Motion Artifact Suppression Method in Wearable

ECG
Jianlong ZHAO and Huanqian ZHANG

Abstract
Because of developing Internet of Things technology and telemedicine, increased attention has
been paid to ambulatory electrocardiogram (WECG) detection for individuals joining in outdoors
activities, family activities, and exercise. During activities the interface between the electrode
metal and the conductive adhesive as well as the stretch of the skin will introduce extra artifacts
to the WECG signal. Processing this interference in WECG is highly difficult because motion
artifacts (MAs) and WECG signals have similar frequency spectra.

Here we first give a brief discussion about motion artifact suppression method, from the original
of motion artifact to detecting motion artifact and suppressing motion artifact.

The metabolic difference between the live skin cells of the inner layer and the dead skin cells of
the stratum corneum cause an ‘injury current’. When a force is applied to the skin, the
membrane of the dead skin cell breaks, and then sodium will flow into the cell through the crack
and ultimately form the ‘injury current’. When the current flows through the resistor of the
stratum corneum, there will be a potential change denoted as MA.

Adaptive filter has an extensive application in biomedical engineering, because of its simplicity,
real time processing ability and robustness. It can remove MAs from WECG with a reference
signal correlated with MAs and uncorrelated with WECG. We describe two concepts of the
reference signal detection.

Because of the non-stationary property of motion artifact, low filter output distortion and high
QRS beat detection accuracy can’t be satisfied simultaneously. We propose a new feed forward
combine adaptive filter algorithm to fix this problem.

We provide an overview of recent findings of adaptive filter algorithm-based motion artifact

suppression method.
1. Introduction
With the increasement of human life, the trend of aging is evident. In 2050, the population of
elder people (above 60 years old) will exceed the young people (below 15 years old). There will
be a large expense in medical care because of aging, and the healthy of old people will determine
the overall cost in medical insurance and the frequency to use advanced medical equipment. So it
is necessary to keep a healthy old life, simultaneously, with increasing the life expectancy of old
people. Wearable medical will be a major part helping old people to decrease the frequency of
hospital medical treatments and increase the survival rate.
Heart disease has the highest mortality rate. ECG is widely used to detect heart disease.
Wearable ECG is the new technology that expand ECG detection from the hospital to daily life.
However, in daily life, the patient is moveable, so the weak ECG signal will be affected by the
motion artifact, and then lead to wrong estimation of ECG features and trigger mistaken warning.
Recently, many researches have been published to find the original of motion artifact and the
method of suppression motion artifact.
In this chapter we will review these researches. In the first, we will discuss the source of motion
artifact from the view of anatomy and electrical model. Secondly, we will describe the detection
of motion artifact from electrical hardware system domain. In the end, we will introduce the
method of motion artifact using adaptive filter.

2. The original of motion artifact

(Tam and Webster 1977) found the amplitude of the deformation potentials decreases when the
horny layer of the skin is scraped away. Their results indicate the skin/paste interface is the major
source of motion artifact. The degree of skin abrasion has a significant effect on the magnitude of
change in skin potential shown in Figure 1.

Figure 1. Skin abrasion reduces both skin potential and motion artifact. (Tam and Webster 1977)
The skin is made up of three layers; the epidermis, the dermis and the subcutaneous layer, shown
in Figure 2. The stratum corneum is the surface layer and is the only layer of dead cells. Below
surface layer is the stratum granulosum and the stratum germinativum, which complete the
layers of the epidermis. The corium lies underneath the germinating layer. The rest of the dermis
is composed of structures of connective tissue, elastic tissue, and living cells.
Figure 2. Schematic diagram of the skin(Tam and Webster 1977)
Many models have been suggested, but they use Edelberg’s model which is most widely accepted,
shown in Figure 3.

Figure 3. Edelberg’s skin model. (Tam and Webster 1977)

