pubs.acs.

org/CR Review

Electronic Textiles for Wearable Point-of-Care Systems

Guorui Chen,§ Xiao Xiao,§ Xun Zhao,§ Trinny Tat, Michael Bick, and Jun Chen*

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ABSTRACT: Traditional public health systems are suffering from limited, delayed, and
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inefficient medical services, especially when confronted with the pandemic and the aging
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population. Fusing traditional textiles with diagnostic, therapeutic, and protective medical
devices can unlock electronic textiles (e-textiles) as point-of-care platform technologies on
the human body, continuously monitoring vital signs and implementing round-the-clock
treatment protocols in close proximity to the patient. This review comprehensively
summarizes the research advances on e-textiles for wearable point-of-care systems. We start
with a brief introduction to emphasize the significance of e-textiles in the current healthcare
system. Then, we describe textile sensors for diagnosis, textile therapeutic devices for medical
treatment, and textile protective devices for prevention, by highlighting their working
mechanisms, representative materials, and clinical application scenarios. Afterward, we detail
e-textiles’ connection technologies as the gateway for real-time data transmission and
processing in the context of 5G technologies and Internet of Things. Finally, we provide new
insights into the remaining challenges and future directions in the field of e-textiles. Fueled
by advances in chemistry and materials science, textile-based diagnostic devices, therapeutic devices, protective medical devices, and
communication units are expected to interact synergistically to construct intelligent, wearable point-of-care textile platforms,
ultimately illuminating the future of healthcare system in the Internet of Things era.

CONTENTS 6. Future Perspectives 3277

6.1. Diagnostics 3277
1. Introduction 3260 6.2. Therapeutics 3277
2. Diagnostics 3260 6.3. Theranostics 3277
2.1. Physical Sensing for Diagnostics 3261 6.4. Clinical Parameter Analysis 3278
2.1.1. Biomechanical Sensing 3262 6.5. Information Security 3279
2.1.2. Optical Sensing 3265 6.6. Network Interference 3279
2.1.3. Biopotential Sensing 3266 6.7. Future Translational Medicine 3279
2.1.4. Thermal Sensing 3266 6.8. Intelligent Wearable Point-of-Care Textile
2.2. Biochemical Sensing for Diagnostics 3266 Platforms 3279
2.2.1. Humidity Sensing 3266 Author Information 3280
2.2.2. Biofluid Sensing 3267 Corresponding Author 3280
2.2.3. Respiratory Analysis 3268 Authors 3280
3. Therapeutics 3268 Author Contributions 3281
3.1. Physical Methods 3269 Notes 3281
3.1.1. Assistive Therapy 3269 Biographies 3281
3.1.2. Phototherapy 3270 Acknowledgments 3281
3.1.3. Electrotherapy 3270 References 3281
3.1.4. Thermotherapy 3271
3.2. Biochemical Methods 3272
3.2.1. Drug Delivery 3272
3.2.2. Antimicrobial Textiles 3272
4. Prevention 3273 Received: June 7, 2021
4.1. Physical Protection 3273 Published: December 23, 2021
4.2. Biochemical Protection 3273
5. E-textile Connections 3275
5.1. Device Connections 3275
5.2. System Connections 3275

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3259 Chem. Rev. 2022, 122, 3259−3291
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1. INTRODUCTION mechanical robustness.60−64 In particular, e-textiles for bio-

monitoring (e.g., biomechanical sensors,65−79 optical sen-
Point-of-care systems with the ability to provide immediate
sors,80−85 biopotential sensors,86−89 temperature sensors,90−94
diagnostic and therapeutic services as close to the patient as
biochemical sensors,95−105 and many others106−111) can
possible have recently become highly sought-after.1−12 Conven-
continuously detect vital signals, thus establishing a tailored
tional healthcare systems have been exposed to a myriad of
health baseline for individual abnormality alerts and disease
obstacles when coping with widespread health-related issues,
diagnosis. Meanwhile, e-textiles featuring therapeutic abilities
such as population aging13 and global pandemics,14 over the past
(e.g., mechanical support,112−120 phototherapy,121−123 electro-
decades.15 For instance, chronic diseases afflicting the elderly therapeutics, 124−126 thermotherapy, 127−132 drug deliv-
require continuous monitoring and long-term nursing care,16 ery, 133−136 antimicrobial protection, 137−139 and many
and hospitals at resource-limited areas do not provide others140−142) are capable of elaborating round-the-clock
ubiquitous access to extensive diagnostic testing for the growing treatment protocols tailored to each individual health profile.
numbers of elderly people.17 Moreover, they only only episodic Moreover, e-textiles with protective functions (e.g., electro-
treatments when encountering medical conditions or attending magnetic-wave-shielding,143 air filtering,144 and toxic degrada-
health screening services.18 In these cases, the diseases usually tion145) are the closest barrier for the human body and can
progress to a severe stage before a diagnosis.19 Furthermore, the protect people in hostile environments. Furthermore, textile
conventional healthcare system is disease-centered and does not biomonitoring and therapeutic devices should communicate
consider patient variability.20 Physicians prescribe one-drug-fits- with each other to form a closed-loop theranostic system, which
all approaches based on population averages rather than would combine diagnosis and therapy in an integrated design.146
individual health profiles.21 Therefore, the conventionally Wireless communication technologies,147 e.g., near-field com-
insufficient, delayed, and inaccurate medical services continue munication (NFC), Bluetooth, ZigBee, etc., customized for
to harm an unacceptably large number of patients, leading to device-to-device communication,148 can benefit the transmitting
skyrocketing expenditures and medical burdens. and processing of clinical data such as treatment progress and
Routine healthcare must move away from its reactive and therapeutic feedback,149−151 thus contributing to precise
disease-centric pattern, which is wholly confined to centralized medical services in a patient-participatory manner. Eventually,
medical institutions, to a point-of-care manner, providing textile-based diagnostic, therapeutic, protective, and wireless
predictive, preventative, and participatory medical services in communication devices will be able to interact synergistically to
close proximity to the patient.22−25 As the world marches into form a wearable point-of-care textile system, providing medical
the era of Internet of Things (IoT) and fifth-generation (5G) care for individuals in the fastest, closest, and most precise
wireless,26−29 wearable medical electronics could be used to manner.152−154 As the 5G era has dawned, wider bandwidths can
monitor and record individual vital signs and treatment link abundant wearable point-of-care textile systems for
processes on the human body, which could then be exchanged communication and telemedicine without running out of
to provide an effective point-of-care schema.30−32 However, network availability. Therefore, with the power of 5G
cost-effective, robust, and comfortable biomedical electronics to technology and IoT, wearable point-of-care textile systems are
continuously measure body conditions are still rare. Specifically, expected to conquer the medical fields across the board by
the majority of wearable biomedical electronics in the current preventing disease,155 providing treatment, and promoting
point-of-care systems are based on polymer thin films,33−39 health anywhere, anytime around the human body. Ultimately,
silicon,40−43 paper,44−47 and many others,48 which lack the wearable point-of-care textile systems will become integral parts
necessary breathability for long-term on-body applications. The of our everyday outfits.
bulky and rigid properties of silicon-based biomedical This review begins with an exhaustive discussion of key
electronics also impede epidermal and implantable interfacing advances in major components of e-textiles for wearable point-
with the human body.49 Paper-based biomedical electronics are of-care devices. First, textile biomonitoring devices for disease
mainly disposable and possess a limited lifetimes,46 which prediction and diagnosis are discussed. Textile therapeutic
hinders them from working repeatedly, thus imposing an devices are then described in detail regarding their biomedical
economic and environmental burden.50 Meanwhile, fluctuations functions. Moreover, protective textiles for damage prevention
in ambient temperature and humidity can considerably in hostile environments are introduced according to their
undermine the analytical accuracy of paper-based sensors.47 working mechanisms. Afterward, textile communication units
Accordingly, conventional biomedical electronics are deficient employed as the gateway for device-to-device communication
in the requisite wearability, long lifespan, and stability for and health data exchange are detailed in the context of 5G
continuously retrieving clinical-grade data from the human technology and IoT. Taking textiles as a platform, a systematic
body. integration of textile-based diagnostic devices, therapeutic
Textiles have played a vital role in the long history of human devices, protective devices, and communication units could
civilization.51 Today, textiles can be fabricated from various build up a wearable point-of-care system that can culminate in
materials, including natural forms,52 such as silk, wool, and transforming the current disease-oriented healthcare system into
cotton, and synthetic forms, including peptide, polyamide, a predictive, preventive, and participatory model. The wearable
polyester, and many others, which endow them with point-of-care devices enabled by e-textiles are expected to
biocompatible,53 biodegradable, and even bioabsorbable redefine the paradigms of the health care system by promoting
features.54−56 These properties enable textiles to serve as on- the welfare of society as a whole.
body healthcare platforms with greatly improved comfort.57−59
Fusing biomedical electronics with textiles can create electronic 2. DIAGNOSTICS
textiles (e-textiles) capable of providing point-of-care diagnoses Point-of-care diagnostics play critical roles in the public health
and therapeutics while maintaining superior breathability, system around the world, which facilitate timely, convenient,
comfort, long service life, environmental stability, and and rapid assessment of health status, providing surveillance data
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Figure 1. Biomechanical sensing with e-textiles for diagnosis. (a) Schematic illustration of a flower-shaped wireless textile sensor for wearable and
continuous pulse wave monitoring. (b) Measured pulse wave signals for obstructive sleep apnea-hypopnea syndrome (OSAHS) diagnosis. The two
dotted circles demonstrate signal abnormalities of an OSAHS patient. Reproduced with permission from ref 68. Copyright 2020 Elsevier. (c)
Photograph of a single-layered ultrasoft washable e-textile for real-time sleep monitoring. Scale bar, 10 cm. (d) Measured respiratory signals for
OSAHS diagnosis. The patient with OSAHS exhibits an episode of apnea for 11 s. Reproduced with permission from ref 69. Copyright 2020 Elsevier.
(e) E-textile-estimated blood pressure was validated by a commercial cuff (left). E-textile-enabled real-time pulse monitoring using a mobile phone
(right). Scale bar, 3 cm. Reproduced with permission from ref 182. Copyright 2021 Wiley-VCH. (f) 3D textile piezoelectric sensors detect differences
between normal gait and toe-out gait for early dementia diagnosis. Reproduced with permission from ref 162. Copyright 2020 Elsevier. (g) Schematic
illustration of large-area textile sensor arrays for physiological signal monitoring. (h) Measured radial artery pressure waves for vascular aging diagnosis.
The arterial stiffness of patients can be evaluated by calculating P2/P1. Reproduced with permission from ref 72. Copyright 2017 Wiley-VCH. (i)
Schematic illustration of a capacitive textile sensor for upper extremity motion monitoring. Reproduced with permission from ref 76. Copyright 2015
Wiley-VCH.

