(19) United States
`(12) Patent Application Publication (10) Pub. No.: US 2007/0265533 A1
`Tran
`(43) Pub. Date:
`Nov. 15, 2007
`
`US 20070265533A1
`
`(54) CUFFLESS BLOOD PRESSURE
`MONITORING APPLIANCE
`
`(76) Inventor: Bao Tran, San Jose, CA (US)
`
`Correspondence Address:
`TRAN & ASSOCATES
`6768 MEADOW VISTA CT.
`SAN JOSE, CA 95135 (US)
`
`(21) Appl. No.:
`
`11/433,900
`
`(22) Filed:
`
`May 12, 2006
`
`Publication Classification
`
`(51) Int. Cl.
`(2006.01)
`A6IB 5/02
`(52) U.S. Cl. ............................................ 600/481; 600/528
`(57)
`ABSTRACT
`Aheart monitoring system for a person includes one or more
`wireless nodes forming a wireless mesh network and a
`wearable appliance having a sound transducer coupled to the
`wireless transceiver; and a heart disease recognizer coupled
`to the sound transducer to determine cardiovascular health
`and to transmit heart sound over the wireless mesh network
`to a remote listener or processor.
`
`REMOTE SERVER 200
`
`
`
`
`
`PARTY (DOCTOR,
`FAMILY, EMERGENCY
`SERVICES,
`CAREGIVER, HOSPITAL,
`NURSNG HOME, CALL
`CENTER, ETC.), 210
`
`- AUTHORIZED THIRD
`
`
`
`
`
`
`
`
`
`
`
`Inlet
`
`BASE STATION -
`LOCAL SERVER 20
`
`
`
`'EN
`
`REA
`
`1. 30
`
`10
`
`Apple Inc.
`APL1196
`U.S. Patent No. 9,289,135
`
`001
`
`

`

`Patent Application Publication Nov. 15, 2007 Sheet 1 of 14
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`US 2007/0265533 A1
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`
`
`
`
`
`
`
`
`
`
`
`
`REMOTE SERVER 200
`
`AUTHORIZED THIRD
`PARTY (DOCTOR,
`FAMILY, EMERGENCY
`SERVICES,
`CAREGIVER, HOSPITAL,
`NURSING HOME, CALL
`CENTER, ETC.).210
`
`
`
`BASE STATION
`LOCAL SERVER2O
`
`
`
`10
`
`30
`
`FIG. 1
`
`002
`
`

`

`Patent Application Publication Nov. 15, 2007 Sheet 2 of 14
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`US 2007/0265533 A1
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`
`
`Place a calibration sheet with known dots at a known distance
`and perpendicular to a camera view
`
`Take snapshot of the sheet, and correlate the position of the
`dots to the camera image
`
`Place a different calibration sheet that contains known dots at
`another different known distance and perpendicular to camera
`view.
`
`Take snapshot of the sheet and correlate the position of the
`dots to the camera image
`
`Smooth the dots to the pixels to minimize digitization errors
`
`For each pixel, draw a line from Dotl (x,y,z) to Dot2 (x, y, z)
`defining a cone center where the camera can view
`
`FIG. 2A
`
`O O O O O O O O
`O
`O
`O
`O
`O O O O O O O O
`O
`O
`O
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`O
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`O
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`O O O O O O O O
`O
`O
`O
`O
`
`FIG. 2B
`
`003
`
`

`

`Patent Application Publication Nov. 15, 2007 Sheet 3 of 14
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`US 2007/0265533 A1
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`Find floor space area
`
`Define camera view
`background 3D scene
`
`Calculate patient's key features
`
`Detect fall
`
`FIG. 3
`
`
`
`Find floor space area
`
`Define camera view background 3D scene
`
`Calculate patient's key features
`
`Extract facial objects
`
`Detect facial orientation
`
`Detect facial expression
`
`FIG. 4
`
`004
`
`

