Measurement of cardiac output by electrical impedance plethysmography

There are many potential applications for cardiac output measurement in clinical and experimental medicine. The most commonly used techniques are invasive procedures, requiring cardiac or arterial catheterization, a disadvantage that has restricted their wider application. Impedance plethysmography has been developed as a non-invasive, beat-by-beat method of cardiac output measurement, which provides an estimate of stroke volume from changes in the electrical impedance of the thorax during cardiac systole. The values for cardiac output obtained by this technique have been extensively compared with values obtained by other methods, both in experimental animals and in the human subject. In the majority of studies high correlation coefficients have been obtained, although impedance plethysmography has tended to give higher absolute values than most other methods. Values for cardiac output obtained by impedance plethysmography are best assessed by comparison with a series of normal values obtained by this technique, rather than with values obtained by other methods. We discuss the results of an investigation of normal cardiac output by impedance plethysmography; theoretical objections to impedance cardiography are considered, and various methods of determining the specific resistivity of blood are reviewed.     

Impedance characteristics of a neuromusculoskeletal model of the human arm I. Posture control

The mechanical impedance of neuromusculoskeletal models of the human arm is studied in this paper. The model analysis provides a better understanding of the contributions of possible intrinsic and reflexive components of arm impedance, makes clear the limitations of second-order mass-viscosity-stiffness models and reveals possible task effects on the impedance. The musculoskeletal model describes planar movements of the upper arm and forearm, which are moved by six lumped muscles with nonlinear dynamics. The motor control system is represented by a neural network which combines feedforward and feedback control. It is optimized for the control of movements or for posture control in the presence of external forces. The achieved impedance characteristics depend on the conditions during the learning process. In particular, the impedance is adapted in a suitable way to the frequency content and direction of external forces acting on the hand during an isometric task. The impedance characteristics of a model, which is optimized for movement control, are similar to experimental data in the literature. The achieved stiffness is, to a large extent, reflexively determined whereas the approximated viscosity is primarily due to intrinsic attributes. It is argued that usually applied Hill-type muscle models do not properly represent intrinsic muscle stiffness. Received: 14 October 1997 / Accepted in revised form: 18 May 1999     

Validity of estimating limb muscle volume by bioelectrical impedance.

The present study aimed to investigate the validity of estimating muscle volume by bioelectrical impedance analysis. Bioelectrical impedance and series cross-sectional images of the forearm, upper arm, lower leg, and thigh on the right side were determined in 22 healthy young adult men using a specially designed bioelectrical impedance acquisition system and magnetic resonance imaging (MRI) method, respectively. The impedance index (L(2)/Z) for every segment, calculated as the ratio of segment length squared to the impedance, was significantly correlated to the muscle volume measured by MRI, with r = 0.902-0.976 (P < 0.05). In these relationships, the SE of estimation was 38.4 cm(3) for the forearm, 40.9 cm(3) for the upper arm, 107.2 cm(3) for the lower leg, and 362.3 cm(3) for the thigh. Moreover, isometric torque developed in elbow flexion or extension and knee flexion or extension was significantly correlated to the L(2)/Z values of the upper arm and thigh, respectively, with correlation coefficients of 0.770-0.937 (P < 0.05), which differed insignificantly from those (0.799-0.958; P < 0.05) in the corresponding relationships with the muscle volume measured by MRI of elbow flexors or extensors and knee flexors or extensors. Thus the present study indicates that bioelectrical impedance analysis may be useful to predict the muscle volume and to investigate possible relations between muscle size and strength capability in a limited segment of the upper and lower limbs.     

Measurement of pulsatile limb and finger blood flow by electrical impedance plethysmography: Criteria for the diagnosis of abnormal flow

The range of pulsatile arm and finger blood flow, measured by electrical impedance plethysmography, has been investigated in a hospital ward. The range of absolute blood flows, in ml min⁻¹, was found to be too wide to be used as a standard for identifying single blood flow readings as being abnormal. A blood flow ratio was calculated by dividing the blood flow in the right forearm or middle finger by the blood flow in the left forearm or middle finger. This ratio was found to have a clearly defined range. A blood flow in a unilaterally injured or otherwise abnormal arm or finger was considered to be significantly altered if the blood flow ratio fell outside the previously defined normal range. The diagnosis of significantly altered arm and finger blood flow from abnormalities in the blood flow ratio was tested in a series of experiments, in which artificial changes in upper limb flow were created by high elevation of the right hand. The ratio was measured in 11 patients with unilateral upper limb injuries and in 3 patients who required an urgent assessment of the upper limb circulation. Abnormalities in the ratio were identified in 12 out of 18 subjects after high elevation of the hand and in 8 out of the 14 patients.     