In figure 3, the voltage 𝐸𝑒 is the potential across the epidermis barrier membrane. The Nernst
equation applies and the magnitude of 𝐸𝑒 is a function of the ingredients of the paste used. 𝑅𝑒
is the total series resistance of the epidermis. Skin abrasion lowers 𝑅𝑒 such that 𝑅𝑒 <<𝑅𝑒 and a
less negative skin potential (lower absolute magnitude) results because |𝐸𝑒 |<|𝐸𝑠 |. Also, the
smaller change of 𝑅𝑒 caused by skin deformation results in a much smaller change in skin
potential.
𝐸𝑠 is the potential across the sweat duct membrane, at the level of the stratum germinativum.
𝐸𝑠 is variable, because sweat has varying salt concentrations. 𝑅𝑠 is the total resistance in the
sweat duct. Its magnitude depends on the permeability of the sweat duct wall and on the height
of the column of sweat (saline) in the sweat duct. Sweat gland activity in response to sympathetic
activation produces the sweat column to rise, decreasing 𝑅𝑠 . Hydration of the corneum also has
an effecting in reducing 𝑅𝑒 . After applying electrodes, increased wetting of the corneum with
time caused by sweat and the interaction between sweat and the paste explains the long settling
time of the offset potential. The interrelationship can be represented by the equation.
𝐸 −𝐸
𝐸𝑠𝑘𝑖𝑛 = 𝐸𝑒 + 𝑅𝑒 (𝑅𝑠 +𝑅𝑒 ) F1
𝑠 𝑒
Changes in any of the four parameters end in a change of the skin potential. Thus, the net change
in offset potential of the recording system is the sum of individual changes in skin potential under
each electrode. In “diagnostic ECG” measurements, a lower cutoff frequency (-3dB) amplifier of
0.05 Hz is usually used. Very slowly varying offset potential does not cause a noticeable drift in
baseline. High speed of change in offset potential (𝑑𝐸𝑜𝑓𝑓𝑠𝑒𝑡 ⁄𝑑𝑡𝑖𝑚𝑒 ) causes observable motion
artifact problems. For example, when 𝑑𝐸𝑜𝑓𝑓𝑠𝑒𝑡 ⁄𝑑𝑡𝑖𝑚𝑒 = 2 𝑚𝑉⁄𝑚𝑖𝑛, the baseline is displaced
0.1mV. In the “monitoring mode,” the lower cutoff frequency is 0.5 Hz or higher and can tolerate
even greater changes of offset potentials.

The metabolic process of different skin layer causes diffusing ions, (Talhouet and Webster 1996).
(Thakor and Webster 1978) have hypothesized the metabolic process is the outcome of the
differences of metabolic activity between the dead cells lying in the outer layer of the skin and
the cells lying in the inner layer.
When mechanically stretching the skin, V becomes more positive by several millivolts. Thakor and
Webster explained the origin of this motion artifact ∆V as a reduction in the extracellular
channel resistance Z. Figure 4 shows the electrical model of the skin that they developed.

Figure 4 Electrical model of the skin(Thakor and Webster 1978)

The basement of this model is formed by two hypotheses form. First, they hypothesized the skin
potential arises from a constant current source called ‘injury current’ generated by the difference
of metabolic activity between the dead cells of the stratum corneum and the viable cells of the
inner layers of the skin. Second, they hypothesized that this injury current flows through the
extracellular channels which generate the negative dc voltage dropping from the inside to the
outside of the skin. The skin potential in Figure 4 is shown in Formula 2:
V = (−𝑅𝐼 )(𝑅𝑚 )(𝐼)/(𝑅𝑡 + 𝑅𝐶 + 𝑅𝑚 ) F2
Where 𝑅𝐶 is the impedance of the stratum, 𝑅𝑡 is the impedance of the transitional region
shunted by the current 𝐼 of negatively charged ions, and 𝑅𝑚 is the impedance of the
measuring device. With 𝑅𝑚 ≫ (𝑅𝑐 + 𝑅𝑡 ) we have:
V = (−𝑅𝑡 )(𝐼) F3
Because of the first hypothesis (𝐼 constant), the only way to obtain variations of V when
stretching the skin is to assume that 𝑅𝑡 alters: ∆V = (−∆𝑅𝑡 )(𝐼)
In Talhouet and Webster report, their model is not perfect because, because the values of ∆Z
that can be positive or negative for high values of Z, and the difference in shape between ∆V
and ∆Z.
They explained the increase in Z. They assume 𝑅𝑐 increasing more than the decrease in
𝑅𝑡 when stretching the skin. The different behavior between 𝑅𝑐 and 𝑅𝑡 could be clarified by
the geometrical configuration of the skin cells. The geometrical arrangement of the stratum
germinativum and granulosum could explain the decrease of 𝑅𝑡 by the truth that the
extracellular channels increase in diameter when stretching the skin. In the horizontally disposed
stratum corneum, the cells fit together so that the main resistance pathway for the ions is
composed of the horizontal channels between the cells.

