Advanced Signal Processing in Wearable Sensors for Health Monitoring

Smart, wearables devices on a miniature scale are becoming increasingly widely available, typically in the form of smart watches and other connected devices. Consequently, devices to assist in measurements such as electroencephalography (EEG), electrocardiogram (ECG), electromyography (EMG), blood pressure (BP), photoplethysmography (PPG), heart rhythm, respiration rate, apnoea, and motion detection are becoming more available, and play a significant role in healthcare monitoring. The industry is placing great emphasis on making these devices and technologies available on smart devices such as phones and watches. Such measurements are clinically and scientifically useful for real-time monitoring, long-term care, and diagnosis and therapeutic techniques. However, a pertaining issue is that recorded data are usually noisy, contain many artefacts, and are affected by external factors such as movements and physical conditions. In order to obtain accurate and meaningful indicators, the signal has to be processed and conditioned such that the measurements are accurate and free from noise and disturbances. In this context, many researchers have utilized recent technological advances in wearable sensors and signal processing to develop smart and accurate wearable devices for clinical applications. The processing and analysis of physiological signals is a key issue for these smart wearable devices. Consequently, ongoing work in this field of study includes research on filtration, quality checking, signal transformation and decomposition, feature extraction and, most recently, machine learning-based methods

The 2023 wearable photoplethysmography roadmap

Photoplethysmography is a key sensing technology which is used in wearable devices such as smartwatches and fitness trackers. Currently, photoplethysmography sensors are used to monitor physiological parameters including heart rate and heart rhythm, and to track activities like sleep and exercise. Yet, wearable photoplethysmography has potential to provide much more information on health and wellbeing, which could inform clinical decision making. This Roadmap outlines directions for research and development to realise the full potential of wearable photoplethysmography. Experts discuss key topics within the areas of sensor design, signal processing, clinical applications, and research directions. Their perspectives provide valuable guidance to researchers developing wearable photoplethysmography technology

The Role of Edge Robotics As-a-Service in Monitoring COVID-19 Infection

Deep learning technology has been widely used in edge computing. However, pandemics like covid-19 require deep learning capabilities at mobile devices (detect respiratory rate using mobile robotics or conduct CT scan using a mobile scanner), which are severely constrained by the limited storage and computation resources at the device level. To solve this problem, we propose a three-tier architecture, including robot layers, edge layers, and cloud layers. We adopt this architecture to design a non-contact respiratory monitoring system to break down respiratory rate calculation tasks. Experimental results of respiratory rate monitoring show that the proposed approach in this paper significantly outperforms other approaches. It is supported by computation time costs with 2.26 ms per frame, 27.48 ms per frame, 0.78 seconds for convolution operation, similarity calculation, processing one-minute length respiratory signals, respectively. And the computation time costs of our three-tier architecture are less than that of edge+cloud architecture and cloud architecture. Moreover, we use our three-tire architecture for CT image diagnosis task decomposition. The evaluation of a CT image dataset of COVID-19 proves that our three-tire architecture is useful for resolving tasks on deep learning networks by edge equipment. There are broad application scenarios in smart hospitals in the future

ARTERIAL WAVEFORM MEASUREMENT USING A PIEZOELECTRIC SENSOR

This study aims to develop a new method to monitor peripheral arterial pulse using a PVDF piezoelectric sensor. After comparing different locations of sensor placement, a specific sensor wrap for the finger was developed. Its composition, size, and location make it inexpensive and very convenient to use. In order to monitor the effectiveness of the sensor at producing a reliable pulse waveform, a monitoring system, including the PZT sensor, ECG, pulse-oximeter, respiratory sensor, and accelerometer was setup. Signal analysis from the system helped discover that the PZT waveform is relative to the 1st derivative of the artery pressure wave. Also, the system helped discover that the first, second, and third peaks in PZT waveform represent the pulse peak, inflection point, and dicrotic notch respectively. The relationship between PZT wave and respiration was also analyzed, and, consequently, an algorithm to derive respiratory rate directly from the PZT waveform was developed. This algorithm gave a 96% estimating accuracy. Another feature of the sensor is that by analyzing the relationship between pulse peak amplitude and blood pressure change, temporal artery blood pressure can be predicted during Valsalva maneuver. PZT pulse wave monitoring offers a new type of pulse waveform which is not yet fully understood. Future studies will lead to a more broadly applied use of PZT sensors in cardiac monitoring applications

