Skin-electrode impedance and its effect on recording cardiac potentials

Facile Fabrication of "Tacky", Stretchable, and Aligned Carbon Nanotube Sheet-Based Electronics for On-Skin Health Monitoring

Point-of-care monitoring of physiological signals such as electrocardiogram, electromyogram, and electroencephalogram is essential for prompt disease diagnosis and quick treatment, which can be realized through advanced skin-worn electronics. However, it is still challenging to design an intimate and nonrestrictive skin-contact device for physiological measurements with high fidelity and artifact tolerance. This research presents a facile method using a "tacky" surface to produce a tight interface between the ACNT skin-like electronic and the skin. The method provides the skin-worn electronic with a stretchability of up to 70% strain, greater than that of most common epidermal electrodes. Low-density ACNT bundles facilitate the infiltration of adhesive and improve the conformal contact between the ACNT sheet and the skin, while dense ACNT bundles lessen this effect. The stretchability and conformal contact allow the ACNT sheet-based electronics to create a tight interface with the skin, which enables the high-fidelity measurement of physiological signals (the Pearson's coefficient of 0.98) and tolerance for motion artifacts. In addition, our method allows the use of degradable substrates to enable reusability and degradability of the electronics based on ACNT sheets, integrating "green" properties into on-skin electronics.

Combining transcutaneous interferential-current for nerve inhibition with a robotic assistant device for increasing ankle dorsiflexion in walking

BACKGROUND

A kilohertz-frequency alternating current transcutaneously applied was introduced as a novel neuromodulation technology for nerve inhibition innervating antagonist muscles. Combining this electrical nerve inhibition with a robotic assistance device has been proposed but not investigated.

RESEARCH QUESTION

This study aimed to demonstrate the effect of combining electrical nerve inhibition with a wearable robotic device on increasing ankle dorsiflexion during walking. We hypothesized that the wearable robotic device would elicit a greater ankle dorsiflexion angle with the same force in walking by applying the transcutaneous interferential-current nerve inhibition (TINI) technique to the tibial nerve.

METHODS

Eleven healthy young adults performed three experimental conditions. The ankle assistance (AA) condition was walking while wearing an ankle device with operating dorsiflexion assistance during pre-swing and swing phases. For the ankle assistance with electrical stimulation (AE) condition, TINI on the tibial nerve was additionally applied from the AA condition. In the ankle non-assistance (AN) condition, participants wore the device, but assistance was not provided. The joint angles during walking were measured and digitized through a motion analysis system.

RESULTS

During a gait cycle, immediate changes in ankle joint motions were observed in the sagittal plane. In the pre-swing phase, ankle dorsiflexion angle was significantly greater in AE condition than AA and AN. There was no significant difference in joint angle between AA and AN.

SIGNIFICANCE

This study demonstrates the effectiveness of combining TINI with a wearable robotic ankle device in increasing dorsiflexion angle during the pre-swing phase. This finding provides the feasibility of using TINI as a neuromodulation technique for assisting functional movement in human walking.

Finite velocity of ECG signal propagation: preliminary theory, results of a pilot experiment and consequences for medical diagnosis

A satisfactory model of the biopotentials propagating through the human body is essential for medical diagnostics, particularly for cardiovascular diseases. In our study, we develop the theory, that the propagation of biopotential of cardiac origin (ECG signal) may be treated as the propagation of low-frequency endogenous electromagnetic wave through the human body. We show that within this approach, the velocity of the ECG signal can be theoretically estimated, like for any other wave and physical medium, from the refraction index of the tissue in an appropriate frequency range. We confirm the theoretical predictions by the comparison with a direct measurement of the ECG signal propagation velocity and obtain mean velocity as low as v=1500 m/s. The results shed new light on our understanding of biopotential propagation through living tissue. This propagation depends on the frequency band of the signal and the transmittance of the tissue. This finding may improve the interpretation of the electric measurements, such as ECG and EEG when the frequency dependence of conductance and the phase shift introduced by the tissue is considered. We have shown, that the ECG propagation modifies the amplitude and phase of signal to a considerable extent. It may also improve the convergence of inverse problem in electrocardiographic imaging.

