Intelligent Medical Clothes is a key topic for the future. In addition, the starting markets for functional clothing and smart textiles are within the health care, fitness and prevention domains. The technology can quietly monitor the wearer's heart beat rate, respiration, temperature and a host of other vital functions, alerting the wearer or physician if there is a problem. The results of the researches will indeed make a positive impact on the quality of life for individuals in the real world. In this study, after presenting the new electronic fabrics, which are blended with conductive materials that used in high-tech clothes, intelligent medical garments, appeared in the market and their properties of them have been reviewed.
Introduction
The fashion industry is facing new challenges: intelligent textiles, smart clothes,i-wear and fashion engineering are only a few of the keywords which will revolutionize new and old industry within the next 5 to 10 years. The integration of high-technology into textiles, e.g. modern communication or monitoring systems or the development of new materials with new functions, has just started with timidity, but the branch already propagates an enormous boom for this sector. Especially applications for the health sector, e.g. clothes with extern monitoring systems, are already today anticipating a great demand [1].
Developments in telecommunication, information technology and computers are the main technical tools for Telemedicine (Telecare, Telehealth, e-health) now being introduced in health care. Telemedicine - medicine at a distance - provides among the many possibilities offered the tools for doctors to more easily consult each other. For individuals, e.g. with chronic diseases, Telemedicine means, the possibility to stay in contact with their health care provider for medical advice or even to be alerted if something begins to go wrong with their health. This opens up new possibilities for personalized health and health care. In line with this, ongoing cutting edge research in fields such as textiles, medical sensors and mobile communication could pave the way to a better life for a large number of patients. The results of the researches will indeed make a positive impact on the quality of life for individuals in the real world [2].
In this review, recent developments on smart garments, designed for medical usage owing to their electronic functions are introduced. The products that appear in the market and application areas are also reviewed.
2. Medical Aspects of Smart Clothes
"Intelligent Clothing" is made from fabrics that are wireless and washable that integrate computing fibers and materials into the structure of the fabrics. This technology represents a quantum leap in healthcare monitoring, producing accurate, real-time result. A garment can have some functions like a computer by using optical and conductive fibers, which is shown on Figure1, integrated into the garment.
When incorporated into the design of clothing, the technology could quietly monitor the wearer's heart rate, respiration, temperature, and a host of vital functions, alerting the wearer or physician if there is a problem. Judging from the number of inquiries that have been received from parents, physicians and caregivers from all over the world, there is a critical need for the medical smart clothing and this need will be met in the near future.
2.1. Smart-Shirt
Georgia Institute of Technology is a university, which conducts research in the area of "intelligent fabric". Georgia Tech developed a "Wearable Motherboard" (GTWM), which was initially intended for use in combat conditions. GTWM is shown on Figure 2.
GTWM is currently being manufactured for commercial use under the name "Smart Shirt" by Sensatex [3].
The commercial applications for the "Smart Shirt" are as follows:
The SmartShirt System incorporates advances in textile engineering, wearable computing, and wireless data transfer to permit the convenient collection, transmission, and analysis of personal health and lifestyle data.
Described as "the shirt that thinks," the SmartShirt allows the comfortable measuring and/or monitoring of individual biometric data, such as heart rate, respiration rate, body temperature, caloric burn, and provides readouts via a wristwatch, PDA, or voice. Biometric information is wirelessly transmitted to a personal computer and ultimately, the Internet.
The "Smart Shirt," a T-shirt wired with optical and conductive fibers, is a garment that functions like a computer. It uses electro-optical fibers embedded in the fabric to collect biomedical information. There are no discontinuities in the smart shirt. The smart shirt is one piece of fabric, without seams. Because the sensors are detachable from the smart shirt, they can be placed at any location, and is therefore adjustable for different bodies. Furthermore, the types of sensors used can be varied depending on the wearer's needs. Therefore, it can be customized for each user. For example, a firefighter could have a sensor that monitors oxygen or hazardous gas levels. Other sensors monitor respiration rate and body temperature or can collect voice data through a microphone [1]. The information is sent to a transmitter at the base of the shirt where it is stored on a memory chip or sent to your doctor, coach, or personal server via a wireless network like Bluetooth, RF(Radio Frequency), WLAN (Wireless Local Area Network), or cellular [4].
