Trends and Challenges of Wearable Multimodal Technologies for Stroke Risk Prediction

We review in this paper the wearable-based technologies intended for real-time monitoring of stroke-related physiological parameters. These measurements are undertaken to prevent death and disability due to stroke. We compare the various characteristics, such as weight, accessibility, frequency of use, data continuity, and response time of these wearables. It was found that the most user-friendly wearables can have limitations in reporting high-precision prediction outcomes. Therefore, we report also the trend of integrating these wearables into the internet of things (IoT) and combining electronic health records (EHRs) and machine learning (ML) algorithms to establish a stroke risk prediction system. Due to different characteristics, such as accessibility, time, and spatial resolution of various wearable-based technologies, strategies of applying different types of wearables to maximize the efficacy of stroke risk prediction are also reported. In addition, based on the various applications of multimodal electroencephalography–functional near-infrared spectroscopy (EEG–fNIRS) on stroke patients, the perspective of using this technique to improve the prediction performance is elaborated. Expected prediction has to be dynamically delivered with high-precision outcomes. There is a need for stroke risk stratification and management to reduce the resulting social and economic burden.

[1]  M. Doppelmayr,et al.  Current State and Future Prospects of EEG and fNIRS in Robot-Assisted Gait Rehabilitation: A Brief Review , 2019, Front. Hum. Neurosci..

[2]  D. McManus,et al.  Wearing Your Heart on Your Sleeve: the Future of Cardiac Rhythm Monitoring , 2019, Current Cardiology Reports.

[3]  B. Ovbiagele,et al.  Association of Systolic Blood Pressure with Progression of Symptomatic Intracranial Atherosclerotic Stenosis , 2017, Journal of stroke.

[4]  Fares Alahdab,et al.  Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2019, The Lancet Neurology.

[5]  K. Nakashima,et al.  [The Rotterdam study]. , 2011, Nihon rinsho. Japanese journal of clinical medicine.

[6]  Cinna Soltanpur,et al.  A review on wearable photoplethysmography sensors and their potential future applications in health care , 2018, International journal of biosensors & bioelectronics.

[7]  G. Ozdemir,et al.  Very early morning increase in onset of ischemic stoke. , 1994, Annals of Saudi medicine.

[8]  J. Liljencrantz,et al.  Cerebral ischemia detection using artificial intelligence (CIDAI)—A study protocol , 2020, Acta anaesthesiologica Scandinavica.

[9]  Mohamad Sawan,et al.  Multichannel wearable fNIRS‐EEG system for long‐term clinical monitoring , 2018, Human brain mapping.

[10]  G. Levine,et al.  Risk Assessment of Stroke in Patients with Atrial Fibrillation: Current Shortcomings and Future Directions , 2019, Cardiovascular Drugs and Therapy.

[11]  Francesca N. Delling,et al.  Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association , 2019, Circulation.

[12]  Hongkyu Park,et al.  Gait Monitoring System for Stroke Prediction of Aging Adults , 2019, AHFE.

[13]  S. Krishna,et al.  Iot based patient monitoring and diagnostic prediction tool using ensemble classifier , 2017, 2017 International Conference on Advances in Computing, Communications and Informatics (ICACCI).

[14]  Qifa Zhou,et al.  Monitoring of the central blood pressure waveform via a conformal ultrasonic device , 2018, Nature Biomedical Engineering.

[15]  Jian Sun,et al.  ADVANCES IN FUNCTIONAL BRAIN IMAGING: A COMPREHENSIVE SURVEY FOR ENGINEERS AND PHYSICAL SCIENTISTS. , 2016 .

[16]  Mahendran Balasubramanian,et al.  Ambulatory cardiac bio-signals: From mirage to clinical reality through a decade of progress , 2019, Int. J. Medical Informatics.

[17]  Francesco Brigo,et al.  Early poststroke seizures following thrombolysis and/or thrombectomy for acute stroke: Clinical and stroke characteristics , 2020, Epilepsy & Behavior.

[18]  Yanping Cong,et al.  The Probability of Ischaemic Stroke Prediction with a Multi-Neural-Network Model , 2020, Sensors.

[19]  K. Wong,et al.  Intracranial Atherosclerosis: From Microscopy to High-Resolution Magnetic Resonance Imaging , 2017, Journal of stroke.

