Biomedical Recorders 187

Compressed Spectral Array (CSA): In this format, a series of computer-smoothed spectral arrays
are stacked vertically, usually at two second intervals, with the most recent EEG event at the
bottom and the oldest at the top. Peaks appear at frequencies, which contain more power
or make larger contributions to the total power spectrum. Since the origin of the plots shifts
vertically with time, this produces a pseudo three-dimensional graph [Fig. 5.19(b)]. With this
method, it is easy to pick up changes in frequency and amplitude of each sample over a longer
period of time as it compresses a large amount of data into a compact, easy to read trend.
Dot-density Modulated Spectral Array (DSA): It is another method for displaying the power
spectra. This format displays a power spectrum as a line of variable intensities and/or densities
with successive epochs again stacked vertically as in the CSA plots. Areas of greatest density
represent frequencies, which make the greatest contribution to the EEG power spectrum. An
advantage of the DSA format is that no data is hidden by the peaks as in the CSA display. DSA
displays could be in the form of gray or colour-scaled densities.

5.6 ELECTROMYOGRAPH
Electromyograph is an instrument used for recording the electrical activity of the muscles to
determine whether the muscle is contracting or not; or for displaying the action potentials
spontaneously present in a muscle in visual and audible form or those induced by voluntary
contractions as a means of detecting the nature and location of motor unit lesions; or for recording
the electrical activity evoked in a muscle by the stimulation of its nerve. The instrument is useful
for making a study of several aspects of neuromuscular function, neuromuscular condition,
extent of nerve lesion, reflex responses, etc.
EMG measurements are also important for the myoelectric control of prosthetic devices
(artificial limbs). This use involves picking up EMG signals from the muscles at the terminated
nerve endings of the remaining limb and using the signals to activate a mechanical arm. This
is the most demanding requirement from an EMG since on it depends the working of the
prosthetic device. EMG is usually recorded by using surface electrodes or more often by using
needle electrodes, which are inserted directly into the muscle. The surface electrodes may be
disposable, adhesive types or the ones which can be used repeatedly. A ground electrode is
necessary for providing a common reference for measurement. These electrodes pick up the
potentials produced by the contracting muscle fibres. The signal can then be amplified and
displayed on the screen of a cathode ray tube. It is also applied to an audio-amplifier connected
to a loudspeaker. A trained EMG interpreter can diagnose various muscular disorders by
listening to the sounds produced when the muscle potentials are fed to the loudspeaker.
The block diagram (Fig. 5.20) shows the stages of data acquisition and signal processing in
an electromyograph. The myoelectric signals are amplified with the use of preamplifiers and
a differential amplifier together having an effective passband of 10 to 1,000 Hz. The signals
are sampled at 5 kHz with 16-bit analog-to-digital conversion, rectified, and smoothed with a
running time window averager with a window length of 240 ms that is updated every 80 ms.
The processed signals are normalized by the amplitudes of the maximum voluntary contractions
and are displayed on a computer monitor. The waveforms can be stored to facilitate playback
and study of the EMG waveforms at a later convenient time. The waveform can also be printed
as a hard copy for records.
The amplitude of the EMG signals depends upon various factors, e.g. the type and placement
of electrodes used and the degree of muscular exertions. The needle electrode in contact with a
188 Handbook of Biomedical Instrumentation

