance and DBZI are 0.17 and 0.20 mOhm/mmHg, respectively. This demonstrates the consistency and repeatability of the measurements. The results show that DBZI can track the Bio-Z based compliance with an error of 9.72% and 11.67%, compared to a gold standard, in terms of mean and standard deviation, respectively.

Non-Invasive Cardiac and Respiratory Activity Assessment From Various Human Body Locations Using Bioimpedance

Objective: Bioimpedance sensing is a powerful technique that measures the tissue impedance and captures important physiological parameters including blood flow, lung movements, muscle contractions, body fluid shifts, and other cardiovascular parameters. This paper presents a comprehensive analysis of the modality at different arterial (ulnar, radial, tibial, and carotid arteries) and thoracic (side-rib cage and top thoracolumbar fascia) body regions and offers insights into the effectiveness of capturing various cardiac and respiratory activities. Methods: We assess the bioimpedance performance in estimating inter-beat (IBI) and inter -breath intervals (IBrI) on six-hours of data acquired in a pilot-study from five healthy participants at rest. Results: Overall, we achieve mean errors as low as 0.003 ± 0.002 and 0.67 ± 0.28 seconds for IBI and IBrI estimations, respectively. Conclusions: The results show that bioimpedance can be effectively used to monitor cardiac and respiratory activities both at limbs and upper body and demonstrate a strong potential to be adopted by wearables that aim to provide high-fidelity physiological sensing to address precision medicine needs.

Fabrication, characterization and applications of graphene electronic tattoos

Numerous fields of science and technology, including healthcare, robotics and bioelectronics, have begun to switch their research direction from developing 'high-end, high-cost' tools towards 'high-end, low-cost' solutions. Graphene electronic tattoos (GETs), whose fabrication protocol is discussed in this work, are ideal building blocks of future wearable technology due to their outstanding electromechanical properties. The GETs are composed of high-quality, large-scale graphene that is transferred onto tattoo paper, resulting in an electronic device that is applied onto skin like a temporary tattoo. Here, we provide a comprehensive GET fabrication protocol, starting from graphene growth and ending with integration onto human skin. The methodology presented is unique since it utilizes high-quality electronic-grade graphene, while the processing is done by using low-cost and off-the-shelf methods, such as a mechanical cutter plotter. The GETs can be either used in combination with advanced scientific equipment to perform precision experiments, or with low-cost electrophysiology boards, to conduct similar operations from home. In this protocol, we showcase how GETs can be applied onto the human body and how they can be used to obtain a variety of biopotentials, including electroencephalogram (brain waves), electrocardiogram (heart activity), electromyogram (muscle activity), as well as monitoring of body temperature and hydration. With graphene available from commercial sources, the whole protocol consumes ~3 h of labor and does not require highly trained personnel. The protocol described in this work can be readily replicated in simple laboratories, including high school facilities.

Multipurpose and Reusable Ultrathin Electronic Tattoos Based on PtSe2 and PtTe2

Wearable bioelectronics with emphasis on the research and development of advanced person-oriented biomedical devices have attracted immense interest in the past decade. Scientists and clinicians find it essential to utilize skin-worn smart tattoos for on-demand and ambulatory monitoring of an individual's vital signs. Here, we report on the development of ultrathin platinum-based two-dimensional dichalcogenide (Pt-TMDs)-based electronic tattoos as advanced building blocks of future wearable bioelectronics. We made these ultrathin electronic tattoos out of large-scale synthesized platinum diselenide (PtSe₂) and platinum ditelluride (PtTe₂) layered materials and used them for monitoring human physiological vital signs, such as the electrical activity of the heart and the brain, muscle contractions, eye movements, and temperature. We show that both materials can be used for these applications; yet, PtTe₂ was found to be the most suitable choice due to its metallic structure. In terms of sheet resistance, skin contact, and electrochemical impedance, PtTe₂ outperforms state-of-the-art gold and graphene electronic tattoos and performs on par with medical-grade Ag/AgCl gel electrodes. The PtTe₂ tattoos show 4 times lower impedance and almost 100 times lower sheet resistance compared to monolayer graphene tattoos. One of the possible prompt implications of this work is perhaps in the development of advanced human-machine interfaces. To display the application, we built a multi-tattoo system that can easily distinguish eye movement and identify the direction of an individual's sight.

