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Saliba I, Hardy A, Wang W, Vialle R, Feruglio S. A Review of Chronic Lateral Ankle Instability and Emerging Alternative Outcome Monitoring Tools in Patients following Ankle Ligament Reconstruction Surgery. J Clin Med 2024; 13:442. [PMID: 38256576 PMCID: PMC10816882 DOI: 10.3390/jcm13020442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/31/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Ankle sprains are exceedingly common injuries in both athletes and the general population. They account for 10 to 30% of all sports injuries. Although the vast majority of lateral ankle ligament injuries respond successfully to conservative management, the absolute number of those that progress to chronic lateral ankle instability (CLAI) remains considerably important. This condition is characterized by persistent symptoms and may be associated with short-term and long-term complications and functional deficits. There is still a lack of ideal postoperative management of CLAI patients. Furthermore, an evidence-based rehabilitation phasing does not exist and most of the published studies regarding this subject suggest some protocols based on a wide variety of functional assessment scores and other modalities that are not accurate enough. Moreover, the literature that assesses the ability to return to work (RTW) and return to sport (RTS) in the general population and athletes operated for CLAI most commonly shows aggregated results with global rates of RTW or RTS without describing a detailed timeline based on the readiness of patients to return to each level of activity. Although stress radiographs and MRI have been assessed as potential tools to improve postoperative management of CLAI patients, the first modality is limited by its low sensitivity to detect laxity and the second one by its static character and its inability to predict neither the healing process phase nor the mechanical properties of the repaired/reconstructed ligaments. Bioelectrical impedance, mechanical impedance and near-infrared spectroscopy are non-invasive methods of measurement that could be potential assessment tools to help surgeons improve the postoperative management of patients after CLAI surgery.
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Affiliation(s)
- Ibrahim Saliba
- LIP6 Department, Sorbonne Université, 75005 Paris, France
| | | | - Wenzheng Wang
- LIP6 Department, Sorbonne Université, 75005 Paris, France
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Ozmen GC, Mabrouk S, Nichols C, Berkebile J, Goossens Q, Gazi AH, Inan OT. Mid-Activity and At-Home Wearable Bioimpedance Elucidates an Interpretable Digital Biomarker of Muscle Fatigue. IEEE Trans Biomed Eng 2023; 70:3513-3524. [PMID: 37405890 PMCID: PMC11092386 DOI: 10.1109/tbme.2023.3290530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Muscle health and decreased muscle performance (fatigue) quantification has proven to be an invaluable tool for both athletic performance assessment and injury prevention. However, existing methods estimating muscle fatigue are infeasible for everyday use. Wearable technologies are feasible for everyday use and can enable discovery of digital biomarkers of muscle fatigue. Unfortunately, the current state-of-the-art wearable systems for muscle fatigue tracking suffer from either low specificity or poor usability. METHODS We propose using dual-frequency bioimpedance analysis (DFBIA) to non-invasively assess intramuscular fluid dynamics and thereby muscle fatigue. A wearable DFBIA system was developed to measure leg muscle fatigue of 11 individuals during a 13-day protocol consisting of exercise and unsupervised at-home portions. RESULTS We derived a digital biomarker of muscle fatigue, fatigue score, from the DFBIA signals that was able to estimate the percent reduction in muscle force during exercise with repeated-measures Pearson's r = 0.90 and mean absolute error (MAE) of 3.6%. This fatigue score also estimated delayed onset muscle soreness with repeated-measures Pearson's r = 0.83 and MAE = 0.83. Using at-home data, DFBIA was strongly associated with absolute muscle force of participants (n = 198, p < 0.001). CONCLUSION These results demonstrate the utility of wearable DFBIA for non-invasively estimating muscle force and pain through the changes in intramuscular fluid dynamics. SIGNIFICANCE The presented approach may inform development of future wearable systems for quantifying muscle health and provide a novel framework for athletic performance optimization and injury prevention.
