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IEEE JOURNAL OF BIOMEDICAL AND HEALTH INFORMATICS, VOL. 19, NO. 3, MAY 2015

A Bendable and Wearable Cardiorespiratory


Monitoring Device Fusing Two Noncontact
Sensor Principles
Daniel Teichmann, Member, IEEE, Dennis De Matteis, Thorsten Bartelt, Marian Walter, Senior Member, IEEE,
and Steffen Leonhardt, Senior Member, IEEE

AbstractA mobile device is presented for monitoring both respiration and pulse. The device is developed as a bendable/flexible
inlay that can be placed in a shirt pocket or the inside pocket of
a jacket. To achieve optimum monitoring performance, the device
combines two sensor principles, which work in a safe noncontact
way through several layers of cotton or other textiles. One sensor,
based on magnetic induction, is intended for respiratory monitoring, and the other is a reflective photoplethysmography sensor
intended for pulse detection. Because each sensor signal has some
dependence on both physiological parameters, fusing the sensor
signals allows enhanced signal coverage.
Index TermsNoncontact monitoring, pulse, respiration, sensor
fusion, wearable sensors.

I. INTRODUCTION
OME or telemonitoring systems need frequent records of
vital signs on a regular basis to assess the health status of
a patient. To maintain the patients quality of life, monitoring of
vital signs should take place as unobtrusively as possible. For
this purpose, on-body sensors can be of considerable benefit.
An ideal on-body sensor for home application should be mobile and easily wearable, so as not to restrict the patients mobility. Also, it should be easy to use without the need for skilled
personal and/or complex electrode application on multiple measurement locations. Because the device should be suitable for
long-term monitoring, direct skin contact should be avoided to
prevent skin irritation. Finally, for better acceptance by the patients, the sensor should be imperceptible, i.e., light weight, flat,
and adaptive to body motion.
The novel device presented here for monitoring respiration
and pulse meets all the aforementioned requirements of an ideal
on-body sensor. It combines two sensors, both of which work in

Manuscript received October 31, 2014; revised February 1, 2015; accepted


March 20, 2015. Date of publication March 27, 2015; date of current version
May 7, 2015.
D. Teichmann is with the Philips Chair for Medical Information Technology,
RWTH Aachen University, 52074 Aachen, Germany (e-mail: teichmann@
hia.rwth-aachen.de).
D. De Matteis is with RWTH Aachen University, Aachen 52074, Germany
(e-mail: dennis.de.matteis@rwth-aachen.de).
T. Bartelt was with the Philips Chair for Medical Information Technology,
RWTH Aachen University, 52074 Aachen, Germany, when this work was carried
out. Currently he is with Fritz Stephan GmbH, 56412 Gackenbach, Germany
(e-mail: thorsten.bartelt@rwth-aachen.de).
M. Walter and S. Leonhardt are with the Philips Chair for Medical Information Technology, RWTH Aachen University, 52074 Aachen, Germany (e-mail:
walter@hia.rwth-aachen.de; leonhardt@hia.rwth-aachen.de).
Color versions of one or more of the figures in this paper are available online
at http://ieeexplore.ieee.org.
Digital Object Identifier 10.1109/JBHI.2015.2417760

a noncontact way allowing unobtrusive monitoring. The device


includes a microcontroller for data processing and a Bluetooth
module for data transmission. The entire device is realized on a
small printed circuit board (PCB) which can easily be placed in
a shirt pocket or the inside pocket of a jacket. Since the carrier
material of the circuit board is flexible, the device adapts its
form to the thoracic surface. Due to its pocket-sized flexible
construction, it is called FlexPock.
The first sensor method incorporated in the FlexPock device is the magnetic induction (MI) technique; this is based on
the electromagnetic coupling between a single sensing coil and
thoracic tissue. This method was chosen due to its excellent
ability to monitor respiratory activity [1]. The use of MI measurements for physiological activity monitoring was introduced
in 1967 by Vas et al. and called displacement cardiograph
[2] (Wilson et al. later claimed this device to work solely via
capacitive coupling [3]). Over the last decades, this method has
been sporadically investigated by various groups in stationary
setups [4][7]. In 2014, a mobile textile-integrated MI device
was presented by our group [8].
The use of the second sensor method is intended for pulse
measurement. For this purpose, an optical sensor was designed
based on photoplethysmography, a technique that was introduced in 1935 [9]. Photoplethysmographic sensors emit light of
a specific wavelength into the tissue region under investigation,
measure the amount of light that passes through the tissue, and
arrive at a measurement unit. Since the light intensity at the measurement unit depends on blood content in the tissue, this sensor
technique is well suited for cardiac pulse detection. The sensor
developed for the present device is a reflective photoplethysmograph [10], i.e., the light source and light measurement unit are
on the same side of the tissue, and the fraction of light reflected
(after superficial penetration) by the thorax is recorded. A similar method was applied by our group for the development of a
wearable in-ear sensor for oxygen saturation monitoring [11].
Combining both sensor techniques enables us to monitor various physiological parameters at the same measurement location.
This reduces both application effort and the size of the device,
and allows us to investigate the dependence between different
physiological measures without time-shifts or damping effects
due to mechanical propagation.
Section II presents an overview of the FlexPock device. The
physical principle and technical realization of the MI and reflective photoplethysmographic sensor are described in Sections
II-B and II-C, respectively. To enable mobile operating of the