A Mass-Producible Washable Smart Garment with Embedded Textile EMG Electrodes for Control of Myoelectric Prostheses: A Pilot Study

Electromyography (EMG) is the resulting electrical signal from muscle activity, commonly used as a proxy for users' intent in voluntary control of prosthetic devices. EMG signals are recorded with gold standard Ag/AgCl gel electrodes, though there are limitations in continuous use applications, with potential skin irritations and discomfort. Alternative dry solid metallic electrodes also face long-term usability and comfort challenges due to their inflexible and non-breathable structures. This is critical when the anatomy of the targeted body region is variable (e.g., residual limbs of individuals with amputation), and conformal contact is essential. In this study, textile electrodes were developed, and their performance in recording EMG signals was compared to gel electrodes. Additionally, to assess the reusability and robustness of the textile electrodes, the effect of 30 consumer washes was investigated. Comparisons were made between the signal-to-noise ratio (SNR), with no statistically significant difference, and with the power spectral density (PSD), showing a high correlation. Subsequently, a fully textile sleeve was fabricated covering the forearm, with 14 textile electrodes. For three individuals, an artificial neural network model was trained, capturing the EMG of 7 distinct finger movements. The personalized models were then used to successfully control a myoelectric prosthetic hand.

Characterization of Ag/AgCl Dry Electrodes for Wearable Electrophysiological Sensing

With the rising need for on-body biometric sensing, the development of wearable electrophysiological sensors has been faster than ever. Surface electrodes placed on the skin need to be robust in order to measure biopotentials from the body reliably and comfortable for extended wearability. The electrical stability of nonpolarizable silver/silver chloride (Ag/AgCl) and its low-cost, commercial production have made these electrodes ubiquitous health sensors in the clinical environment, where wet gels and long wires are accommodated by patient immobility. However, smaller, dry electrodes with wireless acquisition are essential for truly wearable, continuous health sensing. Currently, techniques for the robust fabrication of custom Ag/AgCl electrodes are lacking. Here, we present three methods for the fabrication of Ag/AgCl electrodes: oxidizing Ag in a chlorine solution, electroplating Ag, and curing Ag/AgCl ink. Each of these methods is then used to create three different electrode shapes for wearable application. Bench-top and on-body evaluation of the electrode techniques was achieved by electrochemical impedance spectroscopy (EIS), calculation of variance in electrocardiogram (ECG) measurements, and analysis of auditory steady-state response (ASSR) measurement. Microstructures produced on the electrode by each fabrication technique were also investigated with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). The custom Ag/AgCl electrodes were found to be efficient in comparison with standard, commercial Ag/AgCl wet electrodes across all three of our presented techniques, with Ag/AgCl ink shown to be the better out of the three in bench-top and biometric recordings.

Comparison of silver-plated nylon (Ag/PA66) e-textile and Ag/AgCl electrodes for bioelectrical impedance analysis (BIA)

Recently, researchers have adapted Bioelectrical Impedance Analysis (BIA) as a new approach to objectively monitor wounds. They have indicated various BIA parameters associated to specific wound types can be linked to wound healing through trend analysis relative to time. However, these studies are conducted using wet electrodes which have been identified as possessing several shortcomings, such as unstable measurements. Thus, the adaption of e-textile electrodes has become an area of interest in measuring biosignals. E-textile electrodes are known to possess a significantly large polarization impedance (Z_p) that potentially influences these biosignal measurements. In this study we aim to identify the suitability of e-textile electrodes to monitor wounds using BIA methodologies. By adapting suggested methodologies conducted in-vivo from previous studies, we used an ex-vivo model to observe the behaviour of e-textile electrodes relative to time. This was compared to common clinical wet electrodes, specifically Ag/AgCl. The objective of this study was to identify the BIA parameters that can be used to monitor wounds with e-textile electrodes. By analysing the BIA parameters relative to time, we observed the influence ofZ_pon these parameters.

Wearable 3-Lead Electrocardiogram Placement Model for Fleet Sizing of Medical Devices

