# An IoMT-Based Approach for Real-Time Monitoring Using Wearable Neuro-Sensors

Authors: Mohammed Wasim Bhatt; Sparsh Sharma
Journal: Journal of Healthcare Engineering
 (2023)

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## Abstract

The Internet of Things (IoT) has demonstrated over the past few decades to be a powerful tool for connecting various medical equipment with in-built sensors and healthcare professionals to deliver superior health services that also reach remote areas. In addition to reducing healthcare costs, increasing access to clinical services, and enhancing operational effectiveness in the healthcare industry, it has also enhanced patient health safety. Recent research has focused on using EEG to assist and comprehend brain changes in rehabilitation facilities. These technologies can spot fluctuations in EEG constraints during treatment, which could result in more effective therapy and better functional outcomes. As a result, we have tried to use an IoT-based system for real-time monitoring of the constraints. Another unknown patient who is suffering from acute ischemic stroke may experience stroke-in-evolution or an early worsening of neurological symptoms, which is frequently associated with poor clinical outcomes. Because of this, managing an acute stroke requires early detection of these indications. The present investigation work will act as a standard reference for academic researchers, medical professionals, and everyone else involved in the use of IoMT. This study aims to anticipate strokes sooner and prevent their consequences by early intervention using an Internet of Things (IoT)-based system. Also, this study proposes usage of wearable equipment that can monitor and analyze brain signals for improved treatment and the prevention of stroke-related complications.


