Estimation of body fluids with bioimpedance spectroscopy: state of the art methods and proposal of novel methods.

Determination of body fluids is a useful common practice in determination of disease mechanisms and treatments. Bioimpedance spectroscopy (BIS) methods are non-invasive, inexpensive and rapid alternatives to reference methods such as tracer dilution. However, they are indirect and their robustness and validity are unclear. In this article, state of the art methods are reviewed, their drawbacks identified and new methods are proposed. All methods were tested on a clinical database of patients receiving growth hormone replacement therapy. Results indicated that most BIS methods are similarly accurate (e.g. < 0.5 ± 3.0% mean percentage difference for total body water) for estimation of body fluids. A new model for calculation is proposed that performs equally well for all fluid compartments (total body water, extra- and intracellular water). It is suggested that the main source of error in extracellular water estimation is due to anisotropy, in total body water estimation to the uncertainty associated with intracellular resistivity and in determination of intracellular water a combination of both.

Robustness study of the different immittance spectra and frequency ranges in bioimpedance spectroscopy analysis for assessment of total body composition.

The estimation of body fluids is a useful and common practice for assessment of disease status and therapy outcomes. Electrical bioimpedance spectroscopy (EBIS) methods are noninvasive, inexpensive and efficient alternatives for determination of body fluids. One of the main source of errors in EBIS measurements in the estimation of body fluids is capacitive coupling. In this paper an analysis of capacitive coupling in EBIS measurements was performed and the robustness of the different immittance spectra against it tested. On simulations the conductance (G) spectrum presented the smallest overall error, among all immittance spectra, in the estimation of the impedance parameters used to estimate body fluids. Afterwards the frequency range of 10-500 kHz showed to be the most robust band of the G spectrum. The accuracy of body fluid estimations from the resulting parameters that utilized G spectrum and parameters provided by the measuring device were tested on EBIS clinical measurements from growth hormone replacement therapy patients against estimations performed with dilution methods. Regarding extracellular fluid, the correlation between each EBIS method and dilution was 0.93 with limits of agreement of 1.06 ± 2.95 l for the device, 1.10 ± 2.94 l for G [10-500 kHz] and 1.04 ± 2.94 l for G [5-1000 kHz]. Regarding intracellular fluid, the correlation between dilution and the device was 0.91, same as for G [10-500 kHz] and 0.92 for G [5-1000 kHz]. Limits of agreement were 0.12 ± 4.46 l for the device, 0.09 ± 4.45 for G [10-500 kHz] and 0.04 ± 4.58 for G [5-1000 kHz]. Such close results between the EBIS methods validate the proposed approach of using G spectrum for initial Cole characterization and posterior clinical estimation of body fluids status.

Development and preliminary evaluation of an Android based heart rate variability biofeedback system.

The reduced Heart Rate Variability (HRV) is believed to be associated with several diseases such as congestive heart failure, diabetes and chronic kidney diseases (CKD). In these cases, HRV biofeedback may be a potential intervention method to increase HRV which in turn is beneficial to these patients. In this work, a real-time Android biofeedback application based on a Bluetooth enabled ECG and thoracic electrical bioimpedance (respiration) measurement device has been developed. The system performance and usability have been evaluated in a brief study with eight healthy volunteers. The result demonstrates real-time performance of system and positive effects of biofeedback training session by increased HRV and reduced heart rate. Further development of the application and training protocol is ongoing to investigate duration of training session to find an optimum length and interval of biofeedback sessions to use in potential interventions.

Portable bioimpedance monitor evaluation for continuous impedance measurements. Towards wearable plethysmography applications.

