UNIT IV SMART TEXTILE

Introduction to smart textile- Passive smart textile, active smart textile. Fabrication
Techniques-Conductive Fibres, Treated Conductive Fibres, Conductive Fabrics, Conductive
Inks.Case study-smart fabric for monitoring biological parameters - ECG, respiration.

4.1 Introduction to smart textile

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

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

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

Types of smart textiles

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

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

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

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

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

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

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

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

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

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

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

Materials used

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

* Metal fibers * Conductive Inks

* Chromic materials * Coating with nanoparticles

* Organic semiconductors * Shape memory materials

* Optical fibers * Quantum tunneling composites

* Inherently conductive polymers www.EnggTree.com

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

Applications

1. Thermotron

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

2. Stone Island

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

3. Polar seal

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

4. ZeroI

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

5. ORII

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

6. Lumo Run

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

7. AIO Sleeve

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

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

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

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

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

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

Another way to promote health andwwwelw

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ting yourself from harmful UV rays.
This can help prevent sunburns and skin cancer. And this is also a function that passive smart
textiles can have.

4.3 ACTIVE SMART TEXTILES

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

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

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

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

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

Finally, these fabrics can also be connected to the internet. This can help tell you all sorts of
things like heart rate and blood pressure right on your smartphone. But it can also be used for
fun activities, such as gaming.

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4.4 Fabrication Techniques
Different fabrication techniques like knitting, weaving, and embroidery are used to convert raw
materials like conductive fibers, yarns, polymers, and polymer composites into smart textiles.
Smart electronic textiles are applied in every field of life due to their novel and unique
properties.

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

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

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

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

4.5 Conductive Fibres

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

The textile structures which can cownw

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alled conductive textiles. It may be
either made using conductive fibres or by depositing conductive layers onto non-conductive
textiles.

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

Methods of producing conductive textiles are summarized as follows:

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

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

Types of Conductive Textiles:

Generally, four kinds of conductive textile as follow:

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

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

2. EM shielding:

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

3. E-textiles:

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

4. Functional coatings:

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

Properties of Conductive Textiles:

Physical properties:

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

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

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

Textiles, which have been a part of human civilization for thousands of years, are made from
both natural materials such as silk and cotton, and synthetic materials such as polyamide and
polyester. These materials can be made into textile bioelectronic devices via scalable
weaving, knitting, braid, printing, and electrospinning, showing great wearing comfort and
breathability. Conventional fiber fabrication techniques include coating, spinning, and thermal
drawing. These various types of fibers can also be arranged into different architectures and
structures in textiles endowing them with excellent flexibility, breathability, abrasion
resistance, and material integration. An increasing number of platform technologies, including
electroluminescent piezoresistive thermoelectric and photovoltaic platforms have been utilized
to develop smart healthcare textiles Among them, self-powered biomonitoring textiles that rely
on piezoelectric triboelectric magnetoelastic and electrochemical approaches offer unique and
compelling features that have attracted significant attention. Self-powered textiles have the
capability of sustainably converting the renewable energy from the human body such as
biomechanical, body heat, and biochemical energy into electrical signals for healthcare
purposes. They not only weaken the dependance of wearable bioelectronics on power supply,
but they also provide highly sensitive and real-time information to monitor human
physiological states. Additionally, self-powered textiles are also environmentally friendly,
simple to manufacture, inexpensive, which can be effectively integrated into daily wear such
as clothing, masks, wristbands, and other garments for continuous monitoring.
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We will begin by briefly discussing the physiological signals that can be monitored. Then, we
will present the progress of self-powered biomonitoring textiles which utilize the on-body
renewable energy sources: biomechanical, body heat, and biochemical energy (Fig. ). We will
illustrate the mechanisms of each of these self-powered textiles and describe how they can
monitor various physiological parameters. Finally, we will discuss the challenges within the
community of self-powered biomonitoring textiles. This review provides a critical analysis of
the current advances in smart biomonitoring textiles and the insights into remaining challenges
and future directions.
Platform technologies for self-powered biomonitoring textiles. For self-powered
biomechanical sensing, we have systematically introduced PENGs, TENGs and MEGs. The
TEGs and BFCs are introduced for self-powered boy temperature and biochemical sensing,
respectively. This review provides a critical analysis of the current advances in smart textiles
working in the self-powered manner and the insights into remaining challenges and future
directions, paving a compelling road to personalized healthcare

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

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

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

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

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

The experimental setup, which is illustrated in Figure, consists of the (1) I-MON interrogator
connected to (2) PC with evaluation software, (3) T-shirt with two belts each equipped with an
array of 5 FBGs, (4) mobile phone with VibSensor application.
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UNIT V APPLICATIONS OF WEARABLE SYSTEMS

Medical Diagnostics, Medical Monitoring-Patients with chronic disease,
Hospital patients, Elderly patients, neural recording, Gait analysis, Sports
Medicine.

APPLICATIONS OF WEARABLE SYSTEMS:

In Medical Diagnostics:
Wearable technologies can be innovative solutions for healthcare problems. Some
wearable technology applications are designed for prevention of diseases and
maintenance of health, such as weight control and physical activity monitoring.
Wearable devices are also used for patient management and disease management.
The wearable applications can directly impact clinical decision making.
Wearable technologies enable the continuous monitoring of human physical
activities and behaviors, as well as physiological and biochemical parameters during
daily life. The most commonly measured data include vital signs such as heart rate,
blood pressure, and body tempw erw
atw
ur.eE,nagsgw
Tere
llea.scobm
lood oxygen saturation, posture,
and physical activities through the use of electrocardiogram (ECG),
ballistocardiogram (BCG) and other devices. Potentially, wearable photo or video
devices could provide additional clinical information. Wearable devices can be
attached to shoes, eyeglasses, earrings, clothing, gloves and watches. Wearable
devices also may evolve to be skin-attachable devices. Sensors can be embedded
into the environment, such as chairs, car seats and mattresses. A smartphone is
typically used to collect information and transmit it to a remote server for storage
and analysis. There are two major types of wearable devices that are used for
studying gait patterns. Some devices have been developed for healthcare
professionals to monitor walking patterns, including the accelerometer, multi-angle
video recorders, and gyroscopes. Other devices have been developed for health
consumers, including on-wrist activity trackers (such as Fitbit) and mobile phone
apps and add-ons. Wearable devices and data analysis algorithms are often used
together to perform gait assessment tasks in different scenarios.
Continuous and real-time monitoring is essential for better management of
patients with chronic illnesses, including, cardiovascular diseases, diabetes, and
neurological disorders. According to the World Health Organization (WHO),
chronic diseases account for three quarters (75%) of all deaths around the world and

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impose high economic burdens. Therefore, different strategies are required for the
monitoring and diagnosis of such diseases and an effective strategy in this regard is
HWDs. Wearable devices are defined as devices, which are worn on the human body or
on clothing. They consist of a target receptor and a transducer. A receptor recognizes
the target analyte and responds accordingly. The transducer then convert the
receptor’s response into a useful signal. Several studies have reported applications
of wearable devices in different fields; as a result, these devices have shown
promising results in the field of healthcare due to their ability of deformability and
compliance. These HWDs provide a better understanding of the changes inside a
human body and can help in preventing and treating diseases.

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

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measuring different parameters and biopotentials. These biopotentials include

electrocardiogram (ECG), which is a measure of heart performance,electromyogram
(EMG) which is a measure of the activity of muscles in response tonerve stimulation,
electroencephalogram (EEG), which is a measure of the performance of brain
activity and electrooculogram (EOG), which records eye movements. These HWDs
are extensively employed as noninvasive devices and particularly in point-of-care
(POC) settings. Furthermore, the noninvasive nature of wearable devices has made
therapeutic procedures simple and has decreased the risk of infection, which was
previously related to blood.

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

Classification of Healthcare Wearable Devices (HWDs).

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Skin-based wearable devices

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

Textile-based HWDs
Textiles have been around for centuries and are readily available. Traditionally,
textiles and clothing have been perceived as keeping humans warm and for esthetics.
Due to their accessibility and comfortability, they can be used for sensing important
parameters, such as body temperature, heart rate, and respiration rate. Such HWDs
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are commonly known as electronic textiles or e-textiles. E-textiles are clothes
embedded with sensors and conductive materials. The stretchable nature and large-
scale skin contact make textiles an optimal medium for HWDs. With the emergence
of graphene, carbon nanotubes, and nanowires, a number of efforts have been made
to incorporate sensors into clothing for continuous monitoring. One such effort is by
Yapici et al. who have developed an intelligent textile-based HWD for the
monitoring of ECG. Traditionally, ECG is monitored by using gel-based Ag/AgCl
electrode cables, which are not comfortable for the wearer. For textile-based ECG
monitoring, graphene functionalized cloth has been embedded with ECG sensors.
Graphene has been used for this purpose because of its excellent material properties
and high correlation with conventional gel-based ECG monitoring. A comparison of
the traditional Ag/AgCl electrodes with the ECG HWD . It can be seen that graphene
functionalized textile electrodes highly correlates with the conventional Ag/AgCl
ECG electrodes with a maximum correlation of 97.0%. However, the graphene
functionalized e-textile electrodes for ECG has higher electrode-skin impedance
(87.5–55 kΩ) than the conventional Ag/AgCl electrodes (50.9–20 kΩ), which
distorts the ECG and requires additional components like buffer amplifiers and
adaptive filters23. Similarly, Arquilla et al. have tested textile electrodes for ECG
monitoring using HWDs. They have developed a chest-based ECG system by
sewing ECG electrodes into the textile instead of using gel electrodes. This sensor