BACKGROUND: Electrocardiography (ECG) provides valuable information on astronaut physiological and psychological health. ECG monitoring has been conducted during crewed missions since the beginning of human spaceflight and will continue during astronauts upcoming long-duration exploration missions (LDEMs) in support of automated health monitoring systems. ECG monitoring is traditionally performed in clinical environments with single-use, adhesive electrodes in a 3, 6, or 12-lead configuration placed by a trained clinician. In the space exploration environment, astronauts self-place electrodes without professional assistance. Wearable ECG systems are an attractive option for automated health monitoring, but electrode placement has not been quantified to a high enough degree to avoid artifacts within the data due to position changes. This variability presents challenges for physician-limited, autonomous health monitoring, so quantifying electrode placement is key in the development of reliable, wearable ECG monitoring systems.METHODS: We present a method of quantifying electrode placement for 3-lead, chest-mounted ECG using easy-to-measure, two-dimensional chest measurements.RESULTS: We find that male and female dimensions require different electrode positioning computations, but there is overlap in positioning between men and women. The distribution of electrodes vertical positions is wider than their horizontal positions.DISCUSSION: These results can be translated directly to ECG wearable design for the individual and for the size range and adjustability required for the astronaut fleet. Implementation of this method will improve the reliability in placement and fit of future wearables, increasing comfort and usability of these systems and subsequently augmenting autonomous health monitoring capabilities for exploration medicine.Arquilla K, Leary S, Webb AK, Anderson AP. Wearable 3-lead electrocardiogram placement model for fleet sizing of medical devices. Aerosp Med Hum Perform. 2020; 91(11):868875.

Woven electrocardiogram (ECG) electrodes for health monitoring in operational environments

Electrical signals produced within the human body can reveal information about a wide variety of physiological processes including physical activity, cardiac health, and psychological state. The industry standard for physiological signal detection is the use of adhesive electrodes that stick onto the skin. These electrodes can irritate the skin over long periods of time and are not reusable, making them a challenge for use in operational environments. Further, these electrodes often require gel to improve signal transduction, leading to changes in signal quality as these gels dry over time. Wearable sensors for operational environments should be comfortable, unobtrusive, and non-stigmatizing while maintaining signal quality high enough to allow the detection of health states. Here, we present the development and test of a set of woven textile electrodes of 8 different sizes for chest-mounted, 3-lead electrocardiogram (ECG) monitoring. Ten male subjects were tested with each of the woven electrode sizes and with one set of adhesive electrodes. A derived performance metric and signal-to-noise ratio were calculated for each set of electrodes for comparison between them. The smallest sized electrodes were found to be least effective, while the 6^th of the 8 sizes were found to be most effective.

Ultra-conformal drawn-on-skin electronics for multifunctional motion artifact-free sensing and point-of-care treatment

An accurate extraction of physiological and physical signals from human skin is crucial for health monitoring, disease prevention, and treatment. Recent advances in wearable bioelectronics directly embedded to the epidermal surface are a promising solution for future epidermal sensing. However, the existing wearable bioelectronics are susceptible to motion artifacts as they lack proper adhesion and conformal interfacing with the skin during motion. Here, we present ultra-conformal, customizable, and deformable drawn-on-skin electronics, which is robust to motion due to strong adhesion and ultra-conformality of the electronic inks drawn directly on skin. Electronic inks, including conductors, semiconductors, and dielectrics, are drawn on-demand in a freeform manner to develop devices, such as transistors, strain sensors, temperature sensors, heaters, skin hydration sensors, and electrophysiological sensors. Electrophysiological signal monitoring during motion shows drawn-on-skin electronics' immunity to motion artifacts. Additionally, electrical stimulation based on drawn-on-skin electronics demonstrates accelerated healing of skin wounds.

Recent Advances in Flexible and Stretchable Sensing Systems: From the Perspective of System Integration

Biological signals generated during various biological processes are critically important for providing insight into the human physiological status. Recently, there have been many great efforts in developing flexible and stretchable sensing systems to provide biological signal monitoring platforms with intimate integration with biological surfaces. Here, this review summarizes the recent advances in flexible and stretchable sensing systems from the perspective of electronic system integration. A comprehensive general sensing system architecture is described, which consists of sensors, sensor interface circuits, memories, and digital processing units. The subsequent content focuses on the integration requirements and highlights some advanced progress for each component. Next, representative examples of flexible and stretchable sensing systems for electrophysiological, physical, and chemical information monitoring are introduced. This review concludes with an outlook on the remaining challenges and opportunities for future fully flexible or stretchable sensing systems.

Understanding the Washing Damage to Textile ECG Dry Skin Electrodes, Embroidered and Fabric-Based; set up of Equivalent Laboratory Tests

Reliability and washability are major hurdles facing the e-textile industry nowadays. The main fear behind the product's rejection is the inability to ensure its projected life span. The durability of e-textiles is based on an approximate lifetime of both the electronics and textiles integrated into the product. A detailed analysis of the wash process and the possibility of predicting product behavior are key factors for new standards implementation. This manuscript is focused on the washability issues of different types of woven, knitted, and embroidered, textile-based ECG electrodes. These electrodes are used without the addition of any ionic gel to the skin to reduce impedance. They were subjected to up to 50 wash cycles with two different types of wash processes, and changes in surface resistance, as well as the quality of ECG waves, were observed To investigate the wash damages in detail, the proposed mechanical (Martindale and Pilling box) and chemical test methods were investigated. The electrodes which increased resistance after washing showed the same trend in the proposed test methods. Copper-based electrodes suffered the most severe damage and increased resistance, as was also visible in an SEM analysis. These proposed test methods can be used to predict robustness behavior without washing.