`

`Patent Application Publication Nov. 15, 2007 Sheet 4 of 14
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`US 2007/0265533 A1
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`
`
`
`
`
`
`Determine if patient needs assistance based on in-door position, fall
`detection and vital parameter (1008)
`Confirm prior to calling third party (1010)
`If confirmed or non-responsive, make connection with third party and
`send voice over mesh network to appliance worn by the patient (1012)
`If needed, call emergency personnel to get medical care (1014)
`
`
`
`
`
`
`
`1382
`
`1388
`
`FIG. 6A
`
`005
`
`

`

`Patent Application Publication Nov. 15, 2007 Sheet 5 of 14
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`US 2007/0265533 A1
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`
`
`HDTV REMOTE
`CONTROL 1399
`
`IGHTING
`CONTROL 1398
`
`ROOM
`THERMOSTAT
`CONTROL 1396
`
`HOME SECURITY
`MONITOR 1394
`
`FIRE ALARMS(S)
`1393
`
`HOME
`APPLIANCE(S)
`1392
`
`
`
`MEDCNE
`CONTAINER(S)
`1391
`
`BASE STATION
`OR PERSONAL
`SERVER 1390
`
`POTS/PSTN OR THE
`INTERNET
`
`AUTHORIZED THIRD PARTY (FRIEND, FAMILY, COMMUNITY, EMERGENCY SERVICES,
`HOSPITAL CAREGIVER, ORMONITORING CALL CENTER, AMONG OTHERS) 1194
`
`FIG. 6B
`
`
`
`
`
`
`
`006
`
`

`

`Patent Application Publication Nov. 15, 2007 Sheet 6 of 14
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`US 2007/0265533 A1
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`Star
`
`O PAN coordinator (FFD)
`O Router Node (FFD)
`62 End Device (RFD or FFD)
`
`FIG. 7
`
`
`
`13O
`
`132
`
`FIG. 8
`
`007
`
`

`

`Patent Application Publication Nov. 15, 2007 Sheet 7 of 14
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`US 2007/0265533 A1
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`FIG. 9
`
`
`
`149
`
`FIG. 10
`
`008
`
`

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`Patent Application Publication Nov. 15, 2007 Sheet 8 of 14
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`US 2007/0265533 A1
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`172
`
`
`
`FIG. 11
`
`FIG. 12
`
`009
`
`

`

`Patent Application Publication Nov. 15, 2007 Sheet 9 of 14
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`US 2007/0265533 A1
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`188
`
`FIG. 13
`
`lifydiffin A
`
`A.
`
`96
`
`
`
`92
`
`010
`
`

`

`Patent Application Publication Nov. 15, 2007 Sheet 10 of 14
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`US 2007/0265533 A1
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`
`
`
`
`
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`FIG. 15A
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`011
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`

`

`Patent Application Publication Nov. 15, 2007 Sheet 11 of 14
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`US 2007/0265533 A1
`
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`

`

`Patent Application Publication Nov. 15, 2007 Sheet 12 of 14
`
`US 2007/0265533 A1
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`F.G. 15D
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`013
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`

`

`Patent Application Publication Nov. 15, 2007 Sheet 13 of 14
`
`US 2007/0265533 A1
`
`FIG. 15E
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`

`

`Patent Application Publication Nov. 15, 2007 Sheet 14 of 14
`
`US 2007/0265533 A1
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`Generate a blood pressure model of a patient (2002)
`
`Determine a blood flow velocity using a piezoelectric transducer (2004)
`
`Provide the blood flow velocity to the blood pressure model to
`continuously estimate blood pressure (2006)
`
`FIG. 16A
`
`
`
`Attach monitoring device and calibration device to patient (2010)
`
`Determine blood flow velocity from the monitoring device and actual
`blood pressure from the calibration device (2012)
`
`Generate a blood pressure model based on the blood flow velocity and the
`actual blood pressure (2014)
`
`Remove calibration device (2016)
`
`Determine blood flow velocity (2018)
`
`Provide blood flow velocity to the blood pressure model to estimate blood
`pressure (2020)
`
`FIG. 16B
`
`015
`
`