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TEICHMANN et al.: BENDABLE AND WEARABLE CARDIORESPIRATORY MONITORING DEVICE FUSING TWO NONCONTACT SENSOR

Fig. 2.

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Block diagram of the Photoplethysmographic sensor.

Fig. 1(b) is a photograph of the actual system. Both sensors are


placed on a flexible, one-sided PCB. As can be seen in Fig. 1(b),
the sensing coil of the MI sensor is directly etched onto the PCB.
The measurement circuitry of the rPPG sensor [including the
light-emitting diodes (LEDs) and the photodiode] is placed in
the middle of the sensing coil. All other electronic components
(except for the power management) are also mounted on the
flexible PCB. The power management circuitry is placed on
a thin rigid PCB, which is exactly the same size as the LiPo
battery, and is mounted on the back of the battery.
B. rPPG Sensor
Fig. 1. (a) Block diagram of the system and (b) photograph of the FlexPock
device.

device with a single lithium polymer (LiPo) battery, an elaborate


power management was implemented (which is described
in Section II-D). Laboratory experiments and finite element
method (FEM) simulations were conducted to optimize and
characterize the sensors (see Sections III-A and III-B). Finally,
a first proof of concept was applied in four healthy volunteers and the results of these measurements are presented in
Section III. Preliminary information on this device and parts of
this paper were already presented in [12].
II. METHODS
A. System Overview
Fig. 1(a) presents a system overview of the FlexPock device
in the form of a block diagram. The device uses a MI sensor for
respiratory measurement and a reflective photoplethysmography
(rPPG) sensor for pulse measurement. As already mentioned in
Section I, the MI sensor is based on electromagnetic coupling
and should not be interpreted as a sensor for magnetic field flux
density. The sensor signals are collected by a microcontroller
(MSP430F5437A, Texas Instruments) where data are processed
and passed to a Bluetooth module (BlueMod+B20/BT2.1, Stollmann) for wireless transmission to a display unit. The display
unit can be a personal computer (running C++ Software with
QT-Library) or any Android device (running a Java App).

1) Physical Principle: Human skin is an inhomogeneous


and anisotropic optical medium. Light of a specific wavelength
is absorbed, reflected, or transmitted by the skin.
The reflectivity of the skin, i.e., the fraction between reflected
and incident light intensity, is correlated with the amount of
blood within the subcutaneous tissue. Reflectivity also depends
on oxygen saturation of the blood. This dependence is utilized
for the estimation of blood oxygenation. For this purpose, light
of at least two different wavelengths is typically used.
For detection of the pulse rate, it is sufficient to use light of
a single wavelength emitted by LEDs and observe the alternating component of the reflected (or transmitted) light by means
of a photodiode (see Fig. 2). When the heart pumps blood to
the periphery during a cardiac cycle, the pressure pulse reaches
the subcutaneous tissue within a certain time lag and modulates
the photoplethysmographic signal. The height of the signal amplitude measured by the photodiode is proportional to the difference between systolic and diastolic pressure. The constant
component is almost entirely caused by the basic absorption of
the observed tissue.
Besides pulse activity, other physiological processes may also
influence the rPPG signal. Especially, respiration can vary the
subcutaneous reflectivity by affecting the amount of blood volume pumped by the heart, as well as by increasing the pressure
on thoracic tissue.
2) Realization: Fig. 2 shows the block diagram of the photoplethysmographic sensor developed for the FlexPock device.
To ensure that enough light penetrates the textile layer in front
of the FlexPock device, the illumination of the subcutaneous

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Fig. 3.