[20]  Nino Isakadze,et al.  How useful is the smartwatch ECG? , 2019, Trends in cardiovascular medicine.

[21]  Jochen Schiller,et al.  Next Generation Cooperative Wearables: Generalized Activity Assessment Computed Fully Distributed Within a Wireless Body Area Network , 2017, IEEE Access.

[22]  Z. Gaciong,et al.  Blood Pressure Control and Primary Prevention of Stroke: Summary of the Recent Clinical Trial Data and Meta-Analyses , 2013, Current Hypertension Reports.

[23]  V. Feigin,et al.  Mobile Technology for Primary Stroke Prevention: A Proof-of-Concept Pilot Randomized Controlled Trial , 2018, Stroke.

[24]  Xiaoxi Yao,et al.  Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association. , 2019, Circulation.

[25]  Comparison of 12 Risk Stratification Schemes to Predict Stroke in Patients With Nonvalvular Atrial Fibrillation , 2008, Stroke.

[26]  C. Stoicescu,et al.  Arterial Stiffness and Hypertension - Which Comes First? , 2017, Maedica.

[27]  V. Fuster,et al.  Imaging Subclinical Atherosclerosis: Is It Ready for Prime Time? A Review , 2014, Journal of Cardiovascular Translational Research.

[28]  Risk , 2020, Journal of paediatrics and child health.

[29]  Toshiya Arakawa,et al.  Recent Research and Developing Trends of Wearable Sensors for Detecting Blood Pressure , 2018, Sensors.

[30]  Simon Finnigan,et al.  Defining abnormal slow EEG activity in acute ischaemic stroke: Delta/alpha ratio as an optimal QEEG index , 2016, Clinical Neurophysiology.

[31]  Ming-Tao Yang Multimodal neurocritical monitoring , 2020, Biomedical journal.

[32]  S. Lal,et al.  Heart Rate Variability as a Biomarker for Predicting Stroke, Post-stroke Complications and Functionality , 2018, Biomarker insights.

[33]  K. Dharma,et al.  Use of mobile-stroke risk scale and lifestyle guidance promote healthy lifestyles and decrease stroke risk factors , 2020, International journal of nursing sciences.

[34]  Dingchang Zheng,et al.  Cuffless Single-Site Photoplethysmography for Blood Pressure Monitoring , 2020, Journal of clinical medicine.

[35]  Malka N. Halgamuge,et al.  Internet of Things in healthcare: Smart devices, sensors, and systems related to diseases and health conditions , 2020 .

[36]  J. Spence,et al.  Uses of ultrasound in stroke prevention. , 2020, Cardiovascular diagnosis and therapy.

[37]  Ilias Tachtsidis,et al.  Clinical Brain Monitoring with Time Domain NIRS: A Review and Future Perspectives , 2019, Applied Sciences.

[38]  John Sabino,et al.  Vertically-stacked MEMS PM2.5 sensor for wearable applications , 2019, Sensors and Actuators A: Physical.

[39]  C. Bai,et al.  Blood Pressure, Carotid Flow Pulsatility, and the Risk of Stroke: A Community-Based Study , 2016, Stroke.

[40]  Joanna Wardlaw,et al.  Action Plan for Stroke in Europe 2018–2030 , 2018, European stroke journal.

[41]  Elsayed Z Soliman,et al.  ECG abnormalities and stroke incidence , 2013, Expert review of cardiovascular therapy.

[42]  H. Kamel,et al.  Electrocardiographic left atrial abnormality and stroke subtype in the atherosclerosis risk in communities study , 2015, Annals of neurology.

[43]  Panayiotis A. Kyriacou,et al.  A review of machine learning techniques in photoplethysmography for the non-invasive cuff-less measurement of blood pressure , 2020, Biomed. Signal Process. Control..

[44]  M. Smolensky,et al.  Sleep-time blood pressure: Unique sensitive prognostic marker of vascular risk and therapeutic target for prevention. , 2017, Sleep medicine reviews.

[45]  N. Galldiks,et al.  Early electroencephalography in acute ischemic stroke: Prediction of a malignant course? , 2006, Clinical Neurophysiology.

[46]  Mary G. George,et al.  Prevention of stroke: a strategic global imperative , 2016, Nature Reviews Neurology.

