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SENSORS AND ACTUATORS

Medical Rehabilitation
Syed Hussain Shanas Rizvi

2017-F-MS-MC-33
Contents

Medical Rehabilitation .................................................................................................................... 3

Introduction ................................................................................................................................. 3

Basic Body Physics ..................................................................................................................... 4

Blood Pressure Monitoring ......................................................................................................... 6

Classical .................................................................................................................................. 6

Latest Technology................................................................................................................... 7

Electromyography (EMG) .......................................................................................................... 8

Important features when using EMG ...................................................................................... 9

Electrocardiography (ECG) ...................................................................................................... 11

Cardiac parameters of interest .............................................................................................. 13

Electroencephalography (EEG) ................................................................................................ 14

Working Principle of EEG .................................................................................................... 14

Data Interpretation ................................................................................................................ 16

Non Invasive method for Body Glucose Level Monitoring ..................................................... 18

Human Spine Rehabilitation ..................................................................................................... 19

Conclusion ................................................................................................................................ 19

References ................................................................................................................................. 20

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Medical Rehabilitation

Introduction
Medical Rehabilitation is medical discipline that utilizes physical agents
such as heat, light, water, electricity, massage, manipulations, mechanical appliances etc; manual
procedures and therapeutic exercises in the treatment and management of injuries and diseases. It
aims to enhance and restore
functional ability and quality
of life to those with physical
impairments or disabilities
affecting the brain, spinal
cord, nerves, bones, joints,
ligaments, muscles, and
tendons. The scope of this
subject is limited to sensors
that are used in the
rehabilitation process. The
sensors basically help the
controller to analyze what is
happening inside the body or
the desire of the person.
Sensors which analyze body
sense are motor neuron or
neuron system inside the body which senses the desire of the person. Signal is basically
generated by brain and travel through neuron system of body towards different muscles in the
body to do the desired activity. Whenever an activity is to be perform by the body an electric
pulse is generated inside body, that travel through neuron system of the body , end position for
the pulse is that muscle which is involved in that activity.

The revolutionary advancement and research in this field is proving out to be a blessing for the
person who are impaired or their limbs are infected naturally or after some accidents. Basically if

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the neurons of the body are still active or body is able to generate small electric pulses that can
propagate towards skin then that signal is enough for the sensors to analyze what is happening
inside the body. After the signal is traced than further actuation by the modern actuators can be
done as of the normal person. Even the actuation of different body parts of the body can be done
by just taking the signal from the brain. In other words the person will just have to think of any
actuation related to body or even out of the body and that signal can be traced by the sensors that
were installed on the scalp of the user.

Apart from neuron system, regular monitoring of body by invasive methods utilizing sensors can
prevent a user from future emergencies. For example if heart rate is monitored on daily basis
than user can be aware of possible future heart stroke and important measures can be taken to
avoid it. Body Glucose Level can also be measured by the help of sensors that we are going to
discuss in the later section of this report, and if regular monitoring of glucose level is done then
many other problems can be waived off by maintain proper glucose level.

Basic Body Physics


Everything we do is controlled and enabled by electrical signals running
through our bodies. As we
learned in intro physics,
everything is made up of
atoms, and atoms are made up
of protons, neutrons and
electrons. Protons have a
positive charge, neutrons have
a neutral charge, and electrons
have a negative charge. When
these charges are out of
balance, an atom becomes
either positively or negatively
charged. The switch between
one type of charge and the
other allows electrons to flow

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from one atom to another. This flow of electrons, or a negative charge, is what we call
electricity. Since our bodies are huge masses of atoms, we can generate electricity.

When we talk about the nervous system sending signals to the brain, or synapses firing, or the
brain telling our hands to contract around a door handle, what we're talking about is electricity
carrying messages between point A and point B. It's sort of like the digital cable signal carrying
1s and 0s that deliver "Law & Order." Except in our bodies, electrons aren't flowing along a
wire; instead, an electrical charge is jumping from one cell to the next until it reaches its
destination.

Electricity is a key to survival. Electrical signals are fast. They allow for a nearly instantaneous
response to control messages. If our bodies relied entirely on, say, the movement of chemicals to
tell our hearts to speed up when something is chasing us, we probably would've died out a long
time ago.

