UNIT I INTRODUCTION TO WEARABLE SYSTEMS AND

SENSORS
Wearable Systems- Introduction, Need for Wearable Systems, Drawbacks
of Conventional Systems for Wearable Monitoring, Applications of
Wearable Systems, Types of Wearable Systems, Components of wearable
Systems. Sensors for wearable systems-Inertia movement sensors,
Respiration activity sensor, Inductive plethysmography, Impedance
plethysmography, pneumography, Wearable ground reaction force
sensor.

Chapter 1
Wearable Systems- Introduction
Wearable technology is any kind of electronic device designed to be worn
on the user's body. Such devices can take many different forms, including
jewelry, accessories, medical devices, and clothing or elements of
clothing. The term wearable computing implies processing or
communications capabilities, but in reality, the sophistication among
wearables can vary.

The most sophisticated examples of wearable technology

include artificial intelligence (AI) hearing aids, Google Glass and
Microsoft's HoloLens, and a holographic computer in the form of a virtual
reality (VR) headset. An example of a less complex form of wearable
technology is a disposable skin patch with sensors that transmit patient
data wirelessly to a control device in a healthcare facility.

Need for wearables

Fundamentally, wearables can perform the following basic functions or
unit operations
• Sense
• Process (Analyze)
• Store
• Transmit
• Apply (Utilize)
Of course, the specifics of each function will depend on the application
domain and the
wearer, and all the processing may occur actually on the individual or at
a remote location
(e.g., command and control center for first responders, fans watching the
race, or viewers
enjoying the mountaineer’s view from the Mount Everest base camp).

Figure 2 is a schematic representation of the unit operations associated

with obtaining and
processing situational data using wearables. For example, if dangerous
gases are detected by a wearable on a first responder, the data can be
processed in the wearable and an alert issued. Simultaneously, it may be
transmitted to a remote location for confirmatory testing and the results –
along with any appropriate response (i.e., put on a gas mask) – can be
communicated to the user in real-time to potentially save a life . This same
philosophy can also be used by an avid gamer who might change his
strategy depending on what “weapons” are available to him and how his
opponents are performing. Each of these scenarios requires personalized
mobile information processing, which can transform the sensory data into
information and then to knowledge that will be of value to the individual
responding to the situation. While wearables are being used in many
fields, as discussed, this chapter will focus primarily on wearables in the
healthcare domain. Wearables provide an unobtrusive way to
longitudinally monitor an individual – not just during the day but, over
the individual’s life-time. Such an expansive view of the individual will
be valuable in detecting changes over time and help in early detection of
problems and diseases leading to preemptive care and hence, a better
quality of life. Inferring the potential of wearables in other application
domains should be straightforward and can be accomplished by
instantiating the fundamental principles and concepts presented here.
Attributes of wearables
A sensor is defined as “a device used to detect, locate, or quantify energy
or matter, giving a signal for the detection of a physical or chemical
property to which the device responds”. Not all sensors are necessarily
wearable, but all wearables, as discussed earlier and shown in Figure 2,
must have sensing capabilities. The key attributes required of an ideal
wearable are shown in Figure 4. From a physical standpoint, the wearable
must be lightweight and the form factor should be variable to suit the
wearer. For instance, if the form factor of the wearable to monitor the vital
signs of an infant prone to sudden infant death syndrome prevents the
infant from (physically) lying down properly, it could have significant
negative implications. The same would apply to an avid gamer – if the
form factor interferes with her ability to play “naturally,” the less likely
that she would be to adopt or use the technology. Esthetics also plays a
key role in the acceptance and use of any device or technology. This is
especially important when the device is also seen by others i.e., the
essence of fashion. Therefore, if the wearable on a user is likely to be
visible to others, it should be esthetically pleasing and, optionally, even
make a fashion statement while meeting its functionality. In fact, with
wearables increasingly becoming an integral part of everyday lives, the
sociological facets of the acceptance of wearables open up exciting
avenues for research. Ideally, a wearable should become such an integral
part of the wearer’s clothing or accessories that it becomes a “natural”
extension of the individual and “disappears” for all intents and purposes.
It must have the flexibility to be shape-conformable to suit the desired
end-use; in short, it should behave like the human skin. The wearable must
also have the multifunctional capability and be easily configurable for the
desired end-use application. Wearables with single functionality (e.g.,
measuring just the heart rate) are useful, but in practical applications,
more than one parameter is typically monitored; and, having multiple
wearables – one for each function or data stream – would make the
individual look like a cyborg and deter their use even if the multiple data
streams could be effectively managed. The wearable’s responsiveness is
critical, especially when used for real-time data acquisition and control
(e.g., monitoring a first responder in a smoke-filled scene). Therefore, it
must be “always on.” Finally, it must have sufficient data bandwidth to
enable the degree of interactivity, which is key to its successful use.
Finally, wearables can be classified based on their field of application,
which can range from health and wellness monitoring to position tracking.
“Information processing” is listed as one of the application areas because
many of these traditional functions such as processing e-mail can now be
done on a wearable in the form of a wristwatch. It is important to note that
not all the classes are mutually exclusive. For instance, a wearable can be
multifunctional, active, noninvasive, and be reusable for health
monitoring. The proposed taxonomy serves two key functions: First, it
helps in classifying the currently available wearables so that the
appropriate ones can be selected depending upon the operating
constraints; second, it helps in identifying opportunities for the design and
development of newer wearables with performance attributes for sp ecific
areas that need to be addressed.
Taxonomy for wearables
Figure 5 shows the proposed taxonomy for wearables. To begin with, they
can be classified as a single function or multifunctional. They can also be
classified as invasive or noninvasive. Invasive wearables (sensors) can be
further classified as minimally invasive, those that penetrate the skin
(subcutaneous) to obtain the signals, or as an implantable, such as a
pacemaker. Implantable sensors require a hospital procedure to be put into
place inside the body. Noninvasive wearables may or may not be in
physical contact with the body; the ones not in contact could either be
monitoring the individual or the ambient environment (e.g., a camera for
capturing the scene around the wearer or a gas sensor for detecting
harmful gases in the area). Noninvasive sensors are typically used in
systems for continuous monitoring because their use does not require
extensive intervention from a healthcare professional.
Wearables can also be classified as active or passive depending upon
whether or not they need the power to operate; pulse oximetry sensors fall
into the former, while a temperature probe is an example of a passive
wearable that does not require its power to operate. Yet another view of
wearables is the mode in which the signals are transmitted for processing
wired or wireless. In the former, the signals are transmitted over a physical
data bus to a processor; in the wireless class of wearables, the
communications capability is built into it, which transmits the signals
wirelessly to a monitoring unit.
Components of wearable Systems.
The main components of wearable devices are as follows

1. Control
Wearable-specific microcontrollers are small, so as to be comfortable and
discrete. On the other hand, the distinctive shapes and colors can function
as a decorative element. Several of the boards available are hand-
washable (minus the power source). Read the documentation carefully.

2. Input/Output
In place of pins, these boards have metal eyelets which you can loop
conductive thread through to sew soft circuit connections. Some boards
also have snaps — or eyelets large enough to solder on snaps — for easy
removal.

3. Conductive Textiles
A material containing metals, such as silver or stainless steel, through
which an electrical current can flow is said to be conductive. Wearable
systems can make use of these materials in a variety of ways, such as:
 Thread for making circuits
 Fabric for capacitive touch sensors
 Hook-and-loop for switches

4. Sensors
Sensors gather information about the environment, the user, or both.
Examples of the former include light, temperature, motion (ACC), and
location (GPS). Examples of the latter include heart rate (ECG), brain
waves (EEG), and muscle tension (EMG). A few wearable
microcontrollers have basic sensors onboard. Other manufacturers offer a
range of external sensor modules that connect to the main board.

5. Power
When scoping out a wearable design one of the first things to consider is
the power requirement. Do you just want to illuminate a few LEDs, or do
you want to run a servomotor? Boards with an integrated holder for a
lithium coin battery are nice for low-power projects that need to be self-
contained. However, boards with a standard JST connector (with or
without a circuit to charge LiPo batteries) are more versatile.

6. Actuators
One generic way to describe a wearable system is: In response to X, where
X is the input from a sensor, Y happens. Actuators such as LEDs, buzzers
or speakers, and servomotors are what make things happen.

7. Networking
To communicate with smart devices, the internet, or other wearable
systems, you need wireless connectivity. In addition to Wi-Fi and
Bluetooth, wearable-friendly options include:
 BLE, which has lower power consumption than classic Bluetooth, a
range of 50m, and a data transmission rate up to 1 Mbps
 NFC, a radio frequency field with a range of approximately 20cm and
data transmission rate up to about 400 Kbps

Types of Wearable Systems

1.Smartwatches:

These days, the watches are tech-enabled. They double up as a fitness

tracker, and sleep monitor in addition to being the classic time-keeping
device. Smartwatches provide us with many other features including
enabling us to make & attend phone calls and check messages. Some
watches have the feature of playing FM radio or audio & video files with
a Bluetooth headset. They generally connect to the smartphone via an app
and act as a supporting device. They are often referred to as a ‘Wearable
Computer’ on your wrist because of the bundle of features that can use
through the touchscreen.

2.FitnessTrackers:

Fitness Trackers are among the wearable technology devices wearable on

the wrist. Fitness trackers were primarily launched to perform the function
of pedometer, i.e. counting the number of steps but they have evolved to
become an overall health monitor since then. They perform various
functions including tracking your heartbeat, monitoring your sleep,
calories burned, and other metrics. They share the data to the app on the
smartphone. In toto, they make a perfect health tracker. Some devices are
enabled to regularly share the information on the metrics of the wearer to
their physicians to keep them informed and help early detection of any
issue.

3.SmartJewelry:

Jewelry no more acts like pieces of ornaments on your neck or hand, they
have become smart. Smart Jewelry are those wearables like necklaces,
wrist bands, bracelets, or rings that are tech-enabled to help you track your
steps, track monitor your heartbeat & sleep, and some even notify you of
incomingcalls.

4.GameSimulators:

The rise of VR in gaming has given rise to many wearable devices that
simulate an environment and make the experience more realistic,
engrossing, and adventurous. The devices include VR Headsets (also
called Head-Mounted Displays or HMDs) that create a visual simulation
and bands that come with built-in sensors to detect your movements.
These bands enable you to control your movements through hand
gestures.

5.SmartClothing:

The advancement of technology with IoT has fostered many inventions

including Smart Clothes. Smart clothes are also popularly known as E-
Textile as they come integrated with electronic devices that measure the
health metrics of the wearer. Smart clothes help measure health-related
aspects like heart rate, respiration rate, sleep, the body temperature, and
provide you with that information. Smart clothing also includes smart
shoes that examine your health, steps, fatigue, and collect other metrics to
help you improve health and prevent injury.

6.SmartGlasses:

Ranging from simple smart glasses that are equipped with Bluetooth
wireless music and hands-free calling to the glasses that can live stream
videos to take photos, to advanced smart glasses that are AR-enabled to
give you an immersive experience, these smart glasses are the of eyewear.
Smart glasses can enable the user to read text messages and reply to them
hands-free. Smart glasses by some companies are equipped with features
like internet access and browsing through voice commands.

7.HeartbeatTrackers&BloodPressureMonitors:

There are fitness trackers for a specific use case like monitoring the
heartbeat or regularly measuring the blood pressure. These devices help
track the metrics among the people who suffer from related diseases. The
fitness trackers record and provide the measurements to the wearer
regularly. Some devices are enabled to share the data with the physician.

8.SmartEarbuds:
New to enter the wearable technology market are earbuds. Though
Bluetooth earbuds are existing for a while now, they aren’t considered
among wearable technology because they do not collect and send data.
But some companies are making earbuds smart. Smart earbuds have a
built-in gyroscope, GPS, and compass. The sensors in the earbuds relay
the information to the smartphone, which enables it to know your
direction and movement. Hence, the smart earbuds are equipped to
provide directions in real-time.

9.SmartContactLens:

Smart Contact Lens is among the recent inventions made possible with
IoT. The smart contact lenses currently available in the market are helpful
for medical reasons. It helps monitor eyes for various diseases like
Diabetes, Glaucoma, and cataracts. It helps in the treatment of
farsightedness. Apart from medical reasons, some companies are working
on smart contact lenses that are AR-enabled, work on solar power, and
capture and store images and videos. Smart lenses are among the
implantable devices.
Applications of wearables
Currently other applications within healthcare are being explored, such
as:

 Applications for monitoring of glucose, alcohol, and lactateor blood

oxygen, breath monitoring, heartbeat, heart rate and
its variability, electromyography (EMG), electrocardiogram (ECG)
and electroencephalogram (EEG), body temperature, pressure (e.g. in
shoes), sweat rate or sweat loss, levels of uric acid and ions – e.g. for
preventing fatigue or injuries or for optimizing training patterns,
including via "human-integrated electronics"
 Forecasting changes in mood, stress, and health
 Measuring blood alcohol content
 Measuring athletic performance
 Monitoring how sick the user is
 Detecting early signs of infection
 Long-term monitoring of patients with heart and circulatory problems
that records an electrocardiogram and is self-moistening
 Health Risk Assessment applications, including measures
of frailty and risks of age-dependent diseases
 Automatic documentation of care activities
 Days-long continuous imaging of diverse organs via a
wearable bioadhesive stretchable high-resolution ultrasound imaging
patch or e.g. a wearable continuous heart ultrasound imager (potential
novel diagnostic and monitoring tools)
 Sleep tracking
 Cortisol monitoring for measuring stress
 Measuring relaxation or alertness e.g. to adjust their modulation or to
measure efficacy of modulation techniques

 Epidermal skin technology. According to Science Daily, the

Terasaki Institute for Biomedical Innovation invented wearable
electronic skin for monitoring health. A next-generation of
wearables, this ultra-thin e-skin patch can be attached to the wearer's
chest area along with a small wireless transmitter by using water
spray and can be worn for up to a week. It is sensitive enough to
pick up and record electro signals, such as heartbeats and muscle
movements, which can be sent to healthcare providers via the cloud
so they can monitor the user's vitals remotely. This powerful
wearable is a steppingstone for monitoring chronic illnesses such as
heart failure and diabetes.

 Health monitoring. People use wearable technology to track and

receive notifications for their heart rate and blood pressure, watch
their calorie intake or manage their training regimens. The COVID-
19 pandemic boosted the use of wearable technology, as consumers
gained a broader awareness of personal hygiene and taking
 precautions to prevent the spread of infections. Apple, for instance,
updated its Cardiogram app by introducing a new sleeping beats-
per-minute feature that monitors heart rate fluctuations for COVID-
19 patients.

 Entertainment and gaming. The gaming and entertainment

industries were the first to adopt VR headsets, smart glasses and
controllers. Popular VR head-mounted displays, such as Oculus
Quest, Meta Quest and Sony PlayStation VR, are used for all types
of entertainment purposes, including gaming, watching movies and
virtual traveling.

 Fashion and smart clothing. Clothing known as smart clothing,

or intelligent fashion, has been gaining wide popularity over the past
few years. Smart jackets, such as Levi's jacket made with Google's
Project Jacquard technology whose threads are composed of
electrical fibers, enable the wearer to answer calls, play music or
take photos right from their sleeves. Smartwatches, wristbands,
smart shoes and smart jewelry are also popular examples of
wearable technology.

 Military. These wearables include technology that tracks soldiers'

vitals, VR-based simulation exercises and sustainability technology,
such as boot inserts that estimate how well the soldiers are holding
their equipment weight and how terrain factors can affect their
performance.

 Sports and fitness. Sports use wearable athletic devices that are
either built into the fabric of the sports apparel or are incorporated
into sports equipment, such as bats and balls. The GPS and
Bluetooth-linked devices relay real-time data to coaches for analysis
through connected electronic devices such as laptops. Besides
wearable athletic devices, familiar wearable technology such as
Fitbit, Apple Watch, Garmin, Samsung Galaxy Watch and Polar are
 used extensively to track various areas of the player's health and
performance metrics.

Advantages of Wearable Technology

 Rapid data results can help drive improvements. Having

immediate data to make decisions and drive improvements may
be helpful, rather than waiting for more formal or detailed
assessments.
 Detailed data can supplement loss analysis and loss
trends. Additional data can help identify specific trends in your
claims history.
 Can help build a business case for senior management. It can
be challenging to help senior management make decisions or
determine if some of your funding should be spent on
improvements. The data from wearable technology devices can
help support your business case for that spend.
 Data from wearable sensors offers promising job risk analysis
and evaluation opportunities for safety and ergonomics
practitioners. Most ergonomic assessments or evaluations
require additional time to observe and manually collect data.
Having instant data can save time and expedite ergonomic
assessments or evaluations.
 Enhance employee wellness programs. More organizations are
starting to promote wellness programs for employees. Some
wearable technology devices can assist with easily tracking
wellness program data that could supplement or support your
efforts.

Disadvantages of Wearable Technology

 Requires a time commitment to review and analyze data. A
team or committee may need to review the large amount of data
that is generated from the devices.
 Requires financial commitments and planning. You may need
senior management or finance team approval prior to the full
implementation stage. The cost of wearable technology depends
on how many employees and locations are involved.
 Devices could lead to distraction. For many employees, wearing
this device for an entire shift can be distracting, especially if the
device has haptic feedback or vibration reminders.
 Data security and privacy could be compromised with legal,
financial, and personal consequences. An information
technology (IT) department will need to ensure the data generated
from the devices is secured for authorized individuals and ensure
proper consent is obtained from each individual whose data is
being collected.
 Devices could lead to over-trust or under-trust. This could be
challenging when reviewing all the data to determine realistic
trends. Sometimes this results in trusting or not trusting all the
reviewed data before making any decisions or improvements.
Sensors for Wearable Systems
Introduction
When designing wearable systems to be used for physiological and
biomechanical parameters monitoring, it is important to integrate sensors
easy to use, comfortable to wear, and minimally obtrusive. Wearable
systems include sensors for detecting physiological signs placed on-body
without discomfort, and possibly with capability of real-time and
continuous recording. The system should also be equipped with wireless
communication to transmit signals, although sometimes it is opportune to
extract locally relevant variables, which are transmitted when needed.
Most sensors embedded into wearable systems need to be placed at
specific body locations, e.g. motion sensors used to track the movements
of body segments, often in direct contact with the skin, e.g. physiological
sensors such as pulse meters or oximeters. However, it is reasonable to
embed sensors within pieces of clothing to make the wearable system as
less obtrusive as possible. In general, such systems should also contain
some elementary processing capabilities to perform signal pre-processing
and reduce the amount of data to be transmitted. A key technology for
wearable systems is the possibility of implementing robust, cheap
microsystems enabling the combination of all the above functionalities in
a single device. This technology combines so-called micro-electro-
mechanical systems (MEMS) with advanced electronic packaging
technologies. The former allows complex electronic systems and
mechanical structures (including sensors and even simple motors) to be
jointly manufactured in a single semiconductor chip. A generic wearable
system can be structured as a stack of different layers. The lowest layer is
represented by the body, where the skin is the first interface with the
sensor layer. This latter is comprised of three sub-layers: garment and
sensors, conditioning and filtering of the signals and local processing. The
processing layer collects the different sensor signals, extracts specific
features and classifies the signals to provide high-level outcomes for the
application layer. The application layer can provide the feedback to the
user and/or to the professional, according to the specific applications and
to the user needs. Recent developments embed signal processing in their
systems, e.g. extraction of heart rate, respiration rate and activity level.
Activity classification and more advanced processing on e.g. heart signals
can be achievable exploiting miniaturization and low-power consumption
of the systems. Examples of data classification are[1, 2, 3]: classification
of movement patterns such as sitting, walking or resting by using
accelerometer data [4] or ECG parameters such as ST distance extracted
from raw ECG data [5, 3]; another example is the estimation of the energy
consumption of the body [6, 7]; in [8] the combined use of a triaxial
accelerometer and a wearable heart rate sensor was exploited to accurately
classify human physical activity; estimation of upper limb posture by
means of textile embedded flexible piezo resistive sensors [9]. Examples
of integrated systems for health monitoring are in [10, 11]. In the
following paragraphs, two classes of sensors which can be easily
integrated into wearable systems are reported and described. More
specifically, inertial sensors to monitor biomechanical parameters of
human body and sensors to capture physiological signs are addressed,
describing the operating principles and indicating the possible fields of
application.
Sensors for Wearable Systems
Biomechanical Sensors
Biomechanical sensors are thought to be used to record kinematic
parameters of body segments. Knowledge of body movement and gesture
can be a means to detect movement disturbances related to a specific
pathology or helpful to contextualize physiological information within
specific physical activities. An increasing of heart rate, for example, could
be either due to an altered cardiac behavior or simply because the subject
is running.
Inertial Movement Sensors
Monitoring of parameters related to human movement has a wide range
of applications. In the medical field, motion analysis tools are widely used
both in rehabilitation and in diagnostics. In the multimedia field, motion
tracking is used for the implementation of life like videogame interfaces
and for computer animation. Standard techniques enabling motion
analysis are based on stereo-photogrammetric, magnetic and
electromechanical systems. These devices are very accurate but they
operate in a restricted area and/or they require the application of obtrusive
parts on the subject body. On the other hand, the recent advances in
technology have led to the design and development of new tools in the
field of motion detection which are comfortable for the user, portable and
easily usable in non-structured environments. Current prototypes realized
by these emergent technologies utilize micro-transducers applied to the
subject body (as described in the current paragraph) or textile-based strain
sensors. The first category, instead, includes devices based on inertial
sensors (mainly accelerometers and gyroscopes) that are directly applied
on the body segment to be monitored. These sensors can be realized on a
single chip (MEMS technology) with low cost and outstanding
miniaturization. Accelerometers are widely used for the automatic
discrimination of physical activity and the estimation of body segment
inclination with respect to the absolute vertical. Accelerometers alone are
not indicated for the estimation of the full orientation of body segments.
The body segment orientation can be estimated by using the combination
of different sensors through data fusion techniques (Inertial Measurement
Units, IMU). Usually, tri-axial accelerometers (inclination), tri-axial
gyroscopes (angular velocity), magnetometers (heading angle) and
temperature sensors (thermal drift compensation) are used together. Main
advantages of using accelerometers in motion analysis are the very low
encumbrance and the low cost. Disadvantages are related to the possibility
of obtaining only the inclination information in quasi-static situations (the
effect of the system acceleration is a noise and the double integration of
acceleration to estimate the segment absolute position is unreliable).
Accelerometers are widely used in the field of wearable monitoring
systems, generally used in the monitoring of daily life activities (ADL).
Physical activity detection can be exploited for several fields of
application, e.g. energy expenditure estimation, tremor or functional use
of a body segment, assessment of motor control, load estimation using
inverse dynamics techniques [26, 27] or artificial sensory feedback for
control of electrical neuromuscular stimulation [28, 29, 30]. Usually,
three-axial accelerometers are used. They can be assembled by mounting
three single-axis accelerometers in a box with their sensitive axes in
orthogonal directions or using a sensor based on one mass [31]. An
accelerometer measures the acceleration and the local gravity that it
experiences. Considering a calibrated tri-axial accelerometer (the
accelerometer signal (y) contains two factors: one is due to the gravity
vector (g) and the other depends on the system inertial acceleration (a),
both of them expressed in the accelerometer reference frame :The
inclination vector (z) is defined as the vertical unit vector, expressed in
the accelerometer coordinate frame [4]. In static conditions, only the
factor due to gravity is present and the inclination of the accelerometer
with respect to the vertical is known. In dynamic conditions, the raw
accelerometer signal does not provide a reliable estimation of the
inclination, since the inertial acceleration is added to the gravity factor.
This estimation error grows as the subject movements become faster (e.g.
running, jumping). Many algorithms have been developed and tested to
perform a reliable estimation of the subject body inclination: most of them
use low pass filters with very low cut-off frequency in order to extract
z[4] (i.e. introducing a considerable time delay), others implement more
complex techniques which use a model-based approach mainly based on
Kalman filter techniques. An example of integration of these sensors in a
garment was developed in the frame of the Proetex project (FP6-2004-
IST-4-026987), which aimed at using textile and fibre based integrated
smart wearables for emergency disaster intervention personnel. The
ProeTEX motion sensing platform is used to detect long periods of user
immobility and user falls to the ground and it is realized by means of two
tri-axial accelerometer modules. One accelerometer is placed in the higher
part of the trunk (collar level) in order to detect inactivity and falls to the
ground. The second sensor is placed in the wrist region and its aim is to
achieve more accuracy in inactivity detection, since an operator can move
his arms while his trunk is not moving. The core of the motion sensor is
the processing algorithm described in, which allows to perform a reliable
estimation of the body inclination even in the case of intense physical
activity such as running or jumping. This algorithm allows a good
estimation of subject activities and generated fall alarms with very high
sensitivity and extremely low level of false positives.
Respiration Activity sensor
The most challenging vital sign to accurately record during continuous
monitoring is the respiratory activity due to the fact that the signals are
affected by movement artifacts and filtering or feature recognition
algorithms are not very effective. Monitoring of respiratory activity
involves the collection of data on the amount and the rate at which air
passes into and out of the lungs over a given period of time. In literature,
there are several methods to do this, both directly, by measuring the
amount of air exchanged during the respiration activity, and indirectly, by
measuring parameters physically correlated to breathing, such as changes
in thorax circumference and/or cross section, or trans-thoracic impedance.
Direct methods are based on a spyrometer that measures directly the
airflow in the lung exchanged during inspiration and expiration, but of
course it cannot be integrated into a wearable system because it employs
a mouthpiece, which could interfere with the freedom of movements,
disrupting the normal breathing pattern during measurement, thus causing
discomfort for the user. Indirect methods exploit displacements of the
lung that are transmitted to the thorax wall and vice versa, and therefore
measurements of chest-abdominal surface movements can be used to
estimate lung volume variation. In literature, a number of devices have
been used to measure rib cage and abdominal motion including mercury
in rubber strain gauges, linear differential transducers, magnetometers,
and optical techniques, but almost all cannot be comfortably integrated
into a wearable system. For reference only, it is worthwhile citing a more
sophisticated technique, called stereo photogrammetry, which makes it
possible to estimate the three-dimensional coordinates of points of the
thorax, estimating therefore volume variations. Nevertheless, this system
presents a considerable drawback in that it is cumbersome, extremely
expensive, and can only be used in research environments or in laboratory
applications. Indirect techniques that can be implemented in wearable
systems are respiratory inductive plethysmography, impedance
plethysmography, piezo resistive and/or piezoelectric pneumography.
These systems are minimally invasive and do not interfere with physical
activity.
Inductive Plethysmography
The inductive plethysmography method for breathing monitoring consists
of two elastic conductive wires placed around the thorax and the abdomen
to detect the cross sectional area changes of the rib cage and the abdomen
region during the respiratory cycles. The conductive wires are insulated
and generally sewn in a zig-zag fashion onto each separate cloth band.
They can be considered as a coil and are used to modulate the output
frequency of a sinewave current produced by an electric oscillator circuit.
As a matter of fact, the sinewave current generates a magnetic field, and
the cross-sectional area changes due to the respiratory movements of the
rib cage and of the abdomen determine a variation of the magnetic field
flow through the coils. This change in flow causes a variation of the self-
inductance of each coil that modulates the output frequency of the
sinusoidal oscillator. This relationship allows for monitoring the
respiratory activity by detecting the frequency change in the oscillator
output signal. For accurate volumetric measurements using RIP, it is
assumed that the cross-sectional area within the rib cage and the abdomen
coil, respectively, reflects all of the changes occurring within the
respective lung compartment, and further that the lung volume change is
the sum of the volume changes of the two compartments. Under optimal
situations, lung volume can be approximated with an error less than 10%.
Impedance Plethysmography
This technique consists of injecting a high frequency and low amplitude
current through a pair of electrodes placed on the thorax and measuring
the trans-thoracic electrical impedance changes [40]. As a matter of fact,
there is a relationship between the flow of air through the lungs and the
impedance change of the thorax. The measurements can be carried out by
using either two or four electrode configurations. Electrodes can be made
of fabric and integrated into a garment or,even, embedded into an
undershirt. It is worthwhile noting that by measuring the trans-thoracic
electrical impedance it is possible to non-invasively monitor, in addition
to breathing rate also tidal volume, functional residual capacity, lung
water and cardiac output.
Pneumography Based on Piezoresistive Sensor
Piezoresistive pneumography is carried out by means of piezoresistive
sensors that monitor the cross-sectional variations of the rib cage. The
piezoresistive sensor changes its electrical resistance if stretched or
shortened and is sensitive to the thoracic circumference variations that
occur during respiration. Piezoresistive sensors can be easily realized as
simple elastic wires or by means of an innovative sensorized textile
technology. It consists of a conductive mixture directly spread over the
fabric. The lightness and the adherence of the fabric make the sensorized
garments truly unobtrusive and uncumbersome, and hence comfortable
for the subject wearing them. This mixture does not change the
mechanical properties of the fabric and maintains the wearability of the
garment. Figure 1.3 shows where the two conductive wires or bands could
be applied.
Plethysmography Based on Piezoelectric Sensor
This method is based on a piezoelectric cable or strip which can be simply
fastened around the thorax, thus monitoring the thorax circumference
variations during the respiratory activity. A possible implementation can
be a coaxial cable whose dielectric is a piezoelectric polymer (p(VDF-
TrFE)), which can be easily sewn in a textile belt and placed around the
chest. The sensor is sensitive to the thorax movements and produces a
signal directly proportional to the thorax expansion in terms of charge
variation, which was converted in an output voltage proportional to the
charge by means of a charge amplifier. A suitable local processor can
enable implementation of the Fast FourierTransform in real time and
extraction of the breathing rate.
Wearable GRF Sensor System
The quantitative analysis of gait variability using kinematics and kinetic
characterizations can be helpful to medical doctors in monitoring
patients’ recovery status in clinical applications. Moreover, these
quantitative results may help to strengthen their confidence in the
rehabilitation. Walking speed, stride length, the centre of mass (CoM)
and the centre of pressure (CoP) have been considered as factors in the
evaluation of walking gait. According to one study on slip type falls,
friction force was used to draw up important safety criteria for detecting
safe gait, so the transverse components of ground reaction force (GRF)
may provide important information for quantifying gait variability. Many
kinds of stationary systems such as force plates and instrumented
treadmill devices are available to measure CoP and triaxial GRF. Because
a stationary force plate cannot measure more than one stride, in studies of
continuous walking, a complex system consisting of many force plates
and a data fusion method must be constructed . Therefore, the force plate
technology probably imposes some constraints on our ability to measure
human movement and is not feasible for measurements in everyday
situations. An instrumented treadmill or dynamometric platform formed
by laying two force plates under a treadmill can overcome some
limitations of the system with distributed multiple force plates in
successive measurements of the GRF for gait evaluation. However, a
guide used to constrain the direction of the foot is necessary to ensure
that subjects walk along a straight line, because if a human body segment
motion analysis system is not available for a simultaneous measurement
of the foot orientation, any technique based on force plates conventionally
requires subjects to walk along a pre-defined specific path. Although gait
variability can be assessed in straight walking , gait analysis
concentrating solely on straight-line walking or running may not
adequately interpret gait variability, because turning or walking direction
changes probably have effects on extrinsic gait variability . To overcome
such limitations of stationary devices in GRF measurement, many
researchers are developing wearable sensors attached to shoes . Pressure
sensors have been widely used to measure gaits and the distributed
vertical component of GRF and to analyze the loading pattern on the
plantar soft tissue during the stance phase of gait , but in these systems
the transverse components of GRF (friction forces) which are one of the
main factors leading to falling, have been neglected. By fixing two
externally mounted sensors beneath the front and rear boards of a special
shoe, researchers have developed an instrumented shoe for ambulatory
measurements of CoP and triaxial GRF in successive walking trials, and
the application of the instrumented shoe to estimate joint moments and
powers of the ankle was introduced in. The mounted sensor itself, having
a height of 15.7 mm, increases the height and weight of the shoe, and
affects normal walking gait. Moreover, its application study was
restricted to human kinetics analysis using the spatio temporal
measurements of GRF and CoP.