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system has been applied on eight different subjects (five males and three females) to
validate the accuracy of textile-based ECG with the traditional gel-based ECG
electrode. Differences between the heart rate and R–R intervals of ECGs from both
systems were minimal and are shown in Fig. 2b–d. The statistical parameters for
differences in heart rate are t = −0.70 and p > 0.5 and t = 1.43 and p > 0.1 for R–R
interval and with a high correlation coefficient of 0.94. However, this ECG sensor
has not been tested during movement, which imposes considerable challenges in
maintaining the skin-electrode contact and hence is mandatory for continuous ECG
monitoring.Moreover, Wicaksono et al. have also developed an electronic textile
comfortable suit (E-TeCS). The E-TeCS provides temperature sensing of skin with
a precision of 0.1 °C as well as heart and respiration rates at a precision rate of
0.0012−2 using inertial sensing. Additionally, washability and degradability tests
were also conducted for the E-TeCS and high rigidity along with confirmation for
no flakes or discoloration up to ten cycles of washing were observed, which makes
it suitable for everyday use. Likewise, the use of HWDs can also be extended for
other bipotential signals like EEG and EOG, which are required to be monitored for
the treatment and diagnosis of different diseases. Gao et al. have developed a
multisensory textile-based HWD for the simultaneous detection of EEG from the
forehead and sweat rate. This wearable utilizes silver (Ag) as a conductive material
embedded inside the textile electrode to record an EEG. The multisensor wearable
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consists of an EEG recording module and SHT20 chip for the relative humidity
measurement. It has eight channels that allow independent recording of the EEG
using different electrodes and the relative humidity is used to for the indirect
measurement of the sweat rate. The multisensory HWD was compared with
traditional Ag based wet electrodes used for EEG measurement and was highly
correlated. Alpha rhythm is a standard electrical brain response with frequencies
ranging from 8 to 15 Hz and usually more evident while eyes are closed. Correlation
coefficients of 93.04% and 81.69% between the two electrodes have been found, in
closed and opened eyes conditions, respectively. However, the skin-electrode
impedance of the multisensory HWD decreases in the presence of sweat from 30–
20 to 6 kΩ in comparison to standard Ag wet electrodes that maintains small skin-
electrode impedance irrespective of sweat. Moreover, electrodes embedded inside
the textile can also be used for EMG, which measures the electrical activity of
muscles in response to nerve stimulation and is used for the detection of muscle or
motor neuron abnormalities. Pino et al. have proposed a wearable shirt to monitor
EMG that provides essential feedback during exercise30. The wearable shirt is
shown in the These EMG signals are then sent to monitoring system using Bluetooth
for signal processing.

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Textile-based HWDs experience distortion in their results due to loose contact

between skin and HWD. This requires additional signal processing techniques on
raw data for acquiring clean signals. Moreover, textile-based HWDs provide
comfortability along with real-time and continuous monitoring of the wearer, but
their stability decreases with repeated washing due to the involvement of bio-
recognizable molecules. The instability involved with textile-based HWDs may be
partially resolved with tattoo-based HWDs.

skin or tattoo-based HWDs

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

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with Ag electrode, for 52 h, however, 96 h after its application, crack starts to appear
during the test, which increases its skin impedance, making it unsuitable for further
use

Moreover, Dae et al. used a self-powered piezoelectric sensor for the continuous and
real-time monitoring of the arterial pulse34. The arterial pulse is a measure of heart’s
contraction rate, which is a component of cardiac output (heart rate × stroke
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volume)34,35. A piezoelectric sensor converts the pressure created due to arterial
pulses into electrical pulses. In-time detection of the abnormalities in atrial pulses
could lead to the prevention of serious cardiac diseases. Monitoring arterial pressure
may potentially help in the diagnosis of cardiac and blood diseases36,37. This self-
powered tattoo-based HWDs is POC in nature and mitigates the high-power
consumption required by conventional arterial monitors. Moreover, data are shared
wirelessly in case of any abnormality detected in arterial pressure signals using
smartphone modality. It utilizes BaTiO3 and Pb [Zrx, Ti1- x] O3 (PZT), active
materials for the microelectromechanical sensors, due to their high piezoelectric
coefficients. A thin layer of plastic was covered with PZT using laser lift-off
technique (ILLO), which is an inorganic based technique for transferring polymers
on surfaces38. The ultrathin layer of PZT adheres to the epidermis and responds to
changes in arterial pulses. The self-powered PZT sensor was used for the detection
of arterial pulses before and after the exercise. Before exercising, Vpp of the arterial
pulse is 81.5 mV whereas after exercising its amplitude is 100 mV, an increase of
~22% due to the increase in heart rate after the exercise. The same wearable was
used for experiments in monitoring human respiratory activities, trachea movement
and heart rhythm. These experiments have shown a sensitivity of ≈0.018 kPa −1 and
response time of ≈60 ms with excellent mechanical stability. However, the self-
powered tattoo requires biocompatible piezoelectric material for clinical trials34.

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Furthermore, it is estimated that over one billion people worldwide have

hypertension, or elevated blood pressure (BP). Out of 1 billion, two-thirds are in
developing countries who also lack adequate healthcare facilities39. Daily
monitoring of BP is essential for these patients as hypertension is often
asymptomatic. Due to the lack of monitoring, hypertension is one of the major causes
of premature death across the world39. Traditionally, BP monitors are based on
auscultative techniques with an inflatable cuff and on first and fifth Korotkoff
sounds40. This measures systolic blood pressure (SBP), a number that represents the
pressure in arteries when the heart muscle contracts, and diastolic blood pressure
(DBP), a number that represents the pressure when the heart muscle relaxes40.
Accurate BP measurement requires trained technicians, which adds to the challenge
to meet the WHO target to reduce hypertension by 25% by 2025. However, HWDs
can provide a suitable wearable for the POC setting to help achieve the
aforementioned target. One such wearable is described by Luo et al. who has
developed a cuff-less BP measuring device for real time, continuous measurement
of blood pressure using tattoo-based HWD41. The HWD integrates a thin flexible
piezoelectric sensor (FPS) with epidermal ECG sensor for the cuff-less measurementof
BP, which is much more comfortable than its conventional counterpart. The patchuses
beat-to-beat BP measurements from ECG along with a parametric model, which is very
sensitive to minute changes in physiological signals in the epidermis. The
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epidermal signals and ECG signals were obtained using the piezoelectric patch along
with SBP and DBP. Average BP values for conventional cuff-based BP monitor and
cuff-less BP HWD were evaluated, and they were found to be comparable. The
conventional cuff-based BP monitor showed SBP = 123.8 ± 5.7 mmHg and
DBP = 86.8 ± 4.4 mmHg, while cuff-less BP HWD showed
SBP = 130.3 ± 0.5 mmHg and DBP = 86.5 ± 0.5 mmHg. These results indicate that
cuff-less BP wearable provides high correlation with a conventional BP monitor for
both SBP and DBP values. Additionally, the patch utilizes only 3 nW of power, in
comparison to photoplethysmogram (PPG) based devices that consumes tens of
milliwatts of power, making it more efficient and optimal for home-based settings
in low and middle-income countries

Other competitive skin-based HWDs including wearable vests, smart rings, and
earphones
There are other skin-based biosensors, which are not textile or tattoo based. Various
wrist bands, such as smartwatches, wearable vests, skin patches, and implantable
HWDs, use different monitoring biomarkers. Schreiner et al. and Leonard et al. have
monitored respiratory rate, an essential parameter for many respiratory and
cardiovascular diseases by using alternative wearable technologies35,44. Schreiner

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et al. proposed a chest-based wearable to monitor respiratory rate using pulse

oximetry44. Similarly, heart failure is another clinical syndrome, which requires
continuous monitoring. A structural abnormality, which hinders heart from not
pumping sufficient blood to fulfill the needs of the body, heart failure affects about
26 million people globally45. Heart failure requires real time, continuous
monitoring, which increases the economic burden; HWDs can facilitate the daily
monitoring of such patients. A number of HWDs have been reported that go beyond
diagnosing or monitoring heart failure but can predict it days before it even
occurs31,44,46,47,48. Hafid et al. proposed a wearable system to predict heart failure
using multiple parameters, such as thoracic impedance, heart rate, ECG, and blood
oxygen level48. All of these parameters are measured noninvasively using electronic
circuitry, a schematic of which is shown in Fig. 4a. The most important parameter
may be the thoracic impedance, which is the measure of the resistance to the flow of
ions due to the retention of fluid in the thoracic region of the human body49. Days
before heart failure symptoms such as shortness of breath are noted by the patient,
fluid is retained in the lungs, which decreases thoracic impedance48. The wearable
system tracks the thoracic impedance and other parameters including heart rate, ECG and
level of oxygen in the blood. If the respective values exceed the safe threshold, the
HWD generates an alert using wireless transmission over a cloud server to the
wearer and to the medical provider. The clinician can then make necessary
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interventions. However, the prognosis module has inefficient power consumption
taking it 8 h to charge and can only measure continuously for 5 h, which limits its
utility as a HWD for continuous monitoring at all times48. Similarly, another HWD,
Oura Ring monitors key physiological parameters to help the wearer have a restful
sleep50. Oura Ring is a metallic ring, as shown in Fig. 4b, with miniaturized sensors
to monitor physiological parameters, such as heart rate, body temperature, and
breathing51. These parameters can be monitored for illnesses like cold, flu, and even the
novel Coronavirus 2019 (SARS-CoV-2). Severe acute respiratory syndrome (SARS)
outbroke in 2003 and the Middle East respiratory syndrome (MERS) in 2012; SARS-
CoV-2 is the third and the most recent of coronaviruses52,53. SARS- CoV-2 has
currently become a global pandemic with 66 million cases and 1.54 million deaths
worldwide54. Oura Ring utilizes the aforementioned parameters to potentially detect
symptoms of SARS-CoV-2 in home settings. The wearable ring detects common
SARS-CoV-2 symptoms such as fever, cough, fatigue, and difficulty breathing with
90% accuracy55. Moreover, the ring has a battery life of 4–7 days, depending upon
the usage, and takes only 20–80 min to recharge56.

