SMART MATTRESS TOPPER WITH ENHANCED HYGIENIC

PROPERTIES FOR ECG MEASUREMENT

AND DETECTION OF POSITION
Dana Rástočná Illová1, Ľudmila Balogová1, Katarína Ščasníková1, Michal Gála2,
Branko Babušiak2 and Štefan Borik2
1
Research Institute for Textile Chemistry (VÚTCH) - CHEMITEX, spol. s r.o., Rybníky 954, 011 68 Žilina, Slovakia
2
Department of Electromagnetic and Biomedical Engineering, Faculty of Electrical Engineering and Information
Technology, University of Žilina, Univerzitná 1, 010 26 Žilina, Slovakia
rastocna-illova@vutch.sk; michal.gala@fel.uniza.sk

Abstract: The contribution focuses on technical solution and confirmation of functionality of a prototype
of a smart mattress topper with enhanced hygienic properties, designed for monitoring of human bio-
medicinal data in real time. It involves integration of progressive technologies in a form of low-temperature
atmospheric-pressure plasma, application of nanotechnologies in a form of an antimicrobial nanosol and
integrated sensing system for monitoring electrical activity of the heart (ECG) and position of a lying
person. The sensing system consists of a set of active ECG capacitive textile electrodes with incorporated
microelectronics, capacitive sensors for detection of presence and position of a lying person, passive DRL
electrode, data, control and communication elements integrated into construction of the mattress topper
with an own mobile application. Functionality of prototype of the mattress topper will be demonstrated
by measurement of ECG and position of a lying person by means of a patient simulator as well as a real
person.
Keywords: smart topper, antimicrobial nanosol, low-temperature plasma, ECG, position detection.

1 INTRODUCTION the lesions caused by circulatory insufficiency due to

pressure applied on the affected place between
Cardiovascular diseases belong among leading
a bone and a base, when insufficient congestion
causes of death in Europe and they are responsible
takes place. Therefore, prevention of genesis
for more than 50 % of all deaths [1].
of decubital ulcers is identification of position and
The cardiovascular diseases can be indicated, but
regular displacement of a lying patient.
mainly reduced by a soon diagnostics, suitable
disease management, rehabilitation and prevention The developed original proposal of a prototype
[2]. Electrocardiogram (ECG) sensing represents of smart mattress topper „ECG-SmartSheet“ with
a traditional diagnostic method often used to monitor enhanced hygienic properties designed for
human health and diagnose potential cardiovascular monitoring of human biomedical data in real time
diseases. The conventional method of ECG sensing constitutes a system of unobtrusive long-term
uses electrodes and electro-conductive gel in direct monitoring electric activity of the heart (ECG) and
contact with skin surface of an examined person. position of a lying person over the day and/or during
A special feature of this type of measurement is high sleep. An efficient and advanced design of a smart
quality of measured signal due to low transfer mattress system is involved. Progressive
resistance between the electrode and the skin (when technologies used on elaboration of the project
using an electro-conductive gel). On the other hand, included:
long-term measurement is uncomfortable and can  plasma finish: activation of the surface by low-
cause allergic skin reaction in some cases. In recent temperature plasma under atmospheric pressure
years, capacitive sensing of ECG signal avoiding aimed at achievement of improved adhesion of the
direct conductive contact between the electrode and functional nano-coating on the textile material used
the skin of an examined person is being developed. as basic material for development of the mattress
This unconventional method of capacitive sensing topper;
has been successfully integrated e.g. into office arm-  nanotechnologies: application of antimicrobial
chairs, car seats or beds [3, 4]. Decubital ulcers (bed nanosol with incorporated nano-particles
sores) arise frequently in immobile, usually older, on the plasma activated textile surface aimed
long-term lying patients and/or patients with at creation of nano-structured surface with high
a diagnose requiring monitoring of their health adhesion to achieve functional hygienic properties
condition in a bed. This primarily concerns of the mattress topper;