IEEE JOURNAL OF BIOMEDICAL AND HEALTH INFORMATICS, VOL. 19, NO. 3, MAY 2015

Block diagram of the MI sensor.

tissue is performed by three high-power LEDs (SFH4250, Osram). For optimum signal-to-noise ratio (SNR), they emit infrared light with a wavelength of 850 nm. Each LED provides
a radiant flux of up to e = 60 mW with a forward current
of If = 100 mA. For optimum connection and coupling into
tissue during different postures, the LEDs are placed in a triangular arrangement around the photodiode [see Fig. 1(b)]. The
photodiode has a photosensitive range of 730 to 1100 nm with
maximum sensitivity at = 880 nm and, hence, matches the
chosen LED type very well. The photodiode produces a current
which is proportional to the amount of incident photons. This
current is transferred by an impedance converter into a voltage
signal, which can be measured and digitized by a 24-bit A/D
converter (ADS1292, Texas Instruments).
The data captured by the A/D converter are read out by the
FlexPocks microcontroller unit via the serialperipheral interface. Hardware implemented filter stages were avoided to reduce
the physical dimensions of the device. Therefore, noise reduction and further filtering is performed by the microcontroller.
The microcontroller also provides a pulse width modulation
signal, which controls a current source to drive the LEDs. This
enables to adapt the emitted light intensity to the ambient light,
the light translucency of the textile layer, and the actual connection (i.e., air gap) between LEDs and tissue. In this way, energy
consumption of the device is reduced and saturation of the A/D
converter is prevented.
C. MI Sensor
1) Physical Principle: Human tissue is an inhomogeneous
and anisotropic electrical medium. The impedance distribution
within the thorax is modulated by physiological activity. This
modulation can be explained by volume changes, displacement
of organ boundaries, and microscopic processes.
MI monitoring is a noncontact method to measure the variation of the impedance distribution of an object. It is based on
electromagnetic coupling between a coil and an object in its
vicinity. The basic physical principle is shown in Fig. 3. The
coil is driven by an alternating current and, therefore, sends out
a primary alternating magnetic field, which penetrates a conductive medium in its vicinity and induces eddy currents into it.
The eddy currents excite a secondary alternating magnetic field

affecting the primary one and, thereby, changing the impedance


of the coil in dependence on the objects impedance distribution. If the coil is placed in front of the thorax, the thorax acts as
the medium under test, and the coils impedance changes with
variation of the thoracic impedance distribution produced by
motion of the lungs.
In addition to changes of the inner impedance distribution of
the thorax, the coils impedance may also be influenced by respiratory activity via motion of the thoracic wall. This is mainly
caused by bending of the coil or a variation of the airgap distance between coil and thorax (affecting the coupling factor and
the parasitic stray capacitance).
Besides respiratory activity, other physiological processes
may also influence the MI signal. For instance, cardiac activity
can vary the MI signal by variation of tissue perfusion, mechanical coupling to the precordium, and displacement of the cardiac
wall.
2) Realization: Fig. 3 presents a block diagram of the MI
sensor developed for the FlexPock device.
To have as few electronic components as possible, the
impedance variation of the coil caused by physiological activity
is measured by means of a frequency modulation technique: i.e.,
the coils impedance variation due to physiological activity is
converted into a frequency shift, which is then measured. For
this purpose, the coil operates as a frequency-determining part
of a Colpitts oscillator, as shown in Fig. 3. Here, the inductivity
of the coil together with two capacitances form the oscillatory
tank, which is fed back by an inverter (74VHC04). Therefore,
the frequency of the magnetic field produced by the coil equals
the oscillatory frequency. A variation of the coils impedance
due to physiological activity produces a change of the oscillatory frequency which can be detected by a frequency counter
implemented on the microcontroller. This is realized by rectifying the oscillatory signal and passing it to the counter input of
the microcontroller unit, where it is read out during a constant
gate time. Using interlaced read outs, it is possible to achieve
a sampling rate of fs = 100 Hz and a minimum detectable
frequency change of fm in = 6.25 Hz. Additional details
on the implementation of the frequency counter are presented
in [1].
The dimension of the coil was chosen based on the laboratory
experiments presented in Section III-A. The coil consists of five
windings and has an inner and outer radius of ri = 25 mm
and ro = 30 mm, respectively. Its inductivity is approximately
Lcoil = 2.85 H. The basic operating frequency is tuned to
fbase = 24 MHz, resulting in a penetration depth of 32 cm
and complying with the European safety guideline for radiation
emission (2004/40/EG).
D. Power Management
The entire FlexPock device is powered by a lithium polymer battery with a physical dimension of 49 29 5 mm and
a capacity of 2.95 Wh. Charging of the battery via a USB
is controlled by a power management IC (PMIC) (LTC3553,
Linear Technology). The PMIC also protects the battery from
overcharge and depth discharge. It also includes a PowerPath

TEICHMANN et al.: BENDABLE AND WEARABLE CARDIORESPIRATORY MONITORING DEVICE FUSING TWO NONCONTACT SENSOR

Fig. 4.

Power management of the FlexPock device.