Those crucial signals that tell our hearts to speed up when we're in danger come from a mass of
cells in our heart called the sinoatrial node, or SA node. It's located in the right atrium, and it
controls the rhythm of our heartbeat and the movement of blood from the heart to every other
part of our body. It's our body's natural pacemaker, and it uses electrical signals to set the pace.
But our pulse isn't the only thing that relies on electrical impulses generated by our cells. Almost
all of our cells are capable of generating electricity.

Any cells in body that aren't actively sending messages are slightly negatively charged.
Negativity is the natural resting state of cells. It's related to a slight imbalance between potassium
and sodium ions inside and outside the cell.

At rest, cells have more potassium ions inside than sodium ions, and there are more sodium ions
outside the cell. Potassium ions are negative, so the inside of a cell has a slightly negative charge.
Sodium ions are positive, so the area immediately outside the cell membrane is positive. There
isn't a strong enough charge difference to generate electricity, though, in this resting state.

When the body needs to send a message from one point to another, it opens the gate. When the
membrane gate opens, sodium and potassium ions move freely into and out of the cell.
Negatively charged potassium ions leave the cell, attracted to the positivity outside the

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membrane, and positively charged sodium ions enter it, moving toward the negative charge. The
result is a switch in the concentrations of the two types of ions -- and rapid switch in charge. It's
kind of like switching between a 1 and 0, this flip between positive and negative generates an
electrical impulse. This impulse triggers the gate on the next cell to open, creating another
charge, and so on. In this way, an electrical impulse moves from a nerve in your stubbed toe to
the part of your brain that senses pain.

Blood Pressure Monitoring

Classical
Conventionally, non-invasive BP has been measured using a sphygmomanometer based on the
design proposed by Samuel Siegfried Karl Ritter von Basch in 1881. Riva Rocci further
improved the design by developing a branchial cuff sphygmomanometer in 1896. The detection
of Kortokoff
sound (K-
sound) in 1905
enabled
complete non-
invasive BP
measurement.
The pressure
indicated by the
manometer at
the first K-
sound is noted
as the systolic
BP (SBP) and
the silent fifth sound indicates the diastolic BP (DBP). In the past few decades, oscillometry-
based BP tools have become popular, providing ease of operation. They do not require a
caregiver or experienced personnel to operate and hence can be used to monitor BP in the home
setting. These devices have a cuff wrapping around the arm or leg to detect the oscillations
during cuff-deflation using a built-in pressure sensor. Mean arterial pressure (MAP) is estimated

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using the amplitude of variations of the recorded oscillations which are used to algorithmically
obtain SBP and DBP.

Latest Technology
Photoplethysmography (PPG) is a simple optical technique used to detect volumetric changes in
blood in peripheral circulation. It is a low cost and non-invasive method that makes
measurements at the surface of the skin. The technique provides valuable information related to
our cardiovascular system. Recent advances in technology has revived interest in this technique,
which is widely used in clinical physiological measurement and monitoring.

PPG makes uses of low-intensity infrared (IR) light. When light travels through biological
tissues it is absorbed by bones, skin pigments and both venous and arterial blood. Since light is
more strongly absorbed by blood than the surrounding tissues, the changes in blood flow can be
detected by PPG sensors as
changes in the intensity of
light. The voltage signal
from PPG is proportional to
the quantity of blood
flowing through the blood
vessels. Even small changes
in blood volume can be
detected using this method,
though it cannot be used to quantify the amount of blood. A PPG signal has several components
including volumetric changes in arterial blood which is associated with cardiac activity,
variations in venous blood volume which modulates the PPG signal, a DC component showing
the tissues’ optical property and subtle energy changes in the body. Some major factors affecting
the recordings from the PPG are site of measurement and the contact force between the site and
the sensor. Blood flow variations mostly occur in the arteries and not in the veins.

PPG shows the blood flow changes as a waveform with the help of a bar or a graph. The
waveform has an alternating current (AC) component and a direct current (DC) component. The
AC component corresponds to variations in blood volume in synchronization with the heart beat.
The DC component arises from the optical signals reflected or transmitted by the tissues and is

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determined by the tissue structure as well as venous and arterial blood volumes. The DC
component shows minor changes with respiration. The basic frequency of the AC component
varies with the heart rate and is superimposed on the DC baseline.

Electromyography (EMG)
The fascinating and cutting-edge technology of steering robotic devices
with muscular signals is based on the simple fact that whenever a muscle (or its residual)
contracts a burst of electric activity is generated which propagates through adjacent tissue and
bone and can be recorded from neighboring skin areas.