A wearable GRF sensor system was constructed using five small

triaxial force
sensors (USL06-H5-500N-C, weight: 15 g, size: 20 mm × 20 mm × 5
mm). The GRF and CoP measured using the wearable sensor system were
expressed in a global coordinate system which was located on the
interface between the instrumented shoe and the ground. The origin of
the global coordinate system was fixed to a point around the anatomical
centre of the ankle when the sensor system was worn on the foot. The x-
axis was chosen to represent the anterior-posterior direction on the
interface plane contacting with the floor, which was based on landmarks
from the shoe. The z-axis was made vertical, and the y-axis was chosen
such that the resulting global coordinate system would be right-handed.
By mounting the five triaxial sensors on an aluminum plate beneath the
shoe, we can accurately align all five local coordinate systems defined
for each triaxial sensor with the global coordinates. Fxi, Fyiand Fzi ( I =
1, 2, 3, 4 and 5) indicate triaxial forces measured by the distributed five
triaxial sensors, and (xi, yi) is defined as the position of each triaxial
sensor, for example, (x5, y5) indicates the position of the sensor placed
on the forefoot. The total weight of the sensor shoe is about 300 g, and the
shoe size is 250 mm.
UNIT II SIGNAL PROCESSING AND ENERGY HARVESTING FOR WEARABLE
DEVICES
Wearability issues -physical shape and placement of sensor, Technical challenges - sensor
design, signal acquisition, sampling frequency for reduced energy consumption,
Rejection of irrelevant information. Power Requirements- Solar cell, Vibration based,
Thermal based, Human body as a heat source for power generation, Hybrid
thermoelectric photovoltaic energy harvests, Thermopiles

Wearability issues
Wearable devices and electronics present a unique interface of technology and
humanity, thus producing unique challenges that need to account both for technological
and human aspects of the problem. Human behavior may affect the operation of
wearable as much as the technology advance. The following aspects may be considered
as some of the challenges facing the field of wearables:

(a) Break-through applications of wearable electronics. From the dawn of history, the
evolution of wearables is driven by the practicality, utility, and convenience they
provide. The challenge of modern wearable electronics in discovering ubiquitous
applications, as its future growth is contingent on emerging applications in health,
wellness, and other personal needs. Novel applications of wearables may need to be
supported by extensions of sensing and data analytics capabilities, thus presenting a
compelling use case
(b) Minimization of user burden and integration with everyday wear items. The
illustrations of wearable devices frequently include pictures of individuals
instrumented at every possible location on the body, such as arms, legs, torso, etc.
Practically, such a scenario represents an unrealistically high user burden and is
unfeasible. A related challenge is the seamless integration of wearable electronics in
everyday wear items, such as textiles clothing, footwear and accessories.
(c) Efficient and informative interpretation of data generated by wearable devices.
Wearable devices may generate an abundance of data, for e.g., health-related sensor
signals.The challenge lies in the interpretation of such data streams and connection
with health outcomes, using sensor data to guide behavioral interventions and health
education. Emerging methods of artificial intelligence carry a promise of solution to
the problem of data analysis and interpretation.
(d) Ultra-low power operation. A wearable device should ideally sustain a lifetime
operation without or minimal user interference. In terms of power, this implies
operation on a battery, energy harvested from the body, or a combination thereof.
This requires low-power operation both for analog and digital electronics of a
wearable. Wireless power delivery may be explored to seamlessly charge many
devices without need to connect each individual device to a charging circuit (for e.g.,
charging all socks in a drawer), biofuel cells and supercapacitors may need to be
utilized in the power subsystems.
(e) Flexible and stretchable electronics. Epidermal and body compliant electronic
devices may be considered a subset of wearables with additional requirements of
 allowing shape changes in response to body movement, making such devices
especially sensitive to motion artifacts, demanding high biocompatibility and
adaptability to variation in human body shapes, sizes, and characteristics.
(f) Biocompatible communications. Communications from the body (to the outside
world) and on the body (between multiple wearables) demand new solutions, as
traditional radio methods experience challenges due to absorption by body tissue.
The related challenges include development of efficient methods for communicating
through or on the body, including the organization of wearables in body sensor
networks and their integration into the Internet of Things Biodegradable Electronics.
If wearable electronics are to become the true mainstream, the challenge of
sustainable, ecologically viable manufacturing, and disposal needs to be addressed.
(h) Privacy and Security. By definition, a wearable is an electronic device that resides
on or close to a person and is present in a variety of life situations. The challenges
include protection of personal information, preventing the unauthorized use of
wearables for biometric identification, and ownership of the data produced by
wearables

physical shape and placement of sensor

The sensor such as 3-axis accelerometer can be used as body position sensor. This
sensor provides information of patient's position i.e. standing, sitting, supine, inclined,
left and right. Such accelerometer based sensor can easily be interfaced with any
microcontroller boards such as arduino uno, arduino mega etc.
Design for wearable BSNs focuses on specific and important issues for developing wearable
computing systems that take into account the physical shape of the sensors and their active
relationship with the human form.
Design for wearability requires unobtrusive sensor node placement on the human body based
on application-specific criteria.
Criteria for placement can vary with the needs of functionality and convenience.
Functionality criteria constrains node placement to regions where relevant data can be sensed. The
number of nodes required to capture all relevant data can vary based on the quality of
information sensed at individual locations. Convenience criteria include:(1) physical
interference with movement,(2) difficulty in removing and placing nodes,(3) social and
fashion concerns,(4) frequency and difficulty of maintenance(charging and cleaning)
For example, in continuous healthcare monitoring, patients will be expected to charge the sensors or
replace the batteries on a regular basis, as they do with cellphones and other
electronics.However, the frequent need to charge and the bulk of the battery can frustrate the users,
causing them to no longer wear the sensors. Furthermore, batteries are the heaviest component in
the system. By decreasing power usage, the size and weight of each sensor node can decrease,
thus increasing patient comfort and device wearability.
This makes energy usage a primary constraint in designing BSNs, limiting everything from data
sensing rates and link bandwidth, to node size and weight. Thus, one of the important goals in
designing BSNs is to minimize energy consumption while preserving an acceptable quality
of service. Energy consumption can be decreased by lower sampling frequency, decreasing
processing power, and simplifying signal processing.
Another effective technique is deactivating nodes thatare unnecessary for specific tasks.

Technical challenges - sensor design and signal aquisation

As engineers seek to develop new and innovative wearable diagnostics, many are
focusing on smaller, more energy-efficient devices. In the process, respondents say they
are fighting the kind of typical constraints that factor into many of today’s product
development efforts, citing top among them the areas of cost (38%), durability (37%)
and power management (35%).
There are other unique challenges in designing diagnostic wearables to be used by a
patient, caregiver, or consumer in a non-medical setting. High user expectations around
ease of use, the need for intuitive user interfaces and complete documentation, as well
as the need to account for the vagaries of uncontrolled home care settings top the list of
challenges cited by engineers.
Data collection and connectivity represent another area for concern. Nearly one third
(30%) of respondents pointed to connectivity as a challenge. Over two thirds (82%)
agree that there isn’t a lot of clarify about how to effectively capture and use the data or
doing something medically effective with it once collected. Nearly all (94%) cited a
need to for ownership of data security and privacy.
 sampling frequency for reduced energy consumption
Sampling rate or sampling frequency defines the number of samples per second (or per
other unit) taken from a continuous signal to make a discrete or digital signal. For
example: if the sampling frequency is 44100 hertz, a recording with a duration of 60
seconds will contain 2,646,000 samples.
Long battery runtime is one of the most wanted properties of wearable sensor systems.
The sampling rate has an high impact on the power consumption. However, defining a
sufficient sampling rate, especially for cutting edge mobile sensors is difficult. Often, a
high sampling rate, up to four times higher than necessary, is chosen as a precaution.
Especially for biomedical sensor applications many contradictory recommendations
exist, how to select the appropriate sample rate. They all are motivated from one point
of view — the signal quality. In this paper we motivate to keep the sampling rate as low
as possible. Therefore we reviewed common algorithms for biomedical signal
processing. For each algorithm the number of operations depending on the data rate has
been estimated. The Bachmann-Landau notation has been used to evaluate the
computational complexity in dependency of the sampling rate.
Wearables, or wearable technology, are devices or gadgets that a person wears on
their body. However, these wearable devices are more than the latest pair of
headphones or a new digital watch. Wearables can be considered smart gadgets —
smart meaning they’re equipped with all types of sensors including accelerometers
and gyroscopes, to mention a few, as well as using Bluetooth technology for
making a wireless connection to your smartphone. Some wearables are designed to
help you achieve goals such as staying fit, losing weight, or becoming more
organized.
Power requirements of wearables:
Wearables, like the vast majority of other portable electrical technologies, require
batteries, and the device’s power requirements drive the battery form factor. Of
course, we (consumers) all want products that are smaller, thinner, and have a
longer-lasting battery life. There are scores of battery options for which battery
technology can best fit wearables’ requirements.
Some of the more common types of wearable batteries include:

 Alkaline
 Nickel-Metal-Hybrid (NiMH or Ni-MH)
 Lithium-Ion (Li-Ion) and Lithium-Ion Polymer (LiPo, LIP, Li-poly)

Alkaline batteries are tried-and-true — they’ve been around since the 1960s —
and are both safe to use and are easily replaceable. A few examples of alkaline
batteries are the AA and AAA.
Alkaline batteries are also available in the button cell (AKA: coin cell) form factor.
These batteries have a standard voltage of 1.5 V and a size of 11.6 mm in diameter
by 5.4 mm in height. However, when compared to lithium and silver oxide
batteries, alkaline batteries offer both the least energy capacity and stable voltage
— their voltage drops gradually with use rather than providing a steady and stable
voltage before experiencing a sharp drop-off at the end of life.
A Nickel-metal-hybrid (NiMH or Ni-MH) battery is a type of rechargeable
battery.
NiMH batteries can have two to three times the capacity of an equivalently sized
nickel–cadmium battery (NiCd), and its energy density can approach that of a
lithium-ion battery.
Lithium-ion (Li-ion) and Lithium-ion polymer (LiPo, Li-Po, LIP, Li-poly)
batteries are the most popular batteries today for wearables. “For wearables today
mostly small LiPolymer cells or LiCoin Rechargeable cells are used.”
From lithium-ion batteries to coin cell batteries, and from battery life to size and
fit, there are many options of which battery technology best fits your needs.
Regardless of which battery is utilized, eventually it must either be replaced or
recharged. In a perfect world the battery would last forever, but although the world
is far from perfect, there is another option — energy harvesting. Of course solar
cells (they get their energy from sunlight) and thermoelectric generators (they
produce electricity from a temperature gradient) have both been around for a while,
albeit neither technology would be practical for wearable devices because they
cannot guarantee a continuous supply of energy — sunlight is intermit and body
heat has a low thermoelectricity output. What is needed is an energy harvester that
both works continuously and allows for high levels of electrical energy generation.
Enter TENGs, or triboelectric nanogenerators. This energy-harvesting technology
was invented to generate electricity from ambient mechanical motion such as
rotary motion, vibrations, oscillating motion, and expanding/contracting motion.

Another approach of energy-harvesting technology is by generating small electric

currents through the relative movement of layers, a process called triboelectric
charging. “Materials can become electrically charged as they create friction by
moving against a different material, like rubbing a comb on a sweater. By
sandwiching layers of differently materials between two conducting electrodes, a
few microwatts of power can be generated when we move.” 4

No matter how wearables get their energy, it is expected that wearables will
become the “must-have” gadgets for both personal and professional use. According
to Intersil, “…wearables are such a hot trend that ABI Research forecasts the
category is growing at a CAGR of 56.1% and will reach 487 million units in
2018.”5 And given that we (consumers) all want products that are faster, better, and
cheaper “…system designers are constantly challenged to create smaller, more
efficient and cost effective solutions that will place wearables on the wrists of
many more people.”

Wearable Device Architectures

Intersil states, “A typical wearable device architecture includes a microprocessor,
memory, display, sensors, communication IC and battery charger blocks, among
others. It uses at least three DC-DC converters and 3-5 low dropout (LDO)
regulators, depending on the system application.”5 Perhaps a nice compromise
between wearables that are battery-free (i.e., utilize energy- harvesting
technologies) and wearables that are equipped with rechargeable batteries, is using
rechargeable batteries of which incorporate wireless charging.
Texas Instruments (TI) offers their wireless charging PMP11311 reference
design for wearable devices. TI appreciates the fact that wearable technology
devices “…require advanced power management to achieve long battery run times
with always-on functionality. Additionally, the devices need to use small
rechargeable batteries and enable small footprint designs.”
TI’s reference design provides a wireless charging input, a highly configurable
battery management solution using a Li-Ion battery charger, and a low quiescent
current DC/DC buck/boost converter. Figure 8 below illustrates TI’s wireless
power system.
Another semiconductor company that realizes the coming growth explosion of the
wearable market is Linear Technology. Linear Tech offers their LTC3331 which is
a complete energy-harvesting solution that delivers up to 50mA of continuous
output current when harvestable energy is available.
Solar Cells & Batteries Used in Wearable Devices

Wearable devices have been increasingly popular in the past few years. Everything from
smartwatches as a fashionable, convenient extension of one’s smartphone to thin bands
for fitness tracking, wearable devices are rising in popularity. Such devices can add
value to everyday life by providing a way to access information more readily. These
electronic devices, however, are no help when they are dead. Minimizing charging
frequency is important for all portable devices, but arguably even more so for wearable
devices. If the goal is to always have a device readily available, extended battery life is
essential. Therefore, some companies have created wearable devices that can be
recharged using solar cells. This increases charge time potential while still being able
to wear and operate the device as intended without inconveniencing the user
Basics of Solar Cells
The most common photovoltaic cells are silicon-based. Understanding semiconductor
physics is critical to understanding the operation of solar cells. To create a solar cell,
silicon layers will be doped to have more electrons, an n-type layer, in one (or some)
layer(s) and others doped to have fewer, a p-type layer. P-type layers have an excess of
holes–effectively locations where electrons are missing. These types of doped materials
are configured so a p-type layer will be next to an n-type layer. The excess electrons
and holes flow between the layers. This flow of charge carriers and creation of ions
induce an internal electric field. Photovoltaic cells have this type of structure. When
sunlight hits a photovoltaic cell, absorption of sunlight will excite electrons, creating
holes in their place. The flow of the electrons creates electricity which can then be
harnessed. Silicon solar cells generally have an efficiency hovering somewhere around
20 percent. The performance of solar cells is highly dependent upon the duration
and intensity of the light they are exposed to.

Solar Cells in Wearable Devices

While large solar panels installed on building roofs might be the first thing that comes
to mind when talking about photovoltaic cells, they can be produced for much smaller
applications. Garmin currently advertises a limited offering of solar-powered watches.
These smartwatches have impressive battery lives. They list their Instinct Solar watches
operating for 54 days on a single charge. Going off solar power alone and assuming 3
days outside at 50,000 lux, they claim unlimited battery life for their watch in battery
saver mode. Both the watch’s screen and a photovoltaic ring around the screen can
convert solar energy into electricity. Employing virtually the entire watch face for
capturing solar power maximizes the charging power from the sun.

PowerWatch is a company that also uses solar power to recharge their watches. It is
worth noting, however, that solar power is the secondary charging method. The primary
charging method is not conventional either, but is achieved through a thermoelectric
power sensor. Their MATRIX Prometheus sensor uses the thermal energy from the
wearer’s body and converts it to an electrical output that powers the watch. This is a
prime example of companies finding alternative methods for charging wearable
devices.
Dawn of Solar-Powered Textiles
Not only are photovoltaic cells being developed for powering wearable electronic
devices, but to be woven into everyday clothing. Nottingham Trent University’s School
of Art and Design has a group which is researching how to create solar cells small
enough to be laced into textiles. The group is attempting to combine solar cells into
clothing in a way that is unnoticeable to the wearer. The goal is to create clothing that
appears the same as all other clothing, only while simultaneously producing electricity.
The material comprises of numerous solar cells integrated into the material measuring
3mm by 1.5 mm. The cells would be coated in resin to protect it from the wear and tear
of regular usage and laundering. The photovoltaic cells would produce electricity which
could be used to charge a device via a USB connection integrated into the clothing.

The group out of Nottingham is not the sole party interested in creating solar cells
conducive to being part of daily fashion. Researchers at Rice University have been
exploring flexible photovoltaic cells to be sewn into clothing or other wearable items.
They see the flexibility of the solar cells as a critical achievement as traditional solar
cells are far too rigid and brittle to be practical for clothing. Flexible solar cells are able
to bend with the movement of the fabric without damage to the solar cell itself while
maintaining the integrity of the garment. While their flexible cells are less efficient than
conventional solar cells (a difference of roughly 7%), the flexibility could be well worth
the deficit. The flexibility of the solar cells is achieved through using a material that is
made up of “sulfur-based thiol-ene reagents”. The researchers have reported that cells
with 20% thiol-ene content provide the prime combination of efficiency and flexibility.

Still other researchers have been creating flexible solar cells. Organic, ultrathin
photovoltaic cells have been developed at the RIKEN research center in Japan. These
solar cells were created by using an annealing process to improve the thin cell’s
durability while retaining flexibility. Their solar cells have an energy conversion ratio
of approximately 12%. Again, this is lower than the conventional silicon-based solar
cell’s energy conversion ratio by about 10%. However, their research does show
promising results with regards to the environments in which these ultrathin cells can be
operational. They say that the solar cells are remain stable even under high temperatures
and humidifies. This type of functionality and durability would indeed be beneficial for
use in wearable devices.
Vibration based power Requirements of wearable devices
With the vast amount of wearable technology available, the demand for compact
devices with smaller batteries, or no batteries at all, and longer charge duration has
presented a challenge. Consumers of wearable technology want the convenience of a
portable device without the need for frequent charging or bulky and expensive batteries.
Producers of wearable technology are then tasked with creating devices that meet this
demand. The use of piezoelectric components in wearable technology is a solution for
this issue.
The use of piezoelectricity stands to reduce, or even eliminate, the need for frequent
charging of devices and batteries. Consumers will no longer be burdened with having
to be near an electrical outlet, which will in turn conserve electricity. As a result,
wearable devices and more efficient batteries will have longer usable lives. This will
also reduce the environmental hazards presented by the frequent disposal of batteries
and electrical components into landfills.
Harvesting energy using piezoelectric ceramic involves the conversion of energy from
vibrations that occur during walking, breathing, and moving on many parts of the body.

When stressed, piezoelectric components create an electrical current that can be

immediately used or stored. The amount of energy produced is still relatively small and
required body movements aren’t often regular and predictable. Also, a large surface
area is often necessary to harvest a sufficient amount of energy. This presents a
challenge when thinking of the small size needed in wearable devices.

Direct and inverse piezoelectric effects.

Two promising factors in surmounting these obstacles are the versatility of piezoelectric
components and the fact that the efficiency of piezoelectric energy harvesting has
increased, while the power requirements for current wearable devices have been
reduced.
There are four different types of materials that can be used for piezoelectric energy
harvesting: ceramics, single crystals, polymers, and composites. Of these, ceramic is
the preferred material for this type of energy harvesting because of its low cost, effective
piezoelectric properties and easy incorporation into energy harvesting devices.
Piezoelectric vibration energy harvesting is the preferred method for use with wearable
devices since it is the most capable of producing the power level needed for small-scale
devices.

There are two kinds of mechanical energy that can be scavenged from the human body.
The first is related to continuous activity, such as breathing and heart beating; while the
other is related to discontinuous movements, such as walking and joint movements. Of
these, the process of walking produces the largest amount of power compared with other
body motions. It has been recorded that a 68kg man is able to generate 67W when
walking at a speed of two steps per second. The easiest way to harvest this energy is
through piezoelectric shoe inserts.
Body joints are also attractive locations for harvesting energy due to their high motion
amplitude, fast angular velocity, large impulse force, and high frequency of use in daily
human activities. For example, the knee joint produces high biomechanical energy since
it generates a larger torque in comparison to other human joints. Knee joint motions are
often related to gait motion, where walking and running frequencies are normally in the
range of 0.5-5 Hz.
Even for relatively minor activities such as eye blinking, piezoelectric transducers have
effectively been used to convert motional energy into electricity. For example, a self-
powered sensor was developed for both energy harvesting and health rehabilitation
monitoring, which was based on polymeric piezoelectric nano/microfibers.
Furthermore, continuous energy can be harvested from the process of human breathing.
There are two kinds of energy that can be collected in this case. The first relies on
scavenging energy due to the intake and release of air, which can produce
approximately 1 W of power. The other relies on chest expansion, which requires a tight
band fixed around the chest of the user to generate around 0.83 W when breathing
normally.
Wearable Piezoelectric Applications
Piezoelectric components can be used for wearable technologies and other new
technologies. Their use presents vast possibilities across many industries. Human
comfort, convenience, health and safety have the potential to be greatly improved with
the availability and use of products containing piezoelectric components. Many of these
capabilities and products are already emerging in today’s society.
These include:

 A piezoelectric pacemaker that is powered by the rhythm of a beating heart. This

eliminates the need for invasive and dangerous surgery for battery replacement
 Footpath lighting powered by footsteps striking energy-absorbing tiles
  The ability to power monitoring and sensor devices in remote and dangerous
places (bridges, pipelines, etc.). This eliminates the risk to humans that arises
when batteries need charging or replacing
 A vehicle driver’s seat that uses piezoelectric sensors to monitor and sense
driver’s heart rate and respiration. It uses vibration sensors to allow ventilation
and massage features to be automatically activated in the seat when driver stress
is detected
 Wearable devices that can be charged by walking, running or other physical
activity

Some wearable sensors on the market today include fitness and activity wristbands and
monitors that observe distance, respiration, heart rate, and even sleep patterns. Wireless
blood pressure cuffs measure patient’s blood pressure through a phone app. Quartz
watches have been around for a long time and employ the natural piezoelectric property
of quartz to keep precise time. Monitors that detect and measure fetal heartbeats use
piezoelectric components to convert the vibration into a readable signal.
The use of “smart” fabrics is also gaining popularity. The flexible fabrics are infused
with piezoelectric materials that act as sensors to measure, monitor, and harvest energy.
A single pressure-sensitive layer is sandwiched between two conductive layers. These
sensors are currently being developed for use as shoe insoles, clothing, and wearable
devices that measure information such as pressure, steps, energy expended, etc. The
amount of energy created by the fabrics differs with factors such as the type of piezo
material used and the movement of the user.

Design Challenges in Wearables with Piezoelectric Technology

There are challenges facing the design and implementation of piezoelectric technology
within wearable devices.

Material Choice
Textiles that have a greater elasticity perform at a greater efficiency when harvesting
piezoelectric energy. The greater elasticity of the material increases the stresses
occurring in the garment and, consequently, increases the elongation of piezoelectric
elements. In addition, the garment must be form fitting in order to increase the clothing
pressure and increase the piezoelectricity efficiency by increasing the strain exerted on
the harvester on the garment. However, with this increased tightness of the garment on
the user, this subsequently restricts the user’s movements and their ability to harvest
energy.

Durability
Energy harvesters are required to have high environmental durability and operational
reliability. However, in the case of piezoelectric energy harvesters, the material
properties may change during the manufacturing process, even if the piezoelectric effect
is caused by intrinsic physical properties such as the crystal structure of the material.
When a strain is repeatedly applied to a material, macroscopic cracks may occur
resulting in a drop in the amount of power generated. Clarifying the mechanism behind
the deterioration of materials that occurs during the conversion of kinetic energy into
electric energy and taking countermeasures are challenges for piezoelectric technology.

Operating Frequency
It is a well-known issue with piezoelectric energy harvesters that they do not harvest
energy efficiency at varying frequencies. These devices operate at a high frequency
whereas humans have an ultra-low frequency of around 1Hz. As the operating
bandwidth of piezoelectric energy harvesters is quite high, this significantly limits their
utility within real world applications in wearable devices. In addition, the motion range
of humans is usually much higher than the predetermined device size and so resonant
devices cannot render the advantage of powerful magnification. The operating
excitation frequency must fall in the resonant frequency range of harvester so as to
obtain the best results. Most commonly, the frequency up conversion technique is used
to overcome this hurdle. Mostly, mechanical plucking mechanism by using
piezoelectric bimorph was used for frequency-up conversion to power low-powered
electronics. However, these devices showed some drawbacks such as reduced longevity
due to direct contact between bimorph and plectra and noise. To overcome such
challenges, a prototype for piezoelectric knee-joint EH by replacing mechanical
plucking by the non-contact magnetic plucking device to perform the frequency-up
conversion and achieve a power output. In addition, piezoelectric vibrational EHs with
a flexible 3D structure fabricated by a microfabrication process can cover low
frequencies and achieve a large strain.

Future Considerations and Complications for Wearable Technology in General

Before portable and wearable self-powered system can move toward large-scale
practical applications, there are still many problems that should be fully addressed soon.
Most wearable and portable self-powered systems are based on flexible materials,
which experience device performance degradation during long-term operation.
Therefore, in the future, we should study additional material and structural designs to
improve the stability of the system under long term work while ensuring the wearability
of the device.
Currently, portable wearable self-powered electronic devices are mainly desktop
laboratory devices, which only demonstrate a concept. Since there is no work to propose
a standardized manufacturing process for portable and wearable self-powered electronic
devices, it is impossible to achieve complete consistency with respect to the
performance of two different devices. Therefore, in the future, we need to consider the
issue of performance calibration between different devices, or we can develop
standardized processes for portable wearable devices that can be mass produced.
Hybrid energy harvesting technology that integrates multiple transduction methods is
most likely to act as a power source for future self-powered systems. However, the large
differences in the frequency, amplitude, and waveform of electrical power converted
through different transduction methods make it an unsolved problem to develop power
management technologies suitable for different energy harvesting methods.
Furthermore, an increasing number of functional modules are being integrated into self-
powered systems. We need to rationally design power management circuits to improve
 the energy conversion efficiency and achieve energy distribution among various
functional modules. In addition, a wireless module is needed to realize the transmission
of information.
Human body as a heat source for power generation

Body heat applied to a thermoelectric generator plus energy harvesting to produce

power for a wearable device achieves both minimization of form factor and power
consumption. nother consideration in powering wearable devices is the necessity to
impose weight and size constraints, particularly if you initially choose a battery as the
source of power. To limit size and weight you should use energy harvesting instead of
the battery. The article points out that you can harvest energy from several
environmental sources:

 Light, using photovoltaics

 Movement of the wearer
 Radio frequency energy (RF)
 Temperature differences using a thermoelectric generator (TEG)

An evaluation of these environmental sources reveals that photovoltaic or RF harvesters

limit the application of zero-power wearables to environments where sufficient ambient
light or RF emissions is provided to satisfy the energy budget. Movement-based
harvesting systems require an active wearer and usually have unstable power generation
characteristics. In contrast, the human body is a constant heat source and typically a
temperature difference exists between body core and the environment.

Even in a scenario where the wearer is stationary and situated in a dark room (e.g.,
during sleep), energy can be produced. Lower ambient temperatures, the presence of air
convection, or increased activity of the wearer can drastically increase the amount of
accumulated energy. Because the voltages produced by thermal harvesting are typically
too low to power wearable electronics, you must include a high-efficiency dc-dc
converter into a wearable system.