Effects of inhaled therapies on pulmonary hypertension and right ventricular function in cardiac surgery

Au Canada, on estime que 30 000 chirurgies cardiaques sont effectuées chaque année (1). L'insuffisance ventriculaire droite demeure une complication courante chez les patients subissant une chirurgie cardiaque. L'incidence de l’insuffisance ventriculaire droite périopératoire aiguë sévère peut aller de 0,1 % après une cardiotomie à 20 à 30 % après l'implantation d'un dispositif d'assistance ventriculaire gauche (2). La survenue d'une défaillance ventriculaire droite est encore plus fréquente en présence d'hypertension pulmonaire. Les conséquences de l'insuffisance ventriculaire droite en chirurgie cardiaque comprennent une détérioration périopératoire et des effets indésirables tels qu'un sevrage difficile de la circulation extracorporelle, une utilisation accrue d'agents vasoactifs intraveineux, et un risque accru de mortalité. Par conséquent, le diagnostic et le traitement de l’hypertension pulmonaire et de la dysfonction ventriculaire droite sont essentiels dans la période périopératoire pour éviter les complications. La surveillance simultanée et en continue des courbes de pression de l’artère pulmonaire et du ventricule droit à l'aide du cathétérisme de l'artère pulmonaire est un outil de surveillance important chez les patients en chirurgie cardiaque pour la détection précoce d'un dysfonctionnement du ventricule droit et pour évaluer la réponse au traitement. Les stratégies thérapeutiques dans ce contexte devraient se concentrer sur la réduction de la postcharge du ventricule droit et l'amélioration de la fonction du ventricule droit tout en évitant l'hypotension systémique. Les hypothèses de cette thèse sont les suivantes : 1) les vasodilatateurs inhalés sont supérieurs aux agents administrés par voie intraveineuse pour le traitement et la gestion de l’hypertension pulmonaire en chirurgie cardiaque, 2) la combinaison d'époprosténol inhalé et de la milrinone inhalée (iE&iM) est une stratégie efficace pour faciliter le sevrage de la circulation extracorporelle et pour réduire les besoins en inotropes intraveineux, 3) tous les patients n'ont pas une réponse vasodilatatrice positive à la combinaison de l’iE&iM, 4) la réponse à l’iE&iM est associée à des changements des courbes de pression du ventricule droit et de l’artère pulmonaire, et 5) le gradient de la chambre de chasse du ventricule droit et la vitesse d’augmentation de la pression intraventriculaire droite (dP/dt) ont le potentiel d'être des marqueurs pharmacodynamiques de la réponse au traitement. Le travail compris dans cette thèse consiste en 3 études. La première est une revue systématique et méta-analyse d'essais contrôlés randomisés démontrant que l'administration de vasodilatateurs inhalés pour le traitement de l’hypertension pulmonaire pendant la chirurgie cardiaque est associée à une amélioration de la performance du ventricule droit comparé aux agents administrés par voie intraveineuse. La deuxième étude est une analyse de cohorte rétrospective de 128 patients recevant l’iE&iM avant la circulation extracorporelle. Cette étude a démontré une réponse vasodilatatrice au traitement par l’iE&iM chez 77% des patients. Une réponse favorable était associée à un sevrage facile de la circulation extracorporelle plus fréquent et à une utilisation plus faible d'inotropes intraveineux. De plus, cette étude a également démontré qu'une hypertension pulmonaire plus sévère est prédictive d'une réponse vasodilatatrice pulmonaire positive, tandis qu'un European System for Cardiac Operative Risk Evaluation score (EuroSCORE) II élevé est un prédicteur de non-réponse au traitement. La dernière étude de cette thèse est une étude de cohorte prospective incluant 26 patients recevant iE&iM avec surveillance continue de la courbe de pression du ventricule droit démontrant l'innocuité et l'efficacité de cette approche thérapeutique dans l'amélioration de la fonction ventriculaire droite.In Canada there is an estimated 30,000 cardiac surgeries that are performed each year (1). Right ventricular failure (RVF) remains a common complication in patients undergoing cardiac surgery. The incidence of severe acute perioperative RVF can range from 0.1% after cardiotomy to 20-30% after left ventricular assist device implantation (2). The occurrence of RVF is even more frequent in the presence of pulmonary hypertension (PH). Consequences of RVF in cardiac surgery include perioperative deterioration and adverse outcomes such as difficult separation from cardiopulmonary bypass (CPB), increased use of intravenous (IV) vasoactive agents and an increased risk of mortality. Therefore, the diagnosis and treatment of PH and right ventricular (RV) dysfunction is essential in the perioperative period to circumvent complications. Continuous and simultaneous monitoring of both pulmonary artery pressure (Ppa) and RV pressure (Prv) waveforms using pulmonary artery catheterization is an important monitoring tool in cardiac surgery patients for early detection of RV dysfunction and for evaluating response to treatment. Therapeutic strategies in this context should focus on reducing RV afterload and improving RV function while avoiding systemic hypotension. The hypotheses of this thesis are the following: 1) inhaled aerosolized vasodilators are superior to IV administered agents for the treatment and management of PH in cardiac surgery, 2) the combination of inhaled epoprostenol and inhaled milrinone (iE&iM) is an effective strategy to facilitate separation from CPB and reduce the requirements for IV inotropes, 3) not all patients have a positive vasodilator response to iE&iM, 4) response to iE&iM is associated with changes in RV and PA pressure waveforms, and 5) RV outflow tract (RVOT) gradient and RV maximal rate of pressure rise during early systole (dP/dt) have the potential to be pharmacodynamic markers of response to treatment. The work comprised in this thesis consist of 3 studies. The first is a systematic review and meta-analysis of randomized controlled trials showing that administration of inhaled vasodilators for the treatment of PH during cardiac surgery is associated with improved RV performance compared to IV administered agents. The second study is a retrospective cohort analysis of 128 patients receiving iE&iM before CPB. This study showed that 77% of patients have a vasodilator response to iE&iM treatment. A favorable vasodilator response was associated with more frequent easy separation from CPB and lower use of IV inotropes post-CPB. In addition, more severe PH at baseline is shown to be predictive of a positive pulmonary vasodilator response while high European System for Cardiac Operative Risk Evaluation score (EuroSCORE) II is a predictor of non-response to treatment. The last study of this thesis is a prospective cohort study including 26 patients receiving iE&iM with continuous monitoring of Prv waveform demonstrating the safety and efficacy of this treatment approach in improving RV function