Textile Electrocardiogram (ECG) Electrodes for Wearable Health Monitoring

Wearable health-monitoring systems should be comfortable, non-stigmatizing, and able to achieve high data quality. Smart textiles with electronic elements integrated directly into fabrics offer a way to embed sensors into clothing seamlessly to serve these purposes. In this work, we demonstrate the feasibility of electrocardiogram (ECG) monitoring with sewn textile electrodes instead of traditional gel electrodes in a 3-lead, chest-mounted configuration. The textile electrodes are sewn with silver-coated thread in an overlapping zig zag pattern into an inextensible fabric. Sensor validation included ECG monitoring and comfort surveys with human subjects, stretch testing, and wash cycling. The electrodes were tested with the BIOPAC MP160 ECG data acquisition module. Sensors were placed on 8 subjects (5 males and 3 females) with double-sided tape. To detect differences in R peak detectability between traditional and sewn sensors, effect size was set at 10% of a sample mean for heart rate (HR) and R-R interval. Paired student's t-tests were run between adhesive and sewn electrode data for R-R interval and average HR, and a Wilcoxon signed-rank test was run for comfort. No statistically significant difference was found between the traditional and textile electrodes (R-R interval: t = 1.43, p > 0.1; HR: t = - 0.70, p > 0.5; comfort: V = 15,p > 0.5).

Transcutaneous high-frequency alternating current for rapid reversible muscle force reduction below pain threshold

OBJECTIVE

The development of non-invasive, quickly reversible techniques for controlling undesired muscle force production (e.g. spasticity) could expand rehabilitation approaches in those with pathology by increasing the type and intensity of exercises that can be performed. High-frequency alternating current (HFAC) has been previously established as a viable method for blocking neural conduction in peripheral nerves. However, clinical application of HFAC for nerve conduction block is limited due to the invasiveness of surgical procedures and the painful onset response. This study aimed to examine the use of transcutaneous HFAC (tHFAC) at various stimulation frequencies to address these shortfalls.

APPROACH

Ten individuals participated in the study. Surface electrodes were utilized to apply tHFAC (0.5-12 kHz) to the median and ulnar nerves. Individual pain threshold was determined by gradual increase of stimulation amplitude. Subjects then performed a force-matching task by producing grip forces up to the maximal voluntary contraction level with and without application of tHFAC below the pain threshold.

MAIN RESULTS

Pain threshold current amplitude increased linearly with stimulation frequency. Statistical analysis showed that both stimulation frequency and charge injected per phase had significant effects (p   <  0.05) on grip force reduction. At the group level, application of tHFAC below pain threshold reduced grip force by a maximum of 40.7%  ±  8.1%. Baseline grip force trials interspersed between tHFAC trials showed consistent grip force, indicating that fatigue was not a factor in force reduction.

SIGNIFICANCE

Our results demonstrate the effectiveness of tHFAC at reducing muscle force when applied below the pain threshold, suggesting its potential clinical viability. Future studies are necessary to further elucidate the mechanism of force reduction before clinical application.

Optimal combination of electrodes and conductive gels for brain electrical impedance tomography

BACKGROUND

Electrical impedance tomography (EIT) is an emerging imaging technology that has been used to monitor brain injury and detect acute stroke. The time and frequency properties of electrode-skin contact impedance are important for brain EIT because brain EIT measurement is performed over a long period when used to monitor brain injury, and is carried out across a wide range of frequencies when used to detect stroke. To our knowledge, no study has simultaneously investigated the time and frequency properties of both electrode and conductive gel for brain EIT.

METHODS

In this study, the contact impedance of 16 combinations consisting of 4 kinds of clinical electrode and five types of commonly used conductive gel was measured on ten volunteers' scalp for a period of 1 h at frequencies from 100 Hz to 1 MHz using the two-electrode method. And then the performance of each combination was systematically evaluated in terms of the magnitude of contact impedance, and changes in contact impedance with time and frequency.

