UNIT V APPLICATIONS OF WEARABLE SYSTEMS

Medical Diagnostics, Medical Monitoring-Patients with chronic disease,

Hospital patients, Elderly patients, neural recording, Gait analysis, Sports
Medicine.

APPLICATIONS OF WEARABLE SYSTEMS:

In Medical Diagnostics:
Wearable technologies can be innovative solutions for healthcare problems. Some
wearable technology applications are designed for prevention of diseases and
maintenance of health, such as weight control and physical activity monitoring.
Wearable devices are also used for patient management and disease management.
The wearable applications can directly impact clinical decision making.

Wearable technologies enable the continuous monitoring of human physical

activities and behaviors, as well as physiological and biochemical parameters
during daily life. The most commonly measured data include vital signs such as
heart rate, blood pressure, and body temperature, as well as blood oxygen
saturation, posture, and physical activities through the use of electrocardiogram
(ECG), ballistocardiogram (BCG) and other devices. Potentially, wearable photo
or video devices could provide additional clinical information. Wearable devices
can be attached to shoes, eyeglasses, earrings, clothing, gloves and watches.

Wearable devices also may evolve to be skin-attachable devices. Sensors can be

embedded into the environment, such as chairs, car seats and mattresses. A
smartphone is typically used to collect information and transmit it to a remote
server for storage and analysis. There are two major types of wearable devices that
are used for studying gait patterns. Some devices have been developed for
healthcare professionals to monitor walking patterns, including the accelerometer,
multi-angle video recorders, and gyroscopes. Other devices have been developed
for health consumers, including on-wrist activity trackers (such as Fitbit) and
mobile phone apps and add-ons. Wearable devices and data analysis algorithms are
often used together to perform gait assessment tasks in different scenarios.

Continuous and real-time monitoring is essential for better management of

patients with chronic illnesses, including, cardiovascular diseases, diabetes, and
neurological disorders. According to the World Health Organization (WHO),
chronic diseases account for three quarters (75%) of all deaths around the world
and impose high economic burdens. Therefore, different strategies are required for
the monitoring and diagnosis of such diseases and an effective strategy in this
regard is HWDs. Wearable devices are defined as devices, which are worn on the
human body or on clothing. They consist of a target receptor and a transducer. A
receptor recognizes the target analyte and responds accordingly. The transducer
then convert the receptor’s response into a useful signal. Several studies have
reported applications of wearable devices in different fields; as a result, these
devices have shown promising results in the field of healthcare due to their ability
of deformability and compliance. These HWDs provide a better understanding of
the changes inside a human body and can help in preventing and treating diseases.

 Classification of Healthcare Wearable Devices (HWDs).

Fig.

Skin-based wearable devices

As skin covers most of the human body, it serves as an optimal mode for
noninvasive healthcare wearable devices. Skin-based wearable devices can be used
for physiological and psychological monitoring essential for the treatment of
different diseases, for example cardiovascular and neuromuscular diseases.
Additionally, it can also be used for the diagnosis of different diseases using
qualitative and quantitative analysis of skin secretions, such as sweat. Based on the
type of skin contact skin-based wearable devices can be either textile based or
epidermal based. Textile-based wearable devices involve embedding essential
sensors in clothes whereas epidermal-based wearable devices involve the direct
attachment of wearables to the skin like a tattoo, generally known as electronic
skin (e-skin). The following sections highlight the applications of textile-based
HWDs and tattoobased HWDs for the monitoring and diagnosing of different
diseases.

Textile-based HWDs
Textiles have been around for centuries and are readily available. Traditionally,
textiles and clothing have been perceived as keeping humans warm and for
esthetics. Due to their accessibility and comfortability, they can be used for sensing
important parameters, such as body temperature, heart rate, and respiration rate.
Such HWDs are commonly known as electronic textiles or e-textiles. E-textiles are
clothes embedded with sensors and conductive materials. The stretchable nature
and largescale skin contact make textiles an optimal medium for HWDs. With the
emergence of graphene, carbon nanotubes, and nanowires, a number of efforts
have been made to incorporate sensors into clothing for continuous monitoring.
One such effort is by Yapici et al.