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Nichols CJ, Mabrouk SA, Ozmen GC, Gazi AH, Inan OT. Validating Adhesive-Free Bioimpedance of the Leg in Mid-Activity and Uncontrolled Settings. IEEE Trans Biomed Eng 2023; 70:2679-2689. [PMID: 37027282 DOI: 10.1109/tbme.2023.3262206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Musculoskeletal health monitoring is limited in everyday settings where patient symptoms can substantially change - delaying treatment and worsening patient outcomes. Wearable technologies aim to quantify musculoskeletal health outside clinical settings but sensor constraints limit usability. Wearable localized multi-frequency bioimpedance assessment (MFBIA) shows promise for tracking musculoskeletal health but relies on gel electrodes, hindering extended at-home use. Here, we address this need for usable technologies for at-home musculoskeletal health assessment by designing a wearable adhesive-free MFBIA system using textile electrodes in extended uncontrolled mid-activity settings. METHODS An adhesive-free multimodal wearable leg MFBIA system was developed in-lab under realistic conditions (5 participants, 45 measurements). Mid-activity textile and gel electrode MFBIA was compared across multiple compound movements (10 participants). Accuracy in tracking long-term changes in leg MFBIA was assessed by correlating gel and textile MFBIA simultaneously recorded in uncontrolled settings (10 participants, 80+ measurement hours). RESULTS Mid-activity MFBIA measurements with textile electrodes agreed highly with (ground truth) gel electrode measurements (average [Formula: see text], featuring <1-Ohm differences (0.618 ± 0.340 Ω) across all movements. Longitudinal MFBIA changes were successfully measured in extended at-home settings (repeated measures r = 0.84). Participant responses found the system to be comfortable and intuitive (8.3/10), and all participants were able to don and operate the system independently. CONCLUSION This work demonstrates wearable textile electrodes can be a viable substitute for gel electrodes when monitoring leg MFBIA in dynamic, uncontrolled settings. SIGNIFICANCE Adhesive-free MFBIA can improve healthcare by enabling robust wearable musculoskeletal health monitoring in at-home and everyday settings.
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Aggas JR, Abasi S, Ton C, Salehi S, Liu R, Brandacher G, Grayson WL, Guiseppi-Elie A. Real-Time Monitoring Using Multiplexed Multi-Electrode Bioelectrical Impedance Spectroscopy for the Stratification of Vascularized Composite Allografts: A Perspective on Predictive Analytics. Bioengineering (Basel) 2023; 10:bioengineering10040434. [PMID: 37106621 PMCID: PMC10135882 DOI: 10.3390/bioengineering10040434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 04/29/2023] Open
Abstract
Vascularized composite allotransplantation addresses injuries to complex anatomical structures such as the face, hand, and abdominal wall. Prolonged static cold storage of vascularized composite allografts (VCA) incurs damage and imposes transportation limits to their viability and availability. Tissue ischemia, the major clinical indication, is strongly correlated with negative transplantation outcomes. Machine perfusion and normothermia can extend preservation times. This perspective introduces multiplexed multi-electrode bioimpedance spectroscopy (MMBIS), an established bioanalytical method to quantify the interaction of the electrical current with tissue components, capable of measuring tissue edema, as a quantitative, noninvasive, real-time, continuous monitoring technique to provide crucially needed assessment of graft preservation efficacy and viability. MMBIS must be developed, and appropriate models explored to address the highly complex multi-tissue structures and time-temperature changes of VCA. Combined with artificial intelligence (AI), MMBIS can serve to stratify allografts for improvement in transplantation outcomes.