for emergency as well as chronic diseases.156 In recent years, in a timely manner,159−161 thus allowing physicians and patients
tremendous advances have been achieved in point-of-care to rapidly detect diseases. Properly incorporating these
diagnostics, which are based on continuous advancements in biomonitoring e-textiles into the patient care process can
biosensor technologies. Biosensors are capable of monitoring minimize the time it takes to obtain a diagnosis result and
physiological information, such as vital signs (e.g., heart rate, ultimately enable the transition from the current reactive and
respiration rate, blood pressure, and body temperature)157 and disease-centric healthcare system to a point-of-care model,
biochemical markers (e.g., blood glucose concentration)158 in a focusing on disease prevention and health promotion.68 This
continuous, real-time, and noninvasive manner. However, section discusses the emerging biosensors built on e-textiles for
conventional thin-film-based biosensors possess limited air diagnostics, illustrating their working mechanisms, functional
permeability and poor comfort. These disadvantages impede materials, representative device architectures, and prospective
their practical applicability for point of care. In the past two applications.
decades, textiles have been endowed with various electronic
2.1. Physical Sensing for Diagnostics
functions through the use of chemistry for the design and
synthesis of functional materials. E-textiles have outstanding air Physical sensors built on e-textiles, which detect a physical
permeability and comfort similar to conventional clothes, which quantity, e.g., pressure, body temperature, and biopotentials,
can cover a large specific skin area for a long time without and convert it into electrical signals, have been widely used in the
causing discomfort. Biosensors built on e-textiles are capable of biomedical field.157 These textile physical sensors, possessing
continuously detecting biophysical and biochemical signals of outstanding compatibility with the human body, can continu-
the human body,61 which can be leveraged to assess health status ously track clinical parameters toward disease monitoring and
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diagnosis, e.g., pulse wave for cardiovascular disease diagnosis,72 parameters extracted from the respiration rate can also be
respiratory activities for COVID-19 diagnosis,163 body temper- applied for health assessment. Furthermore, a single-layered
ature for fever diagnosis,94 oxygen saturation for sudden cardiac ultrasoft washable e-textile for subtle respiration monitoring was
death warning,164 biopotentials for cerebrovascular disease also developed (Figure 1c).69 During sleep, OSAHS patients
diagnosis,88 and many others. These timely diagnostic and exhibited less breathing overall, which was clearly illustrated by
continuous health monitoring applications propelled by textile an 11-s apnea episode in their detected respiratory signals
physical sensors are far superior to conventional medical (Figure 1d). Simultaneously, it can also communicate with
services, liberating people from centralized hospitals and intervening devices for health care emergency, such as
offering tailored health care. The implications of textile physical automatically waking up patients to prevent sudden death or
sensors to detect the biomechanical, thermal, optical, and alerting the doctor when patients suddenly experience breathing
biopotential changes around the human body are highlighted in problems while sleeping. Recently, a machine-learning-assisted
this section. textile triboelectric sensor was developed by using the
2.1.1. Biomechanical Sensing. E-textiles for biomechan- nonwoven FEP textile and single-walled carbon nanotubes
ical sensing are widely applied for monitoring various (CNTs)-coated textiles.182 This e-textile is inexpensive, light-
physiological signals, such as heart rate,65 respiratory activity,69 weight, and mechanically durable, which can continuously and
and muscle tension,74 which have ignited exciting point-of-care precisely measure the pulse wave. With the assistance of
applications for disease diagnosis. Owing to their decent machine learning algorithms, systolic and diastolic pressure can
flexibility and comfort, textile biomechanical sensors can be estimated from the acquired pulse wave, fitting well with the
interface intimately with human skin to continuously convert results from a commercial blood pressure cuff at the hospital
subtle biomechanical motions into analog signals by using the (Figure 1e).
triboelectric effect165 (voltage/current output), piezoelectric In addition, textile piezoelectric sensors can convert
effect166 (voltage/current output), piezoresistive effect167 biomechanical motions into electrical signals for self-powered
(resistance change), and capacitance changes.62 Among these biomonitoring.183−186 Based on the piezoelectric effect, they are
working mechanisms, e-textiles based on triboelectric nano- able to convert multifarious biomechanical stimuli like vibration,
generators (TENG) for biomechanical pressure sensing have tension, compression, and torsion into electricity, making them
exhibited remarkable superiority.168−170 Typically, textile ideal for integration with regular garments.187 Typically used
TENGs can convert biomechanical motions into electrical piezoelectric materials for e-textiles include inorganic materials,
signals through the cycle of separation and recontact of e.g., ZnO, BaTiO3, and lead zirconate titanate (PZT); organic
triboelectric materials such as polytetrafluoroethylene (PTFE), piezoelectric polymer, e.g., poly(vinylidene fluoride) (PVDF);
polydimethyl-siloxane (PDMS), fluorinated ethylene propylene and composites, e.g., combining inorganic materials with the
(FEP),171 and polyimide (Kapton) as the electron acceptors and flexible organic matrix such as polydimethylsiloxane
Al, Cu, nylon, skin, silk, wool, and cotton as the electron (PDMS).188 For example, a 3D textile piezoelectric sensor was
donors,172 featuring a collection of compelling properties, developed by using a nanostructured PVDF film, featuring a
including simple structure, light weight, a wide range of high sensitivity of 286 mV/kPa for monitoring multiple body
economically available materials, and biocompatibility. More- movements.162 Through the attachment of a multimode textile
over, within the textile, abundant junctions between yarns and sensor on the shoe insole, the differences between normal gait
their surface roughness are highly beneficial to enhance and toe-out gait on pressure and interval were precisely
triboelectrification for optimal sensing sensitivity.173−181 For measured and characterized (Figure 1f). Because gait pattern
example, a cotton chest strap sensor was fabricated by weaving changes are early indicators of dementia, these gait-generated
Cu-coated polyethylene terephthalate (Cu-PET) yarns and electrical signals were further transmitted to a smartphone via
polyimide (PI)-coated Cu-PET yarns.67 The junctions of weft the integrated Bluetooth modules on the shoes, providing
and warp yarns served as abundant triboelectric sensing sites, diagnostic evidence for remote health care. Recently, a muscle-
which effectively generated contact-induced charges in response inspired nonwoven piezoelectric textile was developed for
to biomechanical movements. The cotton chest strap sensor physiological monitoring.189 Polydopamine (PDA) was dis-
could continuously monitor the respiratory rate and depth for persed among the barium titanate/PVDF nanofibers, and a
diagnosing cardiovascular diseases. To receive reliable disease piezoelectric textile sensor was constructed, showing a high
diagnoses, it is imperative to enhance the sensitivity, eliminate sensitivity of 3.95 V/N and a long-term sensing stability. This
environmental noise, and optimize the analysis of patient- textile sensor could be conformally worn on the human wrist and
generated health data. To this end, a sensitive textile sensor in a accurately detect pulse waves, providing reliable data for
flower shape was developed by embroidering polyester−metal cardiovascular disease diagnosis.
yarns on a silver-coated polyester textile substrate (Figure 1a).68 Besides triboelectric/piezoelectric effect-based textile wear-
Each petal consisted of triboelectric yarns with gradually ables for self-powered biomonitoring, textile resistive sen-
decreasing length from the middle to the edge, which promoted sors,190−192 which require external power, have also been
the perception of tiny pressure fluctuations, thus achieving an extensively investigated for biomechanical monitoring because
excellent sensitivity of 3.88 V/kPa. This comfortable and of their convenient fabrication processes, simple architectures,
sensitive textile sensor was applied to continuously monitor and high gauge factors (GFs). In particular, the porous structure
human pulse waves while sleeping; the acquired voltage signals of textiles could effectively enlarge the compressibility of
could then be wirelessly transmitted to computers or resistive sensors, thus achieving a broad sensing range to track
smartphones for obstructive sleep apnea-hypopnea syndrome biomechanical signals.193 To fabricate a textile resistive sensor,
(OSAHS) diagnosis. Figure 1b presents the distinct pulse signal typical strategies involve coating pressure-sensitive materials,
abnormalities of an OSAHS patient. The regions marked by the including metal nanoparticles (e.g., silver nanoparticles),194
dotted circles provide precise evidence to confirm the breathing nanowires195 (e.g., silver nanowire), graphene,196 and CNTs,197
pauses during sleeping. In addition to pulse waves, pathological onto fiber or textile substrates,71 in situ carbonizing silk or cotton
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Figure 2. Magnetoelastic generator (MEG)-based e-textiles for biomechanical sensing. (a) Internal structure of the soft material system consisted of
micromagnets and polymer matrix. Reproduced with permission from ref 201. Copyright 2021 Springer Nature. (b and c) Schematics of the magnetic
dipole distribution in soft material system of initial state (b) and compressed state (c). Reproduced with permission from ref 203. Copyright 2021
Springer Nature under Creative Commons Attribution 4.0 (http://creativecommons.org/licenses/by/4.0/). (d) A textile MEG developed by sewing
a soft magnetoelastic film with a textile coil. (e) E-textile MEG seamlessly sewn on the clothes or chest strap for breathing monitoring. Scale bar, 8 cm.
Reproduced with permission from ref 202. Copyright 2021 Elsevier. (f) Soft magnetic fibers created by extrusion via an adjustable nozzle. (g) Micro-
computed tomography of the soft magnetic fibers. Scale bar, 0.4 mm. (h) Schematics of the soft magnetic microfiber. (i) Textile MEG as a waterproof
wearable pulse sensor. Scale bar, 6 cm. (j) Measured pulse wave profile in one cardiac cycle of the waterproof textile MEG tested with perspiration and
under water. (k) Measured pulse wave profiles of the textile MEG soaked in artificial perspiration and water for up to 168 h. (l) Photograph showing
that the textile MEG is air permeable without causing skin irritation. Scale bar, 1.5 cm. (m) The developed user interface on a cell phone app. (n) The
tested health data can be passed through a wireless network for wearable point-of-care devices. Reproduced with permission from ref 203. Copyright
2021 Springer Nature under Creative Commons Attribution 4.0 (http://creativecommons.org/licenses/by/4.0/).

fabrics,74 spinning composites into fibers,198 and thermal stiffness (by calculating P2/P1) for vascular aging measurement
drawing.199 For example, a representative textile resistive sensor (Figure 1h).
was developed by coating silver nanoparticles onto rubber Indeed, textile resistive sensors rely on deformation-induced
fibers.71 In response to an external mechanical pressure, the resistance variations, which tend to suffer from hysteretic
resistance of the textile composite decreased proportionally. To behaviors due to the sensing materials’ viscoelasticity. Textile
further investigate their diagnostic capability, a large-area textile capacitive sensors, which generally consist of two electrode
sensor array was designed by laminating CNT-coated cotton textiles separated by a dielectric spacer, provide an alternative
onto textile electrodes (Figure 1g).72 This textile resistive sensor approach.75 Rather than material deformation, capacitance
exhibited a decent sensitivity of 14.4 kPa−1, which is attributed changes of textile sensors depend on the varied area of the
to sufficient contact sites for resistance variation created by the capacitors and the distance between the separated electrodes,200
textile surface roughness. Thus, a sensitive textile sensor was able thus contributing to a rapid response to the biomechanical
to precisely detect radial artery pulse waves, assessing arterial stimulants. For example, a textile capacitive sensor was
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Figure 3. Thermal/optical/biopotential sensing with e-textiles for diagnosis. (a) Illustration of light-emitting and photodetecting fibers for
photoplethysmography pulse measurement. Reproduced with permission from ref 80. Copyright 2018 Springer Nature. (b) Illustration of a
multifunctional and stretchable fabric for blood oximetry monitoring. Reproduced with permission from ref 107. Copyright 2014 Springer Nature. (c)
Mechanical flexibility of the optical fibers enables wearable health monitoring. Scale bar, 4 mm. Reproduced with permission from ref 211. Copyright
2019 Wiley-VCH. (d) Electrocardiogram (ECG) signals from the arms measured by graphene/Kevlar textile electrodes, indicating a clear P-wave,
QRS complex, and T-wave. Reproduced with permission from ref 108. Copyright 2020 American Chemical Society. (e) A textile-based
electromyography (EMG) measurement system. Scale bar, 25 mm. Reproduced with permission from ref 86. Copyright 2015 Springer Nature. (f) A
smart garment for EMG measurement and wireless healthcare data communication. Scale bar, 40 mm. Reproduced with permission from ref 87.
Copyright 2017 Wiley-VCH. (g) An athletic shirt sewn with multiple CNT electrodes for ECG signals testing. Reproduced with permission from ref
212. Copyright 2021 American Chemical Society. (h) Cyclic temperature tests of the textile thermoresistive sensor. Reproduced with permission from
ref 90. Copyright 2019 American Chemical Society. (i) Cyclic temperature tests of the textile pyroelectric sensor. Average temperature error, 2 °C.
Reproduced with permission from ref 93. Copyright 2016 Wiley-VCH.