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## Body

## 1. Introduction

As crucial as ongoing technical innovations are for improving healthcare and lowering costs, they also provide a hurdle for integrating new technologies into clinical treatment [1–3]. In order to address the drawbacks of conventional healthcare and satisfy the growing demand for high-quality healthcare, a significant amount of research is presently concentrated on intelligent healthcare. Traditional healthcare, wearable technology, biosensors, and intelligent quick action services are all entities that can be included in the notion of smart healthcare. For the majority of the people, medicinal plants are frequently the only readily available alternative to conventional medicines, which continue to be an essential part of our comprehensive health system. Indigenous people have demonstrated historical continuity in material use and have a thorough understanding of the intricate biological system that surrounds their environment. Because of their ability to deliver continuously, today’s research information in a variety of healthcare-related applications through dynamic, noninvasive measurements of chemical markers in biofluids, wearable biosensors are generating a lot of interest. Early research in this field concentrated on using physical sensors to track movement and vital signs. Experts are now focusing on overcoming significant obstacles in healthcare applications, moving away from monitoring the physical activity through wearable devices. IoMT, a group of healthcare apps and equipment that links to medical information technological systems through the network, serves as the foundation of innovative healthcare [4, 5]. One example of intelligent healthcare is the automatic identification of epileptic episodes.Recurrent spontaneous seizures characterize a neurological condition known as epilepsy. A seizure is an abrupt disruption of brain activity that lasts for just a short time and may be accompanied by convulsions and loss of consciousness [6]. The quality of life for people with epilepsy suffers significantly as a result. Sudden unexplained death (SUDEP) is more common among people with epilepsy than in the general population [7, 8], which minimizes the severity of this disease. Seizures can be controlled using antiepileptic medicines (AEDs), although 30% of epilepsy patients are resistant to AEDs [9–11]. Only a very tiny percentage of individuals with refractory epilepsy benefit from surgery. Implantable technology in the brain has great potential for seizure management. Predicting and detecting seizures is crucial because early identification and warning can lead to prompt treatment [12–14].Technology for mass consumer electronic (CE) goods is presented in this article as a type of neurosensory wearables for intelligent biomedical systems. A medical-grade wristwatch for an illness related to neurological disorder warns caretakers when a patient is experiencing an epileptic seizure is one example of a wearable CE device [15, 16]. A predicted 57 billion USD would be spent on the Internet of Medical Things (IoMT)-driven smart healthcare sector [17]. The CE research that has already been carried out is effectively advanced by this article. It should be mentioned that this article presents the CE record of the technique and sample with validation, using accessible healthcare information and working with medical schools. Understanding the brain function and dysfunction requires knowledge of the brain’s many physiological states, which the EEG contains in abundance. Visual inspection can identify seizures, but it takes a lot of time and effort [18]. The two stages of interictal (between seizures) and ictal (seizure) are the main areas of attention in epilepsy. The accuracy of classification can be significantly influenced by the specific information captured by extracted features [19, 20]. This information is vital for differentiating EEG dynamics. Feature extraction is therefore essential for categorization. The following are a few instances: Chesti Altaf Hussain’s intelligent IoT and the Android healthcare monitoring solution. The abovementioned projects are the IoT-based systems [21] that monitor people’s heart rates, body temperatures, and heart attacks [22] with the aim to monitor and improve the protective quality provided to population in backward areas and provide information for good health maintenance choices in severely adverse conditions.In this study, we intend to contribute significantly in the field of neuroscience research.The architecture and fundamental components of the Internet of Things system are depicted in Figure1. The topologies of the remote health monitoring system in the medical industry consist of three layers: the layer for the gathering of vitals data, the layer for transmission, and the layer for analysis. The collection layer is constructed out of body area network (BAN) sensors. The data collected by sensors are transmitted to a gateway node by the BAN. The data are saved by the transmission layer, and threshold levels are used to analyze it and report any irregularities. There is also the possibility of the data being processed and stored in the cloud. An intelligent system is one that can detect irregularities and predict a patient’s health using techniques such as machine learning and data mining. In the final step, the data analysis is uploaded to a server located in the cloud. A web-based interface allows medical practitioners to check diagnostics and take the right action depending on their findings. The software sector is currently evolving toward artificial intelligence. Every industry now relies on machine learning to give machines intelligence. Machine learning, to put it simply, is a group of algorithms that analyze data, gain knowledge from it, and then use what they have learned to make wise decisions. Traditional machine learning algorithms have the drawback of remaining machine-like despite their apparent complexity. They are only able to perform what they are created for; nothing more, nothing less; they require a lot of domain expertise and human intervention.Figure 1
IoT architecture [23].Figure2 depicts the system that enables communication across systems, applications, and devices that are all connected to the same network. With the help of this system, patients and their doctors will have an easier time keeping track of and recording extremely important medical information pertaining to patients. A variety of various goods now include a variety of different types of gadgets, such as those for tracking positive metrics, wearable health bands, exercise shoes, watches that are based on RFID technology, and high-end video cameras. Applications that are created specifically for mobile devices, such as smartphones, make it much simpler to keep a case history, complete with access to emergency services and regular warnings. The enormous quantities of data that are produced by these interconnected Internet of Things devices have to be successfully managed by the service providers, which may prove to be an incredibly challenging task. The process of storing and assessing significant volumes of data that is referred to as Internet of Things analytics (particle) is implemented. This is carried out so that the problem can be solved. The unprocessed data are converted into information that is not only helpful but also restoratively significant through the application of methods such as information extraction and information analytics. The following are the prime contributions of the article: (i)
The purpose, restrictions, and potential future application of research are highlighted in this article’s overview of earlier studies that have used IoT in healthcare.(ii)
This research also suggests strategies to monitor patients in real-time settings.(iii)
This research focuses on using IOMT to make it easier to continuously monitor potential patients’ health.(iv)
By offering insights into or solutions to several investigations, the research offers an investigative strategy.(v)
Current investigative article outlines a number of obstacles faced by IoMT.(vi)
The present investigation work will act as a standard reference for academic researchers, medical professionals, and everyone else involved in the use of IoMT.(vii)
To anticipate strokes sooner and prevent their consequences by early intervention, we have tried to establish real-time monitoring of a few metrics using an Internet of Things (IoT)-based system.(viii)
The current study aims to propose wearable equipment that can monitor and analyze brain signals for improved treatment and the prevention of stroke-related complications.Figure 2
IoT building blocks [24].The rest of this article is structured as follows: Most recent seizure detection research is described in Section2 and the proposed research methodology used to select articles is summarized in Section 3. An architectural review of the suggested proposal is provided in Section 4. The discussion of article is covered in Section 5. Conclusions and recommendations for the further study are presented in Section 6.