Personalised Health Systems (PHS) that could benefit the life quality of the patients as well as decreasing the health care costs for society among other factors are arisen. The purpose of this paper is to study the capabilities of the System-on-Chip Impedance Network Analyser AD5933 performing high speed single frequency continuous bioimpedance measurements. From a theoretical analysis, the minimum continuous impedance estimation time was determined, and the AD5933 with a custom 4-Electrode Analog Front-End (AFE) was used to experimentally determine the maximum continuous impedance estimation frequency as well as the system impedance estimation error when measuring a 2R1C electrical circuit model. Transthoracic Electrical Bioimpedance (TEB) measurements in a healthy subject were obtained using 3M gel electrodes in a tetrapolar lateral spot electrode configuration. The obtained TEB raw signal was filtered in MATLAB to obtain the respiration and cardiogenic signals, and from the cardiogenic signal the impedance derivative signal (dZ/dt) was also calculated. The results have shown that the maximum continuous impedance estimation rate was approximately 550 measurements per second with a magnitude estimation error below 1% on 2R1C-parallel bridge measurements. The displayed respiration and cardiac signals exhibited good performance, and they could be used to obtain valuable information in some plethysmography monitoring applications. The obtained results suggest that the AD5933-based monitor could be used for the implementation of a portable and wearable Bioimpedance plethysmograph that could be used in applications such as Impedance Cardiography. These results combined with the research done in functional garments and textile electrodes might enable the implementation of PHS applications in a relatively short time from now.

Textrode functional straps for bioimpedance measurements--experimental results for body composition analysis.

BACKGROUND/OBJECTIVES: Functional garments for physiological sensing purposes have been used in several disciplines, that is, sports, firefighting, military and medicine. In most of the cases, textile electrodes (textrodes) embedded in the garment are used to monitor vital signs and other physiological measurements. Electrical bioimpedance (EBI) is a non-invasive and effective technology that can be used for the detection and supervision of different health conditions.EBI technology could make use of the advantages of garment integration; however, a successful implementation of EBI technology depends on the good performance of textrodes. The main drawback of textrodes is a deficient skin-electrode interface that produces a high degree of sensitivity to signal disturbances. This sensitivity can be reduced with a suitable selection of the electrode material and an intelligent and ergonomic garment design that ensures an effective skin-electrode contact area. SUBJECTS/METHODS: In this work, textrode functional straps for total right side EBI measurements for body composition are presented, and its measurement performance is compared against the use of Ag/AgCl electrodes. Shieldex sensor fabric and a tetra-polar electrode configuration using the ImpediMed spectrometer SFB7 in the frequency range of 3-500 kHz were used to obtain and analyse the impedance spectra and Cole and body composition parameters. RESULTS: The results obtained show stable and reliable measurements; the slight differences obtained with the functional garment do not significantly affect the computation of Cole and body composition parameters. CONCLUSIONS: The use of a larger sensor area, a high conductive material and an appropriate design can compensate, to some degree, for the charge transfer deficiency of the skin-electrode interface.

Electrical Bioimpedance cerebral monitoring. Preliminary results from measurements on stroke patients.

Electrical Bioimpedance Spectroscopy (EBIS) is currently used in different tissue characterization applications. In this work we aim to use EBIS to study changes in electrical properties of the cerebral tissues after an incident of hemorrhage/ischemic stroke. To do so a case-control study was conducted using six controls and three stroke cases. The preliminary results of this study show that by using Cole-based analysis on EBIS measurements and analyzing the Cole parameters R(0) and R(∞), it is possible to detect changes on electrical properties of cerebral tissue after stroke.

Adaptive frequency distribution for electrical bioimpedance spectroscopy measurements.

This paper presents a novel frequency distribution scheme intended to provide more accurate estimations of Cole parameters. Nowadays a logarithmic frequency distribution is mostly used in Electrical Bioimpedance Spectroscopy (EBIS) applications. However it is not optimized following any criterion. Our hypothesis is that an EBIS signal contains more information where the variation of the measurement regarding the frequency is larger; and that there ought to be more measuring frequencies where there is more information. Results show that for EBIS data with characteristic frequencies up to 200 kHz the error obtained with both frequency distribution schemes is similar. However, for EBIS data with higher values of characteristic frequency the error produced when estimating the values from EBIS measurements using an adaptive frequency distribution is smaller. Thus it may useful for EBIS applications with high values of characteristic frequency, e.g. cerebral bioimpedance.

Cole function and conductance-based parasitic capacitance compensation for cerebral electrical bioimpedance measurements.