fabricated by weaving PDMS-coated conductive fibers (Figure conversion and soft bioelectronics. Micromagnets, such as
1i).76 The PDMS coating and the Ag-based conductive core NdFeB-based metal alloy particles, were evenly distributed in
served as the dielectric layers and electrodes, respectively. In the polymer matrix. After being subjected to an impulse
response to biomechanical movements, the contact area of the magnetization, these micromagnets were strongly polarized and
PDMS increased, while the distance between electrodes constructed a wavy chain-like arrangement in the polymer
reduced, resulting in a strong increase in capacitance, which matrix, retaining a large magnetization (Figure 2b). When an
led to a noise-free and stable sensitivity of 0.21 kPa−1. This external pressure, e.g., a 1−100 kPa biomechanical pressure
textile capacitive sensor was able to be integrated into smart caused by the human body, is applied to the soft material system,
gloves and clothes for tracking body movements. The acquired the pressure penetrating the polymer matrix could drive the
data were delivered to a computer wirelessly via Bluetooth for micromagnetic particles to move and rotate (Figure 2c). In this
further analysis and diagnosis. way, magnetic flux density of the soft material system will be
Magnetoelastic effect are usually found in rigid metals and strongly altered. The discovered giant magnetoelastic effect in
metal alloys, which are usually utilized in civil engineering for the soft polymer matrix results from a two-scale magnetic
building vibration control with the assistance of an externally interaction, namley, the magnetic dipole-dipole interaction at
applied magnetic field. Recently, giant magnetoelastic effect was the lattice scale and the magnetic particle-particle interaction at
discovered in a soft material system by Chen group (Figure the micro scale. Through the combination of the soft
2a),201 which can be employed to build up a fundamentally new magnetoelastic system with a coil, a magnetoelastic generator
working mechanism for biomechanical-to-electrical energy (MEG) was developed, which can further convert this magnetic
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flux density variation into electricity. This is a two-step information on health conditions in a noninvasive manner,35
conversion with the giant magnetoelastic effect for biomechan- and textiles, with their intrinsic softness, offer ideal substrates to
ical-to-magnetic conversion and the magnetic induction for construct wearable optical sensors. Numerous optical-based
magnetic-to-electrical conversion. MEGs are fully waterproof diagnostic devices have been routinely used in the clinic35 by
without encapsulation because the magnetic fields can pass applying light absorption materials (e.g, silicon semiconduc-
through fluid with negligible intensity loss. Therefore, MEGs tors204) and light emission materials (e.g, organic semi-
demonstrate unique applicability in working as a self-powered conductor205). Fueled by these developments in materials
biosensor to continuously monitor human physiological signals chemistry, a wide range of textile-based optical sensors have
such as pulse waves, blood flow, and respiratory rate, especially been developed for collecting a spectrum of healthcare
in heavy perspiration situations such as exercising. For example, information.206−208 In general, these e-textile-based optical
a textile MEG was developed by sewing a soft magnetoelastic sensing systems are composed of light-emitting devices and
film with a textile coil (Figure 2d).202 photodetectors capable of monitoring and quantifying various
This e-textile exhibits high air permeability and comfort and light properties, such as intensity and wavelength, after
can be seamlessly sewn on clothes or a chest strap for breathing interacting with the pulse waves. For instance, Figure 3a
monitoring. The expansion and contraction of the chest caused demonstrates an all-fabric heart rate sensor with diode fibers.80 A
by breathing deform the textile MEG, generating a magnetic green light-emitting diode (LED) fiber was embedded in a
field distortion and inducing a current output. With a high cotton fabric sock adjacent to a GaAs photodetecting fiber.
sensitivity of 0.27 mA/kPa, a signal-to-noise ratio of 61.8 dB, and Placing a finger on both fibers allowed for recording of reflected
a response time of 15 ms, this textile MEG-based breath sensor light intensity, which was sensitive to blood circulation in the
can continuously monitor various patterns of breathing activities blood vessels at arterial sites. Another common application of
(Figure 2e). Moreover, assisted by a random forest-based wearable optical sensors is monitoring blood oxygenation or
machine learning algorithm, breathing abnormalities can be perfusion. As shown in Figure 3b, a stretchable electronic on a
continuously recognized, such as coughing and rapid breathing, fabric substrate consisted of three independent functional
hence, allowing a timely diagnosis of respiratory diseases. In components to achieve a rugged and breathable multifunctional
addition to this easily manipulated layer-stacking structure, health monitor device.107 One of these functional components
recently, a textile MEG was developed by weaving the soft was an optical intensity sensor with a microscale inorganic red
magnetoelastic fibers and conductive wires together.203 LED, which monitored blood perfusion to the dermis and
Compared to previous multilayered structures, this fine- subcutaneous tissues by measuring the temporal change of
designed woven e-textile demonstrated a higher porosity and photon absorption.
low Young’s modulus for excellent air permeability and comfort. A polymer optical fiber that can be implanted into e-textiles
Specifically, the 1D soft magnetic fibers were created by has attracted substantial interest because of its numerous
extrusion via an adjustable nozzle (Figure 2f). Then, the metrological properties, such as the resilience to harsh
microbubbles inside the soft fibers were characterized by micro- environments, high accuracy, and immunity to electromagnetic
computed tomography (Figure 2g), and they improved the interferences.209,210 It allows for both sensing and signal
fiber’s softness and reduced the overall density (Figure 2h). transmission and shows the advantages of high durability, easy
With a fundamentally new working principle, the textile MEG is handling, simple connection, and excellent biocompatibility.
intrinsically waterproof (Figure 2i), which can monitor pulse These valuable characteristics make it an emerging solution for
waves under water and in the presence of perspiration (Figure measuring diverse physiological parameters and a competitive
2j). Moreover, the textile MEG is robust and can work after alternative to traditional electrical sensors. Typically, optical
being immersed in water or perspiration for up to 168 h (Figure fiber-based sensors can be designed using two technologies,
2k). Then, an on-skin test was done to prove its wearability, and wavelength (i.e., fiber Bragg gratings) and intensity-modulated
the textile MEG did not cause a negative effect on the skin after modes, that track the change of light wavelength and intensity in
wearing for 1 week (Figure 2l). A customized mobile app with response to an external stimulus such as temperature211 and
built-in algorithm was developed and integrated into the textile deformation.83,85 For example, Figure 3c shows the temper-
MEG (Figure 2m), allowing real-time analysis of pulse wave ature-sensitive up-conversion nanoparticles incorporated into a
signals. The tested health data can be passed through a wireless polymer optical fiber that allowed temperature determination
network for clinical diagnosis or uploaded to the cloud service from emission intensity ratio of the 2H11/2 → 4I15/2 and 4S3/2 →
for data-driven diagnosis (Figure 2n). 4
I15/2 transitions of Er3+ ions.211 Accordingly, the polymer
In summary, textile biomechanical sensors can be worn on the optical fiber provides a promising optical strategy for fabricating
human body in a tight and flexible manner to continuously a flexible, stretchable, and biocompatible wearable health
provide high-quality health monitoring data for disease monitoring system.
diagnoses. In the future, more research efforts are desired for Although textile-based optical sensors can easily realize
optimizing the robustness of textile biomechanical sensors for multiple sensing capabilities, their reliability remains a huge
sustaining periodic deformation on the human body.179 challenge. To be specific, light coupling is a primary factor of
Meanwhile, effective encapsulation to protect sensing materials instability, especially in long-term applications, and self-
from ambient contaminants needs to be further improved in calibration is still an intractable concern because of the high
textile biomechanical sensors.172 Textile biomechanical sensors’ variability of the optical properties. Therefore, a stable
potential to completely innovate traditional health care hinges connection is still required. When it comes to merging textile-
upon their organic integration with IoT, which allows the based optical sensors into smart garments, current optical
wireless transmission of patient-generated health data for electronics and polymer optical fibers are relatively stiff
wearable point-of-care systems. compared to conventional fabrics; thus, light weight and
2.1.2. Optical Sensing. Photonic healthcare devices have touching softness are essential properties for textile-based
emerged as a promising analytical tool to provide multifaceted optical sensors.
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2.1.3. Biopotential Sensing. Electrode biosensors used for clinical trials. Hence, the effectiveness of these textile-based
collecting biopotential signals from the heart (electrocardio- biopotential sensors in point-of-care contexts still needs to be
gram, ECG),213 muscles (electromyography, EMG),86 eyes further explored.
(electrooculography, EOG),214 and brain (electroencephalog- 2.1.4. Thermal Sensing. Because body temperature is one
raphy, EEG)88 provide profound insights into human health of the most vital physiological parameters that provides insight
conditions. As interfaces that translate the body’s ionic currents into a human’s state of health, thermal sensors have been
into electric signals, electrode sensors are usually in direct described as an indispensable part of health monitoring and
contact with the human body. However, conventional electro- diagnostic platforms.218 Tracking any temperature changes on
conductive gels or rigid metals used for biopotential measuring, the skin surface and in the near-body environment can indicate a
e.g., Ag/AgCl disposable gelled electrodes, were highly person’s health condition,219 such as infections, cardiovascular
inconvenient and uncomfortable for long-term monitoring conditions, cognitive state, malignancy diagnostics, wound
because of the potential risk of skin irritation, rashes, and healing, and many inflammatory skin conditions. Moreover,
allergies.215 To this end, owing to the improved breathability thermal sensors are essential for offering information for
and conformability as well as to the lack of a need for maintaining thermophysiological comfort under dynamic
electrolytes, the advent of textile-based electrodes for bio- environmental factors.220 To this end, a considerable number
potential signal acquisition has been thought of as a break- of literature contributions have addressed textile-based temper-
through in the point-of-care community. ature sensors with reliable mechanical flexibility, excellent
Corresponding to the development of textile electrodes for breathability, and wearability.221−223
real-time monitoring of bioelectrical signals, there has been a rise Generally, two working mechanisms can be employed to
in the use of various conductive materials, e.g., stainless steel/ convert thermal signals into electric signals, including the
viscose yarns, silver yarns, silver/polyester covered yarns, or thermoresistive effect, which involves the change of resistance
introducing intrinsically conductive materials, such as CNT, with temperature,90,92 and the pyroelectric effect, which involves
graphene, polypyrrole, and PEDOT: PSS (poly(3,4-ethyl- the change of current with temperature.91,93 The thermor-
enedioxythiophene) polystyrenesulfonate) in a textile/fiber esistive effect mechanism typically utilized graphene,224
forms.216 To give an example of ECG monitoring, Figure 3d CNTs,225 and reduced graphene oxide (rGO). For example, a
shows a magnified ECG signal with a clear P-wave, QRS textile temperature sensor based on rGO-coated yarns was
complex wave, and T-wave.108 These high-quality ECG signals fabricated using a highly scalable and ultrafast yarn-dyeing
were acquired with a high-performance textile electrode technique.90 The temperature-sensing performance and re-
fabricated by the direct writing of laser-induced graphene on a sponse property shown in Figure 3h indicate that resistance
Kevlar textile. For the case of EMG monitoring, a textile-based decreases with an increase in temperature from 25 to 55 °C. The
EMG sensor (Figure 3e) was fabricated by printing an elastic textile temperature sensors were then integrated into a smart
conductor onto a textile garment.86 The elastic conductor ink garment for continuous body temperature measurement and
comprised Ag flakes, fluorine rubber, and a fluorine surfactant. wirelessly sending temperature data to a mobile app.
The fluorine surfactant directed the formation of surface- Apart from the thermoresistive effect, textile thermal sensors
localized conductive networks in the printed elastic conductor, based on the pyroelectric effect have also been extensively
resulting in a conductor ink with high conductivity and investigated owing to their high sensitivity.226 For instance, a
stretchability. As an improvement, the same group designed stretchable temperature sensor based on ZnO nanowires with
another EMG monitoring system on a garment (Figure 3f), in polyurethane fibers shows the potential to be an interface for
which the mechanically and electrically robust wiring was body temperature monitoring.93 Figure 3i demonstrates the
fabricated by controlling ink permeation on the textile stretchable temperature sensor’s high sensitivity and thermal
structure.87 While connected to a wireless module, the system stability under cyclic temperature tests between room temper-
could wirelessly deliver the EMG signals to a personal device. ature and 50 °C. In the future, combining the textiles with more
Moreover, it is worth highlighting that a stretchable, yet pyroelectric materials, such as triglycine sulfate, BaTiO3, and
mechanically and electrically robust e-textile sensory patch was P(VDF/TrFE), is expected to develop more sensitive textile
used.88 It was fabricated by jet-printing Ag-powder/fluoropol- temperature sensors for point-of-care devices.227
ymer-based nanocomposite ink on both sides of the porous
2.2. Biochemical Sensing for Diagnostics
textile substrate. With custom-designed data acquisition and
transmission circuits, the biopotential monitoring system was Alongside physical signals, comprehensively assessing individual
demonstrated to collect high-quality EEG and EMG wirelessly, health status also demands biochemical signals, e.g., sweat
which is comparable to commercial gel electrodes. Recently, a glucose for diabetes diagnoses,228 sweat pH for dehydration
type of washable, sewable, and all-carbon electrode was diagnoses,229 urea for kidney failure diagnoses,230 and breath
developed using CNT threads.212 These electrodes demon- acetone for acute kidney injury diagnoses.158 Because textile
strated metal-level conductivity (6.6 ± 0.7 MS/m), which can be biochemical sensors are biocompatible and conformable when
sewn onto a shirt for ECG signal measurement (Figure 3g). mounted on the skin or implanted in the body, continuous
Even though these textile-based biopotential sensors represent a monitoring of biochemical signals toward disease prevention
promising alternative to the traditional electrodes that are and diagnosis has been made possible.39 In this section, we
usually adopted in clinical practice, currently, there are still two group textile biochemical sensors into three categories according
limitations hampering the broad introduction of e-textiles with to their targeted biomedical elements, as follows.
biopotential signal acquisition capability to the healthcare 2.2.1. Humidity Sensing. Humidity is an essential criterion
system.217 On the one hand, the comfort and flexibility ensured in many biological processes and can significantly influence
by textile sensors are counterbalanced by the reduced robustness people’s health and physiological comfort.231 As such, wearable
to noise and motion artifacts. On the other hand, in-depth humidity sensors that enable monitoring of the skin’s moisture
investigations are still required to address washability issues and level and the humidity of the environment play a critical role in
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Figure 4. Biochemical sensing with e-textiles for diagnosis. (a) The working mechanism of wearable silk fibers for body humidity sensing. Reproduced
with permission from ref 95. Copyright 2017 Springer Nature. (b) Schematic illustration of an organic electrochemical textile transistor for molecular
biomarker analysis. (c) Dependence of the textile transistors’ effective gate voltage on glucose, uric acid, dopamine, and ascorbic acid concentrations.
Reproduced with permission from ref 97. Copyright 2018 Wiley-VCH. (d) Schematic illustration of a stretchable textile biofuel cell for wearable lactate
analysis. (e) Dependence of the textile biofuel cell output voltage on lactate concentration. Reproduced with permission from ref 98. Copyright 2016
Royal Society of Chemistry. (f) Schematic illustration of a helical electrochemical fiber sensor for analyzing Ca2+. (g) Dependence of the fiber sensor
open-circuit voltage on Ca2+ concentration. Reproduced with permission from ref 103. Copyright 2020 Springer Nature. (h) Photograph, schematic
illustration, and SEM image of a textile sensor for NO2 monitoring. Scale bar, 1 cm (left) and 500 μm (right). Reproduced with permission from ref
105. Copyright 2019 American Chemical Society.

