Above, Figure 1: Rita Paradiso with a variety of sensor-equipped garments at the Smartex offices in Italy.
Take note! Your pajamas may have something important to tell you.
If you’re elderly and susceptible to hypothermia, your pajamas might let you know that your temperature has fallen and you should add some blankets or turn up the heat. If you suffer from Chronic Obstructive Pulmonary Disease (COPD), they might let you know that your respiration and pulse rates indicate the possible onset of an attack, giving you time to take preventive medication to avert a trip to the emergency room. If you’ve suffered a stroke, they might help keep track of your rehabilitation. And all that, without the need for any sensors or wires attached to your body or to the fabric: In these pajamas, the sensors are part of the cloth itself—unobtrusive and unnoticed.
That’s the vision that bioengineer Rita Paradiso (Figure 1, above) has been pursuing for most of her professional life, and that goal has been coming closer and closer to reality. The company she now heads in Pisa, Italy, called Smartex (Figure 2), has already been delivering early versions of health-sensing garments to both clinicians and researchers all across Europe, and is carrying out research to refine and expand the fabric’s capabilities. “The technology is ready, and the system is working,” she says.
The possibilities for such smart fabrics, Paradiso says, are enormous. Besides pajamas, the health-monitoring fabrics have taken the form of undershirts (Figure 3), but could be almost any form that can provide close, but comfortable and natural, contact with the skin. “Textile is a more natural interface with the skin” than other kinds of sensors, Paradiso says. Most systems for continuous monitoring of physiological parameters involve electrodes that need to be stuck to the skin with some kind of adhesive, or simple wristbands or other devices that can only get relatively simple and low-fidelity data. “All of our studies are aimed at finding the best compromise between comfort and signal quality,” she says.
The annual Consumer Electronics Show (CES) in Las Vegas is the premiere showcase for the latest in technology, and for the last two years there has been a dramatic increase in exhibits featuring some kind of smart wearable technology, including some with advanced smart fabrics. Earlier this year, the show featured a number of significant new products and concepts.
American company Under Armour, whose CEO Kevin Plank gave a keynote address at CES, introduced smart shoes as the first in a line of wearable products designed to collect a wealth of data about a user’s health and fitness. They plan to combine sensor-derived data about the length and intensity of exercise with other information on diet, sleep and other parameters.
The company, which hopes to double its US$5 billion revenues over two years, integrated sensors into its new line of sports shoes, designed to measure both distance traveled and impact forces, producing data that can be tracked and analyzed by a central computer system. The company is working with IBM Watson to manage the data, and are planning to expand their line with other smart-fabric based apparel.
A number of other new products introduced at the CES are specifically fabric-based, including smart shirts, socks, and sports bras. Companies including Hexoskin in Canada and Xenoma in the US are making tight-fitting athletic shirts that contain a variety of embedded monitoring sensors.
Hexoskin’s vests, first introduced at last year’s show and with new capabilities now added, can monitor heart rate and variability, breathing rate, ventilation, overall activity level, calories burned, and steps taken. Sensors are woven directly into the fabric of the shirts, and the company claims its shirts monitor more parameters than any other existing biometric shirt on the market. Xenoma’s smart shirts are initially aimed at a whole different market: Motion capture video, for use in video games and special-effects movie production. Unlike bulky traditional motion-capture clothing, the “e-skin” clothing developed by Xenoma has lightweight built-in fibers that measure strain and position, while being as comfortable as ordinary clothing, the company says. The same clothing with its built-in sensors can also be used for health and fitness monitoring as well.
And if you have trouble remembering to sit up straight, there’s even a shirt that can nag you about it: the FysioPal has haptic signals embedded in it that can not only detect your posture, but then provide tactile feedback through vibrating patches that will remind you to square your shoulders and straighten your spine. Finally, the Team Pro Shirt, from Polar, has heart-rate sensors woven into the fabric, and a small sensor pod in a pocket in back that both collects motion and acceleration data and relays the data to a phone or other device. The shirts are already being used by many professional sports teams.