`

`US 2007/0265533 A1
`
`Nov. 15, 2007
`
`CUFFLESS BLOOD PRESSURE MONITORING
`APPLIANCE
`
`BACKGROUND
`0001. This invention relates generally to methods and
`apparatus for monitoring blood pressure.
`0002. As discussed in U.S. Pat. No. 6,514,211, three well
`known techniques have been used to non-invasively monitor
`a Subjects arterial blood pressure waveform: auscultation,
`oscillometry, and tonometry. The auscultation and oscillom
`etry techniques use a standard inflatable arm cuff that
`occludes the subjects brachial artery. The auscultatory
`technique determines the Subject's systolic and diastolic
`pressures by monitoring certain Korotkoff sounds that occur
`as the cuff is slowly deflated. The oscillometric technique,
`on the other hand, determines these pressures, as well as the
`Subjects mean pressure, by measuring actual pressure
`changes that occur in the cuff as the cuff is deflated. Both
`techniques determine pressure values only intermittently,
`because of the need to alternately inflate and deflate the cuff,
`and they cannot replicate the Subjects actual blood pressure
`waveform. Occlusive cuff instruments of the kind described
`briefly above generally have been effective in sensing long
`term trends in a subjects blood pressure, but they have been
`ineffective in sensing short-term blood pressure variations.
`0003 Arterial tonometry is also well known in the arts. In
`this technique, pressure in a Superficial artery with Sufficient
`bony support, such as the radial artery, may be accurately
`recorded during an applanation Sweep when the transmural
`pressure equals Zero. The term “applanation” refers to the
`process of varying the pressure applied to the artery. An
`applanation Sweep refers to a time period during which
`pressure over the artery is varied from overcompression to
`undercompression or vice versa. At the onset of a decreasing
`applanation Sweep, the artery is overcompressed into a 'dog
`bone' shape, so that pressure pulses are not recorded. At the
`end of the Sweep, the artery is undercompressed, so that
`minimum amplitude pressure pulses are recorded. Within
`the Sweep, it is assumed that an applanation occurs during
`which the arterial wall tension is parallel to the tonometer
`surface. Here, the arterial pressure is perpendicular to the
`surface and is the only stress detected by the tonometer
`sensor. At this pressure, it is assumed that the maximum
`peak-to-peak amplitude (the "maximum pulsatile') pressure
`obtained corresponds to Zero transmural pressure.
`0004 As mentioned in the 211 patent, one prior art
`device for implementing the tonometry technique includes a
`rigid array of miniature pressure transducers that is applied
`against the tissue overlying a peripheral artery, e.g., the
`radial artery. The transducers each directly sense the
`mechanical forces in the underlying Subject tissue, and each
`is sized to cover only a fraction of the underlying artery. The
`array is urged against the tissue, to applanate the underlying
`artery and thereby cause beat-to-beat pressure variations
`within the artery to be coupled through the tissue to at least
`Some of the transducers. An array of different transducers is
`used to ensure that at least one transducer is always over the
`artery, regardless of array position on the Subject.
`0005 The 211 patent discloses blood pressure measure
`ment by determining the mean arterial blood pressure
`(MAP) of a subject during tonometric conditions. The
