Vrije Universiteit Brussel

Smart Textiles and Sensorized Garments for Physiological Monitoring: A Review of Available
Solutions and Techniques
Angelucci, Alessandra; Cavicchioli, Matteo; Cintorrino, Ilaria A.; Lauricella, Giuseppe; Rossi,
Chiara; Strati, Sara; Aliverti, Andrea
Published in:
Sensors

DOI:
10.3390/s21030814

Publication date:
2021

License:
CC BY

Document Version:
Final published version

Link to publication

Citation for published version (APA):

Angelucci, A., Cavicchioli, M., Cintorrino, I. A., Lauricella, G., Rossi, C., Strati, S., & Aliverti, A. (2021). Smart
Textiles and Sensorized Garments for Physiological Monitoring: A Review of Available Solutions and
Techniques. Sensors, 21(3), 1-23. [814]. https://doi.org/10.3390/s21030814

Copyright
No part of this publication may be reproduced or transmitted in any form, without the prior written permission of the author(s) or other rights
holders to whom publication rights have been transferred, unless permitted by a license attached to the publication (a Creative Commons
license or other), or unless exceptions to copyright law apply.

Take down policy

If you believe that this document infringes your copyright or other rights, please contact [email protected], with details of the nature of the
infringement. We will investigate the claim and if justified, we will take the appropriate steps.

Download date: 26. Jul. 2023

 sensors
Review
Smart Textiles and Sensorized Garments for Physiological
Monitoring: A Review of Available Solutions and Techniques
Alessandra Angelucci * , Matteo Cavicchioli , Ilaria A. Cintorrino, Giuseppe Lauricella, Chiara Rossi ,
Sara Strati and Andrea Aliverti

Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy;

[email protected] (M.C.); [email protected] (I.A.C.);
[email protected] (G.L.); [email protected] (C.R.); [email protected] (S.S.);
[email protected] (A.A.)
* Correspondence: [email protected]; Tel.: +39-3407462830

Abstract: Several wearable devices for physiological and activity monitoring are found on the market,
but most of them only allow spot measurements. However, the continuous detection of physiological
parameters without any constriction in time or space would be useful in several fields such as
healthcare, fitness, and work. This can be achieved with the application of textile technologies
for sensorized garments, where the sensors are completely embedded in the fabric. The complete
integration of sensors in the fabric leads to several manufacturing techniques that allow dealing with
both the technological challenges entailed by the physiological parameters under investigation, and
the basic requirements of a garment such as perspiration, washability, and comfort. This review
is intended to provide a detailed description of the textile technologies in terms of materials and
manufacturing processes employed in the production of sensorized fabrics. The focus is pointed at





 the technical challenges and the advanced solutions introduced with respect to conventional sensors
Citation: Angelucci, A.; Cavicchioli, for recording different physiological parameters, and some interesting textile implementations for the
M.; Cintorrino, I.A.; Lauricella, G.; acquisition of biopotentials, respiratory parameters, temperature and sweat are proposed. In the last
Rossi, C.; Strati, S.; Aliverti, A. Smart section, an overview of the main garments on the market is depicted, also exploring some relevant
Textiles and Sensorized Garments for projects under development.
Physiological Monitoring: A Review
of Available Solutions and Keywords: sensorized garments; smart textiles; textile sensors; textile technologies; physiological
Techniques. Sensors 2021, 21, 814. monitoring; wearables
https://doi.org/10.3390/s21030814

Academic Editor: René M. Rossi

Received: 21 December 2020
1. Introduction
Accepted: 22 January 2021
Published: 26 January 2021
The world of wearable devices is vast, and it is constantly expanding. It is intimately
connected with people’s everyday lives, as anything functional to perform daily activities
Publisher’s Note: MDPI stays neutral
is actually “wearable”. Among all of them, wearables applied in the healthcare field are of
with regard to jurisdictional claims in
major interest. Furthermore, the recent worldwide spread of COVID-19 is forcing several
published maps and institutional affil- healthcare providers to rethink the way services are provided and is leading to a faster
iations. digitalization process [1], thus paving the way to a more intensive use of wearable devices
and remote monitoring solutions in the medical field.
By combining the notion of biosensor and wearability, a useful and comfortable
technology can be obtained. The market offers a great variety of wearables with different
Copyright: © 2021 by the authors.
characteristics and monitoring approaches. These are connected in what can be considered
Licensee MDPI, Basel, Switzerland.
a full-fledged network, commonly referred to as body sensor network (BSN) or body
This article is an open access article
area network (BAN). A complete monitoring system implies the presence of an effective
distributed under the terms and communication protocol and reliable data management and processing [2]. A smartwatch
conditions of the Creative Commons which measures a subject’s heart rate, sending data to an application in the user’s mobile
Attribution (CC BY) license (https:// phone that then processes all the information is a simple example of BSN [3–5].
creativecommons.org/licenses/by/ The ultimate goal of these BSNs is the long-term monitoring of a subject without any
4.0/). constriction in time or space. The utilization of wearable sensors could satisfy multiple

Sensors 2021, 21, 814. https://doi.org/10.3390/s21030814 https://www.mdpi.com/journal/sensors

Sensors 2021, 21, 814 2 of 23

needs such as athletes’ performance evaluation, patient remote monitoring, and rehabili-
tation in a safe and accurate way [6], leading the concept of wearable device closer and
closer to what is commonly referred as a medical device. Therefore, the main challenge
is to succeed in combining the characteristics of these two families of devices. Wearable
devices need to be comfortable, practical and should have an attractive design. Size and
weight must match the intended use and simultaneously an adequate power supply and
wireless communication must be introduced. Instead, medical devices must satisfy the
safety and efficacy requirements, providing a precise measure of the physiological parame-
ters. Moreover, the device needs to be certified (e.g., European Medical Device Regulation,
Food and Drug Administration) so as to be produced and marketed in compliance with
safety standards [3,4]. In other words, the product design must integrate well with the
engineering; the simplicity, the usability and the relative cheapness of wearables should
merge with the technological challenges yielded by medical purposes.
Nevertheless, several limitations must still be overcome, such as the technical limit
regarding the duration of batteries, which must not represent a constraint in terms of size
and shape; additionally, the power supply must grant enough usage time for a continuing
monitoring [5,7]. Secondly, the large amount of circulating data introduced by the BSN
itself leads to the problem of privacy. There are regional regulations regarding data
ownership, such as the General Data Protection Regulation (GDPR) [8], but uniform
worldwide regulations are lacking and this cannot be overlooked when thinking about a
future where the use of wearable devices will be ordinary in medicine, sport, fitness, and
more and more taking part of people’s lifestyle.
Moreover, all the components of the measurement system must be embedded in the
same platform, making the ongoing monitoring as natural as wearing a pair of glasses or a
garment. This is the basic idea behind the new generation of wearable systems, in which
the monitoring devices are not only attached to the garment, but sensors and electronics are
integrated into the garment itself. Therefore, the fusion of the textile world and biosensors
represents the turning point of the new generation of wearables. Textile technologies, also
called “electronic textiles”, or simply “e-textiles”, are fabrics made of filaments woven
together in different ways that are capable of interacting with an external environment,
such as the human body. They are also referred to as “smart textiles” to highlight the
ability to accomplish functions that common clothes cannot fulfil [4] in various sectors,
among which are healthcare [9] and industry [10]. Other commonly used terms include
“intelligent fabrics”, “intelligent clothing”, “smart fabrics”, “wearable electronics”, and
“textronics” [11,12].
In particular, the healthcare sector is the main driving force of the e-textiles market
which is growing very fast. The 2015–2025 decade has been recognized as the “Wearable
Era” and the market size is expected to exceed 5.55 billion USD in the next five years [5,13].
Sensorized garments are spreading very fast thanks to the technological advances in terms
of miniaturization, which is essential for a non-intrusive monitoring.
E-textiles must meet different requirements, regardless of the manufacturing. The
choice of the yarn’s material is fundamental because it affects both the production technique,
that has to be adopted by the manufacturer, and the main properties of the sensing garment,
i.e., sensors’ functioning, washability, elasticity, softness, adherence to the body and the final
product’s life cycle. The integration of electronics into the fabric is the pivotal point of this
technology. The intrinsic rigidity of conductive materials must match the normal wearing
conditions, and this is being addressed with flexible electronics. Moreover, wearable
sensors are subjected to mechanical deformations which can seriously compromise their
sensing capability: the skin-sensor interface is one of the main problems that need to
be addressed.
The complete integration of sensors in the fabric leads to a well-defined industrial
manufacturing process. It means that adding the sensors will mainly concern the weaving
process, thus eliminating the further step of embedding them after the production of the
garment. This represents a big advantage in terms of production costs [5]. Furthermore, the
 Sensors 2021, 21, 814 3 of 23

variety of different physiological parameters requires different measurement approaches

to minimize the noise level, whose origin is multifactorial. Finally, if garments are used for
energy harvesting and electricity generation as well as for physiological measurements,
additional specifications are introduced in the manufacturing process [14].
While there are reviews focused only on the aspect of the materials composing the
fabric [15,16] and others focused only on the physiological measurements that can be
obtained, the purpose of the presented work is to provide the reader with a broader
overview of all the aspects related to smart textiles for physiological monitoring, both
in terms of manufacturing and application. For this reason, this review is intended to
provide a detailed description of the textile technologies, describing the implementation
of e-textile to make sensors for physiological parameters measurements. An additional
focus is pointed at the technical challenges and the advanced solutions introduced with
respect to conventional sensors. The presented paper is a focused literature review of
current, high-quality articles in the field of smart textiles and sensorized garments, and
information is obtained from scientific journals in various fields, including but not limited
to biomedical engineering, electronics, materials science, information technology and
mechanical engineering [17]. The articles have been searched on Google Scholar, Pubmed,
Scopus, Google Patents, and Web of Science, using keywords like “garments”, “smart
textiles”, “textile sensors”, “textile technologies”, or similar, and limiting the publication
date to papers published after 2000.
Section 2 introduces the most common textile technologies from the point of view of
manufacturing of conductive fibres, yarns, and inks. Throughout Section 3, applications of
textile technologies employed to record biopotentials, respiratory parameters, and briefly
temperature and sweat are discussed. Additionally, the section focuses on how the new
e-textile systems deal with the technological, design, and measurement challenges, with
respect to conventional technologies. In Section 4, an overview of the sensorized garments
on the market is depicted, also exploring some relevant projects under development.
Section 5 introduces to the latest frontiers in the field of research and is followed by a brief
conclusion in Section 6.

2. Textile Technologies
From the microscopic to macroscopic scale, the fabric is composed of fibres and yarns.
The former is the basic element of the textile material, whilst the latter is an intermediate
material between fibre and fabrics, composed of interlocked fibres. Both the components
can be made conductive applying different techniques [18], the most used of which are
Sensors 2021, 21, x FOR PEER REVIEW 4 of 2
shown in Figure 1; their advantages and disadvantages are synthesized in Table 1 and
further explained in the following sections.

Figure1.1.Most
Figure Mostcommon
common manufacturing techniques
manufacturing of conductive
techniques textiles: textiles:
of conductive knitting, knitting,
weaving, weaving,
embroi-
dery; coating methods;
embroidery; printing methods.
coating methods; printing methods.

Table 1. Synthesis of the main advantages and disadvantages of the manufacturing techniques.

Advantages Disadvantages
skin comfort; low weight; high
Knitting
Sensors 2021, 21, 814 4 of 23

Table 1. Synthesis of the main advantages and disadvantages of the manufacturing techniques.

