Wearable Health-care Monitoring Device

Review of Related Literature

In many countries, providing care to an aging population has become a

significant challenge. For example, the number of Americans 65 and older will grow
from about 49 million in 2018 to approximately 100 million in 2060 (Vespa,
Armstrong, & Medina, 2018). The World Health Organization expects that the global
elderly population 60 or older will rise to 2 billion by 2050 (World Health Organization
(WHO), 2015). The aging population has increased risks for chronic conditions, falls,
disabilities and other adverse health outcomes (Ambrose, Paul, & Hausdorff, 2013).
Providing preventive interventions to the aged population to improve health outcomes
has become an important research and development topic. Wearable devices could
be used to address some of the challenges related to detecting and managing
adverse health conditions in aging populations. Wearable devices have great
potential to be used in fall prevention among older adults. Falls occur in 30% to 60%
of older adults each year, and 10% to 20% result in injury, hospitalization or death
(Rubenstein, 2006). For the elderly people in the USA, falls lead to four to 12 days of
hospital stay per fall (Bouldin et al., 2013). Recent studies have focused on
developing wearable devices and associated algorithms to collect and analyze gait
(manner of walking) data for fall prevention (Awais et al., 2016). In research settings,
the performance of fall detection using wearable devices has already achieved
considerable good results. For example, one study developed a solution to recognize
walking and activities (González et al., 2015). The study used a genetic algorithm
and two triaxle accelerometer bracelets to detect walking patterns that could lead to
disruptive events, such as falling and seizure onset. Pannurat, Thiemjarus, &
Nantajeewarawat (2017) presented a method to detect a fall at different phases using
a wireless accelerometer and classification algorithms. Their evaluation results
showed an 86% and 91% accuracy for fall pre-impact and post-impact
detection. Hsieh, Liu, Huang, Chu, & Chan (2017) developed a novel hierarchical fall
detection system using accelerometer devices on the waist. The results showed that
the system achieved a high accuracy at 99% in identifying fall events.
Similarly, Gibson, Amira, Ramzan, Casaseca-de-la-Higuera, & Pervez (2017)
presented a fall detection system using a database of fall and daily activities. Their
method used the Shimmer biomedical device on the chest to collect data. The
detection signals were extracted using compress sensing and principal component
analysis techniques. The obtained binary tree classifiers achieved 99% precision in
identifying fall events. These studies were performed in research laboratory settings.
A recent study (Awais et al., 2016) compared and evaluated the performance of
wearable sensors in classifying physical activities for older adults in real-life and in-
lab scenarios. This study found that systems developed in a controlled lab setting
might not be able to perform well in real-life conditions. Therefore, new systems
should be tested in real-life conditions.

Mental Status

Monitoring Developing wearable devices and algorithms to monitor mental

conditions is a relatively new domain. Some wearable devices are equipped with
sensors that can detect human physiology status, such as heartbeat, blood pressure,
body temperature, or other complex vital signs (e.g. electrocardiograms). Using these
signals, new systems can be developed to monitor mental conditions. Stress
detection is the most common application of such systems. To detect stress patterns
of children, Choi, Jeon, Wang, & Kim (2017) proposed a framework using wearable
devices and machine learning-based techniques. The wearable devices collected
both audio and heart rate signals for stress detection. The framework has a potential
to be used to remotely monitor child safety through stress patterns. The study results
showed that by combining audio and heart rate signals, the system had a better
performance in fighting noise signals when compared with audio-only methods.
Support Vector Machine (SVM) is one machine learning method. The accuracy of the
best algorithm (SVM+Wrapper) is 93.47%. A study by Setz and colleagues (2010)
showed that even simple electrodermal activity (EDA) sensors have the capacity to
identify stress level. An EDA sensor can measure skin conductance, which usually is
correlated with the stress level of a person. They described how a Swiss team
developed an EDA-based system called Emotion Board. The system can collect and
measure skin conductance signals. The collected signals were processed using
linear discriminant analysis (LDA) and an SVM-based classifier was used to detect
stress. The evaluation on 33 subjects showed that the maximum accuracy was
82.8%.
Sports Medicine

Wearable devices can help athletes or coaches to systematically manage

athletic training and matches. For example, Skazalski, Whiteley, Hansen, & Bahr
(2018) used commercially available wearable devices as a valid and reliable method
to monitor the jump load of elite volleyball players and to measure jump-specific
training and competition load in the players’ jumps. The results of this study also
indicate that the devices showed excellent jump height detection capacities. The
wearable devices can monitor functional movements, workloads, heart rate, etc., so
they may be more widely used in sport medicine to maximize performance and
minimize injury. Chen, Lin, Lan, & Hsu (2018) developed a method to monitor and
detect heat stroke. Heat stroke can harm people when they are doing exercises in
hot temperatures. The team proposed a fuzzy logic-based method for inferencing
signals collected from multiple wearable devices, environmental temperatures and
humidity sensors. The experimental results showed that the system can be used to
monitor heat stroke risk and alert users.

Chen, Lin, Lan, & Hsu (2018) developed a method to monitor and detect heat
stroke. Heat stroke can harm people when they are doing exercises in hot
temperatures. The team proposed a fuzzy logic-based method for inferencing signals
collected from multiple wearable devices, environmental temperatures and humidity
sensors. The experimental results showed that the system can be used to monitor
heat stroke risk and alert users.