Fig 5 Cross sectional of Skin and current path and the pathway vary with stretching the skin
(Thakor and Webster 1978)
When stretching the skin, figure 5 shows how this resistance pathway could increase. The cells
which are linked together by tight junctions or gap junctions could elongate under stretch and
would cause the length of the current pathway to increase. The cross-sectional area of the
current pathway could decrease.
They also suppose that stretching a cell in the transitional layer increases the diffusion of Na+
ions across the proximal side of its membrane. This will cause the interior of the cell to become
more positive and thus cause V to become more positive. Fig 6 shows their hypothesis. The
viscoelastic stretching and relaxing of the cell membrane could occur with long time constants
and cause the long-time constants observed in variations of the skin potential.
Fig 6 Hypothesis model that force causes the current generator to change and produce the slow
component(Thakor and Webster 1978)

(Burbank and Webster 1978) studied the artefact potential amplitude and strain dependence on
stretch force and time.
They stretched the skin under an electrode site for a time t with a repetition period r. The
resulting artifact potential amplitude A (defined as the maximum skin-potential change during
skin stretch from that just before skin stretch) depended on the relaxation time (r-t) before the
stretch as shown in Fig 7. The fit to an equation characteristic of a 1st-order system also shown if
Fig 7, appeared to be quite good.
A = 𝐴0 (1 − 𝑒 −(𝑟−𝑡)⁄𝜏 ) F4

Figure 7. Dependence of artifact amplitude on the duration of relaxation before stretch. (Burbank
and Webster 1978)
𝐴0 is the maximum artifact possible, and 𝜏 is the time constant of the system. The time
constant for the data in Fig 7 is 26 s, far longer than the skin’s electrical time constant (resistance
* capacitance), normally about 0.1 s at low frequencies.
They compared the strain and stretch force relationship with the artifact potential by changing
the stretch force while monitoring the skin strain, potential, and impedance. They increased the
stretch mass from 0-1 kg mass and then decreased it again to zero at a uniform rate of 30 g/s.
The impedance showed virtually stable during this cycle. Fig. 8 shows the skin strain and artifact
potential plotted against time and stretch mass. Note that although the strain was not a linear
function of the stretch mass, it exhibited little time dependence or ‘creep’. The artifact potential,
however, showed a very pronounced time dependence as discussed above.

Figure 8. Skin strain and artifact potential dependence on time and stretch weight(Burbank and
Webster 1978)
3. The detection of motion artifact
(Hamilton, Curley et al. 2000) reported a system for evaluating and comparing sensor based and
impedance based motion artifact removal. They applied sinusoidal current to the active electrode
pair. The series resistances on the secondary side of the transformer limited the current between
the electrodes to 1 uA with a 1V peak to peak function generator output. High pass and low pass
filters separate the ECG and artifact signals from the impedance signal. They used Butterworth
filters with cutoff frequencies of 50 Hz for the low pass and 100 Hz for the high pass filter. After
separating the motion artifact signal from the impedance signal, they applied an envelope
detector to monitor the amplitude of the impedance signal. The resulting envelope signal is
proportional to the impedance between the two electrodes. This signal is further bandpass
filtered to remove the DC level of the impedance. The bandpass filters have lower cutoff
frequencies of 0.16 Hz and upper cutoff frequencies of 106 Hz. They digitized the motion artifact
signal with 10 bits resolution and a sample rate of 120 samples/sec.

Figure 9 Benchtop motion artifact removal system(Hamilton, Curley et al. 2000)

Figure 10 shows an example of an impedance signal, the associated motion artifact.

Figure 10. Impedance signal (top), filtered signal (middle) and artifact signal (bottom) (Hamilton,
Curley et al. 2000)
(Spinelli, Mayosky et al. 2006) reported a simple direct method to measure the unbalance at
power line frequency.
Figure 11 System proposed to measure electrode-skin impedance unbalance(Spinelli, Mayosky et
al. 2006)
The external resistors 𝑅𝑐 ensure a well-known common mode input impedance. To apply the
method to three electrode amplifiers, the third (right leg) electrode must be disconnected.
They measured actual skin-electrode impedances. Two plate electrodes (12 𝑐𝑚2 area) were
placed on the right and left inner arms of the patient (ECG lead I). In a second experiment, the
electrode impedance unbalance between a plate electrode (right arm) and a cup electrode (left
arm) were measured, which should result in unbalances significantly larger than those obtained
for two similar electrodes placed on the same location. The dominant interference voltage is:
∆𝑍𝐸
𝑉𝐷.𝐸𝑀𝐼 = 𝑉𝐶𝑀 F5
𝑍𝐶

where ∆𝑍𝐸 is the electrode-skin unbalance, 𝑍𝐶 is the average common-mode input impedance,
𝑉𝐶𝑀 is the patient common mode voltage.