Fig. 5. Pulse measurements with different setups of the rPPG sensor. (a) Two
LEDs, LED-to-photodiode distance 20 mm. (b) Two LEDs, LED-to-photodiode
distance 15 mm. (c) One LED, LED-to-photodiode distance 15 mm.

controller to enable operation of the device during battery charging (see Fig. 4).
An LiPO battery provides an usable voltage range from 4.2
(fully charged) to 2.7 V (discharged). Since most of the electronic components of the FlexPock need a supply voltage of
more than 3.1 V, a step-up converter (LT1946A, Linear Technology) is used, which boosts the battery output to a constant
voltage of 3.6 V and, thereby, enables the use of the entire battery
capacity. Voltage regulation to 3.3 V is performed by two linear
voltage regulators. One regulator is integrated in the PMIC and
is responsible for the voltage supply of the microcontroller and
the Bluetooth module, while the other one (LT1963ES8-3.3,
Linear Technology) provides a constant reference supply voltage for the sensor part and is free of possible voltage dips caused
by the digital components. Furthermore, this partition enables
the implementation of a standby mode: The microcontroller is
able to switch the sensors OFF and to start them as soon as the
Bluetooth connection to a display unit is established. During
full operation, i.e., Bluetooth transmission at 115 kb/s, sensors
switched ON (sampling at 100 Hz), and LEDs emitting light
at maximum intensity, the power consumption of the device is
1.32 W. In combination with the chosen battery, this results in a
battery operation period of 2.23 h.
E. Data Processing
To reduce the necessary data rate for Bluetooth transmission
and to facilitate display of the physiological parameters on different platforms, calculation of respiratory and pulse rate can be
performed by the devices microcontroller unit. For extraction of
the respiratory rate, the MI signal is used, while the pulse rate
is calculated using the filtered rPPG signal.
Noise cancellation of the MI and the rPPG sensor is performed by a moving average filter of eight elements. For better
efficiency, it is implemented in a recursive form
sM A (k) =

A(k 1) s(k m) + s(k)


m

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(1)

where sM A denotes the averaged signal, s is the raw signal, k


is the current signal, m is the number of elements, and A is an
accumulator of the last m additions.
To reduce the calculation time of the filter stages, the averaged
signal of both sensors is downsampled by 10. For pulse detection, the averaged and downsampled signal of the rPPG sensor is
bandpass filtered by an FIR-filter with 32 taps. It has a bandwith
of B = 2.7 Hz and a center frequency of fcenter = 2.15 Hz; this
corresponds to a physiological pulse range of 48 to 210 b/min.
Finally, maxima and minima are detected by application of a
peak detection algorithm based on the change of sign of the
signal derivative, and the time intervals between the respiratory
or cardiac cycles are estimated and averaged over the last 10 s.
III. RESULTS
To evaluate the optimum distance between the LED and photodiode, as well as the optimum coil design, laboratory experiments were conducted; the results are presented in Section III-A.
In addition, Section III-B presents a simulative analysis of the
current density distribution within the thorax induced by the MI
sensor. In Section III-C, the FlexPocks suitability for cardiorespiratory monitoring is demonstrated by measurements in four
healthy volunteers.
A. Experimental Evaluation of Optimum Sensor Parameters
1) LED-to-Detector Distance: Since adequate space is
needed around the photodiode to place the impedance and A/D
converter in its direct proximity, a reasonable but minimum distance between an LED and the photodiode in a symmetrical
arrangement is 15 mm. In Fig. 5(a) and (b), some pulse measurements with two LEDs and a photodiode at the wrist covered
by one layer of cotton are plotted for a LED-to-detector distance
of 20 and 15 mm, respectively. This shows that the minimum

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IEEE JOURNAL OF BIOMEDICAL AND HEALTH INFORMATICS, VOL. 19, NO. 3, MAY 2015

TABLE I
PARAMETERS OF THE TESTED COILS

TABLE II
SNR OF THE COIL TEST MEASUREMENTS PRESENTED IN FIG. 6

coil no.

ri

ro

1
2
3

3
5
8

25 mm
25 mm
5 mm

28 mm
30 mm
8 mm

1.44 H
2.85 H
1.82 H

1.25
1.39
1.64

SNR

coil no.1
(L = 1.44 H,
n = 3)
51.8 dB

coil no.2
(L = 2.85 H,
n = 5)
96.2 dB

coil no.3
(L = 1.82 H,
n = 8)
44.7 dB

r i and r o denote the inner and outer radius, respectively.


L is the inductivity and Q the Q-factor of the coil.

Fig. 7.
red.