Physical Diagnosis and Rehabilitation Technologies

The book focuses on the diagnosis, evaluation, and assistance of gait disorders; all the papers have been contributed by research groups related to assistive robotics, instrumentations, and augmentative devices

The 2023 wearable photoplethysmography roadmap

Photoplethysmography is a key sensing technology which is used in wearable devices such as smartwatches and fitness trackers. Currently, photoplethysmography sensors are used to monitor physiological parameters including heart rate and heart rhythm, and to track activities like sleep and exercise. Yet, wearable photoplethysmography has potential to provide much more information on health and wellbeing, which could inform clinical decision making. This Roadmap outlines directions for research and development to realise the full potential of wearable photoplethysmography. Experts discuss key topics within the areas of sensor design, signal processing, clinical applications, and research directions. Their perspectives provide valuable guidance to researchers developing wearable photoplethysmography technology

TIME SERIES ANALYSIS AND CLUSTERING TO CHARACTERIZE CARDIORESPIRATORY INSTABILITY PATTERNS IN STEP-DOWN UNIT PATIENTS

Background: Cardiorespiratory instability (CRI) in noninvasively monitored step-down unit (SDU) patients has a variety of etiologies, and therefore likely manifests in different patterns of vital signs (VS) changes. Objective: We sought to describe differences in admission characteristics and outcomes between patients with and without CRI. We explored use of clustering techniques to identify VS patterns within initial CRI epoch (CRI1) and assessed inter-cluster differences in admission characteristics, outcomes and medications. Methods: Admission characteristics and continuous monitoring data (frequency 1/20 Hz) were recorded in 307 patients. Vital sign (VS) deviations beyond local instability trigger criteria for 3 consecutive minutes or for 4 out of a 5 minute moving window were classified as CRI events. We identified CRI1 in 133 patients, derived statistical features of CRI1 epoch and employed hierarchical and k-means clustering techniques. We tested several clustering solutions and used 10-fold cross validation and ANOVA to establish best solution. Inter-cluster differences in admission characteristics, outcomes and medications were assessed. Main Results: Patients transferred to the SDU from units with higher monitoring capability were more likely to develop CRI (n=133, CRI 44% vs no CRI n=174, 31%, p=.042). Patients with at least one event of CRI had longer hospital length of stay (CRI 11.3 + 10.2 days vs no CRI 7.8 + 9.2, p=.001) and SDU unit stay (CRI 6.1 + 4.9 days vs no CRI 3.5 + 2.9, p< .001). Four main clusters(C) were derived. Clusters were significantly different based on age (p=0.001; younger patients in C1 and older in C2), number of comorbidities (p<0.01; more C2 patients had ≥2), and admission source (p=0.008; more C1 and C4 patients transferred in from a higher intensity monitoring unit). Patients with CRI differed significantly (p<.05) from those without CRI based on medication categories. Conclusions: CRI1 was associated with prolonged hospital and SDU length of stay. Patients transferred from a higher level of care were more likely to develop CRI, suggesting that they are sicker. Future study will be needed to determine if there are common physiologic underpinnings of VS clusters which might inform monitoring practices and clinical decision-making when CRI first manifests