who have developed an intelligent textile-based HWD for the monitoring of ECG.
Traditionally, ECG is monitored by using gel-based Ag/AgCl electrode cables,
which are not comfortable for the wearer. For textile-based ECG monitoring,
graphene functionalized cloth has been embedded with ECG sensors. Graphene has
been used for this purpose because of its excellent material properties and high
correlation with conventional gel-based ECG monitoring. A comparison of the
traditional Ag/AgCl electrodes with the ECG HWD . It can be seen that grapheme
functionalized textile electrodes highly correlates with the conventional Ag/AgCl
ECG electrodes with a maximum correlation of 97.0%. However, the grapheme
functionalized e-textile electrodes for ECG has higher electrode-skin impedance
(87.5–55 kΩ) than the conventional Ag/AgCl electrodes (50.9–20 kΩ), which
distorts the ECG and requires additional components like buffer amplifiers and
adaptive filters23. Similarly, Arquilla et al. have tested textile electrodes for ECG
monitoring using HWDs. They have developed a chest-based ECG system by
sewing ECG electrodes into the textile instead of using gel electrodes. This sensor
system has been applied on eight different subjects (five males and three females)
to validate the accuracy of textile-based ECG with the traditional gel-based ECG
electrode. Differences between the heart rate and R–R intervals of ECGs from both
systems were minimal and are shown in Fig. 2b–d. The statistical parameters for
differences in heart rate are t = −0.70 and p > 0.5 and t = 1.43 and p > 0.1 for R–R
interval and with a high correlation coefficient of 0.94. However, this ECG sensor
has not been tested during movement, which imposes considerable challenges in
maintaining the skin-electrode contact and hence is mandatory for continuous ECG
monitoring.Moreover, Wicaksono et al. have also developed an electronic textile
comfortable suit (E-TeCS). The E-TeCS provides temperature sensing of skin with
a precision of 0.1 °C as well as heart and respiration rates at a precision rate of
0.0012−2 using inertial sensing. Additionally, washability and degradability tests
were also conducted for the E-TeCS and high rigidity along with confirmation for
no flakes or discoloration up to ten cycles of washing were observed, which makes
it suitable for everyday use. Likewise, the use of HWDs can also be extended for
other bipotential signals like EEG and EOG, which are required to be monitored
for the treatment and diagnosis of different diseases. Gao et al. have developed a
multisensory textile-based HWD for the simultaneous detection of EEG from the
forehead and sweat rate. This wearable utilizes silver (Ag) as a conductive material
embedded inside the textile electrode to record an EEG. The multisensor wearable
consists of an EEG recording module and SHT20 chip for the relative humidity
measurement. It has eight channels that allow independent recording of the EEG
using different electrodes and the relative humidity is used to for the indirect
measurement of the sweat rate. The multisensory HWD was compared with
traditional Ag based wet electrodes used for EEG measurement and was highly
correlated. Alpha rhythm is a standard electrical brain response with frequencies
ranging from 8 to 15 Hz and usually more evident while eyes are closed.

Correlation coefficients of 93.04% and 81.69% between the two electrodes have
been found, in closed and opened eyes conditions, respectively. However, the skin-
electrode impedance of the multisensory HWD decreases in the presence of sweat
from 30– 20 to 6 kΩ in comparison to standard Ag wet electrodes that maintains
small skin electrode impedance irrespective of sweat. Moreover, electrodes
embedded inside the textile can also be used for EMG, which measures the
electrical activity of muscles in response to nerve stimulation and is used for the
detection of muscle or motor neuron abnormalities. Pino et al. have proposed a
wearable shirt to monitor EMG that provides essential feedback during exercise30.
The wearable shirt is shown in the These EMG signals are then sent to monitoring
system using Bluetooth for signal processing. Textile-based HWDs experience
distortion in their results due to loose contact between skin and HWD. This
requires additional signal processing techniques on raw data for acquiring clean
signals. Moreover, textile-based HWDs provide comfortability along with real-
time and continuous monitoring of the wearer, but their stability decreases with
repeated washing due to the involvement of bio recognizable molecules. The
instability involved with textile-based HWDs may be partially resolved with
tattoo-based HWDs.

skin or tattoo-based HWDs

Traditionally, tattoos have been perceived as a form of body art because of its
pliability and compliance. These properties can be used for monitoring and
diagnostic purposes. Currently, e-skins are widely used for the detection of
electrical and physical parameters such as ECG, EEG, and EMG. Of these, the
ECG is easiest to detect because of its high amplitude, of the order of ~1 mV. This
allows an accurate, noninvasive detection of heart signals through the skin. In
cardiovascular arrhythmias like tachycardia and bradycardia, ECG is the first point
of reference for diagnosis and treatment. As mentioned, earlier, conventional ECG
monitors require the attachment of gel-based electrode cables along with external
electronic instrumentations for signal acquisition and can be uncomfortable for the
wearer.

Furthermore, these ECG monitors are mostly used in controlled lab or hospital
settings and therefore cannot be carried with the wearer at all times. Many patients
suffering from heart disease would benefit from continuous monitoring of their
heart rhythm but a daily visit to a hospital poses an economic and scheduling
burden. Moreover, tattoo-based ECG monitoring systems can resolve the
instability and sensitivity issues of textile-based ECG monitors, due to their
miniaturization and stretchability. They are also more flexible and comfortable for
the wearer. A notable example of a tattoo-based HWDs ECG monitor is described
by Ameri et al. It consists of miniaturized electronic components built on a
graphene/polymethylmethacrylate (Gr/PMMA) bilayer substrate. The graphene
electronic tattoo (GET) is fabricated using a wet transfer, dry patterning method
and has 463 ± 30 nm thickness with ~85% optical transparency and more than 40%
stretchability. The high stretchability and optical transparency make it light enough
to be embossed on skin, like a tattoo. It binds to the skin using Van der Waals
forces, which makes it mechanically invisible for the wearer. The GET is a
comprehensive epidermal electronic system that is effective for different
biopotentials like ECG, EMG, and EEG. This HWD reports a clean ECG with high
signal to noise ratio, comparable to conventional bulk gel-based electrodes. The
module also works for other electrophysiological parameters, for example, EEG
and EMG by embossing it on different parts of the body.
Moreover, Dae et al. used a self-powered piezoelectric sensor for the continuous
and real-time monitoring of the arterial pulse34. The arterial pulse is a measure of
heart’s contraction rate, which is a component of cardiac output (heart rate × stroke
volume)34,35. A piezoelectric sensor converts the pressure created due to arterial
pulses into electrical pulses. In-time detection of the abnormalities in atrial pulses
could lead to the prevention of serious cardiac diseases.