[47]  S. Rohde,et al.  Noninvasive Cerebral Oximetry during Endovascular Therapy for Acute Ischemic Stroke: An Observational Study , 2015, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[48]  Sen Qiu,et al.  Towards Wearable-Inertial-Sensor-Based Gait Posture Evaluation for Subjects with Unbalanced Gaits , 2020, Sensors.

[49]  H. Kamel,et al.  P-Wave Indices and Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis , 2017, Stroke.

[50]  D. Russell,et al.  Unstable carotid artery plaque: new insights and controversies in diagnostics and treatment , 2016, Croatian medical journal.

[51]  Ming Liu,et al.  Stroke in China: advances and challenges in epidemiology, prevention, and management , 2019, The Lancet Neurology.

[52]  G. Hollander,et al.  Electrocardiogram Changes with Acute Alcohol Intoxication: A Systematic Review , 2018, The open cardiovascular medicine journal.

[53]  Hao Wang,et al.  Chronic Diseases and Health Monitoring Big Data: A Survey , 2018, IEEE Reviews in Biomedical Engineering.

[54]  Solmaz Rastegar,et al.  Non-invasive continuous blood pressure monitoring systems: current and proposed technology issues and challenges , 2019, Physical and Engineering Sciences in Medicine.

[55]  Jongmin Yoon,et al.  Design and Implementation of a New Wireless Carotid Neckband Doppler System with Wearable Ultrasound Sensors: Preliminary Results , 2019, Applied Sciences.

[56]  Salim Lahmiri,et al.  Gait Nonlinear Patterns Related to Parkinson’s Disease and Age , 2019, IEEE Transactions on Instrumentation and Measurement.

[57]  H. Markus,et al.  Doppler Embolic Signals in Cerebrovascular Disease and Prediction of Stroke Risk: A Systematic Review and Meta-Analysis , 2009, Stroke.

[58]  T. Naqvi,et al.  Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography. , 2020, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[59]  Cumara B. O’Carroll,et al.  Cardioembolic Stroke , 2017, Continuum.

[60]  Kunal Mankodiya,et al.  A Newcomer's Guide to Functional Near Infrared Spectroscopy Experiments , 2020, IEEE Reviews in Biomedical Engineering.

[61]  W. Feng,et al.  A Systemic Review of Functional Near-Infrared Spectroscopy for Stroke: Current Application and Future Directions , 2019, Front. Neurol..

[62]  Real-Time Data Analytics for Large Scale Sensor Data , 2020 .

[63]  Hamid Mcheick,et al.  Stroke Prediction Context-Aware Health Care System , 2016, 2016 IEEE First International Conference on Connected Health: Applications, Systems and Engineering Technologies (CHASE).

[64]  Xiao Xiang,et al.  Association between ambient air pollution and daily hospital admissions for ischemic stroke: A nationwide time-series analysis , 2018, PLoS medicine.

[65]  R B D'Agostino,et al.  Probability of stroke: a risk profile from the Framingham Study. , 1991, Stroke.

[66]  E. Topol,et al.  Validation of a genetic risk score for atrial fibrillation: A prospective multicenter cohort study , 2018, PLoS medicine.

[67]  HughMarkus,et al.  Optimizing Protocols for Risk Prediction in Asymptomatic Carotid Stenosis Using Embolic Signal Detection , 2011 .

[68]  Ryusuke Inoue,et al.  Prediction of Stroke by Home “Morning” Versus “Evening” Blood Pressure Values: The Ohasama Study , 2006, Hypertension.

[69]  Chi-Chun Lee,et al.  Development of an intelligent decision support system for ischemic stroke risk assessment in a population-based electronic health record database , 2019, PloS one.

[70]  C. Iadecola,et al.  A Harbinger of Stroke and Dementia , 2022 .

[71]  Arjun G. Yodh,et al.  Diffuse correlation spectroscopy for non-invasive, micro-vascular cerebral blood flow measurement , 2014, NeuroImage.

[72]  Pratyoosh Shukla,et al.  Artificial Intelligence Integration for Neurodegenerative Disorders , 2019, Leveraging Biomedical and Healthcare Data.

[73]  Masa-aki Sato,et al.  Reduction of global interference of scalp-hemodynamics in functional near-infrared spectroscopy using short distance probes , 2016, NeuroImage.

