Zig Bee based Monitoring of Leg Ulcers

A.Sugantha priyan #1, M.dhivya #2

Department of electrical and electronics engineering, Anna university of technology, Coimbatore, India
2 1 sugan.eee@gmail.com Dhivya.erts@gmail.com

Abstract - Leg ulcers or chronic ulcers are wound which persists for long time. This kind of ulcers cant be cured in a normal type. This ulcer mostly affects the elder and paraplegic patients. Owing to this leg ulcer affects 1% of world population and also 4% of cost is spent up by annual budget of National Health Service in U.K. So there is a need to develop a device that able to monitor the patients to care on the wound management under medical counsellor. A wireless wound mapping device is to be develop, that based on electrical impedance spectroscopy and also characterise the electrical properties of wound tissue that sense by electrode array with wireless feature. A main advantage of this wireless wound mapping device is the inclusion of the transducer array into the dressings will protect the ulcer from disturbance and contamination. Also it supports to the healing process, while monitoring the ulcer.
Key words Leg ulcers, Impedance Spectroscopy, Zig Bee.

and financial burden on patients about the entire healthcare system. This chronic wound does not respond to conventional treatments. So research is needed to improve an alternative cost effective method that supports wound healing and quality life to patients. To reduce the hospital costs the patient has to be discharge as quickly as possible. But this long term chronic wounds extends the nursing time. So there is a great need to monitor the patient remotely. II. ULCER ASSESSMENT TECHNIQUES Recording wound area and volume is an essential part of patient assessment and it provides information about the healing process. This entire collection of wound parameter data helps to find goals of care and to decide about treatment at each stage. To make this process as cost effective, patients take charge on the monitoring process. An objective need is to make the clinician to advise the patient on necessary changes in dressing and treatment if necessary [9]. So that patients can get the treatment and assessment from their home itself. It reduces the cost of the nursing time and also will improve their self confidence and quality of life. The initial wound size affects the apparent healing rates. The surface area (S) and its area to perimeter ratio (S/P) are useful to record about healing process. The parameters are accessed by computerized planimetry of digital images using suitable software. This helps in plotting healing rate against initial wound area which supports to know the progress of treatment and care. Wound volume, Wound area, Maximal wound depth and wound margin are the important parameters to be measured. Direct method is inexpensive and convenient although it is time consuming process. This method uses the invasive technique which may disrupt the healing and lead to contamination. Also affects healthy tissues by spreading wound fluid. In the indirect method the wound parameters are measured with non invasive technique. So there is no harm to the wound. Mostly of the method follows the counting squares and scaled photograph technique. In counting squares the small squares were drawn on the

1. INTRODUCTION Leg ulcers or pressure ulcers are wounds that cant be cured in the normal type. These wounds do not heal at an early stage. It is also called as chronic ulcers. If the wounds doesnt show any sign of improvement then this is known as chronic[4]. This ulcer affects mostly to the elder persons over 60 years in age. Also it affects 25 percent of spinal cord injured persons and paraplegic patients at some stage in their lives. An estimated 1% of the population in industrial countries suffer from this pressure ulcer and the treatment costs up to 2 million a year [11]. It adds the costs up to 4% of the total National Health Service budget in 2004 in U.K [5] and also $10 billion is spent each year in the care of leg ulcers in world wide. Much of this cost should be preventable. Mostly 90% of the cost is spent for the nurse time. A pressure ulcer is a painful and serious outcome of failure of routine nursing care. In this pressure ulcer the balance between production and degradation is lost and degradation plays a large role. Pressure ulcers may never cure or may take years to do so. These ulcers cause physical stress

transparency film and it is placed over the wound and the outline is traced. It gives the length and width of wound. but the wound depth cannot be find by this method. Photographic technique is also like the previous method. The reliability of these techniques was based on the investigator. Ruler technique gives the parameters about width and length. But it should be applied only if the wounds are in regular shape. The noncontact photographic technique (planimetry) wipes out the risk of contamination and disturbance to the wounds. The equipment is bulky and costly. Also the results vary depends upon the camera angle.

