Evaluation of key design parameters for mitigating motion artefact in the mobile reflectance PPG signal to improve estimation of arterial oxygenation

OBJECTIVE Pulse oximetry, a widely accepted method for non-invasive estimation of arterial oxygen saturation (SpO2) and pulse rate (PR), is increasingly being adapted for mobile applications. Previous work in mitigating motion artefact, which corrupts the photoplethysmogram (PPG) used in pulse oximetry, has focused on reducing noise using signal processing algorithms or through sensor design that controlled only one variable at a time. In this work, we have investigated the effect of several variables such as sensor weight, relative motion, placement, and contact force against the skin that can impact motion artefact independently or by interacting with each other. APPROACH We have identified a unique combination of these variables that is most optimal in reducing motion artefacts using a full factorial design of experiments methodology and evaluated the effect of these factors on PPG readings with and without motion. MAIN RESULTS Data collected on 10 diverse subjects showed that placement (p  =  0.03), contact force (p  =  0.004), and sensor-to-skin adhesion or relative motion when combined with force (p  <  0.001) had the most significant effect on reducing the motion artefact signal. Sensor weight (p  =  0.822) by itself had no significant effect, however when combined with sensor adhesion (p  <  0.001) had a significant impact. SIGNIFICANCE This lays the foundation for future development of more robust sensors that can significantly reduce the effect of motion artefacts in reflectance-based pulse oximetry and could have great clinical value due to significant reduction of SpO2 errors and false alarms associated with motion artefact, making wearable pulse oximetry more reliable in mobile applications.

[1]  M Mischi,et al.  Improving pulse oximetry accuracy by removing motion artifacts from photoplethysmograms using relative sensor motion: a preliminary study. , 2013, Advances in experimental medicine and biology.

[2]  M. Mathie,et al.  Detection of daily physical activities using a triaxial accelerometer , 2003, Medical and Biological Engineering and Computing.

[3]  Ki H. Chon,et al.  Improving Pulse Rate Measurements during Random Motion Using a Wearable Multichannel Reflectance Photoplethysmograph , 2016, Sensors.

[4]  Y. Mendelson,et al.  A Wearable Reflectance Pulse Oximeter for Remote Physiological Monitoring , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[5]  S. Barker,et al.  Masimo Signal Extraction Pulse Oximetry , 2004, Journal of Clinical Monitoring and Computing.

[6]  L. G. Sison,et al.  Characterization and adaptive filtering of motion artifacts in pulse oximetry using accelerometers , 2002, Proceedings of the Second Joint 24th Annual Conference and the Annual Fall Meeting of the Biomedical Engineering Society] [Engineering in Medicine and Biology.

[7]  X. Teng,et al.  The effect of contacting force on photoplethysmographic signals , 2004, Physiological measurement.

[8]  K. Tremper,et al.  Clinical Evaluation of a Prototype Motion Artifact Resistant Pulse Oximeter in the Recovery Room , 1996, Anesthesia and analgesia.

[9]  Steven J. Barker,et al.  Motion-resistant" pulse oximetry: a comparison of new and old models. , 2002 .

[10]  Mohamed Elgendi,et al.  Optimal Signal Quality Index for Photoplethysmogram Signals , 2016, Bioengineering.

[11]  John M. Graybeal,et al.  The Effect of Motion on Pulse Oximetry and Its Clinical Significance , 2007, Anesthesia and analgesia.

[12]  Signal extraction technology: a better mousetrap? , 1996, Anesthesia and analgesia.

[13]  Ronald M. Aarts,et al.  Reducing motion artifacts in photoplethysmograms by using relative sensor motion: phantom study , 2012, Journal of biomedical optics.

[14]  Augusto Sola,et al.  Oximetría de pulso en la asistencia neonatal en 2005. Revisión de los conocimientos actuales , 2005 .

[15]  R. J. Del Vecchio Understanding Design of Experiments , 2014 .

[16]  Weidong Wang,et al.  Motion artifact removal from photoplethysmographic signals by combining temporally constrained independent component analysis and adaptive filter , 2014, Biomedical engineering online.

[17]  G. S. Agashe,et al.  Forehead Pulse Oximetry: Headband Use Helps Alleviate False Low Readings Likely Related to Venous Pulsation Artifact , 2006, Anesthesiology.