(Romero, Berset et al. 2011) reported an Application Specific Integrated Circuit (ASIC) for the
monitoring of 3-lead ECG signals and one-channel skin-electrode impedance or electrode tissue
impedance (ETI). ETI measurement was achieved by injecting an AC current and measuring the
voltage due to the ETI. Current needs to be applied with a stimulation frequency outside the ECG
range to avoid any interference with the ECG signal. A square-wave current at 2 kHz and known
amplitude was used. Following the model in Fig. 12, accurate measurement of the ETI
information required concurrent measurement of the resistive and capacitive components.
Figure 12. Electrical representation of the skin-electrode interface, and changes in electrical
properties under motion artifact(Romero, Berset et al. 2011)
This was achieved by demodulating the impedance signal with an in-phase frequency f(0), and a
quadrature-phase frequency f(90), respectively.
Fig. 13 shows the continuous time electrode skin impedance monitoring system with ECG signal.
The architecture consists of an instrumentation amplifier, ripple filter, programmable gain
amplifier and bandwidth controllable low pass filter. The ETI is measured and modulated with the
infected AC current signal. The resulting voltage is amplified by an instrumentation amplifier, and
demodulated at the output stage of the IA, with in-phase as well as quadrature phase chopper
clocks. The output signal of the IA (in-phase: IMPI, and quadrature-phase: IMPQ) is passed
through a low-pass filter and amplified with a PGA which has four different kinds of gain. The
output signals are a measure of the (complex) ETI.

Figure 13. Continuous time electrode skin impedance monitoring system with ECG signal(Romero,
Berset et al. 2011)
An important consideration for the design of the current stimulation block is the output
impedance of the current generator and DC component of the AC current source. The prior may
reduce the total input impedance of the ECG readout channel and the latter may further amplify
the effect of motion artifacts at the output of ECG channel. Hence, a chopper stabilized AC
current source is used. Chopper-stabilization is performed at twice the frequency of the AC
currents to set the mean value of the stimulation current to zero. The resulting AC voltage over
the electrode skin interface is only demodulated by the continuous- time impedance monitoring
channels. This enables the separation of ECG and impedance signals in the frequency domain by
using a low-pass filter.
Figure 14. Example of ECG and impedance signals recorded with the system: (a) at rest, (b)during
motion. (Romero, Berset et al. 2011)
Examples of ECG and impedance traces recorded with the system are given in Figure 14.

(Ottenbacher, Jatoba et al. 2007) reported a method to detect motion artifact by the
simultaneous measurement electrode-skin impedance with ECG signal. Figure 15 shows the
system. The sinusoidal current with 400Hz was infected at the same electrodes between which
the potential was measured.

Figure 15. Instrumentation(Ottenbacher, Jatoba et al. 2007)

The impedance and potential signal were separated by a high and low pass filter respectively. The
impedance signal was reconstructed using a dual lock-in amplifier. To be able to measure over a

very wide range of electrode impedance (500 Ω to 1M Ω) and to avoid high filter orders to

separate the ECG and impedance signal a very small current of < 1uA was used. The basic
overview of the experimental setup is shown in Fig.15. The experiments were done on the
forearm. A fixed reference electrode with gel was attached with tape near elbow. In one
experiment the dry measurement electrode was pressed against the arm (𝐹𝑝 ). In a second
experiment the skin under the dry electrode was stretched (𝐹𝑠 ), while the electrode was pressed
with a small weight against the arm.
Figure 16 Sample measurement: pressing on electrode(Ottenbacher, Jatoba et al. 2007)

Figure 17 Sample measurement: stretching skin under electrode(Ottenbacher, Jatoba et al. 2007)
Fig.16 and Fig.17 show sample measurements conducted with this setup. Force, potential and
electrode-skin impedance are depicted over time (in s). When the electrode is pressed against
the skin, the potential falls in the order of some mV. Correspondingly the impedance decreases.
When stretching the skin under the electrode the potential rises about some mV, which the
impedance also increases. The size of the impedance change is different from subject to subject
and very dependent on the humidity/sweat on the skin. It is assumed that the impedance
changes result mostly from the varying area of electrode-skin contact and not from impedance
change in the skin. A very good correlation between force electrode impedance and
electrode-skin potential can be found. Nevertheless, it must be considered that real life
movements are different, also stretching and pressing can occur simultaneously.
Fig.18 shows a measurement made with two dry electrodes on the chest. The correlation
coefficient between the impedance signal and the ECG signal over time is drawn. The peak value
does not give much information because it is dependent on how heavy the signal is contaminated
with artifacts. But the peak at zero time offset again shows the good correlation between the two
signals.

Figure 18. Correlation over time offset(Ottenbacher, Jatoba et al. 2007)

(Oberg 1982) reported a method to monitoring the skin-electrode contact. He added an
ac-voltage source with the potential U6 between the noninverting input of IC4 and ground, as
shown in Fig. 19.

