Active electrodes (AEs), i.e., electrodes with built-in readout circuitry, are increasingly being implemented in wearable healthcare and lifestyle applications due to AEs' robustness to environmental interference. An AE locally amplifies and buffers μV-level EEG signals before driving any cabling. The low output impedance of an AE mitigates cable motion artifacts, thus enabling the use of high-impedance dry electrodes for greater user comfort. However, developing a wearable EEG system, with medical grade signal quality on noise, electrode offset tolerance, common-mode rejection ratio, input impedance, and power dissipation, remains a challenging task. This paper reviews state-of-the-art bio-amplifier architectures and low-power analog circuits design techniques intended for wearable EEG acquisition, with a special focus on an AE system interfaced with dry electrodes.@en

Background and objective: Long-term electrocardiogram monitoring comes at the expense of signal quality. During unconstrained movements, the electrocardiogram is often corrupted by motion artefacts, which can lead to inaccurate physiological information. In this situation, automated quality assessment methods are useful to increase the reliability of the measurements. A generic machine learning pipeline that generates classification models for electrocardiogram quality assessment is presented in this article. The presented pipeline is tested on signals from varied acquisition sources, towards selecting segments that can be used for heart rate analysis in lifestyle applications. Methods: Electrocardiogram recordings from traditional, wearable and ubiquitous devices, are segmented in 10 s windows and manually labeled by experienced researchers into two quality classes. To capture the electrocardiogram dynamics, a comprehensive set of 43 features is extracted from each segment, based on the time-domain signal, its Fast Fourier Transform, the Autocorrelation function and the Stationary Wavelet Transform. To select the most relevant features for each acquisition source we employ both a customized hybrid approach and the state-of-the-art Neighborhood Component Analysis method and compare them. Support Vector Machines (SVM), Decision Trees, K-Nearest-Neighbors and supervised ensemble methods are tested as possible binary classifiers. Results: The results for the best performing models on traditional, wearable and ubiquitous electrocardiogram datasets are, respectively: balanced-accuracy: 89%, F1-score: 93% with the Fine Gaussian SVM model and 10 features; balanced-accuracy: 93%, F1-score: 93% with the Fine Gaussian SVM model and 11 features; balanced-accuracy: 95%, F1-score: 86%, with the Fine Gaussian SVM model and 8 features. Conclusions: According to the results, our generic pipeline can generate classification models tailored to individual acquisition sources, provided that a standard Lead I or Lead II is available. Such models accurately establish whether the electrocardiogram quality is good or bad for heart rate analysis. Furthermore, removing bad quality segments decreases errors in heart rate calculation.@en

Background: Cardiac rehabilitation (CR) is known for its beneficial effects on functional capacity and is a key component within current cardiovascular disease management strategies. In addition, a larger increase in functional capacity is accompanied by better clinical outcomes. However, not all patients respond in a similar way to CR. Therefore, a patient-tailored approach to CR could open up the possibility to achieve an optimal increase in functional capacity in every patient. Before treatment can be optimized, the differences in response of patients in terms of cardiac adaptation to exercise should first be understood. In addition, digital biomarkers to steer CR need to be identified. Objective: The aim of the study was to investigate the difference in cardiac response between patients characterized by a clear improvement in functional capacity and patients showing only a minor improvement following CR therapy. Methods: A total of 129 patients in CR performed a 6-minute walking test (6MWT) at baseline and during four consecutive short-term follow-up tests while being equipped with a wearable electrocardiogram (ECG) device. The 6MWTs were used to evaluate functional capacity. Patients were divided into high- and low-response groups, based on the improvement in functional capacity during the CR program. Commonly used heart rate parameters and cardiac digital biomarkers representative of the heart rate behavior during the 6MWT and their evolution over time were investigated. Results: All participating patients improved in functional capacity throughout the CR program (P<.001). The heart rate parameters, which are commonly used in practice, evolved differently for both groups throughout CR. The peak heart rate (HR peak) from patients in the high-response group increased significantly throughout CR, while no change was observed in the low-response group (F 4,92=8.321, P<.001). Similar results were obtained for the recovery heart rate (HR rec) values, which increased significantly over time during every minute of recuperation, for the high-response group (HR rec1: P<.001, HR rec2: P<.001, HR rec3: P<.001, HR rec4: P<.001, and HR rec5: P=.02). The other digital biomarkers showed that the evolution of heart rate behavior during a standardized activity test differed throughout CR between both groups. These digital biomarkers, derived from the continuous measurements, contribute to more in-depth insight into the progression of patients' cardiac responses. Conclusions: This study showed that when using wearable sensor technology, the differences in response of patients to CR can be characterized by means of commonly used heart rate parameters and digital biomarkers that are representative of cardiac response to exercise. These digital biomarkers, derived by innovative analysis techniques, allow for more in-depth insights into the cardiac response of cardiac patients during standardized activity. These results open up the possibility to optimized and more patient-tailored treatment strategies and to potentially improve CR outcome. @en