Monitoring arterial pressure may potentially help in the diagnosis of cardiac and
blood diseases36,37. This self powered tattoo-based HWDs is POC in nature and
mitigates the high-power consumption required by conventional arterial monitors.
Moreover, data are shared wirelessly in case of any abnormality detected in arterial
pressure signals using smart phone modality.

It utilizes BaTiO3 and Pb [Zrx, Ti1- x] O3 (PZT), active materials for the micro
electro mechanical sensors, due to their high piezoelectric coefficients. A thin layer
of plastic was covered with PZT using laser lift-off technique (ILLO), which is an
inorganic based technique for transferring polymers on surfaces38. The ultrathin
layer of PZT adheres to the epidermis and responds to changes in arterial pulses.
The self-powered PZT sensor was used for the detection of arterial pulses before
and after the exercise. Before exercising, Vpp of the arterial pulse is 81.5 mV
whereas after exercising its amplitude is 100 mV, an increase of ~22% due to the
increase in heart rate after the exercise. The same wearable was used for
experiments in monitoring human respiratory activities, trachea movement and
heart rhythm. These experiments have shown a sensitivity of ≈0.018 kPa −1 and
response time of ≈60 ms with excellent mechanical stability. However, the self
powered tattoo requires biocompatible piezoelectric material for clinical trials34.
There are also HWDs for use in the oral cavity. Kim et al. have developed a
mouthguard for the monitoring of saliva uric acid57. Similarly, Mannoor et al.
have developed an oral cavity HWD for the detection of bacteria on tooth
enamel58. The HWD is based on graphene because of its high strength (42 Nm−1)
and Young’s Modulus (~1 TPa)59. Antimicrobial peptides (AMPs) were probed on
graphene for the detection of bacteria at a single cell level. Moreover, the resonant
coil excludes the need of an external power source making it miniaturized and
power efficient. Results have been reported for the Escherichia coli (E. coli)
bacterium, a foodborne infection. E. coli is commonly found in the intestines of
humans and warm blooded animals60. If food is contaminated with E. coli, it can
cause severe diseases such as gastroenteritis (food poisoning)61. The graphene-
based nanosensor is attached to the tooth and can remotely monitor respiration and
bacteria from the saliva based upon the change in its resistance58. Odorranin-HP
AMP has been probed for the detection of E. coli because of its strong activity
towards this organism. As soon as E. coli binds with the AMP immobilized
graphene, the resistance of graphene decreases and helps in detecting E. coli with a
limit of detection of 1 bacterium μL[−1 58. Results are justified with fluorescent
images for the presence of E. coli. Similar experiments were performed for the
detection of helicobacter pylori (H. pylori), a gram-negative bacterium usually
found in saliva, and stomach. H. pylori is one of the leading cause for over 90% of
stomach cancers and duodenal ulcers62,63. The lower limit for the detection of H.
pylori is ~100 H. pylori cells using tooth enamel HWD and shows linear relation
with its logarithmic concentration.
  Medical Monitoring:
In medicine, monitoring is the observation of a disease, condition or one or several
medical parameters over time.
It can be performed by continuously measuring certain parameters by using
a medical monitor (for example, by continuously measuring vital signs by a
bedside
monitor), and/or by repeatedly performing medical tests (such as blood glucose
monitoring with a glucose meter in people with diabetes mellitus).
Transmitting data from a monitor to a distant monitoring station is known
as telemetry or biotelemetry.

Classification by target parameter

Monitoring can be classified by the target of interest, including:

Cardiac monitoring, which generally refers to continuous electrocardiography

with assessment of the patient’s condition relative to their cardiac rhythm. A small
monitor worn by an ambulatory patient for this purpose is known as a Holter
monitor. Cardiac monitoring can also involve cardiac output monitoring via an
invasive Swan-Ganz catheter.

Hemodynamic monitoring, which monitors the blood pressure and blood

flow within the circulatory system. Blood pressure can be measured either
invasively through an inserted blood pressure transducer assembly, or
noninvasively with an inflatable blood pressure cuff.

Respiratory monitoring, such as:

o Pulse oximetry which involves measurement of the saturated percentage
of oxygen in the blood, referred to as SpO2, and measured by
an infrared finger cuff
o Capnography, which involves CO2 measurements, referred to as EtCO2 or
end-tidal carbon dioxide concentration. The respiratory rate monitored as
such is called AWRR or airway respiratory rate)
o Respiratory rate monitoring through a thoracic transducer belt, an ECG
channel or via capnography