## 2. Literature Review

Rani et al. proposed a unique time-frequency spectrum estimation approach for multichannel data [25]. Furthermore, it is applicable to the epileptic type of electroencephalography (EEG). Smooth localized complex exponential (SLEX) functions, which are time-frequency localized variants of the Fourier functions, are used to construct the approach. As a result, they are particularly well adapted to studying nonstationary signals whose spectral properties shift over time. Because the input signals are generated using a projection operator rather than a window or taper, the SLEX functions are orthogonal and concurrently confined in time and frequency [26].The domain of picture enhancement in digital image processing is one of the most simple and pleasurable to work in. The goal is to highlight specific details in an image or certain attractive traits (Pandey et al. [27]). The quality of the deformed image may be improved by adjusting the luminance of the bone or the brain tissue in the input image [28]. This enhancement method uses a dualistic subimage histogram equalization methodology. A segmentation approach based on directional homogeneity and using an improved metric has been created. The two seed templates must be uniformly orientated in opposed directions for this procedure to operate. There are just a few directions in which one can look for pixels. The production of brain image pixels is swift and accurate since just eight directions are considered. A technique that requires less computer efficiency is used to compare the picture sections to the templates [29]. Anderson are some of the authors contributing to this study. A wearable helmet for humans could be a crucial tool for monitoring employees’ health in the mining industry. However, identifying human emotions in hostile environments has received little research [30]. Another benefit of using this technique would be that the hybrid model for anxiety levels has an appropriate follow-up role in the unpleasant psychological shift [31]. This method may be used to measure how much anxiety a person is experiencing. This method can therefore improve operational safety and prevent incorrect miner operating. It is now possible to collect behavioural, physiological, and social activity indicators invisibly, thanks to the explosive expansion of integrated smart sensors that are found in mobile devices and wearable technology [32]. Self-help applications, electronic cognitive behavioural therapy [33], relaxation aids, video-based instruction [34], virtual reality [35], brain-computer interface (BCI) technologies, and other methods might all be used to offer many of these treatments electronically [36, 37]. The key elements of a perfect sensor are selectivity, linearity, sensitivity, precision, repetition and reproducibility, calibrating, drift, and fast response [38]. Machine learning approaches may help to create a positive feedback loop that makes it possible to continuously improve the therapeutic interventions for a given patient [39]. Any digital item, including wearables and hardware, with a variety of applications that spans many facets of society can be an IoT device [40]. The healthcare sector is quickly adopting IoT-based solutions. Additionally, an IoMT estimate for 2020 has been prepared. By 2022, it is anticipated that the market for connected devices used for patient care, monitoring, and diagnosis would increase from $14.9 billion to $52.2 billion [41]. IoMT security has become extremely difficult since new security issues are emerging while old security issues have intensified along with its rapid growth and diverse nature. To ensure integrity, validity, and data privacy, data must be stored and transferred without any unwanted access [42].