One of the most common measurement artifacts present in Electrical Bioimpedance Spectroscopy measurements (EBIS) comes from the capacitive leakage effect resulting from parasitic stray capacitances. This artifact produces a deviation in the measured impedance spectrum that is most noticeable at higher frequencies. The artifact taints the spectroscopy measurement increasing the difficulty of producing reliable EBIS measurements at high frequencies. In this work, an approach for removing such capacitive influence from the spectral measurement is presented making use of a novel method to estimate the value of the parasitic capacitance equivalent that causes the measurement artifact. The proposed method has been tested and validated theoretically and experimentally and it gives a more accurate estimation of the value of the parasitic capacitance than the previous methods. Once a reliable value of parasitic capacitance has been estimated the capacitive influence can be easily compensated in the EBIS measured data. Thus enabling analysis of EBIS data at higher frequencies, i.e. in the range of 300-500 kHz like measurements intended for cerebral monitoring, where the characteristic frequency is remarkably higher than EBIS measurements i.e. within the range 30 to 50 kHz, intended for body composition assessment.

Prognostic capacity of automated quantification of suppression time in the EEG of post-asphyctic full-term neonates.

AIM: To evaluate the prognostic capacity of a new method for automatic quantification of the length of suppression time in the electroencephalogram (EEG) of a group of asphyxiated newborn infants. METHODS: Twenty-one full-term newborn infants who had been resuscitated for severe birth asphyxia were studied. Eight channel continuous EEG was recorded for prolonged time periods during the first days of life. Artefact detection or rejection was not applied to the signals. The signals were fed through a pretrained classifier and then segmented into burst and suppression periods. Total suppression length per hour was calculated. All surviving patients were followed with structured neurodevelopmental assessments to at least 18 months of age. RESULTS: The patients who developed neurodevelopmental disability or died had significant suppression periods in their EEG during the first days of life while the patients who had a normal follow-up had no or negligible amount of suppression. CONCLUSIONS: This new method for automatic quantification of suppression periods in the raw, neonatal EEG discriminates infants with good from those with poor outcome.

Skin-electrode contact area in electrical bioimpedance spectroscopy. Influence in total body composition assessment.

Electrical Bioimpedance Spectroscopy (EBIS) has been widely used for assessment of total body composition and fluid distribution. (EBIS) measurements are commonly performed with electrolytic electrodes placed on the wrist and the ankle with a rather small skin-electrode contact area. The use of textile garments for EBI requires the integration of textrodes with a larger contact area surrounding the limbs in order to compensate the absence of electrolytic medium commonly present in traditional Ag/AgCl gel electrodes. Recently it has been shown that mismatch between the measurements electrodes might cause alterations on the EBIS measurements. When performing EBIS measurements with textrodes certain differences have been observed, especially at high frequencies, respect the same EBIS measurements using Ag/AgCl electrodes. In this work the influence of increasing the skin-electrode area on the estimation of body composition parameters has been studied performing experimental EBIS measurement. The results indicate that an increment on the area of the skin-electrode interface produced noticeable changes in the bioimpedance spectra as well as in the body composition parameters. Moreover, the area increment showed also an apparent reduction of electrode impedance mismatch effects. This influence must be taken into consideration when designing and testing textile-enable EBIS measurement systems.

AD5933-based electrical bioimpedance spectrometer. Towards textile-enabled applications.

Advances on System-On-Chip and Textile technology allows the development of Textile-enabled measurement instrumentation. Textile Electrodes (Textrodes) have been proven reliable for performing Electrical Bioimpedance Spectroscopy (EBIS) measurements, and the availability of a integrated circuit impedance spectrometer, the AD5933, has allowed the implementation of small size EBIS spectrometers. In this work an AD5933-based spectrometer has been implemented, and its performance on 2R1C circuits and for tetrapolar total right side EBIS measurements has been compared against the commercially available spectrometer SFB7. The study has been focused on the working upper frequency range and the estimation of the Cole parameters required for assessment of body fluid distribution: R(0) and R(∞). The results indicate that AD5933-based spectrometer implemented in this work can perform accurate impedance measurements well above the upper limits recommended in the datasheet. The AD5933-EBIS presents a good performance compared with the SFB7 on the 2R1C circuit and the total right side measurements, showing a smaller error in the resistance spectrum and small deviation error in the reactance when measuring over 270 kHz. The comparison on the Cole parameters estimation obtained with the SFB7 and the AD5933-based spectrometer exhibit a difference below 1% for the estimation of R(0) and R(∞). Consequently the overall measurement performance shown by the implemented AD5933-based spectrometer suggests its feasible use for EBIS measurements using dry Textrodes. This is of special relevance for the proliferation of EBI-based personalized health monitoring systems for patients that require to monitor the distribution of body fluids, like in dialysis.