RESULTS

Results showed that combination of Ag⁺/Ag⁺Cl^- powder electrode and low viscosity conductive gel performed best overall (Ten 20^® in this study); it had a relatively low magnitude of contact impedance and superior performance regarding contact impedance with time (p < 0.05) and frequency (p < 0.05).

CONCLUSIONS

Experimental results indicates that the combination of Ag⁺/Ag⁺Cl^- powder electrode and low viscosity conductive gel may be the best choice for brain EIT.

Technical development of transcutaneous electrical nerve inhibition using medium-frequency alternating current

Background

Innovative technical approaches to controlling undesired sensory and motor activity, such as hyperalgesia or spasticity, may contribute to rehabilitation techniques for improving neural plasticity in patients with neurologic disorders. To date, transcutaneous electrical stimulation has used low frequency pulsed currents for sensory inhibition and muscle activation. Yet, few studies have attempted to achieve motor nerve inhibition using transcutaneous electrical stimulation. This study aimed to develop a technique for transcutaneous electrical nerve inhibition (TENI) using medium-frequency alternating current (MFAC) to suppress both sensory and motor nerve activity in humans.

Methods

Surface electrodes were affixed to the skin of eight young adults to stimulate the median nerve. Stimulation intensity was increased up to 50% and 100% of the pain threshold. To identify changes in sensory perception by transcutaneous MFAC (tMFAC) stimulation, we examined tactile and pressure pain thresholds in the index and middle fingers before and after stimulation at 10 kHz. To demonstrate the effect of tMFAC stimulation on motor inhibition, stimulation was applied while participants produced flexion forces with the index and middle fingers at target forces (50% and 90% of MVC, maximum voluntary contraction).

Results

tMFAC stimulation intensity significantly increased tactile and pressure pain thresholds, indicating decreased sensory perception. During the force production task, tMFAC stimulation with the maximum intensity immediately reduced finger forces by ~ 40%. Finger forces recovered immediately after stimulation cessation. The effect on motor inhibition was greater with the higher target force (90% MVC) than with the lower target (50% MVC). Also, higher tMFAC stimulation intensity provided a greater inhibition effect on both sensory and motor nerve activity.

Conclusion

We found that tMFAC stimulation immediately inhibits sensory and motor activity. This pre-clinical study demonstrates a novel technique for TENI using MFAC stimulation and showed that it can effectively inhibit both sensory perception and motor activity. The proposed technique can be combined with existing rehabilitation devices (e.g., a robotic exoskeleton) to inhibit undesired sensorimotor activities and to accelerate recovery after neurologic injury.

Increased Conductivity and Reduced Settling Time of Carbon-Based Electrodes By Addition of Sea Salt for Wearable Application

A carbon-based dry electrode is designed to measure bio-potential from skin surface without hydrogel. Consequently, unlike Ag/AgCl electrodes, the carbon-based electrodes require some settling time before a high-fidelity signal is obtained due to the process for impedance matching among skin surface, electrode and amplifiers in biometric system. Besides, especially, when electrocardiogram (ECG) is measured at some distance away from the chest using carbon-based electrodes for wearable application, the settling time could be a critical concern for immediate data collection due to the smaller bio-potential and bigger motion artifact noises. The settling time was defined as the time it takes for the carbon-based electrodes to have the same impedance as that of Ag/AgCl electrodes at a particular frequency (< 1 kHz) for bio-signals. In this study, we investigated the characteristics of the skin contact impedance as a function of time using carbon-based electrodes with and without sea salt and different thickness. Specifically, sea salt was added to the carbon black (SCB)/polydimethlysiloxane (PDMS) electrode to examine the level of enhanced conductivity and reduction of settling time. We used SCB/PDMS and CB/PDMS electrodes with thickness of 1.0 mm and 1.5 mm, examined their electrode and skin contact impedance values and compared them to Ag/AgCl electrodes. We collected impedance data from seven subjects using both SCB and CB/PDMS electrodes every 10 minutes for 50 minutes. A SCB/PDMS electrode showed lower impedance than a CB/PDMS electrode, and for both types of electrodes, higher thickness resulted in lower impedance. The same results were found for skin contact impedance. The settling times of the SCB/PDMS electrodes were found to be $20 \pm 10$ minutes and $40 \pm 10$ minutes for widths of 1.0 mm and 1.5 mm, respectively. The settling time for CB/PDMS without sea salt resulted in significantly higher settling time (> 50 minutes) when compared to SCB/PDMS electrodes. In summary, when carbon-based electrodes are used to measure bio-signals from skin surface for wearable application, its settling time can be partially offset by adding sea salt to CB/PDMS electrode and by making it thinner.