Figure 19. A commonly used ECG amplifier. A, B and C are the points where the patient is
connected by means of the electrodes. (Oberg 1982)
As the ECG signal U3 is independent of U5 because of
𝑅1
𝑈3 = (𝑈2 − 𝑈1 ) (2 ∙ + 1)
𝑅2
The feedback loop from output to inverting input pass all contact points A, B and C. Assume that
the impedances 𝑍𝑎 , 𝑍𝑏 , and 𝑍𝑐 no longer are negligible. The impedances 𝑍𝑎 and 𝑍𝑏 are
equal. The sum of the impedances between the ground electrode and one of the inputs is called
𝑍𝑡 . For example, 𝑍𝑡 = 𝑍𝑎 + 𝑍𝑐 . The impedance 𝑍𝑡 together with the input resistance 𝑅𝑖𝑛 of
the amplifier forms a potential divider. In this case, the expression for U5 will be
2𝑍𝑡
𝑈5 = 𝑈6 |1 + |
𝑅𝑖𝑛
This means that U5 depends on 𝑍𝑡 . If the ground electrode is completely loosened, that is 𝑍𝑡 =
∞, then U5 goes to infinity. If the impedance 𝑍𝑎 ≠ 𝑍𝑏 by an amount 𝑍𝑑𝑖𝑓𝑓 , then it can be
shown that

1
𝑈5 = 2𝑈6 |1 − |
𝑍𝑑𝑖𝑓𝑓
+2
𝑅𝑖𝑛
In above U5 is dependent on the contact impedance. If one of the electrodes at points A or B
becomes loose
𝑈5 = 2𝑈6
Hence, if a voltage source is introduced at the noninverting input of IC4, then the output voltage
is dependent on the contact impedance 𝑍𝑎 , 𝑍𝑏 and 𝑍𝑐 . If U5 and U6 are compared, we can
decide whether the impedance in some of the contact points is too large.

Figure 20. Block diagram of the bioelectric amplifier (Degen and Jackel 2008)
(Degen and Jackel 2008) reported a new method that allows to monitor the electrode-skin
impedance in a continuous way. In Fig. 20, each channel is preceded by a protection circuit,
which is limiting the maximal current through the body to 50 uA. The method can be applied to a
three-electrode ECG without the additional reference electrode. The measurement circuit
operates as follows: Any voltage appearing at the positive input of the DRL op-amp forces the
DRL loop to react in such a way that the differential input voltage of the DRL op-amp is again zero.
For a sinusoidal signal, this is true if the frequency remains within the bandwidth of the DRL loop.
As a result, the sinusoidal voltage 𝑉𝑎𝑑𝑑 appears as a common-mode voltage to the input of the
instrumentation amplifier (INA). This additional common-mode voltage is rejected by the CMRR
of the INA, except for the part which is converted to a differential signal by the electrode-skin
impedance mismatch (potential divider effect) and amplified by the differential mode gain of
each INA. This part appears superimposed on the corresponding output voltage 𝑉𝑜𝑢𝑡𝑖 . If we
ignore all other sources, e.g., powerline interference and bioelectric signal, we can calculate the
residue of the additional common mode signal 𝑉𝑎𝑑𝑑𝑖 at electrode i.
The input impedance mismatch is:

𝑉𝑎𝑑𝑑𝑖
̅̅̅̅
∆𝑍𝑒𝑙 ∙ 𝑗𝜔𝐶 𝑖𝑛 𝐺𝐷𝑀 ≈
𝑉𝑎𝑑𝑑
They applied a sinusoidal force to the signal electrode i and both the norm of the residual voltage
|V_addi| and the bioelectric recording was measured. In Fig. 21, there is a strong relationship
between the measured impedance mismatch and the baseline variation. This is in accordance
with previously published results [1], [4] that show a similar relation between impedance
mismatch and baseline shift.

Figure 21. Simultaneous measurement of an ECG and the norm of the residual voltage |V_addi|
resulting from a sinusoidal force applied to electrode i. (Degen and Jackel 2008)

(Bertrand, Mihajlovic et al. 2013) reported the prediction of motion artifacts at one electrode
can be further improved by also incorporating the impedance measurements at other electrodes
in EEG recording.

(Comert and Hyttinen 2014) reported a simultaneous measurement of impedance at 8 current

frequencies during the application of controlled motion to the electrode at monitored electrode
mounting force. They found the different frequencies of impedance measurements do not reflect
the motion in the same manner. The best correlation between impedance and the applied
motion was seen at impedance current frequencies above 11 kHz. The impedance signal
correlated well with the applied motion; however, impedance had lower correlation to actual
motion artifact signal.

