Podiatric skin health sensing in the diabetic foot

Abstract

In this thesis a new approach to sensing soft tissue damage in the diabetic foot is presented and multiple sensor modalities including linear and rotational accelerometers, temperature, humidity and galvanic skin response (GSR), pressure/-force, blood oxygen heart rate and fore foot flexure will be investigated with the aim of using multi modal sensing to improve understanding the diabetic foot. Bioimpedance is proposed and investigated as a novel measurement modality that directly observes the response of the tissue under test as a means of estimating tissue condition. The new sensing system and data collection with critical assessment is presented complimenting the existing metric of assessment.

Diabetes is currently one of the greatest health risks facing the developed world where typically 6% of the population is diabetic and an estimated 1 in 3 people are currently in a pre-diabetic state. The condition adversely affects the body’s glycaemic control mechanisms leading to macro vascular stiffening alongside the possible onset of peripheral neuropathy thus increasing the risk of secondary pathologies such as retinopathy, kidney failure and diabetic foot disorder. For those living with diabetes the loss of a foot due to diabetic foot disorder is one of the most debilitating and feared side effects of diabetes. The national health service (NHS) in the United Kingdom (UK) currently amputates circa 100 lower legs a week due to diabetic complications of which about 85% are avoidable. As amputation leads to increased morbidity and mortality (68% at five years post 1st amputation) as well as a marked reduction in quality of life, this concern is well founded. Many metrics have been investigated as indicators of diabetic foot disorder, though none have shown sensitivity and specificity that would enable their use as a reliable diagnostic or predictor of ulceration.

The following contributions to the body of knowledge will be presented:

1. Novel associations of sensors for monitoring the diabetic foot see Table 6.6.

2. The development of a novel bioimpedance measuring device.

3. The development of a novel wearable extensible multimodal sensing system

4. Demonstrate direct current (DC) through textile GSR measurement.

5. Demonstrate the effect of caffeine on GSR coherence for the first time.

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Identifiers

ORCID for Andrew Chipperfield: orcid.org/0000-0002-3026-9890

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