Estimation of Finger Joint Angles Based on Electromechanical Sensing of Wrist Shape

An approach to finger motion capture that places fewer restrictions on the usage environment and actions of the user is an important research topic in biomechanics and human-computer interaction. We proposed a system that electrically detects finger motion from the associated deformation of the wrist and estimates the finger joint angles using multiple regression models. A wrist-mounted sensing device with 16 electrodes detects deformation of the wrist from changes in electrical contact resistance at the skin. In this study, we experimentally investigated the accuracy of finger joint angle estimation, the adequacy of two multiple regression models, and the resolution of the estimation of total finger joint angles. In experiments, both the finger joint angles and the system output voltage were recorded as subjects performed flexion/extension of the fingers. These data were used for calibration using the least-squares method. The system was found to be capable of estimating the total finger joint angle with a root-mean-square error of 29-34 degrees. A multiple regression model with a second-order polynomial basis function was shown to be suitable for the estimation of all total finger joint angles, but not those of the thumb.

Comparison of the spatial QRS-T angle derived from digital ECGs recorded using conventional electrode placement with that derived from Mason-Likar electrode position

BACKGROUND

The spatial QRS-T angle is ideally derived from orthogonal leads. We compared the spatial QRS-T angle derived from orthogonal leads reconstructed from digital 12-lead ECGs and from digital Holter ECGs recorded with the Mason-Likar (M-L) electrode positions.

METHODS AND RESULTS

Orthogonal leads were constructed by the inverse Dower method and used to calculate spatial QRS-T angle by (1) a vector method and (2) a net amplitude method, in 100 volunteers. Spatial QRS-T angles from standard and M-L ECGs differed significantly (57°±18° vs 48°±20° respectively using net amplitude method and 53°±28° vs 48°±23° respectively by vector method; p<0.001). Difference in amplitudes in leads V4-V6 was also observed between Holter and standard ECGs, probably due to a difference in electrical potential at the central terminal.

CONCLUSION

Mean spatial QRS-T angles derived from standard and M-L lead systems differed by 5°-9°. Though statistically significant, these differences may not be clinically significant.

Finger motion capture from wrist-electrode contact resistance

Hand motion capture is an important yet challenging topic for biomechanics and human computer interaction. We proposed a novel electrical sensing technology for capturing the finger angles from the variation of the wrist shape. The proposed device detects the signal related to the wrist-electrode contact resistances, which change according to the variation of the wrist shape accompanying finger movements. The developed sensing device consists of a wrist band, sixteen electrodes and a sensing circuit of contact resistances. We investigated the relationships between the finger angles and the system outputs by using a glove-type joint angle sensor. As a result, we confirmed high correlations of the system outputs with the finger angles for several electrodes. Therefore, we conclude that the proposed system can be used for the estimation of the finger joint angles.

A high-density nanowire electrode on paper for biomedical applications

Different types of nanowires made from platinum, nickel and copper are fabricated and patterned with microscale resolution on paper substrates and employed for biomedical applications.

Saturation of the right-leg drive amplifier in low-voltage ECG monitors

Electrocardiogram (ECG) monitoring is a critical tool in patient care, but its utility is often balanced with frustration from clinicians who are constantly distracted by false alarms. This has motivated the need to readdress the major factors that contribute to ECG noise with the goal of reducing false alarms. In this study, we describe a previously unreported phenomenon in which ECG noise can result from an unintended interaction between two systems: 1) the dc lead-off circuitry that is used to detect whether electrodes fall off the patient; and 2) the right-leg drive (RLD) system that is responsible for reducing ac common-mode noise that couples into the body. Using a circuit model to study this interaction, we found that in the presence of a dc lead-off system, even moderate increases in the right-leg skin-electrode resistance can cause the RLD amplifier to saturate. Such saturation can produce ECG noise because the RLD amplifier will no longer be capable of attenuating ac common-mode noise on the body. RLD saturation is particularly a problem for modern ECG monitors that use low-voltage supply levels. For example, for a 12-lead ECG and a 2 V power supply, saturation will occur when the right-leg electrode resistance reaches only 2 MΩ. We discuss several design solutions that can be used in low-voltage monitors to avoid RLD saturation.