A model of force and impedance in human arm movements

This paper describes a simple computational model of joint torque and impedance in human arm movements that can be used to simulate three-dimensional movements of the (redundant) arm or leg and to design the control of robots and human-machine interfaces. This model, based on recent physiological findings, assumes that (1) the central nervous system learns the force and impedance to perform a task successfully in a given stable or unstable dynamic environment and (2) stiffness is linearly related to the magnitude of the joint torque and increased to compensate for environment instability. Comparison with existing data shows that this simple model is able to predict impedance geometry well.     

Quantitative technique for bio-electrical spectroscopy

Bio-electrical impedance measurements have been widely used for the study of body tissues. Apart from recordings of biophysical signals (respiration, perfusion, cardiac output, red cell settling, etc.) measurements of specific resistivity of a tissue provide information about its pathological state. Mapping electrical parameters will give more detailed information. The interpretation of recorded data and the design of equipment, both require a preliminary knowledge of the values encountered under normal and pathological conditions. The purpose of the technique described here is to determine the complex resistivity of breast tissue samples in vitro at frequencies between 0.5 kHz and 1 MHz. The equipment is described and the calibration procedure explained. A calculation of the final error interval is given. Characteristic spectra of modulus and phase angle recorded in normal and pathological breast tissue are shown. The technique can however be used for other body tissues, typical applications being fundamental tissue studies and a determination of the most suitable frequencies for use with impedance measuring devices. In clinical practice it could contribute to the determination of intra-and extracellular volume, the monitoring of transplanted organs and the examination of surgically treated tumours, and to any technique based on tissue characterization.     

Estimation of body composition from bioelectrical impedance of body segments

This study provides values of anthropometric measurements and specific impedance, for a sample of 104 adults. The hypothesis that the body composition can be estimated more accurately from measurements of lengths and impedance values of the body segments than from the whole body was tested. The impedance of upper and lower extremities (arm and leg) and trunk were used to compute estimates of body composition parameters (FFM, FM, %F, TBW, ECW). The results were compared with those estimated by the impedance of the whole body. These comparisons demonstrated that significative differences resulted from body composition obtained by segmental impedance and by the whole body.     

Contribution of large airway to the input impedance of the respiratory system

To evaluate the contribution of the large airway to total respiratory impedance, we develop a one-dimensional model of pressure and flow in these airways by coupling conservation of mass and momentum equations with the geometric information obtained by the acoustic reflection technique. We use this model to calculate the impedance of the respiratory system distal to the carina from impedance data estimated at the airway opening by the forced oscillation technique. Simulations show that the real part of the impedance distal to the carina is uniformly decreased from the impedance at the airway opening, indicating a resistive loss, while the imaginary part is increased as a function of frequency. We estimate parameter values for a six-parameter two-compartment lung model and for a three-parameter reduction of this model before and after the application of the upper airway data to the impedance spectrum. Although compliance terms seem to be minimally affected by the manipulation of the data, resistance and inertance terms are influenced in a fashion that suggests that the resistive contribution of the upper airway to total respiratory impedance is significant. Furthermore it appears that the elastic nature of the walls of the upper airway also impact on estimates of total respiratory impedance at the airway opening.     

Normal Values for Segmental Bioimpedance Spectroscopy in Pediatric Patients

Introduction

Localized limb edema is a clinically relevant sign in diseases such as post-thrombotic syndrome and lymphedema. Quantitative evaluation of localized edema in children is mainly done by measuring the absolute difference in limb circumference, which includes fat and fat-free mass. Bioimpedance spectroscopy (BIS) provides information on the fluid volume of a body segment. Our objective was to determine normal ranges for segmental (arm and leg) BIS measurements in healthy children. Additionally, we determined the normal ranges for the difference in arm and ankle circumference and explored the influence of handedness and the correlation between techniques.

Methods

Healthy children aged 1-18 years were recruited. The ratio of extracellular fluid content between contralateral limbs (estimated as the inter-arm and inter-leg extracellular impedance ratio), and the ratio of extracellular to intracellular fluid content for each limb (estimated as the intracellular to extracellular impedance ratio) were determined with a bioimpedance spectrometer. Arm and ankle circumference was determined with a Gulick II tape.

Results

We recruited 223 healthy children (48 infants, 54 preschoolers, 66 school-aged children, and 55 teenagers). Normal values for arm and leg BIS measurements, and for the difference in arm and ankle circumference were estimated for each age category. No influence of handedness was found. We found a statistically significant correlation between extracellular impedance ratio and circumference difference for arms among teenagers.