Neurological monitoring, such as of intracranial pressure. Also, there are

special patient monitors which incorporate the monitoring of brain waves
(electroencephalography), gas anesthetic concentrations, bispectral index (BIS),
etc. They are usually incorporated into anesthesia machines.
In neurosurgery intensive care units, brain EEG monitors have a larger
multichannel capability and can monitor other physiological events, as well.
 Blood glucose monitoring
 Childbirth monitoring
 Body temperature monitoring through an adhesive pad containing
 a thermoelectric transducer.
 Cancer therapy monitoring through circulating tumor cells
Vital parameters
Monitoring of vital parameters can include several of the ones mentioned above,
and most commonly include at least blood pressure and heart rate, and preferably
also pulse oximetry and respiratory rate. Multimodal monitors that simultaneously
measure and display the relevant vital parameters are commonly integrated into the
bedside monitors in critical care units, and the anesthetic machines in operating
rooms. These allow for continuous monitoring of a patient, with medical staff
being continuously informed of the changes in general condition of a patient. Some
monitors can even warn of pending fatal cardiac conditions before visible signs are
noticeable to clinical staff, such as atrial fibrillation or premature ventricular
contraction (PVC)

Medical monitoring with chronic diseases, hospital patient and

elderly patients

A medical monitor or physiological monitor is a medical device used for

monitoring. It can consist of one or more sensors, processing components, display
devices (which are sometimes in themselves called "monitors"), as well as
communication links for displaying or recording the results elsewhere through a
monitoring network
Components
Sensor
Sensors of medical monitors include biosensors and mechanical sensors. For
example, photodiode is used in pulse oximetry, Pressure sensor used in Non
Invasive bood pressure measurement.
Translating component
The translating component of medical monitors is responsible for converting the
signals from the sensors to a format that can be shown on the display device or
transferred to an external display or recording device.
Display device
Physiological data are displayed continuously on a CRT, LED or LCD screen
as data channels along the time axis, They may be accompanied by numerical
readouts of computed parameters on the original data, such as maximum, minimum
and average values, pulse and respiratory frequencies, and so on.
Communication links

Several models of multi-parameter monitors are networkable, i.e., they can send
their output to a central ICU monitoring station, where a single staff member can
observe and respond to several bedside monitors simultaneously. Ambulatory
telemetry can also be achieved by portable, battery-operated models which are
carried by the patient and which transmit their data via a wireless data connection.
Digital monitoring has created the possibility, which is being fully developed, of
integrating the physiological data from the patient monitoring networks into the
emerging hospital electronic health record and digital charting systems, using
appropriate health care standards which have been developed for this purpose by
organizations such as IEEE and HL7. This newer method of charting patient data
reduces the likelihood of human documentation error and will eventually reduce
overall paper consumption. In addition, automated ECG interpretation incorporates
diagnostic codes automatically into the charts. Medical monitor's embedded
software can take care of the data coding according to these standards and send
messages to the medical records application, which decodes them and incorporates
the data into the adequate fields.

Other components

A medical monitor can also have the function to produce an alarm (such as using
audible signals) to alert the staff when certain criteria are set, such as when some
parameter exceeds of falls the level limits.
Mobile appliances
An entirely new scope is opened with mobile carried monitors, even such in
subskin carriage. This class of monitors delivers information gathered in body-area
networking (BAN) to e.g. smart phones and implemented autonomous agents.
Interpretation of monitored parameters
Monitoring of clinical parameters is primarily intended to detect changes (or
absence of changes) in the clinical status of an individual. For example, the
parameter of oxygen saturation is usually monitored to detect changes in
respiratory capability of an individual.
Change in status versus test variability
When monitoring a clinical parameters, differences between test results (or values
of a continuously monitored parameter after a time interval) can reflect either (or
both) an actual change in the status of the condition or a test-retest variability of
the test method.
  Remote patient monitoring for chronic disease
management:
Remote patient monitoring for chronic disease management is an effective solution
for patients with chronic disease. According to the Journal of Medical Internet
Research, telemonitoring is a valid alternative to usual care, reducing mortality and
improving disease self-management in patients who report satisfaction and
adherence. Because chronic diseases are the leading cause of death and disability
nationwide.
A remote patient monitoring program uses technology to transmit data from a
patient’s home to the clinician for review and intervention. The patient is provided
with an RPM medical device that allows them to measure specific vital signs from
the comfort of their homes. Clinicians receive that information in real-time and can
access it whenever they want.
By implementing RPM, clinicians can significantly reduce healthcare costs and
promote better allocation of resources for improving chronic disease management.
Here are 3 reasons why remote patient monitoring can transform chronic disease
management:

1). Promotes Early Identification of Chronic Disease

Most patients only see their doctor when their condition becomes problematic, or
it’s time for their next appointment. But what if something goes wrong in-between
visits? If the patient doesn’t know what to look for, complications will continue to
develop.
Remote patient monitoring for chronic disease management promotes better care
inbetween visits. By keeping track of patients’ vital signs regularly, clinicians will
better understand their patients’ conditions and be alerted immediately if medical
attention is necessary. The RPM device sends real-time readings to the remote
patient monitoring platform for the clinician to access immediately.

Clinicians will automatically be alerted for quick action when a patient’s reading is
above or below the set threshold. RPM promotes the early identification of chronic
diseases. Furthermore, the earlier complications are identified, the sooner patients
can get treatment and minimize the progression of chronic disease.

2). RPM Prompts Adjustments to Treatment Plans

Another way remote patient monitoring helps improve chronic care management is
through timely adjustments to treatment plans. Through the RPM portal, clinicians
can check how their patients are doing whenever they want. As a result, they can
see how their patients respond to medications and adjust prescriptions as
necessary.

Without RPM, many patients go months with an ineffective or unoptimized

treatment plan. Remote patient monitoring in chronic disease management can help
patients find a treatment plan that works for them while reducing chronic disease
progression.