## 3. Publications Related to the Study

Reviewable research publications that stressed on the integration of Internet of Things in healthcare have been included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were used to identify the publications for the investigation.Using the flowchart given in Figure3 for PRISMA, an extensive choice of research articles is made at various phases.(i)
An inclusive examination of research articles on freely available search engines such as Google Scholar, PubMed, Web of Science, Science Direct, and Scopus was carried out during June, 2022. Also, some articles were short listed using hand searches.(ii)
The keywords used for the selection of articles at “IoMT,” “brain signals,” “stroke prediction,” and “wearable sensors”.Figure 3
PRISMA search strategy.Similar articles are eliminated in the first step, leaving only research works published after 2010 for the subsequent screening stage. The choice to include or omit the research articles has been made after research publications have been rejected at a later stage based on title, abstract, and full-text readings at the eligibility stage. The last and inclusion step was when selected research articles were examined for the current study taking into account all the inclusion criteria.Through the real-time modification of patient behavior and health conditions, the IoMT bridges the gap between the digital and physical worlds to improve patient health. IoMT is a group of interconnected devices that provide online health services. IoMT is a connected health system infrastructure that consists of medical tools, software programs, and services, and it strives to give patients and those who are at risk of developing major health issues better individualized or tailored care. More precisely, linking devices and sensors enables the healthcare industry to boost workflow management and clinical operations efficiency while also enabling remote patient health monitoring. Both patients and clinicians are greatly impacted by the connectivity of medically important devices. One of the key benefits of IoMT-based remote health monitoring is the ability for patients to perform routine tasks while their health is being continuously monitored. Another important benefit is the reduction in hospital costs. Traditional remote monitoring systems are uncomfortable for patients due to the size of the modules linked to the body and the frequent charging or replacement of batteries. Deep learning algorithms do not perform too well with little data. This is because deep learning algorithms require a lot of data to fully comprehend it. With each idea established in connection to simple ideas and much more complex depictions computed in terms of less abstraction ones, deep learning, a type of machine learning, learns to depict the world as a layered network of ideas. Many people believe that deep neural networks are the be all and end all and that they should completely replace existing methods. Before abandoning conventional algorithms, it is critical to comprehend how to combine the two to get forecasts that are more accurate. The IoT revolution tackles the aforementioned issues by creating compact, low-power sensor hardware and streamlining communication methods. The sensors and electronic circuits in the portable patient monitoring device can collect vital signs. Figure4 depicts a schematic illustration of IoMT in a live setting. Using an interactive interface, the doctor may see the patient’s condition. The remote health monitoring system is made up of portable monitoring devices for patients and a real-time monitoring system at the hospital that helps to make decisions.Figure 4
IoMT application in real time.The most important sort of monitoring is cardiac monitoring since it can reveal many diseases that are naturally disguised, such as arrhythmia. In order to further research and give patients new treatment options, IoMT-based devices are being developed to monitor the behavior of mental patients. A textile-based autonomic nervous system is one of the crucial parameter collection tools used for remote monitoring of neurological and brain disorders. Additionally, it offers diabetes sufferers remote monitoring tools. A critical area of IoMT is the identification of falls in elderly people who are being monitored in real-time. A variety of sensors, including gyroscope sensors, accelerometers, and respiration rate sensors, are included in the data collection system. Several systems, especially for elderly patients, use different arrangements of sensor nodes to find out when a patient falls. In some hospitals, real-time statistical data are generated, shared on a public ledger, and examined by the healthcare professional. The doctor keeps an eye on the patient using some wearable tracking gadgets. Wearable technology detects changes in the patient’s body and sends the doctor real-time data. The patient is then given advice by the doctor based on their health. The patient’s caregivers can also see the patient history. Every node in the patient network can see the reports and therapy for the patient that are shared on the public ledger. Table1 presents a list of efficient IOT-based sensors for the brain and fitness.Table 1
IoT-supported brain and fitness sensing devices.
NamesReferencesReliabilityAvailabilityIoT-supportedCostData usageThynchttps://www.thync.com/No validationTrueTrueCostlyLowMusehttps://www.muse.mu/No validationTrueTrueAverage expenseAverageNeuroSkyhttps://neurosky.com/No validationTrueTrueCheapAverageYBrainhttps://www.ybrain.com/No validationTrueTrueAverage expenseLowHalohttps://www.haloneuro.com/No validationTrueTrueAverage expenseLowSensoria healthhttps://www.sensoriahealth.com/No validationTrueTrueCheapAverageLumohttps://www.lumobodytech.com/No validationTrueTrueCostlyAverageOMsignalhttps://www.omsignal.com/No validationTrueTrueCostlyAverageMotivhttps://www.mymotiv.com/No validationTrueTrueCheapAverageAthos workshttps://www.liveathos.com/No validationTrueTrueCheapLowAtlas wearableshttps://www.atlaswearables.com/No validationTrueTrueCheapLowMoovhttps://www.welcome.moov.cc/No validationTrueTrueCostlyLowWithingshttps://www.withings.com/No validationTrueTrueVery costlyMaxMisfithttps://www.misfit.com/No validationTrueTrueCheapMaxBiostraphttps://www.biostrap.com/No validationTrueTrueCheapMaxZanthionhttps://www.zanthion.com/No validationTrueTrueAverage expenseMaxVerilyhttps://www.verily.com/No validationTrueTrueAverage expenseAverageTriggerishhttps://www.sensimed.ch/%20sensimed-triggerfish/No validationTrueTrueCheapAverage