Fig. 6. Respiratory measurements with different setups of the MI sensor. (a)


n = 3, ri = 25 mm. (b) n = 5, ri = 25 mm. (c) n = 8, ri = 5 mm.

distance of 15 mm should not be exceeded, since even 5 mm


additional distance reduces the pulse amplitude by half.
As each LED uses 100 mA, it would be beneficial for energy
saving to reduce the number of LEDs. For this reason, pulse
measurement at the wrist was also conducted with only one
LED. The results of this experiment are presented in Fig. 5(c)
and show that the use of fewer LEDs significantly reduces the
signal amplitude and that the use of multiple LEDs is therefore
recommended.
2) Coil Design: Three different coils were produced and
tested for their suitability for respiratory monitoring. They were
connected with a MI sensor (as described in Section II-C2) and
placed on the chest by means of a flexible belt. The parameters
of the different coils are presented in Table I. Two coils with the
same inner radius, but different windings, were tested as well
as a coil with a smaller radius but an inductivity with a range
similar to that in the other two coils. The offset compensated
results are shown in Fig. 6. The SNR of each measurement is
presented in Table II. The SNR was calculated by the ratio of the
signal ( 5 Hz) and high-frequency noise ( 5 Hz) in decibels.
The higher inductivity of coil no. 2 (n = 5, L = 2.85 H)
yields to much better signal than achieved with coil no. 1 of
the same size but with lower inductivity (n = 3, L = 1.44 H).
The SNR of coil no. 2 is about 44.37 dB higher. Comparing

Simplified model of the thorax for FEM simulation. Coil is drawn in

the results of coil no. 1 with those of coil no. 3 shows that the
coils radius also has a significant effect on the sensor signal:
Although coil no. 3 has a higher inductivity, coil no. 2 with the
greater coil area produces a better respiratory signal.
According to these findings, the coil for the final FlexPock
design was chosen to have an outer radius of 30 mm [which is
close to the maximum size that fits into a standard shirt pocket
(approx. 100 mm)] and five windings (providing enough space
within the coil for the components of the rPPG sensor).
B. FEM Simulation of the Induced Current Density and its
Dependence on Coil Deformation
To obtain further information on the physical performance
of MI for thoracic monitoring, simulations based on the FEM
were conducted. In this way, the impact of coil deformation as
expected for a bendable measurement device could be investigated. FEM simulations were done using the ac/dc module
of the COMSOL multiphysics software package (Comsol Inc.,
Burlington, USA).
A simplified thorax model shown in Fig. 7 was composed
of simple three-dimensional geometries. To avoid mathematical
convergence problems, the model was symmetrically arranged.
The thorax is represented by an ellipsoid embedded in a sphere
representing the surrounding air. The coil comprises one turn of
copper (diameter 1 mm) and an outer diameter of 60 mm. It is
driven by an alternating current of Icoil = 1 mA and a frequency
of 30 MHz. Between the coil and thoracic wall, there is an air
gap of 1 mm. Table III summarizes the geometric dimensions
and material properties of the different organs. The electrical
properties of the organs were taken from [13].
In 1968, Tarjan and McFee [4] claimed that MI recordings of
the heart show the best signal quality during maximum inspiration. The authors assumed that due to the distal displacement of
the diaphragm and the lower conductivity of the inflated lung,

TEICHMANN et al.: BENDABLE AND WEARABLE CARDIORESPIRATORY MONITORING DEVICE FUSING TWO NONCONTACT SENSOR

TABLE III
OVERVIEW OF THE GEOMETRIES AND ELECTRICAL PROPERTIES OF THE
OBJECTS APPLIED FOR FEM SIMULATION
object/tissue

environment
thorax
lungs, expired
lungs, inspired
heart

size [mm]

TABLE IV
CALCULATED REFLECTED COIL IMPEDANCES Z c o il FOR THE COIL
TRANSLATIONS SHOWN IN FIG. 9

electrical property

Translation [mm]
0
20
40
60

x-dir.

y-dir.

z-dir.

[S/m]

 r [1]

270
220
55
75
90

270
85
55
75
90

270
180
140
160
90

0
0.366
0.49
0.26
0.880

1
71.88
98.851
98.851
134.97

789

Z c o i l []

|Z c o i l | []

14.41 + j26.09
15.68 + j25.96
10.29 + j26.06
7.28 + j26.09

29.805
30.328
28.018
27.087

(dir. denotes direction).

Fig. 10. Magnetic flux density (B-field) in arrow presentation on the transversal (xy) plane during coil elongation in x-direction by factor (a) 2 and (b) 2.5.
For physical dimensions, see Fig. 7 and Table III. Overlapping regions between
heart and lungs are assigned to heart tissue.
Fig. 8. Absolute value of the induced current density on the frontal (xz) plane
positioned at the center of the heart during (a) expiration (smaller volume and
higher conductivity of the lungs) and (b) inspiration (higher volume and lower
conductivity of the lungs). For physical dimensions, see Fig. 7 and Table III.

