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A Study of Wearable Bio-Sensor Technologies and Applications in Healthcare

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 Vol. 1, No. 1 | Jan – June 2017

A Study of Wearable Bio-Sensor Technologies and Applications

in Healthcare
Amir Mehmood,
Department of Computer Science and IT, Federal Urdu University of Arts, Science
and Technology, Pakistan
[email protected]

Adnan Nadeem
Department of Computer Science and IT, Federal Urdu University of Arts, Science
and Technology, Pakistan & Faculty of Computer Science and Information System,
Islamic University of Madinah, Kingdom of Saudi Arabia
[email protected]

Kashif Rizwan
Department of Computer Science and IT, Federal Urdu University of Arts, Science
and Technology, Pakistan & Department of Computer Science, University of Karachi,
Pakistan
[email protected]

Nadeem Mahmood
Department of Computer Science, University of Karachi, Pakistan
[email protected]

Ahmad Waqas
Department of Computer Science, Sukkur IBA, Sindh, Pakistan
[email protected]

Abstract:
In today’s world the rapid advancements in Micro-Electromechanical Systems
(MEMS) and Nano technology have improved almost all the aspects of daily life routine with
the help of different smart devices such as smart phones, compact electronic devices etc. The
prime example of these emerging developments is the development of wireless sensors for
healthcare procedures. One kind of these sensors is wearable bio-sensors. In this paper, the
technologies of two types of bio-sensors (ECG, EMG) are investigated and also compared with
traditional ECG, EMG equipment. We have taken SHIMMERTM wireless sensor platform as
an example of wearable biosensors technology. We have investigated the systems developed for
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A. Mehmood et al. A Study of Wearable Bio-Sensor Technologies and Applications in Healthcare (pp.67 - 77)

analysis techniques with SHIMMERTM ECG and EMG wearable bio-sensors and these bio-
sensors are used in continuous remote monitoring. For example, applications in continuous
health monitoring of elderly people, critical chronic patients and Fitness & Fatigue observations.
Nevertheless, early fall detection in older adults and weak patients, treatment efficacy
assessment. This study not only provides the basic concepts of wearable wireless bio-sensors
networks (WBSN), but also provides basic knowledge of different sensor platforms available
for patient’s remote monitoring. Also various healthcare applications by using bio-sensors are
discussed and in last comparison with traditional ECG and EMG is presented.

Keywords: Wireless Bio-sensors platforms, ECG, EMG, WBSN & its Applications,
SHIMMERTM

1. Introduction
Technological advancements in wearable electrocardiography (ECG),
microelectromechanical systems (MEMS) electromyography (EMG),
and very large scale integration (VLSI) electroencephalogram (EEG), blood pressure
elevate the field of sensors into more (BP), Saturation of Peripheral Oxygen
prominent field for research. Therefore the (SPO2), temperature monitoring sensors, these
field of wireless sensors is attracting more and are the example of physiological sensors or
more attention from researchers because of its bio-sensors. There are some other types of
wide range of applications. It has applications sensors also used in WBSN, which are inertial
in battlefield, sports, agriculture, fitness, based sensors such as accelerometer, gyro
structural monitoring, traffic control, meter, magnetometer etc.
underground mining and healthcare. Actually
sensors are devices which not only gather the
information about the physical property of an
object but also gather the changes that occur
in the state of that object. These wireless
sensors play a key role in healthcare. The
sensors used in healthcare have wide range of
applications like, remote patient monitoring,
rehabilitation process, ambient assistive living
and for biofeedback. Most of the sensors used
in healthcare are either implanted inside or
placed on the human body. The network of
these sensors is called Wireless Body area
Sensor Network (WBSN). The WBSN
comprises of the sensor nodes (wearable or
implanted inside the human body), the sink Figure. 1: ECG Electrode Placement Positions [1]
node (also called coordinator) refers to a
mobile phone or PDA (Personal Digital Here in this study, the basic introduction of
Assistant) or relay node and the base station. two bio-sensors (ECG, EMG) is presented.
The examples of sensors used in The main reason behind the selection of ECG
WBSN are, implanted cardioverter and EMG is the applications of these two
defibrillators (ICDs), swallowed camera pills, devices in healthcare. The idea behind this
study is to investigate different ECG and
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EMG wireless platforms and how it will affect ECG, the term lead refers to the signal of the
the field of healthcare. ECG and EMG are voltage difference between two electrodes.
used to identify the causes behind chronicle Figure 3 is also shown the limb leads
diseases such as heart attacks, muscle positions. For ECG in bipolar limb lead
dysfunction etc. configuration, electrodes are normally placed
Electrocardiography (ECG) is the on arms or legs as according to their place
process of capturing the tiny electrical activity mentioned in their names but these electrodes
of a heart detected through electrodes for a can also be placed as shown in Figure 1. V1,
defined time period. These electrodes are V2, V3, V4, V5 and V6 are the unipolar leads
placed on the surface of body. ECG is used to used for Wilson’s Central Terminal (WCT)
detect the disruption in pattern of electrical voltage measurement.
activity.
A graph comprises of the peak (refers
to voltage) versus time is called
electrocardiogram. An example of the ECG
pulse graph is shown in Figure 2. In each ECG
graph all the pulses, duration of these pulses
and time interval can be predicted denoted by
P, Q, R, S, T and U as depicting in Figure 2.
The P wave is the atrial depolarization with
time period of 80ms to 100ms; QRS complex
is the depolarization of both right and left
ventricles with time period of 80ms to 120ms
(atria repolarization simultaneously), while T
and U waves are ventricular repolarization.
The positions of the placement of ECG
electrode is shown in figure 1, where LA (Left
Arm), LL (Left Leg), RA (Right Arm) and RL
(Right Leg) refer to the bipolar limb leads. In