Thermoelectric energy conversion of human body heat represents a promising

alternative as it is largely independent of external factors. The average power harvested
per square centimeter is higher using the thermal harvester than an equally sized solar
cell. However, the produced voltage is used to directly charge a supercapacitor as an
energy buffer and the device is only operational if the ambient temperature is lower than
25°C to 27°C. In one application a Thermoelectric Generator (TEG) on a human
forehead powered a 2-channel EEG system with a power consumption of 0.8mW. You
can harvest up to 30 μWcm-2 before dc-dc conversion (Voltage Regulation in Fig. 1).
A two-stage custom dc-dc converter design is used to convert the voltage produced by
the TEG to 2.75V. Due to the large thermal harvester, the system has limited
wearability. Previous systems relied on custom designed and fabricated components,
including the TEG and dc-dc circuits, to optimize the output power for a very specific
application scenario. Application-specific components are necessary to obtain the
power output and physical size required for a wearable sensor application. Plus, state-
of-the-art thermal harvesters may be too bulky and uncomfortable to achieve true
wearability.

Wearable devices have been used to monitor a variety of health and environmental
measures and are now becoming increasingly popular. The performance and efficiency
of flexible devices, however, pale in comparison to rigid devices, which have been
superior in their ability to convert body heat into usable energy.

Hybrid power devices are combinations of different power technologies. Hybrid power
plants often contain a renewable energy component such as photovoltaic (PV) that is
combined with wind power, thermoelectric power, solar thermal power, or a system like
battery storage or solar thermal storage. Thermoelectric generators are semiconductor
devices that have no moving parts and convert heat directly into electricity. When
combined with thermal storage they can provide electricity round the clock at as low as
$0.06 per kilowatt-hour and could achieve 16% efficiency.

PV cells convert the UV and visible regions of the solar spectrum while the
thermoelectric modules use the infrared region to produce electrical energy. Thus,
combining both these systems in a hybrid system provides enhanced performance.
While PV panels convert up to 20% of solar energy into electricity, the solar thermal
collectors capitalise on the untapped heat energy of the PV system, thereby increasing
the energy production efficiency while occupying less space

Global energy demand is likely to increase by 48% in the next 20 years due to
population explosion. Currently 80% of energy needs are met by fossil fuels, which
emit greenhouse gases that lead to global warming and climate change. Their negative
environmental impact is leading to development of renewable energy sources like solar,
geothermal, and hydro.

Photovoltaics

A photovoltaic cell is made of semiconductor materials that absorb photons of the

sunlight and generate a flow of electrons. Photons are elementary particles generated
by Sun that carry solar radiation at a speed of 300,000km/s. When the photons strike a
semiconductor material like silicon, they release the electrons from its atoms, leaving
behind a vacant space called ‘hole.’ The stray electrons move around looking for a hole
to fill.

Generally, a PV cell is made up of two types of silicon. The silicon wafer that is exposed
to the Sun is doped with atoms of phosphorus, which has one more electron than silicon.
The back side of the cell is made of silicon doped with atoms of boron, which has one
less electron than silicon.

The sandwich thus constructed works like a battery. The layer that has surplus electrons
becomes the negative terminal (n) and the other side that has a deficit of electrons acts
as the positive terminal (p). An electric field is created between the two layers at the
junction.

On excitation by photons electrons are swept to the n-side by the electric field at the
junction, while the holes drift to the p-side. Both the sides are provided with metallic
electrical contacts to collect electrons and holes. Electrons then flow in the external
circuit in the form of electrical energy. Fig. 1 shows how a PV cell works.

Fig. 1:
Working of a PV cell
Thermoelectricity, as the name suggests, stands for the conversion of thermal energy
(temperature difference) into electricity. It encompasses mainly two phenomena: the
Seebeck effect and Peltier effect.

Seebeck effect is the phenomenon that a potential difference will appear between the
two ends of a metal or semiconductor wire when they are kept at different temperatures.
The potential difference is proportional to the temperature difference and the material’s
property known as Seebeck coefficient.

All materials are made of atoms, and atoms contain positively charged nucleus with
negatively charged electrons moving around them. The electrons that are closer to the
nucleus are bound more strongly, whereas the outer ones are loosely bound. When the
temperature is uniform, the distribution of negative electrons is uniform and neutralises
positive ions everywhere in the material, as shown in Fig. 2.

Fig. 2:
Uniform distribution of neutral atoms
But when one end of the wire is heated and the other end is kept cool, electrons at the
hot end gain more energy and higher speed than those at the cool end, which is indicated
by the longer arrows in Fig. 3. So, at any instant more electrons move to the cold end
than those moving back. So, the hot end becomes positively charged and the cold end
becomes negatively charged, and current flows through the external conductor of a
thermoelectric generator (TEG).

Fig. 3: Generation of potential difference due to heating in TEG

A single thermoelectric device is constructed from two solid-state devices that are
usually made from bismuth telluride (Bi2Te3), as shown in Fig. 4. One of these pellets
of semiconductor is doped with acceptor impurity to create a p-type component to have
more positive charged carriers or holes, thus providing a positive Seebeck coefficient.
The other is doped with donor impurity to produce an n-type component to have more
negative charged carriers, thus providing a negative type of Seebeck coefficient. The
two semiconductor components are then physically connected serially on one side,
usually with a copper strip, and mounted between two ceramic outer plates that provide
electric isolation and structural integrity.
Fig. 4: Thermoelectric generator (TEG)
The Seebeck effect is a direct energy conversion of heat into a voltage potential. It
occurs due to the movement of charge carriers within the semiconductor. Charge
carriers diffuse away from the hot side of the semiconductor. This diffusion leads to a
build-up of charge carriers at one end. This build-up of charge creates a voltage potential
that is directly proportional to the temperature difference across the semiconductor.

The power generated in a TEG is single-phase DC that equals I2RL, where I is the
current and RL is the load resistance. The output voltage and output power are increased
either by increasing the temperature difference between the hot and cold ends or by
connecting several TEGs in series, as shown in Fig. 5.

Fig. 5: Series-connected thermoelectric generator

The current flows as long as heat is applied to the hot junction. The process is reversible.
If the hot and cold junctions are interchanged, the valence electrons flow in opposite
direction and direction of the current changes. The thermoelectric effect allows
converting waste heat into electric power.
By combining thermoelectric and PV effects, higher solar electricity conversion
efficiency is possible. PV absorbs about 58% of solar energy between 200nm and
800nm wavelengths. The rest of the solar energy from 800nm to 2500nm cannot be
converted to electricity by PV. But this spectrum of solar radiation can generate
electricity through thermoelectric effect by heating TEG.

Thermoelectric figure-of-merit

The performance of thermoelectric materials is defined by unitless figure-of-merit as

given below:

ZT=σS²T/k
where ZT is the thermoelectric figure-of-merit while σ, S, k, and T are electrical
conductivity, the Seebeck coefficient, the thermal conductivity, and the absolute
temperature, respectively.

The Seebeck coefficient of a material is the induced thermoelectric voltage per Kelvin
generated in response to a temperature difference across the material, as induced by the
Seebeck effect. It is often given in microvolts per Kelvin. The Seebeck coefficient
depends on factors like temperature, work functions of the two TE materials, electron
densities of the two components, and scattering mechanism with each solid.
Performance of a TEG is determined by the Seebeck coefficient of the pair of materials
forming the TEG.

Peltier Effect

In a circuit, when DC current flows through two dissimilar material, say copper and
bismuth, the junction where the current passes from copper to bismuth would be hot
and the junction where current passes from bismuth to copper would be cold. This
effect, known as Peltier effect, is used to build devices like Peltier heater, solid-state
refrigerator, and heat pump.

A good thermoelectric material should have following qualities:

1. Its Seebeck coefficient should be as high as possible. It is important to maximise

energy conversion. The open circuit voltage generated by a TEG is proportional to
the Seebeck coefficient and temperature difference across the TEG. Hence high
Seebeck coefficient leads to a high voltage.
2. To minimise thermal loss through the thermoelectric material and to have large
temperature difference across the TEG, thermal conductivity of the TE material
should be as low as possible.
3. Its electrical conductivity should be as high as possible for reducing internal Joule
heating losses of the thermoelectric elements.
A TEG’s efficiency depends very much on the operating temperature difference
between the junctions. The bigger the temperature difference, the more efficient the
TEG.

There are three main types of thermoelectric materials used in thermoelectric

generators:

1. Bismuth telluride (Bi2Te3) alloy: It is a semiconductor that has high electrical

conductivity but is not good at transferring heat. The best working temperature of
this class of material is below 450°C. Bismuth telluride materials with high figure of
merit (ZT) and TEG modules, as shown in Fig. 6, have high conversion efficiency
of more than 8% over temperatures of 25°C to 250°C and are widely utilised in
energy generation and refrigeration.

Fig. 6:
Conversion efficiency of improved BiTe material
With improved techniques, p-type BiTe TE material that has average ZT of 1.08 and
n-type BiTe with 0.84 ZT has been made. The significant enhancement in ZT could
be achieved through compositional and defect engineering.

Type I module is constructed using p-type Bi0.5Sb1.5Te3 and n-type using

Bi2Te2.7Se0.3S0.01. Type II material is constructed from p-type Bi0.4Sb1.6Te3
and n-type Bi2Te2.7Se0.3S0.01Cu0.01 materials. Fig. 7 and Fig. 8 show the Seebeck
coefficient and figure of merit of these two types of improved BiTe materials,
respectively.
 Fig. 7:
Seebeck coefficient of improved Type I and Type II BiTe material

2. Lead telluride (PbTe) alloy: Low conversion efficiency is a big obstacle that
impedes large scale application of TE materials for power generation. Lead telluride
alloy is recognised as an excellent compound for power generation in the mid
temperature range of 500-800°K. It has highly symmetric rock salt crystal structure,
which is chemically and thermally stable. Lead telluride can be made either a p-type
or n-type semiconductor.
Recently researchers have enhanced the ZT of a sintered material to 1.8 (600°C)
using a nanostructure forming technology. Further, an electrode material has been
developed that contacts very well electrically and thermally with PbTe containing
MgTe nanostructures, achieving a conversion efficiency of about 11% with hot side
at 600°C and the cold side at 10°C.

This breakthrough has made the way to convert waste heat and solar thermal power
to large scale practical application. Because the nanostructures formed in the PbTe
sintered material effectively scatter heat carrying phonons, but have no effect on the
charge carrier transport, there is dramatic improvement in the ZT.

3. Silicon-germanium alloy: It is a kind of semiconductor that is often used for

thermoelectricity generation with a working temperature around 1300°C. Combining
Si and Ge allows to retain high electrical conductivity of both components and
reduce the thermal conductivity due to the increased phonon scattering as Si and Ge
have different lattice properties. Due to this reason Si-Ge alloys are currently the best
TE material for high temperature application.
Conventional Si-Ge materials have ZT values of 0.9 and 0.5 at 1200K for n-type and p-
type materials, respectively. By adopting nanocomposite approach reducing the grain
size to around 5nm, ZT values can be increased by a factor of two and conversion
efficiency can also be increased considerably. Ge is a scarce material and hence this
alloy is costly. However, using only 5% of Ge it is possible to have Si-Ge alloy with
improved performance.
The advantage of the newly developed nanocomposites is that its ZT values consistently
remain above 1 over high temperature range between 600°C and 1000°C. Hence, these
are the best TE materials for high temperature application for power generation by solar
radiation, radioisotope devices, and waste heat recovery system. Table 2 shows the ZT
values of bulk and improved nanostructured Si-Ge TE materials.

A thermoelectric device with a ZT of 1.25 will have an efficiency of about 10%. A

segmented Si-Ge TE device over temperature range of 300K to 1300K will have an
efficiency of about 12.1%.

Block diagram of a typical thermoelctric power harvesting system

Fig. 10: Block diagram of thermoelectric power harvesting system

A thermoelectric power generation system has low energy conversion efficiency.
According to the principle of maximum power transfer, the system would transfer the
maximum power when the load resistance is equal to the internal resistance of the TEG.
Based on this principle, several maximum power point tracking (MPPT) algorithms
may be selected with different control logic to harvest the maximum power from the
TEG. If a TEG is connected directly to the load, the load impedance will set the
operating point which might result in the TEG output being less than the maximum
output power.

The MPPT technique is considered an efficient mechanism to improve the performance

of TEG by increasing the conversion efficiency. In this system, the operating point of
the TEG is moved promptly towards an optimal point to increase energy harvesting by
using a variable fractional order fuzzy logic controller (VFOFLC) based MPPT
technique. The variable tracking step size is applied using a dynamic variable fractional
factor whose value is calculated based on the voltage output of the TEG. The fraction
order term introduced in the MPPT algorithm would contract or expand the input
domain of the fuzzy logic controller to shorten the tracking time and maintain a steady-
state output around the maximum power point.
Optimization of the TEG

It has been found that the output power is correlated with the geometry of the device.
By changing the leg height and the number of thermoelectric pellets to an optimum
value it is possible to maximise electric power or efficiency at given operating
conditions. There is interdependence between optimal leg geometry and the electrical
load resistance.

If number of legs is low, the energy conversion is low, because the load resistance (RL)
is not sufficient to obtain an adequate high voltage and vice versa. A reduction of the
leg length leads to a reduction of the electrical resistance, and an increase of the leg
length leads to the higher temperature difference across the TEG. If the geometric
parameters like leg length, number of semiconductor pellets, the base area ratio of the
semiconductor columns are optimised, the output power and thermal efficiency are
considerably improved.

The shape of the legs of TEG devices has considerable effect on the device performance.
The conventional rectangular leg shape found in commercial TEGs is not the optimal
shape for heat-to-power energy conversion. The hourglass shaped TE legs result in more
than double the electrical potential and maximum power compared to conventional
rectangular shape. The trapezoid leg with the largest cross-sectional area at the hot side
results in about double the electrical potential and a 50% increase in the power output
compared to the conventional rectangular shape. The electrical output power values, if
optimised, can be 890% higher than a random value without optimisation.

Heat sink is required at the TEG when a high heat flow rate is applied on the hot side
of the TEG. In order to have quick heat dissipation at the cold side cooling radiators are
provided there, so that bigger temperature difference across the TEG can be obtained.
The fins attached to the heat sinks are very important for enhancing the heat transfer at
the hot and cold sides. The heat transfer increases when the number of fins are increased
and the fin height is more, due to more heat transfer area. However, increase of heat
transfer area is limited to an optimum value beyond which the change in the output
electrical power becomes less significant.

The thermal resistance of the heat sink (Rhs) is:

Rhs=(Theat sink - Tamb)/Qh

where, Theat sink is the sink temperature, Tamb is the environmental temperature, and
Qh is the heat flow. Experimental results show that increasing the thermal resistance of
both cold and hot side heat sinks by 10% improves the electrical output power by 8%.
Aerogel

Aerogels are a class of synthetic porous materials derived from a gel, in which the liquid
component has been replaced with a gas without collapsing the gel structure by freeze-
drying. It can be made from silica, carbon, iron oxide, gold, copper, polymer, etc.

The final product is extremely porous (80-98% porosity) with very little solid material;
up to 99.8% of the aerogel may have nothing but air. It has a typical density of about
0.001gm cm–3. Its thermal conductivity is extremely low, about 0.017W/mK, which
makes the material an ideal insulator. It can be made transparent.

By reducing heat losses and simultaneously being transparent, aerogels allow a solar
plant to operate at higher temperature and at higher efficiency without using any
vacuum device. These advantages make an aerogel assisted solar thermal plant very
economical and eliminates lot of maintenance problems.

Concentrated high-efficiency Solar Thermoelectric Generator

A solar thermoelectric generator (STEG) is a solid-state device that can convert solar
energy at around 15% efficiency.

It has three sections: solar absorber, thermoelectric generator, and the thermal
management system comprising insulation, heat exchangers, and vacuum/aerogel
enclosure, etc.

There are no moving parts and there is no need of high-temperature operating fluids. Its
robustness in harsh temperatures makes it very useful for standalone power conversion
or making hybrid solar thermal power generator in conjunction with a PV system.

The efficiency of STEG depends on both the efficiency of solar absorber and on the
thermoelectric efficiency of the device. There are mainly two approaches to increase
the efficiency of STEG devices: increasing temperature difference between the hot and
cold ends and using improved materials with ZT more than 1. Recently, several
nanostructured materials have been developed that have higher ZT values suitable for
STEG.

There are two routes to increase the temperature difference in a STEG: first, optical
concentration of sunlight enabling to increase the heat flux at the absorber surface, and
second by providing thermal concentration where the area of a highly thermally
conducting absorber is greater than area of the thermoelectric legs increasing the heat
flux through the legs.
It is possible to construct a durable STEG device with more than 15% efficiency using
improved material consisting of a segmented n-type leg composed of skutterudite and
La1Te4 and p-type leg of skutterudite and Yb14MnSb11, and also using nanostructured
Bi2Sb3 based alloys (all these three types have an effective ZT of about 1.4 to 1.6 at
800K).

Fig. 11: Schematic arrangement of concentrated STEG system

Operating temperatures across Thot-Tcold=900°C–200°C are maintained using fresnel
lens to concentrate sunlight. In order to reduce heat losses from the solar collector a
vacuum system is provided, which is costly. Skutterudite is a type of arsenide mineral
having general formula as TPn3, where T is a transition metal like Co, Rh, or Ir, and Pn
is Sb, As, or P. Typical arrangement of STEG system is shown in Fig. 11 and Fig. 12.

Fig. 12: Arrangement of composite segmented thermoelectric LEG

Another excellent way to reduce heat losses is by using high-temperature transparent
aerogels for insulation instead of vacuum system, as shown in Fig. 13.
 Fig. 13:
Transparent aerogel for insulating STEG
Aerogel, being transparent but an excellent insulator, allows sunlight to enter but blocks
the heat from escaping from the receiver of the STEG. It offers many advantages like
higher efficiency, minimises heat loss, boosts solar thermal conversion, eliminates
costly vacuum system and its maintenance cost. Due to efficient thermal transport
system provided by aerogels, most of the solar radiation is absorbed by the cermet
composite pad attached to the thermoelectric elements.

It is desirable to thermally insulate the TE legs to suppress lateral heat leaks that degrade
thermal efficiency. Encapsulation of thermoelectric legs with aerogels prolongs the life
of TE devices.

The primary cause of deterioration of most thermoelectric materials is thermal

decomposition or sublimation at high operating temperatures. For example, aerogel
present near the surface of skutterudite material, such as CoSb3, prevents transport of
Sb vapour by establishing a highly localised equilibrium Sb-vapour atmosphere at the
surface of skutterudite.

Some solar absorbers are painted with black paint to increase the heat absorption and
are fabricated from metal dielectric multilayer cermet composites that are capable of
withstanding more than 950°C.

Photovoltaic/thermoelectric Hybrid System

Solar light and its thermal energy can provide sufficient electricity to meet the global
energy demand. The range of wavelengths that photovoltaic materials generally use to
convert into electricity is between 400nm and 1200nm, the ultra-violet (UV) and visible
range. Excess solar radiation is wasted as heat, which decreases the efficiency of PV
cells and lowers their life.
TEGs are bidirectional devices that act as heat engines, converting the excess heat into
electricity through the thermoelectric effect. Thermoelectric devices utilise the IR
region of sunlight to generate electricity and reduce the amount of heat that PV cells
dissipate. It is possible to combine PV cells and TEGs to make a hybrid system that can
generate more energy. The overall power output of this system would be the sum of the
power output from the PV module and the TEG.

The hybrid systems generally follow two configurations—with or without reflective

components.

With reflective arrangement the spectral splitting method splits the solar spectrum into
two bands. The spectrum below the 800nm cut-off wavelength gets transmitted to the
PV module and above 800nm to the TEG. This system has a reflective component called
wavelength segregator or prism, where the PV module and the TEG are installed
perpendicular to each other. When sunlight passes through the prism, a part of the
sunlight is reflected at cut-off wavelength of approximately 800nm and is absorbed by
the solar cell. The radiation that is longer than the cut-off wavelength—above 800nm—
is reflected to the TEG, as shown in Fig. 14.

Fig. 14: Arrangement of hybrid pv/teg system using spectral splitting

The PV module and the TEG convert solar energy into electricity independently. A
cooling system is installed on the TEG to maintain the temperature difference. A
concentrator increases the light intensity and hence PV modules of reduced surface area
can be installed, which results in a reduced installation and maintenance cost. The
spectrum splitter allows for low operating temperature and hence maximising the
conversion efficiency.

Thermoelectric legs have different values of ZT at different temperatures. Hence the TE

material selected depends on the operating temperature. Generally, bismuth telluride is
used under 500K, lead telluride between 500-900K, and germanium silicon above 900K
operating temperatures.

In configurations without reflective component the PV module is placed as upper

component and TEG device as lower component, as shown in Fig. 15. When sunlight
falls on it, the PV device absorbs the UV and visible light and rest of the solar spectrum
passes through the PV module to the underlying TEG. The IR radiation heats up the
TEG top side creating a temperature difference with the cold side. The solar module is
coated with tedlar PVF film that offers the best protection against UV, thermal,
moisture, chemical and mechanical stress.
Combination of PV and TE generators can make a very efficient device for solar energy
utilisation. A PV/TE hybrid system with high concentration ratio and using
multijunction PV and Bi2Te3 thermoelectric legs has conversion efficiency of about
32%. The direct electrical contribution of the TEG to the hybrid system’s efficiency is
enhanced by increasing the Sun’s concentration by about 300 times. Even higher
efficiency and power values can be achieved by using more advanced PV devices and
improved TE materials, with a potential to reach 50% total efficiency.

Fig. 15:
Hybrid PV/TEG system without reflective component

Hybrid PV and Solar Thermal System

A technique that combines PV and solar thermal systems to efficiently convert solar
radiation to electricity for immediate use and store the remaining inexpensive thermal
energy (not utilised by PV) to convert to electricity on demand has been developed
recently. It is called hybrid electric and thermal solar (HEATS) system. The prototype
performs at 26.8% (with a potential to achieve 35.2%) solar to electricity efficiency and
81% dispatchability of electrical energy from thermal energy at an operating
temperature of 775K using silicon PV cell (gallium arsenide PV cell can also be used).
HEATS contains a PV module as well as a thermal absorber to utilise the best of both.
In this system photons in the PV band are directed to the PV cells whereas these are
most efficiently converted into electricity. Low-energy photons (long wavelengths) that
cannot be converted by PV cells and high-energy photons (short wavelengths), which
would be converted inefficiently, are directed to the thermal absorber instead of being
wasted.

This technique improves overall system efficiency and provides additional thermal
energy, which can be stored at low cost to be used for electricity generation or for
heating on demand. Dispatchability is the ratio of electricity generated from heat engine
and total electricity generated by both heat engine and the PV modules. The
arrangement of HEATS is shown in Fig. 16.

Fig. 16: Hybrid PV and solar thermal system

Fig. 16(A) shows the receiver concept with a cutaway section to show its internal
structure. The HEATS receiver is used in conjunction with a solar concentrator, like a
parabolic trough or a linear Fresnel reflector, to increase the intensity of solar radiation.
The stacked structure consists of a glass protective cover, a thermally insulating
transparent aerogel layer, the spectrally selective light pipe (SSLP), followed by another
insulating transparent aerogel layer, and finally the PV module.

The SSLP structure consists of a series of parallel fins attached to the heat collection
pipes carrying a heat transfer fluid like Therminol VP-1, which collects the thermal
energy absorbed by the SSLP. The SSLP structure is formed from parallel fins made of
a thermally conductive copper sheet substrate coated with a spectrally selective material
in multilayers.
The SSLP absorbs high and low energy photons as thermal energy, while directing the
mid energy photons to the PV module down below as shown in Fig. 16(B). Transparnt
aerogel on either side allows the light to pass through but does not allow the heat to
escape as it is an excellent insulator.

The aerogel layers serve to thermally insulate the SSLP from the PV module to keep
the latter cool. It ensures that the SSLP can be operated at a high temperature without
heat loss while the PV module and the glass cover remain at a safe low operating
temperature. The transparent silica aerogels used have high solar transmittance of about
96% and low thermal conductivity of about 0.055W/m/K. As aerogels are not very
strong, it is ensured that no load is transferred to it.

The advantages of hybrid PV-thermal system are mainly: (a) both solar thermal and PV
cells can be housed in the same module and operated simultaneously, (b) the solar
energy that would have been lost otherwise, if single PV module was used, can be
recuperated usefully, and (c) the amount of energy that is generated per unit area by this
tandem system is more and the payback period is less due to more energy extraction.
Thermopile
A thermopile is a device that converts heat into electricity by using the thermoelectric
effect.
It consists of several thermocouples, which are pairs of wires made of different metals
that generate a voltage when exposed to a temperature difference. Thermocouples are
connected in series or sometimes in parallel to form a thermopile, which produces a
higher voltage output than a single thermocouple. Thermopiles are used for various
applications, such as measuring temperature, generating power, and detecting infrared
radiation. A thermopile works on the principle of the thermoelectric effect, which is the
direct conversion of temperature differences to electric voltage and vice versa. This
effect was discovered by Thomas Seebeck in 1826, who observed that a circuit made of
two different metals produced a voltage when one junction was heated and the other
was cooled.

A thermopile is essentially a series of thermocouples, each of which consists of two

wires of different metals with large thermoelectric power and opposite polarities.

Thermoelectric power is a measure of how much voltage a material generates per unit
temperature difference. The wires are joined at two junctions, one hot and one cold. The
hot junctions are placed in a region with higher temperatures, while the cold junctions
are placed in a region with lower temperatures. The temperature difference between the
hot and cold junctions causes an electric current to flow through the circuit, generating
a voltage output.
The voltage output of a thermopile is proportional to the temperature difference across
the device and the number of thermocouple pairs.

The proportionality constant is called the Seebeck coefficient, which is expressed in

volts per kelvin (V/K) or millivolts per kelvin (mV/K). The Seebeck coefficient depends
on the type and combination of metals used in the thermocouples.

The diagram below shows a simple thermopile with two sets of thermocouple pairs
connected in series.

The two top thermocouple junctions are at temperature T1, while the two bottom
thermocouple junctions are at temperature T2. The output voltage from the thermopile,
ΔV, is directly proportional to the temperature difference, ΔT or T1 – T2, across the
thermal resistance layer and the number of thermocouple pairs. The thermal resistance
layer is a material that reduces the heat transfer between the hot and cold regions.
Diagram of a differential temperature thermopile

T1
 |\
|\
| \
| \
| \
| \ ΔV
| \
| \
| \
| \
| \
| \
| \
| \
| \
| \
------------------
Thermal
Resistance
Layer
------------------
| /
| /
| /
| /
| /
| /
| /
| /
| /
| / ΔV
| /
| /
| /
| /
|/
|/
T2
Thermopiles can also be constructed with more than two sets of thermocouple pairs to
increase the voltage output.

Thermopiles can be connected in parallel as well, but this configuration is less common
because it increases the current output rather than the voltage output.
Thermopiles do not respond to absolute temperature, but only to temperature
differences or gradients.

Therefore, they can be used to measure heat flux, which is the rate of heat transfer per
unit area. Heat flux can be calculated by dividing the voltage output by the thermal
resistance and the area of the device.
Thermopiles use infrared radiation as a means of heat transfer and are also used for non-
contact temperature measurement.

Infrared radiation is electromagnetic radiation with wavelengths between 700 nm and 1

mm, which corresponds to temperatures between 300 K and 5000 K. Infrared radiation
is emitted by any object with a nonzero temperature and can be detected by a thermopile
sensor.

Types of Thermopile Sensors

A thermopile sensor is a device that uses one or more thermopiles to measure
temperature or infrared radiation from an object or a source.

Thermopile sensors are based on non-contact measurement principles and have various
advantages over contact-based sensors, such as higher accuracy, faster response time,
wider range, and lower maintenance.

 There are different types of thermopile sensors, depending on the number,

configuration, and material of the thermocouples, as well as the design of the
infrared absorber and the filter. Some of the common types of thermopile sensors
are: Single-element thermopile sensor: This type of sensor has only one
thermopile with a single hot junction and a single cold junction. The hot junction
is attached to a thin infrared absorber, usually a micro-machined membrane on a
silicon chip. The cold junction is connected to a heat sink or a reference
temperature. The sensor measures the temperature difference between the hot
and cold junctions, which is proportional to the infrared radiation absorbed by
the membrane. This type of sensor is suitable for measuring low to medium
infrared radiation levels and has a fast response time.
 Multi-element thermopile sensor: This type of sensor has multiple thermopiles
arranged in parallel or in series. Each thermopile has its own hot and cold
junctions, which are connected to a common infrared absorber and a common
heat sink. The sensor measures the sum of the voltage outputs from each
thermopile, which is proportional to the total infrared radiation absorbed by the
membrane. This type of sensor is suitable for measuring high infrared radiation
levels and has a high sensitivity.
 Array thermopile sensor: This type of sensor has an array of thermopiles
arranged in rows and columns on a substrate. Each thermopile has its own hot
 and cold junctions, which are connected to individual infrared absorbers and heat
sinks. The sensor measures the voltage output from each thermopile separately,
which is proportional to the local infrared radiation absorbed by each absorber.
This type of sensor can create a two-dimensional image of the infrared radiation
distribution and can detect the position, shape, and movement of an object.
 Pyroelectric thermopile sensor: This type of sensor combines a pyroelectric
material with a thermopile. A pyroelectric material is a material that generates
an electric charge when heated or cooled. The pyroelectric material is attached
to the hot junctions of the thermopiles, while the cold junctions are connected to
a heat sink. The sensor measures the voltage output from the thermopiles plus
the charge output from the pyroelectric material, which is proportional to the rate
of change of infrared radiation absorbed by the material. This type of sensor can
detect rapid changes in infrared radiation and can measure both static and
dynamic temperatures.
Applications of Thermopile Sensors
Thermopile sensors have various applications in different fields, such as:

 Medical devices: Thermopile sensors are widely used in medical devices that
measure body temperature, such as ear thermometers, forehead thermometers,
tympanic thermometers, and thermal imaging cameras. Thermopile sensors can
provide accurate and non-invasive temperature measurements without contact
with the skin or mucous membranes.
 Industrial processes: Thermopile sensors are used in industrial processes that
involve high temperatures, such as metal processing, glass manufacturing,
plastic molding, welding, soldering, and laser cutting. Thermopile sensors can
provide fast and reliable temperature measurements without contact with hot
objects or surfaces.
 Environmental monitoring: Thermopile sensors are used in environmental
monitoring devices that measure ambient temperature, humidity, air quality, soil
moisture, fire detection, and solar radiation. Thermopile sensors can provide
accurate and stable temperature measurements without interference from other
factors.
 Consumer electronics: Thermopile sensors are used in consumer electronics
devices that require temperature sensing or infrared detection, such as
smartphones, tablets, laptops, cameras, remote controls, smart watches, gaming
consoles, and virtual reality headsets. Thermopile sensors can provide low-cost
and low-power solutions for various functions, such as face recognition, gesture
control, proximity sensing, biometric authentication, and thermal imaging.
UNIT III WIRELESS HEALTH SYSTEMS 9
Need for wireless monitoring, Definition of Body area network, BAN and Healthcare,
Technical Challenges- System security and reliability, BAN Architecture – Introduction,
Wireless communication Techniques.