Textile electrode straps for wrist-to-ankle bioimpedance measurements for Body Composition Analysis. Initial validation & experimental results.

Electrical Bioimpedance (EBI) is one of the non-invasive monitoring technologies that could benefit from the emerging textile based measurement systems. If reliable and reproducible EBI measurements could be done with textile electrodes, that would facilitate the utilization of EBI-based personalized healthcare monitoring applications. In this work the performance of a custom-made dry-textile electrode prototype is tested. Four-electrodes ankle-to-wrist EBI measurements have been taken on healthy subjects with the Impedimed spectrometer SFB7 in the frequency range 5 kHz to 1 MHz. The EBI spectroscopy measurements taken with dry electrodes were analyzed via the Cole and Body Composition Analysis (BCA) parameters, which were compared with EBI measurements obtained with standard electrolytic electrodes. The analysis of the obtained results indicate that even when dry textile electrodes may be used for EBI spectroscopy measurements, the measurements present remarkable differences that influence in the Cole parameter estimation process and in the final production of the BCA parameters. These initial results indicate that more research work must be done to in order to obtain a textile-based electrode that ensures reliable and reproducible EBI spectroscopy measurements.

Does indomethacin for closure of patent ductus arteriosus affect cerebral function?

OBJECTIVE: To study whether indomethacin used in conventional dose for closure of patent ductus arteriosus affects cerebral function measured by electroencephalograms (EEG) evaluated by quantitative measures. STUDY DESIGN: Seven premature neonates with haemodynamically significant persistent ductus arteriosus were recruited. EEG were recorded before, during and after an intravenous infusion of 0.2 mg/kg indomethacin over 10 min. The EEG was analysed by two methods with different degrees of complexity for the amount of low-activity periods (LAP, "suppressions") as an indicator of affection of cerebral function. RESULTS: Neither of the two methods identified any change in the amount of LAPs in the EEG as compared to before the indomethacin infusion. CONCLUSION: Indomethacin in conventional dose for closure of patent ductus arteriosus does not affect cerebral function as evaluated by quantitative EEG.

Home e-health system integration in the Smart Home through a common media server.

Home e-health systems and services are revealed as one of the most important challenges to promote Quality of Life related to Health in the Information Society. Leading companies have worked on e-health systems although the majority of them are addressed to hospital or primary care settings. The solution detailed in this paper offers a personal health system to be integrated with Smart Home services platform to support home based e-care. Thus, the home e-health system and architecture detailed in this research work is ready to supply a seamless personal care solution both from the biomedical data analysis, service provision, security guarantee and information management s point of view. The solution is ready to be integrated within the Accessible Digital Home, a living lab managed by Universidad Politécnica de Madrid for R&D activities.

Textile electrodes in Electrical Bioimpedance measurements - a comparison with conventional Ag/AgCl electrodes.

Work has been intensified around the integration of textile and measurement technology for physiological measurements in the last years. As a result nowadays it is possible to find available commercial products for cardiovascular personal healthcare monitoring. Most of the efforts have been focused in the acquisition of EKG for cardiovascular monitoring where textile electrodes have shown satisfactory performance. Electrical Bioimpedance is another type of physiological measurement that can be used for personal healthcare monitoring where the integration and the performance of the textile electrodes has not been investigated that thoroughly. In this work, the influence of the textile electrodes on the measurements and on the estimation of the Cole (R(0), R(infinity), f(C) and alpha) and body composition (TBW, ICW, ECW and FFM) parameters has been especially addressed. Complex Spectroscopy 4-electrode wrist-to-ankle electrical bioimpedance measurements taken with conventional Ag/AgCl and textile-electrodes on customized bracelets have been compared and analyzed in the frequency range 3 to 500 kHz. The obtained results suggest that the use of textile electrodes do not influence remarkably on the complex spectral measurements neither in the estimation of Cole nor body composition parameter. In any case any possible effect introduced by the use of textile is smaller than the effect of preparing the skin by the using abrasive conductive paste.