3). Remote Patient Monitoring Increases Patient Engagement

We all know how to live healthier lives, but it’s challenging to consistently apply
those practices to your everyday life. Remote patient monitoring is about
expanding healthcare outside the conventional hospital setting and into the
patient’s daily lifestyle. It helps patients feel supported in managing their health.
Because they know that their care providers regularly check their health data,
patients are more likely to engage in healthier lifestyle choices and adhere to their
management plans. Patients play an essential role in remote patient monitoring for
chronic disease management. They’re responsible for taking their vital sign
measurement at least 16 days a month. While this provides clinicians with valuable
insight, it also helps the patients engage and better understand their condition.
Regular measurements allow patients to recognize a normal range for their bodies.
They can see if their health is improving or worsening over time and how changes
to their lifestyle choices affect their readings. The better the patient understands
their condition and engages, the more likely they are to practice healthier
behaviors, keep an eye out for complications, and communicate with their
clinician.

 Using Remote Patient Monitoring for Chronic Disease

Management

Using RPM, chronic disease patients are much less likely to be admitted into
hospitals, use emergency departments, and require complicated procedures. This
significantly reduces healthcare costs.
Remote patient monitoring improves the management of various chronic diseases,
including:
Stroke
Heart disease
Diabetes
Chronic heart failure
Kidney disease
Chronic obstructive pulmonary disorder
Depending on the patient’s condition, different vital signs must be monitored. For
example, individuals at risk of stroke or kidney disease will benefit from using a
blood pressure monitor, while those with diabetes will need to keep an eye on their
blood glucose levels.
1. Remote Patient Monitoring Blood Pressure Monitors
Blood pressure monitors are RPM devices that help individuals with hypertension
ensure their blood pressure stays within a healthy range. Hypertension is a major
risk factor for many chronic diseases like heart failure and stroke. Clinicians can
identify complications early and provide prompt treatment by effectively keeping
track of a patient’s blood pressure between visits. A blood pressure monitor will
display systolic blood pressure, diastolic blood pressure, and heart rate.
The top number is the systolic blood pressure measurement. This indicates the
amount of pressure in the arteries when your heart is beating. According to
the American Heart Association, any reading above 130 mmHg is considered
hypertensive. The second number is the diastolic blood pressure measurement.
This
is the amount of pressure in between heartbeats. Any reading above 80 mmHg is
considered hypertensive.
How to Use
Most top RPM digital blood pressure monitor devices are very user-friendly,
making them ideal for remote use. Tenovi’s BPM works right out of the box,
eliminating the hassle of device setup.
For the best results, encourage your patients to:
Relax for about 5 minutes before
Sit comfortably and avoid crossing their legs
Keep their arm rested on top of a table or armrest
Empty their bladder
Measure around the same time every day
Avoid eating, exercise, caffeine, and alcohol for at least half an hour before
Take the measurement twice, about a minute apart, to ensure accuracy, and
then average the numbers To use a blood pressure monitor, wrap the cuff around
the upper arm (ensure the cuff is on bare skin, not clothing) and press the middle
button. The cuff will start inflating, take the blood pressure measurement, and then
automatically send the data to the RPM platform.
2. Remote Patient Monitoring Scales
Weight gain of 3 or more pounds in a single day can indicate congestive heart
failure. Congestive heart failure occurs when the heart cannot efficiently pump
blood throughout the body. At-risk individuals typically experience shortness of
breath, tightness in the chest, and dizziness. While it is entirely normal for weight
to fluctuate, weight gain in at-risk patients can serve as a precursor to more serious
conditions. By monitoring a patient’s body weight, clinicians can quickly identify
signs of heart failure and focus on early management.

How to use
All the patient has to do is step on the scale to turn it on and wait for the reading.
The information will automatically send to the clinician, and the RPM device will
turn off on its own.
For the most accurate results, advise patients to:
Weigh themselves at the same time every day (preferably the morning)
Avoid eating or drinking right before the weigh-in
Wear the same clothing for each weigh-in or weigh without clothes on
Regular bodyweight measurements can help healthcare providers evaluate the
effectiveness of a patient’s management plan and, if necessary, quickly make
adjustments to better control fluid retention.

3. Remote Patient Monitoring Blood Glucose Meters

Diabetes is the 7th leading cause of death in the United States and the 4th most
common cause of physician visits. If poorly managed, diabetes can cause kidney
failure, heart attack, stroke, and blindness. By utilizing a blood glucose meter to
remotely monitor blood sugar levels, clinicians can better assess whether a
patient’s treatment management plan is working and make adjustments to optimize
care.

How to Use
Tenovi’s Blood Glucose Meter is a top-line FDA-cleared RPM device. It includes
a cell-enabled meter, lancet, and custom test strips that make measuring blood
sugar very simple. Gather all the materials and perform the following steps with
clean hands:

1. Insert the test strip into the meter

2. Wipe your finger with an alcohol pad and let dry
3. Gently prick the side of the finger with the lancet
4. Place a drop of blood onto the test strip and wait for the reading
Most patients should aim for blood glucose levels between 80-130mg/dL before a
meal or below 180 mg/dL in about 2 hours after a meal. If patients’ blood glucose
levels are too high, they may need to adjust their diet or medications.