Fibres and Textiles (4) 2020 81

 smart technologies: integration of a system connected with the textile sensor. Connection
of active textile capacitive ECG electrodes with of the electrodes is terminated by a power take-off
incorporated microelectronics, power, data, control connector, connected to the control unit.
and communication components into construction In construction of the core of the mattress topper
layers of the mattress topper using innovative there are pressure capacitive textile sensors for
antimicrobial (AMB) nano-coated textile material, detection of presence and position of a lying person.
customized algorithms and mobile application. The pressure sensors are connected by an electro-
conductive sewing thread. Between the pressure
2 TECHNOLOGIES AND MATERIALS sensors there is a dielectric, which on change
The mattress topper consists of a protective of the pressure changes its thickness and this way
removable shell and a core consisting of several capacity of the pressure sensors changes as well.
internal layers on which functional components The pressure sensors allow to monitor not only
of the sensing system are placed. The sensory part presence of a patient in the bed, but also distribution
of the mattress topper consists of active textile ECG of pressure on the topper and monitor this way
capacitive electrodes with incorporated the most vulnerable places of human body for
microelectronics, designed to monitor electric activity the purpose of positioning a long-term lying patient.
of the heart (ECG) and textile sensors designed The pressure sensors are connected with the circuit
to detect presence and position of a lying person, board by a connector connecting the conductors
made on a base of electro-conductive textiles. conducting signal further to the sensing unit which
A customized application developed for readily passes the information to the control unit.
available imaging equipment allows assessment The control unit captures signals from the electrodes,
of the sensed data in real time. performs their further analog processing, digitizing
of the data and their transfer to a computer by means
2.1 Construction of the mattress topper of universal serial bus (USB). A basic element
Shell of the mattress topper consists of an upholstery of the control unit is an eight-canal integrated circuit,
fabric pre-finished by activation of its surface analog-digital (AD) convertor with internal reference
structure using low-temperature atmospheric- and adjustable amplification, sampling frequency and
pressure plasma and subsequently finished microcontroller ensuring communication with
by an antimicrobial nanosol imparting hygienic a personal computer. A prototype mobile application
properties to the mattress topper during its long-term has been developed for analysis, evaluation, display
use. Permanency of the antimicrobial nanofinish and storage of the sensed data as well as for display
on the surface of the upholstery fabric has been of a position. It monitors actual state of the patent
evaluated after 20 washing cycles performed using in real time.
4N process according to STN EN ISO 6330 and its The active ECG capacitive textile electrodes and
antibacterial efficiency has been evaluated according passive pressure capacitive textile sensors have
to AATCC TM 100 and expressed as a percentage been made from electro-conductive fabrics with
of bacterial reduction of Staphylococcus aureus. electric resistivity of 1.5 Ω/10 cm, creating their
The achieved bacterial reduction after 20 washing sensing part. An advantage of the textile electrodes
cycles was on a level of 50% (bacteriostatic is a pleasant feel, elasticity and ability to adapt
efficiency). A positive influence of the pretreatment to contours of a human body what enhances comfort
by activation of the surface of the upholstery fabric of a man during his stay in bed and ECG
using low-temperature plasma on enhancement measurement. The electrical conductivity
of affinity of the antimicrobial coating to the surface of the fabrics used to prepare the textile sensors and
of the upholstery fabric has been demonstrated by electrodes ensures functionality of the whole sensing
bacterial reduction, which was higher by about 35% system integrated into construction of the mattress
in comparison with an upholstery fabric finished by topper. Influence of washing and mechanical
the antimicrobial nanosol under the same conditions abrasion on change of the surface electric resistance
without activation of the textile surface by low- and electric conductivity of the electro-conductive
temperature plasma. textiles has been evaluated after 20 washing cycles
On a face side of the surface of the shell using 4N process. Functionality of the fabrics
of the mattress topper there is a set of active ECG designed for sensing of ECG and position
capacitive textile electrodes with incorporated of a person has been confirmed. The electric
microelectronics and a reference active ECG resistance of the fabrics increased after 50 000
capacitive textile electrode for monitoring heart abrasions to a level of 19 Ω/10 cm, whereby
activity, creating an eight-lead system of ECG the fabrics preserved their appearance without
measurement. On the shell of the topper there is also significant changes. Tests for human-ecological
a passive textile DRL electrode to repress technical properties of the applied electro-conductive textile
artefacts, primary interference from the electrical materials have been performed according to test
network. Electronics of the ECG electrodes is placed methods of the international association OEKO-
on a flexible circuit board and it is conductively TEX® to confirm health safety and health protection