Advantages Disadvantages
Knitting skin comfort; low weight; high elasticity
long-lasting fabrics; less likely to shrink when
Weaving Complex manufacturing process; limitations in
washing; less likely to lose colour
the choice of fabrics; damaging of the natural
possibility to lay the base material in all directions properties of textiles
Embroidery rather than in pre-defined ones (enhanced
skin-electrode contact)
good conductivity; maintenance of the original fibre
Coating methods properties such as density, flexibility, and handiness; high production cost; difficult to scale production
resistant to corrosion.
durability of printed patterns; optimal
reduction in production cost; possibility of a
Printing methods performance achieved only with smooth and
large-scale production
flat surfaces

2.1. Manufacturing of Conductive Fibres

There are two processes to make conductive fibres: wire drawing and fibre coating.
Wire drawing is a mechanical process that transforms the raw material into microfilaments
with a diameter of 5–8 mm, applying forces with industrial machines. After the drawing,
the microfilament is annealed at a high temperature of 600–900 ◦ C to restore its mechanical
and electrical properties. Afterwards, the wire is cooled and wrapped in a revolving
cylinder. The most used metals for this process are copper, silver, bronze, steel, and silver-
plating copper, and their electrical properties are shown in Table 2. The obtained fibres
yield several advantages. They are resistant to washing and sweat; the fibres are also strong,
biologically inert, and available at low cost. Nevertheless, they are difficult to manufacture
due to their heaviness [4].
Fibre coating consists of applying metals or conductive polymers on the surface of
a non-metallic substrate to make it conductive [19]. The substrate can be either a fibre, a
yarn, or a fabric. In the presented review, the fibre is considered as conductive unit for the
purpose of clarity.
The different techniques used to make conductive fibres are sputtering, chemical
polymerization, electrodeposition, and dip coating. The first two mentioned techniques, i.e.,
sputtering and chemical polymerization, are both classified as Physical Vapor Deposition
(PVD) processes [23,24]. PVD is a coating process carried out in a vacuum in which thin
films are deposited by the condensation of a vaporized form of the desired film material
onto the substrate. The solid coating material is evaporated by heat or by bombardment
with ions, such as in the case of sputtering; at the same time, the introduction of a reactive
gas in the vacuum forms a compound with the metal vapor and is deposited on the
substrate as thin film [25]. This describes what happens in sputtering, where the material is
transformed from solid or liquid to vapor state and then it is carried by a vacuum or plasma
system to the substrate on which it condenses. The conductivity of the final fibre depends
on the type and thickness of the film coating material. The limitations of this technique
concern the elevated production cost and non-trivial scalability of the vacuum processing.
Chemical polymerization is a PVD technique that allows the formation and deposition
of intrinsically conductive polymers with a single step. The deposition is uniform, and the
small thickness does not affect the mechanical properties of the fibres. The deposited films
are wash and wear resistant. This technique shares the limitations of the previous one.
In electrodeposition, a fibre is immersed in a solution containing the ions of the metal
with which the fibre will be coated. An electric current on a conductive material immersed
in the same solution induces the deposition of the metal on the fibre [26].
Sensors 2021, 21, 814 5 of 23

Table 2. Materials used to manufacture e-textiles [4,20–22].

Electrical Properties
Metal
Notes
(Monofilament Conductivity Resistivity Thermal Coefficient of Resistance [10−6 K−1 ]
Fibers) [S·m/mm2 ] [Ω·mm2 /m]
Minimum Typical Maximum
Cu 58.5 0.0171 3900 3930 4000 Corrosion with water
Cu/Ag 58.5 0.0171 3900 4100 4300 -
Biocompatible, stable, rare, unaffected
Ag 99% 62.5 0.0160 3800 3950 4100 by moisture, resonant, moldable,
malleable
AgCu 57.5 0.0174 3800 3950 4100 -
Bronze 7.5 0.1333 600 650 700 -
Steel 304 1.4 0.7300 - 1020 - -
Steel 316 1.3 0.7500 - 1020 - -
Conductive Conductivity
Doping Limitations Advantages
polymer [S/cm]
High conductivity, resistance to
PEDOT:PSS 4700 P Brittle, needs additional steps to process humidity, stable at high temperatures,
transparent
PANI Hard to process, not biodegradable, High conductivity, stable in different
112 P
(Polyaniline) limited solubility environments, low cost
Fabrics Category Relative permittivity (εr ) at 1 kHz Physical characteristics
Cotton Natural 3.004 Absorbent, breathable
Nylon
Synthetic 1.222 Breathable, elasticity
(Polyamide)
Polyester threads
Synthetic 1.178 Breathable
(PES)
Linen Natural 4.007 Absorbent, breathable
Rayon Synthetic 5.082 Breathable, elasticity, transparent
PVC textile Synthetic 3.118 Waterproof, non breathable

Finally, in dip coating, the fibre is immersed in a solution containing conductive

materials. After the removal of the excess material, a drying step (curing) permits the
evaporation of the solvent and the fixation of the conductive particles on the fibre surface.
These coating techniques allow creating conductive substrate with good conductivity,
maintaining the original fibre properties such as density, flexibility, and handiness. More-
over, they are resistant to corrosion, although the adhesion between the fibres and the
metal might present some problems. Finally, the coated fibres are incorporated and twisted
with non-coated fibres so as to form yarns [4].
In general, the fibres are composed of a core made of cotton, polyester and lycra,
whilst the metals chosen for coating purposes are mainly silver, stainless steel and copper,
whose characteristics are listed in Table 2 [4,21,22,27]. In particular, the information on the
metals are reported with a higher level of detail in the works by Stoppa and Chiolerio [4]
and by Kunal Singha et al. [20].

2.2. Manufacturing of Yarns

As far as the yarns are concerned, these can be manufactured in different ways to
form the fabrics. The manufacturing processes are knitting, weaving, and embroidering;
the resulting fabric is named after the used technique. The processes used for smart textiles
are the same as those used for regular textiles.
A knitted fabric is made of a single yarn looped continuously to create a braid-shape
and with the use of a needle, a series of yarns are connected. This manufacturing technology
carries several advantages: skin comfort, low weight, and high elasticity. In fact, the knitted
fabric is slightly more stretchable in width than in length, but if stretched too much it may
lose its shape. Another problem concerns the intermittent contacts between the yarns that
can create fluctuation in electrical resistivity [27].
Sensors 2021, 21, 814 6 of 23

Knitted fabrics provide stretchiness and temperature control, and thus, they are
preferably employed for warmth, comfort, and wrinkle resistant applications, like clothing,
although they shrink when frequently washed.
The knitting technology can be divided into weft and warp fabrics. Weft knitted
fabrics, produced in flat or tubular form, are highly elastic and drapeable, while warp
knitted fabrics are not much elastic while difficult to reveal [18,28].
On the other hand, the woven fabrics interlace two perpendicular sets of yarns that
cross each other at right angles to form the grain. The fabric could loosen along its length,
but never along its width [27]. Thanks to the high manufacturing tension, these fabrics are
long-lasting and less likely to shrink when washing, as well as to lose their colour.
The knitted fabrics and woven fabrics are mass produced using the weft (or warp)
knitting machine and the loom machine, respectively [18,27].
Another typology of fabric is the embroidery, a decoration of conductive patterns on
finished textile surface. This technology is of interest in the field of smart textiles because of
the possibility to lay the base material in all directions rather than in pre-defined ones [29];
because of this, an enhanced skin-electrode contact can be obtained [27].
Among all the fabrics, there are also non-woven textiles that show a random trend
of the fibres, without identifying any ordered structure and privileged directions. Non-
woven substrates are often made of high-quality fibres with versatile properties which can
transform a two-dimensional substrate into a three-dimensional product. They function,
often hidden away, as inserts, paddings, or as backings to give support to outer shell
fabrics or three-layer assemblies or used as linings or insoles. Additionally, the surface
structure, density, porosity, and thickness of non-woven fabrics can be controlled during
the manufacturing process in a faster and cheaper way. For this reason, non-woven fabrics
are more suitable for printing techniques, which will be discussed in the following sections.
However, woven are more comfortable to wear as they are more flexible and breathable
than nonwovens, which are temperature and humidity dependent [28].
All the manufacturing technologies described above (weaving, knitting and embroi-
dery) have many disadvantages such as complex manufacturing processes, limitations in
the type of fabrics, and inevitable damage of the natural properties of textiles. For this
reason, printing technologies, such as screen printing, inkjet and flexographic, were devel-
oped to create conductive patterns on textile substrate allowing a reduction in production
cost and a large-scale production. A drawback of printing methods is that the performance
depends on ink penetration to the substrate, so it is optimized when the surface is smooth
and flat, and ink is thus not dispersed into the internal surface of the substrate. Another
challenge is the durability of the printed pattern with prolonged use [16].
The screen-printing method consists of using of fine meshes or stencils applied on
a substrate. These have openings to enable the preferential passage of conductive inks
only on the area of interest of the substrate. This method allows eco-friendly fabrication
procedures and can be easily applied to various surfaces, such as plastics, paper, polymers,
and textiles.
The inkjet printing method controls the accurate deposition of ink on different sub-
strates, such as paper, glass, PET and polymer substrates. This printing method has a
controllable nozzle to allow spraying the ink in the region of injection without a mask.
Moreover, this technique allows a reduced production time.
Flexographic printing is a faster technique than the previous two and it works better
with conductive inks. It is capable of high-level printing with a high resolution. Flexogra-
phy is a direct rotary printing method, which uses raised matrix plates [27,30].
Various materials can be used to create conductive inks, however, the most largely
used are the silver nanoparticles. Silver is the most suitable material for conductive circuits
in printed electronic devices because of its high electrical conductivity, oxidation resistance,
and good biocompatibility. It is also strong, unaffected by moisture, resonant, moldable,
malleable and with highest thermal coefficient. Moreover, the silver printed fabrics are
washable, although the repeating washing can reduce the conductivity substantially [30].
Sensors 2021, 21, 814 7 of 23

Conductive polymers, like polyaniline (PANI) and PEDOT:PSS, are used in all the
mentioned techniques, as they are light, low cost, with good conductivity and mechanical
flexibility. These organic polymers unite both metals’ electrical properties and plastics’
mechanical features [31].
They are suitable to produce electrically conductive yarns, antistatic coatings, electro-
magnetic shielding, and flexible electrodes. The most explored conductive polymer for
conductive textiles applications is PEDOT:PSS. It can be directly polymerized or printed
on the fabric or it can be used for fibres coating [22]. One of the first e-textiles, still used
nowadays as a basis for the new prototypes in commercial industry, is the U.S. patent:
“a composite elastic and wire fabric for physiological monitoring apparel” [32]. It was
patented in 2002 and it is formed by elastic bands with conductive wire affixed following a
curved pattern.

2.3. Applications of Stretchable and Conductive Inks

Conductive inks can be used for two main purposes: one is to realize electrodes and
sensors themselves, while the other is to obtain the conduction of signals in the garment
(conductive wires).
A procedure to print conductive ink may be constituted by the following steps: print-
ing an adhesive onto a compression fabric in a first pattern (the adhesive is elastic when
dry); printing a conductive ink onto this first pattern; forming a gradient region between
the conductive ink and the adhesive. This gradient region comprises a mixture of the
conductive ink and the adhesive and the concentration of the ink in the gradient region
decreases from a region closer to the layer of conductive ink to the layer of elastic adhe-
sive [33]. There are specific techniques that make it possible to directly print a conductive
ink onto a fabric, however this usually requires high temperatures. For this reason, there
are research and industrial efforts to do so with nanoparticles at lower temperatures in
order not to damage the fabric itself [34,35].
In terms of conductive wires, a limitation that is found in garments for the measure-
ment of physiological parameters is that the leads providing power to and receiving signals
from the sensors have not been fully integrated with the garment in a way that allows
the garment to be flexible and comfortable [33]. A solution that has been found is to
realize these connectors with the material SPIDON, a flexible fabric ribbon [36]. The L.I.F.E.
shirt, which is described later in Section 4, is an example of sensorized garment that uses
conductive ink both for ECG electrodes and connectors.
Furthermore, conductive inks printed atop textiles are vulnerable to cracking because
of the deformable and porous structure of textiles. A solution that has been found to
this problem consisted of controlling the ink permeation in the structure of the textile by
adjusting the ink’s solvent [37].

3. Measurement of Physiological Parameters

Figure 2 shows some common placement sites of the monitors of different physio-
logical parameters on a sensorized compression garment, which keeps the sensors in the
needed positions to perform the needed measurements while avoiding movement artefacts.
In fact, specific solutions have been developed to solve this problem: one example is a
support mechanism that can be expanded in a direction perpendicular to the sensor/inner
surface of the garment, where the support is backed by a supporting structure that is less
flexible than the inner fabric of the garment, so that expanding the support puts the sensor
in contact with the body [38].
In all the presented technologies, it must be noted that the benchmarking of the
sensing performances is referred to single works presented in the literature, since different
research projects obtained different results.
 Sensors2021,
Sensors 21,x814
2021,21, FOR PEER REVIEW 9 8ofof25
23

Typicalplacement
Figure2.2.Typical
Figure placement sites
sites of of sensors
sensors that
that cancan be included
be included in sensorized
in sensorized garments
garments (ECGs,
(ECGs,
respiratorysignal
respiratory signalmonitors,
monitors,IMUs,
IMUs,pulse
pulseoximeters,
oximeters,other
othersensors).
sensors).