numerous applications, such as wound management, bed- a Cu wire. Yarns with relatively high specific surface area and
wetting, skin pathologies, and microclimate control in abnormal cross section were used as a capacitance dielectric
clothing.232−234 To date, pursuits of textile-based humidity layer. The special surface structure enables sufficient water
sensors are categorically described by two distinct working molecule transport on the surfaces and helps with the yarn’s
mechanisms: the resistive235−237 and capacitive type.238−240 capillary action.
Humidity-sensitive fibers in textiles are susceptible to water The primary concerns regarding textile-based humidity
adsorption and desorption, which show changes in capacitance sensors are their inferior selectivity and poor anti-jamming
or resistance upon exposure to the ambient environment’s capability. Almost all humidity sensors are sensitive to
different atmospheric humidity conditions, thereby generating temperature, sometimes also coupled in many strain sensors.
different humidity response signals. Moreover, some humidity-sensitive fibers and textiles exhibit
For the resistive type, a simple bioinspired spinning strategy serious hysteresis, which significantly influences their sensitivity
was elaborated to collect regenerated silk fibers in ambient for practical applications. Therefore, a highly selective textile-
environmental conditions.95 The regenerated silk fibers were based humidity sensor with superior anti-jamming capability
formed directly after extruding or pulling a silk microfibril remains desired.
solution from a spinneret, and they could be amplified by adding 2.2.2. Biofluid Sensing. Biofluids, including sweat, saliva,
conductive silk/CNT coatings, which are sensitive to moisture urine, blood, and interstitial fluids, contain a diversity of
(Figure 4a), thus making them suitable for textile humidity biomarkers (e.g., lactate, glucose, amino acid, proteins, H+, Na+,
sensing. As for the capacitive type, a textile humidity sensor K+, etc.) that can reveal one’s personal health status.158
embedded into an ordinary mask was presented for wireless and Practically, the surface capillary effect of textile biochemical
battery-free monitoring of human respiration.239 It held a sensors and their direct contact with human tissue can
biaxial-type yarn wrapping structure, which was wound twice on dramatically promote biofluid absorption.241−245 Meanwhile,
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textile surface areas provide abundant loading sites for active indicator of an individual’s health status.250 E-textile for
materials to enhance the sensitivity and selectivity of respiration analysis,251−253 which exhibits decent breathability
biochemical analysis.104 For example, a highly sensitive textile and portability, can be easily integrated into masks or
sensor based on electrochemical transistors was fabricated for handkerchiefs to realize point-of-care diagnosis. Moreover, the
selectively analyzing glucose (Glu), uric acid (UA), dopamine surface morphology of the textile/fiber provides abundant sites
(DA), and ascorbic acid (AA) concentrations.97 As illustrated in for gas adsorption and ideal channels for ion migration, which
Figure 4b, Cr/Au, PEDOT:PSS, and parylene that were coated are conducive to rapid responses to exhalant gas stimuli. For
on a nylon fiber layer by layer served as source and drain example, a fiber sensor based on a poly(styrene-butadiene-
electrodes, organic channels, and encapsulation layer, respec- styrene)/graphene composite was developed for breath
tively. Then, another nylon fiber modified with a Pt layer and analysis.99 When exposed to vapor organic composites such as
corresponding enzymes served as the gate for detection of acetone, the adsorptive vapors modulated the resistance of
various biomolecules. Operated in the electrolytic solution with sensitive materials, resulting in a fast 50% response in less than
an applied gate voltage, the redox reaction of targeting analytes 41.5 s. Because an elevated breath acetone concentration is a
(e.g., Glu, UA, DA, AA) occurred with the gate electrodes, biomarker of type 1 diabetes,254 the fiber sensors can be woven
effectively inducing a gate potential change (Figure 4c) and into textiles to guide diabetes diagnostics and track diabetes
consequently outputting the changing current flow through the treatment in a wearable manner.
channel. Moreover, the textile biochemical sensor was woven In addition to exhalation, analysis of gas inhaled from the
into a diaper to monitor glucose concentrations in urine. With ambient environment is also highly desired for point-of-care
Bluetooth-integrated circuitry, the electrical signals and diagnosis, because common toxic gases, e.g., CO, H2S, and NO2,
corresponding concentrations can be conveniently recorded are common and strongly location-dependent.255 Textile-based
by a smartphone for further diabetes diagnosis. inhaled gas sensors can be set on the body to monitor potential
Although electrochemical transistor-based textile sensors poisonous gases,256 ensuring individual respiratory safety
require only low operating voltages (<1 V),246−248 the external regardless of the place or time. For example, a mass-producible
power supply is still indispensable and may cause inconvenience. textile sensor based on a nanocellulose/CNT composite was
In this case, biofuel cells, for example, could be a promising synthesized for detecting ambient NO2 (Figure 4h).105 Once the
candidate to form a self-powered textile biochemical sensor NO2 was adsorbed on the textile even on a parts-per-billion level,
(Figure 4d).98 This self-powered textile sensor consisted of the electron transferring between NO2 and the sensitive
lactate oxidase (LOx)-modified CNT bioanodes and Ag2O/Ag- composite decreased the resistance, resulting in a response
based biocathodes on a textile substrate. The contact lactate was amplitude of 4%. Thus, the textile gas sensor could effectively
enzymatically oxidized on the bioanode, and the generated remind individuals of ambient NO2, preventing people from
electron flow was further accepted by Ag2O in the biocathode, inhaling toxic NO2 or contracting pulmonary diseases like
resulting in output voltage signals proportional to lactate asthma and pulmonary edema. Future development of textile
concentrations (Figure 4e). Moreover, upon fusing the self- respiratory sensors for analyzing inhaled/exhaled gases will
powered textile sensor with socks, the real-time lactate level of contribute to the diagnosis and treatment of a wide range of
prolonged physical activities could be continuously detected and diseases.
wirelessly transmitted to smartphones for diagnosing insufficient In conclusion, applying textile biochemical sensors to monitor
oxidative metabolism during exercise. the human body’s biomarkers for point-of-care diagnosis has
Aside from the aforementioned epidermis textile biochemical made excellent progress. To realize long-term tracking of one’s
sensors, implanted textile sensors for monitoring biomarkers in health status, the chemical-based sensing results should be
vivo have evoked growing interest because of their miniatur- consistent and repeatable. Moreover, reliable sensitivity and
ization and bending stiffness comparable to that of tissues.249 selectivity are crucial for textile biochemical sensors to optimize
Recently, a helical fiber sensor was fabricated by incorporating point-of-care diagnosis. Thus, universal protocols can be devised
twisted CNTs and sensing components for analyzing multiple to relate acquired on-body signals to corresponding diseases or
biomarkers such as H2O2, Pb2+, Ca2+, and glucose in vivo. For health conditions.257 In addition, many textile-based sensors
example, the Ca2+ helical fiber sensor consisted of a were developed to monitor only a single biological signal or
PEDOT:PSS layer and Ca2+ selective membrane (Figure physiological parameter. However, with an increasing number of
4f).103 With adsorptive Ca2+, the potential field was subtly functional requirements for on-body electronics geared toward
shifted, generating output voltage signals with a sensitivity of 4.0 point-of-care diagnostics, e-textiles that support tracking only a
mV/mM (Figure 4g). Injecting the helical fiber sensor into a cat, single parameter may become insufficient.258 Further research
its Ca2+ and glucose concentrations in the venous blood were opportunities lie in heterogeneous integration with multifunc-
continuously monitored and then wirelessly transmitted to a tional e-textiles for simultaneously measuring multiple physio-
smartphone through integrated Bluetooth modules. These logical parameters and self-adaptive therapeutics; thus, a textile
clinical-grade data were timely and accurate, providing a reliable healthcare system could be formed for specific disease
method for diabetes diagnosis, monitoring, and therapy treatment. For this purpose, comprehensive signal processing
feedback. and machine-learning algorithms to simultaneously distinguish
In the future, fusing the textile biochemical sensors with IoT different signals undoubtedly play an important role.259
will enable portable, convenient, and timely tracking of
physiological parameters,228 allowing physicians to remotely 3. THERAPEUTICS
diagnose various diseases and provide revolutionary point-of- The advent of e-textiles has brought infinite opportunities for
care therapy. their utility in wearable point-of-care applications. Beyond
2.2.3. Respiratory Analysis. Human exhalation consists of textile sensors capable of real-time monitoring and diagnostics,
various biomolecules, such as NO, CO2, water vapor, ketones, e-textiles could also provide controlled on-demand therapeu-
hydrocarbons, and alcohols, which could be utilized as an tics.260 Aiding early diagnosis of diseases, e-textiles for
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Figure 5. E-textiles for physical therapy. (a) Exosuits with functional textile anchors worn around the waist and calf to improve walking for stroke
patients. (b) Poststroke deficits in sagittal plane ankle angle and anterior-posterior ground reaction force (GRF) are demonstrated through a
comparison of paretic and nonparetic limbs. Reproduced with permission from ref 113. Copyright 2017 American Association for the Advancement of
Science. (c) Schematic illustration of a subject’s hand wearing a glove fitted with fiber sensors, along with the wireless printed circuit board (PCB). (d)
Photographs of the sign language hand gestures according to American Sign Language and the corresponding generated voltage profiles as recognition
patterns. These patterns allow for the expression of letters, numbers, and short phrases. Reproduced with permission from ref 267. Copyright 2020
Springer Nature. (e) In vivo demonstration of the human-machine interaction on a hairband to control target machine. Reproduced with permission
from ref 268. Copyright 2019 Springer Nature. (f) The fabric-based Phosistos photodynamic therapy (P-PDT) achieved much lower pain scores and
was found to be comparable to the conventional protocol (C-PDT) in terms of efficacy in treating actinic keratosis. Reproduced with permission from
ref 121. Copyright 2020 Wiley-VCH. (g) Circuit diagram of selective muscle stimulation via a self-sustainable wearable textile nanoenergy nanosystem.
Reproduced with permission from ref 125. Copyright 2019 Wiley-VCH. (h) The stretchable solar/electric MXene heaters that were integrated on a T-
shirt for wearable thermal management. (i) The stretchable solar/electric MXene heaters could be copowered by one-sun illumination and different
voltages, achieving various surface temperature. Reproduced with permission from ref 130. Copyright 2019 Wiley-VCH.

therapeutics can reduce patients’ health risks and long-term adaptive, and rehabilitative wearable bioelectronics are designed
medical costs.261 Therapeutics could be implemented on a as accessories for the disabled or the elderly to ameliorate
textile platform to provide sustained and precise medical difficulties in performing daily tasks, such as cognitive
treatments with physical and biochemical approaches. processing, social engagement, communication, literacy, and
3.1. Physical Methods motor skills.263 However, significant challenges have emerged
With an increasing demand for convenient and accessible primarily from the growing demands of diversified application
medical services, e-textiles with the capability of providing markets for more advanced functionality and mechanical
physical therapy are urgently needed. Corresponding therapeu- deformability.264 In this respect, new materials and platform
tic devices, such as exosuits, soft robots, cardiac pacemakers, and technologies remain highly desired to break through the limits of
wearable heaters, have drawn considerable interest in various conventional methodologies. Fortunately, thanks to their range
clinical applications.262 In this section, state-of-the-art e-textiles of compelling and unique properties, including light weight, soft
for assistive therapy, phototherapy, electrotherapy, and texture, and wearable comfort, e-textiles can provide valuable
thermotherapy are comprehensively reviewed and discussed. information to empower wearable assistive devices with
3.1.1. Assistive Therapy. The provision of assistive devices unimaginable capabilities.265
is to reduce social exclusion and marginalization and, above all, Past decades have seen the development of the exosuit, a soft
to make people’s everyday lives easier. In this context, assistive, wearable robot designed to offer walking assistance and support
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the weight of wearers. Exosuits are capable of significantly textiles will play an important role in the assistive therapy
reducing energy expenditure during walking and could support community.
the disabled to regain their full mobility with passive and active 3.1.2. Phototherapy. By utilizing light with different
wearable devices.115,119,120 As illustrated, Figure 5a shows a sources and wavelengths, phototherapy could offer medical
lightweight, flexible, and wearable exosuit interfaced with the treatments to diseases such as dermatitis and congenital
paretic limbs of poststroke patients via functional textile that defects.35 Along these lines, many light treatments are provided
provide minimal assistance of ∼12% of the biological to develop therapeutic strategies, including photodynamic
plantarflexion torque.113 Such an exosuit produced gait- therapy (PDT)269 and photobiomodulation.270 However,
restoring joint torques by transmitting mechanical energy these traditional phototherapies need to be placed at the
from waist-worn or off-board actuators to the user through patient’s bedside because of their bulky size, making them not
interactions with the textile anchors and a cable transmission. As feasible for wearable usage. With these concerns, wearable e-
a result, Figure 5b indicates that the exosuits had an immediate textiles with integrated light-emitting electronics have great
effect on critical biomechanical subtasks that were impaired after potential as phototherapy for noninvasive and wearable
stroke, in particular, ground clearance by assisting ankle therapeutics.123 For example, photodynamic therapy is a
dorsiflexion during the swing phase and propulsive force practical on-site cancer treatment method based on the
generation by assisting ankle thrust during the stance phase. interaction of light with biological tissues,271 such as thin and
Furthermore, the same group also proposed a human-in-the- nonpigmented actinic keratosis (AK) on the face and scalp.
loop optimization that offers tailored assistance by adjusting Recently, a fabric-based biophotonic cap with a phosistos
control parameters based on real-time human physiological protocol (P-PDT) was introduced.121 Resulting in significantly
signal measurements, such as respiration.114 The immediate lower pain scores (∼0) and fewer adverse effects (Figure 5f), the
improvement in assistive performance observed using the cap-based P-PDT proved to be as effective as the conventional
powered exosuits makes it a promising approach for protocol (C-PDT). Considering their compact design and ease
rehabilitation. of use, fabric-based PDTs could be further developed for point-
Much more attractive breakthroughs in textile-based human− of-care applications.
machine interfaces aiming for assistive therapy have recently In addition, photobiomodulation devices that apply red or
received considerably significant attention. One such achieve- near-infrared spectroscopy (NIR) light generated by LEDs or
ment is wearable sign language recognition devices that remove lasers to promote wound healing and tissue regeneration have
the communication barrier between signers and nonsigners. been extensively investigated for emerging photonic healthcare
Surprisingly, about 466 million people worldwideone in every applications.272 With this in mind, polymer optical fibers present
20suffer from hearing impairment of some form.266 People an excellent choice in fabricating a textile-based phototherapy
with hearing impairment are often unemployed and are likely to device. Tightly interweaved polymer optical fibers are able to
suffer from depression, anxiety, and even cognitive decline efficiently emit light with appropriate wavelengths over large
because of the lack of tools to communicate effectively with areas. A luminous fabric device showed excellent optical and
people who do not understand sign language. Very recently, a thermal properties for wearable low-level light therapy.122 In
wireless, wearable, sign-to-speech translation system was vitro experiments proved that the luminous fabric device could
developed as a glove.267 With the assistance of machine-learning be applied for clinical treatment, such as wound healing,
algorithms and a commercial mobile phone application interface photorejuvenation, and anti-inflammation.
(Figure 5c), it can translate sign language into speech in a timely 3.1.3. Electrotherapy. Electrotherapeutic devices are
manner with an accuracy rate of over 98%. As shown in Figure commonly used in clinical applications,273 such as muscle
5d, the wearable sign-to-speech translation system converted rehabilitation, wound healing, and pain relief.274 Thus,
sign language into voltage profiles as recognition patterns combining electrotherapy and wearable textiles is an attractive
capable of expressing letters, numbers, and phrases. Further- and effective method for providing point-of-care therapy.
more, EEG could also be utilized for human−machine Regulated electrical stimulation achieved by textile electrodes
interaction and controlling prosthetic systems or substitutive could help release muscle atrophy, promote wound healing, and
control. regulate cardiac activity.275
For instance, a fully portable, wireless, and wearable EEG- Many neurological disorders,276 e.g., spinal cord injury,
based scalp electronic system on a hairband and a flexible stroke, and multiple sclerosis, can lead to loss of muscle
membrane circuit was developed.268 Using convolutional neural function, resulting in loss of control over certain parts of the
networks, it is capable of helping people with disabilities to body and inconvenience in daily life. As a therapeutic strategy,
accurately and wirelessly control electric wheelchairs, interact electrical stimulation can be effective in preventing or reversing
with computers, or operate small robot vehicles in a real-time muscle atrophy and facilitating the resumption of movements
manner without wearing bulky electrode caps or employing such as gripping and walking.277 For example, wearable textile
conductive paste (Figure 5e). Recently, assistive technologies nanoenergy systems made from soft and comfortable fabric
have attracted great attention owing to their ability to provide materials (Figure 5g) generated enhanced μA-level currents
sustained and precise assistance. However, because of the from body movements. The electrical current was used to
deficiencies of e-textiles in usability and aesthetics, assistive directly stimulate biological tissues without any rectification.125
technology has been an underexplored domain. For example, This wearable e-textile with electrical output provides promising
biomedical devices for assistive therapy are hard to integrate into approaches in wide rehabilitation applications, such as muscle
textiles because of their rigid and bulky structure. 264 and nerve stimulation for movement facilitation. Another case is
Accordingly, it will be helpful to develop e-textiles with high transcranial electrical stimulation for the symptoms of mental
flexibility, light weight, and long-term biosafety for those who and neurophysiological disorders, as well as stroke and
need assistive therapy; we foresee that with the combination of depression. To this end, a textile cap-integrated electrode for
materials science, electrical engineering, and disability studies, e- transcranial electric stimulation and EEG recording was
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Figure 6. E-textiles for biochemical therapy and protection. (a) Schematic illustration of cell-laden core−shell hydrogel microfibers for cell migration.
(b) SEM of the cell-laden hydrogel microfiber-based nonwoven textile. Scale bar, 500 μm. (c) The cell-laden fibers for diabetes mellitus therapy.
Changes in the blood glucose concentration of three mice receiving cell-laden fibers (solid lines) and three mice receiving dispersed islet cells (dashed
lines). Reproduced with permission from ref 134. Copyright 2013 Springer Nature. (d) Schematic illustration of a metal−organic framework (MOF)-
based fiber for drug delivery. Reproduced with permission from ref 135. Copyright 2016 Wiley-VCH. (e) Working mechanism of the antibacterial e-
textile. The released reactive oxygen species (ROS) contact killing pathogens under light irradiation. (f) The antibacterial textile (sample)
demonstrates effective killing of a T7 phage in 5 min under daylight exposure. Reproduced with permission from ref 139. Copyright 2018 American
Association for the Advancement of Science. (g) Schematic illustration of a MXene-based hybrid textile for water resistance, electromagnetic
interference (EMI) shielding, and Joule heating. Reproduced with permission from ref 141. Copyright 2019 Wiley-VCH. (h) Schematic illustration of
an Al-porphyrin-based MOF (Al-PMOF)-modified protective textile for detoxification. (i) Detoxification properties of the Al-PMOF-modified
protective textile by assessing the conversion of toxic CEES to nontoxic CEESO. Reproduced with permission from ref 300. Copyright 2020 Elsevier.