3.1 Need for wireless monitoring

Wireless monitoring through wearable devices could be useful for hospitalized patients,
particularly those who are unstable or at higher risk for serious complications such as critically
ill patients. This review aims at summarizing current evidence regarding the use of wireless
monitoring in the ICU setting.
Wireless sensor network (WSN) technologies have the potential to change our lifestyle with
different applications in fields such as healthcare, entertainment, travel, retail, industry,
dependent care and emergency management, in addition to many other areas. The combination
of wireless sensors and sensor networks with computing and artificial intelligence research
have built a cross-disciplinary concept of ambient intelligence in order to overcome the
challenges we face in everyday life.

3.2 Definition of Body area network

Body Area Network (BAN) technology uses small, low power wireless devices that can be
carried or embedded inside or on the body. Applications include but are not limited to:
 Health and wellness monitoring
 Sports training (e.g., to measure performance)
 Personalized medicine (e.g., heart monitors)
 Personal safety (e.g., fall detection)

A number of wireless BAN communication technologies have been implemented based on the
existing radio technologies. However, if BAN technology is to achieve its full potential, it
needs a more specific and dedicated technology, which is optimized for BAN. For example,
solutions for monitoring people during exercise one or two hours a day, or a few days a week,
may not be suitable for 24/7 monitoring as a part of the Internet of Things (IoT) concept.
3.3 BAN and Healthcare
Body Area Network (BAN) is a technology that allows communication between ultra-small
and ultra low-power intelligent sensors/devices that are located on the body surface or
implanted inside the body. In addition, the wearable/implantable nodes can communicate to a
controller device that is located in the vicinity of the body. These radio-enabled sensors can be
used to continuously gather a variety of important health and/or physiological data. Radio-
enabled implantable medical devices offer a revolutionary set of applications among which we
can point to smart pills for precision drug delivery, intelligent endoscope capsules, glucose
monitors and eye pressure sensing systems. Similarly, wearable sensors allow for various
medical/physiological monitoring (e.g. electrocardiogram, temperature, respiration, heart rate,
and blood pressure), disability assistance, human performance management, etc.
Wearable devices that work outside the confines of the hospital without expert medical
assistance must fulfill a number of characteristics:
 Usability: The device has to be worn on a continuous basis and must therefore be small
and lightweight. The challenge is to compress the device size down.
 Power consumption: The device should have low power consumption, reducing the
need for frequent re-charging and disruptions in monitoring.
 Design: The device must be elegant without the need to attach long wires and electrodes
from the device to the patient and from the device to the mobile gateway that transmits
data (to the remote medical care unit).
 Cost: If a patient is required to purchase the unit, it should cost sub US$200 to be
affordable or for the hospital to give it away free as part of medical care.
Devices that fulfill these conditions can expect to become popular. Manufacturers will find that
users are able to easily integrate such devices into their daily lives for maximum benefit.
The typical set of parameters that the device must monitor include heart activity, fetal heart
rate, skin resistance, skin temperature, refractive index of blood etc. Based on what the device
is required to measure and monitor, its components would include:
 Bio sensors: Application specific bio sensors that emit signals indicating measured
parameters
 Analog-to-digital converters: Application specific analog front end to digitize the
sensor signals. The device may also be equipped with signal conditioning circuitry.
  General purpose micro controller: To process signals for the device to function. Signals
could indicate battery levels, failure, etc. or signals received from accelerometer,
displays and switches, memory and connectivity solutions.
 Wireless interface: In most instances, the device will connect to a mobile gateway over
a Body Area Network (BAN) or the newer Bluetooth LE (low energy) suitable for
continuous transfer of medical data.
 Memory: In modern wearable devices, the data is sent in real-time to a mobile gateway
(smart phone or a tablet) and then to the patient’s remote health care provider. These
devices can also store data in off line mode, synchronizing the data when the device
goes online.
 Power management: The device design must ensure that energy consumption is
minimized for longer uninterrupted device deployment and stand by time.

3.4 Technical Challenges

Effectiveness of the WBAN is important from both patients and healthcare perspective.
As the time passes, challenges to the emerging technologies increases along with the
advancements. There is variety of challenges faced by WBAN as explain below. These
challenges are classified in six major classes such as energy, mobility, security and
communications (i.e., networking, QoS and cooperation).

A. Energy Requirements: Since, most of the devices in WBAN are using the wireless
medium, therefore they are portable. Such devices are small in size and carry power
source too. Hence, the power is always limited. Wireless natures made them roam
free, meaning the devices are free to move. The power to the device of the network
is provided with the help of batteries. Things are not simplified by allowing the
power from battery but is encompasses some more challenges of power
management of the battery supplies especially in case of implants. Since the sensors
that are implanted in the body are so small that the battery cannot sustain more than
a month. Removing the implants and re-installation require even more management
of the complications generated. Different parameters that alter the power
consumption include communication bandwidth and processing power. There is
 need to have better scheduling algorithm along with better power management
schemes.

B. WBAN Security: In any network, communication data is of worth importance. In

case of WBAN, it becomes more critical as it has been connected to the Physical
system. These communication channels are very much visible to the attacker and if
not securely implemented it could any of the attack including eavesdropping on
traffic between the nodes, message injection, message replay, spoofing and off
course compromise the integrity of physical devices. Upon successful attack, such
actions not only invade privacy but may lead to catastrophic situation.

C. Mobility Support: WBAN provides two major advantages, i.e., portable

monitoring and location independence. Regardless of the application, these are the
key factors due to which WBAN is potential candidate in many venues. But these
two advantages put some special limitations i.e., mobility. Mobility can pose
serious problem in some application like E-Health care even posture do effect the
communication. The mobility is defined between the user and the WBAN as a
seamless link. One of the major issues is to reach to sink, which may be single or
multi hop. Message is flooded to all nodes to reach sink node and the path with
minimum delay is selected. Reliable multipath routing is another solution proposed.
A path list is maintained depending upon different factors of the routing and the
link is established accordingly.

D. Quality of Service: Quality of Service (QoS) is the requirements fulfilled by

system as requested by the users. For more life critical system, timeliness may be
the parameter for the quality. System, that cannot fulfill the said requirement, falls
short of providing the QoS. Same is true for other factors like bandwidth, latency,
jitter, robustness, trustworthiness, adaptability. Similarly, seamless roaming and
end to end wireless connection between the body nodes and the sink nodes is
another QoS factor.

E. Cooperation between Nodes: When the intermediate nodes help source

destination pair in communication, the cooperation occurs. The intermediate nodes
may refer as helper or relay as shown in Fig. Cooperation offers a good solution for
many of the limitations in WBAN such as distance, mobility, coverage and channel
impairments.
3.5 System security and reliability

Sensor nodes/actuators represent essentially the wireless sensor network, and the sensor
node senses acoustic factors including temperature, pressure, sound, pulse rate, ECG, blood
pressure, and heart rate of the human body. In healthcare, this form of sensor network is known
as a wireless body area network (WBAN)
Wireless body area networks consist of sensors, biological parameters, body control
unit, personal device assistant, transmission factor, and user access. Figure shows that the
wireless body area network along with the sensor senses the biological factors continuously in
order to obtain the human health information from the body control unit. The electrocardiogram
(ECG) sensor records the patient's electric impulse as it passes through the heart muscle. This
assists in monitoring the patient's heartbeat, which is used to track various movements such as
resting and moving. The temperature of the human body's ears, skin, and forehead are detected
by the body temperature sensor.
The pressure of blood as it travels through the arteries is measured by blood pressure
and the pulse wave is measured by the heart rate sensor as it pumps blood through the patient's
body. The saturation level of oxygen in the blood is measured with a pulse oximeter. The
airflow sensor can be positioned near the human body's nasal to assess the body's respiration.
The collected information will be transferred and stored in the personal device assistants (PDA)
and later transmitted to the base station. From the base station, the data will be transferred to
the respective user applications such as cloud databases, ambulances, family members, and
doctors via the Internet.
A cloud database's purpose is to store the patient's data on a server so that the doctor
can access it and then send the patient's information to the user via the internet. Star topology
is used in the body area network. The body control unit acts as a central node and then each
sensor will sense and communicate to the center node. The center node interfaces the human
body by using Bluetooth or ZigBee or Personal Device Assistants (PDA), and then the patient’s
information can be accessed by the doctors using the Internet.

Security Issues in WBAN

The purpose of network security is to protect data from threats during data transmission.
There are two forms of attacks in network security: active and passive attacks, both of which
contribute to the detection of malicious data. An active attack is primarily focused on data and
has a significant impact on the system's operation. A passive attack damages or modifies data
but does not degrade information resources. The security flaws are applied at various levels.
Each layer of the TCP/IP layered architecture generates attacks. IP attacks are introduced in
the second layer (logic link control), resulting in address spoofing for incorrect communication.
Internet Control Message Protocol (ICMP) attacks is generated in the media access control
layer, which results in sniffing and man-in-the-middle attacks. In the third network layer,
routing attacks such as blackhole and eavesdropping attacks are created. TCP attacks are
originated in the transport layer, resulting in high synchronization flooding in data
communication. Application layer attacks are generated in the OSI model's application layer,
resulting in authentication issues such as accessing the user's username and password
A denial of service (DoS) attack will restrict data from authorized users and prevent
them from accessing their resources. Because of the week password, distributed denial of
service (DDoS) attacks is generated. The main difference between a DOS and a DDOS attack
is that a DOS attack targets a single host at a time, but a DDoS attack targets numerous hosts
simultaneously. These types of attacks will degrade network performance.

The term “reliability” refers to the fact that health-care practitioners receive monitoring
data in a timely and accurate manner. WBAN sensors must be capable of viewing and detecting
essential active signs of human health; therefore, reliability is critical. WBAN sensors must be
capable of viewing and detecting essential active signs of human health; therefore, reliability
is critical
3.6 BAN Architecture

WBAN is designed with special purpose sensor which can autonomously connect with
various sensors and appliances, located inside and outside of a human body.
Below Figure demonstrates a simple WBAN architecture where the architecture is
divided into several sections. Here we have classified the network architecture into four
sections. The first section is the WBAN part which consists of several numbers of sensor nodes.
These nodes are cheap and low-power nodes with inertial and physiological sensors,
strategically placed on the human body. All the sensors can be used for continuous monitoring
of movement, vital parameters like heart rate, ECG, Blood pressure etc. and the surrounding
environment. There are vast monitoring systems are being used already based on wired
connections. Any wired connection in a monitoring system can be problematic and awkward
worn by a person and could restrict his mobility. So, WBAN can be a very effective solution
in this area especially in a healthcare system where a patient needs to be monitored
continuously and requires mobility.
The next section is the coordination node where the entire sensor nodes will directly
connected with a coordination node known as Central Control Unit (CCU). CCU takes the
responsibility to collect information from the sensor nodes and to deliver to the next section.
For monitoring human body activities

there is no such wireless technology is fixed for targeting WBAN. Most popular
wireless technologies used for medical monitoring system are WLAN, WiFi, GSM, 3G,
4G,WPAN (Bluetooth, ZigBee) etc. . Except Cellular network standard all of these
technologies are commonly available for short distance communication. WMTS (Wireless
Medical Telemetry Service) and Ultra-Wide Band are another technology that could be used
for body monitoring system as they operate in low transmission power.
The third section is the WBAN communication which will act as a gateway to transfer
the information to the destination. A mobile node can be a gateway to a remote station to send
Mobile Message to a cellular network using GSM/3G/4G. A router or a PC can be a remote
node to communicate via email or other service using Ethernet which is shown in Figure.
The last section will be a control center consists of end node devices such as Mobile
phone for message, PC for monitoring and email and server for storing the information in the
database.
WBAN Requirements and Workflow
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Requirements for Wireless Medical Sensors in WBAN
Wireless medical sensors should satisfy the following main requirements such as

Figure . A Typical WBAN communication.

wearability, reliability, security, and interoperability :
Wearibility: To achieve non-invasive and unobtrusive continuous monitoring
Wearibility is a very important issue. These sensors must be lightweight and small. Size and
weight of sensors are mainly determined by the size and weight of batteries . But, a battery’s
capacity is directly proportional to its size.
Reliability: Reliable communication in WBANs is of paramount importance for any
WBAN application. So the designer should target a reliable communication technique which
will ensure uninterrupted communication and optimal throughput. A careful trade-off between
communication and computation is very crucial for a reliable system design.
Security: Another important issue is the security of the network. All the wireless
medical sensors must meet the requirements of privacy and should ensure data integrity and
authentication.
Interoperability: Wireless medical sensors should allow users to easily build a robust
WBAN. Standards governing that interaction of wireless medical sensors will help vendor
competition and eventually lead to more accessible systems .
Monitoring Sensors
Wireless body area network is a system which can continuously monitor a person’s
activities. Based on the operating environments the monitoring sensors can be classified into
two types.
v Wearable sensor devices worked on the human body surface.
v Implantable devices operated inside human body
Wearable sensor devices allow the individual to follow closely the changes in her or his
functions and in the surrounding environment and provide feedback for maintaining optimal
and instant status. For example ECG, EEG, Blood pressure sensor can be used to monitor a
critical patient, GPS sensor can be used to locate an area and different types of sensor that can
be used to measure the distance, temperature, movement etc.
To measure heath parameters, implantable sensors are planted in close contact with the
skin, and sometimes even inside the human body. Implantable biosensors are an important class
of biosensors based on their ability to continuously measure metabolite levels, without the need
for person interference and regardless of the person’s physiological state (sleep, rest, etc.) . the
implantable biosensors have great impact to diabetes and trauma care patients, as well as
soldiers in action (military). Figure focuses on the sensor nodes with wireless capabilities.
Traffic Types
In a WBAN traffic can be divided into three categories such as:
v Normal traffic
v Emergency traffic
v On-demand traffic
 Figure . Sensor nodes in WBAN.
Normal traffic is the data traffic which is used to monitor the normal condition of a
person without any criticality and on demand events. Emergency traffic is initiated by nodes
when they exceed a predefined threshold or in any emergency situation. Such type of traffic is
totally unpredictable.
On-demand traffic is initiated by the authorized personnel like doctor or consultant to
acquire certain information for diagnostic purpose .
Work Flow
Figure shows the work flow chart of WBAN. In the flowchart workflow is divided into
two sections. First section is the WBAN where all the sensors devices will collect data and
process them to the control center. While processing if any error occurs then it will read data
again from the sensor and will forward for processing.
The control center will send the data to the desired location. If any problem occurs then
it will generate an error where resend option should be needed again.
WBAN Standards and Technologies
As WBAN is a short range wireless networks so different types of wireless short range
technologies can be involved in different stages. In this segment we will describe most common
technologies such as Bluetooth, ZigBee, WiFi, IEEE 802.15.6 etc. that can be used to deploy
WBAN.
Bluetooth
Bluetooth is an IEEE 802.15.1 standard commonly known as WPAN (Wireless
Personal Area Network). Bluetooth technology was designed as a short range wireless
communication standard, anticipated to form a network with security and low power
consumption. A typical Bluetooth network forms a Piconet where a Bluetooth device works as
a master and another seven Bluetooth devices

Figure Working flowchart of WBAN.

work as slaves which gives each device to communicate with each other
simultaneously. Another type of Bluetooth network can be formed with more than one Piconet
known as Scatternet. In Scatternet a node of a Piconet (can be a master or a slave) joins as a
slave in another Piconet. Figure shows how a Piconet and Scatternet are formed using
Bluetooth nodes. Though, the basic Bluetooth protocol does not support relaying but it is
possible to join together numerous Piconet into a large Scatternet, and to expand the physical
size of the network beyond Bluetooth's limited range using this method.
Bluetooth devices operate in the 2.4 GHz ISM band (Industrial, Scientific and Medical
band), utilizing frequency hopping among 79 1 MHz channels at a nominal rate of 1600
hops/sec to avoid interference. It is classified with three classes of devices with coverage
ranging from 1 to 100 m and different transmission powers ranging from 1 mW to 100 mW
with 3 Mbps data rate. A very key feature of Bluetooth is that all the Bluetooth devices can
communication with each other in NLOS condition. Bluetooth is suitable for short distance
data transmission applications such as between servers of WBANs or between a WBAN and a
personal computer.
ZigBee

ZigBee is an IEEE 802.15.4 standardized solutions for wireless telecommunications

designed for sensors and controls, and suitable for use in harsh or isolated conditions. One of
the biggest advantages of ZigBee network is its low power consumption. Figure shows a
typical ZigBee network topology which consist of three kinds of devices or nodes such as
coordinator, router and end device. One coordinator exists in every ZigBee network. It starts
the network and handles management functions as well as data routing functions. End devices
are devices that are battery-powered due to their low-power consumption. They are in standby
mode most of the time and become active to collect and transmit data.

Bluetooth network.

Figure ZigBee network.

Devices such as sensors are configured as end devices. They are connected to the
network through the routers. Routers help to carry data across multi-hop ZigBee networks. In
some cases ZigBee network topology are formed without routers when the network is point to
point and point to multipoint.
ZigBee is aimed at RF applications that require low data rate, long battery lifespan and
secure networking. Through the standby mode, ZigBee enabled devices can be operational for
several years. ZigBee-based wireless devices operate in three different frequency bands such
as 868 MHz, 915 MHz, and 2.4 GHz. Therefore, one substantial drawback of using ZigBee
network for WBAN applications is due to interference with wireless local area network
(WLAN) transmission, especially at 2.4 GHz. As ZigBee devices operate at low data rate so it
can be unsuitable for large-scale and real time WBAN applications. But, it can be very much
suitable for personal use like assisted living, health monitoring, sports, environment etc. within
a modest range between 50 - 70 meters
WiFi
WiFi is an IEEE 802.11 standard for wireless local area network (WLAN). Generally
WiFi technology comes with four standards (802.11 a/b/g/n) that runs in ISM band 2.4 and 5
GHz with a modest coverage of 100 meter. Wi-Fi permits users to transfer data at broadband
speed when connected to an access point (AP) or in ad hoc mode. Fig shows a WiFi network
where WiFi sensor nodes and users can transfer data using internet by standard WiFi router. In
some modified version, WiFi devices can be used in data acquisition applications that allow a
direct communications between the sensors and the smart phones/ PC even without an
intermediate router.
WiFi is preferably suitable for large amount of data transfers with high-speed wireless
connectivity that allows videoconferencing, voice calls and video streaming. An important
advantage is that all smart phones, tablets and laptops have Wi-Fi integrated; however the main
disadvantage of this technology is high energy consumption.
IEEE 802.15.6 WBAN
IEEE 802.15.6 is the latest addition in WPAN which is known as WBAN standard that
provides various medical and non medical applications and supports communications inside
and around the human body. This standard supports communication inside and outside of
human body which can be used for different medical and non medical applications such as e-
Healthcare monitoring, sports, environment etc.
IEEE 802.15.6 standard is classified by three physical layer standards. Each standard
uses different frequency bands for data transmission with data rate 10 Mbps maximum. First
one is Narrowband (NB) which operates within the range of 400, 800, 900 MHz and 2.3, 2.4
GHz bands. The Human Body Communication (HBC) is another standard which operates at
range of 50 MHz. The Ultra Wideband (UWB) technology operates between 3.1 GHz to 10.6
GHz which supports high bandwidth in short range communication.
3.7 Introduction Wireless communication Techniques
In today’s world, wireless communication has a major application in sharing of
information anywhere and at anytime. We can use wireless networks in the form of WLAN or
Wi-Fi in various fields such as education, healthcare, and industrial sector. As the technology
is growing, the demands of users as well as the demand of ubiquitous networking is increasing.
WBAN(Wireless Body Area Network) allows the user to move another without having the
restriction of a cable for sharing information.
The communication in body sensor networks is of 2 types:
1. In-body communication
2. On-body communication
In-body communication is the communication between sensor nodes that are implanted
inside human body. The MICS (Medical Implant Communication System) communication can
be used only for in-body communication. On-body communication occurs between wearable
devices which consist of sensor nodes. The ISM (Industrial Scientific and Medical) band
and UWB (Ultra-wideband) communication can be used only for on-body communication.
A body area network (BAN), also referred to as a wireless body area network (WBAN)
or a body sensor network (BSN) or a medical body area network (MBAN), is a wireless
network of wearable computing devices. BAN devices may be embedded inside the body,
implants, may be surface-mounted on the body in a fixed position Wearable technology or may
be accompanied devices which humans can carry in different positions, in clothes pockets, by
hand or in various bags. A WBAN system can use WPAN wireless technologies as gateways
to reach longer ranges. Through gateway devices, it is possible to connect the wearable devices
on the human body to the internet. This way, medical professionals can access patient data
online using the internet independent of the patient location. In modern technology wireless
communication provides a lot of possibilities to be able to share its information to each other
at anytime and anywhere. Intelligent mobile communication network and WLAN, Wi-Fi are
applied to various sectors such as education; health care service and industry in order to provide
people a convenient way to communicate with each other. As the demand of ubiquitous
network is increased, the devices for home, office and other information devices that can
communicate wireless in short range have been getting more attention. The standard and
technique development of ubiquitous network has rapidly put itself into the world market.
Wireless Body Area Network (WBAN) is becoming a special application of such technique.
WBAN differs with other wireless sensor networks (WSN) with some significant points. First
difference between a WBAN and WSN is mobility. In WBAN user can move with sensor nodes
with same mobility pattern whereas WSN is generally used to be stationary. Energy
consumption is much less in WBAN than other WSNs arrangement. In addition, WBAN sensor
devices are found cheaper than WSNs. For reliability, node complexity and density, WBAN
nodes are however traditional. WSNs do not tackle specific requirements associated with the
interaction between the network and the human body . The WBAN performs like Virtual
Doctor Server, by keeping the different responsibilities like- maintain the history of the patient,
giving advices to the patient in general/emergency (first aid help from second person) case etc.
To understand the communication approach of this emerging WBAN technology, we first need
to know the conceptual structure of WBAN so that, one can easily know the flow of
communication within the system and to the outside world, this has been achieved by the
demonstration of a simple WBAN communication architecture. Where this architecture is
mainly comprised with three different layers namely: Tier 1, Tier 2 and Tier3 and these are
further described better in the given figure
UNIT IV SMART TEXTILE 9
Introduction to smart textile- Passive smart textile, active smart textile. Fabrication
Techniques-Conductive Fibres, Treated Conductive Fibres, Conductive Fabrics, Conductive
Inks.Case study-smart fabric for monitoring biological parameters - ECG, respiration.

4.1 Introduction to smart textile

The term "Smart Textiles" refers to a broad field of studies and products which extends there
functionality and there use. Smart Textiles are defined as textile products such as fibers,
filaments, and yarn which are woven, knitted or non-woven which can interact with the
environment or wearer. The combination of textile with electronics which is all known as e-
textiles can be applicable to the development of smart material.

"Smart textiles are the fabrics that have been developed with new technologies that provide
added value to the wearer"

Smart textile is the material which can react to the environment. These are the fabrics which
can enable digital components and electronics in itself. Pailes-Friedman of the Pratt Institute
states that "what makes smart fabrics revolutionary is that have the ability to do many things
that traditional fabrics cannot, including communicate, transform, conduct energy and even
grow". The smart textile can sense and react to environmental conditions or stimuli from
mechanical, thermal, chemical, electrical, magnetic or other sources. Smart textiles must
contain three components i.e. sensors, actuators and control units. Smart textile presents a
challenge in several fields such as the medical, sports, military and aerospace.

Types of smart textiles

Smart textiles can be divided into four types based on their functions.

1. Passive smart materials: These are the material which only senses the environmental
conditions or stimuli.

These are just sensors such as changing colour, shape, thermal and electrical resistivity.

g. a shirt with in-built thermistors to log body temperature over time.

2. Active smart material: These are the material which can both sense and respond to the
external conditions or stimuli.

If actuators are integrated into the passive smart textile, it becomes an active smart textile
as it may respond to a particular stimulus.

g. the shirt senses the surrounding temperature. It reacts in the form of rolling up of sleeves
when the temperature gets high.

3. Very smart materials: These are materials are able to execute triple functions; first there are
sensors which can receive signals, secondly, they are able to give reaction based on the received
singles; thirdly they can adapt and changes the shape, size, colour or act according to the given
function.

4. Materials with the even higher level of intelligence develop artificial intelligence to the
computers.

These kinds of materials are not fully achieved in the current investigation of human beings.

This may be achieved with research and development in the field of textile and electronics.
By using the smart fabrics or smart materials with advancement in computer interface this can
be possible.

Materials used

The materials which are used to manufacture products of wearable smart textile can interact,
communicate and sense.

* Metal fibers * Conductive Inks

* Chromic materials * Coating with nanoparticles

* Organic semiconductors * Shape memory materials

* Optical fibers * Quantum tunneling composites

* Inherently conductive polymers

Conductive threads are mainly used in technical areas like garments, military apparels, medical
application and electronic manufacturing. These conductive yarns and fibers are made by
mixing pure metallic or natural fibers with conductive materials. Stainless steel filament,
metallic silk, organza, special carbon fibers etc are used for manufacturing of fabric sensors.
Materials like metallic, conductive polymers, optical fibers supply electrical conductivity,
sensing capabilities and data transmission. These materials are resilient, light in weight,
flexible, inexpensive and easy to process.

Applications

1. Thermotron

Thermotron of UNITIKA is a particular fabric which is able to absorb sunlight and convert the
light energy into thermal energy. It stores heat without wasting it. Inside the thermotron, there
are microparticles of zirconium carbide which allow the fabric to absorb and filter sunlight.
The inner layer of the fabric holds the heat generated by the fabric and prevents it from going
in surrounding atmosphere, thus providing a favorable effect on the human body. It offers a
comfortable, waterproof yet breathable wearing experience.

2. Stone Island

Stone island is a jacket which is made to give information about surrounding temperature. It's
a liquid crystal heat sensitive coating. At 27 degree census, the molecules which are present in
the coating undergo a rotation which modifying the light course. As a result of the colour of
the garment gradually begins to change from the dark colour to the much lighter and brighter
colour of the fabric base. When the garment returns to its normal temperature, it recovers its
original dark coating colour.

3. Polar seal

Feeling cold would be the thing about past there's a product called polar seal which gives instant
heat at the touch of a button. There are three different warming levels high, med and low. There
are two heating zones one in the upper back and lower back so that we can feel warm in winter.
These are easy to use and are tested in alpine conditions. These are flexible, lightweight,
breathable and water resistant which makes them ideal for sports or outdoor. These can be worn
on gloves or inside shirts. These can keep warm up to 8 hrs in a single charge.

4. ZeroI

Zerol is a cap which is built-in with bone conduction speakers. We don't have to use earphones
to listen to music or to make phone calls. As it is a cap our ears are never blocked. It is water
resistant, because of which we can also use it while it's raining.

5. ORII

Orii is a ring, by using it we are able to have called. Orii is a voice assistant ring that turns our
finger into smartphone all through just a touch to the ear. It uses bone conduction and bone
conduction has been used in many medical grade devices. To adjust the ring there are silicon
pads incorporated in design which are durable and allergy proof. It has been packed in such a
way that it sends vibrations through your finger directly into your ear, so only you can hear. So
that allows you to talk and listen just through your finger. There is dual noise-canceling
microphone and bone conduction, we can hear and talk even in loud places. By using this we
are able to do things like navigation, alarms, translation, texting, weather, messaging, calling,
timer, map routes etc. it is water resistant. It has the custom notification, there are four LED
lights that can tell us what kind of messages are coming through.

6. Lumo Run

Self-motivation can be runners greatest assets but self-evaluation can be greatest challenge luco
run are for those who want to get trained by themselves. Luco run is a motion sensor that
collects data and provides motivation all while you run and it fits in a waistband of your shorts.
Luco run analyses running biomechanics then suggest judgments on your form that maximises
true potential by avoiding any injury. You can access data anywhere which gives full post
analyses on the smart phone. We don't need any goggles, smartwatch, wristband no cables.

7. AIO Sleeve

Aio sleeve is a sleeve which can be worn in one hand and gives information which only doctors
can give. It gives you self- analyses, sleep duration, quality of sleep on your mobile phone. It
can play your favorite music. While workout it measures heartbeat, ECG, steps/distance as well
as calories counter. While work it measures your stress level. All these things we are able to
see just on your smartphone anytime any place.
4.2 PASSIVE SMART TEXTILES
These fabrics have functions beyond what you would normally expect clothing to do. However,
they do not use electronics or internet connection at all.

This also means that these fabrics don’t contain sensors or wires. They do not need to change
because of the conditions around them. All you need to do is wear a piece of clothing made
with a passive smart textile and know that it is working.