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There are also HWDs for use in the oral cavity. Kim et al. have developed a
mouthguard for the monitoring of saliva uric acid57. Similarly, Mannoor et al. have
developed an oral cavity HWDwfowrwth.E e ndgeg
teTcrtieoen.coof m
bacteria on tooth enamel58. The
HWD is based on graphene because of its high strength (42 Nm−1) and Young’s
Modulus (~1 TPa)59. Antimicrobial peptides (AMPs) were probed on graphene for
the detection of bacteria at a single cell level. Moreover, the resonant coil excludes
the need of an external power source making it miniaturized and power efficient.
Results have been reported for the Escherichia coli (E. coli) bacterium, a foodborne
infection. E. coli is commonly found in the intestines of humans and warm blooded
animals60. If food is contaminated with E. coli, it can cause severe diseases such as
gastroenteritis (food poisoning)61. The graphene-based nanosensor is attached to the
tooth and can remotely monitor respiration and bacteria from the saliva based upon
the change in its resistance58. Odorranin-HP AMP has been probed for the detection
of E. coli because of its strong activity towards this organism. As soon as E. coli
binds with the AMP immobilized graphene, the resistance of graphene decreases and
helps in detecting E. coli with a limit of detection of 1 bacterium μL[−1 58. Results are
justified with fluorescent images for the presence of E. coli. Similar experimentswere
performed for the detection of helicobacter pylori (H. pylori), a gram-negative
bacterium usually found in saliva, and stomach. H. pylori is one of the leading cause
for over 90% of stomach cancers and duodenal ulcers62,63. The lower limit for the
detection of H. pylori is ~100 H. pylori cells using tooth enamel HWD and shows
linear relation with its logarithmic concentration.

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Furthermore, neurological diseases can also be managed efficiently with continuous

monitoring. EEG, EOG, and motion monitoring can be used to diagnose and keep
track of severe neurological diseases, like epilepsy, Parkinson’s disease (PD) and
Alzheimer’s disease (AD). HWDs like ocular wearables can be used for the indirect
detection of neurological diseases using EOG64. Wearable sensors have been used
for the monitoring of patients with PD65,66. PD is a neurological disease that
involves muscular rigidity and marked by bradykinesia or slow movement67. It is
the second most common degenerative disease after Alzheimer’s, and it is estimated
that 10 million people around the world are affected with PD68,69. Lima et al. have
used body fall sensors for quantifying the probability of falling in PD patients in
home-based settings. The study shows that the ratio of falling nearly doubles in PD
patients in comparison to healthy individuals70. Similarly, Lonini et al. have also
developed an intelligent system based on machine learning algorithms for the
detection of PD symptoms like bradykinesia and tremor (involuntary
movements)71,72. Different motion sensors like, accelerometers, gyrometers,
electromyography, and inertial sensors, are used as shown in Fig. 4c71. For the
detection of aforementioned symptoms, subjects performed different tasks like,
typing and walking, over a course of time. Using machine learning algorithms based
on statistical ensembles along with convolutional neural networks the clinician could
detect bradykinesia and tremor. However, the study was conducted on a limited
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number of participants (19) and therefore was unable to infer generalized
conclusions about the detection of dyskinesia (impaired voluntary movement),
another significant symptom of PD71,73. Similarly, dementia is another neurological
disease, which is characterized by memory loss and difficulty in solving problems. There
are 50 million cases worldwide and every year there are 10 million new cases of
dementia74,75. Alzheimer’s disease is the most common form of dementia. Almost
60–70% of dementia patients are diagnosed with Alzheimer’s disease74. Monitoring
of significant moments can help to support the care of dementia patients and HWDs
can be employed for this purpose. Kwan et al. proposed a wearable, based on
intelligent assistive technology (IAT) where IAT is an adaptive and assistive
technology, integrated with advanced environment techniques of artificial
intelligence (AI)76. The wearable is tailored to an individual’s physiological
responses77. These physiological responses consist of heart rate, electrodermal
activity-responsible for the emotional arousal and skin temperature. These signals
are extracted using the autonomic nervous system (ANS) and using a triple point
sensor (TPS), which can be worn on the fingertips using a Velcro strap. The IAT
detects significant emotional events based upon their physiological response and
provides feedback to dementia patients. Considering theimportance of EEG in daily
routine, portable, and flexible earphones have been developed by Lee et al. for the
acquisition of EEG78. The earphones consist of three

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electrodes (Reference, Source and Ground) made up of a mixture of carbon

nanotubes (CNTs), polydimethylsiloxane (PDMS) and silver nanowires (AgNW),
as shown in Fig. 4d78. The earphones are incapsulated in a plastic frame containing
electronics, for example, conductive elastomers, signal transducers, and metal strip
with soft earbuds for the convenient recording of EEG along with listening music at
the same time. The earphones successfully differentiated the state of drowsiness
from the awake state using the three-electrode system and results were
communicated to a smartphone using a Bluetooth circuit as shown in Fig. 4e.
However, as the earphones measure the EEG in crosstalk with music, EEG signals
have low signal to noise ratio (SNR) and therefore requires additional amplifiers
with post signal processing techniques for signal enhancement

Biofluidic-based HWDs
Body secretions like sweat, saliva, tears, and urine contain important biomarkers that are
essential for monitoring and diagnostic purposes. HWDs can be used directly or
through their integration with other platforms, for example, microfluidic platforms
can be integrated for the extraction of useful information from different biofluids79.
Microfluidic platforms of different materials can be used in HWDs for example,
polymer-based microfluidic devices, paper-based microfluidic devices, and micro-
sized needles known as micronw eewdw
le.sE8n0g
,
8g1T. rTehee.cfo
olm
lowing sections highlight recent
efforts in biofluidic-based HWDs classified according to the type of biofluids.

Sweat-based HWDs
Epidermal biofluids like sweat is an important indicator of changes taking place
inside human body and hence can serve as an important parameter for the chemical
and biological sensing. Sweat is composed of different biomarkers, for example,
metabolites (e.g., glucose, lactate, urea etc.), proteins, nucleotides, and electrolytes
such as chlorine, sodium etc. which have important diagnostic implications32. Sweatis
readily available for chemical sensing and is distributed across the skin with more
than 100 glands cm−2 32. Therefore, sweat can be used for the extraction of different
chemical and biological parameters using HWDs to provide monitoring and
diagnostics in POC settings82. Koh et al. have developed a flexible, soft, and
stretchable device, based on microfluidics, for the colorimetric sensing of sweat
biomarkers as shown in Fig. 5a83. This HWD is capable of quantifying electrolytes,
like chloride and hydronium ions, that are essential for monitoring in cystic fibrosis,
a chronic inherited disease that affects the respiratory and digestive systems, by
forming a thick mucus that can block lungs and can obstruct the pancreas84. People
with cystic fibrosis tend to have a shorter life span than healthy individuals85. The
microfluidic HWD can also provide quantification of glucose and lactate levels,

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which are essential for diabetic patients along with the loss of pH, sweat rate, and
total sweat loss. When the perspiration starts, the sweat is transferred into
microfluidic reservoirs, where chromogenic reagents, like a mixture of glucose oxide and
horseradish peroxide (HRP) for glucose level, respond to aforementioned
biomarkers. Images of the change in color of the chemical analytes can be captured
using a smartphone for the quantification of the concentration of chloride,
hydronium ions, glucose, and lactate levels, as shown in Fig. 5b83,86,87. The HWD
continuously measures the concentrations of aforementioned electrolytes in
excellent agreement with the laboratory analysis of the sweat. They have
demonstrated the flexible microfluidic HWD for human studies on the fitness cycle
in a controlled environment and for long distance bicycle racing in outdoor settings,
to justify the absence of the leakage of fluid and any discomfort due to the
microfluidic HWD during real life arid conditions. The microfluidic device is
fabricated using the soft lithographic technique with PDMS as a material83. Soft
lithography offers high resolution, of the order of submicrometers, and due to its
simplicity and flexibility it has been a widely used technique for fabricating
biosensors83,88,89. However, it is a labor intensive and manually operated
process88.

Fig. 5: Biofluidic-based HWDws.w w.EnggTree.com

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

Tears-based HWDs
Tears are another important biofluid for the purpose of diagnosis and monitoring of
different diseases. One such disease is diabetes and a number of HWDs have been
developed for its diagnosis. Diabetes is a chronic metabolic diseases, with elevated
levels of glucose or blood sugar, which can lead to serious damage to the heart, eye,
kidneys, nerve, and blood vessels93. Globally, patients with diabetes have increased
from 108 million to 463 million in 2020 and if necessary interventions are not taken

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then it is expected to increase, especially in middle and low-income countries93,94.

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

As discussed, microfluidic based devices offer low cost and suitable platforms for
biofluidic-based HWDs; however, they have inherent limitations99,100. These

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limitations include fluid leakage, contamination, and blockage due to debris and
limited flexible materials make them inconvenient for the wearer99. However, with
more flexible materials along with adequate flow rate optimization, these challenges
can be overcome to fabricate low-cost microfluidics based HWDs.

Wearable drug delivery systems

As previously discussed, biodegradable and biocompatible materials are available
due to advancements in materials. Such materials can be used for drug delivery
systems, which can deliver drugs in a controlled manner101,102. One application of
drug delivery, is bimatoprost, using an ocular ring made up of polypropylene for the
treatment of glaucoma101. Glaucoma is an eye condition that damages the optic
nerve and is the leading cause of blindness worldwide103. Bimatoprost is a
medication generally used for the treatment of glaucoma, but fluctuations in its usage can
minimize its efficacy. Therefore, the ocular ring, which is covered with silicone-
bimatoprost matrix, slowly releases bimatoprost in a controlled manner, as shown in
Fig. 6a. Similarly, Al-Shahbazi et al. have developed a self-healable and moldable
gum for the personalized drug delivery104. The gum is made up of two materials,
polyvinyl alcohol (PVA) and tannic acid (TA), collectively referred to as PATA,
which belongs to a human friendly group of materials and makes it a bioactive
material. The polymeric gum dw evwew
lo.pEendg, g
asTsrehoew
.cnom
in the Fig. 6b, has high strength,
stretchability, flexibility, toughness, and self-healing properties. The gum has been
found to display antibacterial and anti-inflammatory properties and is flexible
enough to be molded into any shape suitable for using it in wearables.