Fig. 9. Absolute value of the induced current density on the frontal (xz) plane
positioned at the center of the heart with the coil translated by 0, 20, 40, and
60 mm. For physical dimensions, see Fig. 7 and Table III.

the heart turns more into the focus of the measurement coil. To
validate this hypothesis by means of the FEM facilities available
today, the distribution of the induced current density during lung
expiration and inspiration was simulated and are compared in
Fig. 8(a) and (b), respectively. The intersecting plane lies in the
xz plane (i.e., frontal plane) at the middle of the heart (on the
y-axis).
Both simulations show a distribution of the induced current
density which is concentric around the coil center and has its
maximum value at the hearts surface. Due to the higher conductivity of the expired lung, there are high current densities in
the direct surrounding of the heart and the transition between
the organ boundaries is not well pronounced. In contrast, during inspiration, a much more pronounced change in the current
density distribution is visible, which is caused by the higher
conductivity of the lungs.
Fig. 9 shows the effect of lateral displacement of the coil. The
displacement starts at a central position directly above the heart
and comprises three consecutive translations by 20 mm. As can
be seen, the current density with the coil shifted by 20 mm

Fig. 11. Absolute value of the induced current density on the frontal (xz)
plane positioned at the center of the heart during (a) convex and (b) concave
coil deformation. For physical dimensions, see Fig. 7 and Table III.

Fig. 12.

Healthy volunteer with the FlexPock device.

still mainly focuses in the heart region. In fact, the calculated


reflected impedance of the coil (which is given for each displacement step in Table IV) shows a higher value when shifted
by 20 mm than with the coil at the central position. This may
indicate that the heart has more impact on the coils impedance
at this slightly translated measurement location. When the coil
is further translated to the side (by 40 and 60 mm), the induced
eddy currents inside the heart decrease in favor of less conductive tissue regions; this causes the strong decrease of the
reflected coil impedance, as shown in Table IV.

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IEEE JOURNAL OF BIOMEDICAL AND HEALTH INFORMATICS, VOL. 19, NO. 3, MAY 2015

Fig. 13. Measurement results on a healthy volunteer (subject 4 in Table V) with the FlexPock device placed on the left breast (inside a shirt pocket) during (a)
standing and (b) and (c) sitting posture. In (c), two additional layers of cotton were placed between skin and sensor (total of three layers). (a) Standing posture
(one layer of cotton between skin and sensor). (b) Sitting posture (one layer of cotton between skin and sensor). (c) Sitting posture (three layers of cotton between
skin and sensor).

Because the FlexPock device is flexible, the coil can become


deformed during measurement. Therefore, the impact of coil
deformation was investigated, i.e., elongation of the coil as well
as a convex (due to a drape of the shirt) or concave (generated
by motion of the thoracic wall due to respiration) coil curvature.
The terms convex and concave are here defined as referring to
the thorax.
Fig. 10 shows the magnetic flux density (B-field) in an arrow
presentation on the transversal plane for a coil elongated in the
x -direction by a factor 2 [see Fig. 10(a)] and by a factor 2.5 [see
Fig. 10(b)]. The length and thickness of an arrow represent the
field strength at the position of the arrows shaft. Apparently,
the B-field smears over, the more the coil is elongated. This
implies a lower penetration depth into tissue and less focus in
the direction of elongation.
Fig. 11 shows the induced current densities in the frontal plane
for a convex [see Fig. 11(a)] and a concave [see Fig. 11(b)] coil
curvature. In the case of a convex curvature, two centers of
high current density arise, whereas in the case of concave curvature, the current density distribution maintains the concentric
characteristic of the nondeformed coil.

C. Monitoring of Respiration and Pulse


To verify the ability of the device to monitor respiration and
pulse, four healthy male volunteers wore the FlexPock inside
their left-shirt pocket (see Fig. 12).
The volunteers were asked to perform 60 s of normal breathing as well as a 10-s apnea phase in both standing and sitting
position. To investigate the devices performance when more
than one thin textile layer is placed between the device and the
thorax, the experiment (in sitting position) was also conducted
with volunteers wearing two cotton T-shirts under the shirt. The
derived signals were compared to simultaneously recorded respiratory (Flowmeter, Model 4040, TSI Inc.) and cardiac (Electrocardiogram, IntelliVue MP70, Philips GmbH) references.
To evaluate the quality of the derived signals, three performance metrics were calculated for each sensor.
(1) Respiration-to-pulse ratio (RPR): The ratio between the
mean peak-to-peak amplitude value of the respiratory and
cardiac cycles.
(2) SNR of the cardiac (SNRpulse ) and respiratory (SNRresp )
signal content: The ratio between the mean peak-to-peak