Conclusion

We determined normal BIS ranges for arms and legs and for the difference in circumference between arms and between ankles in children. There was no statistically significant correlation between extracellular impedance ratio and difference in circumference, except in the case of arms in adolescents. This may indicate that limb circumference measures quantities other than fluid, challenging the adequacy of this technique to determine the presence of localized edema in most age groups.     

Some early results related to electrical impedance of normal and abnormal gastric tissue

Gastric cancer is the fourth most common cancer and most patients with gastric cancer are being diagnosed in advanced stages of the disease so they do not gain any survival chance from conventional surgical, chemotherapeutic or radiotherapeutic methods. These are relatively high cost procedures in terms of both time and money. This study considers the introduction of a novel minimally invasive diagnostic technique which shows the relationship between histopathology and the electrical impedance spectrum in the human stomach. In this study, 4 electrode technique was used to differentiate tissues from each other using Tabriz Mark 1 electrical impedance system (30 different frequencies in the range of 2 kHz to 1 MHz). A total of 97 points from 45 patients were studied in terms of their biopsy reports matching to the electrical impedance measurements (in vivo). After impedance measurements and applying calibration factors, a non-parametric statistical technique, the Kruskal–Wallis test was used to evaluate the difference among the groups. According to the calculation of respective data using this spectroscopy system, the resistivity of the normal group was higher than that of the benign group, and the resistivity of these groups were higher than that of the malignant group at frequencies between 470 kHz and 1 MHz (P < 0.05). In these frequencies, the impedivity of the dysplastic tissue was significantly lower than that of the other groups (P < 0.05). Also, Cole equation fitting procedure was used to generate a scatter plot of the malignant and benign points: it shows in general, benign points had higher values of R than the malignant points. Therefore, electrical impedance spectroscopy can be a useful technique to characterize the stomach tissue.     

Kinematics of human arm reconstructed from spatial tracking system recordings

The kinematics of the human arm in terms of angles of rotations in the joints is reconstructed from the spatial tracking system (Fastrack() Polhemus) recordings. The human arm is modeled by three rigid bodies (the upper arm, the forearm and the hand) with seven degrees of freedom (three in the shoulder, two in the elbow and two in the wrist). Joint geometry parameters (orientations of the axes relative to the arm segments, the angles and the distances between the axes) have been calculated on the basis of passive rotations in the joints. The calculated parameters have been used to solve the direct kinematics problem for the reaching movements in different directions. The difference between calculated and recorded positions and accelerations of the hand has been used to assess the accuracy of the proposed method of kinematics reconstruction. The error analysis showed that spatial tracking system recordings and human arm kinematics reconstruction could reliably be used to accurately analyze multijoint movement in humans.     

Limb Dominance Results from Asymmetries in Predictive and Impedance Control Mechanisms

Handedness is a pronounced feature of human motor behavior, yet the underlying neural mechanisms remain unclear. We hypothesize that motor lateralization results from asymmetries in predictive control of task dynamics and in control of limb impedance. To test this hypothesis, we present an experiment with two different force field environments, a field with a predictable magnitude that varies with the square of velocity, and a field with a less predictable magnitude that varies linearly with velocity. These fields were designed to be compatible with controllers that are specialized in predicting limb and task dynamics, and modulating position and velocity dependent impedance, respectively. Because the velocity square field does not change the form of the equations of motion for the reaching arm, we reasoned that a forward dynamic-type controller should perform well in this field, while control of linear damping and stiffness terms should be less effective. In contrast, the unpredictable linear field should be most compatible with impedance control, but incompatible with predictive dynamics control. We measured steady state final position accuracy and 3 trajectory features during exposure to these fields: Mean squared jerk, Straightness, and Movement time. Our results confirmed that each arm made straighter, smoother, and quicker movements in its compatible field. Both arms showed similar final position accuracies, which were achieved using more extensive corrective sub-movements when either arm performed in its incompatible field. Finally, each arm showed limited adaptation to its incompatible field. Analysis of the dependence of trajectory errors on field magnitude suggested that dominant arm adaptation occurred by prediction of the mean field, thus exploiting predictive mechanisms for adaptation to the unpredictable field. Overall, our results support the hypothesis that motor lateralization reflects asymmetries in specific motor control mechanisms associated with predictive control of limb and task dynamics, and modulation of limb impedance.     