In detail, the process is a bit more complex: A voluntary action


commands such as “I’d like to grab my cell phone on the
table” triggers brain processes in motor cortex which travel
along spinal cord and limbs via motor neurons. Eventually,
the elicited action potential arrives at the motor end plate of
the respective muscle. Its arrival causes a release of the
neurotransmitter Acetylcholine (ACh) at the synaptic cleft
inducing a depolarization which is propagated downward
from the muscular surface in a transverse tubule. As a
result, Calcium ions (Ca2+) are released, which results in
cross-bridge binding and muscular contraction.

Importantly, EMG activity (as measured in microvolt) is


linearly related to the amount of muscle contraction as well
as the number of contracted muscles – or in other words, the
stronger the muscle contraction and the higher the number
of activated muscles, the higher the recorded voltage
amplitude will be.

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Since EMG activity
is even measurable
when we do not
display obvious
actions or control
our body to not
perform certain
behaviors, EMG
recordings represent
an additional source
of insights into
cognitive-behavioral
processing which
would be hidden based on pure observation techniques.

Previous research indicates a close coupling between muscular EMG and motor-cortex EEG as
reflected by significant correlations in signal features such as frequency power and phase in the
(12 – 25 Hz) beta band. This emphasizes the power of EMG recordings for monitoring the
interaction of cortical and motor systems.

Important features when using EMG


Use surface electrodes

 Surface EMG is a completely non-invasive technology that allows you to easily place
EMG electrodes with stickers to the skin.
 No muscle innervations is necessary, which renders EMG an ideal method for monitoring
physiological processes without interfering established routines and movement patterns.
 In order to obtain high-quality data, keep in mind to always clean the recording sites and
remove make-up using alcohol rubs.

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Place EMG electrodes over muscle groups of interest

 Admittedly, this requires a certain level of anatomic knowledge. Only if you know the
muscle regimes involved in a specific action you will be able to get valid and reliable
signals of high quality.
 Facial EMG recordings, for example, are complicated by the fact that there are 43
muscles in the face. Most of these are controlled by the seventh cranial nerve (the “facial
nerve”), which routes from the cerebral cortex to five primary branches (temporal,
zygomatic, buccal, mandibular and cervical).
 Each branch innervates muscles in different face areas, allowing for intricate facial twists
and contortions.

Select an appropriate reference site

 EMG data is collected in a bipolar fashion – in fact, the EMG signal is the voltage
difference between recording site and reference site.
 Therefore, selecting an appropriate reference site is as important as the actual recording
site.
 It is recommend placing EMG reference channels at bony body parts such as an elbow,
hip or collar bones.

Use short electrode cables/leads

In order to minimize the amount of electrical noise picked up from surrounding power sources,
keep the length of the cables that connect the recording electrodes with the amplifier/recording
device as short as possible.

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Electrocardiography (ECG)
Before going into the fundamentals of ECG, let’s briefly recap on heart physiology and function:

 The heart has four chambers. The upper two chambers (left/right atria) are entry-points
into the heart, while the lower two chambers (left/right ventricles) are contraction
chambers sending blood through the circulation. The circulation is split into a “loop”
through the lungs (pulmonary) and another “loop” through the body (systemic).

 The cardiac cycle refers to a complete heartbeat from its generation to the beginning of
the next beat, comprising several stages of filling and emptying of the chambers. The
frequency of the cardiac cycle is reflected as heart rate (beats per minute, bpm).

 The heart operates automatically – it is self-exciting (other muscles in the body require
nervous stimuli for excitation). The rhythmic contractions of the heart occur
spontaneously, but are sensitive to nervous or hormonal influences, particularly to
sympathetic (arousing) and parasympathetic (decelerating) activity.

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ECG records the electrical activity generated by heart muscle depolarization, which propagate in
pulsating electrical waves towards the skin. Although the electricity amount is in fact very small,
it can be picked up reliably with ECG electrodes attached to the skin (data unit: microvolt, uV).
The full ECG setup comprises at least four electrodes which are placed on the chest or at the four
extremities according to standard nomenclature (RA = right arm; LA = left arm; RL = right leg;
LL = left leg). Of course, variations of this setup exist in order to allow more flexible and less
intrusive recordings, for example, by attaching the electrodes to the forearms and legs. ECG
electrodes are typically wet sensors, requiring the use of a conductive gel to increase
conductivity between skin and electrodes.