3.1. Biopotentials
3.1. Biopotentials
Biopotentials are physiological electrical signals arising from the activity of electrically
Biopotentials are physiological electrical signals arising from the activity of
excitable cells, the detection of which, depending on the region, allows the monitoring of
electrically excitable cells, the detection of which, depending on the region, allows the
the cardiac activity (ECG), brain activity (EEG), and muscular activity (EMG) [5]. Their
monitoring of the cardiac activity (ECG), brain activity (EEG), and muscular activity
main characteristics are synthesized in Table 3 and later explained in Section 3.1.
(EMG) [5]. Their main characteristics are synthesized in Table 3 and later explained in
Section 3.1.
Table 3. Synthesis of the main characteristics of biopotentials and used electrodes.

Table 3. Synthesis of the main characteristics of biopotentials and used electrodes.

Electroencephalography Electromyography
Electrocardiography (ECG)
(EEG) (Surface EMG)
Electroencephalography Electrocardiography Electromyography
(EEG)Assessment of heart rate (ECG) (Surface
Movement EMG)
tracking;
Sleep monitoring; diagnosis of variability; cardiovascular
Main applications Assessment telerehabilitation; prostheses
neurological diseases disease monitoring; cardiacof heart rate
control
Sleep monitoring; variability;
rehabilitation monitoring Movement tracking;
Main
Textile technologies diagnosis of neurological cardiovascular disease telerehabilitation;
applications
Knitting, printing Knitting, printing, coating Knitting, printing
reported in the literature diseases monitoring; cardiac prostheses control
Skin-electrode contact rehabilitation monitoring
Number of achievable leads; Motion artifacts; variability in
Issues Textileaffected by the
impedance
motion artifacts skin-electrode contact impedance
presence of a hairy scalp
technologies Knitting, printing,
Knitting, printing Knitting, printing
reported in the coating
literature
Traditionally, biopotentials are acquired using wet and disposable Ag/AgCl electrodes
only in clinical or laboratory environments
Skin-electrode contact [39]. These electrodes areMotion
characterized
artifacts;by a
gel layer to decrease the skin-electrode contact impedance,
impedance affected by Number of achievable and an variabilitypadding
adhesive in skin- to
Issuesthe skin contact and reduce the motion artifacts. This system involves several
increase the presence of a hairy leads; motion artifacts electrode contact
disadvantages. The first disadvantage
scalp is the long setting time due to skinimpedance
preparation and
electrodes placement, which requires trained personnel.
The second disadvantage
Traditionally, biopotentialsisare
thatacquired
the gel materials
using wet might
andcause allergic Ag/AgCl
disposable reactions
or irritations, and the third one is that wires constrain the movements resulting in an
electrodes only in clinical or laboratory environments [39]. These electrodes are
uncomfortable system [27]. Therefore, textile technologies are considered an appealing and
characterized by a gel layer to decrease the skin-electrode contact impedance, and an
 Sensors 2021, 21, x FOR PEER REVIEW 10 of 26

adhesive padding to increase the skin contact and reduce the motion artifacts. This system
involves several disadvantages. The first disadvantage is the long setting time due to skin
Sensors 2021, 21, 814 preparation and electrodes placement, which requires trained personnel. 9 of 23
The second disadvantage is that the gel materials might cause allergic reactions or
irritations, and the third one is that wires constrain the movements resulting in an
uncomfortable system [27]. Therefore, textile technologies are considered an appealing
valid
and alternative,
valid introducing
alternative, introducing‘dry’‘dry’
electrodes to replace
electrodes the traditional
to replace ‘wet’ electrodes.
the traditional ‘wet’ The
most important
electrodes. The mostadvantages regard high
important advantages comfort,
regard no setting
high comfort, time, freedom
no setting time, freedom of movement,
ofand performing
movement, and long measurements
performing in any environment.
long measurements Still, e-textile
in any environment. Still,technologies
e-textile entail
some critical
technologies aspects
entail somesuch as aspects
critical high skin-electrodes contact impedance,
such as high skin-electrodes contact sensitivity
impedance, to motion
sensitivity
artifacts to motion
[40]. artifacts
Textile [40]. Textile
electrodes electrodes
are devoid of are
thedevoid of the gel
traditional traditional
layer, thusgel layer,
an additional
thus an additional impedance between the skin and the electrode is introduced,
impedance between the skin and the electrode is introduced, reducing the signal-to-noise reducing
the signal-to-noise
ratio. In Figure 3,ratio. In Figure 3,circuit
an equivalent an equivalent circuit of the skin-electrode
of the skin-electrode interface is depicting
interface is proposed,
proposed, depicting
this effect. this effect.

Figure3. 3.
Figure Equivalent
Equivalent circuit
circuit of theofinterface
the interface
betweenbetween
skin andskin and electrodes
electrodes inofthe
in the case (a)case
wet of (a) wet
electrodes
electrodesand (b)(b)
and textile electrodes.
textile The figure
electrodes. was adapted
The figure from [27].
was adapted Ehc represents
from the electrode;
[27]. Ehc represents the electrode;
Cd and Rd represent the impedance due to the sensor-electrolyte interface; Ct (only present in textile
Cd and Rd represent the impedance due to the sensor-electrolyte interface; Ct (only present in
electrodes) and Rs represent an impedance due to the electrolyte layer; Ce and Re represent the
textile electrodes)
middle-layer and R
impedance; Csp represent an impedance
and Rp represent due
the sweat to theRelectrolyte
glands; layer; Ce and Re represent
a represents the inner-layer
the middle-layer
impedance, acting asimpedance; Cp and
a pure resistance Rp cases.
in both represent the sweat glands; Ra represents the inner-layer
impedance, acting as a pure resistance in both cases.
The reported skin model is composed of an outer layer, modelled as a voltage
TheEreported
generator skinlike
sc, as it acts model is composed of
a semipermeable an outer causing
membrane layer, modelled as ain
a difference voltage
ion genera-
concentration. An like
tor Esc , as it acts innera semipermeable
layer acts like amembrane
pure resistance,
causingRa,a and the middle
difference in ionlayer
concentration.
impedance is modelled
An inner layer as aaresistance
acts like Re and capacitance
pure resistance, Ra , and theCemiddle
in parallel to another
layer couple
impedance is modelled
Cas
p and Rp which represent the sweat glands. Concerning the ‘wet’ electrode, the sensor-
a resistance Re and capacitance Ce in parallel to another couple Cp and Rp which rep-
electrolyte
resent the interface
sweat is depicted
glands. as the parallel
Concerning theof‘wet’
resistance Rd andthe
electrode, capacitance Cd, and the interface
sensor-electrolyte
electrolyte layer is only modelled as the resistance Rs. In the ‘dry’ electrodes circuit, this
is depicted as the parallel of resistance Rd and capacitance Cd , and the electrolyte layer
is only modelled as the resistance Rs . In the ‘dry’ electrodes circuit, this last resistance
is replaced by a significant impedance composed of the capacitance Ct and resistance
Rs , where Ct is inversely proportional to the skin moisture and sweat. Finally, the elec-
trodes in both cases are represented by the potential Ehc [27]. The models of the skin and
electrode-electrolyte interface [41] are based on the combination of equivalent circuits for
the electrode-electrolyte interface [42] and equivalent circuits of the skin [43].
The overall impedance of wet electrodes can be computed as follows:

Rd Req
Zwet = + Rs + + Ra (1)
1 + jωRd Cd 1 + jωReq Ceq
Sensors 2021, 21, 814 10 of 23

Considering Req and Ceq as the resistance and the capacitance obtained from the
parallel of the middle-layer and the sweat glands in both models in Figure 3. In the case of
textile electrodes, the previous formula becomes:

Rd Rs Req
Ztextile = + + + Ra (2)
1 + jωRd Cd 1 + jωRs Ct 1 + jωReq Ceq

Since, in comparison to standard metal electrodes, textile electrodes show a strong

capacitive behaviour at the interface due to the lack of the hydrogel or electrode paste,
which is often used as an electrolyte layer, this behaviour is compensated for by introducing
a hydrogel membrane between the garment and the skin. The knitted pattern has shown to
enhance the fibre-skin contact, a better tolerance to noise, and results to be more comfortable
with respect to the woven pattern. Other factors affecting the skin-electrode impedance
are the electrodes’ dimension: the bigger it is, the lower the contact impedance [27,44];
moreover, the sweat has proven to enhance the SNR. In any case, the skin-electrodes contact
impedance is very difficult to evaluate due to the high inter-subject variability as well as
intra-subject variability, i.e., hairy and non-hairy regions [45].
The second critical aspect concerns the susceptibility to motion artifacts, which de-
pends on the size and tightness of the garment. The adhesion between electrodes and the
skin is not guaranteed by the traditional adhesive padding, and depends on the fitting of
the garment, thus, the artefact is difficult to address This noise is often confined by placing
preamplifiers subsequently after the electrodes and using digital signal processing (DSP)
algorithms [27].

3.1.1. Electroencephalography
Electroencephalography (EEG) is a technique designed to monitor brain activity by
recording the postsynaptic electrical signals non-invasively. The biopotentials are detected
using surface electrodes placed on the scalp, and the recording is characterized by high
temporal but low spatial resolution. EEG is used in several clinical applications, among
which are diagnosis of neurological diseases and sleep monitoring, where e-textile solu-
tions are introduced to provide accessible, comfortable, and long-term measurements [27].
A characteristic hindrance to EEG measurements consists of the high skin-electrode contact
impedance due to the hair on the scalp, which is dealt with by measuring the biopotentials
on the forehead with textile electrodes embedded in garments such as hairbands or hats,
and some explanatory examples follow.
The first e-textile application concerns a set of electrodes manufactured with a seamless
knitting technology in which a wire coated by Ag/AgCl is woven inside a nylon headband.
The electrodes were placed on the forehead to avoid hair interference demonstrating good
functionality on long measurements while maintaining constant and high comfort [46].
Another application consists of a set of electrodes fabricated by a printing technique.
The electrodes are placed on a headband in which the circuit is printed through conductive
ink and connected to the electrical components by silver loaded epoxy adhesive. The whole
system is covered by a printed layer of dielectric and then by a printed layer of conductive
material composed of carbon loaded rubber; an innovative element of this project concerns
the power supply, based on solar panels [47]. To prove the reliability of this approach, the
measurements were correlated with EEG recorded by standard Ag/AgCl electrodes during
a real time emotion classification experiment. The comparison resulted in a correlation of
70.88% and an accuracy of 90 (±9)% [47].
In another work by Lin et al., a novel electrically conductive polymer fabric, which
had 0.07 Ω/square of conductivity, was coated on a 0.2 mm thick taffeta material and
benchmarked against standard electrodes, showing a high correlation of ~96% and ~90%
from the forehead and hairy sites on the head [48].
Lastly, a case is described where the measurement system is composed of a set of
polyaniline (PANI)-coated PU foam electrodes fabricated by an in situ aniline polymeriza-
tion technique. Everything is covered by an insulating cotton fabric with a central hole
Sensors 2021, 21, 814 11 of 23

to allow skin-electrode contact. The advanced characteristic of this research concerns the
electrodes’ location, which is on the hairy scalp. Comparing the EEG in frontal position
(FP2-F4) and on the scalp, the results were very similar, and this was possible thanks
to the deformability of the foam electrode which was maintained in place by a Velcro
with a certain compression. This mechanism allows the maintenance of very low contact
impedance even without gel and for long-term measurements [49].

