Wearable Technology for Monitoring Electrocardiograms (ECGs) in Adults: A Scoping Review.

In the rapidly evolving landscape of continuous electrocardiogram (ECG) monitoring systems, there is a heightened demand for non-invasive sensors capable of measuring ECGs and detecting heart rate variability (HRV) in diverse populations, ranging from cardiovascular patients to sports enthusiasts. Challenges like device accuracy, patient privacy, signal noise, and long-term safety impede the use of wearable devices in clinical practice. This scoping review aims to assess the performance and safety of novel multi-channel, sensor-based biopotential wearable devices in adults. A comprehensive search strategy was employed on four databases, resulting in 143 records and the inclusion of 12 relevant studies. Most studies focused on healthy adult subjects (n = 6), with some examining controlled groups with atrial fibrillation (AF) (n = 3), long QT syndrome (n = 1), and sleep apnea (n = 1). The investigated bio-sensor devices included chest-worn belts (n = 2), wrist bands (n = 2), adhesive chest strips (n = 2), and wearable textile smart clothes (n = 4). The primary objective of the included studies was to evaluate device performance in terms of accuracy, signal quality, comparability, and visual assessment of ECGs. Safety findings, reported in five articles, indicated no major side effects for long-term/continuous monitoring, with only minor instances of skin irritation. Looking forward, there are ample opportunities to enhance and test these technologies across various physical activity intensities and clinical conditions.

The effects of tissue proportions on blood volume change-induced variations using bio-impedance analysis: a simulation study.

Bioimpedance Analysis (BIA) along the radial artery has been widely investigated for hemodynamic monitoring. However, its applicability to different body type populations still lacks sufficient research. The Finite Element Method (FEM) was performed on three different wrist models using ANSYS HFSS, aiming to reveal the influences of different fat and muscle proportions on the sensitivity of blood volume change-induced bioimpedance change. The simulation results confirmed that the current density in each tissue mainly depended on the conductivity of tissues. The higher conductivity of the tissue, the higher current density inside said tissue. The amounts of flowing current were decided by both volume and conductivity of tissues. Moreover, increasing the fat layer thickness from 4 mm to 6 mm raised simulated impedance from 86.82 Ω to 100.39 Ω and impedance change from 0.63 Ω to 1.55 Ω. However, a higher muscle proportion occupied more injected current from the blood and resulted in lower impedance change. Therefore, for the overweight population, the placement of BIA is recommended to avoid the muscular body parts for the acquirement of better-quality pulse waves.Clinical Relevance-This establishes the bio-impedance analysis should avoid the muscular body parts for a better blood pulse wave quality for overweight populations.

A Pilot Study Examining the Dielectric Response of Human Forearm Tissues.

This work aims to describe the dielectric behaviors of four main tissues in the human forearm using mathematical modelling, including fat, muscle, blood and bone. Multi-frequency bioimpedance analysis (MF-BIA) was initially performed using the finite element method (FEM) with a 3D forearm model to estimate impedance spectra from 10 kHz to 1 MHz, followed by a pilot study involving two healthy subjects to characterize the response of actual forearm tissues from 1 kHz to 349 kHz. Both the simulation and experimental results were fitted to a single-dispersion Cole model (SDCM) and a multi-dispersion Cole model (MDCM) to determine the Cole parameters for each tissue. Cole-type responses of both simulated and actual human forearms were observed. A paired t-test based on the root mean squared error (RMSE) values indicated that both Cole models performed comparably in fitting both simulated and measured bioimpedance data. However, MDCM exhibited higher accuracy, with a correlation coefficient (R2) of 0.99 and 0.89, RMSE of 0.22 Ω and 0.56 Ω, mean difference (mean ± standard deviation) of 0.00 ± 0.23 Ω and -0.28 ± 0.23 Ω, and mean absolute error (MAE) of 0.0007 Ω and 0.2789 Ω for the real part and imaginary part of impedance, respectively. Determining the electrical response of multi-tissues can be helpful in developing physiological monitoring of an organ or a section of the human body through MF-BIA and hemodynamic monitoring by filtering out the impedance contributions from the surrounding tissues to blood-flow-induced impedance variations.

The Investigation of Bio-impedance Analysis at a Wrist Phantom with Two Pulsatile Arteries.

