1. Introduction
The radial pulse has long served as a vital aspect of healthcare, offering insights into an individual’s health status [
1,
2,
3,
4]. In Western medicine, the augmentation index and augmentation pressure derived from radial pulse pressure waveforms have emerged as reliable markers for assessing arterial compliance, cardiovascular disease risk, and overall health [
1,
2,
5,
6,
7]. Similarly, Oriental Medicine (OM) and Tactical Combat Casualty Care (TCCC) have relied on palpating radial pulse pressures with three fingers as a diagnostic tool [
8,
9,
10]. The three-finger technique is a well-known and long-standing method of diagnosis in OM, where the physician places three fingers over the patient’s radial artery to assess the patient’s health condition. A physician applies differing levels of pressure to ascertain the medical state of the patient [
9]. While pulse diagnosis is a standard practice in OM, it heavily relies on the expertise and subjectivity of physicians. The readings of a pulse can, indeed, be highly subjective, varying from person to person. Therefore, there is a significant opportunity to enhance the teaching and training of pulse diagnosis in OM by standardizing common pulses. By establishing standardized guidelines, the consistency and accuracy of pulse diagnosis can be greatly improved. Furthermore, the radial pulse serves as an indicator for TCCC on the battlefield, as mentioned in the
TCCC Handbook [
11]. The
TCCC Handbook provides instructions for medical care in combat situations, where the strength of the radial pulse is used to assess the condition of a wounded soldier, particularly to determine if they are in a state of shock. If an “abnormal radial pulse” is observed, the wounded soldier is considered to be in shock, and the appropriate amount of fluid is administered [
11]. However, the term “abnormal” can be vague and inconsistent among soldiers. Thus, the implementation of a standardized approach to measuring pulses could help in training soldiers to accurately assess wounded individuals on the battlefield.
The radial pulse can play a vital role in the wearable healthcare industry. The rise of wearable technology has brought about a revolution in healthcare by enabling continuous real-time monitoring of vital signs, empowering users with a better understanding of their well-being. Wrist-worn systems, in particular, strive to offer non-invasive real-time blood pressure (BP) monitoring through sensor readings from radial pulses. This technology facilitates convenient and accessible blood pressure checks, potentially resulting in enhanced health outcomes.
Advancing the technology and medical applications related to the radial pulse requires the development of pulse simulators that can generate a wide array of human radial pulses. These simulators are essential for calibrating wearable sensors and training medical professionals in pulse palpation techniques. While the subjective nature of the three-finger technique used in OM underscores the need for pulse standardization, wearable healthcare devices require certified and calibrated embedded sensors to ensure the quality and reliability of collected data [
5]. Clinical trials are a valuable means to validate sensor accuracy and provide training for medical personnel. However, it is important to acknowledge that human subject testing can be both expensive and time-consuming. Furthermore, the variability in blood pressure in patients throughout the day adds another layer of complexity [
12]. Therefore, while clinical trials remain crucial, they can be resource-intensive due to the involvement of human subjects, rendering pulse simulators a cost-effective and dependable alternative for validating and calibrating wearable technology.
Currently, a few pulse generators are available on the market. Commercially available pulsatile blood pumps are designed to simulate animal pulses, while other simulators cater to medical professional training [
13,
14]. These pulse generators have limited capacity to generate user-defined pulse waveforms and tend to be bulky. Ongoing research is focused on developing more advanced and versatile simulators. One study presented a model that incorporates all four chambers of the heart to allow for tunable stiffness [
15]. While the article found the set-up can closely match the waveforms of various heart conditions, it did not investigate replicating a range of age-related pulses [
15].
To enhance the versatility and capabilities of pulse generation, another study employed smart or controllable fluids in a pulse simulation system [
16]. This system utilized a peristaltic pump to circulate a magneto-rheological (MR) fluid whose properties could be controlled by an external magnetic field. As a class of smart materials, MR fluids have been utilized in various engineering applications, including automotive suspension systems and haptic devices [
17,
18,
19,
20,
21,
22,
23,
24,
25,
26,
27]. An MR fluid consists of micron-sized iron particles suspended in a carrier fluid [
28]. These particles respond to an external magnetic field by resisting flow, with a resistance proportional to the field’s strength. Consequently, MR fluids are highly controllable, exhibit rapid response times, and require low power for operation. However, MR fluid-based systems typically need an electromagnet to generate the magnetic field, which poses challenges for miniaturizing MR devices. In a peristaltic pump system, a magnetic valve was used to control the fluid motion to create pulse pressure waveforms. By manipulating the peak amplitude ratio and separation or time delay between two peaks, various “two-peak” pulse waveform patterns were created, demonstrating the controllability of the augmentation index. Another investigation involved the development of a small pulsatile simulator using a cam-follower system [
29]. A specially designed disk cam, generated from in vivo radial pulse data, replicated pulse waveforms accurately and consistently. However, this cam-based pulse simulator required the fabrication of a new cam disk for each desired pulse waveform, rendering it unable to continuously generate a range of radial pulses.