designed.126 In clinical practice, the dual-functional cap may damage surrounding tissues, and physiological adjustment
exhibited the capacity to improve noninvasive brain stimulation. always requires a controllable stimulation signal to ensure the
With concurrent monitoring of transcranial electric stimulation desired effect.273 Therefore, efficient electric stimulation
outcome and adapting of parameters in a closed-loop approach, management with fixed point, orientation, and positioning
the dual-functional cap has excellent therapeutic potential in should be developed for future textile-based point-of-care
daily healthcare management. Recently, a TENG-based woven electrotherapy.
patch was developed for electrotherapy.278 In this study, 3.1.4. Thermotherapy. As another promising therapeutic
conductive organogel-based fibers were woven into a fabric modality in physiotherapy, thermotherapy has evoked growing
form that can be used for two purposes: as a TENG patch and as interest because of its point-of-care use and wide range of
a wound dressing. Friction between skin and the TENG patch thermal management applications.280 The heat-induced ther-
was converted into electricity, which could be directly applied to apeutic effects can effectively relieve inflammation and muscle
a wound bed to accelerate wound healing by promoting cell spasm, reduce the elasticity of collagen tissue for pain relief,
migration, proliferation, and secretion of angiogenic growth improve blood circulation for recovery from rheumatoid
factors. Furthermore, in vivo animal testing in mice proved that arthritis, and increase the penetration of active substances into
the TENG patch can effectively reduce the size of wounds. the skin.281 However, corresponding traditional therapeutic
In brief, the electricity generated by e-textiles could be directly heaters based on plastic substrates or metallic nanowires suffer
applied to stimulate cells, tissues, and organs to achieve from impaired permeability and mechanical mismatches with
therapeutic functions.279 Nonetheless, electrical stimulation the skin.127,282 E-textiles with intrinsic flexibility, comfort, and
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breathability have therefore attracted considerable interest as interpenetrating the network hydrogel shell (Figure 6a).134
flexible and wearable thermotherapy applications. This kind of cell fiber, which came in contact with tissues in in
Typically, textile-based thermotherapy devices can be vivo treatment, demonstrated an outstanding mechanical
achieved by Joule heating or light-to-heat methods.283 Joule- stability and therefore could be woven, reeled, or folded into
heating driven by electricity is a widely used method.284 textile form (Figure 6b). By implanting the pancreatic islet cell
Recently, a multifunctional Ti3C2Tx (MXene)-based e-textile fibers onto the subrenal capsular space of a diabetic mouse, the
has been fabricated using a simple repetitive impregnation and secreted insulin from the fiber effectively and continuously
drying procedure, showing excellent Joule heating properties, normalized blood glucose concentrations for more than 13 days
good breathability, and a sensitive humidity response.280 With a (Figure 6c). In addition to the fiber core, the surface of the fiber/
fast response time (∼16 s), the MXene-based e-textile was able textile also possesses abundant reactive sites for loading and
to reach its highest temperature, 100 °C, at an input voltage of 6 releasing drugs. An optical fiber with a thin layer of the metal
V. In vivo experiments show that the generated heat can be organic framework (MOF) UiO-66 coating, for example,
uniformly transferred to bacterially infected skin for bacterial housed anticancer drug 5-fluorouracil on the surface for drug
ablation and accelerated healing of infected wounds. These delivery (Figure 6d).135 Light stimulus from the optical fiber
MXene-based e-textiles demonstrate great potential as a point- induced a structural change in the MOF layer that, in turn,
of-care thermotherapy platform with breath-monitoring and released the trapped drug on demand, providing a novel
temperature-warning capabilities. Besides, in order to extend methodology for precise drug administration.
high-quality tumor treatment to daily life,285 a mobile health With advances in device communication technologies in the
(mHealth) platform was developed using TAT peptide- IoT era, a stimulus to trigger drug emission can be intelligently
modified ferroelectric BiFeO3 nanomaterials (TAT-BFO) and controlled by external sources such as smartphones and portable
smartphone-controlled wearable electronics on clothing. Con- computers, realizing a temporal and dosage-tailored therapy for
trolled by the wearable device on the textile, TAT-BFO can be individuals.133 An e-textile dressing was developed for chronic
magnetically targeted to tumor sites for enrichment and then wound healing with intelligently controlled drug delivery. The
triggered by temperature fluctuations to generate reactive building fibers consisted of a cotton core with a conductive layer
oxygen species (ROS) for effective tumor therapy. for electrical heating, as well as a hydrogel layer housing
In addition, many efforts have been made to generate high thermoresponsive particles loaded with various antibiotics.
temperatures with photothermal clothing in a cost-effective and These fibers were then woven into a textile dressing and
environmentally friendly manner. For example, a photothermal separately connected to a microcontroller. The microcontroller
kneecap was shown to warm the knee joint by photothermal could wirelessly receive commands from external sources to
conversion in natural sunlight.129 However, challenges still exist control the heating amplitude and heating time of each fiber,
in developing wearable heaters powered by multiple energy effectively achieving an intelligently regulated drug delivery
sources and operated continuously and stably. Figure 5h according to personal wound conditions. In the future, with the
illustrates a textile-based solar/electric dual-heater consisting assistance of IoT technologies, closed-loop drug administration
of various 2D materials, including Ti3C2Tx MXene, reduced could be realized by integrating textile biomonitoring and drug
graphene oxide, and MoS2.130 Powered by 1 sun illumination delivery modules.
and different voltages (Figure 5i), this textile dual-heater could For example, textile biofuel cells can monitor sweat glucose
achieve various surface temperatures. This wearable solar/ levels in real time.286 Then, these sensing results can be
electric dual-heater provides a promising choice for thermo- transmitted to drug-delivery textiles and trigger the release of
therapy technologies with superior heating performance, self- drug molecules, achieving autonomous glycemic regulation
powered photothermal options, low energy consumption, and without disturbing the diabetic patients’ daily lives. In this case,
safe low-voltage. closed-loop drug administration systems propelled by e-textiles
would provide timely and precisely treatment for patients,
3.2. Biochemical Methods
illuminating a bright future for the field in point-of-care
In addition to the aforementioned physical mechanisms, e- applications.
textile therapeutic systems based on biochemical methods can 3.2.2. Antimicrobial Textiles. Currently, the global
aid in curing diseases and reducing patients’ health risks.286 The pandemic of COVID-19 places a heavy burden on public health
rough region of a textile’s surface provides enough active sites for and international economies.289 To cope with infectious
chemical reactions. Coupled with textiles’ intrinsic soft and skin- diseases, personal antibacterial and antiviral activities have
conformal properties, these biochemical method-based e- been indispensable parts of daily life. Integrating antimicrobial
textiles can release functional compounds or perform chemical textiles onto clothing, face masks, gloves, or even curtains is
reactions on the target area of the human body, increasing the expected to address the increasing challenges without disturbing
value of daily clothing tthrough precise drug delivery, people’s daily routines.290−292
sterilization, and disinfection.287 To that end, a bioprotective nonwoven textile-based on
3.2.1. Drug Delivery. Textiles demonstrate outstanding photobiocide-modified nanofibers was developed for contact-
structural and mechanical properties, such as tailored killing of pathogens (Figure 6e).139 Driven by daylight, the
architectures, surface morphology, and flexibility,51 which are photobiocide textile released ROS to damage bacteria and
compatible with human skin, vasculature, and many other inactivate viruses with an efficacy of up to 99.999% (Figure 6f).
organs. Thus, textiles loaded with chemotherapeutic com- Moreover, these photobiocide textiles can be conveniently
pounds have raised wide research interest in in vitro and in vivo integrated with N100 masks or protective suits, which attests to
biomedical applications like wound dressing, tissue engineering, their promising biomedical applications in hospitals, biological
and targeted therapy.288 For example, to realize wearable laboratories, and many other places with infectious threats. In
diabetes treatment, a cell fiber was fabricated by culturing the future, these antimicrobial textiles are expected to cooperate
pancreatic islet cells in the core of an alginate agarose with textile biosensors for intelligent bioprotection. For
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example, when receiving a pathogenic signal from textile shown great potential for performing thermal management
biosensors, antimicrobial textiles could selectively generate around the human body.218 In this case, a passive or active
specific biocides to protect humans from infection. thermal textile could expand the comfortable ambient temper-
In addition to ROS release, ROS scavenging for oxidative ature zone by up to 6.5 or 14 °C, respectively, with vastly
stress relief also plays a significant role in regulating chronic improved energy efficiency and cost-effectiveness.219 In
wounds such as of those of diabetic patients with foot ulcers. For addition, a flame-retardant textile-based TENG for fire
example, a silk patch consisting of PEDOT sheath-deposited protection purpose was developed by combining flame-
PDA-silk core fibers was developed for wound healing in those retardant conductive cotton and PTFE-coated fabric.309 The
with diabetes.213 Dynamic redox behavior caused by PDA and fireproof textile can protect firefighters and power warning LEDs
PEDOT layers can capture the electrons and eliminate the ROS, on their protective uniform at the same time.
preventing ROS damage to the cells around the wound. Moreover, a multifunctional e-textile decorated by poly-
In brief, e-textiles for therapeutics can aid the treatment of merized polypyrrole (PPy)/MXene was developed for simulta-
common diseases in a precise, continuous, and timely manner. neous electromagnetic interference (EMI) shielding, heating,
In the future, optimizing the biosafety and biocompatibility of and water erosion protection (Figure. 6g).141 The PPy/MXene
applied materials in e-textiles is highly desired because of their decoration endowed the multifunctional textile with a decent
extended periods of contact with the human body.293 Mean- conductivity of up to 1000 S/m, which could effectively absorb
while, exploring new therapeutic functions of e-textiles deserves and attenuate microwave radiation, realizing an outstanding
in-depth study from the perspectives of materials chemistry and EMI shielding efficiency of 42 dB. Moreover, the hydrophobic
bioengineering.294 For example, currently, electroactive electro- silicone coating on the surface of the multifunctional textile
spun nanofibers for tissue engineering have received wide could prevent water erosion, maintaining the thermal manage-
research interest.295 E-textiles composed of electroactive ment and EMI shielding performance for the long-term.
electrospun nanofibers can exhibit structure and composition However, optimizing the synergistic effects between these
similar to that of the extracellular matrix, providing a biomedical functions is still challenging; for example, an
biocompatible and conformable scaffold to repair and increasing temperature would influence the EMI shielding
regenerate defected tissues. Moreover, investigating multifunc- efficiency. Therefore, more research efforts on investigating the
tional materials for developing e-textiles with versatile material’s working mechanisms are highly desired in order to
therapeutic functions is another promising research direction.195 incorporate multiple biomedical functions in a noninterfering
In the future, smart garments blending multiple therapeutic manner.
abilities are expected to be a part of everyday life and promote In addition, as the world marches into the era of IoT and 5G
the practices of point-of-care systems. wireless, mobile and wearable electronics, such as radio-
frequency identification (RFID), Bluetooth, Wi-Fi, and cellular
4. PREVENTION 4G/5G, greatly increase the frequency and duration of the
Beyond providing physiological sensing and therapeutic treat- human body’s exposure to EM fields. Taking into consideration
ments, e-textiles can also perform protective functions for safety concerns, a polymerized PPy/MXene-decorated textile
damage prevention.296 E-textiles for the protection of humans in has been developed for EM shielding, providing a promising
hostile environments are the fruit of a diverse body of talents, solution for attenuating EM absorption by the human body.301
drawing together scientific and technical expertise across many Also, long-time exposure to UV rays leads to a high risk of
fields of study,297 such as protection against solar irradiation and developing skin cancer. Therefore, e-textiles with anti-UV
biological agents, and electromagnetic-wave shielding.298 In this radiation coating are of great help for outdoor workers to protect
section, we describe e-textiles intended for damage prevention, their skin. A case in point is a MOF-coated UV-blocking textile
including physical protection textiles, e.g., coating an MXene fabricated via a novel environmentally friendly solvent-free hot-
layer on textiles for microwave absorption,299 and chemical pressing technology.304 Such modified fabrics have great
protection textiles, e.g., coating an MOF layer on textiles for potential for stable and highly efficient UV protection.
toxic degradation.300 These protective e-textiles can prevent The health crisis caused by the COVID-19 pandemic and
potential harm caused by dangerous environmental conditions airborne particulate matter (PM) has escalated the demand for
to the human body and promote healthy living. masks because masks are thought to be the most convenient
products for preventing virus transmission and inhalation of
4.1. Physical Protection
airborne particles.14 Recently, nonwoven textiles coated with
Without a doubt, clothing that protects the human body from cationically charged chitosan nanowhiskers have been used in
direct exposure to harsh environments has played an essential face mask filters.307 Biodegradable nanofibers inside the
role in human’s survival and development.51 Recently, nonwoven textiles can sieve 2.5 μm PM with a high filter
innovations in materials and structures have advanced the efficiency of 98.3%. Therefore, considering its efficiency in PM
development of e-textiles featuring multiple physical protection removal and air permeability, e-textiles are expected to promote
capabilities such as individual thermoregulation, electromag- future mask filter production.
netic (EM) shielding,301−303 anti-UV radiation,304,305 air
4.2. Biochemical Protection
filtration,306,307etc. For example, a textile woven with synthetic
fibers, inspired by a polar bear’s hollow hair, exhibits excellent Chemical toxicants from industrial hazards or chemical warfare
thermal insulation, as well as good breathability and agents have deeply hurt human beings because of their
wearability.308 It can prevent heat loss and reduce cost in poisonous properties,145 and their environmental residues
housewarming energy consumption. More profoundly, e-textiles pose an increasing threat to public safety. Besides the threat to
capable of passively manipulating body infrared radiation, human respiration, these toxic substances in the contaminated
moisture, and heat conduction, or actively introducing Joule- ambient environment can also harm exposed skin.310 Therefore,
heating via electro-heating and thermoelectric materials, have efficient whole-body protections are highly desirable for military
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Figure 7. Communication technologies for e-textiles. (a) Schematic illustration of some communication possibilities for wearable point-of-care textile
systems (i.e., 4G/5G, Bluetooth, Wi-Fi, RFID). (b) A near-field-enabled long-sleeved shirt interconnected to a wireless reader for real-time, multinode
measurement of spinal posture, as well as continuous sensing of temperature and gait during exercise. (c) Textile-based near-field relays enable near-
field connectivity up to meter scale in separation between the reader and sensor, while conventional NFC is limited to a separation of at most a few
centimeters. Reproduced with permission from ref 149. Copyright 2020 Springer Nature. (d) Design concept of the body area sensor network
(bodyNET), consisting of multiple sensor nodes positioned in various body locations to collect human physiological signals. (e) A stretchable sensor is
conformably attached on skin and collects signals, which are wirelessly read out by a flexible reader with Bluetooth on the clothing. Reproduced with
permission from ref 150. Copyright 2019 Springer Nature. (f) Metamaterial textile network integrating splitters, antennas, and a ring-resonator for
wireless real-time monitoring of human motion and wireless power transfer. (g) Bluetooth transmission of the ECG waveform along the sleeve to a
textile-integrated antenna. Reproduced with permission from ref 151. Copyright 2019 Springer Nature. (h) Power consumption and data rates for
currently available wireless solutions, demonstrating the need for novel and more efficient methods that satisfy the requirements for wearable point-of-
care textile systems.

