Ewing Tester - Autonomic neuropathy testing system

Ewing Tester - Autonomic neuropathy testing systemEwing Tester - Autonomic neuropathy testing system

EWING TESTER (installed)EWING TESTER (installed)
EWING TESTER (portable)EWING TESTER (portable)
  • Sympathetic and parasympathetic tests
  • Three-channel built-in ECG module
  • Automatic management of examination and analysis
  • Adult and child version
  • Portable and installed version

The simplest way to characterize the autonomic nervous system functions is the reproducible and standardized cardiovascular reflex tests (CRT) described by Ewing. The examination is based on the analysis of the ECG and blood pressure values recorded continuously during the reflex tests. The first group of the reflex tests (fall of the orthostatic blood pressure, handgrip-test) mainly investigate the sympathetic nervous system functions, the others (heart rate response to deep inspiration and expiration, Valsalva maneuver, 30:15 ratio) deal with the operation of the parasympathetic nervous system.

 The importance of examining autonomic neuropathy has become clear by now, but its widespread application was hampered by the time-consuming methods of data registration and evaluation. Our company could solve this problem successfully by creating automatic management of the examination at software level with simultaneous evaluation of data.

System

Patient ManagerPatient Manager

This system is used to carry out Ewing’s reflex tests (for the examination of cardiovascular autonomic neuropathy) automatically. High level of integration of the system allows for execution of a series of tests – cooperation of the patient provided – by an assistant, even without a physician being present.

The patient file control panel is used for adding new patients to the database and for archiving the recorded data and further notes belonging to the patients. Digital data management provides the possibility to reload previous recordings and the related information at any time.

  • Examination of the parasympathetic and sympathetic functions: 30/15 ratio (heart rate response) and decrease in systolic blood pressure upon standing upExamination of the parasympathetic and sympathetic functions: 30/15 ratio (heart rate response) and decrease in systolic blood pressure upon standing up
  • Examination of the parasympathetic function: Heart rate response to the Valsalva maneuverExamination of the parasympathetic function: Heart rate response to the Valsalva maneuver
  • Examination of the parasympathetic function: Heart rate response to the Valsalva maneuverExamination of the parasympathetic function: Heart rate response to the Valsalva maneuver
  • Examination of the sympathetic function: Handgrip test (rise in diastolic blood pressure upon sustained tension of the hand muscles)Examination of the sympathetic function: Handgrip test (rise in diastolic blood pressure upon sustained tension of the hand muscles)
  • Examination of the parasympathetic and sympathetic functions: 30/15 ratio (heart rate response) and decrease in systolic blood pressure upon standing upExamination of the parasympathetic and sympathetic functions: 30/15 ratio (heart rate response) and decrease in systolic blood pressure upon standing up
  • Examination of the parasympathetic and sympathetic functions: 30/15 ratio (heart rate response) and decrease in systolic blood pressure upon standing upExamination of the parasympathetic and sympathetic functions: 30/15 ratio (heart rate response) and decrease in systolic blood pressure upon standing up

The list of NEUROPATHY TESTS (Ewing’s test) provided by this system:

Examination of the parasympathetic functions:

  • Heart rate response to deep inspiration and expiration,
  • Heart rate response to the Valsalva maneuver,
  • 30:15 ratio: heart rate response upon standing up.

Examination of the sympathetic functions:

  • Decrease in systolic blood pressure upon standing up,
  • Handgrip test: rise in diastolic blood pressure upon sustained tension of the hand muscles.
Protocol configuration boardProtocol configuration board
Text messages for help of measurementsText messages for help of measurements
Ewing score tableEwing score table
Automatic averaged ECG analysisAutomatic averaged ECG analysis
Printed ECG reportPrinted ECG report

 

Configuration of the tests can be done in the Protocol board. Beside the basic protocols found in the literature, further protocols applied successfully at the examination facility can be added and used. All protocols can be modified according to the user’s preferences.

 

The system gives assistance in performing the sympathetic and parasympathetic tests by written instructions and sound signals. Automatic management  and evaluation of the test significantly increases the throughput of patient care and results in higher cost-effectiveness.

 

The score values calculated by the automatic evaluation, running continuously during the tests, are automatically saved in the summarizing Ewing Score Board. The results – after validation by the physician – can be printed out immediately as a medical report.

 

The system can be used in Ewing and in ECGmode. Switching between the two is done in the software, thus the two examinations can be applied to the same patient consecutively. The integrated standard three-channel ECG of the system can be used for monitoring or for continuous, cycle- or time-based recording. From the saved data, ECG of the patient can be evaluated and printed out as a medical report by only a few mouse clicks.

