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The Future of Healthcare May Reside in Your Smart Clothes

When most people think of wearables, they often think of the obligatory smart watches, fitness monitors, and heart rate monitors that are typically worn on the wrist or. However, the wearables market extends well beyond just these standard devices and into multiple emerging markets across some different industries.

One such emerging market is smart clothing for healthcare--the idea of weaving electronics into a shirt, a blanket, a bandage, a knitted cap, or pants to perform specific patient care functions.

Smart clothing, or e-textiles, as a whole is still in its infancy, and practical applications that are being used in hospitals and other care facilities are few and far between.

Yet, interest in the potential of this technology is vast with many healthcare providers and medical device manufacturers actively monitoring smart clothing pilot projects and research into the latest e-textiles technology. In fact, smart clothing holds such promise in healthcare it is being seen as a major disruptive force in the industry in the next five years.

"Healthcare in general is experiencing its own crisis especially in the US (also in the UK)," said Aditya Kaul, research director for market research firm Tractica. "Therefore, the focus is more on fixing healthcare rather than on technologies like smart clothing. We see a slow growth for the market in the next three to four years, but beyond that, we see a bright, fast growing market."

Tractica forecasts smart clothing for healthcare to grow from just $2.4 million today to a whopping $1.2 billion by 2021, with the majority of growth coming in the years 2019-2021.

What is an e-Textile and How Does it Work?

Smart clothing is seen as a way to revolutionize the practice of healthcare, and it's hoped that a widespread use of garments used to monitor health or help with treatment could reduce reliance on costly equipment and a heavily burdened healthcare system. Clothing that can track chronic disease or conditions, help with a growing aging population, or make patients more comfortable during a stay at a hospital or treatment facility is seen as a way to create value, boost health insights, and reduce costs.

E-textiles are designed to feel comfortable on the skin but at the same time be functional. These smart fabrics consist of traditional fabric woven with conductive fibers as well as electronic elements such as biomedical sensors, microcontrollers, fiber optics and wearable antennas, such as Mouser's line of Internet of Things system-on-modules.

An example of a biomedical sensor that could be used in e-textile applications is the Analog Devices' AD8232/33 Heart Rate Monitor Front End . It is an integrated signal conditioning block for ECG and other biopotential measurement applications, designed to extract, amplify, and filter small biopotential signals in the presence of noisy conditions. The Intel® Edison development platform is designed to lower the barriers to entry for a range of inventors, entrepreneurs, and consumer product designers to rapidly prototype and produce "Internet of Things" (IoT) and wearable computing products. It is both a system-on-module solution and an item that incorporates a wearable antenna.

In some cases, e-textiles are created, in part, on a typical tabletop sewing machine that embroiders thread into fabric in a pattern via a computer program. Instead of thread, however, metallic fibers from metals such as silver, nickel, carbon, copper, aluminum, and stainless steel, like Adafruit's wearable electronic platforms from Mouser, are used that feel the same as traditional thread to the touch. These products allow you to realize any wearable project. They are fully featured, round, sew-able, and Arduino-compatible devices. They are small enough to fit into any project and low cost enough to use without hesitation.

Depending on how the conductive fibers are woven in and the electronics included in the smart clothing, the fabric is durable and able to be washed similar to regular clothing. While durability is still an on-going issue in many projects, it is a consideration that most researchers and companies are working on as an important step toward mass commercialization of smart clothing for healthcare.

Market Drivers and Challenges for Smart Clothing

So far, there have been relatively few e-textile commercial successes. One of the reasons for this is a lack of willingness by companies in the healthcare field to invest in research projects or academics instead taking a wait-and-see approach. In its place, some manufacturers have turned to the wellness/sports market where the consequences for a wrong signal are much lower.

However, with a continued rise in many parts of the world of chronic disease--such as diabetes, heart disease, cancer and respiratory disorders--aging populations that are living longer and an increase in the number of surgeries performed in key healthcare markets such as Europe and the US, e-textile developments are on the rise to make use of emerging electronics and medical technology. In some clinical trials, smart clothing has shown to protect against infectious disease, help sense the state of the wearer's health, and help prevent, treat, and manage health.

There are lots of opportunities in healthcare development, especially textiles," said Luciano Boesel, group leader for adaptive textiles and hydrogels at Swiss research house Empa (Figure 1). "The need for long-term, unobtrusive monitoring of risk patients at home will stimulate quick development. In five years' time, I believe we'll get to see many innovative textile solutions in healthcare."