Figure. 3: [The Limb leads]

A diagnostic technique which is used

for assessing the condition (health) of skeleton
muscles and motor neurons is called
Electromyography (EMG) [3] . Motor neurons
are nerve cells which control the muscles
through transmitting the electrical signal.
These electrical signals are detected through
tiny electrodes. Intramuscular EMG and skin
surface EMG are the two types of EMG.
Figure. 2: Typical ECG Pulse [2]

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A. Mehmood et al. A Study of Wearable Bio-Sensor Technologies and Applications in Healthcare (pp.67 - 77)

and different applications of wearable bio

sensor are discussed. In section 3, a
comparative analysis between traditional
ECG, EMG and wearable wireless ECG,
EMG sensors is presented and finally the
conclusion and future work is discussed.

2. Background
There have been several sensor
platforms proposed and some are discussed
here but before the discussion about sensor
platforms, one should know about the issues
and challenges associated with the designing
and developments of the sensor platforms.

Figure. 4: Anatomical Positions of Selected 2.1. Issues and Challenges

Electrode Sites, Frontal View [3] A brief description of some issues
and challenges is discussed in the following.
In intramuscular EMG, a needle or 1) Wear-ability: In health care system, the
fine wire inserted into the muscle tissue for majority of the users are patients. So to design
recording the electrical activity and is used for such sensor platforms, one has to keep in mind
deep muscular analysis. In Skin surface EMG, the comfort and continuous health monitoring
surface electrodes are adhesively tapped to the of the patients, the wireless sensors must be
skin to measure the electrical activity between small in size and lightweight also easily
two or more points of a surface muscle tissue. wearable.
EMG can be used for identifying the muscle 2) Energy efficient: As discussed
fatigue, nerve dysfunction and problem in earlier that the sensors used in WBSN are
signal transmission from nerves to muscles. wearable or implanted inside the patient’s
Furthermore in this paper, a study related to body, therefore it is either impossible or very
some available wireless biosensor platforms difficult to change the energy source of the
which are used in different healthcare sensor keeping in mind the discomfort of the
applications, the technologies and the sensor patient. Therefore the sensor should be
types used in these platforms is presented. operated in low power. It will increase the
Also in this paper we investigate and discuss lifetime of the sensor.
the ECG and surface EMG based work has 3) Reliability: Using the
been done so far using SHIMMERTM sensor wearable wireless bio-sensors in healthcare,
platform [4]. The reason behind the selection reliability is another most important factor in
of SHIMMERTM sensor platform is its user designing of sensor node platform because the
friendly hardware and software development treatment of the patients heavily depends on
architecture, which suited for our future and the data acquired from these wearable wireless
current works in healthcare. bio-sensors. Therefore the sensor node
Rest of the paper is organized as platform should be accurate in terms of
follows, next section is Background in which capturing, filtering and preprocessing of the
issues and challenges in designing of wireless sensed data. Another aspect also should be
sensors, various wireless biosensor platforms considered while talking of reliability i.e. data
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forwarding. A biosensor node should have the sensor node platform, authors used three
ability to forward the sensed data to different types of transceivers which are,
coordinator. European 868 MHz band (radio module
4) Multi-Hop: In some critical CC1101), the 2.4 GHz band (radio module
scenarios when patients are not allowed to CC2500). The last one contained ZigBee 2.4
carry their PDA or mobile phones, then the GHz (radio module CC2520). These sensor
wireless sensor attached to patients should be nodes have two 16 Mbit large flash module
able to communicate in multi-hop manner. It and a SD card slot with the support of 2 GB
means the sensor node not only sense and send SD card. In this proposed platform authors
its own data but also send the data of a node considered the monitoring of firefighting
which is connected only to it or that node is scenario. Different types of bio-sensors,
selected for forwarding the data. In some cases inertial sensors, and pressure and temperature
the relay node is used for forwarding the sensors are placed on each fire fighter
sensor node’s data. according to their work responsibility. The
5) Latency: As discussed types of parameter chosen for prototyping are
earlier these wireless biosensors are used for heart rate, blood oxygen saturation,