## 4. Discussion

By 2025, the market for IoT-based smart healthcare is expected to be worth 350 billion US dollars. Smart cabinets and medicines incorporated into the IoT framework for the healthcare industry are getting much attention. Several CE systems have been presented for older health care [43, 44]. Data transfer from the corresponding sensors for electrocardiograms (ECG), electroencephalograms (EEG), and electromyograms (EMG) has been suggested [45]. For ongoing geriatric monitoring, a wireless sensor network (WSN) is provided. CE solutions for automated seizure detection are nonetheless required for the IoT framework in order to improve the state-of-the-art in intelligent medical healthcare. The suggested approach improves CE by including epileptic seizure diagnoses and remote analysis of health.Epileptic seizure detection has been carried out using several different techniques. The approximate entropy (ApEn) value considerably decreases during seizure activity, according to research on a seizure detection algorithm based on ApEn [46]. According to a correlation dimension (CD)-based technique, the epileptogenic zone has low CD values. For identifying seizures, classifiers based on artificial neural networks (ANN) have been suggested [47, 48], with better classification accuracy. Seizure detection using a multilayer perception neural network (MLPNN) [49] has improved detection performance. For differentiating between seizure and nonseizure patterns, ANN and wavelet transform-based feature extraction [49] was applied. The smoothed-pseudo-Wigner–Ville distribution is analyzed for feature extraction in the short-term Fourier transform (STFT)-based technique [50]. A multilayer perception network (MLP) and a radial basis function (RBF) network have both been used to classify seizures [51]. According to permutation entropy-based categorization, a considerable decrease in permutation entropy is seen during seizures [52]. Seizure detection has been improved with an SVM-based technique, which was proposed in references [53, 54]. Seizure detection accuracy was increased and power consumption was decreased via a signal rejection algorithm-based seizure detector [55, 56].Figure5 provides an illustration of a fundamental overview of the system. Disorders associated with stress and anxiety are becoming increasingly prevalent in today’s society. Because of this, improper management of stress can result in stress disorders, emotional suffering, and physical diseases. The authors created an IoMT-powered edge device with deep learning stress management algorithms. Physiological data are used to detect stress at the edge and transferred to the cloud for deep learning analysis. The scientists created a wristband with sensors (contact-temperature, humidity, and accelerometer) to detect stress patterns in users. Using a deep neural network (DNN) algorithm, Stress-Lysis sensor data generate discrete stress values (low, normal, and high). The authors applied their algorithm to diverse datasets and tested its efficiency using real-time metrics to validate the proposed system’s accuracy. Their investigation shows that their proposed approach is 98.3%–99.7% accurate in identifying user stress. The classification of food items is performed by a machine learning model called Single Shot MultiBox MobileNet. To calculate calories, researchers first compare the data they acquire to a nutrition database. User stress is detected by the extraction and analysis of many features. Meal details, such as kind, quantity, timing, and user sex, are all included. Table 2 illustrates the findings of the monitoring system for stress and anxiety in the current state-of-art techniques.Figure 5
Architecture of seizure [57].Table 2
Results of a monitoring system for stress and anxiety.
Ref noModels proposedResults obtained[58]IoT-based low-cost anxiety disorder monitorAccuracy 90%[59]EEG-powered smart emotion-aware IoMT-based framework for health monitoringAccuracy increased by 7–9%[60]IoMT-based novel system has been proposed for chronic stress management in women and the elderlyAccuracy ranges from 98.3% to 99.7%[61]ML-based smart device that detects stress levels in users to aid the IoMT framework of smart cities and officesAccuracy 97% and precision 81.2%[62]Stress monitoringAccuracy 98% andprecision 85.8%Reference [58] suggests developing an Internet of Things (IoT)-based low-cost anxiety disorder monitor. This monitor would deduce emotional aspects from physiological indicators in a semi-immersive environment. The IoT node collects data on the user’s heart rate as well as their level of physical activity. This information is then transmitted to a Raspberry