`apparatus has one or more pressure and ultrasound trans
`
`ducers placed over the radial artery of a human Subjects
`wrist, the latter transmitting and receiving acoustic energy so
`as to permit the measurement of blood velocity during
`periods of variable compression of the artery. During com
`pression, the ultrasound Velocity waveforms are recorded
`and processed using time-frequency analysis. The time at
`which the mean time-frequency distribution is maximal
`corresponds to the time at which the transmural pressure
`equals Zero, and the mean pressure read by the transducer
`equals the mean pressure within the artery. In another aspect
`of the invention, the ultrasound transducer is used to position
`the transducer over the artery such that the accuracy of the
`measurement is maximized.
`
`SUMMARY
`In one aspect, a heart monitoring system for a
`0006.
`person includes one or more wireless nodes forming a
`wireless mesh network and a wearable appliance having a
`Sound transducer coupled to the wireless transceiver, and a
`heart disease recognizer coupled to the Sound transducer to
`determine cardiovascular health and to transmit heart Sound
`over the wireless mesh network to a remote listener if the
`recognizer identifies a cardiovascular problem. The heart
`Sound being transmitted may be compressed to save trans
`mission bandwidth.
`0007. In another aspect, a monitoring system for a person
`includes one or more wireless nodes; and a wristwatch
`having a wireless transceiver adapted to communicate with
`the one or more wireless nodes; and an accelerometer to
`detect a dangerous condition and to generate a warning
`when the dangerous condition is detected.
`0008. In another aspect, a monitoring system for a person
`includes one or more wireless nodes forming a wireless
`mesh network; and a wearable appliance having a wireless
`transceiver adapted to communicate with the one or more
`wireless nodes; and a heartbeat detector coupled to the
`wireless transceiver. The system may also include an accel
`erometer to detect a dangerous condition Such as a falling
`condition and to generate a warning when the dangerous
`condition is detected.
`0009 Implementations of the above aspect may include
`one or more of the following. The wristwatch determines
`position based on triangulation. The wristwatch determines
`position based on RF signal strength and RF signal angle. A
`Switch detects a confirmatory signal from the person. The
`confirmatory signal includes a head movement, a hand
`movement, or a mouth movement. The confirmatory signal
`includes the person's voice. A processor in the system
`executes computer readable code to transmit a help request
`to a remote computer. The code can encrypt or scramble data
`for privacy. The processor can execute voice over IP (VOIP)
`code to allow a user and a remote person to audibly
`communicate with each other. The Voice communication
`system can include Zigbee VOIP or Bluetooth VOIP or
`802.XXVOIP. The remote person can be a doctor, a nurse,
`a medical assistant, or a caregiver. The system includes code
`to store and analyze patient information. The patient infor
`mation includes medicine taking habits, eating and drinking
`habits, sleeping habits, or excise habits. A patient interface
`is provided on a user computer for accessing information
`and the patient interface includes in one implementation a
`touch screen; Voice-activated text reading; and one touch
`
`016
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`