Patient Management

Wearable technology can also improve patient management efficiency in

hospitals. Researchers hope to use wearable technology for the early detection of
health imbalances. Wireless communication in wearable techniques enable
researchers to design a new breed of point-of-care (POC) diagnostic devices
(Ghafar-Zadeh, 2015). For example, garments integrated with wearable solutions,
such as commercial portable sensors and devices in the emergency medical services
(EMS), emergency room (ER) or intensive care unit (ICU) environments, have
facilitated the continuous monitoring of risks that endanger patient lives. The system
enables detection of patient health-state parameters (heart rate, breathing rate, body
temperature, blood oxygen saturation, position, activity and posture) and
environmental variables (external temperature, presence of toxic gases, and heat flux
passing through the garments) to process data and remotely transmit useful
information to healthcare providers (Curone et al., 2010).

Wireless wearable devices have supported mobility in patients. Activity

monitoring is used to manage chronic conditions of patients (Chiauzzi, Rodarte, &
DasMahapatra, 2015). Wearable device activity tracking abilities provide a
mechanism to allow health consumers to enhance their self-management capacities.
Many health consumers are already tracking their weight, diet, or health routines in
some way. Wearable devices further improve the self-tracking ability by providing
sensor data as objective evidence.

Patients with Stroke

Stroke, predominantly a condition of advanced age, is a major cause of

acquired disability in the global population. Conventional treatment paradigms in
intensive therapy are expensive and sometimes not feasible because of social and
environmental factors. Researchers used wearable sensors to monitor activity and
provide feedback to patients and therapists. In a study by Burridge and colleagues
(2017), the researchers developed a wearable device with embedded inertial and
mechanomyographic sensors, algorithms to classify functional movement, and a
graphical user interface to present meaningful data to patients to support a home
exercise program.

As well, heat stroke can be potentially damaging for people while exercising
in hot environments. To prevent this dangerous situation, a researcher designed a
wearable heat-stroke-detection device (WHDD) with early notification ability. If a
dangerous situation was detected, the device activated the alert function to remind
the user to avoid heat stroke (Chen et al., 2018).
Patients with Brain and Spinal Cord Injuries

Patients with brain and spinal cord injuries need exercises to improve motor
recovery. Often, these patients are not qualified to monitor or assess their own
conditions and they need healthcare provider guidance. Therefore, there is a need to
transmit physiological data to clinicians from patients in their home environment.
Researchers like Burns and Adeli (2017) are doing just that, by reviewing wearable
technology for in-home health monitoring, assessment and rehabilitation of patients
with brain and spinal cord injuries.

Heart Disorders

Wearable devices have been developed to do cardiovascular monitoring and

enable mHealth applications in cardiac patients. Low-power wearable ECG
monitoring systems have been developed (Winokur, Delano, & Sodini, 2013). Some
wearable devices can monitor heart rate variability (HRV). In a study, a wearable
patch-style heart activity monitoring system (HAMS) was developed for recording the
ECG signal (Yang et al., 2008). The wearable devices can be used efficiently as
health monitoring system during daily routines in many places and situations.
Wearable technology can assess patient heart activity outside of a laboratory or
clinical environment. It is possible to perform heart assessments during a wide range
of everyday conditions without interfering with a patient's activity tasks. For example,
researchers designed a textile-based wearable device for the unobtrusive recording
of ECG, respiration and accelerometric data and to assess the 3D sternal
seismocardiogram (SCG) in daily life. Researchers also designed a portable and
continuous ballistocardiogram (BCG) monitor that is wearable in the ear (Da He,
Winokur, & Sodini, 2012). The ear devices can reveal important information about
cardiac contractility and its regulation.

Hernandez-Silveira and colleagues (2015) studied the feasibility of using a

wireless digital watch as a wearable surveillance system for monitoring the vital signs
of patients. The researchers compared the wearable system with traditional clinical
monitors. The results showed that the tested wearable device provided reliable heart
rate value for about 80% of the patients and the overall agreement between the new
device and clinical monitor was satisfactory because the comparison was statistically
significant. A similar study by Kroll, Boyd, & Maslove (2016) showed that a wrist-worn
personal fitness tracker device can be used to monitor the heart rate of patients even
though the collected heart rates were slightly lower than the standard of continuous
electrocardiographic (cECG) monitoring.

Blood Disorders

Wearable trackers have drawn interest from health professionals studying

blood disorders. Overall, the U.S. prevalence of hypertension among adults was
29.0% during 2015–2016 (Fryar, Ostchega, Hales, Zhang, & Kruszon-Moran, 2017).
Wearable devices can detect hypertension with physiological signals (Ghosh, Torres,
Danieli, & Riccardi, 2015). Some of the most widely used wearable devices are
applications for evaluating and monitoring blood pressure, including cuff-less blood
pressure sensors, wireless smartphone-enabled upper arm blood pressure monitors,
mobile applications, and remote monitoring technologies. They have the potential to
improve hypertension control and medication adherence through easier logging of
repeated blood pressure measurements, better connectivity with health-care
providers, and medication reminder alerts (Goldberg & Levy, 2016).