3.1.2. Electromyography
The electromyography (EMG) is a technique used to assess the muscular activity by
analysing the electrical signal driven from the central nervous system to activate muscles.
The electromyogram allows the investigation of the complex cooperation of different
muscular groups [39]. Textile technologies are introduced to acquire surface EMG for
home-rehabilitation, telemonitoring, prosthesis control, athletes’ performances tracking in
different environments and other applications [39,45,50–52].
The critical aspects regarding surface EMG measurements concern motion artifacts,
skin-electrode impedance, which depends on the garment fit, and repeatability of the
measurements due to changes in electrodes placement [44,45]. The motion artifact is
counterbalanced by the big size of textile electrodes which target the activity of a whole
muscle group, contrary to traditional electrodes that capture the activity of single muscular
units [45]. Textile-based electrodes used in a study denoted comparable performance to
Ag/AgCl electrodes when the diameter of the electrode was greater than 20 mm and the
applied pressure greater than 10 mmHg, while the baseline noise showed a tendency to
increase with decreasing electrode size [53].
The most conventionally used textile technology for EMG electrodes is based on
conductive yarns. For example, Samner et al. in collaboration with SMARTEX [54] created
a textile electrode based on a conductive yarn made of stainless steel fibres and elastane.
This electrode is backed up by a more rigid material to enhance the skin contact and the
adhesion of the electrode also during movement. The connection between electrodes and
data storage unit is created by yarns composed of stainless-steel fibres coated with PVC [55].
In this case, the fabric and the conductive fibres were intertwined using a knitted pattern,
whereas in other scientific words a different manufacturing technique, the embroidery,
was used instead. This last allows a better customization in the design and shape of the
electrodes compared to knitted patterns, therefore, embroidered electrodes better adapt to
different application and monitoring scenarios [45].
Another application of stainless-steel conductive fibres to record EMG concerned
the control of an active hand and wrist prosthesis. A high density EMG was recorded
using a sleeve on which 100 electrodes are placed and grouped in four 5 × 5 grids [50].
This application is realized because of the employment of textile electrodes; in fact, in a
clinical environment this system would require a long setting time and trained personnel
for the set up and overview, whereas the wearable system permits discarding setting time
and electrodes placement variability, and increased comfortability [50]. Moreover, the
activity can be performed at home while being tele-monitored, increasing the frequency of
rehabilitation and thus the successful rate.
The last example of EMG textile technology is based on an advanced technology.
A conductive Ag-powder/fluoropolymer-based nanocomposite ink is jet-printed on both
side of a porous substrate, creating a high performing textile sensor. The two-layers printing
method introduces several advantages; the conductive ink coats the nanofibers in the inner
fabric layers, enhancing the mechanical durability, conductivity and adhesion of conductors
to the textile, in addition to separating the conductive traces from the skin contact as they
grow on the two opposite sides of the fabric. This two-layer design has signed a new path
for an innovative approach to build textile sensors to record biopotentials in general [40].
Sensors 2021, 21, 814 12 of 23

3.1.3. Electrocardiography
The electrocardiography (ECG) is the most utilized technique to assess the cardiovascu-
lar system. Traditionally, surface electrodes are placed on the chest to detect abnormalities
of the heart rhythm non-invasively or monitoring cardiac rehabilitation [56]. The parame-
ters that are usually extracted are the P-QRS-T complex, the heart rate, and the heart rate
variability, as the alteration of these quantities is associated with cardiovascular diseases
such as atrial fibrillation, and atrioventricular block. Nonetheless, changing heart rhythms
can only be detected in long-term recordings, yet traditional recording systems are highly
uncomfortable and constrain normal movements. In this context, e-textile electrodes are
appealing especially for the high comfort of long-term recordings.
In terms of benchmarking, the evaluation of ECG generally aligns with three levels:
(1) Heart rate (HR), and heart rate variability (HRV); (2) QRS complexes comparison; (3) P,
T waves and related segments for further examination. The same-time-different-location
comparison with a calibrated device is a general method to evaluate the performance of
a new device [57] and different examples can be found in the literature, showing good
correlation results [58]. As an example, in the work by Yapici and Alkhidir [59], the
comparison of the results of conventional electrodes with the textile ones showed that
the signals conform very well in time domain and display an average cross-correlation of
88% for the entire waveform and a maximum of 97% was achieved between two P-QRS-
T segments.
When analysing the textile technologies applied to make ECG electrodes, a wide
variety of techniques is used [27]. Therefore, two e-textile applications that confront the
issues regarding ECG recordings are proposed. The majority of e-textile systems is based
on two and seldomly more leads to record ECG [56]. Yu et al. proposed a research where
a 12-leads ECG measurement has been compared to a traditional Holter recording. The
12-leads are inferred from the combination of 10 textile electrodes based on electrically
conductive fabric (Shieldex Med-tex P180, Statex, Bremen, Germany) [60]. Among the
12 leads, three are independent and nine are redundant, making the recording more reliable
and less prone to motion artefacts, which are one of the most important sources of noise
for e-textile ECG systems. Other strategies to reduce this noise are proposed, based both
on hardware and software solutions [45].
The last application is used for both ECG and EMG recording and stimulation pur-
poses. The electrodes are made of PEDOT:PSS which is brush-coated or printed on a
fabric, and the region of deposition is fenced by a PDMS rubber-like layer that is previ-
ously printed [49,61]. This technique has good performances during long-term monitoring
of dynamic activity, and the use of this polymer is spreading, as it demonstrates high
stability in water and resistance to mechanical stress whilst maintaining conductive prop-
erties [31]. The gel layer decreases the skin-electrodes impedance and the motion artifacts
are highly moderated.

3.2. Respiratory Parameters

Monitoring the respiratory system allows preventing and screening for several dis-
eases such as lung pathologies, heart failure, cardiopulmonary decompensation, and sleep
apnoeas, as the well-functioning of this apparatus depends on several factors. Different
methods have been recently developed to track the respiratory parameters outside of
the clinical environment, and sensorized clothes fit well in this context because of their
comfort, practicality, and non-invasiveness [62]. To track the respiratory trend, it is possible
to use the combination of two parameters related to breathing, oxygen saturation and
minute ventilation [3]; information on the performed activity, available in sensorized gar-
ments equipped with inertial units, helps to understand whether a patient is experiencing
activity-related fatigue or distress [63].
Peripheral blood oxygen saturation (SpO2 ) is a first indicator of a well-functioning
lung as it is the portion of oxygen bond to haemoglobin in the blood; generally, it is recorded
Sensors 2021, 21, 814 13 of 23

at the earlobe or fingers using pulse oximeter. Minute ventilation is defined in function of
time, and it is determined by the parameters’ respiratory rate (RR) and tidal volume.
Concerning the evaluation of oxygen blood saturation, Rothmaier et al. conducted a
study on the feasibility of a textile pulse oximeter. They compared different manufacturing
methods, woven and embroidered textiles, of PET fabrics with embedded PMMA optical
fibres in a pair of gloves to determine which technique results in a better light transmission
and receiving capability of the textile sensor. The woven fabric did not allow a proper
transmission or reception of the light as the optical fibres were arranged parallel to the skin,
and thus, requiring additional conditioning. Instead, the embroidered fabric resulted as
more feasible, and with an SNR directly proportional to the number of optical fibres and the
light intensity [64]. Another solution is proposed by Satharasinghe et al. who developed a
system in which an LED and a photodiode were incorporated into the fabric in a practical
and comfortable way [65]. The technology was tested for the measurement of heart rate
(HR), but its usability was guaranteed for all measurements concerning the use of LEDs and
photodiodes, including the measurement of oxygen saturation [65], as the opto-electronic
performance of the two textile sensors resulted comparable to standard technologies.
Following which, the evaluation of minute ventilation is considered, which is pursued
by the quantification of the tidal volume. In the literature, e-textiles including respiratory
sensors have been largely studied [51]. A limitation that is found in wearable devices
based on the variation of the thoracic dimension is that measurements are acquired in one
spot of the chest wall, i.e., only one degree of freedom is considered in the model [66],
while it is known from the literature that the rib cage and the abdomen give different
contributions to the tidal volume with changing postures [67]. For this reason, garments
that can embed multiple respiratory sensors in different positions allow to obtain more
accurate measurements. Pacelli et al. studied the integration of two piezo-resistors in the
fabric, created with two different manufacturing methods: the first one by embroidering
a conductive yarn, Belltron® 9R1 (Aramid Hpm LLC., Hilton Head, SC, USA), and the
second one by printing a conductive elastomer supplied by Wacker LTD. The two sensors
were tested for the evaluation of respiratory activity, and then employed in the MyHeart
project for the prevention of cardiovascular diseases. To evaluate the respiratory pattern,
the change in chest volume, and therefore, the change in the resistance of the piezo-resistors
due to the deformation of the tissue was detected, and the results were compared with a
plethysmography measurement. In conclusion, both sensors guaranteed a wide area of
linearity, and hence, a good evaluation of the volumetric change, assuming low motion
artefacts between the sensors and the body [68]. Concerning the motion artefact, Messad-
deq et al. proposed a solution, using an antenna sensitive to the volumetric variations of
the chest, and thus, of the lungs. The spiral antenna was made of multi-material fibres
consisting of polyimide-coated hollow-core silica glass capillaries in which a silver layer
was deposited using the liquid state deposition technique; the sensor was subsequently
integrated into a cotton t-shirt. The antenna had the lower return-loss at the resonance
frequency of 2.45 GHz, the gain of 3.41 dB and the radiation pattern that was a combination
of half-wave dipole and multiple-turns spiral antenna. The detection of the breathing rate
relied on the change of the antenna geometry due to the fabric mechanical stretch, and to
the change of dielectric properties of the torso during breathing. Both these mechanisms led
to a shift of the antenna’s resonance frequency: 5% stretch entailing a 0.006 GHz frequency
shift, and 3.6 mm lung offset leading a decreased dielectric constant yielding to 0.030 GHZ
shift [69].
Another project is ProeTEX, which focuses on developing interoperability sensors to
continuously monitor the physiological parameters of the emergency-disaster personnel.
The measurement of SpO2 and minute ventilation was performed by a shirt which is
directly in contact with the body. Minute ventilation recordings were pursued by a textile
piezo-resistor and a wire-shaped piezoelectric transducer with high electromechanical
sensitivity, and this last configuration increased the SNR making the signal detection more
robust and reliable, although the average measurement error increases with increasing
Sensors 2021, 21, 814 14 of 23

temperature. The performances of these sensors were compared with a gold standard
measure performed by a commercial spirometer. In the same context, the SpO2 was
recorded by an optical transducer, based on controlled-source electromagnetic (CSEM)
technology and made of several couples of light transmitter and receivers. A built-in
processor triggered the best-located transmitters to obtain the highest signal level [70].
There are also research projects that use fibre optic technologies to measure the respi-
ratory rate. In particular, Fiber Bragg Grating (FBG) sensors are able to convert the physical
movement of the thorax during inspiration and expiration into a wavelength shift. For this
reason, this technique has been exploited in several research works [71].
Finally, several studies show a good agreement between the results obtained with the
garments and previously validated methods. The work by Scilingo et al. [72] presents a
comparison of performances of strain fabric sensors and a gold standard for the measure-
ment of respiratory parameters, with positive results. Massaroni et al. [73] compared a
smart garment with six piezoresistive elements with the results obtained with optoelec-
tronic plethysmography [74]: the difference between the average respiratory frequency
was always lower than 1% and 4% during quiet breathing and tachypnea, respectively.

3.3. Temperature and Sweat

Among all the different physiological parameters, temperature is an important indica-
tor of the physiological homeostasis. It normally ranges between 36.5 ◦ C and 37.5 ◦ C and
it can change depending on several internal and external factors. The traditional sensors
used for temperature sensing are resistance temperature detectors (RTDs), thermistors, and
thermocouples [75]. However, these conventional and widely used technologies permit
only periodic measurements, whereas several applications require continuous temperature
monitoring, e.g., for new-borns’ care. This problem can be overcome with temperature
sensing fabrics (TSFs), which involve different technologies. The most common are RTDs
and Fiber Bragg Grating (FBG) sensors integrated into the fabric.
Among the traditional sensors, RTDs are proved to be the most suitable to integrate in
a fabric. The design and the simple electronics allow an easy adaptation to the industrial
scale. Copper, Nickel and Tungsten are typically wrapped with a mixture of cotton and
polyester. The resistance-temperature relationship has a linear trend and the measurement
can be performed thanks to a small current supply, which passing through the metal wires
provides a voltage drop proportional to the temperature [75].
The FBG sensor is an optical fibre whose core contains an alternation of a periodic
portion of material with a different refractive index. When the light propagates within
the fibre, some wavelengths are lost, and others are transmitted. The returning light
will present a wavelength shift indicative of the skin’s temperature [76]. The FBG sensor
is made sensitive with a metal coating, whose periodicity will change accordingly to
the temperature and consequently the light’s pathway inside the fibre will be modified.
A further coating is applied to increase the sensitivity of the overall sensing element,
composed by a plurality of FBG sensors. FBG sensors find applications also in pressure
measurement together with capacitive sensors.
Finally, the detection of sweat is a possible application: a real time monitoring of its
chemical composition could be useful in medicine and fitness, and it could help in the
diagnosis of several pathologies such as cystic fibrosis. Moreover, a continuous measure-
ment could be particularly useful for athletes to keep dehydration under control. The
main problem when facing chemical sensors is the collection of the sample, and a textile
application for sweat detection is non-trivial. The majority of the textile solutions are based
on a handling system [77], which collects sweat thanks to a moisture wicking material. The
sweat is collected from the skin surface and it is brought to the sensing area by a micro
pump. Then, an optical detection system is used to perform the measurement, typically
based on a colorimetric approach. However, it should be underlined that the described
process still takes a time around 25–30 min before providing results [77]. This is the average
time needed to produce enough sweat that then needs to saturate the acquisition layer.
Sensors 2021, 21, 814 15 of 23