 

Parameters calculated automatically:
R-R, Hr, Pmax, Qmax, Rmax, Tmax, ST, PQ, QRS, QT, QTc, T-Te.

Among the different versions, anyone can find the most suitable one according to the character of the examination facility, since the system is available in installed form (AC network powered) or in portable version (long-life battery powered). The battery powered version can operate on the currently available standard computer configurations, resulting in significant cost reduction for the user.

Specification

EWING TESTER (installed)

EWING TESTER (portable)

  • Adapter-powered operation with 5 kV isolation
  • 4 GB system memory
  • 3D graphical support
  • 2 GHz processor
  • Full alphanumeric keyboard for data input and mouse to move the cursor
  • Portable, battery-powered ECG device
  • USB connection to the computer providing a 5 kV communication isolation
  • Modern Li-ion battery power supply
  • Running time: 12 hours
  • Built-in automatic battery charger

Program run on Windows-based 64-bit OS

Program run on Windows-based OS

Standard 3-ch ECG recording

Standard 3-ch ECG recording

Screen speed: 5, 10, 25 or 50 mm/sec

Screen speed: 5, 10, 25 or 50 mm/sec

Displayed amplitude range: 5, 10, 20 or 50 mm/mV

Displayed amplitude range: 5, 10, 20 or 50 mm/mV

Each input is defibrillator proof

Each input is defibrillator proof

3-lead monitoring: real-time ECG curve monitoring and recording or review of stored records

3-lead monitoring: real-time ECG curve monitoring and recording or review of stored records

Pressure sensor to perform measurements of neuropathy

Pressure sensor to perform measurements of neuropathy

Measuring range of the pressure sensor: 0-200 mm Hg

Measuring range of the pressure sensor: 0-200 mm Hg

Manual and automatic mode

Manual and automatic mode

Continuous ECG monitoring with heart rate display

Continuous ECG monitoring with heart rate display

Baseline drift correction

Baseline drift correction

AC power noise filtering algorithm (50/60Hz)

AC power noise filtering algorithm (50/60Hz)

Muscle motion (tremble, tremor) filtering algorithm

Muscle motion (tremble, tremor) filtering algorithm

Digital sampling

Digital sampling

Sampling frequency: 1000 sample/sec/channel

Sampling frequency: 1000 sample/sec/channel

 

EWING TESTER (installed) built-in BP module

EWING TESTER (installed) built-in BP module

Configuration and measurement controlled by the software

Configuration and measurement controlled by the software

Blood pressure measurement of infants, children and adults

Blood pressure measurement of infants, children and adults

Oscillometric measurement

Oscillometric measurement

Maximal cuff pressure is 300 mm Hg for adults and 150 mm Hg for infants

Maximal cuff pressure is 300 mm Hg for adults and 150 mm Hg for infants

Real-time measuring, recording, or reviewing the stored data

Real-time measuring, recording, or reviewing the stored data

Pressure measuring ranges for adults: systolicpressure25-280mm Hg,diastolicpressure10-220mm Hg

Pressure measuring ranges for infants: systolicpressure20-150 mm Hg,diastolicpressure5-110mm Hg

Pressure measuring ranges for adults: systolicpressure25-280mm Hg,diastolicpressure10-220mm Hg

Pressure measuring ranges for infants: systolicpressure20-150 mm Hg,diastolicpressure5-110mm Hg

Manual and automatic mode

Manual and automatic mode

Measurement frequency in automatic mode: 1, 2, 3, 4, 5, 10, 15, 30, 60, 90 min

Measurement frequency in automatic mode: 1, 2, 3, 4, 5, 10, 15, 30, 60, 90 min

How can it help?

Cardiovascular autonomic neuropathy (CAN) often occurs in patients with diabetes, liver disease, autoimmune disease, in regular alcohol consumers, but can also occur in people suffering from metabolic syndrome. The importance of CAN is based on the complications threatening the quality of life and life expectancy of the patients. CAN is the most commonly examined form of autonomic nervous system dysfunctions, which is explained – beyond its clinical importance – by the easily performable and reproducible testing methods. The involvement of the autonomic nervous system may also affect cardial electrical activity, including ventricular repolarization. Its signs may also manifest as pathological changes of the surface ECG QT interval. Variable degree of damage in the adrenergic innervation of the myocardium results in the inhomogeneity of sympathetic influence, which can lead to inhomogeneous QT prolongation. Inhomogeneous prolongation of the QT interval, that is, of ventricular repolarization, may predispose to ventricular tachyarrhythmias. Increased QT dispersion is – besides silent myocardial infarction – an important risk factor of sudden cardiac death which can be traced back to malignant ventriculararrhythmia and is common in diabetic patients.