A passive smart textile’s functions are going to be much simpler than those of an active smart
textile. This is because the state of the fabric will never actually change. There are no
electronics involved in these fabrics whatsoever.

This means that all of its functions will allow it to remain in a static state the entire time it’s
worn.

On the topic of static, preventing static cling is one function that passive smart textiles can
have. There’s nothing more frustrating than pulling laundry out of the dryer to find out it’s all
stuck together by static cling. Anti-static textiles can help reduce this effect.

You might also have anti-microbial textiles. These fabrics aim to reduce how often you get
sick by preventing viruses and bacteria from remaining on your clothes. This helps promote
the health and well-being of the wearer.

Another way to promote health and well-being is by protecting yourself from harmful UV rays.
This can help prevent sunburns and skin cancer. And this is also a function that passive smart
textiles can have.

4.3 ACTIVE SMART TEXTILES

On the other hand, active smart textiles are closer to what you probably think of when you talk
about smart technology. These fabrics will actually change to adjust the conditions of the
wearer. Some can even connect to apps and computer software.

In other words, these fabrics actively do something to make the wearer’s life more comfortable
or convenient, rather than the fabric itself being what makes it smart as a passive smart textile
does.

The applications of active smart textiles can be much more varied. This is because there are
many different ways that these fabrics can be changed and adjusted.

First of all, the healthcare industry may find some of these fabrics useful. Smart textiles can
monitor a patient’s heart rate, for example. This can alert nurses to any potential problems
earlier enough to help.

The military can also use some of these fabrics. They can use wires integrated into the fabric
to transport data from one place to another quickly. This means that military strategies can be
updated in real-time.
They can also be used for disaster relief. Some of these textiles can be used as power sources
for housing during natural disasters. This means that no matter what happens, people will have
a warm place to stay.

Finally, these fabrics can also be connected to the internet. This can help tell you all sorts of
things like heart rate and blood pressure right on your smartphone. But it can also be used for
fun activities, such as gaming.
4.4 Fabrication Techniques
Different fabrication techniques like knitting, weaving, and embroidery are used to convert raw
materials like conductive fibers, yarns, polymers, and polymer composites into smart textiles.
Smart electronic textiles are applied in every field of life due to their novel and unique
properties.

The term ‘smart textiles’ is used to describe materials that are advanced in their structure,
composition and ‘behaviour’ in special conditions. Their ‘intelligence’ is classified into three
subgroups:

•Passive smart textiles, which are sensors and can only sense the environment;

•Active smart textiles, which can sense stimuli from the environment and also react to them;
simultaneously with the sensor function, they also play an actuator role;

•Very smart textiles, which are able to adapt their behaviour to the circumstances.

4.5 Conductive Fibres

Conductive polymer-based electrochromic fabrics show promising applications in new
intelligent displays, flexible smart wearables, and military camouflage, thanks to their
flexibility, light weight, high degree of controllability, and wide range of color change.

The textile structures which can conduct electricity are called conductive textiles. It may be
either made using conductive fibres or by depositing conductive layers onto non-conductive
textiles.

A conductive fabric can conduct electricity and made with metal strands woven into the
construction of the textile. It can be inhibited the static charge generated on fabric, to avoid
uncomfortable feelings and electrical shocks also.

Methods of producing conductive textiles are summarized as follows:

 Adding carbon or metals in different forms such as wires, fibres or particles.

 Using inherently conductive polymers.
 Coating with conductive substances.

Types of Conductive Textiles:

Generally, four kinds of conductive textile as follow:

1. Anti-static textiles
2. EM shielding textiles
3. E-textiles
4. Functional coatings

1. Anti-static textiles:
Static electricity can the build-up of electric charge on the surface of objects. Which can be
caused many problems for textile materials, manufacturing and handling the product. In dry
textile process, fibres and fabrics can tend to generate electro-static charges from friction.
When fibres and fabrics are moving at high speeds on different surfaces, (like: conveyer belts,
transport bands, driving cords, etc) causing fibres and yarns to repel each other. These static
charges can be produced electrical shocks and caused the ignition of flammable substances.
Two techniques are known to prevent static electricity in textiles. One is to create a conducting
surface and another is to produce a hydrophilic surface. In these ways antistatic textiles are
produced to avoid the potential hazards caused by static charge or, electricity.

2. EM shielding:

Electro Magnetic shielding (EMs) is the process of restricting the diffusion of electromagnetic
fields into a space. In this process, electrically or magnetically conductive barrier is used.
Shielding is common technique for protecting electrical equipment and human beings from the
radiating electro-magnetic fields. This barrier can be rigid or flexible. When an EM beam
passes through an object, the electro-magnetic beam interacts with molecules of the object and
this interaction may take place as absorption, reflection, polarization, refraction, diffraction
through the object. EM Shielding textiles materials can be found in the form of woven, knitted,
and nonwoven fabric also. The major components of these fabrics are fibres and yarns. To
achieve an effective shielding behaviour, these fibres should be electrically conductive.
Conductive yarns can be made by blending conductive fibres with conventional staple fibres,
twisting conductive or insulator filaments together. For example, conductive metallic yarn
(such as: silver, copper, etc.) can be wrapped with insulating textile materials to create hybrid
yarns. Which could be integrated into woven or knitted structures. Hybrid yarns or metallic
fibre can be integrated into these designs as warp. Electromagnetic shielding effectiveness of
the fabric decreased with the increase in fabric openness.

3. E-textiles:

Electrically conductive fibres and yarns have attracted great interest because of their
distinguished features including reasonable electrical conductivity, flexibility, electrostatic
discharge, and EM interference protection. Conductive textile fibres are the primary component
for wearable smart textiles introduced particularly for different applications such as sensors,
electromagnetic interference shielding, electrostatic discharge, and data transfer in clothing.
Therefore, the demand for electrically conductive fibres and yarns is ever-growing. The
development of novel conductive fibres becomes crucial with technological improvement in
wearable electronics such as wearable displays, solar cells, actuators, data managing devices,
and biomedical sensors. E-textiles play a critical role in selecting the conductivity of smart
textile electronics. Textile applications such as lighting, considerable current is necessary and
low ohmic fibres are preferred. On another hand, for certain sensing or heating applications
lower conductivity would work better. So, it requires fibres exhibiting lower electrical
conductivity. E-textiles need flexible and mechanically stable conducting materials to ensure
electronic capabilities in apparel.

4. Functional coatings:

For many applications, functional coating is the material interfaces and surfaces that provide
beneficial functionality over their intrinsic bulk characteristics. Hence, coatings provide a
versatile method of modifying textiles with conductive properties. Subsequently, the textile
fabric acts as a supporting structure or carrier material for the conductive finish. Conventional
methods such as dip coating or roll coating are typically used to apply bulk coatings in the form
of a saturation or lamination that covers the entire “surface” of the textile. However, as will be
presented herein, the advent of nano-technology in textile research, the development of novel
process techniques, and the advancement of inks and coating formulations affords the
opportunity to apply coatings to increasingly finer structures.

Properties of Conductive Textiles:

Physical properties:

 Low weight,
 High strength,
 Flexibility,
 Durability,
 Elasticity,
 Heat insulation,
 Water absorbency,
 Dyeability,
 Drape,
 Soft handling,
The development of devices on textiles such as sensors1, photodetectors2 ,
transistors3 , electro-luminescent devices4 , supercapacitors5 and solar cells6
is attracting great interest and has led to the emergence of the field of smart textiles.
Smart textiles can find an enormous range of applications in several fields, including
healthcare, military and fashion7 . Since the concept of textiles is much wider than
clothes and garments, the applications can extend to aviation, automotive and
transport, construction, geo-textiles and packaging. While most commercial
applications of smart textiles rely on conventional hardware simply mounted onto
textiles, the integration of specific functionalities directly on textile fibres promises to
revolutionize the field of wearable electronics. With the recent advances in
nanotechnology and materials engineering, different functionalities can now be
incorporated into textile fibres, such as antibacterial properties, static elimination, and
electric conductivity8.
Conducting fibres are an important component of any e-textile, not only because they
can be used as lightweight wiring for simple textile-based electronic components, but
also because they can provide a platform for building electronic devices directly on
textile fibres. For instance, such fibres can be used as gate electrodes for field-effect
transistors, or bottom electrodes for light-emitting diodes and photovoltaic devices.
Conductive textile fibres are currently used as a stronger and more flexible weight-
saving material in the aviation sector, where the aircraft weight and fuel consumption
are reduced by replacing metal wiring with electrically conductive cotton fibres like
ARACON®. The most common approach to produce conductive fibres consists in
mixing an insulating polymeric matrix with a conductive component, which can be a
conducting polymer such as PEDOT:PSS9
,
silver nanowires10, nanocarbon fillers11, or their hybrids12–15. These composite
fibres are usually produced by wet-spinning of the polymer with a suspension of the
active conducting material, or via electrospinning16, techniques that require a large
consumption of expensive materials and that can cause the loss of flexibility and
transparency. A different approach relies on polymer-free fabrication of conducting
fibres, but the methods include the use of strong acids and coagulants17, which greatly
limits the potential for scaling up and commercialization. Another strategy is to
impregnate fibres with conductive materials after they have been manufactured. This
method has been used for fibres, yarns and fabrics that are highly porous with a
complex structure of microfibrils, such as cellulosic fibres. These inks and dyes make
use of several types of conductive materials, such as aluminium18, carbon
nanotubes19, and graphene20, and have been in the base of demonstrations of
wearable and stretchable electronics, including integration onto surfaces of live plants
and insects21, 22. One of the limitations of this methodology is that such multifilament
fibres and fabrics, compared to fibres coated prior or during manufacturing, tend to
lose the conductive filling more easily if not completely encapsulated, and can pose
end-of-life environmental concerns.
A more practicable emerging strategy to prepare conductive textile fibres is to coat
insulating fibres with conductive atomically thin two dimensional layers such as
graphene23. Graphene, a monoatomic carbon layer, is the strongest known material,
the best electrical and thermal conductor which is also mechanically flexible and
transparent24. Thus, it represents a radical alternative to conventional technologies
as it can bend, stretch, compress, twist and deform into complex shapes while
maintaining the same levels of performance and reliability25. There are already
several examples of graphene-based textiles with different functionalities and for
different applications26. The coating we propose is performed by electrostatic
adhesion of graphene at the surface of monofilament fibres and does not involve
impregnating an agglomerate of fibres. The adhesion of the graphene coating to the
textile fibres is strong and durable, and a straightforward passivation can be achieved
by encapsulation with an insulating polymeric layer. This method was developed for
tape-shaped polypropylene (PP) and bio-based polylactic acid (PLA) fibres, two
polymers with widespread use in the textile industry27. This approach depends on the
size of the graphene sample, usually in the centimetre range, and although this might
not be suitable for electronic wiring, it is appropriate to build electronic devices directly
on textile fibres.
In this work, we demonstrate that graphene can be transferred to a large variety of
thermoplastic monofilament textile fibres of different types and shapes. To further
advance the development of this technique, it is important to understand the various
factors that can influence the conductivity achieved by coating textile fibres with
graphene. Surface topography and chemical nature seem to be determinant in the
conductivity achieved. On the other hand, cracks and tears in the graphene coating
will result in a decrease in conductivity, and therefore it
is important to establish their origin. Thus, our present study aims at: (1) establishing
how the above-mentioned factors actually influence the quality of the graphene
coverage and how it correlates with the resulting conductivity; and (2) explore the
suitability of our coating method for different materials, sizes and shapes.Raman
spectra of fibres of the three materials (PP2, PE and PLA2), before and after the
graphene transfer, are shown in Fig. 1e. For all graphene-coated fibres it was possible
to identify the graphene G band at 1585 cm−1 . The
2D peak was clearly visible for graphene-coated PP1 and PLA2, at 2685 cm−1
, as well as a small D peak for PE and PLA2. These values match those found for G
and 2D bands of the same type of graphene transferred to SiO2 (see Supplementary
Fig. S2; more extended Raman spectra of the graphene-coated fibres is shown in
Supplementary Fig. S3, along with details of the G and 2D peaks and corresponding
integrations for PP2, PE and PLA2).
To study the factors that lead to the observed differences in sheet resistance, it is
important to understand the influence of the topography of the fibres on the
effectiveness of the graphene coating. A non-contact optical method was used to
determine the macroscopic surface parameters of the untreated fibres. The images
obtained are shown in Supplementary Figs S4, S5 and S6, and the parameters are
listed in Supplementary Table S1. Figure 2 shows the Atomic Force Microscopy (AFM)
amplitude and topography for 5×5μm images of the PP fibres before coating and
corresponding height profiles taken at the highlighted lines parallel to the extrusion
axis. Compared to PP1, PP2 fibres show considerable differences in terms of AFM
topography. PP2 does indeed have a smoother height profile (Fig. 2a, right) with less
pronounced height differences than PP1 (Fig. 2a, left). The UVO treatment created a
fine roughness throughout the whole surface, which seems to create more points
where the graphene sheet can effectively adhere to the surface of the fibre (Fig. 2a,
middle). The same conclusions are valid for larger and smaller AFM scanning areas
(30×30 μm and 1×1 μm images, see Supplementary Fig. S7). Although in terms of
overall thickness and surface features, PP1 and PP2 are very similar (see
Supplementary Table S1), in a smaller scale AFM shows that PP2 has areas with less
pronounced features than PP1, which is also in accordance with the smaller Kurtosis
value in PP2. A similar study was performed for the PLA-based fibres PLA1 and
PLA2 (Fig. 2b and Supplementary Fig. S8), showing that the changes in polymer
source grade do not have a substantial impact on the surface morphology in the AFM
scale. However, the difference in roughness is much more significant macroscopically,
with PLA2 is rougher than PLA1, showing visible ridges perpendicular to the
extrusion lines (Supplementary Fig. S5). On the other hand, we found that the UVO
treatment does change the surface of PLA-fibres significantly (Fig. 2b, middle). All
three monofilament tape-shaped samples, PP2, PLA2 and PE were also subjected to
UVO treatment. Both PLA1 and PLA2 fibres often appeared to be damaged after
UVO-treatment, particularly towards the edges, where propagating cracks and
microfibrils tearing from the sample were clearly visible to the naked eye (see
Supplementary Fig. S8, top middle, where a loose microfibril is clearly noticeable). The
damage induced by the UVO treatment is even more severe in PLA2 fibres. The
protuberances that are observed on the fibres as a consequence of the UVO treatment
are probably a sign of that degradation, and biodegradable polymers like those based
on PLA are prone to be damaged even more rapidly. These protuberances can be
thermally caused or appear due to the chemical reactions of oxygen radicals at the
surface of the polymer. Attempted coating of these UVO-treated PLA2 fibres with
graphene was unsuccessful, as all the samples remained insulating after the graphene
transfer. The immersion in warm acetone during the PMMA ((poly(methyl
methacrylate)) cleaning step seemed to damage the fibres even further, causing them
to curl and shrink. It should be noted that the UVO treatment was performed under the
same conditions for all fibres, and even though the bio-based PLA1 fibres also showed
some signs of quicker degradation when subjected to the UVO treatment, it was still
possible to achieve considerably low sheet resistance. The fact that PLA2 fibres are
slightly smaller than PLA1, 1.0 mm wide and 0.07 mm thick, compared to 1.2 mm wide
and 0.1 mm thick, may also account for the fact that the formers are more fragile and
easily degradable.
Case study-smart fabric for monitoring biological parameters
Merging electronics with textiles has become an emerging trend since textiles hold magnificent
wearing comfort and user-friendliness compared with conventional wearable bioelectronics.
Smart textiles can be effectively integrated into our daily wearing to convert on-body
biomechanical, biochemical, and body heat energy into electrical signals for long-term, real-
time monitoring of physiological states, showing compelling medical and economic benefits.
This review summarizes the current progress in self-powered biomonitoring textiles along three
pathways: biomechanical, body heat, and biochemical energy conversion. Finally, it also
presents promising directions and challenges in the field, as well as insights into future
development. This review aims to highlight the frontiers of smart textiles for self-powered
biomonitoring, which could contribute to revolutionizing our traditional healthcare into a
personalized model.

Self-powered biomonitoring textiles via biomechanical, body heat, and biochemical energy
conversion are discussed in this work. Platform technologies, including piezoelectric
nanogenerators (PENGs), triboelectric nanogenerators (TENGs), and magnetoelastic
generators (MEGs) for biomechanical energy conversion, thermoelectric generators (TEGs)
for boy heat energy conversion, and biofuel cells (BFCs) for biochemical energy conversion,
are systematically introduced and discussed in a textile form. Working in a self-powered
manner with greatly improved wearing comfort, the smart biomonitoring textiles pave a
compelling road to personalized healthcare.

Highlights
  Self-powered biomonitoring textiles via biomechanical, body heat, and biochemical
energy conversion are discussed.
 Platform technologies, including PENG, TENG, MEG, TEG and BFC are
systematically introduced.
 Self-powered biomonitoring textiles pave a compelling road to personalized healthcare

Textiles, which have been a part of human civilization for thousands of years, are made from
both natural materials such as silk and cotton, and synthetic materials such as polyamide and
polyester. These materials can be made into textile bioelectronic devices via
scalable weaving, knitting, braid, printing, and electrospinning, showing great wearing comfort
and breathability. Conventional fiber fabrication techniques include coating, spinning, and
thermal drawing. These various types of fibers can also be arranged into different architectures
and structures in textiles endowing them with excellent flexibility, breathability, abrasion
resistance, and material integration. An increasing number of platform technologies, including
electroluminescent piezoresistive thermoelectric and photovoltaic platforms have been utilized
to develop smart healthcare textiles Among them, self-powered biomonitoring textiles that rely
on piezoelectric triboelectric magnetoelastic and electrochemical approaches offer unique and
compelling features that have attracted significant attention. Self-powered textiles have the
capability of sustainably converting the renewable energy from the human body such as
biomechanical, body heat, and biochemical energy into electrical signals for healthcare
purposes. They not only weaken the dependance of wearable bioelectronics on power supply,
but they also provide highly sensitive and real-time information to monitor human
physiological states. Additionally, self-powered textiles are also environmentally friendly,
simple to manufacture, inexpensive, which can be effectively integrated into daily wear such
as clothing, masks, wristbands, and other garments for continuous monitoring.

We will begin by briefly discussing the physiological signals that can be monitored. Then, we
will present the progress of self-powered biomonitoring textiles which utilize the on-body
renewable energy sources: biomechanical, body heat, and biochemical energy (Fig. ). We will
illustrate the mechanisms of each of these self-powered textiles and describe how they can
monitor various physiological parameters. Finally, we will discuss the challenges within the
community of self-powered biomonitoring textiles. This review provides a critical analysis of
the current advances in smart biomonitoring textiles and the insights into remaining challenges
and future directions.
Platform technologies for self-powered biomonitoring textiles. For self-powered
biomechanical sensing, we have systematically introduced PENGs, TENGs and MEGs. The
TEGs and BFCs are introduced for self-powered boy temperature and biochemical sensing,
respectively. This review provides a critical analysis of the current advances in smart textiles
working in the self-powered manner and the insights into remaining challenges and future
directions, paving a compelling road to personalized healthcare

ECG Respiration

Wearable light textiles are gaining widespread interest in application for measurement and
monitoring of biophysical parameters. Fiber optic sensors, in particular Bragg Grating (FBG)
sensors, can be a competitive method for monitoring of respiratory behavior for chest and
abdomen regions since the sensors are able to convert physical movement into wavelength
shift. This study aims to show the performance of elastic belts with integrated optical fibers
during the breathing activities done by two volunteers. Additionally, the work aims to
determine how the positions of the volunteers affect the breathing pattern detected by optical
fibers. As a reference, commercial mobile application for sensing vibration is used. The
obtained results show that the FBGs are able to detect chest and abdomen movements during
breathing and consequently reconstruct the breathing pattern. The accuracy of the results varies
for two volunteers but remains consistent.

Wireless devices have pushed forward medical science to an advanced level in which people
have access to a personalized drug delivery, a remote healthcare including simple diagnostics
and data-logging operations outside of hospitals, and a continuous monitoring of biophysical
parameters such as blood pressure, body temperature, breathing rate, etc. Low-cost miniature
technologies help to prevent sudden infant death syndrome, heart-related diseases and provide
minimal invasive continuous monitoring.

For example, Skrzetuska and Wojciechowski studied the ability of T-shirts equipped with a
printed respiratory rate sensor to monitor the breathing pattern of two volunteers and the
influence of the environmental humidity and temperature on the output of the sensor. The
authors have tried several configurations of printed sensor and identified the most optimal
shape and size of the sensor. The breathing of volunteers were monitored during physical
activities and rest. The sensing technology were able to identify breaths but the external climate
conditions were found to have an effect on the accuracy of the results.

Joyashiki and Wada proposed to monitor breathing pattern by a body-conducted sound sensor
placed on the neck. The performance of the sensor was compared with two other sensors,
namely air-coupled microphone and acceleration sensor. A data analysis technique based on
signal processing was developed. The authors came to the conclusion that body-conducted
sensor performs better in four different types of the experiments. Schatz et al. studied the
application of five different types of depth sensors for breathing rate monitoring and usage of
this data for the sleep apnea identification. All of the sensors output were compared with the
reference sensor and two of the five sensors have been found appropriate for sleep apnea
determination.

The aim of the experiments is to study the feasibility of the FBGs arrays for breathing pattern
monitoring application. The breathing pattern is measured at the two locations of the body
(abdomen and chest) by two arrays of 5 FBGs.This allows to apply a diversity technique, which
is used in communication systems to achieve better accuracy of detection by combining the
outputs from several different sensing points. The breathing pattern has been measured in four
different positions of the volunteers (sitting, lying, staying or running). Two volunteers have
participated in the initial experiments: 23-years old woman, height 165 cm, weight 52 kg and
24-years old man, height 171 cm, weight 72 kg. The volunteers wore T-shirts with two
specially designed belts located on the abdomen and chest regions. They have been asked to
breath for 23 seconds in different positions: staying, sitting, lying and running. The results of
the the strain change detected by FBGs have been compared with the output of a reference
sensor, which is a mobile application for acceleration and vibration measurement. The mobile
phone with the application has been attached to the upper belt.

The experimental setup, which is illustrated in Figure, consists of the (1) I-MON interrogator
connected to (2) PC with evaluation software, (3) T-shirt with two belts each equipped with an
array of 5 FBGs, (4) mobile phone with VibSensor application.
UNIT V APPLICATIONS OF WEARABLE SYSTEMS
Medical Diagnostics, Medical Monitoring-Patients with chronic disease,
Hospital patients, Elderly patients, neural recording, Gait analysis, Sports
Medicine.

APPLICATIONS OF WEARABLE SYSTEMS:

In Medical Diagnostics:
Wearable technologies can be innovative solutions for healthcare problems. Some
wearable technology applications are designed for prevention of diseases and
maintenance of health, such as weight control and physical activity monitoring.
Wearable devices are also used for patient management and disease management.
The wearable applications can directly impact clinical decision making.
Wearable technologies enable the continuous monitoring of human physical
activities and behaviors, as well as physiological and biochemical parameters during
daily life. The most commonly measured data include vital signs such as heart rate,
blood pressure, and body temperature, as well as blood oxygen saturation, posture,
and physical activities through the use of electrocardiogram (ECG),
ballistocardiogram (BCG) and other devices. Potentially, wearable photo or video
devices could provide additional clinical information. Wearable devices can be
attached to shoes, eyeglasses, earrings, clothing, gloves and watches. Wearable
devices also may evolve to be skin-attachable devices. Sensors can be embedded
into the environment, such as chairs, car seats and mattresses. A smartphone is
typically used to collect information and transmit it to a remote server for storage
and analysis. There are two major types of wearable devices that are used for
studying gait patterns. Some devices have been developed for healthcare
professionals to monitor walking patterns, including the accelerometer, multi-angle
video recorders, and gyroscopes. Other devices have been developed for health
consumers, including on-wrist activity trackers (such as Fitbit) and mobile phone
apps and add-ons. Wearable devices and data analysis algorithms are often used
together to perform gait assessment tasks in different scenarios.
Continuous and real-time monitoring is essential for better management of
patients with chronic illnesses, including, cardiovascular diseases, diabetes, and
neurological disorders. According to the World Health Organization (WHO),
chronic diseases account for three quarters (75%) of all deaths around the world and
impose high economic burdens. Therefore, different strategies are required for the
monitoring and diagnosis of such diseases and an effective strategy in this regard is
HWDs. Wearable devices are defined as devices, which are worn on the human body
or on clothing. They consist of a target receptor and a transducer. A receptor
recognizes the target analyte and responds accordingly. The transducer then convert
the receptor’s response into a useful signal. Several studies have reported
applications of wearable devices in different fields; as a result, these devices have
shown promising results in the field of healthcare due to their ability of deformability
and compliance. These HWDs provide a better understanding of the changes inside
a human body and can help in preventing and treating diseases.

Biosensors were initially used as invasive devices for controlled lab settings before
their integration into wearable sensors. In 1956, Leland C. Clark, known as the
“father of biosensors”, was the first to use electrodes for the detection of the level of
oxygen in blood. This device was meant for the continuous and real-time detection
of oxygen in operating room settings during the cardiovascular surgery. The
introduction of electrodes for healthcare purposes later led to the discovery of
potentiometric biosensor for the detection of urea in 1969 by Guilbault and
Montalvo, Jr. The introduction of electrodes for healthcare lead to the
commercialization of the first glucose analyzer in 1975 based upon Leland C.
Clark’s electrochemical biosensor. With the miniaturization of electronics that leads
to the micro and nanoelectronics and advancements in material sciences, integrated
HWDs came into existence. These HWDs consists of electronic devices for the
acquisition, processing and sharing of data. Conventional rigid and heavy electronic
devices, for example, Printed Circuit Boards (PCBs) are not a suitable choice for
HWDs therefore, significant advancements have been made in recent years in
electronic devices in terms of their material, fabrication techniques, processing
circuits and transceivers to enhance their compliance with HWDs. Recent
advancements in HWD materials include biocompatible flexible materials for
example, polyethylene naphthalate, polyethylene terephthalate (PET), Ecoflex, and
Polydimethylsiloxane (PDMS), silicone-based materials, and thin film polymers for
example, parylene2,7,8. These materials have high flexibility and stretchability,
which makes them suitable substrates for HWDs. Ecoflex and PDMS have
elongation limits of 900% and 400%, respectively, where Ecoflex has Young’s
modulus close to human skin. In comparison to conventional devices, these flexible
electronic devices are not only low cost but are also power efficient in their
consumption, which allow uninterrupted acquisition of data over long time. With
emergence of communication modules like Bluetooth, Near Field Communication
(NFC), Wi-Fi and Wireless body area networks (WBAN), visualization and sharing
of the data in real time has become possible with HWDs. These HWDs help in
measuring different parameters and biopotentials. These biopotentials include
electrocardiogram (ECG), which is a measure of heart performance,
electromyogram (EMG) which is a measure of the activity of muscles in response to
nerve stimulation, electroencephalogram (EEG), which is a measure of the
performance of brain activity and electrooculogram (EOG), which records eye
movements. These HWDs are extensively employed as noninvasive devices and
particularly in point-of-care (POC) settings. Furthermore, the noninvasive nature of
wearable devices has made therapeutic procedures simple and has decreased the risk
of infection, which was previously related to blood.

The POC wearable devices have revolutionized the healthcare system by decreasing
the load on hospitals and by providing more reliable and timely information. For this
purpose, different types of wearable devices have been employed, e.g., epidermal-
based wearables, flexible wearables, and textile-based wearables. Wearables can be
employed for different body parts, e.g., head-based wearables, eye-based wearables,
and wrist-based wearables. These wearables monitor different psychological and
physiological parameters that can be used for the diagnoses of different diseases13.
In fact, wearable devices can be integrated with different sampling platforms for
sensing different chemical parameters from bodily fluids e.g., saliva, blood, urine,
sweat, etc. Additionally, these HWDs can be used for the delivery of drugs in a more
controlled and efficient manner in comparison to traditional drug delivery systems

Classification of Healthcare Wearable Devices (HWDs).

Skin-based wearable devices
As skin covers most of the human body, it serves as an optimal mode for noninvasive
healthcare wearable devices. Skin-based wearable devices can be used for
physiological and psychological monitoring essential for the treatment of different
diseases, for example cardiovascular and neuromuscular diseases. Additionally, it
can also be used for the diagnosis of different diseases using qualitative and
quantitative analysis of skin secretions, such as sweat. Based on the type of skin
contact skin-based wearable devices can be either textile based or epidermal based.
Textile-based wearable devices involve embedding essential sensors in clothes
whereas epidermal-based wearable devices involve the direct attachment of
wearables to the skin like a tattoo, generally known as electronic skin (e-skin). The
following sections highlight the applications of textile-based HWDs and tattoo-
based HWDs for the monitoring and diagnosing of different diseases.