4. Remote Patient Monitoring Peak Flow Monitors

Learning to use a peak flow meter for asthma care offers several advantages. One
of the most significant benefits is the ability for physicians and patients to evaluate
and pinpoint the causes of asthma flare-ups and determine the most effective
treatment options for the specific lung condition. Remote monitoring of peak flow
enables healthcare providers to identify if medication or treatment adjustments are
required promptly.

How to Use
To begin using the Tenovi peak flow meter, relax for a few minutes before closely
following these 3 easy steps.
1. Turn it on. Press the power button for 3 seconds and wait for the Gateway to
start flashing yellow.
2. Take a reading: Take a deep breath, then exhale quickly into the peak flow
meter.
3. Data transfer: PEF and FEV1 data will automatically transfer to the Tenovi
cloud or clinician portal.
PEF and FEV1 data will automatically transfer to the Tenovi cloud or clinician
portal.
5. Remote Patient Monitoring Pulse Oximeters
Another remote patient monitoring device in healthcare that is useful for assessing
lung disease is a pulse oximeter. A pulse oximeter measures heart rate and oxygen
saturation in a patient’s red blood cells. Patients with conditions that affect blood
oxygen levels, like heart attack, heart failure, COPD, anemia, lung cancer, asthma,
and pneumonia, may benefit from regular pulse oximetry.
How to Use
Pulse oximetry is typically tested at the fingertips to measure how well oxygen is
being sent to areas of your body furthest from the heart. This RPM is simple to use.
To use the Tenovi Pulse Oximeter, all the patient has to do is:
Turn on the device. Place a finger inside the slit, and wait for the reading. A
pulse oximeter uses light to measure the amount of oxygen in your blood at a
given point.
Pulse oximeters will show blood oxygen saturation level (SpO2) and pulse
rate.
Patients should seek medical attention if their reading indicates:
SpO2 under 90% (hypoxia)
Low pulse rate
High pulse rate
Most remote top remote patient monitoring devices will notify the healthcare
provider immediately as well.

6. Remote Patient Monitoring Digital Thermometers

RPM cellular thermometers are used for body temperature monitoring for early
infection detection where timely treatment is crucial. This is especially true in the
case of sepsis. RPM digital thermometers are remote patient monitoring devices
used in cancer care, to monitor COVID-19 and postoperative patients. Regular
temperature monitoring reveals symptom patterns and serves as a warning signal
when abnormalities arise.

How to Use
Patients should follow these 3 easy steps to use the Tenovi RPM thermometer.
1. Turn it on: Press the blue power button and wait for the Gateway to start
flashing yellow.
2. Take a reading: Point the thermometer to the center of the forehead (1-3 cm
away) and press the blue button.
3. Data transfer: The temperature measurement data will automatically transferto
the clinician portal.

 Neural Recording:

In neuroscience, single-unit recordings (also, single-neuron recordings) provide a

method of measuring the electro-physiological responses of a single neuron using
a microelectrode system. When a neuron generates an action potential, the signal
propagates down the neuron as a current which flows in and out of the cell through
excitable membrane regions in the soma and axon. A microelectrode is inserted
into the brain, where it can record the rate of change in voltage with respect to
time.

These microelectrodes must be fine-tipped, impedance matching; they are

primarily glass micro-pipettes, metal microelectrodes made of platinum, tungsten,
iridium or even iridium oxide. Microelectrodes can be carefully placed close to the
cell membrane, allowing the ability to record extra cellularly. Single-unit
recordings are widely used in cognitive science, where it permits the analysis of
human cognition and cortical mapping. This information can then be applied to
brain–machine interface (BMI) technologies for brain control of external devices.
There are many techniques available to record brain activity including electro
encephalography (EEG), magneto encephalography (MEG), and functional
magnetic resonance imaging (FMRI)—but these do not allow for single-neuron
resolution. Neurons are the basic functional units in the brain; they transmit
information through the body using electrical signals called action potentials.
Currently, single-unit recordings provide the most precise recordings from a single
neuron. A single unit is defined as a single, firing neuron whose spike potentials
are distinctly isolated by a recording microelectrode. The ability to record signals
from neurons is centered around the electric current flow through the neuron. As
an action potential propagates through the cell, the electric current flows in and out
of the soma and axons at excitable membrane regions. This current creates a
measurable, changing voltage potential within (and outside) the cell. This allows
for two basic types of single-unit recordings. Intracellular single-unit recordings
occur within the neuron and measure the voltage change (with respect to time)
across the membrane during action potentials. This outputs as a trace with
information on membrane resting potential, postsynaptic potentials and spikes
through the soma (or axon). Alternatively, when the microelectrode is close to the
cell surface extracellular recordings measure the voltage change (with respect to
time) outside the cell, giving only spike information. Different types of
microelectrodes can be used for single-unit recordings; they are typically high-
impedance, fine-tipped and conductive. Fine tips allow for easy penetration
without extensive damage to the cell, but they also correlate with high impedance.

 Applications
Single-unit recordings have allowed the ability to monitor single-neuron activity.
This has allowed researchers to discover the role of different parts of the brain in
function and behavior. More recently, recording from single neurons can be used
to engineer "mind-controlled" devices.