Display

A/D Digital Signal Control NP state

Amplifier
Converter Processing Algorithm Command

Preamplifiers

Electrodes

Fig. 5.20 Block diagram of a typical set-up for EMG recording

single muscle fibre will pick up spike type voltages whereas a surface electrode picks up many
overlapping spikes and therefore produces an average voltage effect. A typical EMG signal ranges
from 0.1 to 0.5 mV. They may contain frequency components extending up to 10 kHz. Such high
frequency signals cannot be recorded on the conventional pen recorders and therefore, are usually
displayed on the CRT screen.
Modern day EMG machines invariably use digital signal processing techniques. Analog-
to-digital converters (ADC) are used to convert the amplified differential signals into digital
signals that are further processed by a microprocessor or a PC. The quality of an EMG signal is
therefore largely dependent on the resolution, accuracy and sampling rate of the ADC used. Present
day ADCs used in EMG equipment range from 10 – 24 bit systems. The sampling rate used in
any EMG system must at least obey Nyquist’s theorem whereby the minimum sampling rate
must be twice that of the signal frequency in question. In all present day EMG applications, the
upper limit on the frequency of interest is around 500Hz, and so the sampling frequency may
be kept at 1000 samples per second (KSPS).
Modern EMG machines are PC based
(Fig. 5.21) available both in console as well
as laptop models. They provide full colour
waveform display, automatic cursors for
marking and making measurements and
a keyboard for access to convenient and
important test controls. The system usually
incorporates facilities for recording of the
EMG and evoked potentials. The stimulators
are software controlled. For report generation
in the hard copy form, popular laser printers
can be used.
Recent developments in all fields of electronic
technologies have pushed EMG equipment to
have a range of new features and networking Fig. 5.21 PC based digital EMG recording system
 Biomedical Recorders 189

capabilities. The RS-232 serial data transfer protocol previously used in the PC-based systems is
now replaced by the Universal Serial Bus 2.0 which provides faster data exchange rates and even a
means of supplying power to the EMG handheld device to recharge the device. Increased storage
capacity of data recordings on digital storage media has become a common place.
Wireless technologies such as Wi-Fi and Bluetooth have also been incorporated into today’s
EMG equipment to provide the user with extended mobility from the PC on PC-based systems.
Acquired EMG signals can now be picked up on the body and sent wirelessly to a PC where it
is recorded, processed and analyzed.
Preamplifier: The preamplifiers used for EMG are generally of differential type with a good
bandwidth. The input impedance of the amplifier must be greater than 2 ¥ 50 MW. Present day
differential amplifiers easily provide input impedances of the order of 1012 ohms in parallel with
5 picofarads. It is preferable to mount the preamplifiers very near the subject using very small
electrode leads, in order to avoid the undesirable effects of stray capacitance between connecting
cables and the earth. Also, any movement of the cable from the output of the electrode will not
generate significant noise signals in the cable, which feeds into the subsequent amplifier. The
preamplifier provides an output with low impedance and, therefore, the high frequencies do
not get attenuated even if long cables are used to connect the preamplifier and the rest of the
machine. The common-mode rejection should be greater than 90 dB up to 5 kHz. A calibrating
square wave signal of 100 μV (peak-to-peak) at a frequency of 100 Hz is usually available. The
main amplifier has controls for gain adjustment from 5 μV/div to 10 mV/div for selecting the
sensitivity most appropriate to the incoming signal from the patient.
Basmajian and Hudson (1974) describe a preamplifier to amplify the EMG signals picked
up by needle electrodes at the electrode site before transmitting them. The effect of electrical
interference is substantially reduced and the microphonic artefacts generated in the wires due
to movement of the subject are virtually eliminated. When surface EMGs are to be measured, it
is convenient to combine the electrode pair and a differential amplifier within a single module.
Johnson et al. (1977) designed a miniature amplifier circuit fully encapsulated in epoxy resin
with two small silver electrodes of 6 mm diameter, exposed flush with the base of the module.
The electrode is attached to the skin using adhesive tape. Fig. 5.22 shows a circuit diagram of the
preamplifier. The amplifier design provides for a flat frequency response between 10 Hz and 1
kHz, with a CMRR of 100 dB at the mains frequency. The noise level was found to be 2 μV rms
and the input impedance greater than 10 MW.
The two ICs in the input stage act as voltage followers, which present the desired high input
impedance to the electrodes. They are coupled via C1 and R5 to provide a high differential signal
gain. Capacitor C1 determines the low frequency performance of the circuit. It also eliminates the
effects, at the output, of any dc offsets due to IC1 and IC2 or any imbalance in electrode potentials.
The second stage IC3 provides further differential signal gain, while rejecting common-mode
signals. The overall gain of the amplifier is 1000.
Input impedance of the amplifier must be higher by several orders than the electrode
impedance. Also, selection of the electrode type without the knowledge of the amplifier’s input
resistance results in distorted records and considerable error. The larger the surface of the
electrode, the less input resistance is allowable. For example, a needle electrode with a surface of
15,000 μm2 may need an amplifier with input impedance of 5 MW, while a needle electrode with
a surface of 500 μm2 will ensure a record with acceptable distortion by means of an amplifier
with minimum input impedance of 100 MW.
190 Handbook of Biomedical Instrumentation