(Zhang, Zhang et al. 2015) reported an approach injects an additional common mode signal
though the reference electrode to measure the electrode tissue impedance and ECG signal
simultaneously. In order to reduce the MA in WECG, adaptive filter (AF) requires a reference
signal which has high correlation with MA and low correlation with WECG. In Fig. 22, MC-ETI
detection approach can generate the reference signal for the AF without any extra sensors.
Amplifier A2 forces an 1 kHz AC voltage though the driven right leg circuit and electrode ZLA .
There are two current paths though the body. One path flows through ZLA , ZRA , Zin to the
ground and the other path flows through ZLA , ZRA , Zin to the ground. Zin is the input
impedance of instrument amplifier. RA places several millimetres below the right collarbone and
LA places several millimetres below the left collarbone and LL places several millimetres below
the left breast.
When ZLA , ZLL , ZRA vary with the electrode movement, the divided voltages vLL , vRA will vary
simultaneously. A3 and A4 amplify these voltages differentially and generate two AC voltage
vETI_LL , vETI_RA . At the same time, A1 detects WECG signal vECG . An analogy-digital convertor
(ADC) samples these voltages with 80kHz sampling rate and transports the data to the person
computer (PC). A digital lock-in amplifier extracts the DC component from vETI_LL , vETI_RA and
calculate the MC-ETI signal by the following equations:
ZETI_LL ≈ ZLL ≈ (Zin − 2ZLA )VETI_LL⁄2VAC − 2ZLA
ZETI_RA ≈ ZRA ≈ (Zin − 2ZLA )VETI_RA⁄2VAC − 2ZLA
(1)

Analog Data Acquisition Personal Computer

Body
Front End NI 6363 LabVIEW

vETI_LL
A4
Phase(0º,90º)

Z in vETI_LL
M
Epidermis

vETI_RA ADC vETI_RA

Dermis

A3
`
U 16-Bit
X
vECG

ZLL vLL vECG

RG À1
ZRA vRA

ZLA
A2
vAC Phase(0º)

Figure 22. MC-ETI detection approach (Zhang, Zhang et al. 2015)

Fig. 23 shows a section of the WECG and reference signals generated by MC-ETI over a period
of 50 seconds with signals in the motionless and motion state. In the motionless state (0-15s and
45-50s), the WECG and MC-ETI signals are stable, but have no correlation. In the motion state
(15-45s), these signals are strongly correlated.

Figure 23 (a) ECG signal, (b) and (c) MC-ETI signals(Zhang, Zhang et al. 2015)
Fig. 24 shows the correlation coefficient between MC-ETI and the WECG signal over time offset.
In motion state, the peak of red curve at zero time offset shows the good correlation between
these two signals. However, there is no obvious peak of black curve at zero time offset in the
motionless state.

Figure 24. Correlation over time offset(Zhang, Zhang et al. 2015)

4. The suppression of motion artifact with adaptive
filter
With digital signal processing, the motion artifact in ECG can be suppressed. Many researches
have been reported, mostly on two methods: blind source separation (BSS) and adaptive filter
(AF).

(Changli 2010) reported BSS has found many applications in digital image processing, speech
signal processing, medical signal processing, geophysical signal processing, communication signal
processing, remote sensing image processing, etc. When the mixing process and the original
signals are unknown, BSS tries decomposing the observed sensor signals in order to obtain the
unmixed source signals, as seems mysterious. However, given some assumptions, BSS has had
great success and many novel and effective methods have been emerging.

(Sweeney, Ward et al. 2012) reported, as a branch of BSS, independent component analysis (ICA)
can separate different component from the source signals by define them as statistical
independent component.

(Romero 2011) reported, motion artifact and ECG signal are statistical independent, so they can
be separated by ICA.

But ICA is restricted by the data redundancy, it needs several independent sensors and can’t be
used in one channel sensor system, besides it is necessary to ensure each sensor’s signal
uncorrelated with other sensors’ signal. The large computational cost makes ICA very difficult for
the real time low power application.

Adaptive filter algorithm can automatically change its filter parameters and widely used in signal
processing field.

(Thakor and Zhu 1991) reported adaptive filtering technique is useful in many biomedical
applications. One simple but important application is in 60 Hz powerline interference
cancellation.

Adaptive filter is low computational cost and high reliability, so it is very suitable for real time low
power application.

(Tong, Bartels et al. 2002) reported motion artifact can be reduced using electrode motion as the
reference signal to an adaptive filter. Electrode motion was measured with two
custom-developed sensors that utilized anisotropic magnetoresistive (AMR) sensors and
accelerometers (ACC).
Figure 25. AMR (left) and ACC (right) sensors attached to ECG lead (Tong, Bartels et al. 2002)
Fig. 25 shows two motion sensors. A two axis AMR sensor were oriented to be parallel to the
body surface. A three axis ACC sensor developed using two dual axis ACC chips.

Figure 26. Schematic of implemented adaptive filter (Tong, Bartels et al. 2002)
Fig.26 shows the adaptive filter implemented in Matlab. The LMS algorithm was implemented for
the adaptive filter weight determination.
Figure 27. Example results for ACC sensor. (Tong, Bartels et al. 2002)
Fig. 27 shows the representative example of the filter results.