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Similarly, Kim et al. have developed a touch actuated transdermal delivery (TATD)
wearable for controlled drug delivery105. The TATD provides quantitative
permeation control of the drug delivery in accordance with the force exerted by the
touch on a wearable patch. The HWD consists of drug reservoirs that are refillable
in nature, strain sensors for force detection, and microneedles for drug release as
shown in Fig. 6d105. With mathematical models between the force exerted and the
quantity of drug released, a controlled drug delivery has been observed, which
enables a real-time drug regulation. Similarly, Di et al. have also developed a
mechanical force based drug delivery system106. This HWD consists of a
stretchable elastomer with drug reservoirs in the form of polymeric nanoparticles
loaded with drugs. These nanoparticles can be loaded with antibacterial drugs or
anti-inflammatory drugs. Likewise, the HWD produces encouraging results with
anticancer therapy. The drug is released in a controlled manner by applying tensile
strain on the elastomer and the rate of release of drug is per Poisson’s ratio. The
HWD is a skin mountable device and can be administered by the motion of muscles
or joints, tendons or by external force using hands.

Moreover, T. Ly et al. have utilized the Bluetooth technology for the controlled
release of insulin107. The Bluetooth enabled insulin pump is tubeless in nature and
can hold up to 200 units of U w-w1w
00.Einng
suglTinr.eeIt.ccoom
nsists of cannula insertion and
automated priming along with a personalized diabetes manager, portable for the
remote control of insulin delivery. In another report, Keum et al. have developed a
smart contact lens for the detection of glucose levels from tears and for delivering
drug for diabetic retinopathy therapy97. The contact lens is 14 mm in diameter,
200 μm in thickness with 8.0 mm radius curvature is based upon an ultrathin,
biocompatible polymer and contains miniaturized electrical circuits along with a
microcontroller chip for the continuous monitoring of glucose level from a tear. The
contact lens as shown in the Fig. 6e, consists of an electrochemical biosensor, a drug
delivery system, a resonant inductive coupling to copper for wireless transfer of
power from an external transmitter coil, an integrated microcontroller chip and a
radio frequency (RF) system for communication. The biosensor contains three
electrodes: Reference Electrode (RE), Working Electrode (WE), and Counter
Electrode (CE) for the detection of glucose. Results in Fig. 6f show a comparison of
glucose levels in blood and tears between healthy and diabetic individuals and it can
be seen that at all times the difference in the level of glucose in both diabetic and
healthy individuals, for both tears and blood, are high enough to diagnose diabetes
from tears. Moreover, the contact lens has an integrated drug delivery system that
allows an on-demand, controlled delivery of an antidiabetic drug. The delivery of
the drug is controlled by on/off control of voltage. Drug delivery is electrically
controlled using a gold (Au) membrane. Drug reservoirs are covered with Au anode

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electrode, a thin layer of Au membrane, which dissolves in phosphate buffer solution

(PBS) in 40 s. When a voltage of 1.8 V is applied, the drug is delivered, and results
are then shared by the wireless transmission using an RF module, which makes it a
suitable HWD at POC. Furthermore, Derakhshandeh et al. have proposed a smart
bandage for the treatment of chronic wounds108. The bandage consists of
microneedles, as shown in the Fig. 6g, for the delivery of pharmacological agents
and vascular endothelial growth factors (VEGF) on the targeted wound. The bandage
delivers the drug in a controlled and wireless manner. Moreover, the microneedles
were fabricated using a 3D printer on polymeric substrate and microchannels were
fabricated using PDMS. The smart bandage was experimented by delivering VEGF
to chronic dermal wounds of diabetic mice and showed an increased closure of the
wound and hair growth in comparison to topical delivery of therapeutics108.

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

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

Commercially available HWDs

In recent times, a number of HWDs have been commercially available in the market.
Biocompatibility, accuracy, comfortability, and uninterrupted battery performance
are essential factors for successful commercializarion of HWDs. This section
highlights some of the most recent commercially available HWDs for the continuous
monitoring of different biomarkers. The major focus of the commercially available
HWDs has been on the motion trackers113. Human movement assessment plays an
important role for the biomechanics and gait analysis and therefore can be used for
diagnosing neurological and psychological diseases. Moreover, motion trackers can
keep a track of step counts, which helps in maintaining a record of calories burned.
Therefore, a number of such devices are available in the market for this purpose and
the most widely used are Misfit Shine, Fitbit Inspire 2, Withings and Apple Smart

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Watch. Misfit, an American based consumer electronics company, has introduced

the Misfit Shine that keeps record of steps count, sleep hours, distance covered, and
calories burnt. It has a nonchargeable battery that lasts for 6 months and needs
replacement every 6 months. Fitbit, an American based fitness company, has
introduced a number of fitness wearables114. Fitbit Inspire 2 is one of the recent
additions for the real-time and continuous monitoring of vital signs like heart rate,
activity, and sleep monitoring. It allows 10 days of charging capacity for continuous
monitoring113. Moreover, Withings Pulse, is a smart fitness tracker by Withings, a
French electronics consumer company115. Withings Pulse allows 24/7 monitoring
of heart rate and also keeps a track of sleep hours. Its battery lasts for 20 days and is
water resistant to up to 50 m113. In contrast to aforementioned fitness wearables,
Apple watch comes with features like irregular rhythm notifications, ECG
application, and blood oxygen application. Irregular rhythms in heart rate may be
suggestive of atrial fibrillation, where atrial fibrillation can lead to stroke, heart
failure, and other heart related complications116. However, Apple watch cannot
constantly look for atrial fibrillation and cannot detect all instances of atrial
fibrillation. It only sends notification if irregular rhythms are detected repeatedly116.
The authenticity of the Apple watch for the detection of atrial fibrillation was
confirmed by a study conducted on 419,297 participants at Stanford117. In this study
participants were monitored with Apple watch and on the reciept of a notification
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for irregular rhythm, were monitored for 90 days for atrial fibrillation using ECG
patch. The study diagnosed 34% participants with atrial fibrillation using the early
detection by Apple watch and 84% of irregular rhythm notifications were found in
accordance with the atrial fibrillation117. Moreover, the ECG application keeps a
track of the irregular rhythm using a built-in electrical heart sensor and provides
notification of atrial fibrillation or normal sinus rhythm. Moreover, it also records
the level of oxygen in blood, which helps in the continuous monitoring of
hypoxemia, and conditions like asthma, and emphysema116,118. However, the
blood oxygen application is available only in selected regions116. Table
1 summarizes the aforementioned health and fitness trackers based on humanmotion.

As discussed, ECG is a vital sign that plays an important role in diagnosing and
preventing cardiovascular diseases. A number of smart wearables have been
introduced in the market for ECG monitoring of ECG. ePatch is an FDA approved,
commercially available ECG patch. ePatch is a 3 lead ECG sensor that consists of a
sensor housed inside an adhesive patch119. The patch can store ECG recordings
continuously for 72 hours and results can be analyzed on computer software
transmitted using a USB cable119. However, the recent advancements in ECG

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monitors are in leadless acquisition of ECG and LifeTouch sensor is a one such
HWD119,120. It offers continuous measurement of respiration rate, heart rate, and
ECG for verification purposes. Moreover, Savvy is another leadless HWD
commercially available HWD for the real-time monitoring of ECG121. It is POC in
nature and consists of a sensor that attaches with the skin with two adhesive
electrodes119. These two electrodes are used for measuring ECG during
measurement mode and for charging the sensor in charging mode. The battery life
of Savvy is up to 20 days119. The HWD is housed inside a biocompatible and
flexible plastic covering for enduring user’s movement. The ECG from the Savvy
can be visualized in real time on a mobile application (MobECG), which also allows
a summary of the ECG that can be stored or shared with the patient’s medical
provider119. Similarly, ZIO XT and SEEQ are two other important commercially
available HWDs for the monitoring of ECG119. However, unlike Savvy, ZIO XT,
and SEEQ cannot be reused and do not have rechargeable batteries. ZIO XT does
not report results in real time; however, it stores data for 14 days after which the
ECG patch is returned to the company for data analysis. Similarly, SEEQ, does not
report data in real time but instead data is transmitted with the company’s cloud and
the ECG reporting time depends on the processing time by the company. Table
2 shows some of the comwmwew rc.iEalnlg
y gaTvareilea.bcloe m
HWDs for ECG monitoring.
Considering the growing market of patients with diabetes, a number of HWDs have
been introduced for the continuous monitoring of glucose. Such devices are
generally known as CGM, continuous glucose monitor122. Notable CGMs are
Dexcom G6, Abbott’s FreeStyle Libre System, and Medtronic Guardian
Connect123,124,125. Dexcom G6 consists of a sensor, transmitter, and a
receiver122,123. With an automatic applicator, the sensor wire is inserted just under
the skin of wearer where sensor measures the glucose readings. However, Dexcom
G6 takes 2 hours of calibration after insertion. Readings from the G6 CGM are
transmitted to the receiver where they can be visualized by the user in real time on
the Dexcom mobile application. However, the application is only compatible with
selected mobile devices. Dexcom G6 is one of the few CGMs commercially
available along with Abbott’s FreeStyle Libre System to measure accurate glucose
readings if the patient is taking acetaminophen. Acetaminophen is an analgesic
medicine that interferes with CGS and causes inaccurate glucose readings122,126.
Abbott’s FreeStyle Libre comes with a sensor and a reader where sensor is a small
minimally invasive device to measure glucose from blood and sends data to the
reader where the glucose levels can be visualized. Abbott’s CGM placement can

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only work accurately if placed at the back of the upper arm and unlike Dexcom G6
it takes 12 h to calibrate122,124. Similarly, Medtronic Guardian connect is another
CGM which like aforementioned CGMs consists of a sensor but does not contain a
reader. The sensor takes 12 h for calibration and can send data directly to a mobile
application instead of a reader device. An important feature about Guardian Connect
is its Sugar IQ122. Sugar IQ helps user in understanding the glucose patterns based
on their daily glucose trends along with insulin intake. It is the only CGM to send
predictive notifications 10–60 min beforehand. It can be seen that these CGMs are
costly in comparison to the widely used invasive blood-based glucose meters and it
is recommended to follow blood-based glucose meters in case CGMs readings do
not match with the symptoms.