`

`US 2007/0265533 A1
`
`Nov. 15, 2007
`
`telephone dialing. The processor can execute code to store
`and analyze information relating to the person’s ambulation.
`A global positioning system (GPS) receiver can be used to
`detect movement and where the person falls. The system can
`include code to map the person's location onto an area for
`viewing. The system can include one or more cameras
`positioned to capture three dimensional (3D) video of the
`patient; and a server coupled to the one or more cameras, the
`server executing code to detect a dangerous condition for the
`patient based on the 3D video and allow a remote third party
`to view images of the patient when the dangerous condition
`is detected.
`0010. In another aspect, a monitoring system for a person
`includes one or more wireless bases; and a cellular telephone
`having a wireless transceiver adapted to communicate with
`the one or more wireless bases; and an accelerometer to
`detect a dangerous condition and to generate a warning
`when the dangerous condition is detected.
`0011. In yet another aspect, a monitoring system includes
`one or more cameras to determine a three dimensional (3D)
`model of a person; means to detect a dangerous condition
`based on the 3D model; and means to generate a warning
`when the dangerous condition is detected.
`0012. In another aspect, a method to detect a dangerous
`condition for an infant includes placing a pad with one or
`more sensors in the infant’s diaper, collecting infant vital
`parameters; processing the vital parameter to detect SIDS
`onset; and generating a warning.
`0013 Advantages of the invention may include one or
`more of the following. The system for non-invasively and
`continually monitors a Subjects arterial blood pressure, with
`reduced susceptibility to noise and Subject movement, and
`relative insensitivity to placement of the apparatus on the
`subject. The system does not need frequent recalibration of
`the system while in use on the subject.
`0014. In particular, it allows patients to conduct a low
`cost, comprehensive, real-time monitoring of their blood
`pressure. Using the web services software interface, the
`invention then avails this information to hospitals, home
`health care organizations, insurance companies, pharmaceu
`tical agencies conducting clinical trials and other organiza
`tions. Information can be viewed using an Internet-based
`website, a personal computer, or simply by viewing a
`display on the monitor. Data measured several times each
`day provide a relatively comprehensive data set compared to
`that measured during medical appointments separated by
`several weeks or even months. This allows both the patient
`and medical professional to observe trends in the data, Such
`as a gradual increase or decrease in blood pressure, which
`may indicate a medical condition. The invention also mini
`mizes effects of white coat syndrome since the monitor
`automatically makes measurements with basically no dis
`comfort; measurements are made at the patient's home or
`work, rather than in a medical office.
`0.015 The wearable appliance is small, easily worn by the
`patient during periods of exercise or day-to-day activities,
`and non-invasively measures blood pressure can be done in
`a matter of seconds without affecting the patient. An on
`board or remote processor can analyze the time-dependent
`measurements to generate statistics on a patient’s blood
`pressure (e.g., average pressures, standard deviation, beat
`
`to-beat pressure variations) that are not available with con