remote monitoring. Therefore some sensors temperature in the fire fighter jacket, air
like ECG, EMG, and BP are most important in temperature, air humidity, methane
the process of treatment. The data acquired concentration, carbon monoxide
from these types of sensors is so critical and concentration, air cylinder pressure, orange
needs continuous monitoring. Therefore smoke above, temperature above etc. authors
latency in data should not be tolerated. One claims the prototype is working fine and ready
has to keep in mind this while designing a for use in such other applications.
sensor platform. Chen et al. [9] proposed a low-cost,
There are some other considerations tiny, lightweight (wearable), ultra-low-power
regarding the designing of a wireless sensor (long lasting), flexible (for research purpose)
node to develop a WBSN that one needs to sensor platform for Wireless Body Area
keep in mind before designing such platforms. Sensor Network (WBSN). In this architecture,
Some of these considerations are Quality of authors used microcontroller (MSP430F1611)
Services QoS, reliability and self- for processing and ChipCon CC2420 radio for
organization. A class based QoS Model [5] communication. They developed an
which prioritized the data according to sensor electrocardiography (ECG) prototype for
types, Reliable Proactive Routing Protocol [6] initial assessment, and the signal acquired
which ensures the reliability of data sending from ECG prototype is transmitted to a PC
and receiving, and the study [7], in which through a Telos mote, so real time ECG signal
authors present the provisioning of the will be displayed on PC.
introduction of self-organization in WBSN. Yamaguchi et al. [10] proposed a low
power field programming gate array (FPGA)
2.2. Wireless Bio-Sensor Platforms: based sensor node working on 950 MHz
There are several wireless biosensors frequency. In this microcontroller (MSP430)
platforms proposed in past 10 to 15 years. and FPGA based architecture, authors
Piotrowski et. al [8] proposed a introduce sensors like, temperature sensor,
microcontroller (MSP430F5438A) based infrared sensor, sound sensor, light sensor and
ultra-low power wireless sensor node platform 3D acceleration based sensor. The main theme
called IHPNode platform. In this proposed of using FPGA is co-processing of the
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acquired data, sensor interface and BioRadio mote is shown in Figure 5.

aggregation of the data. There is no support for Qardiocore[14] is another officially available
physiological sensors. wearable platform which is used for
In [11], authors proposed continuous ECG monitoring. It requires a
architecture for ECG home health monitoring, device compatible with APPLE iOS 9.0 or
in which they used a sensor node, a relay later only. The most important feature of this
(hopping) node and a based station node. 3 device is it is free from wires or patches. It is
lead ECG node is made-up with a bio- easy to use with a chest strap as depicted in
potential amplifier for single supply operation. figure 6.
The relay node is based on low power 8-bit
microcontroller PIC18F452. XBee RF
Wireless module which has the frequency of
2.4 GHz is used for radio transmission and
reception.
In[12], authors proposed a sensor
node platform, in which authors introduced
two microcontroller based architecture for
kinematic sensor with a µSD card for long-
term storage of the data. The core
microcontroller is Jennic JN5148 which
supports IEEE802.15.4 radio transceiver. The
other one is ATMega32 which supports USB
connectivity. Authors claim that their
proposed platform is highly customizable in Figure. 5 BioRadio Technology[13]
terms of both the software and hardware and
can be integrated with inertial sensors for
better results but not supported to the
physiological sensors.
Beside above mentioned platforms, some
other professionally available platforms are
also discussed here.
The BioRadio physiological
monitor[13] is a wireless platform used for
analysis of different physiological signals
such as ECG, EMG, and EEG etc. It works on
Bluetooth with range of 10 meter. The
maximum data rate is up to 200 Kbps. It can
continuous works up to 8 hours with memory
Figure. 6 Qardiocore Technology[14]
of 4 GB. The manufacturer claims that it is the
best solution for research, physiological signal
BTS analysis system[15] is another system
monitoring and teaching. The major drawback
also professionally available platform which
of this platform is it only works on Microsoft
is used for analysis of EMG Signals. This
Windows 7 or later operating systems (OS).
system can be used in medical practice, sports
Therefore it is not possible to use it other OS
and research. Its EMG device BTS
such as MAC or Linux distributions.
FREEEMG is the smallest EMG device in the
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A. Mehmood et al. A Study of Wearable Bio-Sensor Technologies and Applications in Healthcare (pp.67 - 77)