Electrode
R6 R8 D1
R1 IC1

V– R3

IC3 Output
R5 R10

C1

V+ R4
+V
R7 R9
Electrode

IC2 0V

R2 –V
D2

Fig. 5.22 Preamplifier circuit for an EMG machine (Redrawn after Johnson et al., 1977; by permis-
sion of Med. & Biol. Eng. & Comput.)
The capacitance present parallel with the input resistance of the amplifier reduces the
frequency response of the amplifier as well as lowers the common-mode rejection at higher
frequencies. Owing to these, the electrode cable, the extension cable and the input stage of
the amplifier require careful designing. Generally, shielded cables are used which reduce the
disturbing signals but at the same time, the parasite capacitance will increase. By careful design,
a capacitance value of 50 pF or less can be achieved for the input stage. McRobbie (1990)
illustrated a rapid recovery EMG preamplifier without AC coupling capacitors.
To ensure patient safety, the subject should be electrically isolated from any electrical
connection to the power line or ground. This isolation is achieved either through the use of
optical isolators or through the use of isolation transformers.
Low Frequency and High Frequency Filters: These are used to select the passband of the incoming
signal and to modify the progressive reduction in voltage output which occurs at either end of the
frequency spectrum roll-off. The low frequency 3 dB point may be selected over the range of 0.016
to 32 Hz while the high frequency 6 dB point can be selected over the range 16 Hz to 32 kHz. Thus,
the passband may be varied over a very wide range but is normally made as narrow as possible,
subject to the requirements of the particular application in order to restrict displayed noise.
Signal Delay and Trigger Unit: Sometimes, it is necessary to examine the signals from individual
fibres of muscle tissue. For this purpose, special needles are available with a 25 micron diameter
electrode surface and up to 14 pick-up surfaces down the side of one needle. These 14 points
are scanned sequentially to determine which point is acquiring the largest signal. This point
is then considered as the reference and its signal is used to trigger the sweep. Signals from the
remaining 13 points are then scanned sequentially and recorded with respect to the reference
signal. To examine these signals, it is necessary to trigger the sweep from the signal and to delay
the signal so that the whole of its leading edge is displayed. The delay is achieved by passing the
digitized signal through the shift register or random access memory into the recirculate mode
to obtain a non-fade display of a transient phenomenon.
 Biomedical Recorders 191

Integrator: The integrator is used for quantifying the activity of a muscle. Lippold (1952) established
that a linear relationship exists between the integrated EMG and the tension produced by a muscle.
The integrator operates by rectifying an incoming EMG signal, i.e. by converting all negative
potentials to identical positive deflections so that the EMG pattern consists of positive deflections
only. The area under the rectified potentials is accumulated using a low-pass filter so that the
module output, at any time, represents the total area summed from a selected starting time.
The integrator indicates the EMG activity either as a variable frequency saw tooth waveform
or as a steady deflection. In the former case, the output curve is a measure of the total electrical
activity per second, recorded from a muscle during voluntary contraction within the analysis
time. The slope of this curve, measured as the number of resets per second, can be used to
detect changes in the number of motor units firing over a period of time. The steady deflection
or mean voltage mode is used in plotting mean voltage V, isometric tension curves of muscle
interference patterns during voluntary contraction, to show changes in muscle activity due to
neuro-muscular disease such as muscular dystrophy, poliomyelitis, etc. Different time constants
determine the amount of smoothing applied to the output signal. When rapid changes in the
signal have to be followed, the shortest time constant provides maximum smoothing of the
signal and the most easily read mean value.
Stimulators: The stimulators incorporated in the EMG machines are used for providing a single
or double pulse or a train of pulses. Stimulus amplitude, duration, repetition and delay are all
adjustable and facilities are provided for external triggering. The output is either of the constant
voltage type or of the constant current type. The constant voltage type stimulator provides square
wave pulses with amplitudes in the range of 0–500 V, a pulse duration of 0.1–3 ms and frequency
between 0-100 Hz. Output of the constant current generator can be adjusted between 0 to 100 mA.
Usually, the electromyographic changes in an advanced diseased state are readily recognized
on an oscilloscope display and by the sound from a loudspeaker. However, since the loss of
muscle fibres, and therefore, the action potential changes are relatively small in early or mild
disease states, changes in the EMG signals may be obscured by the usual variability of action
potentials. Quantitative analysis is thus necessary to determine when the waveforms have
changed beyond the normal range. Quantities measured for such analysis include zero-crossing
rate, peak rate, negative wave duration and wave rise time. These time-domain techniques are
somewhat different from the classical frequency spectrum and correlation function methods,
but are much simpler to implement with electronic techniques. Fusfeld (1978) details out circuits
used to implement quantitative analysis of the electromyogram.