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Affiliation(s)
- John R Aggas
- Bioelectronics, Biosensors and Biochips (C3B®), Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77843, USA
- Test Development, Roche Diagnostics, 9115 Hague Road, Indianapolis, IN 46256, USA
| | - Sara Abasi
- Bioelectronics, Biosensors and Biochips (C3B®), Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77843, USA
- Media and Metabolism, Wildtype, Inc., 2325 3rd St., San Francisco, CA 94107, USA
| | - Carolyn Ton
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Sara Salehi
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Renee Liu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Gerald Brandacher
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Warren L Grayson
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21231, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Anthony Guiseppi-Elie
- Bioelectronics, Biosensors and Biochips (C3B®), Department of Biomedical Engineering, Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77843, USA
- Department of Cardiovascular Sciences, Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX 77030, USA
- ABTECH Scientific, Inc., Biotechnology Research Park, 800 East Leigh Street, Richmond, VA 23219, USA
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Gipson DS, Pal M, Desmond H, Anderson C, Walsh L, Trachtman H, Massengill SF, Gipson P, Rao PS, Thurman J, Kopp J, Kamil E, Lamothe J, Mariani LH, LaFleur P, Vento S, O'Shaughnessy M, Farag YMK, Simon C, Carlozzi NE. Developing an Edema Clinician-Reported Outcome Measure for Nephrotic Syndrome. GLOMERULAR DISEASES 2023; 3:132-139. [PMID: 37901701 PMCID: PMC10601938 DOI: 10.1159/000531505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/09/2023] [Indexed: 10/31/2023]
Abstract
Introduction Edema is a common manifestation of proteinuric kidney diseases, but there is no consensus approach for reliably evaluating edema. The objective of this study was to develop an edema clinician-reported outcome measure for use in patients with nephrotic syndrome. Methods A literature review was conducted to assess existing clinician-rated measures of edema. Clinical experts were recruited from internal medicine, nephrology, and pediatric nephrology practices to participate in concept elicitation using semi-structured interviews and cognitive debriefing. Qualitative analysis methods were used to collate expert input and inform measurement development. In addition, training and assessment modules were developed using an iterative process that also utilized expert input and cognitive debriefing to ensure interrater reliability. Results While several clinician-rated measures of edema have been proposed, our literature review did not identify any studies to support the reliability or validity of these measures. Fourteen clinician experts participated in the concept elicitation interviews, and twelve participated in cognitive debriefing. A clinician-reported outcome measure for edema was developed. The measure assesses edema severity in multiple individual body parts. An online training module and assessment tool were generated and refined using additional clinician input and investigative team expertise. Conclusion The Edema ClinRO (V1) measure is developed specifically to measure edema in nephrotic syndrome. The tool assesses edema across multiple body parts, and it includes a training module to ensure standardized administration across raters. Future examination of this measure is ongoing to establish its reliability and validity.
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Affiliation(s)
- Debbie S Gipson
- Department of Pediatrics/Pediatric Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Maisha Pal
- Department of Pediatrics/Pediatric Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Hailey Desmond
- Department of Pediatrics/Pediatric Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Charles Anderson
- Department of Pediatrics/Pediatric Nephrology, Levine Children's Hospital at Atrium Health, Charlotte, NC, USA
| | | | - Howard Trachtman
- Department of Pediatrics/Pediatric Nephrology, University of Michigan, Ann Arbor, MI, USA
- Langone Medical Center, New York University, New York, NY, USA
| | - Susan F Massengill
- Department of Pediatrics/Pediatric Nephrology, Levine Children's Hospital at Atrium Health, Charlotte, NC, USA
| | - Patrick Gipson
- Department of Pediatrics/Pediatric Nephrology, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Panduranga S Rao
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Joshua Thurman
- Department of Internal Medicine/Nephrology, University of Colorado, Aurora, CO, USA
| | - Jeffrey Kopp
- National Institutes of Health, National Institute of Diabetes, Digestive, and Kidney Disease, Bethesda, MD, USA
| | - Elaine Kamil
- Department of Pediatrics, Cedars-Sinai Medical Center and the David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jennifer Lamothe
- Department of Pediatrics/Pediatric Nephrology, Levine Children's Hospital at Atrium Health, Charlotte, NC, USA
| | - Laura H Mariani
- Department of Internal Medicine/Nephrology, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | - Christine Simon
- Department of Pediatrics/Pediatric Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Ozmen GC, Nichols C, Mabrouk S, Berkebile J, Lan L, Inan OT. Wearable Mid-Activity Measurement of Lower Limb Electrical Bioimpedance Estimates Vertical Ground Reaction Force Features. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:91-94. [PMID: 36085606 DOI: 10.1109/embc48229.2022.9871267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In recent years, wearable mid-activity electrical bioimpedance (EBI) sensing has been used to non-invasively track changes in edema and swelling levels within human joints. While the physiological origin of the changes in mid-activity EBI measurements have been demonstrated, EBI waveform patterns during activity have not been explored. In this work, we present a novel approach to extract waveform features from EBI measurements during gait to estimate the changes in vertical ground reaction forces (vGRF) corresponding to fatigue. Wearable EBI and vGRF data were measured from six healthy subjects during an asymmetric fatiguing protocol. For the exercised leg, the first peak of vGRF corresponding to the initial phase of simple support, decreased significantly and the loading rate increased significantly between the beginning and the end of the protocol. No significant change in these parameters were observed for the control leg. The first peak of vGRF and loading rate during the protocol (15 walking sessions) were correlated to the multi-frequency EBI features with mean Pearson's r=0.81 and r=0.777, respectively. The results of this proof-of-concept study demonstrate the feasibility of estimating biomechanical parameters during activity with wearable EBI. Clinical Relevance - The proposed wearable system and associated signal processing could enable convenient tracking of changes in vGRFs during daily living activities, allowing physiotherapists and doctors to remotely monitor the progress and adherence of their patients and thereby reducing the number of clinical visits.