Analysis of mechanical impedance in human arm movements using a virtual tennis system

The dynamic characteristics of human upper extremities are usually expressed by mechanical impedance. Although many studies have discussed human impedance characteristics, there are no reports on control abilities of task-related impedance in skilled human hand movements. This paper proposes a virtual sports system using a virtual reality technique to examine human movements. The differences in movements between skilled and unskilled subjects are investigated through a series of experiments. Then, the human impedance of a skilled player is estimated and analyzed in the preliminary phase of motion.     

Acquisition of the lateral inconsistency in involuntary behaviour of upper limbs in 12-year-old children during walking at moderate speed.

The aim of this work was to investigate possible lateralisation in the behaviour of periodic motion of the human upper limb, during normal walking at a comfortable speed of locomotion. Ten healthy pre-adolescent, strongly right-handed, 12-year-old males participated in the experiment. Participants were walking on a treadmill with a standardised velocity of 1.1m/s (comfortable speed for all of them). A video analysis system with Silicon software was used to synchronically measure various angles of arms and forearms. The initial, final and interim angular positions of both arms and forearms in 10 cycles of each participant were compared in terms of variations (cycle to cycle) between both upper extremities at corresponding phases of each cycle for distal and proximal segments, respectively. We compared the coefficients of variation in relation to the spatial and temporal data of both limbs and their angular velocities. In addition we investigated the level of cycle-to-cycle regularity (constancy) of behaviour in relation to various positions, periods and velocities of movement of upper extremities (specifically arms and forearms) using the Eta non-linear method of correlation. All participants exhibited a lower level of regularity for the distal segments. The spatial and temporal variations in the dominant limb were also greater than the non-dominant limb for all participants. This may be due to a larger contribution from the right-sided muscles that are considered to be the main contributing factor to the motion of the dominant upper limb during walking, rather than simply gravity force acting alone. A possible practical application of this information may be useful in the objective clinical identification of the level of dominance of the upper extremity (arm plus forearm), in addition to 'traditional' handedness.     

Identification of dynein heavy chain 7 as an inner arm component of human cilia that is synthesized but not assembled in a case of primary ciliary dyskinesia

Although the basic structure of the axoneme has been highly conserved throughout evolution, the varied functions of specialized axonemes require differences in structure and regulation. Cilia lining the respiratory tract propel mucus along airway surfaces, providing a critical function to the defense mechanisms of the pulmonary system, yet little is known of their molecular structure. We have identified and cloned a dynein heavy chain that is a component of the inner dynein arm. Bronchial epithelial cells were obtained from normal donors and from a patient with primary ciliary dyskinesia (PCD) whose cilia demonstrated an absence of inner dynein arms by electron microscopy. Cilia from normal and PCD cells were compared by gel electrophoresis, and mass spectrometry was used to identify DNAH7 as a protein absent in PCD cilia. The full-length DNAH7 cDNA was cloned and shares 68% similarity with an inner arm dynein heavy chain from Drosophila. DNAH7 was induced during ciliated cell differentiation, and immunohistochemistry demonstrated the presence of DNAH7 in normal cilia. In cilia from PCD cells, DNAH7 was undetectable, whereas intracellular DNAH7 was clearly present. These studies identify DNAH7 as an inner arm component of human cilia that is synthesized but not assembled in a case of PCD.     

How close to a pendulum is human upper limb movement during walking?

The aim of this work was to investigate how close to pendulum-like behaviour the periodic motion of the human upper limb (or upper extremity) is, during normal walking at a comfortable speed of locomotion. Twenty-five healthy young persons (males and females) participated in the experiment. Biomechanical testing was undertaken (mass and centre of mass of each segment of the total upper extremity). Participants were walking on a treadmill with a standardised velocity of 1.1 ms(-1) (comfortable speed for all of them). A video analysis system with Silicon software was used to measure the different angles of the arm and forearm. The theoretical period of motion and maximal angular velocity were computed for the centre of mass of the total upper limb from the measured phases of the arm swing and associated positional potential energies. Actual measured periods of motion, in comparison, represented a level of similarity to a lightly damped simple pendulum. Using this assumption, the "damping factor" was calculated from the ratio between theoretical and measured values. A vast majority of people exhibited an actual angular velocity exceeding the expected theoretical angular velocity calculated for a virtual pendulum of similar mass and length characteristics. This may be due to muscle forces that are contributing to the motion of the upper limb during walking rather than simple gravity force acting alone. The observed positional potential energy of the dominant limb was greater than that of the non-dominant limb for the vast majority of participants.     