4. Sensorized Garments
After revising some applications of textile technologies to monitor physiological
parameters, here we bring attention to the sensorized garments on which the technolo-
gies are embedded. According to the area of application, garments can be divided in
five groups [16], as garments for:
• Healthcare, to be applied for the monitoring of different health conditions.
• Sport, to be applied for the monitoring physiological parameters and the tracking of
athletic performances during training or competitions.
• Fitness, to help the training of general consumers and to allow them to have a more
comprehensive understanding of their wellbeing.
• Social, to facilitate users in leisure activities.
• Work, to support users during work activity, in terms of both performance and safety.
Although there are five categories, the only garments available on the market are
mainly in the fields of health, sport and fitness. In Table 4, the main garments currently pro-
duced are listed, including type of product, company, fabric structure, sensed parameters,
data communication protocol and placement of the e-module, if available. Even though
the majority of garments are applied on the torso and upper limbs, there are also examples
of sensing elements placed on the lower-limbs [78] and the head.
The system architecture includes both hardware and software items, and it is com-
posed of several subunits: control, communication, location, power, storage, display,
sensing, actuator and two supporting subsystems that are the interconnection and soft-
ware.
The sensing and actuator units can be based on textile technologies connected to the
electronic board where all the other electronic subunits are integrated, or non-textile, and
then integrated in the electronic board too [18].
The on-body sensors data are transmitted to the nearest Personal Digital Assistant
(PDA) through a short-range communication node based on a low power wireless system
such as ANT+, NFC, or Bluetooth, and this last is the most used [102]. The PDA can be a
smartphone, computer, or a Field Programmable Gate Array (FPGA) on which processing
algorithms and the data storage system are held. Another communication node permits
the transfer of data to a remote healthcare server [103].
Following this, three garments representing the health and sport/fitness categories
are described, to exemplify the utilization of textile technologies in marketed items.
First, the Hexoskin t-shirt (Carré Technologies Inc., Montréal, Canada) provides a
wearable health monitoring system measuring, for example, HR, maximal heart rate
(HRmax ), heart rate at rest, heart rate variability (HRV), heart rate recovery (HRR), RR,
tidal volume, oxygen consumption, movement, step count, cadence, stride, activity level,
burnt calories, and sleep quality. The commercial t-shirt is composed of textile electrodes
to obtain a single-lead ECG and an e-module including breathing and movement sensors,
called Hexoskin Smart Device. This has 30 h+ of battery life rechargeable with a USB
cable. The Vest is made of Knitted (73% micro polyamide, 27% elastane) fabric that is anti-
bacterial, UV protective, quick dry, and washable. The Hexoskin device can be connected
to the Hexoskin App with a Bluetooth protocol, allowing the user to set up the vest and
visualize the collected data. The system is also compatible with the following mobile
health apps: Apple Health App, Wear OS, MapMyRun, Runkeeper, Runtastic. The user can
also visualize the data on Hexoskin Online Dashboard, whereas healthcare professionals,
researchers and technicians can employ the advanced VivoSense analysis software to
import/export data, batch processing, and to produce ready-to-publish graphs [81]. There
are different models of the device and the costs can vary from 399$ to 579$ for a complete
kit [104]. Additionally, a space-grade smart garment from the same company is available
for medical research and space telemedicine applications (Astroskin); in this case, the
sensors allows the acquisition of a 3-lead ECG, respiration, pulse oximetry, blood pressure,
skin temperature and a three-axial accelerometer [82,83].
Sensors 2021, 21, 814 16 of 23

Table 4. Overview of some garments available on the market or in research settings [79].

Base Company and Name of Knitted Fabric Data Communication e-Module

Sensed Parameters Reference
Products the Product Material Strategy Placement
Biodevices, Bluetooth
80% polyamide, (VJ holter pro, Vital Plug inside shirt
T-shirt, vest Biomedical Engineering HR, HRV, ECG, movement [80]
20% elastane pocket
Systems, S.A. Jaket® )
HR, HRV, HR recovery Bluetooth (Hexoskin,
Shirt (T-shirt, Carré Technologies Inc. 73% micro (HR2), RR, step count, Hexoskin X, Apple
Plug inside vest
sleeveless (Hexoskin)—Hexoskin polyamide, cadence, stride, activity Health App, Wear OS, [81]
pocket
shirt) shirt 27% elastane level, calories burned, MapMyRun, Runkeeper,
sleep assessment) Runtastic)
3-lead ECG, respiration
(RR, minute ventilation,
Carré Technologies Inc. Bluetooth (dedicated
tidal volume), pulse Plug inside vest
Shirt (Hexoskin)—Astroskin - smartphone and web [82,83]
oximetry, systolic blood pocket
shirt app)
pressure, skin temperature,
3-axial accelerometry
12-lead ECG, 5 sensors to
Plug inside the shirt,
Shirt, pants L.I.F.E. Italia s.r.l. - detect RR, accelerometry Bluetooth (L.I.F.E. app) [84]
on the back
(activity level)
Thoracic and abdominal
Plug attached to the
respiration, physical
Chronolife Bluetooth (Chronolife shirt, not to be
Shirt - activity, single-lead ECG, [85]
SAS-KeeSense app) removed when
temperature, pulmonary
washing
impedance
Bluetooth (Emglare
T-shirt, vest, 100% recycled Integrated into the
Emglare Inc. HR, ECG Heart, Apple Heart, [86]
bra, sport bra polyester inside of the clothing
Google Fit)
HR, ECG, skin On the outer surface
Wi-Fi, 3G, 4G
Vest HealthWatch Ltd. - temperature, RR, body above the left side of [87]
(Master Caution® )
posture the waist
Bluetooth
Socks Siren - Foot temperature Above the ankle [88]
(Siren app)
Vest, T-shirt,
AiQ Smart Clothing - HR, ECG, RR, temperature Bluetooth, Wi-Fi Over left chest [89]
sport bra
Underwear, HR, temperature, pressure,
Skiin Connected Bluetooth
customized - motion, body fat and Slides into waistband [90]
Innerwear, Myant Inc. (SKIIN)
smart textiles hydration levels
Attached on the top of
Bluetooth
Shirt, cap Bioserenity-Neuronaute - EEG, ECG the head (cap)/on the [91]
(Neuronaute app)
shoulder (shirt)
Bioserenity- Attached at the level
T-shirt - 12-lead ECG Wi-Fi [92]
Cardioskin™ of the abdomen
Single-lead ECG,
Ventral top right part
Vest Smartex s.r.l. - respiratory signal, 3-axial Bluetooth and Wi-Fi [93]
of the chest
accelerometer
At the level of the
sEMG, HR, calories
Shirt, shorts, Bluetooth sternum in the shirt,
Athos - expenditure, active [94]
leggings (Athos® iOS app) on the thigh in shorts
time/rest time
and leggings
T-shirt, shirt, ECG, RR, temperature,
Medtronic-Zephyr™ 88% PES, 12% BLE Plugs into the
sports bra, accelerometric data, time [95]
Performance Systems Spandex (OmniSense™ app) garments
strap and location
Slides into the
Bluetooth
Vest Polar Electro - Motion sensor, HR, GPS garment at the centre [96]
(Polar Flow app)
back of the neck
ECG/EKG, HR, HRV,
Compression Komodo Technologies, Bluetooth
- SpO2 , activity intensity Wrist [97]
sleeve Inc. (AIO Sleeve)
(MET)
71% polyamide, Bluetooth (MBody Live At the level of the
Shorts Myontec Ltd. EMG [98]
29% elastane 3 app) waist
polyamide
HR, step count, cadence, Bluetooth (Sensoria Connect to snap
T-shirt, 70–90%, elastane
Sensoria stride, calories, altitude, Fitness App, third party buttons under chest, [99]
socks, bra 5–8%, polyester
distance apps) fold sock over anklet
0–18%
Accelerometers, haptic Bluetooth Clip into the pants
Yoga pants Wearable X - [100]
feedback (Nadi X app) behind the left knee
SUPA (based on 95% PES, 5% Bluetooth
Sport bra HR, motion, temperature Under bust band [101]
Movesense platform) lycra (SUPA.AI app)
 Sensors 2021, 21, x FOR PEER REVIEW 19 of 25
Sensors 2021, 21, 814 17 of 23

The second example concerns the company Sensoria that supports professional and
amateur runnersexample
The second in training concerns andthe coaching
company with addressed
Sensoria products.
that supports The available
professional and
garmentsrunners
amateur are smart socks [105],
in training a bra, and
and coaching with a T-shirt
addressed [99]products.
that are antimicrobial, machine
The available garments
washable,
are smart sockscomfortable,
[105], a bra, andand breathable.
a T-shirt The [99] socks
that are have an integrated
antimicrobial, textilewashable,
machine pressure
sensor pairedand
comfortable, via breathable.
Bluetooth with The asocks
detachable
have an and rechargeable
integrated anklet.
textile pressureThissensor
monitors the
paired
user’s
via steps, walking
Bluetooth time, distance,
with a detachable speed, calories,
and rechargeable altitude,
anklet. This cadence,
monitorsand foot landing
the user’s steps,
technique,
walking time, while exercising.
distance, speed,The bra and
calories, the T-shirt
altitude, cadence, provide
and foot anlanding
accurate and consistent
technique, while
heart rate The
exercising. monitoring.
bra and the They work
T-shirt best with
provide the E-modulo
an accurate sensoria
and consistent HRM
heart rate (Heart
monitoring.Rate
Monitor),
They workthat besthaswitha battery
the E-modulolife of over 8 months
sensoria HRMand thatRate
(Heart tracks the performance
Monitor), that has aprogress
battery
of the
life user. 8Itmonths
of over connects and withthat Bluetooth
tracks the Smart and ANT+
performance to the Sensoria
progress of the user.RunIt2.0 mobile
connects
with
app andBluetooth Smart Virtual
the Sensoria and ANT+ Coach to the
andSensoria
has overRun 2.0 mobile
8 months app and
of battery life.the
In Sensoria
addition,
Virtual Coach and
these products advisehasthe over 8 months of
professional battery
runners life. their
about In addition,
runningthese products
mechanics, the advise
correct
the professional runners about their running mechanics, the
or incorrect running positions so they can improve their running style. The price range of correct or incorrect running
positions
the products so they
of thecan improve
Sensoria their running
collection rangesstyle.
fromThe 119$price range of the products of the
to 398$.
Sensoria
The collection
third exampleranges is from 119$ toby
constituted 398$.
the smart shirt produced by Learn Inspire Free
The third
Entertain example
(L.I.F.E.) Italiais Srl
constituted
[106], whichby the smart
has beenshirt produced
developed in bytwoLearn Inspire
versions, oneFreefor
Entertain
sports and (L.I.F.E.)
one forItalia Srl [106],
medicine. which has L.I.F.E.’s
In particular, been developed
medicalincompression
two versions,garment
one for sports
BWell
and one for
(L.I.F.E. medicine.
Italia Srl, Milan,In particular,
Italy) is L.I.F.E.’s
composed medical
of 12 compression
ink-based dry garment BWellfor
electrodes (L.I.F.E.
ECG
Italia
monitoring, five respiratory strain sensors and one accelerometer (Figure 4). five
Srl, Milan, Italy) is composed of 12 ink-based dry electrodes for ECG monitoring, The
respiratory strain sensors
electrodes include a layerand of one accelerometer
adhesive, a layer of (Figure 4). Theink,
conductive electrodes include
a binder, a layera
a solvent,
of adhesive,
thickener anda layer of conductive
a gradient region ink, a binder,
between a solvent, a thickener
the conductive ink and the andadhesive.
a gradientThe region
five
between
respiratory thesensors
conductive ink and theon
are positioned adhesive.
the anteriorThesurface
five respiratory sensorsand
of the garment areare
positioned
made of
on
an the anterior
elastic ribbon surface of the garment
impregnated and are made
with conductive ink, ofanan elastic ribbon
electrical impregnated
connector at each end with of
conductive ink, an electrical connector at each end of the elastic
the elastic ribbon, and a cover made of compression fabric [84]. The version for sports ribbon, and a cover made
of compression
Performer fabric (L.I.F.E.
Wearware [84]. TheItaliaversion for sports
Srl, Milan, Performer
Italy), on the other Wearware (L.I.F.E. Italia
hand, includes two ECG Srl,
Milan, Italy), on the other hand, includes two ECG leads, two
leads, two circumferential respiratory sensors and 10 accelerometers, since the focus is circumferential respiratory
sensors
switchedand from10 health
accelerometers,
monitoring since the focus is monitoring.
to performance switched from health
In this monitoring
case, the garment to
performance monitoring. In this case, the garment includes not
includes not only a shirt but also shorts in order to monitor the movement of the subject’s only a shirt but also shorts
in order to monitor the movement of the subject’s thighs.
thighs.