 Gait analysis:
Human gait depends on a complex interplay of major parts of the nervous,
musculoskeletal and cardiorespiratory systems.
The individual gait pattern is influenced by age, personality, mood and Socio
cultural factors.
The preferred walking speed in older adults is a sensitive marker of general
health and survival.
Safe walking requires intact cognition and executive control.
Gait disorders lead to a loss of personal freedom, falls and injuries and
result in a marked reduction in the quality of life.
Definitions
Gait - the manner or style of walking.

GaitAnalysis -
An analysis of each component of the three phases of ambulation is an es
sential part of the diagnosis of various neurologic disorders and the asses
sment of patient progress during rehabilitation and recovery from the effe
cts of neurologic disease, a musculoskeletal injury or disease process, or
amputation of a lower limb.

Gait speed
o The time it takes to walk a specified distance, usually 6 m or less.
Slower speeds correlate with an increased risk of mortality
in geriatric patients.[2]
o Normal walking speed primarily involves the lower extremities,
with the arms and trunk providing stability and balance.
o Faster speeds - body depends on the upper extremities and trunk for
propulsion, balance and stability with the lower limb joints
producing greater ranges of motion.

Gait cycle is a repetitive pattern involving steps and strides

Step is one single step
Stride is a whole gait cycle
Step time - time between heel strike of one leg and heel strike of the
Contra lateral leg.

Stepwidth - the medio lateral space between the two feet.

The demarcation between walking and running occurs when periods of double
support during the stance phase of the gait cycle (both feet are simultaneously in
contact with the ground) give way to two periods of double float at the beginning
and the end of the swing phase of gait (neither foot is touching the ground)

The Gait Cycle

The sequences for walking that occur may be summarized as follows:
1. Registration and activation of the gait command within the central nervous
system.
2. Transmission of the gait systems to the peripheral nervous system.
3. Contraction of muscles.
4. Generation of several forces.
5. Regulation of joint forces and moments across synovial joints and skeletal
segments.
6. Generation of ground reaction forces.

The normal forward step consists of two phases: stance phase; swing phase,
The Stance phase occupies 60% of the gait cycle, during which one leg and
foot are bearing most or all of the bodyweight
The Swing phase occupies only 40% of it [4], during which the foot is not
touching the walking surface and the bodyweight is borne by the other leg
and foot.
In a complete two-step cycle both feet are in contact with the floor at the
same time for about 25 per cent of the time. This part of the cycle is called
the double-support phase. Gait cycle phases: the stance phase and the swing
phase and involves a combination of open and close chain activities.

Phases of the Gait Cycle (8 phase model):

1. Initial Contact
2. Loading Response
3. Midstance
4.Terminal Stance
5. Pre swing
6. Initial Swing
7. Mid Swing
8. Late Swing.

 Sports medicine
Sports medicine is a branch of healthcare. It deals with the diagnosis, treatment and
prevention of Injuries related to participation in sports and/or exercise.
Scope of sports medicine
In the field of physical education and sports, the fields of various sub-disciplines of
sports medicine are utilize. Without the knowledge of scope of sports medicine, it
isdifficult to carry a sportsperson performance at apex level. There are following
scope of sports medicine:
a) Sports and first aid
b) Human anatomy and physiology
c) Female and sports
d) Study of optimal load for different age groups
e) Scientific promotion of games and sports
f) Sports injury rehabilitation
g) Fitness for games and sports.

Aims of sports medicine

a) To provide information to athletes about injuries.
b) To provide knowledge about the causes of injuries.
c) To provide means or treatment for sports injuries and for rehabilitation of
injuries.
d) To provide knowledge about the preventive measures of sports injuries.
e) To aware the sports person & athlete about the different kinds of injury in
respect
of different games.
f) To concentrate on the causes of injury
Concept of Sports medicine
Bio-mechanics related to sports
Effect of attitude on endurance performance
Psychological aspect performance
Nutrition & metabolism in relation to competition & performance
Recommendations of FISM(the International Federation of Sports Medicine
at world level)
Cardio-respiratory function in relation to performance
Exercise in Cardio-Vascular disease prevention & rehabilitation
Prevention of Sports Injuries :
Pre-participation of medical check up
Proper conditioning
Avoid dehydration
Protective Sports equipment & Gears
Adequate & effectively maintained facilities
Sports person’s psychological conditions & environment
Adequate rehabilitation/Injury management
Proper use of right techniques
Balanced diet & adequate rest
Use of proper skills
Warming up & cooling down
Impact of surface on athletes
There are two types of surfaces used in any indoor or outdoor games. These are
natural and artificial surfaces. Natural surfaces is the surfaces that are prepared
through proper combination of natural elements like soil and grass. On the other
hand, artificial surfaces are more like carpets which are made from artificial
components like rubber, synthetic fiber etc. These surfaces impact performance of
athletes differently. In many contact games like football, cricket, running and
Kabaddi natural surfaces are preferred because they provide more familiarity, grip
and avoid severe injuries. On the other hand, artificial surfaces provide more
opportunities for practice because their use need not be stopped for maintenance.
Also, with innovation in technology, artificial surfaces are becoming more user
friendly. Risks of injuries are reducing in artificial surfaces also nowadays.

Impact of Surfaces and Environment on Athletes

Fig. Sports injury

 Fig.2.