TEICHMANN et al.: BENDABLE AND WEARABLE CARDIORESPIRATORY MONITORING DEVICE FUSING TWO NONCONTACT SENSOR

TABLE V
PERFORMANCE OF THE MI AND RPPG SENSOR WITH THE DEVICE POSITIONED
ON THE LEFT BREAST (INSIDE A SHIRT POCKET) DURING (A) STANDING AND
(B) AND (C) SITTING POSTURE

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During all measurements, both sensor signals show an inverted characteristic in relation to the reference signals: i.e., the
sensor signals decrease during cardiac systole and during lung
inspiration.

IV. DISCUSSION

In (c) two additional layers of cotton were placed between skin and sensor (total of
three layers).

amplitude value of the cardiac or respiratory cycles and


the noise floor (two times the root-mean-square value)
in decibels (dB). Noise was defined as all signal content
above 5 Hz. The peak-to-peak values of the cardiac cycles
were measured during apnea phase.
Fig. 13 shows the representative excerpts of measurements
(three respiratory cycles and a 5-s apnea phase) recorded from
one of the volunteers. Note that the respiratory reference provides the absolute value of the respiratory flow; therefore,
two amplitude waves correspond to one respiratory cycle. Table V provides the calculated performance metrics of the
three measurements for each volunteer, as well as their average
values.
Apparently, in standing posture [see Fig. 13(a)] both sensors
provide excellent SNR values for respiration and pulse monitoring. The RPR of the rPPG signal is much lower than that of the
MI signal. This difference in the sensors RPR values is even
more pronounced in the sitting position, which is also reflected
by the increase in values of the MI sensors SNRresp and the
rPPG sensors SNRpulse (see Table V).
When three layers of cotton textile are placed between the
FlexPock device and the thoracic skin, the respiratory and cardiac signals are still detectable [see Fig. 13(c)] but show a significant loss of signal quality.

The design of the MI sensor and the rPPG sensor conforms


to the results presented in Section III-A. The signal quality
of the MI sensor increases with both the coils radius and its
inductivity. Therefore, the coils outer radius was chosen to
be close to the maximum size that fits into a standard shirt
pocket, while the inner radius provides enough space inside the
coil for the components of the rPPG sensor. According to the
results in Section III-A1, the distance between the LED and the
photodiode was chosen as close as possible.
The results in Section III-C illustrate the ability of the device
to adequately monitor cardiorespiratory activity. Nevertheless,
a more extensive evaluation of the device with more measurements derived from more volunteers is needed. In particular, the
effect of motion artifacts has to be explored. To determine to
what extent and how often the device can be bent without loss
of soldering quality, endurance testing has to be applied to the
FlexPock device.
At the current development stage, the operation period of
the battery is a limiting factor. The operation period of the device could be increased by reducing the sampling as well as
the Bluetooth transmission rate (a low-power Bluetooth transmission stack is also recommended). Furthermore, the LEDs
of the rPPG sensor could be pulsed when the signal from the
photodiode is digitized. Since the LEDs need 330 mW in total,
this procedure would dramatically decrease the devices power
consumption. In this way, the effect of ambient light could also
be compensated for by performing measurements without LED
light and subtracting it from the measured signal.
Both respiratory and cardiac activity were contained in the
signal of the MI sensor and the rPPG sensor when placing the
FlexPock device on the left chest. The much higher respiratory
signal content overlays the lower cardiac one and, therefore,
complicates pulse detection. Since the RPR was much lower for
the rPPG sensor, this sensor is an ideal complement to the MI
sensor which, on the other hand, provides an excellent respiratory signal.
Since the MI sensor is not restricted to optical coupling,
its SNRpulse value shows only a low decrease (SNRpulse =
8.6 dB) in comparison to the one of the rPPG sensor
(SNRpulse = 32.8 dB) when additional layers of cotton textile are placed between the FlexPock device and skin. The increase of RPR in the rPPG sensor case due to additional textile
layers can be explained by the decrease of optical coupling and,
hence, a higher relative influence of respiratory motion.
Measurement locations other than the left pectoralis muscle
(i.e., shirt pocket) could also be advantageous. For instance, a
measurement location on the back of the thorax might yield to a
higher RPR of the MI sensor due to the increased distance from
the heart. Furthermore, the back of the thorax generally shows