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Medical Monitoring:
In medicine, monitoring is the observation of a disease, condition or one or several
medical parameters over time.
It can be performed by continuously measuring certain parameters by usinga
medical monitor (for example, by continuously measuring vital signs by a bedside
monitor), and/or by repeatedly performing medical tests (such as blood glucose
monitoring with a glucose meter in people with diabetes mellitus).
Transmitting data from a monitor to a distant monitoring station is known
as telemetry or biotelemetry.
Classification by target parameter
Monitoring can be classified by the target of interest, including:

• Cardiac monitoring, which generally refers to

continuous electrocardiography with assessment of the patient’s condition
relative to their cardiac rhythm. A small monitor worn by an ambulatory patient
for this purpose is known as a Holter monitor. Cardiac monitoring can also
involve cardiac output monitoring via an invasive Swan-Ganz catheter.
• Hemodynamic monitoring, which monitors the blood pressure and blood flow
within the circulatoryww sywst.eEmn.ggBTloreoed.cporm
essure can be measured either
invasively through an inserted blood pressure transducer assembly, or
noninvasively with an inflatable blood pressure cuff.
• Respiratory monitoring, such as:
o Pulse oximetry which involves measurement of the saturated percentage of
oxygen in the blood, referred to as SpO2, and measured by an
infrared finger cuff
o Capnography, which involves CO2 measurements, referred to as EtCO2 or
end-tidal carbon dioxide concentration. The respiratory rate monitored as
such is called AWRR or airway respiratory rate)
o Respiratory rate monitoring through a thoracic transducer belt, an ECG
channel or via capnography
• Neurological monitoring, such as of intracranial pressure. Also, there are
special patient monitors which incorporate the monitoring of brain waves
(electroencephalography), gas anesthetic concentrations, bispectral index (BIS),
etc. They are usually incorporated into anesthesia machines. In
neurosurgery intensive care units, brain EEG monitors have a larger
multichannel capability and can monitor other physiological events, as well.
• Blood glucose monitoring

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• Childbirth monitoring
• Body temperature monitoring through an adhesive pad containing
a thermoelectric transducer.
[1]
• Cancer therapy monitoring through circulating tumor cells
Vital parameters
Monitoring of vital parameters can include several of the ones mentioned above, and
most commonly include at least blood pressure and heart rate, and preferably also
pulse oximetry and respiratory rate. Multimodal monitors that simultaneously
measure and display the relevant vital parameters are commonly integrated into the
bedside monitors in critical care units, and the anesthetic machines in operating
rooms. These allow for continuous monitoring of a patient, with medical staff being
continuously informed of the changes in general condition of a patient. Some
monitors can even warn of pending fatal cardiac conditions before visible signs are
noticeable to clinical staff, such as atrial fibrillation or premature ventricular
contraction (PVC)
Medical monitoring with chronic diseases,hospital patient and elderly patients
A medical monitor or physiological monitor is a medical device used for monitoring.
It can consist of one or more sensors, processing components, display
devices (which are sometimew s wiw
n .EthnegmgsTerleves.cocm
alled "monitors"), as well as
communication links for displaying or recording the results elsewhere through a
monitoring network
Components
Sensor
Sensors of medical monitors include biosensors and mechanical sensors. For
example, photodiode is used in pulse oximetry, Pressure sensor used in Non Invasive
bood pressure measurement.
Translating component
The translating component of medical monitors is responsible for converting the
signals from the sensors to a format that can be shown on the display device or
transferred to an external display or recording device.
Display device
Physiological data are displayed continuously on a CRT, LED or LCD screenas
data channels along the time axis, They may be accompanied by numerical readouts
of computed parameters on the original data, such as maximum, minimum and
average values, pulse and respiratory frequencies, and so on.

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Besides the tracings of physiological parameters along time (X axis), digital medical
displays have automated numeric readouts of the peak and/or average parameters
displayed on the screen.
Modern medical display devices commonly use digital signal processing (DSP),
which has the advantages of miniaturization, portability, and multi-parameter
displays that can track many different vital signs at once.
Old analog patient displays, in contrast, were based on oscilloscopes, and had one
channel only, usually reserved for electrocardiographic monitoring (ECG).
Therefore, medical monitors tended to be highly specialized. One monitor would
track a patient's blood pressure, while another would measure pulse oximetry,
another the ECG. Later analog models had a second or third channel displayed on
the same screen, usually to monitor respiration movements and blood pressure.
These machines were widely used and saved many lives, but they had several
restrictions, including sensitivity to electrical interference, base level fluctuations
and absence of numeric readouts and alarms.
Communication links
Several models of multi-parameter monitors are networkable, i.e., they can send their
output to a central ICU monitoring station, where a single staff member can observe
and respond to sevewrawl wb.eEdnsgidgeTrm
eeo.nciotomrs simultaneously. Ambulatory telemetry
can also be achieved by portable, battery-operated models which are carried by the
patient and which transmit their data via a wireless data connection.
Digital monitoring has created the possibility, which is being fully developed, of
integrating the physiological data from the patient monitoring networks into the
emerging hospital electronic health record and digital charting systems, using
appropriate health care standards which have been developed for this purpose by
organizations such as IEEE and HL7. This newer method of charting patient data
reduces the likelihood of human documentation error and will eventually reduce
overall paper consumption. In addition, automated ECG interpretation incorporates
diagnostic codes automatically into the charts. Medical monitor's embedded
software can take care of the data coding according to these standards and send
messages to the medical records application, which decodes them and incorporates
the data into the adequate fields.
Long-distance connectivity can avail for telemedicine, which involves provisionof
clinical health care at a distance.

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Other components
A medical monitor can also have the function to produce an alarm (such as using
audible signals) to alert the staff when certain criteria are set, such as when some
parameter exceeds of falls the level limits.
Mobile appliances
An entirely new scope is opened with mobile carried monitors, even such in sub-
skin carriage. This class of monitors delivers information gathered in body-area
networking (BAN) to e.g. smart phones and implemented autonomous agents.
Interpretation of monitored parameters
Monitoring of clinical parameters is primarily intended to detect changes (or absence
of changes) in the clinical status of an individual. For example, the parameterof
oxygen saturation is usually monitored to detect changes in respiratory capabilityof
an individual.
Change in status versus test variability
When monitoring a clinical parameters, differences between test results (or values
of a continuously monitored parameter after a time interval) can reflect either (or
both) an actual change in the status of the condition or a test-retest variability of the
test method. www.EnggTree.com

In practice, the possibility that a difference is due to test-retest variability can almost
certainly be excluded if the difference is larger than a predefined "critical
difference". This "critical difference" (CD) is calculated as:

, where

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

2.77, which reflects a 95% prediction interval, in which case there is less than
5% probability that a test result would become higher or lower than the critical
difference by test-retest variability in the absence of other factors.
• CVa is the analytical variation
• CVi is the intra-individual variability
For example, if a patient has a hemoglobin level of 100 g/L, the analytical variation
(CVa) is 1.8% and the intra-individual variability CVi is 2.2%, then the critical
difference is 8.1 g/L. Thus, for changes of less than 8 g/L since a previous test, the

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possibility that the change is completely caused by test-retest variability may need
to be considered in addition to considering effects of, for example, diseases or
treatments.
Examples and applications
The development cycle in medicine is extremely long, up to 20 years, because of the
need for U.S. Food and Drug Administration (FDA) approvals, therefore many of
monitoring medicine solutions are not available today in conventional medicine.
Blood glucose monitoring
In vivo blood glucose monitoring devices can transmit data to a computer that can
assist with daily life suggestions for lifestyle or nutrition and with the physician can
make suggestions for further study in people who are at risk and help prevent
diabetes mellitus type 2 .
Stress monitoring
Bio sensors may provide warnings when stress levels signs are rising before human
can notice it and provide alerts and suggestions. Deep neural network models using
photoplethysmography imaging (PPGI) data from mobile cameras can assess stress
levels with a high degree of accuracy (86%).
Serotonin biosensor
Future serotonin biosensors may assist with mood disorders and depression.
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Continuous blood test based nutrition
In the field of evidence-based nutrition, a lab-on-a-chip implant that can run 24/7
blood tests may provide a continuous results and a computer can provide nutrition
suggestions or alerts.
Psychiatrist-on-a-chip
In clinical brain sciences drug delivery and in vivo Bio- MEMS
based biosensors may assist with preventing and early treatment of mental disorders
Epilepsy monitoring
In epilepsy, next generations of long-term video-EEG monitoring may predict
epileptic seizure and prevent them with changes of daily life activity like sleep,
stress, nutrition and mood management.
Toxicity monitoring
Smart biosensors may detect toxic materials such mercury and lead and provide
alerts.

Remote patient monitoring for chronic disease management

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Remote patient monitoring for chronic disease management is an effective solution

for patients with chronic disease. According to the Journal of Medical Internet
Research, telemonitoring is a valid alternative to usual care, reducing mortality and
improving disease self-management in patients who report satisfaction and
adherence. Because chronic diseases are the leading cause of death and disability
nationwide.
A remote patient monitoring program uses technology to transmit data from a
patient’s home to the clinician for review and intervention. The patient is provided
with an RPM medical device that allows them to measure specific vital signs from
the comfort of their homes. Clinicians receive that information in real-time and can
access it whenever they want.
By implementing RPM, clinicians can significantly reduce healthcare costs and
promote better allocation of resources for improving chronic disease management.
Here are 3 reasons why remote patient monitoring can transform chronic disease
management:
1). Promotes Early Identification of Chronic Disease
Most patients only see their doctor when their condition becomes problematic, or
it’s time for their next appointm ent. But what if something goes wrong in-between
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visits? If the patient doesn’t know what to look for, complications will continue to
develop.
Remote patient monitoring for chronic disease management promotes better care in-
between visits. By keeping track of patients’ vital signs regularly, clinicians will
better understand their patients’ conditions and be alerted immediately if medical
attention is necessary. The RPM device sends real-time readings to the remote
patient monitoring platform for the clinician to access immediately.
Clinicians will automatically be alerted for quick action when a patient’s reading is
above or below the set threshold. RPM promotes the early identification of chronic
diseases. Furthermore, the earlier complications are identified, the sooner patients
can get treatment and minimize the progression of chronic disease.
2). RPM Prompts Adjustments to Treatment Plans
Another way remote patient monitoring helps improve chronic care management is
through timely adjustments to treatment plans. Through the RPM portal, clinicians
can check how their patients are doing whenever they want. As a result, they can see
how their patients respond to medications and adjust prescriptions as necessary.