Figure4.4.(a)
Figure (a)Front
Frontand
and(b)(b)
back
backviews of L.I.F.E.’s
views medical
of L.I.F.E.’s compression
medical garment
compression (BWell).
garment The back
(BWell). Theview
back(right) shows where
view (right) shows
the plugthe
where is placed
plug iswhen thewhen
placed garmenttheisgarment
worn. Both viewsBoth
is worn. showviews
a cap show
to perform
a capEEG which isEEG
to perform currently
whichbeing developed
is currently by
being
developed
the company. by (c)
theAn
company.
example (c)ofAn example
BWell’s of BWell’s
fitting fitting(d)
when worn. when worn. (d)
Real-time Real-time
data data visualization
visualization dashboard. Thedashboard. The
figure was
figure was
adapted fromadapted from the
the website website
of the companyof the companythe
producing producing
garmentthe garment [106].
[106].
Sensors 2021, 21, 814 18 of 23

Among the products listed in Table 4, the sensorized garments Hexoskin/Astroskin

(Carré Technologies Inc., Montréal, Canada), ZephyrTM (Medtronic, Dublin, Ireland,
Keesense (Chronolife SAS, Paris, France and BWell/Performer Wearware (L.I.F.E. Italia
Srl, Milan, Italy) are the most indicated for respiratory monitoring, since they all include
technologies that are specifically designed for the monitoring of the respiratory frequency.
However, it must be noted that the Chronolife and Hexoskin garments only have a single-
lead ECG, and Astroskin has a 3-lead ECG, while L.I.F.E.’s medical-grade solution has a
12-lead ECG, thus allowing for a comprehensive cardiac monitoring as well. Furthermore,
shirts are the most performing in terms of cardiac monitoring because of the possibility to
detect the ECG directly from the chest. Finally, there are some garments that only measure
one parameter, such as Siren’s socks to detect foot temperature, and are therefore useful
for the monitoring of specific diseases (e.g., in the case of Siren’s product, diabetes and its
effects of limbs).

5. New Frontiers of Smart Garments

Up until now, there have been no commercially available devices that monitor the vital
parameters of workers. Devices belonging to this category are yet under development, and
an interesting example is provided. The PROeTEX project developed emergency disaster
personnel smart garments based on an advanced E-Textile system. All the three developed
prototypes, reserved to civil protections, urban and forest firefighters, are based on a shirt or
inner garment (IG), a jacket or outer garment (OG) and a pair of boots. The IG continuously
monitors physiological measurements like HR, breathing movement, cardiac sounds, and
health-state parameters such as sweat, dehydration, electrolytes, stress indicators, O2 ,
CO, and internal temperature thanks to textile sensors and electrodes that are directly in
contact with the skin. The OG and boots, instead, measure activity and external chemical
environment, including toxic gases and vapours and external temperature. The OG hosts
also the PEB, professional electronic box, containing multiple sensors like accelerometers,
piezoelectric sensors, and GPS module sensor, and collects all the data obtained from
the three garments. Moreover, thanks to a transmission system composed of two textile
antennas and an embedded PC board, the PEB transfers all the information to the local
coordination workstation that is usually near the operative area via Wi-Fi.
The associated monitoring software allows visualizing the parameters related to
each operator as well as his/her position: in the event of imminent danger, such as the
presence of toxic gases, an immediate alarm is launched to the intervention managers that
coordinates all the rescuers. Another long-range communication occurs from the local post
to the central emergency coordination [70,107].
An additional field of research that is becoming important is the cardio-respiratory
monitoring of children. Recently, new research has been accruing interest in the develop-
ment of special garments for infants and children. However, it should be stressed that this
market area has only grown over the past 10 years [18].
As it was previously mentioned, the Astroskin smart shirt is an example of wearable
monitoring system that is usable in space telemedicine applications too [83].
Furthermore, the advent of new mobile communication technologies, such as 5G,
opens the door to a more systematic use of wearable sensors in general, and sensorized gar-
ments in particular, both for telemedicine and sports applications [108]. More specifically,
the 5G communication enhances the acquisition of data from several sensors in parallel
and the opportunity to scale the previously introduced solution to great cohorts of patients
or healthy subjects without losses in the performance. Given the increased bandwidth that
can be obtained with 5G, the fact that a garment usually includes several sensors does not
constitute a problem. A typical architecture of a 5G-enabled telemonitoring system is the
so-called two-hop architecture [102] and is shown in Figure 5.
 mechanical deformation more effectively than fabric electrodes [109]. Thanks to their
characteristics, continuous and long-term tracking of vital physiological signals, such as
Sensors 2021, 21, 814 19 of 23
heart rate, artery pulse pressure and temperature, blood flow, and blood oxygen, can be
realized during daily activities in a manner that is mechanically invisible to users.

Telemonitoringsystem
Figure5.5.Telemonitoring
Figure systemwith
witha atwo-hop
two-hopdata
datatransmission
transmissionarchitecture.
architecture.The
Thefigure
figurewas
wasadapted
adaptedfrom
from[2].
[2].

Finally, flexible epidermal electronic technologies constitute a new frontier of elec-

6. Conclusions
trodes for garments: they are both transparent and resistant to different types of mechanical
Textile technologies
deformation more effectively are than
utilized
fabricfor sensorized
electrodes [109].garments
Thanks tototheir monitor several
characteristics,
physiological parameters in an advanced and innovative way, by
continuous and long-term tracking of vital physiological signals, such as heart rate, artery performing long
recordings in anyand
pulse pressure environment,
temperature, andblood
with high
flow, comfort.
and blood Textile technologies
oxygen, are based
can be realized on
during
the concept of conductive fibres whose manufacturing
daily activities in a manner that is mechanically invisible to users. techniques affect the recording and
the performance of the fabric itself. Among the manufacturing processes, there are more
traditional techniques such as coating, but also advanced techniques such as printing. In
6. Conclusions
this field
Textilelot
a of researchare
technologies is utilized
focusingfor onsensorized
developing new biocompatible,
garments to monitor several robust, and
physio-
sensitive materials. When
logical parameters it comes toand
in an advanced measuring
innovative physiological signals, the
way, by performing longtextile sensorsin
recordings
must meet technological challenges and requirements. Hence, the
any environment, and with high comfort. Textile technologies are based on the concept manufacturing process,
the
of technology, and materials
conductive fibres must be carefully
whose manufacturing chosenaffect
techniques according to the application
the recording and
and the perfor-
the field of use. In most of the cases the reliability and feasibility of
mance of the fabric itself. Among the manufacturing processes, there are more traditional the measurements is
yet to be confirmed with respect to the conventional techniques, and this
techniques such as coating, but also advanced techniques such as printing. In this field a lot field of research
isofvast and still
research developing.
is focusing Finally, thenew
on developing observation is taken
biocompatible, to theand
robust, world of sensorized
sensitive materials.
garments.
When it comesThreetogarments
measuringare described, signals,
physiological as theythepool together
textile sensors most
mustofmeetthe technolog-
features
characterizing
ical challengestheseand wearable
requirements. devices thanks
Hence, thetomanufacturing
the variety of process,
performing the measurements
technology, and
and field ofmust
materials use.beWe observechosen
carefully that the frontierstoin
according thethis fields concern
application and the the development
field of
of use. In most
garments for children as few companies fabricate garments for this category.
of the cases the reliability and feasibility of the measurements is yet to be confirmed with To conclude,
the innovations
respect carried by the
to the conventional employment
techniques, andof textile
this fieldtechnologies
of research isfor sensorized
vast garments
and still developing.
are many,the
Finally, featuring a newisgeneration
observation taken to the of wearable
world of devices.
sensorized Nevertheless,
garments. aThree hugegarments
effort is
yet
arefocused on the
described, as research
they pool and development
together most ofstage of this field.
the features characterizing these wearable
devices thanks to the variety of performing measurements and field of use. We observe
Author
that theContributions:
frontiers in Conceptualization,
this fields concern A.A.
the(Alessandra
development Angelucci) and A.A.
of garments (Andrea
for Aliverti);
children as few
methodology, A.A. (Alessandra Angelucci); formal analysis, M.C.,
companies fabricate garments for this category. To conclude, the innovations carried I.A.C., G.L., C.R., S.S.;
by
investigation, M.C., I.A.C., G.L., C.R., S.S.; resources, A.A. (Alessandra
the employment of textile technologies for sensorized garments are many, featuring a newAngelucci), M.C., I.A.C.,
G.L., C.R., S.S., A.A. (Andrea Aliverti); writing—original draft preparation, A.A. (Alessandra
generation of wearable devices. Nevertheless, a huge effort is yet focused on the research
Angelucci), M.C., I.A.C., G.L., C.R., S.S.; writing—review and editing, A.A. (Alessandra Angelucci)
and development stage of this field.
and A.A. (Andrea Aliverti); supervision, A.A. (Andrea Aliverti). All authors have read and agreed
to the published version of the manuscript.
Author Contributions: Conceptualization, A.A. (Alessandra Angelucci) and A.A. (Andrea Aliverti);
Funding: This research
methodology, received noAngelucci);
A.A. (Alessandra external funding.
formal analysis, M.C., I.A.C., G.L., C.R., S.S.; inves-
tigation, M.C., I.A.C., G.L., C.R., S.S.; resources, A.A. (Alessandra Angelucci), M.C., I.A.C., G.L.,
Institutional Review Board Statement: Not applicable.
C.R., S.S., A.A. (Andrea Aliverti); writing—original draft preparation, A.A. (Alessandra Angelucci),
M.C., I.A.C., G.L., C.R., S.S.; writing—review and editing, A.A. (Alessandra Angelucci) and A.A.
(Andrea Aliverti); supervision, A.A. (Andrea Aliverti). All authors have read and agreed to the
published version of the manuscript.
Funding: This research received no external funding.
Sensors 2021, 21, 814 20 of 23

Institutional Review Board Statement: Not applicable.

Informed Consent Statement: Not applicable.
Data Availability Statement: Data sharing not applicable.
Conflicts of Interest: Andrea Aliverti (A.A.) has been consultant for L.I.F.E. Italia s.r.l. and is inventor
of several patents belonging to that company. The other authors have no conflict of interest to declare.