`ventional devices that only measure systolic and diastolic
`blood pressure at isolated times.
`0016. The wearable appliance provides an in-depth, cost
`effective mechanism to evaluate a patient’s cardiac condi
`tion. Certain cardiac conditions can be controlled, and in
`some cases predicted, before they actually occur. Moreover,
`data from the patient can be collected and analyzed while the
`patient participates in their normal, day-to-day activities.
`0017. In cases where the device has fall detection in
`addition to blood pressure measurement, other advantages of
`the invention may include one or more of the following. The
`system provides timely assistance and enables elderly and
`disabled individuals to live relatively independent lives. The
`system monitors physical activity patterns, detects the
`occurrence of falls, and recognizes body motion patterns
`leading to falls. Continuous monitoring of patients is done in
`an accurate, convenient, unobtrusive, private and Socially
`acceptable manner since a computer monitors the images
`and human involvement is allowed only under pre-desig
`nated events. The patient’s privacy is preserved since human
`access to videos of the patient is restricted: the system only
`allows human viewing under emergency or other highly
`controlled conditions designated in advance by the user.
`When the patient is healthy, people cannot view the patients
`video without the patient’s consent. Only when the patients
`safety is threatened would the system provide patient infor
`mation to authorized medical providers to assist the patient.
`When an emergency occurs, images of the patient and
`related medical data can be compiled and sent to paramedics
`or hospital for proper preparation for pick up and check into
`emergency room.
`0018. The system allows certain designated people such
`as a family member, a friend, or a neighbor to informally
`check on the well-being of the patient. The system is also
`effective in containing the spiraling cost of healthcare and
`outpatient care as a treatment modality by providing remote
`diagnostic capability so that a remote healthcare provider
`(such as a doctor, nurse, therapist or caregiver) can visually
`communicate with the patient in performing remote diag
`nosis. The system allows skilled doctors, nurses, physical
`therapists, and other scarce resources to assist patients in a
`highly efficient manner since they can do the majority of
`their functions remotely.
`0019. Additionally, a sudden change of activity (or inac
`tivity) can indicate a problem. The remote healthcare pro
`vider may receive alerts over the Internet or urgent notifi
`cations over the phone in case of Such Sudden accident
`indicating changes. Reports of health/activity indicators and
`the overall well being of the individual can be compiled for
`the remote healthcare provider. Feedback reports can be sent
`to monitored subjects, their designated informal caregiver
`and their remote healthcare provider. Feedback to the indi
`vidual can encourage the individual to remain active. The
`content of the report may be tailored to the target recipients
`needs, and can present the information in a format under
`standable by an elder person unfamiliar with computers, via
`an appealing patient interface. The remote healthcare pro
`vider will have access to the health and well-being status of
`their patients without being intrusive, having to call or visit
`to get such information interrogatively. Additionally, remote
`healthcare provider can receive a report on the health of the
`
`017
`
`