Pi 3, where it is preprocessed before being sent to the IoT cloud. The findings of this system’s validation revealed that it has an accuracy rate of 90% when it comes to recognising anxiety disorders. The proposed categorization system is elected to take this technique [59] in order to improve its overall accuracy. This ensemble strategy for detecting the emotions of the user improves the classification accuracy of emotion-aware IoMT-based architectures by 7–9%, according to the validation results of the system that was proposed. A unique IoMT-based strategy for managing chronic stress for females and the older adults has been presented [60].The primary concept behind ML is that you create a dataset, give it to ML algorithms to learn from, and afterwards the ML algorithms use the data analysis to produce predictions or suggestions. One effect is that machines may learn to be biased or act against a few people’s interests based on the data input. Results from a machine algorithm that include bias may not be in accordance with societal moral norms. Long offline/batch training is necessary to avoid real-time, interactive or progressive learning, Poor integration, reusability, and transferability of learning. Systems are transparent, which makes them difficult to troubleshoot. As an example of a machine learning (ML)-based smart gadget that can be implemented in smart cities and enterprises, the authors recommend iMirror [61]. Because this tool lowers stress, it helps people with stress-related chronic conditions. Mirror-mounted cameras can be used for facial recognition, stress research, and app updates. When a user takes a picture, the device automatically identifies them and scans the image to pull out information for an ML model that can categorise the user’s stress level depending on the image. We tallied up the number of cases with red eyes, puffy eyes, dilated pupils, frown lines, and perspiration on the face. An ML model (a lightweight and optimised version of SSD Mobilenet) is fed to these features in order to characterize the stress level and update the mobile app. The technology is useful since it customises therapies for individuals. The model had a 97% accuracy rate and an 81.2% precision, as determined by experiments. In order to determine if a person has a stress problem, it is important to keep track of what they consume and how often they eat. Automatically tracking a user’s dietary intake and then converting that into an estimate of their stress level [62] makes use of the camera on a smartphone or a single board computer equipped with a camera. Edge computing devices can use the iLog deep learning model to identify and measure the quantity of food items on a plate. Using plate data, iLog can determine the user’s stress level [63–65]. The cutting-edge method developed by the researchers instantly tallies calories, recognizes food, and establishes a connection between diet and anxiety. This method uses IoMT to send images captured by iLog glasses to a device at the network’s edge. Images are broken up by the edge computing device, and the TensorFlow Object Detection API is used to identify objects in the images [66, 67].


## 5. Conclusion

A few physical items have also been equipped with IoT devices (sensors, actuators, etc.), enabling real-time monitoring and data transmission across different communication protocols, including Bluetooth as well as Wi-Fi. A patient’s electroencephalogram (EEG), heart rate, and electrocardiogram (ECG) are just a few examples of the critical physiological data that these sensors are used to collect in the healthcare industry. These sensors can be worn on the body or embedded in clothing. In addition, environmental information such as temperature, humidity, date, and time can also be analyzed. This exemplifies the potential and utility of IoT, especially related to smart health-based industry. Everyone in society is currently so focused on getting by that they are neglecting their health. With the development of intelligent sensors, it is now possible to continuously monitor a person’s behavior, record data, and predict the onset of a heart attack even prior to the patient feels its effects. Therefore, it is crucial to choose and apply the appropriate sensors. Another decentralized method called “block-chain storage” is developed to produce independent yet distinct groups of data called “blocks.” As a result, a network governed by patients as opposed to a third party is created. Although still in its infancy, the use of edge cloud and blockchain in the healthcare industry is developing as a new topic for research.



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