Figure 1: Fiber optics integrated into a blanket or shirt in order to monitor skin circulation to prevent bed sores or monitor heart rates is what researchers at Empa are working on. (Source: Empa)

Boesel admits e-textiles face challenges that must be overcome including further development in reliability, liability, and certification. Regulatory approvals also present a challenge for device manufacturers and researchers as FDA consent can take many years. Then getting approval and certification from insurance companies is another hurdle. So many smart clothing projects that have been introduced will take between three to five years to come to fruition. Many experts see this inflection point happening in the 2020 time frame.

Solving Current Problems

James Hayward, technology analyst with market research firm IDTechEx, believes that if an immediate financial or economical gain to the technology can be had, the more likely smart clothing will be adopted by providers.

E-textiles such as a bed sheet or mattress that are integrated with pressure sensors to manage and prevent bed sores by making sure the patient is moving around on the surface enough is something that that is garnering a lot of interest from companies, Hayward says. Conditions such as bed sores and incontinence in the elderly cost hospitals and care facilities money and time. Moisture sensors integrated into smart clothes for mapping incontinence in patients could prove to be a very worthwhile investment in the long run.

"If e-textiles continue to prove to be successful, it will start off as a high-end luxury feature before it gets adopted on mass," Hayward said. "These things take time and while typical medical device lead times are coming down slightly, we can expect to see some in five years, more in 10 years. But there is a lasting value here, so I do think it will come to healthcare gradually."

Clothing+ is working with Jabil to mass produce textile-integrated sensors that meet the necessary FDA requirements for medical grade solutions. Some of the ideas for the e-textile include a bioimpedance vest, whichmeasures water accumulation in the lungs to indicate heart conditions, that can be worn at home for trend analysis before hospitalization, saving time and money. Other ideas in development is a chest belt to provide a lung's performance through a topographic picture of the lungs and a light therapy blanket for babies with jaundice allowing them to be removed from cradle light therapies and held by parents or loved ones instead.

Edema ApS is developing a washable stocking to measure and monitor changes in leg volume with patients suffering from edema (fluid accumulation or swelling) in the lower limbs (Figure 2). While not yet available for patients, the stocking is being prepped for clinical trials and validation. Future uses of the stocking could be to monitor congestive heart failure or pre-eclampsia, which happens during pregnancy and involves hypertension, edema, and protein in the urine.

Figure 2: A wearable, washable stocking that can be worn at home for use in monitoring edema in patients' legs is moving into the clinical trial and validation phase. (Source: Edema ApS)

"The stocking will be washable and durable enough for home use, which is the main concept idea of the project. Being able to monitor people when they are home and avoid long problematic trips just to have an eye assessment of the increase or decrease," said Klaus Østergaard, CEO of Edema. The stocking would be monitored via a smartphone app where the user could self-regulate during exercise, identify the need to elevate or reposition legs or call the doctor for medical adjustment, Østergaard says.

Wearable body metrics vendor Hexoskin has been active in developing smart clothing for sports/fitness markets but is also working on e-textiles for healthcare in the areas such as cardiology, respiratory, neurology, mental disorders, and pediatrics. Currently, Hexoskin is conducting trials for long-term remote monitoring of clinical-grade sensors woven into a smart shirt for precise electrocardiography (ECG) cardiac monitoring with lung function and activity monitoring.

Academia Leading the Way

Among those developing e-textiles for the healthcare market, work being done at the university level offers much promise for the future of patient care technology.

One interesting project is being developed by VTT Technical Research Center of Finland, where researchers have created smart fabric that can be used as clothing or blankets that calculate whether a patient needs to be cooled or warmed based on the initial date measured from the person and the environment. These garments could also be used by surgeons that get too hot during an operation with the clothing adjusting to the temperature of the body during surgery.

"Hospital patients have been asked about their most unpleasant experience, and the most common answer is feeling cold-pain comes only second," said Pekka Tuomaala principal scientist at VTT.

Ohio State University's ElectroScience Laboratory is working toward functional e-textiles that gather, store or transmit digital information by weaving antennas-such as the Intel® Edison development platform-into something like a brain cap that senses activity in the brain to help treat conditions such as epilepsy or addiction (Figure 3). The researchers are also working on a smart bandage that tells a doctor how well the tissue beneath it is healing without removing the bandage.

Figure 3: Ohio State University is working on integrating antennas and circuits into clothing for the future of healthcare monitoring and treatment. (Source: Ohio State University)

"Our goal is to understand how we think. Imagine if we can enable our brain into regeneration. To do that we need to understand the brain and how many neurons are working together," says John Volakis, director of the ElectroScience Laboratory at Ohio State University. "These smart clothes could tell an epileptic person to sit down before they have an attack or how to activate or deactivate cells in patients with Parkinsons."

