Abstract:
A method of placing ECG electrodes in an environment where persons of limited training are available includes making a trial placement of the electrodes. Then, testing the electrodes and evaluating signals from the electrodes as a result of the testing. Verbal or visual feedback can be provided to the person placing the electrodes so that placed electrodes could be adjusted as needed.

Description:
FIELD 
       [0001]    The invention pertains to monitoring of physiological conditions of individuals. More particularly, the invention pertains to remote monitoring of such individuals. 
       BACKGROUND 
       [0002]    Various types of monitoring systems of physiological conditions of an individual are known. Some of these monitoring systems are intended to be used by individuals in their residences on an on-going daily basis to implement home based disease management programs. 
         [0003]    Representative monitoring systems are disclosed in “In-Residence Monitoring System Incorporating Voice Output” U.S. Ser. No. 11/226,550 filed Sep. 14, 2005; “Monitoring System for a Residence” U.S. Ser. No. 11/189,332 filed Jul. 26, 2005; and “Residential Monitoring System for Selected Parameters” U.S. Ser. No. 11/119,182 filed Apr. 29, 2005 all of which are assigned to the Assignee hereof and incorporated herein by reference. Such systems are often intended to be used in an environment where they communicate, usually intermittently, with a displaced monitoring facility staffed by trained health care professionals who are able to evaluate the results being received from a monitoring unit local to the resident or patient. 
         [0004]    An electrocardiogram (ECG) is recognized as a non-invasive relatively simply way to diagnose heart conditions. Twelve lead, or electrode, electrocardiograms are commonly used for diagnosis by trained medical personnel in clinical settings. In such settings, the person conducting the evaluation knows where to place the electrodes on the individual being evaluated. 
         [0005]    Electrocardiograms have also been recognized as valuable cardiac evaluation tools for remotely monitored patients. However, in these settings, the person who is having the test, or perhaps a caregiver of limited training will probably be the only ones available to place the electrodes. 
         [0006]    Currently in such settings, ECGs are limited to 2 electrodes, providing a single lead ECG, because anything beyond two electrodes becomes too difficult for most patients or their caregivers to apply. Unfortunately, the single lead ECG provides little clinical value beyond heart rate 
         [0007]    Color coded electrodes are known and used in monitoring patients. Methods for detecting potentially bad electrode placements are also known and in use. 
         [0008]    There is a continuing need to make it possible for residents or patients who may be living in their homes, with or without caregivers with limited training, who are being remotely monitored to more effectively make ECG electrode placements. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0009]      FIG. 1A  is a diagram illustrating aspects of an embodiment of the invention; 
           [0010]      FIG. 1  B is a diagram that illustrates additional aspects of the embodiment of  FIG. 1A ; and 
           [0011]      FIG. 2  is a flow diagram illustrating aspects of a method in accordance with the invention. 
       
    
    