A. Skin Impedance Basics Skin impedance is measured in a wide range of frequencies to find the important features, mostly the range lies between 10 Hz to 1 MHz. Initially frequency range [14] between 11 Hz to 1 kHz is used to increase the speed of to plot image. The measured impedance data can be presented in two types, i. complex impedance plot (Xi Vs R) ii. Bode diagram. Bode diagram is plotted between logarithm of the magnitude of the impedance to logarithm of the frequency and the same to the phase angle. These plots help the clinician to decide model variable, thickness and to find the type of tissue present under study.

Figure 1. Visit rack from Smith and Nephew The traced transparent film is attached to the electrical clipboard. By this the parameters are obtained. In all the above method gives the data only about the length and width but about the wound depth. Normally the wound depth is measured by inserting a cotton swab in the deepest part of the wound. It would be done many times that will lead to severe pain and contamination. Personal digital assistant (PDA)-powered laser digitizer is a recent method. Images of wounds are obtain and recorded. Then it is transferred to electronic patient file. This also depends on camera angle. Till now no technique is avail to solve the problem in this disease. So we have to find a simple technique which supports the patient convenience. III. IMPEDANCE SPECTROSCOPY A non disruptive 3-D technique is preferred to measure the parameters of ulcers. The operation is taken by a small handheld device, which needs a little training, effective monitoring, remotely operated. Non disruptive 3-D technique is based on the concept of electrical impedance spectroscopy. It depends on the tissue impedance. This enable the clinician to measure wound area, depth wound brink and also some calibration measurement that defines the kind of tissue present. All these measurements are obtained without removing the dressing. This avoids interfering with wound healing and contamination. Electrical impedance spectroscopy analyse the electrical properties of tissue over a wide range of frequencies to map the wounds.

Figure 2. Complex impedance plots B. Impedance Model: The complex impedance plot of measured skin impedance normally has the form of a depressed semicircular arc (see Figure 2). Cole equation [25] is used to find an electrical behaviour of biological tissues under wide range of frequencies. R R Z = + 0 (1)
1+(

Where R0 = resistance at 0 Hz and R= resistance at infinitely high frequency. The exponent denotes the level of depression of observed impedance arc (see Fig. 3).

1 0

(2)

Figure 3. Equivalent circuit of wound impedance A simple equivalent circuit model is often used to find the impedance. Actually it is derived from the original Lapicque model and changed by Cole and Fricke. The outer, dry epidermis shows capacitive behaviour at high frequencies. At low frequencies, however, only resistive properties can

be measured for this layer. This has lead to the modelling of the epidermis by a resistor Rp in parallel with a capacitor C. Underneath the epidermis lie the moister dermal layers. Currents can flow through these layers relatively unimpeded and they are therefore represented by a small resistance Rs in series with the aforementioned parallel circuit. It has been observed, however, that the phase angle of the capacitive element of the circuit, although constant over a considerable range of frequencies, is not the expected 90 of an ideal capacitor. This has lead to the use of an empirical constant-phase element, as shown in Fig. 4, which has a phase angle typically between 45 and 90. The constant phase element can be described as follows. ZCPA = K (j) (3) 0 K = = (4) 0 If = 1, = 90, the capacitive element is a true capacitance and the arc has its centre on the x-axis. If is less than unity, as is generally the case, < 90, the capacitive element is not an ideal capacitance and the centre of impedance arc is depressed below the real axis. RP varies considerably between different individuals and under different circumstances. It is basically the current bypassing the capacitive epidermal layers, largely traversing through skin appendages. This parallel resistance varies over time, with sweating and skin preparation. C. Mapping System: A new device has been developed by the authors called ImpediMap, based on impedance spectroscopy, addressing many of the issues outlined earlier. It is targeted at the monitoring of chronic wounds, but could also be utilized in helping to prevent the formation of ulcers as well as in the study of acute wounds or burns. The initial prototype can be seen in Figure 4 with further improvements presently being developed. An array of electrodes is embedded in a sterile carrier dressing. Simplistically, intact skin has high impedance, whereas an open wound has very low impedance, the latter largely due to the resistance Rs of the underlying dermis.

degree of healing, all without removing the dressing (see Figure 5).