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Without RPM, many patients go months with an ineffective or unoptimized

treatment plan. Remote patient monitoring in chronic disease management can help
patients find a treatment plan that works for them while reducing chronic disease
progression.
3). Remote Patient Monitoring Increases Patient Engagement
We all know how to live healthier lives, but it’s challenging to consistently apply
those practices to your everyday life. Remote patient monitoring is about expanding
healthcare outside the conventional hospital setting and into the patient’s daily
lifestyle. It helps patients feel supported in managing their health. Because they
know that their care providers regularly check their health data, patients are more
likely to engage in healthier lifestyle choices and adhere to their management plans.
Patients play an essential role in remote patient monitoring for chronic disease
management. They’re responsible for taking their vital sign measurement at least 16
days a month. While this provides clinicians with valuable insight, it also helps the
patients engage and better understand their condition. Regular measurements allow
patients to recognize a normal range for their bodies. They can see if their health is
improving or worsening over time and how changes to their lifestyle choices affect
their readings.
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The better the patient understands their condition and engages, the more likely they
are to practice healthier behaviors, keep an eye out for complications, and
communicate with their clinician.
Using Remote Patient Monitoring for Chronic Disease Management
Using RPM, chronic disease patients are much less likely to be admitted into
hospitals, use emergency departments, and require complicated procedures. This
significantly reduces healthcare costs.
Remote patient monitoring improves the management of various chronic diseases,
including:
• Stroke
• Heart disease
• Diabetes
• Chronic heart failure
• Kidney disease
• Chronic obstructive pulmonary disorder
Depending on the patient’s condition, different vital signs must be monitored. For
example, individuals at risk of stroke or kidney disease will benefit from using a

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blood pressure monitor, while those with diabetes will need to keep an eye on their
blood glucose levels.
1. Remote Patient Monitoring Blood Pressure Monitors
Blood pressure monitors are RPM devices that help individuals with hypertension
ensure their blood pressure stays within a healthy range. Hypertension is a major
risk factor for many chronic diseases like heart failure and stroke. Clinicians can
identify complications early and provide prompt treatment by effectively keeping
track of a patient’s blood pressure between visits. A blood pressure monitor will
display systolic blood pressure, diastolic blood pressure, and heart rate.
The top number is the systolic blood pressure measurement. This indicates the
amount of pressure in the arteries when your heart is beating. According to the
American Heart Association, any reading above 130 mmHg is considered
hypertensive. The second number is the diastolic blood pressure measurement. This
is the amount of pressure in between heartbeats. Any reading above 80 mmHg is
considered hypertensive.
How to Use
Most top RPM digital blood pressure monitor devices are very user-friendly, making
them ideal for remote use. Tenowvw
i’swBPM works right out of the box, eliminating the
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hassle of device setup.
For the best results, encourage your patients to:
• Relax for about 5 minutes before
• Sit comfortably and avoid crossing their legs
• Keep their arm rested on top of a table or armrest
• Empty their bladder
• Measure around the same time every day
• Avoid eating, exercise, caffeine, and alcohol for at least half an hour before
• Take the measurement twice, about a minute apart, to ensure accuracy, and
then average the numbers
To use a blood pressure monitor, wrap the cuff around the upper arm (ensure the
cuff is on bare skin, not clothing) and press the middle button. The cuff will start
inflating, take the blood pressure measurement, and then automatically send the data
to the RPM platform.
2. Remote Patient Monitoring Scales
Weight gain of 3 or more pounds in a single day can indicate congestive heart failure.
Congestive heart failure occurs when the heart cannot efficiently pump blood
throughout the body. At-risk individuals typically experience shortness of breath,

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tightness in the chest, and dizziness. While it is entirely normal for weight to
fluctuate, weight gain in at-risk patients can serve as a precursor to more serious
conditions. By monitoring a patient’s body weight, clinicians can quickly identify
signs of heart failure and focus on early management.
How to use
All the patient has to do is step on the scale to turn it on and wait for the reading.
The information will automatically send to the clinician, and the RPM device will
turn off on its own.
For the most accurate results, advise patients to:
• Weigh themselves at the same time every day (preferably the morning)
• Avoid eating or drinking right before the weigh-in
• Wear the same clothing for each weigh-in or weigh without clothes on
Regular bodyweight measurements can help healthcare providers evaluate the
effectiveness of a patient’s management plan and, if necessary, quickly make
adjustments to better control fluid retention.
3. Remote Patient Monitoring Blood Glucose Meters
Diabetes is the 7th leading cause of death in the United States and the 4th most
common cause of physician vw isiwtsw
. .IEf npgogoT
rlryeem.cao
namged, diabetes can cause kidney
failure, heart attack, stroke, and blindness. By utilizing a blood glucose meter to
remotely monitor blood sugar levels, clinicians can better assess whether a patient’s
treatment management plan is working and make adjustments to optimize care.
How to Use
Tenovi’s Blood Glucose Meter is a top-line FDA-cleared RPM device. It includes a
cell-enabled meter, lancet, and custom test strips that make measuring blood sugar
very simple.
Gather all the materials and perform the following steps with clean hands:
1. Insert the test strip into the meter
2. Wipe your finger with an alcohol pad and let dry
3. Gently prick the side of the finger with the lancet
4. Place a drop of blood onto the test strip and wait for the reading
Most patients should aim for blood glucose levels between 80-130mg/dL before a
meal or below 180 mg/dL in about 2 hours after a meal. If patients’ blood glucose
levels are too high, they may need to adjust their diet or medications.
4. Remote Patient Monitoring Peak Flow Monitors

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Learning to use a peak flow meter for asthma care offers several advantages. One of
the most significant benefits is the ability for physicians and patients to evaluate and
pinpoint the causes of asthma flare-ups and determine the most effective treatment
options for the specific lung condition. Remote monitoring of peak flow enables
healthcare providers to identify if medication or treatment adjustments are required
promptly.
How to Use
To begin using the Tenovi peak flow meter, relax for a few minutes before closely
following these 3 easy steps.
1. Turn it on. Press the power button for 3 seconds and wait for the Gateway to
start flashing yellow.
2. Take a reading: Take a deep breath, then exhale quickly into the peak flow
meter.
3. Data transfer: PEF and FEV1 data will automatically transfer to the Tenovi
cloud or clinician portal.
PEF and FEV1 data will automatically transfer to the Tenovi cloud or clinician
portal.
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5. Remote Patient Monitoring Pulse Oximeters
Another remote patient monitoring device in healthcare that is useful for assessing
lung disease is a pulse oximeter. A pulse oximeter measures heart rate and oxygen
saturation in a patient’s red blood cells. Patients with conditions that affect blood
oxygen levels, like heart attack, heart failure, COPD, anemia, lung cancer, asthma,
and pneumonia, may benefit from regular pulse oximetry.
How to Use
Pulse oximetry is typically tested at the fingertips to measure how well oxygen is
being sent to areas of your body furthest from the heart. This RPM is simple to use.
To use the Tenovi Pulse Oximeter, all the patient has to do is:
• Turn on the device. Place a finger inside the slit, and wait for the reading. A
pulse oximeter uses light to measure the amount of oxygen in your blood at a
given point.
• Pulse oximeters will show blood oxygen saturation level (SpO2) and pulse
rate.
• Patients should seek medical attention if their reading indicates:
•

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• SpO2 under 90% (hypoxia)

• Low pulse rate
• High pulse rate
Most remote top remote patient monitoring devices will notify the healthcare
provider immediately as well.
6. Remote Patient Monitoring Digital Thermometers
RPM cellular thermometers are used for body temperature monitoring for early
infection detection where timely treatment is crucial. This is especially true in the
case of sepsis. RPM digital thermometers are remote patient monitoring devices used
in cancer care, to monitor COVID-19 and postoperative patients. Regular
temperature monitoring reveals symptom patterns and serves as a warning signal
when abnormalities arise.
How to Use
Patients should follow these 3 easy steps to use the Tenovi RPM thermometer.
1. Turn it on: Press the blue power button and wait for the Gateway to start
flashing yellow.
2. Take a reading: Point the thermometer to the center of the forehead (1-3 cm
away) and press the bluewbw
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3. Data transfer: The temperature measurement data will automatically transfer
to the clinician portal.