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IEEE JOURNAL OF BIOMEDICAL AND HEALTH INFORMATICS, VOL. 19, NO. 3, MAY 2015

less motion [14]; this could decrease the signal content obtained
by the rPPG sensor due to respiratory motion.
The fact that both sensors measure both respiration and pulse
could be used to enhance the coverage of respiratory and pulse
rate estimation, i.e., the time during which a parameter extraction is possible. The fusion of two sensors at the same
measurement location offers additional advantages: It allows
to investigate the dependence between different physiological
measures without time lag or mechanical damping caused by
different measurement locations. Such a measure could be the
time-interval between the ejection of the heart (measured by the
MI sensor via cardiac wall motion) and the corresponding arrival of the blood volume in the subcutaneous tissue (measured
by the rPPG sensor). The spatial fusion of both sensors also allows the possibility of motion artifact cancellation, since motion
artifacts will presumably couple in both sensors simultaneously
and to the same extent. However, further verification of these
ideas has to be provided in future investigation.
V. CONCLUSION
The device presented here shows excellent ability to monitor cardiorespiratory activity. Despite several layers of cotton
textile between the sensor and skin, it is still possible to obtain signals suitable for the extraction of respiratory and pulse
rate (MI sensor: SNRresp = 98.5 dB, SNRpulse = 42.2 dB; rPPG
sensor: SNRresp = 62.3 dB, SNRpulse = 27.7 dB). Combining
two noncontact sensor principles and placing them at the same
measurement location allows enhancement of both physiological information and signal quality. It has been shown that it is
likely to happen that the amount of cardiac or respiratory related
signal content of the MI and rPPG sensor changes in dependence
on body posture. Therefore, by fusing both sensor signals, the
coverage rate of the parameter extraction could be enhanced.
Furthermore, physiological measures derived by combinations
of both signals could be monitored. The spatial sensor fusion
enables the use of adaptive motion artifact cancellation techniques because both signals will be affected by the same motion
artifact. Since the device is mobile, wearable, easy to apply, easy
to operate, noncontact, unobtrusive, motion adaptive, and multimodal, it seems to be well suited for on-body sensor networks
in telemonitoring applications.

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Daniel Teichmann (S12M15) was born in Essen,


Germany, in 1982. He received the Dipl.Ing. degree in
electrical engineering from RWTH Aachen University, Aachen, Germany, where he is currently working
toward the Dr. Ing. degree with the Chair of Medical
Information Technology.
He is currently a Research Assistant at RWTH
Aachen University. His research interests include
noncontact monitoring techniques and signal processing.

Dennis De Matteis was born in Hagen, Germany,


in 1985. He is currently working toward the M.Sc.
degree in computer engineering from RWTH Aachen
University, Aachen, Germany.

REFERENCES
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Thorsten Bartelt was born in Viersen, Germany,


in 1982. He received the Dipl.Ing. degree in electrical engineering from RWTH Aachen University,
Aachen, Germany.
He is currently working with Fritz Stephan
GmbH at Gackenbach, Germany.

TEICHMANN et al.: BENDABLE AND WEARABLE CARDIORESPIRATORY MONITORING DEVICE FUSING TWO NONCONTACT SENSOR

Marian Walter (M97SM13) was born in


Saarbrucken, Germany, in 1966. He studied electrical
engineering, with a specialization in control engineering, and received the Dipl.Ing. and Dr. Ing. degrees
from Technical University of Darmstadt, Darmstadt,
Germany, in 1995 and 2002, respectively.
He was with medical engineering industry for
three years and was appointed as a Senior Scientist
and the Deputy Head at the Philips Chair of Medical
Information Technology at RWTH Aachen University, Aachen, Germany, in 2004. His research interests include noncontact monitoring techniques, signal processing, and feedback
control in medicine.

793

Steffen Leonhardt (M95SM06) was born in


Frankfurt, Germany, in 1961. He received the M.S.
degree in computer engineering from the State University of New York, Buffalo, NY, USA in 1987, the
Dipl.Ing. degree in electrical engineering, in 1989
and the Dr. Ing. degree in control engineering from
the Technical University of Darmstadt, Germany, in
1995, and the M.D. degree in medicine from J. W.
Goethe University, Frankfurt, Germany, in 2001.
He has five years of R&D management experience
in medical engineering industry and was appointed as
a Full Professor and the Head of the Philips endowed Chair of Medical Information Technology at RWTH Aachen University, Germany, in 2003. Among others,
Dr. Leonhardt serves as an associate Editor of the IEEE Journal of Biomedical and Health Informatics and IEEE Transactions on Biomedical Circuits and
Systems. In 2014, he became a fellow of the NRW Academy of Sciences, Humanities and the Arts in Dusseldorf. In 2015, he was appointed a distinguished
lecturer by the EMBS.