References
1. Adans-Dester, C.P.; Bamberg, S.; Bertacchi, F.P.; Caulfield, B.; Chappie, K.; Demarchi, D.; Erb, M.K.; Estrada, J.; Fabara, E.E.; Freni,
M.; et al. Can mHealth technology help mitigate the effects of the COVID-19 pandemic? IEEE Open J. Eng. Med. Biol. 2020, 1,
243–248. [CrossRef]
2. Angelucci, A.; Aliverti, A. Telemonitoring systems for respiratory patients: Technological aspects. Pulmonology 2020, 26, 221–232.
[CrossRef] [PubMed]
3. Aliverti, A. Wearable technology: Role in respiratory health and disease. Breathe 2017, 13, e27–e36. [CrossRef] [PubMed]
4. Stoppa, M.; Chiolerio, A. Wearable electronics and smart textiles: A critical review. Sensors 2014, 14, 11957–11992. [CrossRef]
[PubMed]
5. Andreoni, G.; Standoli, C.E.; Perego, P. Defining requirements and related methods for designing sensorized garments. Sensors
2016, 16, 769. [CrossRef]
6. Kańtoch, E. Recognition of sedentary behavior by machine learning analysis of wearable sensors during activities of daily living
for telemedical assessment of cardiovascular risk. Sensors 2018, 18, 3219. [CrossRef]
7. Cappellieri, A.; Henchoz, N.; Tenuta, L.; Testa, S. Fashion wearable between science and design, from the product to an overall
user experience. Int. J. Lit. Arts 2020, 8, 12–22. [CrossRef]
8. Polkowski, Z. The method of implementing the general data protection regulation in business and administration. Proc. 10th Int.
Conf. Electron. Comput. Artif. Intell. ECAI 2018 2019, 1–6. [CrossRef]
9. Coyle, S.; Diamond, D. Medical applications of smart textiles. In Advances in Smart Medical Textiles; Elsevier: Amsterdam, The
Netherlands, 2016; pp. 215–237.
10. Cherenack, K.; Van Pieterson, L. Smart textiles: Challenges and opportunities. J. Appl. Phys. 2012, 112. [CrossRef]
11. Rambausek, L. Textronics: Definition, Development and Characterization of Fibrous Organic Field Effect Transistors 2014; Ghent
University: Gent, Belgium, 2014.
12. Gandolfo, P. Bluetooth Low Energy, Zigbee, and Cognitive 3D-ICs Add Muscle to Telehealth. Available online: https://www.
eetimes.com/bluetooth-low-energy-zigbee-and-cognitive-3d-ics-add-muscle-to-telehealth/# (accessed on 20 December 2020).
13. Stylios, G.K. Novel smart textiles. Materials 2020, 13, 950. [CrossRef]
14. Chen, G.; Li, Y.; Bick, M.; Chen, J. Smart textiles for electricity generation. Chem. Rev. 2020, 120, 3668–3720. [CrossRef] [PubMed]
15. Islam, G.M.N.; Ali, A.; Collie, S. Textile sensors for wearable applications: A comprehensive review. Cellulose 2020, 27, 6103–6131.
[CrossRef]
16. Ghahremani Honarvar, M.; Latifi, M. Overview of wearable electronics and smart textiles. J. Text. Inst. 2017, 108, 631–652.
[CrossRef]
17. Mokhtari, F.; Cheng, Z.; Raad, R.; Xi, J.; Foroughi, J. Piezofibers to smart textiles: A review on recent advances and future outlook
for wearable technology. J. Mater. Chem. A 2020, 8, 9496–9522. [CrossRef]
18. Sayem, A.S.M.; Teay, S.H.; Shahariar, H.; Fink, P.L.; Albarbar, A. Review on smart electro-clothing systems (SeCSs). Sensors 2020,
20, 587. [CrossRef]
19. Alagirusamy, R.; Eichhoff, J.; Gries, T.; Jockenhoevel, S. Coating of conductive yarns for electro-textile applications. J. Text. Inst.
2013, 104, 270–277. [CrossRef]
20. Singha, K.; Kumar, J.; Pandit, P. Recent advancements in wearable & smart textiles: An overview. Mater. Today Proc. 2019, 16,
1518–1523. [CrossRef]
21. Ng, C.L.; Reaz, M.B.I. Characterization of textile-insulated capacitive biosensors. Sensors 2017, 17, 574. [CrossRef]
22. Tseghai, G.B.; Mengistie, D.A.; Malengier, B.; Fante, K.A.; Van Langenhove, L. PEDOT:PSS-based conductive textiles and their
applications. Sensors 2020, 20, 1881. [CrossRef]
23. Korzeniewska, E.; Tomczyk, M.; Walczak, M. The influence of laser modification on a composite substrate and the resistance of
thin layers created using the PVD process. Sensors 2020, 20, 1920. [CrossRef]
24. Dietzel, Y.; Przyborowski, W.; Nocke, G.; Offermann, P.; Hollstein, F.; Meinhardt, J. Investigation of PVD arc coatings on
polyamide fabrics. Surf. Coatings Technol. 2000, 135, 75–81. [CrossRef]
25. Shahidi, S.; Moazzenchi, B.; Ghoranneviss, M. A review-application of physical vapor deposition (PVD) and related methods in
the textile industry. Eur. Phys. J. Appl. Phys. 2015, 71. [CrossRef]
26. Basile, F.; Benito, P.; Fornasari, G.; Monti, M.; Scavetta, E.; Tonelli, D.; Vaccari, A. A novel electrochemical route for the catalytic
coating of metallic supports. In Scientific Bases for the Preparation of Heterogeneous Catalysts; Gaigneaux, E.M., Devillers, M.,
Hermans, S., Jacobs, P.A., Martens, J.A., Ruiz, P.B.T., Eds.; Elsevier: Amsterdam, The Netherlands, 2010; Volume 175, pp. 51–58.
ISBN 0167-2991.
Sensors 2021, 21, 814 21 of 23

27. Acar, G.; Ozturk, O.; Golparvar, A.J.; Elboshra, T.A.; Böhringer, K.; Kaya Yapici, M. Wearable and flexible textile electrodes for
biopotential signal monitoring: A review. Electronics 2019, 8, 479. [CrossRef]
28. Van Langenhoven, L. Smart Textiles for Medicine and Healthcare: Materials, Systems and Applications; Elsevier: Amsterdam, The
Netherlands, 2007; ISBN 9781845690274.
29. Mecnika, V.; Hoerr, M.; Krievins, I.; Jockenhoevel, S.; Gries, T. Technical embroidery for smart textiles: Review. Mater. Sci. Text.
Cloth. Technol. 2015, 9, 56. [CrossRef]
30. Hong, H.; Hu, J.; Yan, X. UV Curable conductive ink for the fabrication of textile-based conductive circuits and wearable uhf rfid
tags. ACS Appl. Mater. Interfaces 2019. [CrossRef]
31. Grancarić, A.M.; Jerković, I.; Koncar, V.; Cochrane, C.; Kelly, F.M.; Soulat, D.; Legrand, X. Conductive polymers for smart textile
applications. J. Ind. Text. 2018, 48, 612–642. [CrossRef]
32. Istook, C.L. Composite Elastic and Wire Fabric for Physiological Monitoring Apparel. U.S. Patent Application No. 6,341,504,
31 January 2001.
33. Longinotti-buitoni, G.; Aliverti, A. Methods of Making Garments Having Stretchable and Conductive Ink. U.S. Patent Application
No. 8,945,328, 14 July 2014.
34. Jo, Y.H.; Jung, I.; Choi, C.S.; Kim, I.; Lee, H.M. Synthesis and characterization of low temperature Sn nanoparticles for the
fabrication of highly conductive ink. Nanotechnology 2011, 22. [CrossRef]
35. Wang, Z.; Wang, W.; Jiang, Z.; Yu, D. Low temperature sintering nano-silver conductive ink printed on cotton fabric as printed
electronics. Prog. Org. Coat. 2016, 101, 604–611. [CrossRef]
36. Longinotti-buitoni, G.; Aliverti, A.; Pallai, F. Flexible Fabric Ribbon Connectors for Garments with Sensors and Electronics. U.S.
Patent Application No. 10,653,190, 20 July 2016.
37. Jin, H.; Matsuhisa, N.; Lee, S.; Abbas, M.; Yokota, T.; Someya, T. Enhancing the performance of stretchable conductors for e-textiles
by controlled ink permeation. Adv. Mater. 2017, 29. [CrossRef]
38. Longinotti-buitoni, G.; Aliverti, A. Physiological Monitoring Garments with Enhanced Sensor Stabilization. U.S. Patent Applica-
tion No. 15/905,811, 24 August 2016.
39. Papaiordanidou, M.; Takamatsu, S.; Rezaei-Mazinani, S.; Lonjaret, T.; Martin, A.; Ismailova, E. Cutaneous recording and
stimulation of muscles using organic electronic textiles. Adv. Healthc. Mater. 2016, 5, 2001–2006. [CrossRef]
40. La, T.G.; Qiu, S.; Scott, D.K.; Bakhtiari, R.; Kuziek, J.W.P.; Mathewson, K.E.; Rieger, J.; Chung, H.J. Two-layered and stretchable
e-textile patches for wearable healthcare electronics. Adv. Healthc. Mater. 2018, 7, 1–11. [CrossRef] [PubMed]
41. Beckmann, L.; Neuhaus, C.; Medrano, G.; Jungbecker, N.; Walter, M.; Gries, T.; Leonhardt, S. Characterization of textile electrodes
and conductors using standardized measurement setups. Physiol. Meas. 2010, 31, 233–247. [CrossRef] [PubMed]
42. McAdams, E.T.; Jossinet, J. Nonlinear transient response of electrode—electrolyte interfaces. Med. Biol. Eng. Comput. 2000, 38,
427–432. [CrossRef] [PubMed]
43. Webster, J.G. Medical Instrumentation: Application and Design; John Wiley & Sons: Hoboken, NJ, USA, 2009; ISBN 0471676004.
44. Finni, T.; Hu, M.; Kettunen, P.; Vilavuo, T.; Cheng, S. Measurement of EMG activity with textile electrodes embedded into clothing.
Physiol. Meas. 2007, 28, 1405–1419. [CrossRef]
45. Shafti, A.; Ribas Manero, R.B.; Borg, A.M.; Althoefer, K.; Howard, M.J. Embroidered electromyography: A systematic design
guide. IEEE Trans. Neural Syst. Rehabil. Eng. 2017, 25, 1472–1480. [CrossRef]
46. Fleury, A.; Alizadeh, M.; Stefan, G.; Chau, T. Toward fabric-based EEG access technologies: Seamless knit electrodes for a portable
brain-computer interface. In Proceedings of the 2017 IEEE Life Sciences Conference (LSC), Sydney, Australia, 13–15 December
2017; IEEE: New York, NY, USA, 2018; pp. 35–38. [CrossRef]
47. Matiko, J.W.; Wei, Y.; Torah, R.; Grabham, N.; Paul, G.; Beeby, S.; Tudor, J. Wearable EEG headband using printed electrodes and
powered by energy harvesting for emotion monitoring in ambient assisted living. Smart Mater. Struct. 2015, 24. [CrossRef]
48. Lin, C.; Liao, L.; Liu, Y.; Wang, I.; Lin, B.; Chang, J. Novel dry polymer foam electrodes for long-term EEG measurement. IEEE
Trans. Biomed. Eng. 2011, 58, 1200–1207. [CrossRef]
49. Muthukumar, N.; Thilagavathi, G.; Kannaian, T. Polyaniline-coated foam electrodes for electroencephalography (EEG) measure-
ment. J. Text. Inst. 2015, 107, 283–290. [CrossRef]
50. Farina, D.; Lorrain, T.; Negro, F.; Jiang, N. High-density EMG E-textile systems for the control of active prostheses. In Proceedings
of the 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology, Buenos Aires, Argentina, 31
August–4 September 2010; pp. 3591–3593. [CrossRef]
51. Choudhry, N.A.; Rasheed, A.; Ahmad, S.; Arnold, L.; Wang, L. Design, Development and characterization of textile stitch-based
piezoresistive sensors for wearable monitoring. IEEE Sens. J. 2020, 20, 10485–10494. [CrossRef]
52. Di Giminiani, R.; Cardinale, M.; Ferrari, M.; Quaresima, V. Validation of fabric-based thigh-wearable EMG sensors and oximetry
for monitoring quadricep activity during strength and endurance exercises. Sensors 2020, 20, 4664. [CrossRef]
53. Kim, S.; Lee, S.; Jeong, W. Emg measurement with textile-based electrodes in different electrode sizes and clothing pressures for
smart clothing design optimization. Polymers 2020, 12, 2406. [CrossRef] [PubMed]
54. Chandler, D.L. Making clothing smarter: Rita Paradiso of Smartex is engineering clothes that can monitor a wearer’s condition.
IEEE Pulse 2017, 8, 54–57. [CrossRef] [PubMed]
Sensors 2021, 21, 814 22 of 23