Textile-based HWDs
Textiles have been around for centuries and are readily available. Traditionally,
textiles and clothing have been perceived as keeping humans warm and for esthetics.
Due to their accessibility and comfortability, they can be used for sensing important
parameters, such as body temperature, heart rate, and respiration rate. Such HWDs
are commonly known as electronic textiles or e-textiles. E-textiles are clothes
embedded with sensors and conductive materials. The stretchable nature and large-
scale skin contact make textiles an optimal medium for HWDs. With the emergence
of graphene, carbon nanotubes, and nanowires, a number of efforts have been made
to incorporate sensors into clothing for continuous monitoring. One such effort is by
Yapici et al. who have developed an intelligent textile-based HWD for the
monitoring of ECG. Traditionally, ECG is monitored by using gel-based Ag/AgCl
electrode cables, which are not comfortable for the wearer. For textile-based ECG
monitoring, graphene functionalized cloth has been embedded with ECG sensors.
Graphene has been used for this purpose because of its excellent material properties
and high correlation with conventional gel-based ECG monitoring. A comparison of
the traditional Ag/AgCl electrodes with the ECG HWD . It can be seen that graphene
functionalized textile electrodes highly correlates with the conventional Ag/AgCl
ECG electrodes with a maximum correlation of 97.0%. However, the graphene
functionalized e-textile electrodes for ECG has higher electrode-skin impedance
(87.5–55 kΩ) than the conventional Ag/AgCl electrodes (50.9–20 kΩ), which
distorts the ECG and requires additional components like buffer amplifiers and
adaptive filters23. Similarly, Arquilla et al. have tested textile electrodes for ECG
monitoring using HWDs. They have developed a chest-based ECG system by
sewing ECG electrodes into the textile instead of using gel electrodes. This sensor
system has been applied on eight different subjects (five males and three females) to
validate the accuracy of textile-based ECG with the traditional gel-based ECG
electrode. Differences between the heart rate and R–R intervals of ECGs from both
systems were minimal and are shown in Fig. 2b–d. The statistical parameters for
differences in heart rate are t = −0.70 and p > 0.5 and t = 1.43 and p > 0.1 for R–R
interval and with a high correlation coefficient of 0.94. However, this ECG sensor
has not been tested during movement, which imposes considerable challenges in
maintaining the skin-electrode contact and hence is mandatory for continuous ECG
monitoring.Moreover, Wicaksono et al. have also developed an electronic textile
comfortable suit (E-TeCS). The E-TeCS provides temperature sensing of skin with
a precision of 0.1 °C as well as heart and respiration rates at a precision rate of
0.0012−2 using inertial sensing. Additionally, washability and degradability tests
were also conducted for the E-TeCS and high rigidity along with confirmation for
no flakes or discoloration up to ten cycles of washing were observed, which makes
it suitable for everyday use. Likewise, the use of HWDs can also be extended for
other bipotential signals like EEG and EOG, which are required to be monitored for
the treatment and diagnosis of different diseases. Gao et al. have developed a
multisensory textile-based HWD for the simultaneous detection of EEG from the
forehead and sweat rate. This wearable utilizes silver (Ag) as a conductive material
embedded inside the textile electrode to record an EEG. The multisensor wearable
consists of an EEG recording module and SHT20 chip for the relative humidity
measurement. It has eight channels that allow independent recording of the EEG
using different electrodes and the relative humidity is used to for the indirect
measurement of the sweat rate. The multisensory HWD was compared with
traditional Ag based wet electrodes used for EEG measurement and was highly
correlated. Alpha rhythm is a standard electrical brain response with frequencies
ranging from 8 to 15 Hz and usually more evident while eyes are closed. Correlation
coefficients of 93.04% and 81.69% between the two electrodes have been found, in
closed and opened eyes conditions, respectively. However, the skin-electrode
impedance of the multisensory HWD decreases in the presence of sweat from 30–
20 to 6 kΩ in comparison to standard Ag wet electrodes that maintains small skin-
electrode impedance irrespective of sweat. Moreover, electrodes embedded inside
the textile can also be used for EMG, which measures the electrical activity of
muscles in response to nerve stimulation and is used for the detection of muscle or
motor neuron abnormalities. Pino et al. have proposed a wearable shirt to monitor
EMG that provides essential feedback during exercise30. The wearable shirt is
shown in the These EMG signals are then sent to monitoring system using Bluetooth
for signal processing.
Textile-based HWDs experience distortion in their results due to loose contact
between skin and HWD. This requires additional signal processing techniques on
raw data for acquiring clean signals. Moreover, textile-based HWDs provide
comfortability along with real-time and continuous monitoring of the wearer, but
their stability decreases with repeated washing due to the involvement of bio-
recognizable molecules. The instability involved with textile-based HWDs may be
partially resolved with tattoo-based HWDs.

skin or tattoo-based HWDs

Traditionally, tattoos have been perceived as a form of body art because of its
pliability and compliance. These properties can be used for monitoring and
diagnostic purposes. Currently, e-skins are widely used for the detection of electrical
and physical parameters such as ECG, EEG, and EMG. Of these, the ECG is easiest
to detect because of its high amplitude, of the order of ~1 mV. This allows an
accurate, noninvasive detection of heart signals through the skin. In cardiovascular
arrhythmias like tachycardia and bradycardia, ECG is the first point of reference for
diagnosis and treatment. As mentioned, earlier, conventional ECG monitors require
the attachment of gel-based electrode cables along with external electronic
instrumentations for signal acquisition and can be uncomfortable for the wearer.
Furthermore, these ECG monitors are mostly used in controlled lab or hospital
settings and therefore cannot be carried with the wearer at all times. Many patients
suffering from heart disease would benefit from continuous monitoring of their heart
rhythm but a daily visit to a hospital poses an economic and scheduling burden.
Moreover, tattoo-based ECG monitoring systems can resolve the instability and
sensitivity issues of textile-based ECG monitors, due to their miniaturization and
stretchability. They are also more flexible and comfortable for the wearer. A notable
example of a tattoo-based HWDs ECG monitor is described by Ameri et al. It
consists of miniaturized electronic components built on a
graphene/polymethylmethacrylate (Gr/PMMA) bilayer substrate. The graphene
electronic tattoo (GET) is fabricated using a wet transfer, dry patterning method and
has 463 ± 30 nm thickness with ~85% optical transparency and more than 40%
stretchability. The high stretchability and optical transparency make it light enough
to be embossed on skin, like a tattoo. It binds to the skin using Van der Waals forces,
which makes it mechanically invisible for the wearer. The GET is a comprehensive
epidermal electronic system that is effective for different biopotentials like ECG,
EMG, and EEG. This HWD reports a clean ECG with high signal to noise ratio,
comparable to conventional bulk gel-based electrodes. The module also works for
other electrophysiological parameters, for example, EEG and EMG by embossing it
on different parts of the body. Moreover, it has low skin impedance, comparable
with Ag electrode, for 52 h, however, 96 h after its application, crack starts to appear
during the test, which increases its skin impedance, making it unsuitable for further
use

Moreover, Dae et al. used a self-powered piezoelectric sensor for the continuous and
real-time monitoring of the arterial pulse34. The arterial pulse is a measure of heart’s
contraction rate, which is a component of cardiac output (heart rate × stroke
volume)34,35. A piezoelectric sensor converts the pressure created due to arterial
pulses into electrical pulses. In-time detection of the abnormalities in atrial pulses
could lead to the prevention of serious cardiac diseases. Monitoring arterial pressure
may potentially help in the diagnosis of cardiac and blood diseases36,37. This self-
powered tattoo-based HWDs is POC in nature and mitigates the high-power
consumption required by conventional arterial monitors. Moreover, data are shared
wirelessly in case of any abnormality detected in arterial pressure signals using
smartphone modality. It utilizes BaTiO3 and Pb [Zrx, Ti1- x] O3 (PZT), active
materials for the microelectromechanical sensors, due to their high piezoelectric
coefficients. A thin layer of plastic was covered with PZT using laser lift-off
technique (ILLO), which is an inorganic based technique for transferring polymers
on surfaces38. The ultrathin layer of PZT adheres to the epidermis and responds to
changes in arterial pulses. The self-powered PZT sensor was used for the detection
of arterial pulses before and after the exercise. Before exercising, Vpp of the arterial
pulse is 81.5 mV whereas after exercising its amplitude is 100 mV, an increase of
~22% due to the increase in heart rate after the exercise. The same wearable was
used for experiments in monitoring human respiratory activities, trachea movement
and heart rhythm. These experiments have shown a sensitivity of ≈0.018 kPa −1 and
response time of ≈60 ms with excellent mechanical stability. However, the self-
powered tattoo requires biocompatible piezoelectric material for clinical trials34.
Furthermore, it is estimated that over one billion people worldwide have
hypertension, or elevated blood pressure (BP). Out of 1 billion, two-thirds are in
developing countries who also lack adequate healthcare facilities39. Daily
monitoring of BP is essential for these patients as hypertension is often
asymptomatic. Due to the lack of monitoring, hypertension is one of the major
causes of premature death across the world39. Traditionally, BP monitors are based
on auscultative techniques with an inflatable cuff and on first and fifth Korotkoff
sounds40. This measures systolic blood pressure (SBP), a number that represents the
pressure in arteries when the heart muscle contracts, and diastolic blood pressure
(DBP), a number that represents the pressure when the heart muscle relaxes40.
Accurate BP measurement requires trained technicians, which adds to the challenge
to meet the WHO target to reduce hypertension by 25% by 2025. However, HWDs
can provide a suitable wearable for the POC setting to help achieve the
aforementioned target. One such wearable is described by Luo et al. who has
developed a cuff-less BP measuring device for real time, continuous measurement
of blood pressure using tattoo-based HWD41. The HWD integrates a thin flexible
piezoelectric sensor (FPS) with epidermal ECG sensor for the cuff-less measurement
of BP, which is much more comfortable than its conventional counterpart. The patch
uses beat-to-beat BP measurements from ECG along with a parametric model, which
is very sensitive to minute changes in physiological signals in the epidermis. The
epidermal signals and ECG signals were obtained using the piezoelectric patch along
with SBP and DBP. Average BP values for conventional cuff-based BP monitor and
cuff-less BP HWD were evaluated, and they were found to be comparable. The
conventional cuff-based BP monitor showed SBP = 123.8 ± 5.7 mmHg and
DBP = 86.8 ± 4.4 mmHg, while cuff-less BP HWD showed
SBP = 130.3 ± 0.5 mmHg and DBP = 86.5 ± 0.5 mmHg. These results indicate that
cuff-less BP wearable provides high correlation with a conventional BP monitor for
both SBP and DBP values. Additionally, the patch utilizes only 3 nW of power, in
comparison to photoplethysmogram (PPG) based devices that consumes tens of
milliwatts of power, making it more efficient and optimal for home-based settings
in low and middle-income countries

Other competitive skin-based HWDs including wearable vests, smart rings, and
earphones
There are other skin-based biosensors, which are not textile or tattoo based. Various
wrist bands, such as smartwatches, wearable vests, skin patches, and implantable
HWDs, use different monitoring biomarkers. Schreiner et al. and Leonard et al. have
monitored respiratory rate, an essential parameter for many respiratory and
cardiovascular diseases by using alternative wearable technologies35,44. Schreiner
et al. proposed a chest-based wearable to monitor respiratory rate using pulse
oximetry44. Similarly, heart failure is another clinical syndrome, which requires
continuous monitoring. A structural abnormality, which hinders heart from not
pumping sufficient blood to fulfill the needs of the body, heart failure affects about
26 million people globally45. Heart failure requires real time, continuous
monitoring, which increases the economic burden; HWDs can facilitate the daily
monitoring of such patients. A number of HWDs have been reported that go beyond
diagnosing or monitoring heart failure but can predict it days before it even
occurs31,44,46,47,48. Hafid et al. proposed a wearable system to predict heart failure
using multiple parameters, such as thoracic impedance, heart rate, ECG, and blood
oxygen level48. All of these parameters are measured noninvasively using electronic
circuitry, a schematic of which is shown in Fig. 4a. The most important parameter
may be the thoracic impedance, which is the measure of the resistance to the flow of
ions due to the retention of fluid in the thoracic region of the human body49. Days
before heart failure symptoms such as shortness of breath are noted by the patient,
fluid is retained in the lungs, which decreases thoracic impedance48. The wearable
system tracks the thoracic impedance and other parameters including heart rate, ECG
and level of oxygen in the blood. If the respective values exceed the safe threshold,
the HWD generates an alert using wireless transmission over a cloud server to the
wearer and to the medical provider. The clinician can then make necessary
interventions. However, the prognosis module has inefficient power consumption
taking it 8 h to charge and can only measure continuously for 5 h, which limits its
utility as a HWD for continuous monitoring at all times48. Similarly, another HWD,
Oura Ring monitors key physiological parameters to help the wearer have a restful
sleep50. Oura Ring is a metallic ring, as shown in Fig. 4b, with miniaturized sensors
to monitor physiological parameters, such as heart rate, body temperature, and
breathing51. These parameters can be monitored for illnesses like cold, flu, and even
the novel Coronavirus 2019 (SARS-CoV-2). Severe acute respiratory syndrome
(SARS) outbroke in 2003 and the Middle East respiratory syndrome (MERS) in
2012; SARS-CoV-2 is the third and the most recent of coronaviruses52,53. SARS-
CoV-2 has currently become a global pandemic with 66 million cases and 1.54
million deaths worldwide54. Oura Ring utilizes the aforementioned parameters to
potentially detect symptoms of SARS-CoV-2 in home settings. The wearable ring
detects common SARS-CoV-2 symptoms such as fever, cough, fatigue, and
difficulty breathing with 90% accuracy55. Moreover, the ring has a battery life of
4–7 days, depending upon the usage, and takes only 20–80 min to recharge56.
There are also HWDs for use in the oral cavity. Kim et al. have developed a
mouthguard for the monitoring of saliva uric acid57. Similarly, Mannoor et al. have
developed an oral cavity HWD for the detection of bacteria on tooth enamel58. The
HWD is based on graphene because of its high strength (42 Nm−1) and Young’s
Modulus (~1 TPa)59. Antimicrobial peptides (AMPs) were probed on graphene for
the detection of bacteria at a single cell level. Moreover, the resonant coil excludes
the need of an external power source making it miniaturized and power efficient.
Results have been reported for the Escherichia coli (E. coli) bacterium, a foodborne
infection. E. coli is commonly found in the intestines of humans and warm blooded
animals60. If food is contaminated with E. coli, it can cause severe diseases such as
gastroenteritis (food poisoning)61. The graphene-based nanosensor is attached to the
tooth and can remotely monitor respiration and bacteria from the saliva based upon
the change in its resistance58. Odorranin-HP AMP has been probed for the detection
of E. coli because of its strong activity towards this organism. As soon as E. coli
binds with the AMP immobilized graphene, the resistance of graphene decreases and
helps in detecting E. coli with a limit of detection of 1 bacterium μL [−1 58. Results
are justified with fluorescent images for the presence of E. coli. Similar experiments
were performed for the detection of helicobacter pylori (H. pylori), a gram-negative
bacterium usually found in saliva, and stomach. H. pylori is one of the leading cause
for over 90% of stomach cancers and duodenal ulcers62,63. The lower limit for the
detection of H. pylori is ~100 H. pylori cells using tooth enamel HWD and shows
linear relation with its logarithmic concentration.
Furthermore, neurological diseases can also be managed efficiently with continuous
monitoring. EEG, EOG, and motion monitoring can be used to diagnose and keep
track of severe neurological diseases, like epilepsy, Parkinson’s disease (PD) and
Alzheimer’s disease (AD). HWDs like ocular wearables can be used for the indirect
detection of neurological diseases using EOG64. Wearable sensors have been used
for the monitoring of patients with PD65,66. PD is a neurological disease that
involves muscular rigidity and marked by bradykinesia or slow movement67. It is
the second most common degenerative disease after Alzheimer’s, and it is estimated
that 10 million people around the world are affected with PD68,69. Lima et al. have
used body fall sensors for quantifying the probability of falling in PD patients in
home-based settings. The study shows that the ratio of falling nearly doubles in PD
patients in comparison to healthy individuals70. Similarly, Lonini et al. have also
developed an intelligent system based on machine learning algorithms for the
detection of PD symptoms like bradykinesia and tremor (involuntary
movements)71,72. Different motion sensors like, accelerometers, gyrometers,
electromyography, and inertial sensors, are used as shown in Fig. 4c71. For the
detection of aforementioned symptoms, subjects performed different tasks like,
typing and walking, over a course of time. Using machine learning algorithms based
on statistical ensembles along with convolutional neural networks the clinician could
detect bradykinesia and tremor. However, the study was conducted on a limited
number of participants (19) and therefore was unable to infer generalized
conclusions about the detection of dyskinesia (impaired voluntary movement),
another significant symptom of PD71,73. Similarly, dementia is another
neurological disease, which is characterized by memory loss and difficulty in solving
problems. There are 50 million cases worldwide and every year there are 10 million
new cases of dementia74,75. Alzheimer’s disease is the most common form of
dementia. Almost 60–70% of dementia patients are diagnosed with Alzheimer’s
disease74. Monitoring of significant moments can help to support the care of
dementia patients and HWDs can be employed for this purpose. Kwan et al.
proposed a wearable, based on intelligent assistive technology (IAT) where IAT is
an adaptive and assistive technology, integrated with advanced environment
techniques of artificial intelligence (AI)76. The wearable is tailored to an
individual’s physiological responses77. These physiological responses consist of
heart rate, electrodermal activity-responsible for the emotional arousal and skin
temperature. These signals are extracted using the autonomic nervous system (ANS)
and using a triple point sensor (TPS), which can be worn on the fingertips using a
Velcro strap. The IAT detects significant emotional events based upon their
physiological response and provides feedback to dementia patients. Considering the
importance of EEG in daily routine, portable, and flexible earphones have been
developed by Lee et al. for the acquisition of EEG78. The earphones consist of three
electrodes (Reference, Source and Ground) made up of a mixture of carbon
nanotubes (CNTs), polydimethylsiloxane (PDMS) and silver nanowires (AgNW),
as shown in Fig. 4d78. The earphones are incapsulated in a plastic frame containing
electronics, for example, conductive elastomers, signal transducers, and metal strip
with soft earbuds for the convenient recording of EEG along with listening music at
the same time. The earphones successfully differentiated the state of drowsiness
from the awake state using the three-electrode system and results were
communicated to a smartphone using a Bluetooth circuit as shown in Fig. 4e.
However, as the earphones measure the EEG in crosstalk with music, EEG signals
have low signal to noise ratio (SNR) and therefore requires additional amplifiers
with post signal processing techniques for signal enhancement

Biofluidic-based HWDs
Body secretions like sweat, saliva, tears, and urine contain important biomarkers that
are essential for monitoring and diagnostic purposes. HWDs can be used directly or
through their integration with other platforms, for example, microfluidic platforms
can be integrated for the extraction of useful information from different biofluids79.
Microfluidic platforms of different materials can be used in HWDs for example,
polymer-based microfluidic devices, paper-based microfluidic devices, and micro-
sized needles known as microneedles80,81. The following sections highlight recent
efforts in biofluidic-based HWDs classified according to the type of biofluids.

Sweat-based HWDs
Epidermal biofluids like sweat is an important indicator of changes taking place
inside human body and hence can serve as an important parameter for the chemical
and biological sensing. Sweat is composed of different biomarkers, for example,
metabolites (e.g., glucose, lactate, urea etc.), proteins, nucleotides, and electrolytes
such as chlorine, sodium etc. which have important diagnostic implications32. Sweat
is readily available for chemical sensing and is distributed across the skin with more
than 100 glands cm−2 32. Therefore, sweat can be used for the extraction of different
chemical and biological parameters using HWDs to provide monitoring and
diagnostics in POC settings82. Koh et al. have developed a flexible, soft, and
stretchable device, based on microfluidics, for the colorimetric sensing of sweat
biomarkers as shown in Fig. 5a83. This HWD is capable of quantifying electrolytes,
like chloride and hydronium ions, that are essential for monitoring in cystic fibrosis,
a chronic inherited disease that affects the respiratory and digestive systems, by
forming a thick mucus that can block lungs and can obstruct the pancreas84. People
with cystic fibrosis tend to have a shorter life span than healthy individuals85. The
microfluidic HWD can also provide quantification of glucose and lactate levels,
which are essential for diabetic patients along with the loss of pH, sweat rate, and
total sweat loss. When the perspiration starts, the sweat is transferred into
microfluidic reservoirs, where chromogenic reagents, like a mixture of glucose oxide
and horseradish peroxide (HRP) for glucose level, respond to aforementioned
biomarkers. Images of the change in color of the chemical analytes can be captured
using a smartphone for the quantification of the concentration of chloride,
hydronium ions, glucose, and lactate levels, as shown in Fig. 5b83,86,87. The HWD
continuously measures the concentrations of aforementioned electrolytes in
excellent agreement with the laboratory analysis of the sweat. They have
demonstrated the flexible microfluidic HWD for human studies on the fitness cycle
in a controlled environment and for long distance bicycle racing in outdoor settings,
to justify the absence of the leakage of fluid and any discomfort due to the
microfluidic HWD during real life arid conditions. The microfluidic device is
fabricated using the soft lithographic technique with PDMS as a material83. Soft
lithography offers high resolution, of the order of submicrometers, and due to its
simplicity and flexibility it has been a widely used technique for fabricating
biosensors83,88,89. However, it is a labor intensive and manually operated
process88.

Fig. 5: Biofluidic-based HWDs.

A similar soft microfluidic based HWD was developed by Choi et al. that uses
microreservoirs for the detection of sodium, potassium, and lactate concentrations
from sweat along with their temporal variations90. This wearable is a skin-like soft
microfluidic platform that takes 1.8 μL volume of sweat from an area 0.03 cm2 of
skin in 0.8 min of sweating at 0.60 μL min−1 rate as shown in Fig. 5c. The
Fig. 5d shows different concentrations of sodium, potassium, and lactate at different
body locations and at different chambers of the wearable. Concentrations of these
analytes show variations at different times and at different spatial positions on the
body and propose optimal spatial positions for the attachment of the wearable for
sweat analysis. Paper-based microfluidic devices, commonly known as microfluidic
paper-based analytical devices (µPADs), are another promising technique for
fabricating biofluidic-based HWDs. µPADs are biocompatible, low cost and offer
high capillary action91,92. The multisensing patch for sweat monitoring by
Anastasova et al. is a µPADs91. The patch consists of microneedles of 50 μm
diameter and measures the concentration of lactate, pH using sodium ions and
temperature using amperometric sensing. The HWD demonstrates sensitivity of
71.90 ± 0.8 mV unit−1 and 56 ± 1 mV unit−1 for pH and sodium ions respectively
with a response time of around ~90 s. The wearable transmits data wirelessly for
real-time monitoring of sweat in home-based settings. Moreover, the HWD ensures
user compliance with overall thickness of as low as 180 µm with double sided
adhesion to ensure firm adhesion of the patch to skin. Another notable µPADs is a
Smart Wearable Sweat Patch (SWSP) sensor92. SWSP consists of paper substrates,
fluorescent sensing probes and microchannels92. The microchannels are made up of
cotton to absorb sweat from the skin and to transport them to sensing probes to
quantify analytes. The HWD measures the concentrations of glucose, lactate, and
chloride ions from the sweat by quantifying the intensity of the fluorescent from
each analyte, using a smartphone92. The device offers excellent statistical results for
the identification of aforementioned analytes from sweat with limit of detection of
7 μm, 0.4 mM, and 5 mM and correlate coefficients of 0.990, 0.988, and 0.994 for
glucose, lactate, and chloride ions, respectively. The device is low cost (~$0.3) but
cannot be used to measure concentrations of aforementioned analytes in real time92.

Tears-based HWDs
Tears are another important biofluid for the purpose of diagnosis and monitoring of
different diseases. One such disease is diabetes and a number of HWDs have been
developed for its diagnosis. Diabetes is a chronic metabolic diseases, with elevated
levels of glucose or blood sugar, which can lead to serious damage to the heart, eye,
kidneys, nerve, and blood vessels93. Globally, patients with diabetes have increased
from 108 million to 463 million in 2020 and if necessary interventions are not taken
then it is expected to increase, especially in middle and low-income countries93,94.
Prevention of the complications of diabetes, as proposed by WHO, includes a
healthy lifestyle with continuous monitoring of glucose levels. Traditional portable
glucometers were developed to measure the concentration of glucose in blood.
However, it involves finger sticks that is uncomfortable for the patient and can lead
to infections related to blood pathogens. Urine can also be used for blood glucose
measurement, however, it is difficult to handle and can impose limitations when used
at home-based settings. HWDs provide a convenient and comfortable wearable for
measuring the blood sugar and instead of blood and urine, tears can be used for the
glucose measurement. Sen et al. measured the concentration of glucose in tear
samples and related it to the concentration of glucose from blood samples, which
justified the efficacy of tears for glucose measurement95. It was shown that levels
of glucose were much higher in tears for a diabetic patient as compared to blood and
urine samples in healthy individuals. Therefore, several other HWDs have been
developed in the past for the measurement of glucose using tears. Notable examples
are commercialized products, like Triggerfish that monitors the intraocular pressure
of glaucoma patients and Google lens for the diagnosis of diabetes by Google in
collaboration with Novartis96,97. Lin et al. have developed a smart contact lens for
the diagnosis and continuous monitoring of diabetes using tears98. The lens is made
up of phenylboronic acid (PBA), a non-enzyme, and Hydroxyethyl methacrylate
(HEMA), a monomer. It utilizes the reversible covalent interaction of the PBA-
HEMA-based contact lens with glucose for the monitoring of diabetes. The PBA-
HEMA based contact lens swells in the presence of glucose and thereby increases
its thickness. The contact lens thickness increases simultaneously with the increase
in glucose level, at a linear rate, as shown in Fig. 5e98. The HWD has shown an
excellent agreement in sensing the glucose98. It can be seen that the thickness of the
lens increases linearly as the concentration of glucose increases from 0 to 20 mM
within 15 min. The contact lens does not require embedded power circuits and
additional photosensors; however, it only utilizes a smartphone for the detection of
the change in thickness of lens. The smartphone captures the light reflected by the
light-emitting diode on the smart lens. Images captured are then analyzed using an
inbuilt software for the detection of glucose levels, as shown in Fig. 5e98. The
noninvasive nature of the lens and integration with a smartphone, makes it a suitable
sensor for monitoring diabetes at home settings. The lens is lightweight, flexible,
and transparent to ensure the patient’s vision without obstruction. Moreover,
integration with smartphone ensures the portability of the HWD to enhance the
patient’s compliance with HWD98.

As discussed, microfluidic based devices offer low cost and suitable platforms for
biofluidic-based HWDs; however, they have inherent limitations99,100. These
limitations include fluid leakage, contamination, and blockage due to debris and
limited flexible materials make them inconvenient for the wearer99. However, with
more flexible materials along with adequate flow rate optimization, these challenges
can be overcome to fabricate low-cost microfluidics based HWDs.

Wearable drug delivery systems

As previously discussed, biodegradable and biocompatible materials are available
due to advancements in materials. Such materials can be used for drug delivery
systems, which can deliver drugs in a controlled manner101,102. One application of
drug delivery, is bimatoprost, using an ocular ring made up of polypropylene for the
treatment of glaucoma101. Glaucoma is an eye condition that damages the optic
nerve and is the leading cause of blindness worldwide103. Bimatoprost is a
medication generally used for the treatment of glaucoma, but fluctuations in its usage
can minimize its efficacy. Therefore, the ocular ring, which is covered with silicone-
bimatoprost matrix, slowly releases bimatoprost in a controlled manner, as shown in
Fig. 6a. Similarly, Al-Shahbazi et al. have developed a self-healable and moldable
gum for the personalized drug delivery104. The gum is made up of two materials,
polyvinyl alcohol (PVA) and tannic acid (TA), collectively referred to as PATA,
which belongs to a human friendly group of materials and makes it a bioactive
material. The polymeric gum developed, as shown in the Fig. 6b, has high strength,
stretchability, flexibility, toughness, and self-healing properties. The gum has been
found to display antibacterial and anti-inflammatory properties and is flexible
enough to be molded into any shape suitable for using it in wearables.
Similarly, Kim et al. have developed a touch actuated transdermal delivery (TATD)
wearable for controlled drug delivery105. The TATD provides quantitative
permeation control of the drug delivery in accordance with the force exerted by the
touch on a wearable patch. The HWD consists of drug reservoirs that are refillable
in nature, strain sensors for force detection, and microneedles for drug release as
shown in Fig. 6d105. With mathematical models between the force exerted and the
quantity of drug released, a controlled drug delivery has been observed, which
enables a real-time drug regulation. Similarly, Di et al. have also developed a
mechanical force based drug delivery system106. This HWD consists of a
stretchable elastomer with drug reservoirs in the form of polymeric nanoparticles
loaded with drugs. These nanoparticles can be loaded with antibacterial drugs or
anti-inflammatory drugs. Likewise, the HWD produces encouraging results with
anticancer therapy. The drug is released in a controlled manner by applying tensile
strain on the elastomer and the rate of release of drug is per Poisson’s ratio. The
HWD is a skin mountable device and can be administered by the motion of muscles
or joints, tendons or by external force using hands.

Moreover, T. Ly et al. have utilized the Bluetooth technology for the controlled
release of insulin107. The Bluetooth enabled insulin pump is tubeless in nature and
can hold up to 200 units of U-100 insulin. It consists of cannula insertion and
automated priming along with a personalized diabetes manager, portable for the
remote control of insulin delivery. In another report, Keum et al. have developed a
smart contact lens for the detection of glucose levels from tears and for delivering
drug for diabetic retinopathy therapy97. The contact lens is 14 mm in diameter,
200 μm in thickness with 8.0 mm radius curvature is based upon an ultrathin,
biocompatible polymer and contains miniaturized electrical circuits along with a
microcontroller chip for the continuous monitoring of glucose level from a tear. The
contact lens as shown in the Fig. 6e, consists of an electrochemical biosensor, a drug
delivery system, a resonant inductive coupling to copper for wireless transfer of
power from an external transmitter coil, an integrated microcontroller chip and a
radio frequency (RF) system for communication. The biosensor contains three
electrodes: Reference Electrode (RE), Working Electrode (WE), and Counter
Electrode (CE) for the detection of glucose. Results in Fig. 6f show a comparison of
glucose levels in blood and tears between healthy and diabetic individuals and it can
be seen that at all times the difference in the level of glucose in both diabetic and
healthy individuals, for both tears and blood, are high enough to diagnose diabetes
from tears. Moreover, the contact lens has an integrated drug delivery system that
allows an on-demand, controlled delivery of an antidiabetic drug. The delivery of
the drug is controlled by on/off control of voltage. Drug delivery is electrically
controlled using a gold (Au) membrane. Drug reservoirs are covered with Au anode
electrode, a thin layer of Au membrane, which dissolves in phosphate buffer solution
(PBS) in 40 s. When a voltage of 1.8 V is applied, the drug is delivered, and results
are then shared by the wireless transmission using an RF module, which makes it a
suitable HWD at POC. Furthermore, Derakhshandeh et al. have proposed a smart
bandage for the treatment of chronic wounds108. The bandage consists of
microneedles, as shown in the Fig. 6g, for the delivery of pharmacological agents
and vascular endothelial growth factors (VEGF) on the targeted wound. The bandage
delivers the drug in a controlled and wireless manner. Moreover, the microneedles
were fabricated using a 3D printer on polymeric substrate and microchannels were
fabricated using PDMS. The smart bandage was experimented by delivering VEGF
to chronic dermal wounds of diabetic mice and showed an increased closure of the
wound and hair growth in comparison to topical delivery of therapeutics108.