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Neural Recording:
In neuroscience, single-unit recordings (also, single-neuron recordings) provide a
method of measuring the electro-physiological responses of a single neuron using
a microelectrode system. When a neuron generates an action potential, the signal
propagates down the neuron as a current which flows in and out of the cell through
excitable membrane regions in the soma and axon. A microelectrode is inserted into
the brain, where it can record the rate of change in voltage with respect to time.
These microelectrodes must be fine-tipped, impedance matching; they are primarily
glass micro-pipettes, metal microelectrodes made of platinum, tungsten, iridium or
even iridium oxide. Microelectrodes can be carefully placed close to the cell
membrane, allowing the ability to record extracellularly.
Single-unit recordings are widely used in cognitive science, where it permits the
analysis of human cognition and cortical mapping. This information can then be
applied to brain–machine interface (BMI) technologies for brain control of external
devices.
There are many techniques available to record brain activity— including
electroencephalography (EEG), magnetoencephalography (MEG),
and functional magnetic resonance imaging (fMRI)—but these do not allow for
single-neuron resolution. Neurownws wa.rE
e nthgegTbraeseic.cfoum
nctional units in the brain; they
transmit information through the body using electrical signals called action
potentials. Currently, single-unit recordings provide the most precise recordings
from a single neuron. A single unit is defined as a single, firing neuron whose spike
potentials are distinctly isolated by a recording microelectrode.
The ability to record signals from neurons is centered around the electric current
flow through the neuron. As an action potential propagates through the cell, the
electric current flows in and out of the soma and axons at excitable membrane
regions. This current creates a measurable, changing voltage potential within (and
outside) the cell. This allows for two basic types of single-unit recordings.
Intracellular single-unit recordings occur within the neuron and measurethe voltage
change (with respect to time) across the membrane during action potentials. This
outputs as a trace with information on membrane resting potential, postsynaptic
potentials and spikes through the soma (or axon). Alternatively, when the
microelectrode is close to the cell surface extracellular recordings measure the
voltage change (with respect to time) outside the cell, giving only spike information.
Different types of microelectrodes can be used for single-unit recordings; they are
typically high-impedance, fine-tipped and conductive. Fine tips allow for easy
penetration without extensive damage to the cell, but they also correlate with high
impedance. Additionally, electrical and/or ionic conductivity

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allow for recordings from both non-polarizable and polarizable electrodes. The two
primary classes of electrodes are glass micropipettes and metal electrodes.
Electrolyte-filled glass micropipettes are mainly used for intracellular single-unit
recordings; metal electrodes (commonly made of stainless steel, platinum, tungsten
or iridium) and used for both types of recordings.
Single-unit recordings have provided tools to explore the brain and apply this
knowledge to current technologies. Cognitive scientists have used single-unit
recordings in the brains of animals and humans to study behaviors and functions.
Electrodes can also be inserted into the brain of epileptic patients to determine the
position of epileptic foci. More recently, single-unit recordings have been used in
brain machine interfaces (BMI). BMIs record brain signals and decode an intended
response, which then controls the movement of an external device (such as a
computer cursor or prosthetic limb).

Electrophysiology
The basis of single-unit recordings relies on the ability to record electrical signals
from neurons.
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Neuronal potentials and electrodes
When a microelectrode is inserted into an aqueous ionic solution, there is a tendency
for cations and anions to react with the electrode creating an electrode-electrolyte
interface. The forming of this layer has been termed the Helmholtz layer. A charge
distribution occurs across the electrode, which creates a potential which can be
measured against a reference electrode. The method of neuronal potential recording
is dependent on the type of electrode used. Non-polarizable electrodes are reversible
(ions in the solution are charged and discharged). This creates a current flowing
through the electrode, allowing for voltage measurement through the electrode with
respect to time. Typically, non-polarizable electrodes are glass micropipettes filled
with an ionic solution or metal. Alternatively, ideal polarized electrodes do not have
the transformation of ions; these are typically metal electrodes. Instead, the ions and
electrons at the surface of the metal become polarized with respect to the potential
of the solution. The charges orient at the interface to create an electric double layer;
the metal then acts like a capacitor. The change in capacitance with respect to time
can be measured and converted to voltage using a bridge circuit. Using this
technique, when neurons fire an action potential they create changes in potential
fields that can be recorded using microelectrodes. Single unit recordings from the

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cortical regions of rodent models have been shown to dependent on the depth at
which the microelectrode sites were located.
Intracellularly, the electrodes directly record the firing of action, resting and
postsynaptic potentials. When a neuron fires, current flows in and out through
excitable regions in the axons and cell body of the neuron. This creates potential
fields around the neuron. An electrode near a neuron can detect these extracellular
potential fields, creating a spike.
Experimental setup
The basic equipment needed to record single units is microelectrodes,
amplifiers, micromanipulators and recording devices. The type of microelectrode
used will depend on the application. The high resistance of these electrodes creates
a problem during signal amplification. If it were connected to a conventional
amplifier with low input resistance, there would be a large potential drop across the
microelectrode and the amplifier would only measure a small portion of the true
potential. To solve this problem, a cathode follower amplifier must be used as an
impedance matching device to collect the voltage and feed it to a conventional
amplifier. To record from a single neuron, micromanipulators must be used to
precisely insert an electrode into the brain. This is especially important for
intracellular single-unit recordiw
ngw. w.EnggTree.com
Finally, the signals must be exported to a recording device. After amplification,
signals are filtered with various techniques. They can be recorded by an
oscilloscope and camera, but more modern techniques convert the signal with an
analog-to-digital converter and output to a computer to be saved. Data- processing
techniques can allow for separation and analysis of single units.
Types of microelectrodes
There are two main types of microelectrodes used for single-unit recordings: glass
micropipettes and metal electrodes. Both are high-impedance electrodes, but glass
micropipettes are highly resistive and metal electrodes have frequency-dependent
impedance. Glass micropipettes are ideal for resting- and action-potential
measurement, while metal electrodes are best used for extracellular spike
measurements. Each type has different properties and limitations, which can be
beneficial in specific applications.
Glass micropipettes
Glass micropipettes are filled with an ionic solution to make them conductive;a
silver-silver chloride (Ag-AgCl) electrode is dipped into the filling solution as an
electrical terminal. Ideally, the ionic solutions should have ions similar to ionic
species around the electrode; the concentration inside the electrode and surrounding

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fluid should be the same. Additionally, the diffusive characteristics of the different
ions within the electrode should be similar. The ion must also be able to "provide
current carrying capacity adequate for the needs of the experiment". And
importantly, it must not cause biological changes in the cell it is recording from. Ag-
AgCl electrodes are primarily used with a potassium chloride (KCl) solution. With
Ag-AgCl electrodes, ions react with it to produce electrical gradients at the interface,
creating a voltage change with respect to time. Electrically, glass microelectrode tips
have high resistance and high capacitance. They have a tip size of approximately
0.5-1.5 µm with a resistance of about 10-50 MΩ. The small tips make it easy to
penetrate the cell membrane with minimal damage for intracellular recordings.
Micropipettes are ideal for measurement of resting membrane potentials and with
some adjustments can record action potentials. There are some issues to consider
when using glass micropipettes. To offset high resistance in glass micropipettes,
a cathode follower must be used as the first-stage amplifier. Additionally, high
capacitance develops across the glass and conducting solution which can attenuate
high-frequency responses. There is also electrical interference inherent in these
electrodes and amplifiers.

Metal electrodes
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Metal electrodes are made of various types of metals, typically silicon, platinum, and
tungsten. They "resemble a leaky electrolytic capacitor, having a very high low-
frequency impedance and low high-frequency impedance". They are more suitable
for measurement of extracellular action potentials, although glass micropipettes can
also be used. Metal electrodes are beneficial in some cases because they have high
signal-to-noise due to lower impedance for the frequency range of spike signals.
They also have better mechanical stiffness for puncturing through brain tissue.
Lastly, they are more easily fabricated into different tip shapes and sizes at large
quantities. Platinum electrodes are platinum black plated and insulated with glass.
"They normally give stable recordings, a high signal-to-noise ratio, good isolation,
and they are quite rugged in the usual tip sizes". The only limitation is thatthe tips are
very fine and fragile. Silicon electrodes are alloy electrodes doped with silicon and
an insulating glass cover layer. Silicon technology provides better mechanical
stiffness and is a good supporting carrier to allow for multiple recordingsites on a
single electrode. Tungsten electrodes are very rugged and provide very stable
recordings. This allows manufacturing of tungsten electrodes with very smalltips to
isolate high-frequencies. Tungsten, however, is very noisy at low frequencies. In
mammalian nervous system where there are fast signals, noise can be removed with
a high-pass filter. Slow signals are lost if filtered so tungsten is not a good choice
for recording these signals.

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Applications
Single-unit recordings have allowed the ability to monitor single-neuron activity.
This has allowed researchers to discover the role of different parts of the brain in
function and behavior. More recently, recording from single neurons can be used to
engineer "mind-controlled" devices.
Cognitive science
Noninvasive tools to study the CNS have been developed to provide structural and
functional information, but they do not provide very high resolution. To offset this
problem invasive recording methods have been used. Single unit recording methods
give high spatial and temporal resolution to allow for information assessing the
relationship between brain structure, function, and behavior. By looking at brain
activity at the neuron level, researchers can link brain activity to behavior and create
neuronal maps describing flow of information through the brain. For example,
Boraud et al. report the use of single unit recordings to determine the structural
organization of the basal ganglia in patients with Parkinson's disease. Evoked
potentials provide a method to couple behavior to brain function. By stimulating
different responses, one can visualize what portion of the brain is activated. This
method has been used to explore cognitive functions such as perception, memory,
language, emotions, and motorwcownwtr.oEln
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Brain–machine interfaces
Brain–machine interfaces (BMIs) have been developed within the last 20 years. By
recording single unit potentials, these devices can decode signals through a computer and
output this signal for control of an external device such as a computer cursoror
prosthetic limb. BMIs have the potential to restore function in patients with
paralysis or neurological disease. This technology has potential to reach a wide
variety of patients but is not yet available clinically due to lack of reliability in
recording signals over time.

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Gait analysis:
Human gait depends on a complex interplay of major parts of the nervous,
musculoskeletal and cardiorespiratory systems.

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

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

Definitions

• Gait - the manner or style of walking.

• GaitAnalysis -
An analysis of each component of the three phases of ambulation is an es
sential part of the diagnosis of various neurologic disorders and the asses
sment of patient progreswswdwur.E
innggrgeThraebeil.ictoatm
ion and recovery from the effe
cts of neurologic disease, a musculoskeletal injury or disease process, or
amputation of a lower limb.

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

• Gait cycle is a repetitive pattern involving steps and strides

• Step is one single step

• Stride is a whole gait cycle.

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

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

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

The Gait Cycle

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

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

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

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

Phases of the Gait Cycle (8 phase model):

1. Initial Contact
2. Loading Response
3. Midstance

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4. Terminal Stance
5. Pre swing
6. Initial Swing
7. Mid Swing
8. Late Swing.

Heel Strike (or initial contact) -

Short period, begins the momewnw

t tw
he.Efnog
o tgtTorueceh.ecsom
the ground and is the first phase
of double support.