Non-Invasive Hemodynamic Parameters Assessment using Optoelectronic Devices

Tese de doutoramento em Engenharia Biomédica, apresentada à Faculdade de Medicina da Universidade de CoimbraA grande incidência das doenças cardiovasculares no mundo estimulou a procura de novas soluções que permitam a deteção precoce de processos patológicos associados a este tipo de doenças. Especial ênfase foi dada a métodos que permitem a monitorização da pressão arterial e da forma de onda de pressão arterial, que fornecem uma ferramenta precisa que complementa o diagnóstico baseado em múltiplos parâmetros. Da análise das características da forma de onda da pressão arterial, e da sua velocidade de propagação, podem ser extraídas importantes parâmetros clínicos de modo a avaliar o risco cardiovascular, a adaptação vascular e a eficácia terapêutica. O uso de múltiplos parâmetros permite minimizar erros na estimação de um dos parâmetros. As soluções emergentes para a monitorização cardiovascular têm-se afastado de tecnologias invasivas e caras para soluções não invasivas e sem contacto. Neste sentido, os sistemas ópticos apresentam uma grande vantagem devido ao grande progresso tecnológico sofrido nas últimas décadas. A natureza de não contacto desta tecnologia permite a medição sem distorção da forma da onda arterial ultrapassando as limitações dos aparelhos comerciais usados para este tipo de avaliação. O principal objetivo deste trabalho consistia em demonstrar que é possível adquirir através do uso de uma metodologia óptica, a forma da onda de pressão arterial sem contacto, com uma configuração que permite medir a velocidade onda de pulso (VOP) local e determinar os principais parâmetros usando algoritmos dedicados. Foram desenvolvidos quatro protótipos: três baseados em luz não-coerente e um em luz coerente. As sondas foram desenvolvidas usando uma configuração comum, composta por dois fotodetectores distanciados de 2 cm, o que garante a deteção da onda de pulso em dois pontos distintos e permite uma determinação rigorosa do tempo de trânsito. Nas sondas de luz não-coerente foram testados três fotodetectores: fotodíodos de avalanche, fotodíodos planares, e fotodíodos de efeito lateral (LEP). Os componentes do sistema óptico (protótipos das sondas e caixa de aquisição) foram desenhados com as características físicas que permitem o uso clínico, como a portabilidade, o tamanho compacto, leves, de baixo consumo e com materiais de baixo custo, ergonómicas para o operador e confortáveis para o paciente, de modo a serem consideradas uma solução interessante para a comercialização. Os testes in vivo permitiram a seleção da melhor combinação sonda/algoritmo para a determinação da PWV, usando o método da correlação e a sonda baseada em fotodíodos planares que demonstrou ser mais eficiente para a aquisição de sinais em humanos. O sistema óptico desenvolvido mostrou boa reprodutibilidade na avaliação inter e intra-operador. Um estudo alargado foi desenvolvido em 131 sujeitos jovens, com um valor médio PWV de 33.33±0.72 ms-1, confirmando o seu aumento com a idade. O teste comparativo entre a onda de distensão medida com o sistema óptico na carótida e o perfil da onda de pressão adquirida invasivamente por um cateter intra-arterial mostrou uma grande correlação entre as duas ondas (valor médio de 0.958), validando a capacidade das sondas ópticas para estimar a forma da onda de pulso de modo não-invasivo e sem contacto. A sonda óptica baseada em luz coerente foi testada em combinação com algoritmos de processamento de sinal baseados nos métodos short time Fourier transform e empirical mode decomposition, demonstrando ser capaz de determinar os pontos característicos da forma de onda com baixo erro (menor que 5ms). Uma configuração alternativa foi testada usando um fotodetector com uma maior área que permitiu obter o efeito de self-mixing fora da cavidade laser. Esta característica abriu a possibilidade de construir uma nova sonda adaptada a esta nova técnica de modo a melhorar a qualidade do sinal e permitir uma aplicação biomédica. Globalmente, os resultados obtidos para a metodologias desenvolvidas (protótipos e ferramentas de processamento de sinal associados) mostraram ser possível de medir a onda de pulso arterial na carótida, para determinar vários parâmetros clínicos e avaliar a condição cardiovascular.The world wide incidence