PURPOSE: Bio-impedance analysis (BIA) has been widely investigated for hemodynamic monitoring. However, previous works rarely modelled two synchronously pulsatile arteries (representing the radial and ulnar arteries) in the wrist/forearm model. This work aims to clarify and quantify the influences of two pulsatile arteries on BIA. METHODS: First, two blood-filled arteries were structured in a 3D wrist segment using the finite element method (FEM). Afterwards, an easy-to-produce two-arteries artificial wrist was fabricated with two components: gelatine-based surrounding tissue phantom and saline blood phantom. A syringe driver was utilised to constrict the arteries, and the impedance signals were measured using a Multi-frequency Impedance Analyser (MFIA). RESULTS: Both simulation and experimental results demonstrated the non-negligible influences of the ulnar artery on the overall BIA, inducing unwanted resistance changes to the acquired signals from the radial artery. The phantom experiments revealed the summation of the individual resistance changes caused by a single pulsatile artery was approximately equal to the measured resistance change caused by two synchronously pulsatile arteries, confirming the measured impedance signal at the wrist contains the pulsatile information from both arteries. CONCLUSION: This work is the first simulation and phantom investigation into two synchronously pulsatile arteries under BIA in the distal forearm, providing a better insight and understanding in the morphology of measured impedance signals. Future research can accordingly select either a small spacing 4-spot electrode configuration for a single artery sensing or a band electrode configuration for overall pulsatile arteries sensing. A more accurate estimation of blood volume change and pulse wave analysis (PWA) could help to develop cuffless blood pressure measurement (BPM).

A Hydrogel-Based Electronic Skin for Touch Detection Using Electrical Impedance Tomography.

Recent advancement in wearable and robot-assisted healthcare technology gives rise to the demand for smart interfaces that allow more efficient human-machine interaction. In this paper, a hydrogel-based soft sensor for subtle touch detection is proposed. Adopting the working principle of a biomedical imaging technology known as electrical impedance tomography (EIT), the sensor produces images that display the electrical conductivity distribution of its sensitive region to enable touch detection. The sensor was made from a natural gelatin hydrogel whose electrical conductivity is considerably less than that of human skin. The low conductivity of the sensor enabled a touch-detection mechanism based on a novel short-circuiting approach, which resulted in the reconstructed images being predominantly affected by the electrical contact between the sensor and fingertips, rather than the conventionally used piezoresistive response of the sensing material. The experimental results indicated that the proposed sensor was promising for detecting subtle contacts without the necessity of exerting a noticeable force on the sensor.

Comprehensive Understanding of Foot Development in Children Using Capacitive Textile Sensors.

Knowledge of foot growth can provide information on the occurrence of children's growth spurts and an indication of the time to buy new shoes. Podiatrists still do not have enough evidence as to whether footwear influences the structural development of the feet and associated locomotor behaviours. Parents are only willing to buy an inexpensive brand, because children's shoes are deemed expendable due to their rapid foot growth. Consumers are not fully aware of footwear literacy; thus, views of consumers on children's shoes are left unchallenged. This study aims to embed knitted smart textile sensors in children's shoes to sense the growth and development of a child's feet-specifically foot length. Two prototype configurations were evaluated on 30 children, who each inserted their feet for ten seconds inside the instrumented shoes. Capacitance readings were related to the proximity of their toes to the sensor and validated against foot length and shoe size. A linear regression model of capacitance readings and foot length was developed. This regression model was found to be statistically significant (p-value = 0.01, standard error = 0.08). Results of this study indicate that knitted textile sensors can be implemented inside shoes to get a comprehensive understanding of foot development in children.

The Development of a Built-In Shoe Plantar Pressure Measurement System for Children.

There is a rapid increase in plantar pressure from the infant to toddler stage, yet little is known about the reasons for this change. More information about plantar pressure distribution can help clinicians identify early-stage foot-related diseases that may occur during transitions from childhood to adulthood. This information also helps designers create shoes that adapt to different needs. This research describes the development of a low-cost, built-in shoe plantar pressure measurement system that determines foot pressure distribution in toddlers. The study aimed to improve and provide data on pressure distribution during foot growth. This was accomplished by implementing a plantar pressure capacitive measurement system within shoes. The capacitive sensors were laminated using a copper tape sheet on plastic backing with adhesive, elastomer layers, and a combination of conductive and non-conductive fabrics. Constructed sensors were characterized using compression tests with repeated loads. Results demonstrated that the sensors exhibited rate-independent hysteresis in the estimation of pressure. This enabled a calibration model to be developed. The system can mimic more expensive plantar pressure measurement systems at lower fidelity. This emerging technology could be utilized to aid clinicians, researchers, and footwear designers interested in how pressure distribution changes from infants to toddlers.

Towards Estimating Arterial Diameter Using Bioimpedance Spectroscopy: A Computational Simulation and Tissue Phantom Analysis.