and emergency personnel who are in life-threatening environ- protective e-textile consisting of a robust Al-porphyrin-based
ments. Antitoxic suits, which are comfortable and exhibit MOF coating was recently developed for detoxicating sulfur
comprehensive protection, are widely used to degrade toxicants mustard stimulant CEES (2-chloroethyl ethyl sulfide) (Figure
and prevent them from penetrating via the use of surface 6h).300 The Al-porphyrin-based MOF layer was robustly
detoxicating chemical reactions.311−313 For example, organo- immobilized onto the textile surface, effectively oxidizing the
phosphates are the most widely used insecticides, but too much CEES to less toxic CEESO (2-chloroethyl ethyl sulfoxide) under
exposure to organophosphates leads to nervous system light irradiation, realizing a superior decomposition half-life of 4
problems and even human death from asphyxiation.314 To
min (Figure 6i). The decent antitoxic performance has been
cope with this issue, e-textiles uniformly coated with Zr-based
ascribed to excellent accessibility of active sites on the textile−
MOFs were developed for catalyzing the hydrolysis of GD (O-
pinacolyl methylphosphonofluoridate), effectively degrading MOF composites. Despite these research achievements, more
nerve agents with a decomposition half-life of 2 min.314 efforts are desired to prevent antitoxic e-textiles from absorbing
Meanwhile, catalytic activity was fully recovered after water interfering molecules such as H2O from the ambient environ-
cleaning and existed persistently for six months under air ment, which could erode reactive sites with target toxicants. In
exposure. Moreover, this antitoxic e-textile is scalable, which can conclusion, methods to deal with the used antitoxic e-textiles
be conveniently tailored into various forms such as protective without causing secondary contaminants still need to be ironed
suits, paving the way for personal health protection. Similarly, a out.
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Indeed, e-textiles for biochemical protection have scored communication (NFC) technology,323 a low-cost and low-
tremendous research achievements. In the future, more research power wireless technology that supported only D2D connection
inputs are expected to translate these e-textiles from bench to the between two devices with a maximum delivery distance of 10
bedside, realizing a point-of-care prevention. To fulfill this cm. With respect to complexity and cost, the integration of near-
purpose, safety and biocompatibility are the main concerns. For field inductive and wired technologies offers many attractive
materials selection in e-textiles, researchers are encouraged to possibilities for wearable point-of-care textile systems.324 For
directly apply biocompatible materials approved by the Food example, in order to establish power and data connectivity
and Drug Administration (FDA) for medical devices. Mean- around the human body, a recent study shown in Figure 7b
while, investigating innovative textile materials that are fully reported a battery-free and low-cost wearable point-of-care
recyclable is particularly significant for the reutilization of textile system based on wired connections via conductive
protective e-textiles.315 Moreover, personal protective textiles threads for long-distance transmission, as well as near-field-
have been in unprecedented demand in light of the COVID-19 responsive inductor patterns for short-distance wireless trans-
pandemic,316 because many of them are disposable, such as mission (Figure 7c).149
gloves and masks, or need to cover larger body areas (e.g., lab Far-field radiative technologies rely on radio frequency waves
coats). In this way, large-scale fabrication of e-textiles for containing ambient radiofrequency (RF) energy or information,
prevention is highly desired. Electrospinning has been a scalable, which can be generated or collected by an antenna.325 Typically,
easy-to-operate, and effective technique of manufacturing these systems can transmit and receive data at high rates over
ultrafine fibers and nonwoven textiles. Combining appropriate long distances.326 Aiming to make up for the deficiency of a
chemical treatment with the well-established electrospinning single connection method, employing complementary wireless
technology is expected for fabricating nonwoven e-textiles in a technologies with different characteristics for wearable point-of-
larger scale with outstanding protection capability (e.g., care textile systems is a prevalent option. Like the wearable
antimicrobial function and electromagnetic shielding) without point-of-care textile systems illustrated in Figure 7d, the readout
sacrificing breathability and comfort. circuits embedded in the clothes enable the wireless operation of
In addition, IoT-driven biomedical services herald the dawn biomedical devices by a passive radiofrequency identification
of future health care, which will offer a seamless platform to (RFID).150 RFID technology is the foundation of NFC;
wirelessly connect textiles for on-body therapy, protection, and therefore, RFID is compatible with NFC, inexpensive, and
diagnosis with remote hospitals.228 Prospectively, physicians can low-power, but it is limited in transmission range. This popular
continuously track health profiles of individuals and perform wireless technology is widely used primarily for tracking and
tailored treatment or protection remotely. Ultimately, e-textiles identification purposes. As a result, to collect data from the
for protection possess great potential for getting rid of capital- readout circuits, Bluetooth with a longer transmission distance
intensive equipment in the hospital, realizing point of care in the of up to 10 m and a relatively high energy consumption is
long term. utilized by the central control unit (Figure 7e). Alternatively,
previous studies on interconnected device communication using
5. E-TEXTILE CONNECTIONS on-body propagation media, e.g., the textile surface and the body
To achieve a wearable point-of-care system, e-textiles featuring tissue, provide a highly energy-efficient and secure approach for
various medical functions should be fully interconnected and e-textile connection. Figure 7f demonstrates a wearable point-of-
able to transfer patient-generated health data.317−319 This care textile system’s design interconnected through radio surface
demand has sparked rapid development in e-textile connections, plasmons, propagating on conductive metamaterial textiles.151
involving technologies featuring seamless integration around the Such a design was able to confine data and power transmission
human body and maintaining reliable wireless connectivity with within a short distance around the human body to enhance
existing mobile devices. In this case, fully connected e-textiles transmission efficiency and privacy (Figure 7g). Additionally,
can perform wearable medical applications; share sensing, ultrasonic data connection via body tissue is particularly
therapeutic, and protective data with ambient devices; and even advantageous for implanted devices,327 where direct access for
transfer these data to the clinics wirelessly.320 In order to endow battery replacement or charging is not desirable. Because of the
these e-textiles with fully connected capacities, technologies much lower sound speed of ultrasonic waves compared to the
emerging in the era of IoT for data and power connections play radio waves found in human tissue (about 1500 m/s in soft
pivotal roles in a two-stage layer (Figure 7a), as follows. tissue),328 the wavelengths are orders of magnitude smaller for a
given frequency. They provide the possibility of directional
5.1. Device Connections
transmission and reception even for modestly sized transducers,
Device-to-device (D2D) communication within the e-textiles is as long as the system impedes the medium in question.
the first stage to realize a fully connected wearable point-of-care
5.2. System Connections
textile system. Wireless technologies are among the most
important for establishing information connections between e- For the next stage of e-textile connection, the aggregated data
textiles. As such, wireless technologies applying near-field from wearable point-of-care textile systems would be wirelessly
magnetic induction, far-field radiation, and ultrasonic arrays delivered to the nearest gateway node or to remote servers (e.g.,
have been widely considered for practical applications.321 central control units integrated into clothes, smartphones, and
Near-field inductive technology transfers data or energy providers at hospitals/medical centers) that are responsible for
through a magnetic field produced by the primary linking to the data processing, D2D communication, and internet reaction.329
secondary.322 This system can achieve high charging efficiency When assessing a wireless communication protocol for data
without the coils being in close proximity, allowing some degree transmission from wearable point-of-care textile systems to a
of mobility, thereby making the technique highly attractive for personal service, several criteria should be taken into account,330
powering devices in the wearable point-of-care textile system. An such as transmission range, data rate, power consumption, and
analogous mechanism was employed to develop near-field bandwidth, as summarized in Table 1.331 Among them,
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Table 1. Wireless Communication Technologies for Wearable Point-of-Care Textile Systems and IoT331
topology
type protocol range data rate power consumption radio band size network topology
WBANa (body) NFCb 0.1 m 106−424 kbps low (15 mW) 13.56 MHz 1 P2P
IrDAc 0.2−1 m 2.4 kbps to 1 mediun (<100 mW) 300 THz 1 P2P
Gbps
MICSd 2m 200−800 kbps ultra low (25 μW) 402−405 MHz N/A P2P, star
RFIDf 3m 640 kbps medium (<200 mW) 13.56 MHz 1 P2P
860−960 MHz
BANs 2−5 m <10 Mbps ultra low (∼1 mW) 400−2500 MHz 256 P2P, star
standardg
WPAN Bluetooth 10 m 1 Mbps low (∼10 mW) 2.4 GHz 8 P2P, star
(personal) (LE)
UWBe <30 m <30 Mbps low (<50 mW) 3.1−10.6 GHz 8 P2P, star, mesh
ANT 30 m 20−60 kbps ultra low (<1 mW) 2.4 GHz 65,536 P2P, star, Tree,
Mesh
Bluetooth 30−100 m <3 Mbps medium (∼100 mW) 2.4 GHz 8 P2P, star
(HS)
WLAN (local) Zigbee 100 m <250 kbps low (∼50 mW) 868/915 MHz, 2.4 GHz 65,536 P2P, star, Tree,
Mesh
Wi-Fi 70−250 m <150 Mbps high (∼800 mW) 2.4 GHz, 5 GHz 2007 infrastructure-based
WWAN (wide) LoRaWAN <30 km <50 kbps low (1.5−100 mW) 868−928 MHz N/A P2P, star
cellular-4G <100 Mbps high 2−8 GHz N/A N/A
cellular-5G <20 Gbps high 450 MHz to 6.0 GHz N/A N/A
24−53 GHz
a
WBAN: wireless body area network. bNFC: near-field communication. cIrDA: infrared data association. dMICS: medical implant communication
service. eUWB: ultra-wide band. fRFID: radio frequency identification. gBANs Standard: IEEE 802.15.6.