Meanwhile, the University of Bristol is working on soft robotic clothing that could help vulnerable people avoid falls by supporting them while they walk and giving others bionic strength to move between sitting and standing positions or climb stairs (Figure 4). The smart clothing involves nanoscience, 3D fabrication, electrical stimulation, and full-body monitoring technologies. Researchers believe this technology could ultimately lead to potentially freeing wheelchair-bound people from having to use the devices.

Figure 4: Researchers at the University of Bristol are working to integrate soft robotics into clothing to support those vulnerable to falls or have trouble walking up stairs. (Source: University of Bristol)

"Many existing devices used by people with mobility problems can cause or aggravate conditions such as poor circulation, skin pressure damage or susceptibility to falls, each of which is a drain on health resources," said Dr. Jonathan Rossiter, professor of robotics in the Department of Engineering at the University of Bristol. "Wearable soft robotics has the potential to improve many of these problems and reduce healthcare costs at the same time too."

Switzerland's Empa research center is integrating optic fibers into e-textiles to monitor the skin's circulation to prevent bed sores and has created a fitted cap that measures heart rates. The garments are being made to withstand a disinfection wash cycle, which would make it ideal for hospitals.

Researchers believe this technology could be used eventually to measure oxygen saturation or to measure pressure on the tissue or respiration rate. The e-textiles could also be turned into chemical or biosensors, such as those offered by Maxim Integrated to analyze body fluids or vapors. Maxim's ultra-low power and secure development boards are based on Maxim's series of ultra-low power ARM^® Cortex^®-M microcontrollers. These ARM Cortex-M4F 32-Bit MCUs are ideal for the emerging category of wearable medical and fitness applications because their architecture combines ultra-low-power, high-efficiency signal processing functionality, and ease of use. The Maxim MAX30102 Pulse Oximeter & Heart-Rate Sensor is an integrated pulse oximetry and heart-rate monitor module, and it includes internal LEDs, photodetectors, optical elements, and low-noise electronics with ambient light rejection.

"The ductility of the fibers has to match that of textile yarn to provide the same comfort and integrity," said Dr. Maike Quandt, a postdoctoral researcher at Empa. "E-textiles benefit from fiber optics since the fibers can be used for a multitude of sensors. At the same time, optical fibers do not pose a risk for electric shock."

The Future of Smart Clothing

While many of these academic endeavors are moving forward and are working toward commercialization, innovations in high-tech fabrics and the advances in microelectronics are opening even further possibilities for healthcare-related e-textiles.

Some of these ideas and early pilot projects involve t-shirts that relieve chronic back pain, shirts with stretch sensors for monitoring respiratory rates with patients with chronic lung disease, soft all-day belly bands that monitor uterine contractions and fetal heart rate in pregnant women, pressure monitor stocking for use by diabetic patients or even a shirt that delivers shocks to patients experiencing serious heart problems.

Some experts see smart clothing completely replacing bedside monitoring in hospitals with shirts that track heart rate, blood pressure, oxygen intact and more.

Recently, the idea of integrating gesture recognition in smart clothing has garnered attention with the Google-Levi Project Jacquard commuter jacket for bicycle riders. While many experts believe gesture recognition could find its way into clothing for healthcare-maybe for use by paraplegics or elderly that have had strokes or heart attacks or elderly in the home that fall-currently there are far less expensive and established technologies that will be hard to surpass in the next five years.

Haptic feedback , or the use of touch in a user interface design, holds much promise in e-textiles because it can be easily miniaturized and does not require moving mechanical parts. Haptic feedback would be used in Electric Muscle Stimulation (EMS) that could range from a small tingle to a strong force feedback to activate a patient's muscles. Smart clothing with haptic feedback technology could be used at all times during the day and worn on any part of the body to stimulate muscle movements or rehab. Projects involving haptic feedback, such as those from Novasentis, are currently in development for use in garments for healthcare with prototypes expected to arrive later this year.

Peter has nearly 20 years of experience reporting and writing about the electronics industry including semiconductors, semiconductor manufacturing, consumer electronics, power and energy, MEMS and sensors and mobile devices. He previously worked for IHS Technology as Senior Manager for Marketing and Communication, where he wrote, edited and designed the weekly Market Watch newsletter as well as press releases on the latest IHS analytical reports. Peter has held numerous positions at Electronic News including senior editor and managing editor, where he won gold and silver awards from the American Society of Business Publication Editors (ASBPE) for both writing and design.