(Raya and Sison 2002) reported using an accelerometer as a source of noise reference. Least
Mean Squares (LMS) and Recursive Least Squares (RLS) adaptive filter algorithms are used. They
claimed the major kinematic acceleration component during human movement is usually found
in the vertical direction. Their adaptive filter can effectively reduce motion artifact in stress ECGs.

(Hamilton and Curley 1997) reported adaptive removal of motion artifact can be 12.5 dB by
using a skin stretch signal derived from sensors mounted on a foam electrode.
Figure 28. (a) ECG without motion artifact, (b) ECG and motion artifact, (c) ECG after adaptive
motion artifact removal (Hamilton and Curley 1997)
Fig.28 shown a four coefficients LMS adaptive filter’s output. The most significant artifacts
generated by skin stretch can still be adaptively removed. But their sensor cost roughly $600 each,
because of the integrated stretch sensor.

(Hamilton, Curley et al. 2000) reported using variable step size LMS (VSS-LMS) adaptive filter to
removal motion artifact of ECG.
𝑖

𝑠̂ [𝑛] = 𝑠[𝑛] − ∑ 𝑤𝑖 𝑛[𝑛 − 𝑖]

0

𝑤𝑖∗ = 𝑤𝑖 + 𝛽𝑠̂ [𝑛] ∙ 𝑛[𝑛 − 𝑖]

𝑎
β[𝑛] =
|𝑠[𝑛 − 𝑖] ∙ 𝑛[𝑛 − 𝑖]|
∑200
𝑖=1 200
Where 𝑠[𝑛] represents the nth sample of the noise corrupted ECG, 𝑛[𝑛] represents the nth
sample of the skin stretch or skin impedance signal, and 𝑠[𝑛] is the nth estimate of the signal
with motion artifact removed. The w is are filter coefficients that are interactively updated after
each sample according to equations (2) and (3) where a is 8.44 × 10−11 𝑉 2
Fig. 29 shows a segment of ECG recorded in a Lead II configuration while the author road his bike.
The middle trace shows the ECG after adaptive filter noise removal.

Figure 29. ECG and noise (top), filtered ECG (middle), and impedance signal (bottom) (Hamilton,
Curley et al. 2000)

(Wen-Ching, Yi-Shiang Ou et al. 2010) reported using normalized least mean square (NLMS)
adaptive filter algorithm to eliminate the motion artifact of primary input ECG. The NLMS
adaptively adjusts the 120 orders finite impulse response (FIR) filter with 0.05 adaptive step size.
They used ACC signal and Strain gauge (SG) signal as reference signals. They analyze the
correlation between the ECG and ACC, also the correlation between the ECG and the SG. The
higher one is chosen as the master reference and the lower one as the slave reference.

Figure 30. Walking activity (a) Raw ECG (b) noise reduced ECG by the master noise filter (c) noise
reduced ECG by the master slave noise filter (Wen-Ching, Yi-Shiang Ou et al. 2010)
Fig.30 is the experimental result in walking activity. Fig.30 (a) is the raw ECG. Fig.30 (b) is the
noise reduced ECG derived by using the master noise filter. Fig.30 (c) is the noise reduce ECG
derived by using the master-slave noise filter.

(Hyejung, Sunyoung et al. 2012) reported a two stages cascade LMS adaptive filter for ECG
monitoring system. As shown in Fig 31, the first LMS stage consisting of analog feedback prevents
the signal saturation to reduce the impute dynamic range. It employs a high pass filter, which
mainly targets the baseline wandering suppression to prevent the signal saturation. An adaptive
step size LMS algorithm is introduced and employed for the second LMS stage. It is applied to
remove the remained motion artifact. The adaptive step size algorithm can achieve fast
convergence to track large sudden motion artifact quickly, while preventing the distortion of the
ECG component.

Figure 31. System architecture of two-stage cascade adaptive filter(Hyejung, Sunyoung et al.
2012)
Fig 32 shows the proposed LMS algorithm with adaptive step size control. Compared to the
standard LMS algorithm, adaptive step size control block is integrated. The step size is updated as
a function, where it is adjusted to be large at high SNR and small at low SNR. The step size
adaptation function u(n) is changed proportional to both variation of the reference signal x(n)
and the input signal d(n) as given in (3-4)

Figure 32. Proposed LMS algorithm with adaptive step-size controller (Hyejung, Sunyoung et al.
2012)

c(𝑛) = 𝜎𝑥(𝑛) ∙ 𝜎𝑑(𝑛) ⁄𝑝

𝜇0 , 0 ≤ 𝑐(𝑛) < 𝜇0
𝜇′ (𝑛) = { 𝑐(𝑛), 𝜇0 ≤ 𝑐(𝑛) < 0.9
0.9, 0.9 ≤ 𝑐(𝑛)
Where q is the standard deviation (STD) of the signal during the half cycle of the heart rate, and p
is the experimentally determined constants, which sets the u(n) range between 0 and 1.