Bluetoothor more preferably, Bluetooth Low Energy next-generation e-textiles and continually support the trend
(BLE)provides low-power wireless connectivity and thereby toward point-of-care applications.
becomes a strong candidate for wireless personal area network Overall, the enormous progress in diverse, miniature, low-
(WPAN) communication.332 Another available and open power, and low-cost connection technologies offers great
wireless communication standard within the wireless local area potential for e-textiles to realize interconnection among multiple
network (WLAN) is ZigBee,333 which offers a broad perspective components toward achieving point-of-care systems. While
in wearable point-of-care textile systems owing to its merits of competitive research and amazing commercial products have
low power, low cost, and multiple topologies. Because of its emerged in the era of 5G and IoT, some limitations around
extremely high power consumption and complex configurations, communication technologies still need to be addressed. On the
Wi-Fi is inefficient for long-term monitoring systems where one hand, because of the large fraction of power consump-
more extended battery life is indispensable; therefore, it is not tion,337 wireless communication modules usually need to be
appropriate for wearable point-of-care textile systems. combined with power management circuits. Thus, both energy
As for wireless wide area network (WWAN) communication, efficiency and real-time performance with respect to data
the emerging 5G of wireless communications technology transmission speed and distance must be the focus, as currently
services is considered the first wireless protocol to address the an increase in power consumption is concomitant to an increase
inclusion of the massive number of e-textile nodes in the in data rate (Figure 7h). To solve these challenges, combining
network and deliver a solution for machine-type communica- textile-based generators with a wearable point-of-care textile
tion. In other words, in the era of 5G and IoT,334 widely system to sustainably power the e-textiles connection could be a
distributed e-textiles will have wireless interconnection ability promising solution.48 On the other hand, most wireless
and ultrafast data exchange rates, which will be able to provide communication modules require specialized integrated circuit
relevant information to human beings regarding the surrounding chips that are difficult to fabricate with textiles at present.338
environment with the help of real-time communication.335 For Many issues in such circuit chips are left to be resolved, including
point-of-care applications, real-time monitoring and statistical the lack of such chips compatible with the human body and the
analysis of patient-generated health data are necessary for limited volume presented by existing structural designs,
providing appropriate therapy. Therefore, with the capacity, substrates, materials, and fabrication techniques.339 Therefore,
reliability, and low latency to support point-of-care systems that achieving customized wearable point-of-care textile systems
require large-scale equipment connections and network feed- requires multiple strategies and further academic endeavors in
back within 1 ms, 5G begins to make it feasible for patients to be many aspects, including developing efficient wearable antennas,
treated remotely in the comfort of their home with the aid of practical device deployment guidelines, energy-efficient com-
their smart garments.27 It is worth noting that, for future munication protocols, and effective fade mitigation at the
demands of a point-of-care system, rather than a machine- physical layer to support data communication among e-textiles
centric model, the human-centric sixth generation technology within the systems as well as between the systems and the
(6G) network, with higher intelligence, security, affordability, gateway.340 As such, we anticipate exciting innovations for
and energy efficiency, is very likely to be ubiquitous and further developments of wearable point-of-care textile systems.
increasingly significant in the 2030s.336 We believe that the next Driven by the ultimate goal of achieving point-of-care devices,
generation of wireless technologies will facilitate advances for the wearable point-of-care textile system is expected to
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Figure 8. Conclusions and perspectives regarding e-textiles for wearable point-of-care applications. E-textiles have been applied on various body
systems to realize wearable point-of-care devices. In the future, innovations in materials chemistry are expected to constantly renew the functionalities
of e-textiles, tackling the challenges in the field of wearable point-of-care devices. Meanwhile, health data analysis will track individual health status,
exchange personalized health records, and offer medical advice even before clinicians may perceive symptoms. In addition, multidisciplinary and
collaborative efforts on interoperability, standards, and regulations of e-textiles are expected to surmount the obstacles between “what we know in the
lab” and “what we practice in life”, thereby promoting translational research. Created with BioRender.com.

revolutionize the traditional healthcare system, shed light on promising solution in order to protect sensing components
future medical fields, and continue its course to greatly benefit from dynamic environments like sweat fouling, moisture
people’s lives. diffusion, and temperature fluctuations.345 Furthermore,
researchers have endeavored to miniaturize the size of textile
6. FUTURE PERSPECTIVES biomonitoring devices because they need to discretely blend
into fashion garments without sacrificing sensing abilities in the
In this review, textile wearable point-of-care systems, including future. Emerging packaging techniques, such as deposition of an
diagnostic devices, therapeutic devices, protective devices, and ultrathin Al2O3/SiO2 film in precision machining, could
on-body communication technologies, are comprehensively miniaturize textile sensors for ease of integration with a textile
summarized regarding their working mechanisms, representa- platform.346 Finally, optimizing sensing accuracy and quality to
tive materials, structural design, and clinical applications. enhance the signal-to-noise ratio is critical for the continuous
Moreover, widely adopted 5G technologies and IoT allow for and precise supervision of one’s health status during
a wider bandwidth, a higher devices density, and faster rates of physiological fluctuations like falling ill.170 Innovative materials
clinical-level data processing and transmission, which accelerate with optimized sensitivity and selectivity to various stimulus
communication among e-textiles for wearable point-of-care deserve in-depth study.
devices.341 Despite tremendous research progress, many
bottlenecks need to be addressed prior to the widespread use 6.2. Therapeutics
of e-textiles (Figure 8), elaborated as follows. As for textile therapeutic devices, their stimulation modalities,
Textile biomonitoring and therapeutic devices are the such as optical triggers for phototherapy, thermal triggers for
cornerstones of wearable point-of-care textile systems, function- drug delivery, and electrical stimulation, should be accurately
alizing their diagnostic and therapeutic abilities (Table 2). and remotely controlled by users or doctors over a distance to
Innovations in materials science are expected to constantly deliver a safer, adaptive, and precise medical care.133 Meanwhile,
renovate these functionalities,342 ultimately tackling the in vivo applications of textile therapeutic devices require more
challenges in the field of wearable point-of-care systems. research toward either developing long-term biostable materials
6.1. Diagnostics or synthesizing biodegradable active materials to fulfill biosafety
concerns.347 Moreover, further efforts toward sophisticated and
From the perspective of textile sensors for diagnostics, long-term miniaturized power sources for textile therapeutic devices are
stability and durability are the major concerns that hinder their needed,63 although electricity generator-based textile diagnostic
clinical applications.343 To settle this problem, mechanical and therapeutic devices could operate in a self-powered manner.
robustness must be devised to avoid the breakage of sensing
materials or shredding of fiber/textile substrates under 6.3. Theranostics
deformation imposed by body movements.344 Meanwhile, E-textiles coupling diagnostics with therapeutics in one
effective encapsulation or antifouling coating would be a formulation could construct a theranostics system for wearable
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Table 2. Representative E-textiles for Wearable Point-of-Care Devices

e-textile methods materials chemistry healthcare applications ref
textile-based sensor system triboelectric effect Ag-coated polyester obstructive sleep apnea-hypopnea syndrome 68
diagnosis
textile triboelectric sensor triboelectric effect FEP blood pressure measurement 182
CNTs
Al
piezoelectric textile piezoelectric effect polydopamine pulse wave monitoring 189
BaTiO3/PVDF
conformal tactile textile piezoresistive effect graphite nanoparticle body pose detection 356
copper nanoparticle
PDMS
supercapacitive nanofabric pressure-to-capacitance P(VDF-HFP) pulse wave monitoring 75
variation
textile magnetoelastic generator giant magnetoelastic effect NdFeB respiratory monitoring 202
Ecoflex respiration abnormalities detection
soft fibers with giant magnetoelastic effect NdFeB pulse wave monitoring 203
magnetoelasticity Ecoflex
silver
diode fibers light-emitting diodes InGaN pulse wave monitoring 80
GaAs
electronic clothing electrocardiograms CNTs heart rate monitoring 212
graphene textile sensor thermoresistive effect graphene flakes body temperature measurement 90
helical fiber bundles electrochemical sensing multiwalled CNTs H2O2, Ca2+, and glucose analysis 103
integrated textile sensor patch electrochemical sensing nitrogen-doped carbon glucose, lactate, AA, UA, Na+, and K+ analysis 96
textile-based self-powered biofuel cells lactate oxidase-modified CNT Ag2O/Ag lactate analysis 98
sensors
yarn-based stretchable sensor triboelectric effect polyester wearable sign-to-speech translation 267
arrays rubber
PDMS
large-area display textiles electroluminescence ZnS phosphors assistive-technology communication tools 64
nonprinted integrated-circuit piezoresistive effect carbon/PVDF multiple physiological monitoring 373
textile chemoresistive effect polyaniline/CNT
photovoltaic effect PBT/Cu/Mn/ZnO/Dye/CuI early warning for health emergencies
luminous fabric optical fiber poly(methyl methacrylate) increase collagen production 122
photonic textile optical fiber cyclic olefin copolymer phototherapy of neonatal jaundice 123
iTENG patch triboelectric effect polyacrylamide-based organogel accelerate wound healing 278
smart MXene fabric Joule heating Ti3C2Tx nanosheets thermotherapy for wound healing 280
textile dressing thermally responsive alginate/poly(ethylene glycol) diacrylate temporal and dosage-controlled drug delivery 133
microparticles hydrogel
bioinspired conductive silk electromyogram polydopamine multiple physiological monitoring 213
microfiber electrocardiogram poly(3,4-ethylenedioxythiophene)
antioxidative activity (PEDOT) diabetic wound healing