55. Sumner, B.; Mancuso, C.; Paradiso, R. Performances evaluation of textile electrodes for EMG remote measurements. In Proceedings
of the 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Osaka, Japan,
3–7 July 2013; pp. 6510–6513. [CrossRef]
56. Vojtech, L.; Bortel, R.; Neruda, M.; Kozak, M. Wearable textile electrodes for ECG measurement. Adv. Electr. Electron. Eng. 2013,
11, 410–414. [CrossRef]
57. Sun, Y.; Yu, X.B. Capacitive biopotential measurement for electrophysiological signal acquisition: A review. IEEE Sens. J. 2016, 16,
2832–2853. [CrossRef]
58. Seoane, F.; Soroudi, A.; Lu, K.; Nilsson, D.; Nilsson, M.; Abtahi, F.; Skrifvars, M. Textile-friendly interconnection between wearable
measurement instrumentation and sensorized garments—Initial performance evaluation for electrocardiogram recordings.
Sensors 2019, 19, 4426. [CrossRef]
59. Yapici, M.K.; Alkhidir, T.E. Intelligent medical garments with graphene-functionalized smart-cloth ECG sensors. Sensors 2017, 17,
875. [CrossRef]
60. Yu, X.; Boehm, A.; Neu, W.; Venema, B.; Marx, N.; Leonhardt, S.; Teichmann, D. A wearable 12-lead ECG T-shirt with textile
electrodes for unobtrusive long-term monitoring–Evaluation of an ongoing clinical trial. In EMBEC & NBC 2017; Springer:
Berlin/Heidelberg, Germany, 2017; pp. 703–706.
61. Takamatsu, S.; Lonjaret, T.; Crisp, D.; Badier, J.M.; Malliaras, G.G.; Ismailova, E. Direct patterning of organic conductors on
knitted textiles for long-term electrocardiography. Sci. Rep. 2015, 5, 1–7. [CrossRef]
62. Massaroni, C.; Nicolò, A.; Lo Presti, D.; Sacchetti, M.; Silvestri, S.; Schena, E. Contact-based methods for measuring respiratory
rate. Sensors 2019, 19, 908. [CrossRef]
63. Angelucci, A.; Kuller, D.; Aliverti, A. Respiratory rate and tidal volume change with posture and activity during daily life. Eur.
Respir. J. 2020, 56, 2130. [CrossRef]
64. Rothmaier, M.; Selm, B.; Spichtig, S.; Haensse, D.; Wolf, M. Photonic textiles for pulse oximetry. Opt. Express 2008, 16, 12973.
[CrossRef]
65. Satharasinghe, A.; Hughes-Riley, T.; Dias, T. Photodiode and LED embedded textiles for wearable healthcare applications.
In Proceedings of the 19th World Text Conf. Text Crossroads, Ghent, Belgium, 11–15 June 2019; Available online: https:
//ojs.ugent.be/autex/article/view/11528 (accessed on 20 December 2020).
66. Antonelli, A.; Guilizzoni, D.; Angelucci, A.; Melloni, G.; Mazza, F.; Stanzi, A.; Venturino, M.; Kuller, D.; Aliverti, A. Comparison
between the AirgoTM device and a metabolic cart during rest and exercise. Sensors 2020, 20, 3943. [CrossRef] [PubMed]
67. Romei, M.; Mauro, A.L.; D’Angelo, M.G.; Turconi, A.C.; Bresolin, N.; Pedotti, A.; Aliverti, A. Effects of gender and posture on
thoraco-abdominal kinematics during quiet breathing in healthy adults. Respir. Physiol. Neurobiol. 2010, 172, 184–191. [CrossRef]
[PubMed]
68. Pacelli, M.; Caldani, L.; Paradiso, R. Textile piezoresistive sensors for biomechanical variables monitoring. Annu. Int. Conf. IEEE
Eng. Med. Biol. Proc. 2006, 5358–5361. [CrossRef]
69. Guay, P.; Gorgutsa, S.; Larochelle, S.; Messaddeq, Y. Wearable contactless respiration sensor based on multi-material fibers
integrated into textile. Sensors 2017, 17, 1050. [CrossRef]
70. Curone, D.; Secco, E.L.; Tognetti, A.; Loriga, G.; Dudnik, G.; Risatti, M.; Whyte, R.; Bonfiglio, A.; Magenes, G. Smart garments for
emergency operators: The ProeTEX project. IEEE Trans. Inf. Technol. Biomed. 2010, 14, 694–701. [CrossRef]
71. Issatayeva, A.; Beisenova, A.; Tosi, D.; Molardi, C. Fiber-optic based smart textiles for real-time monitoring of breathing rate.
Sensors 2020, 20, 3408. [CrossRef]
72. Scilingo, E.P.; Gemignani, A.; Paradiso, R.; Taccini, N.; Ghelarducci, B.; Rossi, D. De Performance evaluation of sensing fabrics for
monitoring physiological and biomechanical variables. IEEE Trans. Inf. Technol. Biomed. 2005, 9, 345–352. [CrossRef]
73. Massaroni, C.; Tocco, J.D.; Presti, D.L.; Longo, U.G.; Miccinilli, S.; Sterzi, S.; Formica, D.; Saccomandi, P.; Schena, E. Smart textile
based on piezoresistive sensing elements for respiratory monitoring. IEEE Sens. J. 2019, 19, 7718–7725. [CrossRef]
74. Cala, S.J.; Kenyon, C.M.; Ferrigno, G.; Carnevali, P.; Aliverti, A.; Pedotti, A.; Macklem, P.T.; Rochester, D.F. Chest wall and lung
volume estimation by optical reflectance motion analysis. J. Appl. Physiol. 1996, 81, 2680–2689. [CrossRef]
75. Husain, M.D.; Kennon, R.; Dias, T. Design and fabrication of temperature sensing fabric. J. Ind. Text. 2014, 44, 398–417. [CrossRef]
76. Ten Eyck, L.G.; Lynam, L.E.; Xia, H.; Deng, K.-L.J. Temperature Sensing Fabric. U.S. Patent Application No. 7,787,726, 14 March 2007.
77. Morris, D.; Coyle, S.; Wu, Y.; Lau, K.; Wallace, G.; Diamond, D. Bio-sensing textile with integrated optical detection system for
health monitoring. Sens. Actuators B Chem. 2009, 139, 231–236. [CrossRef]
78. Totaro, M.; Poliero, T.; Mondini, A.; Lucarotti, C.; Cairoli, G.; Ortiz, J.; Beccai, L. Soft smart garments for lower limb joint position
analysis. Sensors 2017, 17, 2314. [CrossRef] [PubMed]
79. Fernández-Caramés, T.M.; Fraga-Lamas, P. Towards the internet-of-smart-clothing: A review on IoT wearables and garments for
creating intelligent connected E-textiles. Electronics 2018, 7, 405. [CrossRef]
80. Rodrigues, S.; Paiva, J.S.; Dias, D.; Aleixo, M.; Filipe, R.M.; Cunha, J.P.S. Cognitive impact and psychophysiological effects of
stress using a biomonitoring platform. Int. J. Environ. Res. Public Health 2018, 15, 1080. [CrossRef]
81. Villar, R.; Beltrame, T.; Hughson, R.L. Validation of the Hexoskin wearable vest during lying, sitting, standing, and walking
activities. Appl. Physiol. Nutr. Metab. 2015, 40, 1019–1024. [CrossRef]
Sensors 2021, 21, 814 23 of 23

82. Villa-Colín, J.; Shaw, T.; Toscano, W.; Cowings, P. Evaluation of Astroskin Bio-monitor during high intensity physical activities.
In Proceedings of the Memorias del Congreso Nacional de Ingeniería Biomédica, León, Mexico, 18–20 October 2018; Volume 5,
pp. 262–265.
83. Andreev, E.; Radeva, V.; Nikolova, M. Innovative biomonitoring systems in the aerospace industry. In Proceedings of the
Communications, Electromagnetics and Medical Applications Conference 2019, Sofia, Bulgaria, 17 October–19 October 2019.
84. Sarmento, A.; Vignati, C.; Paolillo, S.; Lombardi, C.; Scoccia, A.; Nicoli, F.; Mapelli, M.; Leonardi, A.; Ossola, D.; Rigoni, R.; et al.
Qualitative and quantitative evaluation of a new wearable device for ECG and respiratory Holter monitoring. Int. J. Cardiol. 2018,
272, 231–237. [CrossRef]
85. Chronolife SAS. Available online: https://www.chronolife.net/ (accessed on 11 November 2020).
86. Emglare Heart. Available online: https://emglare.com/ (accessed on 7 July 2020).
87. Katzburg, S.; Dor-Haim, H.; Weiss, A.T.; Leibowitz, D. Detection of unexpected ischaemia due to left main disease during
tele-rehabilitation using 12-lead electrocardiogram monitoring: A case report. Eur. Hear. J. Case Rep. 2019, 3. [CrossRef]
88. Reyzelman, A.M.; Koelewyn, K.; Murphy, M.; Shen, X.; Yu, E.; Pillai, R.; Fu, J.; Scholten, H.J.; Ma, R. Continuous temperature-
monitoring socks for home use in patients with diabetes: Observational study. J. Med. Internet Res. 2018, 20, e12460. [CrossRef]
89. AiQ Smart Clothing. Available online: http://www.aiqsmartclothing.com/ (accessed on 8 July 2020).
90. Callejas Sandoval, S.; Kwon, S. Smart wearable technologies to promote safety in aging construction labor. In Proceedings of the
Creative Construction Conference 2019, Budapest, Hungary, 29 June–2 July 2019.
91. BioSerenity Neuronaute. Available online: https://www.bioserenity.com/en/neuro/ (accessed on 8 July 2020).
92. Fouassier, D.; Roy, X.; Blanchard, A.; Hulot, J.S. Assessment of signal quality measured with a smart 12-lead ECG acquisition
T-shirt. Ann. Noninvasive Electrocardiol. 2020, 25, 1–7. [CrossRef]
93. Frerichs, I.; Vogt, B.; Wacker, J.; Paradiso, R.; Braun, F.; Rapin, M.; Caldani, L.; Chételat, O.; Weiler, N. Multimodal remote chest
monitoring system with wearable sensors: A validation study in healthy subjects. Physiol. Meas. 2020, 41. [CrossRef]
94. Lynn, S.K.; Watkins, C.M.; Wong, M.A.; Balfany, K.; Feeney, D.F. Validity and reliability of surface electromyography measure-
ments from a wearable athlete performance system. J. Sports Sci. Med. 2018, 17, 205–215. [PubMed]
95. Nazari, G.; Bobos, P.; MacDermid, J.C.; Sinden, K.E.; Richardson, J.; Tang, A. Psychometric properties of the Zephyr bioharness
device: A systematic review. BMC Sports Sci. Med. Rehabil. 2018, 10, 6. [CrossRef] [PubMed]
96. Fox, J.L.; O’Grady, C.J.; Scanlan, A.T.; Sargent, C.; Stanton, R. Validity of the Polar Team Pro Sensor for measuring speed and
distance indoors. J. Sci. Med. Sport 2019, 22, 1260–1265. [CrossRef] [PubMed]
97. Komodo Technologies Inc. Available online: https://komodotec.com/ (accessed on 10 July 2020).
98. Pesola, A.J.; Laukkanen, A.; Tikkanen, O.; Sipilä, S.; Kainulainen, H.; Finni, T. Muscle inactivity is adversely associated with
biomarkers in physically active adults. Med. Sci. Sport. Exerc. 2015, 47, 1188–1196. [CrossRef] [PubMed]
99. D’Addio, G.; Iuppariello, L.; Bifulco, P.; Lanzillo, B.; Pappone, N.; Cesarelli, M. Validity and reliability of textile system Sensoria
for posturographic measurements. G. Ital. Med. Lav. Ergon. 2017, 39, 278–284.
100. Wearable X. Available online: https://www.wearablex.com/ (accessed on 14 July 2020).
101. SUPA. Available online: https://www.supa.ai/ (accessed on 14 July 2020).
102. Gerhardt, U.; Breitschwerdt, R.; Thomas, O. mHealth Engineering: A Technology Review. J. Inf. Technol. Theory Appl. 2018, 19, 5.
103. Majumder, S.; Mondal, T.; Deen, M.J. Wearable sensors for remote health monitoring. Sensors 2017, 17, 130. [CrossRef]
104. Hexoskin. Available online: https://www.hexoskin.com/ (accessed on 11 November 2020).
105. Yeung, J.; Catolico, D.; Fullmer, N.; Daniel, R.; Lovell, R.; Tang, R.; Pearson, E.M.; Rosenberg, S.S. Evaluating the sensoria smart
socks gait monitoring system for rehabilitation outcomes. PM R 2019, 11, 512–521. [CrossRef]
106. L.I.F.E. Multipurpose Wearable Computers. Available online: https://www.x10y.com/ (accessed on 11 November 2020).
107. Curone, D.; Tognetti, A.; Secco, E.L.; Anania, G.; Carbonaro, N.; De Rossi, D.; Magenes, G. Heart rate and accelerometer data
fusion for activity assessment of rescuers during emergency interventions. IEEE Trans. Inf. Technol. Biomed. Publ. IEEE Eng. Med.
Biol. Soc. 2010, 14, 702–710. [CrossRef]
108. Angelucci, A.; Kuller, D.; Aliverti, A. A home telemedicine system for continuous respiratory monitoring. IEEE J. Biomed. Heal.
Inform. 2020. [CrossRef]
109. Huang, S.; Liu, Y.; Zhao, Y.; Ren, Z.; Guo, C.F. Flexible electronics: Stretchable electrodes and their future. Adv. Funct. Mater. 2019,
29, 1805924. [CrossRef]