It uses plastic optical fiber and various sensors and interconnects continuing monitoring human body to detect any dangerous signals or other vital symptoms. A flexible data bus brings the data from sensors to emitters and then sends to PSM (Personal Status Monitor). It is lightweight, comfortable and able to launder. Detailed architecture of the Smart Shirt is shown on Figure 3 and Figure 4.
The system has shown great promise in effectively monitoring the vital signs of infants, as well as chronically ill patients, obstetric patients and the elderly. Similarly the sensor technologies in the garment can be adapted to meet the specific needs of the athletes, astronauts, police officers and firefighters and those involved in hazardous activities [6], [3].
Some of the wireless technology needed to support the monitoring capabilities of the "Smart Shirt" is not completely reliable. The "Smart Shirt" system uses Bluetooth and WLAN. Both of these technologies are in their formative stages and it will take some time before they become dependable and widespread. However, the "Smart Shirt" at this stage of development only detects and alerts medical professionals of irregularities in patients' vital statistics or emergency situations. It does not yet respond to dangerous health conditions. Therefore, it will not be helpful to patients if they do face complications after surgery and they are far away from medical care, since the technology cannot yet fix or address these problems independently, without the presence of a physician. Future research in this area of responsiveness is ongoing [7].
Application areas of Smart Shirt are as follows:
Maintaining a Healthy Lifestyle
Individual Athletes/Team Sports
Continuous Home Monitoring
Remote Patient Examination
Infant Vital Signs Monitoring
Sleep Studies Monitoring
Vital Signs Monitoring for Mentally Ill Patients
Protecting Public Safety Officers
Battlefield Combat Care Solution
2.2. Life-Shirt
Developed by Southern California-based health information and monitoring company VivoMetrics, the Life-Shirt, which is shown on Figure 5, uses embedded sensors and a PDA to monitor and record more than 30 physiological signs and bring standard monitoring technology out of the hospital and into the real-world environment. The information is uploaded to a computer via a datacard and sent over the Internet to VivoMetrics, where it is analyzed and then sent to the physician [8].
The Life-Shirt System is with 12 patents covering wearable sensor design and proprietary software algorithms. It is an enhanced, ambulatory version of an in-patient system currently used in more than 1,000 hospitals worldwide.
Underlying Technology
The Life-Shirt System is based on inductive plethysmography, a non-invasive respiratory monitoring technology recently cited by the FDA (US Food and Drug Administration) as the only technology capable of differentiating between different kinds of sleep apnea. It monitors breathing patterns by passing a continuous, low-voltage electrical current through externally placed sinusoidal arrays of wires that surround the rib cage and abdomen. By virtue of its design, inductive plethysmography reduces the signal interference and distortion that is often associated with other technologies, enabling clinicians to obtain a more accurate measurement of patients' respiratory functions [8].
Life-Shirt System Components
The Life-Shirt system consists of the Life-Shirt Garment, Life-Shirt Recorder and VivoLogic analysis and reporting software. The system continuously measures more than 30 parameters during daily activities. After processing the data, the system integrates subjective patient input from an on-board electronic diary, the VivoLog Digital Diary. Results can be viewed as full-disclosure, high-resolution waveforms or as summary reports [8].
Life-Shirt Garment
The Life-Shirt is a lightweight, machine washable, comfortable, easy-to-use shirt with embedded sensors. To measure respiratory function, sensors are woven into the shirt around the patient's chest and abdomen. A single channel ECG measures heart rate, and a two-axis accelerometer records patient posture and activity level. Optional peripheral devices measure blood pressure and blood oxygen saturation.
Life-Shirt Recorder and VivoLog Digital Diary
The Life-Shirt System includes an integrated PDA that continuously encrypts and stores the patient's physiologic data on a compact flash memory card. Patients may also record time-stamped symptom, mood and activity information in the recorder's diary, the VivoLog Digital Diary, allowing researchers and clinicians to correlate subjective patient input with objectively measured physiologic parameters [8].
VivoLogic Software
VivoMetrics proprietary PC-based software decrypts and processes recorded data using patented algorithms. It includes viewing and reporting features that enable researchers and clinicians to view the full-disclosure, high-resolution waveforms, or look at trends over time. In addition, summary reports can be generated that present processed data in concise, easy-to-interpret graphical and numeric formats.