[18]  Yitzhak Mendelson,et al.  Reflectance Forehead Pulse Oximetry: Effects of Contact Pressure During Walking , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[19]  Steve Warren,et al.  Two-Stage Approach for Detection and Reduction of Motion Artifacts in Photoplethysmographic Data , 2010, IEEE Transactions on Biomedical Engineering.

[20]  Stefan Hey,et al.  Evaluation of design parameters for a reflection based long-term pulse oximetry sensor , 2016, EAI Endorsed Trans. Ambient Syst..

[21]  Kyuichi Niizeki,et al.  Validity of pulse oximetry during maximal exercise in normoxia, hypoxia, and hyperoxia. , 2002, Journal of applied physiology.

[22]  Jo Woon Chong,et al.  Photoplethysmograph Signal Reconstruction Based on a Novel Hybrid Motion Artifact Detection–Reduction Approach. Part I: Motion and Noise Artifact Detection , 2014, Annals of Biomedical Engineering.

[23]  S. Sugino,et al.  Forehead is as sensitive as finger pulse oximetry during general anesthesia , 2004, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[24]  Richard D Branson,et al.  Forehead oximetry in critically ill patients: the case for a new monitoring site. , 2004, Respiratory care clinics of North America.

[25]  A. C. M. Dassel,et al.  Reflectance pulse oximetry at the forehead improves by pressure on the probe , 1995, Journal of Clinical Monitoring.

[26]  Ki H. Chon,et al.  A Novel Time-Varying Spectral Filtering Algorithm for Reconstruction of Motion Artifact Corrupted Heart Rate Signals During Intense Physical Activities Using a Wearable Photoplethysmogram Sensor , 2015, Sensors.

[27]  Jo Woon Chong,et al.  Photoplethysmograph Signal Reconstruction based on a Novel Motion Artifact Detection-Reduction Approach. Part II: Motion and Noise Artifact Removal , 2014, Annals of Biomedical Engineering.

[28]  Peter R. Smith,et al.  A new method for pulse oximetry possessing inherent insensitivity to artifact , 2001, IEEE Transactions on Biomedical Engineering.

[29]  Nigel H. Lovell,et al.  Implementation of a real-time human movement classifier using a triaxial accelerometer for ambulatory monitoring , 2006, IEEE Transactions on Information Technology in Biomedicine.

[30]  H Harry Asada,et al.  Mobile monitoring with wearable photoplethysmographic biosensors. , 2003, IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society.

[31]  B. Chraemmer-jørgensen,et al.  Randomized Evaluation of Pulse Oximetry in 20,802 Patients; I: Design, Demography, Pulse Oximetry Failure Rate, and Overall Complication Rate , 1993, Anesthesiology.

[32]  M R Neuman,et al.  Spectrophotometric investigation of pulsatile blood flow for transcutaneous reflectance oximetry. , 1983, Advances in experimental medicine and biology.

[33]  Rolando P. Hong Enriquez,et al.  Analysis of the photoplethysmographic signal by means of the decomposition in principal components , 2002 .

[34]  Frans Coetzee,et al.  Noise-resistant pulse oximetry using a synthetic reference signal , 2000, IEEE Transactions on Biomedical Engineering.

[35]  Sun K. Yoo,et al.  Motion artifact reduction in photoplethysmography using independent component analysis , 2006, IEEE Transactions on Biomedical Engineering.

[36]  C J Kalkman,et al.  Influence of pulse oximeter lower alarm limit on the incidence of hypoxaemia in the recovery room. , 1997, British journal of anaesthesia.

[37]  Stephen James Wilson,et al.  A computational system to optimise noise rejection in photoplethysmography signals during motion or poor perfusion states , 2006, Medical and Biological Engineering and Computing.

[38]  Steven J. Barker,et al.  The effects of motion on the performance of pulse oximeters in volunteers (revised publication). , 1997 .

[39]  Ronald M. Aarts,et al.  Reduction of Periodic Motion Artifacts in Photoplethysmography , 2017, IEEE Transactions on Biomedical Engineering.

[40]  Ki H. Chon,et al.  Multi-channel pulse oximetry for wearable physiological monitoring , 2013, 2013 IEEE International Conference on Body Sensor Networks.