Dry electrodes for electrocardiography

Patient biopotentials are usually measured with conventional disposable Ag/AgCl electrodes. These electrodes provide excellent signal quality but are irritating for long-term use. Skin preparation is usually required prior to the application of electrodes such as shaving and cleansing with alcohol. To overcome these difficulties, researchers and caregivers seek alternative electrodes that would be acceptable in clinical and research environments. Dry electrodes that operate without gel, adhesive or even skin preparation have been studied for many decades. They are used in research applications, but they have yet to achieve acceptance for medical use. So far, a complete comparison and evaluation of dry electrodes is not well described in the literature. This work compares dry electrodes for biomedical use and physiological research, and reviews some novel systems developed for cardiac monitoring. Lastly, the paper provides suggestions to develop a dry-electrode-based system for mobile and long-term cardiac monitoring applications.

Effect of pressure and padding on motion artifact of textile electrodes

BACKGROUND

With the aging population and rising healthcare costs, wearable monitoring is gaining importance. The motion artifact affecting dry electrodes is one of the main challenges preventing the widespread use of wearable monitoring systems. In this paper we investigate the motion artifact and ways of making a textile electrode more resilient against motion artifact. Our aim is to study the effects of the pressure exerted onto the electrode, and the effects of inserting padding between the applied pressure and the electrode.

METHOD

We measure real time electrode-skin interface impedance, ECG from two channels, the motion artifact related surface potential, and exerted pressure during controlled motion by a measurement setup designed to estimate the relation of motion artifact to the signals. We use different foam padding materials with various mechanical properties and apply electrode pressures between 5 and 25 mmHg to understand their effect. A QRS and noise detection algorithm based on a modified Pan-Tompkins QRS detection algorithm estimates the electrode behaviour in respect to the motion artifact from two channels; one dominated by the motion artifact and one containing both the motion artifact and the ECG. This procedure enables us to quantify a given setup's susceptibility to the motion artifact.

RESULTS

Pressure is found to strongly affect signal quality as is the use of padding. In general, the paddings reduce the motion artifact. However the shape and frequency components of the motion artifact vary for different paddings, and their material and physical properties. Electrode impedance at 100 kHz correlates in some cases with the motion artifact but it is not a good predictor of the motion artifact.

CONCLUSION

From the results of this study, guidelines for improving electrode design regarding padding and pressure can be formulated as paddings are a necessary part of the system for reducing the motion artifact, and further, their effect maximises between 15 mmHg and 20 mmHg of exerted pressure. In addition, we present new methods for evaluating electrode sensitivity to motion, utilizing the detection of noise peaks that fall into the same frequency band as R-peaks.

Field distributions in the rat tibia with and without a porous implant during electrical stimulation: a parametric modeling

Expeditious post-operative ingrowth of bone is necessary for clinically successful fixation of porous joint prostheses. Electrical or electromagnetic fields to stimulate bone growth into porous implants have been used; however, they produced nonconvincing data. This was partially attributable to the lack of quantification of the localized electric fields produced in the pores of the implants. Therefore, this study set out: i) to quantify the local electric field values induced into the surface pores of nonconducting implants by "capacitive" coupling and to determine the magnitude of the macroscopically applied capacitively coupled electrical currents to induce specific electric field amplitudes in the pores, ii) to identify the important dielectric properties of the implant-tissue interface, and iii) to create the basis for successfully applying electrical fields in an animal model to stimulate bone ingrowth. A finite element method was used to calculate the electric field gradients and current densities present in a rat tibia modeled with a porous intramedullary implant when capacitively stimulated. Results indicated that while the current density in the pores are reduced in comparison to the region just outside the pore by about one order of magnitude, a significant current density still exists in the pore region. Furthermore, the presence of the implant increases the current densities in the trabecular bone while decreasing these values in the cortical bone. Replacing the trabecular bone in the pore by saline increases the current density in the pore by three-fold, but decreases the voltage gradient by a similar factor.

Effects of skin blood flow and temperature on skin--electrode impedance and offset potential: measurements at low alternating current density

Skin--electrode impedance was determined at 100 Hz and 1 kHz between two disposable electrodes, 5 cm apart, at current densities < 65 microA.cm-2. Measurements were made on the volar skin of the forearm during cooling on cardiopulmonary bypass, and on the dorsum of the foot in the absence of skin blood flow during aortic aneurysm repair. Both the resistive and reactive components of the skin-electrode impedence showed an inverse linear relationship to temperature between 26 and 36 degrees C. The magnitude of the impedance change was different for each patient studied; resistance changes ranged from 0.03 to 23.2 k omega. Degrees C-1 at 100 Hz and from 0.03 to 2.7 k omega. Degrees C-1 at 1 kHz, while reactance changes ranged from 0.4 to 2.1 k omega. Degrees C-1 at 100 Hz and from 0.04 to 0.18 k omega. Degrees C-1 at 1 kHz. Changes in skin-electrode impedance were not due to changes in skin blood flow. There was no consistent change in offset potential with temperature. Although the skin-electrode impedance increases as temperature falls, it is concluded that temperature effects at the skin-electrode interface are not responsible for the observed failure of evoked electromyography during clinical monitoring of neuromuscular function.