In a feasibility study conducted by Eaton et al., an MR pulse-shaping method was employed for a cam-based pulse system in order to generate a variety of pulse waveforms [
30]. The MR fluid was utilized to shape a base pulse into a desired waveform, successfully replicating age-specific pulse waveforms using multiple cam disks. While the study demonstrated the feasibility of the MR fluid system in shaping age-related pulses, further enhancements are required to achieve a wide range of target pulse waveforms without having to use multiple cams.
The present study aimed to expand upon the aforementioned feasibility study by replicating a range of age-related pulses using a single cam. The primary goal of the “MR fluid based blood pulse-shaping” technique is to eliminate the need for multiple cam disks for different age groups, enabling the continuous and repeatable generation of pulses in a cost-effective manner. A single baseline pulse created by a cam pulse generator is shaped into a variety of age-related radial pulse waveforms using an MR fluid as the means to shape the baseline pulse. Furthermore, a parametric study will be presented, which further investigates the relationship between the input duty values and the resulting waveform. Two cams were utilized in this paper, an MR shaping cam and a half-cam. The MR shaping cam was used to shape the pulses into the desired in vivo waveforms, while the half-cam was used during the parametric study.
The outline of this paper begins with the experimental set-up and the approach to shaping cams via an MR fluid. It then transitions to the discussion and results of shaping a base pulse into three distinct ages using a single cam. Finally, the parametric study is discussed, explaining in detail the relationship between the input duty values and the output slope of the waveform.
4. Slope-Based Pulse Shaping
This section investigates the slope-based pulse-shaping method, aiming to develop a systematic control approach for the MR pulse simulator through a parametric study of the input values. The slope-based pulse technique involved calculating the slopes of the desired radial pulse during the descending phase and then determining the necessary inputs to replicate the pulse accurately. The initial steep ascension of the pulse was not calculated as the incline for normalized pulses is about the same, as can be seen in
Figure 4b. To develop this method, the range of slopes required for age-related slopes was found. As noted before, the radial pulses of 20–80-year-olds can be used to represent the entire lifespan of a human. Therefore, the slopes of 20-, 50-, and 80-year-old radial pulses were determined by breaking each pulse into five regions. Each region was a relatively linear section which, when pieced together, was representative of the entire radial pulse. The slope analysis of the 80-year-old pulse can be found in
Figure 9. An example of the five zones can be noted in
Figure 9a. The resulting slopes of the five regions and the “pieced”-together 80-year-old pulse are shown in
Figure 9b. The overall shape of the slope lines resembles the descending phase of an 80-year-old pulse. Once these slopes were determined, the range of slopes was found to be between 0 (or a horizontal line) and −7.2. This meant the experimental set-up must be able to replicate slopes anywhere from a horizontal line to a steep descent. Once the range of slopes was established, the next step was to investigate the multiple ways to obtain these slopes. Thus, a parametric study was conducted.
Effects of Parametric Variations on Slope
The following section explains the parametric study that was performed to understand how the MR fluid shaped the base pulse. The goals of the parametric study included determining the capability of the system to generate a range of slopes within the required 0 to −7.2 range and the variables that affected the displacement slope. Note that the displacement slope refers to the slope of the pulse waveform generated by the movement of the plunger. Thus, the term “displacement slope” describes the gradient of the pulse waveform influenced by the plunger’s displacement. To better capture the effect of the MR fluid on the slopes, a specific half-cam was used in place of the base pulse cam. A schematic of the design of the half-cam is shown in
Figure 10a, which maintains two distinct radii for half of the circumference. The theoretical normalized displacement of the half-cam is illustrated in
Figure 10b, where the horizontal line displacement is due to the constant radius. The actual physical half-cam is shown in
Figure 10c, with the actual normalized displacement in
Figure 10d. The actual displacement matches well with the design, as there is a constant horizontal displacement over the cycle. The shape and displacement graph of the half-cam is in stark contrast with the base pulse input, which has various slopes throughout its phase. The advantage of using the half-cam for this parametric study was the ability to understand the direct impact the duty values had on the displacement slope. With the half-cam, any deviation in the slope was attributed to the duty values rather than the inherent shape of the cam disk. After choosing the half-cam, the main parameters of the duty values were determined. Duty values that would significantly alter the horizontal displacement slope were chosen. The electromagnet (which altered the state of the MR fluid) was controlled via the duty values, which, in part, changed the displacement. The initial testing showed a ramp input of duty values most affected the displacement. Using a ramp input of duty values, it was concluded there are three main ways in which the duty values can change: slope, magnitude, and time duration. These variables were investigated to determine which ones affected the displacement slope.