of cardiovascular diseases (CVDs), has spurred the research efforts targeting new solutions that may be able to perform an early detection of the pathological processes associated with these diseases. Special emphasis has been given to the methods that allow the monitoring of the blood pressure and the arterial pulse waveform, thus providing a more precise tool to complement the diagnosis process based on a multi-parameter assessment approach. From the analysis of arterial pulse pressure waveform features, and its propagation velocity, important clinical parameters can be extracted in order to evaluate the CVD risk, the vascular adaptation and the therapeutic efficacy. The use of multiple parameters allows to minimize the error when compared to the approach where a subject is classified solely based on a single parameter. Emerging trends in cardiovascular monitoring are moving away from invasive and costly technologies towards non-invasive and low-cost solutions. In this sense, optical solutions represent a great advantage due to the immense technological progresses observed in the recent decades. The truly non-contact nature of optical techniques allows measurements without distortion in the shape of the pulse curve, which is one of the main limitations of the current commercial devices used in hemodynamic parameters assessment. The main objective of this work consists in demonstrating that with an optical system it is possible to acquire the arterial pulse waveform with a configuration that allows the local pulse wave velocity (PWV) measurement and the determination of the most important clinical parameters using dedicated algorithms, without physical contact with the skin of the patient. Four prototypes were developed: three based in non-coherent light and one with coherent light. All the developed optical probes have a common design structure. They include two identical photodetectors placed 2 cm apart from each other to guarantee accurate determination of local pulse transit time. Relatively to the non-coherent light probes three different probes base on photodetectors were tested: an avalanche photodiode, a planar photodiode and a lateral effect photodiode (LEP). The optical system components (probe prototypes and acquisition box) were designed to meet specific requirements that allow the clinical use, such as portability, compact size and low weight, low cost, limited power consumption, ergonomics and easy user-interface in order to be considered as an interesting solution for commercial purposes. The in vivo tests allowed the selection of the best algorithm and probe combination to determine PWV: cross-correlation algorithm and the probe with planar photodiodes demonstrated to be the most efficient. This system showed good reproducibility, as evaluated by both inter-operator and intra-operator analysis. A large study was performed in 131 young subjects, obtaining a mean value for PWV of 3.33±0.72 ms-1, thus confirming its significant increase with age. A comparative test between the distension waveform measured with the optical probe at the carotid artery and the invasive profile of the pulse pressure acquired by an intra arterial catheter showed a strong correlation (mean value of 0.958), and validates the ability of this non-invasive device to estimate the arterial pulse waveform. Also a coherent light probe was developed and tested using several processing techniques based on the short time Fourier transform and empirical mode decomposition algorithm. This approach demonstrated the ability to determine the main feature points in the waveform with low error in the pulse transit time determination (less than 5ms). An alternative configuration for the Doppler effect-based probe was tested, using a photodetector with a larger area in order to obtain the self-mixing effect outside the laser cavity. This feature opened the possibility to improve the quality of the signal which may foresee potential future biomedical applications. Globally, the results obtained with the developed methodologies (prototypes and associated algorithmic tools) proved that it is possible to measure the arterial pulse waveform in the carotid artery, to determine several clinical parameters and assess the cardiovascular condition with optical technology.Fundação para a Ciência e Tecnologia - SFRH / BD / 79334 / 201