Assessment of the autonomic nervous system functions can be done most easily by the reproducible and properly standardized cardiovascular reflex tests (CRTs) described by Ewing. The examination is based on analysis of the ECG and blood pressure values recorded continuously during the reflex tests. One group of the reflex tests (orthostatic hypotension, handgrip strength test) mainly investigates sympathetic nervous system functions, while others (heart rate response to deep inspiration and expiration, Valsalva maneuver, 30:15 ratio) characterizes the functioning of the parasympathetic nervous system.

The importance of examining autonomic neuropathy has been generally recognized by now. Widespread application of this method was hampered because the methods of registration and evaluation of data were time-consuming. Our company has solved this problem successfully by automating the management of the examination at software level, and enabling simultaneous evaluation of data. Quick and easily identifiable data management provided by the software offers new ways in following-up patients with chronic diseases. Furthermore, this system can be perfectly applied in prevention, since cost-effectiveness and shorter examination time makes it suitable for health status surveys in large populations.

Available models

You find details by clicking on the product code.

ESP-01-PA Ewing Tester neuropathic measuring and analysing system with ECG module
(Portable design, adult version)

Code Name
SOFT-E1 Ewing Tester software
HUM-E1 Ewing Tester device
  Network adapter (230V/12V 1A)
CAB-012 USB A/B cable(3,0m)
CAB-023 Patient cable with four leads
HUM-91-42 Limb forceps set (adult, 4 pcs)
HUM-91-51 ECG spray
HUM-91-12 Cuff (22-32)
SEN-23-04 Pressure sensor
HUM-91-22 Pear syringe (5)
HUM-91-25 10 Mouthpiece
  Quick Start Manual
  User's Manual  (Cardiosys module)
  User's Manual (Ewing module)
  Application Assistance

ESP-01-PC Ewing Tester neuropathic measuring and analysing system with ECG module
(Portable design, child version)

Code Name
SOFT-E1 Ewing Tester software
HUM-E1 Ewing Tester device
  Network adapter (230V/12V 1A)
CAB-012 USB A/B cable(3,0m)
CAB-023 Patient cable with four leads
HUM-91-41 Limb forceps set (child, 4 db)
HUM-91-51 ECG spray
HUM-91-11 Cuff (14-21)
SEN-23-04 Pressure sensor
HUM-91-21 Pear syringe (3)
HUM-91-25 10 Mouthpiece
  Quick Start Manual
  User's Manual  (Cardiosys module)
  User's Manual (Ewing module)
  Application Assistance

ESP-01-IA Ewing Tester neuropathic measuring and analysing system with ECG module
(Installed design, adult version)

Code Name
SOFT-E1 Ewing Tester software
HUM-E2 Ewing Tester device
  MS Windows 7 OS
  Monitor
CAB-017 VGA cable
CAB-001 Network cable (230V, DIN)
  Keyboard
  Wireless mouse
CAB-001 Network cable (230V, DIN)
  Network adapter (230V/12V 5A)
CAB-023 Patient cable with four leads
HUM-91-42 Limb forceps set (adult, 4 pcs)
HUM-91-51 ECG spray
HUM-91-12 Cuff (22-32)
SEN-23-04 Pressure sensor
HUM-91-22 Pear syringe (5)
HUM-91-25 10 Mouthpiece
  Quick Start Manual
  User's Manual  (Cardiosys module)
  User's Manual (Ewing module)
  Application Assistance

ESP-01-IC Ewing Tester neuropathic measuring and analysing system with ECG module
(Installed design, child version)

Code Name
SOFT-E1 Ewing Tester software
HUM-E2 Ewing Tester device
  MS Windows 7 OS
  Monitor
CAB-017 VGA cable
CAB-001 Network cable (230V, DIN)
  Keyboard
  Wireless mouse
CAB-001 Network cable  (230V, DIN)
  Network adapter (230V/12V 5A)
CAB-023 Patient cable with four leads
HUM-91-41 Limb forceps set (child, 4 db)
HUM-91-51 ECG spray
HUM-91-11 Cuff (14-21)
SEN-23-04 Pressure sensor
HUM-91-21 Pear syringe (3)
HUM-91-25 10 Mouthpiece
  Quick Start Manual
  User's Manual  (Cardiosys module)
  User's Manual (Ewing module)
  Application Assistance

Media

Cardiovascular and autonomous neuropathy analyzing systems  Download the catatolgue in pdf version!

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