Cardiac rehabilitation (CR) is a highly recommended secondary prevention measure for patients with diagnosed cardiovascular disease. Unfortunately, participation rates are low due to enrollment and adherence issues. As such, new CR delivery strategies are of interest, as to improve overall CR delivery. The goal of the study was to obtain a better understanding of the short-term progression of functional capacity throughout multidisciplinary CR, measured as the change in walking distance between baseline six-minute walking test (6MWT) and four consecutive follow-up tests. One-hundred-and-twenty-nine patients diagnosed with cardiovascular disease participated in the study, of which 89 patients who completed the whole study protocol were included in the statistical analysis. A one-way repeated measures ANOVA was conducted to determine whether there was a significant change in mean 6MWT distance (6MWD) throughout CR. A three-way-mixed ANOVA was performed to determine the influence of categorical variables on the progression in 6MWD between groups. Significant differences in mean 6MWD between consecutive measurements were observed. Two subgroups were identified based on the change in distance between baseline and end-of-study. Patients who increased most showed a linear progression. In the other group progression leveled off halfway through rehabilitation. Moreover, the improvement during the initial phase of CR seemed to be indicative for overall progression. The current study adds to the understanding of the short-term progression in exercise capacity of patients diagnosed with cardiovascular disease throughout a CR program. The results are not only of interest for CR in general, but could be particularly relevant in the setting of home-based CR.@en

Objective: Over the last two decades, radar-based contactless monitoring of vital signs (heartbeat and respiration rate) has raised increasing interest as an emerging and added value to health care. However, until now, the flaws caused by indoor multipath propagation formed a fundamental hurdle for the adoption of such technology in practical healthcare applications where reliability and robustness are crucial. Multipath reflections, originated from one person, combine with the direct signals and multipaths of other people and stationary objects, thus jeopardizing individual vital signs extraction and localization. This work focuses on tackling indoor multipath propagation. Methods: We describe a methodology, based on accurate models of the indoor multipaths and of the radar signals, that enables separating the undesired multipaths from desired signals of multiple individuals, removing a key obstacle to real-world contactless vital signs monitoring and localization. Results: We also demonstrated it by accurately measure individual heart rates, respiration rates, and absolute distances (range information) of paired volunteers in a challenging real-world office setting. Conclusion: The approach, validated using a frequency-modulated continuous wave (FMCW) radar, was shown to function in an indoor environment where radar signals are severely affected by multipath reflections. Significance: Practical applications arise for health care, assisted living, geriatric and quarantine medicine, rescue and security purposes.@en

Cardiovascular diseases (CVD) are often characterized by their multifactorial complexity. This makes remote monitoring and ambulatory cardiac rehabilitation (CR) therapy challenging. Current wearable multimodal devices enable remote monitoring. Machine learning (ML) and artificial intelligence (AI) can help in tackling multifaceted datasets. However, for clinical acceptance, easy interpretability of the AI models is crucial. The goal of the present study was to investigate whether a multi-parameter sensor could be used during a standardized activity test to interpret functional capacity in the longitudinal follow-up of CR patients. A total of 129 patients were followed for 3 months during CR using 6-min walking tests (6MWT) equipped with a wearable ECG and accelerometer device. Functional capacity was assessed based on 6MWT distance (6MWD). Linear and nonlinear interpretable models were explored to predict 6MWD. The t-distributed stochastic neighboring embedding (t-SNE) technique was exploited to embed and visualize high dimensional data. The performance of support vector machine (SVM) models, combining different features and using different kernel types, to predict functional capacity was evaluated. The SVM model, using chronotropic response and effort as input features, showed a mean absolute error of 42.8 m (±36.8 m). The 3D-maps derived using the t-SNE technique visualized the relationship between sensor-derived biomarkers and functional capacity, which enables tracking of the evolution of patients throughout the CR program. The current study showed that wearable monitoring combined with interpretable ML can objectively track clinical progression in a CR population. These results pave the road towards ambulatory CR.@en

This paper presents an active electrode system for gel-free biopotential EEG signal acquisition. The system consists of front-end chopper amplifiers and a back-end common-mode feedback (CMFB) circuit. The front-end AC-coupled chopper amplifier employs input impedance boosting and digitally-assisted offset trimming. The former increases the input impedance of the active electrode to 2 G at 1 Hz and the latter limits the chopping induced output ripple and residual offset to 2 mV and 20 mV respectively. Thanks to chopper stabilization, the active electrode achieves 0.8 μVrms (0.5-100 Hz) input referred noise. The use of a back-end CMFB circuit further improves the CMRR of the active electrode readout to 82 dB at 50 Hz. Both front-end and back-end circuits are implemented in a 0.18 μm CMOS process and the total current consumption of an 8-channel readout system is 88 μA from 1.8 V supply. EEG measurements using the proposed active electrode system demonstrate its benefits compared to passive electrode systems, namely reduced sensitivity to cable motion artifacts and mains interference.@en