Athletes could wear the garments to enhance training and also can monitor heart rate, respiration, and temperature and even listen to MP3s through the shirt. A microphone also can be embedded into the shirt. Firefighters also could wear a Life-Shirt, which is shown on Figure 6, to be monitored for smoke inhalation. On the other hand doctors could use them to monitor patients who've left their offices.
While this wearable technology is developing and trying to take place in the daily market, the Indy racing league has started to use it in the field to see how a race car driver's body reacts to pressure behind the wheel.
2.3 Mamagoose Baby Pyjamas
Smart clothes technologies could help to prevent Sudden Infant Death Syndrome (SIDS) commonly known cot death. The Belgian company Verhaerth Design and Development and the University of Brussels (VUB) have developed a new type of pyjamas which is shown on Figure 7 that monitor babies during the sleep.
The new pyjamas are very aptly called Mamagoose and they draw on technology used in two specific applications: The analogue biomechanics recorder experiment and the respiratory inductive plethysmograhph suit.
The Mamagoose pyjamas have five special sensors positioned over the chest and stomach, three to monitor the infants heart beat and two to monitor respiration. This double sensor system guarantees a high level of measuring precision. The special sensors are actually built into the cloth and have no direct contact with the body, thus creating no discomfort for the baby.
The pyjamas are made of two parts: the first, which comes into direct contact with the baby, can be machine-washed and the second, which contains the sensor system, can be washed by hand. The pyjamas come in three sizes, are made of non-allergic material and have been especially designed to keep the sensors in place during in use. The control unit with alarm system is connected to the pyjamas and continuously monitors and processes the signals received from five sensors. It is programmed with an alarm algorithm which scans the respiration pattern to detect unexpected and possibly dangerous situations.
Mamagoose prototypes have been tested on many babies in different hospitals, environments and conditions. These include babies of various weights and sizes when they are different moods such as calm, nervous or upset, and when they are sleeping in different positions. To date, the results have been extremely promising [9].
2.4. Smart Socks
Every year, more than 50,000 Americans with diabetes must undergo foot or leg amputations. In many of these cases, poor blood circulation is the villain. Its possible to imagine having socks with built-in pressure sensors that would alert the wearer to put his/her feet up for a while. Researchers estimate that about three-quarters of diabetes-related amputations might be avoided with this kind of simple warning system.
Smart socks are another example of the growing push to make high-tech home medical devices a part of everyday lives. It means health care is coming home again. This is one of the most rapidly growing segments of medical technology. It's driven by an aging baby boomer population, pressures to control health spending and the availability of new technology to implement decentralized care [10].
2.5. The Smart Bra
Scientists at the University of Wollongong in Australia are developing a 'smart bra' that will change its properties in response to breast movement, giving better support to active women when they need it most. Crafted from a new generation of intelligent fabrics, the ultimate Smart Bra will tighten and loosen its straps, or stiffen and relax its cups, to restrict breast motion, preventing breast pain and sag. Predicted to outperform any existing bra in the support stakes, it will encourage more women back to sports, and in extreme cases, stop clavicles snapping from the sudden movement of excessively heavy breasts.
Fabric sensors attached to the straps and midriff of a standard bra, worn by a model in motion, will monitor breast movement and relay data in real time to a computer via a telemetry system. Information gathered from the tests will eventually be stored on a tiny microchip that will serve as the 'brain' of the ultimate Smart Bra, signaling the polymer fabric to expand and contract in response to breast movement. The Smart Bra is the first in a suite of smart textiles projects conducted by researchers from the University's internationally-renowned Intelligent Polymer Research Institute (IPRI) in conjunction with the Biomechanics Research Laboratory [11].
2.6. Other Interesting "Smart Clothing"
There are also other "Smart Clothes" that are aimed at consumer use. For example, Philips, a British consumer electronics manufacturer, has developed new fabrics, which are blended with conductive materials that are powered by removable 9V batteries. These fabrics have been tested in wet conditions and have proven resilient and safe for wearers. One prototype that Philips has developed is a child's "bugsuit" that integrates a GPS system and a digit camera woven into the fabric with an electronic game panel on the sleeve. This allows parents to monitor the child's location and actions.