This paper improves the accuracy of quantification in the arterial diameter-dependent impedance variance by altering the electrode configuration. The finite element analysis was implemented with a 3D human wrist fragment using ANSYS Electronics Desktop, containing fat, muscle, and a blood-filled radial artery. Then, the skin layer and bones were stepwise added, helping to understand the dielectric response of multi-tissues and blood flow from 1 kHz to 1 MHz, the current distribution throughout the wrist, and the optimisation of electrode configurations for arterial pulse sensing. Moreover, a low-cost wrist phantom was fabricated, containing two components: the surrounding tissue simulant (20 wt % gelatine power and 0.017 M sodium chloride (NaCl) solution) and the blood simulant (0.08 M NaCl solution). The blood-filled artery was constricted using a desktop injection pump, and the impedance change was measured by the Multi-frequency Impedance Analyser (MFIA). The simulation revealed the promising capabilities of band electrodes to generate a more uniform current distribution than the traditional spot electrodes. Both simulation and phantom experimental results indicated that a longer spacing between current-carrying (CC) electrodes with shorter spacing between pick-up (PU) electrodes in the middle could sense a more uniform electric field, engendering a more accurate arterial diameter estimation. This work provided an improved electrode configuration for more accurate arterial diameter estimation from the numerical simulation and tissue phantom perspectives.

A Flexible Strain Sensor Based on Embedded Ionic Liquid.

We present a simple-structured strain sensor based on a low-cost ionic liquid. The ionic liquid was made of sodium chloride/propylene glycol solution and was embedded in a linear microfluidic channel fabricated using Ecoflex. The proposed sensor is capable of measuring strain up to 100% with excellent repeatability. The highest gauge factor is obtained as 6.19 under direct current excitation and 3.40 under alternating current excitation at 1 kHz. The sensor shows negligible hysteresis and overshoot, and survived 10,000 rapid stretch-release cycles of a 100% peak strain with a minor deviation in the response signal. The sensor can be mounted to different locations on the human body and suits a variety of applications in the field of motion detection, human-machine interface and healthcare monitoring.

Bioimpedance analysis as a tool for hemodynamic monitoring: overview, methods and challenges.

Recent advances in hemodynamic monitoring have seen the advent of non-invasive methods which offer ease of application and improve patient comfort. Bioimpedance Analysis or BIA is one of the currently employed non-invasive techniques for hemodynamic monitoring. Impedance Cardiography (ICG), one of the implementations of BIA, is widely used as a non-invasive procedure for estimating hemodynamic parameters such as stroke volume (SV) and cardiac output (CO). Even though BIA is not a new diagnostic technique, it has failed to gain consensus as a reliable measure of hemodynamic parameters. Several devices have emerged for estimating CO using ICG which are based on evolving methodologies and techniques to calculate SV. However, the calculations are generally dependent on the electrode configurations (whole body, segmental or localised) as well as the accuracy of different techniques in tracking blood flow changes. Blood volume changes, concentration of red blood cells, pulsatile velocity profile and ambient temperature contribute to the overall conductivity of blood and hence its impedance response during flow. There is a growing interest in investigating limbs for localised BIA to estimate hemodynamic parameters such as pulse wave velocity. As such, this paper summarises the current state of hemodynamic monitoring through BIA in terms of different configurations and devices in the market. The conductivity of blood flow has been emphasized with contributions from both volume and velocity changes during flow. Recommendations for using BIA in hemodynamic monitoring have been mentioned highlighting the suitable range of frequencies (1 kHz-1 MHz) as well as safety considerations for a BIA setup. Finally, current challenges in using BIA such as geometry assumption and inaccuracies have been discussed while mentioning potential advantages of a multi-frequency analysis to cover all the major contributors to blood's impedance response during flow.

Tissue phantom to mimic the dielectric properties of human muscle within 20 Hz and 100 kHz for biopotential sensing applications.

Tissue-mimicking materials for phantoms are fabricated for research purposes to simulate the mechanical or electrical properties of real human tissues and promote better understanding of their properties. This research investigated the dielectric properties (from 20 Hz to 100 kHz) of five promising muscle mimicking materials including matrix materials (gelatin powder and agar powder), and fillers (sodium chloride, glycine and aluminum powder) for the development of muscle phantoms. The mechanical behaviors were verified as well. This research determined the effects of electrode polarization (EP) on the dielectric properties of each material and then used a mathematical model to reduce these unwanted effects. Additionally, the results indicated the very low dielectric properties of gels-only samples. Both electrical conductivity and relative permittivity increased with increasing concentrations of fillers. Moreover, all fillers had their own capabilities to alter the levels and trends in the increments of dielectric values, which provide a wider selection to muscle-mimicking materials. Theoretically, it is feasible to achieve desired dielectric properties by mixing these fillers together with certain ratios. In this way, low-cost muscle phantoms can be produced and used as experimental subjects for biopotential sensing application.