As shown, structures like nanotubes, nanopores and nanoparticles can be used in

wearables to deliver drugs; however, their size and structure is specific to a drug
therefore, they are only limited in administrating a specific drug. Moreover,
wearable drug delivery systems based on aforementioned carriers cannot be
administered in patients of all age groups as nanotubes and nanoparticles have been
found to be difficult to administer to infants and older adults109. Ocular wearable
drug delivery systems like the smart contact lens for diabetes treatment, have low
bioavailability and have limited volume of drug (~30 μL) to administer due to the
limited precorneal surface area, which decreases the efficacy of the drug110.
Furthermore, more advancements in drugs are required in developing wearable drug
delivery systems with accurate targeted delivery of drug, as many drugs are not been
able to cross the blood brain barrier (BBB)111. Moreover, the limited biodiversity
of drugs limits the effectiveness of the wearable drug delivery systems112.

Commercially available HWDs

In recent times, a number of HWDs have been commercially available in the market.
Biocompatibility, accuracy, comfortability, and uninterrupted battery performance
are essential factors for successful commercializarion of HWDs. This section
highlights some of the most recent commercially available HWDs for the continuous
monitoring of different biomarkers. The major focus of the commercially available
HWDs has been on the motion trackers113. Human movement assessment plays an
important role for the biomechanics and gait analysis and therefore can be used for
diagnosing neurological and psychological diseases. Moreover, motion trackers can
keep a track of step counts, which helps in maintaining a record of calories burned.
Therefore, a number of such devices are available in the market for this purpose and
the most widely used are Misfit Shine, Fitbit Inspire 2, Withings and Apple Smart
Watch. Misfit, an American based consumer electronics company, has introduced
the Misfit Shine that keeps record of steps count, sleep hours, distance covered, and
calories burnt. It has a nonchargeable battery that lasts for 6 months and needs
replacement every 6 months. Fitbit, an American based fitness company, has
introduced a number of fitness wearables114. Fitbit Inspire 2 is one of the recent
additions for the real-time and continuous monitoring of vital signs like heart rate,
activity, and sleep monitoring. It allows 10 days of charging capacity for continuous
monitoring113. Moreover, Withings Pulse, is a smart fitness tracker by Withings, a
French electronics consumer company115. Withings Pulse allows 24/7 monitoring
of heart rate and also keeps a track of sleep hours. Its battery lasts for 20 days and is
water resistant to up to 50 m113. In contrast to aforementioned fitness wearables,
Apple watch comes with features like irregular rhythm notifications, ECG
application, and blood oxygen application. Irregular rhythms in heart rate may be
suggestive of atrial fibrillation, where atrial fibrillation can lead to stroke, heart
failure, and other heart related complications116. However, Apple watch cannot
constantly look for atrial fibrillation and cannot detect all instances of atrial
fibrillation. It only sends notification if irregular rhythms are detected repeatedly116.
The authenticity of the Apple watch for the detection of atrial fibrillation was
confirmed by a study conducted on 419,297 participants at Stanford117. In this study
participants were monitored with Apple watch and on the reciept of a notification
for irregular rhythm, were monitored for 90 days for atrial fibrillation using ECG
patch. The study diagnosed 34% participants with atrial fibrillation using the early
detection by Apple watch and 84% of irregular rhythm notifications were found in
accordance with the atrial fibrillation117. Moreover, the ECG application keeps a
track of the irregular rhythm using a built-in electrical heart sensor and provides
notification of atrial fibrillation or normal sinus rhythm. Moreover, it also records
the level of oxygen in blood, which helps in the continuous monitoring of
hypoxemia, and conditions like asthma, and emphysema116,118. However, the
blood oxygen application is available only in selected regions116.
Table 1 summarizes the aforementioned health and fitness trackers based on human
motion.

As discussed, ECG is a vital sign that plays an important role in diagnosing and
preventing cardiovascular diseases. A number of smart wearables have been
introduced in the market for ECG monitoring of ECG. ePatch is an FDA approved,
commercially available ECG patch. ePatch is a 3 lead ECG sensor that consists of a
sensor housed inside an adhesive patch119. The patch can store ECG recordings
continuously for 72 hours and results can be analyzed on computer software
transmitted using a USB cable119. However, the recent advancements in ECG
monitors are in leadless acquisition of ECG and LifeTouch sensor is a one such
HWD119,120. It offers continuous measurement of respiration rate, heart rate, and
ECG for verification purposes. Moreover, Savvy is another leadless HWD
commercially available HWD for the real-time monitoring of ECG121. It is POC in
nature and consists of a sensor that attaches with the skin with two adhesive
electrodes119. These two electrodes are used for measuring ECG during
measurement mode and for charging the sensor in charging mode. The battery life
of Savvy is up to 20 days119. The HWD is housed inside a biocompatible and
flexible plastic covering for enduring user’s movement. The ECG from the Savvy
can be visualized in real time on a mobile application (MobECG), which also allows
a summary of the ECG that can be stored or shared with the patient’s medical
provider119. Similarly, ZIO XT and SEEQ are two other important commercially
available HWDs for the monitoring of ECG119. However, unlike Savvy, ZIO XT,
and SEEQ cannot be reused and do not have rechargeable batteries. ZIO XT does
not report results in real time; however, it stores data for 14 days after which the
ECG patch is returned to the company for data analysis. Similarly, SEEQ, does not
report data in real time but instead data is transmitted with the company’s cloud and
the ECG reporting time depends on the processing time by the company.
Table 2 shows some of the commercially available HWDs for ECG monitoring.
Considering the growing market of patients with diabetes, a number of HWDs have
been introduced for the continuous monitoring of glucose. Such devices are
generally known as CGM, continuous glucose monitor122. Notable CGMs are
Dexcom G6, Abbott’s FreeStyle Libre System, and Medtronic Guardian
Connect123,124,125. Dexcom G6 consists of a sensor, transmitter, and a
receiver122,123. With an automatic applicator, the sensor wire is inserted just under
the skin of wearer where sensor measures the glucose readings. However, Dexcom
G6 takes 2 hours of calibration after insertion. Readings from the G6 CGM are
transmitted to the receiver where they can be visualized by the user in real time on
the Dexcom mobile application. However, the application is only compatible with
selected mobile devices. Dexcom G6 is one of the few CGMs commercially
available along with Abbott’s FreeStyle Libre System to measure accurate glucose
readings if the patient is taking acetaminophen. Acetaminophen is an analgesic
medicine that interferes with CGS and causes inaccurate glucose readings122,126.
Abbott’s FreeStyle Libre comes with a sensor and a reader where sensor is a small
minimally invasive device to measure glucose from blood and sends data to the
reader where the glucose levels can be visualized. Abbott’s CGM placement can
only work accurately if placed at the back of the upper arm and unlike Dexcom G6
it takes 12 h to calibrate122,124. Similarly, Medtronic Guardian connect is another
CGM which like aforementioned CGMs consists of a sensor but does not contain a
reader. The sensor takes 12 h for calibration and can send data directly to a mobile
application instead of a reader device. An important feature about Guardian Connect
is its Sugar IQ122. Sugar IQ helps user in understanding the glucose patterns based
on their daily glucose trends along with insulin intake. It is the only CGM to send
predictive notifications 10–60 min beforehand. It can be seen that these CGMs are
costly in comparison to the widely used invasive blood-based glucose meters and it
is recommended to follow blood-based glucose meters in case CGMs readings do
not match with the symptoms.
Medical Monitoring:
In medicine, monitoring is the observation of a disease, condition or one or several
medical parameters over time.
It can be performed by continuously measuring certain parameters by using
a medical monitor (for example, by continuously measuring vital signs by a bedside
monitor), and/or by repeatedly performing medical tests (such as blood glucose
monitoring with a glucose meter in people with diabetes mellitus).
Transmitting data from a monitor to a distant monitoring station is known
as telemetry or biotelemetry.
Classification by target parameter
Monitoring can be classified by the target of interest, including:

 Cardiac monitoring, which generally refers to

continuous electrocardiography with assessment of the patient’s condition
relative to their cardiac rhythm. A small monitor worn by an ambulatory patient
for this purpose is known as a Holter monitor. Cardiac monitoring can also
involve cardiac output monitoring via an invasive Swan-Ganz catheter.
 Hemodynamic monitoring, which monitors the blood pressure and blood
flow within the circulatory system. Blood pressure can be measured either
invasively through an inserted blood pressure transducer assembly, or
noninvasively with an inflatable blood pressure cuff.
 Respiratory monitoring, such as:
o Pulse oximetry which involves measurement of the saturated percentage
of oxygen in the blood, referred to as SpO2, and measured by
an infrared finger cuff
o Capnography, which involves CO2 measurements, referred to as EtCO2 or
end-tidal carbon dioxide concentration. The respiratory rate monitored as
such is called AWRR or airway respiratory rate)
o Respiratory rate monitoring through a thoracic transducer belt, an ECG
channel or via capnography
 Neurological monitoring, such as of intracranial pressure. Also, there are
special patient monitors which incorporate the monitoring of brain waves
(electroencephalography), gas anesthetic concentrations, bispectral index (BIS),
etc. They are usually incorporated into anesthesia machines.
In neurosurgery intensive care units, brain EEG monitors have a larger
multichannel capability and can monitor other physiological events, as well.
 Blood glucose monitoring
 Childbirth monitoring
 Body temperature monitoring through an adhesive pad containing
a thermoelectric transducer.
 Cancer therapy monitoring through circulating tumor cells[1]
Vital parameters
Monitoring of vital parameters can include several of the ones mentioned above, and
most commonly include at least blood pressure and heart rate, and preferably
also pulse oximetry and respiratory rate. Multimodal monitors that simultaneously
measure and display the relevant vital parameters are commonly integrated into the
bedside monitors in critical care units, and the anesthetic machines in operating
rooms. These allow for continuous monitoring of a patient, with medical staff being
continuously informed of the changes in general condition of a patient. Some
monitors can even warn of pending fatal cardiac conditions before visible signs are
noticeable to clinical staff, such as atrial fibrillation or premature ventricular
contraction (PVC)

Medical monitoring with chronic diseases,hospital patient and elderly patients

A medical monitor or physiological monitor is a medical device used for
monitoring. It can consist of one or more sensors, processing components, display
devices (which are sometimes in themselves called "monitors"), as well as
communication links for displaying or recording the results elsewhere through a
monitoring network
Components
Sensor
Sensors of medical monitors include biosensors and mechanical sensors. For
example, photodiode is used in pulse oximetry, Pressure sensor used in Non Invasive
bood pressure measurement.
Translating component
The translating component of medical monitors is responsible for converting the
signals from the sensors to a format that can be shown on the display device or
transferred to an external display or recording device.
Display device
Physiological data are displayed continuously on a CRT, LED or LCD screen
as data channels along the time axis, They may be accompanied by numerical
readouts of computed parameters on the original data, such as maximum, minimum
and average values, pulse and respiratory frequencies, and so on.
Besides the tracings of physiological parameters along time (X axis), digital medical
displays have automated numeric readouts of the peak and/or average parameters
displayed on the screen.
Modern medical display devices commonly use digital signal processing (DSP),
which has the advantages of miniaturization, portability, and multi-parameter
displays that can track many different vital signs at once.
Old analog patient displays, in contrast, were based on oscilloscopes, and had one
channel only, usually reserved for electrocardiographic monitoring (ECG).
Therefore, medical monitors tended to be highly specialized. One monitor would
track a patient's blood pressure, while another would measure pulse oximetry,
another the ECG. Later analog models had a second or third channel displayed on
the same screen, usually to monitor respiration movements and blood pressure.
These machines were widely used and saved many lives, but they had several
restrictions, including sensitivity to electrical interference, base level fluctuations
and absence of numeric readouts and alarms.
Communication links
Several models of multi-parameter monitors are networkable, i.e., they can send
their output to a central ICU monitoring station, where a single staff member can
observe and respond to several bedside monitors simultaneously. Ambulatory
telemetry can also be achieved by portable, battery-operated models which are
carried by the patient and which transmit their data via a wireless data connection.
Digital monitoring has created the possibility, which is being fully developed, of
integrating the physiological data from the patient monitoring networks into the
emerging hospital electronic health record and digital charting systems, using
appropriate health care standards which have been developed for this purpose by
organizations such as IEEE and HL7. This newer method of charting patient data
reduces the likelihood of human documentation error and will eventually reduce
overall paper consumption. In addition, automated ECG interpretation incorporates
diagnostic codes automatically into the charts. Medical monitor's embedded
software can take care of the data coding according to these standards and send
messages to the medical records application, which decodes them and incorporates
the data into the adequate fields.
Long-distance connectivity can avail for telemedicine, which involves provision
of clinical health care at a distance.
Other components
A medical monitor can also have the function to produce an alarm (such as using
audible signals) to alert the staff when certain criteria are set, such as when some
parameter exceeds of falls the level limits.
Mobile appliances
An entirely new scope is opened with mobile carried monitors, even such in sub-
skin carriage. This class of monitors delivers information gathered in body-area
networking (BAN) to e.g. smart phones and implemented autonomous agents.
Interpretation of monitored parameters
Monitoring of clinical parameters is primarily intended to detect changes (or absence
of changes) in the clinical status of an individual. For example, the parameter
of oxygen saturation is usually monitored to detect changes in respiratory capability
of an individual.
Change in status versus test variability
When monitoring a clinical parameters, differences between test results (or values
of a continuously monitored parameter after a time interval) can reflect either (or
both) an actual change in the status of the condition or a test-retest variability of the
test method.
In practice, the possibility that a difference is due to test-retest variability can almost
certainly be excluded if the difference is larger than a predefined "critical
difference". This "critical difference" (CD) is calculated as:

, where

 K, is a factor dependent on the preferred probability level. Usually, it is set at

2.77, which reflects a 95% prediction interval, in which case there is less than
5% probability that a test result would become higher or lower than the critical
difference by test-retest variability in the absence of other factors.
 CVa is the analytical variation
 CVi is the intra-individual variability
For example, if a patient has a hemoglobin level of 100 g/L, the analytical variation
(CVa) is 1.8% and the intra-individual variability CVi is 2.2%, then the critical
difference is 8.1 g/L. Thus, for changes of less than 8 g/L since a previous test, the
possibility that the change is completely caused by test-retest variability may need
to be considered in addition to considering effects of, for example, diseases or
treatments.
Examples and applications
The development cycle in medicine is extremely long, up to 20 years, because of the
need for U.S. Food and Drug Administration (FDA) approvals, therefore many of
monitoring medicine solutions are not available today in conventional medicine.
Blood glucose monitoring
In vivo blood glucose monitoring devices can transmit data to a computer that can
assist with daily life suggestions for lifestyle or nutrition and with the physician can
make suggestions for further study in people who are at risk and help
prevent diabetes mellitus type 2 .
Stress monitoring
Bio sensors may provide warnings when stress levels signs are rising before human
can notice it and provide alerts and suggestions. Deep neural network models using
photoplethysmography imaging (PPGI) data from mobile cameras can assess stress
levels with a high degree of accuracy (86%).
Serotonin biosensor
Future serotonin biosensors may assist with mood disorders and depression.
Continuous blood test based nutrition
In the field of evidence-based nutrition, a lab-on-a-chip implant that can run
24/7 blood tests may provide a continuous results and a computer can provide
nutrition suggestions or alerts.
Psychiatrist-on-a-chip
In clinical brain sciences drug delivery and in vivo Bio-
MEMS based biosensors may assist with preventing and early treatment of mental
disorders
Epilepsy monitoring
In epilepsy, next generations of long-term video-EEG monitoring may
predict epileptic seizure and prevent them with changes of daily life activity
like sleep, stress, nutrition and mood management.
Toxicity monitoring
Smart biosensors may detect toxic materials such mercury and lead and provide
alerts.

Remote patient monitoring for chronic disease management

Remote patient monitoring for chronic disease management is an effective solution
for patients with chronic disease. According to the Journal of Medical Internet
Research, telemonitoring is a valid alternative to usual care, reducing mortality and
improving disease self-management in patients who report satisfaction and
adherence. Because chronic diseases are the leading cause of death and disability
nationwide.
A remote patient monitoring program uses technology to transmit data from a
patient’s home to the clinician for review and intervention. The patient is provided
with an RPM medical device that allows them to measure specific vital signs from
the comfort of their homes. Clinicians receive that information in real-time and can
access it whenever they want.
By implementing RPM, clinicians can significantly reduce healthcare costs and
promote better allocation of resources for improving chronic disease management.
Here are 3 reasons why remote patient monitoring can transform chronic disease
management:
1). Promotes Early Identification of Chronic Disease
Most patients only see their doctor when their condition becomes problematic, or
it’s time for their next appointment. But what if something goes wrong in-between
visits? If the patient doesn’t know what to look for, complications will continue to
develop.
Remote patient monitoring for chronic disease management promotes better care in-
between visits. By keeping track of patients’ vital signs regularly, clinicians will
better understand their patients’ conditions and be alerted immediately if medical
attention is necessary. The RPM device sends real-time readings to the remote
patient monitoring platform for the clinician to access immediately.
Clinicians will automatically be alerted for quick action when a patient’s reading is
above or below the set threshold. RPM promotes the early identification of chronic
diseases. Furthermore, the earlier complications are identified, the sooner patients
can get treatment and minimize the progression of chronic disease.
2). RPM Prompts Adjustments to Treatment Plans
Another way remote patient monitoring helps improve chronic care management is
through timely adjustments to treatment plans. Through the RPM portal, clinicians
can check how their patients are doing whenever they want. As a result, they can see
how their patients respond to medications and adjust prescriptions as necessary.
Without RPM, many patients go months with an ineffective or unoptimized
treatment plan. Remote patient monitoring in chronic disease management can help
patients find a treatment plan that works for them while reducing chronic disease
progression.
3). Remote Patient Monitoring Increases Patient Engagement
We all know how to live healthier lives, but it’s challenging to consistently apply
those practices to your everyday life. Remote patient monitoring is about expanding
healthcare outside the conventional hospital setting and into the patient’s daily
lifestyle. It helps patients feel supported in managing their health. Because they
know that their care providers regularly check their health data, patients are more
likely to engage in healthier lifestyle choices and adhere to their management plans.
Patients play an essential role in remote patient monitoring for chronic disease
management. They’re responsible for taking their vital sign measurement at least 16
days a month. While this provides clinicians with valuable insight, it also helps the
patients engage and better understand their condition. Regular measurements allow
patients to recognize a normal range for their bodies. They can see if their health is
improving or worsening over time and how changes to their lifestyle choices affect
their readings.
The better the patient understands their condition and engages, the more likely they
are to practice healthier behaviors, keep an eye out for complications, and
communicate with their clinician.
Using Remote Patient Monitoring for Chronic Disease Management
Using RPM, chronic disease patients are much less likely to be admitted into
hospitals, use emergency departments, and require complicated procedures. This
significantly reduces healthcare costs.
Remote patient monitoring improves the management of various chronic diseases,
including:
 Stroke
 Heart disease
 Diabetes
 Chronic heart failure
 Kidney disease
 Chronic obstructive pulmonary disorder
Depending on the patient’s condition, different vital signs must be monitored. For
example, individuals at risk of stroke or kidney disease will benefit from using a
blood pressure monitor, while those with diabetes will need to keep an eye on their
blood glucose levels.
1. Remote Patient Monitoring Blood Pressure Monitors
Blood pressure monitors are RPM devices that help individuals with hypertension
ensure their blood pressure stays within a healthy range. Hypertension is a major
risk factor for many chronic diseases like heart failure and stroke. Clinicians can
identify complications early and provide prompt treatment by effectively keeping
track of a patient’s blood pressure between visits. A blood pressure monitor will
display systolic blood pressure, diastolic blood pressure, and heart rate.
The top number is the systolic blood pressure measurement. This indicates the
amount of pressure in the arteries when your heart is beating. According to
the American Heart Association, any reading above 130 mmHg is considered
hypertensive. The second number is the diastolic blood pressure measurement. This
is the amount of pressure in between heartbeats. Any reading above 80 mmHg is
considered hypertensive.
How to Use
Most top RPM digital blood pressure monitor devices are very user-friendly, making
them ideal for remote use. Tenovi’s BPM works right out of the box, eliminating the
hassle of device setup.
For the best results, encourage your patients to:
 Relax for about 5 minutes before
 Sit comfortably and avoid crossing their legs
 Keep their arm rested on top of a table or armrest
 Empty their bladder
 Measure around the same time every day
 Avoid eating, exercise, caffeine, and alcohol for at least half an hour before
 Take the measurement twice, about a minute apart, to ensure accuracy, and
then average the numbers
To use a blood pressure monitor, wrap the cuff around the upper arm (ensure the
cuff is on bare skin, not clothing) and press the middle button. The cuff will start
inflating, take the blood pressure measurement, and then automatically send the data
to the RPM platform.
2. Remote Patient Monitoring Scales
Weight gain of 3 or more pounds in a single day can indicate congestive heart failure.
Congestive heart failure occurs when the heart cannot efficiently pump blood
throughout the body. At-risk individuals typically experience shortness of breath,
tightness in the chest, and dizziness. While it is entirely normal for weight to
fluctuate, weight gain in at-risk patients can serve as a precursor to more serious
conditions. By monitoring a patient’s body weight, clinicians can quickly identify
signs of heart failure and focus on early management.
How to use
All the patient has to do is step on the scale to turn it on and wait for the reading.
The information will automatically send to the clinician, and the RPM device will
turn off on its own.
For the most accurate results, advise patients to:
 Weigh themselves at the same time every day (preferably the morning)
 Avoid eating or drinking right before the weigh-in
 Wear the same clothing for each weigh-in or weigh without clothes on
Regular bodyweight measurements can help healthcare providers evaluate the
effectiveness of a patient’s management plan and, if necessary, quickly make
adjustments to better control fluid retention.
3. Remote Patient Monitoring Blood Glucose Meters
Diabetes is the 7th leading cause of death in the United States and the 4th most
common cause of physician visits. If poorly managed, diabetes can cause kidney
failure, heart attack, stroke, and blindness. By utilizing a blood glucose meter to
remotely monitor blood sugar levels, clinicians can better assess whether a patient’s
treatment management plan is working and make adjustments to optimize care.
How to Use
Tenovi’s Blood Glucose Meter is a top-line FDA-cleared RPM device. It includes a
cell-enabled meter, lancet, and custom test strips that make measuring blood sugar
very simple.
Gather all the materials and perform the following steps with clean hands:
1. Insert the test strip into the meter
2. Wipe your finger with an alcohol pad and let dry
3. Gently prick the side of the finger with the lancet
4. Place a drop of blood onto the test strip and wait for the reading
Most patients should aim for blood glucose levels between 80-130mg/dL before a
meal or below 180 mg/dL in about 2 hours after a meal. If patients’ blood glucose
levels are too high, they may need to adjust their diet or medications.
4. Remote Patient Monitoring Peak Flow Monitors
Learning to use a peak flow meter for asthma care offers several advantages. One of
the most significant benefits is the ability for physicians and patients to evaluate and
pinpoint the causes of asthma flare-ups and determine the most effective treatment
options for the specific lung condition. Remote monitoring of peak flow enables
healthcare providers to identify if medication or treatment adjustments are required
promptly.
How to Use
To begin using the Tenovi peak flow meter, relax for a few minutes before closely
following these 3 easy steps.
1. Turn it on. Press the power button for 3 seconds and wait for the Gateway to
start flashing yellow.
2. Take a reading: Take a deep breath, then exhale quickly into the peak flow
meter.
3. Data transfer: PEF and FEV1 data will automatically transfer to the Tenovi
cloud or clinician portal.
PEF and FEV1 data will automatically transfer to the Tenovi cloud or clinician
portal.
5. Remote Patient Monitoring Pulse Oximeters
Another remote patient monitoring device in healthcare that is useful for assessing
lung disease is a pulse oximeter. A pulse oximeter measures heart rate and oxygen
saturation in a patient’s red blood cells. Patients with conditions that affect blood
oxygen levels, like heart attack, heart failure, COPD, anemia, lung cancer, asthma,
and pneumonia, may benefit from regular pulse oximetry.
How to Use
Pulse oximetry is typically tested at the fingertips to measure how well oxygen is
being sent to areas of your body furthest from the heart. This RPM is simple to use.
To use the Tenovi Pulse Oximeter, all the patient has to do is:
 Turn on the device. Place a finger inside the slit, and wait for the reading. A
pulse oximeter uses light to measure the amount of oxygen in your blood at a
given point.
 Pulse oximeters will show blood oxygen saturation level (SpO2) and pulse
rate.
 Patients should seek medical attention if their reading indicates:

  SpO2 under 90% (hypoxia)
 Low pulse rate
 High pulse rate
Most remote top remote patient monitoring devices will notify the healthcare
provider immediately as well.
6. Remote Patient Monitoring Digital Thermometers
RPM cellular thermometers are used for body temperature monitoring for early
infection detection where timely treatment is crucial. This is especially true in the
case of sepsis. RPM digital thermometers are remote patient monitoring devices
used in cancer care, to monitor COVID-19 and postoperative patients. Regular
temperature monitoring reveals symptom patterns and serves as a warning signal
when abnormalities arise.
How to Use
Patients should follow these 3 easy steps to use the Tenovi RPM thermometer.
1. Turn it on: Press the blue power button and wait for the Gateway to start
flashing yellow.
2. Take a reading: Point the thermometer to the center of the forehead (1-3 cm
away) and press the blue button.
3. Data transfer: The temperature measurement data will automatically transfer
to the clinician portal.
Neural Recording:
In neuroscience, single-unit recordings (also, single-neuron recordings) provide a
method of measuring the electro-physiological responses of a single neuron using
a microelectrode system. When a neuron generates an action potential, the signal
propagates down the neuron as a current which flows in and out of the cell through
excitable membrane regions in the soma and axon. A microelectrode is inserted into
the brain, where it can record the rate of change in voltage with respect to time.
These microelectrodes must be fine-tipped, impedance matching; they are primarily
glass micro-pipettes, metal microelectrodes made of platinum, tungsten, iridium or
even iridium oxide. Microelectrodes can be carefully placed close to the cell
membrane, allowing the ability to record extracellularly.
Single-unit recordings are widely used in cognitive science, where it permits the
analysis of human cognition and cortical mapping. This information can then be
applied to brain–machine interface (BMI) technologies for brain control of external
devices.
There are many techniques available to record brain activity—
including electroencephalography (EEG), magnetoencephalography (MEG),
and functional magnetic resonance imaging (fMRI)—but these do not allow for
single-neuron resolution. Neurons are the basic functional units in the brain; they
transmit information through the body using electrical signals called action
potentials. Currently, single-unit recordings provide the most precise recordings
from a single neuron. A single unit is defined as a single, firing neuron whose spike
potentials are distinctly isolated by a recording microelectrode.
The ability to record signals from neurons is centered around the electric current
flow through the neuron. As an action potential propagates through the cell, the
electric current flows in and out of the soma and axons at excitable
membrane regions. This current creates a measurable, changing voltage potential
within (and outside) the cell. This allows for two basic types of single-unit
recordings. Intracellular single-unit recordings occur within the neuron and measure
the voltage change (with respect to time) across the membrane during action
potentials. This outputs as a trace with information on membrane resting potential,
postsynaptic potentials and spikes through the soma (or axon). Alternatively, when
the microelectrode is close to the cell surface extracellular recordings measure the
voltage change (with respect to time) outside the cell, giving only spike
information. Different types of microelectrodes can be used for single-unit
recordings; they are typically high-impedance, fine-tipped and conductive. Fine tips
allow for easy penetration without extensive damage to the cell, but they also
correlate with high impedance. Additionally, electrical and/or ionic conductivity
allow for recordings from both non-polarizable and polarizable electrodes. The two
primary classes of electrodes are glass micropipettes and metal electrodes.
Electrolyte-filled glass micropipettes are mainly used for intracellular single-unit
recordings; metal electrodes (commonly made of stainless steel, platinum, tungsten
or iridium) and used for both types of recordings.
Single-unit recordings have provided tools to explore the brain and apply this
knowledge to current technologies. Cognitive scientists have used single-unit
recordings in the brains of animals and humans to study behaviors and functions.
Electrodes can also be inserted into the brain of epileptic patients to determine the
position of epileptic foci. More recently, single-unit recordings have been used in
brain machine interfaces (BMI). BMIs record brain signals and decode an intended
response, which then controls the movement of an external device (such as a
computer cursor or prosthetic limb).