Theoretical determination of the current density distributions in human vertebral bodies during electrical stimulation

Electrical stimulation with a 60 kHz sinewave input signal, supplied via external plate electrodes on the skin surface, is presently being studied as a treatment for human systemic osteoporosis. In this paper, Maxwell's equations were solved for voltage and current density values at nodal points in a three-dimensional, anatomically-based, finite element grid model of the human trunk constructed from T5 to L5. Based on the dose response results from Luessenhop's castrated Sprague Dawley breeder rat experiment and our theoretical determination, the magnitude of the input current to the electrodes necessary to induce a response in the human vertebral body was determined. Four different electrode systems in current clinical use were evaluated, and the optimal input current determined. In addition, the effect of subcutaneous fat was studied.

Field distributions in vertebral bodies of the rat during electrical stimulation: a parametric study

The electrical field and current density distributions were found in the various tissues of a mathematical model of the experimental rat used to study systemic osteoporosis. The finite element method was used to solve the boundary value problem derived from Maxwell's equations using a quasistatic approximation for a 60 kHz external output signal applied via skin electrodes. A parametric study was done initially to determine the principle factors which effect the solution of the field in the vertebral bodies. Grid coarseness, model length, and intervertebral space width had little effect on the solution while trabecular bone and abdominal cavity conductivity values had strong effects. The two pair of transversely placed electrodes spaced by at least three vertebral bodies produced the most uniform field distributions and was used in the experimental rat model. The range of current density values in the trabecular bone was determined to be 3.0-5.0 microA/cm2 at the external output signal where evidence of a reversal of bone loss due to castration osteoporosis had been found in the experimental rat.

Precordial voltage variation in the normal electrocardiogram

Intra-individual precordial voltage variation was examined in serial 12 lead electrocardiograms (ECGs) performed at 10 minute and 24 hour intervals in sixteen young, healthy males forming two age matched groups. Significant variation was found in repeat ECGs at both periods. When precordial electrodes remained in situ between serial 10 minute recordings variation was reduced by approximately 60% We conclude that significant precordial voltage variation is present in serial electrocardiography, even when performed over the short term. Alteration in precordial electrode placement accounts for the major proportion of variation and this may be sufficiently large to interfere with the accurate interpretation of serial precordial voltage changes in an individual subject.

Effects of electrode area on electrocardiographic voltages

Effects of two different sizes of chest electrodes--100 and 750 mm2 area--on x and z Frank leads were determined using electrocardiographic data from 25 subjects. In most cases, differences in Rx and Rz were below 50 uV, but in nine cases (36%) differences exceeded this value for either Rx or Rz or both. In six cases, differences exceeded 100 uV. For an additional 20 subjects, standard precordial leads were recorded using the same two electrode sizes. QRS amplitudes were significantly affected for V4 but not for V1 or V6. Variability caused by electrode size is greater than that caused by beat-to-beat variation and is comparable to that found in day-to-day variation. Interchangeability of data among ECG recording laboratories can be significantly improved by standardizing electrode size for precordial electrodes.

The electrical characteristics of some commercial ECG electrodes

The impedance and offset potential of six disposable and two non-disposable electrodes were measured on 80 subjects. A total of 160 measurements were made on skin prepared by wiping with alcohol or acetone. For 640 measurements the skin was prepared by lightly sanding. The sanding of the skin reduced the impedance by a factor of approximately 50 for males and 100 for females. The offset potential for sanded skin was reduced by approximately 2. The performance of the disposable electrodes showed no great practical difference when applied on sanded skin. The median impedance ranged from 1500 to 3250 ohms. The median offset potential ranged from 0.5 to 4 mV. It was shown that a small DC current of 100 nA applied to stainless steel electrodes could cause a polarization voltage of approximately 0.5 volts to appear in 25 min.

3 and 12 lead electrocardiogram interpretation by computer. A comparison on 1093 patients

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