Climatic conditions affect the performance

Environmental conditions, such as excessively high or low temperatures, have the
potential to have a negative impact on an athlete ‘s well-being. An athlete ‘ability
to use a number of thermoregulation techniques helps in regulating body
temperature. Sports injuries are those which are common in the field of games and
sports. During training, competition or practice, any player can be injured. Perhaps
there will not be any player who has not been injured during his career.
Strain is also a muscle injury. A strain is caused by twisting or pulling a muscle or
tendon. A sudden strain is caused by a recent injury, lifting heavy objects or rods in
wrong way and over stressing the muscles. Chronic strain is usually caused by
moving the muscles and tendons in repetition.
Sprain is a ligament injury. It may occur due to overstretching or tearing of
ligaments. Many things can cause sprain. Falling, twisting, or getting hit can force
a point out of its normal position. This can cause ligaments around the joints to
tear. Generally, Sprain occurs at wrist and ankle joints.

Prevention of sprain and strain

a) Conditioning should be performed during the preparatory period.
b) Sports equipments must be of good quality.
c) Play courts should be smooth and clean.
d) The scientific knowledge of games should be must for preventing srain.
e) Player should discontinue during the condition of fatigue.
f) Good officiating is essential for preventing such injury.
g) Players should be careful and alert during practice, training and competition.
Abrasion is a key injury generally occurs due to friction with certain equipments
or a fall over the area where bone is very close to skin. It may be caused by a fall
on hard surface. As someone falls or slides on the ground, friction causes layers of
the skin to rub off.
Bruises are not clearly seen as upper skin remains undamaged and inner blood
vessels are damaged and collect beneath the skin. A fresh bruise may actually be
reddish and after a few hours it turns to blue or dark purple.
A laceration is a wound that is produced by tearing of soft body tissue.
Contusion is a muscle injury. A direct hit with or without any sports equipment
can be the main cause of contusion. Contusion can also be due to minor accidents
to the skin such as falling, bumping into something or being hit or kicked. In
contusion blood vessels in muscles are broken and sometimes bleeding may occur
in the muscles which may cause bruise. Stiffness and swelling are common
features at the site of contusion.

Causes of sports injuries

To effectively diagnose, rehabilitate and ultimately prevent subsequent injuries, a
sport therapist
Anatomical Factors: These are related to make up of the body. Leg length
differences a n d cause injury to ankle, hip and back.
Age related causes as the body ages, it changes. It is less able to produce force,
recovers slower and soft tissues lose the ability to stretch. Therefore, it is more
prone to injury.
Training related cause’s Excessive repetitive loading of the tissues is needed
for successive adaptation. However, without suitable recovery, tissues never
have the chance to adapt and can fail.
Equipment selection factors These are related to the suitability of equipment.
An instance is incorrect footwear, which will not protect the foot and ankle
adequately. It also will not distribute forces effectively. Thus it increases the
risk of injury.
Impact and contact causes Impact or contact can be with objects, surfaces or
other people. These injuries are common in contact sports like football, rugby,
hockey etc. Also they are common in more dangerous sports like motor racing,
boxing and skiing.

Joint injuries & its types

A hard blow to a joint, a fall, a forceful throwing, lifting or hitting may cause
dislocation. Infact it is dislocation of surface of bones.
Types of dislocation
a) Dislocation of lower jaw: it occurs when the chin strikes to any other object. It
may occur if mouth is opened excessively.
b) Dislocation of shoulder joint: dislocation of shoulder joint may occur due to a
sudden jerk or a fall over a hard surface. The end of the humerous comes out
fromthe socket. In face when your shoulder dislocates, a strong force, such as a
sudden
blow to your shoulder. Pulls the bones in your shoulder out of place.
c) Dislocation of hip joint: By putting maximum strength spontaneously may cause
dislocation of hip joint. The end of the femur is displaced from the socket.
d) Dislocation of wrist: A sportsperson who participates in a sports or game in
which
he may fall, runs the risk of getting a dislocated wrist. A miscalculated landing can
also cause a dislocated wrist. Infact, it generally occurs to the person who use his
hand to break his fall.
Preventions:
a) Adequate warming-up should be performed prior to any activity.
b) Proper conditioning should be performed during preparatory period.
c) Stretching exercises should be include in warm-up
d) Players should be careful during training and competition.
e) Protective equipment should be used
f) Players should have good anticipation and concentration power
g) Always obey the rules and regulations.
h) Perform regular exercise around your shoulder, hip, and wrist joints etc.
i) Avoid falls or hits as far as possible.

Causes of fracture
Fracture usually occurs due to a high impact on the bone. It can be causes by
overuse.
The most common causes of fracture are:
a) In such sports event where there is a high impact.
b) Traumatic, forceful and unnatural movements.
c) Prolonged long distance walking or running.
d) Sudden fall on hard surface.
e) Direct strike or hit with any solid sports equipment.
f) Osteoporosis.
Management of Fracture
a) Elevate the extremity and rest while bone heals itself.
b) Apply ice to the affected part for 24 to 48 hrs
c) If pain persists, give painkillers.
d) If there is any need of immobilization to the affected part, use a slint
e) After removal of swelling begin to put partial weight on the affected area.
f) Crutches or walking stick may be used in the beginning. After two weeks start
putting normal weight.
g) For 6 to 8 weeks, avoid the activity that caused stress fracture. Then start doing
the activity slowly.