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Cardiac parameters of interest
Recording heart rate data gives you access to the following parameters that can be interpreted
with respect to one’s arousal

 Heart Rate (HR). HR reflects the frequency of a complete heartbeat from its generation
to the beginning of the next beat within a specific time window. It is typically expressed
as beats per minute (bpm). HR can be extracted using ECG and PPG sensors.
 Inter-Beat Interval (IBI). The IBI is the time interval between individual beats of the
heart, generally measured in units of milliseconds (ms). Typically, the RR-interval is
used for the analysis.
 Heart Rate Variability (HRV). HRV
expresses the natural variation of IBI
values from beat to beat. HRV is closely
related to emotional arousal: High-
frequency (HF) activity has been found to
decrease under conditions of acute time
pressure and emotional stress. Also, HRV
seems to be significantly reduced in
individuals reporting a greater frequency
and duration of daily worry, as well as in
patients suffering from post-traumatic
stress disorder (PTSD). For IBI and HRV
analysis, ECG sensors are recommended as they are more sensitive to certain signal
characteristics which PPG sensors cannot pick up.

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Electroencephalography (EEG)
The brain consists of hundreds of thousands of cells, so-called
neurons, densely interconnected via synapses, which act as gateways of inhibitory or excitatory
activity. In other words: Synapses propagate information across neurons (excitatory) or prevent
the passage of information from one neuron to the next (inhibitory).

Any synaptic activity generates a subtle electrical impulse referred to as post-synaptic


potential (post = behind). Of course, the burst of a single neuron is too tiny to be noticed.
However, whenever a smaller group of neurons (about 1000 or more) fires in sync, they generate
an electrical field which is strong enough to spread through tissue, bone, and skull. Eventually, it
can be measured on the head surface.

Think of this as a constant rumble of subtle earthquakes. Taken by itself, each burst might be too
small to notice, but if several of them occur at the same time, in the same location, and in the
same rhythm, they all add up to a mega-quake that will be noticeable even thousands of miles
away.

Working Principle of EEG


Electroencephalography (encephalon = brain), or
EEG, is the physiological method of choice to record
all of the electrical activity generated by the brain
from electrodes placed on the scalp surface. For
faster application, electrodes are mounted in elastic
caps similar to bathing caps, ensuring that the data
can be collected from identical scalp positions across
all respondents.

Despite its somewhat daunting name (and


pronunciation), grasping the biophysics behind
electroencephalography is actually surprisingly
simple:

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EEG:

 Measures electrical activity generated by the synchronized activity of thousands of


neurons (in voltage)

 Provides excellent time resolution, allowing you to analyze which brain areas are active
at a certain time – even at sub-second timescales

Since the voltage fluctuations measured at the electrodes are very small, the recorded data is
digitized and sent to an amplifier. The amplified data can then be displayed as a sequence of
voltage values.

Price differences in EEG systems are typically due to the number of electrodes, the quality of the
digitization, the quality of the amplifier, and the number of snapshots the device can take per
second (this is the sampling rate in Hz).

EEG is one of the


fastest imaging
techniques available as
it can take thousands
of snapshots per
second (256 Hz or
higher). 100 years ago
the EEG time course
was a plot on paper.
Current systems
display the data as
continuous flow of
voltages on a screen.

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Data Interpretation
As EEG monitors the time course of
electrical activity generated by the brain, you can
interpret which brain areas are responsible for
processing information at a given time:

Occipital cortex

This part of the brain is primarily responsible for


processing visual information. EEG experiments
with visual stimuli (videos, images) focus on
effects in occipital regions.

Parietal cortex

Parietal cortex is primarily responsible for fusing various bodily reference frames (eye-centered,
head-centered, hand-centered, body-centered). Also, parietal cortex is active during self-
referential tasks – when we are encountering objects or information that is important to us.

Temporal cortex

Temporal cortex has lateral aspects which are responsible for language processing and speech
production. Medial (=inner) regions are more active during spatial navigation. You might have
heard about hippocampus: This is the brain region in temporal cortex where we form spatial and
autobiographical memories from early childhood days.

Frontal cortex

The frontal part of the human brain is enlarged compared to other mammals. Basically, frontal
cortex is all about cognitive control: It keeps us from running after flashing lights, makes us
pursue Graduate studies and PhD careers, and binds various memories and experiences into a
consistent conglomerate.