Fibres and Textiles (4) 2020 82

of a consumer: determination of forbidden disperse 1
= (2)
dyestuffs classified as allergenic, carcinogenic and 2
other forbidden dyestuffs, determination If value of the resistor will be 2 GΩ, then the cut off
of extractable heavy metals, determination of total frequency of the filter will be 0.87 Hz. Such a filter
quantity of lead (Pb) and cadmium (Cd), will enable to remove unacceptable biological
determination of total quantity of silver, determination artefact caused by breathing.
of polycyclic aromatic hydrocarbons (PAH),
determination of phenol, chlorinated phenols and 2.3 Position sensing
orthophenylphenol (OPP) and determination of pH Hardware and software modules have been
of water extract. No presence of health harmful developed to detect presence and position of a lying
substance has been determined in the applied person. Result of sensing presence of a person
electro-conductive textiles. The determined quantities in a bed using a method of measurement capacity
have been under detect limit and they meet between two pressure capacitive sensors can be
the required limit concentrations of harmful shown in two ways:
substances for textiles and clothing products for a) curve representing sensed capacity in real time for
children up to 3 years of age, for direct and indirect a pushed sensor (Figure 1b) and/or a non-pushed
contact with the skin according to the technical sensor (Figure 1a).
requirements of the standard STN 80 0055 and b) using a color map (color squares), representing
the international OEKO-TEX® Standard 201. a more sophisticated method to display change
of pressure by presence of a person lying in a bed.
2.2 Capacitive measurement of ECG
Data obtained by measurement can be transformed
The principle of capacitive ECG sensing is that
to „pictures“ where the individual cells will represent
the active ECG textile electrode constitutes one plate
pressure intensity. Innovative algorithms known from
of a plate condenser and surface of human skin
recognition of a picture and software developed for
constitutes the second plate of the plate condenser.
the purpose of data monitoring and data capture
A dielectric layer is placed between these two plates;
from the sensors in real time are used
the most frequently this layer is a layer of cotton
in the developed module. After starting
clothing in which a lying person is dressed during
the measurement the measured values are recorded
measurement. Capacity of such a condenser
and at the same time level of pressing the sensor
is calculated according to the formula 1:
is shown in graphical form by means of colors.
Each square in the map represents one sensor and
= ɛ ɛ (1)
capacity is represented by coloring the square.
where S is surface of condenser plate, d is distance Unloaded (non-pushed) sensor is represented
between the condenser plates, ε0 is permittivity of vacuum by blue color and pushed sensor by yellow color.
and εr is dielectric permittivity. Such a color map displays position of a patient
2
If surface of an electrode is 25 cm , dielectric in a bed. Pressure sensors of matrix 2x2 sensors
material is a cotton fabric with 0,5 mm thickness and in „quiescent“ condition are shown in Figure 2a, from
2.077 permittivity [5], capacity of the plate condenser which is can be seen on the base of the color map,
will be approximately 92 pF. The active ECG that the sensors are not loaded. In Figure 2b one
electrode incorporates a low-noise operational square is yellow; it means that the sensor in left
amplifier in connection of a voltage tracker. Static upper corner was pressed. In Figure 2c it can be
charge of the condenser is discharged by means seen a case when the right lower sensor was
of R resistor. Combination of C condenser with R pressed. After completion of the measurement
resistor creates a filter whose limit frequency it is possible to store the data for subsequent use
is calculated according to the formula 2: when training the innovative algorithms for detection
of position of a man.

a) b)
Figure 1 Capacitive curves: a) non-pushed sensor, capacity about 12.4 pF; b) pushed sensor, capacity about 15.1 pF

Fibres and Textiles (4) 2020 83

 a) b) c)
Figure 2 Color map representing: a) non-pushed sensors; b) pushed left upper sensor; c) loaded right down sensor