5.6.1 Common Artefacts in EMG

Power line interference (50–60Hz ) is the most common artefact transmitted by electrical devices
around the EMG equipment. Typically a notch filter implemented in software is used to remove
this interference.
EKG artefacts are a result of the electrical signals generated by the heart muscle and can also be
picked up in EMG signals. A high-pass filter at 100 Hz implemented in hardware or software
may be used to attenuate or remove all the signal frequencies below the cut-off frequency, which
also may sometimes remove some of the signals of interest.
Movement artefacts occur whenever a patient moves and the electrodes are disturbed or the
cables are pulled. Electrodes must be placed in firm contact with the skin and electrode cables
192 Handbook of Biomedical Instrumentation

must be fastened so as to prevent such artefacts. Hardware or software filters can also be applied
to remove residual artefacts.
DC offset results from a difference in the electrical impedances between the skin and electrodes.
With proper skin preparations and firm placement of electrodes, this problem can be minimized.
When all else fails, conductive gels are used to reduce skin impedance.
Muscle crosstalk results from the electrical signals generated by muscles other than the one
under investigation. Crosstalk is minimized through the appropriate placement of the electrodes.
The recommended inter-electrode distance is about 2 cm.

5.7 OTHER BIOMEDICAL RECORDERS

5.7.1 Apexcardiograph
An apexcardiograph records the chest-wall movements over the apex of the heart. These
movements are in the form of vibrations having a frequency range of 0.1 to about 20 Hz.
The transducer required for recording these movements is similar to that employed for a
phonocarddiagraph (PCG) but which has a frequency response much below the audio range.
It can be an aircoupled microphone or a contact microphone. The apexcardiograph has limited
applications. It is, however, useful in the diagnosis of the enlargement of the heart chambers
and some type of valvular disorders.

5.7.2 Ballistocardiograph (BCG)

A ballistocardiograph is a machine that records the movement imparted to the body with each
beat of the heart cycle. These movements occur during the ventricular contraction of the heart
muscle when the blood is ejected with sufficient force.
In BCG, the patient is made to lie on a table top which is spring suspended or otherwise
mounted to respond to very slight movements along the head axis. Sensing devices are mounted
on the table to convert these movements into corresponding electrical signals. The sensors
usually are piezo-electric crystals, resistive elements or permanent magnets, moving with
respect to fixed coils. In all such cases, the output of the sensor is amplified and fed to an
oscilloscope or to a chart recorder. BCG has so far been used mainly for research purpose only.
It is rarely used in routine clinical applications.

5.7.3 Electro-oculography
Electro-oculography is the recording of the bio-potentials generated by the movement of the eye
ball. The EOG potentials are picked up by small surface electrodes placed on the skin near the eye.
One pair of electrodes is placed above and below the eye to pick up voltages corresponding
to vertical movements of the eye ball. Another pair of electrodes is positioned to the left and
right of the eye to measure horizontal movement. The recording pen is centred on the recording
paper, corresponding to the voltage changes accompanying it. EOG has applications mostly for
research and is not widely used for clinical purposes.