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Apart from the regional characteristics of where certain electrical activity originates, you can
also analyze which frequencies primarily drive the ongoing activity.

Whenever brain is in a certain state, the frequency patterns change – your brain kicks into gears.

 Delta (1 – 4 Hz) – in sleep labs, delta waves are examined to assess the depth of sleep.
The stronger the delta rhythm, the deeper the sleep. Interestingly, delta waves are only
present in non-REM phases – when we’re not dreaming, for example.

 Theta (4 – 8 Hz) – theta is associated with a wide range of cognitive processing such as
memory encoding and retrieval as well as cognitive workload. Whenever we’re
confronted with difficult tasks (counting backwards from 100 in steps of 7, or when
recalling the way home from work, for example), theta waves become more prominent.

 Alpha (8 – 12 Hz) –
whenever we close our eyes
and bring ourselves into a
relaxed, wakeful state, alpha
waves take over. Alpha is
reduced with open eyes and
drowsiness. Therefore, alpha
coordinates multi-sensory
processing, attention, and
concentration. Biofeedback
training often uses alpha
waves to monitor relaxation.

 Beta (12 – 25 Hz)- over motor regions, beta frequencies become stronger as we plan or
execute movements of any body part. Interestingly, this increase in beta is also noticeable
as we observe bodily movements of other people. Our brain seemingly mimics their limb
movements, indicating that there is an intricate “mirror neuron system” in our brain
which is coordinated by beta frequencies.

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 Gamma (>25 Hz, typically 40 Hz) – at the moment, gamma frequencies are the black
holes of EEG research. Some researchers argue that gamma reflects attentive focusing
and serves as carrier frequency to facilitate data exchange between brain regions. Others
associate gamma with rapid eye movements, so-called micro-saccades, which are
considered integral parts for sensory processing and information uptake.

When it comes to analyzing EEG data, it admittedly can get quite challenging. Signal pre-
processing, artifact detection and attenuation, feature extraction and computation of mental
metrics such as workload, engagement, drowsiness or alertness all require a certain level of
expertise and experience to properly identify and extract valuable information from the collected
data.

Non Invasive method for Body Glucose Level Monitoring


This technique is still under research
and no final product is launched yet. Sensors which are used in this process are basically a green
LED, a red LED, IR LED, and a 1550nm NIR LED. The green is used to determine how much
skin is in the way, the Red and IR are used to determine the volume of blood being measured,
and with the volume of blood you can use the 1550nm NIR LED to determine the amount of
glucose. The reason 1550nm is used is because at that specific wavelength water in the blood
does not absorb as much light as other wavelengths, and glucose still absorbs light at a
reasonable rate.

Phenomena behind this research is Beer Lambart


Law which states that the quantity of light absorbed
by a substance dissolved in a fully transmitting
solvent is directly proportional to the concentration
of the substance and the path length of the light
through the solution.

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Human Spine Rehabilitation
This technique is also under research and no product is
launched yet which is working on basis of this research.
Basically orientation angles are monitored by Inertial Sensors
mounted on wearable monitoring systems. It is non invasive
solution to identify the
human back shape
which can help
reducing time needed
for medical
rehabilitation sessions.
It also prevents future
problems caused by
poor posture.

Conclusion
Medical Rehabilitation is moving into the home increasingly often and involving a
mixture of people, a variety of tasks, and a broad diversity of devices and technologies; it is also
occurring in a range of residential environments. The factors driving this migration include the
rising costs of providing health care; the growing numbers of older adults; the increasing
prevalence of chronic disease; improved survival rates of various diseases, injuries, and other
conditions (including those of fragile newborns); large numbers of veterans returning from war
with serious injuries; and a wide range of technological innovations. The health care that results
varies considerably in its safety, effectiveness, and efficiency, as well as its quality and cost.

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References
[1] https://imotions.com/blog/what-is-eeg/

[2] http://iopscience.iop.org/article/10.1088/0967-3334/28/3/R01/meta

[3] https://blog.adafruit.com/2015/05/06/open-source-non-invasive-glucose-meter-project-
wearablewednesday/

[4] https://www.news-medical.net/health/Photoplethysmography-(PPG).aspx

[5] http://www.doctorsbeyondmedicine.com/listing/bodys-electricity

[6] http://www.mdpi.com/2227-7080/5/2/21

[7] https://unizik.edu.ng/nauweb/depts/medical-rehabilitation

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