Involves:

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

Foot Flat (or loading response phase)

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

• Hip moves slowly into extension, caused by a contraction of the adductor
magnus and gluteus maximus muscles.
• Knee flexes to 15° to 20° of flexion.

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• Ankle plantarflexion increases to 10-15°.

Midstance

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

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

Heel Off

• Begins when the heel leaves the floor.

• Bodyweight is divided over the metatarsal heads.
• 10-13° of hip hyperextension, which then goes into flexion.
• Knee becomes flexed (0-5°)
• Ankle supinates and plawnw
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s.Tree.com

Toe Off/pre-swing

• Hip becomes less extended.

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

Early Swing

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

Mid Swing

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

Late Swing/declaration

• Hip flexion of 25-30°

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

Gait Cycle - Anatomical Considerations

• Pelvic region - anterior-posterior displacement, which alternates from leftto

right. Facilitates anterior movement of the leg (each side anterior- posterior
displacement of 4-5°).
• Frontal plane - varus movement in the: foot between heel-strike and foot- flat
and between heel-off and toe-off; hip, in lateral movements (when the
abductors are too weak, aTrendelenburg gaitcan be observed). Valgus
movement between foot-flat and heel off in the feet.
• A disorder in any segm wewnw
t .oEfngthgeTrbeoed.ycocman have consequences on the
individual's gait pattern.

Gait Disorders

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

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

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

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

Gait Descriptions

• Antalgic gait a limp adopted so as to avoid pain on weight-bearing structures,

characterized by a very short stance phase.
• Ataxic gait an unsteady, uncoordinated walk, with a wide base and the feet
thrown out, coming down first on the heel and then on the toes with a

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double tap.This gait is associated with cerebellar disturbances and can be seen
in patients with longstanding alcohol dependency. People with
'Sensory'Disturbances may present with a sensory ataxic gait. Presentation
is a wide base of support, high steps, and slapping of feet on the floor in order
to gain some sensory feedback. They may also need to rely on observation of
foot placement and will often look at the floor during mobility due to a lack
of proprioception.
• Equine gait a walk accomplished mainly by flexing the hip joint; seen in
crossed leg palsy.
• Parkinsonian Gait (seen in parkinson's disease and other neurologic
conditions that affect the basal ganglia). Rigidity of joints results in reduced
arm swing for balance. A stooped posture and flexed knees are a common
presentation. Bradykinesia causes small steps that are shuffling in
presentation. There may be occurrences of freezing or short rapid bursts of
steps known as ‘festination’ and turning can be difficult.
• Trendelenburg gait, the gait characteristic of paralysis of the gluteus medius
muscle, marked by a listing of the trunk toward the affected sideat each
step.
• Hemiplegic gait a gait involving flexion of the hip because of foot- drop
and circumduction of the leg.
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• Steppage gait the gait in foot-drop in whic h the advancing leg is lifted high
in order that the toes may clear the ground. It is due to paralysis of the anterior
tibial and fibular muscles, and is seen in lesions of the lower motor neuron,
such as multiple neuritis, lesions of the anterior motor horn cells, and lesions
of the cauda equina.
• Stuttering gait a walking disorder characterized by hesitancy that resembles
stuttering; seen in some hysterical or schizophrenic patients as well as in
patients with neurologic damage.
• Tabetic gait an ataxic gait in which the feet slap the ground; in daylight the
patient can avoid some unsteadiness by watching his feet.
• Waddling gait exaggerated alternation of lateral trunk movements with an
exaggerated elevation of the hip, suggesting the gait of a duck; characteristic
of muscular dystrophy.
• Diplegic Gait (Spastic gait). Spasticity is normally associated with both lower
limbs. Contractures of the adductor muscles can create a ‘scissor’ type gait
with a narrowed base of support. Spasticity in the lower half of the legs
results in plantarflexed ankles presenting in ‘tiptoe’ walking and often toe
dragging. Excessive hip and knee flexion is required to overcome this

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• Neuropathic Gaits. High stepping gait to gain floor clearance often due to
foot drop

Causes of gait disorders

They include neurological, orthopedic, medical and psychiatric conditions and

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

Musculoskeletal Causes

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

Hip Pathology

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

range of movement during swing phase which causes an exaggeration of
movement in the opposite limb ‘hip hiking[15][20].
• Excessive Hip Flexion can significantly alter gait pattern most commonly due
to; • Hip flexion contractures • IT band contractures, • Hip flexor spasticity, •
Compensation for excessive knee flexion and ankle DF, • Hip pain •
Compensation for excess ankle plantar flexion in mid swing. The deviation of
stance phase will occur mainly on the affected side. The result is forward tilt
of the trunk and increased demand on the hip extensors or increased lordosis
of the spine with anterior pelvic tilt. A person with reduced spinal mobility
will adopt a forward flexion position in order to alter their centre of gravity
permanently during gait.
• Hip Abductor Weakness. The abductor muscles stabilise the pelvis toallow
the opposite leg to lift during the swing phase. Weak abductor muscles will
cause the hip to drop towards the side of the leg swinging forward. This is
also known as Trendelenburg gait[18]

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• Hip Adductor Contracture. During swing phase the leg crosses midline
due to the weak adductor muscles, this is known as ‘scissor gait’[18]
• Weak Hip Extensors will cause a person to take a smaller step to lessen the
hip flexion required for initial contact, resulting in a lesser force of contraction
required from the extensors. Overall gait will be slower to allow time for
limb stabilisation. Compensation is increased posterior trunk positioning to
maintain alignment of the pelvis in relation to the trunk[18]
• Hip Flexor Weakness results in a smaller step length due to the weakness of
the muscle to create the forward motion. Gait will likely be slower and may
result in decreased floor clearance of the toes and create a drag

Knee Pathologies

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

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

Ankle Pathologies

• Ankle Dorsiflexion Weakness results in a lack of heel strike and decreased

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

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length, and excessive knee and hip flexion during swing phase to ensure
floor clearance.

Foot Pathologies

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

Leg length discrepancy

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

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

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

Gait Analysis

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

examination to gain information about lower limb dysfunction in dynamic
movement and loading.
• When analyzing the gait cycle, it is best to examine one joint at a time.

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• Objective and subjective methods can be used.

Subjective

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

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

An objective approach is quantitative and parameters like time, distance, and muscle
activity will be measured. Other objective methods to assess the gait cycle that
use equipment include:[33][31]

• Video Analysis and Treadmill

• Electronic and Computerized Apparatus
• Electronic Pedometers
• Satellite Positioning System
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Qualitative and analyse
methods gait inclu
to assess de:

• Rancho Los Amigos Hospital Rating List

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

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

Scope of sports medicine

In the field of physical education and sports, the fields of various sub-disciplines of
sports medicine are utilize. Without the knowledge of scope of sports medicine, it is

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difficult to carry a sportsperson performance at apex level. There are following scope
of sports medicine:

a) Sports and first aid

b) Human anatomy and physiology

c) Female and sports

d) Study of optimal load for different age groups

e) Scientific promotion of games and sports

f) Sports injury rehabilitation

g) Fitness for games and sports.

Aims of sports medicine

a) To provide information to awthwlewte.E

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s.

b) To provide knowledge about the causes of injuries.

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

injuries.

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

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

f) To concentrate on the causes of injury

Concept of Sports medicine

• Bio-mechanics related to sports

• Effect of attitude on endurance performance
• Psychological aspect performance

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• Nutrition & metabolism in relation to competition & performance

• Recommendations of FISM(the International Federation of Sports Medicine
at world level)
• Cardio-respiratory function in relation to performance
• Exercise in Cardio-Vascular disease prevention & rehabilitation

Prevention of Sports Injuries :

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

Impact of surface on athletes

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

Impact of Surfaces and Environment on Athletes

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SportsInjury

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Intrinsic Risk Factor Extrinsic Risk Factor

Physical Preparation
Lack of proper training

Fitness label Environmental

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

Climatic conditions affect the performance

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Environmental conditions, suc or low temperatures, have the
h as excessively high
potential to have a negative impact on an athlete ‘s well-being. An athlete ‘ability to
use a number of thermoregulation techniques helps in regulating body temperature.

Sports injuries are those which are common in the field of games and sports. During
training, competition or practice, any player can be injured. Perhaps there will not
be any player who has not been injured during his career.

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Strain is also a muscle injury. A strain is caused by twisting or pulling a muscle or

tendon. A sudden strain is caused by a recent injury, lifting heavy objects or rods in
wrong way and over stressing the muscles. Chronic strain is usually caused by
moving the muscles and tendons in repetition.
Sprain is a ligament injury. It may occur due to overstretching or tearing of
ligaments. Many things can cause sprain. Falling, twisting, or getting hit can force a
point out of its normal position. This can cause ligaments around the joints to tear.
Generally, Sprain occurs at wrist and ankle joints.
Prevention of sprain and strain
a) Conditioning should be performed during the preparatory period.

b) Sports equipments must be of good quality.

c) Play courts should be smooth and clean.

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

e) Player should discontinue during the condition of fatigue.

f) Good officiating is essentiaw

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

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

Management:

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

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

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

Joint injuries & its types

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

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

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

sudden jerk or a fall over a hard surface. The end of the humerous comes out from

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the socket. In face when your shoulder dislocates, a strong force, such as a sudden
blow to your shoulder. Pulls the bones in your shoulder out of place.

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

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

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

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

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

b) Proper conditioning should be performed during preparatory period.

c) Stretching exercises should be include in warm-up

d) Players should be careful during training and competition.

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e) Protective equipment should be used

f) Players should have good anticipation and concentration power

g) Always obey the rules and regulations.

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

i) Avoid falls or hits as far as possible.

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

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

b) Traumatic, forceful and unnatural movements.

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Prolonged long distance walking or running.

Sudden fall on hard surface.

Direct strike or hit with any solid sports equipment.

Osteoporosis.

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

Apply ice to the affected part for 24 to 48 hrs

If pain persists, give painkillers.

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

After removal of swelling begin to put partial weight on the affected area.
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f) Crutches or walking stick may be used in the beginni ng. After two weeks start
putting normal weight.

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

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