point-of-care devices.146 This system would be able to provide Combining these versatile materials with textiles is expected to
tailored treatment as well as monitor the resultant response, construct e-textiles for theranostics and promote the wearable
effectively increasing the treatment efficacy and safety.348 point-of-care systems.
However, most of the current e-textiles are still limited to a Patient-generated health data includes health-related in-
single function, let alone realizing theranostics. To address this formation acquired by wearable e-textiles that can be used to
challenge, there are two potential solutions. First, e-textiles for track individual health status and address health concerns.
theranostics can be developed by directly fusing individual However, widely adopted 5G technologies and IoT allow for a
diagnostic and therapeutic devices together.349 With the huge data volume and a high biomedical device density on the
assistance of computing textiles and circuitry textiles,350 the human body, creating challenges in data analysis, information
biomonitoring results from e-textiles could be processed near security, and network interference which are yet to be solved.
sensors351 and then delivered to textile therapeutic components 6.4. Clinical Parameter Analysis
to guide medical treatment. To achieve this goal, more research Because individuals demonstrate unique health profiles
efforts on materials chemistry are desired to develop highly according to their various family medical histories, lifestyles,
conductive fibers/wires for textile circuit blocks.352 Innovations and genetics, providing tailored diagnoses and treatment plans
in multifunctional materials are another promising strategy to depends on practical analysis of e-textile-acquired data.354
develop e-textiles for theranostics. For example, organic However, in the era of IoT and 5G technologies, widely
semiconductors featuring light absorption/light emission distributed textile biomonitoring devices could continuously
abilities,35 such as polymer hydrogels, are able to conduct provide patient-generated health data in the gigabyte level per
optical-sensing and photodynamic therapy simultaneously.353 person per day. Methods for culling effective clinical parameters
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for diagnosis and assessment of therapy progress from such large and prevention.365 Developing e-textiles with low cost, reliable
datasets have become an emerging field of research.35 Data- performance, and easy access for common chronic diseases
processing technologies, such as cloud computing, machine would provide faster and more patient-centered care.
learning, and artificial intelligence,355 hold broad application Ultimately, e-textiles for wearable point-of-care devices could
prospects of transforming the raw data into clinical-grade help replace the costly, prolonged, and in many cases largely
information. For example, machine learning algorithms could incomplete health care performed by trained technicians in
extract abnormalities from the massive raw data and offer laboratories and hospitals. Second, to bring e-textiles to the
medical advice even before clinicians may perceive symp- clinic, assessing the biocompatibility of the materials is essential.
toms.356 However, the resultant challenges regarding data Widely applied natural materials in e-textiles, such as silk, wool,
analysis on wearable point-of-care textile systems, involving data and cotton, that do not cause a reaction upon persistent use, can
storage, calculating algorithms, data sharing policies, and safely be in contact with parts of the body for extended
platform standardization, need further research efforts. periods.51 However, other additive materials to enhance the
6.5. Information Security electric properties of e-textiles, such as carbon materials, metal
nanoparticles, and conductive polymers, might induce inflam-
Information security issues of wearable point-of-care textile mation.293,366,367 Thus, e-textiles should be optimized to
systems might make people’s privacy more vulnerable.357 For perform wearable point-of-care functions in a noninflammatory
instance, transmitted health data from wearable point-of-care and nontoxic manner. For example, introducing an ultrathin and
textile systems to remote hospitals could be captured and biocompatible epoxy coating layer to encapsulate e-textiles
modified by attackers, which would endanger users’ privacy or might effectively reduce and even avoid biological rejection
even lives.172 To achieve comprehensive information security, entirely.368 Third, mass production of e-textiles is a primary goal
data delivery channels as well as data storage inside or outside considering the increasing demand of translational research.
wearable point-of-care textile systems must be encrypted.358 However, producing e-textiles at a large scale while retaining
Meanwhile, access to patient-generated health data should be their diagnostic, therapeutic, and protective functions remains
strictly limited to authorized users via reliable authentication an unmet need.64 Converting typical laboratory-scale fabrication
and encryption techniques.359 Thus, robust system security and into well-established industry-standard equipment and proto-
privacy protection of wearable point-of-care textile systems
cols is a potential solution,369 such as leveraging the digital loom,
deserve more exploration and study, especially in the rapid
programmable sewing machine, and industrial spinning
development of 5G technologies and IoT.
machinery. For this purpose, electronic fibers with mechanical
6.6. Network Interference robustness and fine diameters should be developed by
Wearable point-of-care textile systems might soon become as integrating multidisciplinary and collaborative efforts from
ubiquitous as current smartphones, and the coexisting networks material chemistry, electrical engineering, biomedical engineer-
will unavoidably interfere with each other owing to limited ing, and industrial engineering. Accordingly, careful consid-
frequency bands. For example, ZigBee on wearable point-of-care eration of the interoperability, standards, and regulations of e-
textile systems would collide with nearby Wi-Fi operating on the textiles is necessary before pursuing point-of-care applica-
same frequency band and result in a high packet loss ratio during tions.370
data transmission.360 In light of this challenge, emerging 5G For example, to evaluate the mechanical reliability during the
technology appears promising for mitigating interference machine weaving/knitting process, establishing a globally
because of its sizable bandwidth.29 A broad spectrum of bands recognized standard for e-textiles is highly desired. Meanwhile,
can be applied for effective D2D communications across each the validation of clinical performance of e-textiles should
wearable point-of-care textile system. Meanwhile, introducing consider the device difference and patient variability. Fur-
advanced filter modules could treat interference signals as noise thermore, informed consent for data collected by e-textiles
and remove them from the desired patient-generated data.361 In should be required to specify clearly how the clinical information
addition, introducing textile computing as communication will be shared and utilized in the community. Finally,
control units (CCU) to wisely allocate resources such as slot translational medicine is a bidirectional concept.371 In addition
time and energy supply of sensor and therapeutic nodes can to the bench-to-bedside factors to promote point-of-care
dynamically mitigate wearable point-of-care textile system application, e-textiles featuring sensing abilities can also provide
interference.362 clinical observations about the treatment, and the use of this
6.7. Future Translational Medicine
feedback would in turn feed the scientific hypotheses in the
laboratory. In brief, biomedical research that aims to expedite
E-textiles for wearable point-of-care devices have emerged as a the development of e-textiles for wearable point-of-care systems
promising technology toward promoting overall well-being on a should surmount the obstacles between “what we know in the
global scale with an emphasis on preventive and precise lab” and “what we practice in life”, thereby promoting
medicine. However, the translation of e-textiles from laboratory translational research.
scale to our daily lives is still confronted with grand
6.8. Intelligent Wearable Point-of-Care Textile Platforms
challenges.363 First, most of the current reported e-textiles are
proof-of-concept demonstrations and might be lacking in To date, e-textiles have witnessed remarkable development and
practicality. Thus, the first necessary step toward translational have arrived at the frontier of point of care, given the
medicine is understanding the specific and various needs of proliferation of research investment. With the assistance of
patients and physicians and then designing appropriate e-textiles data delivery and communication, textile diagnostic, therapeutic,
by engineering advances in the chemistry community to achieve and protective nodes distributed on the human body can
a point of care based on that knowledge.364 For example, interact synergistically to foster an intelligent wearable point-of-
developing countries and many rural areas have limited access to care textile system, providing disease prevention and diagnosis,
the medical resources associated with diagnostics, therapeutics, precise treatment, and curative effect feedback in a brilliant
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Figure 9. E-textiles for wearable point-of-care devices in the era of Internet of Things. (a) E-textile-based diagnosis nodes, therapeutic nodes, protective
nodes, as well as communication control units (CCU) contribute to an intelligent wearable point-of-care textile system tailoring medical services in a
closed-loop manner. With the power of 5G technology and IoT, intelligent wearable point-of-care textile systems can collect patient-generated health
data and then wirelessly send the clinical parameters for further patient-centric telemedicine. Reproduced with permission from ref 201. Copyright
2021 Springer Nature. Reproduced with permission from ref 374. Copyright 2021 American Association for the Advancement of Science. (b)
Representative functional units of intelligent wearable point-of-care textile systems, involving diagnostic devices (e.g., biomechanical sensors,
biopotential sensors, temperature sensors, and biochemical sensors), therapeutic devices (e.g., electrotherapeutics, drug delivery, and phototherapy),
protective devices (e.g., thermoregulation, electromagnetic shielding, and toxicant degradation), wearable power sources, and CCU. Ultimately,
intelligent wearable point-of-care textile systems can transform conventional disease-oriented healthcare into a predictive, preventive, and participatory
module.

closed-loop manner (Figure 9a).372−374 Prospective smart marketing practice forecast a great leap in the intelligent textile
clothing built on intelligent wearable point-of-care textile point-of-care arena. With the power of IoT and 5G/6G
platforms would target specific health conditions. Individuals technology, we anticipate that intelligent wearable point-of-
could choose the disease-specific smart clothing from their care textile platforms will unlock a vital source for realizing
wardrobe according to personal health demands, thus receiving predictive, personalized, preventive, and participatory health
precise and effective medical services anytime, anywhere (Figure care, ultimately conquering future medical fields.
9b).
Patients and clinicians alike can acquire constant streams of AUTHOR INFORMATION
physiological signals to track treatment progression through
Corresponding Author
disease-specific clothing with embedded e-textiles. In the future,
the widespread use of intelligent wearable point-of-care textile Jun Chen − Department of Bioengineering, University of
platforms could liberate people from relying on costly and California, Los Angeles,, Los Angeles, California 90095, United
centralized hospitals while promoting better healthcare out- States; orcid.org/0000-0002-3439-0495;
comes. This is why intelligent wearable point-of-care textile Email: [email protected]
platforms are incredibly exciting: they can be discretely
Authors
integrated into our daily lives and can benefit health and
hygiene systems both sweepingly and profoundly. Guorui Chen − Department of Bioengineering, University of
Furthermore, the much-anticipated market of e-textiles for California, Los Angeles,, Los Angeles, California 90095, United
healthcare will be valued at more than $5 billion by 2025.372 On States
the basis of $2.2 trillion in annual garment sales, fusing Xiao Xiao − Department of Bioengineering, University of
intelligent wearable point-of-care textile platforms with daily California, Los Angeles,, Los Angeles, California 90095, United
clothing will continuously undergo pervasive and rapid market States; orcid.org/0000-0002-7861-5596
expansion, and will further outsell other personal electronics like Xun Zhao − Department of Bioengineering, University of
smartphones and smart watches. In order to achieve this, California, Los Angeles,, Los Angeles, California 90095, United
promoting the wearability of intelligent point-of-care textile States
platforms as a part of daily clothing is a must. Specifically, Trinny Tat − Department of Bioengineering, University of
boosting the comfort, e.g., light weight, soft tactile sensations, California, Los Angeles,, Los Angeles, California 90095,
breathability, and biocompatibility, without sacrificing the United States
healthcare outcome, needs further research efforts. Meanwhile, Michael Bick − Department of Bioengineering, University of
intelligent wearable point-of-care textile platforms also require California, Los Angeles,, Los Angeles, California 90095,
more research investments in their fundamental textile features, United States
such as tailorability, washability, and aesthetic properties based Complete contact information is available at:
on user demand. In summary, trends in academic research and https://pubs.acs.org/10.1021/acs.chemrev.1c00502
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Author Contributions (5) Dincer, C.; Bruch, R.; Kling, A.; Dittrich, P. S.; Urban, G. A.
§ Multiplexed Point-of-Care Testing − xPOCT. Trends Biotechnol. 2017,
G.C., X.X., and X.Z. contributed equally to this article.
35, 728−742.
Notes (6) Vashist, S. K.; Luppa, P. B.; Yeo, L. Y.; Ozcan, A.; Luong, J. H. T.
The authors declare no competing financial interest. Emerging Technologies for Next-Generation Point-of-Care Testing.
Trends Biotechnol. 2015, 33, 692−705.
Biographies (7) Bianchi, D. W. From Prenatal Genomic Diagnosis to Fetal
Personalized Medicine: Progress and Challenges. Nat. Med. 2012, 18,
Guorui Chen is currently a Ph.D. student in the Department of
1041−1051.
Bioengineering, University of California, Los Angeles, under the
(8) Sahin, U.; Tü reci, Ö . Personalized Vaccines for Cancer
supervision of Prof. Jun Chen. Immunotherapy. Science 2018, 359, 1355−1360.
Xiao Xiao is currently a Ph.D. student in the Department of (9) Pauli, C.; Hopkins, B. D.; Prandi, D.; Shaw, R.; Fedrizzi, T.;
Bioengineering, University of California, Los Angeles, under the Sboner, A.; Sailer, V.; Augello, M.; Puca, L.; Rosati, R.; et al.
supervision of Prof. Jun Chen. Personalized in Vitro and in Vivo Cancer Models to Guide Precision
Medicine. Cancer Discov. 2017, 7, 462−477.
Xun Zhao is currently a Ph.D. student in the Department of (10) Pappa, A.-M.; Parlak, O.; Scheiblin, G.; Mailley, P.; Salleo, A.;
Bioengineering, University of California, Los Angeles, under the Owens, R. M. Organic Electronics for Point-of-Care Metabolite
supervision of Prof. Jun Chen. Monitoring. Trends Biotechnol. 2018, 36, 45−59.
Trinny Tat is currently a Ph.D. student in the Department of (11) Wang, S.; Chinnasamy, T.; Lifson, M. A.; Inci, F.; Demirci, U.
Bioengineering, University of California, Los Angeles, under the Flexible Substrate-Based Devices for Point-of-Care Diagnostics. Trends
supervision of Prof. Jun Chen. Biotechnol. 2016, 34, 909−921.
(12) Farokhzad, N.; Tao, W. Materials Chemistry-Enabled Platforms
Michael Bick is currently an undergraduate in the Department of in Detecting Sexually Transmitted Infections: Progress Towards Point-
Bioengineering at the University of California, Los Angeles, under the of-Care Tests. Trends Chem. 2021, 3, 589−602.
supervision of Prof. Jun Chen. (13) Gurwitz, J. H.; Pearson, S. D. Novel Therapies for an Aging
Population: Grappling with Price, Value, and Affordability. JAMA
Jun Chen is currently an assistant professor in the Department of
2019, 321, 1567−1568.
Bioengineering at the University of California, Los Angeles. His current (14) Osier, F.; Ting, J. P. Y.; Fraser, J.; Lambrecht, B. N.; Romano, M.;
research focuses on nanotechnology and bioelectronics for energy, Gazzinelli, R. T.; Bortoluci, K. R.; Zamboni, D. S.; Akbar, A. N.; Evans,
sensing, and therapeutic applications in the form of smart textiles, J.; et al. The Global Response to the COVID-19 Pandemic: How Have
wearables, and body area networks. He has published 2 books; 1 book Immunology Societies Contributed? Nat. Rev. Immunol. 2020, 20,
chapter; and 210 journal articles, 120 of them being a corresponding 594−602.
author in Chemical Reviews, Chemical Society Reviews, Nature Materials, (15) Yip, W.; Fu, H.; Chen, A. T.; Zhai, T.; Jian, W.; Xu, R.; Pan, J.;
Nature Electronics, Nature Communications, Science Advances, Joule, Hu, M.; Zhou, Z.; Chen, Q.; et al. 10 Years of Health-Care Reform in
Matter, etc. With a current h-index of 80, he was identified to be one of China: Progress and Gaps in Universal Health Coverage. Lancet 2019,
the world’s most influential researchers in the field of Materials Science 394, 1192−1204.
by the Web of Science Group. Among his many accolades are the (16) Kvedar, J. C.; Fogel, A. L.; Elenko, E.; Zohar, D. Digital
Materials Thought Leaders by Azom, 30 Life Sciences Leaders To Medicine’s March on Chronic Disease. Nat. Biotechnol. 2016, 34, 239−
Watch by Informa, UCLA Society of Hellman Fellows Award, Okawa 246.
(17) Sen, A.; Jette, N.; Husain, M.; Sander, J. W. Epilepsy in Older
Foundation Research Award, Advanced Materials Rising Star, Materials
People. Lancet 2020, 395, 735−748.
Today Rising Star Award, ACS Nano Rising Stars Lectureship Award,
(18) Touati, F.; Tabish, R. U-Healthcare System: State-of-the-Art
Chem. Soc. Rev. Emerging Investigator Award, and many others. Review and Challenges. J. Med. Syst. 2013, 37, 9949.
Beyond research, he is an associate editor of Biosensors and (19) Davenport, M.; Mach, K. E.; Shortliffe, L. M. D.; Banaei, N.;
Bioelectronics. Wang, T.-H.; Liao, J. C. New and Developing Diagnostic Technologies
for Urinary Tract Infections. Nat. Rev. Urol. 2017, 14, 296−310.
ACKNOWLEDGMENTS (20) Vargas, A. J.; Harris, C. C. Biomarker Development in the
Precision Medicine Era: Lung Cancer as a Case Study. Nat. Rev. Cancer
The authors acknowledge the Henry Samueli School of
2016, 16, 525−537.
Engineering & Applied Science and the Department of (21) Collins, F. S.; Varmus, H. A New Initiative on Precision
Bioengineering at the University of California, Los Angeles for Medicine. N. Engl. J. Med. 2015, 372, 793−795.
the startup support. J.C. also acknowledges the 2021 Hellman (22) Hood, L.; Friend, S. H. Predictive, Personalized, Preventive,
Fellows Fund. Participatory (P4) Cancer Medicine. Nat. Rev. Clin. Oncol. 2011, 8,
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