world claimed by its manufacturer. development in different tools such as C#,

BTSFREEEMG uses Wireless IEEE standard MATLAB, Android and LabVIEW so it can
802.15.4 for wireless data transmission. It can be easily integrated with Shimmer.
also continuously record the data up to 8
hours.

Figure. 8: SHIMMER Mote [4]

2.3. Application Systems

In this subsection some ECG and
EMG based applications are discussed.
In[16], Android Java-DSP [AJDSP]
Figure. 7 BTS FREEEMG[15] application was proposed for educational
purpose of signal processing courses. The
Sensing Health with Intelligence, students not only can easily understand the
Modularity, Mobility and Experimental different concepts of signal processing but
Reusability (SHIMMER) [4] is a well reputed also test and design their own DSP algorithms
wearable sensor platform designed for and by using different configurations on their
research and commercial use and well suited android devices. AJDSP can generate Musical
for wearable applications. A system Instrument Digital Interface (MIDI)
developed with Shimmer wearable sensors waveforms, Dual Tone Multiple Frequencies
enables the real time processing, transmission (DTMF) waveforms, deterministic and
and display of the sensed data with the simple random signals. It can also produce not only
and effective capturing from the body. the different frequency and time domain
Shimmer proposes a flexible wireless sensor signal processing functions but also different
platform with wide range of application, algorithms such as Fast Fourier transforms
control over capturing the data, and (FFT), z-domain operations and filter design
scientifically reliable data for interpretation also implemented.
and reliable data. It uses MSP430 In[17], authors proposed a femtocell
microcontroller for core computation and based approach to integrate two different
ChipCon CC2420 radio for communication. types of sensor networks which are Body
Besides this the micro SD card socket is also Sensors Network (BSN) and Ambient Sensors
given in shimmer devices with the support of Network (ASN) to provide remote monitoring
2 GB. Shimmer has the variety of sensing of a house of patients. In this study, four lead
capabilities like kinematic, physiological and based Shimmer ECG sensors are used for
ambient sensing through their daughter board BSN while IRIS mote with MTS400 Sensor
add-ons. Shimmer also allows software Board is used ASN that includes various
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ambient sensors such as humidity and There are some other works have
temperature sensors, light sensor, barometric been done so far using Shimmer physiological
pressure sensors and 2D-accelerometer. The sensors. For example an ECG based real time
ECG experiment is done through placement of allergy detection [19], an EMG based
four ECG leads on left arm (LA), left leg (LL), analytical study on BB (bicep brachii) muscles
right arm (RA) and right leg (RL) with the rate [20], a real time joint angle measurement
of sampling frequency set to 512 Hz. Authors using EMG [21], an ECG based patient
used a peak detection algorithm to detect QRS monitoring system [22], athlete ECG
complex and identify the R peaks correctly monitoring system [23] and activity aware
with threshold mechanism and finding local ECG based patient authentication for remote
maxima in time series, they find out the heart health monitoring [2]. Adnan et. Al [24]
rate of the patient using through identifying highlighted different area in which WBSN can
the correct R peak and sampling rate. help and also proposed new application areas
In[18] authors present a wearable for WBSN also presented a brief comparison
Shimmer biosensors (ECG and surface EMG) of different sensor applications.
with an Android smartphone based solution
for continuous monitoring of patients in daily 3. Comparative Analysis
life. The activity they selected in this study is In this section a comparison between
biking. In this study, standard limb lead II of traditional EMG and ECG with wearable
Einthoven’s triangle as shown in figure 3 is wireless biosensor is presented. In some cases
selected for ECG data. The electrodes for RA the wearable biosensor outperformed their
and LL are positioned as given in figure 1. A counterparts as shown in table 1.
QRS detection algorithm is used which has
different digital signal processing steps 3.1. Advantages
processed on raw data of 10 seconds. The first There are some advantages of
step is band pass filter (comprises of the wearable wireless biosensors discussed here.
cascading of low pass and high pass filter) for 1) Flexibility: Compared with
attenuation of noise, following by 5 steps traditional ECG and EMG machines, the
differentiation, then squaring method and in wireless biosensor are lightweight and easily
last moving window integration. With this wearable. A battery is used for power and in
method author’s claim 94.76% heart beat most sensors platforms it can be recharged,
detection rate for 60 seconds (or 6 samples). while traditional ECG, EMG machines require
In this study EMG is used for treadle electrical sockets where these machines can be
detection. The EMG electrodes are placed on plugged-in.
the Vastus lateralis and the Vastus medialis 2) Size: Normally a wearable wireless
muscles as shown in figure 3. Authors claims biosensor is small in size while traditional
that the placement of EMG electrodes on these ECG and EMG are hand handled machines,
muscles produced satisfactory results. The require some space where they can be placed
raw data is processed firstly with squaring for on especially designed tables or frames.
computing the energy of the signals and then 3) Mobility: The wireless biosensors
moving window process is used for treadle are lightweight and tiny devices, therefore
detection. In total of 60 seconds (6 samples these can be worn by a patient or person and
with each of the samples comprises of 10 patient or person can move with ease, while
seconds), authors claim 91.25% detection rate traditional machines are hand-handled, and
for treadles. therefore these are quite difficult to move
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A. Mehmood et al. A Study of Wearable Bio-Sensor Technologies and Applications in Healthcare (pp.67 - 77)