[74]  Soumyajit Mandal,et al.  Early Detection of Cardiovascular Diseases Using Wearable Ultrasound Device , 2019, IEEE Consumer Electronics Magazine.

[75]  Ja Eun Yu,et al.  Personal Air Pollution Monitoring Technologies: User Practices and Preferences , 2020, HCI.

[76]  Sushmita Purkayastha,et al.  Transcranial Doppler Ultrasound: Technique and Application , 2012, Seminars in Neurology.

[77]  Pablo Maceira-Elvira,et al.  Wearable technology in stroke rehabilitation: towards improved diagnosis and treatment of upper-limb motor impairment , 2019, Journal of NeuroEngineering and Rehabilitation.

[78]  M. Ferrari,et al.  A Mini-Review on Functional Near-Infrared Spectroscopy (fNIRS): Where Do We Stand, and Where Should We Go? , 2019, Photonics.

[79]  Siddhartha Sikdar,et al.  Imaging of high-risk carotid plaques: ultrasound. , 2017, Seminars in vascular surgery.

[80]  C. Estol Is breathing our polluted air a risk factor for stroke? , 2019, International journal of stroke : official journal of the International Stroke Society.

[81]  J. Healey,et al.  Stroke prevention in atrial fibrillation: Closing the gap , 2019, American heart journal.

[82]  Matthias W. Lorenz,et al.  Prediction of Clinical Cardiovascular Events With Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis , 2007, Circulation.

[83]  C. Iadecola,et al.  Hypertension: A Harbinger of Stroke and Dementia , 2013, Hypertension.

[84]  Gihun Joo,et al.  Clinical Implication of Machine Learning in Predicting the Occurrence of Cardiovascular Disease Using Big Data (Nationwide Cohort Data in Korea) , 2020, IEEE Access.

[85]  Tianjian Chen,et al.  Privacy-Preserving Technology to Help Millions of People: Federated Prediction Model for Stroke Prevention , 2020, ArXiv.

[86]  N. Gonzalez,et al.  Management of extracranial carotid artery disease. , 2015, Cardiology clinics.

[87]  Se Jin Park,et al.  Real-time Gait Monitoring System for Consumer Stroke Prediction Service , 2020, 2020 IEEE International Conference on Consumer Electronics (ICCE).

[88]  M. E. Kooi,et al.  Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology , 2018, American Journal of Neuroradiology.

[89]  Seoung Eun Kim,et al.  IoT based wake-up stroke prediction - Recent trends and directions , 2018, IOP Conference Series: Materials Science and Engineering.

[90]  M. Kiguchi,et al.  Assessment of mental stress effects on prefrontal cortical activities using canonical correlation analysis: an fNIRS-EEG study. , 2017, Biomedical optics express.

[91]  Bo Zhang,et al.  The role of carotid stenosis ultrasound scale in the prediction of ischemic stroke , 2020, Neurological Sciences.

[92]  Webb Ajs.,et al.  Action Plan for Stroke in Europe , 2018 .

[93]  Xiao Hu,et al.  Photoplethysmography based atrial fibrillation detection: a review , 2020, npj Digital Medicine.

[94]  P. Gorelick,et al.  Management of blood pressure in stroke , 2019, International Journal of Cardiology Hypertension.

[95]  John P. A. Ioannidis,et al.  Opportunities and challenges in developing risk prediction models with electronic health records data: a systematic review , 2017, J. Am. Medical Informatics Assoc..

[96]  V. Feigin,et al.  What Is the Best Mix of Population‐Wide and High‐Risk Targeted Strategies of Primary Stroke and Cardiovascular Disease Prevention? , 2020, Journal of the American Heart Association.

[97]  Eun Sug Park,et al.  Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019 , 2020, Lancet.

[98]  Mark R Miller,et al.  Air Pollution and Stroke , 2018, Journal of stroke.

[99]  V. Feigin,et al.  Multi-level community interventions for primary stroke prevention: A conceptual approach by the World Stroke Organization , 2019, International journal of stroke : official journal of the International Stroke Society.

[100]  S. Upadhyay,et al.  Transcranial Doppler (TCD) Ultrasonographyand its Clinical Application-A Review and Update , 2018 .

[101]  P. Levy,et al.  Management of hypertension in stroke. , 2014, Annals of emergency medicine.

[102]  Yuan-Ting Zhang,et al.  Investigation on Cardiovascular Risk Prediction Using Physiological Parameters , 2013, Comput. Math. Methods Medicine.