This paper presents a digital active electrode (DAE) system for multi-parameter biopotential signal acquisition in portable and wearable devices. It is built around an IC that performs analog signal processing and digitization with the help of on-chip instrumentation amplifiers, a 12 bit ADC and a digital interface. Via a standard bus, up to 16 digital active electrodes (15-channels) can be connected to a commercially available microcontroller, thus significantly reducing system complexity and cost. In addition, the DAE utilizes an innovative functionally DC-coupled amplifier to preserve input DC signal, while still achieving state-of-the-art performance: 60 nV/sqrt(Hz) input-referred noise and 350 mV electrode-offset tolerance. A common-mode feedforward scheme improves the CMRR of an AE pair from 40 dB to maximum 102 dB.@en

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Simultaneous measurement of Electrocardiogram (ECG) and bio-impedance (BioZ) via disposable health patches is desired for patients suffering from chronic cardiovascular and respiratory diseases. However, a sensing IC must consume ultra-low power under a sub-volt supply to comply with miniaturized and disposable batteries. This work presents a 0.6 V analog frontend (AFE) IC consisting of an instrumentation amplifier (IA), a current source (CS) and a SAR ADC. The AFE can measure ECG and BioZ simultaneously with a single IA by employing an orthogonal chopping scheme. To ensure the IA can tolerate up to 300mVpp DC electrode offset and 400mV pp common-mode (CM) interference, a DC-servo loop (DSL) combined with a common-mode feedforward (CMFF) loop is employed. A buffer-assisted scheme boosts the IA's input impedance by 7x to 140MΩ at 10Hz. To improve the BioZ sensitivity, the CG utilizes dynamic element matching to reduce the 1/f noise of the output current, leading to 35mΩ/√Hz BioZ sensitivity down to 1Hz. The ADC shows a 9.7b ENOB when sampled at 20ksps. The total power consumption of the AFE is 3.8μW. @en

This paper presents a theoretical analysis and measurements of the current noise of several chopper instrumentation amplifiers, which demonstrate that the charge injection and clock feed-through associated with the MOSFETs of the input chopper give rise to significant input current and current noise. In combi- nation with high source impedances, this “chopper noise” is converted to voltage noise, which may then be a significant contributor to the amplifier’s total input-referred voltage noise. Chopper noise has a white power spectral density, whose magnitude is roughly proportional to the chopping frequency. Design guidelines are proposed to reduce chopper noise, as well as the use of a clock-boot- strapped chopper, which generates significantly less noise than a traditional chopper.@en

Heart-rate estimation is a fundamental feature of modern wearable devices. In this paper we propose a machine learning technique to estimate heart-rate from electrocardiogram (ECG) data collected using wearable devices. The novelty of our approach lies in (1) encoding spatio-temporal properties of ECG signals directly into spike train and using this to excite recurrently connected spiking neurons in a Liquid State Machine computation model; (2) a novel learning algorithm; and (3) an intelligently designed unsupervised readout based on Fuzzy c-Means clustering of spike responses from a subset of neurons (Liquid states), selected using particle swarm optimization. Our approach differs from existing works by learning directly from ECG signals (allowing personalization), without requiring costly data annotations. Additionally, our approach can be easily implemented on state-of-the-art spiking-based neuromorphic systems, offering high accuracy, yet significantly low energy footprint, leading to an extended battery-life of wearable devices. We validated our approach with CARLsim, a GPU accelerated spiking neural network simulator modeling Izhikevich spiking neurons with Spike Timing Dependent Plasticity (STDP) and homeostatic scaling. A range of subjects is considered from in-house clinical trials and public ECG databases. Results show high accuracy and low energy footprint in heart-rate estimation across subjects with and without cardiac irregularities, signifying the strong potential of this approach to be integrated in future wearable devices.@en

Heart-rate estimation is a fundamental feature of modern wearable devices. In this paper we propose a machine learning technique to estimate heart-rate from electrocardiogram (ECG) data collected using wearable devices. The novelty of our approach lies in (1) encoding spatio-temporal properties of ECG signals directly into spike train and using this to excite recurrently connected spiking neurons in a Liquid State Machine computation model; (2) a novel learning algorithm; and (3) an intelligently designed unsupervised readout based on Fuzzy c-Means clustering of spike responses from a subset of neurons (Liquid states), selected using particle swarm optimization. Our approach differs from existing works by learning directly from ECG signals (allowing personalization), without requiring costly data annotations. Additionally, our approach can be easily implemented on state-of-the-art spiking-based neuromorphic systems, offering high accuracy, yet significantly low energy footprint, leading to an extended battery-life of wearable devices. We validated our approach with CARLsim, a GPU accelerated spiking neural network simulator modeling Izhikevich spiking neurons with Spike Timing Dependent Plasticity (STDP) and homeostatic scaling. A range of subjects is considered from in-house clinical trials and public ECG databases. Results show high accuracy and low energy footprint in heart-rate estimation across subjects with and without cardiac irregularities, signifying the strong potential of this approach to be integrated in future wearable devices.@en

This book presents fundamental requirements, electrical specification, and parameter tradeoffs of wearable EEG acquisition circuits, especially those compatible with dry electrodes for user-friendly recordings. The authors introduce active electrode, the most promising solution for dry electrodes-based EEG measurement. This architectural concept has been combined with various, innovative circuit design techniques to illustrate structured IC design methodologies for high performance EEG recording. This book also gives examples on the design, implementation and evaluation of three generations of active electrode ICs.@en