3 RESULTS AND DISCUSSION input channels. Raw ECG record is shown

in Figure 4. The channels are arranged in lines,
Functionality of the cover of the mattress topper has
i.e. channels No. 1 and No. 2 are shown in the first
been evaluated on a person lying on his back
line. It is obvious from the figure that signals
for 1 hour (Figure 3).
in the channels are influenced by noise differently
and show also different offset. This phenomenon
is caused by local differences in distribution of
electrical potential on the skin, accumulation of static
charge and different pressure of the electrodes.
Although DRL circuit has been used and electronics
of the active electrodes have been shielded,
the output signals comprise considerable noise
on the frequency of 50 Hz as it is evident from
the power spectral density (PSD) in Figure 5.
A narrow band notch filter for 50 Hz, applied to all
Figure 3 A proband lying on the developed mattress channels, has been proposed to reduce the noise.
topper ECG record after application of the filter is shown
in Figure 4b. The main problem is electrostatic
The subject wore nightdress made from cotton fiber. charge and movement artefacts. The movement
Sampling frequency was adjusted to 250 Hz. artefact causes saturation of the operational
Amplification was adjusted to value 6 for all amplifier inputs and it can take even several
channels with the exception of channel No. 2 and seconds until the signal has been stabilized again.
No. 3. Signal in these channels exceeded the range Solution of this problem consists in application
on amplification 6 and therefore amplification of a special electronic circuit grounding temporarily
in these channels was reduced to 4. DRL circuit was inputs of the operational amplifier as soon as
active and signal for DRL circuit was derived from all a signal gets outside the measuring range [6].

a) b)
Figure 4 Eight-channel ECG record measured from the cover of the mattress topper: a) raw, b) filtered

Fibres and Textiles (4) 2020 84

 results measured without shielding it is not possible
to identify unambiguously a lying person (influence
of spurious capacities), after introduction
of a shielding layer to the construction
of the mattress significant improvement is visible
which allows identification of area of a lying person
and distribution of pressure cause by weight
of a body on the topper.

4 CONCLUSION
The matter of prevention of cardiovascular diseases
Figure 5 Power spectral density (PSD) of the channel is very actual, important and necessary not only
No. 1 in the Slovak Republic but world-wide at present.
The proposed prototype of smart mattress topper
“ECG-SmartSheet“ with enhanced hygienic
The measured signals clearly show visible course properties, designed for monitoring of bio-medicinal
of the ECG signal, suitable for subsequent analysis. human data in real time ensures ECG monitoring
Although not all canals are without disturbing of a patient on capacitive principle in lying position
arfefacts, incidence of these artefacts in some as well as detection of presence and position
canals does not represent any risk from a viewpoint of a lying patient in a bed. It is a conjunction
of determination of diagnosis as the applied of progressive technologies for textile finishing
algorithm selects for the needs of diagnosis only such as plasma treatment and nanotechnologies with
the canal with the best signal quality. application of smart technologies such as smart
A graphical display of results from measurement systems for biodata collection with subsequent
of capacity using colour map (colour squares) was positive impact on socio-health aspects of social and
selected to measure position of a lying person demographic development. The smart topper „EKG-
on a prototype of the mattress topper (Figure 6). SmartSheet“ is a functional system of contactless
and unobtrusive long-term monitoring of human vital
functions in health service establishments or
in the domestic environment. Sensing bio-potentials
using textile electrodes prepared from electro-
conductive textiles is a progressive solution
of measurement of ECG signal without direct contact
with human skin. The method of contactless
measurement of ECG signal becomes an alternative
of common Ag/AgCl electrodes used at present
in health service establishments. The textile
electrodes act as dry electrodes allowing
measurement of ECG signal without electrolyte gel
a) b)
or adhesives. Besides, application of textile material
Figure 6 Detail of colour map of the matrix with antimicrobial nano-coating with plasma
of sensors of position: a) without shielding; b) with application ensures permanently enhanced functional
shielding hygienic properties during the long-term use even
after 20 washing cycles and/or after multiple abrasion
of the surface of electro-conductive textiles
From a viewpoint of monitoring position of a patient in the form of textile sensors and/or ECG electrodes.
it is not necessary to know concrete value of capacity Besides, from a viewpoint of materials used
but only its change. Each square in the map in the construction of mattress topper, health safety
represents one sensor and capacity is represented and maximal protection of consumer health has been
by colouring the square. Unloaded (unpushed) confirmed according to the test methods
sensor is represented by blue colour and loaded of the international association OEKO-TEX®
sensor by yellow colour. Influence of shielding Standard and technical requirements of the standard
on measurement and values of capacities sensed STN 80 0055.
using the sensors is shown in Figure 6a, when
measurement was performed without shielding and ACKNOWLEDGEMENT: This work was supported
in Figure 6b, where measurement was performed by the Slovak Research and Development Agency under
with an applied shielding layer. Shielding layer the contracts No. APW-14-0190, No. APW-16-0190
of the electroconductive fabric has been inserted and No. APW-18-0167.
between shell of the mattress topper and the passive
pressure capacitive textile sensors. While from

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