Neural network classification of myoelectric signal for prosthesis control

An alternate approach to deriving control for multidegree of freedom prosthetic arms is considered. By analyzing a single-channel myoelectric signal (MES), we can extract information that can be used to identify different contraction patterns in the upper arm. These contraction patterns are generated by subjects without previous training and are naturally associated with specific functions. Using a set of normalized MES spectral features, we can identify contraction patterns for four arm functions, specifically extension and flexion of the elbow and pronation and supination of the forearm. Performing identification independent of signal power is advantageous because this can then be used as a means for deriving proportional rate control for a prosthesis. An artificial neural network implementation is applied in the classification task. By using three single-layer perceptron networks, the MES is classified, with the spectral representations as input features. Trials performed on five subjects with normal limbs resulted in an average classification performance level of 85% for the four functions.     

Energy analysis of wrist impact and surface rebound

The mechanical interactions during impact of a falling human body onto a non-rigid surface are complex. Mechanical properties of both the impacting body and the impacted surface contribute to risk of injury. Increased understanding of these properties should provide insight into the process and how to reduce injury risk. We assessed whether modelling energy flows in the body during impact can provide useful information. As input, we used data from gymnastic tumbling mats and from children performing an exercise involving freefall onto an outstretched arm. Even basic energy transfer principles provided information not discerned by the mechanical approach traditionally used. The model identified differences between surfaces in how energy flowed through an arm and the strains imposed on the wrist during impact and rebound. Therefore, it shows promise for identifying potentially injurious human–surface interactions. Analysis of other human impact situations, and the relationship between the energy flow and injury risk, is planned.     

Influence of Vibration on Motor Responses in the Upper Arm Muscles under Stationary Conditions and during Voluntary and Evoked Arm Movements under Limb Unloading Conditions

Locomotion of mammals, including humans, is based on the rhythmic activity of spinal cord circuitries. The functioning of these circuitries depends on multimodal afferent information and on supraspinal influences from the motor cortex. Using the method of transcranial magnetic stimulation (TMS) of arm muscle areas in the motor cortex, we studied the motor evoked potentials (MEP) in the upper arm muscles in stationary conditions and during voluntary and vibration-evoked arm movements. The study included 13 healthy subjects under arm and leg unloading conditions. In the first series of experiments, with motionless limbs, the effect of vibration of left upper arm muscles on motor responses in these muscles was evaluated. In the second series of experiments, MEP were compared in the same muscles during voluntary and rhythmic movements generated by left arm m. triceps brachii vibration (the right arm was stationary). Motionless left arm vibration led to an increase in MEP values in both vibrated muscle and in most of the non-vibrated muscles. For most target muscles, MEP was greater with voluntary arm movements than with vibration-evoked movements. At the same time, a similar MEP modulation in the cycle of arm movements was observed in the same upper arm muscles during both types of arm movements. TMS of the motor cortex significantly potentiated arm movements generated by vibration, but its effect on voluntary movements was weaker. These results indicate significant differences in the degree of motor cortex involvement in voluntary and evoked arm movements. We suppose that evoked arm movements are largely due to spinal rather than central mechanisms of generation of rhythmic movements.     

Segmental body composition assessed by bioelectrical impedance analysis and DEXA in humans

Bracco, David, Daniel Thiébaud, René L. Chioléro, Michel Landry, Peter Burckhardt, and Yves Schutz.Segmental body composition assessed by bioelectrical impedanceanalysis and DEXA in humans. J. Appl.Physiol. 81(6): 2580-2587, 1996.The present study assessed the relative contribution of each body segment to wholebody fat-free mass (FFM) and impedance and explored the use ofsegmental bioelectrical impedance analysis to estimate segmental tissuecomposition. Multiple frequencies of whole body and segmentalimpedances were measured in 51 normal and overweight women. Segmental tissue composition was independentlyassessed by dual-energy X-ray absorptiometry. The sum ofthe segmental impedance values corresponded to the whole body value(100.5 ± 1.9% at 50 kHz). The arms and legs contributed to 47.6 and 43.0%, respectively, of whole body impedance at 50 kHz, whereas they represented only 10.6 and 34.8% of total FFM, asdetermined by dual-energy X-ray absorptiometry. The trunk averaged10.0% of total impedance but represented 48.2% of FFM. For eachsegment, there was an excellent correlation between the specificimpedance index(length²/impedance) and FFM(r = 0.55, 0.62, and 0.64 for arm,trunk, and leg, respectively). The specific resistivity was in asimilar range for the limbs (159 ± 23 cm for the arm and 193 ± 39 cm for the leg at 50 kHz) but was higher for the trunk (457 ± 71 cm). This study shows the potential interest of segmental bodycomposition by bioelectrical impedance analysis and provides specificsegmental body composition equations for use in normal and overweightwomen.