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Sanchez-Perez JA, Berkebile JA, Nevius BN, Ozmen GC, Nichols CJ, Ganti VG, Mabrouk SA, Clifford GD, Kamaleswaran R, Wright DW, Inan OT. A Wearable Multimodal Sensing System for Tracking Changes in Pulmonary Fluid Status, Lung Sounds, and Respiratory Markers. SENSORS 2022; 22:s22031130. [PMID: 35161876 PMCID: PMC8838360 DOI: 10.3390/s22031130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/23/2022] [Accepted: 01/29/2022] [Indexed: 12/17/2022]
Abstract
Heart failure (HF) exacerbations, characterized by pulmonary congestion and breathlessness, require frequent hospitalizations, often resulting in poor outcomes. Current methods for tracking lung fluid and respiratory distress are unable to produce continuous, holistic measures of cardiopulmonary health. We present a multimodal sensing system that captures bioimpedance spectroscopy (BIS), multi-channel lung sounds from four contact microphones, multi-frequency impedance pneumography (IP), temperature, and kinematics to track changes in cardiopulmonary status. We first validated the system on healthy subjects (n = 10) and then conducted a feasibility study on patients (n = 14) with HF in clinical settings. Three measurements were taken throughout the course of hospitalization, and parameters relevant to lung fluid status—the ratio of the resistances at 5 kHz to those at 150 kHz (K)—and respiratory timings (e.g., respiratory rate) were extracted. We found a statistically significant increase in K (p < 0.05) from admission to discharge and observed respiratory timings in physiologically plausible ranges. The IP-derived respiratory signals and lung sounds were sensitive enough to detect abnormal respiratory patterns (Cheyne–Stokes) and inspiratory crackles from patient recordings, respectively. We demonstrated that the proposed system is suitable for detecting changes in pulmonary fluid status and capturing high-quality respiratory signals and lung sounds in a clinical setting.
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Affiliation(s)
- Jesus Antonio Sanchez-Perez
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30313, USA; (J.A.B.); (G.C.O.); (S.A.M.); (O.T.I.)
- Correspondence:
| | - John A. Berkebile
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30313, USA; (J.A.B.); (G.C.O.); (S.A.M.); (O.T.I.)
| | - Brandi N. Nevius
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA;
| | - Goktug C. Ozmen
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30313, USA; (J.A.B.); (G.C.O.); (S.A.M.); (O.T.I.)
| | - Christopher J. Nichols
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA 30332, USA; (C.J.N.); (G.D.C.); (R.K.)
| | - Venu G. Ganti
- Bioengineering Graduate Program, Georgia Institute of Technology, Atlanta, GA 30332, USA;
| | - Samer A. Mabrouk
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30313, USA; (J.A.B.); (G.C.O.); (S.A.M.); (O.T.I.)
| | - Gari D. Clifford
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA 30332, USA; (C.J.N.); (G.D.C.); (R.K.)
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30332, USA
| | - Rishikesan Kamaleswaran
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA 30332, USA; (C.J.N.); (G.D.C.); (R.K.)
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30332, USA
- Department of Emergency Medicine, Emory University, Atlanta, GA 30332, USA;
| | - David W. Wright
- Department of Emergency Medicine, Emory University, Atlanta, GA 30332, USA;
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30313, USA; (J.A.B.); (G.C.O.); (S.A.M.); (O.T.I.)
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA 30332, USA; (C.J.N.); (G.D.C.); (R.K.)