Pulse Wave Modeling Using Bio-Impedance Simulation Platform Based on a 3D Time-Varying Circuit Model

Cardiovascular disease (CVD) threatens the lives of many and affects their productivity. Wearable sensors can enable continuous monitoring of hemodynamic parameters to improve the diagnosis and management of CVD. Bio-Impedance (Bio-Z) is an effective non-invasive sensor for arterial pulse wave monitoring based on blood volume changes in the artery due to the deep penetration of its current signal inside the tissue. However, the measured data are significantly affected by the placement of electrodes relative to the artery and the electrode configuration. In this work, we created a Bio-Z simulation platform that models the tissue, arterial pulse wave, and Bio-Z sensing configuration using a 3D circuit model based on a time-varying impedance grid. A new method is proposed to accurately simulate the different tissue types such as blood, fat, muscles, and bones in a 3D circuit model in addition to the pulsatile activity of the arteries through a variable impedance model. This circuit model is simulated in SPICE and can be used to guide design decisions (i.e. electrode placement relative to the artery and electrode configuration) to optimize the monitoring of pulse wave prior to experimentation. We present extensive simulations of the arterial pulse waveform for different sensor locations, electrode sizes, current injection frequencies, and artery depths. These simulations are validated by experimental Bio-Z measurements.

Wearable Sensors Incorporating Compensatory Reserve Measurement for Advancing Physiological Monitoring in Critically Injured Trauma Patients

Vital signs historically served as the primary method to triage patients and resources for trauma and emergency care, but have failed to provide clinically-meaningful predictive information about patient clinical status. In this review, a framework is presented that focuses on potential wearable sensor technologies that can harness necessary electronic physiological signal integration with a current state-of-the-art predictive machine-learning algorithm that provides early clinical assessment of hypovolemia status to impact patient outcome. The ability to study the physiology of hemorrhage using a human model of progressive central hypovolemia led to the development of a novel machine-learning algorithm known as the compensatory reserve measurement (CRM). Greater sensitivity, specificity, and diagnostic accuracy to detect hemorrhage and onset of decompensated shock has been demonstrated by the CRM when compared to all standard vital signs and hemodynamic variables. The development of CRM revealed that continuous measurements of changes in arterial waveform features represented the most integrated signal of physiological compensation for conditions of reduced systemic oxygen delivery. In this review, detailed analysis of sensor technologies that include photoplethysmography, tonometry, ultrasound-based blood pressure, and cardiogenic vibration are identified as potential candidates for harnessing arterial waveform analog features required for real-time calculation of CRM. The integration of wearable sensors with the CRM algorithm provides a potentially powerful medical monitoring advancement to save civilian and military lives in emergency medical settings.

Wireless, Artefact Aware Impedance Sensor Node for Continuous Bio-Impedance Monitoring

Body bio-impedance is a unique parameter to monitor changes in body composition non-invasively. Continuous measurement of bio-impedance can track changes in body fluid content and cell mass and has widespread applications for physiological monitoring. State-of-the-art implementation of bio-impedance sensor devices is still limited for continuous use, in part, due to artefacts arising at the skin-electrode (SE) interface. Artefacts at the SE interface may arise due to various factors such as motion, applied pressure on the electrode surface, changes in ambient conditions or gradual drying of electrodes. This paper presents a novel bio-impedance sensor node that includes an artefact aware method for bio-impedance measurement. The sensor node enables autonomous and continuous measurement of bio-impedance and SE contact impedance at ten frequencies between 10 kHz to 100 kHz to detect artefacts at the SE interface. Experimental evaluation with SE contact impedance models using passive 2R1C electronic circuits and also with non-invasive in vivo measurements of SE contact impedance demonstrated high accuracy (with maximum error less than 1.5%) and precision of 0.6 Ω. The ability to detect artefacts caused by motion, vertically applied pressure and skin temperature changes was analysed in proof of concept experiments. Low power sensor node design achieved with 50mW in active mode and only 143 μW in sleep mode estimated a battery life of 90 days with a 250 mAh battery and duty-cycling impedance measurements every 60 seconds. Our method for artefact aware bio-impedance sensing is a step towards autonomous and unobtrusive continuous bio-impedance measurement for health monitoring at-home or in clinical environments.