Another Philips product is a life-saving ski jacket that has a built in thermometer, GPS, and proximity sensor. The thermometer monitors the skier's body temperature and heats the fabric if it detects a drastic fall in the body temperature. The GPS locates the skier, and the proximity sensor tells the skier if other skiers are nearby. Philips suggests that wearable computers will be widely used by the end of the next decade [10].
3. Conclusion
Intelligent medical clothing and textiles have the potential to substantially change the provision of health and health care services for large population groups, e.g. those suffering from chronic diseases (such as cardiovascular, diabetes, respiratory and neurological disorders) and the elderly with specific needs. Smart sensor systems and new approaches to analyse and interpret data together with cost-effective telematics approaches can fundamentally change the interface between citizen/patient and the health care provider. Biomedical clothing and functional textiles were believed in the workshop to be a key enabler technology for cost-effective disease management as well as for prevention. Fitness and health are trendy and are becoming a life style. Medical fashion (rather than clothes) offers a unique opportunity to seamlessly integrate health care into the daily lives of citizens [2].
In future e-Textiles, sensing, processing and communication capabilities are integrated in a woven structure to monitor biomechanical variables and physiological signals. This requires research on new fibre electro-conductive materials. This kind of products could even make virtual medical exams possible. A patient would wear one of the shirts and a physician could monitor the vital signs from a remote location via the Internet.
When incorporated into the design of clothing, the technology could quietly perform an ECG, monitor the wearer's heart rate, respiration, temperature, blood pressure and a host of other vital functions, alerting the wearer or physician if there is a problem [12].
The idea is great but several factors must be more considerate. The data communications between smart shirt and personal status monitor can be burst during combat scenario. Therefore, a delicate wireless communication protocol must be carefully designed and implemented. The power consumption of these garments must be addressed. Also since each human is unique somebody may have rapid heart rates and some dont. So there should be no general standards to judge whether a mans life is in dangerous situation. Instead at server (PSM-Personal Status Monitoring) side, it shall keep all records that smart products send back, then server can make more proper decisions by comparing those data. Which means not only the smart medical clothes should be tailored (size, position of sensor etc.), the entire systems should be tailored according to each unique constitution.
The smart medical clothes can be used in several distinct modes, in combat or field operations, in medical monitoring, for personal information processing. Its predicted that not all of them need to be connected to the air all time. For privacy reason, sometimes it is much better to include a memory card to record everything on the garment then send all information to PSM. These data can be used whenever needed. Another important reason is the health issue, sending data wireless means electromagnetic wave and the impact of it to the bodies is not known yet.
At last, the cost for maintenance is also a key factor. The smart medical clothes are high tech products and there are bus connectors all over the garment. What can be done if there is a crack? More specifically, during battle for example, the ability to recover smart clothes in a short time is important. This might be solved by wireless interconnection all sensor components and when a sensor is broken it should be possible to sew another [5].
The results of the researches will indeed make a positive impact on the quality of life for individuals in the real world. While still in an embryonic stage, the smart and functional textile technology has the potential to become ubiquitous.
References
[1] http://www.icewes.net/projdetails_haupt.htm
[2] http://www.hoise.com/vmw/02/articles/vmw/LV-VM-08-02-35.html
[3] http://ldt.stanford.edu/~jeepark/jeepark portfolio/cs147hw8jeepark.html
[4] http://www.techtv.com/freshgear/products/story/0,23008,3348594,00.html
[5] http://nesl.ee.ucla.edu/courses/ee202a/2002f/submissions/hw3/Jea_David/HW3.pdf
[6] http://www.darpa.mil/dso/success/smashirt.htm
[7] http://www.sensatex.com/smartshirt/index.html
[8] http://www.vivometrics.com/site/system_howitworks.html
[9] http://www.esapub.esrin.esa.it/buletin/bullet108/inbrief_108.pdf
[10] http://www.technologyreview.com/articles/upstream0901.asp
[11] http://www.uow.edu.au/science/research/ipri/smartbra.html
[12] http://popularmechanics.com/science/medicine/2000/9/underwear_doctor_aware.html
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