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Critcher S, Freeborn TJ. Flexible PCB Failures From Dynamic Activity and Their Impacts on Bioimpedance Measurements: A Wearable Case Study. IEEE OPEN JOURNAL OF CIRCUITS AND SYSTEMS 2021; 2:732-742. [PMID: 34901875 PMCID: PMC8656411 DOI: 10.1109/ojcas.2021.3122369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Wearable health monitoring systems that collect data in free-living environments are becoming increasingly popular. Flexible printed circuits provide a commercially available option that can conform to the shape of a wearable system and support electronic sensing and flexible interconnect. However, repetitive dynamic activity can stress and damage the interconnect of flexible PCBs which degrades data quality. This case study evaluated the performance of flexible PCBs providing interconnect between electrodes and sensing electronics for tissue bioimpedance measurements in a wearable system. Resistance data (1 kHz to 128 kHz) was collected from localized knee tissues of 3 participants using the wearable design with flexible PCBs over 7 days of free-living. From electrical and optical inspection after use trace cracking of the flexible PCBs occurred, degrading tissue resistances reported by the wearable system. Exploration of these results advances understanding of how flexible PCBs perform in free-living conditions for wearable bioimpedance applications.
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Affiliation(s)
- Shelby Critcher
- Department of Electrical and Computer Engineering, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Todd J Freeborn
- Department of Electrical and Computer Engineering, University of Alabama, Tuscaloosa, AL 35487, USA
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Berkebile JA, Mabrouk SA, Ganti VG, Srivatsa AV, Sanchez-Perez JA, Inan OT. Towards Estimation of Tidal Volume and Respiratory Timings via Wearable-Patch-Based Impedance Pneumography in Ambulatory Settings. IEEE Trans Biomed Eng 2021; 69:1909-1919. [PMID: 34818186 DOI: 10.1109/tbme.2021.3130540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Evaluating convenient, wearable multi-frequency impedance pneumography (IP) based respiratory monitoring in ambulatory persons with novel electrode positioning. METHODS A wearable multi-frequency IP system was utilized to estimate tidal volume (TV) and respiratory timings in 14 healthy subjects. A 5.1 cm 5.1 cm tetrapolar electrode array, affixed to the sternum, and a conventional thoracic electrode configuration were employed to measure the respective IP signals, patch and thoracic IP. Data collected during static posturessitting and supineand activitieswalking and stair-steppingwere evaluated against a simultaneously-obtained spirometer (SP) volume signal. RESULTS Across all measurements, estimated TV obtained from the patch and thoracic IP maintained a Pearson correlation coefficient (r) of 0.930.05 and 0.950.05 to the ground truth TV, respectively, with an associated root-mean-square error (RMSE) of 0.177 L and 0.129 L, respectively. Average respiration rates (RRs) were extracted from 30-second segments with mean-absolute-percentage errors (MAPEs) of 0.93% and 0.74% for patch and thoracic IP, respectively. Likewise, average inspiratory and expiratory timings were identified with MAPEs less than 6% and 4.5% for patch and thoracic IP, respectively. CONCLUSION We demonstrated that patch IP performs comparably to traditional, cumbersome IP configurations. We also present for the first time, to the best of our knowledge, that IP can robustly estimate breath-by-breath TV and respiratory timings during ambulation. SIGNIFICANCE This work represents a notable step towards pervasive wearable ambulatory respiratory monitoring via the fusion of a compact chest-worn form factor and multi-frequency IP that can be readily adapted for holistic cardiopulmonary monitoring.
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Freeborn TJ, Critcher S. Threshold and Trend Artifacts in Localized Multi-Frequency Bioimpedance Measurements. IFAC-PAPERSONLINE 2021; 54:55-60. [PMID: 37097809 PMCID: PMC10122868 DOI: 10.1016/j.ifacol.2021.10.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Localized tissue bioimpedance is being widely investigated as a technique to identify physiological features in support of health focused applications. In support of this method being translated into wearable systems for continuous monitoring, it is critical to not only collect measurements but also evaluate their quality. This is necessary to reduce errors in equipment or measurement conditions from contributing data artifacts to datasets that will be analyzed. Two methods for artifact identification in resistance measurements of bioimpedance datasets are presented. These methods, based on thresholding and trend detection, are applied to localized knee bioimpedance datasets collected from two knee sites over 7 consecutive days in free-living conditions. Threshold artifacts were identified in 0.04% (longitudinal and transverse) and 0.69% (longitudinal) /3.50% (transverse) of the total data collected.