from one place to another while connected identifies it and suggest the patient to take
with patients. some proactive measures through notification
4) Availability: A person or patient can (text message or alarm). This facility can be
wear these biosensors at any time and any used in remote monitoring where a message
place without any difficulty, while traditional sent to care giver or doctor through smart
devices are fixed at one place while connected phone to take some necessary actions.
to patients.
A. Limitations
5) Freedom of natural behavior: If a
person wants to acquire ECG or EMG through There are some limitation of using these bio-
traditional devices, which means he/she sensors.
should perform some simulated activities. It 1) Accuracy: Accuracy is one of the
means that person should be ready for unease biggest factor, sometimes false alarm could be
environment where he/she cannot feel or generated. Although some sensor platforms

Table1: Comparison of ECG and EMG (Traditional Vs. Wireless Sensors)

ECG Real Powe

Data Conn
& Flexi Mobility Availa Freedo time Accurac r
Size Acquis ectivi
EMG bility Type bility m Soluti y Sourc
ition ty
Types on e
Electr
Once
ical
Traditi No Requi Only in done,
In a wall Not
onal (in red Hand particul Not doctor Very
particul socket requir
Machin terms some Handled ar much will High
ar time (unli ed
es of fix) Space places respo
mited
nd
)
Low
Wireles Batter
Yes Compare
s Tiny, Wearabl Anywh Anywh y Requi
Yes Yes (any to
Bio- Small e ere ere (Limit red
time ) Traditio
sensors ed)
nal
express his/her feelings with freedom claim that their sensors are 99% accurate but
according to his/her own will. In contrast to there is always a chance, for example
this a person or patient can do routine work misplacing the electrodes or electrodes are not
while connected with wearable bio sensors. adhesively tapped with body.
6) Any time data acquisition and 2) Power source: Batteries are used in
monitoring: Wearable biosensors enable the these wireless sensors for powering the
acquisition of real time data at any time and sensors, which became discharged so either
any place. Therefore, it allows the real time these batteries should be replaced or
monitoring of the patient. While traditional recharged. The patient may feel
machines do not have these type of luxuries.
uncomfortable when the battery of the sensor
7) Real time solution: A bio sensor
is either changed or recharged. It is also to be
work by a patient can send the data to patient’s
remembered that the smart device has also a
smart device (smart phone) for continuous
battery which also needs to be charged due to
monitoring. With the help of smart computing
continue receiving (also some sending) the
devices where some anomaly detection
data from sensors and computation which are
algorithms, if any anomaly in pattern of
battery discharging processes.
acquired data is found then the device
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