5.7.4 Electroretinograph (ERG)

It is found that an electrical potential exists between the cornea and the back of the eye. This
potential changes when the eye is illuminated. The process of recording the change in potential
when light falls on the eye is called electroretinography. ERG potentials can be recorded with
 Biomedical Recorders 193

a pair of electrodes. One of the electrodes is mounted on a contact lens and is in direct contact
with the cornea. The other electrode is placed on the skin adjacent to the outer corner of the eye.
A reference electrode may be placed on the forehead. A general purpose direct writing recorder
may be used for recording electroretinograms. The magnitude of the ERG voltage depends
upon the intensity and duration of the light falling on the eye. It may be typically about 500 μV.

5.8 BIOFEEDBACK INSTRUMENTATION

Feedback is a common engineering term and refers to its function to control a process. When
this concept is applied to biological processes within the body, it is known as biofeedback. Here
again, biofeedback is a means for gaining control of the body processes to create a specially
required psychological state so as to increase relaxation, relieve pain and develop healthier and
more comfortable life patterns. The technique involves the measurement of a variable produced
by the body process and compares it with a reference value. Based on the difference between
the measured and reference value, action is taken to bring the variable to the reference value.
Fig. 5.23 shows the basic principle of biofeedback which conveys the essentials – information
is detected, provided in an understandable way to the patient who can then, at their own
initiation, use the information to achieve a measure of control over the same process.

Suitable sensor,
Parameter of
transducer,
interest
detector

Directional change

INVOLUNTARY VOLUNTARY Display/

feedback-
VISUAL, AUDIO,
TACTILE,
Recognition of combination
change at
conscious level

Fig. 5.23 Principle of bio-feedback

It may be noted that biofeedback is not a treatment. Rather, biofeedback training is an

educational process for learning specialized mind/body skills. Through practice, one learns
to recognize physiological responses and to control them rather than having them control us.
The objective of biofeedback training is to gain self-regulatory skills which help to adjust the
activity in various systems to optimal levels. Many different physiological processes have been
evaluated for possible control by biofeedback methods. However, the following four neural
functions are commonly employed:
194 Handbook of Biomedical Instrumentation

Electrodermal activity is measured in two ways: BSR (basal skin response) and GSR (galvanic
skin response) is a measure of the average activity of the sweat glands and is a measure of the
phasic activity (the high and low points) of these glands. BSR gives the baseline value of the
skin resistance whereas GSR is due to the activity of the sweat glands. The GSR is measured
most conveniently at the palms of the hand, where the body has the highest concentration of
sweat glands. The measurement is made using a dc current source. Silver-silver electrodes are
used to measure and record the BSR and GSR. Fig. 5.24 shows the arrangement for measuring
these parameters. The BSR output is connected to an RC network with a time constant of 3 to 5
seconds which enables the measurement of GSR as a change of the skin resistance.

C
dc current A1 A2
source

BSR GSR
R
meter meter

Active Neutral
electrode electrode
Fig. 5.24 Block diagram for measurement and record of basal skin resistance (BSR) and galvanic skin
response (GSR)

Biofeedback instrumentation for the measurement of EMG, temperature and pulse/heart

rate is not different from other instruments used for the measurement of physiological variables.
Transducers and amplifiers are employed to measure the variable that is to be controlled by
the feedback process. The magnitude of the measured variable or changes in the magnitude is
converted into a suitable visual or auditory stimulus that is presented to the subject. Based on the
stimulus, the subject learns to control the abnormal conditions. Reports have appeared in literature
regarding applications of biofeedback to control migraine headaches, to slow down heart rate, etc.
Biofeedback techniques have been greatly refined and computerized biofeedback training and
psychological computer-assisted guidance programs in the privacy of one’s home are now a reality.

MODEL QUESTIONS
1. What is an electrocardiograph? Describe the major building blocks of an electrocardiograph machine.
2. Define CMRR (common-mode rejection ratio) and illustrate the techniques used in ECG machines
to achieve high CMRR.
3. Explain the function of an isolation preamplifier commonly used in ECG machines.
4. What is an ECG ‘Lead’? Describe various types of ‘Leads’ used for recording ECG signal.