(Romero, Geng et al. 2012) reported the performance of different implementation of adaptive
filter (AdF) algorithms in the context of motion artifact reduction in ECG signals.
Figure 33. (a) Noisy ECG, (b) filtered ECG using LMS algorithm with the accelerometer as
reference, (c) filtered ECG using RLS algorithm, (d) filtered ECCG using convex AdF and € filtered
ECG using LMS sign-error with the SEI as reference. (Romero, Geng et al. 2012)
Fig. 33 shows an example of an unfiltered ECG signal together with four filtered ECGs (using LMS
algorithm with the accelerometer as reference, recursive least squares (RLS), convex AdF and
LMS sign-error with the skin-electrode impedance (SEI) as reference).

(Zhang, Zhang et al. 2016) reported a feed forward combine adaptive filter (FFC-AF) which is
composed by two separate AFs (one fast convergence speed AF ‘FCS-AF’ and one high
convergence accuracy AF ‘HCA-AF’) and one combination parameter which varies with the
estimation of reference signal stationary. Fig 34 describes its structure and (4) show its equation.
 Fast Convergence
Speed AF (FCS-AF)
d k   s k   n k 
Y1  k  Combination
W1  k  1  k 

X k  ek 

Y k 

W2  k  1  1  k 
Y2  k 

d k   s k   n k  High Convergence
Accuracy AF (HCA-AF)

Fig 34. FFC-AF block diagram(Zhang, Zhang et al. 2016)

Y(k) = λ1 (k) ∙ Y1 (k) + [1 − λ1 (k)] ∙ Y2 (k)
T (k)
Y1,2 = W1,2 ∙ X(k)
2
λ1 (k) = 1+exp[−p∙δ(k)] − 1
2 (4)
1 1
δ(k) = ∑n−1 n−1
i=0 (x i − ∑i=0 x i )
n n
p δ(k) ≥ δth
p = { non
{ psta δ(k) < δth
where X(k) is the reference signal of two separate filters. Parameters λ1 (k) is the combination
weight of the filter output, which lies between 0 and 1. At each iteration, λ1 (k) will update its
value according to the stationary degree of X(k) by its variance δ(k). When the X(k) is in
stationary state, δ(k) is lower than the threshold δth and this means that AF is in motion
artefact (MA) free state. Then λ1 (k) will maintain around 0 to increase the weight of high
convergence accuracy AF (HCA-AF) output. When X(k) is in non-stationary state, δ(k) is larger
than δth and this means that AF is in MA state. Then λ1 (k) will maintain around 1 to increase
the weight of fast convergence speed AF (FCS-AF) output.

Fig 35 Adaptive filter result and QRS beat detection(Zhang, Zhang et al. 2016)
Fig 35 shows the result of AF and one triangle represents one QRS beat detection.

5. Conclusion
With the wearable medical technology development, more and more wearable healthcare
monitoring patients are moving from hospital to home. ECG is one of the important vital
parameters and is the basement of wearable healthcare monitoring.
This chapter illustrates the original of motion artifact. Interesting experimental results are
introduced to describe the physical reason of motion artifact. Electronical models are provided to
qualitatively explain the motion artifact. Then we describe the detection of motion artifact.
Several electrical circuit architectures are provided from single channel skin electrode impedance
measurement and multichannel skin electrode impedance. Finally, we summarize applying
adaptive filter in motion artifact suppression. LMS, NLMS, VSS-LMS, cascade LMS and FFC LMS
algorithms are discussed. These would consist of the foundations to develop an ECG system
without motion artifact.

6. Acknowledgment
The coauthor Zhang would like to thank Prof Zhao JianLong from Chinese Academy of Science for
his support, advice and paper modification during my PhD research. I can’t imagine what will
happen without his hardly work. The support of Prof. Lim Chwee Teck from National University of
Singapore was very critical for me to finish this chapter.
I am particularly grateful Prof. Jiang MingHeng, ShanghaiTech University; Prof. Xie XiaoMing,
Prof. Zhang ShuLing, Prof. Mao HongJu, Prof. Li Gang, Prof. Jin QinHui, Dr. Fang XingXing, Dr. Chen
Ji, Dr. Du XiaoWei, Dr. Huang ShanRuo, Miss Xiao XiaoYu Chinese Academy of Science; Dr. Zong
Wei, Philips Healthcare; Dr. Yang Jian, Xuhui District Central Hospital; for their support in my
research.
My wife Mrs Chen ZhiXian gave me as much support as her can. Thank you my lover.
The editor Prof. Jiu ChengYu, Southeast University, did a very helpful work to read every inch of
the manuscript and provided numerous suggestions for improvements. Thank you for your hard
work.
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