Figure 5. Envisaged use of a PDA device Skin re-grows the skins parallel resistance RP increases dramatically so much that it was quickly difficult to measure accurately within the frequency range chosen. There was a major difference in the magnitude of the impedance for an open wound and that of even only partially regrown skin. IV. HARDWARE MODEL The hardware structure (Figure 6) is used to measure the signal from transducer. The device is battery powered to ensure patient safety. Discreet frequencies between 11 and 935 Hz were initially chosen for early trials. The more and lower the frequencies used in the measurement, the longer the total measurement time will be for the multi electrode array. The measurement current is achieved by a voltage-controlled Current source, chosen to restrict the output current to a safe limit, i.e., 10 A (rms). The output signal from the voltage controlled current source is then switched to the electrode array via a bank of multiplexers. An instrumentation amplifier measures the voltage between each electrode under test and reference electrode. The output signal from the instrumentation amplifier is fed into an amplifier/filter stage for further conditioning. The skin impedance sensing electrodes are use to measure the growth of the skin. A current-to-voltage converter is used to convert the applied current through the electrodeskin impedance into a voltage to be measured. This voltage is later amplified by a second stage to ensure that good use is made of the A/Ds range (5 V). Digital Signal Processing is used in a wide range of applications including: Telecommunications, Data communications, Wireless communications, Image enhancement and processing. In fact, by wireless communication, the user interface sends measured data and information on the metrological characteristics of the system to a DSP. The best solution has been obtained after a redesign of the measurement system by using wireless modules to remotely transmit data to the DSP board, reducing possible damages or interferences during the computational process.

Figure 4. Electrode array Maps with pixels of varying resistance/impedance are produced to show the shape and size of the wound, and to establish the

Zig bee

Figure 6. Hardware overview of the wound-mapping system ZigBee is rapidly becoming the standards of choice for low data rate wireless applications. IEEE 802.15.4 defines a robust radio and medium access control (MAC) layer. ZigBee supports star, mesh and cluster-tree topologies. Unlike Bluetooth or wireless USB devices, ZigBee devices have the ability to form a mesh network between nodes. By this wireless technique the data is transfer to clinician from patients home. V. RESULTS AND DISCUSSIONS It must be noted that in this study, the ability of EIS to characterise tissue and monitor healing was of more importance than mapping of the very small wound with a relatively small number of electrodes. The impedance results were compared to clinically relevant parameters, such as reepithelialisation and transepidermal water loss (TEWL). The impedance plots evidenced very small impedances, almost purely resistive, for day 2 and day 3, mainly due, in the absence of the removed skin layer, to the series resistance, and to a limited extent, the small electrodegel interface. Larger, almost complete impedance arcs were observed for days 8 and 9 indicating a significant re-growth of the skin. The arc diameter increased dramatically from one day to the next. It was therefore obvious from this data that there is a major difference in impedance between an open wound and even partially re-grown skin. The concept of mapping of a wound based purely on the magnitude of the electrode-skin impedance, especially at lower frequencies, was therefore validated. The averages of the K and alpha values for three sites were calculated and compared to the clinical parameters recorded for these sites over time. Figure 7 similarly shows K in comparison with TEWL. Figure 8 presents the comparison of K, derived from the impedance data, with the reepithelialisation rate as determined by the panel of clinicians by means of colour-scaled photographs and visual classification of wound closure.

Figure 7. Average K and TEWL

Figure 8. Average K and reepithelialisation. VI. CONCLUSION The existing wound measurement methods were studied and the problems are manifested. By using a non disruptive 3-D technique, a zig bee enabled wireless device is planned to develop that will enable clinicians to monitor wound healing without disturbing, the wound-healing process. A non disruptive 3-D technique is nothing but an electrical impedance spectroscopy. According to this if the skin re-grows, the skins parallel resistance RP increases dramatically. The recorded data can then be sent to the clinician through wireless transmission if a result exceeds the boundaries. This will enable patients and their families to optimally manage the ulcers themselves under the guidance of a clinician. The correlation between the parameters, reepithelialisation rate is expected to be 95%. The vision for the future is to greatly miniaturize the device and the electrodes (increasing their number/density) and to incorporate a wireless transmitter into the electrode array/ dressing, thus enabling the use of a PDA or similar device to display and store the recorded data. VII. REFERENCE
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