[103]  Jasjit S. Suri,et al.  A Special Report on Changing Trends in Preventive Stroke/Cardiovascular Risk Assessment Via B-Mode Ultrasonography , 2019, Current Atherosclerosis Reports.

[104]  Rajiv Mahajan,et al.  Subclinical device-detected atrial fibrillation and stroke risk: a systematic review and meta-analysis , 2018, European heart journal.

[105]  Mohamad Sawan,et al.  The NIRS Cap: Key Part of Emerging Wearable Brain-Device Interfaces , 2017 .

[106]  N. Bornstein,et al.  Asymptomatic embolisation for prediction of stroke in the Asymptomatic Carotid Emboli Study (ACES): a prospective observational study , 2010, The Lancet Neurology.

[107]  Marta Zanoletti,et al.  Time-domain near-infrared spectroscopy in acute ischemic stroke patients , 2019, Neurophotonics.

[108]  Sabino Joseph Pietrangelo,et al.  A wearable Transcranial Doppler ultrasound phased array system , 2018, Acta neurochirurgica. Supplement.

[109]  R. Agarwal,et al.  Home Blood Pressure Monitoring: How Good a Predictor of Long-Term Risk? , 2011, Current hypertension reports.

[110]  R. Aaslid,et al.  Long-Term Ambulatory Monitoring for Cerebral Emboli Using Transcranial Doppler Ultrasound , 2003, Stroke.

[111]  Rong Zhao,et al.  Pulse pressure as an independent predictor of stroke: a systematic review and a meta-analysis , 2016, Clinical Research in Cardiology.

[112]  Sadiq Ullah,et al.  Cyber Physical System for Stroke Detection , 2018, IEEE Access.

[113]  Robert D. Brown,et al.  The Challenges of Stroke Prediction Scores. , 2016, JAMA neurology.

[114]  J. Hirsch,et al.  The present and future use of functional near‐infrared spectroscopy (fNIRS) for cognitive neuroscience , 2018, Annals of the New York Academy of Sciences.

[115]  M. Wintermark,et al.  Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications , 2019, The Lancet Neurology.

[116]  Fei Wang,et al.  Deep learning for healthcare: review, opportunities and challenges , 2018, Briefings Bioinform..

[117]  Satoshi Teramukai,et al.  Morning Home Blood Pressure Is a Strong Predictor of Coronary Artery Disease: The HONEST Study. , 2016, Journal of the American College of Cardiology.

[118]  Xueli Yang,et al.  Predicting 10-Year and Lifetime Stroke Risk in Chinese Population. , 2019, Stroke.

[119]  Tangchun Wu,et al.  Self-Rated Health Status and Risk of Incident Stroke in 0.5 Million Chinese Adults: The China Kadoorie Biobank Study , 2018, Journal of stroke.

[120]  M. S. Sirsat,et al.  Machine Learning for Brain Stroke: A Review. , 2020, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[121]  J. Ghosh,et al.  Transcranial Doppler Ultrasound: A Review of the Physical Principles and Major Applications in Critical Care , 2013, International journal of vascular medicine.

[122]  Maged N. Kamel Boulos,et al.  Opportunistic atrial fibrillation screening and detection in "self-service health check-up stations": a brief overview of current technology potential and possibilities. , 2020, mHealth.

[123]  A. Hofman,et al.  Transcranial Doppler Hemodynamic Parameters and Risk of Stroke: The Rotterdam Study , 2007, Stroke.

[124]  P Krishna Kumar,et al.  A Review on Carotid Ultrasound Atherosclerotic Tissue Characterization and Stroke Risk Stratification in Machine Learning Framework , 2015, Current Atherosclerosis Reports.

[125]  Q. Bai,et al.  Quantitative electroencephalograph in acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator , 2016 .

[126]  E. Pirondini,et al.  Brain imaging of locomotion in neurological conditions , 2018, Neurophysiologie Clinique.

[127]  Luigi Padeletti,et al.  Usefulness of continuous electrocardiographic monitoring for atrial fibrillation. , 2012, The American journal of cardiology.

[128]  Se Jin Park,et al.  Development of Mobile Application Program for Stroke Prediction Using Machine Learning with Voice Onset Time Data , 2020, HCI.