Recently, a number of companies have introduced sports bras with a variety of built-in sensors. The OMbra has sensors for heart rate and breathing, which are relayed through a clip-on device called OMbox. It then offers customized coaching advice based on that data. Sensoria, meanwhile, offers not only smart bras but also smart socks and shoes to monitor a range of physiological parameters. Their sensors are totally textile based, the company says, and connect with a smart phone or watch. And Hong-Kong based Advanpro is producing sports clothing including bras with what it claims to be the softest fabric sensors now available.
Overall, analysts predict the whole smart wearables market is poised for huge growth, with one firm, Grand View Research, projecting the industry will reach more than US$9 billion globally by 2024, up from about a half-billion in 2015. The most important part of this rapidly growing industry, Under Armour CEO Plank said in his CES keynote, is the way it will allow for massive collection and analysis of health and fitness data. “Going forward,” he said, “we will continue to dive into the data and leverage the insights to deepen and expand our relationship with athletes as their needs change.”
Paradiso’s skills are eclectic. She studied physics, earning her undergraduate degree at the University of Genoa and later working in the physics department of Queen Mary College during her doctoral work in bioengineering, followed by postdoctoral positions in molecular chemistry in Saclay, France and in material engineering in Trento, Italy. She then worked on bio-activation of MEMS (microelectromechanical systems), heading the research department of a technobiochip company. She joined Smartex in 2000 as head of R&D, and in 2011 she became the company’s CEO.
Developing clothing that can monitor health, she says now, enables “a whole new approach to health care. It’s a revolution—for the first time we can have information continuously in a real situation,” without the distractions or stresses of intrusive sensors or a clinical setting.
Her move to research biosensing fabrics came about in part as an attempt to bring together academic research and industrial expertise in her home region of Tuscany. “Pisa is a big university center,” she says, and the region is also “a big textile district” with a long history in that industry. When she joined the company to head its research, they plunged into “a wedding between smart materials and textiles.”
The basic concept began with simply developing conductive fibers that can be integrated into a fabric at the weaving stage—fibers that maintain similar flexibility and washability as the overall fabric. She had been working on molecular electronics in a university setting, and for the first two years on this project “I was basically going around to visit the [textile] factories, which are mostly quite small, but you can find everything. It’s a district in which you can find many small companies that each hold a piece of the puzzle.”
In the early stages, she says “I had to create a lot of the academic part, because the process to go from the laboratory to industry was too long. So instead I used material that was available, to do something different.” For example, at one point she adopted a process that was used in fashion to create special effects in fabric using different types of fibers, including metallic threads, woven into the cloth itself rather than added later. “The project was very successful,” she says, and made it possible to start getting research funding to continue the work.
Much of the research over the years has centered on finding the optimum number and placement of sensors within the garments, and developing the algorithms and software to interpret the signals received and convert them into useful physiological parameters. So far, Paradiso and her team have had success in picking up and interpreting signals that reveal heart rate, respiration rate, electrocardiogram data and information about heart irregularities, body position and activity, stress levels, skin temperature, and motion of joints and limbs. The shirts Paradiso’s company produces now can be tossed right in the washing machine like any other clothing item, she says. “The sensor is just part of the fabric.”
The potential uses for such smart garments span a wide swath of both medical and fitness applications, among others, Paradiso says. Right now, “this is not a product that is addressing a particular application.” Currently they are mostly being used by researchers who are developing ways of using the data for a variety of potential disease-monitoring or mental-health monitoring uses.
For example, one research project, which involves hundreds of patients, is looking for signs of secondary effects such as depression that occur in association with a primary medical condition. By fitting these patients with unobtrusive monitoring systems that require no particular activation or preparation and that can provide readouts of basic vital sign data at regular intervals, the hope is that such secondary conditions could be detected earlier and appropriate responses made available sooner.
There are many other kinds of potential applications for this kind of unobtrusive biosensing undergarments, Paradiso says. One example could be for real-time monitoring of people working in hazardous situations, such as firefighters inside a burning building or soldiers in combat, to provide virtually instant alerts of physical stress or danger, from a sudden spike in heart rate to an interruption of breathing.
“The challenge was developing something that was easy to use, a standard garment, like an ordinary tee-shirt, but able to give a good signal with good quality,” she says. “We start with very ambitious ideas, to make something that would provide data similar to what you would get from a clinical device, able to get all the information you might want. But for now we’re doing something a bit more simple, something that people can use right away.” She and her team of scientists and engineers continue to work on optimizing the configuration of sensors and work with doctors to develop new variations for particular kinds of monitoring (Figure 4). “It’s important to put the sensor as close as possible to the source of the signal you want to measure,” she says.