`

`US 2007/0265533 A1
`
`Nov. 15, 2007
`
`monitored subjects that will help them evaluate these indi
`viduals better during the short routine check up visits. For
`example, the system can perform patient behavior analysis
`Such as eating/drinking/smoke habits and medication com
`pliance, among others.
`0020. The patient’s home equipment is simple to use and
`modular to allow for the accommodation of the monitoring
`device to the specific needs of each patient. Moreover, the
`system is simple to install. Regular monitoring of the basic
`wellness parameters provides significant benefits in helping
`to capture adverse events Sooner, reduce hospital admis
`sions, and improve the effectiveness of medications, hence,
`lowering patient care costs and improving the overall quality
`of care. Suitable users for Such systems are disease man
`agement companies, health insurance companies, self-in
`Sured employers, medical device manufacturers and phar
`maceutical firms.
`0021. The system reduces costs by automating data col
`lection and compliance monitoring, and hence reduce the
`cost of nurses for hospital and nursing home applications.
`At-home vital signs monitoring enables reduced hospital
`admissions and lower emergency room visits of chronic
`patients. Operators in the call centers or emergency response
`units get high quality information to identify patients that
`need urgent care so that they can be treated quickly, safely,
`and cost effectively. The Web based tools allow easy access
`to patient information for authorized parties such as family
`members, neighbors, physicians, nurses, pharmacists, car
`egivers, and other affiliated parties to improved the Quality
`of Care for the patient.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`0022 FIG. 1 illustrates an exemplary system for moni
`toring a person.
`0023 FIG. 2A illustrates a process for determining three
`dimensional (3D) detection.
`0024 FIG. 2B shows an exemplary calibration sheet.
`0.025
`FIG. 3 illustrates a process for detecting falls.
`0026 FIG. 4 illustrates a process for detecting facial
`expressions.
`0027 FIG. 5 illustrates an exemplary process for deter
`mining and getting assistance for a patient or user.
`0028 FIG. 6A shows an exemplary wrist-watch based
`assistance device.
`0029 FIG. 6B shows an exemplary mesh network work
`ing with the wearable appliance of FIG. 6A.
`0030 FIG. 7 shows an exemplary mesh network in
`communication with the wrist-watch device of FIG. 6.
`0031 FIGS. 8-14 show various exemplary wearable
`appliances to monitor a patient.
`0032 FIGS. 15A-15B show exemplary systems for per
`forming patient monitoring.
`0033 FIG. 15C shows an exemplary interface to monitor
`a plurality of persons.
`0034 FIG. 15D shows an exemplary dash-board that
`provides Summary information on the status of a plurality of
`persons.
`
`0035 FIG. 15E shows an exemplary multi-station vital
`parameter user interface for a professional embodiment.
`0036 FIG. 15F shows an exemplary trending pattern
`display.
`0037 FIGS. 16A-16B show exemplary blood pressure
`determination processes.
`
`DESCRIPTION
`0038 FIG. 1 shows an exemplary patient monitoring
`system. The system can operate in a home, a nursing home,
`or a hospital. In this system, one or more mesh network
`appliances 8 are provided to enable wireless communication
`in the home monitoring system. Appliances 8 in the mesh
`network can include home security monitoring devices, door
`alarm, window alarm, home temperature control devices,
`fire alarm devices, among others. Appliances 8 in the mesh
`network can be one of multiple portable physiological
`transducer, Such as a blood pressure monitor, heart rate
`monitor, weight scale, thermometer, spirometer, single or
`multiple lead electrocardiograph (ECG), a pulse oxymeter, a
`body fat monitor, a cholesterol monitor, a signal from a
`medicine cabinet, a signal from a drug container, a signal
`from a commonly used appliance Such as a refrigerator/
`stove? oven/washer, or a signal from an exercise machine,
`such as a heart rate. As will be discussed in more detail
`below, one appliance is a patient monitoring device that can
`be worn by the patient and includes a single or bi-directional
`wireless communication link, generally identified by the bolt
`symbol in FIG. 1, for transmitting data from the appliances
`8 to the local hub or receiving station or base station server
`20 by way of a wireless radio frequency (RF) link using a
`proprietary or non-proprietary protocol. For example, within
`a house, a user may have mesh network appliances that
`detect window and door contacts, Smoke detectors and
`motion sensors, video cameras, key chain control, tempera
`ture monitors, CO and other gas detectors, vibration sensors,
`and others. A user may have flood sensors and other detec
`tors on a boat. An individual. Such as an ill or elderly
`grandparent, may have access to a panic transmitter or other
`alarm transmitter. Other sensors and/or detectors may also
`be included. The user may register these appliances on a
`central security network by entering the identification code
`for each registered appliance/device and/or system. The
`mesh network can be Zigbee network or 802.15 network.
`More details of the mesh network is shown in FIG. 7 and
`discussed in more detail below.
`0039. A plurality of monitoring cameras 10 may be
`placed in various predetermined positions in a home of a
`patient 30. The cameras 10 can be wired or wireless. For
`example, the cameras can communicate over infrared links
`or over radio links conforming to the 802X (e.g. 802.11A,
`802.11B, 802.11G, 802.15) standard or the Bluetooth stan
`dard to a base station/server 20 may communicate over
`various communication links, such as a direct connection,
`Such a serial connection, USB connection, Firewire connec
`tion or may be optically based. Such as infrared or wireless
`based, for example, home RF, IEEE standard 802.11a/b,
`Bluetooth or the like. In one embodiment, appliances 8
`monitor the patient and activates the camera 10 to capture
`and transmit video to an authorized third party for providing
`assistance should the appliance 8 detects that the user needs
`assistance or that an emergency had occurred.
`
`018
`
`