Electrophysiology
The basis of single-unit recordings relies on the ability to record electrical signals
from neurons.
Neuronal potentials and electrodes
When a microelectrode is inserted into an aqueous ionic solution, there is a tendency
for cations and anions to react with the electrode creating an electrode-electrolyte
interface. The forming of this layer has been termed the Helmholtz layer. A charge
distribution occurs across the electrode, which creates a potential which can be
measured against a reference electrode. The method of neuronal potential recording
is dependent on the type of electrode used. Non-polarizable electrodes are reversible
(ions in the solution are charged and discharged). This creates a current flowing
through the electrode, allowing for voltage measurement through the electrode with
respect to time. Typically, non-polarizable electrodes are glass micropipettes filled
with an ionic solution or metal. Alternatively, ideal polarized electrodes do not have
the transformation of ions; these are typically metal electrodes. Instead, the ions and
electrons at the surface of the metal become polarized with respect to the potential
of the solution. The charges orient at the interface to create an electric double layer;
the metal then acts like a capacitor. The change in capacitance with respect to time
can be measured and converted to voltage using a bridge circuit. Using this
technique, when neurons fire an action potential they create changes in potential
fields that can be recorded using microelectrodes. Single unit recordings from the
cortical regions of rodent models have been shown to dependent on the depth at
which the microelectrode sites were located.
Intracellularly, the electrodes directly record the firing of action, resting and
postsynaptic potentials. When a neuron fires, current flows in and out through
excitable regions in the axons and cell body of the neuron. This creates potential
fields around the neuron. An electrode near a neuron can detect these extracellular
potential fields, creating a spike.
Experimental setup
The basic equipment needed to record single units is
microelectrodes, amplifiers, micromanipulators and recording devices. The type of
microelectrode used will depend on the application. The high resistance of these
electrodes creates a problem during signal amplification. If it were connected to a
conventional amplifier with low input resistance, there would be a large potential
drop across the microelectrode and the amplifier would only measure a small portion
of the true potential. To solve this problem, a cathode follower amplifier must be
used as an impedance matching device to collect the voltage and feed it to a
conventional amplifier. To record from a single neuron, micromanipulators must be
used to precisely insert an electrode into the brain. This is especially important for
intracellular single-unit recording.
Finally, the signals must be exported to a recording device. After amplification,
signals are filtered with various techniques. They can be recorded by
an oscilloscope and camera, but more modern techniques convert the signal with
an analog-to-digital converter and output to a computer to be saved. Data-
processing techniques can allow for separation and analysis of single units.
Types of microelectrodes
There are two main types of microelectrodes used for single-unit recordings: glass
micropipettes and metal electrodes. Both are high-impedance electrodes, but glass
micropipettes are highly resistive and metal electrodes have frequency-dependent
impedance. Glass micropipettes are ideal for resting- and action-potential
measurement, while metal electrodes are best used for extracellular spike
measurements. Each type has different properties and limitations, which can be
beneficial in specific applications.
Glass micropipettes
Glass micropipettes are filled with an ionic solution to make them conductive;
a silver-silver chloride (Ag-AgCl) electrode is dipped into the filling solution as an
electrical terminal. Ideally, the ionic solutions should have ions similar to ionic
species around the electrode; the concentration inside the electrode and surrounding
fluid should be the same. Additionally, the diffusive characteristics of the different
ions within the electrode should be similar. The ion must also be able to "provide
current carrying capacity adequate for the needs of the experiment". And
importantly, it must not cause biological changes in the cell it is recording from. Ag-
AgCl electrodes are primarily used with a potassium chloride (KCl) solution. With
Ag-AgCl electrodes, ions react with it to produce electrical gradients at the interface,
creating a voltage change with respect to time. Electrically, glass microelectrode tips
have high resistance and high capacitance. They have a tip size of approximately
0.5-1.5 µm with a resistance of about 10-50 MΩ. The small tips make it easy to
penetrate the cell membrane with minimal damage for intracellular recordings.
Micropipettes are ideal for measurement of resting membrane potentials and with
some adjustments can record action potentials. There are some issues to consider
when using glass micropipettes. To offset high resistance in glass micropipettes,
a cathode follower must be used as the first-stage amplifier. Additionally, high
capacitance develops across the glass and conducting solution which can attenuate
high-frequency responses. There is also electrical interference inherent in these
electrodes and amplifiers.

Metal electrodes
Metal electrodes are made of various types of metals, typically silicon, platinum, and
tungsten. They "resemble a leaky electrolytic capacitor, having a very high low-
frequency impedance and low high-frequency impedance". They are more suitable
for measurement of extracellular action potentials, although glass micropipettes can
also be used. Metal electrodes are beneficial in some cases because they have
high signal-to-noise due to lower impedance for the frequency range of spike
signals. They also have better mechanical stiffness for puncturing through brain
tissue. Lastly, they are more easily fabricated into different tip shapes and sizes at
large quantities. Platinum electrodes are platinum black plated and insulated with
glass. "They normally give stable recordings, a high signal-to-noise ratio, good
isolation, and they are quite rugged in the usual tip sizes". The only limitation is that
the tips are very fine and fragile. Silicon electrodes are alloy electrodes doped with
silicon and an insulating glass cover layer. Silicon technology provides better
mechanical stiffness and is a good supporting carrier to allow for multiple recording
sites on a single electrode. Tungsten electrodes are very rugged and provide very
stable recordings. This allows manufacturing of tungsten electrodes with very small
tips to isolate high-frequencies. Tungsten, however, is very noisy at low frequencies.
In mammalian nervous system where there are fast signals, noise can be removed
with a high-pass filter. Slow signals are lost if filtered so tungsten is not a good
choice for recording these signals.
Applications
Single-unit recordings have allowed the ability to monitor single-neuron activity.
This has allowed researchers to discover the role of different parts of the brain in
function and behavior. More recently, recording from single neurons can be used to
engineer "mind-controlled" devices.
Cognitive science
Noninvasive tools to study the CNS have been developed to provide structural and
functional information, but they do not provide very high resolution. To offset this
problem invasive recording methods have been used. Single unit recording methods
give high spatial and temporal resolution to allow for information assessing the
relationship between brain structure, function, and behavior. By looking at brain
activity at the neuron level, researchers can link brain activity to behavior and create
neuronal maps describing flow of information through the brain. For example,
Boraud et al. report the use of single unit recordings to determine the structural
organization of the basal ganglia in patients with Parkinson's disease. Evoked
potentials provide a method to couple behavior to brain function. By stimulating
different responses, one can visualize what portion of the brain is activated. This
method has been used to explore cognitive functions such as perception, memory,
language, emotions, and motor control.
Brain–machine interfaces
Brain–machine interfaces (BMIs) have been developed within the last 20 years. By
recording single unit potentials, these devices can decode signals through a computer
and output this signal for control of an external device such as a computer cursor
or prosthetic limb. BMIs have the potential to restore function in patients
with paralysis or neurological disease. This technology has potential to reach a wide
variety of patients but is not yet available clinically due to lack of reliability in
recording signals over time.
Gait analysis:
Human gait depends on a complex interplay of major parts of the nervous,
musculoskeletal and cardiorespiratory systems.

 The individual gait pattern is influenced by age, personality, mood and

sociocultural factors.
 The preferred walking speed in older adults is a sensitive marker of general
health and survival.
 Safe walking requires intact cognition and executive control.
 Gait disorders lead to a loss of personal freedom, falls and injuries and
result in a marked reduction in the quality of life.

Definitions

 Gait - the manner or style of walking.

 GaitAnalysis -
An analysis of each component of the three phases of ambulation is an es
sential part of the diagnosis of various neurologic disorders and the asses
sment of patient progress during rehabilitation and recovery from the effe
cts of neurologic disease, a musculoskeletal injury or disease process, or
amputation of a lower limb.

 Gait speed
o The time it takes to walk a specified distance, usually 6 m or less.
Slower speeds correlate with an increased risk of mortality
in geriatric patients.[2]
o Normal walking speed primarily involves the lower extremities,
with the arms and trunk providing stability and balance.
o Faster speeds - body depends on the upper extremities and trunk for
propulsion, balance and stability with the lower limb joints
producing greater ranges of motion.

 Gait cycle is a repetitive pattern involving steps and strides

 Step is one single step

 Stride is a whole gait cycle.

  Step time - time between heel strike of one leg and heel strike of the
contralateral leg.

 Step width - the mediolateral space between the two feet.

The demarcation between walking and running occurs when periods of double
support during the stance phase of the gait cycle (both feet are simultaneously in
contact with the ground) give way to two periods of double float at the beginning
and the end of the swing phase of gait (neither foot is touching the ground)

The Gait Cycle

The sequences for walking that occur may be summarized as follows:

1. Registration and activation of the gait command within the central nervous
system.
2. Transmission of the gait systems to the peripheral nervous system.
3. Contraction of muscles.
4. Generation of several forces.
5. Regulation of joint forces and moments across synovial joints and skeletal
segments.
6. Generation of ground reaction forces.

The normal forward step consists of two phases: stance phase; swing phase,

 The Stance phase occupies 60% of the gait cycle, during which one leg and
foot are bearing most or all of the bodyweight
 The Swing phase occupies only 40% of it [4], during which the foot is not
touching the walking surface and the bodyweight is borne by the other leg
and foot.
 In a complete two-step cycle both feet are in contact with the floor at the
same time for about 25 per cent of the time. This part of the cycle is called
the double-support phase.Gait cycle phases: the stance phase and the swing
phase and involves a combination of open and close chain activities.

Phases of the Gait Cycle (8 phase model):

1. Initial Contact
2. Loading Response
3. Midstance
 4. Terminal Stance
5. Pre swing
6. Initial Swing
7. Mid Swing
8. Late Swing.

Heel Strike (or initial contact) -

Short period, begins the moment the foot touches the ground and is the first phase
of double support.

Involves:

 30° flexion of the hip: full extension in the knee: ankle moves from
dorsiflexion to a neutral (supinated 5°) position then into plantar flexion.
 After this, knee flexion (5°) begins and increases, just as the plantar flexion
of the heel increased.
 Plantar flexion is allowed by eccentric contraction of the tibialis anterior
 Extension of the knee is caused by a contraction of the quadriceps
 Flexion is caused by a contraction of the hamstrings,
 Flexion of the hip is caused by the contraction of the rectus femoris.

Foot Flat (or loading response phase)

 Body absorbs the impact of the foot by rolling in pronation.

 Hip moves slowly into extension, caused by a contraction of the adductor
magnus and gluteus maximus muscles.
 Knee flexes to 15° to 20° of flexion.
  Ankle plantarflexion increases to 10-15°.

Midstance

 Hip moves from 10° of flexion to extension by contraction of the gluteus

medius muscle.
 Knee reaches maximal flexion and then begins to extend.
 Ankle becomes supinated and dorsiflexed (5°), which is caused by some
contraction of the triceps surae muscles.
 During this phase, the body is supported by one single leg.
 At this moment the body begins to move from force absorption at impact
to force propulsion forward.

Heel Off

 Begins when the heel leaves the floor.

 Bodyweight is divided over the metatarsal heads.
 10-13° of hip hyperextension, which then goes into flexion.
 Knee becomes flexed (0-5°)
 Ankle supinates and plantar flexes.

Toe Off/pre-swing

 Hip becomes less extended.

 Knee is flexed 35-40°
 Plantar flexion of the ankle increases to 20°.
 The toes leave the ground.

Early Swing

 Hip extends to 10° and then flexes due to contraction of the iliopsoas
muscle 20° with lateral rotation.
 Knee flexes to 40-60°
 Ankle goes from 20° of plantar flexion to dorsiflexion, to end in a neutral
position.

Mid Swing
  Hip flexes to 30° (by contraction of the adductors) and the ankle becomes
dorsiflexed due to a contraction of the tibialis anterior muscle.
 Knee flexes 60° but then extends approximately 30° due to the contraction
of the sartorius muscle. (caused by the quadriceps muscles).

Late Swing/declaration

 Hip flexion of 25-30°

 Locked extension of the knee
 Neutral position of the ankle.

Gait Cycle - Anatomical Considerations

 Pelvic region - anterior-posterior displacement, which alternates from left

to right. Facilitates anterior movement of the leg (each side anterior-
posterior displacement of 4-5°).
 Frontal plane - varus movement in the: foot between heel-strike and foot-
flat and between heel-off and toe-off; hip, in lateral movements (when the
abductors are too weak, aTrendelenburg gaitcan be observed). Valgus
movement between foot-flat and heel off in the feet.
 A disorder in any segment of the body can have consequences on the
individual's gait pattern.

Gait Disorders

Gait disorders - altered gait pattern due to deformities, weakness or other

impairments eg loss of motor control or pain . Prevalence increases with age and
the number of people affected will substantially increase in the coming decades
due to the expected demographic changes.

 Lead to a loss of personal freedom and to reduced quality of life.

 Precursors of falls and therefore of potentially severe injuries in elderly
person

Gait Descriptions

 Antalgic gait a limp adopted so as to avoid pain on weight-bearing

structures, characterized by a very short stance phase.
 Ataxic gait an unsteady, uncoordinated walk, with a wide base and the feet
thrown out, coming down first on the heel and then on the toes with a
 double tap.This gait is associated with cerebellar disturbances and can be
seen in patients with longstanding alcohol dependency. People with
'Sensory'Disturbances may present with a sensory ataxic gait. Presentation
is a wide base of support, high steps, and slapping of feet on the floor in
order to gain some sensory feedback. They may also need to rely on
observation of foot placement and will often look at the floor during
mobility due to a lack of proprioception.
 Equine gait a walk accomplished mainly by flexing the hip joint; seen in
crossed leg palsy.
 Parkinsonian Gait (seen in parkinson's disease and other neurologic
conditions that affect the basal ganglia). Rigidity of joints results in
reduced arm swing for balance. A stooped posture and flexed knees are a
common presentation. Bradykinesia causes small steps that are shuffling
in presentation. There may be occurrences of freezing or short rapid bursts
of steps known as ‘festination’ and turning can be difficult.
 Trendelenburg gait, the gait characteristic of paralysis of the gluteus
medius muscle, marked by a listing of the trunk toward the affected side
at each step.
 Hemiplegic gait a gait involving flexion of the hip because of foot-
drop and circumduction of the leg.
 Steppage gait the gait in foot-drop in which the advancing leg is lifted high
in order that the toes may clear the ground. It is due to paralysis of the
anterior tibial and fibular muscles, and is seen in lesions of the lower motor
neuron, such as multiple neuritis, lesions of the anterior motor horn cells,
and lesions of the cauda equina.
 Stuttering gait a walking disorder characterized by hesitancy tha t
resembles stuttering; seen in some hysterical or schizophrenic patients as
well as in patients with neurologic damage.
 Tabetic gait an ataxic gait in which the feet slap the ground; in daylight the
patient can avoid some unsteadiness by watching his feet.
 Waddling gait exaggerated alternation of lateral trunk movements with an
exaggerated elevation of the hip, suggesting the gait of a duck;
characteristic of muscular dystrophy.
 Diplegic Gait (Spastic gait). Spasticity is normally associated with both
lower limbs. Contractures of the adductor muscles can create a ‘scissor’
type gait with a narrowed base of support. Spasticity in the lower half of
the legs results in plantarflexed ankles presenting in ‘tiptoe’ walking and
often toe dragging. Excessive hip and knee flexion is required to overcome
this
  Neuropathic Gaits. High stepping gait to gain floor clearance often due to
foot drop

Causes of gait disorders

They include neurological, orthopedic, medical and psychiatric conditions and

multifactorial etiology becomes more common with advancing age, making
classification and management more complex. Any gait disorder should be
thoroughly investigated in order to improve patient mobility and independence,
to prevent falls and to detect the underlying causes as early as possible. Thorough
clinical observation of gait, careful history taking focussed on gait and falls and
physical, neurological and orthopedic examinations are basic steps in the
categorization of gait disorders and serve as a guide for ancillary investigations
and therapeutic interventions.

Musculoskeletal Causes

Pathological gait patterns resulting from musculoskeletal are often caused by soft
tissue imbalance, joint alignment or bony abnormalities affect the gait pattern as
a result.

Hip Pathology

 Arthritis is a common cause of pathological gait. An arthritic hip has

reduced range of movement during swing phase which causes an
exaggeration of movement in the opposite limb ‘hip hiking [15][20].
 Excessive Hip Flexion can significantly alter gait pattern most commonly
due to; • Hip flexion contractures • IT band contractures, • Hip flexor
spasticity, • Compensation for excessive knee flexion and ankle DF, • Hip
pain • Compensation for excess ankle plantar flexion in mid swing. The
deviation of stance phase will occur mainly on the affected side. The result
is forward tilt of the trunk and increased demand on the hip extensors or
increased lordosis of the spine with anterior pelvic tilt. A person with
reduced spinal mobility will adopt a forward flexion position in order to
alter their centre of gravity permanently during gait.
 Hip Abductor Weakness. The abductor muscles stabilise the pelvis to
allow the opposite leg to lift during the swing phase. Weak abductor
muscles will cause the hip to drop towards the side of the leg swinging
forward. This is also known as Trendelenburg gait [18]
 Hip Adductor Contracture. During swing phase the leg crosses midline
due to the weak adductor muscles, this is known as ‘scissor gait’ [18]
 Weak Hip Extensors will cause a person to take a smaller step to lessen
the hip flexion required for initial contact, resulting in a lesser force of
contraction required from the extensors. Overall gait will be slower to
allow time for limb stabilisation. Compensation is increased posterior
trunk positioning to maintain alignment of the pelvis in relation to the
trunk [18]
 Hip Flexor Weakness results in a smaller step length due to the weakness
of the muscle to create the forward motion. Gait will likely be slower and
may result in decreased floor clearance of the toes and create a drag

Knee Pathologies

 Weak Quadriceps. The quadriceps role is to eccentrically control the knee

during flexion through the stance phase. If these muscles are weak the hip
extensors will compensate by bringing the limb back into a more extended
position, reducing the amount of flexion at the knee during stance phase.
Alternatively heel strike will occur earlier increasing the ankle of plantar
flexion at the ankle, preventing the forward movement of the tibia, to help
stabilise the knee joint.
 Severe Quadriceps Weakness or instability at the knee joint will present
in hyperextension during the initial contact to stance phase. The knee joint
will ‘snap’ back into hyperextension as the bodyweight moves forwards
over the limb
 Knee Flexion Contraction will cause a limping type gait pattern. The
knee is restricted in extension, meaning heel strike is limited and step
length reduced. To compensate the person is likely to ‘toe walk’ during
stance phase. Knee flexion contractures of more than 30 degrees will be
obvious during normal paced gait. Contractures less then this will be more
evident with increased speeds.

Ankle Pathologies

 Ankle Dorsiflexion Weakness results in a lack of heel strike and

decreased floor clearance. This leads to an increased step height and
prolonged swing phase.
 Calf Tightening or Contractures due to a period of immobilisation or
trauma will cause reduced heel strike due to restricted dorsiflexion. The
compensated gait result will be ‘toe walking’ on stance phase, reduced step
 length, and excessive knee and hip flexion during swing phase to ensure
floor clearance.

Foot Pathologies

 Hallux Rigidus results in a lack of dorsiflexion of the great toe. The MPJ
uses the windlass effect to raise the arch and stiffen the foot during
dorsiflexion of the hallux. This stiffness increases the efficiency of the
propulsion portion of the gait cycle. To be efficient in creating stiffness,
the hallux should be able to dorsiflex at least 65 degrees.

Leg length discrepancy

Leg length discrepancy can be as a result of an asymmetrical pelvic, tibia, or

femur length or for other reasons such as scoliosis or contractures. The gait
pattern will present as a pelvic dip to the shortened side during the stance phase
with possible ‘toe walking’ on that limb. The opposite leg is likely to increase its
knee and hip flexion to reduce its length.

Antalgic Gait

 Antalgic gait due to knee pain presents with decreased weight bearing on
the affected side. The knee remains in flexion and possible toe weight-
bearing occurs during stance phase [15]
 Antalgic gait due to ankle pain may present with a reduced stride length
and decreased weight bearing on the affected limb. If the problem is pain
in the forefoot then toe-off will be avoided and heel weight-bearing used.
If the pain is more in the heel, toe weight-bearing is more likely. General
ankle pain may result in weight-bearing on the lateral border [15][18].
 Antalgic gait due to hip pain results in a reduced stance phase on that side.
The trunk is propelled quickly forwards with the opposite shoulder lifted
in an attempt to even the weight distribution over the limb and reduce
weight-bearing. Swing phase is also reduced

Gait Analysis

 The analysis of the gait cycle is important in the biomechanical mobility

examination to gain information about lower limb dysfunction in dynamic
movement and loading.
 When analyzing the gait cycle, it is best to examine one joint at a time.
  Objective and subjective methods can be used.

Subjective

 Different gait patterns - We might ask the individual to walk normally, on

insides and outsides of feet, in a straight line, running (all the time looking
to compare sides and understanding of "normal").
 Ask/observe the type of footwear the patient uses (a systematic review
suggests shoes affect velocity, step time, and step length in younger
children's gait[32]).

An objective approach is quantitative and parameters like time, distance, and

muscle activity will be measured. Other objective methods to assess the gait
cycle that use equipment include: [33][31]

 Video Analysis and Treadmill

 Electronic and Computerized Apparatus
 Electronic Pedometers
 Satellite Positioning System

Qualitative methods to assess and analyse gait include:

 Rancho Los Amigos Hospital Rating List

 Ten Meter Walking Test
 6 Minute Walk Test
 2 Minute Walk Test
 Dynamic Gait Index
 Emory Functional Ambulation Profile
 Timed Up and Go Test . This test is statistically associated with falling in
men, but not in women.
 Functional Ambulation Categories
 Tinetti-Test

Sports medicine
Sports medicine is a branch of healthcare. It deals with the diagnosis, treatment and
prevention of Injuries related to participation in sports and/or exercise.

Scope of sports medicine

In the field of physical education and sports, the fields of various sub-disciplines of
sports medicine are utilize. Without the knowledge of scope of sports medicine, it is
difficult to carry a sportsperson performance at apex level. There are following scope
of sports medicine:

a) Sports and first aid

b) Human anatomy and physiology

c) Female and sports

d) Study of optimal load for different age groups

e) Scientific promotion of games and sports

f) Sports injury rehabilitation

g) Fitness for games and sports.

Aims of sports medicine

a) To provide information to athletes about injuries.

b) To provide knowledge about the causes of injuries.

c) To provide means or treatment for sports injuries and for rehabilitation of

injuries.

d) To provide knowledge about the preventive measures of sports injuries.

e) To aware the sports person & athlete about the different kinds of injury in respect
of different games.

f) To concentrate on the causes of injury

Concept of Sports medicine

 Bio-mechanics related to sports

 Effect of attitude on endurance performance
 Psychological aspect performance
  Nutrition & metabolism in relation to competition & performance
 Recommendations of FISM(the International Federation of Sports Medicine
at world level)
 Cardio-respiratory function in relation to performance
 Exercise in Cardio-Vascular disease prevention & rehabilitation

Prevention of Sports Injuries :

 Pre-participation of medical check up
 Proper conditioning
 Avoid dehydration
 Protective Sports equipment & Gears
 Adequate & effectively maintained facilities
 Sports person’s psychological conditions & environment
 Adequate rehabilitation/Injury management
 Proper use of right techniques
 Balanced diet & adequate rest
 Use of proper skills
 Warming up & cooling down

Impact of surface on athletes

There are two types of surfaces used in any indoor or outdoor games. These are
natural and artificial surfaces. Natural surfaces is the surfaces that are prepared
through proper combination of natural elements like soil and grass. On the other
hand, artificial surfaces are more like carpets which are made from artificial
components like rubber, synthetic fiber etc. These surfaces impact performance of
athletes differently. In many contact games like football, cricket, running and
Kabaddi natural surfaces are preferred because they provide more familiarity, grip
and avoid severe injuries. On the other hand, artificial surfaces provide more
opportunities for practice because their use need not be stopped for maintenance.
Also, with innovation in technology, artificial surfaces are becoming more user
friendly. Risks of injuries are reducing in artificial surfaces also nowadays.

Impact of Surfaces and Environment on Athletes

SportsInjury
Intrinsic Risk Factor Extrinsic Risk Factor

Physical Preparation
Lack of proper training

Fitness label Environmental

Coaching Factors
a. Poor techniques a. Climate
Improper warming up & cooling Down
b. Lack of knowledge
 Skill
Over use of muscles b. Playing Surface
 Rules & Regulations
 Surrounding
Muscles imbalance c. Preventive surfaces
 Environment
 Equipment
Individual variables:-  Facilities
d. Medical facilities
a. Gender and Age
b. Nutrition
c. Fatigue
d. Posture deformities

Climatic conditions affect the performance

Environmental conditions, such as excessively high or low temperatures, have the

potential to have a negative impact on an athlete ‘s well-being. An athlete ‘ability to
use a number of thermoregulation techniques helps in regulating body temperature.

Sports injuries are those which are common in the field of games and sports. During
training, competition or practice, any player can be injured. Perhaps there will not
be any player who has not been injured during his career.
Strain is also a muscle injury. A strain is caused by twisting or pulling a muscle or
tendon. A sudden strain is caused by a recent injury, lifting heavy objects or rods in
wrong way and over stressing the muscles. Chronic strain is usually caused by
moving the muscles and tendons in repetition.
Sprain is a ligament injury. It may occur due to overstretching or tearing of
ligaments. Many things can cause sprain. Falling, twisting, or getting hit can force a
point out of its normal position. This can cause ligaments around the joints to tear.
Generally, Sprain occurs at wrist and ankle joints.
Prevention of sprain and strain
a) Conditioning should be performed during the preparatory period.

b) Sports equipments must be of good quality.

c) Play courts should be smooth and clean.

d) The scientific knowledge of games should be must for preventing srain.

e) Player should discontinue during the condition of fatigue.

f) Good officiating is essential for preventing such injury.

g) Players should be careful and alert during practice, training and competition.

Abrasion is a key injury generally occurs due to friction with certain equipments or
a fall over the area where bone is very close to skin. It may be caused by a fall on
hard surface. As someone falls or slides on the ground, friction causes layers of the
skin to rub off.
Bruises are not clearly seen as upper skin remains undamaged and inner blood
vessels are damaged and collect beneath the skin. A fresh bruise may actually be
reddish and after a few hours it turns to blue or dark purple.
A laceration is a wound that is produced by tearing of soft body tissue.
Contusion is a muscle injury. A direct hit with or without any sports equipment can
be the main cause of contusion. Contusion can also be due to minor accidents to the
skin such as falling, bumping into something or being hit or kicked. In contusion
blood vessels in muscles are broken and sometimes bleeding may occur in the
muscles which may cause bruise. Stiffness and swelling are common features at the
site of contusion.

Management:
  Cold compression should be used immediately. Ice or cold water should not
be used for more than 40 minutes persistently.
 The cold compression should be performed 5 to 6 times daily.
 If there is more swelling at the sight of contusion, the anti-inflammatory
medicine should be given.
 If the swelling persists, consult the Doctor immediately.
 For the purpose of rehabilitation, flexibility exercises should be performed.
Causes of sports injuries
To effectively diagnose, rehabilitate and ultimately prevent subsequent injuries, a
sport therapist

 Anatomical Factors: These are related to make up of the body. Leg length
differences a n d cause injury to ankle, hip and back.

 Age related causes as the body ages, it changes. It is less able to produce force,
recovers slower and soft tissues lose the ability to stretch. Therefore, it is more
prone to injury.
 Training related cause’s Excessive repetitive loading of the tissues is needed
for successive adaptation. However, without suitable recovery, tissues never
have the chance to adapt and can fail.
 Equipment selection factors These are related to the suitability of equipment.
An instance is incorrect footwear, which will not protect the foot and ankle
adequately. It also will not distribute forces effectively. Thus it increases the
risk of injury.
 Impact and contact causes Impact or contact can be with objects, surfaces or
other people. These injuries are common in contact sports like football, rugby,
hockey etc. Also they are common in more dangerous sports like motor racing,
boxing and skiing.

Joint injuries & its types

A hard blow to a joint, a fall, a forceful throwing, lifting or hitting may cause
dislocation. Infact it is dislocation of surface of bones.

Types of dislocation
a) Dislocation of lower jaw: it occurs when the chin strikes to any other object. It
may occur if mouth is opened excessively.

b) Dislocation of shoulder joint: dislocation of shoulder joint may occur due to a

sudden jerk or a fall over a hard surface. The end of the humerous comes out from
the socket. In face when your shoulder dislocates, a strong force, such as a sudden
blow to your shoulder. Pulls the bones in your shoulder out of place.

c) Dislocation of hip joint: By putting maximum strength spontaneously may cause

dislocation of hip joint. The end of the femur is displaced from the socket.

d) Dislocation of wrist: A sportsperson who participates in a sports or game in which

he may fall, runs the risk of getting a dislocated wrist. A miscalculated landing can
also cause a dislocated wrist. Infact, it generally occurs to the person who use his
hand to break his fall.

Preventions:
a) Adequate warming-up should be performed prior to any activity.

b) Proper conditioning should be performed during preparatory period.

c) Stretching exercises should be include in warm-up

d) Players should be careful during training and competition.

e) Protective equipment should be used

f) Players should have good anticipation and concentration power

g) Always obey the rules and regulations.

h) Perform regular exercise around your shoulder, hip, and wrist joints etc.

i) Avoid falls or hits as far as possible.

Causes of fracture
Fracture usually occurs due to a high impact on the bone. It can be causes by overuse.
The most common causes of fracture are:

a) In such sports event where there is a high impact.

b) Traumatic, forceful and unnatural movements.

c) Prolonged long distance walking or running.

d) Sudden fall on hard surface.

e) Direct strike or hit with any solid sports equipment.

f) Osteoporosis.

Management of Fracture
a) Elevate the extremity and rest while bone heals itself.

b) Apply ice to the affected part for 24 to 48 hrs

c) If pain persists, give painkillers.

d) If there is any need of immobilization to the affected part, use a slint

e) After removal of swelling begin to put partial weight on the affected area.

f) Crutches or walking stick may be used in the beginning. After two weeks start
putting normal weight.

g) For 6 to 8 weeks, avoid the activity that caused stress fracture. Then start doing
the activity slowly.