Wearable sensor technologies are essential to the realization of personalized medicine through continuously monitoring an individual's state of health. Sampling human sweat, which is rich in physiological information, could enable non-invasive monitoring. Previously reported sweat-based and other non-invasive biosensors either can only monitor a single analyte at a time or lack on-site signal processing circuitry and sensor calibration mechanisms for accurate analysis of the physiological state. Given the complexity of sweat secretion, simultaneous and multiplexed screening of target biomarkers is critical and requires full system integration to ensure the accuracy of measurements. Here we present a mechanically flexible and fully integrated (that is, no external analysis is needed) sensor array for multiplexed in situ perspiration analysis, which simultaneously and selectively measures sweat metabolites (such as glucose and lactate) and electrolytes (such as sodium and potassium ions), as well as the skin temperature (to calibrate the response of the sensors). Our work bridges the technological gap between signal transduction, conditioning (amplification and filtering), processing and wireless transmission in wearable biosensors by merging plastic-based sensors that interface with the skin with silicon integrated circuits consolidated on a flexible circuit board for complex signal processing. This application could not have been realized using either of these technologies alone owing to their respective inherent limitations. The wearable system is used to measure the detailed sweat profile of human subjects engaged in prolonged indoor and outdoor physical activities, and to make a real-time assessment of the physiological state of the subjects. This platform enables a wide range of personalized diagnostic and physiological monitoring applications.

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Fully integrated wearable sensor arrays for multiplexed in situ perspiration analysis

The aim of this review paper is to summarize recent developments in the field of wearable sensors and systems that are relevant to the field of rehabilitation. The growing body of work focused on the application of wearable technology to monitor older adults and subjects with chronic conditions in the home and community settings justifies the emphasis of this review paper on summarizing clinical applications of wearable technology currently undergoing assessment rather than describing the development of new wearable sensors and systems. A short description of key enabling technologies (i.e. sensor technology, communication technology, and data analysis techniques) that have allowed researchers to implement wearable systems is followed by a detailed description of major areas of application of wearable technology. Applications described in this review paper include those that focus on health and wellness, safety, home rehabilitation, assessment of treatment efficacy, and early detection of disorders. The integration of wearable and ambient sensors is discussed in the context of achieving home monitoring of older adults and subjects with chronic conditions. Future work required to advance the field toward clinical deployment of wearable sensors and systems is discussed.

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A review of wearable sensors and systems with application in rehabilitation.

Electronic Textiles (e-textiles) are fabrics that feature electronics and interconnections woven into them, presenting physical flexibility and typical size that cannot be achieved with other existing electronic manufacturing techniques. Components and interconnections are intrinsic to the fabric and thus are less visible and not susceptible of becoming tangled or snagged by surrounding objects. E-textiles can also more easily adapt to fast changes in the computational and sensing requirements of any specific application, this one representing a useful feature for power management and context awareness. The vision behind wearable computing foresees future electronic systems to be an integral part of our everyday outfits. Such electronic devices have to meet special requirements concerning wearability. Wearable systems will be characterized by their ability to automatically recognize the activity and the behavioral status of their own user as well as of the situation around her/him, and to use this information to adjust the systems' configuration and functionality. This review focuses on recent advances in the field of Smart Textiles and pays particular attention to the materials and their manufacturing process. Each technique shows advantages and disadvantages and our aim is to highlight a possible trade-off between flexibility, ergonomics, low power consumption, integration and eventually autonomy.

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Wearable Electronics and Smart Textiles: A Critical Review

Capabilities in health monitoring enabled by capture and quantitative chemical analysis of sweat could complement, or potentially obviate the need for, approaches based on sporadic assessment of blood samples. Established sweat monitoring technologies use simple fabric swatches and are limited to basic analysis in controlled laboratory or hospital settings. We present a collection of materials and device designs for soft, flexible, and stretchable microfluidic systems, including embodiments that integrate wireless communication electronics, which can intimately and robustly bond to the surface of the skin without chemical and mechanical irritation. This integration defines access points for a small set of sweat glands such that perspiration spontaneously initiates routing of sweat through a microfluidic network and set of reservoirs. Embedded chemical analyses respond in colorimetric fashion to markers such as chloride and hydronium ions, glucose, and lactate. Wireless interfaces to digital image capture hardware serve as a means for quantitation. Human studies demonstrated the functionality of this microfluidic device during fitness cycling in a controlled environment and during long-distance bicycle racing in arid, outdoor conditions. The results include quantitative values for sweat rate, total sweat loss, pH, and concentration of chloride and lactate.

A soft, wearable microfluidic device for the capture, storage, and colorimetric sensing of sweat

Smart wearable systems: Current status and future challenges

Textile-based sensors offer an unobtrusive method of continually monitoring physiological parameters during daily activities. Chemical analysis of body fluids, noninvasively, is a novel and exciting area of personalized wearable healthcare systems. BIOTEX was an EU-funded project that aimed to develop textile sensors to measure physiological parameters and the chemical composition of body fluids, with a particular interest in sweat. A wearable sensing system has been developed that integrates a textile-based fluid handling system for sample collection and transport with a number of sensors including sodium, conductivity, and pH sensors. Sensors for sweat rate, ECG, respiration, and blood oxygenation were also developed. For the first time, it has been possible to monitor a number of physiological parameters together with sweat composition in real time. This has been carried out via a network of wearable sensors distributed around the body of a subject user. This has huge implications for the field of sports and human performance and opens a whole new field of research in the clinical setting.

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BIOTEX—Biosensing Textiles for Personalised Healthcare Management

Proetex is a European Integrated Project dedicated to micro- and nano-technology-based wearable equipment for emergency operators. During the first year of work, a careful analysis of several emergency scenarios has been carried out and has resulted in the design of a complete "smart" uniform for fire-fighters and emergency rescuers. These garments aim at monitoring both physiological parameters, position and posture of the operators and the presence of external potential sources of danger and to send these data to a remote coordinating unit. In the following, the main issues of the design flow will be described and discussed.

Managing catastrophic events by wearable mobile systems

The ability to perform real-time chemical measurements of body fluids is an exciting concept for the healthcare sector and the sports industry. This work is part of the BIOTEX project, an EU FP6 project which involved the development of textile-based sensors to measure the chemical composition of sweat. This is a challenging task involving the collection of sweat samples, delivery to an active surface and the removal of waste products. A textile based platform which would be in immediate contact with the skin was developed for this purpose. The system uses capillary action and exhibits a passive pumping mechanism. This is achieved by using a combination of moisture wicking fabric and a highly absorbent material. A fabric channel is created for the integration of sensors. The channel is produced using a mask and screen-printing hydrophobic material onto the fabric. Different channel lengths and widths affect the flow rate of the system. The channel dimensions were designed based on typical sweat rates and also to accommodate sensor placement. A textile patch was developed and integrated into a waistband for collection of sweat on the lower back. Real-time measurements of sweat pH, sodium concentration, conductivity and temperature were measured during exercise using the textile patch.

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Cyril Chuzel

Papers

BIOTEX—Biosensing Textiles for Personalised Healthcare Management

Managing catastrophic events by wearable mobile systems

A textile-based platform for real-time sweat collection and analysis