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Affiliation(s)
- Todd J Freeborn
- Department of Electrical and Computer Engineering, University of Alabama, Tuscaloosa, AL 35404 USA
| | - Shelby Critcher
- Department of Electrical and Computer Engineering, University of Alabama, Tuscaloosa, AL 35404 USA
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Freeborn TJ, Critcher S, Hooper GL. Short-Term Segmental Bioimpedance Alterations During 6° Head-Down Tilt. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6974-6977. [PMID: 34892708 DOI: 10.1109/embc46164.2021.9630851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
As missions in space increase in duration and distance from Earth it is critical to understand the impact that exposure to microgravity has on the health and potential performance of crews. Segmental bioimpedance measurements can track resistances changes in tissues that result from fluid redistribution and could be a tool for continuous fluid shift monitoring in microgravity. In this work, the range of segmental (legs, arms, torso, and neck) 10 kHz and 100 kHz resistances and their relative changes during 4 hours of 6° head down tilt are reported as well as the observed resistance differences between left/right body segments throughout the protocol.
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Ozmen GC, Nevius BN, Nichols CJ, Mabrouk S, Teague CN, Inan OT. An Integrated Multimodal Knee Brace Enabling Mid-Activity Tracking for Joint Health Assessment. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7364-7368. [PMID: 34892799 DOI: 10.1109/embc46164.2021.9630526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Developments in wearable technologies created opportunities for non-invasive joint health assessment while subjects perform daily activities during rehabilitation and recovery. However, existing state-of-art solutions still require a health professional or a researcher to set up the device, and most of them are not convenient for at-home use. In this paper, we demonstrate the latest version of the multimodal knee brace that our lab previously developed. This knee brace utilizes four sensing modalities: joint acoustic emissions (JAEs), electrical bioimpedance (EBI), activity and temperature. We designed custom printed-circuit boards and developed firmware to acquire high quality data. For the brace material, we used a commercial knee brace and modified it for the comfort of patients as well as to secure all electrical connections. We updated the electronics to enable rapid EBI measurements for mid-activity tracking. The performance of the multimodal knee brace was evaluated through a proof-of-concept human subjects study (n=9) with 2 days of measurement and 3 sessions per day. We obtained consistent EBI data with less than 1 Ω variance in measured impedance within six full frequency sweeps (each sweep is from 5 kHz to 100 kHz with 256 frequency steps) from each subject. Then, we asked subjects to perform 10 unloaded knee flexion/extensions, while we measured continuous 5 kHz and 100 kHz EBI at every 100 ms. The ratio of the range of reactance (ΔX5kHz/ΔX100kHz) was found to be less than 1 for all subjects for all cycles, which indicates lack of swelling and thereby a healthy joint. We also conducted intra and inter session reliability analysis for JAE recordings through intraclass correlation analysis (ICC), and obtained excellent ICC values (>0.75), suggesting reliable performance on JAE measurements. The presented knee brace could readily be used at home in future work for knee health monitoring of patients undergoing rehabilitation or recovery.
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Localized Bioimpedance Measurements with the MAX3000x Integrated Circuit: Characterization and Demonstration. SENSORS 2021; 21:s21093013. [PMID: 33923037 PMCID: PMC8123364 DOI: 10.3390/s21093013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 01/24/2023]
Abstract
The commercial availability of integrated circuits with bioimpedance sensing functionality is advancing the opportunity for practical wearable systems that monitor the electrical impedance properties of tissues to identify physiological features in support of health-focused applications. This technical note characterizes the performance of the MAX3000x (resistance/reactance accuracy, power modes, filtering, gains) and is available for on-board processing (electrode detection) for localized bioimpedance measurements. Measurements of discrete impedances that are representative of localized tissue bioimpedance support that this IC has a relative error of <10% for the resistance component of complex impedance measurements, but can also measure relative alterations in the 250 mΩ range. The application of the MAX3000x for monitoring localized bicep tissues during activity is presented to highlight its functionality, as well as its limitations, for multi-frequency measurements. This device is a very-small-form-factor single-chip solution for measuring multi-frequency bioimpedance with significant on-board processing with potential for wearable applications.