Classification of burst and suppression in the neonatal electroencephalogram.

Fisher's linear discriminant (FLD), a feed-forward artificial neural network (ANN) and a support vector machine (SVM) were compared with respect to their ability to distinguish bursts from suppressions in electroencephalograms (EEG) displaying a burst-suppression pattern. Five features extracted from the EEG were used as inputs. The study was based on EEG signals from six full-term infants who had suffered from perinatal asphyxia, and the methods have been trained with reference data classified by an experienced electroencephalographer. The results are summarized as the area under the curve (AUC), derived from receiver operating characteristic (ROC) curves for the three methods. Based on this, the SVM performs slightly better than the others. Testing the three methods with combinations of increasing numbers of the five features shows that the SVM handles the increasing amount of information better than the other methods.

Design evaluation of a home-based telecare system for Chronic Heart Failure patients.

In order to improve the care of Chronic Heart Failure (CHF) patients, a system has been developed for monitoring symptoms and document subjective judgments on health conditions in a home environment. Since system usability is an important issue, a two step evaluation of the solution was conducted. First a ten-patient survey was conducted, which was aimed at spotting possible problem areas. The second step involved a small trial in a home setting with CHF patients. The results are promising, indicating that the system is user friendly and easy to use, and that it is suitable as a prototype for the intended use.

Comparing a supervised and an unsupervised classification method for burst detection in neonatal EEG.

Hidden Markov Models (HMM) and Support Vector Machines (SVM) using unsupervised and supervised training, respectively, were compared with respect to their ability to correctly classify burst and suppression in neonatal EEG. Each classifier was fed five feature signals extracted from EEG signals from six full term infants who had suffered from perinatal asphyxia. Visual inspection of the EEG by an experienced electroencephalographer was used as the gold standard when training the SVM, and for evaluating the performance of both methods. The results are presented as receiver operating characteristic (ROC) curves and quantified by the area under the curve (AUC). Our study show that the SVM and the HMM exhibit similar performance, despite their fundamental differences.

Comparison of three methods for classifying burst and suppression in the EEG of post asphyctic newborns.

Fisher's linear discriminant, a feed-forward neural network (NN) and a support vector machine (SVM) are compared with respect to their ability to distinguish bursts from suppression in burst-suppression electroencephalogram (EEG) signals using five features inherent in the EEG as input. The study is based on EEG signals from six full term infants who have suffered from perinatal asphyxia, and the methods have been trained with reference data classified by an experienced electroencephalographer. The results are summarized as area under the curve (AUC) values derived from receiver operating characteristic (ROC) curves for the three methods, and show that the SVM is slightly better than the others, at the cost of a higher computational complexity.

Spectral distance for ARMA models applied to electroencephalogram for early detection of hypoxia.

A novel measure of spectral distance is presented, which is inspired by the prediction residual parameter presented by Itakura in 1975, but derived from frequency domain data and extended to include autoregressive moving average (ARMA) models. This new algorithm is applied to electroencephalogram (EEG) data from newborn piglets exposed to hypoxia for the purpose of early detection of hypoxia. The performance is evaluated using parameters relevant for potential clinical use, and is found to outperform the Itakura distance, which has proved to be useful for this application. Additionally, we compare the performance with various algorithms previously used for the detection of hypoxia from EEG. Our results based on EEG from newborn piglets show that some detector statistics divert significantly from a reference period less than 2 min after the start of general hypoxia. Among these successful detectors, the proposed spectral distance is the only spectral-based parameter. It therefore appears that spectral changes due to hypoxia are best described by use of an ARMA- model-based spectral estimate, but the drawback of the presented method is high computational effort.