     DETAILED DESCRIPTION 
       [0012]    While embodiments of this invention can take many different forms, specific embodiments thereof are shown in the drawings and will be described herein in detail with the understanding that the present disclosure is to be considered as an exemplification of the principles of the invention, as well as the best mode of practicing same, and is not intended to limit the invention to the specific embodiment illustrated. 
         [0013]    In embodiments of the invention, combining color coded ECG electrodes (more pronounced size and color) and electrode placement evaluation to detect improper electrode placement along with voice guidance provides a higher level of proper successful electrode placement and attachment by untrained patients. If an electrode appears to have been placed incorrectly, voice feedback, locally generated, or, from a remote monitoring site can be provided to instruct the patient as to which electrode is improperly placed and how to move it to a better location. 
         [0014]    In one aspect of the invention, the patient is instructed as to correct electrode placement. After placing electrodes the patient requests a test of the electrode placement. During the test the signal from the electrodes is analyzed in real time to look for likely problems. Common issues (poor contact, reversed electrodes, etc.) are detected by the processing and additional voice feedback can be used to instruct the patient on what correct action to take. After the patient attempts to correct the problem the electrode placement is retested prior to making a diagnostic evaluation. 
         [0015]      FIGS. 1A , B illustrate details of an apparatus  10  which embodies the present invention. Apparatus  10  includes a monitoring unit  12  which might be situated proximate to a resident or patient P, for example in the resident&#39;s house, living room bedroom or the like. Unit  12  can receive inputs from a plurality of color coded ECG electrodes  14 , each of which is intended to be place on, coupled to the resident at a predetermined location indicated in  FIG. 1A  as, R, L, N, and F. Placement is important in obtaining a diagnostically useful set of signals at unit  12 . 
         [0016]    In accordance with the invention, individual P can place the electrodes on himself, or herself as best as possible. The ECG test can then be started at unit  12 . Current from electrodes  14  detected by the unit  12  can be processed, locally, or at a remote monitoring facility M to evaluate placement of the electrodes  14 . For example, if the R and L electrodes are switched, absence of expected types of signals, such as Q or R amplitude from the appropriate electrode, can be detected. Unit  12  can then automatically generate a verbal output to the individual P that the two electrodes need to be switched. 
         [0017]    Individual P, after switching the electrodes and placing them into as appropriate locations as possible, can rerun the test. If appropriate signals are detected at unit  12 , these can then be analyzed locally, or digital representations thereof can be transmitted to remote monitoring facility M for analysis. 
         [0018]    Those of skill will understand that numerous other types of electrode placement errors can be sensed at unit  12 , or at facility M, and automatic verbal outputs can then be generated at unit  12  to advise person P as to how the placement should be adjusted to correct the detected problem. 
         [0019]    In accordance with the above, unit  12  can be carried in a housing  20 , see  FIG. 1B . Unit  12  can include control circuitry  20 , which could be implemented at least in part with a programmable processor  20   a , and associated control software  20   b . The software  20   b  can be stored in executable form in read-only memory, programmable read-only memory or any other desired medium at circuits  20 . 
         [0020]    Software  20   b  could carry out local signal analysis to evaluate incoming signals from electrodes  14 , as well as generate and control verbal, and, or visual outputs via local output units such as speaker  24   a  and display unit  24   b.    
         [0021]    The control software  20   b  could carry out other monitoring related functions as would be understood by those of skill in the art. For example, software  20   b  can present of visual display  24   b  a graphical, educational, display as to how the electrodes should be placed, and, how they should be rearranged to address a problem, or problems detected by the analysis software  20   b.    
         [0022]    Signals from ECG electrodes  14 , and other types of physiological sensors  26  such as blood pressure, temperature sensors and the like, all without limitation, can be coupled to control circuitry  20  via interface circuits  20   c . Control circuits  20  can also communicate bi-directionally via an interface  20   d , wired or wirelessly with remote monitoring facility M. 
         [0023]      FIG. 2  illustrates a method  100  which embodies the invention. Initially, the individual P places the electrodes on himself, or herself, or on a person that is being tested, as at  102 . The unit  12  is activated to perform an ECG as at  104 . 
         [0024]    The unit  12  evaluates signals received from electrodes  14 , or transfers representations of those signals to facility M for analysis, as at  106 . A determination is made, as at  108 , as to validity of the received signals. If the signals are acceptable, results can be presented locally, both verbally, or audibly, and visually via speaker  24   a  and graphical display device  24   b , as at  110 . Alternately, or additionally, such results can be transmitted to facility M and reviewed or stored in the chart of individual P. 
         [0025]    Where analysis of signals from the electrodes  14  reveals a problem with electrode placement, unit  12  can provide verbal, or visual correctional feedback, as at  112 , via speaker  24   a  and display device  24   b , to the person P or to that person&#39;s care giver as to how the placement of the electrodes could be adjusted to provide better results, as at  114 . If the analysis indicates that there is an uncorrectable problem, verbal or visual feedback can be provided to the user, as at  116 , that service needs to be called. 
         [0026]    From the foregoing, it will be observed that numerous variations and modifications may be effected without departing from the spirit and scope of the invention. It is to be understood that no limitation with respect to the specific apparatus illustrated herein is intended or should be inferred. It is, of course, intended to cover by the appended claims all such modifications as fall within the scope of the claims.