Pajamas with embedded sensors could be useful for a wide variety of monitoring situations. In an invited talk last year at an international conference on the Internet of Things in Lisbon, Portugal, Paradiso outlined several important potential applications for such sleepwear. As populations are growing older in many parts of the world and life expectancies are rising, more and more elderly people will be facing the need for systems that can be alert for changes that might signal life-threatening or health-threatening conditions. For example, many older people die in their sleep because of hypothermia, she said, but providing a system that can warn of dropping temperature before it reaches a dangerous level is relatively easy with simple temperature sensors properly placed.
Such sleepwear (and potentially also other fabric systems such as smart bedsheets) could also provide early warning of conditions like sleep apnea or other breathing disturbances. And by monitoring movement and position, they could even automatically alert caregivers to a potentially dangerous fall during the night.
One area that Paradiso and her team are actively exploring now is potential uses for mental health monitoring. In a research project called Psyche, they are using personalized wearable systems that monitor movement and cardiopulmonary data as well as other parameters such as voice analysis to try to determine the emotional state of patients with bipolar syndrome.
Ultimately, Paradiso envisions something she calls a Wearable Wellness System, that would constantly monitor a wide variety of parameters, and do so with enough distributed sensors to provide some robust redundancy to ensure continuous monitoring. The various sensors would all connect wirelessly to a central recording and pre-processing device, which would then relay relevant data to a central facility. Such systems, for example, might allow patients who would otherwise need to remain in a clinical setting to monitor their condition could go home or to work as usual, while being constantly monitored by systems that would have no visible outward sign, and would not restrict normal movements in any way. Patients recovering from a stroke might be able to go about their activities while any indications of a recurrence would be quickly detected, as well as providing detailed quantitative data on their progress in terms of activity, range of motion and so on.
Another area of ongoing research is how to translate the many kinds of data such wearable systems can collect into some kind of useful feedback for the user, for example in the management of chronic disease conditions, or even for athletes who want performance-related real-time information about their breathing and heart rate. Particular kinds of garments could easily be tailored, literally, for such specific applications. “This is a platform that can provide a lot of information, but the way that information is presented to the user” is key to making it a real benefit, she says.
Looking to the future, she says, “it’s important to go beyond the first level of processing of the information, to go into more and more interpretation of the data,” she says. As more of these sensing garments get worn by people with different medical situations and in different settings, the data that gets collected could be mined to provide clues as to early warning signs of disease or circumstances or treatments that help to ameliorate those conditions. “We’d like to be able to combine the information that is coming in from these data sensors to produce an interpretation that can be provided by a smart phone, and provide some advice or education,” she says.
“For people that are living alone, or who need some assistance, or need to be assured that someone is looking after them,” even having such a system available could give a greater level of confidence and improve quality of life. For most such uses, “it’s not necessary to have it on for 24 hours. But when they need it, it can be available to check things,” she says.
Paradiso’s multifaceted career, working both as an engineer and as a company CEO, spans areas in which women are relatively underrepresented, which gives her perhaps a unique view of her industry and her business.
“I think the fact that I am a woman probably can in some way affect the way in which I was more patient compared to a man in the same position,” she says. “We had moments in the past, and will have situations in the future, where it is not so easy. A woman can be more constant” through the tough times. As a small company that operates “more like a research lab,” she says, focused more on developing the technology than on doing much marketing or manufacturing, “if I look at it on the research side, the fact that I’m a woman makes me more focused on obtaining some practical results. I never was happy only with doing a demonstration, I was looking for something more stable and reliable. On the other hand, if I look at the business side, maybe I wasn’t aggressive enough, compared to some men,” she says.
What appeals to her most about this work, she says, is its inherent multidisciplinary and diverse nature. For example, “it’s so difficult to combine the design part with the technical part, but both are really important if you want a good product… For me, it was stimulating. I like to meet people with different backgrounds, to understand how they work, this is the aspect that I like in this work, it’s probably the reason I’m doing it. I like to meet people with different approaches.”