Figure 11 illustrates the three variables related to the duty values. The slope variable is depicted by the difference between lines 1 and 2, with slope 2 being larger than slope 1. The duty slope, which represented the change in duty per millisecond, was calculated by dividing the percent increase in duty by the time period over which the duty values were applied (units: %/s). While the duration of the constant duty input remained the same, the initial duty value, which represented the electromagnetic force input waveform that determined the rising slope of the blood pressure waveform, was held constant. However, the final duty value changed from line 1 to line 2, resulting in an increased slope. The effect of changing the magnitude of the duty cycle is best illustrated between lines 2 and 3. While the slope between these lines remains consistent and the duration over which they act is the same, line 3 is shifted upward, increasing the magnitude of the duty values. Although the initial duty values between the lines differ, they maintain the same slope, which affects the magnitude of the duty values. The final variable examined was the time duration, observed between lines 1 and 4. Both lines exhibit a constant slope and start at the same duty value, but the duration for line 4 (b) is significantly longer than that for line 1 (a). Therefore, lines 1 and 4 highlight the difference in the time duration. These three variables are key methods for adjusting a ramp duty input. The parametric study isolated and varied these variables individually to predict the displacement slope across a range of duty values.
The first of a series of three tests is described as follows. This initial study varied the duty slopes to observe their effect on the displacement slopes, with the results shown in
Figure 12. The overall duration of the duty values remained constant at approximately 0.075 s (750 ms), and the initial duty value was kept at 25% for all slopes. This consistency was based on preliminary tests, which indicated that varying the duty slope had little effect on the displacement slope if the final duty value remained constant. Therefore, the initial duty slopes were kept constant to ensure more reliable results. The input duty slopes, ranging from 0.03%/ms to 0.75%/ms, are illustrated in
Figure 12a. These variations in the duty slopes resulted in final duty values ranging from 28% to 100%. The color and line types in
Figure 12a correspond to the results shown in
Figure 12b, which depicts the normalized displacement of the half-cam for various duty slopes.
In
Figure 12b, the initial ascent and horizontal plateau characteristics of the half-cam are visible. Duties were activated during the middle of the plateau, and the resulting descending slope represents the calculated slope value. To ensure that the descending displacement slope was attributable solely to the duty values, the duty values were delayed during the middle of the half-cam cycle for accurate measurements. The results indicate that the displacement slope ranged from 0 to −7.2, encompassing the range needed to represent various in vivo pulses throughout a human lifespan. Additionally, a direct relationship was observed between the duty slope and the displacement slope: as the duty slope increased, so did the displacement slope. A duty slope of 0.03%/ms had a minimal impact on the displacement slope (appearing as a horizontal line), while a duty slope of 0.75%/ms resulted in a displacement slope of −7.2. These findings demonstrate that the duty slopes significantly affected the normalized displacement slope. Although this test used an initial duty value of 25%, future tests explored the effect of varying the initial duty value, or the magnitude of the duty values.
Once the range of displacement slopes was established, the effect of varying the initial duty value was investigated. The results of changing these initial duty values are shown in
Figure 13. The initial duty values tested were 20%, 50%, and 70%, as illustrated in
Figure 13a, with a constant duty slope of 0.4%/ms. The final displacement slopes are depicted in
Figure 13b within the boxed area. The line types and colors match between the two graphs, showing that as the initial duty value increased, the displacement slope also increased. Specifically, there was a significant change in the displacement slope between the initial duty values of 20% and 70%. An initial duty value of 20% resulted in a minimal change in the displacement slope, while an initial duty value of 70% led to a displacement slope of nearly −7. This suggests there may be a threshold value where the MR fluid’s strength significantly alters the displacement slope. A threshold of around 50% was indicated by the significant displacement slope of −4 observed at this initial duty value. Furthermore, the displacement slope of −6.8 with a 0.4%/ms duty slope was very similar to the displacement slope of −7.2 with a 0.75%/ms duty slope. This implies that various combinations of slope and initial values can produce similar displacement slopes. The goal of this parametric study was to define these relationships and understand how the three variables—duty slope, initial magnitude, and time duration—can be adjusted simultaneously to achieve a desired displacement slope. The final test focused on altering the time duration of the duty values to determine its effect on the displacement slopes.
The third and final test of the parametric study examined the effect of varying the duration for which the duty values were applied. The results of this testing are shown in
Figure 14. The duration of the duty values varied between 100 ms, 200 ms, and 275 ms. The testing was constrained by the period of the half-cam, which allowed a maximum duration of 400 ms. As shown in
Figure 14b, the displacement slope did not change with varying time durations; it remained close to −2, even when the duration of duty value activation nearly tripled. This indicates that only the previous two variables (duty slope and initial magnitude) significantly affected the displacement slope.
This parametric study established a direct relationship between the duty slopes and displacement slopes, with the displacement slopes ranging from 0 to −7.2. Additionally, the initial duty value significantly influenced the displacement slope, showing another direct relationship. However, the duration for which the duty values were applied did not affect the displacement slope. Therefore, the key variables to consider when determining the displacement slope are the duty slopes and initial duty values. The findings of this parametric study provide insights into how duty values influence displacement and help identify the variables that cause changes in pulse waveforms.