Intrusion Detection and Real-Time Adaptive Security in Medical IoT Using a Cyber-Physical System Design

The increasing reliance on Medical Internet of Things (MIoT) devices introduces critical cybersecurity vulnerabilities, necessitating advanced, adaptive defense mechanisms. Recent cyber incidents-such as compromised critical care systems, modified therapeutic device outputs, and fraudulent clinical data inputs-demonstrate that these threats now directly impact life-critical aspects of patient security. In this paper, we introduce a machine learning-enabled Cognitive Cyber-Physical System (ML-CCPS), which is designed to identify and respond to cyber threats in MIoT environments through a layered cognitive architecture. The system is constructed on a feedback-looped architecture integrating hybrid feature modeling, physical behavioral analysis, and Extreme Learning Machine (ELM)-based classification to provide adaptive access control, continuous monitoring, and reliable intrusion detection. ML-CCPS is capable of outperforming benchmark classifiers with an acceptable computational cost, as evidenced by its macro F1-score of 97.8% and an AUC of 99.1% when evaluated with the ToN-IoT dataset. Alongside classification accuracy, the framework has demonstrated reliable behaviour under noisy telemetry, maintained strong efficiency in resource-constrained settings, and scaled effectively with larger numbers of connected devices. Comparative evaluations, radar-style synthesis, and ablation studies further validate its effectiveness in real-time MIoT environments and its ability to detect novel attack types with high reliability.