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Mabrouk S, Whittingslow D, Inan OT. Robust Method for Mid-Activity Tracking and Evaluation of Ankle Health Post-Injury. IEEE Trans Biomed Eng 2021; 68:1341-1350. [PMID: 32997618 DOI: 10.1109/tbme.2020.3027477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To present a robust methodology for evaluating ankle health during ambulation using a wearable device. Methods: We developed a novel data capture system that leverages changes within the ankle during ambulation for real-time tracking of bioimpedance. The novel analysis compares the range of reactance at 5 kHz to the range of reactance at 100 kHz; which removes the technique's previous reliance on a known baseline. To aid in interpretation of the measurements, we developed a quantitative simulation model based on a literature review of the effects on joint bioimpedance of variations in edematous fluid volume, muscle fiber tears, and blood flow changes. Results: The results of the simulation predicted a significant difference in the ratio of the range of the reactance from 5 kHz to 100 kHz between the healthy and injured ankles. These results were validated in 15 subjects - with 11 healthy ankles and 7 injured ankles measured. The injured subjects had lateral ankle sprains 2-4 weeks prior to the measurement. The analysis technique differentiated between the healthy and the injured population (p<<0.01), and a correlation (R = 0.8) with a static protocol previously validated for its sensitivity to edema. Conclusion: The technology presented can detect variations in ankle edema and structural integrity of ankles, and thus could provide valuable feedback to clinicians and patients during the rehabilitation of an ankle injury. Significance: This technology could lead to better-informed decision making regarding a patient's readiness to return to activity and / or tailoring rehabilitation activities to an individual's changing needs.
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Dheman K, Mayer P, Magno M, Schuerle S. Wireless, Artefact Aware Impedance Sensor Node for Continuous Bio-Impedance Monitoring. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2020; 14:1122-1134. [PMID: 32877339 DOI: 10.1109/tbcas.2020.3021186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
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Delano M. Band Electrodes Reduce Simulated Calf Bioimpedance Measurement Errors Due to Muscle Anisotropy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3981-3984. [PMID: 33018872 DOI: 10.1109/embc44109.2020.9175272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Remote monitoring of fluid status via calf bioimpedance measurements could improve the experience of patients with congestive heart failure and reduce readmission rates. Most measurements today use conventional Ag/AgCl electrodes and a short inter-electrode spacing, resulting in current flowing primarily near the electrodes, preventing deeper current penetration and in turn accurate volume estimation. Textile band electrodes may more evenly distribute current throughout the calf. In the present study, simulations were conducted to investigate the impact of inter-electrode spacing/placement and fat tissue on bioimpedance using both Ag/AgCl electrodes and textile band electrodes. Simulation results showed that increasing the inter-electrode spacing can improve current distribution in the tissue, but there are still errors that increase with fat thickness (14.3% error at 10 cm spacing down to 1.7% error at 20 cm spacing for a "nominal" fat thickness, vs. -0.3% and -0.5% error for band electrodes). Band electrodes most closely matched the expected resistance and seem the most suitable regardless of inter-electrode spacing.
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Wang K, Zelko D, Delano M. Textile band electrodes as an alternative to spot Ag/AgCl electrodes for calf bioimpedance measurements. Biomed Phys Eng Express 2019; 6:015010. [PMID: 33438598 DOI: 10.1088/2057-1976/ab5b02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the performance of five different types of textiles as band electrodes for calf bioimpedance measurements in comparison with conventional spot Ag/AgCl electrodes. APPROACH Calf bioimpedance measurements were performed in 10 healthy volunteers with five different textile materials cut into bands and Ag/AgCl spot electrodes as a baseline. Collected bioimpedance data were analyzed in terms of precision, fit error and presence of measurement artifacts. Each textile material was also evaluated for participant comfort. MAIN RESULTS Bioimpedance values for spot electrodes were higher at low frequencies as compared with band electrodes but not at high frequencies. This suggests that spot electrodes have frequency dependent current distributions that adversely impact their use for volume measurements and band electrodes are preferable. The SMP130T-B fabric had the highest precision and the lowest best fit error to the Cole model of the tested textile materials. However, it was the least comfortable textile and most expensive. The Stretch material performed slightly worse than the SMP130T-B fabric, but was half the cost and the most comfortable. SIGNIFICANCE These results suggest that there are suitable textile materials for use as dry, band electrodes for calf bioimpedance measurements and that these band electrodes enable greater current uniformity. These textiles could be integrated into a compression sock for remote monitoring of diseases such as Congestive Heart Failure.
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Affiliation(s)
- Ke Wang
- Department of Biomedical Engineering Duke University Durham, NC 27708, United States of America
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