`

`US 2007/0265533 A1
`
`Nov. 15, 2007
`
`0040. The base station/server 20 stores the patients
`ambulation pattern and vital parameters and can be accessed
`by the patient's family members (Sons/daughters), physi
`cians, caretakers, nurses, hospitals, and elderly community.
`The base station/server 20 may communicate with the
`remote server 200 by DSL, T-1 connection over a private
`communication network or a public information network,
`such as the Internet 100, among others.
`0041. The patient 30 may wear one or more wearable
`patient monitoring appliances such as wrist-watches or clip
`on devices or electronic jewelry to monitor the patient. One
`wearable appliance Such as a wrist-watch includes sensors
`40, for example devices for sensing ECG, EKG, blood
`pressure, Sugar level, among others. In one embodiment, the
`sensors 40 are mounted on the patient’s wrist (such as a
`wristwatch sensor) and other convenient anatomical loca
`tions. Exemplary sensors 40 include standard medical diag
`nostics for detecting the body's electrical signals emanating
`from muscles (EMG and EOG) and brain (EEG) and car
`diovascular system (ECG). Leg sensors can include piezo
`electric accelerometers designed to give qualitative assess
`ment of limb movement. Additionally, thoracic and
`abdominal bands used to measure expansion and contraction
`of the thorax and abdomen respectively. A Small sensor can
`be mounted on the subjects finger in order to detect blood
`oxygen levels and pulse rate. Additionally, a microphone can
`be attached to throat and used in sleep diagnostic recordings
`for detecting breathing and other noise. One or more posi
`tion sensors can be used for detecting orientation of body
`(lying on left side, right side or back) during sleep diagnostic
`recordings. Each of sensors 40 can individually transmit
`data to the server 20 using wired or wireless transmission.
`Alternatively, all sensors 40 can be fed through a common
`bus into a single transceiver for wired or wireless transmis
`Sion. The transmission can be done using a magnetic
`medium such as a floppy disk or a flash memory card, or can
`be done using infrared or radio network link, among others.
`The sensor 40 can also include an indoor positioning system
`or alternatively a global position system (GPS) receiver that
`relays the position and ambulatory patterns of the patient to
`the server 20 for mobility tracking.
`0042. In one embodiment, the sensors 40 for monitoring
`Vital signs are enclosed in a wrist-watch sized case Sup
`ported on a wrist band. The sensors can be attached to the
`back of the case. For example, in one embodiment, Cygnus
`AutoSensor (Redwood City, Calif.) is used as a glucose
`sensor. A low electric current pulls glucose through the skin.
`Glucose is accumulated in two gel collection discs in the
`AutoSensor. The AutoSensor measures the glucose and a
`reading is displayed by the watch.
`0043. In another embodiment, EKG/ECG contact points
`are positioned on the back of the wrist-watch case. In yet
`another embodiment that provides continuous, beat-to-beat
`wrist arterial pulse rate measurements, a pressure sensor is
`housed in a casing with a free-floating plunger as the
`sensor applanates the radial artery. A strap provides a
`constant force for effective applanation and ensuring the
`position of the sensor housing to remain constant after any
`wrist movements. The change in the electrical signals due to
`change in pressure is detected as a result of the piezoresistive
`nature of the sensor are then analyzed to arrive at various
`arterial pressure, systolic pressure, diastolic pressure, time
`indices, and other blood pressure parameters.
`
`0044) The case may be of a number of variations of shape
`but can be conveniently made a rectangular, approaching a
`box-like configuration. The wrist-band can be an expansion
`band or a wristwatch strap of plastic, leather or woven
`material. The wrist-band further contains an antenna for
`transmitting or receiving radio frequency signals. The wrist
`band and the antenna inside the band are mechanically
`coupled to the top and bottom sides of the wrist-watch
`housing. Further, the antenna is electrically coupled to a
`radio frequency transmitter and receiver for wireless com
`munications with another computer or another user.
`Although a wrist-band is disclosed, a number of substitutes
`may be used, including a belt, a ring holder, a brace, or a
`bracelet, among other Suitable Substitutes known to one
`skilled in the art. The housing contains the processor and
`associated peripherals to provide the human-machine inter
`face. A display is located on the front section of the housing.
`A speaker, a microphone, and a plurality of push-button
`Switches and are also located on the front section of housing.
`An infrared LED transmitter and an infrared LED receiver
`are positioned on the right side of housing to enable the
`watch to communicate with another computer using infrared
`transmission.
`0045. In another embodiment, the sensors 40 are
`mounted on the patient’s clothing. For example, sensors can
`be woven into a single-piece garment (an undershirt) on a
`weaving machine. A plastic optical fiber can be integrated
`into the structure during the fabric production process with
`out any discontinuities at the armhole or the seams. An
`interconnection technology transmits information from (and
`to) sensors mounted at any location on the body thus
`creating a flexible “bus' structure. T-Connectors—similar to
`“button clips' used in clothing are attached to the fibers
`that serve as a data bus to carry the information from the
`sensors (e.g., EKG sensors) on the body. The sensors will
`plug into these connectors and at the other end similar
`T-Connectors will be used to transmit the information to
`monitoring equipment or personal status monitor. Since
`shapes and sizes of humans will be different, sensors can be
`positioned on the right locations for all patients and without
`any constraints being imposed by the clothing. Moreover,
`the clothing can be laundered without any damage to the
`sensors themselves. In