Smart wearable systems: Current status and future challenges

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Abstract

Objective

Extensive efforts have been made in both academia and industry in the research and development of smart wearable systems (SWS) for health monitoring (HM). Primarily influenced by skyrocketing healthcare costs and supported by recent technological advances in micro- and nanotechnologies, miniaturisation of sensors, and smart fabrics, the continuous advances in SWS will progressively change the landscape of healthcare by allowing individual management and continuous monitoring of a patient's health status. Consisting of various components and devices, ranging from sensors and actuators to multimedia devices, these systems support complex healthcare applications and enable low-cost wearable, non-invasive alternatives for continuous 24-h monitoring of health, activity, mobility, and mental status, both indoors and outdoors. Our objective has been to examine the current research in wearable to serve as references for researchers and provide perspectives for future research.

Methods

Herein, we review the current research and development of and the challenges facing SWS for HM, focusing on multi-parameter physiological sensor systems and activity and mobility measurement system designs that reliably measure mobility or vital signs and integrate real-time decision support processing for disease prevention, symptom detection, and diagnosis. For this literature review, we have chosen specific selection criteria to include papers in which wearable systems or devices are covered.

Results

We describe the state of the art in SWS and provide a survey of recent implementations of wearable health-care systems. We describe current issues, challenges, and prospects of SWS.

Conclusion

We conclude by identifying the future challenges facing SWS for HM.

Introduction

Efforts to research and develop smart wearable systems (SWS) have been increasing in both academia and industry [1], [2], [3]. The world population is ageing, and the proportion of young workers in developed countries has been shrinking [4], [5]. Elderly people have a greater level of disability due to age-related diseases, a greater need for care and assistance, and are more likely to be admitted to a hospital or nursing home. Permanent admission to a care home is an expensive way of providing care for elderly, most of whom would prefer to remain in their own home [6], [7], [8]. Currently, between 2 and 5% of elderly people reside in nursing homes [9]. Data on health from 30 countries of the Organization for Economic Cooperation and Development (OECD) show that health care expenditures as a proportion of gross domestic product (GDP) are at an all-time high, due to both increased expenditures and to a general economic slow-down [10]. France spent 11.8% of its GDP on healthcare delivery in 2009 according to OECD statistics. France was second among the OECD countries, behind the USA (17.4%), Germany (11.6%), Canada (11.4%), Switzerland (11.4%) and Austria (11. 0%) [11]. Telecare, telehealth and telemedicine are new models of care already in use, bringing solutions to healthcare issues [12], [13]. A large variety of laboratory prototypes, test beds and industrial products have already been produced. The role of SWS is to match the living environment with the physical and cognitive abilities and limitations of those suffering from disabilities or diseases, thereby enhancing performance and minimising the risk of illness, injury, and inconvenience. These systems support independent living for the elderly, postoperative rehabilitation for patients to expedite recovery, and assessment or enhancement of individual sportive or technical abilities [14], [15].

For monitoring heath, an SWS may include a wide range of wearable or implantable devices, including sensors, actuators, smart fabrics, power supplies, wireless communication networks (WCNs), processing units, multimedia devices, user interfaces, software, and algorithms for data capture, processing, and decision support. These systems are able to measure vital signs, such as body and skin temperature, heart rate, arterial blood pressure, blood oxygen saturation (SpO2), electrocardiograms (ECGs), electroencephalograms (EEGs), and respiration rate. The measurements are forwarded via a wireless sensor network (WSN) either to a central connection node, such as a personal digital assistant (PDA), or directly to a medical centre. A physician can then manage the patient based on the transmitted data. An increasingly important type of wearable system is an intelligent medical monitoring device capable of providing real-time processing and feedback to medical staff, patients, athletes, and healthy subjects. A subject can wear the device during normal daily life while medical professionals monitor the patient in real-time for longer periods than are possible during a hospital stay or a visit to a physician's office. The system can even issue alerts in the event of an emergency. For example, when a subject living alone suffers a stroke, an ambulance can be sent as soon as the stroke occurs. Advances in the field of microelectromechanical systems (MEMS) have addressed a number of clinical indications, such as drug release [16] and biosensors for point-of-care testing [17]. Electrical stimulation by implantable or transcutaneous electronic devices or electrodes is often used for motor and sensory function recovery in the treatment of patients during the acute and subacute phase of paralysis induced by a central nervous system lesion [18]. However, there are a number of obstacles that must be overcome to fully implement the use of SWS, including high costs, size and weight limitations, energy consumption, sensor implementation and connectivity, ethics, laws, privacy, freedom, autonomy, reliability, security, and service issues [19], [20], [21].

This paper provides a review of SWS, describing the current status of research and development of wearable systems for HM by reporting the salient characteristics of the most promising projects being developed and the future challenges in this area. The paper is organised as follows. Section 2 describes the common materials and methods used in SWS, and Section 3 describes the current features of wearable systems, the sensor technologies, the wearable systems developed in academia and industry and our own on-going laboratory research in the field. Section 4 presents current issues surrounding SWS, and Section 5 discusses the challenges and the futures perspectives. Section 6 draws the review to a close.

Section snippets

Materials and methods

SWS have the potential to monitor and respond to both the patient and the patient's environment, and the advances in the technology behind the development of SWS are steadily increasing. SWS are commonly recognised as one of the technological cornerstones for HM. Intelligent, low-cost, ultra-low-power sensor networks are designed to help provide services to dependent persons and can collect a huge amount of biomedical information from dependent individuals [22]. They offer new resources and

Current features of wearable systems

Non-invasive sensor systems allow monitoring of physiological functions, daily activities, and individual behaviours. Wearable HM systems may include various types of miniature wearable, implantable or in vivo sensors. These biosensors can measure physiological parameters such as body and skin temperature, heart rate, ECGs, EEGs, electromyograms (EMGs), or SpO2. Smart devices can provide real-time processing. Data transmission via wireless body communication networks enable patient monitoring

User needs, perception and acceptance

User preferences for use of SWS in their daily life need to be studied before actual use of these devices becomes more widespread. In order to explore the relationship between the perceived emotions factor and the use of science technology, Davis [160] developed the Technology Acceptance Model (TAM) that shows how users come to accept and use a technology, which is based on important features related to the perceptions, concerns and attitudes of elderly individuals towards SWS and their

Challenges and future perspectives

To fully realise the health and wellness benefits of smart wearable technologies, researchers and providers have to work towards adoption of these technologies by studying user requirements and developing a comprehensive approach to health and wellness services, instead of devices and applications that monitor only single diseases. At the same time, researchers and providers have to deliver health services using a wide variety of sources from traditional health providers to commercial providers

Conclusions

The aim of this study was to provide an overview of the current status and future perspectives in research and development of wearable systems related to healthcare. For this goal, it was necessary to define the field of wearable systems. These systems may include anything from monitoring the elderly or patients undergoing surgical operations to advanced sensor supervision in the case of infant respiratory disorders or soldiers on the battlefield. Pharmaceutical companies are now undergoing a

Conflict of interest

The authors state no conflict of interest.

Acknowledgements

The authors would like to acknowledge INSERM and CNRS for their support and funding in e-health and ICT research and the French National Research Agency (ANR) for theirs grants.

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